类风湿关节炎中不可接受的工作状态：出勤主义阈值的确定及临床测量工具

Unacceptable Work State in Rheumatoid Arthritis: Establishment of Thresholds for Presenteeism and Clinical Measurement Instruments.

作者信息

Capelusnik Dafne, Ramiro Sofia, Nikiphorou Elena, Maksymowych Walter P, Magrey Marina Nighat, Marzo-Ortega Helena, Boonen Annelies

机构信息

D. Capelusnik, MD, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands, and Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;

S. Ramiro, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, and Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands.

出版信息

J Rheumatol. 2025 May 1;52(5):436-443. doi: 10.3899/jrheum.2024-0833.

DOI:10.3899/jrheum.2024-0833

PMID:39892889

Abstract

OBJECTIVE

We aimed to identify threshold values of presenteeism measurement instruments that reflect unacceptable work state in employed patients with rheumatoid arthritis (RA) and whether those thresholds can predict future adverse work outcomes (AWOs). Additionally, we assessed the performance of presenteeism thresholds previously established in axial spondyloarthritis (axSpA) among patients with RA for the same instruments.

METHODS

Data from the multinational Patient-Reported Outcomes in Employment Study in Rheumatoid Arthritis (RA-PROSE) study were used. Thresholds to determine when patients consider themselves in an "unacceptable work state" were calculated at baseline for 4 instruments assessing presenteeism and for the patient global assessment of RA-related pain. Different approaches derived from the receiver-operating characteristic methodology were used. Accuracy of thresholds to predict AWO throughout 12 months was assessed and previously developed presenteeism thresholds for axSpA were also tested.

RESULTS

A total of 104 employed patients were included: 15% of the patients considered themselves in an unacceptable work state, of which 7 (7%) had at least 1 AWO over 12 months. Thresholds of all instruments specifically developed in RA showed good performance vs the external criterion (area under the curve [AUC] > 0.75), except for the Quantity and Quality (QQ) method (AUC 0.62). The available axSpA thresholds were more accurate by reducing overestimation. The final optimal thresholds were Work Productivity and Activity Impairment Questionnaire (WPAI)-presenteeism ≥ 40, QQ method < 97, Workplace Activity Limitations Scale ≥ 0.75, 25-item Work Limitations Questionnaire with modified physical demands scale ≥ 29, and pain intensity ≥ 4. For AWO over 12 months, pain and WPAI performed best in predicting AWO.

CONCLUSION

The final thresholds to assess unacceptable presenteeism for axSpA were also chosen as most accurate for use in RA. In addition, accurate thresholds of pain reflecting unacceptable work state are available.

摘要

目的

我们旨在确定反映类风湿关节炎（RA）在职患者不可接受工作状态的出勤主义测量工具的阈值，以及这些阈值是否能够预测未来的不良工作结局（AWO）。此外，我们评估了先前在轴向脊柱关节炎（axSpA）中建立的出勤主义阈值在RA患者中对相同工具的表现。

方法

使用来自类风湿关节炎就业研究中多国患者报告结局（RA-PROSE）研究的数据。在基线时，针对4种评估出勤主义的工具以及患者对RA相关疼痛的整体评估，计算出患者认为自己处于“不可接受工作状态”时的阈值。采用了源自受试者工作特征方法的不同方法。评估了阈值在预测12个月内AWO方面的准确性，并且还测试了先前为axSpA制定的出勤主义阈值。

结果

总共纳入了104名在职患者：15%的患者认为自己处于不可接受的工作状态，其中7名（7%）在12个月内至少有1次AWO。除数量与质量（QQ）方法（曲线下面积[AUC]为0.62）外，所有专门针对RA开发的工具的阈值与外部标准相比表现良好（曲线下面积[AUC]>0.75）。可用的axSpA阈值通过减少高估而更准确。最终的最佳阈值为：工作效率和活动障碍问卷（WPAI）-出勤主义≥40，QQ方法<97，工作场所活动限制量表≥0.75，25项工作限制问卷与修改后的体力需求量表≥29，以及疼痛强度≥4。对于12个月内的AWO，疼痛和WPAI在预测AWO方面表现最佳。