Arthritis-Related Work Transitions: A Prospective Analysis of Reported Productivity Losses, Work Changes, and Leaving the Labor Force MONIQUE A. M. GIGNAC, 1 XINGSHAN CAO, 2 DIANE LACAILLE, 3 ASLAM H. ANIS, 3 AND ELIZABETH M. BADLEY 1 Objective. To prospectively examine arthritis-related productivity losses, work changes, and leaving employment, the relationships among these work transitions, and the factors associated with them. Methods. Participants with inflammatory arthritis or osteoarthritis were interviewed at 4 time points, 18 months apart, using a structured questionnaire. At baseline (T1), all participants (n  490; 381 women, 109 men) were employed. At T2, T3, and T4, the sample decreased to 413, 372, and 349 participants, respectively. Respondents were recruited using community advertising and from rheumatology and rehabilitation clinics. Work transitions considered were productivity losses (absenteeism, job disruptions), work changes (reduced hours, changing jobs), and leaving employment. Also measured were demographic, illness, work context, and psychological variables. Generalized estimation equations modeled predictors of work transitions over time. Results. Although 63.1% of respondents remained employed throughout the study, work transitions were common (reported by 76.5% of participants). Productivity losses, especially job disruptions such as being unable to take on extra work, were the most frequently reported. Work transitions were related to subsequently making other work transitions, including leaving employment. Age, sex, education, activity limitations, control, depression, and arthritis-work spillover were also associated with work transitions. Conclusion. This study sheds light on a process of diverse employment changes that may occur in the lives of many individuals with arthritis. It emphasizes the interrelationships among work transitions, as well as other factors in predicting work transitions, and it provides insight into work changes that may signal impending difficulties with remaining employed. INTRODUCTION Considerable evidence links arthritis to loss of employ- ment and identifies clinical, personal, and environmental factors associated with changes in work status (1–13), but until recently, few studies have focused on the employ- ment experiences of people with arthritis. This is chang- ing, however, with increased emphasis on the diverse experiences of individuals with arthritis at work (14 –21) and research being done to measure work place disability and productivity and the indirect costs of arthritis (22–34). The shift in research to include a better understanding of working with arthritis has highlighted underemployment and the work transitions that individuals make in an effort to remain employed. Underemployment captures a wide range of adverse employment situations that result in re- duced job satisfaction and earnings (35). These include unemployment, involuntary part-time work, and a mis- match between training and job requirements (e.g., being overqualified). Work transitions, a less evaluative term, describes labor force changes that may signal problems resulting in an individual leaving the workforce or may reflect positive changes enabling individuals to remain employed (22,36 – 40). To our knowledge, there are few studies of work transitions in arthritis. The objective of our study was to prospectively examine arthritis-related work Supported by grants from the Canadian Institutes of Health Research (MOP-49532), the Canadian Arthritis Net- work (part of the Networks of Centres of Excellence), and by an Ontario Ministry of Health, Health System-Linked grant to the Arthritis Community Research & Evaluation Unit. 1 Monique A. M. Gignac, PhD, Elizabeth M. Badley, PhD: Arthritis Community Research & Evaluation Unit and Uni- versity of Toronto, Toronto, Ontario, Canada; 2 Xingshan Cao, PhD: Arthritis Community Research & Evaluation Unit, Toronto, Ontario, Canada; 3 Diane Lacaille, MD, MHSc, Aslam H. Anis, PhD: Arthritis Research Centre of Canada and University of British Columbia, Vancouver, British Co- lumbia, Canada. Address correspondence to Monique A. M. Gignac, PhD, Arthritis Community Research & Evaluation Unit, Toronto Western Research Institute, Main Pavilion 10-316, 399 Bathurst Street, Toronto, Ontario, M5T 2S8 Canada. E-mail: gignac@uhnres.utoronto.ca. Submitted for publication May 19, 2008; accepted in re- vised form August 15, 2008. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 59, No. 12, December 15, 2008, pp 1805–1813 DOI 10.1002/art.24085 © 2008, American College of Rheumatology ORIGINAL ARTICLE 1805