Comparative Study on the Extent of Damage to Life Quality in Rheumatoid Arthritis Patients with Different Therapeutic Strategies

Rheumatoid arthritis (RA) affects 1% of general global population. The pathology is characterized as an erosive synovitis with chronic pattern that progresses into a systemic affection. The extraarticular events include: rheumatoid nodules, rheumatoid vasculitis, amyloidosis, osteoporosis, Sjogren syndrome or Felty synodrome [1-8]. RA leads to permanent damage of the cartilages and articulations, with a major impact on patients quality of life and maybe more important, life expectancy. Most patients reduce their daily activity to match their current capabilities, they withdraw from their social lifes and isolate themselves. It’s easy to understand why the target of RA therapy must include an improvement of patients life quality besides obtaining clinical response in slowing down the progression of the disease or in best cases the state of RA remmision [3, 5, 9, 10].

Rheumatoid arthritis (RA) affects 1% of general global population. The pathology is characterized as an erosive synovitis with chronic pattern that progresses into a systemic affection. The extraarticular events include: rheumatoid nodules, rheumatoid vasculitis, amyloidosis, osteoporosis, Sjogren syndrome or Felty synodrome [1][2][3][4][5][6][7][8]. RA leads to permanent damage of the cartilages and articulations, with a major impact on patients quality of life and maybe more important, life expectancy. Most patients reduce their daily activity to match their current capabilities, they withdraw from their social lifes and isolate themselves. It's easy to understand why the target of RA therapy must include an improvement of patients life quality besides obtaining clinical response in slowing down the progression of the disease or in best cases the state of RA remmision [3,5,9,10].

Material and method
The statistical analysis was done using the SPSS 19. Parametric mean values, frequency ranges, standard deviations, statistical significance tests by the Student method (t test).
Sensitivity to change can be assessed in various types of clinical research or long-term observational studies. To measure sensitivity to change, we used the statistical calculation system effect width (ES). ES is a method of standardizing the magnitude of changing a variable after a * email:dteaha@yahoo.com, Phone: 0754542882 All authors have the same contribution to this study. Patients were followed up for one year with 3 assessments: initially at 6 months and 12 months.
We followed the evolution of patients according to the type of treatment, as follows: -Group 1 -MTx monotherapy -34 patients -Group 2 -MTx + Biological -28 patients -Group 3 -MTx + corticotherapy -34 patients -Group 4 -MTx + PKT -40 patients The groups were formed mainly by female individuals (85.29% MTX monotherapy, 85.71 % MTX+ Biological therapy, 88.24% MTX+ Corticotherapy and 80% MTX+ PKT), with an average age between 55 and 59 years old. Longest duration of disease is found in the MTX + Biological therapy group, approximately 5.02 years of treatment (Table 1).
Most cases with advanced stages of polyarthritis (stage III and IV) were recorded in patients with MTx + biologically active therapy (42.86%), insignificantly higher than in the corticosteroid group (23.53%, p = 0.108), but significantly higher than in the MTX and MTX + PKT monotherapy groups (14.71% and 15.00% respectively, p = 0.014 and p = 0.011 respectively) ( Table 2, Fig. 1).

Results and discussions
The evaluation of patients life quality was quantified following the HAQ score (the health assessment questionnaire) and VAS troughout an year of treatment.
HAQ is a questionnaire for the assessment of RA, wich evaluates the index of disability showing the grade of dependence/ independece of the patient. The patients autoevaluates it's capabilities, most of the time with the doctor. There are 8 sections: dressing, arising, eating, walking, hygiene, reach, grip, and activities. There are 2 or 3 questions for each section. Scoring within each section is from 0 (without any difficulty) to 3 (unable to do) [11,12].
One of the most essential and important stage in evaluating patient progress of RA is VAS (visual analogue function scale). In RA is used to evaluate patients amount of pain througout the treatement and stages of disease. It usually presents as a scale from 0-100 or 0-10 in wich the patient and the physician evaluates overall pain [13][14][15].

Evolution of HAQ score
In contrast to the initial assessment, at 12 months the effect of treatment on the HAQ score was moderate in all groups (MTx monotherapy -ES = 0.57, MTx + biological -ES = 0.71, MTx + corticotherapy -ES = 0.71 and MTx + PKT -ES = 0.58).

Conclusions
In contrast to the initial assessment, at 12 months the effect of treatment on the HAQ score was moderate in all groups of treatment, with best results in MTx + biological -ES = 0.71, respectively MTx + corticotherapy -ES = 0.71. Regardless of the applied therapy, in all 4 groups the HAQ score improved significantly at 12 months.
As compared to the initial assessment, the treatment effect on the VAS score was very good in all groups, with best results in MTx + biological -ES = 1.38, followed by MTx + PKT -ES = 1.23). Regardless of the therapy applied, in all 4 groups the VAS score decreased significantly at 12 months (p <0.001).
The following study highlights the importance of clinical treatment in keeping the symptoms of RA under control and improving patients life quality on one hand, and proving the importance of biological and physiokinetotherapy in the overall outcome.