Romatoid Artritli Kadın Hastalarda Üst Ekstremitede Hangi Kasların Güçleri Hastalık Aktivitesi, Fonksiyonellik ve Engellilik ile İlişkilidir?

Bu çalışmada kas gücü kaybına neden olan romatoid artrit (RA) hastalarında; dominant üst ekstremitede hangi kas gruplarının etkilendiğinin, bu etkilenmelerin hastalık aktivitesi, fonksiyonellik ve engellilik ile ilişkisinin araştırılması amaçlanmıştır. Çalışmaya 30 RA hastası, 30 sağlıklı gönüllü dahil edildi. Hasta grubunda "hastalık aktivite skoru-28 (DAS28)”, “üst ekstremite fonksiyonel indeksi-15 (UEFI-15)” ve “sağlık değerlendirme anketi (HAQ)” skorları hesaplandı. Gönüllülerin dominant üst ekstremitelerinden; başparmak interfalanjiyal (IP) ve metakarpofalanjiyal (MKF), diğer parmakların proksimal interfalanjiyal (PIP) ve MKF eklem fleksörlerinden, el bileği ile dirsek fleksör ve ekstansörleri ile omuzun fleksör, ekstansör, iç rotator (IR), dış rotator (ER), abduktör ve addüktör kaslarının maksimum ve ortalama kas güçleri ölçüldü. Hastaların toplam PIP ve MKF (PIPtoplam, MKFtoplam) değerleri elde edildi. Hasta ve kontrol grubu arasında yaş ve boy açısından anlamlı fark görülmemiştir. Kas güçleri açısından; RA grubunda, başparmak IP ve MKF ile PIPtoplam, MKFtoplam ve el bileği fleksiyonunun maksimum ve ortalama değerleri, kontrol grubundan anlamlı düşük tespit edilirken; omuz ekstansiyonu ortalama ve adduksiyon, abduksiyon maksimum ve ortalama kas güçleri RA grubunda düşük tespit edilmiştir. DAS28 ile parmak fleksörleri, el bilek ekstansörleri ve dış rotatorlar haricindeki omuz kasları negatif ilişkiliyken; UEFI-15 skorları ile bilek ekstansör ve omuz kuşağı kasları pozitif ilişkili bulunmuştur. HAQ skorlarının ortalama el bilek fleksiyonu, dirsek ekstansiyonu ve omuz kuşak kasları ile ilişkili olduğu saptanmıştır. El ve el bileği kasları hastalık aktivitesinden en çok etkilenenler olmalarına rağmen dirsek ve omuz kuşağı kaslarının fonksiyonelliği ve engelliliği daha çok etkilediği görülmüştür. Üst ekstremite kaslarının toplam kuvveti, hastalık aktivitesi; fonksiyonellik ve engellilik ile ilişkili bulunmuştur.

Anahtar Kelimeler:

romatoid artrit, kas gücü, DAS28, UEFI-15, HAQ

Which Muscles’ Strength in Upper Extremity are Related to Disease Activity, Functionality, and Disability in Patients with Rheumatoid Arthritis?

The aim of this study is to investigate which muscle groups are affected in dominant upper extremity, and relation of these effects with disease activity, functionality, disability in patients with rheumatoid arthritis (RA) which causes muscle strength loss. 30 RA patients, 30 healthy volunteers were included in this study. In patient group, "disease activity score-28 (DAS28)", "upper extremity functional index-15 (UEFI-15)", "health assessment questionnaire (HAQ)" scores were calculated. From dominant upper extremities of volunteers; maximum and average muscle strengths of thumb interphalangeal (IP), metacarpophalangeal (MCP), proximalinterphalangeal (PIP) and MCP joint flexors of other fingers, wrist and elbow flexors/extensors, flexor, extensor, internal rotator (IR), external rotator (ER), abductor/adductor muscles of shoulder were measured. Total PIP/MCP (PIPtotal, MCPtotal) values of patients were obtained. There was no significant difference between patient and control groups in age/height. In muscle strengths; thumb IP, MCP/PIPtotal, MCPtotal, wrist flexion mean and maximum values were significantly lower in RA group than control group; mean shoulder extension, maximum adduction/abduction, mean muscle strengths were low in RA group. DAS28, finger flexors, wrist extensors, shoulder muscles except ER were negatively related; UEFI-15 scores, wrist extensor, shoulder girdle muscles were positively related. HAQ scores were associated with mean wrist flexion, elbow extension, shoulder girdle muscles. Although hand and wrist muscles are the most affected by disease activity, it has been observed that elbow and shoulder girdle muscles affect functionality and disability more. Total strength of upper extremity muscles has been associated with disease activity, functionality and disability.

Keywords:

rheumatoid arthritis, muscle strenght, DAS28, UEFI-15, HAQ,

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