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Rheumatology Advance Access published online on April 15, 2008
Rheumatology, doi:10.1093/rheumatology/ken137
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Morning stiffness and its influence on early retirement in patients with recent onset rheumatoid arthritis

G. Westhoff1, F. Buttgereit2, E. Gromnica-Ihle3 and A. Zink1,2

1Epidemiology Unit, German Rheumatism Research Centre, 2Department of Rheumatology and Clinical Immunology, Charité University Medicine and 3Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany.

Correspondence to: G. Westhoff, Epidemiology Unit, German Rheumatism Research Centre Berlin, Charitéplatz 1, 10117 Berlin, Germany. E-mail: Westhoff{at}drfz.de


  Abstract

Objective. To describe the association between morning stiffness (MS) and early retirement in patients with early RA.

Methods. The study used data from a prospective RA cohort of 916 RA patients with disease duration ≤24 months. Data pertained to standard clinical measures and patients’ self-reports, such as functional capacity, pain and MS. Multivariate logistic regression analyses were performed to determine the association between MS and early retirement at 3 yrs, adjusting for sex, age, baseline working status, functional capacity, pain and 28-joint disease activity score (DAS28).

Results. MS was strongly associated with pain and functional capacity and to a lesser degree with joint counts and active phase responses. Severe MS in early disease had a significant impact on early retirement within the following 3 yrs. Of the 389 patients who were ≤61 yrs old and working at baseline, 80 (21%) had to take early retirement until the end of the study. Early retirement concerned 46% of the patients with severe and 10% of those with mild MS at study entry. Baseline working status was the strongest predictor and was severe compared with mild MS, the second strongest predictor of early retirement (adjusted odds ratio 6.0; 95% CI 2.9, 12.6).

Conclusions. Severe MS in the early course of the disease has a high impact on RA patients’ decision to withdraw from working life. Great attention should be paid to the effective treatment of MS in early RA, to prevent patients from possible untimely decisions that will have long-lasting and costly consequences.

KEY WORDS: Rheumatoid arthritis, Morning stiffness, Early retirement

Submitted 10 January 2008; revised version accepted 13 March 2008.
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