Research article
Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study
1 Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
2 Medcare Oy, Hämeentie 1, 44100 Äänekoski, Finland
3 New York University Hospital for Joint Diseases, 301 East 17 Street, New York, NY 10003, USA
4 Department of Rheumatology and Clinical Immunology F02.127, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
5 Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
6 Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Teaching Hospital of the Charité, University Medicine Berlin, Heubnerweg 2, 14059 Berlin, Germany
7 Medical Faculty of Latvia University, P. Stradina Clinical University Hospital, Pilsonu Street 13, LV 1002, Riga, Latvia
8 Rheumatology Department, Dubai Bone and Joint Center, Al Razi Building, DHCC, PO Box 118855, Dubai 118855, United Arab Emirates
9 Uppsala University Hospital, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
10 Sección de Reumatologia, Hospital General de Castellón, Avda Benicasim s/n, 12004 - Castellon, Spain
11 CentraCare, 1200 6th Avenue North, St. Cloud, MN 56301, USA
12 Serviço de Reumatologia - Hospital Universitário de Brasília, SGAN 605, Av. L2 Norte Brasília, Brazil
13 Rheumatology Institut, Srpskih Junaka 2, 18205 Niška Banja, Serbia
14 Rheumatology & Rehabilitation, Assiut University Hospital, Assiut University, Assiut 71111, Egypt
15 School of Medicine, Catholic University of the Sacred Heart, Via Moscati 31, 00168 Rome, Italy
16 Department of Rheumatology, Kyoto First Red Cross Hospital, 15-749, Mon-machi, Higashiyama-ku, Kyoto, Japan
17 Department of Rheumatology, Semmelweis University, H-1025 Budapest Árpád f.u.7., Hungary
18 Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University, 06530 Ankara, Turkey
19 Faculté de Médecine et de Pharmacie, Route de la Plage, Rabat, Morocco
20 Al-Azhar University, 14 Mustafa Darwish Street, Nasr City, Cairo, Egypt
21 Department of Rheumatology, Service box 416, N-4604 Kristiansand. S, Norway
22 King Christian the Xth Hospital, Toldbodgade 3, 6300 Gråsten, Denmark
23 Clinica de Medicina Interna si Reumatologie, Spitalul Clinic Sf Maria, B-dul Ion Mihalache 37-39 Sector 4, Bucuresti, Romania
24 Department of Early Arthritis, Institute of Rheumatology, Kashirskoye shosse, 34a, Moscow, 115522, Russia
25 Tartu University Hospital, Puusepa str. 6, Tartu 50408 Estonia
26 Faculdade de Medicina da Universidade de São Paulo-FMUSP, Av Dr Arnaldo 455, CEP01246-903, São Paulo, Brazil
27 Rheumatology Section, Riverside Professional Center, 31 Riverside Drive, Sydney, NS, B1S 3N1, Canada
28 Satakunta Central Hospital, Rauman aluesairaala, Steniuksenkatu 2, 26100 Rauma, Finland
29 American Hospital Dubai, P.O. Box 5566, Dubai, United Arab Emirates
30 Connolly Hospital, Waterville Road, Blanchardstown, Dublin 15, Ireland
31 Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, Japan
32 Kenyatta National Hospital, Hospital Road,, PO Box 19701-00202, Nairobi, Kenya
33 Rheumatic Disease Clinic, 4th floor, Vedanta Institute of Medical Sciences Navrangpura, Ahmedabad 380009, Gujarat, India
34 Rheumatology Department, University Clinical Center of Kosova, Kodra e diellit, Rr. II, Lamela 11/9, Prishtina, 10 000, Kosova
35 Department of Clinical Immunology, Jaipur Hospital, Lal Kothi, Jaipur Pin-302021, India
36 Shono Rheumatism Clinic, 1-10-27 Nishi-shin, Sawara-ku, Fukuoka, Japan
37 Service de Rhumatologie, CHU de Strasbourg, Hôpital Hautepierre, Avenue Molière, BP 49, 67098 Strasbourg, France
38 Department of Rheumatology and Internal Diseases, Medical University in Bialystok, 24a Maria Sklodowska-Curie Street, 15-276 Bialystok, Poland
39 Harokopio University and Euroclinic of Athens, Athanasiadou 7-9, 11521 Athens, Greece
40 Institute of Experimental and Clinical Medicine at Vilnius University, 3 Universiteto St, LT-01513 Vilnius, Lithuania
41 Division of Rheumatology, Hospital San Juan Bautista, Avenida Illia 200, Catamarca, CP 4700, Argentina
42 Center for Clinical and Basic Research, Tallinn, Pärna 4, 10128 Tallinn, Estonia
43 Duke of Cornwall Rheumatology Unit, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK
Arthritis Research & Therapy 2010, 12:R42 doi:10.1186/ar2951
See related editorial by Uhlig, http://arthritis-research.com/content/12/2/114
Published: 12 March 2010Abstract
Introduction
Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries.
Methods
The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses.
Results
At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score.
Conclusions
Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
