Ouimet Janine M, Pope Janet E, Gutmanis Iris, Koval John
Department of Epidemiology & Biostatistics, The University of Western Ontario, London, ON, Canada.
Open Rheumatol J. 2008;2:44-52. doi: 10.2174/1874312900802010044. Epub 2008 Sep 23.
To estimate the frequency of work disability (WD) in a cohort of patients with Systemic Sclerosis (SSc) vs an internal control group of patients with rheumatoid arthritis (RA) with a known high frequency of WD; and to investigate the association between WD and other factors including Health Assessment Questionnaire Disability Index (HAQ-DI) scores, HAQ pain, age, sex, disease duration and education level.
Cross-sectional data on WD status were obtained from a questionnaire sent to all SSc (n = 35 limited [lcSSc], 26 diffuse [dcSSc]) and a subset of RA patients (n=104) from a rheumatology practice. WD data, HAQ-DI scores, and demographic/clinical features (age, sex, high school education, disease duration and SSc disease subtype [dcSSc vs lcSSc]) were recorded.
The proportion with WD was 0.56 in SSc (95% CI: 0.43-0.68) vs 0.35 in RA (95% CI: 0.25-0.44), p= 0.009. HAQ-DI scores were significantly higher in work-disabled SSc and RA patients vs those who were employed (p=0.0001, and p <0.0001). Multivariate logistic regression analysis demonstrated that higher HAQ-DI scores (β=1.78, p <0.001), disease type (dcSSc, lcSSc, RA) (β=1.32 for dcSSc, p=0.032), and self-reported disease duration (β=0.04, p=0.042) were significantly associated with WD (R(2)=0.311). Adding a work-related factor (self-reported physically demanding work) improved the regression model (R(2)=0.346) and strengthened the HAQ-DI (β=1.86, p <0.001) and lcSSc (β=1.24, p=0.024) coefficients.
The frequency of WD in SSc was high and was greater than in RA. SSc (and dcSSc) had significantly more WD than RA. The HAQ-DI was strongly associated with WD in SSc.
评估系统性硬化症（SSc）患者队列与已知工作残疾（WD）高发的类风湿关节炎（RA）患者内部对照组中WD的发生率；并调查WD与其他因素之间的关联，这些因素包括健康评估问卷残疾指数（HAQ-DI）评分、HAQ疼痛、年龄、性别、疾病持续时间和教育水平。
通过向所有SSc患者（n = 35例局限性[lcSSc]，26例弥漫性[dcSSc]）以及一家风湿病诊所的一部分RA患者（n = 104）发送问卷，获取关于WD状态的横断面数据。记录WD数据、HAQ-DI评分以及人口统计学/临床特征（年龄、性别、高中教育程度、疾病持续时间和SSc疾病亚型[dcSSc与lcSSc]）。
SSc患者中WD的比例为0.56（95%CI：0.43 - 0.68），而RA患者中为0.35（95%CI：0.25 - 0.44），p = 0.009。与在职的SSc和RA患者相比，工作残疾的患者HAQ-DI评分显著更高（p = 0.0001，p < 0.0001）。多因素逻辑回归分析表明，较高的HAQ-DI评分（β = 1.78，p < 0.001）、疾病类型（dcSSc、lcSSc、RA）（dcSSc的β = 1.32，p = 0.032）以及自我报告的疾病持续时间（β = 0.04，p = 0.042）与WD显著相关（R(2)=0.311）。加入一个与工作相关的因素（自我报告的体力要求高的工作）改善了回归模型（R(2)=0.346），并强化了HAQ-DI（β = 1.86，p < 0.001）和lcSSc（β = 1.24，p = 0.024）的系数。
SSc患者中WD的发生率较高，且高于RA患者。SSc（以及dcSSc）患者的WD明显多于RA患者。在SSc中，HAQ-DI与WD密切相关。
