Free Content A narrative literature review of the impact of anti-TNFα treatment on the occupational performance of people with rheumatoid arthritis or ankylosing spondylitis

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Introduction: Anti-TNF α treatment has revolutionised the disease pathway for some people with rheumatoid arthritis and ankylosing spondylitis, although physiological improvements do not always readily translate into re-engagement in occupational activities. This review explores the evidence base for the impact of anti-TNF α on occupational performance.

Method: Literature was searched from 2000–11. A four-stage process resulted in the review of 19 articles. The Weight of Evidence framework was used to assess quality and relevance to the review question.

Findings: People on anti-TNF α treatment experience increased engagement in functional, psychological and social domains. Most studies focused on employment issues, with conflicting evidence about how well anti-TNF α protected against work disability and very limited evidence that anti-TNF α enabled return to paid work. The increase in productivity was to the detriment of other occupational domains, with resulting occupational imbalance.

Conclusion: The assumption that clinical improvement is relatively trouble free is incorrect, as some people on anti-TNFα treatment continue to experience difficulties in all occupational domains, particularly work. People on anti-TNFα treatment do not routinely have access to occupational therapy services. Further research needs to explore the nuanced experiences of treatment and the role of occupational therapy in maximising the treatment potential of anti-TNFα .


Document Type: Review Article


Publication date: October 1, 2013

More about this publication?
  • The British Journal of Occupational Therapy (BJOT) is the official journal of the College of Occupational Therapists. Its purpose is to publish articles relevant to theory, practice, research, education and management in occupational therapy internationally.

    BJOT publishes research articles, critical reviews, practice analyses, opinion pieces, editorials, letters to the editor, book reviews and an annual index. Please refer to the author's guide at

    Submissions can be made at

    The 2013 Impact Factor for The British Journal of Occupational Therapy is 0.897.

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