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. 2002 Apr;61(4):335–340. doi: 10.1136/ard.61.4.335

Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS)

A Young 1, J Dixey 1, E Kulinskaya 1, N Cox 1, P Davies 1, J Devlin 1, P Emery 1, A Gough 1, D James 1, P Prouse 1, P Williams 1, J Winfield 1
PMCID: PMC1754067  PMID: 11874837

Abstract

Objectives: To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis (RA).

Setting: Inception cohort of patients with RA recruited from rheumatology departments in nine NHS Hospital Trusts in England.

Patients: All consecutive patients with RA of less than two years' duration, before any second line (disease modifying) drug treatment, and followed up for five years.

Methods: Clinical, laboratory, and radiological assessments, and all treatments were recorded prospectively using a standardised format at presentation and yearly.

Outcome measures: Changes in, and loss of paid work by five years' follow up.

Results: 732 patients completed the five year follow up. 353/721 (49%) were gainfully employed at the onset of RA, 211 (60%) were still working at five years, 104 (29%) stopped because of the disease, and 31 (9%) retired for reasons other than RA. Work disability at five years was more likely in manual workers (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.4 to 3.8) and worse baseline Health Assessment Questionnaire (HAQ>1.5, OR 2.26, 95% CI 1.38 to 3.7). In combination with other baseline variables (erythrocyte sedimentation rate, sex, age of onset, and radiological erosions), employment outcome was predicted in 78% using multivariate analysis.

Conclusions: Nearly half of the patients with RA were in paid employment at onset, work disability was an adverse outcome for a third of these patients by five years, and manual work and high baseline HAQ were important predictors for this. These details are likely to be useful to clinicians, health professionals, and patients in order to plan medical, orthopaedic, and remedial treatments in early RA. Future disease modifying treatments could be compared with this cohort of patients who were treated with conventional second line drugs.

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Figure 1 .

Figure 1

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Patients still working at 0–60 months.

Figure 2 .

Figure 2

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Change in HAQ over five years according to reasons for work disability.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albers J. M., Kuper H. H., van Riel P. L., Prevoo M. L., van 't Hof M. A., van Gestel A. M., Severens J. L. Socio-economic consequences of rheumatoid arthritis in the first years of the disease. Rheumatology (Oxford) 1999 May;38(5):423–430. doi: 10.1093/rheumatology/38.5.423. [DOI] [PubMed] [Google Scholar]
  2. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  3. Barrett E. M., Scott D. G., Wiles N. J., Symmons D. P. The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study. Rheumatology (Oxford) 2000 Dec;39(12):1403–1409. doi: 10.1093/rheumatology/39.12.1403. [DOI] [PubMed] [Google Scholar]
  4. Borg G., Allander E., Berg E., Brodin U., From A., Trang L. Auranofin treatment in early rheumatoid arthritis may postpone early retirement. Results from a 2-year double blind trial. J Rheumatol. 1991 Jul;18(7):1015–1020. [PubMed] [Google Scholar]
  5. Callahan L. F., Bloch D. A., Pincus T. Identification of work disability in rheumatoid arthritis: physical, radiographic and laboratory variables do not add explanatory power to demographic and functional variables. J Clin Epidemiol. 1992 Feb;45(2):127–138. doi: 10.1016/0895-4356(92)90005-8. [DOI] [PubMed] [Google Scholar]
  6. Doeglas D., Suurmeijer T., Krol B., Sanderman R., van Leeuwen M., van Rijswijk M. Work disability in early rheumatoid arthritis. Ann Rheum Dis. 1995 Jun;54(6):455–460. doi: 10.1136/ard.54.6.455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Eberhardt K. B., Fex E. Functional impairment and disability in early rheumatoid arthritis--development over 5 years. J Rheumatol. 1995 Jun;22(6):1037–1042. [PubMed] [Google Scholar]
  8. Fex E., Larsson B. M., Nived K., Eberhardt K. Effect of rheumatoid arthritis on work status and social and leisure time activities in patients followed 8 years from onset. J Rheumatol. 1998 Jan;25(1):44–50. [PubMed] [Google Scholar]
  9. Fries J. F., Spitz P. W., Young D. Y. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982 Sep-Oct;9(5):789–793. [PubMed] [Google Scholar]
  10. Fries J. F., Spitz P., Kraines R. G., Holman H. R. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980 Feb;23(2):137–145. doi: 10.1002/art.1780230202. [DOI] [PubMed] [Google Scholar]
  11. Jäntti J., Aho K., Kaarela K., Kautiainen H. Work disability in an inception cohort of patients with seropositive rheumatoid arthritis: a 20 year study. Rheumatology (Oxford) 1999 Nov;38(11):1138–1141. doi: 10.1093/rheumatology/38.11.1138. [DOI] [PubMed] [Google Scholar]
  12. Kaarela K., Lehtinen K., Luukkainen R. Work capacity of patients with inflammatory joint diseases. An eight-year follow-up study. Scand J Rheumatol. 1987;16(6):403–406. doi: 10.3109/03009748709165410. [DOI] [PubMed] [Google Scholar]
  13. Mau W., Bornmann M., Weber H., Weidemann H. F., Hecker H., Raspe H. H. Prediction of permanent work disability in a follow-up study of early rheumatoid arthritis: results of a tree structured analysis using RECPAM. Br J Rheumatol. 1996 Jul;35(7):652–659. doi: 10.1093/rheumatology/35.7.652. [DOI] [PubMed] [Google Scholar]
  14. Mäkisara G. L., Mäkisara P. Prognosis of functional capacity and work capacity in rheumatoid arthritis. Clin Rheumatol. 1982 Jun;1(2):117–125. doi: 10.1007/BF02275601. [DOI] [PubMed] [Google Scholar]
  15. Reisine S., McQuillan J., Fifield J. Predictors of work disability in rheumatoid arthritis patients. A five-year followup. Arthritis Rheum. 1995 Nov;38(11):1630–1637. doi: 10.1002/art.1780381115. [DOI] [PubMed] [Google Scholar]
  16. Ritchie D. M., Boyle J. A., McInnes J. M., Jasani M. K., Dalakos T. G., Grieveson P., Buchanan W. W. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968 Jul;37(147):393–406. [PubMed] [Google Scholar]
  17. Scott D. L., Huskisson E. C. The course of rheumatoid arthritis. Baillieres Clin Rheumatol. 1992 Feb;6(1):1–21. doi: 10.1016/s0950-3579(05)80336-x. [DOI] [PubMed] [Google Scholar]
  18. Shanahan E. M., Smith M. D. Rheumatoid arthritis, disability and the workplace. Baillieres Best Pract Res Clin Rheumatol. 1999 Dec;13(4):675–688. doi: 10.1053/berh.1999.0053. [DOI] [PubMed] [Google Scholar]
  19. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Ann Rheum Dis. 2000 Oct;59(10):794–799. doi: 10.1136/ard.59.10.794. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sokka T., Kautiainen H., Möttönen T., Hannonen P. Work disability in rheumatoid arthritis 10 years after the diagnosis. J Rheumatol. 1999 Aug;26(8):1681–1685. [PubMed] [Google Scholar]
  21. Wolfe F., Hawley D. J. The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients. J Rheumatol. 1998 Nov;25(11):2108–2117. [PubMed] [Google Scholar]
  22. Yelin E., Meenan R., Nevitt M., Epstein W. Work disability in rheumatoid arthritis: effects of disease, social, and work factors. Ann Intern Med. 1980 Oct;93(4):551–556. doi: 10.7326/0003-4819-93-4-551. [DOI] [PubMed] [Google Scholar]
  23. Young A., Dixey J., Cox N., Davies P., Devlin J., Emery P., Gallivan S., Gough A., James D., Prouse P. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS) Rheumatology (Oxford) 2000 Jun;39(6):603–611. doi: 10.1093/rheumatology/39.6.603. [DOI] [PubMed] [Google Scholar]
  24. Young A., van der Heijde D. M. Can we predict aggressive disease? Baillieres Clin Rheumatol. 1997 Feb;11(1):27–48. doi: 10.1016/s0950-3579(97)80031-3. [DOI] [PubMed] [Google Scholar]
  25. van Jaarsveld C. H., Jacobs J. W., Schrijvers A. J., van Albada-Kuipers G. A., Hofman D. M., Bijlsma J. W. Effects of rheumatoid arthritis on employment and social participation during the first years of disease in The Netherlands. Br J Rheumatol. 1998 Aug;37(8):848–853. doi: 10.1093/rheumatology/37.8.848. [DOI] [PubMed] [Google Scholar]
  26. van der Heijde D. M., van 't Hof M. A., van Riel P. L., Theunisse L. A., Lubberts E. W., van Leeuwen M. A., van Rijswijk M. H., van de Putte L. B. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990 Nov;49(11):916–920. doi: 10.1136/ard.49.11.916. [DOI] [PMC free article] [PubMed] [Google Scholar]

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