1247 Morales-Romero, et al: Work disability in RA Factors Associated with Permanent Work Disability in Mexican Patients with Rheumatoid Arthritis. A Case-Control Study JAIME MORALES-ROMERO, LAURA GONZALEZ-LOPEZ, ALFREDO CELIS, BRENDA E. RODRIGUEZ-ARREOLA, CARLOS E. CABRERA-PIVARAL, and JORGE I. GAMEZ-NAVA ABSTRACT. Objective. To assess factors associated with permanent work disability (PWD) in Mexican subjects with rheumatoid arthritis (RA). Methods. From a database of 300 salaried workers with RA, we evaluated 35 cases that developed PWD. These cases were compared with 70 controls randomly selected from the same database who were active workers. The assessment included the following variables: sociodemographic, education, employment, and clinical characteristics of the disease. Logistic regression analysis was performed to adjust variables associated with PWD. Odds ratios and their 95% confidence intervals (95% CI) were computed. Results. Factors associated with PWD in the unadjusted analysis were: lower education level (OR 3.27, 95% CI 1.28–8.49, p = 0.006), > 2 year delay in prescription of a disease modifying antirheumatic drug (DMARD) (OR 4.29, 95% CI 1.49–12.73, p = 0.02), joint prosthesis (OR 8.93, 95% CI 2.02–45.04, p < 0.001), severe radiographic damage (OR 3.33, 95% CI 1.20–9.46, p = 0.01), comorbidity (OR 7.54, 95% CI 1.94–34.25, p < 0.001), and positive rheumatoid factor (RF) (OR 3.53, 95% CI 0.98–13.76, p = 0.03). In the multivariate model PWD was predicted by lower education (OR 3.3, 95% CI 1.1–9.7, p = 0.03), positive RF (OR 4.9, 95% CI 1.2–19.7, p = 0.03), and delay in the prescription of a DMARD (OR 3.3, 95% CI 1.1–10.1, p = 0.04). Conclusion. A low education level, positive RF, and delay in the use of DMARD are risk factors for PWD. Strategies to decrease rates of PWD should include an earlier treatment with DMARD. (First Release June 1 2006; J Rheumatol 2006;33:1247–9) Key Indexing Terms: RHEUMATOID ARTHRITIS WORK DISABILITY DISEASE MODIFYING ANTIRHEUMATIC DRUGS MEXICAN From the Department of Internal Medicine—Rheumatology, Hospital General Regional 110, IMSS; and Department of Public Health Sciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico. Supported by Consejo Nacional de Ciencia y Tecnología (CONACYT), México Grant: SALUD 2003 CO1-082. J. Morales-Romero MD, MPH, Epidemiologist, Research Fellow ; L. Gonzalez-Lopez, MD, PhD, Research Associate; B.E. Rodríguez-Arreola, MD, Research Fellow, Department of Internal Medicine—Rheumatology, Hospital General Regional 110 del IMSS; A. Celis de la Rosa, MD, PhD, Professor of Public Health Sciences and IMSS; C.E. Cabrera-Pivaral, MD, PhD, Professor of Public Health Sciences, Centro Universitario de Ciencias de la Salud Publica, Universidad de Guadalajara; J.I. Gamez- Nava, MD, PhD, Research Associate, Division of Musculoskeletal and Autoimmune Diseases, Clinical Epidemiology Research Unit, Hospital de Especialidades del Centro Medico Nacional de Occidente, IMSS. Address reprint requests to Dr. L. Gonzalez-Lopez, Salto del Agua 2192, Col. Jardines del Country, Guadalajara, Jalisco, Mexico 44210. E-mail: lauragl@mail.udg.mx Rheumatoid arthritis (RA) affects 0.3% of the Mexican popu- lation 1 , leading to functional limitations and high rates of dis- ability. Studies in Europe and the United States describe 3 groups of factors associated with work disability: characteris- tics of the disease 2 , employment 2,3 , and socio-educational variables 3,4 . However, differences in the system of healthcare provision among countries are also important determinants 5 . In Mexico, the main healthcare system for salaried workers is covered by the Mexican Institute of Social Security (IMSS), a prepaid compulsory social insurance system for workers and their families 6 . IMSS covers payments for sick leave and per- manent work disability (PWD) resulting from disease. Although a high proportion of Mexican workers with RA develop PWD, there is a lack of information about the charac- teristics associated with this outcome. Therefore, we evaluated the factors associated with PWD in Mexicans with RA. MATERIALS AND METHODS We conducted a case-control study in the rheumatology clinic of a secondary- care hospital in Guadalajara, Mexico (HGR-110, IMSS). From a database of 300 salaried workers with RA, 35 cases with PWD were compared with 70 randomly selected controls. Inclusion criteria were: RA [1987 American College of Rheumatology (ACR) criteria], age ≤ 18 years, and having salaried work before onset of RA. Definition of cases. Cases with PWD were defined as members of the perma- nent labor force who left employment as a result of RA. Only patients with complete work disability (≥ 75% disabled) certified by the board of occupa- tional medicine were included. Controls. Controls were defined as patients with RA who were salaried work- ers at the time of the study onset, who had no reports of sick leave in the pre- vious year. All patients were interviewed for (a) sociodemographic variables, (b) Personal non-commercial use only. The Journal of Rheumatology Copyright © 2006. All rights reserved. www.jrheum.org Downloaded on October 4, 2022 from