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

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 资助的中心拨款提供的资源的众多研究子项目之一。子项目和研究者 (PI) 可能已从另一个 NIH 来源获得主要资金，因此可以在其他 CRISP 条目中出现。列出的机构是中心的机构，不一定是研究者的机构。目的：类风湿性关节炎 (RA) 是一种慢性炎症性疾病，会导致 1% 的成年人疼痛、身体残疾、工资损失和过早死亡。本研究的主要目标是在残疾过程模型的理论框架内了解 RA 中的残疾。该模型假设了一个主要的疾病-残疾途径，其中病理导致损伤，从而导致功能限制，进而导致残疾。残疾过程发生之前的风险因素以及随后的干预措施或加重因素会改变主要途径。该提案的具体目标是： (1) 定义由于关节结构改变而导致 RA 致残的事件发生的时间顺序； (2) 定义导致 RA 疼痛导致残疾的事件的时间顺序； (3) 确定因抑郁症状导致 RA 残疾的事件的时间顺序； (4) 评估医疗干预措施和合并症的改变效果。 研究计划：本提案的模型和假设是通过对 455 名 RA 患者进行的横断面分析得出的。从提交日期到本提案第一年年底，该群体的成员将增加到 760 名。在最初的基线评估之后，计划每年进行四年的后续行动，在该五年提案的第一年到第四年期间进行。 方法：评估的主要途径因素包括与病理学相对应的炎症反应、血清类风湿因子、骨破坏和关节外体征和症状；与损伤相对应的关节体征和症状、力量、行走和手的灵活性；功能限制下的日常生活活动；和身体残疾。危险因素包括年龄、性别和种族、HLA-DRB1 基因型、教育程度、职业、收入、功能健康素养和文化适应。社会心理调节因素包括社会支持、习得性无助、自我效能、应对策略、压力、抑郁症状和共存的医疗状况。要衡量的干预措施包括抗风湿药物和关节手术、疾病发作和开始抗风湿治疗之间的滞后期、依从性和康复干预措施。 临床相关性：目前缓解 RA 残疾的策略过分关注主要的疾病残疾途径。拟议的研究将评估主要途径和外部修饰剂的相对、竞争性贡献。这将导致重新评估（即价值增加）心理社会因素在确定 RA 残疾方面的作用。