The impact of ankylosing spondylitis/axial spondyloarthritis on work productivity

  • Dr Jane Martindale, Extended Scope Physiotherapist and Therapy Research Lead, Wrightington, Wigan and Leigh Foundation Trust; and Honorary Researcher, Lancaster University
  • Dr Rudresh Shukla, Academic Clinical Fellow in Rheumatology, Lancaster University
  • Professor John Goodacre, Director, Lancaster Health Hub

Introduction: Ankylosing spondylitis (AS)/axial spondyloarthritis (axial SpA) typically affects people from a young age, it often has a detrimental impact on health and wellbeing and it is associated with significant risk of limiting work productivity over the life course. Despite this, relatively little attention has been paid to issues regarding work productivity in this condition. Consequently, there is an urgent need not only to understand better the different perspectives of people with AS/axial SpA, of health professionals, of health service managers and of employers but also to embed issues pertinent to work productivity as a routine element of health care. Exciting opportunities now exist to bring together the key sectors to develop innovative solutions and processes to drive such advances, and to enable the potential of people with AS/axial SpA to succeed in workplace settings to be fully realised.

The full article is published in Best Practice & Research Clinical Rheumatology 29(3), pp. 512-523.

“Whenever I can I push myself to go to work”: a qualitative study of experiences of sickness presenteeism among workers with rheumatoid arthritis


Purpose: UK government policy emphasizes the importance of continuing to work for recovery from poor health, yet sickness presenteeism (going to work whilst ill) is commonly regarded as having negative consequences for organizations and individuals. Our study explores experiences of working after onset of rheumatoid arthritis (RA), a chronic musculoskeletal disorder characterized by high rates of work disability.

Materials and methods: An exploratory qualitative study consisting of in-depth interviews and six-month follow-up with 11 men and women with RA employed at disease onset.

Results: We expand upon previous models of sickness presenteeism by distinguishing between presenteeism that occurs voluntarily (wanting to work despite illness) and involuntarily (feeling pressured to work when ill). RA onset affected participants’ ability to work, yet motivation to remain working remained high. The implementation of workplace adjustments enabled participants to stay working and restore their work capacity. Conversely, managers’ misinterpretation of organizational sickness absence policies could lead to involuntary presenteeism or delayed return to work, conflicting with the notion of work as an aid to recovery.

Conclusion: Workplace adjustments can facilitate voluntary sickness presenteeism. To reduce work disability and sickness absence, organizational policies should be sufficiently flexible to accommodate the needs of workers with fluctuating conditions.

  • Implications for rehabilitation
  • Individuals with rheumatoid arthritis (RA) are at high risk of work disability.
  • Individuals’ motivation to remain in work following onset of RA remains high, yet sickness presenteeism (working while ill) has received largely negative attention.
  • It is important to distinguish between voluntary and involuntary forms of sickness presenteeism.
  • Workplace adjustments facilitate voluntary sickness presenteeism (wanting to work despite illness) and improve job retention and productivity among workers with RA.
  • Involuntary presenteeism (feeling pressured to work while ill) may occur if organizational policies are not sufficiently flexible to accommodate the needs of workers with RA.

The full article is published at

Disability and Rehabilitation, DOI: 10.1080/09638288.2016.1258436