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2004). The patient’s assessment of pain was also predictive of future work disability in the TIRA cohort and this is in agreement with previous studies (Allaire et al. 1996, Gabriel et al. 1997b, Wolfe and Hawley 1998, Sokka et al. 1999, De Roos and Callahan 1999, Merkesdal et al. 2001). Since pain correlates with disability as measured by HAQ (Sokka et al. 2000) and pain and joint mobility explain all 8 subdimensions in HAQ (Häkkinen et al. 2005), pain is, besides HAQ, likely to be a main reason for not being able to maintain working capacity.

There is also a substantial variation in cost domains included in the calculations. The disease duration differs and changes in healthcare systems may occur over time (Rat and Boissier 2004, Rosery et al. 2005). Nevertheless, some comparisons can be made with recently published studies on patients with early RA (Table 13). For comparison, the costs for outpatient care include ambulatory care visits, radiographs and examinations, and the drug costs include monitoring costs. In the studies from the Netherlands, non-medical costs such as assistive devices and home adaptations, were excluded from the calculations.

1987, Lubeck 1995, McIntosh 1996, Kobelt et al. 1999, Newhall-Perry et al. 2000, Jonsson and Husberg 2000, Leardini et al. 2002). Costs are typically higher in an inception cohort, due to frequent ambulatory care visits and high costs associated to numerous nurse visits for blood tests in the early course of disease. In cost-of-illness studies performed before the era of biologic therapy, direct costs were dominated by hospitalisations and surgical interventions. Hospitalisation costs generally accounted for • 60% of the total direct costs, and medication less than 20% (Pugner et al.

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