Objectives: Rheumatoid arthritis (RA) affects patients' capacity to work. The Rheumatoid Arthritis Work Instability Scale (RA-WIS) is a reliable method to measure work instability (WI) (1-3). We lack data on the relationship between RA and work instability among Polish patients. Our study aimed to assess WI and associated factors among patients with RA. Material and methods: The authors conducted a multi-centre cross-sectional observational study. 315 patients from three rheumatology centres were enrolled and filled in questionnaires, including demographic and self-reported clinical data, RA-WIS, and the Health Assessment Questionnaire (HAQ). Swollen and tender joint counts (SJC, TJC) were assessed by the attending physician, and current erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. We excluded 41 patients due to an incorrectly filled in form and analysed questionnaires of 274 patients. DAS28 (Disease Activity Score in 28 joints) and DAS28-CRP were calculated. We performed statistical analysis with Statistica v. 13.3 using the Mann-Whitney U test, χ 2 test, and Spearman's correlation. Results: 140 (51%) patients were currently employed and their characteristics were analysed. In univariable analysis we identified the following risk factors for high risk WI: moderate-to-high disease activity (DAS28 ≥ 3.2-OR 2.29, 95% CI 1.06-4.96, p = 0.033; DAS28-CRP ≥ 3.2-OR 2.34, 95% CI 1.04-5.27, p = 0.038), ESR ≥ 30 mm/h in women and ≥ 20 mm/h in men (OR 2.65, 95% CI 1.20-5.89, p = 0.010), CRP ≥ 1 mg/dl (OR 4.02, 95% CI 1.78-9.10, p < 0.001), HAQ-DI > 1.0 (OR 2.23, 95% CI 1.04-4.81, p = 0.037) and at least moderate pain on the visual analogue scale (VAS p ≥ 4.5 cm-OR 5.31, 95% CI 2.36-11.96, p < 0.001). Correlations were moderate between RA-WIS and VASp (RS = 0.59, p < 0.001) and HAQ-DI (RS = 0.52, p < 0.001) but weak with disease activity indices (DAS28 [RS = 0.31, p < 0.001]; DAS28-CRP [RS = 0.28, p < 0.001]). Conclusions: Pain and disability are the main factors strongly associated with work instability among patients with RA.
Background:Rheumatoid arthritis (RA) affects patients’ capacity to work. Rheumatoid Arthritis Work Instability Scale (RA-WIS) is a reliable method to measure work instability (WI) (1–3). We lack data on relationship between RA and work instability among Polish patients.Objectives:The aim of our study was to assess WI and associated factors among patients with RA.Methods:315 patients from three rheumatology centres were enrolled and filled questionnaires including demographic and self-reported clinical data, RA-WIS, and The Health Assessment Questionnaire (HAQ). Swollen and tender joints count (SJC, TJC) were assessed by attending physician and current erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. We excluded 41 patients due to incorrectly filled form and analysed questionnaires of 274 patients. DAS28 (Disease Activity Score in 28 joints) and DAS28-CRP were calculated. We performed statistical analysis with Statistica v. 13.3 using Mann-Whitney U test, chi-square test and Spearman’s correlationResults:140 (51 %) patients were employed and their characteristics are presented on Table 1. In univariable analysis we identified following risk factors for high risk WI: moderate-to-high disease activity (DAS28≥3.2 – OR 2.29, 95%CI 1.06-4.96, p=0.033; DAS28-CRP≥3.2 – OR 2.34, 95%CI 1.04-5.27, p=0.038), ESR ≥30 mm/h in women and ≥20 mm/h in men (OR 2.65, 95%CI 1.20-5.89, p=0.010), CRP≥1mg/dL (OR 4.02, 95%CI 1.78-9.10 p<0.001), HAQ-DI>1.0 (OR 2.23, 95%CI 1.04-4.81, p=0.037) and at least moderate pain on visual analogue scale (VASp ≥4.5 cm - OR 5.31, 95%CI 2.36-11.96, p<0.001). Correlations were moderate between RA-WIS and VASp (RS=0.59, p<0.001) and HAQ-DI (RS=0.52, p<0.001) whereas weak with disease activity indices (DAS28 - RS=0.31, p<0.001; DAS28-CRP - RS=0.28, p<0.001).Table 1.Demographic and clinical characteristics of employed patients according to work instability risk, N(%) or mean(±SD).CharacteristicRA-WIS scorelow-to-moderate (0-17)high (>17)Patients94 (67.1%)46 (32.9%)Sex, female73 (77.7%)38 (82.6%)Age (years)47.9 (±11.8)50.4 (±9.3)Disease duration (years)13.0 (±8.4)14.0 (±8.7)RF, positive68 (72.3%)34 (73.9%)ACPA, positive59 (62.8%)29 (63.0%)ESR (mm/h)18.3 (±16.0)28.2 (± 21.9)*CRP (mg/dL)0.6 (± 1.0)1.1 (± 1.0)*TJC4.5 (±4.0)7.6(±6.3)*SJC2.7 (±3.0)5.2(±5.5)*HAQ-DI0.7 (±0.5)1.1 (±0.5)*pain - VAS 10 cm3.9 (±1.9)6.5 (± 2.2)*DAS283.5 (±1.2)4.2 (±1.4)*DAS28-CRP3.9 (±1.0)4.3 (±1.2)*WI – work instability, RA-WIS – Rheumatoid Arthritis Work Instability Scale, RF – rheumatoid factor in IgM class, ACPA – anti-citrullinated protein antibodies, ESR – erythrocyte sedimentation rate, CRP – C-reactive protein, TJC – tender joints count, SJC – swollen joints count, HAQ-DI – Heath Assessment Questionnaire Disability Index, VAS – visual analogue scale, DAS28 – Disease Activity Score in 28 joints*p<0.05, Mann-Whitney U testConclusion:Pain and disability are main factors associated with work instability among patients with RA.References:[1]Gilworth G, Chamberlain MA, Harvey A, Woodhouse A, Smith J, Smyth MG, et al. Development of a work instability scale for rheumatoid arthritis. Arthritis Rheum. 2003;49(3):349–54.[2]Gilworth G, Emery P, Gossec L, Vlieland TPMV, Breedveld FC, Hueber AJ, et al. Adaptation and cross-cultural validation of the rheumatoid arthritis work instability scale (RA–WIS). Ann Rheum Dis. 2009;68(11):1686–90.[3]Revicki D, Ganguli A, Kimel M, Roy S, Chen N, Safikhani S, et al. Reliability and Validity of the Work Instability Scale for Rheumatoid Arthritis. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2015;18(8):1008–15.Disclosure of Interests:None declared
Bladder cancer is one of the most common cancers in global statistics. One of the issues associated with this disease is the high incidence of cases with delayed diagnosis and what factors correlate with worse treatment outcomes. A possible reason for this may be the rather limited availability of non-invasive diagnostic tools. This short communication presents a case of a 68 year old male patient after an ineffective therapy, carried on for several years with symptoms commonly associated with prostate overgrowth that masked a carcinoma in situ of the urinary bladder. Implementation of several diagnostic techniques, including urine sediment cytology, immunocytochemistry, the fluorescence in situ hybridisation technique, the Bladder EpiCheck test and whole-genome sequencing, enabled the establishment of a correct diagnosis, implementation of appropriate treatment and provision of patient-friendly monitoring. The described case emphasises the usefulness of cell-based and liquid-based urine tests in bladder cancer diagnostic procedures.
INTRODUCTION. The human papilloma virus (HPV) belongs to double-stranded, DNA circular viruses which infect the epithelial cells. The highest incidence of HPV is identified in malignant processes which affect the uterine cervix, as well as vulvar, penile, rectal and pharyngeal regions. GOAL OF STUDY. An attempt to find correlations between HPV incidence rates in urine sediment cells and in desquamated epithelial cells of the uterine cervix in a group of patients with frequent, recurrent cystitis. MATERIALS AND METHODS. HPV presence was studied, both in urine sediment cells and in uterine cervix epithelial cells of 77 patients.RESULTS. An analysis of urinary sediments brought a total of twenty (25.97%) positive and 57 (74.03%) negative results. In turn, an evaluation of uterine cervix material samples revealed 17 (22.08%) positive and 60 (77.92%) negative results. CONCLUSIONS. The study enabled a comparison between HPV prevalence rates in urine sediment cells and in uterine cervix epithelial cells of an examined patient. The performed observations are likely to trigger a further analysis of the studied issue; however, the obtained results provide arguments for different natural histories of the infection processes. STRESZCZENIEWSTĘP. W przypadku raka urotelialnego jednym z potencjalnych czynników rakotwórczych jest wirus brodawczaka ludzkiego (HPV). Ludzki wirus brodawczaka należy do dwuniciowych wirusów DNA infekujących komórki nabłonka. Największa częstość występowania HPV stwierdzono w złośliwych procesach, które mają wpływ na szyjkę macicy, a także na okolice sromu, prącia, odbytnicy oraz gardła. CEL PRACY. Celem podjętych badań była próba znalezienia korelacji między częstością występowania HPV w komórkach osadu moczu a złuszczonymi komórkami nabłonka szyjki macicy w grupie pacjentów z częstym, nawracającym zapaleniem pęcherza. MATERIAŁ I METODY. Obecność wirusa HPV badano zarówno w komórkach osadu moczu, jak również w komórkach nabłonka szyjki macicy u 77 pacjentów. WYNIKI. Analiza osadów moczowych dała łącznie dwadzieścia (25,97%) pozytywnych i 57 (74,03%) negatywnych wyników. Z kolei ocena próbek pochodzących z macicy wykazała 17 dodatnich wyników (22,08%) i 60 (77,92%) negatywnych wyników.
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