Dr. W. Benjamin Nowell, Ph.D. Director of Patient-Centered Research CreakyJoints, study co-author Co-principal investigator of ArthritisPower

Even With Effective Treatment, Rheumatoid Arthritis Patients Still Face Symptoms and Employment Challenges

MedicalResearch.com Interview with:

Dr. W. Benjamin Nowell, Ph.D. Director of Patient-Centered Research CreakyJoints, study co-author Co-principal investigator of ArthritisPower

Dr. Nowell

Dr. W. Benjamin Nowell, Ph.D.
Director of Patient-Centered Research
CreakyJoints, study co-author
Co-principal investigator of ArthritisPower

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Rheumatoid Arthritis (RA) can diminish patients’ work productivity and increase the risk of long-term disability, economic insecurity and worsening health, but limited research informs these issues. The purpose of our study was to examine associations between patients’ RA disease activity and their productivity and workplace support, using real-world data from the ArthritisPower research registry.

Our study looked at a sample of participants with RA who had a history of or current treatment with non-biologic and/or biologic disease-modifying antirheumatic drugs (DMARD) (n=296). Among the study sample, 74 percent had high disease activity (HDA) as determined by RAPID3 (>12), a common measure of disease activity in RA.

  • High disease activity was associated with lower education (p<0.001) and higher likelihood of disability (9%, p<0.001) compared to those without high disease activity.
    • Patients with HDA missed more days of work than non-HDA patients (mean: 6.1 vs 3.8 days, respectively; p=0.03), but non-HDA participants reported more days off due to medical appointments (2.6 vs 1.2 days, respectively) while HDA patients missed more days due to RA treatment side effects (mean: 0.5 vs 0.1 days, respectively).
  • Based on scores from the Work Productivity and Activity Impairment (WPAI) questionnaire, RA seems to affect work productivity to a greater extent in participants with HDA than without (WPAI scores 5.3 and 3.3, respectively; p<0.001). Participants who were not currently employed reported having more physically demanding tasks (e.g. heavy load lifting) and less workplace flexibility (e.g. working from home) in their most recent paid position than currently employed participants.
  • However, in a multivariate regression analysis, we found that participants who could request changes in work start and stop times on a daily basis were 2.9 (95% CI: 1.53, 5.46) times more likely to be unemployed (adjusting for age, disease activity, and satisfaction with social participation) than those unable to make this request (p<0.0001).

About ArthritisPower: Created by CreakyJoints and supported by a multiyear, multimillion dollar investment by the Patient-Centered Outcomes Research Institute (PCORI), ArthritisPower is the first-ever patient-centered research registry for joint, bone, and inflammatory skin conditions. The free ArthritisPower mobile and desktop application allows patients to track and share their symptoms and treatments while also participating in voluntary research studies in a secure and accessible manner. ArthritisPower Patient Governors serve as gatekeepers for researchers who seek access to registry data or solicit the community to participate in unique, voluntary studies. To learn more and join ArthritisPower, visit www.ArthritisPower.org. 

MedicalResearch.com: What should readers take away from your report?

Response: This study suggests that many people living with rheumatoid arthritis remain significantly impacted by symptoms of their disease, including their ability to work, despite the availability of effective medications. It’s an important reminder for patients that effective disease management is important for a person’s ability to work. The findings point to a need for better RA treatment optimization and patient education about treatment options along with greater workplace flexibility that enable RA patients to remain productively employed. 

For physicians, this study suggests that even with DMARD treatment, many patients remain significantly affected by symptoms of their disease. Failure to promptly reassess a patient’s treatment plan may have a negative impact on the patients’ ability to perform productively at work and in other aspects of their life. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to know more about how employers and employees can work together to improve outcomes. For example, future research should investigate the effectiveness of different workplace accommodations on the ability of a person with Rheumatoid Arthritis to receive optimal care and remain productively employed over a longer period of time.

MedicalResearch.com: Is there anything else you would like to add?

Response: Despite treatment with DMARDs, the majority of HDA patients with RA were more likely to be unemployed or disabled. Physically demanding tasks and less flexible work arrangements were associated with a higher unemployment rate. Attaining lower disease activity and facilitating workplace flexibility (i.e. assigning fewer physical tasks, allowing for telecommuting) may help patients with RA remain employed. Work flexibility policies have been proposed or passed federally in 33 states, yet there is a need for greater visibility, compliance and accessibility to these options for patients with Rheumatoid Arthritis. Indirect costs of RA in the workplace should be considered when determining the total cost of RA care.

I have no disclosures to report


Examining Workplace Supports in the Context of RA Disease Activity

Benjamin Nowell1, Kelly Gavigan1, Guillermo Ernest Gonzales2, Shilpa Venkatachalam1, Jeffrey R. Curtis3, Sheiva Ghazanfari4, Danielle Cavazzini4and Leticia Ferri41Global Healthy Living Foundation, Upper Nyack, NY, 2Silver School of Social Work, New York University, New York, NY, 3University of Alabama at Birmingham, Birmingham, AL, 4Bristol-Myers Squibb, Princeton, NJ

Meeting: 2018 ACR/ARHP Annual Meeting

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Last Updated on November 1, 2018 by Marie Benz MD FAAD