RA is a Hard Job

Rheumatoid arthritis can impact ability to work

/ Author:  / Reviewed by: Joseph V. Madia, MD

Rheumatoid arthritis (RA) is a painful disease that can interfere with many aspects of a person's life, and the workplace is no exception. While plenty of RA patients continue living productive lives, others find that their disease hinders their work and even their chances of finding work.

RA affects more than a million Americans, many of whom develop the condition when they are in the heart of their careers. But that doesn't necessarily mean they have to quit their jobs. Nor does it mean they are sentenced to a lifetime of stagnation.

If you have RA, there are a number of factors to consider with regards to work and productivity. How much does your condition interfere with daily activities? How much freedom do you have at work? Does your work require you to frequently use your affected joints?

But before you start answering these questions, you should see a rheumatologist, an expert in diseases like RA. In addition to giving you a proper diagnosis and appropriate treatment, a rheumatologist can start you on a conversation about your ability to work and your options for employment.

Through working closely with your rheumatologist, you can find ways to overcome the pain and disability of your RA and continue living a fruitful, productive life.

Can RA interfere with employment and work productivity?

To help answer this question, dailyRx News spoke with a rheumatologist who is particularly concerned about the impact of RA and related conditions on the workforce. Nortin M. Hadler, MD, MACP, MACR, FACOEM, is Attending Rheumatologist at the University of North Carolina Hospitals and Master of both the American College of Physicians and the American College of Rheumatology.

According to Dr. Hadler, the answer to this question depends on the patient.

"There is no single answer. For some patients, RA is a very mild illness and they do not find it a barrier. For others, it is a real barrier related to two factors: easy fatigability and biomechanical compromise," Dr. Hadler explained.

In other words, RA patients experiencing fatigue and poor joint function may have a harder time doing their jobs successfully, especially but not exclusively if that job requires manual labor. The ability to continue working depends on a combination of factors, including level of disability, job type and education. It also depends on the availability of accommodation in the workplace, including work content and alternative jobs.

Disability

RA patients who are wondering whether they can continue doing their job effectively will have to consider the intensity of their condition, if their condition limits their functional ability and if their job requires them to work through their functional disability.

RA is a common cause of disability. According to the Mayo Clinic, "1 of every 5 rheumatoid arthritis patients is unable to work two years after diagnosis, and within five years, that rises to one-third."

Other studies have shown that higher levels of disability among RA patients are associated with a higher likelihood of quitting a job. A UK study by Barrett, et al., found that patients with higher scores on the Health Assessment Questionnaire (a self-reported measure of disability) were as much as 32 times more likely to stop work on health grounds.

Job Type

Job type is another important factor patients must consider if they are worried about their ability to work.

Within any given job, there is a certain level of autonomy or lack there of. Some jobs give employees the flexibility to control the pace of their workday or work week, while other jobs keep workers on a rigid schedule.

RA is a variable disease — symptoms may be worse at some points than at others. And this is where job autonomy plays a role. If a patient has more autonomy, then that patient can adjust his or her workload when RA symptoms flare up. Without such autonomy, an RA patient may end up trying to work through pain and fatigue, potentially leading to injury and the inability to work.

"If you're a production worker on a line, RA can become a major constraint on capacity," Dr. Hadler said. "But for a freelance journalist, RA is much less likely to be an assault on earning capacity."

And it's not just freelance journalists who have this flexibility. Many higher paying jobs tend to offer more job autonomy. As Dr. Hadler explained, "RA patients with higher levels of income are able to maintain employment much more readily."

Education

To get higher paying jobs, people typically need higher levels of education — another factor that helps answer the question at hand.

Researchers have addressed the role of education in work disability among people with RA. For example, a 1995 study by Doeglas, et al., looked at the employment status of 119 patients who had jobs before they developed RA. The researchers compared patients with work disability (working less, sick leave or quitting their job) to those without work disability.

Results showed that patients who reported work disability tended to have lower levels of education and more signs of active disease, including higher levels of blood markers of RA, more joint tenderness and poorer function.

What steps can RA patients take to do their job successfully?

First and foremost, patients should get a proper diagnosis so that they begin treatment as soon as possible. Research shows that early diagnosis and treatment often leads to better outcomes.

"It is very important to have rheumatoid arthritis properly diagnosed, and treatment started early on," said Eric Matteson, MD, a Mayo Clinic rheumatologist who co-authored an article last July about approaches to diagnosis and treatment of RA.

"Getting the disease under control leads to better outcomes for the patient, ability to continue working and taking care of one's self, less need for joint replacement surgery and reduced risk of heart disease," Dr. Matteson said in a press release.

According to Jason Poquette, BPharm, RPh, "Early diagnosis and treatment of RA allows us to utilize safer and less costly treatments to help manage a patient’s condition and delay the need for more aggressive therapies."

So what does early treatment entail?

"The early course of treatment, from a pharmacological perspective, generally includes the use of NSAIDs (like ibuprofen, naproxen or piroxicam) and short-term oral corticosteroids like prednisone. These are often effective in reducing the symptoms of joint pain and discomfort, allowing patients to maintain their activities of daily living at home and work," said Poquette, who is a registered pharmacist running the blog The Honest Apothecary.

"However, slowing down the disease progression has become equally, if not more, important when treating RA. Therefore the use of DMARDs (disease modifying anti-rheumatic drugs) such as methotrexate, hydroxychloroquine and others are also becoming important treatment options early on in therapy. These approaches tend to proceed the use of the biologic drugs and TNF inhibitors," said Poquette.

While early treatment is important, Dr. Hadler noted that it is not the only solution to maintaining gainful employment — a conversation between doctor and patient is also key.

Dr. Hadler said that talking about the impact of RA on work and daily life is one of the first things he does upon meeting his patients.

"Part of my initial evaluation is not just about the RA, but also who the patient is in context," he said. "That's the most rewarding part: helping patients continue to feel like people. They are not 'rheumatoids', but people with rheumatoid arthritis."

Dr. Hadler advises treating physicians to talk to their patients early about the impact of their illness on their function, and not just if they are manual laborers or not highly educated.

The conversation should explore the individual patient's situation and options. While one patient may be fortunate enough to find work where performance is not affected by RA, another patient may not be so lucky. Even a highly educated patient can face serious functional limitations at work as a consequence of active RA. Alternative employment is better pursued early before facing disappointment and worse.

Some RA patients have limited options for alternative work because of limitations in work skills. But there is still help.

Dr. Hadler recommends guiding such patients facing potential work incapacity to a Social Security office early, but not to apply for disability. Rather he recommends taking advantage of vocational rehabilitation programs. These programs are designed to enable people with functional disabilities to overcome their barriers to gaining and maintaining employment through job retraining.

How can employers help their employees with RA?

If you are an employer of someone with RA, you must understand that your employee is dealing with a difficult disease and an uncertain future. In order to support your employee, it is important for you to talk about the situation.

According to the UK's National Rheumatoid Arthritis Society (NRAS), "Good communication is essential. Make sure your employee has and understands all the relevant company policies. If he or she would like their colleagues to know, discuss and agree the best way to tell them. Let the employee know who to talk to if they need support or if their situation changes."

Through an open dialog with employers, employees with RA have a better opportunity to understand what they need to do to continue working successfully. In turn, healthy dialog gives employers the opportunity to outline what they expect of their employees.

A caring employer with a close relationship to its workforce should look at the options it can offer to an employee with RA. The NRAS recommends that employers ask themselves, "Can the employee continue with their current role? Do they need adaptations, changes to their working hours or additional training? Is there an appropriate alternative job?"

Unfortunately, not all employers will ask these questions. According to Dr. Hadler, distant relationships between employer and employee lead to less help for those with RA. Close relationships, on the other hand, make it easier for employees to find help.

Some companies even offer the services of an onsite nurse. Workers with RA are encouraged to take advantage of such services.

Working for workers with RA

Employment options are not the same for every RA patient, and help for those who need it most is still lacking.

In a 2001 essay that appeared in Arthritis & Rheumatism, Dr. Hadler wrote, "Just as we have learned to discuss the impediments to coping that beleaguer our patients with rheumatoid arthritis … we must broach discussions of life in the workplace with these patients. We may be as powerless as our patient to put things right. Or, some solution may emerge. The latter becomes more likely if we gain expertise about the dynamics of the workplace and identify resources that can assist us, much as we have regarding life in the home for other of our patients."

Doctors, patients and employers all need a better understanding of how RA impacts daily living in order to find solutions for patients whose RA keeps them from gainful employment. And part of that better understanding is improving the dialog between doctors and their patients.

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Review Date: 
April 11, 2013