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Boonen A, Webers C, Butink M, Barten B, Betteridge N, Black DC, Bremander A, Boteva B, Brzezińska O, Chauhan L, Copsey S, Guimarães V, Gignac M, Glaysher J, Green F, Hoving JL, Marques ML, Smucrova H, Stamm TA, Wiek D, Wilkie R, Woolf AD, Burmester GR, Bijlsma JW, Verstappen SMM. 2021 EULAR points to consider to support people with rheumatic and musculoskeletal diseases to participate in healthy and sustainable paid work. Ann Rheum Dis 2023; 82:57-64. [PMID: 36109139 DOI: 10.1136/ard-2022-222678] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/01/2022] [Indexed: 02/03/2023]
Abstract
AIM As part of its strategic objectives for 2023, EULAR aims to improve the work participation of people with rheumatic and musculoskeletal diseases (RMDs). One strategic initiative focused on the development of overarching points to consider (PtC) to support people with RMDs in healthy and sustainable paid work participation. METHODS EULAR's standardised operating procedures were followed. A steering group identified six research areas on paid work participation. Three systematic literature reviews, several non-systematic reviews and two surveys were conducted. A multidisciplinary taskforce of 25 experts from 10 European countries and Canada formulated overarching principles and PtC after discussion of the results of literature reviews and surveys. Consensus was obtained through voting, with levels of agreement obtained anonymously. RESULTS Three overarching principles and 11 PtC were formulated. The PtC recognise various stakeholders are important to improving work participation. Five PtC emphasise shared responsibilities (eg, obligation to provide active support) (PtC 1, 2, 3, 5, 6). One encourages people with RMDs to discuss work limitations when necessary at each phase of their working life (PtC 4) and two focus on the role of interventions by healthcare providers or employers (PtC 7, 8). Employers are encouraged to create inclusive and flexible workplaces (PtC 10) and policymakers to make necessary changes in social and labour policies (PtC 9, 11). A research agenda highlights the necessity for stronger evidence aimed at personalising work-related support to the diverse needs of people with RMDs. CONCLUSION Implementation of these EULAR PtC will improve healthy and sustainable work participation of people with RMDs.
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Affiliation(s)
- Annelies Boonen
- Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands .,Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
| | - Casper Webers
- Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
| | - Maarten Butink
- Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Birgit Barten
- EULAR Research Partner, EULAR PARE, Zurich, Switzerland
| | | | - Dame Carol Black
- Centre for Ageing Better, London, UK.,Independent Adviser to the UK Government on Combatting Drugs Misuse, London, UK
| | - Ann Bremander
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Boryana Boteva
- EULAR Research Partner, EULAR PARE, Zurich, Switzerland.,Bulgarian Organisation for People with Rheumatic Diseases (BOPRD), Sofia, Bulgaria
| | - Olga Brzezińska
- Department of Rheumatology, Medical University of Lodz, Lodz, Poland
| | | | - Sarah Copsey
- European Agency for Safety and Health at Work (EU-OSHA), Bilbao, Spain
| | - Vera Guimarães
- Liga Portuguesa Contra as Doenças Reumáticas, Lisbon, Portugal
| | - Monique Gignac
- Institute for Work & Health, Toronto, Ontario, Canada.,Dalla Lana School for Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jan L Hoving
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mary Lucy Marques
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Dieter Wiek
- EULAR Research Partner, EULAR PARE, Zurich, Switzerland
| | - Ross Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine - Keele University, Staffordshire, UK
| | - Anthony D Woolf
- Bone and Joint Research Group, Royal Cornwall Hospital, Truro, UK
| | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes W Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research - Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre - Manchester University NHS Foundation Trust, Manchester Academic Health Center, Manchester, UK.,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southhampton, UK
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8
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Hansen SM, Hetland ML, Pedersen J, Østergaard M, Rubak TS, Bjorner JB. Effect of Rheumatoid Arthritis on Longterm Sickness Absence in 1994-2011: A Danish Cohort Study. J Rheumatol 2016; 43:707-15. [PMID: 26879362 DOI: 10.3899/jrheum.150801] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE By linkage of national registries, we investigated the risk of longterm sickness absence (LTSA) ≥ 3 weeks in a large cohort of Danish patients with rheumatoid arthritis (RA) and non-patients. The study aimed to (1) estimate the risk of LTSA for patients with RA compared with the general population, (2) examine whether the risk of LTSA has changed in recent years, and (3) evaluate the effect of other risk factors for LTSA (e.g., physical work demands, age, sex, education, and psychiatric and somatic comorbidities). METHODS A total of 6677 patients with RA aged 18-59 years in the years 1994-2011 were identified in registries and compared with 56,955 controls from the general population matched by age, sex, and city size. The risk of LTSA was analyzed using Cox proportional hazards models with late entry, controlling for other risk factors and assuming separate risks in the first year after diagnosis and the following years. RESULTS Compared with the general population, patients with RA had increased risk of LTSA in the first year after diagnosis (HR 5.4 during 1994-1999, 95% CI 4.2-6.8) and in following years (HR 2.4, 95% CI 2.1-2.8). For established RA (> 1 yr after diagnosis), the excess was 20% lower in 2006-2011 (HR 1.9, 95% CI 1.7-2.2) compared with 1994-1999 (p < 0.001). For patients with RA and controls, older age, shorter education, a physically demanding job, and somatic and/or psychiatric comorbidities increased the risk of LTSA. CONCLUSION While improvements were observed from 1994-1999 to 2006-2011, patients with RA have significant increased risk of LTSA, in particular in the first year after diagnosis.
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Affiliation(s)
- Sofie Mandrup Hansen
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen.
| | - Merete Lund Hetland
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Jacob Pedersen
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Mikkel Østergaard
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Tine Steen Rubak
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Jakob Bue Bjorner
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
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9
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Xu X, Zheng L, Bian Q, Xie L, Liu W, Zhen G, Crane JL, Zhou X, Cao X. Aberrant Activation of TGF-β in Subchondral Bone at the Onset of Rheumatoid Arthritis Joint Destruction. J Bone Miner Res 2015; 30:2033-43. [PMID: 25967237 PMCID: PMC4809636 DOI: 10.1002/jbmr.2550] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/23/2015] [Accepted: 05/07/2015] [Indexed: 02/05/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease that often leads to joint destruction. A myriad of drugs targeting the immune abnormalities and downstream inflammatory cascades have been developed, but the joint destruction is not effectively halted. Here we report that aberrant activation of TGF-β in the subchondral bone marrow by immune response increases osteoprogenitors and uncoupled bone resorption and formation in RA mouse/rat models. Importantly, either systemic or local blockade of TGF-β activity in the subchondral bone attenuated articular cartilage degeneration in RA. Moreover, conditional deletion of TGF-β receptor II (Tgfbr2) in nestin-positive cells also effectively halted progression of RA joint destruction. Our data demonstrate that aberrant activation of TGF-β in the subchondral bone is involved at the onset of RA joint cartilage degeneration. Thus, modulation of subchondral bone TGF-β activity could be a potential therapy for RA joint destruction.
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Affiliation(s)
- Xin Xu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liwei Zheng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qin Bian
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Institute of Spine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Liang Xie
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wenlong Liu
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The University of Hong Kong, Hong Kong, PR China
| | - Gehua Zhen
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janet L Crane
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, PR China
| | - Xu Cao
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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