Sweeney Melissa, Carpenter Lewis, de Souza Savia, Caton Emma, Galloway James, Cope Andrew, Yates Mark, Nikiphorou Elena, Norton Sam
Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Centre for Rheumatic Diseases, King's College London, London, UK.
Rheumatol Int. 2025 Jan 17;45(2):31. doi: 10.1007/s00296-024-05761-8.
Mental health has been shown to impact rheumatoid arthritis (RA) outcomes and is associated with self-management behaviors. The extent to which mental health impacts outcomes via different self-management behaviours has not been thoroughly investigated. Adult RA patients who were starting a new medication or dosage were recruited to a prospective cohort with follow-ups at 3 and 12-months covering clinical and patient-reported outcomes. The longitudinal relationships between mental health, self-management behaviors (diet, physical activity, sleep, smoking, alcohol, and medication nonadherence), disease outcome, and function were assessed. Self-management behaviors were considered mediators of mental health at baseline on outcomes at 3 and 12 months. Depression did not worsen the odds of EULAR response for the total PHQ at 3 months (OR = 0.96, p = 0.36) or 12 months (OR = 0.99, p = 0.99) nor for the categorical PHQ at 3 months (OR = 0.64, p = 0.34) or 12 months (OR = 0.67, p = 0.44). Anxiety also did not worsen the odds of EULAR response for the total GAD at 3 months (OR = 0.98, p = 0.76) or 12 months (OR1.04, 0.53) nor for the categorical GAD at 3 months (OR = 0.99, p = 0.99) or 12 months (OR = 0.94, p = 0.75). However, depression was associated with the DAS-28 at 3 months (b = 0.22, p = 0.04). Among the self-management behaviors, insomnia was found to be a significant mediator between depression and the WSAS (b = 0.08, p = 0.03) as well as anxiety and the WSAS (b = 0.07, p = 0.03). Alcohol was also a significant mediator between depression and the DAS-28 (b = 0.21, p = 0.04). Mental health was associated with worse quality of life and disease outcomes, but not EULAR response. Self-management behaviors were associated with disease outcomes and mental health.
已有研究表明，心理健康会影响类风湿性关节炎（RA）的治疗效果，且与自我管理行为相关。然而，心理健康通过不同自我管理行为对治疗效果产生影响的程度尚未得到充分研究。本研究招募了开始使用新药物或新剂量药物的成年RA患者，纳入一个前瞻性队列，在3个月和12个月时进行随访，涵盖临床和患者报告的结果。评估了心理健康、自我管理行为（饮食、体育活动、睡眠、吸烟、饮酒和药物不依从性）、疾病结果和功能之间的纵向关系。自我管理行为被视为基线时心理健康与3个月和12个月时结果之间的中介因素。抑郁并未增加3个月时（OR = 0.96，p = 0.36）或12个月时（OR = 0.99，p = 0.99）EULAR反应的不良几率，也未增加3个月时（OR = 0.64，p = 0.34）或12个月时（OR = 0.67，p = 0.44）分类PHQ的不良几率。焦虑也未增加3个月时（OR = 0.98，p = 0.76）或12个月时（OR = 1.04，p = 0.53）EULAR反应的不良几率，也未增加3个月时（OR = 0.99，p = 0.99）或12个月时（OR = 0.94，p = 0.75）分类GAD的不良几率。然而，抑郁与3个月时的DAS-28相关（b = 0.22，p = 0.04）。在自我管理行为中，失眠被发现是抑郁与WSAS之间（b = 0.08，p = 0.03）以及焦虑与WSAS之间（b = 0.07，p = 0.03）的重要中介因素。饮酒也是抑郁与DAS-28之间的重要中介因素（b = 0.21，p = 0.04）。心理健康与较差的生活质量和疾病结果相关，但与EULAR反应无关。自我管理行为与疾病结果和心理健康相关。
