Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work?
Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work?
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DOI：
10.1136/annrheumdis-2016-210239
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发表时间：
2017-07-01
影响因子：
27.4
通讯作者：
Neovius, M.
中科院分区：
文献类型：
--
作者：
Olofsson, T.;Petersson, I. F.;Neovius, M.
目的 分别检查工作年龄的类风湿性关节炎 (RA) 患者开始使用抗肿瘤坏死因子 (TNF) 后工作能力增加和丧失的预测因素，特别关注疾病持续时间。方法 RA 患者，年龄 19-62 岁，2006-2009 年开始首次 TNF 抑制剂，具有完全工作能力（生物开始前 3 个月内 0 个病假/伤残养老金天数；n=1048）或没有工作能力（90 天；n=753）在瑞典生物制品登记册（瑞典抗风湿治疗，ARTIS）中确定，病假/伤残养老金天数从社会保险机构检索。结果定义为，对于生物起始时没有工作能力的患者，工作能力增益>= 50%；对于具有完全工作能力的患者，结果定义为工作能力损失>= 50%，并进行生存分析。使用 Cox 回归估计基线预测因素，包括病程、年龄、性别、教育水平、就业、健康评估问卷、疾病活动评分 28 和相关合并症。 结果 在开始抗 TNF 治疗后 3 年内，病程 = 5 年的完全丧失工作能力的患者恢复工作能力的概率为 35%（调整后 HR 2.1（95% CI 1.4 至 3.2））。对于生物启动时具有完全工作能力的患者，疾病持续时间并不能预测工作能力丧失。基线残疾抚恤金也是治疗开始后工作能力恢复的有力预测因素。 结论 开始抗 TNF 治疗的 RA 工作残疾患者中很大一部分恢复了工作能力。与较晚开始治疗的患者相比，那些在症状出现 5 年内开始治疗的患者在 3 年内恢复工作能力的可能性增加了一倍多。这种影响似乎主要是由于疾病持续时间对残疾养老金状况的影响。
Objectives To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration.Methods Patients with RA, aged 19-62 years, starting their first TNF inhibitor 2006-2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain >= 50% for patients without work ability at bio-start and work ability loss >= 50% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression.Results During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35% for those with disease duration = 5 years (adjusted HR 2.1 (95% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start.Conclusions A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.