Study Explores Psychological Effects of Inflammatory Arthritis, Highlights Need for Multidisciplinary Treatment

A new study suggests that inflammatory arthritis (IA) has significant effects on the ability to maintain employment, and reveals key psychosocial areas to consider when treating a patient with IA.

Researchers from the Hospital for Special Surgery (HSS) in New York City presented the findings at the American College of Rheumatology (ARC) Convergence 2023 on Monday in San Diego, emphasizing the importance of early, personalized interventions and a collaborative care approach to help patients with IA navigate workplace accommodations.

"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 ten years of diagnosis, as many as 40 percent of those with IA will be unable to work," said Joan Westreich, MSW, LCSW, social work coordinator for the Early Arthritis Initiative at HSS and author of the study. “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.”

For the investigation, researchers set out to better understand the challenges of maintaining employment for patients with IA. The study analyzed 20 interviews with patients with IA aged 18 and over who had worked within the last five years. A clinical social work researcher conducted the interviews from March 2021 to March 2022.

According to the study, the participants were racially and ethnically diverse and majority female with conditions such as rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis. Nine themes concerning IA and employment emerged in their analysis, including:

• Challenges to identity and pride. The crucial role of employment in shaping self-identity and pride and the difficulties in adjusting to IA's effects in the workplace.
• Guilt, shame, and ableism. Experiencing guilt, shame, and internalized ableism due to reduced capabilities and its influence on professional life.
• Managing perceptions. Efforts to understand and manage actual or perceived views of family and colleagues.
• Grappling with disclosure. Contemplating the decision to reveal one's condition at work and its possible repercussions.
• Pushing through. The internal and external pressures to remain productive at work, including presenteeism and absenteeism.
• Financial security. The necessity of retaining employment for sustaining living expenses, health insurance, and medical care.
• Mental health impact. Experiencing stress, anxiety, anger, and depression as emotional responses.
• Personal/professional support. The complexity, variability, and crucial nature of support in maintaining employment, which is often insufficient.
• New perspectives, transformations, meaning-making. The evolution of personal priorities and values, altering perspectives, focusing on self-care, and engaging in spiritual and other forms of meaning-making.

To Westreich, the findings identify key psychosocial areas that healthcare practitioners should address when conducting a comprehensive health assessment of patients with IA. “With a deeper understanding of patients’ experiences, the healthcare team is better able to provide interventions to meet their needs,” said Westreich. “Rheumatologists may want to think about collaborating early and often with other disciplines to support patients who wish to maintain healthy employment.”

Also underscored in the study is the need for patients with IA to receive education about navigating their employment situation, said study author Theodore Fields, MD, FACP, a rheumatologist and clinical director of the Early Arthritis Initiative at HSS. "Patients may be unaware of accommodations their employer is legally required to make, and some employers may be willing to go beyond the legal requirements to retain a good worker," Fields explained. “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.”

Underlying these findings is the idea that the treatment of patients with IA should involve a whole-person approach that addresses not only immediate symptoms but also their manifestations and root causes. Many in the integrative field are exploring ways to improve the treatment of IA with whole-person medicine. This February, Robert Rountree, MD, Medical Director of Boulder Wellcare in Colorado, will be presenting at the Integrative Healthcare Symposium on the potential of functional medicine in the adjunctive management of chronic inflammatory joint conditions.

Find more on Rountree’s presentation here.