Department of Development and Regeneration, KU Leuven, Skeletal Biology and Engineering Research Centre, ON IV Herestraat 49 - bus 805, 3000, Leuven, Belgium.
Rheumatology, University Hospitals Leuven, Leuven, Belgium.
Arthritis Res Ther. 2021 Oct 27;23(1):269. doi: 10.1186/s13075-021-02651-3.
Self-efficacy, or patients' confidence in their ability to control disease and its consequences, was recently prioritised in EULAR recommendations for inflammatory arthritis self-management strategies. However, it remains unclear which factors influence self-efficacy in early rheumatoid arthritis (RA).
Data were analysed from the 2-year RCT Care in early RA (CareRA), which studied remission-induction treatment regimens for early RA. Participants completed the Arthritis Self-Efficacy Scale (ASES), Short-Form 36 (SF-36), Revised Illness Perception Questionnaire (IPQ-R), Utrecht Coping List (UCL), RAQoL and Health Assessment Questionnaire (HAQ). Depending on time to first remission (DAS28-CRP < 2.6) and persistence of remission, treatment response was defined as persistent response, secondary failure, delayed response, late response or non-response. The association between ASES scores and clinical/psychosocial factors was explored with Spearman correlation and multivariate linear mixed models. Baseline predictors of week 104 ASES were identified with exploratory linear regression followed by multiple regression of significant predictors adjusted for DAS28-CRP, HAQ, treatment arm, treatment response, cumulative CRP/SJC28 and demographic/serologic confounders.
All 379 patients had a recent diagnosis of RA and were DMARD-naïve at study initiation. Most patients were women (69%) and RF/ACPA-positive (66%), and the mean (SD) age was 52 (13) years. For all tested outcome measures, better perceived health correlated with higher self-efficacy. While patient-reported factors (HAQ, SF-36, RAQoL, IPQ-R, pain, fatigue and patient's global assessment) showed moderate/strong correlations with ASES scores, correlations with physician-reported factors (physician's global assessment, SJC28), TJC28 and DAS28-CRP were weak. Only more favourable outcomes on patient-reported factors and DAS28-CRP were associated with higher ASES scores at each time point. An earlier, persistent treatment response predicted higher ASES scores at both weeks 52 and 104. Significant baseline predictors of week 104 ASES included HAQ; SF-36 mental component score, vitality, mental health and role emotional; IPQ-R illness coherence, treatment control, emotional representations and consequences; UCL Passive reacting; and the RAQoL.
Patient-reported outcomes and treatment response were early determinants of long-term self-efficacy in an early RA trial. These results provide further relevance for the window of opportunity in an early treat-to-target strategy and could help to timely identify patients who might benefit from self-management interventions.
EudraCT 2008-007225-39.
自我效能感，即患者对控制疾病及其后果的能力的信心，最近在 EULAR 对炎症性关节炎自我管理策略的建议中被列为优先事项。然而，在早期类风湿关节炎（RA）中，哪些因素影响自我效能感仍不清楚。
对 2 年 RCT Care in early RA（CareRA）的数据进行了分析，该研究研究了早期 RA 的缓解诱导治疗方案。参与者完成了关节炎自我效能量表（ASES）、简短 36 项健康调查（SF-36）、修订后的疾病感知问卷（IPQ-R）、乌得勒支应对清单（UCL）、RAQoL 和健康评估问卷（HAQ）。根据首次缓解的时间（DAS28-CRP<2.6）和缓解的持续时间，治疗反应定义为持续反应、继发性失败、延迟反应、晚期反应或无反应。使用 Spearman 相关和多元线性混合模型探讨了 ASES 评分与临床/心理社会因素之间的关系。使用探索性线性回归确定了第 104 周 ASES 的基线预测因子，然后使用多元回归对 DAS28-CRP、HAQ、治疗臂、治疗反应、累积 CRP/SJC28 和人口统计学/血清学混杂因素进行调整后，对显著预测因子进行了回归。
所有 379 名患者均在最近诊断为 RA 且在研究开始时为 DMARD 初治。大多数患者为女性（69%）和 RF/ACPA 阳性（66%），平均（SD）年龄为 52（13）岁。对于所有测试的结果测量，感知到的健康状况越好，自我效能感越高。虽然患者报告的因素（HAQ、SF-36、RAQoL、IPQ-R、疼痛、疲劳和患者的整体评估）与 ASES 评分呈中度/强相关，但与医生报告的因素（医生的整体评估、SJC28）、TJC28 和 DAS28-CRP 的相关性较弱。只有患者报告的因素和 DAS28-CRP 更有利的结果与每个时间点的 ASES 评分更高相关。更早、持续的治疗反应预测了第 52 周和第 104 周时 ASES 评分更高。第 104 周 ASES 的显著基线预测因子包括 HAQ；SF-36 心理成分评分、活力、心理健康和情绪角色；IPQ-R 疾病一致性、治疗控制、情绪表现和后果；UCL 被动反应；和 RAQoL。
在早期 RA 试验中，患者报告的结果和治疗反应是长期自我效能感的早期决定因素。这些结果为早期治疗目标策略的机会窗口提供了进一步的相关性，并可能有助于及时识别可能从自我管理干预中受益的患者。
EudraCT 2008-007225-39。
