Letters to the Editor |
Work disability from rheumatoid arthritis
Dear Sir,No doubt work disability from rheumatoid arthritis (RA) results from a complex interaction of a large number of variables. Understanding this interaction between work factors, disease factors, patient characteristics, socio-economic variables and intervention strategies is one of the major challenges in this area.
The recent review by Burton et al. [1] highlights some of these factors and comes down to the conclusion that ‘disease status ... ultimately determines work disability and is the primary target for intervention’. While we agree that treatment to modify disease status is likely to be crucial in improving work outcomes for people with RA, and that biological agents hold some promise in this regard, other areas still need attention. As pointed out by Burton, there is little study evidence to date that medical therapies for RA have had a major impact on work-disability rates, and newer agents remain to be proven in this regard. They also remain expensive and in some countries (such as Australia) their use is restricted by cost to those individuals whose disease is severe or uncontrolled by other measures. Workplace approaches may have a role in maintaining these people in the workforce but remain relatively poorly studied.
We have recently surveyed 497 working age Australians with RA with respect to their opinion as to intervention strategies that may have helped them in their daily work. The qualitative data from these interviews are summarized below.
By far, the majority of these responses from the patients related to work or lifestyle changes and not disease control strategies. These qualitative responses (and possibly others) are yet to be trialled in any systematic way as intervention strategies in order to reduce work disability. Such approaches would sit comfortably with most occupational physicians, rather than the traditional clinician role with its emphasis on pharmacotherapy.
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We believe two other points are worth making with respect to the paper by Burton et al. Firstly, they make the point that differences in social policy have been suggested as influencing RA work-disability rates [2] but appear to dismiss this statement by stating that there is no indication that work-disability rates vary systematically by country. We believe their argument is not valid because social policy varies over time within countries, and the studies reported span almost 30 years. Of course during that period, socio-economic conditions (and subsequent social policy responses) have varied widely and employment rates are known to significantly influence disability rates [3,4].
Finally, there is a body of opinion that RA may be moderating in severity over time [5]. This moderation may be contributing to the apparent reduction in work-disability rates suggested by Burton et al. This phenomenon may not be well recognized in the studies reported thus far given the long duration of the disease and the limitations on our measurement tools such as the Health Assessment Questionnaire [6].
Repatriation General Hospital–Rheumatology, Daws Road, Daw Park, Adelaide, South Australia 5062
Flinders Medical Centre–Rheumatology, Flinders Drive, Bedford Park, Adelaide, South Australia 5041
Repatriation General Hospital–Rheumatology, Daws Road, Daw Park, Adelaide, South Australia 5062
e-mail: michael.shanahan{at}rgh.sa.gov.au
References
- Burton W, Morrison A, Maclean R, Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 2006;56:18–27.
- Sokka T. Work disability in early rheumatoid arthritis. Clin Exp Rheumatol 2001;28:1718–1722.
- Autor DH, Duggan MG. The rise in disability rolls and the decline in unemployment. Q J Econ 2003;118:157–206.[CrossRef][Web of Science]
- Rupp K, Stapleton DC. Determinants of the growth in the social security administration's disability programs—An overview. Soc Secur Bull 1995;58:43–70.[Web of Science][Medline]
- Welsing PMJ, Fransen J, van Riel PLCM. Is the disease course of rheumatoid arthritis becoming milder? Arthritis Rheum 2005;52:2616–2624.[Medline]
- Wolfe F. A reappraisal of HAQ disability in RA. Arthritis Rheum 2001;43:2751–2761.
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