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THE QUALITY OF LIFE STATUS OF PATIENTS WITH

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THE QUALITY OF LIFE STATUS OF PATIENTS WITH Powered By Docstoc
					                             DlcLE TIP DERGiSI (JOURNAL OF MEDIcAL SCHOOL) C:27 S:1                            2000


       THE QUALITY OF LIFE STATUS OF PATIENTS WITH RHEUMATOID
                                         ARTHRITIS AND OSTEOARTHRITIS


                        Yrd.Do~.Dr. AIi GDR 1                        Yrd.Do~.Dr. Kemal NAS 2
                 Yrd.Do~.Dr. Remzi c;EviK 3                              Prof.Dr. FERDA ERDOGAN4
                                                         Dr. AliZ DENLi 5


            ABSTRACT
        In chronic rheumatic diseases, traditional epidemiological measures of
  disease outcome reflect only the physical dimension of the disease and neglect
  the mental and social aspects. In recent years, there has been a great interest
  in quality of life measures that reflect physical, mental and social, dimensions
  together.
          This study was designed to assess and compare quality of life status of
. patients with rheumatoid arthritis and osteoarthritis. For this purpose, Arthritis
. Impact Measurement Scales health Status Questionnaire (AIMS) was evaluated
  in 139 subjects: 59 with rheumatoid arthritis and 80 with osteoarthritis. Quality
  of life was assessed using the 9 different subscales of AIMS.
         The mean age of patients with rheumatoid arthritis was 48.8 413,88
  years (range 36-63), while the mean age of patients with osteoarthritis was
  52.20 7.03 years (range 39-68). Patients with rheumatoid arthritis had
  significantly higher impact scores in all subscales (P<0.001) except anxiety.
  There was no significant difference between rheumatoid arthritis and
  osteoarthritis as to anxiety (P>0.05).
       The results point out that among these two patient groups, those with
  rheumatoid arthritis suffer greater impact on the quality of life.
             Key Words: Rheumatoid arthritis, Osteoarthritis, Quality of life, AIMS
             INTRODUCTION
         In chronic rheumatic diseases, such as rheumatoid arthritis (RA and
  osteoarthritis (OA), traditional epidemiological measures of disease outcome
  reflect only the physical dimension of the disease and neglect the mental and
  social aspects. In recent years, there has been a great interest in quality of life
  measures that reflect physical, mental and social, dimensions together.
        The use of questionnaire measures of health status has become an
  important approach to assessing outcome in the rheumatic diseases (1-3).
  There are a number of conceptual and practical advantages in using these
  questionnaires as arthritis outcome measures (4). The major practical
  advantage of health status questionnaires is their relatively low cost. Since they

   (1.2,3.4,5)    Physical    Medicine    and Rehabilitation.   School   of Medicine.   Dicle University,   Diyarbakyr,   TURKEY.
     42

    are usually self-administered, they can provide information in both clinical
    research and clinical practice settings, with a minimal investment of professional
    time. The Arthritis Impact Measurement Scales (AIMS) was one of the first
    questionnaires specifically designed for the purpose of assessing health status
    in subjects with rheumatic diseases (3,5). Its measurement properties are good
    and it has come to be widely accepted in the many countries for a variety of
    uses (5-7).The original AIMS questionnaire contained 45 items grouped into 9
    scales.
              OBJECTIVE

          This study was designed to assess and compare quality of life status of
    patients with rheumatoid arthritis and osteoarthritis.
           MATERIALS AND METHODS

          Arthritis Impact Measurement Scales health Status Questionnaire (AIMS)
    was evaluated in 139 subjects; 59 with rheumatoid arthritis and 80 with
    osteoarthritis. Quality of life was assessed using the 9 different subscales of
    AIMS. The AIMS contain 45 items which form 9 component scales, each related
.   to 1 of 4 dimensions as follows: (a) Physical Disability dimension - Mobility
    scale, Physical Activity scale, Dexterity scale, Activities of Daily Living scale,
    and Household Activities scale; (b) Pain dimension- Pain scale; (c)
    Psychological Disability dimension - Anxiety scale and Depression scale; (d) 1
    other separate scale, the social Activity scale. The score for each component
    scale was obtained by summing the item scores and then indexing this sum to a
    range of scores from 0- 10 for each scale (8). Each participant's sex, age, and
    disease duration were recorded, together with the nature of any health
    problems other than rheumatoid arthritis and osteoarthritis.
            Statistical analysis: Differences between the patients with rheumatoid
    arthritis and osteoarthritis of all assessed variables were examined by using
    the student's t test.
                  RESULTS
              Table1: AIMS scale scores in rheumatoid arthritis and osteoarthritis
    subi -   --     - -   -

        VARIABLES                    OSTEO              RHEUMATOYD             P
        (AIMS Scale)                ARTHRITIS (n=80)   ARTHRITis (n=59)
        Mobility level               0.52 1.03          1.52 1.47            <0.0001
        Physical activity           2.16 1.89          3.48 1.67             <0.0001
        Dexterity                    0.65 0.93         2.96 1.83            <0.0001
        Househould tasks            0.76 0.95          2.35 1.66            <0.0001
        Social activities           0.79   1.18        1.58   1.63           <0.001
       Activities of daily living   0.59   1.01        1.17   1.32            >0.01
       Pain dimension               2.55   1.27        3.28   1.16           <0.001
        Depression                  2.48   1.83        3.21   2.09           >0.05
       Anxiety                      3.02 2.07          3.38 2.17             >0.05
                                                                              43

       The mean age of patients with rheumatoid arthritis was 48.8413,88 years
(range 36-63),while the mean age of patients with osteoarthritis was 52.20 7.03
years (range 39-68) Patients with rheumatoid arthritis had significantly higher
impact scores in all subscales (P<0.001) except anxiety. There was no
significant difference between rheumatoid arthritis and osteoarthritis as to
anxiety levels (P>0.05). The means of the AIMS scale scores for subjects in the
performance test sample, grouped by diagnosis of rheumatoid arthritis or
osteoarthritis, are presented in Table-1. Mean scores ranged from a good
health status score of 0.52 on Mobility level and in sUbjects with osteoarthritis
to a poorer health status score of 3.38 on anxiety levels in subjects with
rheumatoid arthritis. The mean scores for rheumatoid arthritis and osteoarthritis
subjects differed substantially except for the expected poorer scores on anxiety
levels in the osteoartritis group.
      DISCUSSION AND CONCLUSION
     Health is a multidimensional construct that includes biological,
psychological and social features. Health (or the lack of it) is determined by the
complex interactions among environmental/social                  factors and the
psychological and biological characteristics of the individual.
      Chronic disease accounts for the majority of health care expenditures in
the whole world. The primary goals of health care for a chronic disease, such as
rheumatoid arthritis and osteoarthritis, are to minimize functional loss, maintain
indepence, and preserve quality of life. Identifying the determinants of health
status outcomes and the relationships among these determinants may lead to
comprehensive interventions that might reduce the social and economic costs
associated with RA and OA.
        It has been shown that satisfaction with the same level of health status
can vary among patients with the same level of health status (9). The inclusion
of a section to measure the attribution of arthritis health status problems to
arthritis or other causes is important because many patients, especially in
subject groups with elderly patients, have co-morbid conditions that can
independently affect their health status. It has been argued that outcome
assessment should be focused on those aspects of health status that are of
most concern to the patient (10).
        Functional disability is a major outcome for patients with rheumatoid
arthritis. It has been described as a progressive deterioration of functional
abilities during the course of the disease. However, functional disability in early
RA is not clearly documented because few studies have focussed on physical
functional disability at this stage (11-13). There is controversy about either a
rapid progression or a stable of functional disability in the early years of the
disease (14). Moreover, the definition of early RA varies from the 0-2 year to the
0-5 year period after the onset of the disease. Also, the components of
functional disability in early RA have not been much documented in the
literature (14,15). The Health Assessment Questionnaire (HAQ) is a measure of
functional disability, that has been developed and proved valid in RA. It is widely
used and provides a useful measure of a major component of health status (1).
It has been translated and validated in at least 10 languages (16). Guillemin
     44

    (14)et ai, have reported that functional disability is marked at the early stage of
    the disease, and disease activity is a major contributor to functional disability in
    the first 5 years of the disease.
          Impaired muscle function and reduced functional capacity is frequently
    observed in patients with rheumatoid arthritis (17) or osteoarthritis of the
    hip-and knee joints (18) and is often the reason for rehabilitation provided in
    primary health care (19).
           Muscular weakness and atrophy in RA have been described as -being
    due not only to inactivity or pain but also to muscular involvement attributable
    either to the disease       (myopathy or neuropathy) or to treatment with
    corticosteroids. In addition, psychological factors such as motivation and
    personality may influence muscle function in RA (19).
           Apparently, muscle function in diseases of this sort depends partly on
    specific characteristics of the disease and partly on psychological, social and
    pain-related factors. Problems concerning the aspects of experienced muscle
    function were reported frequently in both the RA and OA groups. These findings
    are in line with the basic view of rheumatic disorders being associated with
.   muscular impairment.
           To conclude, the results of this study to be the following: - the RA groups
    differed on the indices of experienced problems used relating to muscle
    strength, endurance, dexterity, social activities, depression; -RA patients with
    multi-joint involvement appeared to experience muscular, physical, and social
    problems to a greater extent than those with osteoarthritis; - even though
    subjective reports of these problems did not differ for the two groups, OA
    patients showed less impact than RA patients, as assessed by quality of life
    tests. This suggested patients with RA to be a major factor in muscular,
    functional, social and psychosocial problems and emphasized the need of
    considering it in planning rehabilitation programs for these patients. In addition,
    psychological factors (e.g. motivation) and social factors may be involved. Thus,
    RA patients are participating in local rehabilitation programs to a higher extent
    than OA patients and are therefore, perhaps, more experienced in coping with
    pain during physical exercise.
           The results point out that among these two patient groups, those with
    rheumatoid arthritis suffer greater impact on the quality of life. In addition, our
    study support further investigations of the relationships between psychosocial
    factors, such as helplesness, and the development of physical disability in
    patients with this often devastating chronic rheumatic disorder, such as RA and
    OA.
                                                                               45

                                         OZET
          ROMATOiD ARTRiTLi VE OSTEOARTRiTLi HASTALARIN
                        YA~AM KALiTESi DURUMLARI
      Kronik romatizmal hastallklarda hastahgm gidi~atmm geleneksel
epidemiyolojik olyOmlerihastallgm sadece fiziksel yonOnOyansltlr ve mental ve
sosyal yonO ise gozardl edilir. Son Ylllarda hastahgm fiziksel, mental ve sosyal
yonOnO hep birlikte degerlendiren ya~am kalitesi olyOmlerine ilgi gittikye
artmaktadlr.

         Bu yall~ma osteoartritli ve romatoid artritli hastalann ya~am kalitesi
durumlanm belirlemek ve klyaslamak iyin tasarlandl. Bu amayla, 59 romatoid
artritli ve 80 osteoartritli olmak Ozere toplam 139 hastada Arthritis Impact
Measurement Scales (AIMS) sorgulama olyegi degerlendirildi. Ya~am kalitesi 9
farkh subskaladan olu~an AIMS kullamlarak degerlendirildi.
       Romatoid artritli hastalann ortalama ya~1 48.84 13,88 YII (36-63 ya~lar
arasl) iken, osteoartritli hastalann ortalama ya~1 52.20 7.03 YII (39-68 ya~lar
arasl) idi. Romatoid artritli hastalar osteoartritli hastalara gore anksiyete hariy
tOm alt skalalarda anlamll olarak daha yOksekm skorlara sahipti (P<0.001).
Oysa anksiyete aylSlndan osteoartritli ve romatoid artritli hastalar arasmda
anlamll farkllhk yoktu (p>0.05).
      Bu sonuylar bu iki hasta grubudan romatoid artritli hastalann osteoartritli
hastalara gore ya~am kalitesi yonOnden daha fazla etkilendiklerini ortaya
koymaktadlr.
       Anahtar Kelimeler: Romatoid artrit, Osteoartrit, ya~am kalitesi, AIMS.
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