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Fit For Work EuropeThe Work Foundation

Fit EU Blog

Discourse on work and wellbeing in the EU


Early Intervention Keeps Phil on Course

The news that World No 2 golfer Phil Mickelson has been diagnosed with Psoriatic Arthritis brings into sharp relief the importance of the early diagnosis and treatment of inflammatory conditions if people are to stand the best chance of living normal lives and staying in work.

The Fit for Work initiative has examined some of the literature on Psoriatic Arthritis. We know, for example that:

•    Psoriatic Arthritis (PsA) is a chronic inflammatory arthritis which occurs in people with Psoriasis. It can involve both skin lesions and joint inflammation, together with chronic pain. In 10 per cent of patients with PsA, 5 or more joints are affected (Reich and Mrowietz, 2007). Prevalence data for PsA in Europe is difficult to find, though a review by Cimmino (2007) suggested that its prevalence could be as high as 0.42 per cent.
•    1 in 6 psoriasis patients also develop PsA, but up to 30 per cent of these remain unaware or undiagnosed (Ibrahim, Waxman et al 2009)

•    Mortality risk in PsA patients has improved in the last 30 years (Castro-Rueda and Kavanaugh, 2008)

•    The mean onset of PsA is in the 30’s, with males and females equally affected (Leung, Tam et al, 2008)

•    Up to 33 per cent of PsA patients report losing their jobs as a result of their condition (Leung, Tam et al, 2008).
•    Psoriasis precedes PsA in 70 per cent of cases (Leung, Tam et al, 2008). In a US study, psoriasis was estimated to precede PsA by an average of 8.5 years (Gelfand et al, 2005)

•    PsA patients have higher incidence of obesity, insulin resistance and hypertension (Leung, Tam et al, 2008)

•    The majority of PsA patients respond to anti-TNF drug therapy (Coates et al, 2008). Clinical studies have demonstrated that these treatments can improve work productivity, increase employment rates and reduce days lost from work (Kavanaugh et al, 2006).

•    Psoriasis affects up to 2 per cent of the population, of whom between 20-30 per cent subsequently develop PsA (Filer, Barton et al, 2007; Radke, Reich et al, 2009).

•    There appears to be good evidence of a genetic link to PsA, one third of patients with PsA have a first degree relative with psoriasis and 10 per cent have a first degree relative with PsA (Coates, McHugh et al, 2007).

•    Psychological well-being among people with PsA can also be damaged (Aitken et al, 2006).

•    A study among PsA patients in Germany found that work disability rates were often not as high as RA patients, but that work disability among those with PsA who had developed the condition ten years previously or more (Mau et al 2005). The authors also found that workers with PsA were 1.5 times more likely to be unemployed if they had fewer than 9 years of formal education.

•    A survey conducted in the UK by the Psoriatic Arthropathy Alliance (PAA) – now the Psoriasis and Psoriatic Arthritis Alliance (Papaa) – found that 27 per cent of their members with PsA had experienced ‘job discrimination’ as a result of their condition (Papaa, 2006).

•    Work disability has been calculated to account for the majority of the costs associated with Spondyloarthropathies (Yelin, 2007). For all forms of arthritis, the costs associated with lost wages and other indirect costs represent 74 per cent of total costs (Callahan and Yelin, 2001).

•    A large study conducted in Norway indicated that the impact of PsA on a number of dimensions of quality of life – including work disability – was worse for people with psoriatic arthritis than for those with psoriasis alone (Zachariae et al, 2002).
•    There is evidence that vocational rehabilitation interventions which focus on job retention among workers with rheumatic conditions – including PsA and ankylosing spondylitis – can protect against job loss (Allaire et al, 2003). These interventions, which concentrated on supporting job accommodation, vocational counselling and self-advocacy, were found to be effective in promoting job retention 3-5 after they were initiated.

The signs are that Phil Mickelson has been able to get access to a diagnosis and treatment in good time, and that he has been able to keep playing golf at the highest level. For others with inflammatory disease the story isn’t always so positive. The Fit for Work initiative is continuing to campaign for earlier clinical and workplace interventions to enable those who develop these conditions to remain in or return to work.

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This entry was posted on Thursday, August 12th, 2010 at 2:47 pm and is filed under Musculoskeletal Disorders. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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