AB0883-HPR CHRONIC RHEUMATIC DISEASE MANAGEMENT AND THE SELF-EFFICACY OF RHEUMATOID ARTHRITIS

Abstract

Background:Rheumatoid arthritis (RA) is a common chronic disabling autoimmune disease, which cannot be cured completely at present, and patients need long-term medication treatment. The overall management of RA disease and patient self-management is important. Therefore, we built up a chronic rheumatic disease management team, formed by rheumatoid clinicians, clinical nurses and case managers, to provide “integrity continuity” disease management for RA by hospital on-site and WeChat APP. To this end, we used the arthritis self-efficacy scale-8 (ASES-8) to investigate the effect of the chronic disease management with RA.Objectives:To explore the effect of chronic rheumatic disease management and the related factors of self-efficacy of RA patients.Methods:Consecutive outpatients with RA who had been implemented chronic disease management were recruited from January 2019 to January 2020. A questionnaire survey of ASES-8 and clinical data were collected.Results:1. Among the 376 RA patients who have completed the survey, mean follow-up time of chronic disease management was 29 (8, 41) months, 35.4% patients in CDAI remission stage of disease activity, median ASES-8 score was 59(47,70), and 61.2% patients had medium or above medication adherence.2. Patients with low ASES-8 had higher RA disease activity (including TJC28, SJC28, Pain VAS, PtGA, PrGA, ESR, CRP), more patients with dysfunction and lower medication adherence than those with high ASES-8 (all P<0.05).3. Patients were divided into CDAI active RA group and in remission group, and those with low ASES-8 in remission group participated in chronic disease management for fewer months than those with high ASES-8 (median 20 vs. 32, P=0.033), and the HAQ-DI score was higher (P < 0.05). Active RA patients with low ASES-8 had higher disease activity, higher HAQ-DI (median 0.25 vs.0), fewer times of participating in patients’ exchange meeting (median 0 vs.1), lower medication adherence (10.8% vs. 25.9%), and more anxiety or depression (57.6% vs. 31.8%) than those with high ASES-8 (all P < 0.05, Table 1 below).Conclusion:The rheumatic chronic disease management team can help RA patients achieve a higher remission rate by continuous chronic disease management through hospital on-site and the Internet, and can help patients with good self-efficacy and medication adherence. In addition to disease control, we should pay attention to functional limitations and problems of back to work with RA patients in remission, while should pay attention to activity participation, medication adherence and emotional problems with active RA in further practice.Table 1.Comparison of ASES in different RA disease activityCharacteristicsCDAI remissionCDAI activeLow ASES (ASES≤59, n=36)High ASES (ASES>59, n=97)PLow ASES (ASES≤59, n=158)High ASES (ASES>59, n=85)PFemale, n (%)32 (88.9)81 (83.5)0.440137 (86.7)74 (87.1)0.939Age, yrs,± s47.4±11.746.0±12.50.57449.8±12.949.7±12.70.933Disease duration, month, median (IQR)48 (24,94)60 (35,96)0.56075 (36,120)72 (36,120)0.625Duration of chronic disease management, month, median (IQR)20 (6,39)32 (13,41)0.03329 (6,41)29 (5,42)0.766Attend patients’ exchange meeting, times, median (IQR)6 (4,10)8 (6,13)0.6730 (0,2)1 (0,4)0.035Incapable to work, n (%)11 (30.6)15 (15.5)0.05146 (29.1)18 (21.2)0.180Morisky medication adherence scale0.8570.002Low adherence, n (%)12 (33.3)30 (30.9)78 (49.4)26 (30.6)Medium adherence, n (%)15 (41.7)38 (39.2)63 (39.9)37 (43.5)High adherence, n (%)9 (25.0)29 (29.9)17 (10.8)22 (25.9)28TJC, median (IQR)0 (0,0)0 (0,0)0.1483 (1,5)1 (1,3)0.00328SJC, median (IQR)0 (0,0)0 (0,0)0.7341 (0,3)1 (0,2)0.044PtGA, median (IQR)0 (0,0)0 (0,0)0.3024 (2,5)2 (1,3)<0.001PrGA, median (IQR)0 (0,0)0 (0,0)0.3024 (2,5)2 (1,3)<0.001Pain VAS, median (IQR)0 (0,0)0 (0,1)0.8003 (2,4)2 (1,2)<0.001CRP, (mg/L), median (IQR)3 (3,3)3 (3,3)0.8333 (3,10)3 (3,6)0.422HAQ-DI, median (P5, P95)0 (0,0.1625)0 (0,0.0125)0.0160.25 (0,1.25)0 (0,0.837)<0.001Anxiety or depression, n (%)12 (33.3)24 (24.7)0.32291 (57.6)27 (31.8)<0.001Disclosure of Interests:None declared