Original Article
Health Related Quality of Life in Rheumatoid Arthritis, Osteoarthritis, Diabetes Mellitus, End Stage Renal Disease and Geriatric Subjects. Experience From a General Hospital in Mexico
Calidad de vida relacionada con la salud en artritis reumatoide, osteoartritis, diabetes mellitus, insuficiencia renal terminal y población geriátrica. Experiencia de un Hospital General en México
Yesenia Ambriz Murilloa,
, Raul Menor Almagrob, Israel David Campos-Gonzálezc, Mario H. Cardiela,c,d
Corresponding author
a Unidad de Investigación Dr. Mario Alvizouri Muñoz, Hospital General Dr. Miguel Silva, Morelia, Michoacán, Mexico
b Servicio de Reumatología, Hospital del Servicio Andaluz de Salud (SAS) de Jerez, Jerez de la Frontera, Spain
c Servicio de Medicina Interna, Hospital General Dr. Miguel Silva, Morelia, Michoacán, Mexico
d Servicio de Reumatología, Hospital General Dr. Miguel Silva, Morelia, Michoacán, Mexico
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"apellidos" => "Cardiel" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Unidad de Investigación Dr. Mario Alvizouri Muñoz, Hospital General Dr. Miguel Silva, Morelia, Michoacán, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital del Servicio Andaluz de Salud (SAS) de Jerez, Jerez de la Frontera, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital General Dr. Miguel Silva, Morelia, Michoacán, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital General Dr. Miguel Silva, Morelia, Michoacán, Mexico" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calidad de vida relacionada con la salud en artritis reumatoide, osteoartritis, diabetes mellitus, insuficiencia renal terminal y población geriátrica. Experiencia de un Hospital General en México" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Quality of life related to health (HRQoL) is a multidimensional concept, related to the individual impact of the disease and its treatment, as well as functional capacity and the patient's perception in social, physical and mental<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> roles.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis (RA) and osteoarthritis (OA) are two common rheumatic diseases associated with impaired physical function and HRQoL, affecting different age groups, most of them in<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> productive stages of life.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Chronic diseases impact on morbidity and quality of life of patients worldwide, and are responsible for 72% of the total burden of disease.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is well known that end-stage renal disease (ESRD) and diabetes mellitus (DM) have a great impact on a patient's physical, mental and emotional role.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The instruments to assess quality of life can be generic and specific. Generic instruments such as the SF-36 questionnaire allow us to compare HRQoL between chronic diseases (DM and ESRD) and rheumatic diseases (RA and OA).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The level of activity of rheumatic diseases correlates inversely with HRQoL; one of the instruments used to determine the activity in RA is the Disease Activity Score (DAS-28),<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and, for OA, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which allows us to determine the degree of functional compromise.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The specific instruments used for estimating HRQoL in ESRD and DM (DQOL and KDQOL SF) explore points such as satisfaction with glycemic control, dialysis sessions and drug therapy.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is well known that HRQoL is reduced in rheumatic diseases as well as metabolic diseases, and this aspect has become so important that it is one of the main primary outcomes used to determine the effectiveness of treatments in each disease.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Rheumatic diseases have not been fully recognized as having a high impact on HRQoL. No information about the comparison of the quality of life of chronic diseases and rheumatic diseases exists in our country, and for that reason, we decided to evaluate HRQoL in two rheumatic diseases (RA, OA), 2 chronic diseases with high medical and social impact (DM and ESRD), a group of geriatric patients and a control group.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and Methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">This was a cross-sectional study which included consecutive patients attending the rheumatology, internal medicine, endocrinology and nephrology clinics in Morelia, Michoacán's General Hospital “Dr. Miguel Silva”, within a one year period. The patients met the classification criteria of the American College of Rheumatology for RA or OA<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> (hip and knee) and the criteria of the American Diabetes Society 2004<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> for DM (at least 2 years of evolution), and the ESRD group<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> was undergoing renal function substitution therapy (hemodialysis or peritoneal dialysis). Two groups were chosen for contrast: control group subjects aged ≥30 years attending a sports group and a group of<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> geriatric patients (aged ≥65years) as part of an institutional program that provides medical care and treatment for this age group.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Upon entering the study demographic and clinical characteristics were recorded. Through an interview performed by trained personnel, different HRQoL questionnaires were applied, as detailed below.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The study was approved by the local ethics committee and informed consent of all participants was obtained.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Measurements</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Generic</span><p id="par0060" class="elsevierStylePara elsevierViewall">The SF-36 questionnaire was administered to all groups; visual analog scales were applied to assess pain (0–10, where 0 is no pain and 10 is the worst possible pain); overall assessment of patient health (GPH), on a scale of 0–10, where 0 is the worst possible health state and 10 is the best; and physician global assessment, where 0 is the worst possible health state and 10 is best. The Beck questionnaire was used to assess depression. The Health Assessment Questionnaire (HAQ-Di), in the group of OA and RA, which assesses physical disability was applied according to the following scores: 0–1, mild disability; 1–2, moderate and more than; 2, severe disability.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Specific</span><p id="par0065" class="elsevierStylePara elsevierViewall">RA: DAS-28 was measued,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> to establish the degree of disease activity, setting the following levels of activity: remission <2.6; mild activity ≤3.2; moderate activity <5.1; and severe active >5.1.</p><p id="par0070" class="elsevierStylePara elsevierViewall">OA: the WOMAC was applied in the OA group, which is an instrument that assesses pain, function, vitality and mood, in the past 4 weeks, where scores <3 indicate no functional disability, <7 moderate disability, and >8 severe disability.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">DM: DQOL is an instrument that researches satisfaction regarding glycemic control. It consists of 46 questions divided into the following dimensions: satisfaction with treatment, disease impact, social concern, concern regarding diabetes and wellness. The score is 0–100, where a higher score reflects a better quality of life.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">ESRD: KDQOL is an instrument that assesses 11 dimensions: impact of renal disease in the patient's life, quality of social interaction, cognitive function, symptoms, stress, sexual function, sleep, social support, employment status, satisfaction, and support by health workers. The score ranges from 0 to 100, where a higher score reflects a better HRQoL.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Biochemical</span><p id="par0085" class="elsevierStylePara elsevierViewall">In all groups a complete blood count was performed; in RA the erythrocyte sedimentation rate was measured; we performed HbA<span class="elsevierStyleInf">1</span>C in DM as well as central glucose; and in the ESRD group we measured nitrogen products.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical Analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">Descriptive statistics were used. A comparative analysis was used to determine the quality of life, and the identification of relationships was conducted with the chi-square test for nominal variables. Quality of life of the control group was compared using the Kruskal–Wallis test. Spearman's rho was used to correlate variables. The comparison between independent groups was made with the Mann–Whitney test. The strength of association was evaluated with odds ratios and 95% confidence intervals. A value of <span class="elsevierStyleItalic">P</span><.05 was considered significant. SPSS 14.0 software was used.</p></span></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">We evaluated 290 subjects distributed as follows: 100 in the control group with an age of 53±11.2 years (mean±SD), 30 subjects in the geriatric population with 72.8±7, 3 years of age and 40 subjects in each group with different diseases (RA, OA, DM, and ESRD). The average age in the rest of the groups was as follows: RA, 52.4±16.2 years; OA, 63.4±15.2 years; DM2, 58.6±14 years; and ESRD, 40.38±18.5. Differences in baseline characteristics were detected regarding the instruments used to assess HRQoL, depression and visual analog scales (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The SF-36 scores were significantly different between the control and groups, with statistical significance (<span class="elsevierStyleItalic">P</span>=.007). The worst HRQoL was observed in patients with ESRD (mean±SD 48.06±18.84) and the RA group, with an average score on the SF-36 questionnaire of 49.1 (SD 19.37), with these 2 groups having the worst HRQoL, taking as a control a value of 71.9 (SD 15.43/min.–max.28.5–94.9). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes the SF-36 scores in each of its dimensions: physical function, physical role, bodily pain, general health, vitality, social function and mental health; of all the dimensions, general health was the most affected in all groups studied. The RA group had the lowest score on the general health dimension of the SF-36 (38.80 SD±22.64; 0–87 min–max) and it was statistically significant (<span class="elsevierStyleItalic">P</span>=.0001).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Global health assessments were performed by the physician and the patient regarding the GPS for OA, DM2, ESRD, geriatric population and control groups, with similar scores; the best score was in the control group followed by the RA group (7.1<span class="elsevierStyleHsp" style=""></span>cm±1.39 and 7<span class="elsevierStyleHsp" style=""></span>cm±2, respectively) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0110" class="elsevierStylePara elsevierViewall">The visual analog pain scale in the OA group was 5.2<span class="elsevierStyleHsp" style=""></span>cm±2.46; in RA, 5.1±2.5; and after them, the geriatric population group, ESRD, DM, and finally the control group which had the lowest score for pain.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Mild to moderate depression was detected in 29% (84), and 26% (76) had severe depression. The group with major depression was the ESRD with a score of 22.23 in the questionnaire ((SD/min.–max. 11.26/4–42), <span class="elsevierStyleItalic">P</span>=.0001).</p><p id="par0120" class="elsevierStylePara elsevierViewall">The HAQ-Di was higher in the OA group compared with that in the RA group, 1.12±.76 vs .82±.82 respectively (<span class="elsevierStyleItalic">P</span>=.001).</p><p id="par0125" class="elsevierStylePara elsevierViewall">Differences between the groups were as follows: number of drugs used, which was higher in the ESRD group (5.20±2.45) followed by the RA group (3.53±1.1); and age, higher in the geriatric population and the OA group.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The WOMAC in OA group was 3.42 (SD/min.–max. 1.97/.1–8.7), where the pain subscale score was the highest (3.86±2.37).</p><p id="par0135" class="elsevierStylePara elsevierViewall">DQOL assessed with HRQoL in patients with DM was 45.6 (SD 11.2), being impaired in all 5 areas assessed with this instrument: treatment satisfaction, disease impact, social concern, concern regarding diabetes and general welfare.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The causes of ESRD in the study group were DM in 21 subjects (28%) and hypertension in 21%. Time undergoing dialysis therapy was 1.66 years. The most common dialysis mode was peritoneal dialysis (67.5%/27). HRQoL assessed with KDQOL was 60.8 (SD 18.7), and the best score subscale was that supported by the medical staff.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In RA patients the ESR was 24.23<span class="elsevierStyleHsp" style=""></span>mm/h (SD/min.–max. 7.6/10–48). Glycemic control rates in the DM group was 9.37% for the HbA<span class="elsevierStyleInf">1</span>C (SD/min.–max. 4.15/3–29) with a fasting blood glucose of 173.43<span class="elsevierStyleHsp" style=""></span>mg/dL (SD/min.–max. 64.96/77–329). Finally, in patients with ESRD, nitrogenous products were as follows: creatinine 12.44<span class="elsevierStyleHsp" style=""></span>mg/dL (SD/min.–max. 4.53/1.4–21.34) and urea 208.66<span class="elsevierStyleHsp" style=""></span>mg/dL (SD/min.–max.95.5/36.4–389).</p><p id="par0150" class="elsevierStylePara elsevierViewall">The correlations that were of interest were as follows: GPS with the erythrocyte sedimentation rate in patients with RA (Spearman rho −.33, <span class="elsevierStyleItalic">P</span>=.03) and in the DM group and, in ESRD, correlation of depression (measured by Beck) with GPS (rho .64/<span class="elsevierStyleItalic">P</span>=.001 and rho<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.46/<span class="elsevierStyleItalic">P</span>=.002 respectively). No correlations between GPS and DAS-28, HAQ, HbA<span class="elsevierStyleInf">1</span>C, fasting blood glucose and creatinine were found.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">This study describes the findings in HRQoL in 4 chronic diseases. The quality of life was low in all the groups, consistent with previous studies.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a> Differences were seen in the perception of pain and disability, which were higher in the groups of rheumatic disease. The lowest level of HRQoL was found in the ESRD group followed by the RA and OA groups.</p><p id="par0160" class="elsevierStylePara elsevierViewall">There are no similar studies in Mexico. A Swedish study published by Arne et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> has similar results. They compared HRQoL in patients with obstructive lung disease, RA, DM and a control group. They found that the group with obstructive lung disease had the lowest HRQoL and that fatigue was the most important symptom in both the obstructive pulmonary disease and the RA group. This paper also states that the impact on HRQoL in patients with RA is important and greater than that in patients with DM, because of the greater intensity of pain and functional disability in these patients.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Several studies have shown that patients with musculoskeletal disorders have poor HRQoL; worse HRQoL among rheumatic disease has been detected in patients with OA, RA, osteoporosis and fibromyalgia.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In our study, the RA group had a poorer HRQoL when compared with the OA and control groups.</p><p id="par0170" class="elsevierStylePara elsevierViewall">A study of HRQoL, held at the Helsinky University clinic<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> where patients with rheumatic diseases are sent, found that patients with OA and chronic arthritis reported worse HRQoL scores (.81 on a scale of 0–1, using a generic instrument 15-D).</p><p id="par0175" class="elsevierStylePara elsevierViewall">The functional capacity was accessed using traditional HAQ method<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>; in the RA group a mean value of .82 was found, somewhat higher than that found in a Canadian study where a HAQ of .66 was found in patients with RA undergoing disease modifying treatment, and 1.14 even in patients without disease modifying treatment.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Krein et al.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> demonstrated that chronic pain causes diabetic patients to have limitations in the control of their own disease, and, that in patients with higher body pain and poor physical function, glycosylated hemoglobin levels are higher. In our study we found no correlation between the patient global assessment and glycosylated hemoglobin levels, but noted that the degree of depression is correlated with the general perception of the patient's health. This correlation is expected, given that depressed patients found that their quality of life scores are lower.</p><p id="par0185" class="elsevierStylePara elsevierViewall">The impact on HRQoL cannot be attributed only to the underlying illness, influencing other variables such as comorbidity, gender and age, among others. This aspect has already been discussed in previous studies<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> where it was found that RA patients have multiple comorbidities, higher scores on cardiovascular risk, and psychiatric disorders such as depression. The depression score of patients evaluated was 18.77±9.3, which places them in mild to moderate depression.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Models with these factors combined have also been observed in studies of HRQoL in DM, where personal, medical and lifestyle factors explained 29% and 14% of the variance of HRQoL and personal satisfaction, respectively, in patients with DM.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">The ESRD study group was very heterogeneous, as some of the patients were on replacement therapy with hemodialysis or peritoneal dialysis; in our country this latter method is still widely used. This point has been evaluated in previous studies, and the type of dialysis and time on dialysis definitely influence the quality of life of these patients.</p><p id="par0200" class="elsevierStylePara elsevierViewall">A prospective observational Australian study<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> conducted in 351 geriatric subjects, reported that the quality of life measured by EQ-5D was .55 (.20), and that the most affected areas were the vitality and muscle strength, which make the HRQoL score low. In our study, the lowest score was obtained in the SF-36 in the general health and physical roles; as in the Australian study decrease in physical function in our elderly subjects was probably associated with muscle wasting and changes in OA.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Our study has some limitations. First, it is a cross-sectional study, which could not detect changes over time. The results obtained may not be used for patients with severe disease activity, since patients had mild to moderate levels of activity.</p><p id="par0210" class="elsevierStylePara elsevierViewall">This information is important for both clinicians and health authorities. These measures are needed to improve HRQoL in rheumatic diseases. The results of this study prove that the impact of rheumatic disease on HRQoL is high and is comparable to that of traditional chronic diseases. Therefore, strategies should be aimed at improving HRQoL in these diseases.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Quality of life is a widespread term that allows us to measure the impact of different diseases and the degree of control of these; rheumatic diseases definitely should be considered as high impact diseases, and therapeutic measures should focus more intensively to impact changing their progression which, if not properly modified, leads to deformity, functional limitation, and professional and daily life limitation.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical Responsibilities</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of people and animals</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that in this research no experiments was performed on humans or animals.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Data confidentiality</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of data from patients, and all patients included in the study have received sufficient information and gave written informed consent to participate in the study.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of Interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres436715" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Patients and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec459950" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres436714" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Pacientes y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec459951" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and Methods" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0015" "titulo" => "Measurements" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Generic" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Specific" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Biochemical" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical Analysis" ] ] ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-08-02" "fechaAceptado" => "2014-03-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec459950" "palabras" => array:7 [ 0 => "Health-related quality of life" 1 => "Chronic diseases" 2 => "Rheumatoid arthritis" 3 => "Osteoarthritis" 4 => "Diabetes mellitus" 5 => "End-stage renal disease" 6 => "Geriatric subjects" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec459951" "palabras" => array:7 [ 0 => "Calidad de vida relacionada con la salud" 1 => "Enfermedades crónicas" 2 => "Artritis reumatoide" 3 => "Osteoartritis" 4 => "Diabetes mellitus" 5 => "Insuficiencia renal terminal" 6 => "Población geriátrica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chronic diseases have a great impact on the morbidity and mortality and on the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, and end-stage renal disease, in geriatric subjects and in a control group.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Patients and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met the classification criteria for RA, OA, diabetes mellitus, and end-stage renal disease; the geriatric subjects group was aged ≥65 years and the control group ≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analog scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA<span class="elsevierStyleInf">1</span>C, serum creatinine and urea.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and the rest of groups: 160). Differences were detected in baseline characteristics (<span class="elsevierStyleItalic">P</span><.0001). The SF-36 scores were different between the control group and other groups (<span class="elsevierStyleItalic">P</span>=.007). The worst HRQoL was observed in the end-stage renal disease group (SD: 48.06±18.84<span class="elsevierStyleItalic">x</span>/SD). General health was the principal affected area in RA. Pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±.76 vs .82±.82, respectively; <span class="elsevierStyleItalic">P</span>=.001). Forty-five percent of all subjects had depression.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The HRQoL in RA patients is poor and comparable to that of other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered as high impact diseases and therefore should receive more attention.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Patients and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las enfermedades crónicas impactan en la morbimortalidad y en la calidad de vida relacionada con la salud (CVRS) de los pacientes a nivel mundial. El impacto de las enfermedades reumáticas no ha sido totalmente reconocido.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar la CVRS y evaluar áreas específicas en artritis reumatoide (AR), osteoartritis (OA), diabetes mellitus, insuficiencia renal terminal, población geriátrica y un grupo control.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pacientes y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal, realizado en el Hospital General de Morelia. Los sujetos cumplían criterios para AR, OA, diabetes mellitus, insuficiencia renal terminal, un grupo de población geriátrica (≥<span class="elsevierStyleHsp" style=""></span>65 años) y un grupo control ≥<span class="elsevierStyleHsp" style=""></span>30 años. Se determinaron características sociodemográficas y se aplicaron instrumentos: SF-36, escala visual analógica de dolor, valoración global del paciente y médico, inventario para depresión de Beck, e instrumentos específicos (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] y Kidney Disease Questionnaire of Life [KDQOL]). Mediciones bioquímicas: velocidad de sedimentación globular (VSG), biometría hemática (BH), glucosa, HbA1C, creatinina y urea.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Fueron evaluados 290 sujetos (un grupo control: 100, población geriátrica 30 y 160 en los demás grupos). Se detectaron diferencias (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001) en las características basales. Los puntajes del SF-36 fueron diferentes entre los grupos (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,007). La peor CVRS se observó en el grupo de insuficiencia renal terminal (media<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>DE: 48,06<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18,84). En el grupo de AR la salud en general fue el área más afectada. El dolor fue mayor en las enfermedades reumáticas: OA (5,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,4) y AR (5,1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3). El HAQ-Di fue mayor en OA comparado con AR (1,12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,76 vs. 0,82<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,82 respectivamente; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001). El 45% de los sujetos tuvo depresión.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La CVRS en pacientes con AR es mala y equiparable a lo que sucede en pacientes con enfermedades crónicas (insuficiencia renal terminal y diabetes mellitus). Las enfermedades reumáticas deben considerarse padecimientos de alto impacto y por ello merecen mayor atención.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Pacientes y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ambriz Murillo Y, Menor Almagro R, Campos-González ID, Cardiel MH. Calidad de vida relacionada con la salud en artritis reumatoide, osteoartritis, diabetes mellitus, insuficiencia renal terminal y población geriátrica. Experiencia de un Hospital General en México. Reumatol Clin. 2015;11:68–72.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">RA, rheumatoid arthritis; DAS-28, Disease Activity Score; DM, diabetes mellitus; DQOL, Diabetes Quality of Life; PGS, physician global assessment; PGS, patient global assessment; VASP, visual analog pain scale; Di-HAQ, Health Assessment Questionnaire Disability Index; ESRD, terminal renal failure; KDQOL, Kidney Disease Quality Of Life; NA, not applicable for the group; OA, osteoarthritis; GP, geriatric population; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Groups \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ESRD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GP \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, years (x¯±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52.4±16.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63.4±15.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.6±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40.38±18.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.3±72.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Female, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33±(82.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25±(62.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21±(52.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14±(45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15±(50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Schooling, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.88±5.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.23±4.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.95±4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.28±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.13±4.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean disease duration (x¯±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.57±4.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.29±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.06±7.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.01±3.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SF-36 (x¯±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.11±19.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52.41±21.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.66±25.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.06±18.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51.69±22.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Beck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18.78±9.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19.8±9.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.4±12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.9±10.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.2±11.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VASP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.1±3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.2±2.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4±2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4±3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.3±2.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">GPS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.18±2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.65±2.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.60±3.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.82.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.77±2.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PGS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.0±2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.8±1.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.48±2.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.58±1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.1±1.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">KDQOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60.8±18.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">DQOL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.6±11.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">DAS-28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.81±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">WOMAC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.42±1.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HAQ-Di \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.82±.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.12±.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab681845.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Demographic Characteristics, Measurement of Quality of Life, Physical Function and Disease Activity.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">RA, rheumatoid arthritis; DM, diabetes mellitus; CG, control group; ESRD, chronic renal failure; OA, osteoarthritis; GP, geriatric population.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OA \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ESRD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">GP \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CG \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Physical function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.37±30.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.62±30.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.75±38.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.12±29.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.83±33.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.95±17.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Physical role \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.5±40.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.37±40.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.62±41.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.87±42.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.5±37.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.75±31.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Body pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.42±20.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54±25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.55±30.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.37±21.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.16±23.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.25±20.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">General health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.8±22.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.87±24.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.55±40.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.3±21.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.96±22.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.52±21.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vitality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.51±8.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.62±23.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.87±25.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.12±20.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.66±20.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.5±19.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Social function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55±27.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55±24.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.32±25.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.68±22.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.41±23.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.25±20.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Emotional role \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55±46.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65±42.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.49±37.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.33±45.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.33±42.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79±33.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mental health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.3±21.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.8±24.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.2±26.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.7±20.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.66±22.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.76±17.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total physical health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.82±19.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49±22.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.77±28.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.7±19.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.5±22.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.69±15.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total mental health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.12±20.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.86±21.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.07±24.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.62±19.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.81±21.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.20±16.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">SF-36 total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49.11±19.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.41±21.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.66±25.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.06±18.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.69±22.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.99±15.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab681846.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison of the SF-36 Between Groups. <span class="elsevierStyleItalic">P</span> Values Were Obtained With Kruskal Wallis Test for Independent Samples.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 6 | 11 |
| 2024 October | 39 | 41 | 80 |
| 2024 September | 37 | 33 | 70 |
| 2024 August | 49 | 48 | 97 |
| 2024 July | 107 | 42 | 149 |
| 2024 June | 51 | 38 | 89 |
| 2024 May | 51 | 33 | 84 |
| 2024 April | 43 | 32 | 75 |
| 2024 March | 54 | 42 | 96 |
| 2024 February | 34 | 27 | 61 |
| 2024 January | 38 | 30 | 68 |
| 2023 December | 30 | 31 | 61 |
| 2023 November | 34 | 38 | 72 |
| 2023 October | 49 | 46 | 95 |
| 2023 September | 113 | 38 | 151 |
| 2023 August | 37 | 18 | 55 |
| 2023 July | 32 | 27 | 59 |
| 2023 June | 25 | 28 | 53 |
| 2023 May | 38 | 40 | 78 |
| 2023 April | 28 | 5 | 33 |
| 2023 March | 56 | 27 | 83 |
| 2023 February | 42 | 30 | 72 |
| 2023 January | 40 | 28 | 68 |
| 2022 December | 79 | 25 | 104 |
| 2022 November | 53 | 31 | 84 |
| 2022 October | 70 | 24 | 94 |
| 2022 September | 32 | 31 | 63 |
| 2022 August | 38 | 38 | 76 |
| 2022 July | 32 | 48 | 80 |
| 2022 June | 52 | 39 | 91 |
| 2022 May | 38 | 38 | 76 |
| 2022 April | 61 | 66 | 127 |
| 2022 March | 66 | 56 | 122 |
| 2022 February | 54 | 25 | 79 |
| 2022 January | 29 | 29 | 58 |
| 2021 December | 26 | 32 | 58 |
| 2021 November | 30 | 49 | 79 |
| 2021 October | 36 | 42 | 78 |
| 2021 September | 32 | 40 | 72 |
| 2021 August | 21 | 38 | 59 |
| 2021 July | 18 | 33 | 51 |
| 2021 June | 20 | 31 | 51 |
| 2021 May | 30 | 43 | 73 |
| 2021 April | 72 | 80 | 152 |
| 2021 March | 41 | 21 | 62 |
| 2021 February | 37 | 25 | 62 |
| 2021 January | 53 | 22 | 75 |
| 2020 December | 49 | 16 | 65 |
| 2020 November | 31 | 31 | 62 |
| 2020 October | 22 | 14 | 36 |
| 2020 September | 38 | 38 | 76 |
| 2020 August | 32 | 28 | 60 |
| 2020 July | 39 | 22 | 61 |
| 2020 June | 40 | 24 | 64 |
| 2020 May | 30 | 26 | 56 |
| 2020 April | 40 | 15 | 55 |
| 2020 March | 19 | 11 | 30 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 9 | 2 | 11 |
| 2018 April | 55 | 7 | 62 |
| 2018 March | 78 | 8 | 86 |
| 2018 February | 47 | 4 | 51 |
| 2018 January | 32 | 8 | 40 |
| 2017 December | 46 | 8 | 54 |
| 2017 November | 47 | 9 | 56 |
| 2017 October | 35 | 12 | 47 |
| 2017 September | 41 | 27 | 68 |
| 2017 August | 58 | 11 | 69 |
| 2017 July | 69 | 9 | 78 |
| 2017 June | 85 | 16 | 101 |
| 2017 May | 92 | 32 | 124 |
| 2017 April | 75 | 10 | 85 |
| 2017 March | 71 | 21 | 92 |
| 2017 February | 66 | 14 | 80 |
| 2017 January | 45 | 8 | 53 |
| 2016 December | 64 | 24 | 88 |
| 2016 November | 54 | 16 | 70 |
| 2016 October | 89 | 10 | 99 |
| 2016 September | 90 | 27 | 117 |
| 2016 August | 143 | 7 | 150 |
| 2016 July | 69 | 12 | 81 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 1 | 21 | 22 |
| 2015 October | 1 | 26 | 27 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 25 | 8 | 33 |
| 2015 June | 65 | 14 | 79 |
| 2015 May | 110 | 35 | 145 |
| 2015 April | 94 | 33 | 127 |
| 2015 March | 80 | 24 | 104 |
| 2015 February | 8 | 4 | 12 |
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