Povezanost izmenjene funkcije šake sa težinom bolesti i kvalitetom života bolesnika sa sistemskom sklerozom
Association of the altered hand function with disease severity and life quality in patients with systemic sclerosis
Doktorand
Vidaković, Predrag A.Mentor
Damjanov, NemanjaČlanovi komisije
Radak Perović, MarijaŠefik Bukilica, Mirjana
Stamenković, Bojana
Metapodaci
Prikaz svih podataka o disertacijiSažetak
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 šak...a 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 d...egrees, 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)...