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  • Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries

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Rheumatoid arthritis
Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries
  1. Polina Putrik1,
  2. Sofia Ramiro2,3,
  3. Francis Guillemin4,
  4. Márta Péntek5,6,
  5. Francisca Sivera7,
  6. Tuulikki Sokka8,
  7. Maarten de Wit9,
  8. Anthony D Woolf10,
  9. Angela Zink11,
  10. Daina Andersone12,
  11. Florian Berghea13,
  12. Irena Butrimiene14,
  13. Sandra Brouwer15,
  14. Karen Cassar16,
  15. Paraskevi Charalambous17,
  16. Roberto Caporali18,19,
  17. Elena Deseatnicova20,
  18. Nemanja S Damjanov21,
  19. Axel Finckh22,
  20. Oliver FitzGerald23,
  21. Gerður Gröndal24,
  22. Nino Gobejishjvili25,
  23. Piotr Gluszko26,
  24. Marco Hirsch27,
  25. Igor Jovanovic28,
  26. Jiří Vencovský29,
  27. Xavier Janssens30,
  28. Andras P Keszei31,
  29. Maria Kovarova32,
  30. Mart Kull33,34,
  31. Luís Cunha Miranda35,
  32. Miroslav Mayer36,37,
  33. Snezana Misevska - Percinkova38,
  34. Nevsun Inanc39,
  35. Oleg Nadashkevich40,
  36. Ingemar F Petersson41,42,
  37. Kari Puolakka43,
  38. Bernadette Rojkovich44,
  39. Helga Radner45,
  40. Fruzsina Szabados46,
  41. Gleb Slobodin47,
  42. Ivan Shirinsky48,
  43. Nikolay Soroka49,
  44. Prodromos Sidiropoulos50,
  45. Russka Shumnalieva51,
  46. Sekib Sokolovic52,
  47. Surayo Shukurova53,
  48. Argjend Tafaj54,
  49. Matija Tomšič55,
  50. Till Uhlig56,
  51. Suzanne M M Verstappen57,58,59,
  52. Annelies Boonen1
  1. 1 Internal Medicine, Division of Rheumatology, Maastricht University, CAPHRI and Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
  2. 2 Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
  4. 4 APEMAC unit, University of Lorraine, Nancy, France
  5. 5 Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
  6. 6 Rheumatology, Flór Ferenc County Hospital, Kistarcsa, Hungary
  7. 7 Rheumatology, Hospital Genral Universitario de Elda, Alicante, Spain
  8. 8 Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
  9. 9 Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands
  10. 10 Rheumatology, Royal Cornwall Hospital, Truro, UK
  11. 11 Epidemiology, German Rheumatism Research Centre and Rheumatology, Charité University Medicine, Berlin, Germany
  12. 12 Rheumatology, Pauls Stradina Clinical University Hospital, Riga, Latvia
  13. 13 Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  14. 14 Clinic of Rheumatology, Orthopedics Traumatology and Reconstructive Surgery, Institute Clinical Medicine, Vilnius University, Vilnius, Lithuania
  15. 15 Department of Community and Occupational Medicine, Groningen UMC, Groningen, The Netherlands
  16. 16 Faculty of Medicine and Surgery, University of Malta, Msida, Malta
  17. 17 Cyprus Society for Rheumatology, Nicosia, Cyprus
  18. 18 IRCCS Policlinico San Matteo Foundation, Pavia, Italy
  19. 19 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
  20. 20 Rheumatology, State Medical and Pharmaceutical University Nicolae Testemitanu, Chisinau, Moldova (the Republic of)
  21. 21 Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
  22. 22 Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
  23. 23 Rheumatology, St Vincents University Hospital, Dublin, Ireland
  24. 24 Center for Rheumatology Research, Landspitali University Hospital, Reykjavík, Iceland
  25. 25 Rheumatology, Health Center of Georgia, Tbilisi, Georgia
  26. 26 Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
  27. 27 Rheumatology, Hôpitaux Robert Schuman, Luxemburg, Luxembourg
  28. 28 Rheumatology, Filipovic polyclinic, Podgorica, Montenegro
  29. 29 Institute of Rheumatology and Dept. of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
  30. 30 Rheumatology, Ghent University Hospital, Ghent, Belgium
  31. 31 Center for Translational & Clinical Research Aachen (CTC-A), Medical Faculty RWTH Aachen University, Aachen, Germany
  32. 32 Rheumatology, St.CM University, Trnava, Slovakia
  33. 33 Rheumatology, Tartu University, Tartu, Estonia
  34. 34 Internal Medicine, Viljandi Hospital, Tartu, Estonia
  35. 35 Rheumatology, Portuguese Institute of Rheumatology, Lisbon, Portugal
  36. 36 Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
  37. 37 School of Medicine, University of Zagreb, Zagreb, Croatia
  38. 38 Rheumatology, University Rheumatology Clinic, Skopje, North Macedonia
  39. 39 Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
  40. 40 Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  41. 41 Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
  42. 42 Skåne University Hospital, Lund and Malmö, Lund, Sweden
  43. 43 Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland
  44. 44 Rheumatology, Polyclinic of the Hospitaller Brothers of St. John of God, Semmelweis University, Budapest, Hungary
  45. 45 Internal Medicine III, Department of Rheumatology, Medical University Vienna, Vienna, Austria
  46. 46 Rheumatology, North Denmark Regional Hospital, Hjørring, Denmark
  47. 47 Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
  48. 48 Laboratory of Clinical Immunopharmacology, Institute of Fundamental and Clinical Immunology, Novosibirsk, Russian Federation
  49. 49 Internal Medicine, Society of Internal Medicine of Belarus, Minsk, Belarus
  50. 50 Rheumatology, University of Crete School of Medicine, Heraklion, Greece
  51. 51 Clinic of Rheumatology, Department of Internal Medicine, Medical University, Sofia, Bulgaria
  52. 52 Rheumatology, Clinic of Heart and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
  53. 53 Internal Medicine, Medical Science Academy, Dushanbe, Tajikistan
  54. 54 Rheumatology clinic, Medical University Of Tirana, "Nene Tereza" Hospital, Tirane, Albania
  55. 55 Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  56. 56 Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  57. 57 Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  58. 58 NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  59. 59 Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
  1. Correspondence to Dr Polina Putrik,Rheumatology, Maastricht University, Maastricht, Netherlands; polina.putrik@gmail.com

Abstract

Objectives To describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system’s performance, across European countries.

Methods We conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates.

Results Forty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (β=−0.5 (95% CI −0.9 to −0.2) and β=−0.5 (95% CI −1.0 to −0.1), respectively). The Scandinavian and Bismarckian system scored best on patients’ and rheumatologists’ perceptions of regulations and system performance.

Conclusions There is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country’s wealth.

  • epidemiology
  • outcomes research
  • rheumatoid arthritis

https://doi.org/10.1136/annrheumdis-2019-215294

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    Footnotes

    • Handling editor Dr David S Pisetsky

    • Collaborators Working group ‘Working Group Access to Social Security for Patients with RA across Europe’: Ermir Tafaj (Albania), Edi Rembeci (Albania), Saskia Decuman (Belgium), Anastasia Tushina (Belarus), Iva Miteva (Bulgaria), Šárka Forejtová (Czech Republic), Esben Toftegaard Knudsen (Denmark), Maxime Wach (France), Matthieu Mangin (France), Márta Fekete (Hungary), Antonella Celano (Italy), Grainne O’Leary (Ireland), Giedre Dereseviciene (Lithuania), Mona Thorekildsen (Norway), Leszek Roszkowski (Poland), Claudia Handra (Romania), Inessa Samko (Russia), Jenny Hubertsson (Sweden), Tapparel Ludovic (Switzerland), Zumrad Hamroeva (Tajikistan), Ilker Yagcı (Turkey), Ana Zekovic (Serbia), James Anderson (UK)

    • Contributors PP, SR and AB conceived the study idea. FG, MP, FSiv, TS, MdW, ADW and AZ contributed to the protocol and conceptualisation. APK advised on statistical analyses. DA, FB, IB, SB, KC, PC, RC, ED, NSD, AF, OF, GG, NG, PG, MH, IJ, JV, XJ, MKov, MKull, LCM, MM, SP, NI, ON, IFP, KP, BR, HR, FSza, GS, IS, NS, PS, RS, SSok, SShuk, AT, MT, TU, SMMV collected data. All authors read the manuscript draft and approved the final submission.

    • Funding This study was partially funded by Abbvie in the context of Fit for Work initiative. SMMV was supported by Versus Arthritis (grant no. 20385) and NIHR Manchester Biomedical Research Centre.

    • Competing interests None declared.

    • Ethics approval The project has been approved by Maastricht Ethical Committee. Principal investigators in each country were responsible for local ethical approvals, where necessary.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.