Employment Trajectories of Patients with Systemic lupus erythematosus ( <scp>SLE</scp> ) and Factors Driving Transitions Between States

OBJECTIVE: Systemic lupus erythematosus (SLE) significantly impacts employment capacity. This study aimed to investigate the impact of burden of disease activity, damage, and treatment on employment outcomes and transitions in patients with SLE. MATERIALS AND METHODS: Using data from a single center, we analyzed employment transitions, adjusted mean disease activity, and organ damage. Sankey diagrams helped visualize transitions between the categories. Multinomial logistic regression identified predictors of final employment status (employed, unemployed, disability benefit, retired, economically inactive, death while employed) for the disease activity and damage domains. RESULTS: Of 1,806 patients, limited transition was observed across employment categories. Of the 1155 ever employed, 398 patients (34.5%) permanently transitioned out of employment to disability benefits (n=82) or short-term sick leave (n = 71). Patients with disability showed high retention alongside significant health vulnerabilities, with the highest severe flare rates (0.3/year) and glucocorticoids use (47.8% on >30 mg/day), with a substantial proportion dying during follow-up. Early retirement was associated with malignancy, endocrine, and musculoskeletal damage (OR 2.51; 2.56; 1.47 respectively), while disability showed similar patterns with additional neuropsychiatric (OR 1.87) and renal damage (OR 1.89). CONCLUSION: There is a lack of transitions between employment categories over the disease course, high persistence in the disability benefits and economically inactive categories and a low probability of re-entry after leaving the workforce. Neuropsychiatric and renal damage are key drivers of disability. Unemployed and disability-bound patients face the worst disease progressions, underscoring the need for early occupational intervention and an unmet need for novel therapeutic treatments.