Withdrawal from labour force due to work disability in patients with ankylosing spondylitis

Objective-To investigate withdrawal from the labour force because of inabil ity to work owing to ankylosing spondylitis (AS) and to determine the chara cteristics of patients with no job because of work disability attributable to AS. Methods-A postal questionnaire was sent to 709 patients with AS aged 16-60 years followed up by a rheumatologist. Kaplan-Meier survival statistics wer e used to assess the time lapse between diagnosis and withdrawal from work. Standardised incidence ratios were calculated to compare withdrawal from t he labour force in patients with AS and the general population. Determinant s of withdrawal were assessed by Cox's proportional hazard regression analy sis using variables assumed to be time independent. Cross sectional charact eristics of patients without a job owing to disability were further analyse d by simple and multiple regression analyses. Results-A total of 658 patients returned the questionnaire. Of 529 patients with a paid job before diagnosis of AS, 5% had left the labour force withi n the first year after the diagnosis, 13% after 5 years, 21% after 10 years , 23% after 15 years, and 31% after 20 years. Age and sex adjusted risk for withdrawal was 3.1 (95% CI 2.5 to 3.7) times higher than in the general po pulation. In patients with AS, determinants of withdrawal from work were ol der age at diagnosis, manual work, and coping strategies characterised by l imiting or adapting activities. Patients with work disability at the time o f the study were older, came from a lower social class, and were more likel y to have total hip replacement, peripheral arthritis, or comorbidity. More over, they reported worse physical function (BAS-FI), experienced lower qua lity of life, and more often had extraspinal disease than those with a job. Conclusion-Withdrawal from work is 3.1 times higher in patients with AS tha n expected in the general population. Within patients, higher age at diagno sis, manual work, and unfavourable coping strategies are important determin ants of withdrawal. Patients without a job experience a lower quality of fi fe.