From the Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and the Aberdeen Centre for Arthritis and Musculoskeletal Health, and the Medical Research Council (MRC)/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
G.J. Macfarlane, MD, Dean of Research and Knowledge Exchange (Life Sciences and Medicine) and Chair in Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; J. Shim, PhD, Research Fellow (Epidemiology), Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; G.T. Jones, PhD, Reader of Epidemiology, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen; K. Walker-Bone, PhD, Professor of Occupational Rheumatology, MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, and MRC Lifecourse Epidemiology Unit, University of Southampton; E. Pathan, PhD, Research Fellow (Rheumatology), Spondylitis Program, Department of Rheumatology, Toronto Western Hospital, University Health Network; L.E. Dean, PhD, Research Assistant, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, and Aberdeen Centre for Arthritis and Musculoskeletal Health, and MRC/Arthritis Research UK Centre for Musculoskeletal Health and Work, University of Aberdeen.
J Rheumatol. 2019 Feb;46(2):145-152. doi: 10.3899/jrheum.180477. Epub 2018 Nov 1.
First, to test the hypothesis that, among working patients with axial spondyloarthritis (axSpA), those who report issues with reduced productivity at work (presenteeism) are at higher risk of work absence (absenteeism), and patients who report absenteeism are at higher risk of subsequently leaving the workforce. Second, to identify characteristics of workers at high risk of poor work outcome.
The British Society for Rheumatology Biologics Register in Ankylosing Spondylitis has recruited patients meeting Assessment of Spondyloarthritis international Society criteria for axSpA from 83 centers. Data collection involved clinical and patient-reported measures at recruitment and annually thereafter, including the Work Productivity and Activity Impairment scale. Generalized estimating equations were used to identify factors associated with poor work outcomes.
Of the 1188 participants in this analysis who were working at recruitment, 79% reported some presenteeism and 19% some absenteeism in the past week owing to their axSpA. Leaving employment was most strongly associated with previous absenteeism (RR 1.02 per % increase in absenteeism, 95% CI 1.01-1.03), which itself was most strongly associated with previous presenteeism, a labor-intensive job, and peripheral joint involvement. High disease activity, fatigue, a labor-intensive job, and poorer physical function were all independently associated with future presenteeism.
Clinical and patient-reported factors along with aspects of work are associated with an increased risk of axSpA patients having a poor outcome in relation to work. This study has identified modifiable factors as targets, facilitating patients with axSpA to remain productive at work.
首先，检验以下假说，即对于有工作的中轴型脊柱关节炎（axSpA）患者，报告工作时生产力下降（出勤主义）的患者缺勤（旷工）的风险更高，而报告缺勤的患者更有可能随后离开劳动力市场。其次，确定工作结果不良风险较高的劳动者的特征。
英国风湿病学会生物制剂注册处招募了符合 axSpA 评估性脊柱关节炎国际学会标准的患者，这些患者来自 83 个中心。数据收集包括招募时和此后每年的临床和患者报告的测量，包括工作效率和活动障碍量表。广义估计方程用于确定与工作结果不良相关的因素。
在这项分析中，1188 名有工作的参与者中，79%的人在过去一周因 axSpA 报告存在一些出勤主义，19%的人存在一些旷工。离职与之前的旷工最密切相关（旷工每增加 1%，RR 为 1.02，95%CI 为 1.01-1.03），而旷工又与之前的出勤主义、劳动密集型工作和外周关节受累最密切相关。高疾病活动度、疲劳、劳动密集型工作和较差的身体功能均与未来的出勤主义独立相关。
临床和患者报告的因素以及工作的各个方面都与 axSpA 患者在工作方面出现不良结果的风险增加有关。本研究确定了可改变的因素作为目标，使 axSpA 患者能够保持工作效率。
