The relationship between physical activity level, gastrointestinal complaints and quality of life in patients with familial mediterranean fever

Abstract

AimIn this study, we aimed to examine the relationship between physical activity (PA) level, gastrointestinal complaints, and quality of life (QoL) in patients with Familial Mediterranean Fever (FMF) and to compare them with healthy individuals.MethodsThe study included patients diagnosed with FMF and healthy volunteers. Thirty-six FMF patients aged between 18-50 years and 38 healthy subjects were included in the study. The short form of the International Physical Activity Questionnaire (UFAA short form) was used to determine the PA levels of individuals. QoL was evaluated using the Short Form-36 (SF-36), and the Gastrointestinal Quality of Life Index (GIQLI) was used for gastrointestinal complaints.ResultsThe mean age of the FMF patients (women = 28 and men = 8) was 41.27 ± 14.19 years, which is comparable to that of the healthy individuals (43.26 ± 10.72 years; women = 32; men = 6) (P >0.05). When the group results were compared, there was a significant difference in UFAA short form, SF-36, and GIQLI (P < 0,05). A significant correlation was found between UFAA short form and SF-36, GIQLI in FMF patients (P < 0,05).ConclusionIt was observed that as the PA level of FMF patients decreased, their gastrointestinal complaints increased and their quality of life decreased. Therefore, recommendations should be made to increase PA levels in FMF patients.

Keywords

Introduction

Familial Mediterranean Fever (FMF) is a chronic inflammatory disease. FMF patients have fever and inflammation of the serous membranes with recurrent attacks..¹ The most common symptom is abdominal pain. Today, the most effective treatment of FMF is with lifelong colchicine. The most common side effects of colchicine are diarrhea and nausea.²
In addition, FMF is a chronic disease. Chronic diseases lead to the loss of various functions over time.³ They cause many psychiatric disorders such as depression and anxiety, both by reducing the quality of life and their direct biological effects.^4-6 For this reason, it is known that gastrointestinal system functional diseases such as Irritable Bowel Syndrome (IBS) and dyspepsia are more common during the course of chronic diseases.^7,8 However, there are no data in the literature showing the frequency of these disorders in FMF. Chronic disease is not the only reason for the expectation that digestive system complaints will be seen more frequently in patients with FMF. There are studies in the literature that plasma serotonin 2 levels are low in FMF patients.^9,10 In the pathogenesis of IBS and similarly dyspepsia, along with psychosocial factors, dysregulation in serotoninergic functions is also involved. Plasma serotonin levels were found to be low in constipation-predominant patients with IBS. Plasma serotonin levels were found to be high in IBS patients with diarrhea.¹¹ Based on these data, it can be thought that constipation-predominant IBS may be seen more frequently in FMF patients. Although there are digestive system complaints related to both the disease itself and the drug used in the treatment, there are not many studies on the frequency of digestive system disorders in these patients.
Physical activity (PA) and exercise have some benefits and risks for the gastrointestinal tract. Vigorous exercise inhibits gastric emptying, inhibits gastrointestinal absorption, and causes many gastrointestinal symptoms. However, moderately intense exercise is well tolerated and has beneficial effects on inflammatory bowel disease, liver disease, constipation, diverticulosis, and gallstones. PA also increases gastric emptying and reduces the relative risk of PA levels of patients and digestive system complaints in FMF. Considering the benefits of PA, individuals should be encouraged to engage in optimal PA for healthier individuals and healthier societies. It is clear that this is necessary for prolongation of life expectancy and quality of life (QOL).¹³ Since FMF is a chronic disease, it negatively affects the quality of life. A decrease in the level of PA is also expected. However, there is no study examining the effect of PA levels on QOL in FMF patients.
Our aim is to examine the relationship between PA level, gastrointestinal complaints and QOL in patients with FMF and to compare them with healthy individuals.

Materials and Methods

ParticipantsIndividuals aged 18 years and over who were treated with the diagnosis of FMF in Pamukkale University Hospital Rheumatological Diseases Polyclinic, as well as volunteers who met the inclusion criteria without any known additional disease were included in the study. The study included 36 FMF patients aged 18 years and older who were treated with the diagnosis of FMF in Pamukkale University Hospital Rheumatological Diseases Polyclinic, who voluntarily agreed to participate and met the inclusion criteria in the study, and 38 healthy controls of the same age group without any known additional disease. Our study was carried out between March 2021 and June 2023. Patients meeting the inclusion criteria were included. Written consent was obtained from all patients. Permission for our study was given by Pamukkale University Non-Interventional Clinical Research Ethics Committee dated 02.03.2021 (no. 05). Informed consent forms were signed by FMF patients who agreed to participate in this study. We evaluated FMF patients face to face.Inclusion and Exclusion CriteriaIndividuals over the age of 18, who did not have any additional disease other than FMF, who were oriented and cooperative, who agreed to participate in the study, and who did not have a neurological or physical disease that would prevent them from performing PA were included in the FMF group (FMFG). In the control group (CG), healthy people over 18 years of age, oriented and cooperative, who agreed to participate, and who did not have any problems that would prevent them from performing PA were included. Those with diseases such as Diabetes Mellitus (DM), hypothyroidism, colon cancer, a recent surgery to affect mobility, diagnosed gastrointestinal disease, the integrity of the gastrointestinal tract, and the use of drugs that can change the gastrointestinal motility were not included in the CG and FMFG.Evaluation MethodsPatient information regarding age, height, weight, gender, disease duration, age of diagnosis, duration of attacks, family history for FMF. The symptoms of the FMF patients were noted.
Demographic data were recorded after obtaining consent from the patients. Socio-demographic characteristics of the patients were determined by a face-to-face patient evaluation form. The short form of the International Physical Activity Questionnaire (UFAA) was used to determine the PA levels.¹⁴ QoL was assessed using Short Form-36 (SF-36).¹⁵ The Gastrointestinal Quality of Life Index (GIQLI) includes 36 parameters. Parameters, the answers were divided into 5 degrees using a Likert scale and scoring was done (0-4; 0: worst and 4: best).¹⁶Ethical ApprovalEthics Committee approval for the study was obtained.Statistical AnalysisIt was seen that the effect size obtained in the reference study was at a strong level (d=1.04).⁴ Based on the results of the reference study, as a result of the power analysis we made by assuming that we could achieve a lower effect size (d=0.8), it was calculated that 95% power could be achieved at the 95% confidence level, when at least 70 people (at least 35 people for each group) were included in the study. The data were analyzed with the SPSS package program. Continuous variables were presented as mean ± standard deviation and categorical variables as numbers and percentages. In the comparison of differences, the significance of the Man-Whithney U Test was used when the non-parametric test assumptions were not met, and Spearman’s Correlation analysis was used when the non-parametric test assumptions were not met.

Results

Of the 39 FMF patients, 1 patient was deemed ineligible for this study and 2 patients declined to participate. As a result, 36 FMF patients were analyzed. Of the 40 healthy individuals, 2 were deemed ineligible for this study. As a result, 38 healthy individuals were analyzed (Figure 1).
Thirty-six patients with FMF (men = 8 / women = 28) and 38 healthy individuals (Men = 6 / women = 32) were included (P = 0.560). The mean age of the patients with FMF was 41.27±14.19 years, which was comparable to that of the healthy individuals (43.26 ± 10.72) (P > 0.05). There was no significant difference in terms of age, weight, height and body mass index (BMI) (p > 0.05). A significant difference was found between the groups in terms of IPAQ, SF36, and GIQLI results (p < 0.05). The results are shown in Table 1.
The evaluation of all participants’ results showed a highly positive relationship between IPAQ and physical function (r = 0.563, P = 0.000), physical role (r = 0.462, P = 0.005), general health (r = 0.256, P = 0.132), bodily pain (r =0.407, P = 0.014), vitality (r = 0.683, P = 0.000), social functioning (r = 0.317, P = 0.059), emotional role (r = 0.313, P = 0.064) and mental (r = 0.646, P = 0.000) in patients with FMF. The evaluation of all participants’ results showed a highly positive relationship between IPAQ and GIQLI (r = 0.726, P = 0.000) in FMFG. The relationship between IPAQ, SF36, and GIQLI in patients with FMF is presented in Table 2.

Discussion

Chronic diseases cause both physical and mental problems. In this case, it impairs the quality of life.^5-7 At the same time, lack of PA is a condition that increases gastrointestinal complaints.^17,18 It is very important to improve the QOL in patients.
This is the first study to examine the relationship between PA level, and gastrointestinal findings. As a result of our study, we determined that gastrointestinal system (GIS) symptoms increased as PA decreased. At the same time, we found that the PA level of FMF patients was lower than that of healthy individuals, their GIS findings were higher, and their quality of life was more impaired.
As a result of this study, physical function, physical role, bodily pain and vitality of SF36 were lower in FMF patients than in health controls. Previous studies have shown that the quality of life of pediatric and adult FMF patients is impaired.^19,20 Our findings on quality of life are consistent with previous studies. Decreased quality of life may be associated with episodes of illness, and PA may also be associated with symptoms of depression, anxiety, and GIS symptom.^4-6
We determined that their PA was lower than that of healthy individuals. In a study, it was reported that the level of depression and fatigue in FMF patients was higher than in healthy individuals.⁴ This can reduce the PA level in people and reduce their desire to exercise. At the same time, musculoskeletal symptoms are common in FMF patients. Arthritis, arthralgia, and myalgia can mostly affect the knee or hip.²¹ Since the attacks in these patients are painful and physical exertion ultimately causes attacks, this forces patients to a sedentary lifestyle.²² This can cause a decrease in PA. Therefore, patients with FMF have more problems in performing activities of daily living than healthy individuals due to their low level of PA. In a study, it was reported that the exercise capacity of patients with FMF also decreased.²³ . In the study Babaoğlu et al., patients with FMF were physically inactive during the attack.²² In addition, the EULAR (Europa League Against Rheumatism) recommendations stipulated that FMF patients should be informed by physicians that physical stress triggers FMF episodes.²⁴ All this lowers the level of PA. Therefore, the level of PA was evaluated. In this study, the PA level in patients with FMF was found to be lower than in healthy individuals. There are not many studies comparing PA with healthy individuals.²³ In the previous study, a decrease was found in exercise capacity and PA level.²⁴
Joint pain is the third most common clinical finding of FMF after abdominal pain and fever. Episodic abdominal pain, which generally lasts less than 72 hours, is frequently seen in the course of FMF with a frequency of 89.2–93.7%.¹ Constipation and abdominal pain are seen in FMF. However, it is sometimes difficult to distinguish abdominal pain from an attack of FMF or from organic GIS disorders with visceral inflammation.²⁵ In addition, studies have previously found FMF to be associated with a higher risk of inflammatory bowel disease.^7,8 It was uncertain whether MEFV mutations were the cause.^1,7,8 Complaints such as constipation and diarrhea have been reported in FMF patients.²⁰

Limitations

Limitations of the current study were the small number of patients and the fact that most of the patients were under colchicine treatment. Colchicine treatment has controlled most of the FMF symptoms and we cannot be know whether colchicine has a positive or negative impact on GIS symptoms. There are no studies examining the relationship between PA and GIS findings in FMF patients. However, it was observed that low PA levels negatively affected the QOL and increased GIS complaints.¹⁸ For this reason, we think that GIS findings in FMF patients should be considered and studies should be conducted to increase the PA levels in FMF patients.

Conclusion

It was seen that as the PA level of FMF patients decreased, their gastrointestinal complaints increased and their QOL decreased. Therefore, recommendations should be made to increase PA levels in FMF patients. At the same time, it was observed that gastrointestinal complaints of FMF patients were higher than in healthy individuals. It is important to evaluate these patients’ GIS complaints.

Declarations

References

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Tables