Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study
Date
2010-03-12Author
Sokka, Tuulikki
Kautiainen, Hannu
Pincus, Theodore
Verstappen, Suzanne MM
Aggarwal, Amita
Alten, Rieke
Andersone, Daina
Badsha, Humeira
Baecklund, Eva
Belmonte, Miguel
Craig-Müller, Jürgen
da Mota, Licia Maria Henrique
Dimic, Alexander
Fathi, Nihal A
Ferraccioli, Gianfranco
Fukuda, Wataru
Géher, Pál
Gogus, Feride
Hajjaj-Hassouni, Najia
Hamoud, Hisham
Haugeberg, Glenn
Henrohn, Dan
Horslev-Petersen, Kim
Ionescu, Ruxandra
Karateew, Dmitry
Kuuse, Reet
Laurindo, Ieda Maria Magalhaes
Lazovskis, Juris
Luukkainen, Reijo
Mofti, Ayman
Murphy, Eithne
Nakajima, Ayako
Oyoo, George O
Pandya, Sapan C
Pohl, Christof
Predeteanu, Denisa
Rexhepi, Mjellma
Rexhepi, Sylejman
Sharma, Banwari
Shono, Eisuke
Sibilia, Jean
Sierakowski, Stanislaw
Skopouli, Fotini N
Stropuviene, Sigita
Toloza, Sergio
Valter, Ivo
Woolf, Anthony
Yamanaka, Hisashi
the QUEST-RA study group
Type
Journal ArticleMetadata
Show full item recordAbstract
Abstract
Introduction
Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries.
Methods
The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses.
Results
At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score.
Conclusions
Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
URI
http://www.ncbi.nlm.nih.gov/pubmed/20226018http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/14731