# Development of a clinical tool to identify patients with early inflammatory arthritis at high risk of employment loss: analysis from the National Early Inflammatory Arthritis Audit

## TL;DR

A new tool was developed to identify patients with early inflammatory arthritis who are at high risk of losing their jobs, based on factors like occupation, age, and mental health.

## Contribution

The study introduces a risk stratification tool using routinely collected clinical data to predict employment loss in early inflammatory arthritis patients.

## Key findings

- Manual workers had a higher risk of employment loss compared to non-manual workers.
- A risk score incorporating age, occupation, musculoskeletal burden, and mental health effectively stratified patients into low, medium, and high-risk groups.
- The tool demonstrated good discrimination and calibration, with high-risk patients having nearly 20% employment loss.

## Abstract

Work disability is an early consequence of inflammatory arthritis. Preventive interventions exist but access is limited, highlighting the need for risk stratification. We aimed to develop a tool using routinely collected data to identify patients at greatest risk of employment loss.

This cohort study used data from the National Early Inflammatory Arthritis Audit. Patients ≥16 years with early inflammatory arthritis (EIA), enrolled May 2018–April 2025, employed at diagnosis and with three-month follow-up were included. The outcome was self-reported employment loss at 3 months. Predictors were occupation (manual vs non-manual), age, sex, disease activity (DAS28 > 5.1), mental health (anxiety/depression) and musculoskeletal burden (MSKHQ ≤25v > 25). Employment loss was modelled using Poisson regression. Model discrimination, calibration and bootstrap validation were assessed. A risk score was derived and stratified into low, medium and high-risk groups.

Of 11 894 patients with EIA, 6036 were employed at baseline and 1662 had complete work-outcome data. At 3 months, 168(10.1%) reported employment loss. Manual workers had higher risk than non-manual (14.1% vs 7.8%). In multivariable analysis, manual work (IRR: 1.54, 95% CI: 1.15–2.06), older age (per 10 years: IRR: 1.65, 95% CI: 1.43–1.90), high musculoskeletal burden (IRR: 1.55, 1.10–2.19) and anxiety/depression (IRR: 1.45, 1.02–2.06) were associated with employment loss, whereas DAS28 was not. The optimal model (age, occupation, musculoskeletal and mental health) showed good discrimination (C-statistic 0.710) and calibration. An 8-point score stratified patients into low (2.5%), medium (9.1%) and high-risk (19.5%).

Employment loss in EIA is driven by occupation, age, musculoskeletal symptoms and mental health. A risk tool incorporating these domains can stratify patients and guide targeted interventions.