The broad objective of this research is to understand disability in rheumatoid arthritis (RA) within the theoretical framework of The Disablement Process Model. This model postulates a main disease-disability pathway in which pathology causes impairments, which lead to functional limitations, which, in turn, cause disability. Risk factors that precede and interventions or exacerbation's that follow the onset of the process of disablement, modify the main pathway.
The specific aims of this application are: (1) To define the temporal sequence of events in the development of disability due to RA attributable to altered articular structure; (2) To define the temporal sequence of events leading to disability in RA attributable to pain; (3) To define the temporal sequence of events leading to disability in RA attributable to symptoms of depression; (4) To evaluate the modifying effect of medical interventions and co-morbidity. The models and hypotheses of this application are based on cross-sectional analyses on a cohort of 455 persons with RA participating in Dr. Escalante's current ORALE Study (Outcome of Rheumatoid Arthritis Longitudinal Evaluation). The ORALE cohort will be augmented to 760 members by the end of the first year of this application. Four yearly follow-ups are planned after the initial baseline assessment, to be conducted during the first through fourth years of this 5-year application. Main pathway factors that will be assessed include the inflammatory response, serum rheumatoid factor, bone destruction and extra-articular signs and symptoms, corresponding to pathology; articular signs and symptoms, strength, ambulation and manual dexterity, corresponding to impairments; activities of daily living, under functional limitations; and physical disability. Risk factors are age, gender and ethnicity, the HLA-DRB1 genotype, education, occupation, income, functional health literacy and acculturation. Psychosocial modifiers include and social support, learned helplessness, self-efficacy, coping strategies, stress, symptoms of depression, and coexistent medical conditions. Interventions to be measured include anti-rheumatic drugs and joint surgery, the lag between disease onset and initiation of anti-rheumatic therapy, compliance, and rehabilitation interventions.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD037151-02
Application #
6182560
Study Section
Behavioral Medicine Study Section (BEM)
Program Officer
Quatrano, Louis A
Project Start
1999-08-01
Project End
2004-05-31
Budget Start
2000-06-01
Budget End
2001-05-31
Support Year
2
Fiscal Year
2000
Total Cost
$278,247
Indirect Cost
Name
University of Texas Health Science Center San Antonio
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
800772162
City
San Antonio
State
TX
Country
United States
Zip Code
78229
Molina, Emily; Del Rincon, Inmaculada; Restrepo, Jose Felix et al. (2015) Association of socioeconomic status with treatment delays, disease activity, joint damage, and disability in rheumatoid arthritis. Arthritis Care Res (Hoboken) 67:940-6
Molina, Emily; del Rincon, Inmaculada; Restrepo, Jose Felix et al. (2015) Mortality in Rheumatoid Arthritis (RA): factors associated with recording RA on death certificates. BMC Musculoskelet Disord 16:277
Arya, Rector; Del Rincon, Inmaculada; Farook, Vidya S et al. (2015) Genetic Variants Influencing Joint Damage in Mexican Americans and European Americans With Rheumatoid Arthritis. Genet Epidemiol 39:678-88
Restrepo, José Félix; del Rincón, Inmaculada; Battafarano, Daniel F et al. (2015) Clinical and laboratory factors associated with interstitial lung disease in rheumatoid arthritis. Clin Rheumatol 34:1529-36
del Rincón, Inmaculada; Polak, Joseph F; O'Leary, Daniel H et al. (2015) Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis. Ann Rheum Dis 74:1118-23
del Rincón, Inmaculada; Battafarano, Daniel F; Restrepo, Jose F et al. (2014) Glucocorticoid dose thresholds associated with all-cause and cardiovascular mortality in rheumatoid arthritis. Arthritis Rheumatol 66:264-72
Molina, Emily; Haas, Roy; del Rincon, Inmaculada et al. (2014) Does the "Hispanic paradox" occur in rheumatoid arthritis? Survival data from a multiethnic cohort. Arthritis Care Res (Hoboken) 66:972-9
Evans, Matthew R; Escalante, Agustín; Battafarano, Daniel F et al. (2011) Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum 63:1211-20
Roldan, Jose F; Escalante, Agustin; del Rincon, Inmaculada (2008) Impaired arterial function associated with thinning of cortical bone in rheumatoid arthritis. Arthritis Rheum 59:523-30
Del Rincon, Inmaculada; O'Leary, Daniel H; Freeman, Gregory L et al. (2007) Acceleration of atherosclerosis during the course of rheumatoid arthritis. Atherosclerosis 195:354-60

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