Study finds people with inflammatory arthritis face significant psychological challenges in maintaining employment

Research from Hospital for Special Surgery (HSS) reveals a significant psychological impact related to inflammatory arthritis patients' efforts to maintain employment while coping with the challenges of their illness. The study, titled "The Psychological Experience of Work for People with Inflammatory Arthritis (IA)," was presented at the American College of Rheumatology (ACR) Convergence 2023 on November 13 in San Diego.

"A large body of research indicates that people with inflammatory arthritis are at increased risk for work disability, which can profoundly affect their lives. Within 10 years of diagnosis, as many as 40% of those with IA will be unable to work," said Joan Westreich, MSW, LCSW, social work coordinator, Early Arthritis Initiative at HSS.

"While previous studies have described challenges in maintaining employment, they have largely focused on addressing concrete barriers and strategies. To our knowledge, none of these studies has adequately explored the nuanced psychological experience of working while living with the challenges of these diseases."

Westreich and colleagues set out to explore the psychological experience of people with IA in the workplace. A clinical social work researcher conducted interviews from March 2021 to March 2022 with patients 18 years of age and older who were employed at the time or had worked within the past five years. The interviews, conducted via Zoom, averaged one hour in duration.

Researchers compiled a preliminary analysis of 20 interviews of racially and ethnically diverse participants. Seventy-five percent of respondents were female, with conditions including rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. Westreich points to nine themes that emerged related to the impact of IA on employment:

• Challenges to identity and pride. (The vital role of work in sense of identity, pride in achievements, struggle coping with IA and its impact at work.)
• Guilt, shame and ableism. (Guilt, shame and internalized ableism about one's diminished capacity and its impact at work.)
• Managing perceptions. (Attempts to process and cope with real or imagined perceptions of family and/or colleagues.)
• Grappling with disclosure. (Weighing decisions about whether to disclose condition at work and the potential consequences.)
• Pushing through. (Internal/external pressure to be productive at work, presenteeism, absenteeism.)
• Financial security. (The need to maintain employment to sustain living costs, medical insurance and health care.)
• Mental health impact. (Feelings of stress, anxiety, anger, depression.)
• Personal/professional support. (Support is complex, variable, vital to maintaining work and often inadequate.)
• New perspectives, transformations, meaning-making. (Evolving priorities and values, shift in perspective, prioritizing self-care and turning to spiritual practices and other forms of meaning-making.)

The study findings reveal key psychosocial areas to consider in a comprehensive health assessment of patients with inflammatory arthritis, Westreich said. "With a deeper understanding of patients' experiences, the health care team is better able to provide interventions to meet their needs. Rheumatologists may want to think about collaborating early and often with other disciplines to support patients who wish to maintain healthy employment."

Theodore R. Fields, MD, FACP, a rheumatologist and clinical director of the Early Arthritis Initiative at HSS, noted that the study also underscores the need for patients with IA to receive education about how to navigate their employment situation.

"Patients may be unaware of accommodations that their employer is legally required to make, and some employers may be willing to go beyond the legal requirements to retain a good worker," he said. "In view of possible accommodations such as more flexible schedules and ergonomic desk setups, the study of work issues can lead to major gains for people with inflammatory arthritis."