When an employee has rheumatoid arthritis
June 2008: Helen Bunyan, NRAS Membership Manager
Rheumatoid arthritis (RA) often begins when people are in the prime of their
working lives, which can be difficult both for them and their employers. But the
good news is that there are ways to minimise the effects of RA and help
employers retain valued staff members.
Find the answers to employers’ frequently asked questions here. For more
information, ask for your copy of When an employee has rheumatoid
arthritis - a guide for employers
What are the key facts about rheumatoid arthritis?
How can RA affect someone at work?
What should I do when an employee tells me they have RA?
What are my legal responsibilities?
What is a workplace assessment?
Where can I get more advice?
More information
- There’s a wealth of further information available about symptoms and
treatments . While RA is a chronic and often painful condition, there have been
huge advances in its treatment in recent years. Most people with RA can remain
active and continue to enjoy satisfying and productive working lives.
- Rheumatoid arthritis is a lifelong condition.
- It’s not an older person’s disease. People can develop it any age, even as
children. The most common age of onset is between 40 and 60.
- It’s very different from the better-known type of arthritis, osteoarthritis.
Rheumatoid arthritis is an ‘auto-immune disease’ – it results from a problem
with the immune system. For no known reason, the body’s immune system attacks
and damages joints and soft tissues surrounding the bones.
- Its main symptoms are joint pain, stiffness and swelling. Any joint may be
affected, but it is usually hands, wrists and feet. Some people also have
difficulty sleeping, feel intensely tired and feel like they have bad flu. Less
usually, it can also affect other parts of the body.
- There is no obvious pattern to symptoms. People get ‘flares’, or periods
when symptoms are much worse, which then subside. They can have periods when the
disease is quiet and causes no problems.
- Left untreated, RA can cause serious damage to joints, which can become
weakened, damaged and deformed.
- BUT there have been significant advances in the treatment of RA. People are
diagnosed and treated early, with drugs that control the disease process. And
once the disease is controlled, symptoms can be managed effectively, and people
have less joint damage than used to be the case. They can remain active and
enjoy satisfying and productive working lives.
When someone is diagnosed with RA, they are usually
prescribed a drug to control the disease process. The drugs are effective but
they take a while to kick in, usually a few weeks. During this time it’s
understandable if people are distressed: they’re in pain and coming to terms
with having a lifelong and incurable condition. Having an employer who
understands makes a huge difference.
The symptoms of RA that can affect someone’s at work are:
problems with mobility or function; severe stiffness, particularly in the early
morning; pain; and fatigue. But many people can manage these effectively.
People can get ‘flares’ in their symptoms, even when their
RA is well controlled. There may be no warning signs: a person can be at work
one day and be physically unable to get out of bed the next. Flares usually
subside in a couple of days. Some people need treatment to manage severe flares.
It can be difficult for colleagues to appreciate what’s happening – particularly
when the person looks exactly the same as usual.
People need some time off for medical appointments to manage
their disease. Once stabilised on treatment, most people see their consultant
rheumatologist every four to six months. Some drug treatments need blood tests
for safety reasons, which means people need to give regular samples, e.g. once a
month. Often people arrange to do this on their way to or from work.
- For most employees this isn’t an easy conversation. They are coping with a
life-changing diagnosis and are uncertain about the future. A supportive
approach from their employer can really help.
- Talk about the situation . Good communication is essential.
Make sure your employee has and understands all the relevant company policies.
If he or she would like their colleagues to know, discuss and agree the best way
to tell them. Let the employee know who to talk to if they need support or if
their situation changes.
- Agree a series of review meetings – or use your normal review meetings – so
that you can discuss any adjustments they may need.
- If an employee has an extended absence, keep in touch. Find out what kind of
communication the person prefers, whether it’s visits, phone calls or an
occasional email.
- Find out what your employee needs. Explore their situation
and identify any aspects of their role that cause problems. Examine their
working environment and accessibility. Arrange a workplace assessment if
necessary, through the Access to Work scheme, an occupational therapist or
occupational health physiotherapist.
- Look at the options and decide . Can the employee continue
with their current role? Do they need adaptations, changes to their working
hours or additional training? Is there an appropriate alternative job?
People with RA are entitled to protection under the Disability Discrimination
Act (DDA) if their RA affects them so that they meet the Act’s definition of
disabled. The Act recognises that some diseases are of a fluctuating nature and
that people may be impaired more at certain times.
In summary, the DDA applies to employees in the UK who have a physical or
mental impairment which has a substantial and long-term adverse effect on their
ability to carry out normal day-to-day activities.
The Act says that employers must make reasonable adjustmentsto allow a person with a disability to continue working. These can include:
- changes to working hours
- changes to duties
- equipment to help at work (e.g. telephone headsets; ergonomic computer
keyboards; adapted door handles)
- support from someone else with a particular part of a job
- improvements to physical access (e.g. disabled parking; rails; stair lifts)
- a move or transfer to another role in the company
- excluding absences that are directly related to a person’s disability in the
monitoring of sick leave. (Though it is not a requirement to pay higher levels
of sick pay to disabled employees.)
What is considered reasonable depends on the size and type of your business,
how practical the adjustment is, the cost and disruption of work involved, and
the potential benefit to employees and customers. There is further advice at www.tuc.org.uk
The Act protects employees against any discrimination in employment on the
grounds of disability, including recruitment, training opportunities, promotion
and redundancy.
This is an assessment carried out by an occupational health therapist or
occupational health physiotherapist. Through a visit to the workplace, a
therapist assesses the employee’s job and physical environment, evaluates tasks
and advises how to simplify or modify them. Recommendations can include:
adaptations to equipment; assistive technology; and changes to the work
environment.
- Your company’s occupational health adviser, if you have one
- The Access to Work scheme (AtW) (called the Disablement Advisory Service in
Northern Ireland). Provides support that can include help (including
financial help) with equipment, the costs of travel to and from work,
and adaptations to premises and equipment. For details and your local office, click here
- NHS Plus. A network of NHS occupational health (OH) departments across
England, providing services to non-NHS employers. These include telephone
advice; access to occupational health teams; appointments for employees in local
health centres; site visits.www.nhsplus.nhs.uk
- Workplace Health Connect. Confidential, practical and free advice to small
businesses. In England and Wales www.workplacehealthconnect.co.uk;
in Scotland see www.sahw.co.uk
- Employers’ Forum on Disability. Publications and advice include best
practice, reasonable adjustments and understanding the law. www.employers-forum.co.uk
- AbilityNet. A dvice on computing and disability. www.abilitynet.org.uk
- Some rehabilitation case management companies specialise in
employment-related services. For details of practitioners and companies search
under ‘vocational rehabilitation’ at www.cmsuk.org
You will find more details in 'When an employee has Rheumatoid
Arthritis - an employer’s guide' Available free of charge from
NRAS.
Employees with Rheumatoid Arthritis can request a copy of 'I want
to work - a self help guide for people with Rheumatoid
Arthritis'
Click here to go to our Publications request page