THU0654 INFLUENCE OF THE NEW PHARMACOLOGICAL AND NON-PHARMACOLOGICAL APPROACHES IN RHEUMATOID ARTHRITIS ON WORK PARTICIPATION: A SYSTEMATIC LITERATURE REVIEW
Authors: Famke Wildemeersch, Peggy Jacques, Philippe Carron, Xavier Janssens
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic and progressive autoimmune disease that frequently has a negative impact on work participation among patients. Even more, patients with RA are at greater risk to become work disabled, have a reduced work productivity (presenteeism) or increased sick leave (absenteeism) compared to the general population. This outcome can be related to the World Health Organization International Classification of Functioning, Disability and Health (the WHO ICF framework), that is useful in understanding the impact of RA regarding functioning. Since 2000, the management of RA has made significant progress. With the establishment of the new ACR/EULAR criteria and the treat-to-target (T2T) strategies, patients are nowadays diagnosed and treated earlier. Furthermore, the improvement of the management of RA has led to much better results regarding disease activity and joint destruction. However, many of these patients are confronted with additional fees when contracting private insurances, since the risk assessment by insurances is mainly based on historical data. <h3>Objectives:</h3> This systematic literature review was performed to study the influence of new pharmacological and non-pharmacological approaches on work participation among patients with RA with the objective to improve the risk assessment of RA patients when contracting private insurances. <h3>Methods:</h3> A systematic literature review from January 1990 until January 2018 was performed using Pubmed, Embase and Web of Science. Different search terms were used in each database: employment, workplace, sick leave, absenteeism, work capacity and international classification of functioning, disability and health. All studies assessing one of the search terms were analysed. <h3>Results:</h3> Finally, 49 relevant articles were selected. The selected studies were subdivided according to study design (RCT versus cohort study) and disease duration of the studied patients. Studies that examined the value of an adequate early intervention were grouped separately. Overall, studies on the impact of the non-pharmacological approach were limited and very heterogeneous. Positive results of pharmacological agents (combination of DMARDs or biologic therapy) on work participation could be demonstrated in patients with recent-onset RA. Long-term observational studies showed an association between initiation of new therapeutic strategies and a reduction in work disability among patients with RA. However a causal relation was difficult to confirm because of the study design. Moreover, some studies pointed out other contextual factors that also influence work disability such as political policy, demographic changes in age distribution or educational level. <h3>Conclusion:</h3> The large heterogeneity in terms of patient population, study design and outcome measures limits interpretation of the data. However, this systematic literature review could demonstrate that the effect of a treatment is of utmost importance and not the treatment itself. This emphasizes also the importance of early intervention with pharmacological agents regarding work productivity outcomes in RA. In addition, the impact of personal and environmental factors on work participation may not be neglected. <h3>References:&nbsp;:</h3> <h3><b>Disclosure of Interests:</b>&nbsp;:</h3> None declared