Early predictors of injectable disease modifying drugs suboptimal response based on clinical and radiological data assessment in Polish Multiple Sclerosis patients

Background. Prospective database studies can provide useful information regarding ‘real-world’ outcomes and drug efficacy. Objective. To determine the early predictors of suboptimal treatment responses at two and three years under injectable Disease Modifying Therapy (DMT). Methods. This was a multi-centre prospective database study. Adult patients who started injectable DMTs between January 2008 and June 2013 were included. The follow-up continued until July 2014. Suboptimal treatment responses were defined as: the presence of clinical relapse and/or Expanded Disability Status Score (EDSS) progression and/or newly emerging T2 lesions or/and gadolinium enhancing lesions on magnetic resonance imaging (MRI). The parameters were assessed up to 24 months prior to, and every 12 months during, the treatment. Results. Analysis included 297 MS (multiple sclerosis) patients followed for a mean time of 2.3 ± 1.3 years (range 1–5). Within the three years of observation, the persistence and efficacy with injectable DMTs was high. With increased disability, defined by EDSS ≥ 3, the risk of treatment failure increased up to seven times, OR 7.33 in the second year radiological analysis (CI 95% : 1.69–29.2) p < 0.01, similar to over two times in the second year clinical analysis, with the baseline symptomatic hemiparesis OR 2.75 (CI 95% : 1.06–7.06) p 0.034. A high relapse rate one year prior to treatment adversely influenced the treatment success at three years, OR 3.04 (CI 95% : 1.49–8.43) p < 0.01. Conclusions . Injectable DMTs should not be chosen for treatment initiation in motoric disabled patients (EDSS ≥ 3) with a high grade of clinical activity. These drugs are effective in less active relapsing-remitting (RR) MS patients

Multiple sclerosis and autoimmune diseases — a case control study

Introduction. Multiple sclerosis (MS) is one of the most common autoimmune diseases worldwide, and various autoimmune comorbidities have been reported with MS. The aim of this study was to estimate the prevalence of autoimmune disease comorbidity in patients with MS and their relatives in a Polish population. Material and methods. In this retrospective multicentre study, we investigated a group of patients with MS, and their relatives, in terms of age, gender, and the presence of simultaneous autoimmune diseases such as Graves’s Disease, Hashimoto’s thyroiditis, type 1 diabetes mellitus, myasthenia gravis, psoriasis, ulcerative enteritis, Crohn’s Disease, coeliac disease, rheumatoid arthritis, autoimmune hepatitis and systemic lupus erythematous. Results. This study included 381 patients with MS, of whom 52.23% were women. 27 patients (7.09%) had at least one autoimmune disease. The most common comorbidity was Hashimoto’s thyroiditis (14 patients). 77 patients (21.45%) had relatives with an autoimmune disease, of which the most common was Hashimoto’s thyroiditis. Conclusions. Our study revealed that the probability of autoimmune diseases co-occurring in patients with MS, and in their relatives, is higher and we found the greatest risk to be for Hashimoto’s thyroiditis

Czynniki socjodemograficzne, kliniczne i poczucie własnej skuteczności a zindywidualizowana ocena znaczenia choroby przewlekłej

Wstęp: Subiektywna ocena znaczenia choroby wzbudza określone emocje, uruchamia odpowiednią motywację i strategie radzenia sobie, które sprzyjają bądź utrudniają proces leczenia i adaptacji oraz prognozowanie przebiegu choroby. Postanowiono zweryfikować zależności między wybranymi czynnikami psychospołecznymi a oceną znaczenia przewlekłej choroby. Materiał i metoda: W skład grupy badawczej weszło 118 pacjentów z rzutowo-remisyjną postacią stwardnienia rozsianego (SMRR), a do grupy odniesienia – 61 osób z cukrzycą typu 2. Wyniki: Przewlekle chorych pacjentów istotnie statystycznie różnicuje ocena znaczenia choroby jako korzyści oraz jako przeszkody. Analiza wyników uzyskanych przez pacjentów z SMRR pokazała, że płeć, wykształcenie, niepełnosprawność i poczucie własnej skuteczności są statystycznie istotnie powiązane z oceną znaczenia własnej choroby. Wnioski: Przeprowadzone badanie wskazuje, że czynniki psychospołeczne są powiązane ze zindywidualizowaną oceną znaczenia choroby przewlekłej. Uzyskane wyniki dowodzą konieczności dokonywania diagnostycznej oceny znaczenia indywidualnie nadawanego swej chorobie, wyznaczając tym samym kolejne etapy terapii ukierunkowanej na poprawę jakości życia osób chorych. Porównanie z grupą odniesienia uwidoczniło specyfikę zależności stwierdzonych wśród osób z SMRR, co potwierdza wartość indywidualnego podejścia diagnostyczno-terapeutycznego

Psychosocial determinants of the appraisal of disease significance by patients with a chronic disease

The literature on the subject identifies chronic disease as a stressor which imposes new adaptive tasks on patients and requires them to change their lifestyle. Therefore, the issues of disease assessment and adaptation to illness, based on individual knowledge of the disease and subjective appraisal of its influence on day-to-day functioning, are becoming increasingly important. In the present article, the appraisal of disease significance is to be understood as a dynamic effect of subjective assessment of one’s own life situation due to chronic disease. The aim of the analysis was validation of the relationship between the basic sociodemographic factors and the appraisal of the significance of a chronic disease among patients with RRMS and diabetes type 2, as well as verification whether these two diseases show any differences in terms of appraisal of their significance in opinion of the patients. In order to verify the hypotheses, The Disease-Related Appraisals Scale, and original scorecard designed to obtain sociodemographic data were used. The analysis was conducted on 118 patients with RRMS and 61 patients with diabetes type 2. The results show a statistically significant relationship between education level and the appraisal of disease significance considered as benefit and injustice among the two groups of patients. Additionally, in the group of patients with diabetes type 2, the aforementioned relationship was also found for appraisal of disease significance considered as a threat. Moreover, it was found that the analysed groups show significant differences in terms of recognition of the disease as an obstacle/loss. Diagnostic assessment of disease significance sets the direction and methods of therapeutic intervention provided, with the primary aim of improving the quality of life of patients suffering from a chronic disease

Serum natremia affects health-related quality of life in patients with liver cirrhosis: a prospective, single centre study

Introduction. Hyponatremia is associated with high mortality and predicts hepatic encephalopathy but its effect on health-related quality of life remains to be established.Material and methods. In this study we prospectively analyzed the relationship between hyponatremia, clinical features and quality of life in a cohort of 116 patients with cirrhosis. Chronic Liver Disease Questionnaire and Medical Outcomes Study 36-Item Short Form Health Survey were performed to assess quality of life. Evaluation of hepatic encephalopathy included West-Haven criteria, Psychometric Hepatic Encephalopathy Score and Critical Flicker Frequency analysis. Severity of liver disease was assessed with Child-Pugh score and MELD. Univariate and multivariate analysis were implemented to evaluate the influence of analyzed factors on quality of life.Results. Multivariate analysis has identified serum natremia, Psychometric Hepatic Encephalopathy Score, Critical Flicker Frequency and severity of liver disease measured with MELD and Child-Pugh score as independent factors affecting quality of life in patients with cirrhosis. West Heaven criteria failed to show the relationship with quality of life in analyzed subjects. Serum kalemia showed correlation with neither quality of life, hepatic encephalopathy nor severity of the disease.Conclusion. In patients with cirrhosis serum natremia along with severity of liver disease and hepatic encephalopathy exerts a significant effect on patients’ quality of life

Prevalence and factors leading to unemployment in MS (multiple sclerosis) patients undergoing immunomodulatory treatment in Poland

<div><p>Multiple Sclerosis (MS) is the most common, primary neurogenic cause of disability among young adults. We investigated demographic and clinical factors associated with unemployment on the example of 150 MS patients receiving immunomodulatory treatment in Poland. This study was based on clinical evaluation and collection of self-reported questionnaires, with an attention to self-motivation, severe fatigue and moderate disability. Patients who were unemployed (40% of all patients) had a mean disease duration of almost 5 years. Older (p<0.001), less educated (p = 0.007) and more severely disabled patients (p<0,001) were most likely to be unemployed. Moderate disability (OR = 11.089 95% CI: 4.11–34.201, p<0,001), severe fatigue (OR = 2.625 95% CI: 1.02–6.901, p = 0,046) and lower level of self-motivation (KNS) (OR = 0.947, 95% CI: 0.896–0.006, p = 0.042) were independently associated with unemployment.</p></div

Multivariate logistic regression analysis of factors influencing employment.

<p>Multivariate logistic regression analysis of factors influencing employment.</p

Main predictors of unemployment.

<p>Main predictors of unemployment.</p

Socio-demographic and clinical characteristic of MS patients.

<p>Socio-demographic and clinical characteristic of MS patients.</p