Morning stiffness and its influence on early retirement in patients with recent onset rheumatoid arthritis

Objective. To describe the association between morning stiffness (MS) and early retirement in patients with early RA. Methods. The study used data from a prospective RA cohort of 916 RA patients with disease duration 24 months. Data pertained to standard clinical measures and patients self-reports, such as functional capacity, pain and MS. Multivariate logistic regression analyses were performed to determine the association between MS and early retirement at 3 yrs, adjusting for sex, age, baseline working status, functional capacity, pain and 28-joint disease activity score (DAS28). Results. MS was strongly associated with pain and functional capacity and to a lesser degree with joint counts and active phase responses. Severe MS in early disease had a significant impact on early retirement within the following 3 yrs. Of the 389 patients who were 61 yrs old and working at baseline, 80 (21) had to take early retirement until the end of the study. Early retirement concerned 46 of the patients with severe and 10 of those with mild MS at study entry. Baseline working status was the strongest predictor and was severe compared with mild MS, the second strongest predictor of early retirement (adjusted odds ratio 6.0; 95 CI 2.9, 12.6). Conclusions. Severe MS in the early course of the disease has a high impact on RA patients decision to withdraw from working life. Great attention should be paid to the effective treatment of MS in early RA, to prevent patients from possible untimely decisions that will have long-lasting and costly consequences.