van der Weijden Maria A C, Boonen Annelies, van der Horst-Bruinsma Irene E
From the Department of Rheumatology, Vrije Universiteit University Medical Center; Department of Rheumatology, Jan van Breemen Research Institute/Reade, Amsterdam; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Caphri Research Institute, Maastricht, Netherlands.M.A.C. van der Weijden, MD, MSc; I.E. van der Horst-Bruinsma, MD, PhD, Department of Rheumatology, VU University Medical Center, and Department of Rheumatology, Reade Institute; A. Boonen, MD, PhD, Professor, Department of Internal Medicine, Division of Rheumatology Maastricht University Medical Center, and Caphri Research Institute.
J Rheumatol. 2014 Dec;41(12):2413-20. doi: 10.3899/jrheum.140396. Epub 2014 Oct 15.
To explore the effect of early spondyloarthritis (SpA) on worker participation and to investigate variables associated with work outcomes as well as the effect on resource use.
Patients included in an early SpA cohort completed a questionnaire comprising items on employment status, sick leave, presenteeism, and resource use. Logistic regressions were used to investigate the associations between work status and clinical characteristics, and linear regressions were used to investigate the association between at-work productivity loss and clinical characteristics. Resource use across patient groups with different employment status was investigated with linear regression analyses.
One hundred forty patients participated in our study. Of the patients, 69% were male, the mean age was 41 years, and the disease duration was 4.8 years. Twenty-six patients (19%) were not employed because of SpA. Among 114 employed patients, sick leave was reported in 28% in the previous year. Forty-one percent of the patients reported reduced productivity at work. Multivariable regression analyses showed that high Bath Ankylosing Spondylitis Metrology Index and Ankylosing Spondylitis Quality of Life score were associated with not being employed and with reduced productivity at work. Annual costs of productivity loss attributable to sick leave and presenteeism amounted to €2000 per patient. Patients who reported sick leave show a higher (health-related) resource use.
After only 5 years of diagnosis, a considerable proportion of patients with SpA is not employed, and those working have substantial sick leave and productivity loss. Among patients reporting sick leave, resource use is higher. Alertness to work participation even in patients with a short disease duration is urgently needed.
探讨早期脊柱关节炎（SpA）对患者工作参与度的影响，调查与工作结果相关的变量以及对资源利用的影响。
纳入早期SpA队列的患者完成一份问卷，内容包括就业状况、病假、出勤主义及资源利用情况。采用逻辑回归分析工作状态与临床特征之间的关联，采用线性回归分析工作时生产力损失与临床特征之间的关联。通过线性回归分析调查不同就业状况患者组的资源利用情况。
140名患者参与了本研究。其中，69%为男性，平均年龄41岁，病程4.8年。26名患者（19%）因SpA未就业。在114名就业患者中，28%报告上一年度请过病假。41%的患者报告工作效率下降。多变量回归分析显示，高巴斯强直性脊柱炎测量指数和强直性脊柱炎生活质量评分与未就业及工作效率下降有关。因病假和出勤主义导致的生产力损失年度成本为每位患者2000欧元。报告请过病假的患者显示出更高的（与健康相关的）资源利用。
确诊仅5年后，相当一部分SpA患者未就业，就业患者病假和生产力损失严重。在报告请过病假的患者中，资源利用更高。即使对于病程短的患者，也迫切需要关注其工作参与度。
