Productivity at Work and Quality of Life in Patients With Rheumatoid Arthritis

Myrthe van Vilsteren; Cecile RL Boot; Dirk L Knol; Dirkjan van Schaardenburg; Alexandre E Voskuyl; Romy Steenbeek; Johannes R Anema


BMC Musculoskelet Disord. 2015;16(107) 

In This Article


Rheumatoid arthritis (RA) is a chronic inflammatory disease with an impact on daily activities such as work.[1] The impact on work can be profound since permanent work disability (inability to continue working), is common among patients with RA.[2] In addition to the consequences for the patient, such as a decreased quality of life, work disability also leads to high costs. Approximately one-third of the total cost for patients with RA is caused by production losses.[3] Production losses include both lost work hours and times when patients are working, but their ability to meet work demands is limited (at-work productivity loss). Recently, the greatest impact on costs for patients with RA was shown to be reduced performance while working (at-work productivity loss), followed by wage loss from quitting or changing jobs, decreased working hours, and missed work days (sick leave).[4] This implies that at-work productivity loss is an important concern, since work hours are not only lost incidentally through sick leave, but also more structurally and profoundly by at-work productivity loss.

Predictors for permanent work disability have been studied extensively and highlight the importance of personal factors such as education level and age, as well as disease-related factors such as perceived health complaints and limitations in daily activities caused by the disease.[5,6] In contrast, predictors for sick leave and at-work productivity loss have not been well researched, although interest in at-work productivity loss has been increasing since 49% of patients with RA have this experience.[4] The importance of at-work productivity loss has been recognized by the OMERACT (Outcome Measures in Rheumatology) initiative[7] and recently, measures for at-work productivity loss have been identified and validated.[8–10] Since measures for at-work productivity loss are now available, it is possible to investigate the work functioning of patients with RA. Until now, little has been known about the at-work productivity loss of this patient population.[11] Knowledge about factors associated with at-work productivity loss is needed to prevent both this loss and the possibility of leaving employment permanently in the future for patients with RA.[12] Therefore, it is vital to identify patients with RA who are at risk for at-work productivity loss in an early stage.

Prolonging work participation reflects an important contribution to fulfilling societal roles. It has been suggested that becoming permanently work-disabled is associated with a poorer quality of life in general.[13–15] Since patients who experience at-work productivity loss are prone to develop sick leave and permanent work disability in the future, we hypothesize that at-work productivity loss is associated with a low quality of life. This study has two research questions:

  1. Which combination of personal, disease-related and environmental factors is best associated with at-work productivity loss in patients with RA?

  2. Is at-work productivity loss associated with a low quality of life in patients with RA?