Continuing to Work With Arthritis

How to Manage Work Challenges When You Have Arthritis

Painful knee at work.
What should you know if you wish to continue working with arthritis?. beetle8/E+/Getty Images

If you have arthritis, you've likely wondered how you can work and continue your career despite the functional limitations of the disease. Let's take a look at some of the questions you might have and what options may help you continue to work despite the challenges.

Work Challenges Related to Arthritis

Arthritis can affect your ability to work. Because pain and physical limitations cannot be ignored, people with arthritis often need to adapt their work environment or modify their work schedule in order to continue working.

As arthritis becomes more severe, significant changes may be necessary.

Should you be open about your challenges with your employer? What modifications are most helpful? And when do you need to consider disability?

Relationship With Employer Is a Factor in Working

There are various circumstances that determine whether you can continue working despite having arthritis. Some circumstances and factors may be controllable, while others are not. Two of the most important factors are somewhat tied together—the severity of your arthritis, coupled with the support you get from your employer. If the employee-employer relationship is strong, communicative, respectful, and honest, difficulties are more likely to be overcome. In contrast, a relationship with an employer or supervisor that is antagonistic or disinterested will not foster a cooperative effort to find solutions.

Should You Be Honest About the Challenges?

The has been debate over how much you should tell your employer about the challenges of living with arthritis.

After all, an employer has one primary goal and that's productivity. Would knowing the truth about your struggles threaten that goal? 

Some people fear losing their job and choose to not divulge the whole truth about their arthritis. They minimize the struggles by:

  • Not confessing the actual severity of pain and other symptoms
  • Going to work when they should not
  • Not wearing splints, supports, or braces when they should

Other people believe that hiding the truth ultimately backfires. Lack of full disclosure becomes more difficult as arthritis worsens. Simply put, it becomes harder to fake it.

Type of Work Must Be Considered

A certain level of productivity is expected of any employee. That said, the ability to complete tasks and meet deadlines naturally becomes more difficult as the level of disability increases. A large company that has many employees may not be as concerned about individual productivity as a smaller company. The large company may have a sufficient workforce whereby employees tend to balance each other out. Not that they don't expect performance, but a large company may be able to allow for additional sick days more easily or handle temporary setbacks. Because there are more people available to cover for you, the burden is less to the larger company.

The exact nature of a job determines how much arthritis may affect your performance. A physically demanding job which involves lifting, carrying, walking, or a lot of standing would certainly be impacted more than a desk job. A job that is physically demanding may become difficult or impossible to keep over time.

That said, desk activities may also be difficult with arthritis, and a 2016 study of people with rheumatoid arthritis found that handgrip strength and hand range of motion deficits were the factors most associated with an inability to work.

Flexibility Helps

Whether or not your job must be performed according to a precise schedule is another consideration. If arthritis has caused you to miss a lot of work, or unexpected arthritis flares have made you less dependable, a job that operates on a tight schedule is not optimal.

Adapting Your Work Environment

If it is possible for specific adaptations to be made in the workplace, it may help you continue working and maintain the expected level of productivity.

This should certainly be considered and discussed before you consider leaving your job. Some adaptations may cost money, but a company will be more eager to spend money on modifications and adaptations if your work record is good,  you intend to stay employed by the company, and they feel you would be hard to replace.

There is a wide range of possible adaptations or modifications that have proved helpful for people living with arthritis. Some are quite simple. Others are more extensive and expensive. It could be as uncomplicated as changing your chair or desk height, changing the location of supplies, or using ergonomic equipment. The necessary modifications may not even involve your physical work environment, but instead, it may involve requesting a later start-time, or a change to the lunch or break schedule.

An occupational therapist can be consulted to help assess your work area and offer valuable suggestions. It is also important to understand the Americans With Disabilities Act to know your rights and understand the reasonable efforts your employer must make to accommodate your needs. Familiarize yourself with the law.

Disability Statistics Are Daunting

Studies showing the impact of rheumatoid arthritis on employment are daunting. Older studies found that over 50 percent of people who worked before the onset of the disease stopped working within 10 years of their diagnosis. Those who had more work autonomy and flexibility were more likely to stay employed. Other studies have found that between 20 and 30 percent of people are already unable to work two to three years after diagnosis. Arthritis remains the most cause of disability in the United States.

In the last few decades, disease modifying anti-rheumatic drugs, biologics, and early and aggressive treatment have become the norm, yet disability rates remain surprisingly high. We are, however, beginning to see some improvement. In 2012, it was noted that biologic therapy, as well as aggressive use of traditional disease-modifying anti-rheumatic drugs (DMARDs), was associated with significant gains in disability outcomes. Recently, a 2017 Swedish study found that for those people with rheumatoid arthritis who had anti-tumor necrosis factor (anti-TNF) therapy started within five years of diagnosis were twice as likely to be able to work three years down the line.​

Since early and aggressive treatment seems to play an important role in helping people continue to work, take some time to understand the current rheumatoid arthritis treatment guidelines and talk with your doctor to make sure your treatment plan is thorough and up-to-date.

Depression, Arthritis, and Work Disability

It's important to note that while the physical limitations of arthritis are often looked at as the major factor in work disability, the presence of depression is extremely important. Depression, rather than disease activity or response to therapy, was a stronger predictor as to whether a person would consider work disability. Depression is all too common and frequently co-exists with arthritis. Not only does depression, as in this case, increase the need for work disability, but it can rob people with arthritis of the joy of living. Talk to your doctor about the possibility that you may be coping with depression so that she can help you address this all-too-common concern if needed.

The Bottom Line on Working With Arthritis

In order to continue working, you must be compliant with your treatment to keep the disease well-controlled. You must be working at a job where you can still function and be productive within your set of physical and functional limitations. It is also imperative to have the support and understanding of your employer and co-workers.

It is a fact that with a diagnosis of rheumatoid arthritis, there is an inherent risk of work disability. The risk is greater with a physically demanding job, older age, lower level of education, and greater functional disability with activities of daily living. That said, early and aggressive treatment, making sure any adaptations to your work environment are done, and addressing other conditions, such as depression, can improve your chance of continuing to work and the benefits of work to your self-esteem and financial well-being.

Sources:

Hansen, S., Hetland, M., Pedersen, J., Ostergaard, M., Rubak, T., and J. Biomer. Work Ability in Rheumatoid Arthritis Patients: A Register Study on the Prospective Risk of Exclusion and Probability of Returning to Work. Rheumatology (Oxford). 2017 March 28. (Epub ahead of print).

Krishnan, E., Lingala, B., Bruce, B., and J. Fries. Disability in Rheumatoid Arthritis in the Era of Biological Treatments. Annals of the Rheumatic Diseases. 2012. 71(2):213-8.

Verstappen, S. Rheumatoid Arthritis and Work: The Impact of Rheumatoid Arthritis on Absenteeism and Presenteeism. Best Practice and Research. Clinical Rheumatology. 2015. 29(3):495-511.

Wechalekar, M., Quinn, S., Lester, S. et al. A Treat-To-Target Strategy Preserves Work Capacity in a Rheumatoid Arthritis Inception Cohort Treated With Combination Conventional DMARD Therapy. Journal of Clinical Rheumatology. 2017. 23(3):131-137.

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