Objective. The chronicity of juvenile idiopathic arthritis (JIA) into adulthood and attendant potential disability may adversely influence educational attainment and the ability to secure and maintain gainful employment. We undertook this study to investigate the effects of patient-and disease-specific factors on education and employment outcomes in a group of adult patients with JIA.Methods. We performed a cross-sectional study of 103 consecutive adults attending a JIA continuity clinic, and patients who consented completed questionnaires relating to educational achievement, employment status, and functional disability (the Health Assessment Questionnaire disability index [HAQ DI]), and, for those who were employed, the rheumatoid arthritis Work Instability Scale. We used the structural equation modeling technique to study key patient and disease variables for employment in adults with JIA.Results. The median age of patients was 24 years (range 17-71 years) with median disease duration of 19 years (range 7-67 years). Functional disability (the mean HAQ DI score) was significantly lower in patients who were employed (P ‫؍‬ 0.03) and in those with oligoarticular JIA (t ‫؍‬ 2.29, P ‫؍‬ 0.02). Educational achievement was not influenced by JIA subtype (F ‫؍‬ 1.18, P ‫؍‬ 0.33). Educational achievement measured by General Certificate of Secondary Education (GCSE) grades had a positive effect on the type of job achieved in later life (F ‫؍‬ 11.63, P ‫؍‬ 0.001), with greater success leading to more professional or managerial posts. In the complex structural equation model, job stability was influenced positively by educational achievement measured by GCSE grades and negatively by the HAQ DI score (t ‫؍‬ 10.94, P ‫؍‬ 6.36 ؋ 10 ؊16 ). Conclusion. Educational attainment is key to successful employability and is influenced by functional disability rather than by JIA subtype. These findings have implications for choice of occupation and delivery of career advice to aid decision making by young people with JIA.

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Background Despite advances in medical therapies, the chronicity of symptoms of Juvenile Idiopathic Arthritis (JIA) in childhood and the potential for attendant disability persisting into adulthood may adversely influence educational attainment and the ability to secure and maintain gainful employment in a way which has not been well-defined. Objectives Postulating that there are likely to be a series of indirect and direct effects of the disease, we investigated the impact of patient and disease specific factors on education and employment outcomes in an adult JIA population. Methods A prospective, observational cohort study of 103 consecutive adult patients attending a JIA continuity clinic was performed. These included questions on educational achievement and employment status; a Health Assessment Questionnaire (HAQ score); and, for those who were in employment, a Work Instability Score (RA-WIS). A combination of generalised linear modelling and structural equation modelling was used to explore the complex interactions between JIA subtype, age, disease duration, functional disability, educational achievement and employment outcomes. Results The median age of the patients was 24 years (range 17-71) with median disease duration of 19 years (range 7-67). Of the 103 patients, 64% (n=66) were in either full- or part-time employment. Functional disability (HAQ score) was significantly lower in patients who were in employment (mean=0.83, s.d.=0.85,) compared to those not in any (mean=1.25, s.d.=0.92) (p=0.03), and those with oligoarticular JIA (t=2.29, p=0.02) versus other JIA subtypes. Educational achievement was not influenced by JIA subtype (F=1.18, p=0.33). Educational achievement in General Certificate of Secondary Education (GCSE) examinations (F=11.63 p=0.001) had a positive impact on the type of job achieved in later life, with higher success leading to more professional or managerial posts. Job stability was influenced positively by educational achievement at GCSE and negatively by the disability score (t=10.94 p=6.36-16), which were themselves impacted by age of patient. Conclusions We have used modelling techniques to study the key patient and disease variables for employment in adult patients with JIA. We have measured the impact of the disease on employment outcomes like duration of employment, job classification status achieved and problems encountered at work. Our study suggests that the interactions between disability, education and employment are subtle: influencing both job type and the stability of employment. This has implications on the choice of occupation and forms the basis for further research to guide career decisions for these patients. Disclosure of Interest None Declared