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

EFFECT OF DISEASE-MODIFYING ANTIRHEUMATIC DRUGS ON THE VALUES OF APOLIPOPROTEIN A-1 AND ACUTE PHASE REACTANTS IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS

U ovom opservacijskom radu istražili smo utjecaj antireumatskih lijekova koji mijenjaju tijek bolesti (BMARL) na: aktivnost bolesti, vrijednosti reaktanata akutne faze i apolipoproteina A-1 (Apo A-1) u bolesnika s aktivnim reumatoidnim artritisom (RA). Osamdeset pacijenata s aktivnim i novootkrivenim RA, u skladu s revidiranim klasi fi kacijskim kriterijima Američkoga reumatološkog udruženja (ARA) iz 1987. godine, liječeno je lijekovima koji mijenjaju tijek upalne reumatske bolesti – BMARL-ima, u skladu sa standardnim protokolom liječenja u svakodnevnoj praksi. Nakon 6 i 12 mjeseci liječenja pacijenti su postigli značajno smanjenje vrijednosti DAS28 (disease activity score), CRP-a (C-reaktivni protein) i SE (sedimentacija eritrocita). S druge strane, razine Apo A-1, koje su na početku bile niske, značajno su se povisile. Zaključno, primjena BMARL-a u bolesnika s RA smanjila je aktivnost bolesti i upalu, ali je imala pozitivne učinke u smislu povišenja razine ateroprotektivnog Apo A-1, što može sniziti kardiovaskularne rizike.In this observational study we examined the impact of disease-modifying antirheumatic drugs (DMARDS) on the disease activity as well as the values of acute phase reactants and the apolipoprotein A1 (Apo A1) in patients with active rheumatoid arthritis (RA). Eighty patients with active RA and newly discovered RA patients who meet the American Rheumatology Association (ARA) 1987 revised criteria were treated with disease modifying anti-rheumatic drugs – DMARDs according to the standard protocol of everyday clinical practice. At 6 and 12 months of treatment the patients achieved a signifi cant decrease in the disease activity score 28 (DAS28), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) values. On the other hand, the levels of Apo A-1, which were low at baseline, were signifi - cantly higher. In conclusion, the use of DMARDs in patients with RA reduced disease activity and infl ammation, but also had a benefi cial eff ect in increasing the levels of atheroprotective Apo A-1 lipoprotein, which can reduce CV risks in these patients