Biologics and improved strategies for their use have significantly reduced the relatively high rate of sick leave among patients with rheumatoid arthritis, but more efficient, multiprofessional intervention strategies are still needed to reduce its incidence, Mathilda Bjork, Ph.D., reported at the annual European Congress of Rheumatism.
Dr. Bjork, of Jonkoping University, Sweden, conducted a subanalysis of the Swedish Early Rheumatoid Arthritis cohort study (Swedish acronym – TIRA). The study included patients with early rheumatoid arthritis, and was designed to calculate direct and indirect costs of the disease over a 3-year period. There have been two TIRA cohorts – one in 1996-1998 and one in 2005-2008. All had early disease; they were a mean of 62 years at baseline.
At all follow-up visits, the patients met with a multidisciplinary team including a physician, an occupational therapist and a physiotherapist, and were given individual treatment based on their needs.
Those in the more recent cohort were treated more aggressively with disease-modifying antirheumatic drugs (DMARDs), mainly methotrexate, starting at their first visit. They also received biologics when required.
Dr. Bjork’s study examined sick leave rates between the two TIRA cohorts: 1996-1998 and 2005-2008. The comparison found that sick leave rates in the newer cohort declined about 50% compared to those in the older cohort.
In the early cohort, sick leave rates were stable over the 3-year study period. At baseline, 60% of the patients were taking sick leave due to their RA; that number was unchanged at 3 years.
In the newer cohort, the baseline sick leave rate was similar, with 55% taking leave due to their disease. But at the 3-year follow-up, only 30% were on sick leave.
"I think it’s good news," Dr. Bjork said in an interview. Since both groups were making use of the multidisciplinary team treatment, DMARD treatment appeared to be the main driver behind the difference. "They are being used more frequently and in higher doses, and it’s working."
Dr. Bjork said the study came about not only because RA is associated with such high indirect costs for sick leave, but also because of the direct treatment costs of new medications such as biological agents.
"The rationale behind the study was to explore whether more effective disease control reduces sick leave in a postbiologic cohort compared to a prebiologic cohort, with the potential for compensating some of the increased treatment cost."
The researchers suggested that changes in political policies and the sickness insurance system may also have had some impact on the differences in sick leave between the two cohorts.
Despite the significant reductions in sick leave, she suggested that more could be done to address the persistently high rate of sick leave among individuals with RA.
"The impact of rheumatoid arthritis on an individual’s ability to work is a complex interaction of biological, psychological, social, and occupational factors," she said. "The interventions need to have a wider perspective than the rheumatoid arthritis per se and [should be] done in a close interaction between the patient, clinicians, employers, and policy makers early in the disease process."
Dr. Bjork had no conflicts of interest relevant to the study.