P108 The impact of physically demanding occupation on employment loss in early inflammatory arthritis: analysis from the National Early Inflammatory Arthritis Audit

Abstract Background/Aims Workers in physically demanding occupations face higher rates of employment loss following inflammatory arthritis diagnosis, but the mechanisms underlying this association remain unclear. We aimed to quantify the effect of occupational physical demands on early work loss and determine the extent to which this relationship is mediated by disease activity, mental health, and functional impairment. Methods The study comprised adults with EIA recorded in the National Early Inflammatory Arthritis Audit (NEIAA) from May 2018 to April 2025. Participants were eligible if employed at diagnosis and with three-month follow-up data. Occupations were classified using the Standard Occupational Classification and dichotomised into manual and non-manual work based on physical demands. The primary outcome was self-reported employment loss within three months of diagnosis. Poisson regression with robust standard errors was used to estimate incidence rate ratios (IRRs) with 95% confidence intervals. Mediation analysis examined pathways linking occupation with employment loss, decomposing total effects into direct and indirect components through nested logistic regression models and estimated using the difference method Results Of 11,894 patients, 6,036 were employed at baseline and 1,662 had complete data. Within three months of diagnosis, 168 (10.1%) reported employment loss. Manual work was associated with an 82% increased risk of job loss (IRR 1.82, 95% CI 1.37-2.42). Compared with non-manual workers, manual workers had higher disease activity (mean DAS28 4.72 vs 4.49, p = 0.001), poorer mental health scores (mean 4.87 vs 4.28, p = 0.001), and worse functional outcomes. The proportion of the occupational effect mediated by disease activity (DAS28 5.1), mental health (combined PHQ-2/GAD-2 scores), and musculoskeletal symptom burden (MSKHQ) was 15%, 7%, and 6% respectively. Combined, these factors explained only 16.5% of the occupational effect. The direct effect remained substantial after adjustment for mediators (IRR 1.54, 95% CI 1.15-2.06). Conclusion Physical job demands confer a substantial risk of early employment loss that operates largely independently of disease activity and symptom burden. The predominant direct effect suggests that employment loss primarily reflects work-related factors rather than inadequate disease control. These findings highlight the limitations of purely medical interventions and support integrated approaches combining clinical care with vocational support. Disclosure E. Alveyn: None. J. Galloway: Grants/research support; Versus Arthritis, NIHR. M. Adas: None. P. Amlani-Hatcher: None. M. Dey: None. S. Gallagher: None. M. Gibson: None. B.E. Jones: None. D. Mehta: None. S. Norton: Grants/research support; NIHR. E.J. Price: None. M. Russell: Grants/research support; NIHR. K. Walker-Bone: None. E. MacPhie: None. K. Bechman: None.