{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:54:55Z","timestamp":1785412495470,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, Romania"},{"id":[{"id":"https:\/\/ror.org\/052sta926","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory rheumatic diseases associated with impaired quality of life, persistent disease burden, and increased healthcare utilization. Treatment adherence and psychosocial factors may influence outcomes, but their longitudinal associations in real-world hospitalized populations remain insufficiently characterized. Methods: We conducted a single-center, retrospective, mid-term longitudinal observational study including 50 adults with RA or AS who experienced repeated hospitalizations over a four-year period. The final dataset comprised 196 hospitalization episodes analyzed as repeated observations nested within individual patients. Disease activity was assessed using DAS28 in RA and ASDAS and\/or BASDAI in AS, according to data availability and routine clinical practice. Treatment adherence, quality of life, anxiety, social isolation, patient\u2013provider communication, dietary support, inflammatory markers, and hospitalization-related outcomes were extracted from medical records and structured inpatient assessments. Linear mixed-effects models were used for continuous outcomes, and ordinal mixed-effects models were used for ordered categorical outcomes, with adjustment for age, sex, and time where appropriate. Results: In RA, higher treatment adherence was associated with lower disease activity over time. In AS, comparable associations were not detected, possibly reflecting disease-specific factors, limited variability in adherence, and reduced statistical power in the smaller AS subgroup. Better patient\u2013provider communication was associated with higher adherence and lower anxiety, whereas greater social isolation was associated with poorer quality of life. More favorable dietary support was associated with better adherence, although the magnitude of this association should be interpreted cautiously because of sparse categories and wide confidence intervals. Lower inflammatory burden, particularly lower CRP over time, was associated with lower hospitalization-related costs. Conclusions: In this selected cohort of repeatedly hospitalized patients with RA or AS, treatment adherence, psychosocial factors, and supportive care indicators were associated with clinically relevant longitudinal outcomes. The findings support a multidisciplinary, patient-centered approach to inflammatory rheumatic disease care. However, because of the retrospective design, modest sample size, selected inpatient population, non-standardized assessment of several variables, and possible instability of some ordinal model estimates, the results should be interpreted as exploratory and confirmed in larger prospective cohorts.<\/jats:p>","DOI":"10.3390\/medsci14020278","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:11:01Z","timestamp":1780333861000},"page":"278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment Adherence, Psychosocial Factors, and Clinical Outcomes in Repeatedly Hospitalized Patients with Rheumatoid Arthritis and Ankylosing Spondylitis: An Exploratory Mid-Term Longitudinal Mixed-Effects Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5438-666X","authenticated-orcid":false,"given":"Gabriela Isabela Verga","family":"R\u0103u\u021b\u0103","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"\u2018Sf. Ioan\u2019 Emergency Clinical Hospital for Children, 800487 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana \u0218erban","family":"(Gr\u0103dinaru)","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"\u2018Sf. Ioan\u2019 Emergency Clinical Hospital for Children, 800487 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8327-1364","authenticated-orcid":false,"given":"Gabriela","family":"Gur\u0103u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"\u2018Sf. Ioan\u2019 Emergency Clinical Hospital for Children, 800487 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8838-8817","authenticated-orcid":false,"given":"Carmen Loredana","family":"Petrea (Clive\u021bi)","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"\u2018Sf. Ioan\u2019 Emergency Clinical Hospital for Children, 800487 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u0103d\u0103lina Nicoleta","family":"Matei","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"\u2018Sf. Ioan\u2019 Emergency Clinical Hospital for Children, 800487 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexia Anastasia \u0218tefania","family":"Balt\u0103","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"St. \u201cApostol Andrei\u201d County Emergency Clinical Hospital, 800578 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana-Andreea","family":"Ciortea","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"\u201cMaria Sklodowska Curie\u201d Emergency Clinical Hospital for Children, 041451 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doina Carina","family":"Voinescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Center in the Medico-Pharmaceutical Field, \u201cDunarea de Jos\u201d University of Galati, 800008 Galati, Romania"},{"name":"St. \u201cApostol Andrei\u201d County Emergency Clinical Hospital, 800578 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1038\/s41584-021-00652-9","article-title":"Autoinflammation and autoimmunity across rheumatic and musculoskeletal diseases","volume":"17","author":"Szekanecz","year":"2021","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/ard-2022-223356","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update","volume":"82","author":"Smolen","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e070856","DOI":"10.1136\/bmj-2022-070856","article-title":"Therapeutic advances in rheumatoid arthritis","volume":"384","author":"Brown","year":"2024","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1038\/s41392-023-01331-9","article-title":"Signaling pathways in rheumatoid arthritis: Implications for targeted therapy","volume":"8","author":"Ding","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Radu, A.F., and Bungau, S.G. (2021). Management of rheumatoid arthritis: An overview. Cells, 10.","DOI":"10.3390\/cells10112857"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1002\/(SICI)1097-0258(19971030)16:20<2349::AID-SIM667>3.0.CO;2-E","article-title":"Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data","volume":"16","author":"Cnaan","year":"1997","journal-title":"Stat. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.2147\/PPA.S140457","article-title":"Medication adherence has an impact on disease activity in rheumatoid arthritis: A systematic review and meta-analysis","volume":"11","author":"Li","year":"2017","journal-title":"Patient Prefer. Adherence"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e000585","DOI":"10.1136\/rmdopen-2017-000585","article-title":"Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: A large cross-sectional study","volume":"5","author":"Smolen","year":"2019","journal-title":"RMD Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1477-7525-7-25","article-title":"The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: A comparison with a selected sample of healthy people","volume":"7","author":"Salaffi","year":"2009","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/1756-185X.13774","article-title":"Depression has an impact on disease activity and health-related quality of life in rheumatoid arthritis: A systematic review and meta-analysis","volume":"23","author":"Zhang","year":"2020","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"105125","DOI":"10.1016\/j.jbspin.2020.105125","article-title":"Patients and spouses coping with inflammatory arthritis: Impact of communication and spousal perceived social support and burden","volume":"88","author":"Rat","year":"2021","journal-title":"Jt. Bone Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e001647","DOI":"10.1136\/rmdopen-2021-001647","article-title":"Effectiveness of self-management interventions in inflammatory arthritis: A systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis","volume":"7","author":"Marques","year":"2021","journal-title":"RMD Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1136\/annrheumdis-2021-220249","article-title":"2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis","volume":"80","author":"Nikiphorou","year":"2021","journal-title":"Ann. Rheum. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1136\/ard-2022-223296","article-title":"ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update","volume":"82","author":"Ramiro","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1213\/ANE.0000000000003511","article-title":"Repeated measures designs and analysis of longitudinal data: If at first you do not succeed\u2014Try, try again","volume":"127","author":"Schober","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.semarthrit.2014.05.001","article-title":"The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis","volume":"44","author":"Matcham","year":"2014","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.2147\/PPA.S165101","article-title":"Medication adherence and persistence in patients with autoimmune rheumatic diseases: A narrative review","volume":"12","author":"Anghel","year":"2018","journal-title":"Patient Prefer. Adherence"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s13075-018-1644-6","article-title":"The prevalence of depression in axial spondyloarthritis and its association with disease activity: A systematic review and meta-analysis","volume":"20","author":"Zhao","year":"2018","journal-title":"Arthritis Res. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1002\/art.1780380107","article-title":"Modified disease activity scores that include twenty-eight-joint counts: Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis","volume":"38","author":"Prevoo","year":"1995","journal-title":"Arthritis Rheum."},{"key":"ref_20","first-page":"2286","article-title":"A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Disease Activity Index","volume":"21","author":"Garrett","year":"1994","journal-title":"J. Rheumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1007\/s10067-022-06189-w","article-title":"Patient-reported adherence to physical exercises of patients with ankylosing spondylitis","volume":"41","author":"Ma","year":"2022","journal-title":"Clin. Rheumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.2147\/PPA.S403437","article-title":"Influence of disease acceptance on the quality of life of patients with ankylosing spondylitis\u2013single centre study","volume":"17","author":"Wysocki","year":"2023","journal-title":"Patient Prefer. Adherence"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.2147\/PPA.S324097","article-title":"Predictors of health-related quality of life in patients with ankylosing spondylitis in Southwest China","volume":"15","author":"Song","year":"2021","journal-title":"Patient Prefer. Adherence"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7504","DOI":"10.1017\/S0033291723002660","article-title":"A revitalized biopsychosocial model: Core theory, research paradigms, and clinical implications","volume":"53","author":"Bolton","year":"2023","journal-title":"Psychol. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Verga, G.I.R., Balt\u0103, A.A.\u0218., Mateescu Costin, S.A., Ailene, D.M., Apostol, L.L., Gurau, T.V., Dinu, C.A., Stuparu-Cre\u021bu, M., and Voinescu, D.C. (2025). Diet, Lifestyle Factors, and Quality of Life in Patients with Rheumatic Diseases: A Cross-Sectional Study. Nutrients, 17.","DOI":"10.3390\/nu17223499"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"152203","DOI":"10.1016\/j.semarthrit.2023.152203","article-title":"Self-management support needs of patients with inflammatory arthritis and the content of self-management interventions: A scoping review","volume":"60","author":"Damgaard","year":"2023","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1007\/s00296-024-05615-3","article-title":"Diagnosis, monitoring, and management of axial spondyloarthritis","volume":"44","author":"Zimba","year":"2024","journal-title":"Rheumatol. Int."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Li, Y., Ma, D., and Yang, L. (2024). Experiences and perceptions of patients with ankylosing spondylitis: A systematic review and meta-synthesis of qualitative studies. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0311798"},{"key":"ref_29","first-page":"e97825","article-title":"Pain Catastrophizing in Rheumatoid Arthritis and Spondyloarthritis Patients Receiving Biologic Therapy: A Cross-Sectional Study","volume":"17","author":"Hmamouchi","year":"2025","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e002058","DOI":"10.1136\/rmdopen-2021-002058","article-title":"Association between social deprivation and disease activity in rheumatoid arthritis: A systematic literature review","volume":"8","author":"Dey","year":"2022","journal-title":"RMD Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1136\/ard.2008.094870","article-title":"Development of an ASAS-endorsed disease activity score, ASDAS, in patients with ankylosing spondylitis","volume":"68","author":"Lukas","year":"2009","journal-title":"Ann. Rheum. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1136\/ard.2008.100826","article-title":"ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis","volume":"68","author":"Lie","year":"2009","journal-title":"Ann. Rheum. Dis."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/278\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T17:23:43Z","timestamp":1780334623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,30]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medsci14020278"],"URL":"https:\/\/doi.org\/10.3390\/medsci14020278","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,30]]}}}