Effects of rheumatoid arthritis on employment and social participation during the first years of disease in The Netherlands.

SUMMARY Objective. To study the eVect of rheumatoid arthritis (RA) on working capabilities and social participation, including nonpaying jobs, during the first 6 yr of disease. Design. Cross-sectional study. Methods. In April 1996, a self-reporting questionnaire was sent to 424 participants of a population-based clinical trial of therapeutic strategies for early RA initiated in 1990. Results. A total of 363 completed questionnaires were returned (response= 86%). Disease duration varied from < 1t o 6 yr (mean 2.8 yr). The employment rate was low in the RA population compared to the Dutch population. In the male 45- to 64-yr-old group, 63% of RA patients were not employed compared to 32% of the Dutch population (P< 0.01). In the female 45- to 64-yr-old group, 76% of the RA population vs 67% of the Dutch were not employed (P< 0.05). Of the employed patients, 59% reported that RA aVected their working capabilities, e.g. they worked an average of 21 h per week less due to RA. Of the patients without a paying job, 41% believed that this was (partly) due to RA. In addition, fewer RA patients had non-paying jobs and they performed fewer household activities compared to the general Dutch population. Conclusion. RA already has a negative influence on the working capabilities, social participation and household activities of these patients during the first 6 yr of disease. Chronic diseases have a major eVect on the life of a The costs of illness consist of three components: patient. Life expectancy and the quality of life may direct costs, indirect costs and intangible costs [4]. be reduced, while the financial situation of chronically Direct costs are those owed mainly to the health care ill people is often influenced negatively. A Dutch sector for treatment of the disease. Indirect costs report has shown that patients with rheumatism, represent a loss in financial resources, e.g. production diabetes or low back pain have high disease-related losses attributable to those who are unemployed or expenses and a relatively low income compared to cannot work as a result of illness. Intangible costs patients with chronic heart and lung diseases [1]. reflect the reduction in the quality of life. These three About 50% of these diVerences in income can be components of cost are discussed in detail in ‘Direct explained by diVerences in age, gender and educa- cost of rheumatoid arthritis during the first six years: tional level; the other 50% are related to the chronic a cost-of-illness study’ on page 837 of this issue [8]. disease itself.