KRITERIJI ZA OCJENU RADNE SPOSOBNOSTI U REUMATOIDNOM ARTRITISU
Kapidžić-Bašić N. 1, Selesković H. 2 .
1 Reumatološko odjeljenje Klinike za fizikalnu medicinu i rehabilitaciju, UKC Tuzla
2 Klinika za Interne bolesti, UKC Tuzla, Bosna i Hercegovina

Bolesnici sa reumatoidnim artritisom (RA) su prema našim podacima češće privremeno ili trajno nesposobni za posao, nego u drugim sredinama, kako se to vidi iz dostupnih podataka u literaturi. Mogući uzroci su ograničene mogućnosti primjene moderne terpije što rezultira težim kliničkim tokom bolesti, kao i neujednačeni kriteriji ljekara za ocjenu radne sposobnosti.

CILJ: Cilj rada je evaluacija metoda za procjenu aktivnosti bolesti i funkcionalnog stanja bolesnika i prijedlog kriterija za sigurniju procjenu radne nesposobnosti bolesnika sa RA.

MATERIJAL I METODE: Za formiranje prijedloga kriterija korišteni su parametri iz vlastitih istraživanja, dopunjeni prijedlozima vrhunskih svjetskih institucija (OMERACT, EULAR) , a koji su prilagođeni za korištenje u svakodnevnoj praksi.

REZULTATI: Za procjenu radne sposobnosti bolesnika sa RA neophodni su: klinički pregled, osnovni laboratorijski nalazi (reaktanti akutne faze): SE, CRP i fibrinogen i radiografija šaka i stopala. Klinički pregled treba sadržavati: trajanje jutarnje ukočenosti, ocjenu bola, Ritchie artikularni indeks, broj bolnih i otečenih zglobova, ocjena funkcionalne sposobnosti mjerena nekim široko prihvaćenim testom (predlažemo HAQ) i indeks pokretljivosti zglobova. Dokazano je da za ocjenu visoke aktivnosti bolesti nije dovoljna samo visoka SE nego i drugi reaktanti akutne faze. Radiografske promjene treba ocjenjivati metodama pomoću kojih se mogu što jednostavnije kvantificirati promjene na zglobovima i pratiti njihova progresija (Larsen ili SES). Iz ovih parametara treba izračunati "skor aktivnosti bolesti"-DAS (Disease Activity Score) kojim se daje ljekarska ocjena trenutnog stanja bolesti. Važno je uzeti u obzir i ocjenu bolesnika o trenutnom stanju bolesti. Ako se mišljenja ljekara i bolesnika značajno razilaze, treba uzeti u obzir i psihičko stanje bolesnika (prisustvo depresije npr.) koje utiče na smanjenu radnu sposobnost.

ZAKLJUČAK: Pravilna procjena trenutne aktivnosti bolesti i praćenje njene progresije pomoću predloženih instrumenata je neophodna za usaglašavanje kriterija za ocjenu radne sposobnosti. Ona treba da olakša rad ljekaru u primarnoj zaštiti i medicini rada, i omogući donošenje što realnije ocjene privremene ili trajne radne nesposobnosti.

CRITERIA FOR EVALUATION OF WORKING ABILITY IN RHEUMATOID ARTHRITIS
Kapidžić-Bašić N 1, Selesković H 2.
1 Department of Rheumatology of the Clinic for Physical Medicine and Rehabilitation of the UKC Tuzla
2 Clinic for the Internal Medicine of the UKC Tuzla, Tuzla, Bosnia and Herzegovina

According to our information, patients with rheumatoid arthritis (RA) are often temporarily or permanently disabled to work than in other countries as it can be seen from available data in literature. Possible causes for that are limited possibilities of application of modern therapy, which result in severer clinical course of the disease, as well as of the different criteria of the physicians for the evaluation of the working ability.

AIM: The aim of this work was to evaluate methods for assessment of the activity of disease and functional condition of patients and to propose criteria for most certain assessment of working disability of patients with RA.

MATERIAL AND METHODS: For the purpose of forming the proposal of criteria, parameters from our own research complemented by the proposals of the top world's institutions (OMERACT, EULAR) are used.

RESULTS: In order to asses working ability one needs: clinical examination, main lab findings (reactants of acute phase): ESR, CRP, and fibrinogen, rtg of the hand and feet. Clinical examination needs to consist of the evaluation of the morning stiffness, evaluation of pain, Ritchie articulate index, the number of the painful and swelled joints, evaluation of the functional ability measured by HAQ and index of the joint motion. It is proven that for the evaluation of high activity of the disease not only accelerated ESR but also other reactants of acute phase are needed. Radiographic changes need to be evaluated with methods by which one could easily quantified changes on the joints and analyze their progression (Larsen or SES). Out of these parameters one should calculate Disease Activity Score which is used for the physicians' evaluation of the immediate state of the disease. If the opinions of the physician and the patient significantly differ one should consider the mental condition of the patient (presence of depression) that influences the working ability of the patient.

CONCLUSION: The appropriate evaluation of the immediate disease activity and follow up of its progression with the usage of the proposed instruments is necessary for co-ordination of criteria for the assessment of the working ability. It should help primary care physician and occupational medicine physician to evaluate temporary and permanent working disability.