Adaptations made by rheumatoid arthritis patients to continue working: A pilot study of workplace challenges and successful adaptations

Objectives. The goals of this pilot study were to use qualitative research techniques in a group of currently employed patients with rheumatoid arthri tis (RA) to develop categories of challenges encountered in maintaining emp loyment and categories of successful adaptations made to continue working; and to identify obstacles considered to be persistent threats to continued employment. Methods. Patients were interviewed by telephone with a questionnaire compos ed of structured-response format and open-ended response format questions f ocusing on specific challenges and adaptations in the workplace. Results. Of the 22 patients interviewed, 96% were women, mean age was 50 ye ars, 84% were college graduates, and the majority had light physical job de mands and high autonomy over their work and hours worked. Patients encounte red diverse challenges, such as fatigue, pain, typing, writing, physical re quirements, maintaining a pleasant disposition, working overtime, traveling for business, commuting, being on time, not being able to choose rest peri ods, and environmental issues. Patients also made multiple adaptations to c ontinue working, the most helpful being changing job or altering career pat h (36%), altering work hours (32%), using more disease-modifying antirheuma tic drugs (27%), using car service (23%), sleeping more (18%), and working at home (14%). Patients were not at all confident in their ability to conti nue working because of RA, and perceived the following persistent threats t o continued employment: fatigue (45%), not being able to use hands (45%), n ot being able to choose rest periods (27%), and commuting problems (18%). I n addition, patients confronted psychological stresses, such as dealing wit h coworkers and supervisors and balancing job and personal roles. These cha llenges and adaptations included unfavorable work-related occurrences, or " negative work-role events." Conclusions. Seemingly successfully employed patients with RA faced multipl e challenges and made major adaptations to maintain employment and still pe rceived their employment to be in jeopardy because of RA. The findings of t his study have important implications for screening patients at risk for ne gative work-role events and for possible work-related and social support in terventions aimed at preserving employment.