| Abstract |
Background
Autoimmune diseases are diseases caused by an excessive and incorrect response of the immune system of the organism against itself. Autoimmune inflammatory diseases are chronic and have a negative impact on the functionality and quality of life of patients, while significantly burdening families, society and the health care system as they represent a large percentage of pathological conditions and are the most common medical cause of long-term absence from work. Chronic pain, prolonged disease activity, and progressive joint involvement lead to reduced functional capacity and a lower quality of life for the patient, which can ultimately lead to permanent damage and disability but also increase the risk of emotional disturbances. As a result of the above to have serious consequences both socially and economically with a significant burden on the health and welfare budgets of the states but also a reduction of the available workforce and overall productivity. It is known that a person's quality of life depends on his psychological state, his relationship with the environment in which he lives, but also on his physical condition and functionality. When a person is ill, especially when the disease is chronic and accompanied by pain, he is expected to have a lower standard of living compared to that of healthy people. Given the high prevalence of rheumatic diseases, there is a need to determine which parameters have the greatest impact on health-related quality of life (QoL). It is therefore important to determine not only the state of health of citizens suffering from a disease, but also the way in which this disease affects and affects their lives. Inevitably, the development of tools that measure the quality of life of the population has emerged. In the past, treatment options for autoimmune diseases were limited. Conventional disease-modifying Antirheumatic drugs (cDMARDs) have shown limited efficacy. In recent years the use of biological agents proving their usefulness and reliability have changed the therapeutic approach to many of the autoimmune rheumatic diseases, thus reducing their long-term complications and has led to a significant improvement in all parameters of function and quality of life of patients. The earlier the disease is treated, the lower the impact on the cost of insurance funds, especially in the specific age group where it works. Objective
The aim of this study was to evaluate whether systemic administration of biological agent on the one hand improves the quality of life and functionality in daily activities of patients with chronic autoimmune inflammatory diseases and on the other hand reduces pain and its effect on inflammatory markers.
Methods This is a retrospective study performed at the Rheumatology Clinic of the University General Hospital of Heraklion (PAGNI). Data were collected and analyzed from the existing database - University of Crete Rheumatology Clinic Registry. The population included patients of both sexes under 35 years of age with autoimmune inflammatory disease who received biological agent for the first time and remained in treatment for at least 12 months. Also participated Control group: AFN patients who did not receive biological agent. Questionnaires were used: Health Assessment Questionnaire (HAQ) Euroquol (EQ-5D) Bath Ankylosing Spondylitis Functional Index(BASFI) In addition, the Visual Analogue Scale (VAS) was used. The study analyzed the following: Demographics, type of treatment, disease, duration of illness, duration of previous treatment, current medication and non-medication in both groups, the type of biological agent, the indicators of chronology and activity, the marital status of work, laboratory data, and possible comorbidities. Results A total of 130 patients participated, of which 90 received biological and 40 were the control group and received DMARD. The majority of patients were women and the mean age was approximately 29 years. From the general characteristics there were no differences between the two groups. The most common disease at present was Ankylosing spondylitis (ΑS) for the biological group (55.6% n = 50, p-value = 0.008). The second most common disease was Rheumatoid arthritis (RA) in the DMARD group (50% n = 20 p-value = 0.008). The mean disease duration was longer in patients receiving biological than those not receiving (p-value = 0.01). The most commonly administered anti-TNFα agent was Adalimumab (n = 29, 32.2%). Steroids is the initial treatment for both groups [biological group11 (12.2%) vs control group 5 (12%), p = 0.965]. NSAIDs were given more often to patients in the control group than to the group receiving biological [3 (3.3%) vs 4 (10%), p = 0.120], but without reaching a statistically significant degree. Patients receiving biological agent receive concomitant MTX [2 (2.2%) vs 0 (0%) p-value = 0.342]. In the baseline for the quality-of-life questionnaire (EURO-QOL), for control patients a better quality of life is reported (0.67 vs 0.58, p-value = 0.037) a significant difference between the two groups was found in the intensity of pain (VAS-pain group of biological 46.6 vs 56.2, p-value = 0.018), while the results of the VAS activity group index were similar (biological 56.6 vs. control group 49.2, p-value = 0.060). Regarding HAQ and EURO-QOL, both groups showed an improvement from the start time to 12 months (p <0.05), but there was no difference between them HAQ (p = 0.831). The biological group has a greater intensity of pain and symptoms. The change from 0-12 months showed a decrease in pain intensity and improvement in both groups with a statistically significant difference. Regarding which group had the greatest improvement in the variables, we observe that both groups improved from the start of monitoring at 12 months but did not notice a statistically significant difference between them. For the EURO-QOL quality of life questionnaire, the group that started biological factor had higher scores, however the p-value did not reach statistically significant levels (p = 0.112), probably due to a small sample of the population. Conclusion Biological agents are modern therapies in the treatment of autoimmune inflammatory rheumatic diseases. It is also found that in a young population the predominant disease is ankylosing spondylitis. The most commonly used drugs are the TNFα monoclonal antibody in combination with MTX and corticosteroids. Quality of life indicators reliably reflect the magnitude of the problem in all autoimmune diseases but also the tendency to improve stagnation or deterioration and can be used as indicators to assess the severity of the disease and response to treatment. Patients with biologics have significantly improved functionality and mobility compared to patients receiving DMARDs. Future studies will show new results - treatments, to better treat disease and improve quality of life.
|
Search
