An Investigation Of Work Disability And Related Factors In Ankylosing Spondylitis Patients

BackgroundAnkylosing spondylitis is one kind of chronic inflammatory diseases which mainly affect sacroiliac joint, axial skeleton and peripheral joint can also be affected. the spine can be deformed with the extention of the course of disease.AS occurs commonly in the young people which in the rising period of their career, they paly an important role in social labour and home life. Back pian, morning stiffness, tiredness, heel pain, anterior uveitis can occur in AS patients. the daily work productivity and life quality can be affected by various symptoms, Initially, it may manifested as the lose of productivity, with the continuous progress of the disease,the patients will finnally lose their jobs. At present,the work outcome of AS patients is not cheerful, medical staffs and patients pay less attention to the this problem especially in domestic. Associated reports are in short supply. The purpose of the research is to evaluate the work ability of AS patients with the Work and Productivity Activity Impairment Questionnaire (WPAI), we also analyse the associated factors of WPAI, and observe the change of work productivity to supply some clinical evidence to prevent adverse outcomes.ObjectiveTo study the characteristics of work disability and its influencing factors in patients with ankylosing spondylitis(AS)with WPAI, calculate the score of different items of WPAI and then analyse its associated factors; survey the change of work productivity, analyse its correlation with the changing value of clinical factors by follow-up.MethodsRecord the demographic data, work conditions and disease related characteristics of 277 patients with AS, randomly selected from the Department of Rheumatology ,Chinese PLA General Hospital from November 2014 to January 2015.Work and Productivity Activity Impairment Questionnaire (WPAI) was used to survey the work disability and productivity loss, then explore its influencing factors and the relationships between other patient-reported outcomes and WPAI scores. Survey the change of work productivity and other clinical factors.Result1 .Basic information and work condition: 136 of 277 AS patients were in the normal work conditions. The prevalence of work disability was 30.3%(84 patients).20 patients were unemployed because of working disability.200 patients were employed, with average 36.5 hour working time in the past week .average AS related absenteeism is 4.4hour. average work productivity loss is 26.4%.2.Logistic multiple regression analysis: Bath AS disease activity index(BASDAI)、SF-36 physical component summary(PCS)scores may be the important influencing factors among those clinical measures(OR=1.270, 0.959).3.Correlation analysis: Presenteeism and overall work impairment were moderately correlated with patients’ global assessment of disease activity(VAS),BASDAI,Bath AS Functional Index(BASFI) ,SF-36 Physical Functioning(PF),SF-36 Body Pain(BP) and SF-36 Physical Component Summary(PCS)( |r| =0.539-0.648).4.Linear multivariate analyses indicated that work presenteeism and absenteeism were significantly associated with BASDAI(p< 0.001).5.The WPAI scores in patients with different disease activity are significantly different.patients with a higher ASDAS score has more severe work productivity lose problem.6.107 patients complete the WPAI questionnaire in the follow-up survey, 11 patients(15%) which were in a normal work situation at baseline turned to be work disabled, 17 patients(50%) which were disabled at baseline turned to be normal in their daily work.7.The difference of WPAI score before and after follow-up has a low correlation with the difference of BASFI,BASDAI,ASDAS,back pain assessment, patients’ global assessment before and after follow-up( |r| =0.342 -0.466). the change of BASDAI between biologic-treatment group and non-biological-treatment group show significant difference(p=0.039), the change of other clinical indicators and work productivity lose show no difference between two groupsConclusions1.High prevalence of work disability in patients with AS is noted ;High attention should be paid to AS patients with work disability.2.Work disability has a close relationship with disease activity(BASDAI), The heel pain predict the work disability; An impaired body function(BASFI) may predict absenteeism.3.Patients with a higher disease activity have more severe work productivity lose.the increase of disease activity predict the increase of work productivity lose.4.The follow-up result show the patients’ condition improved and it was related with the change of work productivity.5.The result of our observational research: the change of disease activity between biologic-treatment group and non-biological-treatment group show significant difference,the change of other clinical indicators and work productivity lose show no difference between two groups.