Povezanost izmenjene funkcije šake sa težinom bolesti i kvalitetom života bolesnika sa sistemskom sklerozom

Abstract

Uvod: Oštećenje funkcije šaka je jedan od najznačajnijih uzroka smanjenja kvaliteta ţivota i sposobnosti za rad bolesnika sa sistemskom sklerozom (SSc). Još uvek nije dovoljno poznato koliko je oštećenje funkcije šaka bolesnika sa SSc povezano sa promenama na unutrašnjim organima, sa aktivnošću bolesti i sa teţinom bolesti. Cilj rada: Da se kod bolesnika sa SSc ispita povezanost izmenjene funkcije šake sa promenama na unutrašnjim organima, sa aktivnošću bolesti, sa teţinom bolesti, sa kvalitetom ţivota i sa radnom sposobnošću. Bolesnici i metode: Ispitivanje je sprovedeno u Institutu za reumatologiju u Beogradu na 50 punoletnih hospitalizovanih bolesnika (43 ţene i 7 muškaraca) sa dijagnozom SSc (bez pridruţenih drugih sistemskih bolesti vezivnog tkiva) postavljenom prema preporukama EULAR-a, koje su revidirane 2013. god. u zajedničkom odboru EULAR-a i ACR-a. Na rukama su mereni obim pokreta zglobova podlaktice (šake - ručja i posebno prstiju šaka) u stepenima, snaga mišića prstiju šaka manuelnim mišićnim testom u procentima, rasprostranjenost koţnih promena modifikovanim Rodnanovim koţnim skorom, funkcije podlaktice (i posebno šaka sa prstima) HAMIS testom, stanje kapilara na prstima ruku kapilaroskopijom i koštanozglobne promene radiografijom šaka. Promene na unutrašnjim organima ispitivane su radiografijom i kompjuterizovanom tomografijom pluća, FVC, DLCO, EKG, ehokardiografijom, endoskopijom jednjaka i klirensom kreatinina. Od laboratorijskih analiza odreĎivana su skleroderma-specifična antitela i nespecifični pokazatelji zapaljenja. Za procenu drugih promena vezanih za SSc korišćeni su: za procenu teţine bolesti SySQ i TIFS upitnik, za procenu aktivnosti bolesti EScSG indeks, za procenu kvaliteta ţivota SF-36 upitnik i za procenu radne sposobnosti WAI indeks. Rezultati: Analiza povezanosti patoloških promena na šakama sa oštećenjima unutrašnjih organa i drugim pojavama koje prate SSc pokazuje da postoji statistički značajna ili visoko značajna povezanost zadebljanja koţe koje bitno umanjuje funkciju šaka (na prstima kod 96.0% ispitanika) sa lošijim kvalitetom ţivota (zbog emotivnih problema- prosek 20.56)...

Introduction: Altered hand function in patients with systemic sclerosis (SSc) is one of the most important causes of diminished quality of life and working ability. It is still not determined how strong altered hand function is connected with changes on internal organs, disease activity and disease severity. The aim of the study: To determine, in patients with SSc, connection of the altered hand functions with changes on internal organs, disease activity, disease severity, quality of life and working ability. Patients and methods: Investigation was conducted at the Institute for rheumatology in Belgrade on 50 adults hospitalized patients (43 female and 7 male) with diagnose of SSc (without other systemic diseases of connective tissue) estimated according to recommendations of EULAR which were updated in 2013. on the EULAR and ACR mutual committee. The following parameters were observed on hands: active range of motion on lower arm joints (hands- wrists and particularly on fingers) in degrees, finger muscles strength by manual muscle tests in percentages, skin changes through modified Rodnan skin score (mRSS), function of the lower arm (and additionally hands and fingers) using HAMIS test, condition of the capillaries on fingers using capillaroscopy and changes on bones and joints of hands using radiography. Changes on internal organs and locomotor system were determined using radiography and computed tomography of the lungs, FVC, DLCO, ECG, heart ultrasound, endoscopy of the esophagus and kreatinine clearance. Laboratory analyses were used to confirm existence of scleroderma specific antibodies or non-specific inflammatory parameters. To determine other changes in connection to SSc, several questionnaires were used: for disease severity SySQ and TIFS, for disease activity EScSG index, for quality of life SF-36 questionnaire and to evaluate work ability WAI index. The results: Analysis of the connection between pathological changes on hands with damages on internal organs and other manifestations that are following SSc is showing that there is statistically significant or highly significant connection in thickened skin on hands that is seriously diminishing hand functions (on fingers in 96.0% of patients) with worsened life quality (due to emotional problems- average 20.56)...