Comparison of employability outcomes among patients with early or long-standing rheumatoid arthritis

Authors

  • Chenglong Han,

    Corresponding author
    1. Centocor Research and Development, Malvern, Pennsylvania
    • Centocor Research and Development, 200 Great Valley Parkway, Malvern, PA 19355
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    • Drs. Han, Baker, and Bala own stock and hold stock options in Johnson & Johnson. Dr. Smolen has received honoraria (less than $10,000 each) from Abbott, Centocor, Roche, Wyeth, Bristol-Meyers Squibb, and Schering-Plough. Dr. St.Clair has received consultant fees (less than $10,000 each) from Centocor, Genentech, Medimmune, and Xoma, and has received research grants from Genentech and Amgen.

  • Josef Smolen,

    1. Medical University of Vienna and Hietzing Hospital, Vienna, Austria
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    • Drs. Han, Baker, and Bala own stock and hold stock options in Johnson & Johnson. Dr. Smolen has received honoraria (less than $10,000 each) from Abbott, Centocor, Roche, Wyeth, Bristol-Meyers Squibb, and Schering-Plough. Dr. St.Clair has received consultant fees (less than $10,000 each) from Centocor, Genentech, Medimmune, and Xoma, and has received research grants from Genentech and Amgen.

  • Arthur Kavanaugh,

    1. University of California at San Diego
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  • E. William St.clair,

    1. Duke University Medical Center, Durham, North Carolina
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    • Drs. Han, Baker, and Bala own stock and hold stock options in Johnson & Johnson. Dr. Smolen has received honoraria (less than $10,000 each) from Abbott, Centocor, Roche, Wyeth, Bristol-Meyers Squibb, and Schering-Plough. Dr. St.Clair has received consultant fees (less than $10,000 each) from Centocor, Genentech, Medimmune, and Xoma, and has received research grants from Genentech and Amgen.

  • Daniel Baker,

    1. Centocor Research and Development, Malvern, Pennsylvania
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    • Drs. Han, Baker, and Bala own stock and hold stock options in Johnson & Johnson. Dr. Smolen has received honoraria (less than $10,000 each) from Abbott, Centocor, Roche, Wyeth, Bristol-Meyers Squibb, and Schering-Plough. Dr. St.Clair has received consultant fees (less than $10,000 each) from Centocor, Genentech, Medimmune, and Xoma, and has received research grants from Genentech and Amgen.

  • Mohan Bala

    1. Centocor Research and Development, Malvern, Pennsylvania
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    • Drs. Han, Baker, and Bala own stock and hold stock options in Johnson & Johnson. Dr. Smolen has received honoraria (less than $10,000 each) from Abbott, Centocor, Roche, Wyeth, Bristol-Meyers Squibb, and Schering-Plough. Dr. St.Clair has received consultant fees (less than $10,000 each) from Centocor, Genentech, Medimmune, and Xoma, and has received research grants from Genentech and Amgen.


Abstract

Objective

To compare employability between patients with early and long-standing rheumatoid arthritis (RA) and examine the relationships between improvement in employability and disease stage after adjustment for demographic characteristics, disease activity, physical functioning, and response to therapy.

Methods

We evaluated the employability data from 2 double-blind, randomized, placebo-controlled studies of infliximab plus methotrexate (MTX) in patients with RA. Patients were incomplete responders to MTX in 1 study and had never taken MTX in the other study. Patients age <65 years were categorized as having early RA (≤3 years disease duration) or long-standing RA (>3 years disease duration). Physical functioning was assessed using the Health Assessment Questionnaire (HAQ) and clinical response was determined based on the American College of Rheumatology 20% improvement criteria (ACR20).

Results

Patients with early RA were more likely to be employable at baseline than those with long-standing RA, even after adjusting for baseline HAQ scores. Among patients who were not employable at baseline but achieved an ACR20 response after 1 year of treatment, after adjusting for baseline HAQ score, the patients with early RA who had never taken MTX were 3 times more likely to become employable compared with those with long-standing RA who had an incomplete response to MTX at baseline.

Conclusion

In 2 clinical trials, patients with early RA were more likely to show improved employment outcomes after treatment than those with long-standing RA, suggesting intervention as early as possible in the disease course maximizes an individual patient's employment potential.

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