This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. OBJECTIVE: Rheumatoid arthritis (RA) is a chronic inflammatory condition that causes pain, physical disability, lost wages and early mortality in 1% of the adult population. The broad objective of this research is to understand disability in 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 exacerbators that follow the onset of the process of disablement modify the main pathway.
The specific aims of this proposal 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; and (4) To evaluate the modifying effect of medical interventions and co-morbidity. RESEARCH PLAN: The models and hypotheses of this proposal have been informed by cross-sectional analyses on a cohort of 455 persons with RA. This cohort will increase to 760 members between the submission date and the end of the first year of this proposal. Four yearly follow-ups are planned after the initial baseline assessment, to be conducted during the first through fourth years of this 5-year proposal. METHODS: 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 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. CLINICAL
Current strategies for alleviating disability in RA focus disproportionately on the main disease-disability pathway. The proposed research will evaluate the relative, competing contributions of the main pathway and external modifiers. This will result in a re-evaluation (i.e. increase in value) of the role of psychosocial factors in determining disability in RA.
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