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Background/aim: to evaluate treatment adherence and predictors of drug discontinuation among patients with inflammatory arthritis receiving bDMARDs within the first 100 days after the announcement of the COVID-19 pandemic. Materials and methods: a total of 1871 patients recorded in TReasure registry for whom advanced therapy was prescribed for rheumatoid arthritis (RA) or spondyloarthritis (SpA) within the 3 months (6-9 months for rituximab) before the declaration of COVID-19 pandemic were evaluated, and 1394 (74.5%) responded to the phone survey. Patients' data regarding demographic, clinical characteristics and disease activity before the pandemic were recorded. The patients were inquired about the diagnosis of COVID-19, the rate of continuation on bDMARDs, the reasons for treatment discontinuation, if any, and the current general disease activity (visual analog scale, [VAS]). Results: a total of 1394 patients (493 RA [47.3% on anti-TNF] patients and 901 SpA [90.0% on anti-TNF] patients) were included in the study. Overall, 2.8% of the patients had symptoms suggesting COVID-19, and 2 (0.15%) patients had PCR-confirmed COVID-19. Overall, 18.1% of all patients (13.8% of the RA and 20.5% of the SpA; p = 0.003) discontinued their bDMARDs. In the SpA group, the patients who discontinued bDMARDs were younger (40 [21-73] vs. 44 years [20-79]; p = 0.005) and had higher general disease activity; however, no difference was relevant for RA patients. Conclusion: although the COVID-19 was quite uncommon in the first 100 days of the pandemic, nearly one-fifth of the patients discontinued bDMARDs within this period. The long-term effects of the pandemic should be monitored., Hacettepe Rheumatology Society

Şahin, Nilay (Balikesir Author), Objectives: This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey. Patients and methods: A total of 961 patients (346 males, 615 females; mean age: 46.9+/-12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and Short Form-36 scores were all recorded. Results: Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The Visual Analog Scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD. Conclusion: In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment.

WOS: 000511872800013, PubMed: 31773391, Psoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of 'active enthesitis', 'history of enthesitis' or 'none' in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by - 9.740 and - 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis.

Keskin, Yasar/0000-0003-4457-5917; KILIC, Erkan/0000-0003-4355-4356; Yurdakul, Ozan Volkan/0000-0003-4567-8133; cuzdan, nihan/0000-0001-7238-657X; gezer, halise hande/0000-0001-8790-304X; alkan, hakan/0000-0001-8461-9131 WOS:000541406200002 PubMed: 32564159 Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia.

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease affecting mainly the axial skeleton and sacroiliac joints. The aim of the current study was to investigate the effects of inspiratory muscle training (IMT) on respiratory muscles and functional exercise capacity, as well as on the specific outcomes of the disease in AS patients. A total of 32 AS patients (mean age 37.37 ± 10.41 years) were randomly assigned as the Training Group (TG) (n = 16, mean age = 35.62 ± 8.18 years) who received IMT + conventional exercise, and the Control Group (CG) (n = 16, mean age = 39.12 ± 12.26 years) who only performed the conventional exercise program. All the subjects were evaluated at baseline and at the end of the 8th week. Respiratory muscle strength was assessed by measuring the maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax). Functional exercise capacity was measured using the 6-min walk test (6MWT). The Bath AS Disease Activity Index (BASDAI), Bath AS Disease Function Index and Bath AS Metrology Index were used for activity, function and basic measurements of the disease. A statistically significant improvement was determined in the PImax (p = 0.000), PEmax (p = 0.002), 6MWT (p = 0.041) and BASDAI (p = 0.049) values in the TG after training. There was a significant difference between baseline and after conventional exercise in terms of PEmax (p = 0.017) in the CG. The PEmax (p = 0.001) and the 6MWT (p = 0.053) values were significantly better in the TG. The results of this study demonstrated that IMT in addition to conventional exercises increased inspiratory muscle strength, functional exercise capacity and positively affected the disease activity in AS. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Objectives: This study aims to evaluate the cardiopulmonary functions and exercise performance of patients with ankylosing spondylitis (AS) and to investigate the relationship between these parameters and disease activity, spine mobility and quality of life (QoL). Patients and methods: Forty-five patients with AS (group 1; 33 males, 12 females; mean age 43.1±12.1 years; range 22 to 70 years) and 30 control subjects (group 2; 23 males, 7 females; mean age 42.8±10.0; range 23 to 70 years) were included in the study. Disease activity was assessed with the Bath Ankylosing Spondylitis Disease Activity Index and spinal mobility measures with the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Ankylosing Spondylitis Quality of Life (ASQoL) Questionnaire and the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) were used. The pulmonary function test (PFT) and cardiopulmonary exercise testing (CPET) were performed. Results: There was no significant difference between groups 1 and 2 in terms of mean age. The peak expiratory flow value in PFT was significantly lower in group 1 (p

Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by pain, functional deformities, negatively affecting quality of life. A previous study showed that Tai Chi had a positive effect on disease activity and flexibility of patients with AS. The aim of this study was to investigate the effect of Tai Chi exercises on disease activity, functionality, spinal mobility, quality of life and inflammatory markers in patients with AS. Methods: This randomised controlled trial allocated 36 patients with AS to either a Tai Chi or a home exercise group using the block randomization. Both groups received a 1-h exercise program twice a week for 10 weeks and encouraged to practice at home. Outcome measures included: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functionality Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Quality of Life (ASQoL) scales and Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP). Results: After training, there was a statistically significant difference within groups for the Tai Chi and the home exercise groups for all parameters (p:0.00). When the delta values were compared between the groups, BASDAI (p:0.00), cervical rotation (p:0.02), and ASQoL (p:0.00) were found to be significantly in favor of the Tai Chi group. No side-effects were noted during or after the exercise programs. Conclusion: Tai Chi should be considered for inclusion in rehabilitation programs as a safe alternative type of exercise to reduce disease activity, improve spinal mobility and quality of life in patients with AS. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03807180. Clinical trial number: NCT03807180. © 2020 Elsevier GmbH

The pain associated with spondyloarthritis (SpA) can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP) that characterises fibromyalgia (FM). The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF) inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.

Objective.Acne vulgaris is a chronic inflammatory disease involving the pilosebaceous unit of the skin. Isotretinoin is a systemic retinoid that is often used as an effective treatment option for severe and treatment-resistant acne. Isotretinoin may also cause rheumatologic symptoms. The aim of this prospective observational study was to present followup results regarding the rheumatologic symptoms of patients who received systemic therapy for the treatment of acne (isotretinoin and tetracycline).Methods.For inclusion in the study, all consecutive patients with acne who were aged > 18 years were evaluated by the same dermatologist. The first 42 consecutive patients were included in the isotretinoin group, and after matching for age and sex, 32 consecutive patients were included in the tetracycline group. Isotretinoin treatment was planned as an average dose of 30 mg daily and a total dose of 120–150 mg/kg for 4–6 months. The patients were administered a dose of 1 g/day of tetracycline as 2 equal doses for 3 months.Results.Forty-two patients diagnosed with acne vulgaris were treated with isotretinoin 20.6 ± 4.4 (male/female: 17/22), and 32 patients were treated with tetracycline 20.6 ± 2.7 (male/female: 8/24). There was no significant difference between the 2 groups with respect to age and sex. Unilateral Achilles enthesopathy developed in 3 patients, whereas both Achilles enthesopathy and unilateral sacroiliitis developed in 1 patient. Inflammatory back pain developed in 6 patients in the isotretinoin group.Conclusion.To our knowledge, this was the first prospective observational study that assessed the rheumatologic symptoms of isotretinoin treatment. The spondyloarthropathy findings were identified in 23.1% of the patients who used isotretinoin.

Bu çalışma, EULAR 2013 Konferansı'nda bildiri olarak sunulmuştur. Background: Risk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. Methods: Eighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 +/- 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured. Results: Forty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients' BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R = 0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000). Conclusions: Assessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.

Spondyloarthritis (SpA) is a family of inflammatory diseases sharing clinical, genetic, and radiological features. While crucial for tailoring early interventions, validated prognostic biomarkers are scarce in SpA. We analyze the correlation between serum levels of vasoactive intestinal peptide (VIP) and disease activity/severity in patients with early chronic inflammatory back pain. The study population comprised 54 patients enrolled in our early chronic inflammatory back pain register. We collected demographic information, clinical data, laboratory data, and imaging findings. VIP levels were measured by enzyme immunoassay in serum samples from 162 visits. The association between independent variables and VIP levels was analyzed using longitudinal multivariate analysis nested by patient and visit. No significant differences were observed in VIP levels between these two groups. Lower levels of VIP were significantly associated with a higher Bath Ankylosing Spondylitis Disease Activity Index (BASFI) score, presence of bone edema in magnetic resonance imaging (MRI) scan, and lower hemoglobin levels. Coexistence of cutaneous psoriasis was independently associated with lower VIP levels, and similar trend was observed for enthesitis.We conclude that SpA patients with low serum VIP levels had worse 2-year disease outcome, suggesting that

Original English questionnaires – Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patient Global Score, and Bath Ankylosing Spondylitis Disease Activity Index – are designed to evaluate health, physical and psychical state of patients with spondyloarthropathies and to assess efficiency of the treatment. Objective. The objective of the study was to adapt Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patient Global Score, Bath Ankylosing Spondylitis Disease Activity Index questionnaires to the Lithuanian context and examine their psychometric aspects: reliability and validity. Patients and methods. Validation and linguistic and cultural adaptation of Lithuanian questionnaires were performed according to the requirements for adaptation of the international questionnaires. Psychometric features of Lithuanian questionnaires were examined in 139 patients with spondyloarthropathies. The validity of questionnaires was tested by comparing these questionnaires with Health Assessment Questionnaire Modified for Spondyloarthropathies, metrology indices (tragus-to-wall distance, lateral flexion, modified Schober’s distance, intermalleolar distance), pain intensity, patient’s well-being, physician’s assessment of the disease activity, and total enthesis count. The reliability of questionnaires was assessed by determining internal consistency of scales and scale stability and by calculating the intraclass correlation coefficient. Results. The linguistic and cultural adaptation of these questionnaires was made during the study. Internal consistency was high for functional and disease activity index (Cronbach a³0.80) and moderate for the Bath Ankylosing Spondylitis Patient Global Score (Cronbach a=0.58). High stability in regard to time was characteristic of all three questionnaires (intraclass correlation coefficient &gt, 0.95). A significant association between the separate questions of examined instruments, their joint results and other factors reflecting patient’s health was established. Conclusions. Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Patient Global Score, and Bath Ankylosing Spondylitis Disease Activity Index questionnaires in Lithuanian fully correspond to psychometric requirements. They are appropriate and relevant in assessing the influence of spondyloarthropathies on a patient’s health.

Back groundDickkopf-1 (DKK-1) is an inhibitory molecule that regulates Wnt pathway, which is critically important in osteoblastic new bone formation, therefore it may play a role in the process of new bone formation in Ankylosing Spondylitis (AS).Aim of the workTo measure serum level of DKK-1 in AS patients and study the relation between these levels with disease activity, spinal dysmobility and radiographic findings.Patients and methodsThirty AS patients as well as 20 healthy subjects as a control group were included in this study. DKK-1 serum levels were measured using ELISA technique, disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, radiographic assessment by Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-s) and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS).ResultsDKK-1 was not correlated to ESR, CRP or BASDAI (p>0.05) and was negatively correlated to BASRI-s and mSASSS (p0.05).ConclusionOur finding suggests dysfunction of DKK-1 in patient with AS.