The objectives of this study are: (a) to determine the occurrence of permanent work disability (PWD) in early rheumatoid arthritis (RA); (b) to identify prognostic groups of patients; (c) to assess the employment rates for these groups over time. Seventy-three gainfully employed consecutive out-patients with early RA (> or = 5 ARA 1958 criteria, disease duration < or = 12 months) at time one (T1) were re-examined at time two (T2) after a mean follow-up of 6 yr (S.D. +/- 2 yr). Potential risk factors, identified at T1, for PWD at T2 were entered in a tree structured survival analysis using RECPAM (RECursive Partition and AMalgamation). Cumulative 3 yr employment rates (3-yrER +/- S.E.M.) were computed from the resulting Kaplan-Meier curves. At T2, PWD occurred in 27 of the 73 patients (37%). The fastest decline in the employment rate was found within the first 3 yr of the disease onset, with a 3-yrER reduced to 73 +/- 5%. The group with the poorest prognosis (n = 14; 3-yrER 14 +/- 9%) was defined by age > or = 50 yr with either ESR > or = 60 mm/h or the combination of modified functional class (1-7) > or = 4 with a disease duration > or = 7 months. An intermediate group (n = 38; 3-yrER 79 +/- 6%) was defined by (a) age > or = 50 yr and low or moderate disease activity, (b) age < 50 yr and more strenuous job-related physical requirements, (c) age < 50 yr and less strenuous work, but joint count > or = 15. No case of PWD occurred in 21 individuals aged < 50 yr with a joint count < 15 and less physically demanding jobs. PWD occurs early in a substantial number of patients with RA. RECPAM defines risk profiles that can readily be applied in actual clinical situations and allow an estimation of the risk of PWD at different time points using the resulting Kaplan-Meier curves.
Even though sick-leave (SL) is a direct consequence of the reduction of work capacity due to the disease, this has not gained much attention in early rheumatoid arthritis (RA). Therefore, the occurrence and duration of SL (defined as the history of SL as certified by a physician) was determined in a cross-sectional multicenter study of early RA (< or = 12 months duration) and compared to the members of the compulsory health insurance. One hundred and thirty four gainfully employed consecutive outpatients fulfilled > or = 4 of 7 ACR 1987 criteria of RA: 85 females (63% of 134 patients), age 50 years (median), disease duration 7 months (median). SL due to RA occurred in 102 of 134 patients (76%). The duration of SL because of RA was 11 days per month (about one-third of the disease duration) in males and 8 days per months (one-quarter of the time since the onset of RA) in females. SL due to RA was five times longer than expected from controls. In addition to SL because of RA, SL due to other causes occurred with a similar duration as in controls. Already in the first year of RA the large proportion of patients with SL due to RA and the long SL duration indicate the extent of substantial handicap concerning gainful employment.
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