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Attempting to quantify the burden of disease as it relates to work productivity is a significant theme in autoimmune research. But does the level of work-related impairment differ across the spectrum of autoimmunity? A new cross-sectional study explores this question with data from the CorEvitas Registries, comparing work productivity in patients from their Inflammatory Bowel Disease (IBD), Psoriasis, and Psoriatic Arthritis/Spondyloarthritis registries.¹

The authors analyzed data from employed patients aged 20鈥�64 years, including 7169 adults with psoriasis (n=4768, 67%), psoriatic arthritis (n=1208, 17%), Crohn鈥檚 disease (CD, n=621, 9%), and ulcerative colitis (UC, n=572, 8%). They analyzed all patient-reported impairment documented in the Work Productivity and Activity Index (WPAI) from May 2017 through June 2020.¹

Absenteeism is common in moderate-to-severe IBD

For most patients across cohorts, living with an autoimmune disease negatively impacted their ability to work. Across the four diseases studied, patients were affected by presenteeism, work productivity loss, and activity impairment, with the prevalence of these domains ranging from 54% to 97%. In particular, patients with IBD reported an especially high burden when it came to absenteeism: nearly half of those with moderate-to-severe IBD disease activity reported this domain compared to about 20% of psoriasis patients and 35% of psoriatic arthritis patients. Even though the occurrence of absenteeism was comparable between disease cohorts, younger IBD patients with moderate-to-severe disease activity were disproportionately affected. The authors warn about the long-term burden in patients diagnosed with IBD at an early age, potentially leading to premature retirement and even mortality in some cases.¹

CD can be in remission but still cause work impairment

In the setting of autoimmunity, many providers and patients decide on a care pathway that aims for remission. In the current study, patients with moderate-to-severe disease activity reported the highest WPAI burden, while those with lower disease activity reported a lesser burden; such results suggest the effectiveness of a treat-to-target approach. However, even among patients in remission, at least 1 in 3 still reported some work-related impairment. This trend was especially strong among CD patients in remission: presenteeism (53% [48%-57%]) and work productivity loss (54% [49%-59%]) were more prevalent in this cohort compared to patients with other autoimmune conditions (presenteeism [range: 33%-39%] and work productivity loss [range: 37%-41%]). These outcomes highlight the burden of autoimmune chronicity on quality of life, even in patients with well-managed disease activity.¹

Productivity depends on disease-specific characteristics 

Across the 4 autoimmune diseases studied, WPAI appeared to be driven not just by higher disease activity, but also by the presence of psychosocial symptoms. Autoimmune patients often report fatigue, pain, and anxiety, even in the absence of active inflammation, highlighting the persistent impact of autoimmunity on well-being. 鈥淭hese findings support the utilization of multidisciplinary treatment approaches to address both residual inflammation and psychosocial comorbidities specific to the needs of individual patients,鈥� the authors write in their discussion.¹

Caveats

Some limitations to this study were noted. In particular, the definitions of disease severity and remission vary across autoimmune disorders, which could have affected data. Patients with IBD were subject to differential inclusion criteria in the IBD Registry from 2017 to 2019, resulting in a lower proportion of those patients with moderate to severe disease compared with patients with psoriasis or psoriatic arthritis. In addition, the authors wrote that work productivity and loss and activity measurement with the WPAI were highly skewed, with the choices being either 鈥渘one鈥� or 鈥渁ny.鈥� Meaningful differences would be present for a patient who might have had a smaller percentage of work hours affected compared with a patient who had more time affected. This study focused on employed patients and cannot be generalized to all patients with these conditions. Finally, the authors wrote, 鈥渢he cross-sectional nature of the study design did not allow us to explore temporal associations between disease activity, associated psychosocial symptoms, and work productivity loss and activity impairment.鈥�¹

Jump on the diagnosis and make the most of therapy

Ultimately, the authors emphasize that early diagnosis and optimized therapy can prevent downstream effects of disease activity that drive work productivity loss. The unique, disease-specific factors observed in this study underscore the importance of a coordinated approach to autoimmune care. For example, symptoms were more prevalent in IBD patients with comorbid anxiety and depression. Indeed, the literature supports the idea that WPAI is largely influenced by disease-specific clinical factors, including periarticular psoriatic arthritis manifestations such as enthesitis, and features of CD such as penetrating disease. The severity of each patient鈥檚 symptoms should inspire a holistic treatment approach which encompasses psychosocial well-being, the authors conclude.¹

Published: July 30, 2024