| Abstract | Cilj istraživanja: Cilj istraživanja bio je istražiti lipidni profil bolesnika s RA te ispitati potencijalnu povezanost s aktivnosti bolesti.
Ispitanici i postupci: Ovo retrospektivno opažajno istraživanje je provedeno na 509 bolesnika s RA liječenih u Zavodu za reumatologiju i kliničku imunologiju KBC-a Split, u Klinici za unutarnje bolesti od 1. listopada 2021.godine do 12. siječnja 2023. godine. Izvor podataka bili su stacionar i dnevna bolnica navedenog Zavoda. Podatke iz povijesti bolesti unijeli smo u tablicu programa Microsoft Excel, a u statističkoj obradi koristili smo program MedCalc
Rezultati: Od 509 ispitanika žene su činile 85% (N=431), a muškarci 15% (N=78). Omjer žena i muškaraca bio je 5,7:1. Medijan životne dobi iznosio je 63 godine (min-max: 18-87 godina; Q1-Q3: 54-70 godina). Od 138 bolesnika koliko ih je imalo dostupan podatak o funkcionalnom statusu (HAQ) u Povijesti bolesti, njih 65,9% (N=91) imalo je blagu onesposobljenost u svakodnevnim aktivnostima, 28,3% (N=39) umjerenu, a svega 5,8% (N=8) imalo je tešku nesposobnost i zahtijevalo pomoć svojih ukućana. Po pitanju stupnja aktivnosti bolesti, njih 62,8% bilo je u stadiju remisije (N=306), 19,1% (N=93) imalo je blago aktivnu bolest, 11,3% (N=55) umjereno aktivnu, a 6,8% (N=33) visoko aktivan stupanj bolesti. Nadalje, uvidjeli smo da postoji statistički značajna negativna korelacija između stupnja aktivnosti bolesti (DAS 28) i količine kolesterola u serumu (r=-0.437), statistički značajna pozitivna korelacija funkcionalnog statusa (HAQ) s DAS 28 ( r=0.472) te da između DAS 28 i količine LDL-a postoji statistički značajna slabija negativna korelacija (r=-0.363). Postoji i statistički značajna razlika vrijednosti kolesterola χ²= 17,56; P= 0,001), HDL-a ( χ²=15,2 ; P=0,002), LDL-a (P=0.003) ovisno o stupnju aktivnosti bolesti. Razdioba ispitanika prema HAQ (blaga onesposobljenost prema umjerenoj i teškoj) statistički se značajno razlikovala u odnosu na aktivnost bolesti (χ²= 22,5 ; P<0,001). Što se tiče terapije, 4 puta je više onih koji nisu uzimali hipolipemike Razdioba ispitanika prema korištenju hipolipemika statistički se značajno razlikovala u odnosu na aktivnost bolesti (χ²=16,8 ; P=0,001). Najviše bolesnika koji su uzimali hipolipemike imao je umjereno aktivnu bolesti. Uočili smo i da je izgled za pojavnost uredne vrijednosti kolesterola u odnosu na patološku 2,13 puta veća u skupini ispitanika koji su uzimali hipolipemike. Nema statistički značajne razlike dobi ispitanika(χ²=5,26 ; P=0,154), ITM (χ²=4,15 ; P=0,245), sistoličkog tlaka (χ²=0,561; P=0,905), dijastoličkog tlaka (χ²=3,3 ; P=0,352), triglicerida (χ²=3,1 ; P=0,381) i trajanja bolesti (χ²=1,2 ; P=0,756) u odnosu na aktivnost bolesti.
Zaključak: U Klinici za unutarnje bolesti, u četrnaestomjesečnom razdoblju liječilo se gotovo 6 puta više žena nego muškaraca. 63% ih je bilo u remisiji bolesti, a u funkcionalnom statusu, najveći je broj imao blage poteškoće pri obavljanju svakodnevnih poslova. S porastom aktivnosti bolesti, opadala bi razina kolesterola, HDL-a i LDL-a u serumu čime smo dokazali postojanje lipidnog paradoksa i u našoj populaciji. Razina triglicerida se nije mijenjala ovisno o aktivnosti bolesti. Pogoršanje funkcionalnog statusa bilo je sukladno porastu aktivnosti. Također smo zaključili da je bilo 4 puta više onih bolesnika koji nisu uzimali hipolipemike, iako je medijan kolesterola bio 5,8. No, uočili smo i da su oni koji su uzimali hipolipemike imali 2,3 puta veći izgled za pojavnost uredne razine kolesterola u serumu. |
| Abstract (english) | Objectives: The aim of this research was to explore the relationship between lipid levels in patients with rheumatoid arthritis (RA) and disease activity
Subjects and metods: This retrospective, descriptive study included 509 patients with RA that were treated in the Department of Rheumatology and Clinical Immunology, of the University Hospital of Split from October 1st, 2021 until January 12th, 2023. The source of medical data were medical records of RA patients from outpatient clinic, daily hospital and inpatients of the Department of Rheumatology and Clinical Immunology. Medical data were entered in Microsoft Excel program. For statistic analysis, we used MedCalc program.
Results: 509 patients with RA participated in the study, 85% (N=431) were women and 15% (N=78) were men. Women to men ratio was 5,7:1. The median age was 63 years (min-max: 18-87 years; Q1-Q3: 54-70 years). Out of 138 patients who had the information about functional status (HAQ) in their medical history, 65,9% (N=91) of them had mild difficulties in doing their daily chores, 28,3% (N=39) had moderate disabilities, and only 5,8% (N=8) had severe disabilities and needed help from their family members. In terms of disease activity, 62,8% were in remission (N=306), 19,1% (N=93) had low disease activity, 11,3% (N=55) had moderate disease activity, and 6,8% (N=33) had highly active disease. Furthermore, there is statistically significant negative correlation between the disease activity (DAS28) and level of total cholesterol (TC) in serum (r=-0.437), statistically significant positive correlation between functional status (HAQ) and DAS28 ( r=0.472) and statistically significant negative correlation of weaker strength between DAS28 and level of LDL-C (r=-0.363). There is also a statistically significant difference in serum TC levels (χ²= 17,56; P= 0,001), serum HDL-C levels ( χ²=15,2 ; P=0,002), serum LDL-C levels (P=0.003) between different disease activity groups. There is statistically significant difference among different groups according to HAQ (mild – moderate – severe disability) and disease activity (χ²= 22,5 ; P<0,001). Regarding the therapy, there were 4 times more RA patients who weren´t using hypolipemic agents. There is a statistically significant difference between differrent disease activity groups and usage of hypolipemic agents
(χ²=16,8 ; P=0,001). Majority of those using hypolipemics had moderate disease activity. Odds ratio for detecting TC level in serum compared to detection of raised TC is 2,13 times higher in a group that was using hypolipemics. Lastly, there is no statistically significant difference between the age of participants (χ²=5,26 ; P=0,154), BMI (χ²=4,15 ; P=0,245), systolic pressure (χ²=0,561; P=0,905), diastolic pressure (χ²=3,3 ; P=0,352), triglycerides (χ²=3,1 ; P=0,381), duration of the disease (χ²=1,2 ; P=0,756) and the disease activity.
Conclusion: There were nearly 6 times more women treated in the Clinic for Internal Diseases at University Hospital of Split in a fourteen-month period. 63% of patients were in low disease activity or remission. According to functional status, majority of patients had mild difficulties in doing their daily tasks. With the disease activity incresement, the serum levels of TC, HDL-C and LDL-C would drop, which proved the existence of the lipid paradox in our RA population as well. The level of triglycerides did not change depending on the activity of the disease. Deterioration of functional status was consistent with the increase in disease activity. We also concluded that there were 4 times more patients who did not take hypolipemic agents, although the median TC was 5,8. However, we also noticed that those who took hypolipemics were 2,3 times more likely to have normal serum TC levels. |
