CHRONIC MULTIMORBIDITY OF LOW BACK PAIN OR OTHER CHRONIC BACK DISORDERS IN THE REPUBLIC OF CROATIA.

The aim was to assess the prevalence of chronic multimorbidity in patients with chronic low back pain or other chronic back disorders (BD). We analyzed data from the population-based cross-sectional European Health Interview Survey (EHIS) performed in the Republic of Croatia 2014-2015 by the Croatian Institute of Public Health. Outcome was the point-prevalence of chronic multimorbidity defined as having ≥2 chronic illnesses out of 14 contained in the EHIS questionnaire, after adjustment for ten sociodemographic, anthropometric and lifestyle confounders. Amoung fourteen targeted illnesses were asthma, allergies, hypertension, urinary incontinence, kidney diseases, coronary heart disease or angina pectoris, neck disorder, arthrosis, chronic obstructive pulmonary disease, diabetes mellitus, myocardial infarction, stroke, depression, and the common category "other". We analyzed data on 268 participants with BD and 511 without it. Participants with BD had a significantly higher relative risk of any chronic multimorbidity (RRadj=2.12; 95% CI 1.55, 2.99; p<0.001), as well as of non-musculoskeletal chronic multimorbidity (RRadj=2.29; 95% CI 1.70, 3.08; p=0.001) than participants without BD. All chronic comorbidities except for asthma and liver cirrhosis were significantly more prevalent in participants with BD than in participants without BD. In the population with BD, the participants with multimorbidity had three to four times higher odds for unfavorable self-reported health outcomes than the participants with no comorbid conditions, whereas the existence of only one comorbidity was not significantly associated with a worse outcome compared to the population with no comorbidities. In conclusion, the population suffering from BD has a higher prevalence of chronic multimorbidity than the population without BD and this multimorbidity is associated with unfavorable health outcomes.

QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS - A PRELIMINARY STUDY.

The most severe effects of rheumatoid arthritis (RA) are loss of physical function and chronic pain, which may have a major impact on different areas of the person's existence. The aim of this study was to get an insight into the quality of life (QOL) in subjects with RA in connection with pain perception and functional ability. The following instruments were used: the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Short Form Health Survey (SF-36), Health Assessment Questionnaire Disability Index (HAQ-DI) and Visual Analog Scale for Pain (VAS Pain). The results indicated that there was no statistical difference in the QOL between subjects with RA and healthy population according to SF-36 Croatian norms. Also, the results showed that stronger pain experience was significantly associated with poorer social functioning assessment (SF36SF, Spearman's rho=-0.463, p<0.05), poorer general health perception (SF36GH, Spearman's rho=-0.432, p<0.05) and poorer physical functioning (WHOPH, Spearman's rho=-0.688, p<0.01). Furthermore, the subjects evaluating their general functional state worse were found to have worse physical functioning (SF36PF, Spearman's rho=-0.699 and WHOPH, Spearman's rho=-0.769), poorer social functioning (SF36SF, Spearman's rho=-0.580) and experienced greater pain intensity (SF36BP, Spearman's rho=-0.652). Therefore, additional efforts should be invested to define a holistic and integrative model of treatment and rehabilitation of people with RA, focused on pain relief, improvement of functional ability, encouraging social interaction and supporting positive emotional responses.

[Therapeutic exercise for patients with chronic low-back pain]. / Medicinske vjezbe za bolesnike s kronicnom krizoboljom.

Low Back Pain (LBP) is a major medical and socio-economical problem in the industrialized countries. Exercise therapy is the keystone of conservative treatment for chronic low back pain (CLBP). Numerous randomized trials and clinical practice guidelines have supported that exercise diminishes disability and pain severity while improving fitness and occupational status in patients with CLBP, as well as decrease its recurrence rate. However, there is no significant evidence that one particular type of exercise is clearly more effective than others. Here we present a descriptive review of different types of exercise for therapeutic or prevention purposes in patients with CLBP. Studies suggest that individually tailored, supervised exercise programs are associated with the best outcomes. High quality clinical trials are needed to determine the effectiveness of specific interventions (type, time, intensity and other characteristics) aimed at individuals and/or specific target groups.

Complementary and alternative treatment of musculoskeletal pain.

The use of complementary and alternative medicine (CAM) is high and increasing worldwide. Patients usually use CAM in addition to conventional medicine, mainly to treat pain. In a large number of cases, people use CAM for chronic musculoskeletal pain as in osteoarthritis, back pain, neck pain, or fibromyalgia. Herewith, a review is presented of CAM efficacy in treating musculoskeletal pain for which, however, no scientific research has so far provided evidence solid enough. In some rare cases where adequate pain control cannot be achieved, CAM might be considered in rational and individual approach based on the first general rule in medicine "not to harm" and on the utility theory of each intervention, i.e. according to the presumed mechanism of painful stimulus and with close monitoring of the patient's response. Further high quality studies are warranted to elucidate the efficacy and side effects of CAM methods. Therefore, conventional medicine remains the main mode of treatment for patients with musculoskeletal painful conditions.

[Obesity: risk factor and predictor of osteoarthritis]. / Debljina: cimbenik rizika i prediktor razvoja osteoartritisa.

Osteoarthritis (OA) is the most common articular disease of the developed world and a leading cause of chronic disability, mostly as a consequence of the knee OA and/or hip OA. In spite of misrecognition of the exact cause, a number of studies have shown that obesity represents one of the most important risk factors and it is also a predictor for progression of OA, especially of a knee joint and less of the hip joint. Relationship between body mass index (BMI) and OA of the knee is mainly linear, and duration of increasedjoint loading or gaining weight is also significant. Studies about obesity and hand OA are contradictory. Risk gradient for BMI and the hip OA is somewhere between the knee and the hand gradient. Disability may be significantly relieved if a body weight is decreased for more than 5.1%. Twenty seven percent of cases of hip arthroplasty and 69% knee arthroplasty may be attributed to obesity. Nonpharmacologic treatment of OA includes treatment of obesity.