The Interplay Between Functional Status, Quality of Life, and Productivity: A Rheum4U Precision Health Registry Study

Objectives Inflammatory arthritis (IA) often results in joint damage, functional disability, and reduced health-related quality of life (HRQoL) and work productivity. These domains of arthritis burden have traditionally been examined in isolation. This study assessed the interrelationship between functional disability, HRQoL, and productivity in IA in Canada. Methods A cross-sectional analysis of data prospectively captured in the Rheum4U Precision Health Registry. Adults with IA attending rheumatology clinics in Calgary completed Patient-reported Outcomes Measures (PROMs), including the Clinical Health Assessment Questionnaire for functional disability (ClinHAQ; score range 0-3, no to severe disability), EQ-5D-5L for HRQoL (utility range −0.148 to 0.949, worst to perfect health), and Work Productivity and Activity Impairment instrument (WPAI domains: absenteeism, presenteeism, work impairment, and activity impairment; 0-100%, higher scores = greater impairment). Spearman rank correlations assessed associations overall and by IA type at the first registry visit with complete PROMs data (very weak (0–0.19), weak (0.2–0.39), moderate (0.40–0.59), strong (0.6–0.79), and very strong (0.8–1).[1] Partial correlations adjusted for age and sex. Results A total of 1,336 patients were included, 68% were women, the median age was 52 [IQR 39-62] years. Among diagnoses, 51% had rheumatoid arthritis, 16% ankylosing spondylitis, and 15% psoriatic arthritis. The median time since diagnosis was 7.3 [IQR 2.8-13.2] years. Higher ClinHAQ scores (greater disability) were significantly associated with lower EQ-5D-5L utilities (poorer HRQoL) and higher WPAI scores (greater work and activity impairment). Absenteeism (r=0.32) showed weak associations, while presenteeism (r=0.58) and overall work impairment (r=0.57) were moderately correlated with disability. The strongest effects were between disability and both activity impairment (r=0.7), and EQ-5D-5L utilities (r= −0.75). EQ-5D-5L utilities were negatively associated with all WPAI domains, with weak relationship for absenteeism (r= −0.31), moderate for presenteeism (r= −0.62) and work impairment (r= −0.61), and strong for activity impairment (r= −0.74). Results were consistent across IA types and remained stable after adjusting for age and sex. Conclusion The Rheum4U Precision Health Registry uniquely enabled deciphering the interrelationship of key domains impacted by IA in a large Canadian cohort. Greater disability was associated with poorer HRQoL and increased productivity loss. Similarly, lower HRQoL was related to greater work impairment. The results emphasize the multidimensional, interconnected burden of IA. Day-to-day physical limitations have a more direct impact on participation than missed work alone, highlighting the importance of early, function-preserving interventions. These may yield meaningful benefits across multiple domains of patient well-being. References [1.] Swinscow TDV. https://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one