Skip to main content


Log in

Fifteen-year trends of long-term disability and sick leaves in ankylosing spondylitis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript


The aim of this study is to assess the trends in work disability and sick leave in ankylosing spondylitis (AS). In 1993 and 2007, patients diagnosed with AS that attended to a secondary- or a tertiary-care outpatient rheumatology clinics were evaluated for demographics, disease characteristics, axial mobility, working status, and work days missed due to sick leave or permanent disability. Factors that impacted labor status were identified by multiple regression analysis. In 1993, 91 study individuals (mean age 35 years, mean disease duration 10 ± 8 years) included 28 (31%) on permanent disability and 63 currently working; of these 63, 42 (67%) had missed at least 1 work day in the previous 12 months (mean 69 ± 63 days). In the next 5 years, the annual permanent disability was 3%. In 2007, 185 study individuals (mean age 42, mean disease duration 12 ± 10 years) included 53 (39%) on permanent disability and 132 active workers; 35 (66%) out of the 53 began permanent disability between 1999 and 2007 (2.1% annual disability rate), and 53 (40%) out of 132 active workers missed at least 1 work day in the previous 12 months (mean 52 ± 63 days). Only age predicted disability, with 10% and 11% increases in risk per year in 1993 and 2007, respectively (hazard ratios 1.09 and 1.11, respectively; p = 0.03 for both). Although the impact of AS on work seems to decrease slightly during the last 15 years, the actual impact is still substantial. An important proportion of patients went on permanent disability in the three decades before retirement. Extrapolating these results to official data for the year 2005, we may infer that between 1.3 million and nearly 15 million working days were missed that year due to AS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Gran JT, Husby G (1993) The epidemiology of ankylosing spondylitis. Semin Arthritis Rheum 22:319–334

    Article  PubMed  CAS  Google Scholar 

  2. Gran JT, Skomsvoll JF (1997) The outcome of ankylosing spondylitis: a study of 100 patients. Br J Rheumatol 36:766–771

    Article  PubMed  CAS  Google Scholar 

  3. Rkain H, Allali F, Bentalha A et al (2007) Socioeconomic impact of ankylosing spondylitis in Morocco. Clin Rheumatol 26:2081–2088

    Article  PubMed  Google Scholar 

  4. Boonen A, Severens JL (2002) Ankylosing spondylitis: what is the cost to society, and can it be reduced? Best Pract Res Clin Rheumatol 16:691–705

    Article  PubMed  CAS  Google Scholar 

  5. Boonen A, Chorus A, Miedema H et al (2001) Withdrawal from labour force due to work disability in patients with ankylosing spondylitis. Ann Rheum Dis 60:1033–1039

    Article  PubMed  CAS  Google Scholar 

  6. Strombeck B, Jacobsson LT, Bremander A et al (2009) Patients with ankylosing spondylitis have increased sick leave—a registry-based case–control study over 7 years. Rheumatol (Oxford) 48:289–292

    Article  Google Scholar 

  7. Boonen A, Chorus A, Miedema H et al (2001) Employment, work disability, and work days lost in patients with ankylosing spondylitis: a cross sectional study of Dutch patients. Ann Rheum Dis 60:353–358

    Article  PubMed  CAS  Google Scholar 

  8. Mau W, Listing J, Huscher D et al (2005) Employment across chronic inflammatory rheumatic diseases and comparison with the general population. J Rheumatol 32:721–728

    PubMed  Google Scholar 

  9. Khan MA (1990) Ankylosing spondylitis: clinical aspects. In: Khan MA (ed) Ankylosing spondylitis and related spondyloarthropathies. Hanley & Belfus, Philadelphia, pp 529–551

    Google Scholar 

  10. Ramos-Remus C, Macias MA, Suarez-Almazor ME (1997) Labor status and working-days lost in a consecutive sample of 103 patients with ankylosing spondylitis. Arthritis Rheum 40(supplement):1392

    Google Scholar 

  11. Jenkinson TR, Mallorie PA, Whitelock HC et al (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21:1694–1698

    PubMed  CAS  Google Scholar 

  12. Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291

    PubMed  CAS  Google Scholar 

  13. Calin A, Jones SD, Garrett SL et al (1995) Bath ankylosing spondylitis functional index. Br J Rheumatol 34:793–794

    Article  PubMed  CAS  Google Scholar 

  14. Daltroy LH, Larson MG, Roberts NW et al (1990) A modification of the health assessment questionnaire for the spondyloarthropathies. J Rheumatol 17:946–950

    PubMed  CAS  Google Scholar 

  15. van der Linden SM (1990) Clinical and functional assessment of ankylosing spondylitis. In: Khan MA (ed) Ankylosing spondylitis and related spondyloarthropathies. Hanley & Belfus, Philadelphia, pp 583–593

    Google Scholar 

  16. Boonen A, van der Linden SM (2006) The burden of ankylosing spondylitis. J Rheumatol Suppl 78:4–11

    PubMed  Google Scholar 

  17. Forejtova S, Mann H, Stolfa J et al (2008) Factors influencing health status and disability of patients with ankylosing spondylitis in the Czech Republic. Clin Rheumatol 27:1005–1013

    Article  PubMed  CAS  Google Scholar 

  18. Zhu TY, Tam LS, Lee VW et al (2008) Costs and quality of life of patients with ankylosing spondylitis in Hong Kong. Rheumatol (Oxford) 47:1422–1425

    Article  CAS  Google Scholar 

  19. Boonen A, Brinkhuizen T, Landewe R et al (2010) Impact of ankylosing spondylitis on sick leave, presenteeism and unpaid productivity, and estimation of the societal cost. Ann Rheum Dis 69:1123–1128

    Article  PubMed  Google Scholar 

  20. Braun J, Bollow M, Remlinger G et al (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67

    Article  PubMed  CAS  Google Scholar 

  21. Zink A, Braun J, Listing J et al (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. German Collaborative Arthritis Centers. J Rheumatol 27:613–622

    PubMed  CAS  Google Scholar 

  22. Verstappen SM, Jacobs JW, van der Heijde DM et al (2007) Utility and direct costs: ankylosing spondylitis compared with rheumatoid arthritis. Ann Rheum Dis 66:727–731

    Article  PubMed  CAS  Google Scholar 

  23. Duijts SF, Kant I, Swaen GM et al (2007) A meta-analysis of observational studies identifies predictors of sickness absence. J Clin Epidemiol 60:1105–1115

    Article  PubMed  Google Scholar 

  24. Chorus AM, Miedema HS, Boonen A et al (2003) Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis 62:1178–1184

    Article  PubMed  CAS  Google Scholar 

  25. Suarez-Almazor ME (2002) In quest of the holy grail: efficacy versus effectiveness in rheumatoid arthritis. J Rheumatol 29:209–211

    PubMed  Google Scholar 

Download references



Author information

Authors and Affiliations


Corresponding author

Correspondence to Cesar Ramos-Remus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ramos-Remus, C., Hernandez-Rios, G., Duran-Barragan, S. et al. Fifteen-year trends of long-term disability and sick leaves in ankylosing spondylitis. Clin Rheumatol 30, 361–367 (2011).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: