Satisfaction and discontent of Polish patients with biological therapy of rheumatic diseases : results of a multi-center questionnaire study

Objectives: Biologics are medications widely applied in the management of inflammatory rheumatic diseases. The drugs were found to be effective but their application is associated with some disadvantages. Medication with biologics is relatively expensive, and in Poland, it is carried out in specialized centers. The study was designed to evaluate various aspects of satisfaction and dissatisfaction of Polish patients treated with biologics. Material and methods: An anonymous questionnaire was distributed in 23 Polish rheumatological centers involved in the treatment; 1212 returned questionnaires were used for analysis. Responses were received from 606 patients with rheumatoid arthritis, 427 with ankylosing spondylitis, 117 psoriatic arthritis, and 62 adult patients with juvenile idiopathic arthritis (in whom administration of the drugs had been introduced before they were 18 years old). The investigated group constituted about one-fifth of all rheumatic patients on biologics in Poland. Results: A beneficial or very beneficial influence of the medication on the state of physical health was found mostly in patients with rheumatoid arthritis (51.3 and 30.5%) and ankylosing spondylitis (51.0 and 36.8%). Family life was improved by the treatment especially in patients with ankylosing spondylitis (40.7 and 35.6% beneficial and very beneficial, respectively), sleep quality and sexual life mostly in those with ankylosing spondylitis (beneficial/very beneficial influence 41.5/38.4, and 38.7/23.9, respectively). There was a rather small influence of biological treatment on the financial situation of the patients. In general, satisfaction with the treatment was evaluated as positive or very positive in 88% of all investigated patients. In a significant part of the patients, transportation to the medical center was considered as a disadvantage of the treatment. About one-third of the patients considered laboratory and imaging tests to be done before initiation of the medication as a difficulty, and for about 40% waiting time for qualification for the medication was a significant disadvantage. The route of drug administration was without importance for 4/5 of the patients. Conclusions: Summing up, the results were similar in the patients suffering from various diseases although those with psoriatic arthritis felt the highest satisfaction (possibly due to the positive aesthetic effect), and those with ankylosing spondylitis had significant improvement in sexual life (probably due to younger age). Relatively low satisfaction was found in patients with juvenile idiopathic arthritis. There was a small influence of medication on financial status of the patients. Application of biologics has few disadvantages and most of them are associated with the organization of health services (waiting time for the tests, transportation to the medical centers)

Związki między reumatoidalnym zapaleniem stawów a zakażeniami układu moczowego

Ryzyko rozwoju zakażenia układu moczowego (ZUM) u chorych nareumatoidalne zapalenie stawów (RZS) jest większe niż w podobnejpopulacji osób zdrowych. W pracy na podstawie wybranychdanych z piśmiennictwa przeanalizowano zależności między RZSa ZUM (tab. I). Na wyraźnie częstsze występowanie ZUM u chorychna RZS wpływają zaburzenia immunologiczne wynikające z samejchoroby oraz leczenie modyfikujące przebieg choroby lekami syntetycznymii biologicznymi.Występowanie ZUM w istotny sposób wpływa na zwiększonąumieralność chorych na RZS. W pracy przedstawiono równieżhipotezę łączącą patogenezę RZS z ZUM wywołanym przez Proteusmirabilis. Szybkie rozpoznanie i leczenie ZUM ma u chorychna RZS bardzo istotne znaczenie z uwagi na zwiększone ryzykowpływu przewlekania się procesu chorobowego na rozwój amyloidozyoraz zwiększone ryzyko zgonu z powodu ZUM

Chorzy trudni nietypowiZapalenie mięśnia sercowego w przebiegu twardziny układowej u wyniszczonej chorej nadużywającej niesterydowych leków przeciwzapalnych

A case of 70-year-old cachectic female, nonsteroid anti-inflammatory drugs abuser, with progressive systemic sclerosis, who was admitted to our hospital due to joint pain and fatigue is presented. During hospitalisation the patient developed symptoms of acute myocarditis. Angiography of coronary arteries did not reveal narrowing of the vessels. Alimentary supplementation and therapy for heart failure (diuretics, vasodilators, angiotensin-converting enzyme inhibitor and beta-blocker) were used. In repeated echocardiography examinations ejection fraction systematically improved and hemodynamic stabilisation was obtained. Scleroderma, malnutrition, toxicity of nonsteroid anti-inflammatory drugs and infectious agents were considered as a cause of myocarditis