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Objectives This systematic review assessed which variables are associated with or are predictors for work participation outcomes in patients with systematic lupus erythematosus (SLE). Methods A literature search using MEDLINE, The Cochrane Library, Embase and CINAHL was conducted to identify all studies published from inception (1947) to June 2021 on factors related to and/or predicting employment status, absenteeism and/or presenteeism in SLE patients aged ≥18 years. The quality of included articles was assessed using the QUIPS tool. Narrative summaries were used to present the data. Results Fifteen studies (nine on associations, four on predictions, and two assessing both) were included, encompassing data of 3800 employed patients. Younger age, Caucasian ethnicity, higher educational level, lower disease activity score, shorter disease duration, absence of specific disease manifestations, higher levels of physical functioning and less physical job demands and higher levels of psychological/cognitive functioning were associated with or predicted favorable work outcomes. Older age, non-Caucasian ethnicity, female gender, never being married, poverty, lower educational level, higher disease activity score, longer disease duration, specific disease manifestations, lower levels of physical functioning, more physical job demands and low job control, less job tenure and lower levels of cognitive functioning were associated with or predicted an unfavorable work outcome. Limitations of the evidence were the quality of the studies and the use of heterogeneous outcome measures, applied statistical methods and instruments used to assess work participation. Conclusion We recommend applying the EULAR points to consider for designing, analysing and reporting on work participation in inflammatory arthritis also to SLE studies on work participation, to enhance the quality and comparability between studies and to better understand the impact of SLE on work participation. Trial registration registration in PROSPERO (CRD42020161275; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=161275).

Background: Medication use during pregnancy and lactation can be unavoidable, but knowledge on safety for the fetus or breastfed infant is limited among patients and healthcare providers. Research aim: This study aimed to determine (a) the prevalence of medication use in pregnant and lactating women in a tertiary academic center, (b) the types and safety of these medicines, and (c) the influence of medication use on initiation of breastfeeding. Methods: This study used a cross-sectional survey among women ( N = 292) who underwent high-risk or low-risk deliveries. Data about their use of prescribed, over-the-counter, and homeopathic medication during pregnancy were obtained through a structured interview, followed by a questionnaire during lactation. Safety was classified according to the risk classification system from the Dutch Teratological Information Service. Results: Overall, 95.5% of participants used medication. One third of participants used at least one medicine with an unknown risk for the fetus. Teratogenic medication was used by 6.5% of participants, whereas 29.5% used medication with a (suspected) pharmacological effect on the fetus. Lactation was initiated by 258 (88.7%) participants, of which 84.2% used medication while breastfeeding. In 3.8% of participants, this medication was classified unsafe, but none used medication with an unknown risk. One-third of the nonlactating participants decided not to initiate breastfeeding because of medication use. In 70% of participants, this decision was appropriate. Conclusion: The prevalence of overall use of medication in Dutch pregnant and lactating women admitted to a tertiary center was high. There is an urgent need for pharmacometric studies for determination of the safe use of the most frequently used medicines during pregnancy or lactation.

Background The treatment of Systemic Lupus Erythematosus (SLE) has improved over the last decades. However, patients are more vulnerable for sick leave, work disability and unemployment compared to the general population. It is therefore important to understand the magnitude of the problem and the factors that might affect work participation in patients with SLE, to evaluate which actions can be taken to limit the burden on a patient and society level. The aim of this research is to summarize the existing literature on 1) the prevalence of work disability, 2) prognostic factors for work participation and 3) the effectiveness of interventions to improve work participation in patients with SLE. Methods A scoping review, using the PRISMA-ScR statement will be conducted. Full-text original articles published before April 2019 were identified by literature search performed in MEDLINE, Cochrane, Embase and CINAHL. Articles in all languages, concerning work participation in patients with SLE, aged ≥18 years were included. Results In total, 2050 non-duplicate citations were screened. After title/abstract screening, 75 articles were retrieved. Relevant articles will be identified and reference lists will be searched for additional articles by two independent researchers. Information on author(s), year of publication, study location, intervention type, comparator, duration of the intervention, study population, aims of the study, methodology, outcome measures and important results will be collected. The results will be presented at the congress. Conclusion Based on this scoping review, implications for future research including a research agenda and daily practice will be identified.

Background Women with systemic lupus erythematosus (SLE) might be more vulnerable to reduce or stop working during pregnancy because of the increased risk of pregnancy complications compared to the general population. However, no data on work loss during pregnancy and return to work after maternity leave in patients with SLE are available. Objectives We aimed to investigate several work outcomes during and after pregnancy in women with SLE compared to matched pregnant controls. Methods A case-control study on employment was performed in pregnant women with SLE and matched controls. Matching criteria were age, year of delivery, and number of living infants. Employment was defined as having ≥8 hours/week of paid work before conception. Four work outcomes were investigated: interruption of work for >1 week during pregnancy, complete cessation of work for >1 week until delivery, reduction in working hours during pregnancy, and the time in weeks to return to work after maternity leave. Results A total of 42 women were included (21 SLE patients, 21 controls). Mean SELENA-SLEDAI before pregnancy in SLE patients was 2.6 (SD 2.3). Interruption of work for >1 week or completely stop working during pregnancy occurred in 10 SLE women, compared to 2 controls (OR=8.6, 95% CI [1.6-46.8], p=0.012). From the women who completely stopped working until delivery (n=8), 7 women had SLE (OR=1.4, 95% CI [0.07-28.1], p=0.826). In addition, in women continuing work, reduction of working hours occurred in 5 women with SLE versus 3 controls (OR=1.9, 95% CI [0.4-9.1], p=0.436). After delivery, the median (IQR) duration of return to work after maternity leave was 4 weeks after maternity leave (0 - 6.8) for women with SLE and 2 weeks later (0 - 4) for controls (Mann-Whitney U test; p=0.977). No difference in number of women with delay of return to work after maternity leave (yes/no) was found between women with SLE and controls (n=9 versus n=11, respectively; OR=1.0, 95% CI [0.3-3.7], p=0.973). Conclusion Pregnant women with SLE more frequently completely stop working or reduce working hours compared to matched healthy controls. These findings warrant improved counseling of these women and attention of health care providers, including company doctors. Disclosure of Interests Birgit Blomjous Speakers bureau: UCB Pharma BV, Marieke ter Wee Grant/research support from: Nonrestricted grant from Lilly Netherlands BV, Speakers bureau: ARC Preceptorship program, Alexandre Voskuyl: None declared, Hanneke de Vries Grant/research support from: Pfizer, Speakers bureau: UCB Pharma BV, Irene E.M. Bultink Consultant for: Consultant fee from Sanofi Genzyme, Speakers bureau: Speaker fees from Lilly Netherlands BV, MSD Corp, Amgen BV, UCB Pharma BV, Roche Netherlands BV and Sanofi Genzyme

Background Women with systemic lupus erythematosus (SLE) might be more vulnerable to reduce or stop working during pregnancy because of the increased risk of pregnancy complications compared to the general population. However, no data on work loss during pregnancy and return to work after maternity leave in patients with SLE are available. We aimed to investigate several work outcomes during and after pregnancy in women with SLE compared to matched pregnant controls. Methods A case-control study on employment was performed in pregnant women with SLE and matched controls. Matching criteria were age, year of delivery, and number of living infants. Employment was defined as having 8 hours/week of paid work before conception. Four work outcomes were investigated: interruption of work for >1 week during pregnancy, complete cessation of work during pregnancy for >1 week until delivery, reduction in working hours during pregnancy, and the time in weeks to return to work after maternity leave. Results A total of 42 women were included (21 SLE patients, 21 controls). Mean SELENA-SLEDAI before pregnancy in SLE patients was 2.6 (SD 2.3). Interruption of work for >1 week or completely stop working during pregnancy occurred in 10 women with SLE compared to 2 controls (OR=8.6, 95% CI [1.6–46.8], p=0.012). From the women who completely stopped working until delivery (n=8), 7 women had SLE versus 1 control (OR=1.4, 95% CI [0.07–28.1], p=0.826). In addition, in women continuing work, reduction of working hours during pregnancy occurred in 5 women with SLE versus 3 controls (OR=1.9, 95% CI [0.4–9.1], p=0.436). After delivery, the median (IQR) duration of return to work after maternity leave was 4 (0–6.8) weeks after maternity leave for women with SLE and 2 (0–4) weeks later for controls (Mann-Whitney U test, p=0.977). No difference in number of women with delay of return to work after maternity leave (yes/no) was found between women with SLE and controls (n=9 versus n=11, respectively, OR=1.0, 95% CI [0.3–3.7], p=0.973). Conclusions Pregnant women with SLE more frequently completely stop working or reduce working hours compared to matched healthy controls. These findings warrant improved counseling of these women and attention of health care providers, including company doctors. Funding Source(s): None

Background:The treatment of systemic lupus erythematosus (SLE) has improved over the last decades, however, absenteeism and work disability numbers remain higher than those observed in the general population (1). SLE has its onset between the ages of 20 and 40 years, and has a major burden on the lives of patients, both mentally and financially. A recent online survey amongst 2070 European SLE patients revealed that 69.5% of patients had their careers affected due to SLE (2).Objectives:To determine the magnitude of absenteeism and work disability in patients with SLE and to investigate the factors that might affect work participation in these patients in order to develop interventions to reduce the impact of the burden in the future.Methods:A systematic literature search was performed to identify published articles reporting on the prevalence of work related burden, as well as the relation of having SLE on employment status, sick leave and/or presenteeism. Full-text original articles (all languages) published before April 2019 were identified by literature search performed in MEDLINE, Cochrane, Embase and CINAHL.Results:In total, 2057 non-duplicate citations were screened after database searching and snowballing. Finally, 81 articles were included; most studies (n=59) had a cross-sectional design and the remaining 22 studies had a longitudinal design. Only 15 longitudinal cohort studies reported on associations, 6 studies described a longitudinal prediction model, 2 studies reported on associations and described a prediction model, and 3 studies had a longitudinal design but only reported on prevalences over time. In total, 3500 working patients were included in the studies reporting on associations or describing a longitudinal prediction model. In the association studies, the most frequently used outcome measures were respectively being employed/probability of being employed and work loss/job cessation. Other studies used loss of days from (non)workforce activities/sick leave days, work disability, productivity loss or work entry. Most associations with work outcome were found for demographic variables and two or three disease variables, like Systemic Lupus Activity Questionnaire (SLAQ) score and depressive symptoms. This was also the case in the prediction studies. Most studies did not assess work related variables as possible predictors for work outcome.Conclusion:A large heterogeneity was found in type of study design and outcome measures, which limits comparison with other studies. More longitudinal studies are needed to truly assess the impact of SLE on work participation, and to identify factors that could be influenced during interventions, in order to encourage work participation of these patients.References:[1]Bultink IE, Turkstra F, Dijkmans BA, Voskuyl AE. High prevalence of unemployment in patients with systemic lupus erythematosus: association with organ damage and health-related quality of life. J Rheumatol. 2008;35(6):1053-7.[2]Gordon C, Isenberg D, Lerstrom K, Norton Y, Nikai E, Pushparajah DS, et al. The substantial burden of systemic lupus erythematosus on the productivity and careers of patients: a European patient-driven online survey. Rheumatology (Oxford). 2013;52(12):2292-301.Disclosure of Interests:None declared

Background The Rheumatoid Arthritis Impact of Disease (RAID) score was developed as a European League Against Rheumatism initiative to obtain a patient reported outcome score for clinical trials in patients with rheumatoid arthritis (RA), based on patients’ perception of the impact of the disease on several domains of health. The objective of this study was to assess the content validity of this score in Dutch RA patients. Methods During three focus group discussions (n = 23), patients with RA reflected on comprehensiveness of the RAID to measure impact of RA on their life, relevance of the RAID domains and formulation of questions. Also, the domains of the RAID score were compared to the comprehensive International Classification of Functioning, Disability and Health core set for RA. Results Patients confirmed that RA had impact on five domains already incorporated in the RAID score: emotional well-being, pain, performing daily activities, fatigue and coping. There was variation in interpretation of some of the items of the RAID score, suggesting problems in comprehension. Patients indicated that the domains work, relationships with others (such as family and friends) and spare time/hobbies were missed in the RAID and could be added to obtain a more ‘complete’ picture of the impact of the disease. Conclusion The RAID score has fairly good content validity. If confirmed as important in other patient groups, items in the above mentioned areas should be considered in a future upgrade. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0911-z) contains supplementary material, which is available to authorized users.