Uticaj izmenjenih funkcija šaka na radnu sposobnost obolelih od sistemske skleroze
Sažetak
Uvod/Cilj. Oštećenje šaka kod obolelih od sistemske skleroze (SSc) je najčešća manifestacija ovog progresivnog oboljenja i često uzrokuje probleme tokom svakodnevnih aktivnosti i radnih obaveza. Povezanost izmenjenih funkcija šaka obolelih od sistemske skleroze i njihov uticaj na radnu sposobnost nije u potpunosti objašnjen. Cilj ovog rada je da se kod obolelih od SSc ispita povezanost izmenjenih funkcija šaka sa njihovom radnom sposobnošću. Metode. Ispitano je 20 bolesnika sa SSc (17 ženskog i 3 muškog pola), prosečne starosti 45,5 ± 11,9 godina (min 29, max 69, Med 44,0 godine). Ispitana je pokretljivost prstiju, ručja i podlaktice kroz merenje aktivnog obima pokreta šake i prstiju, snaga mišića prstiju ruku, rasprostranjenost kožnih promena modifikovanim Rodnanovim kožnim skorom, funkcije prstiju, šaka i podlaktica Hand Mobility in Scleroderma (HAMIS) testom, stanje kapilara na prstima ruku kapilaroskopijom i procena radne sposobnosti primenom Work Ability Index (WAI).Rezultati. Rezultati. Smanjena mišićna snaga na bar jednom ispitivanom mišiću, utvrđena je kod svih ispitanika, zadebljanje kože na šakama kod 14/20 (70%), na prstima kod 19/20 (95%), promene kapilara “sklerodermnog tipa” kod 15/17 (85%), smanjen obim pokreta u zglobovima prstiju kod 16/20 (80%). Na probleme na poslu žalilo se 14/20 (70%) ispitanika [na smanjenje postignutog učinka (8/20) (40%), na skraćenje radnih sati, takođe, 8/20–40%, na izostavljanje nekih radnji 14/20 (70%), na ulaganje dodatnog napora 15/20 (75%)]. Procenom radne sposobnosti WAI upitnikom utvrđeno je da je radna sposobnost umanjena kod 11/20 (55%) ispitanika. U grupi najtežih slučajeva, kategoriji „loše“, tj. ispitanika gde je bila izraženo umanjena radna sposobnost, nije bilo nijednog ispitanika; u grupi koja pripada kategoriji „osrednje“ bilo ih je 6/20 (30%) i u grupi sa najmanje umanjenom radnom sposobnošću (kategorija “dobro”) 5/20 (25%) ispitanika. Nađena je statistički značajna povezanost između zadebljale kože na prstima ruku (p < 0,05), smanjene mišićne snage prstiju (p < 0,002) i ograničene pokretljivosti pojedinih zglobova prstiju (p < 0,05), sa podacima o umanjenoj radnoj sposobnosti dobijenim WAI upitnikom i sa odgovorima na pitanja o problemima na poslu. Zaključak. Zadebljala koža na prstima ruku, smanjena mišićna snaga prstiju i ograničena pokretljivost pojedinih zglobova prstiju kod bolesnika sa SSc uzrokuju smanjenje radne sposobnosti za sve poslove vezane za manuelne aktivnosti.
Reference
Varga J. Systemic Sclerosis (Scleroderma) and Related Disor-ders In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo JL, editors. Harrison’s Principles of internal medicine. 19 th ed. New York: Mc Graw Hill Education; 2015; p. 2154–66.
Young A, Namas R, Dodge C, Khana D. Hand Impairment in Systemic Sclerosis: Various Manifestations and Currently Available Treatment. Curr Treatm Opt Rheumatol 2016; 2(3): 252–69.
Takehara K, Fujimoto M, Kuwana M. Systemic Sclerosis. Tokio: Springer Japan; 2016.
Varga J, Denton CP, Wigley FM, Allanore Y, Kuwana M. Sclero-derma: From Pathogenesis to Comprehensive Management. New York: Springer; 2016.
Govedarica V. Recomendation for expertise of diminished liv-ing activities and work ability. Belgrade: Association of Medi-cal Expert Witnesses in Occupational Medicine; 2015. (Serbi-an)
Zlatanović M. Modified Rodnan skin score. Acta Rheumatolog-ica Belgradensia. 2005; (Suppl 2): 54–6. (Serbian)
Damjanov N. Systemic sclerosis: clinical types and early diag-nostic of the disease. Acta Rheumatologica Belgradensia. 2005; (Suppl 2): 44–9. (Serbian)
Ciesla N, Dinglas V, Fan E, Kho M, Kuramoto J, Needham D. Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically III Patients. J Vis Exp 2011; (50): 2632–7.
Sandquist G, Nilsson JA, Wuttge DM, Hesselstrand R. Develop-ment of a modified hand mobility in scleroderma (HAMIS) test and its potential as an outcome measure in systemic scle-rosis. J Rheumatol 2014; 41(11): 2186–92.
Ostojić P, Damjanov N. The scleroderma Assessment Question-naire (SAQ). A new self-assessment questionnaire for evalua-tion of disease status in patients with systemic sclerosis. Z Rheumatol 2006; 65(2): 168–75.
de Zwart BC, Frings-Dresen MH, van Duivenbooden JC. Test-retest reliability of the Work Ability Index questionnaire. Oc-cup Med (Lond) 2002; 52(4): 177–81.
Radkiewich P, Widerszal-Bazyl M. Psychometric properties of Work Ability Index in the light of comparative survey study. In: International Congress Series 1280. Amsterdam: Elsevier; 2005: 304–9.
El Fassi M, Bocquet V, Majery N, Lair ML, Couffignal S, Mairiaux P. Work ability assessment in a worker population: comparison and determinants of Work Ability Index and Work Ability score. BMC Public Health 2013; 13: 305.
van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclero-sis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72(11): 1747–55.
Schieir O, Thombs BD, Hudson M, Boivin JF, Steele R, Bernatsky S, et al. Prevalence, severity, and clinical correlates of pain in patients with systemic sclerosis. Arthritis Care Res (Hoboken) 2010; 62(3): 409–17.
Racine M, Hudson M, Baron M, Nielson WR; Canadian Scleroder-ma Research Group. The Impact of Pain and Itch on Function-ing and Health-Related Quality of Life in Systemic Sclerosis: An Exploratory Study. J Pain Symptom Manage 2016; 52(1): 43–53.
Stisi S, Sarzi-Puttini P, Benucci M, Biasi G, Bellissimo S, Talotta R, et al. Pain in systemic sclerosis. Reumatismo. 2014; 66(1): 44–7.
Clements P. Management of Musculoskeletal Involvement in Systemic Sclerosis. Curr Treat Options Rheum 2016; 2(1): 61–8.
Ziemek J, Man A, Hinchcliff M, Varga J, Simms RW, Lafyatis R. The relationship between skin symptoms and the scleroderma modification of the health assessment questionnaire, the mod-ified Rodnan skin score and skin pathology in patients with systemic sclerosis. Rheumatology (Oxford) 2016; 55(5): 911–7.
Sawy NE, Suliman I, Nouh M, Naguib A. Hand function in sys-temic sclerosis: A clinical and ultrasonographic study. Egypt Rheumatol 2012; 34(4): 167–78.
Souza EJ, Kayser C. Nailfold capillaroscopy: relevance to the practice of rheumatology. Rev Bras Reumatol 2015; 55(3): 264–71. (Portuguese)
Pavlov-Dolijanović S, Damjanov N, Vujasinović Stupar NZ, Baltić S, Babić DD. The value of pattern capillary changes and antibod-ies to predict the development of systemic sclerosis in patients with primary Raynaud's phenomenon. Rheumatol Int 2013; 33(12): 2967–73.
Pavlov-Dolijanović S, Damjanov N. The importance of capillaros-copy in early detection of systemic sclerosis. Acta Rheumato-logica Belgradensia 2005; (Suppl 2): 50–4. (Serbian)
Wigley FM, Flavahan NA. Raynaud’s Phenomenon. N Engl J Med 2016; 375(6): 556–65.
Koenig M, Joyal F, Fritzler MJ, Roussin A, Abrahamowicz M, Boire G, et al. Autoantibodies and Microvascular Damage are Inde-pendent Predictive Factors for the Progression of Raynaud’s Phenomenon to Systemic Sclerosis. Arthritis Rheum 2008; 58(12): 3902–12.
Silva I, Almeida J, Vasconcelos C. A PRISMA-driven systematic review for predictive risk factors of digital ulcers in systemic sclerosis patients. Autoimmun Rev 2015; 14(2): 140–52.
Mouthon L, Carpentier PH, Lok C, Clerson P, Gressin V, Ha-chulla E, et al. Ischemic digital ulcers affect hand disability and pain in systemic sclerosis. J Rheumatol 2014; 41(7): 1317–23.
García de la Peña Lefebvre P, Nishishinya MB, Pereda CA, Loza E, Sifuentes Giraldo WA, Román Ivorra JA, et al. Efficacy of Raynaud’s phenomenon and digital ulcer pharmacological treatment in systemic sclerosis patients: a systematic literature review. Rheumatol Int 2015; 35(9): 1447–59.
Khimidas S, Harding S, Bonner A, Zummer B, Baron M, Pope J. Associations with digital ulcers in a large cohort of systemic sclerosis: results from the Canadian Scleroderma Research Group registry. Arthritis Care Res (Hoboken) 2011; 63(1): 142–9.
Lóránd V, Czirják L, Minier T. Musculoskeletal involvement in systemic sclerosis. Presse Med 2014; 43(10 Pt 2): e315–28.
Morrisroe KB, Nikpour M, Proudman SM. Musculoskeletal mani-festations of systemic sclerosis. Rheum Dis Clin North Am 2015; 41(3): 507–18.
Pelrine ER, Ah-Kioon MD, Zhang M, Barrat FJ, Spiera RF, Gor-don JK. Musculoskeletal Involvement in SSc Is Associated with Worse Scores on Short Form-36 and Scleroderma Health As-sessment Questionnaire and Lower Tumor Necrosis Factor-α Gene Expression in Peripheral Blood Mononuclear Cells. HSS J 2016; 12(3): 255–60.
Freire V, Bazeli R, Elhai M, Campagna R, Pessis É, Avouac J, et al. Hand and wrist involvement in systemic sclerosis: US fea-tures. Radiology 2013; 269(3): 824–30.
Avouac J, Walker UA, Hachulla E, Riemekasten G, Cuomo G, Carreira PE, et al. Joint and tendon involvement predict dis-ease progression in systemic sclerosis: a EUSTAR prospective study. Ann Rheum Dis 2016; 75(1): 103–9.
Balint Z, Farkas H, Farkas N, Minier T, Kumanovics G, Horvath K, et al. A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis. Clin Exp Rheumatol 2014; 32(6 Suppl 86): S68–74.
Tuomi K, Illmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work abillity index. 2nd ed. Helsinki: Finish Insitute of Occupational Health; 1998.
ven den Berg TI, Elders LA, de Zwart BC, Burdorf A. The effects of work-related and individual factors on the Work Ability Index: a systematic review. Occup Environ Med 2009; 66(4): 211–20.
Tengland PA. The concept of work ability. J Occup Rehabil 2011; 21(2): 275–85.
Illmarinen J, Tuomi K. Past, present and future of work ability. In: Illmarinen J, Lehtinen S, editors. People and Work, Research Reports. Helsinki: Finish Institute of Occupational Health 2004; 65: 1–25.
Illmarinen J. The aging workforce- challenges for occupational health. Occup Med (Lond) 2006; 56(6): 362–4.
Sandquist G, Scheja A, Hesselstrand R. Pain, fatigue and hand function closely correlated to work ability and employment status in systemic sclerosis. Rheumatology 2010; 49(9): 1739–46.