Ask your patients with psoriatic arthritis whether their disease impacts their work life. Like those in this study, they may say it takes quite a toll. What can you do to help?
Kennedy M, Papneja A, Thavaneswaran A, Chandran V, and Gladman D. Prevalence and predictors of reduced work productivity in patients with psoriatic arthritis. Clinical and Experimental Rheumatology. 2014;CER6748 [In Press: 07/04/2014] PMID: 24708934
The disability of arthritis often takes a toll on their work life, and a new study finds that psoriatic arthritis (PsA) is no exception: More than a third of patients report that their disease impairs their ability to work.
Clinicians should ask themselves whether their PsA patients require “more aggressive intervention, including the use of effective drugs to control disease activity," say the authors of this study, and should advocate for a supportive work environment.
Among 186 patients at the University of Toronto Psoriatic Arthritis Clinic, increased joint activity was significantly associated with diminished work capacity. Greater use of medication was a marker of more severe disease.
About half of the subjects were employed men in their 50s, and respondents had had PsA for a mean of about 14 years and/or psoriasis for a mean of just over 24 years.
They filled out the 25-item Work Limitations Questionnaire (WLQ), which asked about physical and psychological work demands, hours spent working, pain and other challenges.
Overall, 35% reported impaired work productivity, with almost as many reporting absenteeism. More than a third (36.6%) said their work involved at least some physical labor, and more than a fourth (27%) reported being at least "mildly impaired". Just over 17% said they had lost one or more full days at work during the previous two weeks, and 28.7% missed one or more partial workdays due to health concerns.
Reduced work productivity, or “presenteeism,” was significantly associated with greater disease activity as reflected by Psoriasis Area and Severity Index (PASI) scores (mean=3.5), active joint counts (AJC, mean=6.5) and damaged joint counts (DJC, mean=10.5), as well as in the Functional Co-morbidity Index (FCI).
Medication use was significantly associated with reduced productivity. Over 61% of patients were using a non-steroidal antiinflammatory drug (NSAID), 52.2% were on disease-modifying antirheumatic drugs (DMARDs), and 47.8% were taking a biologic.
The presence of erosive disease is “independently associated with work disability in PsA and may relate to a unique aspect of disease burden that limits productivity,” the study authors wrote.