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Work productivity impaired by autoimmune bullous disorders

Study highlights how patients with severe forms of disease are affected

In addition to negatively impacting quality of life (QoL), autoimmune bullous dermatoses (AIBDs) reduce work productivity and activity impairment (WPAI) scores across all domains of the scale in patients with severe disease, researchers report in a paper published online in the Journal of Cutaneous Medicine and Surgery (Apr. 17, 2015).

“Work productivity has never been investigated in AIBD patients,” says study author Dr.Kara

Helan, Dermatology Specialist Registrar at Our Lady’s Children’s Hospital, Crumlin, Dublin,


“This study both confirms what we know but also highlights for the first time [loss of work

productivity] as a major obstacle for patients suffering from these difficult severe blistering


Dr. Heelan notes that there is some published research, though limited in quantity, which hassuggested that AIBD diseases have a significant negative impact on physical and emotional status and quality of life. “We postulated that as bullous dermatoses affect QoL, it is also conceivable that they have an effect on work productivity.

Work productivity has been assessed in other dermatological conditions, for example psoriasis,” she says.

The study, primarily carried out at the Sunnybrook Health Sciences Centre in Toronto, was developed to determine whether greater severity of AIBD has a negative impact on QoL and work productivity, she says. As well, the researchers sought to assess whether patients who had a response to treatment of their dermatoses also experienced changes to their QoL.

“We felt that having a bet-ter understanding of these factors may lead to improvements in care and refined treatment approaches in order to manage aspects that are particularly problematic for AIBD patients,” says Dr. Heelan.

The study included 94 patients referred to Sunnybrook’s tertiary AIBD centre between Feb. and May 2013. Participants completed both the Dermatology Life Quality Index (DLQI) and WPAI-Specific Health Problem questionnaires.

Patients who responded to treatment for their AIBD had significantly (p<0.001) less impairment than nonresponders, and those with severe AIBD had significantly more impairment than

patients with either mild (p<0. 001) or moderate (p=0.002) AIBD. Higher DLQI scores were also associated with greater work impairment(p=0.041) and activity impairment (p=0.024).

Patients who did not respond to treatment had increased impairment while working (p<0. 001), overall work impairment (p<0.001), and activity impairment (p<0. 001). Finally, patients with severe disease were found to have worse impairment on all domains of the WPAI.

Dr. Heelan says these findings are valuable for both AIBD patients and for their treating


“A decrease in work productivity has an impact on society as a whole. It is important for physicians when assessing response to treatment to consider how the disease and its treatments are impacting upon a patients life both in terms of quality of life but also as impact on work productivity and activity impairment,” she says.

Doctors may consider using some agents earlier in the course of a patient’s treatment than they typically would, if treatment response would ensure a patient’s productivity at work, she says, adding that cost effectiveness does need to be considered as well.

Customized care beneficial

Most of the patients in the study were undergoing active immunosuppressant treatment at the time of recruitment, so their QoL may have already been improved somewhat at the time thestudy was conducted, which one would expect in a treated population in a state of remission, says Dr.Heelan. This emphasizes the importance of using QoL and work-productivity measuring tools before starting treatment and while treatment is ongoing, she says.

It would be beneficial if physicians made QoL and work productivity measures part of their assessment, and recorded them in the patient records during out patient clinic visits, says Dr. Heelan. This study was cross sectional which limited the findings.“However regular followup and longitudinal assessment of these measures may lead to a better interpretation of the impact of these entities.”

Evaluating the impact of treatment on work productivity in AIBD over the short and long-term could enable establishment of customized care, which could increase patient satisfaction levels during the treatment process “Including cases that have increased activity of disease, or cases at an earlier stage after diagnosis, or cases with untreated disease may be more representative of the disease population. However, with our ever expanding armamentarium of treatments, more patients are enjoying remission and successful treatment results.”

Originally published in The Chronicle of Skin + Allergy (Aug. 2015; 21(5)).

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