Work status and its determinants among patients with ankylosing spondylitis. A systematic literature review.

OBJECTIVE: To evaluate work status and its determinants among patients with ankylosing spondylitis (AS).
METHODS: A systematic literature review of original studies published after 1980 in which work status in AS was an outcome. Medline was searched and references of retrieved reports were checked for additional studies.
RESULTS: Sixteen full articles and 2 abstracts were identified, describing work status in 14 patient groups. Employment ranged from 34 to 96% after 45 and 5 years disease duration, respectively, and work disability from 3 to 50% after 18 and 45 years disease duration, respectively. Days of sick leave varied from 12 to 46 days per patient per year among those who had a paid job. Determinants of work status were reported in 9 studies. Age, education, and physical function were shown to be associated with work disability, while peripheral joint disease was associated with sick leave.
CONCLUSION: Results on work status show considerable variability due to heterogeneity of patient populations studied, but also because of large variation in choices and definitions of endpoints. The absence of data referring to a reference population and failure to adjust results for age and sex are striking. Although standardization in analyzing and reporting data on work status is badly needed, it is clear that work disability and sick leave in AS are substantial.