van Griethuysen Simonetta R G, Dumoulin Quirine A, van Mulligen Elise, van der Helm-van Mil Annette H M
Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands.
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands.
Rheumatology (Oxford). 2025 Jun 1;64(6):3444-3450. doi: 10.1093/rheumatology/keaf095.
Negative illness perceptions (IPs) are associated with poorer disease outcomes in rheumatoid arthritis (RA). Unfortunately, IPs are generally stable in established RA. We hypothesized that IPs, especially in the cognitive domain, are modifiable in arthralgia at risk of RA. We aimed to study if receiving DMARD treatment, or the offer of DMARD treatment associates with more positive IPs in patients with clinically suspect arthralgia (CSA).
The population studied were CSA patients to which a wait-and-see approach was adopted without offering DMARD treatment, or patients were offered DMARD treatment via the TREAT EARLIER trial and subsequently randomized to receive methotrexate or placebo. IPs were assessed using the Brief Illness Perception Questionnaire (BIPQ), covering cognitive, emotional and comprehensibility domains. The effect of DMARD treatment on IPs over time was studied by comparing the 2-year course of BIPQs of patients receiving methotrexate or placebo. The effect of offering DMARD treatment was examined by comparing the BIPQs of CSA patients in the trial with those undergoing a wait-and-see policy.
In total, 375 CSA patients were studied, of which 236 of the TREAT EARLIER trial and 139 with a wait-and-see approach. Patients who received treatment showed sustained improvements in IPs over time compared with placebo in four cognitive domains: experience of physical complaints (P = 0.040), the illness's influence on life (P = 0.001), treatment effectiveness (P = 0.041) and disease duration (P = 0.045). Comparison at baseline showed that CSA patients to whom treatment was offered had more confidence in treatment (P < 0.001) and tended to have a deeper understanding of their disease (P = 0.054).
Both the prospect of and DMARD treatment itself improved IPs in CSA, mainly in cognitive domains. These data suggest CSA as a suitable time period for influencing IPs, which may provide possibilities to improve disease outcomes in patients developing RA.
在类风湿关节炎（RA）中，消极的疾病认知（IPs）与较差的疾病预后相关。遗憾的是，在已确诊的RA中，IPs通常较为稳定。我们推测，IPs，尤其是认知领域的IPs，在有RA风险的关节痛患者中是可改变的。我们旨在研究接受改善病情抗风湿药（DMARD）治疗，或提供DMARD治疗是否与临床疑似关节痛（CSA）患者更积极的IPs相关。
研究人群为采用观察等待方法且未提供DMARD治疗的CSA患者，或通过“早期治疗”试验提供DMARD治疗并随后随机接受甲氨蝶呤或安慰剂的患者。使用简短疾病认知问卷（BIPQ）评估IPs，该问卷涵盖认知、情感和可理解性领域。通过比较接受甲氨蝶呤或安慰剂治疗患者的BIPQ两年病程，研究DMARD治疗随时间对IPs的影响。通过比较试验中CSA患者与采用观察等待策略患者的BIPQ，研究提供DMARD治疗的效果。
总共研究了375例CSA患者，其中“早期治疗”试验中的236例和采用观察等待方法的139例。与安慰剂相比，接受治疗的患者在四个认知领域的IPs随时间持续改善：身体不适体验（P = 0.040）、疾病对生活的影响（P = 0.001）、治疗效果（P = 0.041）和疾病持续时间（P = 0.045）。基线比较显示，接受治疗的CSA患者对治疗更有信心（P < 0.001），并且对疾病往往有更深入的理解（P = 0.054）。
DMARD治疗的前景和治疗本身都改善了CSA患者的IPs，主要是在认知领域。这些数据表明CSA是影响IPs的合适时间段，这可能为改善患RA患者的疾病预后提供可能性。
