Impact of ankylosing spondylitis on work in patients across the UK

Abstract

Objectives: To examine the impact of ankylosing spondylitis (AS) on patients across the UK and to identify factors associated with unemployment, absenteeism, and presenteeism.

Methods: One thousand patients with AS from 10 specialist rheumatology centres across the UK were invited to participate in a study evaluating a new outcome measure. Patients completed a questionnaire, which included questions relating to their work, sociodemographic and clinical characteristics.

Results: The questionnaire was completed by 612 patients (438 males; 72%). The mean age of the participants was 50.8 (SD 12.2) years, mean disease duration was 17.3 (SD 11.7) years, and mean symptom duration 22.4 (SD 12.4) years. A total of 206 (40%) patients of working age were not employed. Factors associated with not being employed were social deprivation [odds ratio (OR) 3.52, 95% confidence interval (CI) 2.14–5.80], poor function (OR 3.42, 95% CI 1.90–6.13), depression (OR 2.05, 95% CI 1.12–3.78), increasing age (OR 1.05 per year, 95% CI 1.02–1.08), and longer disease duration (OR 1.03 per year, 95% CI 1.01–1.06). Disease activity (OR 3.24, 95% CI 1.11–9.48) and depression (OR 3.22, 95% CI 1.22–8.48) were associated with absenteeism, while depression (OR 5.69, 95% CI 1.77–18.27, disease activity (OR 3.97, 95% CI 1.76–8.98), anxiety (OR 3.90, 95% CI 1.83–8.31), self-efficacy (OR 0.71, 95% CI 0.58–0.86), and increasing age (OR 1.04 per year, 95% CI 1.00–1.08) were associated with presenteeism.

Conclusion: Psychological, sociodemographic, and disease-related factors were all found to be related to work status. These factors should be taken into account when considering early treatment and management. Depression, in particular, appears to be associated with employment, absenteeism, and presenteeism, and should therefore be prioritized in clinical practice.

Acknowledgements

This study was funded by an unrestricted educational research grant from Wyeth UK. We thank all the patients who participated in the study, and the consultant rheumatologists, physiotherapists, and research nurses in the EASi-QoL study group: Dr K. McKay (Torbay Hospital), Prof R Sturrock (Glasgow Royal Infirmary), Dr M Bukhari (Royal Lancaster Infirmary), Dr P Creamer (Southmead Hospital), Dr S Linton (Nevill Hall Hospital), Prof H Gaston (Addenbrookes Hospital), Dr L Kay (Freeman Hospital), Dr D Mulherin (Cannock Chase Hospital), Dr R Withrington, and L van Rossen (Kent and Canterbury Hospital).