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Immuno-rhumatologie et TRAVAIL : outils d’évaluation ?

Pascal Zufferey: 25 avril 2013. Immuno-rhumatologie et TRAVAIL : outils d’évaluation ? . Rhumatismes inflammatoires et travail. Presenteeism : impact of chronic health conditions on job performance and work productivity. Absenteeism Seak leaves.

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Immuno-rhumatologie et TRAVAIL : outils d’évaluation ?

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  1. Pascal Zufferey: 25 avril 2013 Immuno-rhumatologie et TRAVAIL : outilsd’évaluation ?

  2. Rhumatismes inflammatoires et travail Presenteeism : impact of chronic health conditions on job performance and work productivity Absenteeism Seakleaves Work instability « discordance entre les capacités fonctionnelles et les exigences du travail » can be seen as the precursor to work loss

  3. RHUMATISME inflammatoire ET TRAVAIL PR et travail : - épidémiologie PR et travail-facteurs prédictifs -démographie -types de PR -examens cliniques et paracliniques -questionnaires -mesures d’activité de la maladie -TTT -low Das et remission -US PR -fibromyalgie secondaire et travail SPA et travail -épidemiologie -facteurs predictifs PSO et travail

  4. review of 12 cross-sectional studies found that RA patients had an increased risk of being without paid employment, with odds ratios between 1.2 and 3.4 compared with reference groups Among nine longitudinal studies, three studies in early RA showed that about a third of patients who were employed lost their jobs in the first 2 years after diagnosis, while another study found even higher figures (40% stopping work by 2.5 years and 53% by 6 years) The prevalence of sick leave among early RA patients is high at 53–82% per year, and the amount of sick leave taken can be as high as 118 days per patient in the first year The proportion of patients taking sick leave decreased over 3 years, whereas the proportion with work disability increased. A US observational study of work disability in RA over 12.8 years found annualized incidence rates of 8.7% for stopping work and 4.0% for stopping and not resuming work A study comparing patients with early RA in Finland and the USA found that Finnish patients had higher rates of work disability (probability of working at 36 month) Polyarhtrite et travail: Epidemiologie Best Practice & Research Clinical Rheumatology: 25, 4, August 2011, Pages 607–624

  5. Invalidite et rhumatismes inflammatoires:british registry The study population included 3291 consecutive patients with RA, 254 patients with PsA and 229 patients with AS whostarted anti-TNFtherapy (2001-2005) RA :49% Spa: 36% Pso:39% Rheumatology 2010;49:1570–1577

  6. The study population included 2021/7270 inflammatory arthritis consecutive patients 43 % à l’AI whenstartinganti-TNF therapy (1997-2011) Disease duration: 6 years DAS : around 4.2 HAQ: aroud 1.0 Invalidite et rhumatismes inflammatoires:swissregistry(SCQM) Joint BoneSpine. 2013 Mar;80(2):160-5

  7. Pr et incapacite et travail:, démographie Ann Rheum Dis 2004;63:1362–1367

  8. PR et incapacité: facteurs prédictifs , durée de la maladie Pr ClinRheumatol (2011) 30 (Suppl 1):S3–S8

  9. Pr et incapacite: : anamnèse , status, biologie Ann Rheum Dis 2004;63:1362–1367. Ann Rheum Dis 2013;72:493–505

  10. Pr et incapacite: questi0nnaires standards Ann Rheum Dis 2004;63:1362–1367. Ann Rheum Dis 2013;72:493–505

  11. PR : EVA : MCID et PASS Relation avec le travail ? Arthritis Care & Research . 64, 2012, 1699–707

  12. PR et travail : questionnaires specifiques Arthritis Care & Research 63, November 2011, 337–49

  13. PR et questionnaires: Validite Ann Rheum Dis. 2009 Nov;68(11):1686-90

  14. RA-Wiss questionnaire The RA-WIS is a self-report measure Work instability. It can be seen as the precursor to work loss the predictive power of the RA-WIS for permanent job loss remains unclear Final RA-WIS is 23 item questionnaire User-friendly and quick to complete Simple ‘true’ / ‘not true’ response options Physical and psychosocial factors in a single questionnaire Score 0 –9 = low WI 10 –16 = medium WI 17 + = high WI Ann Rheum Dis 2009;68:1686–1690

  15. Pr et incapacite: facteurs predictifs: DAS Ann Rheum Dis 2013;72:493–505 Rheumatology2011;50:12591267

  16. DAS and HAQ versus RA-WIS the DAS28 and HAQ explain only about half of the variability of the RA-WIS J Rheumatol 2009;36;225-230

  17. Pr et incapacite: DAS et niveaueconomique DAS moyen des patients et avec PR qui continuent de travailler dans la QUEST-RA study

  18. Pr et incapacite: facteurs predictifs: «  Treat to target » 199 pts withearlyRa no DMaRDS by response group at 6 months 166 after 5 years Clin ExpRheumatol 2012; 30 (Suppl. 73): S27-S31.

  19. Biologicalshave shown to have beneficial effects on sick leave and presenteeism the impact on remaining in paid employment or gaining employmentis still uncertain. Under biologics 5-10% recover work , 5-10 % /years lose their work in the three first years There is evidence that especially in early RA work disability can be prevented Ann Rheum Dis 2013;72:493–505 Pr et incapacite: facteurs predictifs: « les biologiques

  20. PR et incapacite: facteur predictifRemision Remission et travail ? MDA sustained for 1 year had a 10-fold reduction in work disability in a cohort of 18000 pts Arthritis & Rheumatism 57, 2007, 935–942 Patients achieving DAS-28 remission were 54% less likely to stop work than those with DAS-28 > 3.2 (P < 0.05) Rheumatology 2012 ;51:270-4

  21. US : score « SONAR » et remission EULAR 2012

  22. RA : US et travail ? Quel % de patients en rémission US travaillent par apport à ceux en remision DAS ? La persistance d’un score US élevé alors que patient est en rémission clinique a-t-elle un effet sur la capacité de travail ? Dans les PR précoces l’effet du ttt à 3 mois sur le score US est il aussi prédictif sur le maintien au travail

  23. RA : US et travail Score SONAR in patients withpolyarthralgia projectongoing in CHUV: 70 patients Ultrasound imaging for the rheumatologist ,Sonographic assessment of the hip in fibromyalgia patients G. Meenagh, G. Sakellariou, A. Iagnocco, A. DelleSedie, L. Riente, E. Filippucci, L. Di Geso, W. Grassi, S. Bombardieri, G. Valesini, C. Montecucco Clin exprheumatol 2012

  24. PR 15-30% PSO 20-30 % Crohn 20-50 % SPA 10-50% LED 30-50% rhumatismes inflammatoires et Fybromyalgie Primaire problème de diagnostic Secondaire réponse aux traitements Fibromyalgie pas d’invalidité en Suisse

  25. Fibromalgie et PR Rheumatology 2010;49:924–928

  26. US : score SONAR et fibromyalgie US-/DAS+ US+/DAS+ Target to DAS Diagnosis? DAS and US US-/DAS+ Target to DAS ? Diagnosis? Fribromyalgia ? DAS and US US-/DAS+ Stop treatment ? Diagnosis ? DAS and US

  27. % Nbrediseaseduration BASDAI BASFI • British registry1: transversal TTbiologic36% 229pts 14 years 7 • Spanish regitry2 transversal: 25% 680 pts 14 years 4.7 • Norvegian registry3cumulative 22 years45% 687pts 18 years 4.2 • Chuv: transversal TT biologic 29% 159 pts 9 years 5.9 SPA et invalidite : épidemiologie 1 Rheumatology 2010;49:1570–1577 • 2J Rheumatol 2009;36;2512-2516 2000-2005 3J Rheumatol 2011;38;479-484 1998 to 2002

  28. SpA ET travail: EXAMEN CLINIQUE 699 pts permanentlyworkdisabled 360pts stop working Espagne NORVEGE J Rheumatol 2011;38;479-484 J Rheumatol 2009;36;2512-2516

  29. Spondylarhrite et travail : questionnaires Espagne UK 699 pts 612 pts unemployed Scand J Rheumatol 2011;40:34–40

  30. Spondylarhrite et travail : questionnaires specifiques The WPAI:SpAconsists of six questions to determine employment status,: hours missed from work due to AS, hours missed from work for other reasons, hours actually worked, the degree to which AS affected work productivity while at work and the degree to which AS affected activities outside of work Rheumatology 2010;49:812–819

  31. SPA et questionnaires spécifiques • Instabilité au travail • Élevée dans cette population (40.4%) • Expliquée surtout par EVA globale patient • La valeur prédictive de l’AS-WIS en terme de maintien de l’emploi reste à être évaluée AS-WIS score cut-off points representing low (<11), medium (11–18) and high (19–20) risk of job loss to bedetermined I Fabreguet: Rheumatology 2012;51:333337

  32. SPA et biologiques : effet sur capacité de travail it remains unclear whether TNF inhibition in patients with longstanding AS improves presenteeism, absence from paid work or work status Ann Rheum Dis 2012;71:1924–1933.

  33. Enthésitesversus points de fibromaylgie Critères ASA S de spondylarthrite Points de fibromyalgie

  34. Enthésites et Ultrason enthesis F E H B G C D A A bursitis F edema, inhomogenity of the texture B increasedvascularisation G degenerative changes in the periostal fibrocartilage C focal thinning of the subchondral bone H non-insertion tendinosis D erosion E enthesophyte

  35. US good tool for enthesisevaluation No cleardifferenceaccording to the etiology No consensus on the scoring system Importance of Doppler Vascularisation oftenassociatedwith pain Monitoring the treatmentwithultrasound? Relation to workstatus ? US et enthésites Fibromyalgie ou enthèsite dans le cadre d’une SPA ? Ann Rheum Dis April 2012 474 -7

  36. rhumatisme pso et instabilité au travail Rheumatology 2012;51:275283

  37. PSA versus fibromyalgie : US des enthèses 30 PSA 30 FM MASES + Epicondyles, quadriceps gluteusmedius Semiquantitative 70% at least 1 enthesis doppler+ 22% 1 enthesis doppler+ -more sites with PDUS + in PSA than in FM -badcorrelationbetween PDUS+ and pain in PSA -Asymptomatic PDUS + frequent in PSA J Rheumatology : Supplement 2012;

  38. Taux élevé d’absentéisme, d’instabilité ou de perte définitive du travail dans les arthrites inflammatoires. • PR : paramètres cliniques et d’activité de la maladie pas suffisants pour prédire ou justifier la perte de travail. • paramètres qui prédisent et qui supportent l’incapacité • Pr précoce avec réponse favorable au ttt dans les 3 mois • HAQ > DAS DAS < 2.6 et >3.8 • HAQ>0.5 • Utilité des questionnaires spécifiques : RA-wis ? • Cave fibromyalgie secondaire -tender joint> swollen joints • - US • -facteurs environnementaux -niveau économique • -cadre assécurologique • -jurisprudence, adéquation handicap travail • facteurs personnels -autres pathologies conclusions

  39. SPA: diagnostic • Critères diagnostiques à géométrie variables • Handicap > lombalgie commune ? • Jurisprudence. • paramètres qui prédisent et qui supportent l’incapacité • SPA axiale: -Tests cliniques > PR • -BASFI >4 • -BASDAI >6 • -Questionnaire spécifiques? • -Réponse au TTT? < PR • SPA enthésitique • - Cave fibromyalgie • -US ? conclusions

  40. HAQ: in french

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