The incidence of impaired job function, missed days of work, and unemployment is greater among patients with inflammatory arthritis, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). However, new studies show that treatment with tumor necrosis-alpha (TNF-α) blockers and other disease modifying anti-rheumatic drugs (DMARDs) can help get people back on the job.
A systematic review of 15 randomized controlled trials and 7 controlled cohort studies published up to 2014, presented by French researchers at the 2015 European League Against Rheumatism (EULAR) annual meeting, shows that biologics improve both absenteeism and “presenteeism” -- being at work but not functioning fully – among patients with RA, AS, and PsA.
A second study, from a real-life cohort in the UK, suggests that work disability among PsA patients is reversible with TNF-α inhibitors and DMARDs. TNF drugs produced the biggest and quickest improvement in presenteeism, productivity loss, and disease activity.
“Rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis confer significant patient and economic burden,” said Cécile Gaujoux Viala, MD, head of the Rheumatology Department of Nȋmes University Hospital at a EULAR press conference. She notes that one-fifth of patients were forced to change careers, one-third stopped working within 2 years of disease onset, and half were unable to work within 10 years.
The French literature review shows that the 15,881 patients treated with biological agents (most of them with RA) had significantly fewer missed workdays and lost fewer hours of worktime. They also had improved work productivity at 24 weeks, compared with the 9,713 patients on non-biologics.
In 8 of the trials, the positive effect of biologic drugs on employment loss among RA, PsA, and AS patients nearly reached significance.
“I think the high cost of biological DMARDs could be partly offset by the savings they demonstrate in indirect costs, such as reduced absenteeism, missed work days, and improved productivity. In fact, the high cost of infliximab could be largely offset by savings on work productivity,” concludes Dr. Gaujoux Viala. “The big question is that we have few data for some diseases, such as ankylosing spondylitis and psoriatic arthritis.”
The British researchers note that work disability in PsA patients is high. Unemployment ranges from 20% to 50% and reduced job ability reaches around 16% to 39%. Joblessness is more related to employers and limited work capacity is associated with disease activity.
This study, the first to assess the effects of DMARDs or anti-TNF treatment in a real world population, shows a clinically significant improvement in work disability, productivity loss, and disease activity –- especially among patients receiving TNF-α blockers.
“This study suggests that work disability is reversible in the real world setting,” the UK researchers conclude.
Tubery A, Castelli C, Erny F, et al. The effect of biological agents on work in patients with chronic inflammatory arthritides: a meta-analysis of randomized controlled trials and controlled cohorts. EULAR Abstract OP0148. DOI: 10.1136/annrheumdis-2015-eular.4799.
Tillett W, Shaddick G, Jobling A, et al. Work disability after initiation of anti-tnf and dmard treatment in psoriatic arthritis; investigator led, uk, multicentre observational cohort study (lopas ii). EULAR Abstract OP0001. DOI: 10.1136/annrheumdis2015eular.1881.