Abstract: Factors Associated with Permanent Work Disability in Mexican Patients with Rheumatoid Arthritis. A Case-Control Study

Factors Associated with Permanent Work Disability in Mexican Patients with Rheumatoid Arthritis. A Case-Control Study

JAIME MORALES-ROMERO, LAURA GONZALEZ-LOPEZ, ALFREDO CELIS, BRENDA E. RODRIGUEZ-ARREOLA, CARLOS E. CABRERA-PIVARAL, and JORGE I. GAMEZ-NAVA

ABSTRACT.

Objective. To assess factors associated with permanent work disability (PWD) in Mexican subjects with rheumatoid arthritis (RA).

Methods. From a database of 300 salaried workers with RA, we evaluated 35 cases that developed PWD. These cases were compared with 70 controls randomly selected from the same database who were active workers. The assessment included the following variables: sociodemographic, education, employment, and clinical characteristics of the disease. Logistic regression analysis was performed to adjust variables associated with PWD. Odds ratios and their 95% confidence intervals (95% CI) were computed.

Results. Factors associated with PWD in the unadjusted analysis were: lower education level (OR 3.27, 95% CI 1.28–8.49, p = 0.006), ≥ 2 year delay in prescription of a disease modifying antirheumatic drug (DMARD) (OR 4.29, 95% CI 1.49–12.73, p = 0.02), joint prosthesis (OR 8.93, 95% CI 2.02–45.04, p < 0.001), severe radiographic damage (OR 3.33, 95% CI 1.20–9.46, p = 0.01), comorbidity (OR 7.54, 95% CI 1.94–34.25, p < 0.001), and positive rheumatoid factor (RF) (OR 3.53, 95% CI 0.98–13.76, p = 0.03). In the multivariate model PWD was predicted by lower education (OR 3.3, 95% CI 1.1–9.7, p = 0.03), positive RF (OR 4.9, 95% CI 1.2–19.7, p = 0.03), and delay in the prescription of a DMARD (OR 3.3, 95% CI 1.1–10.1, p = 0.04).

Conclusion. A low education level, positive RF, and delay in the use of DMARD are risk factors for PWD. Strategies to decrease rates of PWD should include an earlier treatment with DMARD. (First Release June 1 2006; J Rheumatol 2006;33:1247-9)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
WORK DISABILITY
DISEASE MODIFYING ANTIRHEUMATIC DRUGS
MEXICAN

From the Department of Internal Medicine—Rheumatology, Hospital General Regional 110, IMSS; and Department of Public Health Sciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico.

Supported by Consejo Nacional de Ciencia y Tecnología (CONACYT), México Grant: SALUD 2003 CO1-082.

J. Morales-Romero MD, MPH, Epidemiologist, Research Fellow ; L. Gonzalez-Lopez, MD, PhD, Research Associate; B.E. Rodríguez-Arreola, MD, Research Fellow, Department of Internal Medicine—Rheumatology, Hospital General Regional 110 del IMSS; A. Celis de la Rosa, MD, PhD, Professor of Public Health Sciences and IMSS; C.E. Cabrera-Pivaral, MD, PhD, Professor of Public Health Sciences, Centro Universitario de Ciencias de la Salud Publica, Universidad de Guadalajara; J.I. Gamez-Nava, MD, PhD, Research Associate, Division of Musculoskeletal and Autoimmune Diseases, Clinical Epidemiology Research Unit, Hospital de Especialidades del Centro Medico Nacional de Occidente, IMSS.

Address reprint requests to Dr. L. Gonzalez-Lopez, Salto del Agua 2192, Col. Jardines del Country, Guadalajara, Jalisco, Mexico 44210. E-mail: lauragl@mail.udg.mx