Factors Affecting Work Productivity and Activity Impairment in Axial Spondyloarthritis Patients

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that commonly affects individuals during their economically productive years and may substantially impair physical function, quality of life, and participation in work. A systematic review and meta-analysis reported that more than half of employed patients with active axSpA experienced work impairment, with presenteeism accounting for a major component of productivity loss. Evidence reported mean absenteeism, presenteeism, overall work productivity loss, and activity impairment of 4.5%, 24.9%, 27.6%, and 35.2%, respectively. However, evidence concerning occupational outcomes and their determinants among patients with axSpA in Bangladesh remains limited. This study aimed to assess work productivity and activity impairment (WPAI) and to identify demographic, clinical, functional, and psychosocial factors associated with employment status among patients with axSpA in Bangladesh. This analytical cross-sectional study was conducted at the Department of Rheumatology, Bangladesh Medical University (BMU), Dhaka, from June 2023 to June 2024. Of 222 patients aged 18-55 years with axSpA fulfilling the Assessment of SpondyloArthritis International Society (ASAS) classification criteria were included. Participants were recruited using purposive consecutive sampling. Work productivity and activity impairment were assessed using the WPAI questionnaire for axSpA (WPAI-axSpA). Disease activity, functional limitation, spinal mobility, health-related quality of life and psychological well-being were assessed using BASDAI, BASFI, BASMI, ASDAS-CRP, ASQoL, SF-12 and GHQ-12, respectively. Continuous and categorical variables were compared using appropriate parametric or non-parametric and categorical tests. Associations between WPAI domains and patient-reported outcomes were examined using Spearman's rank correlation. Multivariable logistic regression was performed to identify factors independently associated with unemployment. Statistical significance was defined as p<0.05. The mean age was 34.0±8.5 years, and 66.7% of participants were male (male-to-female ratio 2:1), with 38.7% unemployed. Mean disease duration was 6.31±3.40 years; peripheral arthritis (72.1%) and enthesitis (45.0%) were the most frequent musculoskeletal manifestations. Activity impairment (AI) was significantly greater among unemployed than employed participants (59.39±18.19% vs 50.46±16.33%; p=0.006), whereas absenteeism, presenteeism and overall work productivity loss (OWPL) did not differ significantly by employment status. Among employed participants, education was associated with presenteeism (p=0.016) and OWPL (p=0.011), while smoking was also associated with OWPL (p=0.030). AI differed significantly across BMI categories (p=0.031). Spearman's analysis demonstrated positive correlations between disease activity and functional limitation and all WPAI domains, with the strongest correlations observed for BASDAI and BASFI with OWPL (ρ=0.71 for both; p<0.001). PCS-12 was inversely correlated with all WPAI domains, most strongly with OWPL (ρ=−0.74; p<0.001). In multivariable logistic regression, age, male sex, married status, NRS pain score and PCS-12 were independently associated with unemployment, whereas education, BASDAI, ASDAS-CRP ≥3.5, ASQoL and GHQ-12 were not independently associated. AxSpA was associated with a substantial burden of unemployment and AI in this Bangladeshi tertiary-care facility. Work-related impairment was closely associated with disease activity, functional limitation and physical health, while employment status was additionally associated with demographic characteristics. Management strategies should therefore address disease control, functional capacity and preservation of participation in work and daily activities. Bangladesh Med J. 2026 Jan; 55(1) : 1-10