Employment and disability issues in systemic lupus erythematosus: A review

Authors

  • Lacie Scofield,

    1. National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, and US Department of Health and Human Services Office on Women's Health, Washington, DC
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  • Leslie Reinlib,

    1. National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
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  • Graciela S. Alarcón,

    1. University of Alabama at Birmingham
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  • Glinda S. Cooper

    Corresponding author
    1. National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, and National Center for Environmental Assessment, US Environmental Protection Agency, Washington, DC
    • National Center for Environmental Assessment (8601-P), US Environmental Protection Agency, 1200 Pennsylvania Avenue NW, Washington, DC 20460
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  • The views expressed are those of the authors and do not necessarily reflect the views or policies of the US Environmental Protection Agency, Department of Health and Human Services, or National Institute of Environmental Health Sciences.

Abstract

Objective

To summarize research pertaining to work disability in lupus patients, discuss challenges patients face applying for federal disability assistance in the US, and make recommendations for clinical and health policy research.

Methods

We searched Medline for articles on work or disability in lupus patients and gathered information from the Social Security Administration and the National Organization of Social Security Claimants' Representatives.

Results

We found 12 publications with employment-related data; 6 included analysis of predictors of work status. The prevalence of inability to work or cessation of work was 15–51% in these studies (3–15 years after diagnosis); 20–32% of patients received disability benefits. Lower education level, higher disease activity, higher disease damage, older age, and higher physical job strain were independent predictors of work disability or work cessation in at least 2 studies. Lupus patients may be less successful than patients with other diseases when applying for federal disability assistance, possibly because medical records may not accurately reflect functional limitations. In addition, symptoms contributing to work disability (e.g., fatigue, pain, neurocognitive dysfunction) may be difficult to assess and quantify.

Conclusion

Work disability in lupus patients is common. Additional research on risk factors for work disability in lupus patients and on strategies for reducing the impact of these factors on work-related activities is needed. The development of better measures and rating scales for the symptoms responsible for work disability in lupus patients and studies of factors influencing the success of obtaining federal disability benefits would also be useful.

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