Kvaliteta života osoba oboljelih od psorijatičnoga artritisa u usporedbi s reumatoidnim artritisom i degenerativnom bolešću zglobova [Quality of life in patients with psoriatic arthritis in comparison to rheumathoid arthritis and degenerative joint disease]

Grubišić, Frane (2016) Kvaliteta života osoba oboljelih od psorijatičnoga artritisa u usporedbi s reumatoidnim artritisom i degenerativnom bolešću zglobova [Quality of life in patients with psoriatic arthritis in comparison to rheumathoid arthritis and degenerative joint disease]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Objectives. The main objective of this research is to compare quality of life in patients with PsA with the quality of life with patients suffering from RA and patients suffering from degenerative joint disease and to determine predictors of both quality of life and functional ability in PsA patients. Methodology. The research was conducted in the 2007-2012 period in the Department of Rheumatology, Physical Medicine and Rehabilitation, University Hospital Center Sestre Milorsdnice, Zagreb, Croatia. A total of 177 patients was enrolled in first phase: 114 patients with PsA and 63 patients in the control group which comprised 31 patients suffering from degenerative joint disease and 32 patients suffering from RA. In the second phase of the research 164 patients were enrolled: 104 patients with PsA and 60 patients in the control group which comprised 30 patients suffering from degenerative joint disease and 30 patients suffering from RA. The patients were recruited from the database of our Clinic and were invited by either invitation letter or in person by the researcher (rheumatologist) himself. The patients signed the informed consent forms prior to the enrollment in the study. The researcher conducted an interview and a physical examination with each patient and he also helped the patients to fill in their questionnaire when necessary. Questionnaires used in this research are divided as follows: questionnaires which are part of physical examination (PASI index, BASMI index, BASFI index, MASES index, HAQ-DI index), questionnaires which are used to assess the impact of disease on pyhsical, emotional and social domaine of quality of life (SF 36, FACIT indeks, RAQoL, PsAQoL) and questionnaires which are used to assess disease activity (DAS28 , BASDAI). Results. In both phases of the research, it was shown that age of diagnosis of PsA and duration of PsA may influence the functional ability, but not the quality of life of PsA patients. Statistically significant differences in the cohort of PsA patients compared to controls were found in the following variables: age of patient (PsA < RA and degenerative joint disease), patient’s global health assessment (PsA <degenerative joint disease<RA), HAQ score (PsA <degenerative joint disease<RA), morning stiffness (degenerative joint disease< PsA< RA) and erythrocyte sedimentation rate (degenerative joint disease< PsA< RA). In PsA patients, the physical domaines of quality of life is deteriorated with the exception of general health domaine. Furthermore, both the emotional and the social component of quality of life is significantly decreased in PsA patients: SF-36 Pain (degenerative joint disease<RA<PsA), SF-36 Body Function (RA<degenerative joint disease<PsA), SF-36 Body Health (RA<degenerative joint disease<PsA in phase one, degenerative joint disease< RA < PsA in phase two), SF-36 Emotional (degenerative joint disease<RA<PsA), SF-36 Psychological Health (degenerative joint disease<RA<PsA in phase two), SF-36 Vitality/Energy (degenerative joint disease< RA < PsA), SF-36 Social Function (degenerative joint disease<RA<PsA). The results have also shown that PsA patients have significantly higher functional ability in relation to RA patients and patients with degenerative joint disease in all observed subgroups of SF-36 questionnaire. Conclusion. Since this research showed that functional ability in PsA patients depends on age of diagnosis of PsA and disease duration, these two variables could be considered as the predictors of functional ability in PsA patients. On the whole, this research shows that PsA should be diagnosed and treated as early as possible in order to preserve functional ability and quality of life of PsA patients. Quality of life in patients with PsA is not significantly reduced compared to patients with RA or degenerative joint disease.

Abstract in Croatian

Ciljevi. Usporediti kvalitetu života oboljelih od PsA s oboljelima od RA i degenerativne bolesti i odrediti prediktore kvalitete života i funkcionalne sposobnosti među bolesnicima oboljelima od PsA. Metodologija. Istraživanje je provedeno u Klinici za reumatologiju, fizikalnu medicinu i rehabilitaciju KBC-a Sestre Milosrdnice u Zagrebu na uzorku od ukupno 177 ispitanika u prvoj fazi istraživanja (114 ispitanika s PsA kao ispitivana skupina, 63 ispitanika u kontrolnoj skupini: 31 ispitanik s dijagnozom degenerativne bolesti zglobova i 32 ispitanika s dijagnozom RA). U drugoj fazi istraživanja sudjelovalo je 164 ispitanika (104 ispitanika s PsA kao ispitivana skupina, 60 ispitanika u kontrolnoj skupini: 30 ispitanik sa dijagnozom degenerativne bolesti zglobova i 30 ispitanika s dijagnozom RA). Vremenski raspon istraživanja bio je od 2007. do 2012. god. Ispitanici su regrutirani iz baze podataka Klinike (ambulanta ili klinički odsjek) i pozivani ili pismom namjere ili ih je istraživač (liječnik subspecijalist reumatolog) pitao jesu li zainteresirani za sudjelovanje u istraživanju. Svi su ispitanici prije početka istraživanja potpisali informirani pristanak za sudjelovanje. Razgovor i klinički pregled bolesnika obavio je liječnik subspecijalist-reumatolog koji je i pomagao pri ispunjavanju određenog upitnika. Upitnici upotrijebljeni u ovom istraživanju mogli bi se podijeliti na one koje su dio kliničkog pregleda (PASI indeks, BASMI indeks, BASFI indeks, MASES indeks, HAQ-DI indeks), one kojima se procjenjuje utjecaj bolesti na tjelesnu i emocionalnu komponentu života (SF-36, FACIT indeks, RAQoL, PsAQoL) i na određivanje aktivnosti bolesti (DAS28 ili BASDAI). Rezultati. Analiziranjem rezultata kanoničke regresije, moguće je pretpostaviti da u objema fazama istraživanja životna dob postavljanja dijagnoze PsA i dužina trajanja PsA značajno utječu na funkcionalnu sposobnost pojedinca, ali ne utječu na njihovu kvalitetu života. U kohorti oboljelih od PsA statistički je značajna razlika nađena u slijedećim varijablama u usporedbi s kontrolnom skupinom: životna dob ispitanika (PsA < RA i degenerativna bolest), globalna procjena zdravlja prema bolesniku (PsA <degenerativna bolest<RA), HAQ (PsA <degenerativna bolest<RA), jutarnja zakočenost (degenerativna bolest < PsA< RA) i sedimentacija eritrocita (degenerativna bolest < PsA< RA). U bolesnika sa PsA utvrđeno je da je tjelesna komponentna kvalitete života narušena u svim promatranim domenama, osim domene općeg zdravlja. Značajno je smanjena i emocionalna i socijalna komponenta kvalitete života tih bolesnika: SF-36 Opće zdravlje (RA<degenerativna bolest<PsA), SF-36 Bol (degenerativna bolest<RA<PsA), SF- 36 Tjelesna funkcija (RA<degenerativna bolest<PsA), SF-36 Tjelesno zdravlje (RA<degenerativna bolest<PsA u prvoj fazi, degenerativna bolest<RA<PsA u drugoj fazi), SF- 36 Emocionalno stanje (degenerativna bolest<RA<PsA), SF-36 Psihičko zdravlje (degenerativna bolest<RA<PsA u drugoj fazi), SF-36 Vitalnost i energija (degenerativna bolest<RA<PsA), SF- 36 Socijalna funkcija (degenerativna bolest<RA<PsA). Prema tome, bolesnici sa PsA imaju značajno višu funkcionalnu sposobnost u odnosu na bolesnike sa RA i degenerativnom bolešću u svim promatranim podgrupama SF-36 upitnika. Zaključak. Budući da je ovim istraživanjem pokazano da funkcionalna sposobnost oboljelih od PsA ovisi o dobi postavljanja dijagnoze i dužini trajanja PsA, te bi se dvije varijable mogle smatrati prediktorom funkcionalne sposobnosti u osoba sa PsA. Sveukupno, ovim smo istraživanjem ukazali na potrebu što ranijeg dijagnosticiranja PsA i njegova odgovarajućeg liječenja s ciljem očuvanja funkcionalne sposobnosti i kvalitete života tih bolesnika. Kvaliteta života s PsA-om nije značajno smanjena u odnosu na bolesnike s RA ili sa degenerativnom bolešću.

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