Opportunities and challenges in rheumatology research in Central Europe.

The Central European Congress of Rheumatology (CECR) has been organized by seven Central European countries: Austria, Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. These countries have lots of similarities, but also differences, with respect to rheumatology research. In this paper, based on questionnaires, we wish to demonstrate achievements and difficulties in rheumatology research performed in our region.

[Helping reintegration of patients suffering from chronic musculoskeletal diseases with decreased working ability in the National Institute of Rheumatology and Physiotherapy, Budapest, Hungary]. / Csökkent munkaképességu krónikus mozgásszervi betegek reintegrációjának elosegítése.

INTRODUCTION: An important task of our institute is to support social reintegration: including occupational rehabilitation of patients suffering from chronic musculoskeletal diseases with decreased working ability. AIM: The aim of the authors was to provide informations of their daily practice, how they perform patient education, giving information for their patients about their disease, the rehabilitation possibilities, how they support the patients with decreased working ability to take part in their own rehabilitation. METHOD: Patients taking part in in-patient rehabilitation received teaching and education about their disease and rehabilitation options in groups. Patients interested in part-time jobs were individually interviewed by a 30-120 minutes talk about their educational level and training, social conditions and about the available part time jobs. The part time jobs were available with the help of the Motivation Foundation of the National Association of the Societies of Motion Disabled, and the Alfa Rehabilitation Nonprofit Rt. The data of patients receiving in-patient rehabilitation betwen the 1st of January 2009 and 31st of December 2014 were analyzed. RESULTS: Out of the 230 patients seeking our help for part time job, our social service could organise jobs for 180 disabled persons, all town-inhabitants, but was unsuccesful in getting jobs for patients living in villages and separated farms. CONCLUSION: Part time jobs can be organized for musculoskeletal disabled living in cities and towns. For village-dwellers there are no suitable jobs and working places. It is necessary to organize rehabilitation working possibitities for musculoskeletal disabled patients living in villages. Orv Hetil. 2017; 158(17): 662-667.

Clinical and radiological dissociation of anti-TNF plus methotrexate treatment in early rheumatoid arthritis in routine care: results from the ABRAB study.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients. Anti-tumour necrosis factor (anti-TNF) drugs can halt radiological progression better than conventional DMARDs even in clinical non-responders. METHODS: The efficacy of anti-TNF plus methotrexate (MTX) treatment versus MTX monotherapy on clinical and radiological outcomes were compared in early rheumatoid arthritis (RA) patients in clinical practice by retrospective analysis of an observational cohort.49 early RA patients (group A) on first-line MTX monotherapy and 35 early RA patients (group B) on anti-TNF plus MTX treatment were selected from an observational cohort and evaluated retrospectively focusing on their first twelve months of treatment. Data on disease activity (DAS28) and functional status (HAQ-DI) were collected three monthly. One-yearly radiological progression was calculated according to the van der Heijde modified Sharp method (vdHS). Clinical non-responder patients in both groups were selectively investigated from a radiological point of view. RESULTS: Disease activity was decreased and functional status was improved significantly in both groups. One-yearly radiological progression was significantly lower in group B than in group A. The percentage of patients showing radiological non-progression or rapid radiological progression demonstrated a significant advantage for group B patients. In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A. CONCLUSIONS: Clinical efficacy within our study was similar for tight-controlled MTX monotherapy as well as for combination treatment with anti-TNF and MTX. However MTX monotherapy was accompanied by more rapid radiological progression and less radiological non-progression. Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.

[Survey of quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary]. / Hazai kórházakban rehabilitált rheumatoid arthritises betegek életminosége.

INTRODUCTION: There are limited data about the quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary. AIM: The aim of the authors was to assess demographic data, social status, health related quality of life, and needs for assistance and disease-related information of 239 rheumatoid arthritis patients (169 women and 7 men) admitted to four rehabilitation centres in Hungary. METHOD: For the assessment of demographic, social and other data the authors developed questionnaires. The health related quality of life was evaluated using the validated Short Form 36 questionnaire. RESULTS: The authors found that rheumatoid arthritis patients require in-patient rehabilitation relatively early in their disease course. 80.4% of the patients were over 50 years of age, and their social status was low as compared to the average of the Hungarian population. The health related quality of life of patients was significantly lower than that of the average population, but it was similar to the quality of life of patients with osteoarthritis, osteoporosis and low back pain. Among domains of the quality of life, the scores for physical function and pain were the lowest. The most common accompanying diseases included hypertension and osteoporosis. In case of knee and hip surgeries, postoperative rehabilitation was performed in due time. Patients were not satisfied with disease-related information and education given by health care providers. CONCLUSIONS: There is poor quality of life of rheumatoid arthritis patients admitted to rehabilitation centres in Hungary. More efforts should be done to provide disease-related information and education for patients.

[Quality of life of osteoporotic patients treated in rheumatology rehabilitation in-patient units]. / Reumatológiai rehabilitációs osztályokon kezelt osteoporosisos betegek életminosége.

UNLABELLED: There has been no report on demographic, social and quality of life data of osteoporotic patients attending rheumatology rehabilitation in-patient units in Hungary. AIM: The authors analyzed the data of osteoporotic patients treated in rheumatology rehabilitation departments as in-patients in four hospitals in Hungary. METHODS: Demographic and social data were obtained by using a questionnaire developed by the authors, and quality of life was assessed with the use of the SF-36 questionnaire. The quality of life data of osteoporotic patients were compared to that obtained from patients with rheumatoid arthritis, osteoarthrosis and chronic low back pain who were treated in the same department at the same time. RESULTS: Of the 253 patients who were asked to participate in the study, 211 patients filled out the questionnaires. 25.6% of the patients were male. 58% of the patients were younger than 60 years of age, and 40% of them were heavy physical workers earlier. More than 50% of the patients did not complete secondary school education, and only 6.7% of the patients had a per capita monthly income higher than 100 000 HUF. The quality of life of the osteoporotic patients assessed by SF-36 scored 34.7, which was significantly lower than that of the mean of the Hungarian population scoring 70-90. The SF-36 scores of osteoporotic patients were lower in all domains compared to the scores of patients with rheumatoid arthritis, osteoarthritis and low back pain, although the difference was significant only in the domain of physical activity. The affective role of patients with osteoporosis was significantly lower than those with rheumatoid arthritis and osteoarthritis. CONCLUSIONS: Osteoporotic patients attending in-patient rheumatology in-patient rehabilitation units in Hungary have poor quality of life comparable, even worse than that found in patients with rheumatoid arthritis, osteoarthritis and chronic low back pain.