Predictors of presenteeism, absenteeism and job loss in patients commencing methotrexate or biologic therapy for rheumatoid arthritis

Objectives: Work is an important health outcome. This study aimed to identify predictors of work loss, absenteeism and presenteeism over one year in rheumatoid arthritis (RA) patients commencing treatment with methotrexate (MTX) or biologics.

Methods: Patients aged 18-65 years in full/part-time employment from two UK prospective cohorts were included: MTX-starters = Rheumatoid Arthritis Medication Study, biologic-starters = Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate. Presenteeism/absenteeism were assessed using the RA-specific Work Productivity Survey at baseline, 6 and 12 months. Potential predictors including baseline age, gender, clinical measures (e.g. disability, pain, fatigue), psychological distress, occupation, and EULAR response from baseline-6 months were investigated.

Results: 51/463 MTX-starters and 30/260 biologic-starters left work over 12 months. Higher baseline psychological distress in MTX-starters (OR 1.1 [95% CI 1.0, 1.1]) and higher disability in biologic-starters (OR 3.5 [95% CI 1.4, 8.6]) predicted work loss. 16.1% of patients reported sick-leave which was predicted by disability (OR [95% CI], MTX-starters: 1.5 [0.9, 2.3]; biologic-starters: 2.4 [1.1, 5.2]). Median presenteeism scores were very low (minimal interference) in both cohorts. Higher fatigue for MTX starters (IRR 1.2 [95% CI 1.0, 1.4]) and higher disability in biologic-starters (IRR 1.4 [95% CI 1.1, 1.7]) predicted presenteeism. Good EULAR response was associated with lower absenteeism and presenteeism in both cohorts.

Conclusions: Patients with RA still face significant limitations regarding their ability to work. Disability and EULAR response were the main predictors of work outcomes, emphasizing the need to control the disease and the importance of function in enabling work participation.