Predicting the Timing of Job Loss and Change in Patients Receiving Standard and Biologic Treatment for Radiographic and Non-Radiographic Axial Spondyloarthritis

Abstract We focused on investigating clinical and laboratory predictors of the timing of job loss and job changes in non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA (r-axSpA) patients and the effect of biological therapies used. The study included 202 axSpA (42 nr- axSpA, 160 r-axSpA) patients who were employed in paid jobs at the time of axSpA treatment initiation. Spinal mobility, disease activity, and functional status were evaluated. During a 5-year follow-up period, patientsʼ occupations, instances of job loss, and occupational changes were documented. Data regarding the timing of job loss and job changes were recorded, including instances of early retirement following job loss. r-axSpA patients were diagnosed with notably higher disease activity and required more biologic treatments (p=0,001, p=0,001). Job loss and job changes were more prevalent in r-axSpA patients compared to nr-axSpA patients (p=0,021, p=0,001). There was no statistically significant association between job loss and biologic therapy type (p=0,068). High BASMI scores were an independent predictor of job loss (p=0,040). High BASFI scores and lateral lumbar flexion limitations were significant independent predictors of job change (p=0,021, p=0,003). Job loss occurred significantly earlier in patients with a family history of SpA, those who were HLA-B27 positive, and those with cervical limitations, compared to their respective counterparts (p=0,004, p=0,050, p=0,010, respectively). r-axSpA patients are particularly vulnerable to these adverse outcomes early in the disease course. Job loss and changes occur more rapidly in patients with HLA-B27 positivity, a family history of the disease, and spinal limitations.