Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries

Abstract

ObjectivesTo describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system’s performance, across European countries.MethodsWe conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates.ResultsForty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (β=−0.5 (95% CI −0.9 to −0.2) and β=−0.5 (95% CI −1.0 to −0.1), respectively). The Scandinavian and Bismarckian system scored best on patients’ and rheumatologists’ perceptions of regulations and system performance.ConclusionsThere is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country’s wealth.

2021 EULAR points to consider to support people with rheumatic and musculoskeletal diseases to participate in healthy and sustainable paid work

“…While policies in social security organisations within countries can have important effects on overall employment/work disability, across countries none of these characteristics is consistently associated with differences in employment or work disability rate in RA. 50 Some evidence suggests that systems requiring vocational rehabilitation before granting work disability have higher employment rates among people with chronic diseases. [50][51][52][53] Of note, persons with RMDs who face long-term sickness absence or work disability often feel stigmatised along the process towards recognition of work disability.…”

“…50 Some evidence suggests that systems requiring vocational rehabilitation before granting work disability have higher employment rates among people with chronic diseases. [50][51][52][53] Of note, persons with RMDs who face long-term sickness absence or work disability often feel stigmatised along the process towards recognition of work disability. This is less so for persons within Scandinavian social security systems.…”

The role of support from significant others in the association between disease-related factors and sickness absence in early rheumatoid arthritis: a longitudinal study

“…There is a general discussion about potential problems when comparing results related to sickness absence as there are variations in definitions, measures, outcomes, and systems worldwide. Large differences between European countries in terms of rules and regulations of social security systems have been found, without any particular patterns to explain these differences (41). Therefore, the patients in our study may not have had the same choices as patients in other studies focusing on sickness absence.…”

Rehabilitation von Patienten mit entzündlich-rheumatischen Erkrankungen

“…Was die Beurteilung von Studien zu rheumatologischen Rehabilitationsmaßnahmen erschwert, sind die allein in Europa bestehenden deutlichen Unterschiede in den Strukturen der rehabilitationsmedizinischen Versorgung von Patienten mit entzündlich-rheumatischen Erkrankungen [37]. Patienten mit eingeschränkter beruflicher Teilhabe sind in Europa mit unterschiedlichen Regularien und Konzepten bezüglich der rehabilitativen Versorgung konfrontiert [38]. Weiterhin spielen im internationalen Vergleich auch die wirtschaftlichen Kapazitäten und der Stand der Gesundheitsversorgung für eine erfolgreiche Integration von Patienten mit entzündlich-rheumatischen Erkrankungen eine wesentliche Rolle [39].…”