Disclosure of Personalized Rheumatoid Arthritis Risk Using Genetics, Biomarkers, and Lifestyle Factors to Motivate Health Behavior Improvements: A Randomized Controlled Trial.
Disclosure of Personalized Rheumatoid Arthritis Risk Using Genetics, Biomarkers, and Lifestyle Factors to Motivate Health Behavior Improvements: A Randomized Controlled Trial.
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DOI：
10.1002/acr.23411
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发表时间：
2018-06
影响因子：
4.7
通讯作者：
Karlson EW
中科院分区：
文献类型：
--
作者：
Sparks JA;Iversen MD;Yu Z;Triedman NA;Prado MG;Miller Kroouze R;Kalia SS;Atkinson ML;Mody EA;Helfgott SM;Todd DJ;Dellaripa PF;Bermas BL;Costenbader KH;Deane KD;Lu B;Green RC;Karlson EW
确定披露类风湿关节炎（RA）风险与遗传学，生物标志物和生活方式因素对健康行为意图的影响。我们在没有RA的一级亲属中进行了一项随机对照试验。分配到RA个性化风险评估（PRE-RA）组的受试者接受基于网络的PRE-RA工具，用于RA风险因素教育和披露个性化RA风险评估，包括基因型/自身抗体结果和行为（n=158）。分配至对照组的受试者接受标准RA教育（n=80）。主要结果是基于跨理论模型的变化准备，使用经验证的沉思阶梯量表。改善RA风险相关行为（吸烟、饮食、运动或牙齿卫生）的动机增加定义为与干预后立即、6周和6个月评估的基线相比，任何阶梯评分增加。受试者在每次访视时报告行为变化。我们使用广义估计方程对二元结局进行意向治疗分析。与随机分配到非个性化教育组的受试者相比，随机分配到PRE-RA组的受试者更有可能在干预后评估中增加阶梯评分（RR 1.23，95%CI 1.01-1.51）。在6个月时，63.9%的PRE-RA受试者和50.0%的对照受试者增加了改善行为的动机（年龄校正差异15.8%，95%CI 2.8-28.8%）。与非个性化教育相比，更多的PRE-RA受试者增加了鱼类摄入量（45.0% vs. 22.1%; p=0.005），刷牙频率更高（40.7%与22.9%; p=0.01）、更频繁地使用牙线（55.7%与34.8%; p=0.004）和戒烟（11名吸烟者中，62.5%与0.0%; p=0.18）。披露与基因型/生物标志物结果和行为个性化的RA风险增加了改善RA风险相关行为的动力。个性化的医疗方法可能会促进RA风险人群的健康行为改善，并为评估行为变化对临床结局（如RA相关自身抗体产生或RA发展）的影响的大型研究提供依据。
To determine the effect of disclosure of rheumatoid arthritis (RA) risk personalized with genetics, biomarkers, and lifestyle factors on health behavior intentions. We performed a randomized controlled trial among first-degree relatives without RA. Subjects assigned to the Personalized Risk Estimator for RA (PRE-RA) group received the web-based PRE-RA tool for RA risk factor education and disclosure of personalized RA risk estimates including genotype/autoantibody results and behaviors (n=158). Subjects assigned to the comparison arm received standard RA education (n=80). The primary outcome was readiness for change based on the transtheoretical model, using validated contemplation ladder scales. Increased motivation to improve RA risk-related behaviors (smoking, diet, exercise, or dental hygiene) was defined as an increase in any ladder score compared to baseline assessed immediately, 6 weeks, and 6 months post-intervention. Subjects reported behavior change at each visit. We performed intention-to-treat analyses using generalized estimating equations for the binary outcome. Subjects randomized to PRE-RA were more likely to increase ladder scores over post-intervention assessments (RR 1.23, 95%CI 1.01–1.51) than those randomized to non-personalized education. At 6 months, 63.9% of PRE-RA subjects and 50.0% of comparison subjects increased motivation to improve behaviors (age-adjusted difference 15.8%, 95%CI 2.8–28.8%). Compared to non-personalized education, more PRE-RA subjects increased fish intake (45.0% vs. 22.1%; p=0.005), brushed more frequently (40.7% vs. 22.9%; p=0.01), flossed more frequently (55.7% vs. 34.8%; p=0.004), and quit smoking (62.5% vs. 0.0% among 11 smokers; p=0.18). Disclosure of RA risk personalized with genotype/biomarker results and behaviors increased motivation to improve RA risk-related behaviors. Personalized medicine approaches may motivate health behavior improvements for those at risk for RA and provide rationale for larger studies evaluating effects of behavior changes on clinical outcomes such as RA-related autoantibody production or RA development.
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影响因子：
4.2
作者：
Amodei, N;Lamb, RJ
通讯作者：
Lamb, RJ
影响因子：
4.7
作者：
Losina, Elena;Michl, Griffin L.;Katz, Jeffrey N.
通讯作者：
Katz, Jeffrey N.
影响因子：
158.5
作者：
Green, Robert C.;Roberts, J. Scott;Farrer, Lindsay A.
通讯作者：
Farrer, Lindsay A.
影响因子：
4.5
作者：
Fernando MM;Stevens CR;Walsh EC;De Jager PL;Goyette P;Plenge RM;Vyse TJ;Rioux JD
通讯作者：
Rioux JD
影响因子：
4.7
作者：
Aimer, Pip;Treharne, Gareth J.;Stamp, Lisa K.
通讯作者：
Stamp, Lisa K.