ROMATOİD ARTRİTLİ HASTALARDA EROZYON ŞİDDETİ FONKSİYONEL DURUMUN BELİRLEYİCİSİ OLABİLİR Mİ?

Amaç: Romatoid artrit (RA) başlıca diartrodial eklemlerin kronik inflamasyonu ile karakterize sistemik bir hastalıktır. Sinovit, eklem erozyonları ve fonksiyonel bozukluk hastalığın temel bulgularıdır. Bu çalışmada RA’da fonksiyonel bozukluğun radyolojik erozyonlarla ilişkisi olup olmadığını araştırmayı amaçladık. Materyal ve Metot: Amerika Romatoloji Birliği (ACR) 1987 kriterlerine göre RA tanısı konan 68 (59 kadın, 9 erkek) hasta çalışmaya alındı. Hastaların demografik özellikleri, sabah tutukluğunun süresi ve şiddeti, ağrının şiddeti sorgulandı. Laboratuvar parametrelerinden eritrosit sedimantasyon hızı (ESH) ve C-reaktif protein (CRP) düzeyleri değerlendirildi. Hastalık aktivitesi Ritch İndeksi ve DAS28 Skoru ile, fonksiyonel durum ise Sağlık Değerlendirme Anketi (SDA) ve Duruöz El Skalası (DES) ile değerlendirildi. Erozyonların şiddeti el ve ayak grafilerinden Larsen Skoru'na göre derecelendirildi. Bulgular: Çalışmaya alınan hastaların ortalama yaşı 54.30±11.27 ve ortalama hastalık süresi 8.4±6.4 yıl idi. SDA ve DES ile Larsen Skoru sabah tutukluğunun süresi ve şiddeti, verbal ağrı skoru, Ritch İndeksi ve DAS 28 skorları arasında istatistiksel olarak anlamlı korelasyon saptandı Sonuç: RA’lı hastalarda radyolojik olarak saptanan erozyonlar fonksiyonel durumun bir göstergesi olmayabilir. Bu nedenle RA’da tedavinin planlanmasında ve takibinde sadece radyolojik değerlendirmelerle sınırlı kalınmayarak hastaların fonksiyonel durumlarının da mutlaka düzenli takip edilmesi gerektiğini düşünmekteyiz.

CAN EROSION SEVERITY BE A PREDICTOR OF FUNCTIONAL STATUS IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Objective: Rheumatoid arthritis (RA) is a systemic disease that is primarily characterized by chronic inflammation of the diarthrodial joints. Synovitis, joint erosions and functional impairment are main findings of the disease. In this study, we aimed to investigate whether functional impairment is related to radiological erosions in RA. Material and Method: Sixty-eight patients who were diagnosed to have RA according to American College of Rheumatology (ACR) criteria were included in the study. The demographic characteristics of patients, duration and severity of morning stiffness imprisonment, and the severity of pain were recorded. Erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) were measured. Disease activity was assessed by Ritch Index and DAS28 score, and functional status by Health Assessment Questionnaire (HAQ) and Duruöz Hand Index (DHI). The severity of the erosions was graded according to the Larsen Score from radiographs of hands and feet. Results: Patients had the mean age of 54.30±11.27 and an average disease duration of 8.4±6.4 years. There was no correlation between HAQ and DHI and Larsen Score (p>0.05). However, statistically significant correlation was found between HAQ and DHI with duration and severity of morning stiffness, verbal pain score, Ritch Index and Conclusion: The radiological erosisons in patients with RA may not be an indicator of functional status. Therefore, we think that not only radiological evaluation but also functional status must be followed regularly in the treatment and follow-up of RA.

PDF

___

Navarro-Compan V, Landewe R, Provan SA, Odegard S, Uhlig T, Kvien TK, et al. Relationship between types of radiographic damage and disability in patients with rheumatoid arthritis in the EURIDISS cohort: a longitudinal study. Rheumatology (Oxford). 2015;54(1):83-90.
Aletaha D, Funovits J, Smolen JS. Physical disability in rheumatoid arthritis is associated with cartilage damage rather than bone destruction. Ann Rheum Dis. 2011;70(5):733-9.
Radner H, Smolen JS, Aletaha D. Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis. Rheumatology (Oxford). 2011;50(2):381-8.
Kaya T, Karatepe AG, Günaydın R, Türkmen G, Özbek G. Romatoid artritli hastalarda yaşam kalitesi: hastalık aktivitesi, fonksiyonel durum ve sağlık durumu ile ilişkisi. Romatizma. 2007;2:119-22.
Zvaifler NJ. Etiology and pathogenesis of rheumatoid arthritis. In Arthritis & Allied Conditions. McCarty DJ, Kopman WJ (eds) 12th ed. Philadelphia, Lea&Febiger, 1993; 723-36.
Favalli EG, Becciolini A, Biggioggero M. Structural integrity versus radiographic progression in rheumatoid arthritis. RMD Open. 2015;1(1):e000064.
Plant M. Radiological progression and outcome in early rheumatoid arthritis. MD Thesin. University of London,1996.
Şahin-Akyar G. Romatoid Artrit: Görüntüleme Yöntemleri: In: Immunoloji-Romatoloji. Romatoid Artrit özel sayısı. 2001;14-25.
MacGregor JA, Silman JA. Classification and epidemiology. In:Rheumatology. Ed’s; Hochberg CM, Silman JA, Weinblatt EM, Weisman HM, Smolen SJ. Mosby, Fourth Edition, 2008;755-61.
Van Gestel AM, Haagsma CJ, van Riel PLCM. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998;41(10):1845-50.
Başaran S, Güzel R, Sarpel T. Yaşam kalitesi ve sağlık sonuçlarını değerlendirme ölçütleri. Romatizma. 2005;20(1):55-63.
Küçükdeveci A, Şahin H, Ataman S, Griffiths B, Tennant A. Issues in cross-cultural validity: example from adaptation, reliability and validity of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum. 2004;51(1):14-9.
Poole JL, Measures of adult hand function. Arthritis Rheum. 2003;49:59-66.
Duruöz MT, Poiraudeau S, Fermanian J, Menkes C, Amor B, Dougados M, et al, Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996;23:1167-72.
Larsen A. How to apply Larsen score in evaluating radiographs of rheumatoid arthritis in longterm studies? J Rheumatol. 1995;22:1974-5.
Paimela L, Laasonen L, Helve T, Leirisalo-Repo M. Comparision of the original and the modified Larsen methods an the Sharp method in scoring radiographic progression in early rheumatoid arthritis. J Rheumatol. 1998;25(6):1063-6.
Sokka T, Kankainen A, Hannonen P. Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores, Arthritis Rheum. 2000;43(2):386-9.
Yaşa E, Öz B, Ölmez N, Memiş A. Romatoid Artrit Hastalarında El Deformiteleri ile Disabilite Arasındaki ilişki. J PMR Sci. 2011;14:16-22.
Salaffi F, Stancati A. Disability and quality of life of patients with rheumatoid arthritis: assessment and perspectives. Reumatismo. 2004;56(suppl 1):87-106.
Aletaha D, Smolen J, Ward MM. Measuring function in rheumatoid arthritis: identifying reversible and irreversible components. Arthritis Rheum. 2006;54(9):2784-92.
Aletaha D, Strand V, Smolen JS, Ward MM. Treatment-related improvement in physical function varies with duration of rheumatoid arthritis: a pooled analysis of clinical trial results. Ann Rheum Dis. 2008;67(2):238-43.
Plant M. Radiological progression and outcome in early rheumatoid arthritis. MD Thesin. University of London,1996.
Özsoy MH, Altınel L, Başarır K, Çavuşoğlu AT, Dinçel E. Romatoid artritte eklem hastalığının patogenezi. TOTBİD Derg. 2006;5:3-4.
Geuskens GA, Burdorf A, Hazes JM. Consequences of rheumatoid arthritis for performance of social roles-a literature review. J Rheumatol. 2007;34(6):1248-60.
Eberhardt KB, Fex E. Functional inpairment and disability in early rheumatoid arthritisdevelopment over 5 years. J Rheumatol. 1995;22(6):1037-42.
Arvidson NG, Larsson A, Larsen A. Simple function tests, but not modified HAQ, correlate with radiological joint damage in rheumatoid arthritis. Scand J Rheumatol. 2002;31(3):146-50.
Houssein DA, Choy EHS. Berry H. Scott DL. Differences between the clinical and radiological progression of rheumatoid arthritis. Br J Rheumatol. 1996;35(1):199.
Welsing AM, van Gestel AM, Swinkels HL, Kiemeney LA, van Riel PL. The relationship between disease activity, joint destruction, and functional capasity over the course of rheumatoid arthritis. Arthritis Rheum. 2001;44(9):2009-17.
Firestein GE: Etiology and pathogenesis of rheumatoid arthritis. Kelley WN, Harris ED, Ruddy S, Sledge CB (Ed.). Textbook of Rheumatology, 3. Ed. WB Saunders Company, Philadelphia, 1997; 851-97.
Regan-smith M, O’Connor GT, Kwoh CK, Brown LA, Olmstead EM, Burnett JB. Lack of correlation between the Steinbrocker staging of hand radiographs and the functional health status of individuals with rheumatoid arthritis. Arthritis Rheum. 1989;32(2):126-33.
McEntegart A, Morrison E, Capell HA, Duncan MR, Porter D, Madhok R et al. Effect of social deprivation on disease severity and outcome in patients with rheumatoid arthritis. Ann Rheum Dis. 1997;56(7):410-3.