Impact on Work Productivity Among Patients with Axial Spondyloarthritis in a Rheumatology Specialized Care Centre in Sri Lanka

Background: Axial Spondyloarthritis (AxSpA) is a chronic inflammatory condition which impacts various aspects of patients’ lives, including work productivity. This study aims to identify the impact of AxSpA on key work outcomes including sick leave rate, disease related unemployment rate, work productivity loss and its association with disease activity.

Methods:

62 Adult patients aged ¿20 years who met the Assessment in Spondyloarthritis International Society (ASAS) 2009 criteria for AxSpA were enrolled. Work productivity was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA). The validated Sinhala version of WPAI questionnaire was used to obtain data and calculate absenteeism, presenteeism and work productivity loss (WPL). Higher scores for presenteeism, absenteeism, or WPL indicate greater work impairment due to illness. Disease activity was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS). Multivariate linear regression was utilized to assess the association between work productivity and disease activity.

Results:

Among 62 patients who were on paid employment, permanent loss of employment rate due to disease was 20.9% and disease related sick leave rate for $>$ 2 months was 58.06%. Out of them 48% engaged in heavy labor jobs and 65% had high or very high disease activity. (Figure 1) Among employed patients, mean Absenteeism, Presenteeism and WPL were 22%, 51.04% and 56% respectively. A decrease in work productivity was related to an increase in disease activity. Disease activity was strongly correlated with absenteeism (p $<$ 0.01), presenteeism (p $<$ 0.01) and work productivity loss (p $<$ 0.001). (Figure 2)

Conclusion:

The impact of AxSpA on work outcomes is substantial and necessitates effective intervention, like controlling disease activity. The significantly elevated levels of presenteeism, absenteeism, and WPL when compared to global data may be linked to suboptimal disease management due to limited availability of biological treatments as well as labor-intensive jobs among the population.