Can treatment expectations or treatment itself in patients with arthralgia suspicious for progression to rheumatoid arthritis improve illness perceptions?

IF 4.7 2区医学 Q1 RHEUMATOLOGY

Rheumatology Pub Date : 2025-06-01 DOI:10.1093/rheumatology/keaf095

Simonetta R G van Griethuysen, Quirine A Dumoulin, Elise van Mulligen, Annette H M van der Helm-van Mil

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引用次数: 0

Abstract

Objectives: 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).

Methods: 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.

Results: 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).

Conclusion: 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.

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怀疑进展为类风湿关节炎的关节痛患者的治疗预期或治疗本身能否改善疾病认知？

目的：在类风湿性关节炎（RA）中，消极的疾病感知（IPs）与较差的疾病结局相关。不幸的是，在已建立的RA中，ip通常是稳定的。我们假设IPs，尤其是认知领域的IPs，在类风湿关节炎的风险中是可改变的。我们的目的是研究在临床疑似关节痛（CSA）患者中，接受dmard治疗或提供dmard治疗是否与IPs阳性相关。方法：研究人群为csa患者，采用观望方法，不提供dmard治疗，或患者通过治疗早期试验提供dmard治疗，随后随机接受甲氨蝶呤或安慰剂。使用简短疾病感知问卷（Brief-Illness-Perception-Questionnaire， BIPQ）评估知识产权，涵盖认知、情感和可理解性三个领域。通过比较接受甲氨蝶呤或安慰剂的患者的2年bipq，研究了dmard治疗对IPs的长期影响。提供dmard治疗的效果是通过比较试验中csa患者的bipq与接受“观望”政策的患者的bipq来检验的。结果：共研究了375例csa患者，其中236例采用早期治疗试验，139例采用观望方法。与安慰剂相比，接受治疗的患者在四个认知领域的IPs表现出持续的改善：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），对自己的疾病有更深入的了解（p= 0.054）。结论：dmard治疗本身和前景均可改善CSA的IPs，主要是认知领域的IPs。这些数据表明CSA是影响IPs的合适时间段，这可能为改善RA患者的疾病结局提供可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

7.30%

发文量

1091

审稿时长

2 months

期刊介绍： Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.