BOSTON, Massachusetts—More than one third of rheumatoid arthritis (RA) patients become unable to work within 10 years of disease onset, but a surprising number of those patients eventually return to work, most do not attribute their work disability to RA, and the new therapies developed over the past decade may be helping patients with long-standing disease remain functional and able to work.

Saralynn Allaire, ScD, of Boston University, Massachusetts, reported in Arthritis Care & Research a major new study of the contemporary prevalence and incidence of work disability associated with RA in the US.¹ The semiannual survey included 5384 subjects with rheumatologist-diagnosed RA , 85% of whom were employed at disease onset. Mean disease duration was 14 years.

“Work disability prevalence in this sample was high (35% within 10 years’ disease duration), but may represent a decline from the 50% prevalence reported in 1987. Annual incidence of work disability was higher than prior studies, but the return-to-work rate was also higher,” Dr. Allaire said.

As might be expected, the researchers found that inability to work became greater with longer disease duration [Table]. The annual incidence of work cessation among subjects with RA ranged from 12% in 2003 to 8.6% in 2004, and 9.4% in 2005. However, the proportion of work cessation attributed to arthritis fell from 6.7% in 2003 to 5.1% in 2004, and 4.8% in 2005.

Work Disability and RA Duration

	RA Duration
	1-3 years	10 years	≥25 years
Premature work cessation (%)	23	35	51
Arthritis-attributed work cessation (%)	14	29	41

Adapted from Arthritis Care Res. 2008;59:474-480.¹

Dr. Allaire said that if RA work disability has really been declining, contributing factors might include more potent agents, early use of aggressive therapy, and use of combination therapy. “The possibility of a secular decline in the severity of RA has also been noted,” she said.

Among the subjects who had to stop working at some point, 39% later returned to work, considerably more than the 10% return-to-work reported in a previous study.

"We found many more incident episodes of work cessation than in previous studies," Dr. Allaire told Musculoskeletal Report. "Many of these were short term episodes, ie, ≤6 months. As we said in the article, this might be due to the method of collecting data—we collected data every 6 months, while other studies collected it annually. Therefore, we probably picked up more short-term episodes of work cessation than other studies. About a quarter of all subjects who stopped working reported they were unemployed.

We can't be sure, but they may have lost their jobs for reasons unrelated to RA. Nineteen percent said they were disabled, and this would be primarily due to RA."

Dr. Allaire et al were surprised to find no reduction in work disability prevalence in early RA. "Newer treatments are supposed to be most effective in early disease, so one would expect greatest change then," she said. Her group further examined this issue in a paper currently under review.

Reference

1. Allaire S, Wolfe F, Niu J, Lavalley MP. Contemporary prevalence and incidence of work disability associated with rheumatoid arthritis in the US. Arthritis Care Res. 2008;59:474-480.