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      Predictors of presenteeism, absenteeism and job loss in patients commencing methotrexate or biologic therapy for rheumatoid arthritis

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          Abstract

          Objectives

          Work is an important health outcome. This study aimed to identify predictors of work loss, absenteeism and presenteeism over 1 year in RA patients commencing treatment with MTX or biologics.

          Methods

          Patients aged 18–65 years in full/part-time employment from two UK prospective cohorts were included: MTX-starters = Rheumatoid Arthritis Medication Study; and biologic-starters = Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate. Presenteeism and absenteeism were assessed using the RA-specific Work Productivity Survey at baseline, and 6 and 12 months. Potential predictors including baseline age, gender, clinical measures (e.g. disability, pain, fatigue), psychological distress, occupation and EULAR response from baseline to 6 months were investigated.

          Results

          A total of 51/463 MTX-starters and 30/260 biologic-starters left work over 12 months. Higher baseline psychological distress in MTX-starters [odds ratio (OR) 1.1 (95% CI: 1.0, 1.1)] and higher disability in biologic-starters [OR 3.5 (95% CI: 1.4, 8.6)] predicted work loss. Some 16.1% of patients reported sick-leave, which was predicted by disability [OR (95% CI): MTX-starters: 1.5 (0.9, 2.3); biologic-starters: 2.4 (1.1, 5.2)]. Median presenteeism scores were very low (minimal interference) in both cohorts. Higher fatigue for MTX starters [incidence rate ratio 1.2 (95% CI: 1.0, 1.4)] and higher disability in biologic-starters (incidence rate ratio 1.4 (95% CI: 1.1, 1.7)] predicted presenteeism. Good EULAR response was associated with lower absenteeism and presenteeism in both cohorts.

          Conclusion

          Patients with RA still face significant limitations regarding their ability to work. Disability and EULAR response were the main predictors of work outcomes, emphasizing the need to control the disease and the importance of function in enabling work participation.

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          Most cited references36

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          EuroQol: the current state of play.

          R. Brooks (1996)
          The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
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            The Disease Activity Score and the EULAR response criteria.

            In rheumatoid arthritis (RA), inflammatory activity cannot be measured using one single variable. For this reason the Disease Activity Score (DAS). has been developed. The DAS is a clinical index of RA disease activity that combines information from swollen joints, tender joints, the acute phase response and general health. The DAS-based European League Against Rheumatism (EULAR) response criteria were developed to measure individual response in clinical trials. The EULAR response criteria classify individual patients as non-, moderate, or good responders, dependent on the extent of change and the level of disease activity reached.
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              Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis.

              The Stanford Health Assessment Questionnaire was modified for use amongst British patients by the substitution of colloquial expressions. Completion of the modified questionnaire was shown to be simplified compared with the original. Results correlated well with scores obtained at interview and were shown to be more sensitive to patients' functional changes than the Steinbrocker grading.
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                Author and article information

                Journal
                Rheumatology (Oxford)
                Rheumatology (Oxford)
                brheum
                Rheumatology (Oxford, England)
                Oxford University Press
                1462-0324
                1462-0332
                October 2020
                25 February 2020
                25 February 2020
                : 59
                : 10
                : 2908-2919
                Affiliations
                [k1 ] Centre for Epidemiology Versus Arthritis , Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
                [k2 ] Centre for Genetics and Genomics Versus Arthritis , Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
                [k3 ] NIHR Manchester Biomedical Research Centre , Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
                [k4 ] MRC Versus Arthritis Centre for Musculoskeletal Health and Work , University of Southampton, Southampton, UK
                Author notes
                Correspondence to: Suzanne M. M. Verstappen, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. E-mail: Suzanne.Verstappen@ 123456manchester.ac.uk
                Author information
                http://orcid.org/0000-0002-1435-8797
                http://orcid.org/0000-0001-8242-9262
                Article
                keaa027
                10.1093/rheumatology/keaa027
                7516097
                32097471
                d019a641-1d84-4517-aa36-e2aebf1e27f3
                © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 September 2019
                : 2 January 2020
                Page count
                Pages: 12
                Funding
                Funded by: Versus Arthritis, DOI 10.13039/501100012041;
                Award ID: 20385
                Award ID: 20380
                Funded by: National Institute for Health Research, DOI 10.13039/501100000272;
                Funded by: NIHR, DOI 10.13039/100006662;
                Funded by: Manchester Biomedical Research Centre, DOI 10.13039/100014653;
                Funded by: National Health Service;
                Funded by: NIHR, DOI 10.13039/100006662;
                Funded by: Department of Health, DOI 10.13039/501100003921;
                Categories
                Clinical Science
                AcademicSubjects/MED00360

                Rheumatology
                rheumatoid arthritis,work,work disability,presenteeism,absenteeism,disability
                Rheumatology
                rheumatoid arthritis, work, work disability, presenteeism, absenteeism, disability

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