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Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study

Tuulikki Sokka12*, Hannu Kautiainen2, Theodore Pincus3, Suzanne MM Verstappen4, Amita Aggarwal5, Rieke Alten6, Daina Andersone7, Humeira Badsha8, Eva Baecklund9, Miguel Belmonte10, Jürgen Craig-Müller11, Licia Maria Henrique da Mota12, Alexander Dimic13, Nihal A Fathi14, Gianfranco Ferraccioli15, Wataru Fukuda16, Pál Géher17, Feride Gogus18, Najia Hajjaj-Hassouni19, Hisham Hamoud20, Glenn Haugeberg21, Dan Henrohn9, Kim Horslev-Petersen22, Ruxandra Ionescu23, Dmitry Karateew24, Reet Kuuse25, Ieda Maria Magalhaes Laurindo26, Juris Lazovskis27, Reijo Luukkainen28, Ayman Mofti29, Eithne Murphy30, Ayako Nakajima31, Omondi Oyoo32, Sapan C Pandya33, Christof Pohl6, Denisa Predeteanu23, Mjellma Rexhepi34, Sylejman Rexhepi34, Banwari Sharma35, Eisuke Shono36, Jean Sibilia37, Stanislaw Sierakowski38, Fotini N Skopouli39, Sigita Stropuviene40, Sergio Toloza41, Ivo Valter42, Anthony Woolf43, Hisashi Yamanaka31 and the QUEST-RA study group

Author Affiliations

1 Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland

2 Medcare Oy, Hämeentie 1, 44100 Äänekoski, Finland

3 New York University Hospital for Joint Diseases, 301 East 17 Street, New York, NY 10003, USA

4 Department of Rheumatology and Clinical Immunology F02.127, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands

5 Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India

6 Department of Internal Medicine II, Rheumatology, Schlosspark-Klinik Teaching Hospital of the Charité, University Medicine Berlin, Heubnerweg 2, 14059 Berlin, Germany

7 Medical Faculty of Latvia University, P. Stradina Clinical University Hospital, Pilsonu Street 13, LV 1002, Riga, Latvia

8 Rheumatology Department, Dubai Bone and Joint Center, Al Razi Building, DHCC, PO Box 118855, Dubai 118855, United Arab Emirates

9 Uppsala University Hospital, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden

10 Sección de Reumatologia, Hospital General de Castellón, Avda Benicasim s/n, 12004 - Castellon, Spain

11 CentraCare, 1200 6th Avenue North, St. Cloud, MN 56301, USA

12 Serviço de Reumatologia - Hospital Universitário de Brasília, SGAN 605, Av. L2 Norte Brasília, Brazil

13 Rheumatology Institut, Srpskih Junaka 2, 18205 Niška Banja, Serbia

14 Rheumatology & Rehabilitation, Assiut University Hospital, Assiut University, Assiut 71111, Egypt

15 School of Medicine, Catholic University of the Sacred Heart, Via Moscati 31, 00168 Rome, Italy

16 Department of Rheumatology, Kyoto First Red Cross Hospital, 15-749, Mon-machi, Higashiyama-ku, Kyoto, Japan

17 Department of Rheumatology, Semmelweis University, H-1025 Budapest Árpád f.u.7., Hungary

18 Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University, 06530 Ankara, Turkey

19 Faculté de Médecine et de Pharmacie, Route de la Plage, Rabat, Morocco

20 Al-Azhar University, 14 Mustafa Darwish Street, Nasr City, Cairo, Egypt

21 Department of Rheumatology, Service box 416, N-4604 Kristiansand. S, Norway

22 King Christian the Xth Hospital, Toldbodgade 3, 6300 Gråsten, Denmark

23 Clinica de Medicina Interna si Reumatologie, Spitalul Clinic Sf Maria, B-dul Ion Mihalache 37-39 Sector 4, Bucuresti, Romania

24 Department of Early Arthritis, Institute of Rheumatology, Kashirskoye shosse, 34a, Moscow, 115522, Russia

25 Tartu University Hospital, Puusepa str. 6, Tartu 50408 Estonia

26 Faculdade de Medicina da Universidade de São Paulo-FMUSP, Av Dr Arnaldo 455, CEP01246-903, São Paulo, Brazil

27 Rheumatology Section, Riverside Professional Center, 31 Riverside Drive, Sydney, NS, B1S 3N1, Canada

28 Satakunta Central Hospital, Rauman aluesairaala, Steniuksenkatu 2, 26100 Rauma, Finland

29 American Hospital Dubai, P.O. Box 5566, Dubai, United Arab Emirates

30 Connolly Hospital, Waterville Road, Blanchardstown, Dublin 15, Ireland

31 Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, Japan

32 Kenyatta National Hospital, Hospital Road,, PO Box 19701-00202, Nairobi, Kenya

33 Rheumatic Disease Clinic, 4th floor, Vedanta Institute of Medical Sciences Navrangpura, Ahmedabad 380009, Gujarat, India

34 Rheumatology Department, University Clinical Center of Kosova, Kodra e diellit, Rr. II, Lamela 11/9, Prishtina, 10 000, Kosova

35 Department of Clinical Immunology, Jaipur Hospital, Lal Kothi, Jaipur Pin-302021, India

36 Shono Rheumatism Clinic, 1-10-27 Nishi-shin, Sawara-ku, Fukuoka, Japan

37 Service de Rhumatologie, CHU de Strasbourg, Hôpital Hautepierre, Avenue Molière, BP 49, 67098 Strasbourg, France

38 Department of Rheumatology and Internal Diseases, Medical University in Bialystok, 24a Maria Sklodowska-Curie Street, 15-276 Bialystok, Poland

39 Harokopio University and Euroclinic of Athens, Athanasiadou 7-9, 11521 Athens, Greece

40 Institute of Experimental and Clinical Medicine at Vilnius University, 3 Universiteto St, LT-01513 Vilnius, Lithuania

41 Division of Rheumatology, Hospital San Juan Bautista, Avenida Illia 200, Catamarca, CP 4700, Argentina

42 Center for Clinical and Basic Research, Tallinn, Pärna 4, 10128 Tallinn, Estonia

43 Duke of Cornwall Rheumatology Unit, Royal Cornwall Hospital, Truro, Cornwall, TR1 3LJ, UK

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Arthritis Research & Therapy 2010, 12:R42  doi:10.1186/ar2951

See related editorial by Uhlig,

Published: 12 March 2010



Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries.


The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses.


At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score.


Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.