Patients with Rheumatic Disease Hesitant to Return to Work During COVID-19 Pandemic

A recent study explores the correlation between work obligations and anxiety in patients with inflammatory rheumatic diseases during the second wave of the COVID-19 pandemic. Poor quality of life due to self-isolation has been reported in this patient population.

Patients with inflammatory rheumatic disease (IRD) have been shielded from the general population in order to prevent infection, which inadvertently caused anxiety related to work obligations, specifically returning to an in-person work environment, according to a study published in BMJ Journals.1

Patients with IRD, such as those with psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (axSpA), have reported poor quality of life (QoL) related to self-isolation. The correlation between work obligations and anxiety in this patient population has not been thoroughly explored.

“Work obligations could potentially affect opportunities to self-isolate. The World Health Organization has expressed concerns that some workers may be at higher risk of developing severe COVID-19 illness because of age or pre-existing medical conditions,” stated investigators. “Despite being a topic on the political agenda, in social media and patient organizations, surprisingly little is known regarding the impact of the ongoing pandemic on anxiety and concerns related to the work situation.”

Investigators created a nationwide online survey, running from October and November 2020, that included >5000 patients with IRD. They also routinely followed the Danish Database for Biological Therapies in Rheumatology (DANBIO) registry. Questions were geared towards the impact of the second wave of the COVID-19 pandemic and how it relates to their current work situation, as well as associated concerns, disease activity, disease-modifying antirheumatic agents (DMARDs) treatment, educational level, and any comorbidities.

Demographics and clinical factors that were associated with work-related concerns were collected. A multivariable logistic regression was utilized (mostly or completely agree vs other responses), which included gender, diagnosis, age, educational level, and QoL, among other information. A higher education level was defined as further education for ≥2 years.

A total of 14758 participants responded, with 38% of eligible patients. Of these participants, 5950 patients (40%) were currently working, with 60% working full time, 31% part time, and 9% self-employed. Females accounted for 61% of patients, the median age was 55 years, 47% had other comorbidities, 36% were treated with bDMARDs, and 53% reported higher educational levels.

The study revealed concerns and anxiety related to the work situation, which mainly affected women (odds ratio (OR) [95% confidence interval (CI)] 1.96 [1.68 to 2.28]), biologically treated patients (1.46 [1.27 to 1.68]), those with poor QoL, and those with a higher education level (1.34 [1.17 to 1.54]). Although 69% of patients reported that their workplace helped make arrangements to keep them safe, 22% stated that they found it difficult to social distance at work and 20% had concerns about being in the work environment. For those with concerns about their work environment, 94% believed physical distance was important, yet 75% found it difficult to achieve, and 75% stated that their IRD diagnosis increased their risk of COVID-19 infection.

Results showed that patients with higher education, such as those with teaching and healthcare positions, had occupations poorly suited for shielding and social distancing. However, working activities and working conditions, such as those who are able to work from home, were not included in the questionnaire.

“In this study, we included a large cohort of well-characterized patients with IRD who were working during the second wave of the COVID-19 pandemic. Anxiety and concerns related to their work situation were frequent,” concluded investigators. “In the light of the ongoing pandemic and future waves, continuous awareness of the difficult balance between social distancing and work obligations is important.”

Reference:

Glintborg B, Jensen DV, Engel S, et al. Anxiety and concerns related to the work situation during the second wave of the COVID-19 pandemic in >5000 patients with inflammatory rheumatic disease followed in the DANBIO registry. RMD Open. 2021;7(2):e001649. doi:10.1136/rmdopen-2021-001649