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Objective Knowledge on the time-course (trends) of work-related asthma (WRA) remains sparse. The aim of this study was to describe WRA trends in terms of industrial activities and the main causal agents in France over the period 2001–2009. Method Data were collected from the French national network of occupational health surveillance and prevention ( Reseau National de Vigilance et de Prevention des Pathologies Professionnelles (RNV3P)). Several statistical models (non-parametric test, zero-inflated negative binomial, logistic regression and time-series models) were used and compared with assess trends. Results Over the study period, 2914 WRA cases were included in the network. A significant decrease was observed overall and for some agents such as isocyanates (p=0.007), aldehydes (p=0.01) and latex (p=0.01). Conversely, a significant increase was observed for cases related to exposure to quaternary ammonium compounds (p=0.003). The health and social sector demonstrated both a growing number of cases related to the use of quaternary ammonium compounds and a decrease of cases related to aldehyde and latex exposure. Conclusions WRA declined in France over the study period. The only significant increase concerned WRA related to exposure to quaternary ammonium compounds. Zero-inflated negative binomial and logistic regression models appear to describe adequately these data.

Summary To assess the effects of napping + bright light on shift work drivers sleepiness at the wheel, we performed a pilot study on nine shift workers on three shifts (morning, afternoon, night), driving on a private road circuit. Sleepiness at the wheel was measured by ambulatory polysomnography and assessed using 30-s segments of recordings with a percentage of theta electroencephalogram of at least 50% (15 s) of the period recorded. Sleepiness was also assessed by the Stanford Sleepiness Scale (SSS). Participants drove the same car on two similar 24-h periods of work, with three drivers in each shift (morning, afternoon, night), separated by 3 weeks. During the baseline period, the subjects were told to manage their rest as usual. During the second experimental period, they had to rest lying in a dark room with two naps of 20 min and then exposed to bright light (5000 lux) for 10 min. Subjects showed a significantly decreased sleepiness at the wheel with an average of 10.7 ± 6.7 episodes of theta sleep during the baseline (766 ± 425 s) versus 1.0 ± 1.0 episode lasting 166 ± 96 s during the second period (P = 0.016; P = 0.0109). The percentage of driving asleep was also significantly reduced (3.7% ± 1.9% versus 0.9% ± 0.6%, P = 0.0077). The average SSS score in the group decreased from 2.76 ± 1.27 to 2.28 ± 0.74 (P = 0.09). In this pilot and preliminary study, a combination of napping and bright light pulses was powerful in decreasing sleepiness at the wheel of shift work drivers.

BACKGROUND Severity of occupational asthma at diagnosis is an important prognostic factor. The aim of this study was to determine which factors affect the severity of occupational asthma with a latency period at diagnosis. METHODS The study population consisted of 229 consecutive subjects with occupational asthma with a latency period recruited by four occupational health departments and divided into two groups according to the severity of the disease at diagnosis. The moderate-severe (FEV(1) /=70% predicted and PD(20) methacholine >300 microg, n = 128) groups were compared in terms of clinical and demographic parameters. Multivariate analysis using logistic regressions was performed to examine factors associated with asthma severity. RESULTS Duration of symptoms before diagnosis was significantly longer in the moderate-severe group (mean +/- SD: 6.3 +/- 6.8 years vs 3.4 +/- 4.4 years, P < 0.001). Sex ratio, age, atopy, smoking habits, duration of exposure before symptoms, and molecular weight of the causal agent were not significantly different between the two groups. On multivariate analysis, only duration of symptoms before diagnosis was associated with asthma severity (aOR = 1.12, 95% CI 1.05-1.18, P < 0.001). CONCLUSIONS Severity of occupational asthma with a latency period at diagnosis was associated with duration of symptoms before diagnosis, but not with the type of causal agent. This finding emphasizes the need for early diagnosis and avoidance of exposure.

Objectives Methacholine bronchial responsiveness and variations in the pulmonary function of workers exposed to wheat flour and a reference group were compared. Methods Each subject [140 men exposed to flour (bakers and pastry makers) and 77 controls] completed a standardized questionnaire. Bronchial responsiveness was quantified by measuring the slope between percentage decrements in forced expiratory volume in 1 second (FEV 1 ) and cumulative methacholine dose. FEV 1 and peak expiratory flow (PEF) were recorded four times a day for 15 days using a handheld electronic spirometer. The variability in the FEV 1 and PEF readings was expressed as variation coefficients (100 × standard deviation/mean). Results The mean duration of exposure to flour was 14 (SD 9) years. Rhinitis was significantly more common in the exposed group than in the control group (30.7% versus 11.7%, P=0.001). The mean FEV 1 and PEF did not significantly differ between the two groups. The slope of the dose–response to methacholine and the variation coefficients were lower among the unexposed nonsmokers than among the exposed workers and smokers. The differences were significant for the exposed smokers. The two variation coefficients correlated with each other (r=0.82) but not with the slope of the methacholine challenge. Conclusions Occupational exposure to flour and smoking increase bronchial responsiveness, as measured by the slope of the dose–response to methacholine and the variation coefficients of airflow. However, methacholine bronchial responsiveness and the variability of lung function do not measure exactly the same aspect of airway behavior.

Aims: To compare the prevalence and incidence of respiratory symptoms and lung function values between hairdressing apprentices and office apprentices. Methods: A total of 322 hairdressing apprentices and 277 office apprentices (controls) were studied. Two cross sectional surveys were conducted in 1994 and 1996/97 with longitudinal follow up for a subgroup of apprentices (191 hairdressing apprentices and 189 office apprentices). Results: In the initial phase, the prevalence of respiratory symptoms was significantly lower among hairdressing apprentices than among office apprentices. Lung function test results showed significantly higher values for hairdressing apprentices. Non-specific bronchial reactivity was similar in the two groups. In the final phase, results for respiratory symptoms were similar. The incidence of respiratory symptoms was not significantly different between hairdressing apprentices and office apprentices. Subjects who dropped out had lower values for FVC and FEV1 in the initial phase than those who completed the final phase. There was a significant deterioration of FEV1 and FEF25–75% in hairdressing apprentices compared to office apprentices. There was a link between atopy and the incidence of most of the respiratory symptoms (day/night cough, wheezing, dyspnoea, mucosal hyperresponsiveness) and between smoking and the incidence of bronchial hyperreactivity. There was no significant correlation between change in lung function tests and specific hairdressing activities reported at the end of the apprenticeship or with environmental working conditions in hairdressing salons. Conclusions: Although a healthy worker effect can be suspected, results showed a significant deterioration of baseline values of lung function tests in the hairdressing apprentice group. However, no clear link was shown between change in lung function tests and specific parameters of occupational activities.

International audience; We rely on a recent French matched case-control study to investigate the effect of occupational exposure to asbestos on the occurrence of lung cancer. We build a large collection of threshold regression models, data-adaptively select a better model in it by multi-fold likelihood-based cross-validation, then fit the resulting better model by maximum likelihood. A necessary preliminary step to eliminate the bias due to the case-control sampling is made possible because the conditional distribution of being a case given the matching variable and the marginal distribution of the matching variable can be computed beforehand based on two studies independent from our dataset. The implications of the fitted model in terms of expected years of life free of lung cancer lost due to the occupational exposure to asbestos are discussed.

International audience; We analyze the effect of occupational exposure to asbestos on the occurrence of lung cancer based on arecent French case–control (CC) study. We build a large collection of threshold regression models, dataadaptivelyselect a better model by CC-weighted likelihood-based cross-validation and then fit this bettermodel by CC-weighted maximum likelihood. The CC-weighting allows us to draw valid inferences fromCC data without relying on a logistic regression. This is possible because the joint distribution of theindicator of being a case and matching variable is available beforehand owing to two studies independentfrom our data set. The implications of the fitted model in terms of years of life free of lung cancer lost dueto the exposure to asbestos are discussed.

International audience; Cleaning products may cause work-related asthma, but information regarding the specific exposures involved is scarce. We aimed to determine the associations between asthma and occupational exposure to cleaning agents in hospital workers. Analyses were conducted in 179 (136 women) hospital workers and a reference population of 545 subjects (18-79 years) from the French case-control and familial Epidemiological study on the Genetics and Environment of Asthma (2003-2007). Exposures to cleaning agents were estimated using three methods: self-report, expert assessment and an asthma-specific job-exposure matrix (JEM). Associations between cleaning products and current asthma were evaluated by logistic regressions, stratified by sex and adjusted for age and smoking status. According to expert assessment, 55% of male and 81% of female hospital workers were exposed to cleaning/disinfecting tasks weekly (p

OBJECTIVES--This study assessed the prevalence of respiratory manifestations among French pig and dairy farmers and determined the relationship between bronchial reactivity and respiratory manifestations. METHODS--The pig farmers included 102 men working more than half-time inside swine confinement buildings. There were 51 male dairy farmers and 81 male referents. The demographic characteristics of the three groups were similar except for more smokers among the referents. Each subject completed a standardized questionnaire. Pulmonary function tests were performed before and after a methacholine challenge (cumulative doses 80, 240, and 560 micrograms). Airborne dust, ammonia, and carbon dioxide were measured inside 28 swine confinement buildings. RESULTS--The pig farmers were exposed to a total dust level of 2.41 mg.m-3. The respirable particle concentration was low. The pig and dairy farmers had a significantly higher prevalence of cough and morning phlegm than the referents. Before the methacholine challenge, the dairy farmers had nonsignificantly lower mean lung function values than the other groups. Among the subjects with no history of asthma, nonspecific bronchial hyperreactivity was significantly higher among the pig and dairy farmers than among the referents. There was a fall in the forced expiratory volume in 1 s (FEV 1.0) that was greater than 10% in 6.7% of the referents, 17.9% of the swine workers, and 35.6% of the dairy farmers. This result was unchanged after adjustment for the initial FEV1.0. CONCLUSIONS--The prevalence of respiratory symptoms was significantly higher among the pig farmers without base-line lung function impairment. However, both the pig and the dairy farmers had increased bronchial reactivity.

International audience; OBJECTIVES: The aim of the study was to determine whether self-reported occupational exposure to cleaning/disinfecting agents in hospital workers is accurate, in comparison to expert assessment, taken to be the gold standard. METHODS: In the Epidemiological Study of the Genetics and Environment of Asthma (EGEA), participants were interviewed on occupation with a specific questionnaire for hospital workers regarding tasks and cleaning/disinfecting agents. Two estimates of exposure were available: self-report and expert assessment. The expert assessment involved a standardised procedure to estimate intensity, frequency and probability of exposure for each job. The present analysis focused on eight exposures: formaldehyde, glutaraldehyde, bleach/chlorine, alcohol, quaternary ammonium components, ammonia, sprays and latex gloves. Agreement and differences between self-reported and expert estimates were studied by kappa and phi coefficients and McNemar tests, respectively. RESULTS: In the survey of 1571 adults, 176 ever hospital workers (327 occupations) with both self-reported and expert exposure assessments were studied. An underestimation of self-reported exposure was observed especially for formaldehyde (26.5% vs 32.7%, p=0.01), ammonia (7.4% vs 18.8%, p

From the registry of self employed workers living in Paris, a group of 105 dental technicians was studied to evaluate occupational exposure, to determine respiratory manifestations, and to investigate immune disturbances. Seventy one dental technicians (age range 43-68: group D), 34 dental technicians younger than 43 or older than 68 (group d), and 68 control workers (age range 43-66: group C) were investigated. The demographic characteristics and the smoking habits of the groups D and C did not differ significantly. The dental technicians often worked alone (43.7%) or in small laboratories without adequate dust control. The mean duration of their exposure was long (group D 34.0 (SD 8.4) years). The prevalence of respiratory symptoms did not differ between groups D and C except for the occurrence of increased cough and phlegm lasting for three weeks or more over the past three years (group D 16.9%, group C 2.9%, p < 0.007). The effect of cigarette smoking on respiratory symptoms and lung function was obvious. All mean values of lung function for dental technicians and controls were within normal limits. Significant decreases in all mean lung function values were found among smokers by comparison with non-smokers, however, and a positive interaction with occupational exposure was established. The x ray films of dental technicians (n = 102, groups D and d) were read independently by four readers and recorded according to the International Labour Office classification of pneumoconioses. The prevalence of small opacities greater than 1/0 was 11.8% with a significant increase with duration of exposure. The prevalence among dental technicians with 30 years or exposure or more was significantly higher (22.2%) than those with less than 30 years (3.5, p < 0.004). The prevalence of autoantibodies (rheumatoid factors, antinuclear antibodies, and antihistone antibodies) was not significantly different in the groups D and C. When positive, autoantibodies only occurred at low concentrations. This finding contrasts with previous reports on the occurrence of autoantibodies and even of connective tissue diseases in dental technicians. In conclusion, the study confirms an increased risk of pneumoconiosis among dental technicians. Moreover, there may be other lung disorders such as impairment of lung function especially in association with cigarette smoking.

A new case of occupational asthma caused by Chrysonilia sitophila (asexual state of Neurospora sitophila ) was diagnosed by molecular identification of the mold and confirmed by skin prick test, peak expiratory flow rate measurements, and experimental immunoglobulin E analysis.

Immunoblotting analysis of wheat allergens can be a two-step procedure: an incubation with a human serum and one with an anti-IgE-horseradish peroxidase (HRP) conjugate, visualised by chemiluminescence. Different procedures produced side reactions that appeared as non-specific additional bands which hampered the identification of specific IgE-reacting proteins. We then showed that the rabbit anti-human IgE-HRP conjugate most likely contains anti-wheat antibodies that bind with the proteins. We investigated another procedure to accurately identify wheat specific IgE-reacting proteins. The use of polyvinylpyrrolidone-40 throughout the procedure and 3% cow milk for the conjugate incubation provided signals clear-cut enough to detect proteins up to the allelic level. Tested against patients, the procedure identified IgE-reacting proteins. It also provided new data in terms of gliadins for patients suffering from hypersensitivity to hydrolysed wheat proteins. Lastly, we investigated why dried cow milk blocks. Using rabbit serum containing anti-wheat antibodies, we detected wheat cross-reacting polypeptides in it.

Aerosol particles which deeply penetrate the human airways and which trigger baker's asthma manifestations are known to represent only a part of flour and of airborne particles found in bakeries. They were a major focus of this study. To this end, aerosols were produced from different wheat and rye flours, using an automatic generator designed for bronchial challenge. Particles were characterized for their size distribution, their ability to be deposited in the airways, their protein content, their histological composition and their reactivity with immunoglobulin E (IgE) present in sera from asthmatic bakers. Like dust particles collected in the bakery, the aerosols produced showed increased protein content but decreased IgE reactive protein content when compared to the corresponding bulk flours. The sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis of these particles showed a predominance of endosperm gluten proteins. Under scanning electron microscopy, flour particles displayed various tissue fragments with entrapped large A-starch and small B- or C-starch granules, whereas aerosol particles appeared primarily as a mixture of the endosperm intracellular interstitial protein matrix and small B- or C-starch granules free or still associated. These observations showed that aerosols supposed to penetrate deeply the airways, mainly correspond to intracellular fragments of endosperm cells enriched in gluten proteins but with lower amount of allergens belonging to albumins or globulins.

Background As a result of prolonged survival, more patients with CF participate in the labour force. The available data on employment in CF have been based on cross-sectional studies. To our knowledge, no cohort study, evaluating the evolution of employment status in CF patients has been conducted so far. In 2009, we assessed occupational levels and risk factors for work disability in 207 patients cared for at our CF centre in Paris. Five years later, we reassessed employment status in the same cohort, with a special focus on lung transplantation recipients. Methods We first reviewed the status of the patients from the 2009 cohort (alive, deceased, lost to follow-up). A self-administered questionnaire, identical to the one used in 2009 on work status and treatment, was submitted to the patients still in the cohort. A section relating to lung transplantation was added when appropriate. In parallel, medical records were reviewed for illness severity indicators. Results Of the 207 initial patients, 16 had died, 7 were lost to follow-up and 184 were still alive (35 of which had received a lung transplantation). To date, data have been collected for 166 patients (80%). In comparison to 2009, 97 (58%) vs 117 (57%) were employed, 14 (8%) vs 13 (6%) were unemployed, 45 (27%) vs 38 (18%) were inactive and 9 (5%) vs 39 (19%) were students. Conclusion The proportion of employed patients was unchanged after 5 years but fewer patients were students. Data collection will be completed for the patients in the cohort who have moved and are no longer followed in our CF center. We plan to analyze employment promoting factors and the impact of lung transplantation on occupational life.

To determine whether insomnia impact the professional life of patients and have an economical weight, this review article focused on the socioeconomic impacts of sleep related problems in working populations. The goal is to summarise the work that has been accomplished in that field. Several occupational factors have an impact on insomnia: the work schedules (shift work and night work), the physical environment at work and the occupational stressors. Insomnia is also a common problem in daytime workers. The daytime functioning of insomniacs is a key point to understand the impact of insomnia on workers. Absenteeism is one major target in the evaluation of severe insomnia at the workplace. Most of the studies find a higher rate of work accidents in insomniacs. The economic impact is severe in term of direct and indirect costs. Insomnia is a common problem at the workplace. The negative impact is not only on individual but also at the societal levels. More epidemiological studies appear warranted to demonstrate a reciprocal link between work conditions and sleep disorders.

Objectives The aim of this study was to assess the long term pre-clinical effects of low-dose radiation on the micro-vascular structure among interventional physicians whose hands are exposed to ionising radiation in their daily practice. Method The study, approved by the ethics committee, included 186 radiation-exposed (surgeons, cardiologists and radiologists) and 35 unexposed physicians. The study participants filled in a questionnaire describing their present and past daily practice from which the present and cumulative radiation exposures were estimated. Their dermal microcirculation was assessed by capillaroscopy of the nailfold of 8 fingers -thumbs excluded- of each study participant. Two quantitative scores characterising respectively extravasation and morphological abnormalities were obtained based on post-hoc codings of seven semi-quantitative indices by five capillaroscopists. These assessments were randomised and were blind to the exposure. The effect of the radiation exposure on both features was modelled using multilevel proportional odds regression adjusted for potential confounders. Results The exposure intensity of each act was greatest among surgeons but with a lesser number of acts. The mean estimated cumulated exposure was largest among radiologist and cardiologists. No effect of the exposure could be detected on the extravasation score. The morphological anomaly score increased significantly with duration of exposure and cumulative exposure indices among surgeons and interventional radiologists contrary to cardiologists among which no effect could be detected. Conclusions Capillaroscopy showed significant effects of chronic low-dose exposure to ionising radiation on micro-vascular structure among exposed physicians but its interest for individual monitoring has not been demonstrated.

OBJECTIVES—To develop a method suitable for estimating exposure risks in population studies of asthma from job titles and international codes, by combining a new job exposure matrix (JEM) with the expert judgement approach. The method was applied in the French epidemiological study of the genetics and environment in asthma (EGEA). METHODS—The JEM contains 22 exposure groups including 18 high risk groups based on known risk factors for occupational asthma, divided into high molecular weight agents, low molecular weight agents, and mixed environments. After applying the JEM to job codes, exposure estimates for each subject were re-evaluated by examining job title texts. Three high risk exposure estimates for asthma were compared: firstly, applying the JEM to original codes (from different coders in each study centre); secondly, applying the JEM to revised codes (from one experienced coder); and thirdly, after reviewing JEM exposure estimates in the light of job title texts. RESULTS—The study comprised 173 cases with asthma and 285 controls (age 18-65). Odds ratios (ORs) for asthma for high risk jobs were 1.0 (95% confidence interval (95% CI) 0.6 to 1.7), applying the JEM to original codes; 1.4 (95% CI 0.8 to 2.3), applying the JEM to revised codes; and 1.7 (95% CI 1.1 to 2.7), applying the JEM and subsequently re-evaluating exposure estimates from job title texts. Asthma ORs were 1.4 (95% CI 0.6 to 2.9) for high molecular weight agents, 2.3 (95% CI 1.2 to 4.4) for low molecular weight agents, and 2.1 (95% CI 0.9 to 5.2) for mixed environments. CONCLUSIONS—This asthma JEM, when enhanced by expert re-evaluation of exposure estimates from job title texts, may be a useful tool in general population studies of asthma. In this study, a 1.7-fold increase in prevalence odds of high risk exposures was found among asthmatic workers compared with controls, with risk magnitude varying for different classes of exposure. Keywords: job exposure matrix; asthma; occupational exposure; epidemiological methods; case-control

The aim of this study was to describe changes in employment and income following a diagnosis of occupational asthma, and to determine what factors might affect these changes. Two hundred and nine patients with occupational asthma were reviewed on average 3.1 yrs after the diagnosis had been made. They were contacted by telephone or were sent a self-administered questionnaire by post. Multiple logistic regression models were constructed to determine which variables were associated with loss of employment after the diagnosis. At the time of review, 44% of patients had left their previous job and 25% were currently unemployed. Remarkably, 32% remained exposed to the offending agents in the same job. Forty six percent of the patients had suffered a reduction of income (84% of those who had left their employer versus 19% of those still employed in the same company (p < 0.001)). Claims for compensation, size of the company, level of education, and age at the time of diagnosis were significantly associated with a risk for becoming unemployed or having a new employer after the diagnosis of occupational asthma. Occupational asthma results in severe socioeconomic consequences. The French compensation system for occupational asthma should be revised, as the criteria currently used to determine compensation for this disease largely underestimate the social and occupational damages.

Objectives The deleterious role of cleaning products in work-related asthma has been suggested in recent studies. We aimed to study the relationship between asthma and occupational asthmogens, with a particular attention to cleaning agents, separately in men and women. Methods Analyses were conducted in 656 men and 699 women (18–79 years) from the follow-up of the case-control and familial Epidemiological study on the Genetics and Environment of Asthma (EGEA), with available data for work history. Lifetime and current occupational exposures to 18 specific asthmogens, including industrial cleaning agents, were estimated using an asthma job-exposure matrix with an expert re-evaluation step. Subjects with current asthma (266 men, 247 women), current adult-onset asthma (77 men, 98 women), or current asthma with high asthma symptom score (164 men, 176 women) were compared to non-asthmatics. Analyses were stratified by sex and adjusted for age and smoking. Results 32% of men and 28% of women had ever been exposed to asthmogens. Women were more exposed than men to cleaning agents (9% vs 2%,p Conclusions Our results confirm the deleterious role of occupational exposure to cleaning agents on asthma in women and are consistent with a role in both new-onset and work-exacerbated asthma. Grants: AFSSET-EST-09-15, PHC Van Gogh.

Respiratory manifestations among 41 workers exposed to amorphous silica dust were compared with a control group comprising 90 workers of equivalent socioeconomic state in the same plant. Flow volumes were determined, blood gas concentrations were measured at rest and during exercise, chest radiographs were obtained, and data about respiratory symptoms were collected by questionnaire. A dust exposure index was calculated for each exposed worker. It was not possible to differentiate between the two groups from the questionnaire, blood gas analysis, or chest radiographs. On the other hand, the tests of respiratory function showed a significant decrease in forced expiratory flow (FEF25-75, FEF50, and FEF75) in the exposed group compared with the controls, although no correlation was found between the exposure index and pulmonary function. It appears that smoking and exposure to amorphous silica synergise to induce small airway disease.

Respiratory manifestations have been reported after exposure to hydroquinone and to methionine. One hundred and three men in the same chemical plant were divided into three groups according to their exposure and compared by questionnaire, respiratory functional tests with methacholine then salbutamol challenges, and measurements of serum immunoglobulins G and E. Group H included 33 workers exposed to hydroquinone, trimethyl-hydroquinone, and retinene-hydroquinone. Group M included 15 workers exposed to methionine. Group C was a control group of 55 workers. The prevalence of respiratory symptoms was higher in the two exposed groups. Before challenges, pulmonary function values were significantly lower in groups H and M than those in group C. The challenges induced significant variations in the three groups but these variations were less pronounced in group M than in the other groups. The level of immunoglobulin G in group H (m +/- SD = 12.5 gram/liter +/- 2.6) was significantly higher than in group C (10.6 gram/liter +/- 2.4; p less than 0.002). The level of immunoglobulin E in group H (m = 140 IU/l) was also higher in group C (109 IU/l) but this difference was not significant. These findings suggest that exposure to methionine and to hydroquinone and its derivatives induce ventilatory impairment, perhaps by an immunological mechanism.

Objective To assess employment status and socio-economic burden in SSc patients. Methods Eighty-seven SSc patients (72 females), fulfilling the ACR or the Leroy and Medsger criteria, or both, were evaluated for employment status, socio-economic burden and handicap. Statistical analysis involved Mann-Whitney U-test and Fisher's exact test and backward stepwise regression analysis. Results In total, 60.9% of the SSc patients were on full-time sick leave and 35.6% were receiving a disability pension. On univariate analysis, myalgia was the only clinical manifestation more frequently encountered in sick-leave patients than others (73.6 vs 47.1%; P = 0.012). Karnofsky performance status (KPS) was lower in SSc patients who were on sick leave or were receiving a disability pension than others [78.5 (10.6) vs 85.8 (9.0); P = 0.004 and 78.1 (8.7) vs 83.1 (11.2); P = 0.016, respectively]. In addition, greater global, hand and mouth handicaps and depression were observed in patients on sick leave [HAQ 0.9 (0.7) vs 0.6 (0.5); P = 0.021; Cochin Hand Function Scale 21.7 (18.9) vs 10.7 (12.1); P = 0.003; mouth handicap scale 20.2 (10.8) vs 14.6 (10.0); P = 0.014; and depression dimension of the hospital anxiety and depression scale 7.1 (3.9) vs 4.8 (3.4); P = 0.003]. On multivariate analysis, factors associated with sick leave were KPS [odds ratio (OR) 0.92; 95%CI 0.88, 0.98] and myalgias (OR 3.19; 95% CI 1.19, 8.58), and the factor associated with receiving a disability pension was decreased income (OR 8.19; 95% CI 2.67, 25.12). Conclusions SSc patients commonly have to take full-time sick leave from work. Despite such patients receiving disability pensions, the socio-economic burden is considerable.