Predicting the Timing of Job Loss and Change in Patients Receiving
                    Standard and Biologic Treatment for Radiographic and Non-Radiographic Axial
                    Spondyloarthritis

Halil Harman; Canan Avcı; Kadriye Öneş; Nur Berna Turgut; Nuran Erden

doi:10.1055/a-2563-3504

Aktuelle Rheumatologie, Table of Contents

Aktuelle Rheumatologie
DOI: 10.1055/a-2563-3504

Original Article

Predicting the Timing of Job Loss and Change in Patients Receiving Standard and Biologic Treatment for Radiographic and Non-Radiographic Axial Spondyloarthritis

Vorhersage des Zeitpunkts des Arbeitsplatzverlusts und -wechsels bei Patienten, die eine standard-und biologische Behandlung für radiologische und nicht radiologische axiale Spondyloarthritis erhalten

Halil Harman

¹Rheumatology, University of Health Sciences, İstanbul Physical Medicine and Rehabilitation Education and Research Hospital, İstanbul, Turkey

,

Canan Avcı

²Physical Medicine and Rehabilitation, University of Health Sciences, İstanbul Physical Medicine and Rehabilitation Education and Research Hospital, İstanbul, Turkey

,

Kadriye Öneş

²Physical Medicine and Rehabilitation, University of Health Sciences, İstanbul Physical Medicine and Rehabilitation Education and Research Hospital, İstanbul, Turkey

,

Nur Berna Turgut

²Physical Medicine and Rehabilitation, University of Health Sciences, İstanbul Physical Medicine and Rehabilitation Education and Research Hospital, İstanbul, Turkey

,

Nuran Erden

³Anatomy, Nisantasi University, Istanbul, Turkey

⁴Physical Medicine and Rehabilitation, Private Yasar Hospital, Istanbul, Turkey

› Author Affiliations

Abstract

Objectives

We focused on investigating clinical and laboratory predictors of the timing of job loss and job changes in non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA (r-axSpA) patients and the effect of biological therapies used.

Method

The study included 202 axSpA (42 nr- axSpA, 160 r-axSpA) patients who were employed in paid jobs at the time of axSpA treatment initiation. Spinal mobility, disease activity, and functional status were evaluated. During a 5-year follow-up period, patientsʼ occupations, instances of job loss, and occupational changes were documented. Data regarding the timing of job loss and job changes were recorded, including instances of early retirement following job loss.

Results

r-axSpA patients were diagnosed with notably higher disease activity and required more biologic treatments (p=0,001, p=0,001). Job loss and job changes were more prevalent in r-axSpA patients compared to nr-axSpA patients (p=0,021, p=0,001). There was no statistically significant association between job loss and biologic therapy type (p=0,068). High BASMI scores were an independent predictor of job loss (p=0,040). High BASFI scores and lateral lumbar flexion limitations were significant independent predictors of job change (p=0,021, p=0,003). Job loss occurred significantly earlier in patients with a family history of SpA, those who were HLA-B27 positive, and those with cervical limitations, compared to their respective counterparts (p=0,004, p=0,050, p=0,010, respectively).

Conclusions

r-axSpA patients are particularly vulnerable to these adverse outcomes early in the disease course. Job loss and changes occur more rapidly in patients with HLA-B27 positivity, a family history of the disease, and spinal limitations.

Keywords

non-radiographic axial spondyloarthritis - radiographic axial spondyloarthritis - work capacity evaluation - biological therapy

Schlüsselwörter

nicht-radiologische axiale Spondyloarthritis - radiologische axiale Spondyloarthritis - Bewertung der Arbeitskapazität - biologische Therapie

Full Text

References

References
1 Rudwaleit M, van der Heijde D, Landewé R. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-783
2 Protopopov M, Poddubnyy D. Radiographic progression in non-radiographic axial spondyloarthritis. Expert Rev Clin Immunol 2018; 14: 525-533
3 Kennedy LG, Will R, Calin A. Sex ratio in the spondyloarthropathies and its relationship to phenotypic expression, mode of inheritance and age at onset. J Rheumatol 1993; 20: 1900-1904
4 Sieper J, van der Heijde D. Review: Nonradiographic axial spondyloarthritis: new definition of an old disease?. Arthritis Rheum 2013; 65: 543-551
5 Molto A, López-Medina C, Sepriano A. et al. Sacroiliac radiographic progression over 10 years in axSpA: data from the DESIR inception cohort. Ann Rheum Dis 2024; 83: 858-864
6 Singh JA, Strand V. Spondyloarthritis is associated with poor function and physical health-related quality of life. J Rheumatol 2009; 36: 1012-1020
7 Strand V, Singh JA. Patient burden of axial spondyloarthritis. J Clin Rheumatol. Lippincott Williams and Wilkins 2017. 23. 383-391
8 Boonen A, Brinkhuizen T, Landewe R. et al. Impact of ankylosing spondylitis on sick leave, presenteeism and unpaid productivity, and estimation of the societal cost. Ann Rheum Dis 2010; 69: 1123-1128
9 Frauendorf R, Pinheiro Mde M, Ciconelli RM. Variables related to work productivity loss in patients with ankylosing spondylitis. Rev Bras Reumatol 2013; 53: 303-309
10 Barkham N, Coates LC, Keen H. et al. Double-blind placebocontrolled trial of etanercept in the prevention of work disability in ankylosing spondylitis. Ann Rheum Dis 2010; 69: 1926-1928
11 Hokkanen AM, Aaltonen K, Relas H. et al. Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study. Rheumatol Adv Pract 2023; 7: rkad050
12 Cobilinschi C, Ionescu R, Opris-Belinski D. AB1082 Impact of ankylosing spondylitis versus non-radiographic spondyloarthritis on early retirement. Annals of the Rheumatic Diseases 2017; 76: 1433-1434
13 Cakar E, Taskaynatan MA, Dincer U. et al. Work disability in ankylosing spondylitis: differences among working and work-disabled patients. Clin Rheumatol 2009; 28: 1309-1314
14 Malaviya AN, Rawat R, Agrawal N. et al. The Nonradiographic axial spondyloarthritis, the radiographic axial spondyloarthritis, and ankylosing spondylitis: the Tangled Skein of rheumatology. Int J Rheumatol 2017; 2017: 1-9
15 Sieper J, Rudwaleit M, Baraliakos X. et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 2009; 68: ii1-ii44
16 Ramiro S, van Tubergen A, Stolwijk C. et al. Reference intervals of spinal mobility measures in normal individuals: the MOBILITY study. Ann Rheum Dis 2015; 74: 1218-1224
17 Garrett S, Jenkinson T, Kennedy LG. et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21: 2286-2291
18 Jenkinson TR, Mallorie PA, Whitelock HC. et al. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994; 21: 1694-1698
19 Calin A, Jones SD, Garrett SL. et al. Bath Ankylosing Spondylitis Functional Index. Br J Rheumatol 1995; 34: 793-794
20 Gilworth G, Emery P, Barkham N. et al. Reducing work disability in Ankylosing Spondylitis: development of a work instability scale for AS. BMC Musculoskelet Disord 2009; 10: 68
21 Ramonda R, Marchesoni A, Carletto A. et al. Patient-reported impact of spondyloarthritis on work disability and working life: The ATLANTIS survey. Arthritis Res Ther 2016; 18: 78
22 Boonen A, Chorus A, Miedema H. et al. Withdrawal from labour force due to work disability in patients with ankylosing spondylitis. Ann Rheum Dis 2001; 60: 1033-1039
23 Guillemin F, Briancon S, Pourel J. et al. Long-term disability and prolonged sick leaves as outcome measurements in ankylosing spondylitis. Possible predictive factors. Arthritis Rheum 1990; 33: 1001-1006
24 Lehtinen K. Working ability of 76 patients with ankylosing spondylitis. Scand J Rheumatol 1981; 10: 263-265
25 Ariza-Ariza R, Hernández-Cruz B, Collantes E. et al. Work disability in patients with ankylosing spondylitis. J Rheumatol 2009; 36: 2512-2516
26 Ward MM, Reveille JD, Learch TJ. et al. Impact of ankylosing spondylitis on work and family life: comparisons with the US population. Arthritis Rheum 2008; 59: 497-503
27 van Hoeven L, Boonen AERCH, Hazes JMW. et al. Work outcome in yet undiagnosed patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis; results of a cross-sectional study among patients with chronic low back pain. Arthritis Res Ther 2017; 19: 143
28 Küçükdeveci AA, Ataman Ş, Genç A. et al. Adaptation and validation of the Ankylosing Spondylitis Work Instability Scale (AS-WIS) for use in Turkey. Rheumatol Int 2015; 35: 125-131
29 Fabreguet I, Koumakis E, Burki V. et al. Assessment of work instability in spondyloarthritis: a cross-sectional study using the ankylosing spondylitis work instability scale. Rheumatology (Oxford) 2012; 51: 333-337
30 Haglund E, Bremander A, Bergman S. et al. Work productivity in a population-based cohort of patients with spondyloarthritis. Rheumatology (Oxford) 2013; 52: 1708-1714
31 Macfarlane GJ, Shim J, Jones GT. et al. Identifying persons with axial spondyloarthritis at risk of poor work outcome: results from the British society for rheumatology biologics register. J Rheumatol 2019; 46: 145-152
32 Espahbodi S, Bassett P, Cavill C. et al. Fatigue contributes to work productivity impairment in patients with axial spondyloarthritis: a cross-sectional UK study. Clin Exp Rheumatol 2017; 35: 571-578
33 Goh Y, Kwan YH, Leung YY. et al A crosssectional study on factors associated with poor work outcomes in patients with axial spondyloarthritis in Singapore. Int J Rheum Dis 2019; 1 22: 2001-2008
34 Molto A, Tezenas du Montcel S, Wendling D. et al. Disease activity trajectories in early axial spondyloarthritis: results from the DESIR cohort. Ann Rheum Dis 2017; 76: 1036-1041
35 Ramiro S, Landewé R, van Tubergen A. et al. Lifestyle factors may modify the effect of disease activity on radiographic progression in patients with ankylosing spondylitis: a longitudinal analysis. RMD Open 2015; 1: e000153
36 van der Heijde D, Braun J, Rudwaleit M. et al. Improvements in workplace and household productivity with certolizumab pegol treatment in axial spondyloarthritis: results to week 96 of a phase III study. RMD Open 2018; 4: e000659
37 van der Heijde D, Joshi A, Pangan AL. et al. ASAS40 and ASDAS clinical responses in the ABILITY-1 clinical trial translate to meaningful improvements in physical function, health-related quality of life and work productivity in patients with non-radiographic axial spondyloarthritis. Rheumatology. 2016; 55: 80-88
38 Van Der Heijde D, Deodhar A. et al. The effect of golimumab therapy on disease activity and health-related quality of life in patients with ankylosing spondylitis: Curr Rheumatol Rep (2020) 22: 55 Page 7 of 8 55 2-year results of the GO-RAISE trial. J Rheumatol. 2014; 41: 1095-1103
39 van der Heijde D, Han C, DeVlam K. et al. Infliximab improves productivity and reduces workday loss in patients with ankylosing spondylitis: results from a randomized, placebo-controlled trial. Arthritis Rheum 2006; 55: 569-574
40 Dougados M, Tsai WC, Saaibi DL. et al. Evaluation of health outcomes with etanercept treatment in patients with early nonradiographic axial spondyloarthritis. J Rheumatol 2015; 42: 1835-1841
41 Shim J, Jones GT, Pathan EMI. et al. Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis. Ann Rheum Dis 2018; 77: 1578-1584
42 Keat AC, Gaffney K, Gilbert AK. et al. Influence of biologic therapy on return to work in people with work disability due to ankylosing spondylitis. Rheumatology (Oxford) 2008; 47: 481-483
43 Chung HY, Machado P, van der Heijde D. et al. HLA-B27 positive patients differ from HLA-B27 negative patients in clinical presentation and imaging: results from the DESIR cohort of patients with recent onset axial spondyloarthritis. Ann Rheum Dis 2011; 70: 1930-1936