J Rheum Dis 2018; 25(2): 122-130  
Productivity Loss of Rheumatoid Arthritis Patients according to the Their Stages of the Disease Activity Score
Sang-Cheol Bae1, Jin-Hye Cha2, Jung-Yoon Choe3, Sung Jae Choi4, Soo-Kyung Cho1, Won-Tae Chung5, Chung-Il Joung6, Young-Ok Jung7, Young Mo Kang8, Dong-Wook Kim9, Jinseok Kim10, Young-Joo Kim2, Choong-Ki Lee11, Hye-Soon Lee12, Jisoo Lee13, Sang-Heon Lee14, Sang-Hoon Lee15, Shin-Seok Lee16, Yeon-Ah Lee17, Seong-Su Nah18, Seung Cheol Shim19, Gwan-Gyu Song20, Chang-Hee Suh21, Soyoung Won1, Wan-Hee Yoo22, Bo Young Yoon23
1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 2Outcomes Research/Real World Data Team, Corporate Affairs and Health & Value Division, Pfizer Pharmaceuticals Korea Limited, Seoul, 3Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, 4Division of Rheumatology, Korea University Ansan Hospital, Ansan, 5Department of Rheumatology, Dong-A University Hospital, Busan, 6Department of Rheumatology, Konyang University Hospital, Daejeon, 7Department of Rheumatology, Hallym University Kangnam Sacred Heart Hospital, Seoul, 8Department of Rheumatology, Kyungpook National University Hospital, Daegu, 9Department of Rheumatology, Inje University Busan Paik Hospital, Busan, 10Department of Rheumatology, Jeju National University School of Medicine, Jeju, 11Department of Infectious Diseases and Rheumatology, Yeongnam University Hospital, Daegu, 12Department of Rheumatology, Hangyang University Guri Hospital, Guri, 13Division of Rheumatology, Ewha Womans University Mokdong Hospital, 14Department of Rheumatology, Konkuk University Medical Center, 15Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Seoul, 16Division of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, 17Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, 18Department of Rheumatology, Soonchunhyang University Cheonan Hospital, Cheonan, 19Department of Rheumatology, Chungnam National University Hospital, Daejeon, 20Division of Rheumatology, Korea University Guro Hospital, Seoul, 21Department of Rheumatology, Ajou University School of Medicine, Suwon, 22Department of Rheumatology, Chonbuk National University Hospital, Jeonju, 23Division of Rheumatology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
Correspondence to: Sang-Cheol Bae http://orcid.org/0000-0003-4658-1093
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. E-mail:scbae@hanyang.ac.kr
Received: November 23, 2017; Revised: February 2, 2018; Accepted: February 20, 2018; Published online: April 1, 2018.
© Korean College of Rheumatology. All rights reserved.

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Objective. Productivity loss was compared by 3-stage of disease activity and associations between higher disease activity and high productivity loss were identified. Methods. Data were extracted from Rheumatoid Arthritis (RA) Patient-reported Outcomes Research, which enrolled 2,000 RA patients (>20-year) on disease-modifying-antirheumatic-drugs (DMARDs) (≥ 6-month) from December 2012 to June 2013. This included 1,457 RA patients with the disease activity score (DAS-28-ESR) in their medical charts. Productivity loss in time and indirect cost was estimated using The World Health Organization Health and Work Performance Questionnaire (HPQ). Baseline characteristics and productivity loss outcomes were compared according to DAS-28-ESR groups. Results. 84.4% were females, 54.2% had low DAS-28-ESR (<3.2), and 38.2% and 7.6% had moderate (3.2~5.1) and high DAS-28-ESR (>5.1). Patients with moderate to high DAS-28-ESR had higher lost productivity time (LPT) and monthly costs of LPT than those with low DAS-28-ESR (time in hours: 110.0±58.4 vs. 132.4±57.2 vs. 71.5±52.0, p<0.0001; monthly costs of LPT in 1,000 Korean won: 1,097±607 vs. 1,302±554 vs. 741±531, p<0.0001). Multiple regression analyses revealed significant associations with high LPT in high (adjusted odds ratio [OR]=3.87, 95% confidence interval [CI]: 2.18~6.87) and moderate DAS-28-ESR (adjusted OR=1.88, 95% CI: 1.41~2.52) compared to low DAS-28-ESR. In addition, positive associations with high monthly costs of LPT were observed in high (adjusted OR=3.45, 95% CI: 1.98~5.99) and moderate DAS-28-ESR (adjusted OR=1.93, 95% CI: 1.43~2.54) compared to low DAS-28-ESR. Conclusion. Timely therapeutic strategies should be taken into consideration given that the RA patients with moderate to high DAS-28-ESR showed strong associations with high productivity loss for effective management of RA.
Keywords: Rheumatoid arthritis, Productivity loss, Disease activity score, Patient reported outcome measures

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