Burden of idiopathic inflammatory rheumatic diseases in occupational healthcare: increased absenteeism and healthcare resource utilization.

OBJECTIVES: Patients with idiopathic inflammatory rheumatic diseases (IIRD) often have decreased working capacity resulting in indirect costs. However, data on patients' short-term sick leave has been limited. This retrospective cohort study evaluated the number and length of sick leave, including short-term leave, and occupational healthcare resource utilization (HCRU) of the working-aged patients with IIRD compared to controls. METHODS: The data on sick leave and occupational HCRU were gathered from the electronic medical records of the largest occupational healthcare provider in Finland from January 2012 to December 2019. Employed patients with an IIRD (including rheumatoid arthritis, spondyloarthritis, psoriatic and enteropathic arthritis, juvenile arthritis, and reactive arthritis) with at least a 12-months follow-up were identified and compared to age-, sex-, and follow-up matched controls without IIRD. RESULTS: Altogether 5405 patients with IIRD were identified and compared with an equal number of controls. The patients incurred approximately 2.5 times more sick leave than controls: 21.7 versus 8.5 days per patient year, respectively. Short-term sick leave was common: 83% of sickness absence periods of the patients lasted 1-9 days and represented 30% of the total absenteeism. Loss of productivity due to lost workdays was on average €4572 (95% confidence interval €4352-4804) per patient year. Occupational HCRU was approximately 1.8 times higher among IIRD patients than controls. CONCLUSIONS: Workers with an IIRD incur considerably more sick leave and use more occupational healthcare services than controls. Short sick leave not registered in national insurance registers constitute a significant portion of days off work among patients with IIRD.

Effect of Disease Severity on Comorbid Conditions in Atopic Dermatitis: Nationwide Registry-Based Investigation in Finnish Adults.

The majority of registry studies on atopic dermatitis include only patients and diagnoses from specialized healthcare. The aim of this retrospective, real-world cohort study was to evaluate the effect of atopic dermatitis severity on comorbidities and total morbidity, with comprehensive data from both primary and specialty healthcare registries covering the entire Finnish adult population. In total, 124,038 patients were identified (median age 46 years; 68% female) and stratified by disease severity. All regression analyses (median follow-up 7.0 years) were adjusted at a minimum for age, sex, obesity, and educational level. Compared with mild atopic dermatitis, severe atopic dermatitis was significantly associated with multiple morbidities, including neurotic, stress-related and somatoform disorders, abscesses, erysipelas/cellulitis, impetigo, herpes zoster, extragenital herpes, bacterial conjunctivitis, septicaemia, lymphomas, alopecia areata, urticaria, other dermatitis, contact allergy, osteoporosis, and intervertebral disc disorders (p < 0.001). In addition, there were significant associations with alcohol dependence, depression, condylomas, rosacea, migraine, sleep apnoea, hypertension, enthesopathies, atherosclerosis, and drug-induced cataract (p < 0.05). Odds ratios were modest and mostly were between 1.10 and 2.75. Furthermore, patients with severe atopic dermatitis had lower incidences of prostate cancer, cystitis, and anogenital herpes than patients with mild atopic dermatitis (p < 0.05). These results suggest that severe atopic dermatitis results in significant overall morbidity.

Patients with Hidradenitis Suppurativa Suffer from Low Health-Related Quality of Life as Measured by the Generic 15D Instrument.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with various comorbidities and diminished quality of life (QoL). Among dermatological conditions, HS is reported to most severely diminish QoL. This study aimed to analyse the health-related QoL (HRQoL) of patients with HS in more detail by using generic to disease-specific HRQoL questionnaires. Correlations between the HRQoL measures and HS disease severity measures were assessed. Methods: We analysed the HRQoL and clinical severity of patients with HS (N = 92) treated in 5 Finnish hospitals using HRQoL measurement tools most often used in dermatological clinics, as well as the generic 15D instrument (standardized and self-administered 15-dimensional measure of HRQoL). The disease severity was assessed using the Hurley stage, International Hidradenitis Suppurativa Severity Score System, and disease severity evaluation by the investigator. Results: The mean 15D score of HS patients was low and comparable with that of patients with cancers. No correlation was found between HS severity measures and 15D score, indicating that even mild HS has a high impact on HRQoL. Conclusions: Our findings strengthen the understanding about HS as a debilitating disease and even compared with non-dermatological conditions and highlight the need of comprehensive care of patients with HS.

Health-Related Quality of Life of Patients with Hidradenitis Suppurativa Measured with the 15D Instrument and Comparison with the General Population and Patients with Psoriasis.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease significantly impacting health-related quality of life (HRQoL). We measured the HRQoL of Finnish HS patients and compared it with that of the general population and psoriasis patients. METHODS: Twenty-six diagnosed HS patients completed the 15D HRQoL questionnaire (15D), the Dermatology Life Quality Index (DLQI), and the Beck Depression Inventory-21 (BDI-21). The correlation between the results of these instruments was analyzed and the 15D results were compared with an age-standardized general population and psoriasis patients. RESULTS: Compared with an age-standardized general population, HS patients scored statistically significantly worse on several 15D dimensions. A statistically significant difference compared to psoriasis patients was detected on the sexual activity dimension. Even though not statistically significant, the observed mean values of the remaining dimensions suggest that clinically important differences may exist. The 15D score negatively correlated with the DLQI score (r = -0.492; p = 0.011) and the BDI-21 score (r = -0.592; p = 0.001). CONCLUSIONS: HS is a serious condition, with an impact at least comparable to that of psoriasis. This study shows that the 15D is a feasible tool for examining HRQoL in HS patients.

The Burden of Hidradenitis Suppurativa in a Cohort of Patients in Southern Finland: A Pilot Study.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that impacts the quality of life. METHODS: We evaluated its burden in a cohort of 26 Finnish patients in a single-center cross-sectional study. Demographic data, disease history, clinical data, treatment patterns, and workability were collected. Patients responded to the Dermatology Life Quality Index (DLQI) and Beck Depression Inventory (BDI-21). RESULTS: Mean age of HS patients was 44.2 years and mean diagnostic delay was 13.7 years. Pain was rated the most bothersome symptom. Mean DLQI score was 8.31. Women consistently had higher scores than men for every item of the DLQI. Mean BDI-21 score was 10.69. Higher Hurley stage at visit (p = 0.001), female gender (p = 0.018), and higher BDI-21 score (p = 0.022) were variables that significantly affected the total DLQI score, whereas female gender (p = 0.004) was the only variable that significantly affected the total BDI-21 score using stepwise regression analysis. CONCLUSIONS: The burden of HS is for the first time reported in Finland. The diagnostic delay is longer than previously reported and the results suggest that women are impacted by the disease more than men.

Lead poisoning and recurrent abdominal pain.

Severe abdominal colic because of lead poisoning is an uncommon condition in adults. The diagnosis of lead toxicity is often delayed and abdominal pain is mistaken for acute abdomen. We describe three blood brothers who were involved in pottery glazing and suffered from repeated episodes of severe abdominal pain, nausea, vomiting, constipation and anemia due to lead toxicity. The patients had a history of several hospitalizations and one or two unnecessary laparotomies. One patient had wrists drop and weakness of the fingers extensors. All three patients had microcytic microchromic anemia with basophilic stippling of the erythrocytes, lead lines in X-ray of the knee joint and high blood lead levels. A diagnosis of lead poisoning was made and a course of chelating treatment started. Motor neuropathy, anemia and all gastrointestinal symptoms disappeared. Our report highlights the importance of taking a detailed occupational history and considering lead poisoning in the differential diagnosis of acute abdominal colic of unclear cause.