Quality of Marital Life in Korean Patients with Fibromyalgia / 대한류마티스학회지

OBJECTIVE: Fibromylagia (FM) is a rheumatic disorder characterized by widespread bodily pain, tenderness, and fatigue. It has a major impact on the quality of life including the quality of marital life. The objectives of this study were to assess the quality of marital life in patients with FM in Korea and to identify the correlation of the quality of marital life with disease severity. MEHTODS: Subjects were the patient group, composed of 50 married patients with FM, and a comparison group composed of 50 healthy married adults with similar demographic characteristics. The quality of marital life was measured using the Korean-Marital Satisfaction Inventory (K-MSI). The K-MSI consists of two valid scales, one global affective scale, and eleven additional scales measuring specific dimensions of relationship distress. The clinical parameters were assessed by Korean Fibromyalgia Impact Questionnaire (KFIQ) and tender point, respectively from 50 patients with FM. RESULTS: Of the 50 subjects, 48 (96%) were women with mean (+/-SD) age of 52.6(+/-8.8) years. The mean (+/-SD) duration of disease was 25.7 (+/-19.8) months. The mean (+/-SD) scores of KFIQ and tender point count were 52.9 (+/-14.9) and 13.1 (+/-1.6), respectively. The T-score of most scales of K-MSI of FM patients were higher than that of healthy controls (p<0.01). The scores of KFIQ were positively correlated with the eight scales of K-MSI and negatively correlated with one scale (Role orientation) of K-MSI. The tender point count was positively correlated with only one of scale (Conflict with in-law) of K-MSI. CONCLUSION: The results suggest that the quality of marital life in Korean patients of FM is lower than healthy subjects. In a simple correlation analysis, KFIQ was a meaningful variable correlated with the quality of marital life.

Association of Polymorphism in Glutathione S-transferase Gene with Susceptibility and Severity of Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: We examined the genetic polymorphisms of glutathione S-transferase M1 (GSTM1), T1 (GSTT1), and P1 (GSTP1) in Korean patients with rheumatoid arthritis (RA) and studied to determine whether GSTs influence susceptibility or outcome in RA. METHODS: RA patients with disease duration above 2 years (n=267) and healthy control (n=400) were enrolled. Genetic polymorphism were determined using polymerase chain reaction-based assays. We assumed stage I (Steinbroker's radiologic stage by the ACR criteria) regarded as mild RA and stage II, III, IV as severe RA. Data were analysed using multiple regression analysis with correction for age, sex, disease duration, and rheumatoid factor positivity. RESULTS: The frequency of GSTM1 null genotype in Korean RA patients was significantly higher than that of control (61.7% vs 53.5%, p=0.04). No significant differences in the frequency of the GSTT1 null genotype and GSTP1 genotypes between RA patients and normal controls were identified. The GSTM1 null genotype significantly influence the disease progression and bony erosive change in severe RA groups (p=0.03) compared with in mild RA groups. CONCLUSION: The GSTM1 null genotype increases the risk of rheumatoid arthritis in Korean patients. More severe erosive damage was associated with GSTM1 null genotype. Our study suggests that GSTM1 null genotype may be an independent marker for development of more erosive disease in RA.

Health-Related Quality of Life in Korean Patients with Rheumatic Diseases / 대한류마티스학회지

OBJECTIVE: The rheumatic disease is a chronic disease, which can result in a functional disability and impaired health-related quality of life (HRQOL). Recently, the concerns about the HRQOL have been increasing especially in chronic diseases, but there has been no report with Korean patients with rheumatic disease. The objective of this study is to assess HRQOL and the correlation among each measurement and to identify the predictors for HRQOL in Korean patients with rheumatic disease. METHODS: A cross-sectional study with 100 patients with rheumatoid arthritis (RA), 103 patients with osteoarthritis (OA), 111 patients with systemic lupus erythematosus (SLE), 104 patients with fibromyalgia (FM), 90 patients with ankylosing spondylitis (AS), and 228 healthy persons as control was done. We measured the HRQOL (with 36 item Short Form Health Survey (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG) method), the disease specific health state (with Korean Health Assessment Questionnaire (KHAQ) for RA, Korean Western Ontario and McMaster Universities (KWOMAC) for OA, SLE Disease Activity Index (SLEDAI) & Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) for SLE, Korean Fibromyalgia Impact Questionnaire (KFIQ) for FM, Korean Bath Ankylosing Spondylitis Functional Index (KBASFI) for AS), the psychosocial factors (with Centers for Epidemiologic Studies-Depression (CES-D), social support, social network, self-efficacy scale), and clinical features. We compared the means of each group by Student's t-test and ANOVA test, analyzed the correlation among HRQOL and other variables with Pearson and/or Spearman coefficient, and performed the multiple regression analysis with SF-36 as a dependent variable. RESULTS: There were significant differences in sociodemographic and clinical features among groups. Therefore these differences were compensated later in multiple regression analysis. The HRQOL of disease group was significantly lower than that of healthy control. Among disease groups, the SF-36 global score was highest in SLE and lowest in FM. The SF-36 physical component summary was highest in SLE and lowest in OA and FM. The SF-36 mental component summary was lowest in FM. The EQ-5D utility was highest in SLE and lowest in OA, RA, and FM. The EQ-5D visual analog scale was highest in SLE and lowest in OA, AS, and FM. The CES-D was highest in FM and the self-efficacy scale was lowest in FM. The social support and social network was highest in SLE and lowest in OA and FM. In correlation analysis, the SF-36 and EQ-5D were well correlated with each other, but SG and TTO were not. In general, the disease specific health state (except SLEDAI & SDI), CES-D, and self-efficacy scale were well correlated with SF-36 & EQ-5D. In multivariate models, in a point of view of 5 diseases as a whole, the statistically significant variables of SF-36 global were age, income, the disease specific health state, and self-efficacy scale. The statistically significant variables of SF-36 PCS were age, income, the disease specific health state, and self-efficacy scale, and the statistically significant variables of SF-36 MCS were age, the disease specific health state, social support, and self-efficacy scale. The disease type itself was a statistically significant variable with all SF-36 scores in multiple regression analysis. CONCLUSION: These results suggest that HRQOL in Korean patients with rheumatic disease is significantly lower than healthy control and there is a difference in HRQOL among disease types. Among variables, age, disease type, the disease specific health state, CES-D, self-efficacy were most constant meaningful variables correlated with HRQOL. Therefore, the efforts to improve HRQOL for Korean patients with rheumatic disease should be designed to improve the self-efficacy and to alleviate the depression in addition to conventional treatment. In addition, to define the more definite feature of HRQOL in Korean patients with rheumatic disease, the study with more and larger epidemiological controlled disease group and detailed variable adjustment should be done.

Health-Related Quality of Life in Korean Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To assess the health-related quality of life (HRQOL) of systemic lupus erythematosus (SLE) patient, to compare the HRQOL of SLE patients with that of healthy controls, and to identify the predicting variables on physical and mental health in Korean patients with SLE. METHODS: In this cross sectional study, the HRQOL and clinical and laboratory parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG), Centers for Epidemiologic StudiesDepression (CES-D), self-efficacy scale, social support, social network, SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI), respectively, from 111 outpatients with SLE. And the data of the SF-36 and EQ-5D in SLE patients were compared with those in 228 healthy controls. RESULTS: 106 (95.5%) were women and 5 (4.5%) were men, with a mean (+/-SD) age of 33.2 years (+/-9.9) and mean disease duration of 7.19 years (+/-4.59). The mean scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 62.2 (+/-20.4), 67.5 (+/-24.6), and 65.7 (+/-24.8), respectively. The mean EQ-5D utility and visual analogue scale (VAS) score were 0.73 (+/-0.20) and 67.5 (+/-17.9). The mean scores of the TTO and SG were 0.60 (+/-0.55) and 0.59 (+/-0.45). The scores on the SF-36 global, EQ-5D utility and EQ-5D VAS in healthy controls were 77.5 (+/-13.1), 0.73 (+/-0.20) and 67.5 (+/-17.9), respectively. The mean scores of CES-D, self-efficacy scale, social support, and social network were 9.09 (+/-6.82), 66.5 (+/-17.4), 2.53 (+/-0.17) and 2.29 (+/-0.46), respectively. The mean SLEDAI and the mean SDI were 5.87 (+/-4.32) and 0.73 (+/-1.02). The SDI was negatively correlated with the scores of SF-36 global, PCS, and EQ-5D VAS (r=-0.30, p<0.001; r=-0.34, p<0.001; r=-0.28, p<0.003), and positively correlated with the CES-D (r=0.19, p<0.04). In multivariate models, the predicting variables on SF-36 global and 6 MCS was self-efficacy, and the predicting variables on SF-36 PCS were SLEDAI and self-efficacy. CONCLUSION: In this study, we observed that HRQOL in Korean patients with SLE was lower than those in healthy control. The SF-36 and the EQ-5D were valid measurements to assess HRQOL in patients with SLE. In multivariate model, self-efficacy and SLEDAI were only meaningful variables correlated with HRQOL among variables. Therefore, to improve the HRQOL in Korean patients with SLE, we should focus on a program to improve self-efficacy.

Nutritional Status in Korean Patients with Arthritis / 대한류마티스학회지

OBJECTIVE: Based on the data of National Health and Nutrition Survey (NHNS),which was conducted by Ministry of Health and Welfare in 1998,we analyzed nutritional status among arthritis patients in Korea. METHODS: Nutrition survey was performed through interview which was subdivided to food intake survey,frequency of food intake survey,and dietary habits survey.Nutrient intake was calculated from the recall of food ingested in previous 1-day.Overall,1,025 patients with arthritis and 2,773 normal controls recorded a detailed dietary history.Information collected was analyzed for intake of energy,fats,protein,carbohydrate,vitamins and minerals,which was then statistically compared between the arthritis patients and the control group. RESULTS:In patients with arthritis,body mass index (BMI)was significantly greater than in control in both men and women.Patients with arthritis ingested significantly less energy from fat and more energy from carbohydrates.They ingested less dietary intakes of the following nutrients:protein,fat,carbohydrates,calcium,iron,vitamin A,B1,B2,and niacin. Especially,the intake of calcium and vitamin B2 were only about 60%of the Reference Daily Intake (RDI).Deficiency of calcium intake was predominantly revealed in all age groups,even in normal controls.Female patients with arthritis seemed to take less dietary intake than male. CONCLUSION:Using these national data,we showed that the deficiency of calcium intake was revealed in our population,and female patient with arthritis had a tendency to ingest less nutrient intake.