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

描述（由申请人提供）：类风湿性关节炎（RA）是一种使人衰弱和进行性疾病，影响1- 2%的美国成年人，导致慢性疼痛、功能丧失、残疾、失业和死亡率增加。目前，治疗类风湿性关节炎的方法尚不存在。治疗类风湿性关节炎的最终目标是预防或控制关节损伤，防止功能丧失，减少疼痛。实现这些目标需要早期诊断和及时开始积极治疗。在过去的5年里，类风湿性关节炎的治疗发生了巨大的变化。引入抗肿瘤坏死因子制剂（生物制剂），虽然非常昂贵，但作用强大，可以显着减少疾病进展；当不使用生物制剂时，现在使用强效的新型DMARDS（疾病调节抗风湿药物）组合来积极地停止炎症。然而，目前我们对新的类风湿性关节炎疗法的依从性知之甚少，特别是生物学和更有效的DMARDS的组合。因此，评估和预测依从性，了解常见的调节因素对于临床实践和研究治疗结果的决定因素以及提高患者依从性的努力至关重要。本研究计划的目标是：(1)在一组患者中严格评估当前RA治疗的依从性；(2)将依从性与疾病活动和健康结果联系起来；(3)探讨依从性与预后关系的潜在影响因子。我们假设坚持治疗是次优的，并且会因治疗（即生物学vs. DMARDS），疾病（即负担/严重程度，DMARDS的既往使用）和患者特征（抑郁状态，人口统计学）而异。依从性将与临床和影像学结果以及1年后的健康状况相关。抑郁将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名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.