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Fujino Y, Okawara M, Hino A, Muramatsu K, Nagata T, Tateishi S, Tsuji M, Ogami A, Ishimaru T. A prospective cohort study of presenteeism and increased risk of unemployment among Japanese workers during the COVID-19 pandemic. J Occup Health 2024; 66:uiad015. [PMID: 38344801 PMCID: PMC11020229 DOI: 10.1093/joccuh/uiad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Presenteeism adversely affects workers' quality of life, leading to further deterioration of their health and affecting their ability to continue working. Unemployment is one of the most serious consequences for workers experiencing presenteeism. A worker's ability to work depends on the degree of mismatch between their health status and job demands and work factors. The COVID-19 pandemic has affected workers' experiences of presenteeism as well as their employment status. We examined the association between presenteeism and risk of job resignations and unemployment among Japanese workers during the COVID-19 pandemic. METHODS A prospective study of 27 036 internet monitors was conducted, starting in December 2020, with 18 560 (68.7%) participating in the follow-up by December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment. RESULTS The group with the highest WFun scores had higher odds ratios (ORs) for both retirement and unemployment for health reasons than the group with the lowest WFun scores. ORs were 2.99 (95% CI, 2.48-3.62; P < .001) and 1.82 (95% CI, 1.65-2.00; P < .001), respectively. CONCLUSIONS Workers with work functioning impairment are at increased risk of resignation or unemployment. Management strategies for workers with work functioning impairment are needed to reduce their disadvantages in employment.
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Affiliation(s)
- Yoshihisa Fujino
- Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
| | - Makoto Okawara
- Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
| | - Ayako Hino
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
| | - Seiichiro Tateishi
- Disaster Occupational Health Center, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555,Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu,
807-8555, Japan
| | - Akira Ogami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
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2
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Ribeiro AL, Dullius L, Sartori NS, Azeredo-da-Silva A, Kohem CL, Coates L, Monticielo OA, Palominos P. Challenges in the Management of Psoriatic Arthritis in Latin America: A Systematic Review. Clin Ther 2023; 45:860-867. [PMID: 37198042 DOI: 10.1016/j.clinthera.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE In 2020, the International League of Associations for Rheumatology published recommendations for managing psoriatic arthritis (PsA), aiming to adapt the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the European Alliance of Associations for Rheumatology recommendations to low-income countries. At that time, the paucity of clinical studies examining the management of patients with PsA in Latin America was remarked on by the international working group. Therefore, the primary objective of this systematic literature review was to investigate the main challenges in managing PsA in Latin America as described in recent publications. METHODS A systematic literature review of trials reporting at least one challenge/difficulty in the management of PsA in Latin America was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. References published in the PubMed, EMBASE, and LILACS (Latin American and Caribbean Health Sciences Literature) databases between 1980 and February 2023 were included. The selection of references was conducted independently by 2 researchers in the Rayyan Qatar Computing Research Institute program. Two other reviewers independently extracted data. All challenges were noted and categorized into domains. Data analysis was descriptive. FINDINGS The search strategy yielded 2085 references, with 21 studies included in the final analysis. Most studies were conducted in Brazil (66.6%; n = 14) and were observational studies (100%; N = 21). Difficulties faced by PsA patients and physicians included the high incidence of opportunistic infections (described in 42.8% of the publications; n = 9), followed by nonadherence to therapy, discordance between patients and physicians regarding remission rates, low drug persistence, limited access to disease-modifying antirheumatic drugs, issues related to the storage of biologic drugs, elevated cost of biologic drugs, limited access to medical care, diagnostic delay, and the individual- and country-level impact of socioeconomic factors on work- and health-related outcomes. IMPLICATIONS Challenges in the management of PsA in Latin America extend beyond the care of opportunistic infections, encompassing several other socioeconomic factors. More research is needed to better understand the peculiarities of treating PsA in Latin America to improve patient care. PROSPERO identifier: CRD42021228297.
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Affiliation(s)
- Andre Lucas Ribeiro
- Hospital de Clínicas de Porto Alegre, Rheumatology Department, Porto Alegre, Brazil.
| | - Larissa Dullius
- Hospital de Clínicas de Porto Alegre, Rheumatology Department, Porto Alegre, Brazil
| | | | | | | | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Rheumatology, Oxford, United Kingdom
| | | | - Penelope Palominos
- Hospital de Clínicas de Porto Alegre, Rheumatology Department, Porto Alegre, Brazil
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3
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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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4
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Boussaid S, Ben Majdouba M, Rekik S, Jammali S, Cheour E, Sahli H, Elleuch M. Poor work outcomes in patients with spondyloarthritis: causes, consequences, and solutions. Clin Rheumatol 2021; 41:463-470. [PMID: 34618257 DOI: 10.1007/s10067-021-05904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spondyloarthritis (SpA) affects patients in the prime of their economic productivity and can cause loss of work productivity and unemployment. We aim to identify factors associated with poor work outcomes in patients with SpA. METHODS A cross-sectional study was performed in 100 patients with SpA who were employed, retired, or off work because of SpA. Data on sociodemographic and professional characteristics were collected as well as specific indices: BASDAI, ASDAS-CRP, BASFI, and BASMI. Work productivity in employed patients was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). RESULTS Patients were divided into 73 men and 27 women; the mean age was 43.68 ± 10.3 years. Fifty-nine percent of patients were employed and 26% were off work. The average disease duration was 12.24 ± 8.73 years. The mean BASDAI score was 4.4 ± 2.4, the average BASFI score was 4.6 ± 2.7, and the average ASDAS-CRP score was 2.77 ± 1.18. The mean BASMI was 4.4 ± 2.8. Among employed patients, the mean of absenteeism, presenteeism, and work productivity loss was 21.8 ± 33.13%, 42 ± 32%, and 46.5 ± 35.31%, respectively. In multivariable analysis, absenteeism was associated with ASDAS ≥ 2.1 (β = 20.14), peripheral joint involvement (β = 15.6), manual work (β = 14.31), low level of education (β = 7.92), and BASFI ≥ 4 (β = 6.39). Presenteeism and work productivity loss were associated with manual work, BASFI ≥ , body mass index ≥ 25 kg/m2, smoking, the use of symptomatic treatment, and ASDAS-CRP ≥ 2.1. CONCLUSION Spondyloarthritis affects work productivity. Screening for predictive factors should be considered by the clinician in the overall management of the disease. Key Points • SpA occurs among young and active patients; it could affect their professional lives and thus lead to loss of work productivity and unemployment. • The management of patients with SpA must be multidisciplinary; this includes assessing contextual factors in order to act on modifiable factors such as smoking and BMI, optimal management of the disease to maintain at least a low disease activity, and to ensure workstation layout and elimination of professional constraints that can affect work outcomes in patients with SpA.
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Affiliation(s)
- Soumaya Boussaid
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia.
| | - Marouene Ben Majdouba
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sonia Rekik
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Samia Jammali
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Elhem Cheour
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Hela Sahli
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Research Unit LR 05 SP 01, La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Elleuch
- Rheumatology Department, Rabta Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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5
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Kiltz U, Boonen A, van der Heijde D, Bautista-Molano W, Vargas RB, Chiowchanwisawakit P, El-Zorkany B, Gaydukova I, Geher P, Gossec L, Gilio M, Grazio S, Gu J, Khan MA, Kim TJ, Maksymowych WP, Marzo-Ortega H, Navarro-Compán V, Ozgocmen S, Patrikos D, Pimentel-Santos FM, Reveille J, Schirmer M, Stebbings S, Van den Bosch F, Weber U, Braun J. Development of an environmental contextual factor item set relevant to global functioning and health in patients with axial Spondyloarthritis. Rheumatology (Oxford) 2021; 61:2054-2062. [PMID: 34534275 DOI: 10.1093/rheumatology/keab653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the development of an Environmental contextual factors (EF) Item Set (EFIS) accompanying the disease specific Assessment of SpondyloArthritis international Society Health Index (ASAS HI). METHOD First, a candidate item pool was developed by linking items from existing questionnaires to 13 EF previously selected for the ICF/ASAS Core Set. Second, using data from two international surveys, which contained the EF item pool as well as the items from the ASAS HI, the number of EF-items was reduced based on the correlation between the item and the ASAS HI sum score combined with expert opinion. Third, the final English EFIS was translated into 15 languages and cross-culturally validated. RESULTS The initial item pool contained 53 EF addressing 4 ICF EF-chapters: products and technology (e1), support and relationship (e3), attitudes (e4) and health services (e5). Based on 1754 responses of axial spondyloarthritis patients in an international survey, 44 of 53 initial items were removed based on low correlations to the ASAS HI or redundancy combined with expert opinion. 9 items of the initial item pool (range correlation 0.21-0.49) form the final EFIS. The EFIS was translated into 15 languages and field tested in 24 countries. CONCLUSIONS An EFIS is available complementing the ASAS HI and helps to interpret the ASAS HI results by gaining an understanding of the interaction between a health condition and contextual factors. The EFIS emphasizes the importance of support and relationships, as well as attitudes of the patient and health services in relation to self-reported health.
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Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne Germany; and.,Ruhr-Universität Bochum, Germany
| | - Annelies Boonen
- Department of Internal MedicineDivision of Rheumatology, Maastricht University Medical Center, the Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands
| | | | - Wilson Bautista-Molano
- University Hospital Fundación Santa Fe de Bogotá, and Universidad El Bosque, Bogotá, Colombia
| | | | | | | | | | - Pal Geher
- Semmelweis University, Budapest, Hungary
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris France.,Pitié-Salpêtrière hospital, AP-HP Sorbonne Université, Rheumatology department, Paris, France
| | - Michele Gilio
- Department of Internal Medicine - "San Carlo" Hospital Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Simeon Grazio
- Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | | | - Muhammad Asim Khan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tae-Jong Kim
- Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | | | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Salih Ozgocmen
- Department of RheumatologyIstinye University, Medicalpark Gaziosmanpasa Hospital, Istanbul, Turkey
| | | | | | - John Reveille
- Department of Internal MedicineUniversity of Texas Health Science Center at Houston, USA
| | - Michael Schirmer
- Innsbruck Medical University, Department of Internal Medicine, Clinic IIAustria
| | - Simon Stebbings
- University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Filip Van den Bosch
- VIB Center for Inflammation Research, Ghent, Belgium.,Department of Rheumatology Ghent University Hospital, Ghent, Belgium
| | - Ulrich Weber
- Practice Buchsbaum, Rheumatology, Schaffhausen, Switzerland
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Herne Germany; and.,Ruhr-Universität Bochum, Germany
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6
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Boonen A, Putrik P, Marques ML, Alunno A, Abasolo L, Beaton D, Betteridge N, Bjørk M, Boers M, Boteva B, Fautrel B, Guillemin F, Mateus EF, Nikiphorou E, Péntek M, Pimentel Santos F, Severens JL, Verstappen SMM, Walker-Bone K, Wallman JK, Ter Wee MM, Westhovens R, Ramiro S. EULAR Points to Consider (PtC) for designing, analysing and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis. Ann Rheum Dis 2021; 80:1116-1123. [PMID: 33832966 PMCID: PMC8372378 DOI: 10.1136/annrheumdis-2020-219523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Clinical studies with work participation (WP) as an outcome domain pose particular methodological challenges that hamper interpretation, comparison between studies and meta-analyses. OBJECTIVES To develop Points to Consider (PtC) for design, analysis and reporting of studies of patients with inflammatory arthritis that include WP as a primary or secondary outcome domain. METHODS The EULAR Standardised Operating Procedures were followed. A multidisciplinary taskforce with 22 experts including patients with rheumatic diseases, from 10 EULAR countries and Canada, identified methodologic areas of concern. Two systematic literature reviews (SLR) appraised the methodology across these areas. In parallel, two surveys among professional societies and experts outside the taskforce sought for additional methodological areas or existing conducting/reporting recommendations. The taskforce formulated the PtC after presentation of the SLRs and survey results, and discussion. Consensus was obtained through informal voting, with levels of agreement obtained anonymously. RESULTS Two overarching principles and nine PtC were formulated. The taskforce recommends to align the work-related study objective to the design, duration, and outcome domains/measurement instruments of the study (PtC: 1-3); to identify contextual factors upfront and account for them in analyses (PtC: 4); to account for interdependence of different work outcome domains and for changes in work status over time (PtC: 5-7); to present results as means as well as proportions of patients reaching predefined meaningful categories (PtC: 8) and to explicitly report volumes of productivity loss when costs are an outcome (PtC:9). CONCLUSION Adherence to these EULAR PtC will improve the methodological quality of studies evaluating WP.
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Affiliation(s)
- Annelies Boonen
- Division of Rheumatology, Maastricht University Medical Centre+ Internal Medicine, Maastricht, The Netherlands
- Universiteit Maastricht Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Polina Putrik
- Division of Rheumatology, Maastricht University Medical Centre+ Internal Medicine, Maastricht, The Netherlands
- Universiteit Maastricht Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Mary Lucy Marques
- Rheumatologist, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Alessia Alunno
- Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Italy
| | - Lydia Abasolo
- Department of Rheumatology, Instituto de Investigation Sanitaria San Carlos, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Dorcas Beaton
- Mobility Program Clinical Research Unit, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | | | - Mathilda Bjørk
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Maarten Boers
- Department of Epidemiology and Data Science; Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Amsterdam, The Netherlands
| | - Boryana Boteva
- Patients with Arthritis and Rheumatism (PARE) working group, European League Against Rheumatism, Zurich, Switzerland
| | - Bruno Fautrel
- PEPITES teams, Pierre Louis Institute for Epidemiology and Public Health, Inserm UMR 1136, Paris, France
- Rheumatology Dept, Pitié Salpetriere Hospital, Sorbonne University / Assistance Publique- Hôpitaux de Paris, Paris, Fance
| | - Francis Guillemin
- APEMAC, Université de Lorraine, Nancy, France
- CIC Epidémiologie Clinique, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR) and Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
- People with Arthritis and Rheumatism (PARE), European League Against Rheumatism, Zurich, Switzerland
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College of London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Fernando Pimentel Santos
- Rheumatology Department, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
- NOVA Medical School, Lisboa, Portugal
| | - Johannes L Severens
- Erasmus School of Health Policy & Management and iMTA, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, 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
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Life course Epidemiology Unit, Southampton General Hospital, Southampton, UK
| | - Johan Karlsson Wallman
- Department of Clinical sciences, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Rheumatology and immunology, AI&I, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - René Westhovens
- Dept of Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration, Leuven, Belgium
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
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7
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Nikiphorou E, Carvalho PD, Boonen A, Fautrel B, Richette P, Machado PM, van der Heijde D, Landewé R, Ramiro S. Sick leave in early axial spondyloarthritis: the role of clinical and socioeconomic factors. Five-year data from the DESIR cohort. RMD Open 2021; 7:rmdopen-2021-001685. [PMID: 34172511 PMCID: PMC8237733 DOI: 10.1136/rmdopen-2021-001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the occurrence of sick leave (SL) and the impact of clinical and socioeconomic factors on SL in early axial spondyloarthritis (axSpA). METHODS Patients with a clinical diagnosis of axSpA from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort with work-related data and up to 5-year follow-up were studied. Incidence, time to first SL and potential role of baseline and time-varying clinical and socioeconomic factors (age, gender, ethnicity, education, job type, marital and parental status) were analysed. Univariable analyses, followed by collinearity and interaction tests, guided subsequent multivariable time-varying Cox survival model building. RESULTS In total, 704 axSpA patients were included (mean (SD) age 33.8 (8.6); 46% men). At baseline, 80% of patients were employed; of these, 5.7% reported being on SL. The incidence of SL among those at risk during the study period (n=620, 88%) was 0.05 (95% CI 0.03 to 0.06) per 1000 days of follow-up. Mean (SD) time to first SL was 806 (595) days (range: 175-2021 days). In multivariable models, male gender (HR 0.41 (95% CI 0.20 to 0.86)) and higher education (HR 0.48 (95% CI 0.24 to 0.95)) were associated with lower hazard of SL, while higher disease activity (HR 1.49 (95% CI 1.04 to 2.13)), older age, smoking and use of tumour necrosis factor inhibitors were associated with higher hazard of SL. CONCLUSIONS In this early axSpA cohort of young, working-age individuals, male gender and higher education were independently associated with a lower hazard of SL, whereas older age and higher disease activity were associated with higher hazard of SL. The findings suggest a role of socioeconomic factors in adverse work outcomes, alongside active disease.
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Affiliation(s)
- Elena Nikiphorou
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands .,Centre for Rheumatic Diseases, King's College London, London, UK.,Department of Rheumatology, King's College Hospital, London, UK
| | - Pedro D Carvalho
- Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Faro, Portugal.,Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Annelies Boonen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Maastricht University Medical Center, Department of Internal Medicine, Division of Rheumatology, Maastricht, The Netherlands
| | - Bruno Fautrel
- Sorbonne University - Assistance Publique Hopitaux de Paris, Pitie Salpetriere Hospital, Dept of Rheumatology. Pierre Louis Institute for Epidemiology and Public Health, INSERM UMRS 1136, PEPITES Teams, Paris, France
| | - Pascal Richette
- Université de Paris, Hopital Lariboisière, Department of Rheumatology, INSERM U1132, Paris, France
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Desirée van der Heijde
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands
| | - Robert Landewé
- Zuyderland Medical Center, Department of Rheumatology, Heerlen, The Netherlands.,Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sofia Ramiro
- Leiden University Medical Center (LUMC), Department of Rheumatology, Leiden, The Netherlands.,Zuyderland Medical Center, Department of Rheumatology, Heerlen, The Netherlands
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Association between individual and country-level socioeconomic factors and work participation in spondyloarthritis including psoriatic arthritis: Analysis of the ASAS-perSpA study. Semin Arthritis Rheum 2021; 51:804-812. [PMID: 34153894 DOI: 10.1016/j.semarthrit.2021.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine whether associations between socioeconomic factors and work outcomes in spondyloarthritis (SpA) differ across axial (axSpA), peripheral SpA (pSpA) and psoriatic arthritis (PsA), and whether associations for individual-level socioeconomic factors are modified by country-level factors. METHODS Patients with a physician diagnosis of SpA within working age (18-65 years) were included. Associations between individual- (age, gender, education, marital status) and country-level factors (Human Development Index, Health Care Expenditure (HCE), Gross Domestic Product, percentage unemployed) with work outcomes (employment status, absenteeism, presenteeism) were assessed using multivariable mixed-effects models. Associations between individual factors and outcomes were compared according to SpA phenotypes and country-level factors using interaction terms. RESULTS A total of 3835 patients (mean age 42 years, 61% males) from 23 countries worldwide were included (66% axSpA, 10% pSpA, 23% PsA). Being employed was associated with gender (male vs. female OR 2.5; 95%CI 1.9-3.2), education (university vs. primary OR 3.7; 2.9-4.7), marital status (married vs. single OR 1.3; 1.04-1.6), and age in a non-linear manner. University (vs primary) education was associated with lower odds of absenteeism (OR 0.7; 0.5-0.96) and presenteeism (OR 0.5; 0.3-0.7). Associations were similar across SpA phenotypes. Higher HCE was associated with more favourable work outcomes, e.g., higher odds of employment (OR 2.5; 1.5-4.1). Gender discrepancy in odds of employment was greater in countries with lower socioeconomic development. CONCLUSION Higher educational attainment and higher HCE were associated with more favourable work outcomes, independently of SpA phenotype. The disadvantageous effect of female gender on employment is particularly strong in countries with lower socioeconomic development.
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Ogdie A, Duarte-García A, Hwang M, Navarro-Compán V, van der Heijde D, Mease P. Measuring Outcomes in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:47-71. [PMID: 33091248 DOI: 10.1002/acr.24266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Mark Hwang
- University of Texas Health Science Center at Houston
| | | | | | - Philip Mease
- Swedish Medical Center, Providence St. Joseph Health, and University of Washington School of Medicine, Seattle
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10
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Cucos I, Dadoun S, Jacquemin C, Kreis S, Fabre S, Hudry C, Pertuiset E, Fautrel B, Gossec L. Prediction of Work Impact in Axial Spondyloarthritis by the Work Instability Scale: A Prospective Cohort Study of 101 Patients. J Rheumatol 2020; 48:1002-1006. [PMID: 32934129 DOI: 10.3899/jrheum.191397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Axial spondyloarthritis (axSpA) may have an effect on work. The Ankylosing Spondylitis Work Instability Scale (AS-WIS) assesses difficulties at work. The objective of this study was to evaluate the predictive value of the AS-WIS on work impact. METHODS This is a prospective cohort study with 2 timepoints (at baseline and after 1.5 yrs) that included patients with axSpA who had paid employment. Patients completed the AS-WIS at baseline and work instability was scored as moderate/high if ≥ 11 (0-20 scale). At follow-up, adverse work outcomes (AWO) were grouped as moderate (short-term sick leave) or severe AWO (long-term sick leave, disability, unemployment). Univariable and multivariable logistic regression analyses were performed to explain AWO. RESULTS Of 101 patients, mean age 45 (SD 9) years, 52% male, disease duration was 14 (SD 8) years. The Bath AS Disease Activity Index and the Bath AS Functional Index were 34 (SD 21) and 23 (SD 23), respectively, and 69 (68%) received a tumor necrosis factor inhibitor. At baseline, 46 (46%) patients had moderate/high AS-WIS. At 1.5 years of follow-up, 37 patients (36%) had AWO: 25 patients (25%) a short-term sick leave, and 12 patients (12%, 7/100 patient-years) a severe AWO. Independent baseline factors associated with AWO were a moderate/high AS-WIS score (OR 2.71, 95% CI 1.04-7.22) and shorter disease duration (OR 0.94, 95% CI 0.89-0.99). CONCLUSION In patients with axSpA, a moderate/high AS-WIS score was predictive of AWO in this population with well-controlled axSpA. This short questionnaire can be helpful to screen for future difficulties at work.
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Affiliation(s)
- Irina Cucos
- I. Cucos, MD, Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris;
| | | | - Charlotte Jacquemin
- C. Jacquemin, MD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, and Rheumatology Department, Rene Dubos Hospital, Pontoise
| | - Sarah Kreis
- S. Kreis MD, S. Fabre, MD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris
| | - Stephanie Fabre
- S. Kreis MD, S. Fabre, MD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris
| | | | - Eduard Pertuiset
- E. Pertuiset, PhD, Rheumatology Department, Rene Dubos Hospital, Pontoise
| | - Bruno Fautrel
- B. Fautrel, PhD, L. Gossec, PhD, Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, and Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Laure Gossec
- B. Fautrel, PhD, L. Gossec, PhD, Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP, and Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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11
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Ibáñez Vodnizza SE, van Bentum RE, Valenzuela O, van der Horst-Bruinsma IE. Patients with axial spondyloarthritis report significant differences between men and women and high impact of the disease: Large websurvey analysis. Joint Bone Spine 2020; 87:315-319. [PMID: 32109577 DOI: 10.1016/j.jbspin.2020.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In axial spondyloarthritis (axSpA), mounting evidence shows female patients to experience a higher disease burden. These differences appear to be particularly large in South America. One explanation could be inequity in treatment access between men and women. The objective was to evaluate gender differences in disease burden and work participation, and the potential influence of treatment, in Latin American patients. METHODS A cross sectional online survey among axSpA patients, collecting disease characteristics, treatment, disease burden (BASDAI, BASFI, ASAS Health Index) and work participation (WPAI). Associations between gender and disease burden or work participation were assessed through regression analyses, correcting for treatment. RESULTS AxSpA was reported by 472 participants (63% women) and disease activity (BASDAI≥4: 83%), ASASHI (≥moderately impaired: 91%) and work disability (absenteeism: 41%; presenteeism 82%) were high. Biological use was very low (20%), while 34% used opiates. Females had significantly higher BASDAI, ASAS HI, work absenteeism and presenteeism, although were less likely to receive biologics (26% versus 16%, P<0.01). Gender differences disappeared after correction for treatment. CONCLUSIONS This web survey in Latin American axSpA patients shows a high disease burden and work impairment. The use of biologics is low, while the use of opiates was alarmingly high. Women used significantly less biologics despite reporting a worse disease state and work disability, which could be due to treatment inequity.
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Affiliation(s)
- Sebastian E Ibáñez Vodnizza
- Department of Rheumatology, Clínica Alemana, Universidad del Desarrollo medicine Faculty, 1410, Av. Manquehue Norte, 7650567 Vitacura, Santiago, Chile.
| | - Rianne E van Bentum
- Department of Rheumatology, Amsterdam University Medical Center, location VUmc, 1117, De Boelelaan, 1081HV Amsterdam, Netherlands
| | - Omar Valenzuela
- Department of Rheumatology, Clínica Alemana, Universidad del Desarrollo medicine Faculty, 1410, Av. Manquehue Norte, 7650567 Vitacura, Santiago, Chile
| | - Irene E van der Horst-Bruinsma
- Department of Rheumatology, Amsterdam University Medical Center, location VUmc, 1117, De Boelelaan, 1081HV Amsterdam, Netherlands
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12
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Abstract
PURPOSE OF REVIEW Patients with ankylosing spondylitis (AS) warrant a comprehensive clinical assessment because of the lack of biomarkers of disease activity, prognosis and response to biologic therapy. Multiple AS-related questionnaires have been developed to assess the disease status accurately, but feasibility remains a problem in clinical practice. The purpose of this review is to assess the pearls and pitfalls of AS-related outcome measures. RECENT FINDINGS Single-item questionnaires to measure pain, stiffness and fatigue in patients with AS are easily administrable but may lack a sufficient degree of responsiveness on an individual patient level. The Bath Ankylosing Disease Activity Index remains the gold standard for assessing disease activity in a routine practice, despite poor correlation with C-reactive protein (CRP) levels and MRI inflammation. The Ankylosing Spondylitis Disease Activity Score, a validated and highly discriminatory tool for assessing disease activity in AS, has been developed but lacks feasibility as erythrocytic sedimentation rate and CRP values are often not available during a clinic visit. RAPID-3 appears feasible to assess patients with AS quantitatively over time in busy clinical settings. SUMMARY The assessment of disease status in AS is complex and is impacted by multiple factors. The biggest challenge in AS is to incorporate the disease-specific indices into a routine practice. VIDEO ABSTRACT: http://links.lww.com/COR/A42.
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13
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Tužil J, Mlčoch T, Jirčíková J, Závada J, Nekvindová L, Svoboda M, Uher M, Křístková Z, Vencovský J, Pavelka K, Doležal T. Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry. Expert Opin Biol Ther 2019; 20:183-192. [PMID: 31736377 DOI: 10.1080/14712598.2020.1694900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To assess the role of short-term response to first anti-TNF in long-term prediction of disability.Methods: In nationwide registry ATTRA, we identified ankylosing spondylitis patients starting anti-TNF between 01/2003 and 12/2016. Full disability and work impairment (WI; WPAI questionnaire) were predicted via the Cox- and lagged-parameter mixed-effect regression.Results: 2,274 biologicals-naïve patients newly indicated to anti-TNF were prospectively followed (6,333 patient-years; median follow-up 1.9 years). Reaching BASDAI < 4 (77.4%) and ASDAS-CRP < 2.1 (61.1%) after 3 months of anti-TNF both decreased the risk of future disability by ≈2.5-fold. ASDAS-CRP < 2.1 predicted non-disability better than BASDAI < 4 & CRP < 5 mg/L (p = 0.032). BASDAI < 4 & CRP < 5 mg/L was comparable to BASDAI < 4 (p = 0.941) and to BASDAI change by >50% or by >2 points (p = 0.902). ASDAS-CRP change >1.1 and >2.0 both failed to predict non-disability. Once on anti-TNF therapy, the strongest predictor of WI was Pain (SF36). Yearly increase in indirect costs remains below €3,000 in those reaching ASDAS-CRP < 2.1.Conclusions: Low disease activity measured by ASDAS-CRP ≤ 2.1 should be used to measure the outcome of new anti-TNF therapy. Continuous WI could be decreased through pain management.
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Affiliation(s)
- Jan Tužil
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Mlčoch
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jitka Jirčíková
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jakub Závada
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Lucie Nekvindová
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Uher
- Faculty of Medicine of the Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic
| | - Zlatuše Křístková
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Jiří Vencovský
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Karel Pavelka
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Tomáš Doležal
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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