Rehabilitación y terapia ocupacional desde un enfoque centrado en la persona y basado en la ocupación: un estudio de caso de artritis psoriásica / Rehabilitation and occupational therapy from a person-centred and occupation-based approach: a case study of psoriatic arthritis

Se presenta un estudio de caso con diagnóstico de artritis psoriásica. La propuesta de intervención se articuló desde un enfoque centrado en la persona y basado en las necesidades ocupacionales, atendiendo al posicionamiento institucional de la Federación Mundial de Terapeutas Ocupacionales (WFOT).Objetivo: Evaluar la eficacia de un programa de terapia ocupacional individualizado basado en la ocupación y centrado en un paciente con artritis psoriásica, en términos de mejoría en el desempeño ocupacional y la calidad de vida percibida.Metodología: Se evaluaron problemas del desempeño ocupacional (COPM y DASH), así como la calidad de vida percibida (WHOQOL-BREF). Secundariamente se registraron medidas de dolor (EVA), movilidad articular (goniometría y mediciones centimétricas) y fuerza (dinamometría). Se establecieron objetivos funcionales de intervención desde la metodología SMART y se aplicó un programa de intervención combinando diversas modalidades de tratamiento que vienen acumulando diversos niveles de evidencia científica: férulas, productos de apoyo, ejercicio, protección articular y educación para la salud. Resultados: Se registraron mejoras significativas en desempeño ocupacional (COPM y GAS), así como en satisfacción (COPM) y en calidad de vida percibida (WHOQOL-BREF). Se obtuvieron, igualmente, resultados positivos en el resto de las variables observadas: reducción del dolor, incremento del movimiento articular y de la fuerza muscular.Conclusiones: La intervención propuesta, bajo un enfoque top-down logró cambios significativos no sólo en el desempeño ocupacional y en la calidad de vida percibida, sino también en las deficiencias de funciones corporales.

A case study with a diagnosis of psoriatic arthritis is presented. The intervention proposal was articulated from a person-centered and occupational-based approach, attending to the position statement of the World Federation of Occupational Therapists (WFOT).Aim: To evaluate the efficacy of an individualized occupational therapy program, based on occupation-based and centered on a patient with psoriatic arthritis, in terms of occupational performance improvement, and perceived quality of life.Methodology: Occupational performance problems (COPM and DASH), as well as perceived quality of life (WHOQOL-BREF) were evaluated. Secondarily, pain measurements (VAS), joint mobility (goniometry and centimeter measurements) and strength (dynamometry) were recorded. Functional intervention aims were established from the SMART methodology, and an intervention program was applied combining various treatment modalities that have accumulated scientific evidence: splints, support products, exercise, joint protection and health education.Results: Significant improvements were registered in occupational performance (COPM and GAS), as well as in satisfaction (COPM) and in perceived quality of life (WHOQOL-BREF). Likewise, positive results were obtained in the rest of the variables observed: reduction in pain, increase in joint movement and muscle strength.Conclusions: The proposed intervention, from a top-down approach, achieved significant changes not only in occupational performance and perceived quality of life, but also in deficiencies in body functions.

Health-related quality of life in patients with psoriatic and rheumatoid arthritis: data from the prospective multicentre NOR-DMARD study compared with Norwegian general population controls.

OBJECTIVES: To compare (1) Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS), scale scores and Short Form-6 dimensions (SF-6D) between patients with rheumatoid arthritis (RA) and patients with psoriatic arthritis (PsA) and Norwegian general population controls and (2) improvements in these measures between patients with RA and PsA. METHODS: Analyses of covariance were performed to compare SF-36 measures between first-time enrolled patients with RA (n=3898) and PsA (n=1515) from the prospective observational multicentre NORwegian-Disease Modifying Anti-Rheumatic Drug study (6 months follow-up) and general population controls (n=2323). RESULTS: In age and gender-adjusted analyses, patients with PsA compared with patients with RA had similar PCS, MCS and SF-6D (p≥0.14), worse vitality and general health, but better physical functioning at 0/6 months (p≤0.03). With additional 28-joint disease activity scores adjustment as a proxy for joint inflammation, PCS, most scale scores and SF-6D were worse in patients with PsA than patients with RA at 0/3/6 months (p≤0.01). PCS was more impaired than MCS both in RA and PsA compared with general population controls (p≤0.001). Mean 3-month and 6-month improvements after disease-modifying anti-rheumatic drug treatment were larger in patients with RA than patients with PsA for bodily pain, vitality and mental health (p≤0.02). CONCLUSIONS: Health-related quality of life was overall similar in patients with RA and patients with PsA-with a tendency to worse scores in PsA-and worse compared with Norwegian general population controls.

A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial.

The objective of this study is to assess the effectiveness of resistance training in patients with psoriatic arthritis (PsA). The study is a randomized controlled trial with 41 patients aged between 18 and 65 years with diagnosis of psoriatic arthritis (PsA). The patients were randomized into the following: intervention group (IG) and control group (CG). The IG underwent resistance exercise twice a week, for 12 weeks. The CG remained with the conventional drug therapy. The outcome measurements were the following: BASFI and HAQ-S for functional capacity, one maximum repetition test (1RM) for muscle strength, SF-36 questionnaire for general quality of life, and BASDAI and DAS-28 for disease activity. The evaluations were done by a blinded evaluator at baseline (T0) after 6 (T6) and 12 weeks (T12). At baseline, the groups were homogeneous regarding clinical and demographic characteristics. The IG significantly improved functional capacity measured by HAQ-S and disease activity measured by BASDAI, compared to CG, at week 12. Regarding quality of life, the IG improved the domains "pain" and "general health status" compared to CG (p < 0.05). There was improvement in muscular strength in almost all exercises in IG, except in the exercise for biceps. However, there were statistical differences between groups only on exercise "leg extension" in IG compared to CG. Resistance training is effective in improving functional capacity, disease activity, and quality of life of patients with psoriatic arthritis. The clinical improvements were not coupled to significant changes in muscular strength.

Effects of cold mist shower on patients with inflammatory arthritis: a crossover controlled clinical trial.

OBJECTIVES: To evaluate the safety and effects of a new home treatment method, a whole-body cold mist treatment, on patients with chronic inflammatory arthritis. METHOD: Whole-body cold mist shower therapy was given to 121 voluntary patients with chronic inflammatory arthritis in this crossover study during 1-week rehabilitation periods. Pain and sleep quality were assessed by a 10-cm visual analogue scale (VAS). Mental status was assessed by the Depression Scale (DEPS). Body temperature, blood pressure, heart rate, use of occasional pain and sleep medication, and possible side-effects were recorded. RESULTS: The differences in pain (VAS) between treatment and control periods were significant (2.0 vs. 2.4, p = 0.006, paired t-test) in the last measurement, when assessing the pain of the past week as a whole. A trend could be seen of an increasing difference towards the end of the week. The treatment effect was statistically significant [likelihood ratio test (LRT), p < 0.0001] after controlling for period and sequence effects. There was an indication of better sleep quality (VAS) during the treatment period (2.3 vs. 2.7, p = 0.058 paired t-test) when assessing the past week as a whole. The mean DEPS scores showed no difference between the treatment periods (5.5 vs. 5.0, p = 0.1874 paired t-test, at start, and 4.5 vs. 4.1 p = 0.29 paired t-test, at the end). No significant side-effects were recorded. CONCLUSIONS: The new whole-body cold treatment method may offer a safe option for self-treatment of pain at home but further study is needed to determine the clinical significance of the effect after longer use.

Physical activity in spondyloarthritis: a systematic review.

Physical activity (PA) is associated with numerous health-related benefits among adults with chronic diseases and the general population. As the benefits are dose-dependent, this review aims to establish the PA levels of adults with spondyloarthritis and to compare these to the general population. Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE/PubMed, PEDro, AMED, CINAHL) were systematically searched from inception to May 2014 using medical subject headings and keywords. This was supplemented by searching conference abstracts and hand-searching reference lists of included studies. Eligible studies were randomized controlled trials and observational studies of adults with SpA in which free-living PA or energy expenditure levels were measured. Subjects less than 18 years or with juvenile-onset SpA were excluded. Outcomes included objective and self-report measurements. Two reviewers independently screened studies for inclusion and assessed methodological quality using the Cochrane risk of bias tool and the RTI item bank. From the 2,431 records reviewed, nine studies involving 2,972 participants were included. This review focused on qualitative synthesis. Meta-analyses were not undertaken due to differences in study design, measurement tools, and participant characteristics. This heterogeneity, coupled with the risk of bias inherent in the included observational studies, limits the generalizability of findings. Objective measurements suggest PA levels may be lower among adults with spondyloarthritis than in healthy population controls. Self-reported PA and self-reported rates of adherence to PA recommendations varied largely across studies; higher disease activity was associated with lower self-reported PA levels. Physical activity levels may be lower in adults with axial spondyloarthritis, with higher disease activity associated with lower PA levels.

The International Dermatology Outcome Measures Group: formation of patient-centered outcome measures in dermatology.

As quality standards are increasingly in demand throughout medicine, dermatology needs to establish outcome measures to quantify the effectiveness of treatments and providers. The International Dermatology Outcome Measures Group was established to address this need. Beginning with psoriasis, the group aims to create a tool considerate of patients and providers using the input of all relevant stakeholders in assessment of disease severity and response to treatment. Herein, we delineate the procedures through which consensus is being reached and the future directions of the project.

Smoking and delay to diagnosis are associated with poorer functional outcome in psoriatic arthritis.

OBJECTIVE: To identify predictors of poorer physical function in established psoriatic arthritis (PsA). METHODS: PsA patients with disease duration of ≥10 years were identified from the Bath longitudinal cohort. Physical function was assessed using the Stanford Health Assessment Questionnaire (HAQ). Sex, age at diagnosis, duration of symptoms prior to diagnosis, smoking, treatment and year of diagnosis were included in a multivariable regression analysis to identify associations with HAQ. RESULTS: 267 patients were identified for inclusion. The median age was 56 years (IQR 45-63), median disease duration was 13 years (IQR 10-18) and median HAQ score was 0.63 (IQR 0.13-1.25). The model predicted significant increases in HAQ related to smoking (0.23, 95% CI 0.04 to 0.42), age >50 years at diagnosis (0.27, 95% CI 0.03 to 0.51), symptom duration of ≥1 year before diagnosis (0.22, 95% CI 0.02 to 0.42), female sex (0.39, 95% CI 0.20 to 0.57) and history of treatment with an anti-TNF agent (0.63, 95% CI 0.32 to 0.93) at follow-up. CONCLUSIONS: Smoking, delay to diagnosis, older age at diagnosis, female sex and a history of anti-TNF treatment are associated with worse physical function in established PsA.

Long-term work disability in patients with psoriatic arthritis treated with anti-tumour necrosis factor: a population-based regional Swedish cohort study.

OBJECTIVE: To study long-term work disability before and after tumour necrosis factor (TNF)-antagonist therapy in patients with psoriatic arthritis (PsA). METHODS: Using the population-based South Swedish Arthritis Treatment Group Register, we identified 191 patients with PsA (median age 43 years, range 18-58 years, 54% men), who between January 2003 and December 2007 started treatment with adalimumab, etanercept or infliximab. We linked data to the Swedish Social Insurance Agency and calculated the proportion of work disability in 30-day intervals from 12 months before the start of treatment until 3 years after. For each patient with PsA we randomly selected four matched reference subjects from the general population. RESULTS: At treatment initiation 67% of the patients with PsA were work disabled-that is, either on sick leave (41.5%) or receiving a disability pension (25.3%). Patients sustaining treatment were, on average, work disabled 12.5 days a month at treatment initiation declining to 10.6 days a month after 3 years of treatment. Patients for whom the first treatment course failed were work disabled 16.5 days at treatment start decreasing to 15.6 days after 3 years. The background population were 2.5 days and 3.0 days off work each month, respectively. Regression modelling identified prior work disability status, anti-TNF treatment failure, higher age, female gender and longer disease duration as significant predictors of working disability. CONCLUSIONS: There was a decline in net work disability after initiation of anti-TNF treatment in patients with PsA. Patients withdrawing from treatment had a 50% increased risk of being work disabled. Prior work disability, higher age, female gender and longer disease duration were also associated with long-term work disability.

Linfedema bilateral en miembros superiores asociado a artritis psoriásica / Bilateral lymphedema in upper limbs associated to psoriatic arthritis

El linfedema en pacientes afectos de artritis reumatoide, aunque poco frecuente, es bien conocido, sin embargo existen muy pocos casos descritos en la literatura de linfedema en miembros en pacientes con artritis psoriásica. Se trata de una rara complicación en las artropatías inflamatorias. La etiología de esta alteración no se ha definido aún. Se ha sugerido que los productos inflamatorios de la sinovial son depositados en los vasos linfáticos adyacentes conduciendo a una linfangitis y obstrucción linfática. Su manejo no está estandarizado. Se describe el caso clínico de una paciente de 42 años con antecedentes personales de psoriasis con artritis psoriásica con linfedema bilateral en miembros superiores (AU)

Lymphedema associated to rheumatoid arthritis is a rare but recognized complication. However, there are only a few of cases of lymphedema of the limbs associated with psoriatic arthritis described in the literature. It is a rare complication of inflammatory arthropathy. The etiology of this disorder has still not been defined. It has been suggested that inflammatory products from the synovium are deposited in the adjacent lymphatics, leading to lymphangitis and lymphatic obstruction. Its management has not been standardized. We report a 42-year old woman with a long history of psoriasis and serious psoriatic arthritis with bilateral upper limb lymphedema (AU)

Impact of psoriatic arthritis on the patient: through the lens of the WHO International Classification of Functioning, Health, and Disability.

Psoriatic arthritis is associated with a broad range of problems from the perspective of the patient. These include symptoms relating to skin and musculoskeletal disease to difficulties with day-to-day activities, social interactions, paid employment, and community participation. Additional problems related to frequent comorbidities impose further impact. It has been shown that individuals with psoriatic arthritis have similar or worse disability than men older than 75 years of age in the general population, and psoriatic arthritis confers worse health status than many other common chronic diseases. The World Health Organization International Classification of Functioning, Disability, and Health provides a useful framework for considering the impact of this disease. Ideal clinical management of psoriatic arthritis would provide access to an interdisciplinary team with expertise in functional, social, vocational, and community issues, as well as to medical expertise.

Two-year direct and indirect costs for patients with inflammatory rheumatic joint diseases: data from real-life follow-up of patients in the NOR-DMARD registry.

OBJECTIVE: The overall aim of this study was to estimate the total costs for patients with RA, AS and psoriatic arthritis (PsA) treated with DMARDs. Specific aims were to compare the costs across diagnoses and over time. METHODS: The main data source was the Norwegian DMARD register (NOR-DMARD) that captures outcomes and resource use among patients starting therapy with synthetic and biologic DMARDs. Costs were estimated for four 6-month periods from the start of a DMARD regimen. We included RA (n=1152), AS (n=186) and PsA (n=374) patients with available 2-year data. Direct costs included pharmaceuticals, imaging examinations, in-hospital and out-hospital care, stays in rehabilitation units and visits to general practitioners, private rheumatologists and physiotherapists. Indirect cost included patients' work absenteeism. Differences in costs across diagnoses were tested by Kruskal-Wallis equality-of-populations rank test and changes in costs between first and fourth 6-month periods were tested by paired t-tests. RESULTS: Total 2-year costs were similar across diagnoses for patients on synthetic treatment (RA/AS/PsA €64,300/63,200/64,500) and on biologic treatment (€121,900/115,319/111,200). The largest cost component was productivity loss. Total costs decreased significantly from the first to the fourth 6-month periods for all diagnoses, and this decrease was influenced by reductions both in direct and indirect costs. CONCLUSION: Total costs were similar across the main inflammatory rheumatic diseases. Biologic DMARD treatment entails considerable drug cost, but the total costs decline during the first 2 years on treatment in both RA, AS and PsA.

Measuring participation in people with spondyloarthritis using the social role participation questionnaire.

OBJECTIVES: People with spondyloarthritis (SpA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have identified the importance of understanding how their disease and its treatment impacts on their social roles. This requires a reliable and valid standardised measure, and this study evaluates these measurement properties of the Social Role Participation Questionnaire (SRPQ). METHODS: 109 participants (44 with AS, 65 with PsA) completed questionnaires on demographics, participation measures (SRPQ, Keele Assessment of Participation (KAP), Late Life Disability Instrument (LLDI)), disease severity (physician global) and activity (pain, fatigue, Bath Ankylosing Spondylitis Disease Activity Index), psychological measures (depressive symptoms (Hospital Anxiety and Depression Scale), Illness Intrusiveness)) and function (Health Assessment Questionnaire, Bath Ankylosing Spondylitis Functional Index). After testing scaling properties, test-retest reliability of the SRPQ was evaluated using intraclass correlation coefficients (ICC) and hypotheses of construct validity were evaluated using correlation coefficients. RESULTS: Patients with AS had a mean age of 40 years and 65% were male, whereas patients with PsA had a mean age of 53 years and 63% were male. Although there were some differences between AS and PsA participants in their social role participation, scaling properties were good for both groups. ICCs were >0.90 for the satisfaction subscales of the SRPQ. For construct validity, SRPQ satisfaction subscales were moderately correlated with the KAP and LLDI (0.64-0.78), and less satisfaction was associated with higher disease severity and activity, more depressive symptoms, more illness intrusiveness and more disability (coefficients -0.67 to -0.88). CONCLUSION: Social role participation is an important concept for people with SpA, and the SRPQ is a reliable and valid measure for use with people with AS and PsA.

[Rehabilitation in rheumatology]. / Rehabilitation in der Rheumatologie.

Rehabilitation in rheumatology focuses on prevention of functional disorders of the musculoskeletal system, maintenance of working ability and prevention of care dependency. Drug treatment alone rarely results in long-term remission, therefore rehabilitative measures must be integrated into rheumatic care. Rehabilitative therapy in rheumatology includes physiotherapy, patient education and occupational therapy. Positive effects of physical therapy methods have been proven by various studies. Patient education and occupational therapy are important tools for stabilizing the course of the disease. To maintain positive rehabilitative results patients have to be involved in the selection of treatment measures and should take an active part in the long-term treatment process. Despite proven efficacy of physical measures there is evidence for a lack of utilization of rehabilitative therapy due to increasing cost pressure in the health care system which will further increase over time.

Psoriatic arthritis.

Psoriatic arthritis (PSA) is an entity of inflammatory joint disease associated with psoriasis. PSA belongs to the heterogeneous group of seronegative spondylarthropathies. Both peripheral joints and axial skeleton can be affected in a characteristic pattern. In addition to that, enthesitis and dactylitis are important extracutaneous manifestations. Uveitis anterior is temporarily seen in about one quarter of PSA patients. There is a closer relationship of nail and joint disease. This review provides data on drug and physical treatment options. In particular DMARDS and inhibitors of tumor necrosis factor alpha are established therapies with importance for quality of life and long term outcome. New drugs are tested in various trials.

Team-based rehabilitation improves long-term aerobic capacity and health-related quality of life in patients with chronic inflammatory arthritis.

PURPOSE: To examine the effect of an interdisciplinary, out-patient rehabilitation programme for patients with chronic inflammatory arthritis on aerobic capacity and health-related quality of life (HRQOL). METHOD: One hundred and seventy-four patients, 115 with peripheral arthritis (PA) (91 women, mean age 53 years, disease duration 16 years) and 59 with spondylarthropathies (SpA), (27 women, mean age 46 years, disease duration 14 years) were consecutively enrolled in 18 days of interdisciplinary rehabilitation. We report data from evaluations at inclusion, at discharge, and at 4 and 12 months using a sub-maximal treadmill test of aerobic capacity and the Nottingham Health Profile (NHP) (t-test). RESULTS: At inclusion, less than 20% of all patients tested had aerobic capacity classified as 'average' or better. At discharge, 41% (PA) and 54% (SpA) reached the 'average' level or better with improvements maintained for 12 months. The total NHP scores improved in both groups (mean change -12 (99%CI -15, -9) for PA; mean change -13 (99%CI -19, -8) for SpA) and were maintained. CONCLUSION: Aerobic capacity and HRQOL improved significantly in this interdisciplinary out-patient rehabilitation study, and improvements were maintained for 12 months. The preserved level of aerobic capacity after 12 months indicated a change to a more physically active lifestyle among the participants.

Rapid and sustained health utility gain in anti-tumour necrosis factor-treated inflammatory arthritis: observational data during 7 years in southern Sweden.

BACKGROUND: Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and other spondylarthritides impose a great impact on the individual in addition to the costs on society, which may be reduced by effective pharmacological treatment. Industry-independent health economic studies should complement studies sponsored by industry. OBJECTIVE: To study secular trends in baseline health utilities in patients commencing tumour necrosis factor (TNF) blockade for arthritis in clinical practice over 7 years; to address utility changes during treatment; to investigate the influence of previous treatment courses; to study the feasibility of health utility measures and to compare them across diagnostic entities. METHODS: EuroQoL 5 dimensions (EQ-5D) utility data were collected from a structured clinical follow-up programme of anti-TNF-treated patients with RA (N = 2554), PsA (N = 574) or spondylarthritides (N = 586). Time trends were calculated. Completer analysis was used. RESULTS: There were weak or non-significant secular trends for increasing baseline utilities over time for RA, PsA and spondylarthritides. The maximum gain in utilities had already occurred after 2 weeks for all diagnoses and remained stable for patients remaining on therapy. The first and second anti-TNF courses performed similarly. CONCLUSIONS: Utilities at inclusion remained largely unchanged for RA, PsA and spondylarthritides over 7 years. Improvement occurred early during treatment and not beyond 6 weeks at the group level. Improvement during the first course was not consistently greater than the second. There were no major differences between RA, PsA and spondylarthritides. EQ-5D proved feasible and applicable across these diagnoses. These "real world" data may be useful for health economic modelling.

Rehabilitation in psoriatic arthritis.

This article summarizes the state of the art of rehabilitation in psoriatic arthritis (PsA). Very little evidence was available to assess the efficacy of rehabilitation. Some data were borrowed from studies on ankylosing spondylitis. Covering certain aspects of the disease by the standard measure of functioning was difficult. However, rehabilitation was considered by the GRAPPA Group (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis), as part of treatment of axial PsA.

Involvement, satisfaction and unmet health care needs in patients with psoriatic arthritis.

OBJECTIVE: To examine the involvement in care, participation in medical decision, satisfaction of health care and unmet needs in patients with PsA. To explore factors related to involvement and satisfaction with care. METHODS: One hundred and five patients with PsA attending four regional hospital rheumatology outpatient clinics were invited and consented to self-administer questionnaires, including socio-demographic data, quality of life with SF-12, involvement in medical decision, satisfaction with care and unmet health care needs. RESULTS: The overall perceived knowledge of disease was moderate. Good disease knowledge and good physical functioning were positively associated with involvement in care. Age, sex and pain scores were not associated with involvement in multivariate analysis. A low score in at least one question on involvement was the single independent negative predictor for satisfaction with health care. Only a minority (9%) was actively participating in medical decision-making. Among non-participants, 61.5% expressed the wish to participate. In aspects of education of disease, advice for exercise, psychological support and social support, respectively, 68.3, 73.3, 29.3 and 41.6% of the patients expressed unmet needs. CONCLUSION: Low involvement is negatively associated with satisfaction with health care in PsA. Good knowledge of disease and good physical functioning is positively associated with involvement. The current study supports patient education as an important factor associated with involvement of and satisfaction with care in PsA patients. Such patients have a high desire for information and numerous unmet health care needs. There is a need for improvement in the delivery of care to patients with PsA.

Work disability and health-related quality of life in males and females with psoriatic arthritis.

OBJECTIVES: To compare health status, demographic variables and work disability (WD) between males and females with psoriatic arthritis (PsA) in the 18-45 age group, and further to compare health status between those with and without WD for each gender and to identify variables associated with WD. METHODS: A cross-sectional study was carried out of patients with PsA with peripheral arthritis at the time at which they started disease-modifying antirheumatic drug therapy (DMARD) and/or biological treatment. Patients receiving a permanent national WD pension corresponding to >or=50% were defined as work disabled. Gender differences were examined with regard to health status, demographic variables and WD. Mann-Whitney U test and Pearson chi(2) were applied for group comparisons between males and females and work disabled versus not work disabled for each gender. Multiple logistic regression analyses with adjustments for duration of education, disease duration, age, erosive disease, disability score (Modified Health Assessment Questionnaire; MHAQ), the short form-36 (SF-36) mental health score, and gender were used to identify variables associated with WD. RESULTS: Out of 271 (102 females) patients, the number (%) of work-disabled females/males was 33 (32.7%)/29 (17.4%) (p = 0.004). Work-disabled patients had generally worse health status than non-work-disabled patients, and these differences were generally more pronounced in males than in females. In the multiple logistic regression model, low educational level, increasing disability score (MHAQ), presence of erosive disease, female gender and disease duration were independently associated with WD. CONCLUSIONS: WD in patients with PsA below 45 years of age was independently associated with educational level, disability score, erosive disease, female gender and disease duration.