నైరూప్య

Comparison of changes of fatigue and psycho-physical wellbeing in rheumatoid arthritis patients during add-on treatment with alfacalcidol or prednisolone

Katarina Simic Pasalic, Tatjana Zivanovic Radnic, Mirjana Sefik Bukilica, Nemanja Damjanov, Andjela Gavrilovic & Jelena Vojinovic

The aim of this study was to investigate and compare effects of vitamin D analogue alfacalcidol (1αD3) or prednisolone add-on treatment to fatigue and psycho-physical well-being in patients with active RA. The study included 67 RA patients with active disease (DAS28 >3,2), despite standard methotrexate (MTX) therapy. We collected data on disease activity based on joints examination and erythrocyte sedimentation rate (DAS28 ESR). Psycho-psychical wellbeing assessed by patient reported outcomes (PRO): health assessment questionnaire (HAQ), short form 36 quality of life (SF-36Qol) and functional assessment of chronic illness therapy (FACIT F) questionnaires. At enrolment, patients were randomly assigned to three-month supplementation with 1 μg (group A1) or 2 μg (group A2) or 3 μg (group A3) of 1αD3 daily or prednisone (group C) 20 mg daily, for the first month and 10 mg afterwards, in addition to MTX. We found significantly improved functional status-HAQ-DI (p<0,05) and physical components of quality of life - PCSQol (p<0,05), in A2 group (N=19). Subscales of quality of life such as vitality, general health (p<0,01), social, pain and mental components of quality of life - MCSQol (p<0,05) significantly improved only in the same, A2 group, while fatigue improved in all 1αD3 treated patients, in contrast to negative change in group C. Upon completed treatment, we found disease activity highly significantly reduced in all four treatment groups (DAS28 p<0,01). Alfacalcidol add-on treatment has positive impact on fatigue and psycho-physical wellbeing in RA patients, particularly 2 μg daily, which was as effective as prednisolone in disease control with significant multifaceted favourable impact on fatigue and wellbeing.