Epidemiološke i kliničke karakteristike obolelih od reumatoidnog artritisa ili spondiloartropatija

Abstract

UVOD: Reumatoidni artritis (RA) i spondiloartropatije (SpA) u koje se ubrajaju ankilozirajući spondilitis (AS), psorijazni artritis (PsA), reaktivni artritis (ReA), enteropatski artritis (EA), i nediferentovane spondiloartropatije (NeSpA) spadaju u najčešće zapaljenske reumatske bolesti. Do sada objavljeni rezultati prevalencije ovih bolesti pokazuju veoma velike varijacije za koje je moguće da su, pored razlika u genetskim, rasnim i kulturološkim obeležjima, klimatskim faktorima i slično, uzrokovane i različitim metodama istraživanja. CILJEVI RADA: odrediti ukupnu prevalenciju RA i SpA (kao i pojedinih vrsta SpA) u populaciji centralne Srbije, kao i u odnosu na demografske karakteristike ispitanika; ispitati razlike izmedju obolelih od RA ili SpA u odnosu na njihove demografske i kliničke karakteristike (lična i porodična anamneza); analizirati sposobnost primarne zdravstvene zaštite da odgovori na zahteve obolelih od RA ili SpA; proceniti validnost skraćene verzije upitnika kao skrining testa za rano otkrivanje osoba sa RA ili SpA u primarnoj zdravstvenoj zaštiti. ISPITANICI I METODE: Istraživanje je sprovedeno u okviru identične metodološke studije određivanja prevalencije RA i SpA u zemljama Evrope pod pokroviteljstvom Evropske Lige za zaštitu od Reumatskih bolesti (European League Against Rheumatism-EULAR), pod rukovodstvom Glavnog Komiteta za Epidemiologiju i Istraživanje Javnog Zdravlja (EULAR Standing Committee of Epidemiology and Health Service Research- SCEHSR). Jedinstven Upitnik je prethodno preveden uz proces transkulturne adaptacije i uspešno validiran. U srpsku verziju Upitnika dodata su ciljana pitanja koja se odnose na demografske karakteristike ispitanika. Urbano područje centralne Srbije predstavljaju 4 grada: Beograd (glavni grad) u severnom delu i tri grada u južnom delu: Čačak (Moravički okrug), Užice (Zlatiborski okrug) i Kruševac (Rasinski region). Izborom svakog 100-tog telefonskog pretplatnika u ovim gradovima dobijen je sistematski uzorak telefonskih brojeva koji su pozivani u prvoj, fazi detekcije. Na osnovu pozitivnih odgovora iz Upitnika, kao i dijagnoze dobijene od bolesnika, reumatolog je ponovo telefonom pozivao ispitanike za koje postoji sumnja da boluju od RA ili SpA u drugoj, fazi konfirmacije. Postavljana su ciljana pitanja o lekarima i ustanovi gde se leče, kao i o primenjenim lekovima, sa posebnim akcentom na dva pitanja: „Koliko je vremena prošlo od kada ste osetili prve simptome bolesti dok nije postavljena dijagnoza Vaše bolesti“ i „ Koju terapiju ste uzimali ili koristili u periodu od pojave prvih simptoma do vremena kada ste posetili reumatologa“...

INTRODUCTION: Among the most common rheumatic diseases are Rheumatoid arthritis (RA) and Spondyloarthritis (SpA) (comprising of ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), enteropatic arthritis (EA) and undifferentiated spondyloarthritis (NeSpA)). Up to date prevalence results for those diseases are very discrepant, caused by genetic, racial or cultural differences, different climate factors etc, or maybe because of different study methods which have been used in the applied investigations. OBJECTIVES: to estimate total RA and SpA prevalence (and separate for diseases which belong to SpA group) in population of central Serbia, as well as according to demographic characteristics of patients (pts); to examine differences between RA and SpA pts according to their demographic and clinical characteristics (personal and family anamnesis); to analyze the capacity of the primary care units for RA and SpA early detection and care; to estamate validity of the short Questionnaire as a screening test for the early detection of RA and SpA pts in primary care units. PATIENTS AND METHODS: This investigation was conducted as part of the unique prevalence estimation study for RA and SpA in the European countries under the patronage of EULAR (European League Against Rheumatism), under the auspices of the SCEHSR (EULAR Standing Committee of Epidemiology and Health Service Research). The unique Questionnaire was previosly translated using transcultural adaptation process and successfully validated. The Serbian version of the Questionnaire was amended with demographic characteristics of the respondents. The urban population from central Serbia was represented by four towns: Belgrade (the capital) from the north and three towns from the south: Cacak (Moravicki okrug), Uzice (Zlatiborski okrug) and Krusevac (Rasinski region). The representative sample was formed by choosing every 100th telephone number from those towns. In a first, detection phase, the Questionnaire was conducted by trained interviewers in the selected towns. Relying on positive Questionnaire items and self reported diagnosis, persons suspected with RA or SpA were called again by a rheumatologist in a second, confirmation phase. They were asked about the institution they have been treated in, their doctor and the medicines they have been using, with two questions specially emphasized: „How long has it been since you felt the first symptoms of the disease until the confirmation of the diagnosis," and "What treatment have you been on and which medicines have you been using during the time period from the onset of symptoms to your rheumatologist visit."...