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Prognostic Factors for Permanent Work Disability in Patients With Rheumatoid Arthritis Who Received Combination
M Luisa Vazquez-Villegas1, Jorge I Gamez-Nava, Alfredo Celis
1From the *Department of Epidemiology, Unidad Medica Familiar 4, Instituto Mexicano del Seguro Social (IMSS); †Department of Public Health, Centro Universitario de Ciencia de la Salud (CUCS), Universidad de Guadalajara (U de G); ‡Clinical Epidemiology Research Unit, Hospital de Especialidades del Centro Medico Nacional de Occidente (HECMNO), IMSS; §Postgraduate Program of Doctor in Pharmacology, CUCS, U de G; and ∥Division of Disciplines for the Development, Promotion and Preservation of Health, CUCS, U de G, Guadalajara, Jalisco, Mexico; ¶Postgraduate Program of Master in Sciences, Universidad de Colima (UCol), Colima, Colima; #Research Coordination Department, Hospital Civil Dr. Juan I. Menchaca, Guadalajara, Jalisco; **Universitary Center for Biomedical Research (CUIB), UCol, Colima, Colima; ††Division of Health Sciences, Department of Biomedical Sciences; Centro Universitario de Tonala, U de G, Tonala; and ‡‡Department of Internal Medicine-Rheumatology, Hospital General de Zona 45, IMSS, Guadalajara, Jalisco; §§Rheumatology Staff, Star Medica, Hospital, Yucatan, Merida; ∥∥Clinical Research Center of Morelia (Centro de Investigación Clínica de Morelia SC), Morelia, Michoacán; and ¶¶Department of Internal Medicine-Rheumatology, Hospital General Regional 110, IMSS, 44710. Guadalajara, Jalisco, Mexico.
Background:
There is limited information about the factors related with the development of long-term permanent work disability (PWD) in rheumatoid arthritis (RA) treated with a combination of conventional synthetic disease-modifying antirheumatic drugs (cs-DMARDs).
Objective:
The aim of this study was to evaluate incidence and factors associated with the development of PWD in RA treated with combination therapy using conventional synthetic cs-DMARDs.
Methods:
We assessed in multivariate models the effect of clinical and demographic factors in the development of PWD in a long-term retrospective cohort of 180 workers with RA who were treated with a combination of cs-DMARDs.
Results:
Incidence rates of PWD were 2.2% at 1 year, 7.7% at 5 years, 24.9% at 10 years, 34.9% at 15 years, and 45% at 20 years. In the adjusted Cox regression analysis, factors associated with PWD development were the first failure with combination of cs-DMARDs (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.05-5.46; P = 0.03), poor functioning at time of cohort onset (HR, 2.2; 95% CI, 1.05-4.70; P = 0.03), and requirement for joint replacement (HR, 3.3; 95% CI, 1.28-8.79; P = 0.01).
Conclusions:
Around 25% of workers with combination therapy with cs-DMARDs developed PWD in 10 years following the diagnosis of RA. Some factors increase the risk of disability. Permanent work disability generates a relevant society burden and increases health care costs. Therefore, indicators predicting failure of combination therapies with cs-DMARDs might provide clinicians of useful tools for modifying treatments avoiding the disease progression.
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