Data presented at EULAR 2013, the Annual Congress of the European League Against Rheumatism, demonstrate that indicators of depression are stronger predictors of work disability in early arthritis than disease activity or response to therapy.
The study showed that in a multivariable analysis none of the arthritis activity measures or cardiovascular, metabolic or pulmonary diseases investigated were associated with early retirement, yet a single depression statement “having little pleasure or interest in doing things most of the days during the past 2 weeks” identified those patients more likely to request disability pension.
“Our findings demonstrate that whether or not patients with early arthritis consider applying for disability pension is more dependent on mental conditions than disease activity. As arthritis has a significant financial impact on patients and society, well-directed attention on well-being in the early stages of disease may help patients remain in the workforce”, commented lead author of the study Professor Angela Zink, Head of the Epidemiology Unit at the German Rheumatism Research Centre in Berlin.
Musculoskeletal diseases affect at least 100 million people in Europe, accounting for one half of all European absences from work and 60% of work incapacity. If inadequately managed, they represent a significant economic burden on European society, estimated to be up to 2% of GDP.2
573 patients <63 years enrolled in an early inflammatory arthritis (IA) cohort (<6 months) were analysed with respect to their decision to request disability pension within the first 12 months of treatment. Patient reported parameters included pain, morning stiffness, fatigue, functional capacity, and the depression statement “having little pleasure or interest in doing things most of the day.
Patients had symptom duration of 13 +7 weeks, 67% were rheumatoid factor (RF) and/or anti-citrullinated protein antibody (ACPA)-positive, 65% fulfilled the new ACR-EULAR RA criteria* at baseline and 87% took disease-modifying antirheumatic drugs (DMARDs) at 12 months. Within one year of care, 21% of patients with indicators of moderate depression and 45% of those with severe depression had considered or entered early retirement.
* ACR-EULAR criteria: diagnosis based on confirmed synovitis in at least 1 joint, absence of alternative diagnosis to explain synovitis, and achievement of a total score of >6 (0-10) from individual scores in 4 domains: number and site of involved joints (0), serologic abnormality (0), elevated acute-phase response (0), and symptom duration (2 levels; 0)
1.Westhoff G et al., Indicators of depression are stronger predictors of work disability in early arthritis than disease activity or response to therapy [abstract]. EULAR Annual European Congress of Rheumatology; 12-15 June 2013; Madrid, Spain. Abstract nr. OP0092.
2.Making work count – how Health Technology Assessment can keep Europeans in work. A Fit for Work Europe paper, 2012. Available from: http://www.fitforworkeurope.eu/Making%20work%20count%20-%20how%20HTA%20can%20keep%20Europeans%20in%20work_FULL%20PAPER.pdf. Last accessed: 16 June 2013