Blue-collar workers more likely to miss work, quit due to psoriatic arthritis
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Key takeaways:
- Physically demanding jobs were linked to greater rates of work disability in patients with PsA.
- Occupation type had no effect on response to PsA treatment.
Blue-collar workers with psoriatic arthritis demonstrate an increased risk for work disability vs. white-collar workers with the same disease, according to data published in Clinical Rheumatology.
However, the researchers additionally concluded that occupation type does not appear to impact response to PsA treatment.
“The pathogenesis of PsA is the result of a multifaceted interaction between genetic, environmental and unknown factors,” Nina Colla, of the department of rheumatology at University Hospital Zurich, in Switzerland, and colleagues wrote. “One proposed environmental trigger for inflammation in PsA is biomechanical stress, sometimes called the ‘deep Köbner phenomenon.’
“Despite these hypotheses, the direct implication of work-related physical demands in PsA patients remains unexplored,” they added. “It remains unclear whether PsA patients with high physical workloads experience increased disease activity or diminished treatment response.”
To examine the impact of occupation type — manual labor vs. more sedentary employment — on PsA disease activity, treatment response and related work disability, Colla and colleagues conducted an observational cohort study of data from the Swiss Clinical Quality Management in Rheumatic Diseases registry. The analysis included 564 adults with PsA (mean age, 46 years; 53% men), 71% of whom were white-collar workers, treated with biological or targeted synthetic disease-modifying antirheumatic drugs between January 2000 and September 2020.
Jobs were classified as blue or white collar based on seven sectors, as well as patients’ reported level of physical stress at work. The main outcomes were 1-year remission rates, assessed via Disease Activity Score-28 with C-reactive protein, and work disability, defined as being absent from work due to PsA.
At baseline, disease activity was comparable between the two groups, with mean DAS28-CRPs of 3.3 for white-collar workers and 3.2 for manual laborers. However, the rate of work disability was higher among blue-collar workers, at 84% vs. 27.9% (P < .01), according to the researchers. In addition, blue-collar workers were more likely to quit their jobs due to PsA, at a rate of 19.1% vs. 7.8% for white-collar workers (P = .03).
Meanwhile, the 1-year remission analysis, which included 174 treatment-courses in 165 patients, revealed no difference between white- and blue-collar workers. Blue-collar work was associated with longer treatment retention (mean duration, 3.15 years vs. 2.15 years; P = .006) in a Kaplan-Meier analysis, but not in an adjusted Cox regression analysis (HR = 0.71; 95% CI, 0.48-1.05), according to the researchers.
“This study suggests that physically demanding occupations correlate with increased rates of work disability among PsA patients, particularly men,” Colla and colleagues wrote. “Further research is needed to fully understand the impact of physical workload on disease burden and to develop effective interventions for preventing long-term work disability among PsA patients.”
Perspective
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The Rheumatology Nurses Society is undertaking a project focused on the social determinants of health, exploring how various social and societal factors influence patients' interactions with the health care system and their personal health management. Some of the key elements under investigation include socioeconomic status, health literacy and access to health care.
This study by Colla and colleagues emphasizes the significant impact of high physical workplace stress on disease activity, and underscores the importance of socioeconomic factors in shaping patients’ health care experiences. For blue-collar workers, lower education levels can limit their understanding of disease management and restrict access to health care resources. Consequently, there is an urgent need for educational initiatives designed to empower these patients with essential self-management skills.
The study authors point to the possibility that social and economic factors very likely impact disease progression and treatment adherence. Understanding the interplay between occupation, disease progression and treatment response is crucial for enhancing patient-centered care. By addressing the social barriers to health care access, health care providers can better support patients in navigating their conditions.
A collaborative approach that actively involves patients in their care planning is vital for tailoring interventions to their specific circumstances. This strategy aims to improve treatment adherence and empower patients to take an active role in managing their health, ultimately leading to better health outcomes.
I encourage everyone to attend one of our sessions coming to a city near you this fall.
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