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早期类风湿关节炎患者强化治疗 52 周后,预测病假和提高工人生产力的因素。

Predictors of sick leave and improved worker productivity after 52 weeks of intensive treatment in patients with early rheumatoid arthritis.

机构信息

a Department of Rheumatology , Amsterdam Rheumatology and immunology Center , Amsterdam UMC, Vrije University Amsterdam, Amsterdam , The Netherlands.

b Department of Epidemiology and Biostatistics , Amsterdam UMC, Vrije University Amsterdam , Amsterdam , The Netherlands.

出版信息

Scand J Rheumatol. 2019 Jul;48(4):271-278. doi: 10.1080/03009742.2019.1570549. Epub 2019 May 28.

Abstract

: To identify predictors of sick leave and improved worker productivity in patients with early rheumatoid arthritis (RA) treated for 52 weeks with intensive combination strategies. : Patients with early RA were included in the COmbinatietherapie Bij Reumatoïde Artritis (COBRA)-light trial and followed for 52 weeks. As the COBRA-light strategy proved to be non-inferior to the COBRA strategy, all patients were pooled. Predictors for sick leave and improved worker productivity were assessed through a 3 month time-lag multivariable logistic generalized estimating equations model. : At baseline, 97 patients had a paid job, 59 had no job, and for six patients the work status was unknown. During the trial, 13 patients stopped working (8%) and six started working (4%). Only sick leave in the past 3 months predicted sick leave. By excluding this variable, patient global assessment and actual hours of sick leave became predictors. Increased worker productivity was predicted by higher patient global assessment levels, Sharp van der Heijde score ≥ 1, actual hours on sick leave, and higher worker productivity in the past 3 months. : Sick leave and improved worker productivity were mainly predicted by non-disease-specific variables. Both outcomes can be predicted on a 3 month basis, using the outcome over the past 3 months for the next 3 months. By applying this model in daily practice, decisions for therapy change could be based not solely on disease activity but also taking into account a possible high risk for sick leave in the upcoming 3 months.

摘要

:目的是确定接受强化联合治疗方案治疗 52 周的早期类风湿关节炎(RA)患者的病假和提高工作生产力的预测因素。

:早期 RA 患者纳入 COmbinatietherapieBij Reumatoïde Artritis(COBRA)-light 试验并随访 52 周。由于 COBRA-light 策略被证明不劣于 COBRA 策略,所有患者均被纳入。通过 3 个月的时间滞后多变量逻辑广义估计方程模型评估病假和提高工作生产力的预测因素。

:基线时,97 名患者有带薪工作,59 名患者没有工作,6 名患者的工作状态未知。在试验期间,有 13 名患者停止工作(8%),6 名患者开始工作(4%)。只有过去 3 个月的病假预测病假。通过排除这个变量,患者整体评估和实际病假时间成为预测因素。更高的患者整体评估水平、Sharp van der Heijde 评分≥1、实际病假时间和过去 3 个月更高的工作生产力预测了工作生产力的提高。

:病假和提高工作生产力主要由非疾病特异性变量预测。这两种结果都可以在 3 个月的基础上预测,使用过去 3 个月的结果来预测接下来的 3 个月。在日常实践中应用该模型,可以不仅仅根据疾病活动来做出治疗改变的决策,还可以考虑未来 3 个月内病假的高风险。

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