Identifying Persons with Axial Spondyloarthritis At Risk of Poor Work Outcome: Results from the British Society for Rheumatology Biologics Register

Gary J. Macfarlane (Corresponding Author), Joanna Shim, Gareth T. Jones, Karen Walker-Bone, Ejaz Pathan, Linda E. Dean

Research output: Contribution to journalArticle

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Objective: Firstly to test the hypothesis that, amongst working patients with axSpA, those who report issues with reduced productivity at work (presenteeism)
are at higher risk of work absence (absenteeism), and patients who report absenteeism are at higher risk of subsequently of leaving the workforce. Secondly to identify characteristics of workers at high risk of poor work outcome.
Methods: The British Society for Rheumatology Biologics Register in Ankylosing Spondylitis has recruited patients meeting ASAS criteria for axSpA from eighty-three centres. Data collection involves clinical and patient reported measures at recruitment and annually thereafter, including the Work Productivity and Activity Impairment scale. Generalised Estimating Equations were used to identify factors associated with poor work outcomes.
Results: Of the 1188 participants in this analysis who were working at recruitment, 79% reported some presenteeism and 19% some absenteeism in the past week due to their axSpA. Leaving employment was most strongly associated with previous absenteeism (Risk Ratio 1.02per % increase in absenteeism, 95% CI
1.01, 1.03) which itself was most strongly associated with previous presenteeism, a labour intensive job and peripheral joint involvement. High disease activity, fatigue, a labour intensive job and poorer physical function were all independently associated with future presenteeism.
Conclusion: Clinical and patient reported factors along with aspects of work are associated with an increased risk of axSpA patients having a poor outcome in relation to work. This study has identified modifiable factors as targets, facilitating patients with axSpA to remain productive in work.
Original languageEnglish
Pages (from-to)145-152
Number of pages8
JournalJournal of Rheumatology
Issue number2
Early online date1 Nov 2018
Publication statusPublished - Feb 2019



  • Spondyloarthritis
  • work
  • absenteeism
  • presenteeism
  • cohort
  • epidemiology

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

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