title: Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Work factors and behavioural coping in relation to withdrawal from the labour force in patients with rheumatoid arthritis Predictors of productivity loss in early rheumatoid arthritis: a 5 year follow up study. Lost Productive Work Time Costs From Health Conditions in the United States: Results From the American Productivity Audit Sustained improvement over two years in physical function, structural damage, and signs and symptoms among patients with rheumatoid arthritis treated with infliximab and methotrexate. The work dynamics of the person with rheumatoid arthritis. The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients. Costs of rheumatoid arthritis in Germany: a micro-costing approach based on healthcare payer’s data sources Effect of rheumatoid arthritis on work status and social and leisure time activities in patients followed 8 years from onset. Work capacity of patients with inflammatory joint diseases. An eight-year follow-up study. High work disability rate among rheumatoid arthritis patients in Lithuania. Work disability in rheumatoid arthritis 10 years after the diagnosis. Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS) Lost productive time and cost due to common pain conditions in the US workforce. Labour force participation among patients with rheumatoid arthritis Association between etanercept use and employment outcomes among patients with rheumatoid arthritis. Becoming a disability pensioner with rheumatoid arthritis in Norway 1971-1990. Work characteristics, demographic factors and clinical variables could predict work disability in rheumatoid arthritis. Auranofin treatment in early rheumatoid arthritis may postpone early retirement. Results from a 2-year double blind trial. Anakinra as a new therapeutic option in rheumatoid arthritis: clinical results and perspectives.
abstract: OBJECTIVE To investigate 1 ) the magnitude of indirect costs , 2 ) changes in cost components , and 3 ) correlations between changes in cost and social , clinical , and occupational variables within the first 3 years of rheumatoid arthritis ( RA ) . METHODS We evaluated the indirect costs  per person-year in 133 consecutive gainfully employed out- patients with early RA , in a prospect i ve multicenter followup study . Costs due to RA-related sick leave , work disability , and other work loss were assessed using the human capital approach . Variables associated with reduction in lost productivity were tested by multivariate logistic regression analysis . RESULTS Mean + /- SEM annual indirect costs were $ 11,750 + /- 1,120 per person . During the 3-year period of observation , a marked reduction in the costs associated with sick leave was seen , which exceeded the increase in costs due to work disability and other work loss . This phenomenon result ed in an overall reduction in indirect costs of 21 % . The final logistic regression model of reduced loss of productivity included 3 variables : no problems with st and ing ( odds ratio [ OR ] 7.1 ) , no problems with working speed ( OR 4.1 ) , and no problems with outdoor work ( OR 3.1 ) . CONCLUSION High indirect costs in early RA were demonstrated . An overall decrease of costs can be seen in the first 3 years , due to the reduction in sick leave . Since the absence of problems due to strenuous working conditions was found to be associated with a reduction in indirect costs , it is assumed that early intensified vocational rehabilitation , apart from controlling disease activity by adequate treatment , might help to reduce indirect costs OBJECTIVE To assess separate and combined effects of work factors and behavioural coping in relation to withdrawal from the labour force among patients with rheumatoid arthritis ( RA ) . METHODS A cross sectional study was conducted in a Dutch nationwide r and om sample of 720 patients with RA . Information about work factors and behavioural coping was collected by a self-administered postal question naire . A broad variety of work factors and coping styles were evaluated separately and in combination using multivariate logistic regression analyses , controlling for sociodemographic and disease related variables . Attributable and preventable fractions were calculated from the combined analyses to assess the relative importance of the contributing factors . RESULTS Additional job training , equal career opportunities , letting the disease influence the choice of the current job position , and informing colleagues about having the disease were negatively associated with withdrawal from the labour force . The most relevant factor in terms of decreasing the risk was adjusting job dem and s which accounted for 63 % of the patients still in the labour force . Decreasing activities and diverting attention in order to cope with pain , and pacing in order to cope with limitations were the coping styles which were positively associated with withdrawal from the labour force . The most relevant factor in terms of increasing the risk of withdrawal was pacing which accounted for 67 % of the withdrawals . CONCLUSION Work factors are potentially important modifiable risk factors for withdrawal from the labour force in patients with RA .  Behavioural coping is also relevant OBJECTIVE To explore baseline risk factors for productivity loss and work disability over 5 years in patients with early , active RA . PATIENTS AND METHODS In the FIN-RACo trial , 195 patients with recent onset RA were r and omised to receive either a combination of DMARDs with prednisolone or a single DMARD for 2 years . At baseline , 162 patients were working or available for work . After 5 years ' follow up , data on sick leave and retirement were obtained from social insurance registers or case records . The cumulative duration of sick leaves and RA related disability pensions was counted for each patient . To analyse predictors of productivity loss , the patients were divided into four groups according to duration of work disability per patient year . RESULTS Patient 's and physician 's global assessment of RA severity > or = 50 and HAQ score > or = 1.0 were risk factors for extension of productivity loss ( OR ( 95 % ( CI ) 1.77 ( 1.00 to 3.16 ) , 1.85 ( 1.03 to 3.32 ) , and 1.78 ( 1.01 to 3.14 ) , respectively ) . Additional risk factors were low education level ( 2.40 ( 1.18 to 4.88 ) ) and older age ( 1.03 ( 1.00 to 1.06 ) ) ; combination treatment was a protective factor ( 0.59 ( 0.35 to 0.99 ) ) . CONCLUSION At baseline , the risk of future productivity loss is best predicted by education level , age , global assessment s of RA severity , and HAQ score Learning Objectives Recall the overall magnitude of lsot  productive time ( LPT ) and its dollar cost as found in the American Productivity Audit , and the respective contributions of absenteeism and decreased producitivity at work . Be aware of how LPT varies with a number of demographic and workrelated factors . Compare the factors predisposing to LPT for personal and family-related reasons . The American Productivity Audit ( APA ) is a telephone survey of a r and om sample of 28,902 U.S. workers design ed to quantify the impact of health conditions on work . Lost productive time ( LPT ) was measured for personal and family health reasons and expressed in hours and dollars . Health-related LPT cost employers $ 225.8 billion/year ( $ 1685/employee per year ) ; 71 % is explained by reduced performance at work . Personal health LPT  was 30 % higher in females and twice as high in smokers ( ≥1 pack/day ) versus nonsmokers . Workers in high-dem and , low-control jobs had the lowest average LPT/week versus the highest LPT for those in low-dem and , high-control jobs . Family health-related work absence accounted for 6 % of all health-related LPT . Health-related LPT costs are substantial but largely invisible to employers . Costs vary significantly by worker characteristics , suggesting that intervention needs vary by specific subgroups OBJECTIVE To evaluate the efficacy and safety of repeated administration of infliximab plus methotrexate ( MTX ) over a 2-year period in patients with rheumatoid arthritis ( RA ) who previously experienced an incomplete response to MTX .  METHODS Four hundred twenty-eight patients were r and omly assigned to receive MTX plus placebo or infliximab at a dose of 3 or 10 mg/kg plus MTX for 54 weeks , with an additional year of followup . The protocol was later amended to allow for continued treatment during the second year . Of 259 patients who entered the second year of treatment , 216 continued to receive infliximab plus MTX for 102 weeks . Ninety-four of these 259 patients experienced a gap in therapy of > 8 weeks before continuing therapy . Infusions were administered at weeks 0 , 2 , and 6 , followed by treatment every 4 weeks or every 8 weeks ( alternating with placebo infusions in the interim 4-week visits ) at a dose of 3 or 10 mg/kg for a total of 102 weeks ( including the gap in therapy ) . For safety and efficacy assessment s , data on the patients who were r and omized to receive treatment , irrespective of whether treatment was administered for 102 weeks , were evaluated using all actual observations available . The efficacy measures included the Health Assessment Question naire ( HAQ ) ( physical function ) , Short Form 36 health survey ( SF-36 ) ( health-related quality of life ) , total radiographic scores ( structural damage ) , and the American College of Rheumatology 20 % improvement criteria ( ACR20 ) ( signs and symptoms ) . RESULTS The infliximab plus MTX regimens result ed in significantly greater improvement in HAQ scores ( P < or = 0.006 ) and SF-36 physical component summary scores ( P < or = 0.011 ) compared with the MTX-only group . There also was stability in the SF-36 mental component summary score among patients who received the infliximab plus MTX regimens . Median changes from baseline to week 102 in the total radiographic score were 4.25 for patients who received the MTX-only regimen and 0.50 for patients who received the infliximab plus MTX regimen . The proportion of patients achieving an ACR20 response at week 102 varied from 40 % to 48 % for the infliximab plus MTX groups compared with 16 % for the MTX-only group . CONCLUSION Throughout 102 weeks of therapy , infliximab plus MTX provided significant , clinical ly relevant improvement in physical function and quality of life , accompanied by inhibition of progressive joint damage and sustained improvement in the signs and symptoms of RA among patients who previously had an incomplete response to MTX alone This paper traces the work history of patients with rheumatoid arthritis ( RA ) from the year of diagnosis to 1985 . The paper also describes the risk factors for work loss among patients with RA . It uses data from a panel of 698 RA patients , observed for 4 years , from the practice s of a r and om sample of northern California rheumatologists . Of these 698 , 353 had worked for pay at some point in their lives . Three hundred six of the 353 had worked when diagnosed as having RA . Of these 306 , 157 ( 51 % ) were no longer working in 1985 . Forty-seven individuals started working after the onset of illness , but of these , approximately one-third had stopped working by 1985 . In all , 50 % of RA patients with some work experience stopped working within a decade of diagnosis , 60 % within 15 years , and 90 % within 30 years . We found that the probability of work loss is lessened among persons in jobs that have few physical requirements , among those with high levels of discretion over the pace and activities of work , and among those who were able to stay on the job held when the diagnosis was made . The probability of work loss is increased among service workers . The findings of this longitudinal study , showing that work characteristics profoundly alter the probability of work loss among persons with RA , are consistent with the findings of our earlier cross-sectional studies of work outcome and RA OBJECTIVE Work disability is a common outcome of rheumatoid arthritis ( RA ) . Yet there have been no longitudinal , longterm , prospect i ve studies of work disability in this illness . This 18 year longitudinal study investigates the rate of work disability , its concomitants , and its predictors , using a large series of clinical , laboratory , and self-report measures . METHODS In 1974 , a computerized data base was developed for the contemporaneous entry of all patient visits . Data included clinical , laboratory , and self-report information . Patients were also assessed by mailed question naires at 6 month intervals . In 1994 , patients with RA were interviewed in detail about lifetime work status and work disability . RESULTS Work disability was estimated to occur in 25 % at 6.4 years and 50 % at 20.9 years after disease onset , and most disability occurred late in the course of disease . Work disability was predicted by almost every demographic and clinical variable . Education level , body mass index ( BMI ) , erythrocyte sedimentation rate , rheumatoid factor , pain , Health Assessment Question naire ( HAQ ) disability , and physical dem and s of the job were independently associated with disability . Over the course of their illness , the work disabled had a 35 % reduction in family income , and had more abnormal scores for joint counts , grip strength , sedimentation rate , pain , global severity , HAQ disability , and anxiety and depression . Except for BMI , the results were essentially similar in a subset of 156 patients seen first with a disease duration of less than one year . CONCLUSION Work disability can be predicted by patient and work characteristics present at the first clinic visit , but it is persistent abnormalities of sedimentation rate , HAQ disability , and pain , which may be detected in longitudinal followup , that best predict work disability after work and demographic characteristics are accounted for Objective : To develop a systematic set of German cost data in rheumatoid arthritis ( RA ) based solely on valid healthcare payer ’s cost data sources . Methods : Retrospectively one year cost data of 338 patients with RA were generated and analysed . The cost data were derived from a major statutory health insurance plan ( “ Allgemeine Ortskrankenkasse Niedersachsen ” ) and the regional physicians ’ association ( “ Kassenärztliche Vereinigung Niedersachsen ” ) . The recently published matrix of cost domains in RA was applied to structure the analysis . Descriptive statistics were used to analyse the data . Results : The total direct costs for the 338 patients during one year ( third quarter 2000 to second quarter 2001 ) were € 3815 per patient-year . RA related direct costs were € 2312 per patient-year . Outpatient costs accounted for 73.7 % , inpatient costs for 24.0 % , and other disease related costs for 2.3 % of RA related direct costs . Out patients cost drivers were RA related drugs ( € 1019 per patient-year ) , physician visits ( € 323 per patient-year ) , diagnostic and therapeutic procedures and tests ( € 185 per patient-year ) , and devices and aids ( € 168 per patient-year ) . 98 patients were retired prematurely owing to RA related work disability and incurred costs of € 8358 per retired patient-year . 96 patients were gainfully employed and incurred sick leave costs of € 2835 per employed patient-year . Conclusion : Micro-costing based on healthcare payer ’s data provides a relatively conservative albeit highly accurate estimate of costs in RA . Both RA related and non-RA related costs must be taken into account . In gainfully employed patients and in patients who receive RA related retirement payments productivity costs exceed direct costs OBJECTIVE To evaluate the development of h and icap in patients with rheumatoid arthritis ( RA ) followed 8 years from onset . METHODS The study group consisted of 106 patients participating in a prospect i ve early RA study . The mean duration of joint symptoms at inclusion was one year . The patients were assessed at least once annually . Disability was measured with the  Health Assessment Question naire ( HAQ )  and emotional distress with a  self-administered test ( Symptom Checklist ) . Work status and different social measures were registered . A  structured interview regarding work capacity , leisure time , and social activities  was performed about 8 years after disease onset . RESULTS Compared to study start , disease activity had decreased , emotional distress was unchanged , disability had increased somewhat , and radiographic changes had increased markedly . The prevalence of work disability at the end of the study was 37 % . The majority of patients that eventually got disability pension had stopped working the first year after onset . Seventy-eight percent of the patients who continued to work had to adjust their work conditions to stay employed . The 3 most important predictors for work disability were higher HAQ at study start , lower educational level , and older age . Three-quarters of the patients had to alter leisure time activities and half of them were not satisfied with their recreation . Many patients experienced difficulties in their roles as spouse and parent . Higher levels of emotional distress were associated with these h and icaps . CONCLUSION In this cohort of patients with RA we found a high frequency of different types of  h and icaps  at an early stage . Slightly more than 1/3 were work disabled . The majority had stopped working during the first year . Patients perceived h and icaps in terms of changed leisure time activities , and difficulties performing different social roles were frequent . Patients with these h and icaps felt more emotional distress In a prospect i ve study of recent arthritis , 103 patients had rheumatoid arthritis ( RA ) , 63 seronegative oligoarthritis ( SO ) , 67 reactive arthritis ( REA ) , 20 ankylosing spondylitis ( AS ) , and 13 psoriatic arthritis ( PA ) . At the 8-year check-up , 36 % of patients with RA were at work , compared with 69 % in PA ( p less than 0.002 ) , and 85 - 90 % in AS , SO , and REA ( p less than 0.001 ) . Correspondingly 43 % of the RA patients were disabled by arthritis , compared with 23 % in PA ( NS ) , 15 % in AS ( p less than 0.005 ) , none in SO , and 4 % in REA ( p less than 0.001 ) . No significant differences in work capacity were noted between patients with PA , AS , SO or REA . In RA , the educational background s of patients unable to work ( 44 patients ) and able to work ( 37 patients ) did not differ from each other or from the overall population of Finl and , but a significantly ( p less than 0.01 ) smaller number of patients with arduous work were able to continue at work . The mean age of 49 years for RA patients unable to work differed highly significantly ( p less than 0.001 ) from the 35 years of RA patients at work . However , the weightiest cause of limited work capacity was severity of disease OBJECTIVE To evaluate labor force characteristics among patients with rheumatoid arthritis ( RA ) in Lithuania . To assess if Lithuania 's transition from a state-planned to a free-market economy after 1990 changed the employment perspectives of patients with RA . METHODS RA patients , age 16 - 65 years ( n = 238 ) , were r and omly selected from the RA register in Vilnius . They completed questions about sociodemographics , working status , and disease characteristics , they underwent a clinical examination , and they completed the  modified Health Assessment Question naire and the Short Form 36 .  RESULTS Age- and sex-adjusted employment was 24.2 % lower and work disability 51.7 % higher in patients compared with the general population in Lithuania . After 10 years of disease , 48 % of the patients had withdrawn from the labor force . In those with a paid job , the average sick leave in the past year was 31.9 days compared with the national average of 10.8 days . Although disease activity was not significantly different in employed compared with work-disabled patients , physical function and perceived quality of life ( except general health ) were worse among patients with work disability . The change in economic organization in 1990 was noted to increase the risk for work withdrawal by a factor of 2.75 ( 95 % confidence interval 1.68 - 4.53 ) . CONCLUSION In Lithuania , the impact of RA on work disability is important . Although work disability in Lithuanian patients with RA seems more pronounced compared with reports from Western societies , variables associated with work disability are comparable . The transition to a market-orientated economy in 1990 increased the risk of becoming work disabled OBJECTIVE To describe employment status of patients with early rheumatoid arthritis ( RA ) 10 years after diagnosis ; and to identify predictive and associative factors related to permanent work disability . METHODS The study population consisted of 82 patients with early RA who were gainfully employed at onset of RA . Patients were prospect ively followed for an average of 10 years and were treated according to the " sawtooth " strategy . RESULTS After a time since diagnosis of 2 and an average of 9.9 years , respectively , 19/82 ( 19 % ) and 36/82 ( 44 % ) cases have been retired merely or partly due to RA . Further , at the latest checkup 42/82 ( 51 % ) patients were still gainfully employed , while the prevalence of patients working full time under the common retirement age of 65 yrs was 58 % ( 42/72 ) . Cox regression analysis revealed that physically heavy work at baseline was the strongest independent predictive factor for permanent work disability . Ten years after disease onset , however , work disabled patients had more severe disease than those who continued in work . CONCLUSION Our study confirms that the working capacity of patients with RA is in danger from the very start . Despite early and active therapy with disease modifying antirheumatic drugs , at 10 years the cumulative work disability prevalence was 44 % 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 Engl and . 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 assessment s , and all treatments were recorded prospect ively using a st and ardised 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 Question naire ( 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 CONTEXT Common pain conditions appear to have an adverse effect on work , but no comprehensive estimates exist on the amount of productive time lost in the US workforce due to pain . OBJECTIVE To measure lost productive time ( absence and reduced performance due to common pain conditions ) during a 2-week period . DESIGN AND SETTING Cross-sectional study using survey data from the American Productivity Audit ( a telephone survey that uses the Work and Health Interview ) of working adults between August 1 , 2001 , and July 30 , 2002 . PARTICIPANTS R and om sample of 28 902 working adults in the United States . MAIN OUTCOME MEASURES Lost productive time due to common pain conditions ( arthritis , back , headache , and other musculoskeletal ) expressed in hours per worker per week and calculated in US dollars . RESULTS Thirteen percent of the total workforce experienced a loss in productive time during a 2-week period due to a common pain condition . Headache was the most common ( 5.4 % ) pain condition result ing in lost productive time . It was followed by back pain ( 3.2 % ) , arthritis pain ( 2.0 % ) , and other musculoskeletal pain ( 2.0 % ) . Workers who experienced lost productive time from a pain condition lost a mean ( SE ) of 4.6 ( 0.09 ) h/wk . Workers who had a headache had a mean ( SE ) loss in productive time of 3.5 ( 0.1 ) h/wk . Workers who reported arthritis or back pain had mean ( SE ) lost productive times of 5.2 ( 0.25 ) h/wk . Other common pain conditions result ed in a mean ( SE ) loss in productive time of 5.5 ( 0.22 ) h/wk . Lost productive time from common pain conditions among active workers costs an estimated 61.2 billion dollars per year . The majority ( 76.6 % ) of the lost productive time was explained by reduced performance while at work and not work absence . CONCLUSIONS Pain is an inordinately common and disabling condition in the US workforce . Most of the pain-related lost productive time occurs while employees are at work and is in the form of reduced performance OBJECTIVES To assess work history and labour force participation among patients with rheumatoid arthritis ( RA ) in the Netherl and s. METHODS A r and om sample of 1056 patients with RA aged 16–59 years from 17 rheumatology practice s in the Netherl and s was examined . Data on disease status and outcome were obtained by a question naire including st and ardised instruments , such as the Rapid Assessment of Disease Activity in Rheumatology ( RADAR ) and R AND -36 question naires . Labour force participation was defined as having a paid job . RESULTS Of the study group with a mean disease duration of 12 years , 35.7 % held a paid job ( men 56.7 % ; women 27.7 % ) . When st and ardised for age , sex , and educational level , the labour force participation of patients with RA was 61.2 % compared with 65.5 % for the general population , which was not statistically significant . Disease duration of six years and more was negatively associated with labour force participation . CONCLUSIONS After controlling for the confounding effects of age , sex , and education , the labour force participation of patients with RA in the Netherl and s is only slightly lower than that of the general population OBJECTIVE To assess the association between use of etanercept and employment outcomes among patients with rheumatoid arthritis ( RA ) . METHODS In 1999 , 497 RA patients of working ages ( 18 - 64 years ) reported their employment status in the year of diagnosis and as of the study year , in structured telephone interviews . Of these , 238 had been in clinical trials of etanercept and were currently taking that medication , while 259 were members of an observational study and were not taking etanercept .  We used regression techniques to estimate whether employment outcomes in 1999 ( employed versus not and , among the employed , hours of work per week , weeks of work per year , and hours of work per year ) among the 379 of the 497 patients who were employed at the time of diagnosis were associated with etanercept use , with and without adjustment for demographic characteristics , RA status , overall health status , and the nature of the job held at the time of diagnosis . RESULTS At the time of diagnosis , 75 % of RA patients from the observational study who did not take etanercept and 77 % of those who did take the medication were employed . By 1999 , among those employed at diagnosis , 55 % of the former group and 71 % of the latter were employed ( difference 16 percentage points ) . After adjustment for demographics , overall health status , duration of RA , RA status , and occupation and industry , the difference widened to 20 percentage points . Among all who were employed at the time of diagnosis , those from the etanercept clinical trials worked an average of 5.4 more hours per week in 1999 ; after adjustment , the etanercept group worked 7.4 more hours per week . CONCLUSION Among all persons who were employed at the time of RA diagnosis , having been in the etanercept clinical trials was associated with higher employment rates in 1999 and a greater number of hours per week of work in that year , suggesting that a r and omized trial to establish the relationship between treatment and employment outcomes is now warranted OBJECTIVE Physically dem and ing occupations have been associated with becoming a disability pensioner with rheumatoid arthritis ( DPRA ) , but not with the disease of RA . The association with becoming DPRA probably reflects that patients with RA have difficulties in maintaining employment in a physically dem and ing occupation . However , the attitudes of the employers concerning employment of persons with RA might vary . For example , the patient 's age may influence the strength of the association between a physically dem and ing occupation and becoming DPRA . We assessed whether the association between the predictors and becoming DPRA was stronger for the youngest or the oldest age group . METHODS The study was prospect i ve with data on persons in Norway 30 - 56 years old either in the census of 1970 or 1980 . All new cases of DPRA during the 2 followup periods 1971 - 80 and 1981 - 90 were identified and analyzed by logistic regression . RESULTS For women the predictors employment , low level of education , and period ( 1981 - 90 compared to 1971 - 80 ) were more strongly associated with becoming DPRA for the youngest compared to the oldest persons , while manual work and part time work were not predictors of becoming DPRA .  For men , all the predictors in the study were more strongly associated with becoming DPRA for the youngest compared to the oldest age group . CONCLUSION The higher risk of becoming DPRA was associated with most predictors for persons aged 30 - 39 years than the group aged 50 - 56 years . Our results appear to indicate that the consequences of having RA in the labor market are greater for the youngest age group Aim : Work disability is a frequent and serious outcome of rheumatoid arthritis ( RA ) , accounting for the greatest indirect costs of this condition . A longitudinal , long-term prospect i ve study was conducted on a large cohort of RA patients ( pts ) to investigate the rate/risk of work disability and the factors that may be considered concomitant with and therefore predictors of work disability , using a broad series of clinical , laboratory and self-reported measures in all pts and in a subgroup of early RA pts . Methods : RA pt data from 1974 were recorded in a data base at the Wichita Arthritis Center in which demographic , clinical , and pt self-reported variables were registered at every pt visit . In 1994 , 823 RA pts were examined and interviewed about their employment and work history .  The pts were asked for occupation data the start and stop date s of each job , the specific job title , the reason for which the job was stopped ; demographic variables ( sex , age , ethnic origin , education level , number of children , smoking history , total income , and current marital status ) ; and clinical data [ tender joint count , grip strength , health assessment question naire ( HAQ ) , pain on a visual analogic scale ( VAS ) , VAS global severity , AIMS anxiety and depression , co-morbid conditions , body mass index ( BMI ) , and rheumatoid factor ( RF ) ] . Values used in the prediction of work disability were those detected at the first visit , 2-year average values , and average values over the length of the study . Average variables were considered as full predictors when work disability could not be considered to have caused the predictor value . The primary analyses were Kaplan-Meier survival statistics and Cox regression . Proportional hazard assumptions were verified . Results : 79 out of the 823 RA pts ( 9.6 % ) never worked for a salary . All the males and 87.3 % of the females had been employed with a salary . 509 pts were employed at the time they had RA : the following statistical analyses were limited to these subjects . Work discontinuation was reported by 37.7 % . The median survival time or time to work disability was 20.9 years , but the 25 % survival time was 6.4 years . Out of 456 pts working at the first visit , 23 % were work disabled in the first 5 years ( 8.6 in the first 2.5 years ) , 19.4 % in the next 5 years and 57.6 % beginning after 10 years of follow-up . The 25 % survival time ( time to work disability ) was 10.05 years . Fewer years of formal education , a high BMI ( showing a late e ffect on wo rk disab i l i t y ) , VAS pain score s , high HAQ scores , high RF and erythrocyte sedimentation rate ( ESR ) values , and high physical dem and s of the job were the covariates independently associated with work disability . Over the course of the illness , the work disabled patients had a 35 % reduction in family income , and more abnormal scores for the joint count , grip strength , ESR , depression and anxiety . The results , except for BMI , were essentially similar in a subset of 156 pts in whom RA duration was less than one year . Conclusions : Work disability in RA pts was frequent and could be predicted by almost all of the demographic and clinical variables and by the physical characteristics of the work process present at the first visit . The best predicting factors were a persistent elevation of ESR , pain , and disability according to HAQ detected in longitudinal follow-up . Thus , the optimal management of RA pts may differ based on their clinical , demographic , and work variables . The physician should try to treat the clinical variables medically and to m o d u l ate the demographic and wo rk va ri ables by active interaction with the patient , calling in other specialists ( e.g. , psychiatrists or psychiatrics ) where necessary The effect of early vs delayed initiation of slow acting antirheumatic drug ( SAARD ) therapy on the ability to maintain regular work , was evaluated in 83 patients with early rheumatoid arthritis ( RA ) in a placebo controlled , double blind 24-month study . The estimated probability to maintain working ability was higher in the early treatment group , especially during the second study year . Predicting factors were age , type of work , degree of disability and number of swollen joints . Despite the difficulties in interpreting the results due to the complexity of the underlying socioeconomical and labor market situation , the study supports early treatment in RA with regard to the maintenance of normal life Interleukin-1 receptor antagonist ( IL-1Ra ) is a member of the IL-1 gene family , which blocks IL-1-mediated signal transduction . In rheumatoid arthritis ( RA ) , recombinant human IL-1Ra ( anakinra ) has been evaluated in 5 r and omized , placebo-controlled clinical trials . In the European monotherapy study , 43 % of patients receiving 150 mg/day anakinra  achieved a 20 % response according to the American College of Rheumatology criteria ( ACR 20 ) , compared to 27 % in the placebo group . In the methotrexate combination therapy study , 42 % of the patients receiving 1 mg/kg/day anakinra  achieved an ACR20 response , 24 % an ACR50 response , and 10 % an ACR70 response . In each study , clinical ly meaningful improvements in the Health Assessment Question naire scores were observed . The Economic Re source Survey was employed in the European monotherapy study to evaluate patient and caregiver days of missed work or domestic activity in successive 4-week periods . There were rapid gains in the number of days at work or domestic activity in the treated patients , and the increases in productivity were dose-related . The mean change in the total modified Sharp score of patients who completed treatment with  anakinra was significantly less than in the patients who received placebo . Anakinra , a new biologic approach to the treatment of RA , results in significant improvements in the signs and symptoms , has beneficial effects on functional status , and on the rate of progressive structural joint damage
target: RA-related work-disability rates were similar in the USA and European countries .
  An apparent decrease in the prevalence of RA-related work disability since the 1970s may be related to a decrease in physically dem and ing work rather than to epidemiologic changes in RA .
  The majority of the literature addresses permanent disability and temporary work loss ; none of the studies review ed reported the effect of RA on presenteeism , i.e. work limitation from the employer perspective , and there are few published studies of the effectiveness of disease-modifying anti-rheumatic drugs in reducing work-related productivity loss
background: BACKGROUND Rheumatoid arthritis ( RA ) is a chronic , debilitating disease with a significant impact on workplace productivity .
  AIM To perform a systematic review of studies of the relationship between RA and reduced  workplace productivity .