ABSTRACT
Összefoglaló. Bevezetés: A sarcopenia - idoskori izomero- és izomtömeg-csökkenés - a természetes öregedés része, ha viszont súlyos muködési zavarokat okoz, már betegségnek tekintendo. Ezért a szövodményes, rossz kimenetelek mérsékléséhez minél korábbi felismerése nélkülözhetetlen. Célkituzés: A sarcopenia kockázatának gyors értékelésére a SARC-F szerzoi egyszeru szuro kérdoívet alkottak, amelyet a sarcopeniát meghatározó diagnosztikus ajánlások kiemelten javallanak. E kérdoív magyar változatának jellemzoit vizsgáltuk, annak validálása céljából. Módszer: A kérdoívet 105, 65 éves vagy ennél idosebb személy bevonásával teszteltük. Az izomtömeg, az izomero és a teljesítmény értékelése elott a résztvevok kitöltöttek két generikus, valamint egy betegségspecifikus életminoség-kérdoívet. A megbízhatóság, konvergens, divergens, valamint konstruktumérvényesség vizsgálata mellett az eszköz diagnosztikus alkalmasságát is teszteltük. Statisztikai analízis: A Cronbach-alfa-érték, a Spearman/Pearson-féle korrelációs koefficiensek, a khi-négyzet-teszt, a szenzitivitás, a specificitás meghatározásához, a pozitív és negatív predikciós számításokhoz az SPSS 17.0 programot használtuk. Eredmények: A sarcopenia várható kockázata a SARC-F-teszt szerint (≥4 pont) 36%, míg az európai konszenzusdefiníció alapján sarcopeniásnak minosített esetek elofordulása 40% volt. A sarcopeniás egyéneknek jelentosen magasabb - domének szerinti és összesített - SARC-F-pontjaik voltak. A kérdoívet nagyon jó belso konzisztencia (Cronbach-alfa: 0,755), jó specificitás és magas negatív predikciós értékek jellemezték. Következtetés: A SARC-F magyar változata megbízható eszköznek tekintheto a sarcopenia kockázatának gyors és olcsó elorejelzésére. Orv Hetil. 2020; 161(47): 2000-2005. INTRODUCTION: Sarcopenia is an age-related involution process, causing a significant functional disability, therefore it can be classified as a disease. Early recognition of the disease is essential. Objetive: Authors of the original SARC-F questionnaire developed a simple and rapid screening tool, recommended by the European Working Group on Sarcopenia as the mandatory first step in the diagnostic process of sarcopenia. Our study aimed to test and validate the Hungarian version of this instrument. METHOD: 105 volunteers of 65+ years were recruited and evaluated for sarcopenia (muscle mass, strength and performance). Participants completed the SARC-F, other two generic and one disease-specific quality-of-life questionnaires. We checked the instrument for reliability, validity (discriminative power, construct, convergent and divergent validity) and screening performance. STATISTICAL ANALYSIS: Cronbach's alpha test, the Pearson/Spearman's correlation coefficient, chi-square test, sensitivity, specificity, positive and negative predictive value calculations have been performed. The SPSS 17.0 statistical program was used. RESULTS: The prevalence of sarcopenia according to the SARC-F test (score: ≥4) was 36%, while 40% was diagnosed with the European consensus definition. Sarcopenic individuals had significantly higher SARC-F total and domain scores. Very good internal consistency (Cronbach's alpha 0.755), specificity and negative predictive values were found. CONCLUSION: A reliable, rapid and inexpensive sarcopenia indicator is now available to timely detect the Hungarian-speaking patients at risk of sarcopenia. Orv Hetil. 2020; 161(47): 2000-2005.
Subject(s)
Geriatric Assessment/methods , Mass Screening/methods , Sarcopenia/diagnosis , Surveys and Questionnaires/standards , Aged , Aged, 80 and over , Female , Humans , Hungary , Language , Male , Reproducibility of ResultsABSTRACT
INTRODUCTION: Sarcopenia, or age-related muscle loss, is emerging as a serious public health concern. Due to the impaired physical performance associated with sarcopenia, a reduced quality of life (QoL) has been evidenced in the affected individuals. Generic instruments, such as Rand Corporation Short Form 36 (SF-36) or the European Quality of Life (EuroQoL-5D) questionnaires do not accurately assess the impact of sarcopenia on QoL. SarQoL (Sarcopenia Quality of Life) questionnaire, was the first disease-specific questionnaire addressing the quality of life in patients with sarcopenia and has been recently designed for providing a global assessment of the quality of life in community-dwelling elderly subjects aged 65 years and older. AIM: Our aim was the development of a valid Hungarian version of the original SarQoL, through the translation, cultural adaptation and content validation of the original questionnaire. METHOD: We followed the recommended process, the international protocol of translation in five steps: two initial translations, synthesis of the two translations, backward translation, expert committee to compare translations with the original questionnaire and pretest. The pretest process involved 20 subjects (10 clinically sarcopenic and 10 non-sarcopenic with different educational and socioeconomic backgrounds) who were asked to complete the questionnaire. Feedbacks were requested from all subjects regarding the comprehensibility of questions or difficulties in completing the test. RESULTS: Using the recommended best practice protocol for translation, the pre-final version is comparable with the original instrument in terms of content and accuracy. CONCLUSION: After the content validation with clinically sarcopenic persons it should be a useful tool to assess the quality of life of people with sarcopenia among elderly Hungarian patients. Orv Hetil. 2018; 159(36): 1483-1486.
Subject(s)
Quality of Life/psychology , Sarcopenia/psychology , Surveys and Questionnaires/standards , Aged , Aged, 80 and over , Female , Humans , Hungary , Male , Psychometrics , Reproducibility of Results , TranslationsABSTRACT
65 years old male patient received 4 mg/day methylprednisolone baseline therapy and 50 mg/week etanercept treatment for 5 years due to rheumatoid arthritis. The patient experienced pain in neck, and developed weakness, fever and dysphagia. He had normal blood count but accelerated erythrocyte sedimentation rate (88 mm/hour), elevated CRP (49.3 mg/l) and hyperthyroidism (TSH 0.006 mIU/l, fT4 27.22 pmol/l, fT3 5.61 pmol/l). The autoimmune origin could be excluded because of normal values of antibodies against thyreoidea peroxidase and TSH receptor. The ultrasound investigation showed focal hypoechogenic structure and low vascularisation. Based on the laboratory and ultrasound results as well as clinical signs etanercept related subacute thyroiditis was supposed. As part of the treatment we interrupted the etanercept treatment and gave 16 mg methylprednisolone for 5 days, then 8 mg for 7 days, after that the patient received the daily 4 mg of methylprednisolone as baseline therapy. After rapid improvement the symptoms got worse again so we repeated the administration of methylprednisolone treatment with a higher dose (16 mg/day for 5 days then 8 mg/day for two months). Thyroid functions and the inflammatory markers got normalized. We conclude the necessity of monitoring the thyroid function during etanercept treatment thus avoiding this rare but serious side effect. Orv Hetil. 2017; 158(39): 1550-1554.
Subject(s)
Antirheumatic Agents/adverse effects , Etanercept/adverse effects , Methylprednisolone/administration & dosage , Thyroiditis, Subacute/chemically induced , Aged , Antirheumatic Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Etanercept/administration & dosage , Humans , Male , Thyroid Function Tests , Thyroid Gland/drug effects , Thyroiditis, Subacute/blood , Thyroiditis, Subacute/drug therapy , Thyrotropin/blood , Thyroxine/bloodABSTRACT
In this review the available evidences regarding the most frequently applied medication (peroral and transdermal non-steroidal anti-inflammatory agents) for the most frequent musculoskeletal complaints (regional pain syndromes) have been collected for the appropriate medical professionals who are most frequently faced with these conditions (general practitioners, rheumatologists, orthopedics, occupational and sports medicine experts). The special population at risk (with repeated and high energy overuse because of occupational or sport activities) and the pathology of their syndromes are identified. Mode of action, pharmacological properties of the non-steroidal anti-inflammatory drugs and the unwanted effects of their application especially in infants and elderly are highlighted. Recommendations of the general and specific pain management guidelines have been selected and listed in the review. Orv Hetil. 2017; 158(Suppl. 3): 3-30.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Musculoskeletal Pain/drug therapy , Pain Management/methods , Analgesics, Non-Narcotic/therapeutic use , Humans , Primary Health Care , Rheumatic Diseases/drug therapyABSTRACT
Analysis of the effect of psychosocial factors and co-morbidities on the health status of patients with chronic nonspecific low back pain and patients with surgical intervention because of disk herniation was performed. One hundred and two nonselected consecutive inpatients with chronic nonspecific low back pain were included in the study. Their average age was 56.7 (SD = 10.9) years. The control group consisted of 199 subjects matched according to age and sex, chosen from the database of the national representative health survey Hungarostudy 2006, which involved 4,527 subjects. We measured quality of life including mental health with the SF-36 questionnaire validated for use in Hungary, the short 9-item version of the Beck Depression Inventory, the WHO-Five Well-Being Index, and the Hospital Anxiety-Depression Scale. We characterized the socio-demographic status with variables on age, sex, marital status, and education. Data on symptoms and signs of low back pain, other musculoskeletal diseases, and their treatments including spinal surgery were recorded. Co-morbidity and body mass index were considered as independent indicators of health. Depression as measured by Beck Depression Inventory and severity of depression did not vary significantly according to marital status, education, hypertension, diabetes, and gastrointestinal disease. Only half of the patients (52 %) were in the normal range of the scale; 22 % suffered from mild, 16 % from moderate, and 12 % from severe depression. Average values for anxiety and depression as measured by Hospital Anxiety-Depression Scale and Beck Depression Inventory were both significantly higher in the patient than in the control group (Hospital Anxiety Scale: p = 0.0001; Beck Depression Inventory: p = 0.0001). According to the WHO Well-Being Index-5 scale, the difference between patients and the control group was significant (p = 0.0001). Furthermore, correlation was found between the incidence of depression and surgery. Depression was demonstrated in 47.4 % of those patients who had no surgery, in 50 % of patients who had one round of surgery, and in 62.5 % of those who had undergone surgery more than once; the contingence coefficient was 0.211. According to different measurements, the psychological state of patients with chronic nonspecific low back pain was significantly altered as compared to the matched Hungarian population. Higher anxiety and depression markers occurred in 48 % of the patients. There was no correlation between the depression of patients with low back pain and variables such as marital status, education, and co-morbidities. Our study is the first to demonstrate that depression runs parallel with the number of surgical procedures. Therefore, if there is a relative indication for surgery, depression and severity of depression should be assessed and considered when deciding on the intervention.
Subject(s)
Low Back Pain/psychology , Aged , Anxiety/epidemiology , Body Mass Index , Chronic Disease , Depression/epidemiology , Educational Status , Female , Humans , Male , Middle Aged , Quality of LifeABSTRACT
There have been only scattered reports suggesting that musculoskeletal manifestations including back pain and sacroiliac joint involvement may be associated with celiac disease. In order to confirm this issue in a larger cohort, rheumatic manifestations were analyzed in 21 adult celiac patients using a comprehensive clinical, laboratory and radiological analysis. The diagnosis of celiac disease was based on the histopathology of jejunal biopsy specimens. The mean duration of celiac disease was 15 (0-31) years. All patients were currently on gluten-free diet and none of the patients had gastrointestinal symptoms at the time of the study. Using various imaging techniques, involvement of the sacroiliac joints was confirmed in 70% of celiac patients. Imaging revealed different morphological changes in the sacroiliac joint, e.g. accumulation of synovial fluid, synovitis, erosion with concomitant sclerosis, sacroiliitis or calcification of the ligament. These changes probably represent different clinical stages and/or manifestations of the same process. In a follow-up study of eight patients, after 11 years on a gluten-free diet, the great majority of patients had no clinical symptoms; yet, a subclinical progression of the sacroiliac joint involvement could be verified. Our results suggest the importance of regular rheumatologic follow-up of patients with celiac disease.
Subject(s)
Arthritis/pathology , Back Pain/pathology , Celiac Disease/pathology , Sacroiliac Joint/pathology , Adult , Aged , Arthritis/epidemiology , Arthritis/physiopathology , Back Pain/epidemiology , Back Pain/physiopathology , Celiac Disease/epidemiology , Celiac Disease/physiopathology , Comorbidity , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Hungary/epidemiology , Male , Middle Aged , Sacroiliac Joint/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The objectives of this study were to assess the costs of psoriatic arthritis (PsA) in Hungary and to identify key cost drivers among demographic and clinical variables and to compare cost-of-illness of PsA and rheumatoid arthritis (RA). Cross-sectional retrospective survey of 183 consecutive patients from eight rheumatology centres was conducted. Mean direct medical, direct non medical, indirect and total costs were 1,876, 794, 2,904 and 5,574 euros/patient/year, respectively. Total costs were in significant linear relationship with health assessment questionnaire score and psoriatic area severity index. Costs of RA were higher in all domains than of PsA. Our study was the first from the Eastern European region that provides cost-of-illness data on PsA. Our study revealed that functional status and severity of skin symptoms were the key cost drivers. The costs of PsA in Hungary were lower than in the high-income European countries.
Subject(s)
Arthritis, Psoriatic/economics , Arthritis, Rheumatoid/economics , Aged , Cost of Illness , Cross-Sectional Studies , Disability Evaluation , Female , Health Care Costs/statistics & numerical data , Humans , Hungary/epidemiology , Male , Middle Aged , Quality of Life , Retrospective Studies , Severity of Illness IndexABSTRACT
INTRODUCTION: Biologic treatments are newly used in rheumatoid arthritis. Three tumornecrosis factor alfa (TNF-alpha) inhibitors--adalimumab, etanercept and infliximab--have been licensed for rheumatoid arthritis in Hungary. B-cell targeted treatment with rituximab is the next biologic treatment. Rituximab was used earlier for the treatment of non-Hodgkin's lymphoma. Rituximab was registered to be used in patients with rheumatoid arthritis who have had an inadequate response or an intolerance to one or more TNF-alpha blocking agents. AIM: Systematic review in the literature of efficacy of rituximab in rheumatoid arthritis. To assess the efficacy and safety of rituximab treatment in patients with rheumatoid arthritis. METHODS: MEDLINE and Cochrane database were searched for randomized controlled trials with rituximab in rheumatoid arthritis. A meta-analysis of trial data was conducted. RESULTS: Three randomized controlled trials were identified including 1145 patients. 54% of patients with inadequate response to TNF-alfa inhibitors and severe disease-activity have reached American College of Rheumatology 20 criteria. This ratio is larger with 33% (95% CI, 25-41%) than without treatment, and patients have almost five times (relative risk = 4.77 95% CI, 3.12-7.31) chance to improve. Functional status represented by Health Assessment Questionnaire score improves significantly (p < 0.001) in rituximab arms (-0.4 scores) compared with placebo arms (-0.1 scores). EULAR moderate and good responses in the rituximab group were significant (p < 0.00001) compared with the placebo group, rate difference is 38% (95% CI, 32-44%). Rituximab improves also radiological symptoms of rheumatoid arthritis. CONCLUSIONS: New therapeutic options, rituximab is efficacious in patients with rheumatoid arthritis. Rituximab can improve symptoms of patients with inadequate response to or intolerance of TNF-alpha inhibitors.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Adalimumab , Antibodies, Monoclonal, Humanized , Antibodies, Monoclonal, Murine-Derived , Drug Approval , Etanercept , Health Status , Humans , Hungary , Immunoglobulin G/therapeutic use , Infliximab , Receptors, Tumor Necrosis Factor/therapeutic use , Rituximab , Surveys and Questionnaires , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
OBJECTIVE: We describe a unique family where each of the 5 siblings in the second generation has rheumatoid arthritis (RA). Two other members of the family have RA and systemic lupus erythematosus (SLE), respectively. No members of previous generations in the family had documented inflammatory arthritis. Due to the suspected genetic predisposition, HLA-DR genotypes were determined in the affected siblings and their parents, children, and grandchildren. We investigated the possible role of various HLA-DR alleles in the evolution of RA in this multicase family. METHODS: HLA-DRB1* alleles were determined by polymerase chain reaction using the sequence-specific primer-Olerup method. RESULTS: The most common alleles in the 6 persons with RA were HLA-DRB1*07 and DRB1*15, which are known to be protective and neutral in RA. No patient or family member carried any HLA-DR4 alleles. CONCLUSION: HLA-DRB1*07 and DRB1*15 alleles are thought to be protective or neutral in RA. However, the majority of RA patients in the family and nearly half of all family members carried these alleles, suggesting a role of these genotypes in susceptibility to RA. No RA patient in this family carried HLA-DR4 alleles. Thus, in our rare family with 6 RA cases, an unexpected genetic background may be involved in the increased susceptibility to inflammatory arthritis.
