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Study Finds People with Inflammatory Arthritis Face Significant Psychological Challenges in Maintaining Employment

Research from Hospital for Special Surgery (HSS) reveals a significant psychological impact related to inflammatory arthritis patients’ efforts to maintain employment while coping with the challenges of their illness. The study, titled “The Psychological Experience of Work for People with Inflammatory Arthritis (IA),” was presented at the American College of Rheumatology (ACR) Convergence 2023 on November 13 in San Diego. 

“A large body of research indicates that people with inflammatory arthritis are at increased risk for work disability, which can profoundly affect their lives. Within 10 years of diagnosis, as many as 40% of those with IA will be unable to work,” said Joan Westreich, MSW, LCSW, social work coordinator, Early Arthritis Initiative at HSS. “While previous studies have described challenges in maintaining employment, they have largely focused on addressing concrete barriers and strategies. To our knowledge, none of these studies has adequately explored the nuanced psychological experience of working while living with the challenges of these diseases.” 

Westreich and colleagues set out to explore the psychological experience of people with IA in the workplace. A clinical social work researcher conducted interviews from March 2021 to March 2022 with patients 18 years of age and older who were employed at the time or had worked within the past five years. The interviews, conducted via Zoom, averaged one hour in duration. 

Researchers compiled a preliminary analysis of 20 interviews of racially and ethnically diverse participants. Seventy-five percent of respondents were female, with conditions including rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. Westreich points to nine themes that emerged related to the impact of IA on employment: 

• Challenges to identity and pride. (The vital role of work in sense of identity, pride in achievements, struggle coping with IA and its impact at work.) 
• Guilt, shame and ableism. (Guilt, shame and internalized ableism about one’s diminished capacity and its impact at work.) 
• Managing perceptions. (Attempts to process and cope with real or imagined perceptions of family and/or colleagues.) 
• Grappling with disclosure. (Weighing decisions about whether to disclose condition at work and the potential consequences.) 
• Pushing through. (Internal/external pressure to be productive at work, presenteeism, absenteeism.) 
• Financial security. (The need to maintain employment to sustain living costs, medical insurance and health care.) 
• Mental health impact. (Feelings of stress, anxiety, anger, depression.) 
• Personal/professional support. (Support is complex, variable, vital to maintaining work and often inadequate.) 
• New perspectives, transformations, meaning-making. (Evolving priorities and values, shift in perspective, prioritizing self-care and turning to spiritual practices and other forms of meaning-making.) 

The study findings reveal key psychosocial areas to consider in a comprehensive health assessment of patients with inflammatory arthritis, Westreich said. “With a deeper understanding of patients’ experiences, the healthcare team is better able to provide interventions to meet their needs. Rheumatologists may want to think about collaborating early and often with other disciplines to support patients who wish to maintain healthy employment.” 

Theodore R. Fields, MD, FACP, a rheumatologist and clinical director of the Early Arthritis Initiative at HSS, noted that the study also underscores the need for patients with IA to receive education about how to navigate their employment situation. “Patients may be unaware of accommodations that their employer is legally required to make, and some employers may be willing to go beyond the legal requirements to retain a good worker,” he said. “In view of possible accommodations such as more flexible schedules and ergonomic desk setups, the study of work issues can lead to major gains for people with inflammatory arthritis.” 

Authors: Joan Westreich, MSW, LCSW (presenting author), Adena Batterman, MSW, LCSW, Anna Balakrishnan, MSW, LMSW, Roberta Horton, LCSW, ACSW, Minerva Nong, BA, Vivian P. Bykerk, BSc, MD, FRCPC, Theodore R. Fields, MD, FACP. 

About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.