135 Work disability and productivity impairment among Malaysian systemic lupus erythematosus patients

Abstract

Background: Systemic lupus erythematosus (SLE) is a chronic multisystemic autoimmune disorder which often affects young people in their most productive life and thus may lead to work disability (WD) and reduction in productivity. Methods: This was a cross-sectional study which recruited consecutive SLE patients who attended the nephrology and rheumatology clinic at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from March 2017 to July 2017. Their current and past employment history was obtained from a customised questionnaire. WD was defined as unemployment or an inability to do paid work due to SLE illness. Disease activity was assessed at study visit and during the onset of WD using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) and the British Isles Lupus Assessment Group's 2004 index (BILAG-2004). Meanwhile, disease damage and Health QOL were measured using SLICC ACR Damage Index and SF-36 respectively. Productivity and Activity Impairment (WPAI) Questionnaire then was subsequently used to determine the work productivity impairment. Statistical analyses were subsequently performed to determine the factors associated with WD and work productivity impairment, while multivariate logistic regression was performed to determine the independent predictors of WD among SLE patients. This study was approved by UKM Ethics Committee (FF-2017-109). Results: A total of 197 patients were recruited, and their median age was 37(32 to 47) years with median disease duration of 12(8 to 17) years. The prevalence of work disability was 35% (n=69) and the reported work productivity impairment among patients who were employed was 79.8% (n=135). A total of 172 patients (87.3%) reported impairment of daily activities. The onset of WD was 4 (IQR:1 to 9) years after SLE diagnosis, and it was associated with older age, lower education level, more frequent disease flare, longer disease duration, higher SLICC ACR Damage Index, active disease (SLEDAI 2K and BILAG 2004) and had involvement of lupus nephritis, haematological and neuropsychiatric lupus. Patients with WD also had significantly impaired QOL with lower SF 36 scores. On multivariate logistic regression analysis, the independent predictors of WD were lower education level, married and involvement of lupus nephritis, haematological and neuropsychiatric lupus. Conclusion: More than one third of SLE patients had experienced work disability and the prevalence of work productivity impairment was even higher. Lower education level, married and major organ involvement were the independent predictors for work disability.