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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR051351-03
Application #
7271363
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Serrate-Sztein, Susana
Project Start
2005-09-23
Project End
2009-07-31
Budget Start
2007-08-01
Budget End
2008-07-31
Support Year
3
Fiscal Year
2007
Total Cost
$258,671
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Bartlett, Susan J; Moonaz, Steffany H; Mill, Christopher et al. (2013) Yoga in rheumatic diseases. Curr Rheumatol Rep 15:387
Haaz, Steffany; Bartlett, Susan J (2011) Yoga for arthritis: a scoping review. Rheum Dis Clin North Am 37:33-46