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

描述(申请人提供)：类风湿性关节炎(RA)是一种衰弱和进行性疾病，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，治疗类风湿关节炎的方法还不存在。治疗类风湿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迅速开始积极的治疗。在过去的5年里，类风湿关节炎的治疗发生了巨大的变化。抗肿瘤坏死因子制剂(生物制剂)的引入，虽然非常昂贵，但作用强大，可以极大地减少疾病的进展；当不使用生物制剂时，现在使用有效的新DMARDS(疾病修改抗风湿药物)的组合来积极地阻止炎症。然而，目前我们对坚持新的RA疗法知之甚少，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，并了解共同的调节因素，对于临床实践和研究治疗结果的决定因素和努力改善患者依从性是至关重要的。这项研究计划的目标是：(1)严格评估一组患者对当前RA疗法的长期依从性；(2)与疾病活动和健康结果的依从性相关；以及(3)探索依从性和结果之间关系的潜在效应调节剂。我们假设坚持治疗是次优的，并将根据治疗(即生物学与DMARDS)、疾病(即负担/严重程度、以前使用DMARDS)和患者特征(抑郁状态、人口统计学)而有所不同。依从性将与临床和放射学结果以及一年后的健康状况相关。抑郁将与更多的不遵守相关。为了验证这些假设，我们将利用约翰霍普金斯关节炎中心对200名RA患者进行的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.