Systemic autoimmune diseases and work outcomes in Brazil: a scoping review

Cordeiro, Rafael Alves; Fischer, Frida Marina; Shinjo, Samuel Katsuyuki

doi:10.11606/s1518-8787.2022056003918

Brasil

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Review • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003918 linkcopy

Systemic autoimmune diseases and work outcomes in Brazil: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To review articles that assessed work-related outcomes such as workability, work productivity, presenteeism, absenteeism, sick leave, return to work, and employment status of Brazilian patients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren’s syndrome, and systemic autoimmune myopathies.

METHODS This study was conducted in Medline databases (PubMed), SciELO, and Lilacs through a combination of descriptors of interest. Studies published until December 2020 were considered in the search strategy.

RESULTS Eight out of 90 articles met the eligibility criteria and were included in this review. The studies are highly heterogeneous. Most of them are cross-sectional, and all of them address rheumatoid arthritis or systemic lupus erythematosus. A common denominator among these studies is the high proportion of patients outside the labor market.

CONCLUSIONS In general, the studies show unfavorable labor outcomes and impaired participation in the Brazilian workforce among the samples of patients assessed. There is a need to better understand several topics about Brazilian patients with systemic autoimmune diseases and their work context, as well as to conduct studies focusing on rarer diseases and on the themes of return and reintegration to work.

Autoimmune Diseases; Absenteeism; Employee Performance Appraisal; Occupational Health; Review

First author	Year of publication	Study design	Country/region	Disease studied	Source of patients/recruitment strategy	Sample size and characteristics	Disease characteristics
Sacilotto et al.⁹	2020	Cross-sectional analysis (initial assessment of a cohort study)	Brazil/different geographic regions of Brazil	Rheumatoid arthritis	11 public reference centers	1115 RA patients; mean age (56.7); female (90%)	Mean disease duration: 12.7 years; median DAS28^a: 3.5; median CDAI^b score: 9
Xavier et al.¹⁰	2019	Longitudinal	Latin America (Brazil, Argentina, Colombia, and Mexico)	Rheumatoid arthritis	18 rheumatology public and private clinics (4 Latin American countries)	68 RA patients in the Brazilian sample; mean age (45.9); female (86.8%)	Mean disease duration at baseline: 10.8 years; RAPID3^c score: remission (4.4%), low (1.5%), moderate (33.8%), high (55.9%)
Gomes et al.¹¹	2018	Cross-sectional	Brazil/Blumenau (SC)	Rheumatoid arthritis	Primary care centers, specialty outpatient clinics, and pharmacy	296 RA patients included; 185 in the final sample; mean age (54.5); female (82.7%)	Mean disease duration: 127.8 months
Pinheiro et al.¹²	2013	Cross-sectional	Brazil	Rheumatoid arthritis	not mentioned	526 RA medical records; mean age (51.0); female (81%)	Mean disease duration: 6.5 years; physician’s subjective rating on disease severity: the majority were mild or moderate
Azevedo et al.¹³	2008	Cross-sectional	Brazil/São Paulo (SP)	Rheumatoid arthritis	Rheumatology outpatient clinics of a public hospital	192 RA patients; mean age (47.3); female (85.9%)	Mean disease duration: 9.8 years; ACR functional class I (13.5%), II (29.7%), III (56.3%), IV (0.5%)
Louzada-Junior et al.¹⁴	2007	Cross-sectional	Brazil/State of São Paulo	Rheumatoid arthritis	Department of Rheumatology (four university hospitals)	Occupational data available in 650 revised RA medical records; mean age (53.7); female (86%)	Mean disease duration: 7.8 years; ACR functional class I (50%), II (37%), III (11%), IV (2%)
Teixeira et al.¹⁵	2017	Cross-sectional	Brazil/Maceió (AL) and São Paulo (SP)	Systemic Lupus Erythematosus	3 university hospitals and private clinics	523 SLE patients; mean age (37.8); female (96%)	Mean disease duration: 9.6 years; mean ACR/SLICC-DI^d score: 1.4; mean Mexican-SLEDAI: 1.82
Appenzeller et al.¹⁶	2009	Longitudinal	Brazil/Campinas (SP)	Systemic Lupus Erythematosus	Rheumatology unit of a public university	167 SLE patients at study entry; mean age (32.1); female (94.6%)	Mean disease duration at study entry: 64.5 months; mean SLEDAI^e: 11.5; 47.3% with SLEDAI ≥ 8

First author	Work outcomes assessed	How work outcomes were assessed	Work-related findings
Sacilotto et al.⁹	Employment status	Individual questionnaire; medical records used as secondary sources	Retired: 39%, housewives: 20%, disease support: 9%, unemployed: 5%, unemployed looking for work: 1%, formally registered worker: 16%, unregistered worker: 6%, self-employed worker: 4%. Employed patients: lower HAQ-DI^a averages and fewer erosions. Among the patients who retired: 56% due to RA; among the patients on disability benefit or temporarily retired: 82% due to RA.
Xavier et al.¹⁰	Wok productivity, absenteeism, presenteeism, and employment rate	WALS^b, WPAI^c, and WLQ-25^d questionnaires	Brazilian sample: WALS-score (0–36): 10.6 ± 6.8. WPAI-RA (0–100%): presenteeism (32,6%), absenteeism (5.8%), overall work impairment (5.9%). WLQ-25 - 4 dimensions (0–100%): work impairment (WI) due to physical demands (37.7%); WI due to time demands (29.3%); WI due to output demands (18.1%); WI due to mental-interpersonal demands (15.2%); WLQ-25 index: 5.9. The employment rate (Brazilian sample): 44.2% of the respondents of WPAI-RA. Considering the total sample (Brazil and other Latin American countries), higher educational levels were associated with better WLQ-25; previous orthopedic surgeries reduced absenteeism and work limitations; and worsening in disease activity was associated with decreased work productivity.
Gomes et al.¹¹	Employment status	Self-reported employment status during structured interviews	Prevalence of RA working patients: 44.3%. The prevalence of working patients was 90% higher among those under 60 years, 132% higher among low-income individuals (< 2 minimum wages) and 73% higher among patients with high functional disability assessed through the HAQ^a.
Pinheiro et al.¹²	Employment status, impairment while at work, and overall work impairment	Patient record form, patient self-completion form, and WPAI	Employed: 29%, retired: 24%, unemployed due to arthritis: 2% (other categories: student, self-employed, homemaker). Work and activity impairment rose with increasing disease severity. Severe RA patients had more unemployment due to arthritis and greater disease duration.
Azevedo et al.¹³	Employment status, days absent from work, time on sick leave, and time on retirement due to RA	Systematically structured interview	Early retirement due to RA: 24.5%, sick leave due to RA: 32.3%, working: 43.2%. Retired patients and those on sick leave tended to belong to lower socioeconomic categories, while those who were working were in the higher classes. Meantime on disability benefit: 2.25 years; meantime on retirement: 7.33 years.
Louzada-Junior et al.¹⁴	Employment status	Review of medical records	Formally employed: 31%; housewives: 40%; sick leave: 9%; unemployed: 4%; retired: 16%.
Teixeira et al.¹⁵	Employment status	Sociodemographic data were collected through a specific questionnaire	Unemployment rate: 63.7%. Among them, 47.4% were receiving social security and 23% referred to be permanently out of work because of SLE (higher for non-white patients). Out-of-work profile was associated with damage.
Appenzeller et al.¹⁶	Employment status	Structured interview at study entry and every 6 months for 3 years	At study entry, 70.7% of the patients were employed. After 3 years, 51.7% who were working at study entry, were still employed. Unemployment was predicted by the number of cognitive domains impaired, depression, fewer years of education, and the presence of anticardiolipin antibodies at study entry.

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[TFN1] ^a DAS28: Disease Activity Score 28-joints; ^b CDAI: Clinical Disease Activity Index; ^c RAPID3: Routine Assessment of Patient Index Data 3; ^d SLICC/ACR-DI score: Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score; ^e SLEDAI: Systemic Lupus Erythematosus Disease Activity Index.