RESEARCH - Predictive factors of work disability in RA: a systematic literature review

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ls of the Rheumatic Diseases 2004;63:1362-1367

© 2004 by BMJ Publishing Group Ltd & European League Against Rheumatism

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REVIEW

Predictive factors of work disability in rheumatoid arthritis: a systematic

literature review

E M de Croon1, J K Sluiter1, T F Nijssen2, B A C Dijkmans2,3, G J

Lankhorst2,4 and M H W Frings-Dresen1

1 Coronel Institute for Occupational and Environmental Health, Academic

Medical Centre, Research Institute Amsterdam Centre for Health and Health

Care Research (AmCOGG), Amsterdam, The Netherlands

2 Department of Rehabilitation Medicine, Jan van Bremen Institute,

Amsterdam, The Netherlands

3 Department of Rheumatology, VU Medical Centre, Amsterdam, The Netherlands

4 Department of Rehabilitation Medicine, VU Medical Centre, Amsterdam, The

Netherlands

Correspondence to:

Dr E M de Croon

Coronel Institute for Occupational and Environmental Health, Academic

Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;

e.m.decroon@...

ABSTRACT

Background: Work disability-a common outcome of rheumatoid arthritis (RA)-is

a societal (for example, financial costs) and individual problem (for

example, loss of status, income, social support, and distraction from pain

and distress). Until now, factors that predict work disability in RA have

not been systematically reviewed.

Objective: To determine predictive factors of work disability in RA as

reported in the literature.

Methods: A systematic literature search in Cinahl (1988-2004), Embase

(1988-2004), and Medline (1989-2004) was followed by the application of two

sets of criteria related to: (a) methodological quality, and ( measurement

of the predictive factor. Based on the quality and the consistency of the

findings, a rating system was used to assess the level of evidence for each

predictive factor.

Results: Nineteen publications (17 cohorts) were identified, of which 13 met

the general methodological quality criteria. Results provided strong

evidence that physical job demands, low functional capacity, old age, and

low education predict work disability in RA. Remarkably, biomedical

variables did not consistently predict work disability. Moreover, owing to

the lack of high quality studies no evidence was found for personal factors

such as coping style, and work environmental factors such as work autonomy,

support, work adjustments that are presumed crucial in the work disablement

process.

Conclusions: The results indicate that work disability in RA is a

biopsychosocially determined misfit between individual capability and work

demands.

http://ard.bmjjournals.com/cgi/content/abstract/63/11/1362

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