Rheumatoid Arthritis Treatment, Work Disability and Employability
The pain, fatigue and limited mobility associated with RA affect all parts of a persons’ life, especially the ability to work productively. Several studies in the past few years have shown that people with Rheumatoid Arthritis tend to have a much higher rate of functional limitation in work activities, use more sick days than people without rheumatoid arthritis and have a high rate of unemployment due to disability.
Two studies published this month in the journal Arthritis Care & Research discussed work disability or employability in people with RA. In one large study, researchers tried to study work disability over time. The study included over 5,000 people, ages 19 to 64 with disease duration from one year to 20 or more years. The study also looked at data about the type of employment and, if unemployed, whether subjects were retired, homemakers, students or were disabled. Overall, the study found that while 85% of the subjects were employed at disease onset; as disease duration increased, so did the proportion of subjects who were not employed (in other words, the longer people had rheumatoid arthritis, the less likely they were to continue working). For example, 23% of subjects with 1 to 3 years disease duration were not employed (35% for those with 10+ years and 51% of those with 25+ years). The researchers found that much of this premature work-cessation was arthritis related.
However, the researchers were careful to note that the prevalence of rheumatoid arthritis disability has generally declined in the past 15 to 20 years. They also found that many of the cases of work disability were temporary, with people later returning to work. The study suggested that the earlier availability of more potent drugs or the use of combinations of drugs might be a factor. They also cited the national unemployment rate trends over time and the decline in physically demanding jobs as possible factors.
RA Patients More Likely To Keep Working If Treated Early
The second study focused on employability outcomes for patients in two ongoing studies of patients being treated with a combination of infliximab and methotrexate (MTX). “Employability” was reported by the patient, based on whether they felt well enough to work if a job were available. This study found that participants with early onset disease who had not previously taken MTX were four times more likely to become employable with longstanding rheumatoid arthritis that had previously not responded as well to MTX, but had a better response to infliximab plus MTX. This finding was consistent with the findings of other studies that emphasize the importance of early and effective treatment of rheumatoid arthritis.
I was particularly interested in these articles because I find that most attention or discussions about arthritis in the news deals with new drugs or the effectiveness of drugs. It seems like much less attention is paid to how arthritis affects our lives and how we can manage those effects. When I think about my own experience with RA, I think it definitely affected my jobs and career choices in some ways. Even though I have relatively mild/moderate disease activity, I have had RA since I was a toddler and I do have longstanding joint wear and some deformities. I have also found that there are certain jobs that I shouldn’t do. For example, I worked at a couple retail jobs in college and graduate school. At each one, I stood for most of my shift, 4 to 8 hours and was not allowed to sit on a stool, even while working the register. By the end of the day, my hips, knees and feet were very stiff and painful. Eventually, my knees would flare and get extremely swollen. I tried to wear knee braces, which helped stabilize my knee, but didn’t stop the swelling or pain. I would occasionally have to have one knee aspirated and injected with steroids.
Now, I work a desk job that requires long hours typing on the computer. My knees still get stiff from sitting, but I move around a lot and I prop up my feet on an empty copy paper box under my desk. Since my arthritis is most active in my hands now, the typing and mouse clicking can be the most painful, so I switch the mouse between hands. I also have recurring bouts of carpal tunnel syndrome, so I sometimes wear a splint at work so help ease the pain.
How has arthritis affected your ability to work? Have you changed jobs or careers because of it? Are there any accommodations or modifications that you’ve made that have you have found to be helpful on the job? Please share your experiences.
In addition, the Arthritis Foundation has an interesting page on their website devoted to arthritis in the workplace including tips for job searching, work relationships and whether and how to tell coworkers about your arthritis and several articles with personal advice.
For other recent reports on RA and work see:
Christine Miller wrote about rheumatoid arthritis as a Patient Expert for HealthCentral. She was diagnosed at 16 months old with polyarticular juvenile rheumatoid arthritis and has gone through the ebbs and flows of disease activity — many medications, much time spent in physical and occupational therapy, surgeries, and periods of relative remission.