Is the Arthritis Impact Measurement Scales 2 a good tool to assess quality of life in Slovak patients with rheumatoid arthritis?

OBJECTIVES: The aim of this study is to evaluate the measurement properties of the Arthritis Impact Measurement Scales 2 (AIMS2) in Slovak patients with rheumatoid arthritis (RA). BACKGROUND: RA impacts all aspects of life quality (QoL). Many instruments for QoL in RA patients frequently assess only biological aspects. The AIMS2 instrument covers physical, emotional and social QoL and it is widely and successfully used as an indicator of the outcomes of care for arthritis patients, but not in Slovak RA patients. METHODS: After translation 178 patients with RA were asked to complete the AIMS2, Visual Analogue Scale for pain - VAS, Health Assessment Questionnaire Disability Index - HAQ-DI, Beck Anxiety Inventory - BAI and Zung Self-Rating Depression Scale - SDS to analyse the validity of the Slovak-AIMS2. Pearson correlations, one-way analysis of variance (ANOVA), t-test, and principal component analysis were used to test validity of AIMS2. The reliability was assessed by internal consistency, as estimated by Cronbach's alpha coefficients, and using the test-retest procedure. RESULTS: The Cronbach's alpha coefficients for AIMS2 scales ranged from 0.78 to 0.94, the test-retest reliability was significant (p<0.05), ranging from 0.61 to 0.99. The correlations between most of the Slovak-AIMS2 scales and HAQ-DI, VAS, BAI and SDS were statistically significant (p<0.05). The principal component analysis identified three factor models explaining 66.82 % of the variance. CONCLUSIONS: The results showed that Slovak-AIMS2 is culturally appropriate, valid and reliable for measuring the health status in adult RA patients (Tab. 6, Ref. 20).

[Evaluating of quality of life and functional status in patients with rheumatoid arthritis]. / Hodnotenie kvality zivota a funkcného stavu u pacientov s reumatoidnou artritídou.

There is a growing worldwide interest for more information regarding morbidity and especially chronic diseases as well as the economical burden which it creates for the disabled individual and the society as a whole. Recently, increased attention has been paid to the scientific assessment of quality of life in chronically ill. Measures of physical and other abilities have shown a great prognostic value regarding disease outcomes. Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory disease which negatively influences quality of life of patients. In rheumatology quality of life is assessed with two types of instruments: generic and specific. Current research has shown that specific measures are more sensitive to treatment induced changes in comparison with the generic measures. However, the choice of an instrument largely depends on the specific goal of the study. Both types of measures have shown strengths and weaknesses and they have been used simultaneously in order to provide a complex evaluation of quality of life.

Autoimmune thyroid disease and autoimmune rheumatic disorders: a two-sided analysis.

UNLABELLED: Chronic autoimmune thyroiditis (ATD) frequently overlaps with autoimmune rheumatic diseases. The aim of this study was to evaluate the prevalence of various non-organ-specific autoantibodies in patients with ATD, as well as the presence of ATD in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). SUBJECTS AND METHODS: Group 1 comprised 80 patients with ATD, and group 2 contained 80 patients with SLE or RA. A control group consisted of 34 healthy subjects. Group 1 was examined for the presence of non-organ-specific autoantibodies. Serum fT3, fT4, TSH, and antibodies against thyroglobulin, thyroperoxidase, as well as ultrasound of thyroid gland, were determined in group 2. RESULTS: Patients with ATD had a significantly higher prevalence of antinuclear antibodies (ANA) than control subjects (45% vs. 14.7%, P < 0.001). There were no significant differences in the prevalence of other antibodies between the groups. ANA-positive patients were younger than ANA-negative ones and had significantly higher anti-TG values (P < 0.05). The prevalence of ATD in group 2 was significantly higher than in the control subjects (24% vs. 8%, P < 0.05). No significant differences in the prevalence of ATD were detected between SLE and RA. CONCLUSION: The authors conclude that ANA is the most frequent non-organ-specific antibody associated with ATD, while the other antibodies occur rarely. The prevalence of ATD in SLE and RA patients was 24%. These results indicate that it is clinically important to screen patients with SLE and RA for the coexistence of thyroid autoimmune disease.

Successful therapy with intravenous immunoglobulin in the management of polymyositis.

Polymyositis is an inflammation of muscle tissue of unknown etiology. It is characterized by symmetric, mainly proximal muscle weakness, muscle fiber damage proved on biopsy, increased enzymes and myoglobin, and has corresponding electromyography findings. Other systems such as joints, lungs, heart, and gastrointestinal system are involved. Lung involvement is rather common. The most frequent symptom represents shortness of breath caused by muscle weakness. We report a case of a 66 year old woman with primary idiopathic polymyositis. The clinical state of the patient was complicated by progressive muscle weakness, dysphagia, and respiratory failure. Due to the ineffectiveness of the treatment with corticsteroids and cyclophosphamide, treatment with high doses of immunoglobulins was started. A total of 100 g of i.v. immunoglobulin therapy was administered beginning on the 13th day after hospital admission. The state of the patient progressively improved and after 7 weeks of treatment in a significantly improved state the patient was transferred to a Rehabilitation Unit. We therefore conclude that IVIg therapy may be an effective therapeutic approach for the treatment of acute complications of polymyositis, especially in cases in whom other therapeutic strategies are ineffective or harmful (Ref. 10). Full Text (Free, PDF) www.bmj.sk.

[Prolactin--a marker of the activity of connective tissue systemic disease?]. / Prolaktin--marker aktivity systémových ochorení spojiva?

The ethiopathogenesis of auto-immune diseases has not yet been fully explored. Auto-immune diseases develop in individuals with a genetic pre-disposition. Among the endogenous factors, also sexual hormones play a role, especially prolactin. The objective of the study was to use basal exam and TRH test to determine stimulated prolactin values in patients with a systemic connective tissue disease: systemic lupus erythematosus (SLE), systemic sclerosis, Sjögren's syndrome, dermatomyositis. PATIENT GROUP AND METHODS: The authors examined 43 patients with systemic connective tissue diseases: 20 patients with SLE, 7 patients with Sjögren's syndrome, 7 patients with systemic sclerosis and 9 patients with dermatomyositis. The mean age of the patients was 39.87 years. The control group consisted of 30 volunteers with a mean age of 35.17 years. OUTCOME: Prolactin level in the patients with systemic connective tissue diseases was 14.629 ng/ml, which is more than in the control group. A statistically significant increase in prolactin level was recorded 20 minutes after i.v. stimulation as compared with the control group (30.982 ng/ml). This statistically significant difference was still present 60 minutes after the TRH administration, with 16.43 ng/ml in the control group, and 36.890 ng/ml in the systemic connective tissue disorder patient group. The differences between prolactin levels for the different systemic connective tissue diseases were not statistically significant. A positive correlation in the patient group was found between the stimulated prolactin values and the FW value. On the whole, however, there was no clear correlation found between laboratory activity and prolactin levels. CONCLUSION: The authors found out that post-stimulation prolactin levels were statistically significantly higher in patients with systemic connective tissue disease as compared with the control group. Correlation analyses did not show a clear link between inflammatory activity and prolactin levels, and therefore the authors assume that medium increased values of prolactin are rather a risk factor for the disease than an inflammation marker in patients with a systemic connective tissue disease.

Efficacy of intravenous immunoglobulin treatment in lupus erythematosus chorea.

Chorea is a rare complication of systemic lupus erythematosus (SLE) and is strongly related to the presence of antiphospholipid antibodies. Various infections may also be triggering factors in the development of choreiform movements. Additionally, Salmonella infection is the most common opportunistic bacterial infection in SLE patients. We report a case of a 33-year-old woman with SLE who developed lupus erythematosus-associated chorea with multiple involuntary movements and cognitive disturbances. Because the methylprednisolone therapy administered appeared to lead to Salmonella enteritidis infection, intravenous immunoglobulin (IVIg) in a total dose 100 g was administered after which a remarkable improvement of the abnormal movements and cognitive function was noted. Within 7 days, the patient had returned to normal. We therefore conclude that IVIg therapy may be an effective therapeutic approach for the treatment of the acute cerebral complications of SLE, especially in cases in whom other therapeutic strategies are ineffective or harmful.

Severe limb necrosis: primary thrombotic microangiopathy or "seronegative" catastrophic antiphospholipid syndrome? A diagnostic dilemma.

An episode of gastroenteritis triggered severe necrosis of all extremities in a previously asymptomatic male. Hepatic and renal involvement were also manifest, while the hematological picture was one of thrombotic microangiopathic hemolytic anemia. Antiphospholipid antibodies were negative. He responded well to a combination of plasma exchange, anticoagulation (heparin), parenteral steroids, and antibiotics, as well as vasodilators (prostacycline) and hyperbaric oxygen, but died because of a cerebral hemorrhage. The differential diagnosis included thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome, or seronegative catastrophic antiphospholipid (Asherson's) syndrome. The dangers of administering such a combination of therapies with anticoagulation, as well as vasodilatation (prostacycline) and hyperbaric oxygen, are highlighted by the case report and emphasized.

[Chronic autoimmune thyroiditis and connective tissue system diseases]. / Chronická autoimunitná tyreolditída a systémové ochorenia spojiva.

Autoimmune thyroiditis is often related to non-specific autoimmune organ diseases such as Rheumatoid Arthritis, Sjögren's syndrome, systemic sclerosis, Systemic Lupus Erythematosus or polymyalgia rheumatica. Etiology of autoimmune diseases has not been clearly discovered yet. In many aspects, mechanisms leading to organ-specific autoimmune diseases are identic with mechanisms causing organ-nonspecific autoimmune disease. In many cases genetic disposal combined with specific antigens can be seen. Another possible factor in terms of endogenesis is genus. External factors are important too, such as undergoing infection, stress situations, exposion to ultraviolet radiation. Authors of this work summarize facts about chronic autoimmune thyroiditis and system connective tissue disease. The most literature supports more frequent appearance of these diseases, while the thyroiditis can appear both in clinical form with typical symptoms and in subclinical form.

[Reliability and validition of the Slovak modified version of the Stanford Health Assessment Questionnaire using the functional disability index in patients with rheumatoid arthritis]. / Reliabilita a validita slovenskej verzie a modifikácia Stanfordského dotazníka hodnotiaceho zdravie pomocou indexu disability (HAQ) u pacientov s reumatoidnou artritídou.

BACKGROUND: Functional disability is one of the most important consequences of RA in the patient's daily life. The HAQ has been widely used in its self administered form for the assessment of disability. A sensitive and valid instrument is needed for a Slovak population with RA. OBJECTIVE: To evaluate reliability and validity of the Slovak version of the HAQ in patients with RA and to explore relationships between HAQ score and disease activity and to provide information concerning utilization of this instrument in clinical practice. METHODS: In preparing the Slovak version of the HAQ careful attention has been paid to the translation, in terms of linguistic and conceptual equivalence, in order to preserve the original purpose of the instrument. The wording of some items required adaptation to the current activities of daily living and Slovak lifestyle. The sample consisted of 160 RA-patients, out of which 135 were women and 25 were men. The inclusion criteria were the following: age from 20 to 70 years at the onset of the study, diagnosis of RA according to the ARA criteria. The exclusion criteria were the presence of another serious disease or very disabling RA (stage IV of the Steinbrocker's classification). To analyze the data t-test, correlations, one-way analysis of variance (ANOVA), and principal component analysis (PCA) available in the SPSS/PC+ statistical package were used. RESULTS: The Cronbach's coefficient of reliability alpha for the HAQ total scale was 0.94. The results of PCA showed that the 20 HAQ items loaded on four components for which the eigen values were greater than 1, accounting for 70% of overall interpersonal variability. Orthogonal varimax rotation of the principal components provided factor loadings reflecting the eight dimensions within the HAQ. Validity of the HAQ was examined further by means of known-groups technique. The HAQ was found to be sensitive to differentiate between the Steinbrocker's functional capacity groups, as well as between males and females. Moreover, significant correlations (p < or = 0.01) were found between the HAQ and the C-reactive protein, the ESR, the NHP-pain, the Ritchie articular index, the Steinbrocker's functional capacity (r = 0.31-0.62) and disease duration (p < or = 0.05, r = 0.17). CONCLUSION: The results of the current investigation provide support for reliability and construct validity of the Slovak version of the HAQ in patients with RA. The HAQ has sufficient discriminant ability. The index disability can be used as an criterion of severity of RA, as a criterion of effectiveness in therapeutical trials for patient stratification of the Slovak population with RA.

[Pain and rheumatoid arthritis]. / Bolest a reumatoidná artritída.

OBJECTIVE: Chronic pain is an important part of the clinical picture in patients with RA and therefore the authors attempted to assess the relationship of pain of patients with RA to the inflammatory process, articular damage and to predict the variance of pain in relation to psychosocial, demographic factors and functional disability. METHOD: Pain was examined using the Nottingham Health Profile (NHP), psychological health by means of the General Health Questionnaire (GHQ) and disability was assessed by the Health Assessment Questionnaire (HAQ). RESULTS: The authors examined 160 patients with RA with a mean age of 48.34 +/- 12.13 years and persistence of the disease for 21.32 +/- 15.61 months. Pain was significantly related to clinical manifestations of inflammation and articular damage. The relationship between pain and laboratory manifestations of inflammation (CRP, FW) was not very close. The relationship between age and pain and between persistence of the disease and pain was not statistically significant. Pain correlated significantly with functional disability (HAQ) (r = -0.54) and the articular index (RAI) (r = 0.58). Pain did not correlate with manifestations of depression (r = -0.15), but correlated significantly with anxiety (r = -0.35) and social dysfunction (r = -0.36). Among the investigated parameters (demographic factors, GHQ and HAQ) the most marked variation of pain was caused by HAQ (32%), GHQ (8%). Almost unrelated were demographic parameters (0.6%) (age, persistence of disease, education lifestyle, and gender).

[The Groningen Activity Restriction Scale (GARS) in the evaluation of severity of rheumatoid arthritis]. / Groningenská mierka obmedzenia cinností (GARS) pri posúdení závaznosti reumatoidnej artritídy.

BACKGROUND: The functional ability of the patient in chronic diseases reflects the severity of the pathological process and the success of treatment. OBJECTIVE: Evaluation of the functional ability of patients with RA and assessment of the influence of the pathological process on the performance of simple everyday tasks. METHODS: Physical capacity and functional ability were examined using the Groningen activity restriction scale (GARS) and Health Assessment Quesionnaire (HAQ). RESULTS: The authors examined 160 patients with RA (135 women and 25 men), mean age 48.3 +/- 12.13 years and a duration of the disease of 21.32 +/- 15.61 months. The mean value of the functional ability according to GARS was 32.67 +/- 11.61. Women had a poorer score (33.36 +/- 11.91) than men (28.96 +/- 9.44), the difference was however not statistically significant. The mean value of functional ability according to HAQ/FDI of the patients was 1.079 +/- 0.65. Women had a poorer score (1.156 +/- 0.625) than men (0.722 +/- 0.936), the difference being significant (P < 0.01). The authors found a significant correlation (P < 0.001) between HAQ and GARS as well as a significant relationship with parameters assessing the inflammatory activity. In GARS a relationship with the duration of the disease was found (P < 0.05), but not with HAQ. There was no significant relationship between GARS or HAQ with the patients age. In investigations of the restriction of functional ability during common everyday activities it was revealed that the greatest problem of patients is care of feet and nails, climbing stairs and personal hygiene. As to household activities the highest score was recorded for "strenuous house work" (scrubbing floors, cleaning windows and vacuum cleaning), shopping ironing and bedmaking. CONCLUSION: GARS is a reliable practical and simple scale of functional ability of patients with RA which can be used for the accurate description of the severity and for evaluation of the degree of functional ability.