SAT0619 Associations between clinical manifestations of behcet’s syndrome and work outcomes: results from a uk cross-sectional analysis

Background Behcet’s syndrome (BS) is a multi-systemic auto-inflammatory disease which exhibits significant heterogeneity in clinical manifestations, including orogenital ulceration, skin rash, arthralgia and ocular, venous, gastro-intestinal and neurological involvement. BS affects adults of working age, usually presenting between 20–40 years,1 and can therefore have a significant impact on work. The association between individual and cumulative clinical manifestations of BS on employment status has not previously been assessed. Objectives To 1) describe demographics, clinical manifestations, work outcomes and use of unemployment benefits in a UK BS cohort and 2) to explore the relationship between individual and cumulative manifestations of BS and work outcomes. Methods A cross sectional analysis was performed using the Liverpool Behcet’s Centre of Excellence clinical database. Inclusion criteria were clinical characteristics meeting International Criteria for Behcet’s Disease (ICBD) diagnostic criteria and recorded employment data. Patients meeting ICBD but thought unlikely to have BS on clinical review by our multi-disciplinary team were excluded. Demographics, clinical manifestations, work outcomes and use of employment related benefits were described. A binomial variable ‘Out of work’ was generated and defined as unemployment, sickness absence, or patients marked as retired but of working age, a carer or a homemaker if the patient had to stop work due to BS. Associations between Out of work and: 1) individual clinical manifestations of BS, and 2) number of clinical BS manifestations, were explored using multivariate logistic regression adjusted for age, gender, mean EQ5D score and socio-economic status. Odds ratios (OR) and 95% confidence intervals were calculated. Results 120 patients met inclusion criteria. Mean age was 41.1 years and 33 patients (28%) were male. The minimum number of clinical manifestations were two in order to meet ICBD; the frequencies were 100% oral ulceration, 94% genital ulceration, 71% arthralgia, 43% skin rash and 20% ocular, 7% neurological, 6% vascular and 5% gastro-intestinal involvement. 37 patients (31%) were out of work with 44 patients (37%) claiming employment related benefits. With regard to individual clinical manifestations, ocular disease had a statistically significant increased risk for being out of work when assessed alone with OR 2.84 (95% CI 1.13, 7.13) but lost statistical significance when analysed in the multivariate model: OR 2.45 (95% CI 0.70, 8.60). With regard to cumulative clinical manifestations, patients with four or more clinical manifestations of BS had a statistically significant increased risk of being out of work with OR 5.57 (95% CI 1.33, 23.27) in comparison to patients with two manifestations in the multivariate model. Conclusions This study has highlighted the significant burden of BS on work outcomes in this UK cohort. In particular, four or more cumulative BS manifestations were independently associated with being out of work in this young cohort. Further work is required to identify whether education or intervention in the workplace can help prevent disease related job loss in BS. Reference [1] Ambrose NL, Haskard DO. Differential diagnosis and management of Behcet syndrome. Nat Rev Rheumatol2013;9:79–89. doi:10.1038/nrrheum.2012.156 Disclosure of Interest None declared