FUNCTIONAL HINDRANCE, COMORBID DEPRESSION AND EARLY DEVELOPMENT OF RESTRICTIVE LUNG DISEASE ARE LINKED TO ANKYLOSING SPONDYLITIS PATIENTS’ WITHDRAWAL FROM THE WORKFORCE

Authors

  • Alexandra Maria BURLUI “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Anca CARDONEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Luana Andreea MACOVEI “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ioana BRATOIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Patricia RICHTER “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Danuta Mihaela STINCESCU Clinical Rehabilitation Hospital Iasi
  • L.V. BOICULESE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Elena REZUS “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Keywords:

ANKYLOSING SPONDYLITIS, DISABILITY, RESTRICTIVE LUNG DISEASE, DEPRESSION, OBESITY

Abstract

Ankylosing spondylitis (AS) is a debilitating inflammatory rheumatic condition that has been associated with young patients’ early retirement from the workforce. The present study aimed to examine the characteristics of professionally active patients with AS who were applying for work disability. Material and methods: We conducted a prospective observational study on working age patients with AS. The inclusion criteria were confirmed AS diagnosis, professionally active status, and stable treatment for at least 6 months. We assessed functional impairment using BASFI (Bath Ankylosing Spondylitis Functional Index). Results: The study group included 114 patients with AS. Functional hindrance (based on BASFI scores) was a major factor leading to work disability. Work impairment was more frequent in male patients, yet females were the only ones to retire from the workforce in the first 5 years of illness. We obtained statistically significant results regarding the association between work disability and restrictive lung disease as well as depression. Moreover, the relationship with restrictive lung disease remained statistically significant in subjects under 40 years of age as well as in the subgroup with a disease duration under 10 years. Conclusions: Our results indicate that, together with functional impairment, comorbid depression and an early development of restrictive lung disease may impact the work status of AS patients. Further longitudinal studies are needed to define and monitor the factors that lead to work disability in AS.

Author Biographies

  • Alexandra Maria BURLUI, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Department of Medical Specialties (II)
    Clinical Rehabilitation Hospital Iasi

  • Anca CARDONEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Department of Medical Specialties (II)
    Clinical Rehabilitation Hospital Iasi

  • Luana Andreea MACOVEI, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Department of Medical Specialties (II)
    Clinical Rehabilitation Hospital Iasi

  • L.V. BOICULESE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Department of Preventive Medicine and Interdisciplinarity

  • Elena REZUS, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    Department of Medical Specialties (II)
    Clinical Rehabilitation Hospital Iasi

References

1. Tomita T, Sato M, Esterberg E, Parikh RC, Hagimori K, Nakajo K. Treatment patterns and health care resource utilization among Japanese patients with ankylosing spondylitis: A hospital claims database analysis. Mod Rheumatol 2020; 31(2): 431-441.
2. Goeree R, Chiva-Razavi S, Gunda P, Jain M, Jugl SM. Cost-effectiveness analysis of secukinumab in ankylosing spondylitis from the Canadian perspective. J Med Econ 2019; 22(1): 45-52.
3. Ulus Y, Akyol Y, Bilgici A, Kuru O. Association of work instability with fatigue and emotional status in patients with ankylosing spondylitis: comparison with healthy controls. Clin Rheumatol 2019; 38(4): 1017-1024.
4. Pécourneau V, Degboé Y, Barnetche T, Cantagrel A, Constantin A, Ruyssen-Witrand A. Effectiveness of exercise programs in ankylosing spondylitis: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2018; 99(2): 383-389.
5. Espahbodi S, Bassett P, Cavill C, Freeth M, Hole J, Sengupta R. Fatigue contributes to work produc-tivity impairment in patients with axial spondyloarthritis: a cross-sectional UK study. Clin Exp Rheu-matol 2017; 35(4): 571-578.
6. Nikiphorou E, Ramiro S, van der Heijde D, et al. Assessment of SpondyloArthritis International Society Comorbidities in Spondyloarthritis Study Task Force. Association of comorbidities in spon-dyloarthritis with poor function, work disability, and quality of life: results from the Assessment of SpondyloArthritis International Society Comorbidities in Spondyloarthritis Study. Arthritis Care Res 2018; 70(8): 1257-1262.
7. Macfarlane GJ, Shim J, Jones GT, et al. Identifying persons with axial spondylarthritis at risk of poor work outcome: results from the British Society for rheumatology biologics register. J Rheumatol 2019; 46: 145-152.
8. Krüger K, von Hinüber U, Meier F, et al. Ankylosing spondylitis causes high burden to patients and the healthcare system: results from a German claims database analysis. Rheumatol Int 2018; 38(11): 2121-2131.
9. Druce KL, Aikman L, Dilleen M, Burden A, Szczypa P, Basu N. Fatigue independently predicts different work disability dimensions in etanercept-treated rheumatoid arthritis and ankylosing spondy-litis patients. Arthritis Res Ther 2018; 20(1): 96 / doi: 10.1186/s13075-018-1598-8.
10. Goh Y, Kwan YH, Leung YY, Fong W, Cheung PP. A cross‐sectional study on factors associated with poor work outcomes in patients with axial spondyloarthritis in Singapore. Int J Rheum Dis 2019; 22(11): 2001-2008.
11. Lubrano E, Perrotta FM, Manara M, et al. Improvement of function and its determinants in a group of axial spondylarthritis patients treated with TNF inhibitors: a real-life study. Rheumatol Ther 2020; 7(1): 301-310.
12. Song Y, Wang C, Chen H. Functional limitation and associated factors in outpatients with ankylosing spondylitis in Southwest China. Clin Rheumatol 2017; 36(4): 871-877.
13. Stolwijk C, Castillo‐Ortiz JD, Gignac M, et al. Importance of contextual factors when measuring work outcome in ankylosing spondylitis: a systematic review by the OMERACT worker productivity group. Arthritis Care Res 2015; 67(9): 1316-1327.
14. Haglund E, Bremander A, Bergman S, Jacobsson LTH, Petersson IF. Work productivity in a popula-tion-based cohort of patients with spondyloarthritis. Rheumatology 2013;52(9):1708-14.
15. Castillo‐Ortiz JD, Ramiro S, Landewé R, et al. Work outcome in patients with ankylosing spondylitis: results from a 12‐year follow-up of an international study. Arthritis Care Res 2016; 68(4): 544-552.
16. Danve A, Raychaudhuri SP. Comorbidities in spondyloarthritis. Curr Treat Options Rheumatol 2017; 3(1): 63-74.
17. Nikiphorou E, Ramiro S. Work Disability in Axial Spondyloarthritis. Curr Rheumatol Rep 2020; 22(9): 1-8.
18. Sağ S, Nas K, Sağ MS, Tekeoğlu İ, Kamanlı A. Relationship of work disability between the disease activity, depression and quality of life in patients with ankylosing spondylitis. J Back Musculoskelet Rehabil 2018; 31(3): 499-505.
19. Saidane O, Mahmoud I, Gafsi L, Houda A, Tekaya R, Abdelmoula L. Factors leading to work absen-teeism in Tunisian ankylosing spondylitis patients. Egypt Rheumatol 2018; 40(3): 183-185.
20. Webers C, Vanhoof L, Leue C, Boonen A, Köhler S. Depression in ankylosing spondylitis and the role of disease-related and contextual factors: a cross-sectional study. Arthritis Res Ther 2019; 21(1): 215.
21. Park JY, Howren AM, Zusman EZ, Esdaile JM, De Vera MA. The incidence of depression and anxiety in patients with ankylosing spondylitis: a systematic review and meta-analysis. BMC Rheumatol 2020; 4: 12 / doi: 10.1186/s41927-019-0111-6.
22. Nam B, Koo BS, Nam SW, et al. Gender differences in factors associated with low quality of life and depression in Korean patients with ankylosing spondylitis. Qual Life Res 2021 / doi: 10.1007/s11136-021-02800-w.
23. Shim J, Jones GT, Pathan EMI, Macfarlane GJ. Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis. Ann Rheum Dis 2018; 77(11): 1578-1584.
24. Tu L, Chiie Y, Liao Z, et al. Cost of illness, quality of life, and work outcomes in active ankylosing spondylitis patients treated with adalimumab in China. Front Public Health 2020; 8(1): 602334 / doi: 10.3389/fpubh.2020.602334.
25. Opris-Belinski D, Erdes SF, Grazio S, et al. Impact of adalimumab on clinical outcomes, healthcare resource utilization, and sick leave in patients with ankylosing spondylitis: an observational study from five Central and Eastern European countries. Drugs Context 2018; 7(1): 212556 / doi: 10.7573/dic.212556.
26. Purmonen T, Törmälehto S, Wahlman H, Puolakka K. Budget impact analysis of secukinumab vs. adalimumab in the treatment of ankylosing spondylitis. J Med Econ 2019; 22(2): 151-157.
27. Nakagawa H, Tanaka Y, Sano S, et al. Real-world post marketing study of the impact of adalimumab treatment on work productivity and activity impairment in patients with psoriatic arthritis. Adv Ther 2019; 36(3): 691-707.
28. Maas F, Arends S, van der Veer E, et al. Obesity is common in axial spondyloarthritis and is associated with poor clinical outcome. J Rheumatol 2016; 43(2): 383-387.
29. Micheroli R, Hebeisen M, Wildi LM, et al. Impact of obesity on the response to tumor necrosis factor inhibitors in axial spondyloarthritis. Arthritis Res Ther 2017; 19(1): 1-8.
30. Gunawan H, Mukti I, Mudjanarko SW, Rahmawati LD, Pranoto A. Correlation of radiographic damage and central obesity in ankylosing spondylitis: A cross sectional study. Obes Med 2019; 14(1): 100091 / doi.org/10.1016/j.obmed.2019.100091.
31. Deminger A, Klingberg E, Geijer M, et al. A five-year prospective study of spinal radiographic pro-gression and its predictors in men and women with ankylosing spondylitis. Arthritis Res Ther 2018; 20: 162 / doi.org/10.1186/s13075-018-1665-1.
32. Kong W, Jefferies C, Learch TJ, et al. Risk Factors for Spinal Structural Damage in a Chinese Cohort with Ankylosing Spondylitis. J Clin Rheumatol 2020. DOI: 10.1097/ rhu. 0000000000001658.
33. Park JH, Lee SG, Jeon YK, Park EK, Suh YS, Kim HO. Relationship between serum adipokine levels and radiographic progression in patients with ankylosing spondylitis: a preliminary 2-year longitudinal study. Medicine 2017; 96(33): e7854.
34. Durcan L, Wilson F, Conway R, Cunnane G, O’Shea FD. Increased body mass index in ankylosing spondylitis is associated with greater burden of symptoms and poor perceptions of the benefits of ex-ercise. J Rheumatol 2012; 39(12): 2310-2314.
35. Lee Y Chi, Kwan YH, Png WY, et al. Association of obesity with patient-reported outcomes in patients with axial spondyloarthritis: a cross-sectional study in an urban Asian population. Clin Rheumatol 2017; 36(10): 2365-2370.

Additional Files

Published

2021-06-30

Issue

Vol. 125 No. 2 (2021): The Medical-Surgical Journal

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INTERNAL MEDICINE - PEDIATRICS

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