Patients with rheumatoid arthritis facing sick leave or work disability meet varying regulations: a study among rheumatologists and patients from 44 European countries

Polina Putrik*, Sofia Ramiro, Francis Guillemin, Marta Pentek, Francisca Sivera, Tuulikki Sokka, Maarten de Wit, Anthony D. Woolf, Angela Zink, Daina Andersone, Florian Berghea, Irena Butrimiene, Sandra Brouwer, Karen Cassar, Paraskevi Charalambous, Roberto Caporali, Elena Deseatnicova, Nemanja S. Damjanov, Axel Finckh, Oliver FitzGeraldGerdur Grondal, Nino Gobejishjvili, Piotr Gluszko, Marco Hirsch, Igor Jovanovic, Jiri Vencovsky, Xavier Janssens, Andras P. Keszei, Maria Kovarova, Mart Kull, Luis Cunha Miranda, Miroslav Mayer, Snezana Misevska-Percinkova, Nevsun Inanc, Oleg Nadashkevich, Ingemar F. Petersson, Kari Puolakka, Bernadette Rojkovich, Helga Radner, Fruzsina Szabados, Gleb Slobodin, Ivan Shirinsky, Nikolay Soroka, Prodromos Sidiropoulos, Russka Shumnalieva, Sekib Sokolovic, Surayo Shukurova, Argjend Tafaj, Matija Tomsic, Till Uhlig, Suzanne M. M. Verstappen, Annelies Boonen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objectives To describe and explore differences in formal regulations around sick leave and work disability (WD) for patients with rheumatoid arthritis (RA), as well as perceptions by rheumatologists and patients on the system's performance, across European countries.

Methods We conducted three cross-sectional surveys in 50 European countries: one on work (re-)integration and social security (SS) system arrangements in case of sick leave and long-term WD due to RA (one rheumatologist per country), and two among approximately 15 rheumatologists and 15 patients per country on perceptions regarding SS arrangements on work participation. Differences in regulations and perceptions were compared across categories defined by gross domestic product (GDP), type of social welfare regime, European Union (EU) membership and country RA WD rates.

Results Forty-four (88%) countries provided data on regulations, 33 (75%) on perceptions of rheumatologists (n=539) and 34 (77%) on perceptions of patients (n=719). While large variation was observed across all regulations across countries, no relationship was found between most of regulations or income compensation and GDP, type of SS system or rates of WD. Regarding perceptions, rheumatologists in high GDP and EU-member countries felt less confident in their role in the decision process towards WD (beta=-0.5 (95% CI -0.9 to -0.2) and beta=-0.5 (95% CI -1.0 to -0.1), respectively). The Scandinavian and Bismarckian system scored best on patients' and rheumatologists' perceptions of regulations and system performance.

Conclusions There is large heterogeneity in rules and regulations of SS systems across Europe in relation to WD of patients with RA, and it cannot be explained by existing welfare regimes, EU membership or country's wealth.

Original languageEnglish
Pages (from-to)1472-1479
Number of pages8
JournalAnnals of the Rheumatic Diseases
Issue number11
Publication statusPublished - Nov 2019


  • RA

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