Introduction 1 2 3 4 5 6 7 9 10 7 11 13 7 14 15 Until now, the number of studies on work disability and sick leave in early arthritis is confined to the situation after diagnosis, with no data being available on the occurrence of sick leave or permanent work disability in the preceding period. In addition, little is known about the extent of adaptations to the work place or guidance by health professionals in these early stages of the disease. The aim of this study was therefore to describe the occurrence of sick leave and permanent work disability and its predictors in the very early phases of the disease. Moreover, this study aimed to describe the provision of adaptations to the workplace and professional guidance in patients with chronic arthritis. Materials and methods Patients 16 17 Be St 17 16 18 17 All patients included in the work disability study gave written informed consent. Assessment methods Assessments were done at study entry (at study inclusion of the EAC cohort) and after 12 months of follow-up. Basic sociodemographic and clinical data were obtained from the baseline assessments of the EAC, whereas data on the working situation and mental health were gathered by means of additional questionnaires. Sociodemographic and clinical characteristics Sociodemographic variables Disease activity 19 Physical functioning 20 Anxiety and depression 21 Job characteristics, sick leave, work disability, work adaptations and guidance with working problems Current occupation 22 Sick leave Permanent work disability The presence of material or immaterial adaptations Guidance with working problems Background information on sick leave and work disability http://www.cbs.nl Statistical analysis Data entry was performed using Microsoft Office Access 2000. Statistical analyses were executed using SPSS 10.0 for Windows. U Proportions of patients being on sick leave or receiving a work disability pension at study entry and after 12 months of follow-up were compared using McNemar tests for paired comparisons of categorical data, whereas the average numbers of hours per week patients were working were compared by means of the Wilcoxon signed rank test. These analyses were repeated excluding all patients with a symptom duration >6 months at study entry. U p The numbers of patients receiving adaptations in the workplace or vocational guidance in the past year at study entry and after 12 months of follow up were compared by the McNemar test, whereas the median total numbers of workplace adaptations per patient at both time points were compared by means of the Wilcoxon signed rank test. Results In the study period, in total, 418 patients entered the EAC cohort. One hundred and five of these 418 patients (25.1%) were older than 65 years. From the remaining 313 patients, 81 patients (25.9%) were found eligible and willing to participate. The reasons for not being included were not recorded on the individual level. A group of patients was not eligible for the study because they were not having a paid job 12 months before the first visit in connection with the EAC cohort. In addition, a number of patients were eligible but declined participation, and some patients were not invited because of logistic reasons. Twelve of the initially included patients were excluded within 2 weeks after enrollment because a diagnosis of gout, chondrocalcinosis, sarcoidosis or a non-rheumatic disease was confirmed after additional diagnostic procedures so that they did not meet the inclusion criteria for the EAC. p p 1 Table 1 Sociodemographic and disease characteristics of 69 patients with early arthritis Characteristics n Sociodemographic characteristics   Age, in years; median (range) 42 (18–64) n 38 (55) n 57 (83) n    High 18 (26)   Medium 32 (46)   Low 19 (28) Disease characteristics  n    RA (definite) 39 (57)   RA (probable) 8 (12)   Psoriatic arthritis 10 (15)   Arthritis unspecified 9 (13)   Spondylarthropathy 3 (4)  Duration of arthritis symptoms, in years; median (range) 0.3 (0–2)  VAS, 0–10 cm; median (range)    Disease activity patient 5.3 (0–10.0)   Pain patient 4.7 (1.0–9.8)   Fatigue patient 4.8 (0–10.0) ESR, in mm/hr; median (range) 20 (2–105) Ritchie index (0–68); median (range) 6 (1–32) HAQ (0–3); median (range) 0.63 (0–1.88) HADS anxiety; median (range) 5 (0–16) HADS depression; median (range) 4 (0–13) In total, 6 patients (9%) had a symptom duration of >1 year, 6 patients (9%) had a symptom duration between 6 months and 1 year and 57 patients (83%) had a symptom duration of <6 months. Overall, disease activity was moderate, with the median VAS disease activity score being 5.3 (range, 0–10.0) cm, the median ESR 20 (range, 2–105) mm/h and the median Ritchie score being 6 (0–32). 2 Table 2 Working status in 69 patients with early arthritis   Study entry Follow-up (12 months) p a Job characteristics n      Mental demands 18 (26)     Mixed mental/physical demands 14 (20)     Light physical demands 20 (29)    Heavy physical demands 17 (25)    Hours of work per week; median (range) 36 (5–70) b 0.455 n 34 (50) 29 (42) 0.375 Sick leave n 22 (32)   n 28 (41) 18 (26) 0.031 n      Complete sick leave 15 (54) 12 (67)    Partial sick leave 7 (25) 3 (17)    Unknown 6 (21) 3 (17)  n   2–4 weeks 5 (18) 7 (41) 0.754   1–3 months 14 (50) 2 (12) 0.002   3–12 months 8 (29) 8 (44) 1.0   Unknown 1 (4) 1 (4) 1.0 Work disability     Work disability pension    n 5 (7) 13 (19) 0.008 n 0 3 (4) 0.250 n 5 (7) 10 (15) 0.180 a p b http://www.cbs.nl Five patients (7%) received a partial disability pension at study entry. In two of these patients, this entitlement was extended to a full work disability pension after 12 months, whereas in the other three patients, the disability pension remained unchanged. In addition, eight patients (12%) started receiving a work disability pension in the 12-month follow-up period (one patient a full disability pension and seven a partial disability pension). http://www.cbs.nl A repetition of the analyses excluding the six patients with a symptom duration of >1 year showed similar results (data no shown). 3 Table 3 a   n n p b Sociodemographic characteristics     Age, years; median (range) 42 (28–58) 44 (18–64) 0.484 n 5 (50) 33 (56) 0.996 n      High 5 (50) 13 (22) 0.141   Medium 3 (30) 29 (49) 0.435   Low 2 (20) 17 (29) 0.846 Disease characteristics    n      RA (definite) 9 (90) 30 (51) 0.049   RA (probable) 0 8 (14) 0.481   Arthritis unspecified 1 (10) 8 (14) 1.0   Psoriatic arthritis 0 10 (17) 0.356   Spondylarthropathy 0 3 (5) 1.0  Duration of symptoms, years; median (range) 0.4 (0–0.9) 0.3 (0–2) 0.955  VAS, 0–10 cm; median (range)      Disease activity patient 7.5 (4.1–9.8) 5.1 (0–10.0) 0.038   Pain patient 5.7 (2.1–9.8) 4.6 (1.0–9.6) 0.096   Fatigue patient 5.9 (5.0–9.8) 4.0 (0–10.0) 0.131  Disease activity      ESR, mm/h; median (range) 26 (6–105) 17 (2–93) 0.264   Ritchie index (0–68); median (range) 14 (2–17) 6 (1–32) 0.068  Physical and mental functioning      HAQ (0–3); median (range) 0.88 (0–1.75) 0.63 (0–1.88) 0.174   HADS anxiety; median (range) 6.5 (0–13) 5 (0–16) 0.650   HADS depression; median (range) 5 (1–13) 3 (0–11) 0.195 Job characteristics    n      Mental demands 3 (30) 15 (25) 1.0   Mixed mental/physical demands 3 (30) 11 (19) 0.689   Light physical demands 1 (10) 19 (32) 0.292   Heavy physical demands 3 (30) 14 (24) 0.977 n 9 (90) 19 (32) 0.002 n      2–4 weeks 0 5 (26) 0.767   1–3 months 5 (56) 9 (47) 0.036   3–12 months 4 (44) 5 (26) 0.026 a b p U In the multivariate logistic regression analysis, the occurrence of sick leave in 12 months before study entry was found to be the only significant predictor of deterioration of the working situation (odds ratio, 16.1; 95%CI, 1.8–142.8). 4 Table 4 Presence of material and immaterial adaptations at the workplace in 69 patients with early arthritis   n n p a n 20 (29) 28 (42) 0.134 b 2.5 (1–6) 3.0 (1–9) <0.001 Types of adaptations    n 1 (3) 11 (17) 0.002 n 2 (3) 12 (18) 0.013 n 9 (13) 18 (27) 0.064 n 9 (13) 15 (23) 0.210 n 10 (15) 7 (11) 0.581 n 7 (10) 17 (26) 0.021 n 8 (12) 12 (18) 0.424 n 5 (7) 7 (11) 0.774 a p b 5 Table 5 Usage of and satisfaction with professional guidance and help of employers/colleagues with respect to arthritis-related problems at work in 69 patients with early arthritis   Study entry Follow-up (12 months) Usage Satisfaction Usage Satisfaction n 37 (54) 35 (95) 21 (30) 21 (100) n 34 (49) 29 (85) 12 (17)  12 (100) n 24 (35) 20 (83) 21 (30) 21 (100) n 16 (23) 12 (75) 19 (28) 13 (68) n 6 (9) 6 (100) 4 (6) 4 (100) n 6 (9) 6 (100) 9 (13) 8 (89) n 5 (7) 5 (100) 9 (13) 8 (89) Total 48 (70)  41 (59)  n 23 (33) 21 (91) 21 (30) 19 (91) All values expressed as numbers (%) Thirteen patients (19%) would have liked to have more guidance with problems at work, especially from their rheumatologist, a nurse specialized in rheumatology or from their employer. Discussion This study in patients with early chronic arthritis shows that about half of the patients reported arthritis-related sick leave, and 19% became permanently work disabled over a period 1 year before and 1 year after entering an EAC cohort. Partial work disability was more common than full work disability, and sick leave appeared to be its most important predictor. In addition, work place adaptations, professional guidance and help from employer and/or colleagues were common in this population. 7 14 15 6 Table 6 Working situation after 12 months of follow-up in 27 patients with early arthritis who reported sick leave at study entry (in one patient the duration of sick leave was unknown) Study entry Follow-up Duration of sick leave Partial work disability Full work disability Sick leave 2–4 weeks Sick leave 1–3 months Sick leave 3–12 months No sick leave n 0 0 1 2 0 2 n 2 1 3 1 3 4 n 1 1 0 0 4 2 7 9 23 25 17 In this study, the duration of symptoms varied among patients, so that not all patients were at equal risk of developing sick leave or work disability. The impact of the symptom duration may however be limited, as one of our analyses showed that symptom duration had no effect on the development of more work disability in the follow-up period of 12 months. http://www.cbs.nl 26 27 28 29 30 31 32 33 34 11 35 37 In conclusion, this study in patients with early chronic arthritis and a paid job showed that the occurrence of arthritis-related sick leave, before and directly after a diagnosis is made, is substantial. In contrast, full permanent work disability developed in a relatively small minority. Work place adaptations, professional guidance and help from employers or colleagues to maintain a paid job were fairly common. Future research should aim at the detection of patients at risk for the development of sick leave and permanent work disability, as well as the optimization of the process of vocational guidance.