The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients.
The longterm outcomes of rheumatoid arthritis: Work disability: a prospective 18 year study of 823 patients.
复制标题
DOI：
--
复制
发表时间：
1998-11
期刊：
影响因子：
--
通讯作者：
F. Wolfe;D. Hawley
中科院分区：
文献类型：
--
作者：
F. Wolfe;D. Hawley
目的工作残疾是类风湿关节炎(RA)的常见后果。然而，目前还没有关于这种疾病中工作能力丧失的纵向、长期、前瞻性研究。这项长达18年的纵向研究使用了大量的临床、实验室和自我报告测量方法，调查了工作残障率、伴随因素和预测因素。方法1974年，开发了一个计算机化的数据库，用于所有患者就诊的同期录入。数据包括临床、实验室和自我报告信息。每隔6个月邮寄问卷对患者进行评估。1994年，对类风湿关节炎患者进行了详细的终生工作状态和工作残疾的访谈。结果发病后6.4年和20.9年，工作残疾发生率分别为25%和50.00%，大部分残疾发生在病程晚期。几乎所有的人口统计学和临床变量都能预测到工作失能。受教育程度、体重指数(BMI)、血沉、类风湿因子、疼痛、健康评估问卷(HAQ)残疾和工作身体需求与残疾独立相关。在他们的病程中，残疾工作人员的家庭收入减少了35%，关节计数、握力、沉降率、疼痛、整体严重程度、HAQ残疾以及焦虑和抑郁方面的异常分数更多。除BMI外，在156名首次就诊的病程不到一年的患者中，结果基本相似。结论首次就诊时患者和工作特征可以预测工作残疾，但在纵向随访中可以检测到的沉降率、HAQ残疾和疼痛等持续性异常才是预测工作后工作残疾的最好方法。
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.