OUTCOMES OF RHEUMATOID ARTHRITIS LONGITUDINAL EVALUATION: ORALE!

类风湿关节炎纵向评估的结果：ORALE！

• 批准号: 7378191
• 负责人: AGUSTIN ESCALANTE
• 金额: $ 0.94万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7378191
• 关键词: OUTCOMES; RHEUMATOID; ARTHRITIS; LONGITUDINAL; EVALUATION; OUTCOMES; RHEUMATOID; ARTHRITIS; LONGITUDINAL; EVALUATION

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. OBJECTIVE: Rheumatoid arthritis (RA) is a chronic inflammatory condition that causes pain, physical disability, lost wages and early mortality in 1% of the adult population. The broad objective of this research is to understand disability in RA within the theoretical framework of The Disablement Process model. This model postulates a main disease-disability pathway in which pathology causes impairments, which lead to functional limitations, which in turn cause disability. Risk factors that precede and interventions or exacerbators that follow the onset of the process of disablement modify the main pathway. The specific aims of this proposal are: (1) To define the temporal sequence of events in the development of disability due to RA attributable to altered articular structure; (2) To define the temporal sequence of events leading to disability in RA attributable to pain; (3) To define the temporal sequence of events leading to disability in RA attributable to symptoms of depression; and (4) To evaluate the modifying effect of medical interventions and co-morbidity. RESEARCH PLAN: The models and hypotheses of this proposal have been informed by cross-sectional analyses on a cohort of 455 persons with RA. This cohort will increase to 760 members between the submission date and the end of the first year of this proposal. Four yearly follow-ups are planned after the initial baseline assessment, to be conducted during the first through fourth years of this 5-year proposal. METHODS: Main pathway factors that will be assessed include the inflammatory response, serum rheumatoid factor, bone destruction and extra-articular signs and symptoms, corresponding to pathology; articular signs and symptoms, strength, ambulation and manual dexterity, corresponding to impairments; activities of daily living, under functional limitations; and physical disability. Risk factors are age, gender and ethnicity, the HLA-DRB1 genotype, education, occupation, income, functional health literacy and acculturation. Psychosocial modifiers include social support, learned helplessness, self-efficacy, coping strategies, stress, symptoms of depression, and coexistent medical conditions. Interventions to be measured include anti-rheumatic drugs and joint surgery, the lag between disease onset and initiation of anti-rheumatic therapy, compliance, and rehabilitation interventions. CLINICAL RELEVANCE: Current strategies for alleviating disability in RA focus disproportionately on the main disease-disability pathway. The proposed research will evaluate the relative, competing contributions of the main pathway and external modifiers. This will result in a re-evaluation (i.e. increase in value) of the role of psychosocial factors in determining disability in RA.

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子弹和调查员（PI）可能已经从其他NIH来源获得了主要资金，因此可以在其他清晰的条目中代表。列出的机构适用于该中心，这不一定是调查员的机构。目的：类风湿关节炎（RA）是一种慢性炎症性疾病，可导致1％的成年人口疼痛，身体残疾，工资损失和早期死亡率。这项研究的广泛目标是在残疾过程模型的理论框架内了解RA中的残疾。该模型假设病理学会导致损害的主要疾病可诊断途径，从而导致功能局限性，从而导致残疾。遵循残疾过程开始之前和干预措施或加剧的风险因素会改变主要途径。该提案的具体目的是：（1）定义由于关节结构改变的RA而导致的残疾发展中事件的时间顺序； （2）定义事件的时间顺序，导致疼痛归因于RA的残疾； （3）定义事件的时间顺序，导致造成抑郁症状的RA的残疾； （4）评估医疗干预措施和合并症的修改作用。 研究计划：该提案的模型和假设已通过对455人的RA人群进行的横断面分析得知。在提交日期到本提案第一年结束之间，该队列将增加到760名成员。计划在最初的基线评估后进行四年的随访，并在该5年提案的第四年内进行。 方法：将评估的主要途径因素包括炎症反应，血清类风湿因子，骨骼破坏和关节外征兆和症状，与病理相对应；关节体征和症状，力量，行动和手动敏捷性，对应于损害；日常生活的活动，在功能限制下；和身体残疾。危险因素是年龄，性别和种族，HLA-DRB1基因型，教育，职业，收入，功能健康素养和适应性。社会心理修饰符包括社会支持，学习的无助，自我效能感，应对策略，压力，抑郁症状和共存的医疗状况。要测量的干预措施包括抗震荡药物和联合手术，疾病发作和抗疾病疗法的滞后，依从性和康复干预措施之间的滞后。 临床相关性：当前减轻RA残疾的策略不成比例地放在主要疾病可识别途径上。拟议的研究将评估主要途径和外部修饰符的相对，相互竞争的贡献。这将导致社会心理因素在确定RA残疾的作用的重新评估（即增加价值）。