Fatigue independently predicts different work disability dimensions in etanercept-treated rheumatoid arthritis and ankylosing spondylitis patients
Fatigue independently predicts different work disability dimensions in etanercept-treated rheumatoid arthritis and ankylosing spondylitis patients
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DOI：
10.1186/s13075-018-1598-8
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发表时间：
2018-05-29
影响因子：
4.9
通讯作者：
Basu, Neil
中科院分区：
文献类型：
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作者：
Druce, Katie L.;Aikman, Laraine;Basu, Neil
背景：尽管有生物治疗，但工作能力丧失仍然是强直性脊柱炎（AS）和类风湿性关节炎（RA）的一个重要问题。本研究旨在检验这一假设，即疲劳的流行症状纵向预测工作能力障碍RA和AS患者开始etanercept.Methods：两项观察性研究，包括RA和AS etanercept开始，分别进行了分析。两者都提供了超过1年的工作残疾数据和一套全面的推定预测因子，包括疲劳。建立了一系列重复测量模型，包括基线变量、访视（6/12个月）以及访视与每个解释变量之间的相互作用。结果：共评估了1003例AS和1747例RA患者。对于AS，疲劳与出勤率显著相关（线性混合模型系数3.75，95%置信区间（CI）2.14 - 536）和活动障碍（2.62，126至3.98），但不存在工作生产率损失（1.81，-0.40至4.02）或缺勤（广义线性混合模型比值比（OR）1.18，95% CI 0.92至1.51）。在RA中，疲劳与出勤（系数3.44，95% CI 2.17至4.70）、活动障碍（1.52，0.79至2.26）、工作生产力下降（4.16，2.47至5.85）和缺勤（OR 1.23，95% CI 1.02至1.49）相关。缺乏显着的疲劳和访问之间的相互作用支持一致的基线疲劳随着时间的推移。结论：在开始依那西普治疗的患者中，疲劳有一个显着的和独立的影响缺勤，出勤，生产力下降，活动障碍类风湿关节炎患者和一个显着的，但尺寸选择性影响AS患者的工作能力。
Background: Work disability remains a significant problem in ankylosing spondylitis (AS) and rheumatoid arthritis (RA), despite biological therapy. This study aimed to test the hypothesis that the prevalent symptom of fatigue longitudinally predicts work disability among RA and AS patients commencing etanercept.Methods: Two observational studies, comprising RA and AS etanercept commencers, respectively, were analysed. Both provided data on work disability over 1 year and a comprehensive set of putative predictors, including fatigue. A series of repeated measures models were conducted, including baseline variables, visit (6/12 months), and the interaction between visit and each of the explanatory variables.Results: A total of 1003 AS and 1747 RA patients were assessed. For AS, fatigue was significantly associated with presenteeism (linear mixed model coefficient 3.75, 95% confidence interval (CI) 2.14 to 536) and activity impairment (2.62, 126 to 3.98), but not with work productivity loss (1.81, -0.40 to 4.02) or absenteeism (generalised linear mixed model odds ratio (OR) 1.18, 95% CI 0.92 to 1.51). In RA, fatigue was associated with presenteeism (coefficient 3.44, 95% CI 2.17 to 4.70), activity impairment (1.52, 0.79 to 2.26), work productivity loss (4.16, 2.47 to 5.85), and absenteeism (OR 1.23, 95% CI 1.02 to 1.49). The lack of significant interactions between fatigue and visit supported a consistent effect of baseline fatigue over time.Conclusions: Among patients beginning etanercept therapy, fatigue has a significant and independent effect on absenteeism, presenteeism, productivity loss, and activity impairment for RA patients and a significant but dimension-selective effect on work disability among AS patients.