Regional differences in work productivity in patients with early rheumatoid arthritis in England and Wales

Background/Aims<br /> Inflammatory arthritis including rheumatoid arthritis (RA) causes significant work disability. Rapid diagnosis and early intervention can reduce the impact of disease. We have previously shown significant regional variation in care delivery. In this study we aim to study regional variation in work outcomes in early RA in England and Wales. Methods<br /> We used data from the UK National Early Inflammatory Arthritis Audit between April 2018 and March 2023 to identify patients with early-onset RA in England and Wales. At diagnosis, clinicians collected information on demographics and disease activity. Participants were invited to complete work outcome questionnaires at baseline and 3 months. Our analysis was restricted to patients with work data available at 3 months. The primary outcome was discontinuation of work due to arthritis. Patient characteristics were tabulated by region. Regression models (adjusted for age and gender) examined the associations between work discontinuation and region. Clustered standard errors were estimated to account for within-Trust correlations. Sensitivity models further explored the effects of deprivation and treatment delay. Results<br /> A total of 3,730 patients with confirmed RA provided work data. Mean age was 67, 62.3% were female and 7.8% from minority ethnic backgrounds. 14% were current smokers and 55.6% had one or more comorbidities. Median baseline DAS28 was 5.2 (IQR: 4.2-6.1). 363/3730 (10%) had stopped work due to RA by 3 months. 534/3,730 (14%) stopped work for any reason. In regression analysis, significant regional differences were seen in the odds of stopping work due to RA. The Midlands was the largest regional contributor of data and was used as the reference group. Patients from Northwest England were most likely to stop work by 3 months (age- and gender-adjusted OR 1.59, [95% CI 1.13-2.25]) with Midlands patients least likely. Sensitivity analysis showed that deprivation and treatment delay only partially attenuate the association between region and work outcome (OR for Northwest 1.57 [1.06-2.33]). Conclusion<br /> There is evidence of regional variation in the impact of new onset RA on work participation. Our analyses suggest that the associations are only partly explained by regional differences in care delivery or deprivation. Other factors such as job type and access to occupational health support warrant further investigation.