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Early arthritis patients’ mental conditions determined early retirement plans

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Patients with early inflammatory arthritis based their decisions to apply for disability pensions more on mental conditions than disease activity, according to research presented at the annual congress of the European League Against Rheumatism in Madrid.

Researchers in Germany studied 573 employed patients (aged 63 years or younger; 67% women) with early inflammatory arthritis (IA; disease duration, 13 ± 7 weeks) and their plan to begin early retirement within the first 12 months of rheumatologic care.

Gender, education, baseline BMI, rheumatoid factor (RF) and/or anti-citrullinated peptide antibody (ACPA) serology, acute phase reactants, tender and swollen joint counts and 12 physician-reported common conditions were independent variables in multivariate logistic regression. Pain, morning stiffness, fatigue, functional capacity and the first item on the Patient Health Questionnaire Depression scale (PHQD9) were among the patient-reported parameters.

Sixty-seven percent of patients were RF and/or ACPA-positive at baseline, and 65% fulfilled the new ACR-EULAR criteria. At 1 year, 87% of patients took disease-modifying antirheumatic drugs. Thirty-six patients considered applying for early retirement at 1 year, 14 had applied for retirement benefits and 22 had retired early. Compared with the other patients in the cohort, these patients had similar education levels, were older (aged 53 years vs. 47 years) and had significantly higher disease activity and severity, particularly fatigue.

No other arthritis activity measures or assessed cardiovascular, metabolic or pulmonary diseases were associated with early retirement in multivariate analysis. “Having little pleasure or interest in doing things on most days” was reported by 10.6% of patients and showed the greatest association (P<.001), with 30% of those patients considering or entered into early retirement. Results were confirmed by PHQD9 scores.

“Our findings demonstrate that whether or not patients with early arthritis consider applying for disability pension is more dependent on mental conditions than disease activity,” researcher Angela Zink, MD, head of the epidemiology unit at the German Rheumatism Research Center in Berlin, said in a press release. “As arthritis has a significant financial impact on patients and society, well-directed attention on well-being in the early stages of disease may help patients remain in the workforce.”

For more information:

Westhoff G. OP0092: Indicators of Depression Are Stronger Predictors of Work Disability in Early Arthritis Than Disease Activity or Response to Therapy. Presented at: EULAR 2013; June 12-15, Madrid.