İsmihan SUNAR, Yeşim GARİP, Şebnem ATAMAN

Romatoid Artrit, Aksiyel Spondiloartrit ve Psöriatik Artritte İş Gücü Kaybı: Yorgunluk ve Diğer Klinik Parametrelerle İlişkisi

Amaç Romatizmal hastalıklar doğrudan maliyetlerin yanısıra iş gücü kaybına bağlı indirekt maliyetler ile de ekonomik yüke neden olurlar. Bu çalışmada Romatoid Artrit (RA), Aksiyel Spondiloartrit (SpA) ve Psöriatik Artrit (PsA) hastalarında iş gücü kaybının değerlendirilmesi ve yorgunluk, hastalık aktivitesi, depresyon ve hayat kalitesi ile ilişkisinin araştırılması amaçlanmıştır. Gereç ve yöntem Bu kesitsel vaka-kontrol çalışmasına 42 SpA, 36 PsA, 34 RA hastası ve 30 sağlıklı kontrol dahil edilmiştir. Hassas ve şiş eklem sayısı, eritrosit sedimentasyon hızı (ESH), C-Reaktif protein düzeyleri kaydedildi. Hastalık aktivitesinin belirlenmesi amacıyla RA hastalarında DAS28 (Disease Activity Score 28), SpA hastalarında BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), PsA için ise DAPSA (Disease Activity in Psoriatic Arthritis for PsA) kullanıldı. Tüm hasta gruplarına fonksiyonel durum, hayat kalitesi, yorgunluk ve depresyonun değerlendirilmesi için HAQ (The Stanford Health Assessment Questionnaire), Short Form-36 (SF-36), Yorgunluk Semptom Envanteri (Fatigue Symptom Inventory) ve Beck Depresyon anketi uygulandı. Ağrı görsel analog skala ile, iş gücü kaybı ise WPAI (Work Productivity and Activity Impairment) ile değerlendirildi. Bulgular Çalışma oranı SpA hastalarında %83.33, PsA’da %52.8, RA’da %61.8 ve kontrollerde %93.3 olarak belirlendi. Işte var olamama sorunu (presenteeism) ve işe devamsızlık (absenteeism) SpA ve PsA hastalarında kontrollerden daha yüksekti. İşte var olamama yüzdesi, sağlık problemlerine bağlı toplam iş gücü kaybı ve sağlık problem nedenli aktivite bozukluk yüzdeleri RA, PsA ve SpA hastalarında kontrollerden yüksekti (p0.05). Sonuç Çalışmamızda kontrollerle kıyaslandığında RA, SpA ve PsA hastalarında yüksek işte var olamama sorunu ve SpA ve PsA hastalarında artmış işe devamsızlık yüzdesi saptadık. Fonksiyonel kapasitenin işe devamsızlık ve iste var olamama sorunu üzerine, ağrı düzeyinin ise işe devamsızlık üzerine etkisi olduğu gözlendi.

Anahtar Kelimeler:

presenteeism, romatoid artrit, psöriatik artrit, iş gücü, absenteeism, spondiloartrit

Absenteeism and Presenteeism in Rheumatoid Arthritis, Axial Spondyloarthritis, and Psoriatic Arthritis: Relationship with Fatigue and Clinical Parameters

Aim: Rheumatic diseases cause economic burden due to apparently costs along with indirect costs including productivity loss. This study aims to assess work productivity in axial spondyloarthritis (SpA), rheumatoid arthritis (RA), and psoriatic arthritis (PsA), and determine its relation with fatigue, disease activity, depression, and quality of life. Material and Method: This cross-sectional study included 42 SpA, 36 PsA, 34 RA patients, and 30 controls. The number of swollen and tender joints, erythrocyte sedimentation rate, and C-reactive protein were recorded. Disease activity was determined by the Bath Ankylosing Spondylitis Disease Activity Index for SpA, Disease Activity in Psoriatic Arthritis for PsA, and Disease Activity Score-28 for RA. The Stanford Health Assessment Questionnaire, Short Form-36, Fatigue Symptom Inventory, and Beck Depression Inventory were performed. Pain was measured using the Visual Analog Scale. The Work Productivity and Activity Impairment scale was administered for work productivity. Logistic regression analysis was used to determine factors affecting work productivity. Correlations were assessed by Spearman’s correlation coefficient. Results: The rate of employment was 83.3% in SpA, 52.8% in PsA, 61.8% in RA, and 93.3% in controls. The percentage of absenteeism was higher in SpA and PsA. Percentage of presenteeism, percent total work impairment caused by health problems, and percent activity impairment due to health problems were higher in SpA, PsA, and RA patients than controls (p0.05). Conclusion: We have found high percentage of presenteeism in all patient groups and high percentage of absenteeism in SpA and PsA patients compared to controls. We observed impact of functionality on percentage of absenteeism and presenteeism; whereas pain affected the percentage of absenteeism.

Keywords:

presenteeism, rheumatoid arthritis, spondyloarthritis, absenteeism, work productivity, psoriatic arthritis,

PDF

___

1. Anno S, Sugioka Y, Inui K, et al. Evaluation of work disability in Japanese patients with rheumatoid arthritis: from the TOMORROW study. Clin Rheumatol. 2018;37:1763-71
2. Hresko A, Lin TC, Solomon DH. Medical Care Costs Associated With Rheumatoid Arthritis in the US: A Systematic Literature Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2018;70:1431-8.
3. Xavier RM, Zerbini CAF, Pollak DF, et al. Burden of rheumatoid arthritis on patients’ work productivity and quality of life. Advances in Rheumatology. 2019;59:47.
4. Walsh JA, McFadden ML, Morgan MD, et al. Work productivity loss and fatigue in psoriatic arthritis. J Rheumatol. 2014;41:1670-4.
5. Sağ S, Nas K, Sağ MS, et al. Relationship of work disability between the disease activity, depression and quality of life in patients with ankylosing spondylitis. J Back Musculoskelet Rehabil. 2018;31:499-505.
6. Sruamsiri R, Mahlich J, Tanaka E, et al. Productivity loss of Japanese patients with rheumatoid arthritis - A cross-sectional survey. Mod Rheumatol. 2018;28:482-9.
7. Tillett W, Lin CY, Zbrozek A, et al. A Threshold of Meaning for Work Disability Improvement in Psoriatic Arthritis Measured by the Work Productivity and Activity Impairment Questionnaire. Rheumatol Ther. 2019;6:379-91.
8. Nikiphorou E, Ramiro S. Work Disability in Axial Spondyloarthritis. Current Rheumatology Reports. 2020;22.
9. Hann DM, Jacobsen PB, Azzarello LM, et al. Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Qual Life Res. 1998;7:301-10.
10. van Vilsteren M, Boot CR, Knol DL, et al. Productivity at work and quality of life in patients with rheumatoid arthritis. BMC Musculoskelet Disord. 2015;16:107.
11. Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1-44.
12. Akkoc Y, Karatepe AG, Akar S, et al. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int. 2005;25:280-4.
13. Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54:2665-73.
14. Schoels MM, Aletaha D, Alasti F, et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis. 2016;75:811-8.
15. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569-81.
16. Prevoo ML, van 't Hof MA, Kuper HH, et al. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44-8.
17. Price DD, McGrath PA, Rafii A, et al. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17:45-56.
18. Küçükdeveci AA, Sahin H, Ataman S, et al. Issues in cross-cultural validity: example from the adaptation, reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum. 2004;51:14-9.
19. Bilir Kaya B, İçağasıoğlu A. Reliability and validity of the Turkish version of short form 36 (SF-36) in patients with rheumatoid arthritis. Journal of Surgery and Medicine. 2018;2.
20. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
21. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmacoeconomics. 1993;4:353-65.
22. Oksuz E, Malhan S, Tulunay F. Reliability, and validity of The Fatigue Symptom Inventory. Value in Health. 2008;11:A426.
23. Donovan KA, Jacobsen PB. The Fatigue Symptom Inventory: a systematic review of its psychometric properties. Support Care Cancer. 2010;19:169-85.
24. Massardo L, Aguirre V, García ME, et al. Clinical expression of rheumatoid arthritis in Chilean patients. Semin Arthritis Rheum. 1995;25:203-13.
25. Manica S, Sepriano A, Ramiro S, et al. Work participation in spondyloarthritis across countries: Analysis from the ASAS-COMOSPA study. Annals of the Rheumatic Diseases. 2018;77:annrheumdis-2018.
26. Barlow JH, Wright CC, Williams B, et al. Work disability among people with ankylosing spondylitis. Arthritis Rheum. 2001;45:424-9.
27. Citera G, Ficco HM, Alamino RS, et al. Work disability is related to the presence of arthritis and not to a specific diagnosis. Results from a large early arthritis cohort in Argentina. Clin Rheumatol. 2015;34:929-33.
28. Kruntorádová K, Klimeš J, Šedová L, et al. Work Productivity and Costs Related to Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis. Value Health Reg Issues. 2014;4:100-6.
29. Guler MA, Celik OF, Ayhan FF. The important role of central sensitization in chronic musculoskeletal pain seen in different rheumatic diseases. Clin Rheumatol. 2020;39:269-74.
30. McWilliams DF, Walsh DA. Pain mechanisms in rheumatoid arthritis. Clin Exp Rheumatol. 2017;35 Suppl 107:94-101.
31. Wolfe F, Michaud K. Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize ra patients with fibromyalgia. J Rheumatol. 2004;31:695-700.
32. Michaud K, Pope JE, Emery P, et al. Relative Impact of Pain and Fatigue on Work Productivity in Patients with Rheumatoid Arthritis from the RA-BEAM Baricitinib Trial. Rheumatol Ther. 2019;6:409-19.
33. Bansback N, Zhang W, Walsh D, et al. Factors associated with absenteeism, presenteeism and activity impairment in patients in the first years of RA. Rheumatology (Oxford). 2012;51:375-84.
34. Enns MW, Bernstein CN, Kroeker K, et al. The association of fatigue, pain, depression and anxiety with work and activity impairment in immune mediated inflammatory diseases. PLoS One. 2018;13:e0198975.
35. Hazes JM, Taylor P, Strand V, et al. Physical function improvements and relief from fatigue and pain are associated with increased productivity at work and at home in rheumatoid arthritis patients treated with certolizumab pegol. Rheumatology (Oxford). 2010;49:1900-10.