Changes in social relations as a consequence of rheumatoid arthritis and osteoarthritis

Reumatski bolesnici trpe bolove i imaju problema sa kretanjem, što može dovesti do promjena u socijalnim odnosima. Cilj rada je da se ispitaju socijalni odnosi u bolesnika s reumatoidnim artritisom i osteoartritisom i utvrde razlozi za takve odnose. U ispitivanju je sudjelovalo 55 bolesnika (29 sa reumatoidnim artritisom i 26 sa osteoartritisom koljena). Uzeti su podaci iz domena socijalnih odnosa, popunili su samoprocjensku skalu za depresiju po Zungu, a funkcionalna sposobnost je ocijenjena sa funkcionalnim indexima. Utvrđeno je u obje skupine bolesnika da je funkcionalna sposobnost smanjena, da većina ima stalnu bol i depresiju (teži stupnjevi depresije su nađeni kod reumatoidnog artritisa). Većina je suzila broj osoba sa kojima se druže (82,8 % sa reumatoidnim artritisom i 80,7 % sa osteoartritisom), dok nikako ne može praviti posjete 55 % bolesnika sa reumatoidnim artritisom i 30,7 % bolesnika s osteoartritisom. Na smanjenje socijalnih kontakata je svakako utjecala smanjena funkcionalna sposobnost i bol, ali značajan utjecaj ima i depresija, koja može biti i uzrok i posljedica, o čemu se malo vodi računa.Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) suffer from a lot of pain, have difficulties with movement, so it is therefore logical for them to have less social contact, i.e. socializing with friends and family. Aim of the study was to examine social relations of the patients with RA and OA, and to establish the reasons for such relations. Survey conducted 55 patients, 29 patients with RA and 26 patients with knee OA. From all patients data from domain of social contacts have been taken. They filled in self-evaluation scale for depression by Zung-SDS, and functional ability was assessed by Health Assessment Questionnaire HAQ (for RA) and by Laquesne index (for OA). Most patients in both groups narrowed the number of people with whom they socialize 82.8 % RA patients and 80.7 % OA patients and now they socialize with the closest family. Able to socialize are 31 % RA patients and 53 % OA patients. Daily pain cites 71 % RA patients and 64 % OA patients. Depression is present by most of the patients, 82.8 % RA patients, and 73.1 % OA patients. Functional ability is decreased by all patients, slightly more by RA patients. Most examined patients narrowed the number of people with whom they socialize, where RA patients feel more unable for going for visit. The reason for decreased social contact is not just reduced functional ability, and daily pain, but also depression that is present in high percentage in both groups, more and in higher level by patients with RA

Structural changes on hands as predicative factors of structural changes in the cervical spine and atlantoaxial joint in patients with rheumatoid arthritis

Utvrđivanje promjena vratne kralježnice važno je u bolesnika s reumatoidnim artritisom (RA), često je klinički asimptomatsko, a tijekom kineziterapije može doći do komplikacija, pa i smrti. Cilj rada bio je ustanoviti čimbenike koji upućuju na promjene vratne kralježnice i atlanto-aksijalnog zgloba (AA) u bolesnika s RA i njihovu povezanost s promjenama na šakama. Istraživanje je obuhvatilo 80 ispitanika s RA koji su podijeljeni u dvije grupe prema duljini trajanja bolesti (do 10 godina i više). Strukturne promjene šaka i vratne kralježnice praćene su nativnom radiografijom. Strukturne promjene na vratnoj kralježnici nađene su u obje grupe ispitanika, a bez statistički znatne razlike među njima (p = 0,165). AA-zglob češće je promijenjen u ispitanika s duljim trajanjem bolesti (p = 0,012). Promjene na šakama bile su veće u ispitanika s trajanjem bolesti više od 10 godina (p = 0,002) i korelirale su s AA-subluksacijom (p = 0,002) i luksacijom (p = 0,004) te s erozijama u području vratne kralježnice (p = 0,000). Na osnovi ovog istraživanja možemo zaključiti da u bolesnika s RA identificiranje promjena vratne kralježnice zahtijeva redovito radiografsko praćenje bolesnika i trebalo bi biti obvezatno kod duljeg trajanja bolesti i izraženih strukturnih promjena na šakama.Determination of changes in the cervical spine of patients with rheumatoid arthritis (RA) is important. Although they are often clinically asymptomatic, during exercise therapy complications, or even death, may occur. The aim of the study was to determine the factors which indicate changes in the cervical spine and atlantoaxial joint (AA) in patients with RA, as well as the association between those changes and changes occurring on the hands. The study included 80 patients with RA who were divided into two groups according to the duration of the disease (up to 10 years and more than 10 years). Structural changes in the hands and cervical spine were monitored by ordinary radiography. Structural changes in the cervical spine were found in both groups of patients without a statistically significant difference between them (p = 0.165). The AA joint was more often deformed in patients with a longer duration of the disease (p = 0.012). The changes on the hands were worse in patients who had the disease for longer than 10 years (p = 0.002), and they correlated with AA subluxation (p = 0.002) and luxation (p = 0.004), as well as with an erosion of the cervical spine (p = 0.000). According to our findings, in order to recognize changes in the cervical spine, patients with RA must be regularly monitored radiographically, and monitoring should be mandatory in patients who had a longer duration of the disease as well as those with more advanced structural changes on the hands

The effect of physical theraphy on the most severe forms of knee structral changes caused by osteoarthritis

Kod najtežih strukturnih promjena na koljenima, usljed osteoartritisa, nekirurški tretman daje minimalne rezultate i postavlja se pitanje njegove svrsishodnosti. Cilj je rada ispitati kakve su mogućnosti fizikalne terapije kod bolesnika s najtežim stupnjem strukturnih promjena nastalih usljed osteoartritisa koljena. Ispitivanje je vršeno na 60 bolesnika koji su bili na fizikalnoj terapiji zbog OA koljena. Strukturne su promjene ocjenjene sa skalom po Kellgren-Lawrenc-u, funkcionalna sposobnost sa Lequesne indeksom, a bol sa Vizualnom analognom skalom. Fizikalna je terapija trajala 4 tjedna. Nakon fizikalne terapije došlo je do signifikantnog smanjenja jačine bola i do signifikantnog poboljšanja funkcionalne sposobnosti (p=1,78E-07), ali se veličina poboljšanja smanjivala s težinom strukturnih promjena, bila je signifikantno manja u IV. klasi u odnosu na III. i II. klasu (p<0,05). Fizikalna terapija ima manji učinak kod bolesnika s najtežim strukturnim promjenama nastalim zbog osteoartritisa koljena, ali još uvijek može pomoći bolesnicima da ublaže nastanak potpune ovisnosti o tuđoj pomoći.In the most severe form of structural changes on knee caused by osteoarthritis non-surgical treatment provide minimal results and a question of its purpose is being raised. Aim of the study was to examine the possibilities of physical treatment of patients with the most severe degree of structural changes caused by knee osteoarthritis. Examination was conducted on 60 patients that were on physical treatment because of the knee OA. Structural changes are evaluated by Kellgren-Lawrence scale, functional ability by Lequesne index, and pain by Visual analog scale. Physical treatment lasted for 4 weeks. After the physical treatment there was a significant improvement of functional ability (p=1.78E-07), but the size of improvement was reduced by the level of structural changes. It was significantly lower in IV class in relation to III and II class (p<0.05). Physical treatment has lower affect by patients with the most severe form of structural changes caused by knee osteoarthritis, but it still can help patients to ease the appearance of complete dependence on other people’s help