Poremećaj koštane gustoće u oboljelih od reumatoidnog artritisa

master's thesis

• Title (english): Bone Density Disorders in Patients with Rheumatoid Arthritis
• Author: Ana Pavić
• Mentor: Ana Gračanin Gudelj (mentor)
• Committee member: Tina Dušek (predsjednik povjerenstva)
• Committee member: Marija Bakula (član povjerenstva)
• Committee member: Ana Gračanin Gudelj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Reumatoidni artritis (RA) autoimuna je upalna bolest koja primarno zahvaća zglobove, ali može zahvatiti i druge organe. Uz zglobne manifestacije bolesti često su prisutne i udružene bolesti kao što je osteoporoza. Cilj ovog istraživanja bio je utvrditi učestalost poremećaja koštane gustoće u bolesnika s RA. Istraživanje je provedeno u Kliničkoj bolnici “Sveti Duh”, a uključivalo je 42 ispitanika, od toga 38 žena i 4 muškarca prosječne dobi 60 +/- 11,49 godina. Najveći udio ispitanika (48%) bolovao je od RA u trajanju od 5 do 10 godina, 14% ispitanika bolovalo je kraće od 5 godina, a 38% dulje od 10 godina. Denzitometrijom je mjerena koštana gustoća u 40 od 42 ispitanika. Poremećaj koštane gustoće utvrđen je u 50% ispitanika, od toga osteopenija u 35%, a osteoporoza u 15%. Prijelomi su pronađeni u 8 ispitanika. Povećani indeks tjelesne mase pronađen je u 28 ispitanika, a srednja i visoka aktivnost bolesti izmjerene su pomoću DAS28-CRP u 12 ispitanika. Uočena je pozitivna korelacija veće aktivnosti bolesti i većeg indeksa tjelesne mase s poremećajem koštane gustoće. Glukokortikoidnu terapiju primalo je 11 ispitanika, terapiju lijekovima skupine csDMARD primalo je 16 ispitanika, bDMARD 17, a tsDMARD 10. NSAID je primalo 5 ispitanika. Uočeno je manje poremećaja koštane gustoće u liječenih s tsDMARD, a pojavnost poremećaja koštane gustoće bila je veća u oboljelih od RA na glukokortikoidnoj i biološkoj terapiji. Vitamin D u terapiji primalo je 26 ispitanika te nije pronađena statistički značajna poveznica između primjene vitamina D i poremećaja koštane gustoće niti aktivnosti bolesti. U ovoj su studiji četiri pušača od 42 ispitanika te nije pronađena statistički značajna korelacija između pušenja i poremećaja gustoće kostiju. Poremećaji koštane gustoće česti su u oboljelih od RA. U svakodnevnoj kliničkoj praksi bolesnike s RA preporučljivo je uputiti na redovnu provjeru serumskih vrijednosti vitamina D i denzitometriju, evaluirati pojavu prijeloma te pažljivo birati terapiju uzimajući u obzir nuspojave lijekova, komorbiditete i aktivnost bolesti.

Abstract (english)

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that primarily affects joints, but can affect other organs as well. Alongside joint manifestations of the disease, many associated diseases are common, for example osteoporosis. The aim of this study was to determine the frequency of bone density disorders in patients suffering from RA. The research was conducted at the Clinical Hospital “Sveti Duh”. 42 subjects were included, 28 of which were female and 4 were male with an average age of 60 +/- 11,49 years. The largest proportion of respondents (48%) had been suffering from RA for a duration of 5 to 10 years, 14% for a duration of less than 5 years, and 38% for more than 10 years. Densitometry was used to measure bone density in 40 out of 42 subjects. Bone density disorders were found in 50% of the respondents, with 35% having osteopenia and 15% having osteoporosis. Fractures were found in 8 subjects. A positive correlation was observed between bone density disorders and higher disease activity and greater body mass index (BMI). Increased BMI was found in 28 subjects. DAS28-CRP was used to measure disease activity and the results revealed that 12 subjects had moderate to high scores. 11 respondents received glucocorticoid therapy, 16 were given csDMARDs, 17 bDMARDs and 10 were given tsDMARDs. 5 subjects received NSAIDs. Fewer bone density disorders were observed in those treated with tsDMARDs, while the prevalence of bone density disorders was higher in those on glucocorticoid and biological therapy. 26 subjects received vitamin D therapy, but no statistically significant association was found between the use of vitamin D and bone density disorders or disease activity. This study included 4 smokers out of 42 subjects. Statistically significant correlation between smoking and bone density disorders was not found, probably due to a small sample size. Bone density disorders are common in patients suffering from RA. It is advisable to monitor serum vitamin D levels and densitometry in patients suffering from RA in everyday clinical practice, to evaluate the occurrence of fractures and carefully choose between different therapeutic options, taking into account medication side effects, comorbidities and disease activity.

• Keywords: reumatoidni artritis; poremećaj koštane gustoće; liječenje reumatoidnog artritisa
• Keywords (english): Rheumatoid Arthritis; Osteoporosis; Treatment of Rheumatoid Arthritis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:898194
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-07-01 15:51:22