Sistemik skleroz hastalarında hastalık özelliklerinin yaşam kalitesine etkisinin araştırılması
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Sistemik skleroz (SSc) yaygın vaskülopati, deri ve iç organların (akciğerler, böbrekler, gastrointestinal sistem, kardiyovasküler sistem gibi) ilerleyici fibrozisi ile seyreden kronik, otoimmün romatolojik hastalıktır. SSc’li hastalarda görsel etkilenme, şekil bozuklukları, fonksiyonel kısıtlılık, organ sistem tutulumları gibi nedenlerle yaşam kalitesi olumsuz etkilenir. Yapılan çalışmalarda her bir tutuluma ilişkin ayrı ayrı ve farklı ölçeklerle değerlendirmeler yapılmıştır. Hastalık yüküne etkileri bakımından bu özelliklerin kıyaslandığı bir çalışma ise yoktur. Ülkemizde skleroderma hastalarında yaşam kalitesine ilişkin yapılmış herhangi bir çalışma mevcut değildir. Bu çalışmanın amacı “skleroderma sağlık değerlendirme ölçeği” kullanılarak SSc hastalarında hastalık özelliklerinin yaşam kalitesine etkisinin saptanmasıdır. Gereç ve Yöntem: Çalışmamızda Ege Üniversitesi Tıp Fakültesi İç Hastalıkları Romatoloji Bilim Dalı bünyesinde Skleroderma Polikliniği’nde sorumlu araştırıcı tarafından takip edilen, Amerikan Romatoloji Birliği kriterlerine göre tanısı konulan, 68 hasta ele alınmıştır. Sistemik skleroz hastalarının verileri retrospektif olarak değerlendirilmiştir. Hasta ve hastalık özelliklerine ilişkin veriler hasta poliklinik takip dosyalarından, hastane veritabanı sisteminden, telefonla ya da poliklinik vizitleri sırasında yüz yüze yapılan görüşmelerden elde edilmiştir. Hastaların yaşam kalitesi düzeyi “Skleroderma Sağlık Derlendirme Ölçeği (s-HAQ)” anketi ile değerlendirilmiştir. Toplanan veriler olgu rapor formuna kaydedilmiştir. Elde edilen veriler SPSS 20.0 paket programı kullanılarak analiz edilmiştiryaşam kalitesi düzeyini gösteren S-HAQ skoru ile hasta ve hastalık özelliklerinin ilişkisi incelenmiştir. Ölçüm değişkenleri ortalama±SD ile sınıflanmış veri ise sayı-% tabloları ile sunulmuştur. Bağımsız değişkenlerin bağımlı değişken üzerindeki etkisi ki-kare analizleri ile gösterilmiştir. Anlamlı bulunan bağımsız değişkenlerin bağımlı değişken üzerindeki etkisi lojistik regresyon modelleri ile açıklanmıştır. P<0.05 anlamlı kabul edilmiştir. Bulgular: Çalışmaya 63’ü (%92,6)kadın 68 hasta dahil edilmiştir. Hastaların yaş ortalaması 56,76±11,5 olup medyan hastalık süresi 13 (1-36) yıldır 37 (%54,4) hasta difüz, 31 hasta (%45,6) ise sınırlı hastalık tipine sahiptir. Rodnan deri skoru medyanı 24(4-46) olup hastalık yükünü gösteren “scleroderma clinical tirals consortium index (SCTCI)” medyanı 11,5 (4-29), S-HAQ medyanı ise 5,8 (3,4-8) bulunmuştur. Organ/sistem tutulumlarının dağılımı %97,1’inde gastrointestinal sistem %73,5’inde interstisyel akciğer; %70,6’sında lokomotor sistem; %67,6’sında dijital ülser; %52,9’unda kontraktür; %16,2’sinde kardiyak; %16,2’de pulmoner arteriyel hipertansiyon; %7,4’de böbrek tutulumu şeklindedir. S-HAQ skoru ile Rodnan deri skoru arasında koralasyon saptanmazken (r=-0,03; p>0,05); S-HAQ skoru ile SCTCI skoru arasında anlamlı koralasyon saptanmıştır (r=0,502;P<0,001). Yaşam kalitesiyle organ/sistem tutulumlarının ilişkisi incelendiğindeyse dijital ülser olup olmamasına göre SHAQ skorları arasında anlamlı fark gözlenmezken (p>0,05), interstisyel akciğer hastalığı, lokomotor tutulum kardiyak tutulum, pulmoner hipertansiyon, böbrek tutuluşu ve kontraktür varlığında SHAQ skorlarının anlamlı şekilde daha yüksek (yaşam kalitesinin daha kötü) olduğu saptanmıştır (sırasıyla p=0,003; p<0,001; p<0,001; p<0,001; p=0,021; p=0,015). Kadın ve erkek arasında SHAQ skorlarında anlamlı bir fark bulunmazken (5,80(3,4-8) ; 6,5(5,4-7,2) ve p>0,05), yaş (r=0,717 p=0,001) ve hastalık süresi (r=0,478, p=0,000) arasında pozitif orta derecede anlamlı ilişki bulunmaktadır. Hipotezler: Sistemik sklerozda yaşam kalitesi hastalık tutulumlarından etkilenir.
Aim: Systemic sclerosis (SSc) is a chronic, autoimmune rheumatological disease with diffuse vasculopathy and progressive fibrosis of the skin and internal organs (lungs, kidneys, gastrointestinal tract, cardiovascular system).Quality of life is adversely affected in patients with SSc due to visual impairment, deformities, functional limitations, and organ system involvements. In previous studies, evaluations of each involvement were made separately and with different scales. To our knowledge, any study comparing these characteristics in terms of their effects on disease burden does not exist. In our country, there are no studies on quality of life in patients with scleroderma. The aim of this study is to determine the effects of disease characteristics on quality of life in SSc patients by using the "scleroderma health assessment scale" and to compare them to each other. Materials and Methods: Our study included 68 patients who were diagnosed according to the criteria of the “American Rheumatology Association, followed by the primary investigator in the Scleroderma Outpatient Clinic of the Ege University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology. The data of patients with systemic sclerosis were evaluated retrospectively. Data were obtained from patients’ outpatient follow-up files, hospital database system, telephone or face-to-face interviews during outpatient clinic visits. The patients included in the study were asked about their demographic information, then a questionnaire was applied and the patients completed the "scleroderma health assessment scale". All information was recorded in the case report form. The data obtained were analyzed using the SPSS 20.0 package program. The measurement variables were presented as mean±SD and the categorical data were presented with number-percentile tables. The effects of the independent variables on the dependent variables were shown by chi-square analysis. The effect of the independent variables found significant on the dependent variable was further analyzed with logistic regression analysis. p<0.05 was considered significant. Results: A total of 68 patients, 63 (92.6%) of whom were female, were included in the study. The age of the patients was 56.5 and the median disease duration was 13 (1-36), 37 (54.4%) patients had diffuse and 31 (45.6%) patients had the disease type. The median of the Rodnan skin score was 24(4-46) and the median of the "scleroderma clinical tirals consortium index (SCTCI)" showing the disease burden was found to be 11.5 (4-29) and the S-HAQ median was 5.8 (3.4-8). The distribution of organ/system involvement was gastrointestinal system in 97.1%, interstitial lung in 73.5%; locomotor system in 70.6%; digital ulcer in 67.6%; contracture in 52.9%; cardiac in 16.2%; pulmonary arterial hypertension in 16.2%; It is in the form of kidney involvement in 7.4%.While no correlation was found between S-HAQ score and Rodnan skin score (r=-0.03; p>0,05); A significant correlation was found between the S-HAQ score and the SCTCI score (r=0.502;P<0.001). When the relationship between quality of life and organ/system involvement was examined, no significant difference was observed between SHAQ scores according to the presence of digital ulcer or not (p>0.05), while SHAQ scores were significantly higher in the presence of interstitial lung disease, locomotor involvement, cardiac involvement, pulmonary hypertension, kidney involvement and contracture(worse quality of life, respectively p=0,003; p<0,001; p<0,001; p<0,001; p=0,021; p=0,015). While there was no significant difference in SHAQ scores between men and women (5.80(3.4-8) ; 6.5(5.4-7.2) and p>0.05), age (r=0.717 p=0.001) ) and disease duration (r=0.478, p=0.000) there is a positive moderate significant relationship. Hypotheses: Quality of life in systemic sclerosis is affected by disease involvement.
Aim: Systemic sclerosis (SSc) is a chronic, autoimmune rheumatological disease with diffuse vasculopathy and progressive fibrosis of the skin and internal organs (lungs, kidneys, gastrointestinal tract, cardiovascular system).Quality of life is adversely affected in patients with SSc due to visual impairment, deformities, functional limitations, and organ system involvements. In previous studies, evaluations of each involvement were made separately and with different scales. To our knowledge, any study comparing these characteristics in terms of their effects on disease burden does not exist. In our country, there are no studies on quality of life in patients with scleroderma. The aim of this study is to determine the effects of disease characteristics on quality of life in SSc patients by using the "scleroderma health assessment scale" and to compare them to each other. Materials and Methods: Our study included 68 patients who were diagnosed according to the criteria of the “American Rheumatology Association, followed by the primary investigator in the Scleroderma Outpatient Clinic of the Ege University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology. The data of patients with systemic sclerosis were evaluated retrospectively. Data were obtained from patients’ outpatient follow-up files, hospital database system, telephone or face-to-face interviews during outpatient clinic visits. The patients included in the study were asked about their demographic information, then a questionnaire was applied and the patients completed the "scleroderma health assessment scale". All information was recorded in the case report form. The data obtained were analyzed using the SPSS 20.0 package program. The measurement variables were presented as mean±SD and the categorical data were presented with number-percentile tables. The effects of the independent variables on the dependent variables were shown by chi-square analysis. The effect of the independent variables found significant on the dependent variable was further analyzed with logistic regression analysis. p<0.05 was considered significant. Results: A total of 68 patients, 63 (92.6%) of whom were female, were included in the study. The age of the patients was 56.5 and the median disease duration was 13 (1-36), 37 (54.4%) patients had diffuse and 31 (45.6%) patients had the disease type. The median of the Rodnan skin score was 24(4-46) and the median of the "scleroderma clinical tirals consortium index (SCTCI)" showing the disease burden was found to be 11.5 (4-29) and the S-HAQ median was 5.8 (3.4-8). The distribution of organ/system involvement was gastrointestinal system in 97.1%, interstitial lung in 73.5%; locomotor system in 70.6%; digital ulcer in 67.6%; contracture in 52.9%; cardiac in 16.2%; pulmonary arterial hypertension in 16.2%; It is in the form of kidney involvement in 7.4%.While no correlation was found between S-HAQ score and Rodnan skin score (r=-0.03; p>0,05); A significant correlation was found between the S-HAQ score and the SCTCI score (r=0.502;P<0.001). When the relationship between quality of life and organ/system involvement was examined, no significant difference was observed between SHAQ scores according to the presence of digital ulcer or not (p>0.05), while SHAQ scores were significantly higher in the presence of interstitial lung disease, locomotor involvement, cardiac involvement, pulmonary hypertension, kidney involvement and contracture(worse quality of life, respectively p=0,003; p<0,001; p<0,001; p<0,001; p=0,021; p=0,015). While there was no significant difference in SHAQ scores between men and women (5.80(3.4-8) ; 6.5(5.4-7.2) and p>0.05), age (r=0.717 p=0.001) ) and disease duration (r=0.478, p=0.000) there is a positive moderate significant relationship. Hypotheses: Quality of life in systemic sclerosis is affected by disease involvement.
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