Fibromiyalji sendromunda kemik mineral yoğunluğu değerlerinin ağrı, depresyon ve yaşam kalitesi üzerine
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Dosyalar
Tarih
2016
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda fibromiyalji tanısı olan ve olmayan premenapozal kadın hastaların kemik mineral dansitesinin ağrı, depresyon ve yaşam kalitesi üzerine etkilerinin karşılaştırılması ile fibromiyalji sendromunda (FMS) yaşam kalitesine etki eden faktörlerin belirlenmesi amaçlanmıştır. Gereç ve yöntem: Vaka-kontrol tipindeki bu çalışmaya Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Fizik Tedavi ve Rehabilitasyon Polikliniklerinde American Collage of Rheumatology (ACR) 1990 kriterlerine göre FMS tanısı almış 100 premenapozal kadın ve Aile Hekimliği Polikliniğine herhangi bir sebeple başvurmuş FMS tanısı almamış, şikâyeti olmayan 100 premenapozal kadın alınmıştır. Hastalarla ile ilgili verilerin toplanmasında araştırmacıların literatür doğrultusunda geliştirdikleri sosyodemografik özellikleri belirleyen bir anket formu, Vizüel Analog Skalası (VAS), Fibromiyalji Etki Anketi (FEA), Hastane Anksiyete ve Depresyon Ölçeği (HADÖ) kullanılmıştır. Anketler araştırmacı tarafından yüz yüze görüşme tekniği ile doldurulmuştur. Yüz (100) FMS'li hasta ve 100 sağlıklı kadının kemik mineral yoğunluğu değerleri, DXA yöntemi ile ölçülmüştür. Frekanslar, ortalama, standart sapma, ortanca, minimum ve maksimum değerler, Odds ratioları hesaplandı. Sonuçlar % 95'lik güven aralığında, anlamlılık p<0.05 düzeyinde değerlendirildi. Bulgular: Çalışmamıza katılan FMS'li hastaların yaş ortalaması 43,06±7,57 yıl (min:23- max:55) bulundu. Eğitim düzeyi düşük olan kadınların fibromiyalji olma riski eğitim düzeyi yüksek olanlardan 3,9 kat daha fazla idi [OR=3,973, %95 CI(2,203-7,165)]. Düşük eğitim düzeyi ile FMS arasında anlamlı bir ilişki vardı (p<0,001 ). Çalışmayan kadınlarda (ev hanımı ve emekli) FMS olma riski çalışan kadınlara göre 2,5 kat daha fazla idi [OR=2,548, %95 CI (1,422-4,566)]. Çalışma durumu ile FMS arasında anlamlı bir ilişki vardı (p<0,001). Fibromiyalji olan kadınların ağrılı nokta sayısı, VAS, FEA, HAD-A ve HAD-D puanları kontrol grubuna göre anlamlı derecede yüksek bulundu (p<0,001). FMS hastalarının %64,3'ünde anksiyete, %59,9'unda depresyon vardı. FMS hastalarının eğitim düzeyi düşük olanlarda yüksek olanlara göre ve ek hastalığı olanlarda olmayanlara göre yaşam kalitesi daha düşük idi (p=0,042, p=0,003). Obezlerde, evli olanlarda, eğitim düzeyi düşük, çalışmayan ve ek hastalığı olan fibromiyaljili kadınlarda hissedilen ağrı düzeyi daha yüksek bulundu (p=0,002, p=0,022, p=0,006, p=0,023, p=0,005). Premenapozal FMS'li kadınlar ve kontrol grubunda yaptığımız kemik mineral yoğunluğu (KMY) ölçümlerinde; L1-L4 lomber vertebra, sol femur toplam, Wards, trokanter ve femur boyun kemik kütlesi (g/cm2), T ve Z skoru ortalamaları iki grupta karşılaştırıldığında aralarında istatistiksel olarak anlamlı bir fark bulunmadı (p>0,05). Fibromiyaljisi olan hastaların KMY ölçümleri ile HAD-A ve HAD-D puanları karşılaştırıldığında, anksiyetesi ve depresyonu olan hastaların L1-L4 bölgesinde hem g/cm2, hem T skoru, hem de Z skoru anksiyetesi ve depresyonu olmayanlara göre sırasıyla daha düşük bulundu (p=0,011) (p=0,040). Sonuç: Premenapozal dönemdeki kadınların FMS olma durumu KMY değerlerini değiştirmemektedir. Ancak FMS olan hastaların ağrı düzeyi, yaşam kaliteleri, anksiyete ve depresyon durumları KMY değerlerini etkilemektedir. Fibromiyalji sendromu ve buna eşlik eden komorbid durumların varlığı hem sağlık sistemine, hem de ülke ekonomisine maddi yönden ağır yükler getirmektedir. Fibromiyalji osteoporoz için bir risk faktörüdür. Bu nedenle hastalar osteoporoz açısından erken dönemde değerlendirilmeli, beslenme takviyesi (kalsiyum, vitamin D vb.), uygun egzersiz programları ve gerekli medikal tedavinin uygulanmasına önem verilmelidir. Anahtar kelimeler: Fibromiyalji Sendromu, Kemik Mineral Yoğunluğu, Ağrı, Depresyon, Yaşam Kalitesi
In our study it is aimed to compare the effects of bone mineral density of premenopausal women with and without fibromyalgia on pain, depression and life quality; and to determine the factors that affect the quality of life in fibromyalgia syndrome (FMS). Material and Methods: 100 premenopausal women diagnosed as FMS according to ACR 1990 criteria at Konya Necmettin Erbakan University Physical Therapy and Rehabilitation Clinic; and 100 premenopausal women who applied to Family Practice Clinic for any reason and were not diagnosed as FMS and did not have any complaints were included in this case control study. A questionnaire form determining sociodemographic attributes and created by the researchers according to the literature, Visual Analog Scala (VAS), Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Scala (HADS) were used to collect data about patients. The surveys were completed by the researchers in face to face meetings. Bone mineral density values of hundred (100) patients with FMS and of 100 healthy women were measured with DXA method. Frequencies, average, standard deviation; average, minimum and maximum values, odds ratio were calculated. The results were evaluated at 95 % confidence interval and significance was evaluated at p<0.05 level. Results: Average age of the fibromyalgia patients participated in our study was found 43,06±7,57 years (min:23- max:55). The risk to get fibromyalgia for the women with a low level of education was 3.9 times more than those with higher education [OR=3.973, 95 % CI (2.203-7.165)]. There was a significant relationship between low level of education and FMS. (p<0.001 ). The risk to get working women [OR=2.548, 95 % CI (1.422-4.566)]. There was a significant relationship between employment status and FMS (p<0.001). The number FMS for the non-working women (retired or housewives) was 2.5 times more than of tender points of the women with fibromyalgia, VAS, FIQ, HAD-A and HAD-D scores were found significantly higher than control group (p<0.001). 64.3 % of FMS patients had anxiety and 59.9 % of them had depression. The quality of life of FMS patients with low level of education and with comorbidities was lower than those with higher education and without comorbidities (p=0.042, p=0.003). The pain level of the women with fibromyalgia who were obese, married, uneducated, non-working and with comorbidities was found higher (p=0.002, p=0.022, p=0.006, p=0.023, p=0.005). In the measurements of bone mineral density (BMD) carried out in premenopausal women with FMS and in control group; no statistically significant difference was found when the averages of L1-L4 lumbar vertebrae, left femur total, Wards, trochanter, bone mass in the femoral neck (g/cm2) and T and Z scores were compared in two groups (p>0.05). When comparing BMD measurements to HAD-A and HAD-D scores of the patients with fibromyalgia; in the area of L1-L4 of the patients with anxiety and depression, g/cm2, T score and Z score were found respectively lower than those without anxiety and depression (p=0.011) (p=0.040). Conclusions: The fact that the women in premenopausal period have fibromyalgia does not change their BMD values. However, the pain level, life quality, anxiety and depression of the patients with FMS affect their BMD values. Fibromyalgia syndrome and the existence of comorbidity with it place a burden on healthcare system and national economy materially. Fibromyalgia is a risk factor for osteoporosis. For this reason, the patients must be evaluated for osteoporosis in the early period and dietary supplement (calcium, vitamin D etc.), proper exercise programs and applying necessary treatment must be placed importance. Keywords: Fibromyalgia Syndrome, Bone Mineral Density, Pain, Depression, Quality of Life
In our study it is aimed to compare the effects of bone mineral density of premenopausal women with and without fibromyalgia on pain, depression and life quality; and to determine the factors that affect the quality of life in fibromyalgia syndrome (FMS). Material and Methods: 100 premenopausal women diagnosed as FMS according to ACR 1990 criteria at Konya Necmettin Erbakan University Physical Therapy and Rehabilitation Clinic; and 100 premenopausal women who applied to Family Practice Clinic for any reason and were not diagnosed as FMS and did not have any complaints were included in this case control study. A questionnaire form determining sociodemographic attributes and created by the researchers according to the literature, Visual Analog Scala (VAS), Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Scala (HADS) were used to collect data about patients. The surveys were completed by the researchers in face to face meetings. Bone mineral density values of hundred (100) patients with FMS and of 100 healthy women were measured with DXA method. Frequencies, average, standard deviation; average, minimum and maximum values, odds ratio were calculated. The results were evaluated at 95 % confidence interval and significance was evaluated at p<0.05 level. Results: Average age of the fibromyalgia patients participated in our study was found 43,06±7,57 years (min:23- max:55). The risk to get fibromyalgia for the women with a low level of education was 3.9 times more than those with higher education [OR=3.973, 95 % CI (2.203-7.165)]. There was a significant relationship between low level of education and FMS. (p<0.001 ). The risk to get working women [OR=2.548, 95 % CI (1.422-4.566)]. There was a significant relationship between employment status and FMS (p<0.001). The number FMS for the non-working women (retired or housewives) was 2.5 times more than of tender points of the women with fibromyalgia, VAS, FIQ, HAD-A and HAD-D scores were found significantly higher than control group (p<0.001). 64.3 % of FMS patients had anxiety and 59.9 % of them had depression. The quality of life of FMS patients with low level of education and with comorbidities was lower than those with higher education and without comorbidities (p=0.042, p=0.003). The pain level of the women with fibromyalgia who were obese, married, uneducated, non-working and with comorbidities was found higher (p=0.002, p=0.022, p=0.006, p=0.023, p=0.005). In the measurements of bone mineral density (BMD) carried out in premenopausal women with FMS and in control group; no statistically significant difference was found when the averages of L1-L4 lumbar vertebrae, left femur total, Wards, trochanter, bone mass in the femoral neck (g/cm2) and T and Z scores were compared in two groups (p>0.05). When comparing BMD measurements to HAD-A and HAD-D scores of the patients with fibromyalgia; in the area of L1-L4 of the patients with anxiety and depression, g/cm2, T score and Z score were found respectively lower than those without anxiety and depression (p=0.011) (p=0.040). Conclusions: The fact that the women in premenopausal period have fibromyalgia does not change their BMD values. However, the pain level, life quality, anxiety and depression of the patients with FMS affect their BMD values. Fibromyalgia syndrome and the existence of comorbidity with it place a burden on healthcare system and national economy materially. Fibromyalgia is a risk factor for osteoporosis. For this reason, the patients must be evaluated for osteoporosis in the early period and dietary supplement (calcium, vitamin D etc.), proper exercise programs and applying necessary treatment must be placed importance. Keywords: Fibromyalgia Syndrome, Bone Mineral Density, Pain, Depression, Quality of Life
Açıklama
Anahtar Kelimeler
Depresyon, Depression, Ağrı, Pain, Fibromiyalji, Fibromyalgia
Kaynak
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Künye
Demirbaş, N. (2016). Fibromiyalji sendromunda kemik mineral yoğunluğu değerlerinin ağrı, depresyon ve yaşam kalitesi üzerine. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Aile Hekimliği Anabilim Dalı, Konya.
