P047 Experiences of working with early inflammatory arthritis: a qualitative descriptive study
Authors: Codd Yvonne , Coe Áine , Kane David , Mullan Ronan H , Stapleton Tadhg 
Published: April 2023

Abstract

Background/Aims
Work instability and work disability are common consequences of inflammatory arthritis with 40% of people with rheumatoid arthritis in Ireland leaving the workforce in the first five-years of diagnosis. Although medical and drug therapy advances have significantly decreased disease activity and work absenteeism, work loss among employees with inflammatory arthritis remains high and retaining work ability remains a challenge. EULAR self-management recommendations for those with inflammatory arthritis specifically highlight the need to address work issues as part of routine clinical care to successfully support work retention. Current Irish work-based services are suboptimal and could be augmented by an improved understanding of the challenges associated with working with arthritis and clients’ priorities for work interventions in early disease. The aim of this study was to describe the impact of early inflammatory arthritis on work participation.

Methods
The study design employed a Qualitative Descriptive (QD) framework and was guided by the COREQ criteria to for designing and reporting qualitative studies. Thirty individuals (24 women) of working age (age 18-69 years) with inflammatory arthritis (&lt;2 years duration) who were in paid employment or fulltime education were interviewed using one-off semi-structured interviews. Data was analysed using thematic analysis.

Results
Half of participants (n = 15) reported work disability within the first two-years post diagnosis. Physical and psychosocial sequelae of early disease were reported as negatively impacting work capacity. Prioritisation of work above all other life roles was widely reported in early disease and was synonymous with internalised anxiety and worry reflecting the invisible burden of maintaining employment whilst concurrently adjusting to the diagnosis. Fear, and a forced reconstructed future negatively influenced work participation and perceived work capacity. Disclosure of diagnosis early in the disease trajectory was identified as a sensitive issue. Most participants reported preconceived ideas of negative results of disclosure further adding to internalised worry. However, disclosure was synonymous with positive outcomes and influenced capacity for sustained working. As such, support with disclosure is required to reduce premature work cessation early in the disease trajectory for people with inflammatory arthritis.

Conclusion
The scale of early work disability in Ireland appears to be higher than previously understood. Although early medical intervention has improved disease management, significant work-based restrictions in early disease remain. Exploring the subjective experience is fundamental when identifying work participation restrictions and should inform the type of work support required. While disclosure of diagnosis in the work environment is associated with anxiety and fear, disclosure is influential in supporting capacity to retain work participation. Internalised and invisible work-related anxieties present early in the disease need to be acknowledged and addressed by healthcare providers as part of routine early healthcare to avoid work disability.
Disclosure
Y. Codd: None. Á. Coe: None. D. Kane: None. R.H. Mullan: None. T. Stapleton: None.