Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: a mixed-methods study within a national register

Abstract

ObjectiveTo examine differences in clinical and patient-reported outcomes, including work, in individuals with axial spondyloarthritis (axSpA) living in rural and urban settings.MethodsUsing a sequential, explanatory mixed-method design, data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were used to (1) characterise participants with axSpA living in rural and urban areas and (b) assess any differences in outcome after commencement of biologic therapy (phase 1). Semistructured interviews (phase 2) further explored the results from phase 1.ResultsPatients with axSpA living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but after adjustment for age, sex and local area deprivation rural dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in disease activity, fatigue, physical function and job type. Interviews highlighted the complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken were important. Support from employers was variable and healthcare professionals were often perceived as unsupportive.ConclusionsPatients with axSpA living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future European League Against Rheumatism axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.

Secukinumab in axial spondyloarthritis: a narrative review of clinical evidence

“…The ability to work has a positive impact on psychosocial health; this is, however, impaired by musculoskeletal disorders such as axSpA. 53 Up to 30% of patients with axSpA are affected by work disability, and patients with axSpA are three times more likely to withdraw from work compared with those without axSpA, particularly from physically demanding jobs. 53 Presenteeism (productivity loss due to ill health) and work impairment are often experienced by patients with axSpA, which in turn leads to absenteeism (being absent from work due to ill health) and job loss.…”

“… 53 Up to 30% of patients with axSpA are affected by work disability, and patients with axSpA are three times more likely to withdraw from work compared with those without axSpA, particularly from physically demanding jobs. 53 Presenteeism (productivity loss due to ill health) and work impairment are often experienced by patients with axSpA, which in turn leads to absenteeism (being absent from work due to ill health) and job loss. 53 Work Productivity and Activity Impairment (WPAI) is an instrument commonly used to measure work productivity in patients and includes questions to assess absenteeism, presenteeism and overall work productivity impairment.…”

“… 53 Presenteeism (productivity loss due to ill health) and work impairment are often experienced by patients with axSpA, which in turn leads to absenteeism (being absent from work due to ill health) and job loss. 53 Work Productivity and Activity Impairment (WPAI) is an instrument commonly used to measure work productivity in patients and includes questions to assess absenteeism, presenteeism and overall work productivity impairment. 54 In MEASURE 2, patients with r-axSpA receiving secukinumab 150 mg demonstrated clinically meaningful changes from baseline in absenteeism (−4.9), presenteeism (−19.2) and overall work impairment (−21.3).…”

Factors Associated with the Risk of Major Adverse Cardiovascular Events in Patients with Ankylosing Spondylitis: A Nationwide, Population-Based Case—Control Study

“…A higher risk of MACE in rural AS patients has not been sufficiently reported in the current English literature. Rural AS patients were found to be older, have labour-intensive jobs, and experienced presenteeism and impaired work productivity [ 24 ]. The abovementioned characteristics might make them more prone to MACE development compared with their urban counterparts.…”

Enabling work participation for people with musculoskeletal conditions: lessons from work changes imposed by COVID-19: a mixed-method study

“…Similarly, 9 out of 10 workers in one national survey reported that they got at least as much, if not more, work done at home as in the office, with almost three quarters of employees saying that they wanted to adopt hybrid working arrangements in the future. 25 For people with MSK conditions, we have already shown that commuting to work, and driving, can be a significant challenge for people with inflammatory arthritis, 7 26 and these findings suggest that, for many, reduced need for commuting was beneficial.…”