Work Disability in Axial Spondyloarthritis
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SPONDYLOARTHRITIS (M KHAN, SECTION EDITOR)
Work Disability in Axial Spondyloarthritis Elena Nikiphorou 1,2 & Sofia Ramiro 1,3
# The Author(s) 2020
Abstract Purpose of Review Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects people of working age. Work-related outcomes are therefore important to study, both from an individual but also a societal perspective. Through this review of the literature, we explore the impact of axSpA on key work outcomes including work and productivity loss and predictors for these. Recent Findings Recent evidence confirms that axSpA is associated with substantial consequences on the ability to work. Reassuringly, early treatment and use of biologics have been associated with improved wok outcomes highlighting the importance of prompt diagnosis and management. High disease activity, labour-intensive jobs, poor physical function and impaired spinal mobility are among identified predictors of adverse work outcomes in axSpA. Summary The impact of axSpA on work outcomes is considerable and necessitates optimal intervention, including suppression of disease activity, to enhance people’s chances of remaining in work. Keywords Axial spondyloarthritis . Ankylosing spondylitis . Absenteeism . Presenteeism . Work productivity . Sick leave
Introduction Spondyloarthritis (SpA) is a chronic inflammatory disease that can affect the axial skeleton (axSpA) and/or the peripheral joints. AxSpA can have radiographic evidence of sacroiliitis fulfilling the New York criteria (radiographic axSpA, r-axSpA [1], what is classically referred to as ankylosing spondylitis [2], or it can be without radiographic sacroiliitis (non-radiographic axSpA, nr-axSpA) [3]. Large variations are seen in reports on prevalence rates of SpA, ranging from 0.20% (95% confidence interval [95% CI] 0.00–0.66) in South-East Asia to 1.61% (95% CI 1.27–2.00) in Northern Arctic communities [4]. These variations are thought to be driven by differences for example in the mean age of samples studied, source population and geographical areas (also reflecting a different prevalence of HLA-B27 positivity), differences in social
This article is part of the Topical Collection on Spondyloarthritis * Elena Nikiphorou [email protected] 1
Leiden University Medical Center, Leiden, The Netherlands
2
King’s College London, London, UK
3
Zuyderland Medical Center, Heerlen, The Netherlands
security systems and different labour markets, year of data collection and the study methodology [4, 5]. Aside from spinal inflammation, peripheral arthritis and dactylitis, extra-articular manifestations such as uveitis, psoriasis and inflammatory bowel disease, can add to the burden of axSpA. A number of other conditions can also co-exist with axSpA, classically referred to as comorbidities. These include metabolic bone and cardiovascular disease [6–8] which further contribute to the complexity of patients, challenging their management and outcomes. AxSpA has been associated with severe physical limitation, functional
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