{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:37:27Z","timestamp":1791466647070,"version":"4.3.4"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Versuss Arthritis Endowed Chair in Rheumatology"},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Work disability is an early consequence of inflammatory arthritis. Preventive interventions exist but access is limited, highlighting the need for risk stratification. We aimed to develop a tool using routinely collected data to identify patients at greatest risk of employment loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cohort study used data from the National Early Inflammatory Arthritis Audit. Patients \u226516\u2009years with early inflammatory arthritis (EIA), enrolled May 2018\u2013April 2025, employed at diagnosis and with three-month follow-up were included. The outcome was self-reported employment loss at 3\u00a0months. Predictors were occupation (manual vs non-manual), age, sex, disease activity (DAS28\u2009&amp;gt;\u20095.1), mental health (anxiety\/depression) and musculoskeletal burden (MSKHQ \u226425v\u2009&amp;gt;\u200925). Employment loss was modelled using Poisson regression. Model discrimination, calibration and bootstrap validation were assessed. A risk score was derived and stratified into low, medium and high-risk groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 11\u00a0894 patients with EIA, 6036 were employed at baseline and 1662 had complete work-outcome data. At 3\u00a0months, 168(10.1%) reported employment loss. Manual workers had higher risk than non-manual (14.1% vs 7.8%). In multivariable analysis, manual work (IRR: 1.54, 95% CI: 1.15\u20132.06), older age (per 10\u2009years: IRR: 1.65, 95% CI: 1.43\u20131.90), high musculoskeletal burden (IRR: 1.55, 1.10\u20132.19) and anxiety\/depression (IRR: 1.45, 1.02\u20132.06) were associated with employment loss, whereas DAS28 was not. The optimal model (age, occupation, musculoskeletal and mental health) showed good discrimination (C-statistic 0.710) and calibration. An 8-point score stratified patients into low (2.5%), medium (9.1%) and high-risk (19.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Employment loss in EIA is driven by occupation, age, musculoskeletal symptoms and mental health. A risk tool incorporating these domains can stratify patients and guide targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/rap\/rkaf149","type":"journal-article","created":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T12:55:06Z","timestamp":1766235306000},"source":"Crossref","is-referenced-by-count":2,"title":["Development of a clinical tool to identify patients with early inflammatory arthritis at high risk of employment loss: analysis from the National Early Inflammatory Arthritis Audit"],"prefix":"10.1093","volume":"10","author":[{"given":"Ed","family":"Alveyn","sequence":"first","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Bechman","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5560-6603","authenticated-orcid":false,"given":"Maryam","family":"Adas","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Amlani-Hatcher","sequence":"additional","affiliation":[{"name":"NEIAA Patient Panel, British Society for Rheumatology , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mini","family":"Dey","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gallagher","sequence":"additional","affiliation":[{"name":"NEIAA, British Society for Rheumatology , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gibson","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethan","family":"Jones","sequence":"additional","affiliation":[{"name":", University of Liverpool Faculty of Health and Life Sciences , Liverpool,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daksh","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-9963","authenticated-orcid":false,"given":"Sam","family":"Norton","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]},{"name":"Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3042-0201","authenticated-orcid":false,"given":"Elizabeth","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Great Western Hospital NHS Foundation Trust , Swindon,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8171-7772","authenticated-orcid":false,"given":"Mark","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5992-1459","authenticated-orcid":false,"given":"Karen","family":"Walker-Bone","sequence":"additional","affiliation":[{"name":"Monash Centre for Occupational and Environmental Health, Monash University , Melbourne,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"MacPhie","sequence":"additional","affiliation":[{"name":"Rheumatology, Minerva Health Centre , Preston,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1230-2781","authenticated-orcid":false,"given":"James","family":"Galloway","sequence":"additional","affiliation":[{"name":"Department of Inflammation Biology, Centre of Rheumatic Disease, King\u2019s College London , 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