Organ damage is a major determinant of work productivity impairment in Behçet's Syndrome: a post-hoc analysis of the BODI validation study

Alberto Floris; Riccardo Laconi; Gerard Espinosa; Giuseppe Lopalco; Luisa Serpa Pinto; Nikolaos Kougkas; Jurgen Sota; Andrea Lo Monaco; Marcello Govoni; Claudia Fabiani; George Bertsias; João Correia; Florenzo Iannone; Ricard Cervera; Carlos Vasconcelos; Alessandro Mathieu; Alberto Cauli; Matteo Piga

doi:10.1093/rheumatology/kead681

Organ damage is a major determinant of work productivity impairment in Behçet's Syndrome: a post-hoc analysis of the BODI validation study

Rheumatology (Oxford). 2023 Dec 13:kead681. doi: 10.1093/rheumatology/kead681. Online ahead of print.

Authors

Alberto Floris^{1

2}, Riccardo Laconi^{1

2}, Gerard Espinosa³, Giuseppe Lopalco⁴, Luisa Serpa Pinto⁵, Nikolaos Kougkas⁶, Jurgen Sota⁷, Andrea Lo Monaco⁸, Marcello Govoni⁸, Claudia Fabiani⁹, George Bertsias⁶, João Correia⁵, Florenzo Iannone⁴, Ricard Cervera³, Carlos Vasconcelos¹⁰, Alessandro Mathieu¹, Alberto Cauli^{1

2}, Matteo Piga^{1

2}

Affiliations

¹ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
² Rheumatology Unit, AOU of Clinic, Cagliari, Italy.
³ University of Barcelona, Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
⁴ University of Bari, Rheumatology Unit, Bari, Italy.
⁵ Hospital Santo Antonio Centro Hospitalar do Porto, Unidade de Imunologia Clinica, Porto, Portugal.
⁶ University of Crete, Rheumatology, Clinical Immunology and Allergy Unit, Heraklion, Greece.
⁷ University of Siena, Rheumatology Unit, Siena, Italy.
⁸ Rheumatology Unit-AOU, S. Anna, Ferrara, University of Ferrara, Italy.
⁹ Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
¹⁰ University of Porto, UMIB Abel Salazar Biomedical Sciences Institute, Porto, Portugal.

PMID: 38092032
DOI: 10.1093/rheumatology/kead681

Abstract

Objectives: To evaluate the prevalence, magnitude, and potential determinants of work productivity impairment in patients with Behçet's Syndrome (BS), focusing on the role of irreversible organ damage.

Methods: A post-hoc analysis of the BS overall damage index (BODI) prospective validation study was performed. Demographics and clinical features were recorded in all patients. The Work Productivity and Activity Impairment: General Health (WPAI: GH) questionnaire was administered to assess the work limitation and the BODI to measure organ damage. The independent effect of BS features on WPAI: GH outcomes was evaluated by regression analysis.

Results: Out of 148 patients, 34.5% were unemployed, with age (OR 1.035) and BODI score (OR 1.313 for 1-unit increase) as the only factors significantly (p< 0.05) associated with the unemployment state. An overall work impairment was reported in about 64.2% of the employed patients. Indeed, 22.7% reported missing work h due to their health (absenteeism), with a mean time loss of 34.4%; whereas 60.2% declared a reduced performance at work because of their health (presenteeism), with a mean productivity impairment of 45.4%. Ocular damage was associated with absenteeism (β 0.225); female sex (β 0.260), physician global assessment of disease activity (β 0.502) and an increased BODI score (β 0.166 for 1-point increase) with presenteeism; fibromyalgia (β 0.246), physician global assessment (β 0.469), and musculoskeletal damage (β 0.325) with overall work impairment.

Conclusions: Disease activity and organ damage accrual remarkably affect work productivity in BS patients. Achieving remission and preventing damage accrual are crucial and complementary objectives.

Keywords: Behçet's syndrome; damage; outcomes; work productivity.