RESEARCH - Which patients stop working because of RA?

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ls of the Rheumatic Diseases

2002;61:335-340

Which patients stop working because of rheumatoid arthritis? Results of five

years' follow up in 732 patients from the Early RA Study (ERAS)

A Young1, J Dixey2, E Kulinskaya3, N 4, P Davies5, J Devlin6, P Emery7, A

Gough6, D 8, P Prouse9, P 10 and J Winfield11

1 City Hospital, St Albans AL3 5PN, UK

2 Orthopaedic Hospital, Oswestry TF6 6TF, UK

3 Health Research and Development Support Unit, University of Hertfordshire,

UK

4 Royal Hants Hospital, Winchester SO22 5DG, UK

5 Broomfield Hospital, Chelmsford CM1 6ET, UK

6 Selly Oak Hospital, Birmingham B29 6JD, UK

7 Rheumatology Research Unit, Leeds LS2 9NZ, UK

8 Princess of Wales Hospital, Grimsby DN33 2BA, UK

9 District Hospital, Basingstoke RG24 9NA, UK

10 Medway Hospital, Gillingham ME7 5NY, UK

11 Royal Hallamshire Hospital, Sheffield S11 9EL, UK

Correspondence to:

Dr A Young, ERAS Coordinator, Rheumatology Unit, City Hospital, St Albans,

Herts AL3 5PN, UK;

erascm@...

Objectives: To assess the occurrence and prognostic factors for the ability

to maintain paid work in patients with rheumatoid arthritis (RA).

Setting: Inception cohort of patients with RA recruited from rheumatology

departments in nine NHS Hospital Trusts in England.

Patients: All consecutive patients with RA of less than two years' duration,

before any second line (disease modifying) drug treatment, and followed up

for five years.

Methods: Clinical, laboratory, and radiological assessments, and all

treatments were recorded prospectively using a standardised format at

presentation and yearly.

Outcome measures: Changes in, and loss of paid work by five years' follow

up.

Results: 732 patients completed the five year follow up. 353/721 (49%) were

gainfully employed at the onset of RA, 211 (60%) were still working at five

years, 104 (29%) stopped because of the disease, and 31 (9%) retired for

reasons other than RA. Work disability at five years was more likely in

manual workers (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.4 to

3.8) and worse baseline Health Assessment Questionnaire (HAQ>1.5, OR 2.26,

95% CI 1.38 to 3.7). In combination with other baseline variables

(erythrocyte sedimentation rate, sex, age of onset, and radiological

erosions), employment outcome was predicted in 78% using multivariate

analysis.

Conclusions: Nearly half of the patients with RA were in paid employment at

onset, work disability was an adverse outcome for a third of these patients

by five years, and manual work and high baseline HAQ were important

predictors for this. These details are likely to be useful to clinicians,

health professionals, and patients in order to plan medical, orthopaedic,

and remedial treatments in early RA. Future disease modifying treatments

could be compared with this cohort of patients who were treated with

conventional second line drugs.

http://ard.bmjjournals.com/cgi/content/abstract/61/4/335

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