Defining stress REsilience And Mindfulness Effects in Rheumatoid Arthritis (DREAMER)

定义压力恢复力和正念对类风湿性关节炎的影响 (DREAMER)

• 批准号: 10352082
• 负责人: Sarah Lynn Patterson
• 金额: $ 17.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10352082
• 关键词: Acute; Address; Adverse event; Affect; American; Arthralgia; Autoimmune; Autoimmune Diseases; Biological; Blood specimen; Cardiovascular system; Chronic; Chronic Disease; Clinical; Clinical Trials; Clinical assessments; Communities; Data; Disease; Disease Outcome; Disease-Modifying Second-Line Drugs; Enrollment; Equation; Fatigue; Feedback; Flare; Focus Groups; Foundations; Frequencies; Funding; Future; Goals; Immune; Inflammatory; Inflammatory Arthritis; Infrastructure; Intervention; K-Series Research Career Programs; Knowledge; Lead; Life; Longitudinal Studies; Longitudinal cohort study; Measures; Mediating; Medical; Medicine; Methods; Mind-Body Intervention; Modeling; Outcome; Pain; Participant; Patient Outcomes Assessments; Patients; Persons; Pharmaceutical Preparations; Phase; Phenotype; Physicians; Pilot Projects; Premature Mortality; Preparation; Psychological Impact; Psychological Stress; Psychosocial Stress; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Research; Research Training; Resources; Rheumatism; Rheumatoid Arthritis; Rheumatology; Risk; Sampling; Scientist; Severities; Severity of illness; Sleep disturbances; Standardization; Stress; Symptoms; Testing; Therapeutic; Time; United States; acceptability and feasibility; base; career development; chronic pain; cohort; design; disorder risk; evidence base; experience; follow-up; improved; improved outcome; innovation; instrument; intervention effect; intervention program; joint inflammation; mindfulness; mindfulness intervention; mindfulness-based stress reduction; patient population; perceived stress; pilot test; premature; programs; prospective; recruit; resilience scale; side effect; stress management; stress reduction; stress resilience; systemic autoimmune disease; systemic inflammatory response; treatment as usual; treatment strategy

ABSTRACT Rheumatoid arthritis (RA), the most common rheumatic disease, affects 1.5 million people in the United States and can lead to debilitating joint pain, functional limitations, and premature mortality. Existing treatment approaches based on immunosuppressive medications reduce disease severity but often fail to adequately control symptoms and can lead to severe adverse side effects. This proposal addresses the critical unmet need for non-pharmacologic strategies to augment medical management of RA, improve long-term clinical outcomes, and reduce disease-related symptoms. Psychological stress is postulated to exacerbate disease severity in autoimmune diseases, but few studies have prospectively examined its impact on disease activity in RA patients or the therapeutic potential of interventions that improve stress resilience in this patient group. Furthermore, while mindfulness-based interventions (MBIs), including the mindfulness-based stress reduction program (MBSR), have been shown to reduce psychological stress and pain in several chronic diseases, it remains unknown whether they represent an effective adjunctive approach for improving disease outcomes in RA. To address these significant knowledge gaps, I propose to examine the effects of stress, stress-buffering factors, and MBIs on risk of disease flares and symptom severity in RA and related autoimmune conditions. I will first identify mechanistic targets for mind-body interventions in RA by building on an actively enrolling RO1-funded longitudinal cohort study of RA patients. Aim 1 will determine whether greater negative psychological stress independently associates with increased risk of worse RA disease activity and symptom severity over time. I will further test whether stress resilience and mindfulness longitudinally correlate with better outcomes—including less severe disease activity and symptoms—to identify key targets for non-pharmacologic interventions in this patient group. In Aim 2 I will develop augmentations to the mindfulness-based stress reduction (MBSR) course for people with inflammatory arthritis, and conduct a pilot study to assess the feasibility and acceptability of an MBSR trial for improving disease outcomes in RA. This will be the first longitudinal study to examine the effects of psychological stress and stress resilience on RA disease activity. Further, this study will advance the field of integrative rheumatology by developing innovate methods to augment MBSR for people with immune-mediated inflammatory diseases. The proposed study will generate proof-of-concept data to inform a subsequent randomized controlled trial with R-level funding to test whether MBSR improves RA disease activity and symptoms. Importantly, this K23 Career Development Award will catalyze my successful transition to an independent physician-scientist with an impactful research program defining mechanisms and efficacy of MBIs in people with rheumatic conditions.

摘要 类风湿性关节炎(RA)是最常见的风湿病，影响着美国150万人 可能导致衰弱的关节疼痛、功能受限和过早死亡。现有治疗方法 基于免疫抑制药物的方法可以降低疾病的严重程度，但往往不足以 控制症状，并可能导致严重的不良副作用。这项提议解决了未得到满足的关键需求 对于非药物策略，以加强对RA的医疗管理，改善长期临床结果， 并减少与疾病相关的症状。 心理压力被认为会加重自身免疫性疾病的严重程度，但很少有研究 前瞻性地研究了其对RA患者疾病活动性的影响或治疗潜力 改善这一患者群体的压力恢复能力的干预措施。此外，虽然以正念为基础 干预措施(MBIS)，包括基于正念的压力减轻计划(MBSR)，已被证明 在几种慢性病中减轻心理压力和疼痛，目前尚不清楚它们是否代表着 改善类风湿性关节炎疾病结局的有效辅助方法。要解决这些重要的知识 ，我建议研究压力、压力缓冲因素和mbi对疾病爆发风险的影响。 类风湿关节炎和相关自身免疫性疾病的症状严重程度。 我将首先通过积极登记来确定类风湿关节炎心身干预的机械性目标 RO1资助的类风湿关节炎患者纵向队列研究。目标1将决定更大的负面影响 心理压力独立地与RA疾病活动和症状恶化的风险增加相关 随着时间的推移，严重程度。我将进一步测试压力韧性和正念是否在纵向上与更好的 结果--包括不太严重的疾病活动和症状--确定非药物治疗的关键靶点 这组患者的干预措施。在目标2中，我将开发对基于正念的压力的增强 炎症性关节炎患者的减量(MBSR)课程，并进行试点研究以评估其可行性 以及MBSR试验改善类风湿关节炎疾病结局的可接受性。 这将是第一次对心理压力和压力弹性的影响进行纵向研究。 关于类风湿性关节炎疾病的活动。此外，这项研究将通过发展综合风湿病领域 创新方法，为免疫介导性炎症性疾病患者增加MBSR。建议数 这项研究将产生概念验证数据，为随后的随机对照试验提供R水平的信息 用于测试MBSR是否改善RA疾病活动和症状的资金。重要的是，这份K23职业生涯 发展奖将催化我成功地过渡到一名独立的内科医生-科学家 有影响力的研究计划，确定了风湿性疾病患者应用MBIS的机制和疗效。