Wolfe F, Hawley D J
Arthritis Research Center and University of Kansas School of Medicine, Wichita 67214, USA.
J Rheumatol. 1998 Nov;25(11):2108-17.
Work disability is a common outcome of rheumatoid arthritis (RA). Yet there have been no longitudinal, longterm, prospective studies of work disability in this illness. This 18 year longitudinal study investigates the rate of work disability, its concomitants, and its predictors, using a large series of clinical, laboratory, and self-report measures.
In 1974, a computerized database was developed for the contemporaneous entry of all patient visits. Data included clinical, laboratory, and self-report information. Patients were also assessed by mailed questionnaires at 6 month intervals. In 1994, patients with RA were interviewed in detail about lifetime work status and work disability.
Work disability was estimated to occur in 25% at 6.4 years and 50% at 20.9 years after disease onset, and most disability occurred late in the course of disease. Work disability was predicted by almost every demographic and clinical variable. Education level, body mass index (BMI), erythrocyte sedimentation rate, rheumatoid factor, pain, Health Assessment Questionnaire (HAQ) disability, and physical demands of the job were independently associated with disability. Over the course of their illness, the work disabled had a 35% reduction in family income, and had more abnormal scores for joint counts, grip strength, sedimentation rate, pain, global severity, HAQ disability, and anxiety and depression. Except for BMI, the results were essentially similar in a subset of 156 patients seen first with a disease duration of less than one year.
Work disability can be predicted by patient and work characteristics present at the first clinic visit, but it is persistent abnormalities of sedimentation rate, HAQ disability, and pain, which may be detected in longitudinal followup, that best predict work disability after work and demographic characteristics are accounted for.
工作能力丧失是类风湿关节炎（RA）的常见后果。然而，尚无针对该疾病工作能力丧失的纵向、长期、前瞻性研究。这项为期18年的纵向研究使用一系列临床、实验室和自我报告测量方法，调查工作能力丧失的发生率、伴随情况及其预测因素。
1974年建立了一个计算机化数据库，用于同步录入所有患者就诊信息。数据包括临床、实验室和自我报告信息。患者还每隔6个月通过邮寄问卷进行评估。1994年，对类风湿关节炎患者就其一生的工作状况和工作能力丧失情况进行了详细访谈。
据估计，发病后6.4年有25%的患者出现工作能力丧失，20.9年时有50%的患者出现工作能力丧失，且大多数工作能力丧失发生在病程后期。几乎每一个人口统计学和临床变量都可预测工作能力丧失。教育水平、体重指数（BMI）、红细胞沉降率、类风湿因子、疼痛、健康评估问卷（HAQ）残疾评分以及工作的体力要求与工作能力丧失独立相关。在患病过程中，工作能力丧失的患者家庭收入减少了35%，关节计数、握力、沉降率、疼痛、整体严重程度、HAQ残疾评分以及焦虑和抑郁方面的异常得分更高。除BMI外，在首次就诊时病程不到一年的156名患者亚组中，结果基本相似。
首次就诊时患者的特征和工作特征可预测工作能力丧失，但在考虑工作和人口统计学特征后，沉降率、HAQ残疾评分和疼痛的持续异常（可在纵向随访中检测到）最能预测工作能力丧失。
