Examination of the predictive value of quality of life in the assessment of therapeutic adherence to methotrexate in patients with rheumatoid arthritis

[J. Ćeranić]

92 str.

Medicina - Epidemiologija / Medicine - Epidemiology

Uvod . Neade kvatno lečen i nedovoljno kontrolisan reumatoidni artritisa (RA) dovodi do ozbiljnog oštećenja zglobova i smanjenja funkcionalne sposobnosti kao i kvaliteta života. Uočeno je da nezadovoljavajuća adherencija za metotreksat (MTX) predstavlja značajnu barije ru u optimalnom lečenju pacijenata sa RA. Indentifikovan je veliki broj varijabli koji utiču na adherenciju za MTX, ali se nijedna nije izdvojila za precizno definisanje rizika za neadherenciju. Ciljevi Procena prevalencije neadherencije za metotreksat k od bolesnika sa reumatoidnim artritisom i analiza prognostičnog značaja socio demografskih karakteristika, kliničkih determinanti bolesti i kvaliteta života u proceni neadherencije na metotreksat. Metod. Studijom su obuhvaćeni pacijenti sa RA lečeni u Kli nici za reumatologiju, Vojnomedicinske akademije u Beogradu. Procena aktivnosti RA je vršena primenom tri skale: indeksa kliničke aktivnosti bolesti (Clinical Disease Activity Index CDAI) i skora aktivnosti bolesti (Disease Activity Score 28 joint count DA S 28), dok je za procena funkcionalne sposobnosti korišćen HAQ Di upitnik (Health Assessment Questionnaire HAQ). Za procenu stepena depresije odnosno anksioznosti korišćen je HADS upitnik (Hospital anxiety and depression scale). Procena kvaliteta života ra đena je pomoću tri upitnika: opšteg upitnika za ispitivanje kvaliteta života SF 36 (36 Item Short Form Survey) odnosno RAND36, RAQoL (Rheumatoid Arthritis Quality of Life RAQoL) i EQ 5D 3L upitnika (EuroQol Group 5 questionnaire). Adherencija je procenjena pomoću dva upitnika i skalom samoprocene: upitnikom komplijanse u reumatologiji, CQR19 upitnikom (Compliance Questionnaire for Rheumatology CQR), skalom ocene pridržavanja terapiji/leku (Medication adherence rating scale MARS 5) i procenom adherencije na VAS skali (Analogue Scale VAS). Statistička obrada podataka je rađena u SPSS Windows, verzije 26.0. Nivo statističke značajnosti je iznosio p < 0,05. Rezultati. Studijom je obuhvaćeno 111 ispitanika sa RA. Adherencija za MTX je iznosila 48,6% kada je proc enjena pomoću CQR19 upitnika, 70,3% putem MARS 5 upitnik i 82,9% procenom na VAS skali. Između sva tri upitnika za procenu adherencije dobijena je visoko značajna pozitivna korelacija . U odnosu na stepen adherencije za MTX merenom sa tri upitnika nije uoče na razlika u sociodemografskim i kliničkim karakteristikama kao i prisustvu komorbiditeta . Statistički značajna nezavisna prediktivna vrednost za adherenciju za MTX u sva tri merna instrumenta je dobijena za konkomitantnu upotrebu steroida...

Introduction. Inadequately treated and poorly controlled rheumatoid arthritis (RA) leads to serious joint damage, reduced functional capacity, and diminished quality of life. Non adherence to methotrexate (MTX) is a significant barrier to optimal treatment of RA patients. A large number of variables influencing adherence to MTX have been identified, but none have been singled out to pre cisely define the risk of non adherence. Objective. Assessment of the prevalence of non adherence to methotrexate in patients with rheumatoid arthritis and analysis of the prognostic significance of socio demographic characteristics, clinical determinants of the disease and quality of life in the assessment of non adherence to methotrexate. Methods. The study included RA patients who were treated at the Rheumatology Clinic of the Military Medical Academy in Belgrade. Assessment of RA activity was performed using three scales: the Clinical Disease Activity Index (CDAI) and the Disease Activity Score 28 joint count DAS 28 (DAS28), while the HAQ Di questionnaire was used to assess functional ability (Health Assessment Questionnaire HAQ). The degree of depressio n or anxiety was measured using the HADS (Hospital Anxiety and Depression Scale) questionnaire. To evaluate the quality of life, we used three questionnaires.: the general questionnaire for examining the quality of life SF 36 (36 Item Short Form Survey) or RAND36, RAQoL (Rheumatoid Arthritis Quality of Life RAQoL) and the EQ 5D 3L questionnaire (EuroQol Group 5 questionnaire). Adherence was assessed using two questionnaires and a self assessment scale: compliance questionnaire in rheumatology, CQR19 questi onnaire (Compliance Questionnaire for Rheumatology CQR), medication adherence rating scale (MARS 5) and assessment of adherence on the VAS scale (Analogue Scale VAS). Statistical data processing was done in SPSS Windows, version 26.0. The level of statisti cal significance was p < 0.05. Results. A cross section study included 111 patients with RA. Adherence to MTX was 48.6% when assessed by the CQR19 questionnaire, 70.3% by the MARS 5 questionnaire and 82.9% by the VAS scale assessment. A highly significant positive correlation was obtained between all three adherence assessment questionnaires. After analyzing sociodemographic and clinical characteristics, as well as comorbidities, no statistically significant difference was found in questionnaire scores for questionnaire scores for adherence to MTX. A statistically significant independent predictive adherence to MTX. A statistically significant independent predictive value for adherence to MTX in all three measurement instruments was obtained for concomitant value for adherence to MTX in all three measurement instruments was obtained for concomitant steroid use. Patients with RA have been shown to experience a reduced quality of life, primaristeroid use...

Ključne reči: reumato idni artritis, adherencija, metotreksat, kvalitet života, upitnici, predikcija, konkomitantna terapija, kortikosteroidi

rheumatoid arthritis, adherence, methotrexate, quality of life, questionnaires, prediction, concomitant therapy, steroids

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