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 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 .
Work characteristics, demographic factors and clinical variables could predict work disability in rheumatoid arthritis.
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
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 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 .