Musculoskeletal Research Group, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK.
Rheumatology (Oxford). 2012 Feb;51(2):293-6. doi: 10.1093/rheumatology/ker237. Epub 2011 Aug 25.
Following the recent National Institute for Health and Clinical Excellence guidance on the management of RA, we were interested to see if we could negotiate targets for treatment with patients in routine clinics, how they would express this and whether staying at work would be a target.
One hundred RA patients were recruited. They were consecutive within clinics, but not all clinics were used. They were asked their understanding of the DAS score and a target for treatment negotiated. Any impact of the RA on their paid employment was then explored.
Four participants were unable to specify a target for their RA. Negotiated targets were expressed as restricted activities and either as maintaining an activity (70) if the disease was stable, or regaining an activity (26) if the treatment was being increased. Targets were walking a distance for 50% of patients; leisure activities for 18%; domestic activities for 17%; work for 14% and personal care for 2%. For the 21 participants currently working, maintaining work was the target for 12, with 1 wishing to regain lost hours. No patient currently not working expressed returning to work as a target. There were some differences in targets between men and women.
Patients are able to negotiate a target for their treatment, expressed as maintaining or regaining a physical activity. Work ceases to be a target once it is lost. Therefore, preventing loss of occupation is likely to be more effective than trying to regain it.
在最近的国家卫生与临床卓越研究所（National Institute for Health and Clinical Excellence）发布的类风湿关节炎（rheumatoid arthritis，RA）管理指南之后，我们希望了解能否在常规临床中与患者协商治疗目标，他们会如何表达这些目标，以及是否保持工作状态是一个目标。
共招募了 100 名 RA 患者。他们是在诊所内连续招募的，但并非所有诊所都参与了研究。我们询问了他们对 DAS 评分的理解，并协商了治疗目标。然后，探讨了 RA 对他们有偿就业的任何影响。
有 4 名参与者无法为他们的 RA 指定目标。协商的目标表示为受限活动，并且如果疾病稳定，则维持活动（70 名患者），或者如果正在增加治疗，则恢复活动（26 名患者）。目标是 50%的患者行走一定距离；18%的患者休闲活动；17%的患者家务活动；14%的患者工作；2%的患者自理。对于目前正在工作的 21 名参与者，维持工作是 12 人的目标，其中 1 人希望恢复失去的工作时间。目前没有工作的患者没有将重返工作作为目标。男性和女性之间的目标存在一些差异。
患者能够协商治疗目标，表达为维持或恢复身体活动。一旦失去工作，工作就不再是目标。因此，预防职业丧失可能比试图重新获得职业更有效。
