Depression, adherence and health outcomes in Rheumatoid Arthritis (RA) patients

类风湿关节炎 (RA) 患者的抑郁、依从性和健康结果

• 批准号: 7125489
• 负责人: Susan J Bartlett
• 金额: $ 26.43万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-23 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7125489
• 关键词: antineoplastics; antirheumatic agents; behavioral /social science research tag; biological products; clinical research; depression; disease /therapy duration; human data; human subject; human therapy evaluation; longitudinal human study; mental health epidemiology; patient oriented research; rheumatoid arthritis; skeletal disorder chemotherapy; therapy compliance; tumor necrosis factor alpha

DESCRIPTION (provided by applicant): Rheumatoid arthritis (RA) is a debilitating and progressive disease that affects 1-2 percent of US adults and leads to chronic pain, loss of function, disability, loss of employment, and increased mortality. Currently, a cure for RA does not exist. Ultimate goals in managing RA are to prevent or control joint damage, prevent loss of function, and decrease pain. Achieving these goals requires early diagnosis and prompt initiation of aggressive treatment. In the past 5 years, treatment of RA has changed dramatically. The introduction of anti-TNF agents (biologies), which are powerful in action though very costly, can dramatically reduce disease progression; when biologies are not used, now combinations of potent new DMARDS (disease modifying anti-rheumatic drugs) are used to aggressively halt inflammation. However, currently we know very little about adherence to new RA therapies, especially biologies and combinations of more potent DMARDS. Thus, assessing and predicting adherence, and understanding common moderating factors is essential to clinical practice and research on determinants of treatment outcomes and efforts to improve patient adherence. The goals of this research proposal are to: (1) rigorously evaluate adherence to current RA therapies overtime in a cohort of patients; (2) relate adherence to disease activity and health outcomes; and (3) explore potential effect modifiers on the relationship between adherence and outcomes. We hypothesize that adherence to therapy is suboptimal, and will vary in relation to treatment (i.e., biologies vs. DMARDS), disease (i.e., burden/severity, previous use of DMARDS) and patient characteristics (depression status, demographics). Adherence will be associated with clinical and radiographic outcomes and health status at 1 yr. Depression will be associated with increased non-adherence. To test these hypotheses, we will utilize a one year observational study of 200 RA patients seen in the Johns Hopkins Arthritis Center.

描述（由申请人提供）：类风湿性关节炎 (RA) 是一种使人衰弱的进行性疾病，影响 1-2% 的美国成年人，并导致慢性疼痛、功能丧失、残疾、失业和死亡率增加。目前，尚不存在治疗 RA 的方法。治疗 RA 的最终目标是预防或控制关节损伤、防止功能丧失和减轻疼痛。实现这些目标需要早期诊断并立即开始积极治疗。在过去的5年里，RA的治疗发生了巨大的变化。抗 TNF 药物（生物制剂）的引入虽然价格昂贵，但作用强大，可以显着减少疾病进展；当不使用生物制剂时，现在使用有效的新型 DMARDS（疾病缓解抗风湿药物）组合来积极阻止炎症。然而，目前我们对新的 RA 疗法的依从性知之甚少，尤其是生物制剂和更有效的 DMARDS 组合。因此，评估和预测依从性以及了解常见的调节因素对于治疗结果决定因素的临床实践和研究以及提高患者依从性的努力至关重要。本研究计划的目标是：（1）严格评估一组患者对当前 RA 治疗的依从性； (2) 将依从性与疾病活动和健康结果联系起来； (3) 探索依从性和结果之间关系的潜在影响因素。我们假设对治疗的依从性不是最佳的，并且会因治疗（即生物制剂与 DMARDS）、疾病（即负担/严重程度、既往使用 DMARDS）和患者特征（抑郁状态、人口统计）而有所不同。依从性与 1 年时的临床和放射学结果以及健康状况相关。抑郁症与不依从性的增加有关。为了检验这些假设，我们将对约翰·霍普金斯关节炎中心的 200 名 RA 患者进行为期一年的观察性研究。