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Depression more strongly linked to productivity than disease activity in early RA
Applying for work disability was more strongly linked to depression rather than disease activity in patients with early rheumatoid arthritis, according to recently published data.
Researchers studied 528 patients with early rheumatoid arthritis (RA) who were 63 years of age or younger and gainfully employed, unemployed or available for work. Mean disease duration was 3 months at study inclusion, and patients were followed for 24 months at 188 outpatient rheumatology clinics in Germany.
Patients data, including BMI, components of the disease activity score (DAS28) and 14 chronic comorbid conditions, were collected. Patient-reported data included information about educational level, job requirements, sick leave taken during the last 6 months, physical workload required, pain and morning stiffness, the first five questions of the Profile of Fatigue and Discomfort (PROFAD), the Rheumatoid Arthritis Impact of Disease Score (RAID) and functional capacity by the percentage of full function according to the Hannover Functional Status Questionnaire (FFbH).
Depression was measured by the Patient Health Questionnaire Depression Score (PHQ-9) based on mood statements about activities during the previous 2 weeks.
At 12 and 24 months, patients were asked whether or not they were considering applying for, or if they had already applied for, disability. Patients were considered not at risk for work loss if no desire to apply for disability was expressed at 24 months.
Forty-two patients (8%) reported they were considering applying for disability at 2 years after onset of RA; 18 (3.4%) said they had applied and nine (1.7%) had obtained disability payments. On average, all were 5 years older than those who had not considered early retirement and had significantly higher disease activity, disease severity and fatigue, according to the researchers.
Univariate logistic regression models were used to identify variables predictive of work loss. Age, days of sick leave taken, baseline DAS28, FFbH and PROFAD values, PHQ-9 sum scores and questions one from the PHQ-9 were linked to the desire to seek disability.
Twelve percent of patients reported moderate-to-severe depression. Significant association was seen between the desire to retire and response to question one on the PHQ-9 about having “little pleasure or interest in doing things,” to which 10% of patients reported positively for at least half of the days in the prior 2 weeks. Of those patients, one-third reported having a work disability.
Disease activity measures and comorbidities did not correlate with decisions about early retirement, according to the researchers. – by Shirley Pulawski
Disclosures: The authors report no relevant financial disclosures.