Working with arthritis: more common than you think
21 Aug 2017
Stephen Bevan, Head of HR Research Development
Mention ‘arthritis’ to most people and the mental image it conjures up is of an elderly person living with pain, deformation or inflammation of their joints, and impaired mobility. For many, the idea that arthritis could have a major effect on working-age people – or even very young people – would be a surprise. To discover that arthritis is a major cause of sickness absence and lost productivity in the UK might also raise a few eyebrows.
Today Arthritis Research UK (ARUK) is shining the spotlight on the prevalence and impact of arthritis, especially on working-age people in the UK and it is worth pausing to consider the effects these conditions have not just on employees but on their families and their employers. Having run a major multi-country study between 2007 and 2016 looking at the impact of arthritis on employment, and given my association with the Centre for Musculoskeletal Health and Work at Southampton University, I do not need to be convinced of its significance, especially as the workforce ages. But others might.
By way of background it is worth defining our terms. First, there are two main kinds of arthritis: osteoarthritis and rheumatoid arthritis. In research published in 2011, my colleagues and I found that Osteoarthritis (OA) is the most common cause of disability in the UK, incurring considerable societal costs[1]. It most frequently affects the hips and the knees but is common in the hands too. It can result from ‘wear and tear’, genetic factors or from joint or soft tissue injury. Each year, over 2 million adults visit their GP because of osteoarthritis. For over 93 per cent of people having hip procedures and 97 per cent of those undergoing knee procedures the primary indication is osteoarthritis. Over 40 per cent of UK men who have a hip replacement are of working age.
Rheumatoid Arthritis (RA) is an autoimmune condition, which means it is caused by the immune system attacking healthy body tissue such as joints and other tissues. Whilst the clinical course of RA is extremely variable, its features include pain, stiffness in the joints and tiredness (particularly in the morning or after periods of inactivity), weight loss and fever or flu-like symptoms. It affects the synovial joints, producing pain and eventual deformity and disability. Estimates suggest that in the UK the prevalence of RA is roughly three times higher for women than men (at 1.16 per cent and 0.44 per cent respectively)[2]. The disease affects people of any age, although peak incidence is in the mid age range of the working age population, between the ages of 25 and 55 years. Epidemiological studies have shown that RA shortens life expectancy by around 6-10 years.
There are two other forms of arthritis which affect young people specifically. Juvenile Idiopathic Arthritis (JIA) affects young people under 16 and can have a significant impact on education and transitions into employment. Similarly, Ankylosing Spondylitis (AS) is another inflammatory form of arthritis which is most common among young men. It can be hard to diagnose and it is not uncommon for there to be a gap of five years or more between symptom onset and diagnosis.
The effects of the disease can therefore make it difficult to complete everyday tasks, often forcing many people to give up work. According to the World Health Organisation work capacity is affected in most individuals within five years. One review of work productivity loss due to RA estimated that work loss was experienced by 36-85 per cent of RA sufferers in the previous year, for an average (median) of 39 days. In 2002, Young et al reported that 22 per cent of those diagnosed with RA stopped work five years after diagnosis because of their RA. However, in some cases the condition itself is not the main or only cause of having to leave work. Indeed the same study found a further group of respondents who stopped work due to a combination of RA, depression and other personal factors, giving an estimate of 40 per cent of those with RA withdrawing from the workforce because of their condition.
According to ARUK the economic impact of arthritis is considerable. For example, the annual work-related costs of ankylosing spondylitis alone due to early retirement, absenteeism and presenteeism are estimated to be £11,943 per person. Rheumatoid arthritis has been estimated to cost the UK economy between £3.8–4.8 billion per year, the combined costs of rheumatoid arthritis and osteoarthritis £14.8 billion and a further £10 billion of indirect costs are attributable to back pain.
So, what conclusions have I drawn about helping people with arthritis to remain – and thrive – in work? I’d pick out three key points:
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First, most people living with arthritis want to work. This is backed up by several surveys and by my own experience of working with hundreds of people worldwide who have contributed to my research. Sadly stigma, reluctant employers or even healthcare professionals who think that work has no therapeutic benefits remain serious barriers. Up to 60 per cent of people with arthritis are the main income earners in their household, so there is a financial imperative at play too.
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Second, workplace adjustments which help people with arthritis are usually inexpensive and very effective. This does not always involve physical alterations or even technology. Sometimes simple flexibility over the time and place of work, coupled with some compassion, are enough to help people with arthritis remain productive at work.
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Third, the biggest lesson I have learned is that the most qualified person to decide what works best is the employee themselves. Self-management – which places the individual at the centre of their clinical care and their vocational rehabilitation – is one of the most empowering and effective approaches to supporting people living with arthritis to continue to have fulfilling working lives.
[1] Bevan S, Zheltoukhova K, McGee R (2011), Adding Value: The Economic and Societal Benefits of Medical Technology, The Work Foundation
[2] Bevan S, Passmore E and Mahdon M (2007), Fit For Work? Musculoskeletal Disorders and Labour Market Participation, The Work Foundation
Any views expressed are those of the author and not necessarily those of the Institute as a whole.
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