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INTRODUCTION[|]To determine the validity and reliability of the Turkish version of the Trunk impairment scale (TIS), used in the evaluation of somatic, motor, and coordination disturbances in stroke patients, and provide a culturally adapted version for use in the Turkish population.[¤]METHODS[|]A total of 80 patients who were either hospitalized at our facility and rehabilitated for stroke or admitted at our outpatient clinics were included in this study. Reliability was evaluated by the internal consistency (Cronbach α) and test reproducibility [intra-class correlation coefficient (ICCC)] methods, and validity was evaluated by the correlation between subgroups and the total scores of the TIS and Berg Balance Scale (BBS), Brunnstrom phases, Barthel index (BI), Rivermead mobility index (RMI), and Short Form-36 (SF-36) scores.[¤]RESULTS[|]The mean age of the patients was 63.00+-12.1 years. Out of a total of 80 subjects, 34 were female and 46 were male. The reliability of the scale was evaluated by the internal consistency, inter- and intra-observer reliability, and test reproducibility. The findings showed that the Turkish form of the scale was reliable at a good level. The test values were as follows; Cronbach α: >0.70, ICCC: 0.969–1, subgroups and total score comparison: 0. The correlation between TIS and BBS was considerably high in the validity analysis (p

The aim of this study was to investigate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6, insulin and HOMA-IR levels in patients with rheumatoid arthritis.This study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were measured. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). To evaluate quality of life, the Health Assessment Questionnaire disability index was applied.The serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were found to be higher than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively). A positive correlation was evident between the DAS 28 score and IL6 levels (r=0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p0.05). Fetuin A levels were positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032).Elevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of fetuin-A, insulin HOMA-IR, pentraxin-3, CRP and ESR were not associated with clinical severity of the RA.

BACKGROUND AND OBJECTIVE Rheumatoid arthritis (RA), insulin-dependent diabetes mellitus (IDDM), inflammatory bowel disease, systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are some of the autoimmune diseases related to the decreases in Vitamin D levels. The same immunological properties as psoriasis, such as Th1/Th2 dysregulation, are seen in all of them. This study aims to compare 25-hidroksi Vitamin D (25-OHD) serum concentrations in patients with psoriasis and psoriatic arthritis. METHODS This study includes 91 outpatients; 48 of these patients were chosen randomly among the psoriasis (PS) patients from the dermatology department of the researchers' hospital. Forty-three of them were chosen among the psoriatic arthritis (PsA) patients matching the age and gender criteria from the rheumatology department of the researchers' hospital. In this study, 25-OHD serum concentrations among the psoriasis and psoriatic arthritis patients were compared. RESULT There are more patients in the PsA group with 25-OHD levels lower than 20 ng/ml; however, this finding is insufficient to obtain statistical significance (p= 0.09). PsA and psoriasis groups had similar numbers of patients with 25-OHD levels ranging from 20 to 30 mg/mL and those higher than 30 mg/mL (p> 0.05). CONCLUSION The literature does not show significant differences between the PS and PsA groups in terms of serum 25-OHD levels and a prevalence of Vitamin D deficiency. Besides, PASI scores were higher in the PS group. CRP values in the PsA group were higher than in the PS group. There was a poor negative correlation between CRP and serum 25-OHD levels in the PsA group. This correlation was not found in the PS group.

Musculoskeletal findings in Sjogren’s syndrome are arthralgia, arthritis, myalgia, myositis, fibromyalgia, and chronic fatigue. Enthesis zones are important in the formation of pain in the musculoskeletal system. Musculoskeletal ultrasound (US) may show subclinical enthesitis in the synovial joints and in the axial skeleton before joint swelling in inflammatory diseases characterized by arthritis. In this study, we aimed to determine the presence of enthesopathy using the Madrid sonographic enthesitis index (MASEI) in patients with primary Sjogren’s syndrome (PSS). Consecutive patients with PSS and age-matched healthy controls were included in this study. All the patients met the 2002 American College of Rheumatology/European League against Rheumatism classification criteria for PSS. The demographic characteristics of the patients were recorded. Six enthesis sites were evaluated using gray-scale and Doppler US with a linear transducer, and they were scored using the MASEI. They were assessed by the EULAR Sjogren’s syndrome disease activity index (ESSDAI). We evaluated 40 patients with PSS (average age 48.67 ± 11.23 years) and 30 healthy controls (average age 45.40 ± 8.24 years). Patients with PSS had significantly higher MASEI scores than the healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendons were significantly thicker in the PSS group than in the healthy controls. The MASEI total score had a positive correlation with age. There was no correlation between MASEI total score and BMI and ESSDAI. In this study, it was shown that the MASEI scores assessed by US were significantly higher in patients with PSS than in healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendon were significantly thicker in the PSS group than in the healthy controls. This result suggests that PSS may be one of the causes of musculoskeletal pain that can be seen in patients with PSS. Our study was the first study to use an enthesis index ultrasonographically in patients with PSS. In addition, it is the first study to investigate the relationship between the presence of enthesopathy and disease activity by means of US.

OBJECTIVES In this study, we aimed to investigate the relationship of NLR (Neutrophil lymphocyte ratio), MPV (mean platelet volume), PDW (distribution width) rates in rheumatoid arthritis (RA) patients with IL-17 and IL-1 beta which are within the cytokines playing an important role in etiopathogenesis and activity of the disease. PATIENTS AND METHODS Fifty-seven RA patients diagnosed according to RA classification criteria of ACR/EULAR 2010 and 37 controls were included into the study. WBC (white blood cell), NEU (neutrophil), PLT (platelet), LYM (lymphocyte) values in complete blood count received from routine blood examination of patients were recorded, and NLR, PLR (platelet lymphocyte ratio) rates were recorded. IL-17 and IL-1 beta were studies in serum samples. Disease activity of RA patients was evaluated with Disease Activity Score (DAS28). Age, gender, disease age, BMI (body mass index), medications used, co-morbid diseases, smoking of the patients were recorded. RESULTS Fifty-seven RA patients (46 (80.7%) females, 11 (19.3%) males), and 34 patients (24 (70.6% females and 10 (29.4) males) as a control group were involved. Demographic characteristics were similar between two groups, and statistically significant difference was not detected between patient and control groups in terms of gender, age, and BMI (p> 0.05). We found higher NLR, MPV, PDW, IL-17 values in RA patients compared to control group (p< 0.05). There was a positive correlation of NLR with DAS28, CRP. While erythrocyte sedimentation rate (ESR) had negative correlation with MPV and PDW, it had positive correlation with PLT. We found positive correlation of C-reactive protein (CRP) with NLR and PLT. We could not find correlation of IL-1 beta and IL-17 with hematologic markers. CONCLUSION In this study, we investigated the relationship of IL-17 and IL-1 beta which play an important role in pathogenesis of RA patients with the parameters analyzed in routine complete blood count, providing information about disease activity such as DAS 28, CRP, and ESR. We illuminated on an issue which has not discussed before by looking from a different angle. More extensive, follow-up studies are needed to emphasize the importance of these parameters and to reveal the relationship between cytokines during the follow-up of the disease activity.

OBJECTIVES In this study, our objective was to determine the work productivity and work disability of the patients with ankylosing spondylitis (AS) and to investigate the relation of these parameters with disease activity, anxiety, depression and quality of life. PATIENTS AND METHODS Fifty patients with the diagnosis of AS and 30 healthy control were included in the study. In patients with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to evaluate the disease activity; Bath Ankylosing Spondylitis Metrology Index (BASMI) was used to evaluate the spinal mobility and Bath Ankylosing Spondylitis Functional Index (BASFI) was used to determine the functional status. In addition, the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and The Short Form (SF-36) Health Survey was used to evaluate the health status, Hospital Anxiety and Depression Scale (HADS) was used for the evaluation of depression and anxiety and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem v2.0 (WPAI:SHP) was used to evaluate the work productivity. RESULTS In AS patients duration of disease at the diagnosis was 7.24 ± 6.23 years. The time lost at work due to the disease, decrease in the work productivity and impairment in the time off daily activities were worse in the patient group compared with the control group (p< 0.05). The impairment in the work productivity was correlated with BASDAI and depression; difficulty in time-off activities was correlated with BASFI and anxiety and depression was correlated with BASDAI (p< 0.05). While the impairment in work productivity was correlated with the subparameter vitality in SF-36, difficulty in time off activities was correlated with general health status, social functions, vitality and mental health (p< 0.05). CONCLUSION In this study, we determined that AS had a significant influence on the working conditions and the factors related to the disease had a significant correlation with work productivity. Factors related to the psychology and the disease were also correlated with the working conditions.

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 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 RA is a chronic disease with a yet unclarified etiology, which causes the activation of pro-inflammatory pathways that bring about joint and systemic inflammations (1).In recent years, the pathophysiology of brain damage that can occur in RA has drawn attention. Emphasis is being put on the possibility that brain damage occurs due to blood-brain barrier (BBB) damage that is linked to chronic inflammation Objectives In this study, we aimed to investigate the peripheral blood levels of brain-specific proteins such as S100 beta and GFAP (glial fibrillary acidic protein), the differences in these proteins in patients who did and did not undergo TNF blocker therapy and their relationship with cranial MR lesions, disease activity and cognitive functions with the purpose of determining CNS (central nervous system) damage in patients with rheumatoid arthritis (RA). Methods 58 RA patients (47 (81.0%) females, 11 (19.0%) males) and 34 healthy controls (24 (70.6%) females, 10 (29.4%) males) were included in the study. All RA patients were on synthetic DMARD therapy at the beginning. While 30 patients continued sDMARD therapy, 28 patients with high disease activity were started on TNF blocker therapy. All demographic characteristics of the patients were recorded. Disease activity was evaluated using DAS28. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive functions, and the Fazekas Scale was used to assess the cranial MRI lesions. The peripheral blood S100 beta, GFAP, claudin, IL-17, IL-1 beta levels of the patients were measured at the beginning and on the 6th month. Results Demographic characteristics were similar between the two groups and no statistical difference was detected between the patient group and the control group in terms of sex, age, and BMI. (p>0.05) S100 beta and GFAP levels were higher to a significant degree compared to the control group. (p 0.05) As the lesions in the deep white matter seen in the cranial MRI of RA patients increased, their S100 beta levels were also seen to increase. (p Conclusions In conclusion, next to decreasing disease activity and joint erosions by suppressing inflammation, anti-TNF therapy in RA can also suppress potential brain damage linked to subclinical BBB (blood-brain-barrier) dysfunction. Further studies with broader participation and longer patient follow-up are needed to reinforce this hypothesis. References McInnes, I.B. and Schett, G. (2011). Thepathogenesis of rheumatoidarthritis. N Engl J Med 365, 2205 2219.doi:10.1056/ NEJMra1004965. Disclosure of Interest None declared

Background We aimed in this study to investigate blood-brain barrier (BBB) dysfunction in RA patients who had no neurological symptoms, and were receiving synthetic DMARD treatment. Objectives We investigated correlations between cranial MRI images and brain specific proteins (S100 Beta, GFAP), cytokines (IL-1 beta, IL-17) in plasma which had important roles in disease activity. Methods In our study, 57 patients (46 females and 11 males) were included included in RA group, and 34 patients (24 females and 10 males) in the control group. All of RA patients were receiving synthetic DMARD treatment. Demographic characteristics of all patients were recorded. Disease activity was evaluated by using DAS-28. Mini-mental test (MMT) was used for evaluation of cognitive functions, and Fazekas scale was used to evaluate cranial MR lesions. S100 beta, GFAP, claudin, IL-17, and IL-1 beta levels were measured in peripheral blood of both groups. Results Demographic characteristics were similar between the groups, and there was no statistically significant difference in gender, age, and body mass index (BMI) between patient and control groups (p>0.05). S100 beta, and GFAP levels were significantly higher in RA group (p 0.05). There were positive correlations between IL-17 S100 beta and GFAP, and IL-1 beta and S100 beta. Conclusions In our study, we have shown that blood-brain barrier may be damaged subclinically in RA patients, brain specific proteins related to BBB dysfunction may be increased in the peripheral blood, and BBB dysfunction may be related to cytokines which play an important role in disease pathogenesis. In conclusion, cytokines which circulate in the peripheral blood in RA may cause subclinical BBB damage. Further large scale studies with long-term follow-up are required which will support this hypothesis. Disclosure of Interest None declared

We aimed to analyse the nailfold capillaryscopy findings morphologically and examine their relationship with disease activity and demographic characteristics in patients with rheumatoid arthritis. In accordance with the 2010 ACR/EULAR classification criteria, 201 patients diagnosed with Romatoiad artrit (RA) and 50 healthy controls were included. We analysed capillaroscopic abnormalities such asmegacapillaries, haemorrhages, ramifications and avascular areas in patients affected with rheumatoid arthritis. The findings in our study are as follows: in 45.77% of the RA patients, there were nonspecific capillaryscopy findings. When compared to control group, the incidence of tortuosity, dilated capillary and bushy capillary was higher in RA patients (p values, respectively, 0.110, 0.330, 0.440 and 0.516). In RA patients with Raynaud's phenomenon, the incidence of nonspecific capillaryscopy findings was higher. While there is a weak relationship between tortuosity and the duration of disease, no significant relation was detected between capillaryscopy findings and parameters such as RF, anti-CCP positivity and disease activity score (DAS28). When compared to controls, we have detected that RA patients have more nonspecific capillaryscopic findings. We could not find a relationship between nonspecific capillaryscopic findings and RA'a clinical findings and laboratory parameters. There is a need for a long-term wider-scale follow-up study to investigate whether there is a capillaryscopic pattern that can be correlated with RA's clinical findings.

Objectives: This study aims to investigate the effect of additional trunk exercises to conventional exercise program on balance, functional condition and ambulation in early stage stroke patients. Patients and methods: A total of 65 patients were included in this double-blinded randomized controlled study. Patients were assigned to two groups as experimental group (n=32) who performed trunk exercises two hours/day/three weeks accompanied by conventional exercise program, and control group (n=32) who received only conventional exercise program during the three weeks. Balance, trunk balance, functional level and ambulation were assessed by Berg Balance Scale, Trunk Impairment Scale, Functional Independence Measurement, Rivermead Mobility Index, respectively. Patients were evaluated pretreatment and on the third month after the treatment. Results: There was no statistically significant difference between the outcome measurements between the groups at the pretreatment evaluation. All outcome measurements were improved significantly between pre-and post-treatment evaluation in general linear repeated measures model. The interaction parameter of “time x condition” according to time and recovery was significantly better in experimental group than in control group. The highest mean difference in efficacy between the two rehabilitation interventions was found for dynamic sitting balance in post hoc calculations. Conclusion: According to the results of our study, in early stroke patients either conventional exercises or conventional exercises plus trunk balance exercises can provide significant improvement in balance, functional condition and ambulation. However, the level of the improvement is better for the group which was applied trunk balance exercises to conventional exercises. Trunk balance exercises that are easily applicable with simple mechanisms by the patients themselves can be added to the rehabilitation. © 2016 by Turkish Society of Physical Medicine and Rehabilitation.

The aim of our study was to assess the levels of depression, anxiety, and fatigue in patients diagnosed with FMF (Familial Mediterranean Fever) and to examine their associations with drug compliance, attack, and being employed or not. Patients presenting to our rheumatology outpatient clinic Tel-Hashomer Classification Criteria were included in the study. Fifty-two diagnosed patients followed up in our rheumatology outpatient clinic (35 female, 17 male), and 30 healthy control subjects whose ages and genders match consisting of the accompanists and visitors of the patients (25 female, 5 male) were included. Risk for depression and anxiety was assessed with HADS (Hospital Anxiety and Depression Scale). Depression and anxiety were observed to be significantly more common in the patients with FMF compared to the healthy controls in this study. Also, the frequency of FMF attacks was found to be associated with depression, anxiety, and fatigue and that regular use of colchicine decreased fatigue. In the light of all these results, the mood should definitely be evaluated during the routine practice in case of a chronic disease such as FMF having a younger patient population compared to other rheumatic diseases, and, if needed, psychiatric support should be received. Also, it should be explained to the patients that the regular use of colchicine would be beneficial for both the disease and fatigue. There is a need for follow-up studies with large case series in order to support the results we obtained. [Med-Science 2018; 7(4.000): 773-6]

We aimed to determine the relationship between the pulmonary functions with disease activity, functionality, spinal mobility and quality of life in patients with ankylosing spondyilitis (AS). PATIENTS AND METHOD: 52 patients (44 male, 8 female) who were diagnosed as AS in Sisli Etfal Education and Research Hospital physical medicine and rehabilitation policlinics according to the Modified New York criteria, participated in our study. The demographic characteristics and smoking habbits were questioned, the chest expansion was measured. The functional activity, disease activity, spinal mobility measurement were evaluated by BASFI, BASDAI,BASMI (Bath Ankylosing Spondylitis functional, disease activity, metrology index),and the life quality was evaluated by life quality spesific to the disease (ASQOL). The respiratory functions were measured by spirometry. 52 patients in 31 patients restrictive, and in 1 patient mixed pattern pulmonary involvement were detected. There was no determined no significant difference between who detected and not detected restrictive lung disease regarding age, gender, body mass index, lung expansion (LE), history of smoking (p>0.005). Pulmonary function tests results and LE of smoker and no smoker patients were similar. While LE was found to be positively correlated with FEV1 and FVC (p [Med-Science 2017; 6(1.000): 69-72]

The aim of this study was to investigate the acute-stage and later-stage impacts of trauma on a patient, and to determine the relationship between the degree of the impact of the event and recovery of hand function in patients with traumatic hand injury. The functional status of patients was assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; psychological influence was assessed by the Beck Depression Inventory (BDI); and the impact of the event was assessed by the Impact of Event Scale-Revised (IES-R) both during the acute stage and at a later stage. Fifty-four patients completed the study. The DASH, BDI, and IES-R scores were significantly improved at a later stage compared with the acute stage (P0.05). Our study suggests that depression status, functional status of the hand, and impact of the event improve at a later stage, and that the functional outcome at a later stage is affected by the degree of impact of the event, and the functional status of the hand in the acute stage, in patients with traumatic hand injury. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Sarcoidosis is an inflammatory disease which is characterized by chronic, systemic noncaseating granuloma formation. This disease generally affects the respiratory system. Bone lesions in sarcoidosis are developed in the cases with 3-13 percentage that generally asymptomatic. In this study we presented a patient of sarcoidosis that had been pulmoner symptoms a long time, and then diagnosed with excisional biopsy from her rib bone