Standardisation is needed for sick leave and disability rules for people with RA

There is large variation between countries in Europe in the rules for sick leave and work disability pensions.

Rheumatoid arthritis is a chronic inflammatory disease that affects a person’s joints, causing pain and disability. Rheumatoid arthritis affects people of all ages, although it is more common in women than men.

Rheumatoid arthritis can affect a person’s functional ability, and limit their ability to work. After 10 years with the disease, around one-third of people with rheumatoid arthritis are no longer able to work. The rules for sick leave and disability pensions for people with rheumatoid arthritis vary between countries. Previous research
has grouped the different welfare and social security systems into five types. These are listed out below, with the countries that each applies to:

• Anglo-Saxon: UK, Ireland
• Scandinavian: Denmark, Iceland, Sweden, Norway, Finland
• Bismarckian: Austria, Belgium, Germany, France, Israel, Netherlands, Switzerland;
• Mediterranean: Cyprus, Greece, Italy, Portugal, Spain, Turkey
• Post-Communist: Albania, Bulgaria, Czech Republic, Croatia, Estonia, Georgia, Hungary, Latvia, Lithuania, Poland, Romania, Russian Federation, Serbia, Tajikistan, Slovak Republic, Slovenia

What did the authors hope to find?
The authors hoped to find out whether rules for sick leave and work disability for people with rheumatoid arthritis are different across European countries. They were also interested in how well people with rheumatoid arthritis and their doctors think the system works. For example, how well the system supports people to remain
at work, and whether the process to apply for disability pension is transparent.

How was the study conducted?
The study was made up of three surveys. The first survey looked at the formal rules and regulations that apply when a person with RA is not able to work (either temporarily or permanently). This survey was filled in by one rheumatologist in every country. The person completing this first survey was encouraged to seek help from
other experts and local authorities for specific questions.

For the second and third surveys, 15 people with rheumatoid arthritis and 15 rheumatologists in each country completed a questionnaire that asked about their perceptions of different aspects of the social security and welfare system.

What are the main findings of the study?
The study found that there was a lot of variation between countries in the regulations around staying at work or being put on a disability pension. These variations could not be explained by a country’s wealth or the type of welfare system that they had.

The study also found that nearly three-quarters of the rheumatologists thought there was a lack of standardisation in how decisions are made about people’s ability to work. Rheumatologists in wealthier countries and EU-member countries were less confident about making decisions on people’s ability to work. One reason for this could be that rheumatologists in lower income countries interact more with patients on these issues and accept disability questions as part of their responsibility.

Overall, patients and rheumatologists in countries with Scandinavian or Bismarckian systems were the most satisfied with the regulations in place, and the performance of the welfare and social security system in their country.

Are these findings new?
Previous studies have looked at differences in work disability rates and regulations in people with rheumatoid arthritis. However, this study is the first to show that there are differences across a large number of European countries in the rules around staying in work, and people’s work disability rights.

What are the limitations of the study?
The major limitation is that social security systems are very complex. Also, just because rules are in place does not mean they are always followed, and this was not captured in this study.

What do the authors plan on doing with this information?
This information supports calls to streamline policies for people with rheumatoid arthritis who experience restrictions in their work ability.

What does this mean for me?
If you have rheumatoid arthritis, there are many different factors which can affect whether you will be well enough to stay at work, if you need adaptations in the work place, or if you will need to go on a disability pension. Some of these apply to you as an individual, and some are because of the country or region you live in.

Social security systems are different and complex. If you have questions about your disease or your ability to work, you should talk to your rheumatologist, and check the rules and regulations in your country so that you can take well-informed decisions about continuing or stopping work.

If you are interested in finding out more, have a look at the EULAR campaign called “Don’t Delay, Connect Today – Time2Work”. This campaign was run in 2019, and highlights how important it is for employers to support people with rheumatic and musculoskeletal diseases like rheumatoid arthritis. You can find the campaign here:

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Date prepared: October 2019
Summary based on research article published on: 19 August 2019
From: Putrik P, et al. Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries. Ann Rheum Dis 2019;78:1472–1479. doi:10.1136/annrheumdis-2019-215294
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