Malviya Ajay, Rushton Stephen P, Foster Helen E, Ferris Calum M, Hanson Helen, Muthumayandi Karthik, Deehan David J
Wansbeck General Hospital, Ashington, UK.
Arthritis Rheum. 2012 Sep;64(9):3016-24. doi: 10.1002/art.34499.
The chronicity of juvenile idiopathic arthritis (JIA) into adulthood and attendant potential disability may adversely influence educational attainment and the ability to secure and maintain gainful employment. We undertook this study to investigate the effects of patient- and disease-specific factors on education and employment outcomes in a group of adult patients with JIA.
We performed a cross-sectional study of 103 consecutive adults attending a JIA continuity clinic, and patients who consented completed questionnaires relating to educational achievement, employment status, and functional disability (the Health Assessment Questionnaire disability index [HAQ DI]), and, for those who were employed, the rheumatoid arthritis Work Instability Scale. We used the structural equation modeling technique to study key patient and disease variables for employment in adults with JIA.
The median age of patients was 24 years (range 17-71 years) with median disease duration of 19 years (range 7-67 years). Functional disability (the mean HAQ DI score) was significantly lower in patients who were employed (P = 0.03) and in those with oligoarticular JIA (t = 2.29, P = 0.02). Educational achievement was not influenced by JIA subtype (F = 1.18, P = 0.33). Educational achievement measured by General Certificate of Secondary Education (GCSE) grades had a positive effect on the type of job achieved in later life (F = 11.63, P = 0.001), with greater success leading to more professional or managerial posts. In the complex structural equation model, job stability was influenced positively by educational achievement measured by GCSE grades and negatively by the HAQ DI score (t = 10.94, P = 6.36 × 10(-16) ).
Educational attainment is key to successful employability and is influenced by functional disability rather than by JIA subtype. These findings have implications for choice of occupation and delivery of career advice to aid decision making by young people with JIA.
青少年特发性关节炎（JIA）迁延至成年期及其伴随的潜在残疾可能会对教育程度以及获得并维持有收益工作的能力产生不利影响。我们开展本研究以调查患者特异性因素和疾病特异性因素对一组成年JIA患者的教育和就业结局的影响。
我们对连续就诊于一家JIA连续性诊所的103名成年人进行了横断面研究，同意参与的患者完成了与教育成就、就业状况和功能残疾（健康评估问卷残疾指数[HAQ DI]）相关的问卷，对于已就业者，还完成了类风湿关节炎工作不稳定性量表。我们使用结构方程建模技术研究JIA成年患者就业的关键患者和疾病变量。
患者的中位年龄为24岁（范围17 - 71岁），中位病程为19年（范围7 - 67年）。已就业患者的功能残疾（平均HAQ DI评分）显著更低（P = 0.03），寡关节型JIA患者也是如此（t = 2.29，P = 0.02）。教育成就不受JIA亚型的影响（F = 1.18，P = 0.33）。用普通中等教育证书（GCSE）成绩衡量的教育成就对晚年所从事工作的类型有积极影响（F = 11.63，P = 0.001），成绩越好，获得更专业或管理岗位的可能性越大。在复杂的结构方程模型中，工作稳定性受GCSE成绩衡量的教育成就的正向影响，受HAQ DI评分的负向影响（t = 10.94，P = 6.36×10⁻¹⁶）。
教育程度是成功就业的关键，受功能残疾而非JIA亚型的影响。这些发现对职业选择以及为JIA青少年提供职业建议以帮助其决策具有启示意义。
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