Department of Internal Medicine, 4th Military Teaching Hospital, 50-981 Wrocław, Poland.
Student Research Club at the Division of Nursing in Internal Medicine, Department of Clinical Nursing, Wrocław Medical University, 51-618 Wrocław, Poland.
Nutrients. 2021 Apr 12;13(4):1259. doi: 10.3390/nu13041259.
Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient's functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient's perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (β = -0.069), perceived health (β = -0.172), physical domain (β = -0.425), psychological domain (β = -0.432), social domain (β = -0.415), environmental domain (β = -0.317). Malnutrition was a significant independent determinant of QoL in the "perceived health" domain (β = -0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (β = 1.414) and environmental domains (β = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.
类风湿关节炎（RA）是一种进行性关节疾病。除了损害关节外，它还可能引起多种器官并发症，并严重影响患者的功能。患有 RA 的老年患者报告疼痛、疲劳、情绪障碍、睡眠障碍和失眠，同时伴有虚弱、食欲不振和体重减轻。所有这些因素都会对患者的感知生活质量（QoL）产生不利影响。由于 RA 的慢性性质和该患者群体中营养不良的高风险，本研究调查了 MNA（迷你营养评估）问卷评分与老年人 RA 患者的生活质量、日常生活活动和虚弱综合征严重程度之间的关系。该研究包括 98 名（年龄超过 60 岁）根据 ARA（美国风湿病学会）标准诊断为 RA 的患者。使用了以下标准化工具：WHOQoL-BREF 用于生活质量，埃德蒙顿虚弱量表用于虚弱综合征严重程度，MNA 用于营养状况评估，以及 MMSE（迷你精神状态检查）用于评估任何认知障碍。医疗数据来自医院记录。在日常生活活动（ADL）和工具性日常生活活动（IADL）方面，具有不同营养状况的患者差异显著。营养不良程度越高，活动受限越严重。较低的体重也对认知功能产生不利影响（营养不良患者中有 33.33%被诊断为痴呆症，而体重正常的患者中为 1.79%）。同样，营养不良患者更容易出现虚弱（轻度虚弱综合征 33.3%，中度 16.67%，重度 16.67%）。与体重正常的患者相比，营养不良患者的所有 WHOQoL-BREF 问卷领域的生活质量评分明显较低，对每个领域中选定变量对生活质量影响的多因素分析表明，虚弱是所有领域较差生活质量的显著独立决定因素：感知生活质量（β=-0.069），感知健康（β=-0.172），身体领域（β=-0.425），心理领域（β=-0.432），社会领域（β=-0.415），环境领域（β=-0.317）。营养不良是“感知健康”领域生活质量的显著独立决定因素（β=-0.08）。此外，回归分析表明，男性性别对心理领域（β=1.414）和环境领域（β=1.123）的生活质量评分有积极影响。与体重正常的患者相比，营养不良的患者生活质量较低。营养不良会降低日常生活功能、认知功能和虚弱综合征的严重程度。虚弱综合征是所有 WHOQoL BREF 领域较差生活质量的显著独立决定因素。
