rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2012-711rsp-848Research ArticleСтатьиArticlesВзаимосвязь клинических характеристик ревматоидного артрита с трудоспособностью и производительностью трудаRelationship of the clinical characteristics of rheumatoid arthritis to work capacity and efficiencyVakulenkoO YuVakulenkoO YuVakulenolga@yandex.ruKrichevskayaO AKrichevskayaO A-GoryachevD VGoryachevD V-ЭрдесШ. Ф.ErdesSh F-201215062012503№3 (2012)6067Copyright © Vakulenko O.Y., Krichevskaya O.A., Goryachev D.V., Эрдес Ш.Ф., 20122012Vakulenko O.Y., Krichevskaya O.A., Goryachev D.V., Эрдес Ш.Ф.Vakulenko O.Y., Krichevskaya O.A., Goryachev D.V., Erdes S.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/848

Цель - изучить влияние клинических характеристик ревматоидного артрита (РА) на производительность труда. Материал и методы. Обследовано 137 больных РА: 116 женщин и 21 мужчина. Средний возраст 52,03+13,17 года, средний возраст начала заболевания - 42,12±14,43 года. Медиана продолжительности РА - 84 [24-174] мес. Активность заболевания по DAS 28 была умеренной - 4,8±1,4. Индекс HAQ составил 1,42±0,82. Результаты. Из 137 больных работало 59 человек (43%). Абсентеизм составил 28,2%. У 28 из 59 работающих больных абсентеизм был равен 0. Среднее значение презентеизма 42,3+27,9%. Снижение общей производительности составило 54,8+34,4%. Повседневная деятельность, определявшаяся у всех больных, была снижена на 53,6+25,7%. Абсентеизм оказался негативно взаимосвязан с продолжительностью РА (R=0,26). Индекс DAS 28 оказался напрямую взаимосвязан со всеми показателями WPAI: абсентеизм (R=0,28), презентеизм (R=0,63), снижение общей производительности (R=0,47), повседневной деятельности (R=0,64). Наиболее сильная взаимосвязь показателей WPAI (R>0,5), исключая абсентеизм, отмечена с интенсивностью боли по визуальной аналоговой шкале (ВАШ). Индекс HAQ не был связан с абсентеизмом, но ассоциация его с презентеизмом, снижением общей производительности, повседневной деятельности оказалась высокой (R=0,65; R=0,43; R=0,75 соответственно). Связь составляющих WPAI с трансформированным индексом физического состояния больного SF-36 (PCS) была существенно выше, чем ментального (MCS). Вывод. Основное влияние на производительность труда оказывала активность РА. Презентеизм значительно сильнее взаимосвязан с клиническими характеристиками РА по сравнению с абсентеизмом. Все показатели WPAI ассоциировались с активностью, выраженностью функциональной недостаточности, показателями качества жизни, утомляемостью. При этом абсентеизм был наименее взаимосвязан с клиническими характеристиками РА.

Objective: to study the impact of the clinical characteristics of rheumatoid arthritis (RA) on work efficiency. Subjects and methods. One hundred and thirty-seven patients (116 women and 21 men) with RA were examined. Their mean age was 52.03+13.17 years; mean age at disease onset was 42.12+14.43 years. Median RA duration was 84 (range 24-174) months. DAS 28 for RA was moderate. The HAQ score was 1.42+0.82. Results. Fifty-nine (43%) of the 137 patients were in work. Absenteeism was 28.2%. It was equal to 0 in 28 of the 59 working subjects. The mean presenteeism was 42.3±27.9%. The reduction of overall work efficiency was 54.8±34.4%. The day-to-day activity determined in all the patients was reduced by 53.6±25.7%. Absenteeism turned out to be negatively related to RA duration (R = 0.26). DAS 28 scores were directly related to all WPAI indicators: absenteeism (R = 0.28), presenteeism (R = 0.63), lower overall work efficiency (R = 0.47), day-to-day activity (R = 0.64). The WPAI indicators (R >0.5), exclusive of absenteeism, were noted to have the strongest correlation with VAS pain intensity. The HAQ score was unassociated with absenteeism, but its association with presenteeism, lower overall work efficiency, and day-to-day activity proved to be high (R = 0.65; R = 0.43; R = 0.75, respectively). The correlation of the WPAI components with the transformed index of a patient's physical state (SF-36 PCS) was much higher than that with mental one (MCS). Conclusion. RA activity had a major influence on work efficiency. Presenteeism was much stronger related to the clinical characteristics of RA than with absenteeism. All WPAI scores were associated with activity, degree of functional defect, quality-of-life values, and fatigability. At the same time, absenteeism was least related to the clinical characteristics of RA.

ревматоидный артритпроизводительность трудаабсентеизмпрезентеизмповседневная деятельностьWPAIrheumatoid arthritiswork efficiencyWPAIabsenteeismpresenteeismday-to-day activityReferences<div><p>Ревматология: Национальное руководство. Под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2008;290-1.</p><p>Фоломеева О.М., Лобарева Л.С., Ушакова М.А. Инвалидность, обусловленная ревматическими заболеваниями, среди жителей Российской Федерации. Науч-практич ревматол 2001;1:15-21.</p><p>Fex E., Jonsson K., Johnson U et al. Development of radiographic damage during the first 5-6 year of rheumatoid arthritis. A prospective follow-up study of a Swedish cohort. J Rheumatol 1996;35(11):1106-15.</p><p>Pincus T., Callahan L.F. What is the natural history of rheumatoid arthritis? Rheum Dis Clin North Am 1993;19(1):123-51.</p><p>Verstappen S.M.M., Bijlsma J.W., Verkleij H. et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthr Rheum 2004;51:488-97.</p><p>Sogaard R., Sorensen J., Linde L., Hetland M.L. The significance of presenteeism for the value of lost production: the case of rheumatoid arthritis. Clin Econom Outcom Res 2010;2:105-12.</p><p>Goetzel R.Z., Long S.R., Ozminkowski R.J. et al. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med 2004;46(4):398-412.</p><p>Geuskens G.A., Hazes J.M., Barendregt P.J. et al. Work and sick leave among patients with early inflammatory joint conditions. Arthr Rheum 2008;59:1458-66.</p><p>Merkesdal S., Ruof J., Schoffski O. et al. Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Arthr Reum 2001;44:528-34.</p><p>Burton W., Morrison A., Maclean R., Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 2006;56(1):18-27.</p><p>Reilly M.C., Zbrozek A.S., Dukes E.M. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmaсоeconomics 1993;4(5):353-65.</p><p>Prasad M., Wahlqvist P., Shikiar R. et al. A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. Pharmacoeconomics 2004;22(4):225-44.</p><p>Arnett F.C., Edworth S.M., Bloch D.A. et al. The American Rheumatism Assocoation 1987 revised criteria for the classification of rheumatoid arthritis. Arthr Rheum 1988;31:315-24.</p><p>Prevoo M.L.L., van Hoff M., Kuper H.H. et al. Modified disease activity scores that include twenty-eight-joints counts. Arthr Rheum 1995;38:44-102.</p><p>Pincus T., Swearingen C., Wolfe F. Toward a multy-dimensional Health Assessment Questionnaire (MDHAQ) - assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthr Rheum 1999;42:2220-30.</p><p>Van der Heijde D.M.F.M., van Leeuwen M.A., van Riel P.L.C.M. et al. Biannual radiographic assessment of hands and feet in a three-year prospective follow up of patients with early rheumatoid arthritis. Arthr Rheum 1992;35:26-34.</p><p>Sokka T., Kautiainen H., Pincus T. et al. Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study. Arthr Res Ther 2010;12(2):R42.</p><p>Verstappen S.M.M., Bijlsma J.W., Verkleij H. et al. Overview of work disability in rheumatoid arthritis patients as observed in crosssectional and longitudinal surveys. Arthr Rheum 2004;51:488-97.</p><p>Burton W., Morrison A., Maclean R., Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 2006;56(1):18-27.</p><p>Wolfe F., Michaud K., Choi H.K., Williams R. Household income and earnings losses among 6,396 persons with rheumatoid arthritis. J Rheumatol 2005;32(10):1875-83.</p><p>Krishnan E., Lingala B., Bruce B. et al. Disability in rheumatoid arthritis in the era of biological treatments. Ann Rheum Dis 2012;71:213-8.</p><p>Ziegler S., Huscher D., Karberg K. et al. Trends in treatment and outcomes of rheumatoid arthritis in Germany 1997-2007: results from the National Database of the German Collaborative Arthritis Centres. Ann Rheum Dis 2010;69:1803-8.</p><p>Hallert E., Husberg M., Bernfort L. The incidence of permanent work disability in patients with rheumatoid arthritis in Sweden 1990-2010: before and after introduction of biologic agents. Rheumatology (Oxford) 2012;51(2):338-46.</p><p>Фоломеева О.М., Насонов Е.Л., Андрианова И.А. и др. Ревматоидный артрит в ревматологической практике России: тяжесть заболевания в российской популяции больных. Одномоментное (поперечное) эпидемиологическое исследование (RAISER). Науч-практич ревматол 2010;1:50-61.</p><p>Verstappen S.M.M., Watson K.D., Lunt M. et al.Working status in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2010;49(8):1570-7.</p><p>Nikiphorou E., Guh D., Bansback N. et al. Work disability rates in RA. Results from an inception cohort with 24 years follow-up. Rheumatology (Oxford) 2012;51(2):385-92.</p><p>Mattke S., Balakrishnan A., Bergamo G. et al. A review of methods to measure health-related productivity loss. Am J Manag Care 2007;13(4):211-7.</p><p>Ter Wee M.M., Lems W.F., Usan H. et al. The effect of biological agents on work participation in rheumatoid arthritis patients: a systematic review. Ann Rheum Dis 2011, Oct 13 [Epub. ahead of print].</p><p>Zhang W., Bansback N., Boonen A. et al. Validity of the work productivity and activity impairment questionnaire - general health version in patients with rheumatoid arthritis. Arthr Res Ther 2010;12:R177.</p><p>Khandker R., Pinheiro G., Kay S. et al. Moderate to severe rheumatoid arthritis is associated with significant work and activity impairment in Brazil: findings from an observational study. Arthr Rheum 2009;60(abstr. suppl.).</p><p>Radner H., Smolen J., Aletaha D. Remission of rheumatoid arthritis: benefits from socioeconomic and quality of life perspectives. Arthr Rheum 2009;60(abstr. suppl.).</p></div><br /><div><p>Ревматология: Национальное руководство. Под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа, 2008;290-1.</p><p>Фоломеева О.М., Лобарева Л.С., Ушакова М.А. Инвалидность, обусловленная ревматическими заболеваниями, среди жителей Российской Федерации. Науч-практич ревматол 2001;1:15-21.</p><p>Fex E., Jonsson K., Johnson U et al. Development of radiographic damage during the first 5-6 year of rheumatoid arthritis. A prospective follow-up study of a Swedish cohort. J Rheumatol 1996;35(11):1106-15.</p><p>Pincus T., Callahan L.F. What is the natural history of rheumatoid arthritis? Rheum Dis Clin North Am 1993;19(1):123-51.</p><p>Verstappen S.M.M., Bijlsma J.W., Verkleij H. et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthr Rheum 2004;51:488-97.</p><p>Sogaard R., Sorensen J., Linde L., Hetland M.L. The significance of presenteeism for the value of lost production: the case of rheumatoid arthritis. Clin Econom Outcom Res 2010;2:105-12.</p><p>Goetzel R.Z., Long S.R., Ozminkowski R.J. et al. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers. J Occup Environ Med 2004;46(4):398-412.</p><p>Geuskens G.A., Hazes J.M., Barendregt P.J. et al. Work and sick leave among patients with early inflammatory joint conditions. Arthr Rheum 2008;59:1458-66.</p><p>Merkesdal S., Ruof J., Schoffski O. et al. Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Arthr Reum 2001;44:528-34.</p><p>Burton W., Morrison A., Maclean R., Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 2006;56(1):18-27.</p><p>Reilly M.C., Zbrozek A.S., Dukes E.M. The validity and reproducibility of a work productivity and activity impairment instrument. Pharmaсоeconomics 1993;4(5):353-65.</p><p>Prasad M., Wahlqvist P., Shikiar R. et al. A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. Pharmacoeconomics 2004;22(4):225-44.</p><p>Arnett F.C., Edworth S.M., Bloch D.A. et al. The American Rheumatism Assocoation 1987 revised criteria for the classification of rheumatoid arthritis. Arthr Rheum 1988;31:315-24.</p><p>Prevoo M.L.L., van Hoff M., Kuper H.H. et al. Modified disease activity scores that include twenty-eight-joints counts. Arthr Rheum 1995;38:44-102.</p><p>Pincus T., Swearingen C., Wolfe F. Toward a multy-dimensional Health Assessment Questionnaire (MDHAQ) - assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthr Rheum 1999;42:2220-30.</p><p>Van der Heijde D.M.F.M., van Leeuwen M.A., van Riel P.L.C.M. et al. Biannual radiographic assessment of hands and feet in a three-year prospective follow up of patients with early rheumatoid arthritis. Arthr Rheum 1992;35:26-34.</p><p>Sokka T., Kautiainen H., Pincus T. et al. Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study. Arthr Res Ther 2010;12(2):R42.</p><p>Verstappen S.M.M., Bijlsma J.W., Verkleij H. et al. Overview of work disability in rheumatoid arthritis patients as observed in crosssectional and longitudinal surveys. Arthr Rheum 2004;51:488-97.</p><p>Burton W., Morrison A., Maclean R., Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 2006;56(1):18-27.</p><p>Wolfe F., Michaud K., Choi H.K., Williams R. Household income and earnings losses among 6,396 persons with rheumatoid arthritis. J Rheumatol 2005;32(10):1875-83.</p><p>Krishnan E., Lingala B., Bruce B. et al. Disability in rheumatoid arthritis in the era of biological treatments. Ann Rheum Dis 2012;71:213-8.</p><p>Ziegler S., Huscher D., Karberg K. et al. Trends in treatment and outcomes of rheumatoid arthritis in Germany 1997-2007: results from the National Database of the German Collaborative Arthritis Centres. Ann Rheum Dis 2010;69:1803-8.</p><p>Hallert E., Husberg M., Bernfort L. The incidence of permanent work disability in patients with rheumatoid arthritis in Sweden 1990-2010: before and after introduction of biologic agents. Rheumatology (Oxford) 2012;51(2):338-46.</p><p>Фоломеева О.М., Насонов Е.Л., Андрианова И.А. и др. Ревматоидный артрит в ревматологической практике России: тяжесть заболевания в российской популяции больных. Одномоментное (поперечное) эпидемиологическое исследование (RAISER). Науч-практич ревматол 2010;1:50-61.</p><p>Verstappen S.M.M., Watson K.D., Lunt M. et al.Working status in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2010;49(8):1570-7.</p><p>Nikiphorou E., Guh D., Bansback N. et al. Work disability rates in RA. Results from an inception cohort with 24 years follow-up. Rheumatology (Oxford) 2012;51(2):385-92.</p><p>Mattke S., Balakrishnan A., Bergamo G. et al. A review of methods to measure health-related productivity loss. Am J Manag Care 2007;13(4):211-7.</p><p>Ter Wee M.M., Lems W.F., Usan H. et al. The effect of biological agents on work participation in rheumatoid arthritis patients: a systematic review. Ann Rheum Dis 2011, Oct 13 [Epub. ahead of print].</p><p>Zhang W., Bansback N., Boonen A. et al. Validity of the work productivity and activity impairment questionnaire - general health version in patients with rheumatoid arthritis. Arthr Res Ther 2010;12:R177.</p><p>Khandker R., Pinheiro G., Kay S. et al. Moderate to severe rheumatoid arthritis is associated with significant work and activity impairment in Brazil: findings from an observational study. Arthr Rheum 2009;60(abstr. suppl.).</p><p>Radner H., Smolen J., Aletaha D. Remission of rheumatoid arthritis: benefits from socioeconomic and quality of life perspectives. Arthr Rheum 2009;60(abstr. suppl.).</p></div><br />

The authors declare that there are no conflicts of interest present.