THU0684 Work impact in axial spondyloarthritis: the as-wis questionnaire predicts the risk of work impact: a longitudinal study of 101 patients

Abstract

Background: Axial spondyloarthritis (axSpA) mainly affects the working-age subject and can have a moderate (short-term sick leave) or significant (long-term sick leave, disability status, unemployment) work impact. Objective(s): To evaluate the value of a simple and short (2 minutes) questionnaire, the AS-Work instability scale (AS-WIS) to predict the work impact of axSpA after 1-2 years. Method(s): Longitudinal study in 3 centers in Paris, France. Patients with axSpA according to the rheumatologist and the ASAS criteria were included. Patients were asked twice (1 to 2 year interval) to answer questionnaires evaluating: disease activity, demographic characteristics, impact on work (short-term and long-term sick leave, disability, unemployment), and the ASWIS questionnaire (1): a 20 item, simple screening tool for Work Instability (the consequences of a mis-match between an individual's functional ability and their work tasks). The risk of disability is assessed as low if the score is <11, medium between 11-18 and high>18. Only patients who answered both questionnaires were included for analyses. Statistical analyses included descriptive analyses and univariate/ multivariate analyses to search for baseline factors of work impact at 1-2 years (including a medium/high ASWIS score, gender, age, schooling level, BASDAI, BASFI). Result(s): Among the 188 patients who answered the first questionnaire, 144 were currently working and were asked to answer the second questionnaire. A total of 101 patients answered both questionnaires. Mean age at inclusion was 45 (SD 9) years, 52% were male, disease duration was 14 (SD 8) years and 62% had an education level equivalent to more than high school. The BASDAI and the BASFI were respectively 34 (SD 21) and 23 (SD 23). At baseline, median ASWIS was 10, a low-risk score was found in 55 patients (54%), and a medium/high risk score in 46 (46%). 1 -2 years later, 37 patients (36%) had work impact: 25 patients (25%) a short-term sick leave, and 12 patients (12%) a significant work impact (long-term disability or unemployment due to Ax-SpA). Among patients with a low ASWIS score at baseline (n=55), only 13 (24%) had a work impact (including only 2 with a significant impact). Among patients with a medium/high ASWIS score (n=46), 24 (52%) had a work impact (including 10 patients of a significant impact). In univariate analysis, baseline factors associated with work impact (moderate or significant) were a medium/high ASWIS score, a high BASFI and a shorter disease duration. In multivariate analysis, medium/high ASWIS (odds ratio, OR 2.71 (1.04-7.22)) and a lower disease duration (0.94 (0.89-0.99)) were independent predictive factors of work impact. Conclusion(s): In patients with axSpA, a medium/high ASWIS score was followed by a work impact in 50% of cases within 2 years in this well-controlled population. This short questionnaire can be helpful to screen for future difficulties at work, whatever the stage of disease.