Work Loss Is Still a Significant Problem for Rheumatoid Arthritis Patients Starting Therapy with Methotrexate

A new study evaluated how patients living with rheumatoid arthritis (RA) who are commencing methotrexate (MTX) treatment fared in terms of work loss, absenteeism, and presenteeism over a one-year period. The researchers concluded that the disease continues to pose a significant professional burden.

“Patients with RA consistently report that they want to remain in work, but research has shown that 36–84% of individuals with RA take sickness absence because of their condition (absenteeism), and up to 50% of patients have to stop work altogether over a period of 4.5–22 years,” according to the study authors. “In the UK, 10% of early RA patients left work over a median of 3 years of follow-up, and 49% of patients starting a biologic were work disabled. This loss of productivity is accompanied by significant socio-economic consequences.”

Full- and part-time employed RA patients aged between 18 and 65 years were identified from two UK-based prospective cohorts. MTX-starters (n=463) were identified in the Rheumatoid Arthritis Medication Study, and biologic-starters (n=260) were identified in the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate. Patients filled out the RA-specific Work Productivity Survey at baseline, six months, and 12 months to assess presenteeism and absenteeism. Possible predictors that were assessed included baseline age, gender, clinical measures (e.g. disability, pain, fatigue), psychological distress, occupation and European League Against Rheumatism (EULAR) response from baseline to six months.

Work Absenteeism Still a Problem for RA Patients

During the study period, 51 MTX-starters and 30 biologic-starters left work. In the MTX-starters group, higher baseline psychological distress was predictive of work loss (odds ratio [OR]=1.1; 95% confidence interval [CI], 1.0 to 1.1), and in the biologic-starters group, work loss was predicted by higher disability (OR=3.5; 95% CI, 1.4 to 8.6). An estimated 16.1% of patients reported sick leave; disability was predictive of sick leave in both the MTX-starters (OR=1.5; 95% CI, 0.9 to 2.3) and biologic-starters (OR=2.4; 95% CI, 1.1 to 5.2) groups. Both cohorts had significantly low median presenteeism scores. Presenteeism was predicted by higher fatigue (incidence rate ratio [IRR]=1.2; 95% CI, 1.0 to 1.4) in MTX-starters and higher disability (IRR=1.4; 95% CI, 1.1 to 1.7) in biologic-starters. In both groups, an association was observed between good EULAR response and lower absenteeism and presenteeism.

The results were published in Rheumatology.

The study authors concluded that a holistic disease management strategy should be employed in conjunction with disease activity control in order to improve work-related outcomes for RA patients.