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

描述（由申请人提供）：风湿性关节炎（RA）是一种使人衰弱和进行性疾病，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，RA的治疗方法并不存在。管理RA的最终目标是预防或控制关节损伤，防止功能丧失，并减少疼痛。实现这些目标需要早期诊断和迅速开始积极的治疗。在过去的5年里，RA的治疗发生了巨大的变化。抗肿瘤坏死因子药物（生物制剂）的引入，虽然非常昂贵，但作用强大，可以大大减少疾病进展;当不使用生物制剂时，现在使用有效的新DMARDS（疾病修饰抗风湿药物）的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，特别是生物制剂和更有效的DMARDS组合。因此，评估和预测依从性，并了解常见的调节因素是必不可少的临床实践和研究的决定因素的治疗结果和努力，以提高患者的依从性。本研究提案的目标是：（1）严格评估一组患者随时间推移对当前RA治疗的依从性;（2）将依从性与疾病活动和健康结局联系起来;（3）探索依从性与结局之间关系的潜在影响因素。我们假设对治疗的依从性是次优的，并且将根据治疗而变化（即，生物制剂对DMARDS），疾病（即，负担/严重程度、既往使用DMARDS）和患者特征（抑郁状态、人口统计学）。依从性将与1年时的临床和影像学结局以及健康状况相关。抑郁症与不依从性增加相关。为了验证这些假设，我们将对约翰霍普金斯关节炎中心的200例RA患者进行为期一年的观察性研究。

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.