OP0260-HPR PREDICTORS OF WORK PARTICIPATION IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS AFTER 12 MONTHS OF T2T THERAPY INTERVENTION
Authors: Meyer S. E. , Hoeper J. R. , Witte T. , Hoeper K. , Meyer-Olson D. 
Published: May 2021

Background:

Rheumatoid arthritis (RA) is associated with restrictions on work participation (WP) caused mainly by periods of sick leave (absenteeism), reduced productivity at work due to disease (presenteeism) and occupational disability, which account for a significant proportion of indirect costs.

Objectives:

We investigate the predictors of WP after 12 months of Treat-to-Target (T2T) intervention.

Methods:

Data were analyzed from the multi-center ERFASS study, which included patients with rheumatoid factor and/or APCA positive RA after initiation or escalation of disease modifying anti rheumatic drug (DMARD) therapy following a T2T regimen prospectively over 12 months from 01/2018 to 12/2019. A total of 157 patients of working age (18 to 65 years) were included in this evaluation. Socio-demographic and occupational characteristics (WPAI, self-conducted work questionnaire), clinical parameters including disease activity (DAS28, RADAI), impact of disease (RAID), functional capacity (FFbH), depression (PHQ-9) and fatigue (VAS) were analyzed and logistic regression analysis to detect baseline predictors for unimpaired WP after 12 months was performed.

Results:

The mean age of the patients was 52.9 years (standard deviation (SD): 8.19) and 117 (74.5%) were female. 51 patients (32.5%) started first line DMARDs and in 106 patients (67.5%) treatment was escalated. T2T resulted in a significant decrease in mean DAS28 from 4.2 (SD 1.10) at baseline to 2.5 (SD 1.11; p<0.001) after 12 months, 64.3% of the patients were in remission (DAS28<2.6) and 12.1% had low disease activity (DAS28 2.6-3.2). The proportion of patients with no impairment of WP increased significantly and presenteeism and absenteeism became significantly less prevalent, but the proportion of patients with reduced WP at month 12 remained high (74.1%; graph 1). We observed a moderate positive significant correlation between presenteeism and absenteeism (rMo12=0.446; p<0.001). Patients with no restrictions on WP showed a significantly greater decrease in mean DAS28 from 3.7 (SD 1.15) at baseline to 1.9 (SD 0.61) at month 12 as compared to patients with restrictions (mean DAS28: 4.4 (SD 1.04) at baseline to 2.7 (SD 1.15) at month 12; p<0.001). Results from univariate and logistic regression analyses revealed high functional capacity and low depression score at baseline as major contributing factors for unimpaired WP (Table 1).

Table 1.

Baseline predictors of work participation1 at month 12

Predictors (independent variables)Univariate analysis2:
p-valuesMultivariate analysis3: Odds Ratios, p-valuesgender0.117+OR: 0.412; p=0.113age0.010*+OR:0.951; p=0.071school graduation0.150+professional degree0.739duration of complaints0.127+therapy group (starters vs. escalation/ change)0.004*+DAS-28(CRP)0.001*CRP0.906tender joints0.004*swollen joints0.021*disease activity (VAS)0.003*+OR: 0.827; p=0.086subjective disease activity (RADAI)<0.001*disease burden (RAID)<0.001*functional capacity (FFbH)<0.001*+OR: 1.477; p=0.031*fatigue (VAS)<0.001*+depression (PHQ-9)<0.001*+OR: 0.876; p=0.035*working time model (full vs. part-time)0.498physical work load0.427

1 dependant variable: 0=reduced WP (not working/ absenteeism/ presenteeism (≥2)); 1=full WP (working without absenteeism/ presenteeism (≥2))

2 according to applicability chi-square test, t-test for independent variables, Mann-Whitney-U test

3 binary logistic regression analysis, stepwise-backward procedure

+ included into logistic regression model

* significance level: p<0.05

Conclusion:

Despite T2T and high DAS28 remission, we observed persistent limitations in WP. Impaired WP was associated with increased disease activity but logistic regression revealed a significant influence of depression and functional capacity. Our data underscore the multifactorial causes of impaired WP, which should be targeted by vocational rehabilitation.

Disclosure of Interests:

Sara Eileen Meyer: None declared, Juliana Rachel Hoeper: None declared, Torsten Witte: None declared, Kirsten Hoeper Speakers bureau: She has received consultancy and speaker honoraria from Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi., Dirk Meyer-Olson Speakers bureau: He has received consultancy and speaker honoraria from Abbvie, Amgen, Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB.