RESUMEN
OBJECTIVES: Biologics are medications widely applied in the management of inflammatory rheumatic diseases. The drugs were found to be effective but their application is associated with some disadvantages. Medication with biologics is relatively expensive, and in Poland, it is carried out in specialized centers. The study was designed to evaluate various aspects of satisfaction and dissatisfaction of Polish patients treated with biologics. MATERIAL AND METHODS: An anonymous questionnaire was distributed in 23 Polish rheumatological centers involved in the treatment; 1212 returned questionnaires were used for analysis. Responses were received from 606 patients with rheumatoid arthritis, 427 with ankylosing spondylitis, 117 psoriatic arthritis, and 62 adult patients with juvenile idiopathic arthritis (in whom administration of the drugs had been introduced before they were 18 years old). The investigated group constituted about one-fifth of all rheumatic patients on biologics in Poland. RESULTS: A beneficial or very beneficial influence of the medication on the state of physical health was found mostly in patients with rheumatoid arthritis (51.3 and 30.5%) and ankylosing spondylitis (51.0 and 36.8%). Family life was improved by the treatment especially in patients with ankylosing spondylitis (40.7 and 35.6% beneficial and very beneficial, respectively), sleep quality and sexual life mostly in those with ankylosing spondylitis (beneficial/very beneficial influence 41.5/38.4, and 38.7/23.9, respectively). There was a rather small influence of biological treatment on the financial situation of the patients. In general, satisfaction with the treatment was evaluated as positive or very positive in 88% of all investigated patients.In a significant part of the patients, transportation to the medical center was considered as a disadvantage of the treatment. About one-third of the patients considered laboratory and imaging tests to be done before initiation of the medication as a difficulty, and for about 40% waiting time for qualification for the medication was a significant disadvantage. The route of drug administration was without importance for 4/5 of the patients. CONCLUSIONS: Summing up, the results were similar in the patients suffering from various diseases although those with psoriatic arthritis felt the highest satisfaction (possibly due to the positive aesthetic effect), and those with ankylosing spondylitis had significant improvement in sexual life (probably due to younger age). Relatively low satisfaction was found in patients with juvenile idiopathic arthritis. There was a small influence of medication on financial status of the patients. Application of biologics has few disadvantages and most of them are associated with the organization of health services (waiting time for the tests, transportation to the medical centers).
RESUMEN
Osteoporosis is the most frequent metabolic bone disease. Until recently it was believed to mainly affect women in menopause. A review of the literature indicates that a lot of the research to date on women. The patogenesis of bone loss in men has not been explained yet. It has not been determined what is the contribution of androgens as opposed to environmental factors and stimulants. The behaviour of bone turnover markers during ageing and their role in diagnosing the risk of osteoporosis development and fractures in men are not clear. The objective of the paper was to evaluate bone metabolism markers and to determine their relevance in early diagnosis of osteoporosis in men, and to determine any possible impact of testosterone concentration on bone mass. The study covered 100 volunteers-males, aged 40-85. All were subjected to a densitometric examination, using theDEXA method, of three regions of the osseous system: lumbar spine in anterior-posterior height, proximal femur, distal radius. Based on these results, subjects were divided into three groups: without osteoporosis, with osteopenia and with osteoporosis. In all men the serum level of the following was marked: 1) 3 markers of bone formation: osteocalcin (BGP), bone alkaline phosphatase (b-ALP) and Procollagen I Aminoterminal propeptide (PINP); 2) 2 markers of bone resorption: Collagen Type I Crosslinked C-telopeptide (Ctx) and Tartarate Resistant Acid Phosphatase (TRAP); 3) testosterone. The results obtained were subjected to thorough statistical analisis. Mean concentrations of bone metabolism, testosterone and calcium consumption in the groups examined were compared by mean of ANOVA variance analysis and the smallest significant difference test. Relationship between markers of bone resorption and formation, testosterone level and bone mineral density (BMD) were shown by means of Pearson linear correlation. The relevance of markers in the diagnosing of osteoporosis in men was evaluated by means of the ROC curves. The results obtained lead to the following conclusions: Among the markers of bone turnover analysed, Collagen Typ I Crosslinked C-telopeptide (Ctx-serum) is the most useful marker in the diagnosis of osteoporosis in men, followed by Tartarate Resistant Acid Phosphatase (TRAP) and osteocalcin (BGP). There is no relationship between bone mineral density and serum testosterone level.
