Federico Fattorini1, Cosimo Cigolini2, Gabriele Marchetti3, Andrea Delle Sedie4, Linda Carli5 and Marta Mosca5, 1Rheumatology Unit, University of Pisa, Pisa, Italy, 2Rheumatology Unit, University of Pisa, Pisa, Toscana, Italy, 3University of Pisa, Pisa, Toscana, Italy, 4University of Pisa, Pisa, Pisa, Italy, 5Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, PISA, Italy
Background/Purpose: Spondyloarthropathies (SpA) may compromise the working ability (WA) of patients, often affected by the disease during their productive life. The Work Productivity and Activity Impairment (WPAI) questionnaire assess the impact of various diseases on work productivity, evaluating presenteeism (P) (a reduced performance and productivity at work), absenteeism (A) (the percentage of hours lost at work), work productivity loss (WPL) (an indicator of the total work disability) and limitation in non-work daily activities; results are expressed as percentages, with higher values indicating a greater disability and a lower productivity. This study aims at assessing the impact of SpA on WA in a monocentric cohort of SpA patients, exploring possible correlations with parameters of disease activity, therapies, emotional status and quality of life (QoL).
Methods: Adult patients with Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS) according to the assessment of spondyloarthritis international international society (ASAS) criteria, regularly followed at the SpA clinic of our unit, were consecutively enrolled from September 2021 to May 2022. Their epidemiologic, clinic and clinimetric data were collected; together with WPAI, patients were asked to fill in patient reported outcomes questionnaires: FACIT-Fatigue, SHORT-FORM 36 (SF-36), Hospital Anxiety and Depression Scale (HADS). Intergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values < 0.05 were considered significant.
Results: A total of 100 patients were enrolled, 45 women (45%), with a mean age of 55.1 years (±13.8) and a mean disease duration of 11.8 years (±9); 72 (72%) had a diagnosis of PsA and 28 (28%) of AS. P was 24.7%, A 5.4%, WPL 25% and limitation of activities not related to work 34.8%. A statistically significant correlation of P and WPL with Leeds Enthesitis Index (LEI) and Spondyloarthritis Research Consortium of Canada index (SPARCC) (p < 0.006) was found. A correlated with Disease Activity Index for PsA (DAPSA), LEI and SPARCC (p < 0.02); limitation of non-work activities was associated to Ankylosing Spondylitis Disease Activity Score (ASDAS) PCR, DAPSA and SPARCC (p < 0.05). Lower levels of P were found in patients who had been treated with leflunomide, Cyclosporine A, or Certolizumab (p < 0.001). Values of HADS, FACIT-F and all the domains of SF-36 correlated with P, WPL and with the limitation of extra-work activities.
Conclusion: Data from our cohort show low levels of absenteeism, compared to values of presenteeism near to 25% and limitation in non-work daily activities higher than 30%. Disease activity, in particular entheseal involvement, seems able to compromise every parameter of WA and extra-work activities; it is interesting to note that some drugs seem more efficacious in preserving WA. Worse working outcomes may determine a significant psychological burden in SpA patients and correlate with an impaired QoL. Therefore, rheumatologists should design clinical strategies to assure a better control of disease activity (especially for entheseal involvement), to improve the social functioning of SpA patients, thus preserving their emotional status and their QoL.
Disclosures: F. Fattorini, None; C. Cigolini, None; G. Marchetti, None; A. Delle Sedie, None; L. Carli, None; M. Mosca, None.
