Spotlight on Research 2007

December 2007 (historical)

Despite Decrease in Disease Activity, Workforce Dropout Rate in Women With RA Remains High

In two groups of women with rheumatoid arthritis (RA) studied 11 years apart, researchers found that despite decreased disease activity, the rate at which women left the workforce did not fall significantly. The research was partly supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

In both cohorts, more than a quarter of the women stopped working within four years after being diagnosed with RA. Researchers began studying the cohorts in 1987 and 1998, respectively. There were 48 women in the 1987 cohort and 91 women in the 1998 cohort. Most participants were white, married and more than 50 years old.

The study investigated work disability among women with recent-onset RA, and assessed the demographics, work characteristics and health-status factors that affected whether these women stopped working.

Susan T. Reisine, Ph.D., and her colleagues at the University of Connecticut , Farmington , hypothesized that the rate of stopping work would be lower in the 1998 cohort than in the 1987 cohort because of improvements in disease management and advances in pharmaceutical therapies. But they did not find the difference (31 percent in the 1987 cohort and 26 percent in the 1998 cohort) to be statistically significant.

While the rate of stopping work did not decrease as much as researchers predicted it would, disease activity as measured by the severity of patients' malformations did: In the 1987 cohort, 39.6 percent of women had malformations in at least one joint group within the first year of diagnosis compared with 22 percent in the 1998 cohort.

Researchers cited several possible reasons to explain why the rate of stopping work did not decline as predicted, even while disease activity did. The authors concluded that patients' reasons for leaving work had changed between the time the 1987 and 1998 cohorts were studied, and that more women were leaving work in 1998 for reasons other than increased disease activity.

"In 1998, these factors might have included the negative effects of prevailing economic conditions and/or the changing economic structure towards a more service-based economy," the authors stated. They called for further study to assess the underlying mechanisms accounting for this effect.

Researchers pointed out that in terms of demographics and work characteristics, the two cohorts were similar. The only significant demographic difference was that the 1998 cohort was more affluent, adjusting to 1998 dollars. Another similarity between cohorts was that married women had a greater tendency to leave the workforce compared to those who were unmarried. Researchers noted that this tendency could be related to the financial assistance that a spouse provides, or to the greater physical and social demands placed on married women with families.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a part of the Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at http://www.niams.nih.gov/.

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Reisine S, et al. Work disability among two cohorts of women with recent-onset rheumatoid arthritis: A survival analysis. Arthritis & Rheumatism 2007; 57:372-380.