Rheumatic diseases and employment

Research on rheumatic diseases and employment has examined demographic, health, work-context, psychological and social factors. Findings are not always consistent. Demographic variables frequently studied include age, education and gender. To date, a relatively consistent body of evidence points to older age and lower education as significantly related to leaving the labour force . Less evidence exists examining outcomes such as absenteeism and presenteeism, although some research suggests that older working adults with rheumatic diseases may be less likely to take sick days than younger adults . Findings are mixed for gender with some studies finding no differences and others suggesting that women are less likely to be employed or more likely to need workplace accommodations than men . Other research finds that, although men with arthritis were more likely to remain working, they reported more negative job experiences such as being passed over for a promotion than women .

Health factors associated with employment problems include greater pain, fatigue, number of joints involved and functional limitations . Interestingly, although clinical disease activity and damage indices have been examined across different rheumatic conditions, many are not significant in multivariate models once functional limitations and work-context variables are included . Recent research has also examined health factors such as unpredictable symptoms or episodic workplace activity limitations. Findings indicate that intermittent disability is common but that only high levels of workplace limitations are associated with disruptions at work, absenteeism and difficulties with managers and co-workers .

Job context factors are also critical to understanding workforce participation. Jobs with high physical demands and work pace; those involving the hands; where there are few adaptations or accommodations available; low control over work tasks or scheduling; and commuting difficulties are associated with greater employment difficulties for many people . Job disruptions, absenteeism, permanently reducing work hours and sick leave can also predict future job difficulties, including leaving employment .

Although they are gaining attention, personal or psychological factors such as job stress, perceived work-health conflict, social support and coping have been studied less extensively . Those reporting high job stress or work-health conflict report more negative employment outcomes . Some coping strategies such as limiting activities and pacing have been associated with giving up employment , although they are commonly used both at home and work along with modifying activities, accommodations and getting help from others . Studies also report benefits with the use of different self-management strategies . A difficulty when studying the impact of coping strategies is that greater amounts of coping often signal that an individual has greater needs (e.g., more pain) or that a strategy is not working and is being used repeatedly, making analysis of coping as a contextual factor complex. Finally, support at home and work has been associated with better employment outcomes .

A range of work outcomes has been examined in research on rheumatic diseases. Much of the emphasis has been on short- and long-term disability, absenteeism and giving up employment altogether . Increasingly however, studies are assessing presenteeism . Costs related to rheumatic diseases and their management are a third type of outcome examined . Finally, a wide range of additional behavioural outcomes such as work transitions (e.g., reduced hours and changing jobs) and psychosocial outcomes (e.g., work stress and workplace interpersonal relationships) have begun to garner attention .