EXTENDED REPORT Employment perspectives of patients with ankylosing spondylitis

Objectives: To assess the labour market position of patients with ankylosing spondylitis (AS) in relation to disease duration and to identify potential factors in relation to withdrawal from the labour force. Methods: A cross sectional mail survey was conducted among 658 patients with AS. Participation in the labour force was defined as having a paid job. The independent effect of duration of disease was examined by an indirect method of standardisation. A broad variety of risk factors were examined separately and in a combined analysis, including sociodemographic factors, disease related variables, coping styles, and work related factors. Attributable and preventable fractions were calculated from the combined analyses to assess the relative importance of the contributing factors. Results: Probability of participation in the labour force was similarly reduced in patients with AS with different durations of disease. Pacing to cope with limitations was the most relevant factor in increasing the risk of withdrawal from the labour force, accounting for 73% of withdrawals. Coping with limitations by often seeking creative solutions, high disease activity, increased age, and insufficient support from colleagues or management were also positively associated with withdrawal from the labour force. Technical or ergonomic adjustments of the workplace, working in large companies, and coping with dependency style through frequent acceptance were negatively associated. Of these factors, technical or ergonomic adjustment was the most relevant in terms of reducing the risk. Conclusion: Sociodemographic factors, disease related factors, coping styles, and work related factors contribute simultaneously to withdrawal from the labour force.