Sistemik tedavi ve biyolojik tedavi olan psoriasis hastalarında yaşam kalitesi ve iş verimliliğinin değerlendirilmesi
Assessment of quality of life and work productivity in psoriasis patients who are treated with systemic therapy and biologic therapy?
Yazar: ARTAN OSMENLLARİ
Danışman: DOÇ. DR. EROL KOÇ
GATA / Tıp Fakültesi / Deri ve Zührevi Hast. Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2012
Konu: Dermatoloji = Dermatology
Dizin: Psoriyazis = Psoriasis ; Tedavi = Treatment ; Verimlilik = Productivity ; Yaşam kalitesi = Quality of life

Özet:
Çalışmamıza Ağustos 2011 - Mayıs 2012 tarihleri arasında, Gülhane Askeri Tıp Akademisi (GATA) Tıp Fakültesi Eğitim Hastanesi Deri ve Zührevi Hastalıklar Anabilim Dalı polikliniği ve kliniğinde takip ve tedavi edilen 35 psoriasis vulgaris hastası dahil edildi.Çalışmada GATA Dermatoloji kliniğinde psoriasis vulgaris nedeniyle klasik sistemik tedavi (Metotreksat, Siklosporin, Asitretin) veya biyolojik tedavi (Etanersept, İnfliksimab, Adalimumab) alan hastaların 0., 4., 8., 12., 16. ve 24. haftalardaki PASİ ve DYKİ skorları ve ayrıca 0. ila 24. haftalardaki WPAI skorları kayıt altına alındı. 24. haftanın sonunda elde edilen değerler SPSS programı yardımıyla analiz edildi ve bu skorlardaki düzelmenin istatistiksel olarak anlamlı olup olmadığı değerlendirildi. Çalışmamızda, 11 hasta metotreksat, 4 hasta siklosporin, 4 hasta asitretin, 4 hasta etanersept, 7 hasta infliksimab ve 5 hasta adalimumab kullanmıştır. Hastalar, klasik tedavi alanlar (metotreksat, siklosporin ve asitretin) ve biyolojik tedavi alanlar (Anti-TNF; etanersept, infliksimab ve adalimumab) olarak iki gruba ayrıldı ve bu gruplar arasında istatistiki değerlendirme yapıldı. Çalışmamızda 24. hafta sonunda PASİ, DYKİ ve WPAI skoru ortalama iyileşme yüzdeleri; klasik tedavi grubunda sırasıyla 67.5, 79.4 ve 75.6; biyolojk tedavi gubunda ise sırasıyla 70.2, 76.3 ve 66 olarak bulunmuştur. Çalışmamızda sonuç olarak; klasik sistemik tedavi ve Anti-TNF tedavi alan hastaların PASİ, DYKİ ve WPAI-PSO indeksleri bakımından her grubun tedavi başlangıcına göre 24. hafta sonunda anlamlı bir iyileşme gösterdiğini, ancak klasik grup ile Anti-TNF tedavi grubu arasında istatistiksel bir fark olmadığını saptadık.Sonuç olarak çalışmamız göstermektedir ki psoriasis tedavisinde hem klasik sistemik tedaviler hem de biyolojik tedaviler, hastada sadece klinik iyileşme sağlamamakta, aynı zamanda hastanın yaşam kalitesini ve iş verimliliğini de olumlu etkilemektedir.

Abstract:
Psoriasis is a common, chronic, repetitive, inflammatory disease of the skin with unknown etiology, which is characterized with well-defined plaques covered with white pearly squamas on erythematous ground. Psoriasis has several treatment modalities either topical or systemic. Topical treatment is usually applied alone for mild cases, and for moderate or severe cases it is used in combination with systemic therapy or phototherapy. Indications of the systemic therapy includes erythrodermic psoriasis, generalized pustular psoriasis, psoriatic arthritis, and moderate-severe plaque psoriasis that causes more than 10 % decrease at quality of life which is irresponsive-incompatible to topical modalities or phototherapy. As the role of the immunology in pathophysiology of psoriasis understood better, new generation biological therapies affecting molecular mechanisms which take role at onset of psoriasis have been developed. Today, cyclosporine, methotrexate, and acitretin are used systemically; etanercept, infliximab or adalimumab are used for biologic therapy for treatment of psoriasis.Psoriasis leads to massive performance loss because of time and work loss at business and daily life as a result of either disease itself or its treatment. It?s a reality that psoriasis affects decreases quality of life and work productivity. There is no large scaled study in the literature considering how much work productivity is affected from psoriasis. Therefore, in this study we aim to detect how much work productivity is affected from psoriasis. The aim of our study is to assess quality of life and work productivity at psoriasis patients who are treated with systemic therapy and biologic therapy.35 patients who were diagnosed as psoriasis vulgaris between August 2011- May 2012 at polyclinic and clinic of Dermatology and Venerology Department of Gulhane Military Medical Academy (GMMA) were included in our study.In addition at clinic of Dermatology of GMMA to PASI and DLQI scores at 0, 4, 8, 12, 16, and 24th weeks, WPAI scores at 0th and 24th weeks of the patients who had classical systemic treatment (methotrexate, cyclosporine, acitretin) or biologic treatment (etanercept, infliximab, adalimumab) for psoriasis vulgaris were recorded in the study. The values obtained at the end of 24th week were analyzed with the help of SPSS program, and was assessed the statistical significance of the progress of these scores. In our study, 11 patients used methotrexate, 4 patients used cyclosporine, 4 patients used acitretin, 4 patients used etanercept, 7 patients used infliximab, and 5 patients used adalimumab. The patients were divided into two groups as either receiving classical therapy (methotrexate, cyclosporine, and acitretin) or receiving biologic therapy (Anti-TNF; etanercept, infliximab, and adalimumab) and was performed statistical evaluation between these groups. In our study, at the end of 24th week, PASI, DLQI and WPAI scores average improvement percentages are; while in the conventional treatment group 67.5, 79.4 and 75.6 respectively; in the biological treatment group, 70.2, 76.3 and 66, respectively. As a result of our study, we detected that both two groups who received either classical systemic therapy or anti-TNF showed significant progress at 24th week compared to initiation of the therapy in terms of PASI, DLQI, and WPAI-PSO scores.Consequently, our study shows that both classical systemic therapy and biologic therapy for psoriasis treatment not only provide clinical progress, but also affect the quality of life and work productivity of the patient positively.