The prevalence and incidence of work disability in rheumatoid arthritis, and the effect of anti-tumor necrosis factor on work disability

Objective. To determine the prevalence and incidence rates of work disability in rheumatoid arthritis (RA), and to determine the effect of anti-tumor necrosis factor (TNF) therapy on work disability. Methods. Participants with RA who were employed when RA was diagnosed (N = 8082) were evaluated for up to 5.5 years. Work disability incidence rates were determined in a subset (N = 4155) of those who stated they were currently employed, and the effect of anti-TNF therapy was determined by conditional logistic regression, after adjustment for covariates. Results. At a median of 12.8 years after RA onset, 56.2% were still employed and 43.8% were not working. Of those not working, 22.7% considered themselves disabled. In addition, 30.5% had stopped work over their lifetimes for health reasons and 20.6% were currently receiving Social Security disability benefits. The annualized incidence rate for self-reported disability was 2.5% and for Social Security disability 1.9%. The incidence rate for persons who stopped working and did not resume employment was 4.0%. Anti-TNF therapy was not associated with Social Security disability, but was associated with an increased risk of self-reported disability (odds ratio 1.6) after adjustment for covariates. Conclusion. Rates of self-reported disability were lower than noted in previous studies, perhaps reflecting overall improvement in RA therapy. We could not discern a positive effect of anti-TNF therapy on the risk of work disability.