{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:07:45Z","timestamp":1790863665221,"version":"4.1.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec018\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Rheumatoid arthritis (RA) causes chronic polyarthritis and joint dysfunction, reducing work productivity. This reduction is mainly due to presenteeism, characterized by impaired work performance despite being present at work. This study aims to investigate the impact of specific joint involvement, particularly in the upper extremities, on work disability in RA patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec019\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Annual surveys assessing work disability were conducted among RA outpatients enrolled in the Nagahama Riumachi Cohort at Nagahama City Hospital, using the Work Productivity and Activity Impairment Questionnaire (WPAI). A multivariate regression analysis was performed to examine the cross-sectional and longitudinal associations between self-reported presenteeism and the tender joint count (TJC) in the extremities across two WPAI surveys.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec020\">\n<jats:title>Results<\/jats:title>\n<jats:p>The analysis included 201 patients, 52% of whom reported presenteeism. Cross-sectional analysis revealed a significant positive correlation between three or more TJCs of the upper extremity and presenteeism, with a regression coefficient (\u03b2) = 17.9 (95% confidence interval [CI]: 9.85\u201325.9). Among the joints evaluated, the sum of TJCs in the shoulder area (\u03b2\u2009=\u20099.55, CI: 5.39\u201313.7) and the fingers (\u03b2\u2009=\u20091.60, CI: 0.35\u20132.85) were significantly correlated with presenteeism. Additionally, change in presenteeism was significantly correlated with change in upper extremity TJCs (\u03b2\u2009=\u20091.41, CI: 0.05\u20132.77). No significant correlation was observed between lower extremity TJCs and presenteeism in these multivariate regression analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec021\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The upper extremity TJC is strongly associated with presenteeism in RA patients. Minimizing TJC in the upper extremities, particularly in the shoulders and fingers, could be important treatment goal to reduce work disability in RA patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318047","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T17:50:01Z","timestamp":1749145801000},"page":"e0318047","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Upper extremity joint tenderness as a practical indicator for assessing presenteeism in rheumatoid arthritis patients: A cross-sectional observational study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9961-2020","authenticated-orcid":true,"given":"Ryota","family":"Naito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Taniguchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Onizawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoya","family":"Nakajima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayo","family":"McCracken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Hiwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuji","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Onishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuichi","family":"Matsuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Morinobu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Hirose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Shinkawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisanori","family":"Umehara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8942-2933","authenticated-orcid":true,"given":"Masao","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"pone.0318047.ref001","article-title":"The burden of illness of rheumatoid arthritis","author":"A Boonen","year":"2011","journal-title":"Clin Rheumatol"},{"issue":"11","key":"pone.0318047.ref002","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1136\/ard.2003.020115","article-title":"Predictive factors of work disability in rheumatoid arthritis: a systematic literature review","volume":"63","author":"EM de Croon","year":"2004","journal-title":"Ann Rheum Dis"},{"issue":"6","key":"pone.0318047.ref003","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1136\/annrheumdis-2019-216243","article-title":"Economic burden of rheumatoid arthritis: a systematic review of literature in biologic era","volume":"79","author":"P-H Hsieh","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"pone.0318047.ref004","article-title":"The economic burden of rheumatoid arthritis: beyond health care costs","author":"W Zhang","year":"2011","journal-title":"Clin Rheumatol"},{"issue":"3","key":"pone.0318047.ref005","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1080\/14397595.2017.1361893","article-title":"Productivity loss of Japanese patients with rheumatoid arthritis - A cross-sectional survey","volume":"28","author":"R Sruamsiri","year":"2018","journal-title":"Mod Rheumatol"},{"issue":"3","key":"pone.0318047.ref006","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1002\/art.20419","article-title":"Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys","volume":"51","author":"SMM Verstappen","year":"2004","journal-title":"Arthritis Rheum"},{"issue":"8","key":"pone.0318047.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0285227","article-title":"How do symptoms of each joint contribute to global pain, disease activity and functional disability in rheumatoid arthritis? A comprehensive association study using a large cohort","volume":"18","author":"A Umemoto","year":"2023","journal-title":"PLoS One"},{"issue":"3","key":"pone.0318047.ref008","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/art.1780310302","article-title":"The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis","volume":"31","author":"FC Arnett","year":"1988","journal-title":"Arthritis Rheum"},{"issue":"9","key":"pone.0318047.ref009","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1136\/ard.2010.138461","article-title":"2010 rheumatoid arthritis classification criteria: an American college of rheumatology\/European league against rheumatism collaborative initiative","volume":"69","author":"D Aletaha","year":"2010","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"pone.0318047.ref010","doi-asserted-by":"crossref","first-page":"353","DOI":"10.2165\/00019053-199304050-00006","article-title":"The validity and reproducibility of a work productivity and activity impairment instrument","volume":"4","author":"MC Reilly","year":"1993","journal-title":"Pharmacoeconomics"},{"issue":"1","key":"pone.0318047.ref011","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3899\/jrheum.130815","article-title":"Worker productivity outcome measures: OMERACT filter evidence and agenda for future research","volume":"41","author":"K Tang","year":"2014","journal-title":"J Rheumatol"},{"issue":"6","key":"pone.0318047.ref012","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/art.1780360601","article-title":"The American college of rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The committee on outcome measures in rheumatoid arthritis clinical trials","volume":"36","author":"DT Felson","year":"1993","journal-title":"Arthritis Rheum"},{"issue":"6","key":"pone.0318047.ref013","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1002\/acr2.11658","article-title":"Having more tender than swollen joints is associated with worse function and work impairment in patients with early rheumatoid arthritis","volume":"6","author":"CF Meng","year":"2024","journal-title":"ACR Open Rheumatol"},{"key":"pone.0318047.ref014","article-title":"Quantitative joint assessment in rheumatoid arthritis","volume":"23","author":"T Sokka","year":"2005","journal-title":"Clin Exp Rheumatol"},{"issue":"11","key":"pone.0318047.ref015","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1002\/art.24828","article-title":"Effect of certolizumab pegol with methotrexate on home and work place productivity and social activities in patients with active rheumatoid arthritis","volume":"61","author":"A Kavanaugh","year":"2009","journal-title":"Arthritis Rheum"},{"issue":"10","key":"pone.0318047.ref016","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1002\/acr.22022","article-title":"Impact of etanercept on work and activity impairment in employed moderate to severe rheumatoid arthritis patients in the United States","volume":"65","author":"D Hone","year":"2013","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"pone.0318047.ref017","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/ard-2022-223356","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update","volume":"82","author":"JS Smolen","year":"2023","journal-title":"Ann Rheum Dis"},{"issue":"2","key":"pone.0318047.ref018","doi-asserted-by":"crossref","DOI":"10.1186\/ar2951","article-title":"Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study","volume":"12","author":"T Sokka","year":"2010","journal-title":"Arthritis Res Ther"},{"issue":"11","key":"pone.0318047.ref019","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1002\/acr.23619","article-title":"Patient-reported outcomes are more important than objective inflammatory markers for sick leave in biologics-treated patients with rheumatoid arthritis","volume":"70","author":"T Olofsson","year":"2018","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"2","key":"pone.0318047.ref020","article-title":"The impact of disease severity and duration on cost, early retirement and ability to work in rheumatoid arthritis in Europe: an economic modelling study","volume":"4","author":"J Galloway","year":"2020","journal-title":"Rheumatol Adv Pract"},{"issue":"11","key":"pone.0318047.ref021","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1002\/art.1780381115","article-title":"Predictors of work disability in rheumatoid arthritis patients. A five-year followup","volume":"38","author":"S Reisine","year":"1995","journal-title":"Arthritis Rheum"},{"issue":"2","key":"pone.0318047.ref022","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/acr.20342","article-title":"Impact of systemic sclerosis on occupational and professional activity with attention to patients with digital ulcers","volume":"63","author":"A B\u00e9rezn\u00e9","year":"2011","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"7","key":"pone.0318047.ref023","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1093\/rheumatology\/ker523","article-title":"Work status and its determinants among patients with systemic sclerosis: a systematic review","volume":"51","author":"AA Schouffoer","year":"2012","journal-title":"Rheumatology (Oxford)"},{"issue":"11","key":"pone.0318047.ref024","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1007\/s00296-019-04436-z","article-title":"LAUDES Study: impact of digital ulcers on hand functional limitation, work productivity and daily activities, in systemic sclerosis patients","volume":"39","author":"I Castellv\u00ed","year":"2019","journal-title":"Rheumatol Int"},{"issue":"3","key":"pone.0318047.ref025","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/DER.0b013e3182910416","article-title":"Hand and upper extremity function in workers with hand dermatitis","volume":"24","author":"DL Holness","year":"2013","journal-title":"Dermatitis"},{"issue":"6","key":"pone.0318047.ref026","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/oemed-2018-105647","article-title":"Work participation and working life expectancy after a disabling shoulder lesion","volume":"76","author":"M Sir\u00e9n","year":"2019","journal-title":"Occup Environ Med"},{"issue":"6","key":"pone.0318047.ref027","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1002\/art.21589","article-title":"Impact of shoulder, elbow, and knee joint involvement on assessment of rheumatoid arthritis using the American college of rheumatology core data set","volume":"53","author":"E Tanaka","year":"2005","journal-title":"Arthritis Rheum"},{"issue":"3","key":"pone.0318047.ref028","first-page":"481","article-title":"Work disability in rheumatoid arthritis--development over 15 years and evaluation of predictive factors over time","volume":"34","author":"K Eberhardt","year":"2007","journal-title":"J Rheumatol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0318047","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T17:50:09Z","timestamp":1749145809000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0318047"}},"subtitle":[],"editor":[{"given":"Martin","family":"Feuchtenberger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,5]]},"references-count":28,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0318047","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,5]]}}}