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Objectives: In this study, we aimed to evaluate the factors associated with disability and quality of life (QoL) in Turkish patients with systemic sclerosis (SSc). Patients and methods: Between January 2018 and January 2019, a total of 256 SSc patients (20 males, 236 females; mean age: 50.9±12.4 years; range, 19 to 87 years) who were diagnosed with SSc were included in the study. Disability and health-related QoL (HRQoL) were evaluated by the Health Assessment Questionnaire (HAQ), scleroderma HAQ (SHAQ), Duruöz Hand Index (DHI), and Short Form-36 (SF-36). Linear regression analysis methods were used to describe factors associated with disability and QoL of the patients. Results: All disability scores were higher and HRQoL scores were lower in diffuse cutaneous SSc patients compared limited cutaneous SSc, and differentiations were significant (p=0.001 and p=0.007). In multiple regression, pain (VAS) was the strongest predictor for high disability and low QoL scores (p Conclusion: Clinicians should consider the management of the pain and its sources as a key to improve better functional state and quality of daily life in SSc.

Objectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p Conclusion: The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.

WOS:000626257900003 PMID: 33948539 Abstract Objectives: In this study, we aimed to investigate whether there was any difference in kinesiotaping (KT) application on the upper trapezius muscle between a trained and untrained physiatrist in the management of patients with myofascial pain syndrome (MPS). Patients and methods: Between April 2013 and July 2015, a total of 45 patients (44 females, 1 males; mean age 31.9 +/- 8.0 years; range, 18 to 55 years) with MPS were included in this prospective, single-blind, randomized-controlled study. The patients were randomly divided into two groups. The first group (intervention group, n=24) was administered KT band with the muscle in a tense condition according to the muscle technique performed by a trained physiatrist, from the muscle origo toward its insertion point. The second group (control group, n=21) received no technique and KT was applied to the painful area by an untrained physiatrist using a randomly selected method. Primary outcome measures were pain at rest, during activity (0-10 cm visual analog scale), and threshold measurement with algometry (kg/cm(2)). Secondary outcome measures were function (Neck Pain and Disability Scale), degree of palpable muscle spasm, and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, at three and six weeks after the treatment. Results: There were significant improvements in all parameters in both groups. There were no significant differences in any parameters at six weeks. We demonstrated that KT, which was applied on active trigger points on the upper trapezius muscle by trained and untrained physiatrists, improved pain, palpable muscle spasm, neck function, quality of life, and patient satisfaction degree in patients with MPS. Conclusion: Our study results show that KT, which is applied by trained and untrained physiatrists, improves pain, palpable muscle spasm, neck function, quality of life in patients with MPS.

Introduction Rheumatoid arthritis is a chronic inflammatory disease with different disease activity grades. Several registries have been designed to determine the appropriate regimens of disease-modifying antirheumatic drugs to obtain sustained clinical remission. We examined epidemiological and clinical characteristics of rheumatoid arthritis patients using a clinical registry database (BioSTaR) and analyzed the differences in patients with sustained and switched therapies. Methods A multicenter, observational cross-sectional study for rheumatoid arthritis was performed between February 2019 and September 2020 using the BioStaR-RA registry. Demographic and clinical characteristics were prospectively recorded into a specifically designed electronic database. The patients were divided into three groups due to the heterogeneity of the study cohort. Patients were grouped as Group I (Initial; within the first 6 months of treatment with biological/targeted synthetic drugs), Group ST (Sustained Treatment; any first drug lasting for at least 6 months without any change), and Group S (Switch; any switching to another drug). Comparative analysis was performed between sustained treatment (Group ST) and drug switching (Group S) groups. Results The study included a total of 565 patients. The mean age was 53.7 +/- 12.8 years, and the majority were female (80.4%). There were 104, 267, and 194 patients in Groups I, ST, and S, respectively. Erosive arthritis and hematological extra-articular involvement were more frequently detected in Group S than Group ST (p = 0.009 and p = 0.001). The patients in Group S had significantly higher disease activity scores (DAS28-CRP, CDAI, and SDAI) (p = 0.025, p = 0.010, and p = 0.003). There were significantly more patients with moderate disease activity in Group S (p < 0.05). Conclusions The groups with sustained treatment and switching included patients with different disease activity status, although higher disease activity was determined in switchers. Overall, moderate disease activity and remission were the most common disease activity levels. Lower disease activity scores, lower hematologic manifestations, better functional status, and lesser radiographic damage are associated with sustained treatment. Turkish Medicine and Medical Devices Agency ; Ankara Numune Egitim ve Arastirma Hastanesi

Objectives: This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods: Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results: The DHI had significant correlations with VAS-pain (r=0.367, p0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p0.05 for all). Conclusion: In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

Purpose: In this study, we aimed to show whether a difference exists between retinal and choroidal microcirculation findings between patients with familial Mediterranean fever and healthy controls. Methods: Thirty-two patients with familial Mediterranean fever and 30 healthy controls were included in the study. All the patients underwent a complete ophthalmologic examination, including best-corrected visual acuity and intraocular pressure measurement. The AngioVue optical coherence tomography angiography device (Optovue, Fremont, CA) with split-spectrum amplitude-decorrelation angiography was used to evaluate and examine the retinal microvascular structure. Three-dimensional en face Optical coherence tomography angiography images were obtained by examining the macula using the 3 x 3 mm scanning protocol in the Angio Retina mode and the optic nerve using the 3 x 3 mm scanning protocol in the Angio Disk mode. All the patients' right eyes were examined. Results: A total of 62 subjects were included in the study, of whom 32 (53.3%) were female and 30 (46.7%) were male. No statistically significant difference was found between the two groups in terms of optic nerve head or radial peripapillary capillary vessel density. On examination, the superficial capillary plexuses were statistically similar between the two groups, but the deep capillary plexus vessel density in the parafovea, superior hemi, temporal, and superior areas were significantly lower in the patients with familial Mediterranean fever. Conclusions: We found that the capillary plexus vessel density was significantly lower in the parafovea, superior hemi, temporal, and superior regions in the patients with familial Mediterranean fever than in the control group. Therefore, OCTA, a noninvasive study, may be useful for understanding the systemic effects of familial Mediterranean fever. RESUMO Objetivos: Este estudo teve como objetivo mostrar se há diferença entre os achados da microcirculação retiniana e coroidal entre pacientes com febre mediterrânica familiar e um grupo controle saudável. Métodos: Trinta e dois pacientes com febre mediterrânica familiar e 30 controles saudáveis foram incluídos neste estudo. Todos os pacientes foram submetidos a um exame oftalmológico completo, incluindo a acuidade visual melhor corrigida e medida da pressão intraocular. O aparelho AngioVue Optical coherence tomography angiography (Optovue, Fremont, CA) com angiografia de correlação de amplitude de espectro dividido foi utilizado para avaliar e examinar a estrutura microvascular da retina. As angiotomografias de coerência ópticas en face tridimensionais foram obtidas examinando o protocolo de varredura macular 3 x 3 mm (modo angio retina) e o nervo óptico com o protocolo de varredura 3 x 3 mm (modo angio-disco). Todos os olhos direitos dos pacientes foram examinados. Resultados: Foram incluídos neste estudo, 62 sujeitos, dos quais 32 (53,3%) eram do sexo feminino e 30 (46,7%) do sexo masculino. Não houve diferença estatisticamente significativa entre os dois grupos quanto à densidade dos vasos da cabeça do nervo óptico ou da densidade dos vasos capilares peripapilares radiais. Durante o exame, os plexos capilares superficiais foram estatisticamente semelhantes entre esses dois grupos, mas a densidade profunda dos vasos do plexo capilar nas areas parafovea, hemi superior, temporal e superior foram significativamente menores nos pacientes com febre mediterrânica familiar. Conclusões: Verificamos que a densidade dos vasos do plexo capilar foi significativamente menor nas regiões parafovea, hemi superior, temporal e superior em pacientes com febre mediterrânica familiar em comparação com o grupo controle. Portanto, pode ser útil usar a angiotomografia de coerência óptica, por tratar-se de um estudo não invasivo, para melhor compreensão dos efeitos sistêmicos da febre mediterrânica familiar.

Background/aim: In this study, it was aimed to investigate the effects ofpulsed electromagnetic field(PEMF) therapy on pain, disability, psychological state, and quality of life in cervical disc herniation.Materials and methods: Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0?10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment.Results: A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment. Conclusion: PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.

Objectives: This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients. Patients and methods: This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale. Results: The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT. Conclusion: Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

The rheumatoid arthritis impact of disease (RAID) score was developed as a patient-derived composite response index for the evaluation of the disease impact on cases with rheumatoid arthritis (RA). The aim of this study was to evaluate the psychometric properties and performance of RAID score in the real-life settings. Cases with RA from our multi-center, nationwide registry called Biologic and targeted Synthetic antirheumatic drugs Registry RA (BioStaR RA) were included in this cross-sectional observational study. Demographic data, disease duration, pain, patient's global assessment (PGA) and physician's global assessment (PhyGA) were recorded. DAS28-ESR, DAS28-CRP, the simplified disease activity index (SDAI) and the clinical disease activity index (CDAI) were assessed as disease activity evaluations. The health assessment questionnaire-disability index (HAQ-DI) and RAID were completed by all the participants. The construct validity was tested by the analysis of correlations between RAID score and scores of PGA, disease activity indexes and HAQ-DI. We also evaluated the discriminatory ability of RAID to distinguish patients with different levels of disease activity and disability and the cut-off values were calculated by ROC analysis. 585 cases with RA were included in this investigation. The RAID score was significantly positively correlated with PGA, all disease activity indexes and HAQ-DI (p < 0.001). The discriminatory ability of RAID score in different disease activity and disability groups was also demonstrated (p < 0.001). To estimate DAS28-ESR (remission/low + moderate + high), RAID score cut-off points were 2.88 (sensitivity 73%, specificity 62%), 3.23 (sensitivity 75%, specificity 60%) and 3.79 (sensitivity 74%, specificity 58%), respectively. Our study indicated that RAID was a reliable tool in daily clinical practice by presenting its correlations with disease activity and disability assessments and by showing its discriminatory ability in these parameters in the real-life experiences. Turkish League Against Rheumatism (TLAR)

Objectives In this study, we aimed to evaluate the effect of gender on clinical findings, disease activity, functional status and quality of life in patients with axial involvement in Turkey. Methods Patients with PsA who met the CASPAR classification criteria were enrolled consequently in this cohort. Turkish League Against Rheumatism (TLAR)-Network was formed with the participation of 25 centres. The demographic variables, fatigue, diagnostic delay, the beginning of peripheral arthritis, enthesitis, dactylitis and spine involvement, inflammatory low back pain, BASFI, HAQ, HAQ-s, visual analogue scale-pain (VAS-pain), anxiety, depression and disease activity parameters (ESR, DAS28, BASDAI) were recorded. Axial involvement was assessed according to clinical and radiological data according to modified New York (MNYC) or Assessment of SpondyloArthritis international Society (ASAS) criteria. Results A total of 1018 patients with PsA were included in this study. Of the 373 patients with axial involvement, 150 were male (40.2%) and 223 (59.8%) were female. Spondylitis was detected in 14,7% of men and 21,9% of women in all patients. Pain score (VAS) (p < .002), fatigue (p < .001), ESR (p < .001), DAS28 (p < .001), BASDAI score (p < .001), PsAQoL (p < .001), HAQ score (p < ,01), HAQ-S score (p < .001), anxiety (p < .001), depression (p < .024), FACIT (p < .001) and FiRST (p < .001) scores were statistically significantly worse in women than males with axial PsA. However, quality of life was better (p < .001) and PASI score (p < .005) were statistically worse in male patients than in female patients with axial involvement. Conclusion This study has shown that the burden of disease in axial PsA has significant difference between genders. Disease activity, physical disability, functional limitation, depression and anxiety scores were higher in female patients, while quality of life were better and PASI score were higher in male patients. Therefore, we suggest that new strategies should be developed for more effective treatment of axial PsA in female patients.

The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is used as a new instrument in measuring the function, disability and health of patients with spondyloarthritis (SpA). However, the real-world evidence of ASAS HI is very limited. In the present study, our objective is to evaluate the psychometric properties and performance of ASAS HI in the real-world setting as well as comparing ASAS HI with the current instruments to assess the construct validity and determine the cut-off points in patients with both ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). A total of 991 patients with axSpA who fulfilled either the ASAS classification criteria for axial SpA (axSpA) or the Modified New York Criteria (mNY) for AS were recruited from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStaR) SpA. The construct validity of ASAS HI against the Bath Ankylosing Spondylitis Disease Activities Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) the Bath Ankylosing Spondylitis Functional index (BASFI) was performed. Using the receiver operating characteristic (ROC) curves analysis, the cut-off points were calculated. Of all the recruited patients, 851 (85.9%) were AS and 140 (14.1%) were nr-axSpA. The difference in the mean ASAS HI scores of the patients with AS and the ones with nr-axSpA were not statistically significant (6.12 +/- 4.29 and 6.42 +/- 4.86, respectively). The mean ASAS HI score was significantly higher in females and small city residents. The ASAS HI had a strong construct validity against ASDAS-CRP, BASDAI and BASFI. A cut-off point of = 12 to discriminate moderate and poor health status. In conclusion, ASAS HI is a reliable instrument to evaluate health and functioning for both patients with AS and nr-axSpA in clinical practice. Turkish League Against Rheumatism (TLAR)

Aim This study aimed to investigate the relationship between the level of serum signal peptide-CUB-EGF domain-containing protein (SCUBE)-1, SCUBE-2 and SCUBE-3 and clinical findings and ultrasonographic skin thickness in systemic sclerosis (SSc). Material and methods Thirty patients who met the American College of Rheumatology/European League against Rheumatism 2013 SSc classification criteria and 44 healthy volunteers who were compatible with the patient group in terms of age and gender were included in the study. Serum SCUBE levels were measured by enzyme-linked immunosorbent assay. Ultrasonographic skin thickness measurements were simultaneously performed. Results No significant difference was found between the serum SCUBE levels of SSc patients and serum SCUBE levels of the control group. A negative correlation was detected between serum SCUBE-1 level and forced expiratory volume in 1 second (FEV1 ). While a positive correlation was detected between serum SCUBE-2 level and the Duruoz Hand Index and serum C4 level, a negative correlation was determined with the forced vital capacity (FVC) value. A negative correlation was determined between serum SCUBE-3 level and echocardiographic pulmonary artery pressure (PAP). A correlation could not be determined between serum SCUBE levels and ultrasonographic skin thickness. However, a positive correlation was observed between ultrasonographic skin thickness and the modified Rodnan skin score. Conclusion In this study, a correlation was observed between serum SCUBE levels and some clinical and laboratory parameters (FEV1 , FVC, PAP, C4, and Duruoz Hand Index) in SSc patients. New clinical studies are needed to better understand the contribution of these molecules in the progression and pathogenesis of SSc.

Fibromyalgia syndrome (FMS) is a non-articular rheumatic disorder of unclear etiology, characterized by widespread body pain, fatigue and, psychological complaintsOBJECTIVES: To investigate the serum levels of neuron-specific enolase (NSE) in patients with FMS and to evaluate the relationship between cognitive function, quality of life and psychological state.Fifty-five female patients diagnosed with fibromyalgia according to the American College of Rheumatology (ACR) classification criteria, and 40 healthy female subjects were enrolled in the study. Life quality scale [(Fibromyalgia Impact Questionnaire (FIQ)], psychological state (Beck Depression Scale), and cognitive dysfunction (mini mental test, clock drawing test) scales were used for patients and control subjects. Serum NSE levels were studied using the ECLIA method.No significant differences were found in the serum NSE levels between the FMS patients and the control subjects (p0.05). Life quality and psychological state scores were found to be higher in FMS patients relative to the control group (p0.001). However, no significant differences were detected in cognitive function (p0.05). Significant correlations were not found between the serum NSE levels and quality of life, psychological state and cognitive functions (p0.05).No significant difference was determined between the groups in terms of NSE levels. Further studies, including larger series, should be carried out to clarify this relationship.

Background Lateral epicondylitis (LE) is a painful condition that affects the tendinous tissue of the lateral epicondyle of the humerus and leads to loss of function of the affected limb. Therefore it can have a major impact on the patient's social and personal life. Many treatments are recommended for lateral epicondylitis; unfortunately the evidence is limited. Objectives The aim of study was to investigate the effect of kinesio taping (KT) on pain, grip strength and function in patients LE. Methods Thirty-one (23 females, 8 males) patients with LE were included. KT was applied twice a week for 2 weeks. Pain at rest, activity of daily living (ADL), night and palpation on lateral epicondyle was evaluated with the visual analog scale (VAS 0-10 cm), and the grip strength was measured with a hand held dynamometer. The stage of the disease was evaluated by the Nirschl score and the functional status was assessed with Patient-Rated Forearm Evaluation Questionnaire (PRTEQ) score. These parameters were evaluated before, at 2 weeks and 6 weeks after treatment. Patients' satisfaction was also recorded on a Likert scale after treatment at 2 weeks and 6 weeks. Results The average age of the patients was 43.58 ± 9.02. The dominant limb was affected in 64.5% (20) of the patients. After the application of KT on lateral epicondyle, there was a significant improvement in all parameters in terms of pain, Nirschl score, hand grip strength, patient satisfaction, and PRTEQ scores at 2 and 6 weeks. Conclusions Kinesio taping can be an effective treatment method in LE. This application improves pain, grip strength and functional status of the patients with LE.

BACKGROUND: Subacromial impingement syndrome (SIS) is characterized by pain and disability of shoulder. Various treatment methods have been used for SIS. OBJECTIVES: The aim of our study was to evaluate efficacy of therapeutic ultrasound (US) on pain, disability, anxiety, depression, sleep quality and quality of life in patients with SIS. METHODS: Patients with SIS were randomly divided into two groups, including the group 1 (continuous US group; 3 MHz, 1.5 W/cm2, n = 26) and group 2 (sham US group, n = 24). Additionally, transcutaneous electrical nerve stimulation (TENS) + exercise program were added in both groups. Pain and disability of the shoulder were assessed by the Shoulder Pain and Disability Index (SPADI), while anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Quality of life was evalutaed by the Nottingham Health Profile (NHP). Patients were evaluated at baseline and after end of three weeks. RESULTS: Both groups had significantly improvements in terms of SPADI-pain, SPADI-disability, SPADI-total, NHP-pain and NHP-sleep scores after the three weeks interventions. There were significantly improvements in the Group 1 in terms of PSQItotal, and NHP-physical activity. Group 2 had significantly improvements in terms of anxiety-HADS, depression-HADS and NHP-emotional reaction scores. In the inter-group comparison, there were no significantly differences in the change scores were observed in any domains of SPADI scores, anxiety, depression and sleep scores, or any NHP scores. CONCLUSIONS: Our study showed that US does not have any benefits on SIS. TENS + exercise program are not effective on anxiety, depression and fatigue, however TENS + exercise program are effective on pain, disability and sleep disturbance in patients with SIS. © 2016 - IOS Press and the authors. All rights reserved.

Annual European Congress of Rheumatology (EULAR) -- JUN 12-15, 2019 -- Madrid, SPAIN, WOS: 000472207102501, Background PsA is a chronic musculoskeletal disease. The prevalence of axial involvement in PsA varies according to the duration of the disease. In early stage the incidence varies between 5% and 28%, but it increases up to 25-70% in later stages of the disease. In the literature, there is limited data on the differences in disease activity, functional status and quality of life of men and women with axial PsA., European League Against Rheumatism

BACKGROUND Diseases causing disabilities lead to sexual dysfunction. However, studies that evaluate sexual functions in patients with traumatic lower limb amputations (LLA) are limited and controversial. OBJECTIVE The objective is to evaluate sexual functions in male patients with LLA and to identify factors that might contribute to sexual dysfunction. The hypothesis is that male patients with LLA would experience worse sexual and emotional functioning and consequently emotional impairment that consequently influenced the sexual function. METHODS Sixty men with traumatic LLA and 60 healthy men were assessed according to the International Index of Erectile Function (IIEF) scoring system. Emotional state was assessed by the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and the quality of life by the Short Form-36 Health Survey (SF-36). RESULTS Patients had significantly lower scores in the IIEF total score and subscores in comparison with the controls. Intercourse satisfaction scores were significantly higher (p< 0.05) in patients with trans-tibial amputation than in those with trans-femoral amputation. BDI and BAI scores negatively correlated with erectile function, sexual desire, intercourse satisfaction, overall satisfaction and total IIEF scores. The mental and physical scores of SF-36 significantly correlated with some of the sub scores and IIEF total scores. The power of statistical analysis for study population was 100% according to the given effect size (α= 0.01). CONCLUSION The present study suggests that the LLA leads to impairments in the sexual function and quality of life in male patients. Also, sexual dysfunction in patients is strongly associated with emotional state, pain, level of amputation and quality of life.

Objectives To evaluate the radiological, clinical and functional properties of hand osteoarthritis and to assess their relationship in a Turkish population. Methods The subjects with hand OA recruited into the study from the multi-centre national osteoarthritis cohort by the Turkish League Against Rheumatology (TLAR–OA). The demographic characteristics, body mass index (BMI), smoking, finger ratio,(2nd to 4th finger lenght), grip strengths with Jamar dynamometer, hand pain duration (month), hand pain severity (visual analogue scale; 0–100 mm) were evaluated. The radiological stage of hand OA was assessed according to the Kellgren Lawrence OA staging. The hightest stage among the joints involvement was noted as the OA stage of the hand. The functional disability concerning to hand involvement was assessed with Duruoz Hand Index (DHI). The SPSS 24.0 statistical package was used for analysis. The descriptive analysis was performed for all parameters. Spearman’s correlation coefficient was used to assess the relation between quantitative variables. Results A total of 364 subjects (330 female, 34 male) from 15 centres with mean of age 62.96 (SD: 10.22) were recruited into the study. The mean of BMI was 29.54 (SD: 4.51) and the percentage of smoking person was 6.3%. The mean of 2nd finger to 4th finger ratio of the patients was 0.96 (SD: 0.05). The mean of grip strengths of the right hand and left hand were respectively 15.55 kg (SD: 12.88) and 14.13 kg (SD: 11.39), which is lower than normal population.1 The median pain duration of hand was 24 months (min-max: 1–480 months). The mean VAS score of pain was 5.05 (SD: 2.33). The mean DHI score was 16.82 (SD: 15.53). The patients’ radiological OA involvement stages (2,3 and 4) of right and left hands were respectively 26.1% and 23.6% (stage 2); 22.5% and 20.9% (stage 3); 13.2% and 12.4% (stage 4) according to the Kellgren Lawrence scoring. The radiological stages of right and left hands respectively had poor correlation with VASpain (rho=0.152, p=0.010; rho=0.158, p=0.009); low but significant correlations with Duruoz Hand Index (rho=0.257, p 0.05). Conclusions Although the subjects with hand OA had pain, low grip strenght and hand disability; the radiological findings had meaningful relations with only functional involvement and pain duration in our population. Reference [1] Massy-Westropp N, et al. Hand grip strenght: age and gender stratified normative data in a population-based study. BMC Res Notes2011;4:127. Disclosure of Interest M. T. Duruoz Grant/research support from: ABVIE, Consultant for: NOVARTIS, Speakers bureau: ABDI IBRAHIM, D. Erdem: None declared, T. Tuncer: None declared, L. Altan: None declared, F. Ayhan: None declared, A. Bal: None declared, L. Cerrahoglu: None declared, E. Capkin: None declared, R. Cevik: None declared, D. Dulgeroglu: None declared, S. Gursoy: None declared, S. Hizmetli: None declared, C. Kacar: None declared, E. Kaptanoglu: None declared, T. Kaya: None declared, H. Kocabas: None declared, K. Nas: None declared, S. Ozcakir: None declared, D. Sindel: None declared, O. Sahin: None declared, G. Tasci Bozbas: None declared, C. Tikiz: None declared, H. Ugurlu: None declared

This study aimed to compare continuous and pulsed ultrasound therapy with sham ultrasound in terms of pain, severity of muscle spasm, function, depression, and quality of life in patients with myofascial pain syndrome.Patients were randomly divided into three groups, including the continuous ultrasound group (3 MHz, 1 W/cm, n = 20), the pulsed ultrasound group (3 MHz, 1 W/cm, 1:1 ratio, n = 20), and control group (sham, n = 20). The primary outcome measures were severity of pain at rest and during activity (visual analog scale, 0-10 cm). The secondary outcome measures were function (Neck Pain and Disability Scale), depressive mood (Beck Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, after treatment, and at the 6th and 12th wks.All three groups had significant improvements in all of the pain scores, the severity of muscle spasms, function assessments, and certain subparameters of the quality of life scale (P0.05). The continuous ultrasound group had significantly greater improvements in pain at rest (P0.05). However, no statistically significant differences were observed in the other parameters (P0.05).Continuous ultrasound therapy is more efficient in reducing pain at rest for myofascial pain syndrome patients than is sham or pulsed ultrasound therapy.

WOS: 000443738600001, PubMed ID: 30632540, Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining >= 70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.

Objectives: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range, 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range, 16 to 97 years) by trained general practitioners across the country, in 25 provinces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

WOS: 000429930000001, PubMed ID: 29900976, Objectives: This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloarthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Materials and methods: A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results: Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion: Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.

WOS:000435672000002, PubMed ID: 30207576, Objectives: This study aims to establish the first national treatment recommendations by the Turkish League Against Rheumatism (TLAR) for psoriatic arthritis (PsA) based on the current evidence. Materials and methods: A systematic literature review was performed regarding the management of PsA. The TLAR expert committee consisted of 13 rheumatologists and 12 physical medicine and rehabilitation specialists experienced in the treatment and care of patients with PsA from 22 centers. The TLAR recommendations were built on those of European League Against Rheumatism (EULAR) 2015. Levels of evidence and agreement were determined. Results: Recommendations included five overarching principles and 13 recommendations covering therapies for PsA, particularly focusing on musculoskeletal involvement. Level of agreement was greater than eight for each item. Conclusion: This is the first paper that summarizes the recommendations of TLAR as regards the treatment of PsA. We believe that this paper provides Turkish physicians dealing with PsA patients a practical guide in their routine clinical practice.

Background Psoriatic arthritis (PsA) is a chronic progressive inflammatory disease characterized by peripheral arthritis, dactylitis, axial joint involvement and extraarticular features. Disease consequences such as chronic pain, severe joint damage and fatigue may adversely effect on a patient9s physical function and health-related quality of life (QoL) to perform daily activities. Objectives The aim of this study was to investigate the potential relationship between physical function and health-related QoL and disease activity measures in patients with PsA. Methods For all participating patients, quality of life, functional and disease activity measures were measured by different ways: Nottingham Health Profile (NHP), psoriatic arthritis quality of life (PsAQoL), Ankylosing Spondylitis Quality of Life (ASQoL), SF36 health survey, Health Assessment Questionnaire (HAQ), BASFI, VAS pain, DAS28, BASDAI and acute phase markers including ESR and CRP.Patients with PsA were discriminated into low and high disease activity according to BASDAI (≥6 vs ≤4). Results A total of 186 patients with PsA (116 female, 70 male, mean age 43,9±12,6) who met CASPAR criteria were included. Their mean symptom duration was 7.9±9.1 years. Patients with higher BASDAI score (≥6) had significantly higher scores on all important items including health related QoL, fatigue, pain, and functional status. Correlation coefficients between disease activity and various health related QoL measurements were given in Table1. SF36 physical component score was significantly correlated with VAS-pain, BASDAI and DAS28 compared to SF36 mental component. Also, physical activity subscore of NHP was found higher correlated with disease activity indices for PsA in all NHP sections. Other quality of life measurements including PsQoL, HAQ and ASQoL were also significantly correlated with disease activity measurements. Conclusions Psoriatic arthritis has a major impact on patients9 lives. Variable disease activity measurements were found correlated with all important QoL measurementss including NHP, SF36, PsQoL, HAQ and ASQoL. In patients with PsA, high disease activity may lead to severe impairments in daily activities and influence on participation in society. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is an immune-mediated chronic inflammatory arthropathy-associated with psoriasis. T helper 17 pathway has been shown to play an important role in PsA. Objectives In this study, we aimed to investigate concentrations of TH17 pathway cytokines such as IL-17, IL-22 and IL-23 in psoriasis (PsO) with/and without structural bone damage and psoriatic arthritis (PsA), and their relationship with disease activity and clinical findings. Methods A total number of 74 patients, 24 patients with PsA (mean age 57.5±11.37; 13 women, 11 men) and 25 patients with PsO and structural bone damage (mean age 49±13.92; 11 women, 14 men) and 25 patients with PsO and no structural bone damage (mean age 41±16.77; 7 women, 18 men), were recruited from the Department Internal Medicine 3 of the University of Erlangen-Numberg. Both PsO and PsA patients were evaluated according to the CASPAR criteria. Demographic and disease specific variables were recorded. Bone architecture of the metacarpal heads II and III were assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT, XtremeCT, Scanco, Switzerland). Disease activity was assessed with Disease Activity Score (DAS28). Psoriatic skin and nail disease activity were measured by the PASI. Results The ages of the patients in the three groups were similar. IL-17A concentrations were significantly differed between the groups (p=0.000). However, for other cytokines there was no difference between PsA and PsO groups. Serum levels of IL-17A were significantly correlated to patient pain of VAS (r=-0.318, p=0.06), VAS patient global assessment (r=0.272, p=0.021), DAS28 (r=-0.394, p=0.001) and PASI (r=0.519, p=0.000) in PsA and PSO. PASI score were also positively correlated with IL23 (r=-0.286, p=0.015) and S100A8 (r=0.298, p=0.011). Conclusions IL-17A seems to play an important role in development of PsA and bone damage in PsO. This role should be elucidated by further and larger clinical studies. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, axial involvement, enthesitis, dactylitis and uveitis. The differences and similarities between patient9s global assessment (PtGA) and physician9s global assessment (PhGA) were not assessed clearly in PsA. Objectives The aim of this study was to assess differences and similarities between patient9s and physician9s perspective of global assessment in patients with PsA. Methods Patients with PsA over the age of 18-year-old who met the CASPAR classification criteria were underwent clinical and laboratory evaluation by using standardized protocol and case report form, from two universities outpatient9s clinics. PtGA and PhGA, VAS-pain, fatigue, BASDAI, BASFI, health-related QoL were recorded at baseline visit. Pearson correlation coefficient were calculated for PtGA and PhGA. Linear regression model were used to asses relationship between global assessments and clinical finding. Results A total 144 patients with PsA (male 51, female 93) were included. Symptom duration (7.8±7.5 vs 11.3±11.2), VAS-pain (4.4±2.6 vs 4.9±2.6), PtGA (4.7±2.5 vs 5.0±2.4) and PhGA (4.0±2.2 vs 4.4±2.2) were similar between male and female patients with PsA (p>0.05). VAS-fatigue was higher in female patients with PsA than male ones (5.9±2.7 vs 4.4±2.8, p=0.001). Disease activity measurements such as, tender and swollen joint count, DAS28, BASDAI and acute phase reactant were similar for both sex. Correlation coefficient of Physician9s global assessment was higher than PtGA in various clinical findings. The highest correlation coefficient was observed in VAS-pain (r=0.784) and followed by SF36-bodily pain (r=-0.613), BASDAI (r=0.587), NHP-physical activity (r=0.584), VAS-fatigue (r=0.555), BASFI question 5 (r=0.551) for PhGA (p Conclusions Assessment of disease activity as well as clinical parameters is considered to be complex in PsA. Patient9s and physician9s have different perspective of disease activity. Severity of pain and fatigue may be predictor of PtGA whereas; pain and objective disease activity measurement may be predictor of PhGA in patient with PsA. Disclosure of Interest None declared

Background Systemic sclerosis (SSc) is an autoimmune rheumatic disease with unknown etiology that characterized fibrosis and vascular endotelial damage with obliteration of the microvasculature caused from exaggerated syntesis of collagen and extracellular matrix deposition in skin and internal organs. Pentraxin 3 (PTX3) accepted as a vascular inflammatory marker which secreted in early stage of endothelial dysfunction. Objectives In this study, we aimed to investigate plasma PTX3 and serum complement C1q levels and their relations with cytokines and pulmonary arterial pressure in SSc. Methods Fifty nine patients diagnosed SSc and 28 subjects without inflammatory rheumatic disease recruited to the study. Plasma PTX3, and serum TNF-α, IL-1β, IL-4, IL-10, INF-γ, TGF-β and complement C1q measured in both groups. Clinical findings and pulmonary arterial pressure of the SSc patients assessed. Results Ages of fifty nine with SSc (54 female and 5 male) and 28 control subjects (23 female and 5 male) were 49,47±12.74 and 43,07±13,71 respectively. PTX3, IL-1β and IL-4 levels found decreased in SSc patients. There were no differentiations between limited and diffuse cutaneous SSc subgroups in terms of PTX3, cytikines and C1q levels. Plasma PTX3 and serum IL-1β concentrations found decreased only limited cutaneous SSc subgroup comparing controls. According to the immunosupressive drugs use; PTX3 levels found decreased in using group and TNF-α ve IL-1β levels found decreased in not using group comparing controls. Significant positive association found between PTX3 and C1q and all cytokines except TGF- β. Conclusions PTX3 suggested to be used in the pathogenesis and assessment of disease treatment efficacy of SSc, because of found decreased in SSc patients especially in limited cutaneous and immunosupressive drugs using subgroups. Associations between C1q, and PTX3 and pulmonary artey pressure highlighted possible roles of both parameters in development of pulmonary hypertension. It is possible to develop preventive treatment strategies with better understanding of these associations. Advanced studies should be carried out for clarifying this condition. Disclosure of Interest None declared

Aim: The aim of this study was to evaluate sleep quality and the related variables in patients with Behcet’s disease (BD). Method: One hundred and twelve patients diagnosed with BD and 67 age- and gender-matched healthy controls were enrolled in the study. The Pittsburgh Sleep Quality Index (PSQI) was used for the evaluation of sleep disturbance in all participants. The quality of life (QoL) of all patients were evaluated by Nottingham Health Profile (NHP), and anxiety and depression which were assessed by Hospital Anxiety and Depression Scale (HADS). Results: The patients with BD had significantly higher scores in subjective sleep quality, sleep latency, sleep efficiency, sleep disorder, functional disorder in the morning and total PSQI score compared to the healthy control group. According to Pearson’s analysis, there was a significantly higher correlation between the anxiety, depression and all components of NHP scores and the total PSQI score. Logistic regression analyses indicated that genital ulcer and arthritis were predictors for poor sleep quality. Conclusion: Sleep quality is disturbed in patients with BD. The lower quality of sleep is greatly associated with anxiety, depression, QoL, genital ulcers and arthritis.

Objective: To determine the affective temperaments and somatoform amplification of the symptoms and its relation with the complex regional pain syndrome [CRPS] in patients who had tendon injuries of the forearm and hand.Methods: Sixty-seven patients [60 males, 7 females] with a forearm or hand tendon injury were enrolled in the present study. The patients were divided into two groups: CRPS and non-CRPS. The patients’ pain levels within the last 48 hours were assessed using the visual analog scale [VAS]. The temperament of the patients was evaluated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire [TEMPS-A]. Their anxiety levels were evaluated with the help of the State-Trait Anxiety Inventory [STAI]. The depression assessment was performed using the Beck Depression Inventory [BDI]. The Somato sensory Amplification Scale [SSAS] was employed for the evaluation of the somatoform disorders.Results: The mean age of the patients was 26.21 ± 8.01 years [age range:...

Objectives To investigate performance of some of the published psoriatic arthritis (PsA) classification criteria as well as Assessment of Spondyloarthritis International Society (ASAS) criteria for peripheral spondyloarthritis (SpA) in Turkish patients with PsA (in early and late disease subgroups). Methods Patients were recruited using case report forms and physical examination methods proposed by the Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD). The Moll and Wright (MW), modified Fournie (MF), modified McGonagle (mMG), Vasey and Espinoza (VE), classification of PsA (CASPAR) criteria and ASAS criteria were assessed in patients with PsA who were diagnosed based on expert opinion. Results One hundred and twenty-eight patients with PsA (58 male, 70 female, mean age 41.8 years) were included. Thirty patients were in the early PsA and 98 patients were in the late PsA groups. Diagnostic delay was 2.6 years. In the 15.6% of patients arthritis developed before the skin findings. The proportion of patients fulfilling the MW, MF, mMG, VE, CASPAR and ASAS criteria were at a ratio of 90.6%, 82.8%, 62.5%, 84.4%, 96.1% and 76.5%, respectively. In early PsA (< 12 months disease duration) the proportions were 93.4%, 83.3%, 76.7%, 76.7%, 96.7% and 66.6%, respectively. On the other hand, in late PsA the proportions were 89.8%, 82.6%, 57.1%, 86.7%, 95.9%, 79.5%, respectively. Conclusions Even though the sensitivity of PsA classification criteria in Turkish patients changes, the CASPAR criteria seems to be more prominent among all criteria for both early and late cases with its high sensitivity.

The aim of this study is to evaluate the rela- tionship between the sleep quality and the disease-related variables, functional status, quality of life, and depressive symptoms in patients with systemic sclerosis (SSc). Forty- eight patients diagnosed with SSc and 42 healthy control subjects were enrolled in the study. The demographic and clinical characteristics of the patients such as the Ray- naud's phenomenon, SSc subtype, digital ulcers, gastroin- testinal and lung involvement, and disease activity were recorded. All patients were assessed using the short form 36 (SF-36) quality of life scale, the health assessment questionnaire and the beck depression inventory. Gen- eralized pain and fatigue were assessed with the Visual Analoge Scale. For the evaluation of the sleep disturbance, the SSc and control groups were assessed with the help of the Pittsburgh Sleep Quality Index (PSQI). The patients with SSc had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, daytime dysfunction domains, and in terms of the total PSQI score compared to the healthy control group (p \ 0.05). According to the results of spearman's analysis, there was a significantly higher correlation between the generalised pain, fatigue, depressive symptoms, functional status, and physical score of the SF-36 and the sleep dis- turbance (p \ 0.01). There was also a significantly lower correlation between the menopause status, dyspnoea, gas- troesophageal reflux, dysphagia, the mental score of the SF-36, and the sleep disturbance (p \ 0.05). The sleep quality is disturbed in patients with SSc. The lower quality of sleep is especially associated with the pain, fatigue, depressive symptoms, and functional status.

OBJECTIVES: The HLA-DRB1 gene plays an important role in the genetic predisposition to rheumatoid arthritis. The anticitrullinated protein antibody (ACPA) is known to be associated with the susceptibility to rheumatoid arthritis (RA), as well as the severity of the disease. The aim of this study is to determine the HLA genes that are associated with the severity of the RA measured by seropositivity, functional status, radiological damage and the anti-modified citrullinated vimentin (MCV) levels. MATERIAL AND METHOD: Ninety-six patients diagnosed with rheumatoid arthritis and a control group consisting of 84 healthy individuals were enrolled in the study. The HLA-DRB1 type and subtypes were specified using the polymerase chain reaction with sequence-specific primers (PCR-SSP). The association of the HLA-DRB1 type and subtypes with seropositivity, anti-MCV levels, functional status and anatomical joint damage were explored using the modified Larsen scoring method. RESULTS: The DRB1*01, DRB1*04, DRB1*07, DRB1*10, DRB1*11 and DRB1*15 alleles were found to be related with higher anti-MCV levels ( p< 0.05). The DRB1*11 type and the DRB1*1001 subtype were observed to be associated with poor functional status (Stages 3–4). The DRB1*0801 subtype was associated with lower anti MCV levels (OR = 8.35, p = 0.02). DRB1*04 type and DRB1*0405 subtypes were related with radiological damage (OR = 0.52 and 0.25; p = 0.04 and 0.03, respectively). No significant relationship was observed between the RF seropositivity and the HLA-DRB1 alleles. CONCLUSION: This study revealed the association between the HLA alleles and seropositivity, functional status, anti-MCV levels and radiological damage in patients in the Southeast Anatolian region of Turkey.

Growth differentiation factor (GDF)-15 was originally identified as a factor secreted by activated macrophages, and plays an important role in cell growth and differentiation. GDF-15 plays an important role in cell growth, signal transduction, and apoptosis regulation. The aim of this study was to evaluate the serum GDF-15 levels and their relationship with disease-related characteristics in patients with rheumatoid arthritis (RA).Forty-six patients diagnosed with RA and 36 demographically matched healthy control subjects participated in this study. GDF-15 levels were measured in blood samples from patients and controls. The disease activity score-28 (DAS28) was used to evaluate the disease activity of RA. The quality of life was evaluated using the disease-specific rheumatoid arthritis quality of life (RAQoL) scale. The health assessment questionnaire (HAQ) was used to evaluate the functional status. The degree of joint damage was assessed according to Larsen's method. Atherosclerosis was assessed by a cardiologist with the help of echocardiography according to the carotid intima media thickness (CIMT) method; vascular stiffness was assessed by using the flow mediated dilatation (FMD) method.Serum GDF-15 levels were significantly higher in RA patients when compared to the control subjects (p0.05). RA patients were divided into two groups according to the disease activity; while 26 subjects (57%) were in the active group, 20 patients were in the non-active group (43%). Serum GDF-15 levels were significantly higher in the group that was considered to have an active disease. According to Pearson's correlation, serum GDF-15 levels were positively correlated with erythrocyte sedimentation rate (ESR) levels, morning stiffness, DAS28 score, tender joint count, and CIMT (p0.05).GDF-15 may play a role in the pathway of disease activity, joint involvement, and atherosclerosis in patients with rheumatoid arthritis.

Objectives: To assess gender related differences in a cohort of patients with psoriatic arthritis (PsA).Methods: Consecutively recruited patients were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms.Results: Women (n=115) with PsA had higher symptom duration and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), Erythrocyte sedimentation rate (ESR) and poorer physical activity and fatigue than men (n=72) with PsA. Psoriasis area and severity index (PASI) were higher in male patients. However quality of life (SF36 physical and mental component scores), articular pattern, extra-articular features (including uveitis, iritis) and family history for psoriasis, spondyloarthritis (SpA) (PsA and ankylosing spondylitis [AS]) were quite similar between men and women.Conclusions: Some of the clinical and laboratory variables tend to be different between men and women with PsA. The extent of quality of life and articular pattern seem to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations.

The aim of this study was to evaluate changes in jaw bones due to osteoporosis using cone beam computed tomography (CBCT) images. Subjects that had undergone CBCT for various oral conditions and demonstrating clinical findings of osteoporosis were invited to participate in the study. Dual X-ray absorptiometry (DXA) was performed on 90 patients aged over 30 years who underwent CBCT. The study groups were based on DXA results, and included 26 osteoporosis patients (mean age ± standard deviation; 58.52 ± 5.91), 33 osteopenia patients (52.67 ± 8.61) and 31 healthy controls (49.81 ± 10.47). CBCT images of jaw bones were evaluated using radiomorphometric indexes, CT values, histogram analysis (HA) and fractal dimension (FD) analysis. Right and left mandibular radiomorphometric indexes, CT values and HA measurements in osteoporosis patients were significantly lower than measurements in osteopenia patients and control subjects (P ≤ 0.05). Positive correlations were observed between measurements of spine bone mineral density (BMD) and right and left mandibular CT values (P ≤ 0.01) and HA (P ≤ 0.01) measurements. Left maxilla FD measurements in osteoporosis patients were significantly lower than in the control (P ≤ 0.05) and osteopenia (P ≤ 0.05) groups. Osteoporosis caused significant changes in radiomorphometric indexes, CT values, and HA and FD measurements in the jaw bones. (J Oral Sci 58, 185-194, 2016).

Objectives: This study aims to investigate the frequency of fibromyalgia syndrome and to specify fibromyalgia syndrome-associated clinical symptoms in patients with acne vulgaris. Patients and methods: Eighty-eight patients (28 males, 60 females; mean age 23.2±5.1 years; range 18 to 40 years) with acne vulgaris and age, sexand body mass index-similar 76 healthy controls (14 males, 62 females; mean age 24.5±2.9 years; range 18 to 35 years) were included. Acne vulgaris was evaluated by using the Global Acne Scale, while Hospital Anxiety and Depression Scale was used to evaluate anxiety. Results: Fibromyalgia-associated pain, sleep disturbance, anxiety, and menstrual cycle disturbance were significantly more frequent in patients with acne vulgaris than controls. Also, the severity of anxiety and the number of tender points were significantly higher in the acne vulgaris patients than controls. Conclusion: This study indicates that patients with acne vulgaris have increased frequency of fibromyalgia syndrome than healthy controls (21.6% versus 5.3%, respectively).

Amac: Bu calismanin amaci Romatoid Artrit\'li (RA) hastalarda Osteoprotegerin (OPG), Nukleer faktor kappa B reseptor aktivatoru ligandi (RANKL), katepsin-K duzeylerini ve ayrica bu parametrelerin kemik mineral yogunlugu (BMD) ile iliskisini arastirmaktir. Gerec ve yontem: Calismaya postmenopozal saglikli (n=30), postmenopozal osteoporozlu (n=30) ve postmenopoz RA\'li (n=30) toplam 90 olgu alindi. Serum RANKL, OPG ve katepsin-K ELISA yontemiyle calisildi. Bulgular: Postmenopozal RA\' li hastalarda serum RANKL ve OPG seviyeleri postmenopozal saglikli kontrollere kiyasla anlamli yuksekken, serum OPG/RANKL orani anlamli dusuk bulundu. Bununla birlikte postmenopozal RA\'li hastalarda, postmenopozal osteoporozlu hastalara gore serum OPG ve OPG/RANKL orani anlamli dusuk iken, serum RANKL seviyesi anlamli yuksekti. Postmenopozal RA\'li hastalarda lomber spine (LS) ve femur neck (FN) kemik mineral dansiteleri (BMD) ile OPG/RANKL orani arasinda pozitif korelasyon saptanirken; RANKL duzeyleri ile negatif korelasyon bulundu. Sonuc: RANKL/RANK/OPG sistemi osteoporoz ve RA patogenezinde rol alabilmektedir ve OPG/RANKL orani kemik dansitesinin onemli bir belirleyicisi olabilir.

Objectives: The aim of this study was to evaluate thelevels of osteoprotegerin (OPG), nuclear factor kappa Breceptor activator ligand (RANKL), cathepsin K in patientswith rheumatoid arthritis (RA) and the relation betweenthese parameters and bone mineral density (BMD).Materials and methods: Totally 90 cases including 30postmenopausal and healthy women, 30 with postmenopausalosteoporosis and 30 with postmenopause RAwere enrolled in the study. The serum RANKL, OPG andcathepsin K were measured by ELISA method.Results: The levels of serum RANKL and OPG in the patientswith postmenopausal RA were found significantlyhigher compared to the postmenopausal healthy womenwhereas the rate of serum OPG/RANKL was found significantlylower. In addition, the rate of OPG and OPG/RANKL were significantly lower in patients with postmenopausalRA compared to the postmenopausal osteoporosis,whereas the level of serum RANKL was significantlyhigher. Positive correlation was detected betweenbone densities of lumbar spine (LS), femur neck (FN) andthe rate of OPG/RANKL in patients with postmenopausalRA. Also negative correlation was detected between LSand FN bone densities and RANKL levels.Conclusions: The system of RANKL/RANK/OPG mayhave a role in osteoporosis and RA pathogenesis and therate of OPG/RANKL might be a significant determiner ofbone density.Key words: Osteoporosis, rheumatoid arthritis, RANKL,OPG, cathepsin-K

Aim: Physiotherapy is an integral part of the management of ankylosing spondylitis (AS) and there is a needfor recommendations which focus on the rehabilitation of patients with AS. We aimed to develop recommen-dations for the physical therapy and rehabilitation of patients with AS based on the evidence and expertise.Methods: The Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD) is a scientific group ofTurkish academicians (physiatrists and rheumatologists) who are experts in the rehabilitation of patients withAS. A systematic literature search summarizing the current available physiotherapy and rehabilitation trials inAS were presented to the experts before a special 2-day meeting. Experts attending this meeting first defined aframework based on the main principles and thereafter collectively constructed six major recommendationson physiotherapy and rehabilitation in AS. After the meeting an email survey was conducted to rate thestrength of the recommendations.Results: Six key recommendations which cover the general principles of rehabilitation in AS in terms of earlyintervention, initial and follow-up assessments and monitoring, contraindications and precautions, key advicefor physiotherapy methods and exercise were constructed.Conclusion: These recommendations were developed using evidence-based data and expert opinion. The imple-mentation of these recommendations should encourage a more comprehensive and methodical approach in therehabilitation of patients with AS. Regular lifelong exercise is the mainstay of rehabilitation and there is a consid-erable need for well-designed studies which will enlighten the role of physical therapy in the management of AS.Key words: ankylosing spondylitis, physiotherapy, recommendations, rehabilitation.Ankylosing spondylitis (AS) is a common inflamma-tory rheumatic disease that predominantly affects thesacroiliac joints and spine, leading to structural

©2011 Turkish League Against Rheumatism. All rights reserved. Amac: Bu calismada ankilozan spondilitli (AS) hastalarda hastalik aktivitesiyle iliskili fonksiyonel disabilite, yasam kalitesi ve klinik bulgular arasindaki iliskiler degerlendirildi. Hastalar ve yontemler: Ankilozan spondilit tanisi konulan ve modifiye New York kriterlerine uyan 73 hasta (62 erkek, 11 kadin; ort. yas 33.3±9.5 yil; dagilim 17-60 yil) calismaya alindi. Kadin hastalarin yas ortalamasi 29.2±7.3, erkek hastalarin yas ortalamasi ise 34.0±9.7 yil idi. Hastalarin demografik verileri kaydedildi. Hastalik aktivitesi, Bath ankilozan spondilit hastalik aktivitesi indeksi (BASDAI) kullanilarak degerlendirildi. Fonksiyonel disabilite, Bath ankilozan spondilit fonksiyonel indeksi (BASFI) kullanilarak degerlendirildi. Klinik durum Bath ankilozan spondilit metroloji indeksi (BASMI) ve yasam kalitesi ise Short Form 36 (KF-36) ile degerlendirildi. Bulgular: Hastalar BASDAI puani dortten dusuk (BASDAI

Son yıllarda immün yetersizlik oluşturan hastalıklar ve ilaç kullanımı gibi nedenlerle tüberküloz insidansında artış görülmektedir. Ayrıca osteoartiküler tutulum da artmıştır. Bu yazıda diz ve akromiyoklaviküler eklem tüberkülozu tanısı konulan 22 yaşında bir erkek hasta sunuldu. Bu eklemin tüberkülozu çok nadirdir ve diz eklem tutulumu ile birlikteliği literatürde bildirilmemiştir. Kesin tanı sinoviyal biyopsinin histopatolojik incelemesiyle konuldu. Göğüs radyografisinde kavitasyon ve manyetik rezonans görüntüleme incelemesinde ise ile karakteristik demonstratif bulgular saptandı. Antitüberküloz ilaç tedavisine tatmin edici bir yanıt ile başlandı. An increased incidence of tuberculosis has been seen in recent years due to factors such as immunocompromising diseases and drug use. There has also been an increase in osteoarticular involvement. In this article, we report a 22-year- old male patient who was diagnosed with tuberculosis of the knee and acromioclavicular joints. Tuberculosis of this joint is very rare, and concomitancy with the knee has not been reported in the literature. The definitive diagnosis was performed by the histopathological examination of a synovial biopsy. The chest radiograph showed cavitation and the magnetic resonance imaging examination showed characteristic demonstrative findings. Antituberculosis drug treatment was started with a satisfactory response.

Background: Recent recommendations have established clinical remission ideally or low disease activity (LDA) as therapeutic targets in all patients with rheumatoid arthritis (RA). Controlled studies of biologic agents have primarily assessed treatment effects in patients with severe RA; patients with moderate disease activity, whoconstitute a larger group, have received far less attention. In Period 1 of the PRESERVE trial, the proportion of subjects with moderately active RA achieving LDA or remission were evaluated after treatment with etanercept 50mg once weekly (QW) plus methotrexate for 36 weeks.Methods: Subjects with DAS28 >3.2 and ≤5.1 despite stable doses of oral methotrexate received open-label etanercept 50mg QW plus methotrexate (screening dose permitted to be titrated up to 25 mg/wk through week 28) for 36 weeks.Results: 834 subjects received treatment and were analyzed. Subjects were mostly female (83%), Caucasian (74%), RFþ (73%), and aCCPþ (78%), with a mean age of 48 years and disease duration of 7 years. Mean baseline DAS28 was 4.4; SDAI, 19.1; ESR, 22.2 mm/hr; and CRP, 12.3 mg/L. Efficacy results from Period 1 are shown in the table. The most commonly reported adverse events (AEs) were headache (6.1%), nasopharyngitis (5.4%), and upper respiratory tract infection (4.4%). Twenty-two subjects (2.6%) discontinued due to AEs.Conclusions: Substantial proportions of subjects with moderately active RA who received etanercept 50mg QW plus methotrexate for 36 weeks achieved LDA (85%-86%), DAS28 remission (67%), or SDAI remission (25%). Therefore, these ambitious goals can be achieved realistically in a high percentage of patients with moderate disease activity.

Objectives: It has been reported that increased sempathic nerve system activity due to infalammatory stress and it cause disturbance of heart rate variability (HRV) in rheumatoid arthritis (RA). In this study, it was assessed cardiac sempatovagal activity by noninvasive parameters such as HRV in patients with RA.Materials and methods: 49 patients with RA and age-matched 28 healthy subjects as control group were enrolled to this study. Clinical and laboratory parameters of all subjects were assessed and 24-hour electrocardiographic Holter monitoring were performed to all of them.Results: Minimum, maximum and mean heart rate were significantly higher while mean RR interval were significantly lower in patients with RA when compared with controls. In addition, among time domain HRV parameters, SDNN, SDANN ve triangular index were significantly lower in patients with RA (p

Objectives: To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS). Methods: Patients consecutively included into the joint database of five university hospitals were analyzed for low or high disease activity according to different criteria. Standardized mean differences (SMD) for two ASDAS versions were evaluated. Results: The ASDAS versions (back pain, morning stiffness, patient global pain, pain/swelling of peripheral joints, plus either erythrocyte sedimentation rate or C-reactive protein) discriminated high and low disease activity in subgroups according to Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and ASAS remission/partial remission criteria. ASDAS versions were also not influenced by peripheral arthritis and correlated well with other outcome measurements and acute-phase reactants. The ASDAS versions performed better than patient-reported measures or acute-phase reactants discriminating high and low disease activity status. Conclusion: Both ASDAS versions, consisting of both patient-reported data and acute-phase reactants, performed well in discriminating low and high disease activity. Further longitudinal data may better estimate the usefulness of ASDAS to assess disease activity subgroups and treatment response.

Objective: In medicine, traction is used for act of pulling force for producing distraction or separation between two or more parts of body. However, it is limited to the cervical or lumbar spine in physiotherapic application. We aimed to investigate effect of new traction technique on anatomic structures of lumbar vertebrae, and its’ relation to different application of heating

Aim Psoriatic arthritis (PsA) is a chronic, inflammatory disease. The purpose of this study was to examine the association between PsA and comorbid conditions. This is the first study to investigate comorbid diseases in PsA in Turkey. Methods This study was performed under the auspices of the Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD) and involved participation by six university research hospitals. Patients diagnosed with and treated for PsA on the basis of clinical, radiological and laboratory findings and expert opinion were monitored using standardized examination methods and jointly prepared forms. Clinical status, accompanying systemic diseases and surgical history were recorded. Results One hundred and seventy-three patients with PsA (75 male, 98 female, mean age 41.8) and 138 patients with rheumatoid arthritis (RA) (17 male, 121 female, mean age 48.6) and 67 with psoriasis (PsO) (43 male, 24 female, mean age 36.1) were included in the study. No accompanying disease was determined in 72.8% of PsA, 50.0% of RA and 80.6% of PsO groups. In regression analysis, patients with PsA had higher risk for cataract/glaucoma surgery (odds ratio [OR] = 11.99; 95% CI 1.36–105.4, P = 0.025) compared to patients with RA, and higher risk for hypertension (HT) (OR = 4.26; 95% CI 1.27–14.23, P = 0.018) compared to the patients with PsO. Conclusion Patients with PsA have relatively lower frequency of comorbidities like diabetes mellitus, HT and cataract/glaucoma surgery compared to the patients with RA. The increased risk for having cataract/glaucoma surgery in RA compared to PsA may be particularly attributed to the more prevalent glucocorticoid use in RA.

The aim of this study was to compare the discriminative ability of Ankylosing Spondylitis Disease Activity Score (ASDAS) with Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) and other clinical disease activity parameters in patients with axial psoriatic arthritis (axPsA). Patients with axPsA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and Anatolian Group for the Assessment in Rheumatic Disease (ANGARD) cohort and were assessed for BASDAI, ASDAS, BASFI (Bath Ankylosing Spondylitis Functional Index), Ankylosing Spondylitis Quality of Life (ASQoL), and visual analog scale (VAS) pain. The discriminant ability of ASDAS-C-reactive protein (-CRP) and ASDAS-erythrocyte sedimentation rate (-ESR) was assessed using standardized mean differences between patients with high and low disease activity. Fifty-four patients with axPsA were included in the study. Both ASDAS scores showed good discriminative ability between high and low disease activity states. Both ASDAS versions and BASDAI had relatively high area under the curve (AUC) according to ASAS partial remission, patient and physician global assessments in receiver operating characteristic (ROC) curve analysis. There was no significant difference between AUC scores for the models that compared ASDAS-CRP and ASDAS-ESR with BASDAI for each individual definition of disease activity states. ASDAS versions and BASDAI showed good similar discriminative ability between high and low disease activity as reflected by the AUC analysis in axPsA. The cutoff values for inactive disease and high disease activity were relatively similar to predefined cutoff values for AS. Further, prospective validation is now required to identify the appropriate assessment tools and cutoff values in axPsA.

We aimed to determine arthritis frequency, quality of life (QoL), anxiety, and depression levels in Behcet's disease (BD) and thereby the effect of joint involvement on QoL, anxiety, and depression. Sixty-three patients diagnosed with BD according to the International Study Group Diagnostic Criteria and 45 healthy subjects as control were included in the study. All patients were evaluated in terms of clinical findings, the number and site of the joints involved, sacroiliac joint involvement, pain intensity, QoL, anxiety, and depression scale. The instruments used were Beck Depression Inventory (BDI) for depression, State-Trait Anxiety Inventory (STAI-T) for anxiety, and Health Assessment Questionnaire (HAQ) and Nottingham Health Profile (NHP) for health status and QoL. Joint involvement was seen in 41.3% of the patients. The most characteristic form was asymmetric oligoarthritis, which was seen in 65.3% of the patients. The joints most commonly involved were found to be in the wrist (53.8%) and knee (50%). Sacroiliitis was found at a rate of 38.1%. In BD patients without arthritis, rates of men (p=0.004) and genital ulcer (p=0.001) were higher, and rates of erythema nodosum (p=0.001) and human leukocyte antigen B5 positivity (p=0.023) were less than those of BD patients with arthritis. Pain intensity (p=0.000), NHP (p=0.004), and HAQ (p=0.003) scores were significantly higher in BD patients with arthritis than those without arthritis. Pain intensity, NHP, BDI, and STAI-T scores were significantly higher in BD patients without arthritis than in healthy controls, while pain intensity, NHP, HAQ, BDI, and STAI-T scores were significantly higher in BD patients with arthritis than in healthy controls (p=0.000). In conclusion, our study establishes that arthropathy is one of the common manifestations of BD. Arthritis in BD affects considerably patients' pain levels and QoL. A multistep approach is required for these patients. We are of the opinion that this approach may also improve the QoL of these patients and prevent the activation of the disease.