Chronic Disease

Studies examine the impact of rheumatic diseases on the ability to work

Work loss accounts for more of the economic costs of rheumatic diseases such as rheumatoid arthritis, fibromyalgia, and systemic lupus erythematosis than medical care costs. Two studies supported by the Agency for Healthcare Research and Quality (HS13893) examined work disability among persons suffering from rheumatic diseases.

The first study concluded that flexible working conditions are important for retaining persons with rheumatic diseases in the workforce. The second study found that the work productivity of persons with lupus had declined by nearly one-third since their diagnosis. Both studies, led by Edward Yelin, Ph.D., of the University of California, are summarized here.

Yelin, E. (2007, March). "Work disability in rheumatic diseases." Current Opinion in Rheumatology 19, pp. 91-96.

Flexible working conditions are critical for keeping persons with rheumatic diseases in the work force, according to a review of recent literature on work disability among persons suffering from a variety of rheumatic diseases. The first set of studies analyzed alternative research methods to document work disability, indicating the early growth of this area of research.

The second set of studies identified the specific factors that affect the decision to leave work among those with rheumatic diseases. Individuals with rheumatoid arthritis emphasized the need for employer support, understanding of the disease by their fellow employees, "suitable" working conditions, and support from colleagues and health professionals.

Health professionals tended to focus on patient commitment to work and coping. While individuals do differ in their commitment to work, other factors, such as the ability to control the pace of work activities and coworker and supervisor support, appear to drive employment of persons with rheumatoid diseases.

A third set of studies examined interventions to reduce work disability. Several studies found that enhancing the ability of individuals to obtain work accommodations or improve their psychological status had a positive impact on employment. More recent studies found lower rates of work cessation among those with rheumatoid diseases. This is consistent with the view that decreasing physical demands of today's jobs may place fewer persons with rheumatic diseases at risk for work loss. Also, newer medications, which can reduce inflammation, relieve symptoms, and improve functioning, may play a role. However, no randomized trials of these agents have been run long enough to show a positive impact on actual employment status.

Yelin, E., Trupin, L., Katz, P., and others (2007, February). "Work dynamics among persons with systemic lupus erythematosus." Arthritis & Rheumatism 57(1), pp. 56-63.

Work limitations and work loss are common among persons with lupus, who suffer from problems ranging from joint stiffness and muscle pain to end-stage renal disease, seizures, vision loss, clotting disorders, and cognitive impairment. For example, this study found that since their diagnosis, the productivity (number of hours worked per year) of persons with lupus declined by nearly one-third. Also, similar to persons with rheumatoid arthritis, overall productivity in this group was much more a function of whether or not they continued to work rather than how much they worked if they continue to be employed, note the researchers.

They interviewed 900 persons diagnosed with lupus in 2002 and 2003 (mostly women in their mid-forties who had had the disease for 12 years) and again in 2004 (92 percent were re-interviewed). The proportion of workers with lupus who were employed declined from 74 to 54 percent between the year of diagnosis and the second interview. Over the same period, hours of work per year declined by 32 percent among all individuals with a work history, but by only 1 percent among those continuously employed from the time of diagnosis. Among individuals working when diagnosed, the proportion employed declined by 15 percent after 5 years and 63 percent after 20 years.

Demographics (age, sex, and education) and work characteristics (physical and psychological demands of jobs and level of worker control over the job) were the principal determinants of work loss. During this period of declining labor force participation among this group, there was also a relatively high rate of transition of persons with lupus into the workforce. This may reflect the relatively young age at lupus onset, the fluctuating nature of the disease, or the educational attainment of many of those in the study (60 percent had completed some college). Due to their loss of work, many persons with lupus face a greater risk of poverty in retirement.

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