INFLUENCE OF POLYPHARMACY ON THE FUNCTIONAL ABILITY  OF PATIENTS WITH RHEUMATOID ARTHRITIS

Nikola Krstić; Nikola Stefanović; Valentina  Gocić; Katarina  Ilić; Ivana Damnjanović

Nikola Krstić 0644332245
Nikola Stefanović Univerzitet u Nišu, Medicinski fakultet, Departman za farmaciju, Niš, Srbija
Valentina Gocić Univerzitet u Nišu, Medicinski fakultet, Niš, Srbija
Katarina Ilić Univerzitet u Nišu, Medicinski fakultet, Niš, Srbija
Ivana Damnjanović Univerzitet u Nišu, Medicinski fakultet, Departman za farmaciju, Niš, Srbija

Ključne reči: Polifarmacija, Reumatoidni artritis, HAQ-DI

Sažetak

Kliničke smernice lečenja reumatoidnog artritisa (RA) zasnivaju se na primeni: nesteroidnih, antiinflamatornih lekova (NSAID), konvencionalnih lekova, koji modifikuju tok bolesti (csDMARD), imunosupresiva i biološke terapije. Nažalost, veliki broj bolesnika pored RA ima i druge hronične bolesti, što zahteva dodatnu višestruku primenu lekova i često vodi ka polifarmaciji. Prema definiciji Svetske zdravstvene organizacije (SZO; World Health Organization – WHO; eng), polifarmacija predstavlja rutinsku upotrebu 5 ili više lekova, uključujući lekove sa lekarskim receptom ili bez lekarskog recepta, dijetetske suplemente i tradicionalne lekove. Cilj sprovedenog istraživanja jeste ispitivanje uticaja polifarmacije na funkcionalnu sposobnost bolesnika, koji boluju od RA, procenjenu na osnovu vrednosti HAQ-DI indeksa.

Sprovedeno retrospektivno istraživanje uključivalo je 131 bolesnika sa dijagnozom RA. U sklopu kliničkih karkteristika, pažnja je bila usmerana ka prisutnim komorbiditetima, terapiji i ukupnom broju primenjivanih lekova. Za procenu zdravstvenog stanja i funkcionalne sposobnosti primenjivan je HAQ upitnik. Dobijeni podaci analizirani su i statistički obrađeni primenom odgovarajućih softverskih i statističkih metoda.

U sprovedenom istraživanju učestvovao je 131 bolesnik, 29 bolesnika muškog i 102 bolesnika ženskog pola, prosečne starosti 60,25 godina ± 11,21 godina. Analizom prikupljenih kliničkih podataka uočeno je prisustvo komorbiditeta kod 80,15% bolesnika. Lekove koji modifikuju sintetičke bolesti primenjivalo je 88,55%, dok je na biloškoj terapiji bilo 13,74% bolesnika. Vrednosti HAQ-DI < 1,5 bile su prisutne kod 83,21% ispitanika, dok su vrednosti HAQ-DI ≥ 1,5 zabeležene kod 16.79% ispitanika. Polifarmacija je bila prisutna kod 75,57% ispitanika. Potencijalne interakcije bile su učestalije u grupi ispitika koji mogu obavljati uobičajene fizičke aktivnosti bez ogranicečnja ili uz blaga ograničenja (HAQ-DI < 1,5), dok je prisustvo jedne ozbiljne potencijalne interakcije bilo izraženije u grupi ispitanka sa smanjenom funkcionalnom sposobnošću (HAQ-DI ≥ 1,5).

Rezultati spovedenog istraživanja pokazuju veliku učestalost polifarmacije i posledničnih potencijalnih interakcija lekova kod bolesnika sa RA. U skladu sa tim, praćenje polifarmacije kod bolesnika koji boluju od RA neophodno je u cilju postizanja optimalnog funkcionalnog statusa, kontrole bolesti, minimiziranja interakcija i neželjenih efekta lekova.

Biografije autora

Nikola Stefanović, Univerzitet u Nišu, Medicinski fakultet, Departman za farmaciju, Niš, Srbija

Katedra Farmacija, UNO Farmakokinetika i klinička farmacija, docent

Valentina Gocić, Univerzitet u Nišu, Medicinski fakultet, Niš, Srbija

Istraživač pripravnik

Katarina Ilić, Univerzitet u Nišu, Medicinski fakultet, Niš, Srbija

istraživač pripravnik

Ivana Damnjanović, Univerzitet u Nišu, Medicinski fakultet, Departman za farmaciju, Niš, Srbija

Katedra Farmacija, UNO Farmakokinetika i klinička farmacija, docent

Reference

800x600

Normal

0

false

EN-US

X-NONE

DefSemiHidden="false" DefQFormat="false" DefPriority="99"

LatentStyleCount="371">

UnhideWhenUsed="true" QFormat="true" Name="heading 2"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 3"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 4"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 5"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 6"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 7"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 8"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 9"/>

Name="index 1"/>

Name="index 2"/>

Name="index 3"/>

Name="index 4"/>

Name="index 5"/>

Name="index 6"/>

Name="index 7"/>

Name="index 8"/>

Name="index 9"/>

UnhideWhenUsed="true" Name="toc 1"/>

UnhideWhenUsed="true" Name="toc 2"/>

UnhideWhenUsed="true" Name="toc 3"/>

UnhideWhenUsed="true" Name="toc 4"/>

UnhideWhenUsed="true" Name="toc 5"/>

UnhideWhenUsed="true" Name="toc 6"/>

UnhideWhenUsed="true" Name="toc 7"/>

UnhideWhenUsed="true" Name="toc 8"/>

UnhideWhenUsed="true" Name="toc 9"/>

Name="Normal Indent"/>

Name="footnote text"/>

Name="annotation text"/>

Name="header"/>

Name="footer"/>

Name="index heading"/>

UnhideWhenUsed="true" QFormat="true" Name="caption"/>

Name="table of figures"/>

Name="envelope address"/>

Name="envelope return"/>

Name="footnote reference"/>

Name="annotation reference"/>

Name="line number"/>

Name="page number"/>

Name="endnote reference"/>

Name="endnote text"/>

Name="table of authorities"/>

Name="macro"/>

Name="toa heading"/>

Name="List"/>

Name="List Bullet"/>

Name="List Number"/>

Name="List 2"/>

Name="List 3"/>

Name="List 4"/>

Name="List 5"/>

Name="List Bullet 2"/>

Name="List Bullet 3"/>

Name="List Bullet 4"/>

Name="List Bullet 5"/>

Name="List Number 2"/>

Name="List Number 3"/>

Name="List Number 4"/>

Name="List Number 5"/>

Name="Closing"/>

Name="Signature"/>

UnhideWhenUsed="true" Name="Default Paragraph Font"/>

Name="Body Text"/>

Name="Body Text Indent"/>

Name="List Continue"/>

Name="List Continue 2"/>

Name="List Continue 3"/>

Name="List Continue 4"/>

Name="List Continue 5"/>

Name="Message Header"/>

Name="Salutation"/>

Name="Date"/>

Name="Body Text First Indent"/>

Name="Body Text First Indent 2"/>

Name="Note Heading"/>

Name="Body Text 2"/>

Name="Body Text 3"/>

Name="Body Text Indent 2"/>

Name="Body Text Indent 3"/>

Name="Block Text"/>

Name="Hyperlink"/>

Name="FollowedHyperlink"/>

Name="Document Map"/>

Name="Plain Text"/>

Name="E-mail Signature"/>

Name="HTML Top of Form"/>

Name="HTML Bottom of Form"/>

Name="Normal (Web)"/>

Name="HTML Acronym"/>

Name="HTML Address"/>

Name="HTML Cite"/>

Name="HTML Code"/>

Name="HTML Definition"/>

Name="HTML Keyboard"/>

Name="HTML Preformatted"/>

Name="HTML Sample"/>

Name="HTML Typewriter"/>

Name="HTML Variable"/>

Name="Normal Table"/>

Name="annotation subject"/>

Name="No List"/>

Name="Outline List 1"/>

Name="Outline List 2"/>

Name="Outline List 3"/>

Name="Table Simple 1"/>

Name="Table Simple 2"/>

Name="Table Simple 3"/>

Name="Table Classic 1"/>

Name="Table Classic 2"/>

Name="Table Classic 3"/>

Name="Table Classic 4"/>

Name="Table Colorful 1"/>

Name="Table Colorful 2"/>

Name="Table Colorful 3"/>

Name="Table Columns 1"/>

Name="Table Columns 2"/>

Name="Table Columns 3"/>

Name="Table Columns 4"/>

Name="Table Columns 5"/>

Name="Table Grid 1"/>

Name="Table Grid 2"/>

Name="Table Grid 3"/>

Name="Table Grid 4"/>

Name="Table Grid 5"/>

Name="Table Grid 6"/>

Name="Table Grid 7"/>

Name="Table Grid 8"/>

Name="Table List 1"/>

Name="Table List 2"/>

Name="Table List 3"/>

Name="Table List 4"/>

Name="Table List 5"/>

Name="Table List 6"/>

Name="Table List 7"/>

Name="Table List 8"/>

Name="Table 3D effects 1"/>

Name="Table 3D effects 2"/>

Name="Table 3D effects 3"/>

Name="Table Contemporary"/>

Name="Table Elegant"/>

Name="Table Professional"/>

Name="Table Subtle 1"/>

Name="Table Subtle 2"/>

Name="Table Web 1"/>

Name="Table Web 2"/>

Name="Table Web 3"/>

Name="Balloon Text"/>

Name="Table Theme"/>

Name="List Paragraph"/>

Name="Intense Quote"/>

Name="Subtle Emphasis"/>

Name="Intense Emphasis"/>

Name="Subtle Reference"/>

Name="Intense Reference"/>

UnhideWhenUsed="true" Name="Bibliography"/>

UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>

Name="Grid Table 1 Light Accent 1"/>

Name="Grid Table 6 Colorful Accent 1"/>

Name="Grid Table 7 Colorful Accent 1"/>

Name="Grid Table 1 Light Accent 2"/>

Name="Grid Table 6 Colorful Accent 2"/>

Name="Grid Table 7 Colorful Accent 2"/>

Name="Grid Table 1 Light Accent 3"/>

Name="Grid Table 6 Colorful Accent 3"/>

Name="Grid Table 7 Colorful Accent 3"/>

Name="Grid Table 1 Light Accent 4"/>

Name="Grid Table 6 Colorful Accent 4"/>

Name="Grid Table 7 Colorful Accent 4"/>

Name="Grid Table 1 Light Accent 5"/>

Name="Grid Table 6 Colorful Accent 5"/>

Name="Grid Table 7 Colorful Accent 5"/>

Name="Grid Table 1 Light Accent 6"/>

Name="Grid Table 6 Colorful Accent 6"/>

Name="Grid Table 7 Colorful Accent 6"/>

Name="List Table 1 Light Accent 1"/>

Name="List Table 6 Colorful Accent 1"/>

Name="List Table 7 Colorful Accent 1"/>

Name="List Table 1 Light Accent 2"/>

Name="List Table 6 Colorful Accent 2"/>

Name="List Table 7 Colorful Accent 2"/>

Name="List Table 1 Light Accent 3"/>

Name="List Table 6 Colorful Accent 3"/>

Name="List Table 7 Colorful Accent 3"/>

Name="List Table 1 Light Accent 4"/>

Name="List Table 6 Colorful Accent 4"/>

Name="List Table 7 Colorful Accent 4"/>

Name="List Table 1 Light Accent 5"/>

Name="List Table 6 Colorful Accent 5"/>

Name="List Table 7 Colorful Accent 5"/>

Name="List Table 1 Light Accent 6"/>

Name="List Table 6 Colorful Accent 6"/>

Name="List Table 7 Colorful Accent 6"/>

/* Style Definitions */

table.MsoNormalTable

{mso-style-name:"Table Normal";

mso-tstyle-rowband-size:0;

mso-tstyle-colband-size:0;

mso-style-noshow:yes;

mso-style-priority:99;

mso-style-parent:"";

mso-padding-alt:0in 5.4pt 0in 5.4pt;

mso-para-margin:0in;

mso-para-margin-bottom:.0001pt;

mso-pagination:widow-orphan;

font-size:10.0pt;

font-family:"Times New Roman","serif";}

Normal

0

false

EN-US

X-NONE

DefSemiHidden="false" DefQFormat="false" DefPriority="99"

LatentStyleCount="371">

UnhideWhenUsed="true" QFormat="true" Name="heading 2"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 3"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 4"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 5"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 6"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 7"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 8"/>

UnhideWhenUsed="true" QFormat="true" Name="heading 9"/>

Name="index 1"/>

Name="index 2"/>

Name="index 3"/>

Name="index 4"/>

Name="index 5"/>

Name="index 6"/>

Name="index 7"/>

Name="index 8"/>

Name="index 9"/>

UnhideWhenUsed="true" Name="toc 1"/>

UnhideWhenUsed="true" Name="toc 2"/>

UnhideWhenUsed="true" Name="toc 3"/>

UnhideWhenUsed="true" Name="toc 4"/>

UnhideWhenUsed="true" Name="toc 5"/>

UnhideWhenUsed="true" Name="toc 6"/>

UnhideWhenUsed="true" Name="toc 7"/>

UnhideWhenUsed="true" Name="toc 8"/>

UnhideWhenUsed="true" Name="toc 9"/>

Name="Normal Indent"/>

Name="footnote text"/>

Name="annotation text"/>

Name="header"/>

Name="footer"/>

Name="index heading"/>

UnhideWhenUsed="true" QFormat="true" Name="caption"/>

Name="table of figures"/>

Name="envelope address"/>

Name="envelope return"/>

Name="footnote reference"/>

Name="annotation reference"/>

Name="line number"/>

Name="page number"/>

Name="endnote reference"/>

Name="endnote text"/>

Name="table of authorities"/>

Name="macro"/>

Name="toa heading"/>

Name="List"/>

Name="List Bullet"/>

Name="List Number"/>

Name="List 2"/>

Name="List 3"/>

Name="List 4"/>

Name="List 5"/>

Name="List Bullet 2"/>

Name="List Bullet 3"/>

Name="List Bullet 4"/>

Name="List Bullet 5"/>

Name="List Number 2"/>

Name="List Number 3"/>

Name="List Number 4"/>

Name="List Number 5"/>

Name="Closing"/>

Name="Signature"/>

UnhideWhenUsed="true" Name="Default Paragraph Font"/>

Name="Body Text"/>

Name="Body Text Indent"/>

Name="List Continue"/>

Name="List Continue 2"/>

Name="List Continue 3"/>

Name="List Continue 4"/>

Name="List Continue 5"/>

Name="Message Header"/>

Name="Salutation"/>

Name="Date"/>

Name="Body Text First Indent"/>

Name="Body Text First Indent 2"/>

Name="Note Heading"/>

Name="Body Text 2"/>

Name="Body Text 3"/>

Name="Body Text Indent 2"/>

Name="Body Text Indent 3"/>

Name="Block Text"/>

Name="Hyperlink"/>

Name="FollowedHyperlink"/>

Name="Document Map"/>

Name="Plain Text"/>

Name="E-mail Signature"/>

Name="HTML Top of Form"/>

Name="HTML Bottom of Form"/>

Name="Normal (Web)"/>

Name="HTML Acronym"/>

Name="HTML Address"/>

Name="HTML Cite"/>

Name="HTML Code"/>

Name="HTML Definition"/>

Name="HTML Keyboard"/>

Name="HTML Preformatted"/>

Name="HTML Sample"/>

Name="HTML Typewriter"/>

Name="HTML Variable"/>

Name="Normal Table"/>

Name="annotation subject"/>

Name="No List"/>

Name="Outline List 1"/>

Name="Outline List 2"/>

Name="Outline List 3"/>

Name="Table Simple 1"/>

Name="Table Simple 2"/>

Name="Table Simple 3"/>

Name="Table Classic 1"/>

Name="Table Classic 2"/>

Name="Table Classic 3"/>

Name="Table Classic 4"/>

Name="Table Colorful 1"/>

Name="Table Colorful 2"/>

Name="Table Colorful 3"/>

Name="Table Columns 1"/>

Name="Table Columns 2"/>

Name="Table Columns 3"/>

Name="Table Columns 4"/>

Name="Table Columns 5"/>

Name="Table Grid 1"/>

Name="Table Grid 2"/>

Name="Table Grid 3"/>

Name="Table Grid 4"/>

Name="Table Grid 5"/>

Name="Table Grid 6"/>

Name="Table Grid 7"/>

Name="Table Grid 8"/>

Name="Table List 1"/>

Name="Table List 2"/>

Name="Table List 3"/>

Name="Table List 4"/>

Name="Table List 5"/>

Name="Table List 6"/>

Name="Table List 7"/>

Name="Table List 8"/>

Name="Table 3D effects 1"/>

Name="Table 3D effects 2"/>

Name="Table 3D effects 3"/>

Name="Table Contemporary"/>

Name="Table Elegant"/>

Name="Table Professional"/>

Name="Table Subtle 1"/>

Name="Table Subtle 2"/>

Name="Table Web 1"/>

Name="Table Web 2"/>

Name="Table Web 3"/>

Name="Balloon Text"/>

Name="Table Theme"/>

Name="List Paragraph"/>

Name="Intense Quote"/>

Name="Subtle Emphasis"/>

Name="Intense Emphasis"/>

Name="Subtle Reference"/>

Name="Intense Reference"/>

UnhideWhenUsed="true" Name="Bibliography"/>

UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>

Name="Grid Table 1 Light Accent 1"/>

Name="Grid Table 6 Colorful Accent 1"/>

Name="Grid Table 7 Colorful Accent 1"/>

Name="Grid Table 1 Light Accent 2"/>

Name="Grid Table 6 Colorful Accent 2"/>

Name="Grid Table 7 Colorful Accent 2"/>

Name="Grid Table 1 Light Accent 3"/>

Name="Grid Table 6 Colorful Accent 3"/>

Name="Grid Table 7 Colorful Accent 3"/>

Name="Grid Table 1 Light Accent 4"/>

Name="Grid Table 6 Colorful Accent 4"/>

Name="Grid Table 7 Colorful Accent 4"/>

Name="Grid Table 1 Light Accent 5"/>

Name="Grid Table 6 Colorful Accent 5"/>

Name="Grid Table 7 Colorful Accent 5"/>

Name="Grid Table 1 Light Accent 6"/>

Name="Grid Table 6 Colorful Accent 6"/>

Name="Grid Table 7 Colorful Accent 6"/>

Name="List Table 1 Light Accent 1"/>

Name="List Table 6 Colorful Accent 1"/>

Name="List Table 7 Colorful Accent 1"/>

Name="List Table 1 Light Accent 2"/>

Name="List Table 6 Colorful Accent 2"/>

Name="List Table 7 Colorful Accent 2"/>

Name="List Table 1 Light Accent 3"/>

Name="List Table 6 Colorful Accent 3"/>

Name="List Table 7 Colorful Accent 3"/>

Name="List Table 1 Light Accent 4"/>

Name="List Table 6 Colorful Accent 4"/>

Name="List Table 7 Colorful Accent 4"/>

Name="List Table 1 Light Accent 5"/>

Name="List Table 6 Colorful Accent 5"/>

Name="List Table 7 Colorful Accent 5"/>

Name="List Table 1 Light Accent 6"/>

Name="List Table 6 Colorful Accent 6"/>

Name="List Table 7 Colorful Accent 6"/>

/* Style Definitions */

table.MsoNormalTable

{mso-style-name:"Table Normal";

mso-tstyle-rowband-size:0;

mso-tstyle-colband-size:0;

mso-style-noshow:yes;

mso-style-priority:99;

mso-style-parent:"";

mso-padding-alt:0in 5.4pt 0in 5.4pt;

mso-para-margin-top:0in;

mso-para-margin-right:0in;

mso-para-margin-bottom:8.0pt;

mso-para-margin-left:0in;

line-height:107%;

mso-pagination:widow-orphan;

font-size:11.0pt;

font-family:"Calibri","sans-serif";

mso-ascii-font-family:Calibri;

mso-ascii-theme-font:minor-latin;

mso-hansi-font-family:Calibri;

mso-hansi-theme-font:minor-latin;

mso-bidi-font-family:"Times New Roman";

mso-bidi-theme-font:minor-bidi;}

Bansback N, Young A, Brennan A, Dixey J: A prognostic model for functional outcome in early rheu-matoid arthritis. J Rheumatol 2006;33:150. [PubMed]

Bechman K, Clarke BD, Rutherford AI, Yates M, Nikiphorou E, Molokhia M et al. Polypharmacy is asso-ciated with treatment response and serious adverse events: results from the British Society for Rheuma-tology Biologics Register for Rheumatoid Arthritis. Rheumatology 2019;58(10):1767-76. [CrossRef] [PubMed]

Cunha-Miranda L, Santos H, Ferreira J, Coelho P, Silva C, Saraiva-Ribeiro J. Finding Rheumatoid Arthritis Impact on Life (FRAIL Study): economic burden. Acta Reumatol Port 2012;37:134-42. [PubMed]

Duerden M, Avery T, Payne R. Polypharmacy and medicines optimization: Making it safe and sound. London: The King’s Fund; 2013.

Filkova M, Carvalho J, Norton S, Scott D, Mant T, Molokhia M et al. Polypharmacy and Unplanned Hospi-talizations in Patients with Rheumatoid Arthritis. The Journal of Rheumatology 2017;44:12. [CrossRef] [PubMed]

Filkova M, Carvalho J, Norton S, Scott DL, Mant T, Cope AP et al. Polypharmacy Is a Predictor of Hospitalisation in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol 2015;67(suppl 10).

Fuchs HA, Brooks RH, Callahan LF, Pincus T. A simplified twenty-eight-joint quantitative articular index in rheumatoid arthritis. Arthritis Rheum 1989; 32:531-7. [CrossRef] [PubMed]

Gabriel SE. Why do people with rheumatoid arthritis still die prematurely? Ann Rheum Dis 2008;67 Suppl 3:iii30-4. [CrossRef] [PubMed]

Gomides AP, Alburquerque CP, Santos ABV, Amorim RBC, Bertolo MB, Junior PL et al. High Levels of Polypharmacy in Rheumatoid Arthritis—A Challenge Not Covered by Current Management Recommenda-tions: Data From a Large Real-Life Study. Journal of Pharmacy Practice 2021;34(3):365-371. [CrossRef] [PubMed]

Gülfe A, Kristensen LE, Saxne T, Jacobsson LT, Petersson IF, Geborek P. Rapid and sustained health utility gain in anti-tumour necrosis factor-treated inflammatory arthritis: observational data during 7 years in southern Sweden. Ann Rheum Dis 2010; 69:352-7. [CrossRef] [PubMed]

Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2011;25:469-83. [CrossRef] [PubMed]

Huscher D, Merkesdal S, Thiele K, Zeidler H, Schneider M, Zink A. Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany. Ann Rheum Dis 2006;65:1175-83. [CrossRef] [PubMed]

Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet 2001;358:903–11. [CrossRef] [PubMed]

Ma SN, Zaman Huri H, Yahya F. Drug-related pro-blems in patients with rheumatoid arthritis. Ther Clin Risk Manag 2019;15:505-24. [CrossRef] [PubMed]

Medication Safety in Polypharmacy. Geneva: World Health Organization; 2019 (WHO/UHC/SDS/2019.11).

Michaud K, Wallenstein G, Wolfe F. Treatment and nontreatment predictors of health assessment questionnaire disability progression in rheumatoid arthritis: a longitudinal study of 18,485 patients. Arthritis Care Res (Hoboken) 2011;63:366-72. [CrossRef] [PubMed]

Payne RA, Avery AJ. Polypharmacy: one of the greatest prescribing challenges in general practice. Br J Gen Pract 2011;61(583):83-4. [CrossRef] [PubMed]

Quinn MA, Gough AK, Green MJ, Devlin J, Hensor EMA, Greenstein A et al. Anti-CCP antibodies measu-red at disease onset help identify seronegative rheu-matoid arthritis and predict radiological and functional outcome. Rheumatology (Oxford) 2006;45:478-80. [CrossRef] [PubMed]

Rigby W, Ferraccioli G, Greenwald M, Zazueta-Montiel B, Fleischmann R, Wassenberg S, et al. Effect of rituximab on physical function and quality of life in patients with rheumatoid arthritis previously untreated with methotrexate. Arthritis Care Res 2011;63:711-20. [CrossRef] [PubMed]

Scott DL, Pugner K, Kaarela K, Doyle DV, Woolf A, Holmes J et al. The links between joint damage and disability in rheumatoid arthritis. Rheumatology (Oxford) 2000;39:122-32. [CrossRef] [PubMed]

Scott DL, Smith C, Kingsley G. What are the con-sequences of early rheumatoid arthritis for the indi-vidual? Best Pract Res Clin Rheumatol 2005;19:117-36. [CrossRef] [PubMed]

Treharne GJ, Douglas KMJ, Iwaszko J, Panoulas VF, Hale ED, Mitton DL et al. Polypharmacy among people with rheumatoid arthritis: The role of age, disease duration and comorbidity. Musculoskelet Care 2007; 5(4):175-90. [CrossRef] [PubMed]

Vetter TR. A primer on health-related quality of life in chronic pain medicine. Anesth Analg 2007;104:703-18. [CrossRef] [PubMed]

Viktil KK, Blix HS, Moger TA, Reikvam A. 30 medi-cation safety in polypharmacy References Poly-pharmacy as commonly defined is an indicator of limi-ted value in the assessment of drug-related problems. Br J Clin Pharmacol 2007;63(2):187-95. [CrossRef] [PubMed]

Wiles N, Dunn G, Barrett E, Silman A, Symmons D. Associations between demographic and disease-related variables and disability over the first five years of inflammatory polyarthritis: a longitudinal analysis using generalized estimating equations. J Clin Epidemiol 2000;53:988-96. [CrossRef] [PubMed]

UTICAJ POLIFARMACIJE NA FUNKCIONALNU SPOSOBNOST OBOLELIH OD REUMATOIDNOG ARTRITISA

Sažetak

Biografije autora

Reference