Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Determinants of Work Disability in Patients with Systemic Sclerosis: A Longitudinal Study of the GENISOS Cohort.

Sharif2,  Roozbeh, Mayes8,  Maureen D., Nicassio1,  Perry M., Gonzalez6,  Emilio B., Draeger5,  Hilda T., McNearney7,  Terry A., Nair3,  Deepthi K.

Department of Psychiatry, University of California, Los Angeles, CA
Division of Rheumatology and Immunogenetics, University of Texas Health Science Center at Houston, Houston, TX
Division of Rheumatology and Immunogenetics, University of Texas Health Science Center at Houston, Houston, TX
Univ Texas Health Sci Ctr, Houston, TX
University of Texas Health Science Center at San Antonio, San Antonio, TX
University of Texas Medical Branch at Galveston, Galveston, TX
University of Texas Medical Branch at Galveston, TX
University of Texas-Houston, Houston, TX
UT Medical School, Houston, TX

Background:

Systemic sclerosis (SSc) is associated with substantial morbidity and mortality. SSc can have profoundly detrimental impact on the patients' personal and professional life. There are no published data on the prevalence of the work disability (WD) in patients with SSc in the United States, nor longitudinal studies examining long-term predictors of WD in general. The goal of this study was to determine the prevalence and correlates of WD at enrollment and to investigate the longitudinal determinants of WD in the patients enrolled in the Genetic versus Environment in Scleroderma Outcome Study (GENISOS) cohort.

Methods:

Patients were subdivided into three groups based on their employment status at enrollment: work disabled, working, and retired or homemakers. The latter group was excluded from further analysis. Utilizing logistic regression analysis with a forward hierarchical variable selection strategy, we evaluated the independent socio-demographic, clinical, and quality of life measure correlates of WD at enrollment. Furthermore, patients working at enrollment were included in the longitudinal study. We used a Cox regression proportional Hazard's model with a similar variable selection strategy to determine the predictors of WD on follow up visits. All quality of life measures demonstrated adequate internal consistency reliability in the current study.

Results:

At the time of analysis, 284 patients with mean age of 48.7 (±13.2) years were enrolled in the GENISOS cohort. There were 237 (83.5%) female; 133 (46.8%) Caucasian, 83 (28.9%) Hispanic, 58 (20.4%) African American, and 10 (3.5%) from other ethnic groups. Overall; 162 (57.0%) patients had diffuse cutaneous involvement; the disease duration at enrollment was 2.5 (±1.6) years. Patients were followed for 3.9 (±3.6) years; in 1438 consecutive visits. At entry; 124 patients (43.7%) were WD, 131 (46.1%) working, and 29 (10.2%) retired or homemakers. In a multivariate regression model, older age (p=0.012), educational level below associate degree (p<0.001), higher Fatigue Severity Score (p=0.045), lower SF-36 physical component scores (p<0.001) and lower % predicted FVC (p=0.009) were independently associated with WD at the cross sectional level.

At mean follow-up of 4.4 (±3.8) years (range up to 12 years) of those working at baseline, 96 (73.3%) were still working while 35 (26.7%) became disabled. Using multivariate Cox regression analysis, lower coping skills as measured by higher IBQ scores (p=0.004), lower % predicted DLCO (p=0.047), and the presence of joint contractures in small joints (p=0.004) were the independent predictors of WD on follow up visits.

Conclusion:

Socio-demographic, lung involvement, fatigue severity, and SF-36 physical component scores were the strongest independent correlates of WD in patients with SSc at early stages of the disease. Whereas small joint contracture, lung involvement, and higher IBQ scores, reflecting lower coping skills are the main predictors of the WD at the later stages of the disease.

To cite this abstract, please use the following information:
Sharif, Roozbeh, Mayes, Maureen D., Nicassio, Perry M., Gonzalez, Emilio B., Draeger, Hilda T., McNearney, Terry A., et al; Determinants of Work Disability in Patients with Systemic Sclerosis: A Longitudinal Study of the GENISOS Cohort. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1211
DOI: 10.1002/art.28977

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