Effect of Adalimumab on Work Ability Assessed in Rheumatoid Arthritis Disease Patients in Saudi Arabia (AWARDS)

Waleed Hussain 1, Nahid Janoudi 2, Abdulsalam Noorwali 3, 4, Narges Omran 4, Matouqa Baamer 5, El Hussain Assiry 6, Hanan Alrayes 7, Hanan Alosaimi 8, Ashraf Ibrahim 8, Shereen Gohary 8, Joan Minguet8, Hani Almoallim*, 2, 3, 8
1 Department of Medicine, Heraa General Hospital, Makkah, Saudi Arabia
2 Department of Medicine, Dr. Soleiman Fakeeh Hospital, Jeddah, Saudi Arabia
3 Department of Medicine, Umm Alqura University, Makkah, Saudi Arabia
4 Department of Medicine, Alnoor General Hospital, Makkah, Saudi Arabia
5 Department of Medicine, King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia
6 Department of Medicine, Aseer Center Hospital, Abha, Saudi Arabia
7 Department of Medicine, Riyadh Military Hospital, Riyadh, Saudi Arabia
8 Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah, Saudi Arabia

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© Hussain et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Medicine, Umm Alqura University, P.O. Box 1821 Jeddah 21441, Saudi Arabia; E-mails:,


Objectives :

Rheumatoid arthritis (RA) is a chronic disabling disease that can jeopardize the ability of affected individuals to participate in paid work. Our objective was to evaluate the effectiveness of a 6-month course of tumor necrosis factor (TNF) antagonist (adalimumab) on work ability, overall health, and fatigue in RA patients.

Methods :

Between October 2012 and February 2014, this prospective, observational study enrolled 63 consecutive patients with established adult RA at outpatient clinics in Makkah, Jeddah, Riyadh and Abha (Saudi Arabia). Patients received subcutaneous injections of adalimumab (40 mg every 2 weeks). Outcomes were measured at baseline and 6 months using the following tools: Work Productivity and Activity Impairment (WPAI), Health Assessment Questionnaire Disability Index (HAQ-DI), Fatigue Severity Scale (FSS), Visual Analog Scale for Fatigue (VAS-F), and work disability self-assessment.

Results :

All outcomes showed improvements after 6 months of adalimumab therapy. Significant improvements from baseline were observed in absenteeism (64% ± 11.62 to 11.60% ± 11.17 [p<0.0001]), presenteeism (62.15% ± 20.11 to 34.92% ± 20.61 [p<0.0001]), overall work impairment (69.08% ± 18.86 to 40.73% ± 22.29 [p<0.0001]), overall activity impairment (68.46% ± 18.58 to 36.46% ± 20.79 [p<0.0001]), HAQ score (1.69 ± 0.57 to 0.81 ± 0.61 [p<0.0001]), and FSS score (47.08 ± 9.55 to 27.86 ± 13.43 [p<0.0001]).

Conclusion :

A 6-month course of adalimumab improved work ability, fatigue, and overall health assessments in patients with established RA. Our findings encourage randomized controlled trials investigating the cost-effectiveness and long-term effects of TNF inhibitors on work disability.

Keywords: Adalimumab, health assessment, rheumatoid arthritis, tumor necrosis factor (TNF) inhibitor, work ability.