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Objectives This study aims to compare the serum calcitonin gene-related peptide (CGRP) and CGRP receptor protein levels between patients with fibromyalgia syndrome (FM) and healthy control subjects. Patients and methods The study included 88 patients (7 males, 81 females; mean age 44.5±9.1 years; range, 20 to 72 years) newly-diagnosed with FM according to the 2010 American College of Rheumatology criteria and 88 healthy volunteers (6 males, 82 females; mean age 43.0±6.1 years; range, 20 to 57 years). Venous blood samples were collected from both groups for the measurement of the levels of serum CGRP and CGRP receptor proteins (receptor component protein [RCP], receptor activity modifying protein 1 [RAMP 1] and calcitonin receptor-like receptor [CLR]). Results A comparison of the serum CGRP, CLR and RCP levels of the FM and control groups revealed a statistically significant difference (p=0.001, p=0.005, p=0.001, respectively). The difference between the groups in respect of the serum RAMP 1 levels was not statistically significant (p=0.107). Conclusion The serum CGRP, CLR and RCP levels were found to be higher in the FM patients, but no difference was determined between the FM patients and the healthy control group in respect of the RAMP 1 level. These results can be of guidance for further clinical studies of the etiopathogenesis and treatment of FM.

Acute spinal cord injury (SCI) is one of the serious central nervous system injuries, which can lead to significant neurological impairments and a reduction in quality of life with loss in sensory and motor functions. Although recent advancements contribute to the understanding of the underlying pathophysiological processes developed after SCI, currently, there is limited innovative and effective treatment options besides conventional rehabilitation and management of SCI to alleviate the condition. Improvements in neurological functions of the individuals with SCI depend mainly on the mechanical damage occurring in the primary injury and on pathophysiological alterations associated with secondary damage. Since in the treatment of SCI, there are no therapeutic strategies for neurological alterations caused by primary injury, all innovative treatments utilize treatment strategies targeting to the secondary damage. Non-steroidal anti-inflammatory drugs (NSAIDs) have become the focus of various experimental SCI models as these may be expected to reduce inflammation in secondary damage due to their potent anti-inflammatory effects. Experimentally, they exhibit neuro-protective and apoptotic effects by suppressing axonal re-growth, thus inhibiting the RhoA pathway, which leads to apoptotic cell death, in addition to the recovery of motor functions along with histological improvement. However, histological improvement is not significantly associated with improvement of motor function. The main target of SCI research should not only focus on histological improvement of lesion, but also on its potential for contribution to effective clinical therapies targeting improvements in sensory and motor functions. In the present review, we have summarized the current knowledge about pathophysiologic mechanisms working after SCI and discussed the potential of NSAIDs as promising agents in the management of SCI.

Objective: In the present study we investigate the level of subclinical inflammatory markers neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and red blood cell distribution width (RDW) in FMS Method: Included in the study were 98 patients who had been newly diagnosed with FMS according to the 2010 American College of Rheumatology (ACR) criteria and 38 healthy controls. The age, Body Mass Index (BMI), White Blood Cell (WBC), neutrophil, lymphocyte, platelet, high-sensitivity C-reactive protein (hsCRP) and Erythrocyte Sedimentation Rate (ESR) values of the participants in both groups were recorded, and also the Visual Analogue Scale (VAS) and Fibromyalgia Impact Questionnaire (FIQ) scores of the patients Results : There was no statistically significant difference between Groups 1 and 2 with respect to NLR, PLR and RDW values (p>0.05). Conclusions: Blood NLR, PLR and RDW values in patients with FMS have no significance in an investigation of subclinical inflammation.

OBJECTIVES: This study aims to compare the serum vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor-1 (VEGFR-1) levels between patients with fibromyalgia syndrome (FMS) and healthy controls. PATIENTS AND METHODS: The study included 40 female patients (mean age 39.9±10.2 years; range, 22 to 52 years) diagnosed with primary FMS according to the American College of Rheumatology criteria (1990) and 40 healthy female volunteers (mean age 40.9±8.3 years; range, 25 to 53 years). The sociodemographic data of both groups were recorded. The disease duration and the number of tender points were recorded for patients with FMS, and venous blood samples were collected from the two groups for the measurement of serum VEGF and VEGFR-1 levels. RESULTS: The FMS and control groups were comparable in terms of age and body mass index (p>0.05). A comparison of the serum VEGF levels of the FMS and control groups revealed a statistically insignificant difference (p>0.05), while a comparison of the serum VEGF-1 levels of the FMS and control groups revealed a statistically significant difference (p

Objective: The aim of this study is to evaluate sensorineuralhearing loss (SHNL) and tinnitus in patients with Behcet’s disease (BD), while also determining the association between the clinical symptoms of BD and the disease duration with the development of hearing loss. Materials and methods: The study included 44 patients with BD and 42 healthy volunteers as the control group. The level of tinnitus-induced annoyance and the effects of tinnitus on daily life were evaluated with Visual Analog Scale (VAS) and the Tinnitus Reaction Questionnaire (TRQ). The hearing levels of all participants were measured with high-frequency audiometry and transient auto-acoustic emission tests. Results: The patients with BD were significantly more affected by SNHL and tinnitus than the controls (p < 0.05). The correlation between disease duration and age among those with SNHL was statistically significant (p < 0.05). No association was found between the clinical findings and SNHL and tinnitus (p > 0.05) in the BD patients. Conclusion: In the present study, high-frequency SNHL was found to be common in among the patients with BD. SNHL in BD is positively correlated with the patients’ age of the and the disease duration. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

WOS: 000438530500024, Background: The aim of the study is to identify the kind of traditional practices used for the rheumatic diseases in the central Anatolia. Materials and Methods: A total of 440 volunteer patients with chronic rheumatic diseases including osteoarthritis (OA), fibromyalgia, rheumatoid arthritis (RA), spondyloarthropathy (SpA), familial Mediterranean fever (FMF), Behcet's disease (BD), systemic lupus erythematosus (SLE), and mixed connective tissue disease (MCTD) were enrolled in the study. All patients were administered a 36-item questionnaire. Results: Of the patients, 49.3 % were using CAM. Herbal medicine was the most commonly (58.1 %) preferred methods. The CAM was used by 86 (48%) of 179 patients with OA and by 51 (60%) of 85 patients with RA. The difference in the CAM use across the disease groups was not statistically significant (chi(2)=7.343; p=0.290). When the patients using or not using CAM were assessed according to their education status, it was found that CAM was used by 59 (66.3%) of 89 patients with university degree and indicating a statistically significantly higher number of patients from higher education status among the CAM users (chi(2)=17.651; p=0.001). Conclusions: Our study results suggest that among patients with rheumatic disease, patients with RA more commonly resort to the methods of CAM.

WOS: 000363083300005, Objectives: This study aims to evaluate the relationship between serum homocysteine levels and atherosclerotic plaques in carotid arteries in female patients with rheumatoid arthritis (RA). Patients and methods: Fifty-eight females with RA (mean age 45.50 +/- 11.69 years; range 42 to 60 years) and 22 female controls (mean age 47.3 +/- 8.9 years; range 38 to 62 years) with mechanical low back pain were included in the study. RA patients were divided into two groups: patients who were under methotrexate (MTX) therapy at least for two years (MTX group, n=32), and patients who did not receive MTX at least for past two years (non-MTX-disease-modifying antirheumatic drug group, n=26). RA patients' disease activity scores in 28 joints were calculated. Carotid intima-media thickness and presence of atherosclerotic plaque were evaluated by high-resolution B-mode ultrasonography. Results: Plasma homocysteine levels were higher in MTX and non-MTX-disease-modifying antirheumatic drug groups compared to controls (16.88 +/- 6.84 and 10.37 +/- 2.54 mu mol/L, respectively) and the difference was statistically significant (p=0.001). In MTX, non-MTX-disease-modifying antirheumatic drug and control groups, atherosclerotic plaque was detected in 11 (34.5%) and four (15.4%) patients, and one patient (4.5%), respectively. Carotid intima-media thickness was significantly higher in MTX group compared to other two groups and the difference was statistically significant (p=0.002). Pearson correlation analysis revealed a significant correlation between intima-media thickness and homocysteine levels in MTX group (r=0.49, p=0.006). Conclusion: According to our study results, methotrexate treatment in female patients with RA increases plasma homocysteine levels and prevalence of atherosclerotic plaque. High homocysteine levels in these patients may be a cause of atherosclerosis.

WOS: 000360385500003, PubMed ID: 27708927, Objective: To assess sarcopenia status in women with rheumatoid arthritis (RA). Material and Methods: Thirty female patients with RA and 30 female controls without RA were enrolled in this study. Sarcopenia status in patients with RA was evaluated by assessing body composition using dual X-ray absorptiometry (DXA). C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) were measured, and body mass index (BMI) and Disease Activity Score (DAS28) were calculated. Because sarcopenia differs between men and women, the study groups comprised only females. Results: It was found that skeletal muscle index (SMI) was lower in patients with RA (5.83 +/- 0.807) than in controls (7.30 +/- 1.640). Sarcopenia (in females with an SMI of

WOS: 000391751500003, OBJECTIVE: We aimed to evaluate the effects of extra corporeal shock-wave therapy (ESWT) on the calcaneal spur length and pain severity in overweight and obese patients with symptomatic calcaneal spur. METHODS: In eighty patients with symptomatic calcaneal spur, ESWT was administered on days 0 and 7, and visual analog scale (VAS) scores and calcaneal spur lengths (CSLs) before and 3 months later after treatment were recorded. A lateral heel radiograph was used for computer-aided linear measurements of CSL. RESULTS: Of 80 patients, 59 (73.7%) were female and 21 were male (26.3%); age was 45.9 +/- 8.3 years; BMI was 31.6 +/- 4.4 kg/m(2); and symptom duration was 2.3 +/- 2.4 years. The CSL and VAS score after treatment were significantly lower than those before treatment (CSL before vs. after: 5.7 +/- 1.0 vs. 4.4 +/- 0.9, p = 0.001; VAS score before vs. after: 8.3 +/- 1.4 vs. 4.6 +/- 2.2; p = 0.03). The CSLs before and after treatment had a significant strong correlation (r = 0.832, p = 0.001). The VAS scores before and after treatment presented a significant mild correlation (r = 0.242, p = 0.03). CONCLUSIONS: In overweight and obese patients with symptomatic calcaneal spur, ESWT reduces the CSL and pain severity during a follow-up of three-month duration.

WOS: 000401073400003, The purpose of this study is to investigate the effect of clinical features including duration of FM and sexual partnership, and severity of pain, anxiety, and depression on the severity of sexual dysfunction in women with Fibromyalgia (FM). This cross-sectional study was conducted on 130 female patients with FM, who were admitted to Physical Therapy and Rehabilitation Polyclinic in August and September 2015, and 60 healthy controls. The data was collected with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Women Sexual Function Index (FSFI), Fibromyalgia Impact Questionnaire (FIQ) and Visual Analogue Scale (VAS). Evaluating FM and control group according to the FSFI Score, it was found that 103 (84.4%) and 19 (15.6%) had sexual dysfunction, respectively. The median scores of FSFI scale and subscale, and VAS in the FM patients were significantly higher than those in the control group (p < 0.05). The mean scores of FIQ, BAI, and BDI in the FM patients were significantly higher than those in the control group (p < 0.05). The FSFI score was significantly predicted by FIQ, BAI, duration, and duration of partnership. FSFI score has a negative correlation with BAI score, disease duration and duration of partnership. This study supports that FM may affect all domains of sexual function. In our clinical settings, multiple regression analysis reveals that the duration and severity of FM and duration of sexual partnership, and severity of anxiety but not severity of pain and depression can increase the severity of sexual dysfunction. Knowledge about meaningful contributing factors of duration of FM and sexual partnership, and severity of FM and anxiety may be helpful for physicians for determining correct strategies for prevention and management of sexual dysfunction in FM.

WOS: 000406096700003, PubMed ID: 30375572, Objectives: This study aims to investigate the relationship of serum insulin-like growth factor 1 (IGF-1) level with obstructive sleep apnea, the Pittsburgh sleep quality index (PSQI), age, body mass index, and fibromyalgia impact questionnaire (FIQ) in fibromyalgia syndrome (FMS) patients. Patients and methods: A total of 105 female patients (mean age 41.8 +/- 9.0 years; range 26 to 55 years) with fibromyalgia (FMS group) who were diagnosed according to 2010 American College of Rheumatology criteria, and 51 female patients (mean age 39.9 +/- 10.8 years; range 24 to 54 years) with mechanical low back pain (MLBP) (control group) were included in the study. Age, smoking, educational status, tender point number, body mass index, duration of disease, FIQ, PSQI, and polysomnographic assessment of both FMS and control groups were recorded. Results: Sleep disorder was detected in 88 patients in FMS group and 15 patients in control group (p< 0.05). The PSQI score was higher in the FMS group compared to the control group (9.9 +/- 4.6 vs 5.7 +/- 3.5). The FIQ score was higher in the FMS group compared to the control group (53.4 +/- 17.4 vs 26.4 +/- 13.9; p

Amaç: Fibromyalji'li hastaların (FS) ortaya koydukları psikosomatik semptomlar; içe kapanıklık, duygusal ihtiyaçlarını yansıtmada yetersizlik, öz güven eksikliği ve sosyal ilişkilerde yetersizliği içermektedir. Hastalar ve eşlerinin duygu ifadelerinin arasındaki ilişkiyi FS'nin şiddetine göre değerlendiren ölçekler bulunmaktadır. Bu çalışmanın amacı FS'li hastanın duygu durumunun ve onun eşinin tutumunun hastalığın kliniği üzerine etkisini değerlendirmektir. Yöntem: çalışmaya 123 hasta ve 105 sağlıklı kontrol dahil edilmiştir. Bu çalışmada, fibromyalji etki anketi (FIQ), Montgomery-Asberg Depresyon Ölçeği (MADRAS), ve duygu ifadesi seviyesi (LEE) ve duygu ifadesi (EE) kaydedilmiştir. Bulgular: FS'deki LEE sağlıklı kontrollere kıyasla oldukça yüksekti [15 vs. 11 ; p0.05) arasında bulunmamaktaydı. EE'nin LEE ve FIQ skoru üzerindeki etkisini belirlemek için Lineer regresyon analizi yapıldı ve herhangi bir etkisi olmadığı bulundu (p>0.05). Sonuç: bu çalışmanın bulguları, FS'nin tedavisi esnasında hastalar ve onların eşleri açısından EE'nin ölçme açısından değerli olduğunu desteklemektedir. FS hastalarında psikolojik fonksiyonları iyileştirmek için, klinik uygulamada, eşlerin rolünü değerlendirmeye almak önemli bir avantajdır ve FS'nin tedavi başarısını arttırır., Objective: Psychopathological symptoms presented by fibromyalgia patients include introversion, inability to reflect emotional needs, lack self-esteem, and inefficiency in social relationships. There are measures to assess the relationship of the expressed emotion of patients and spouses with severity of fibromyalgia syndrome (FS). The aim of this study to assess the effect of expressed emotion of patient (LEE) and her spouse (EE) on the severity of FS in women. Method: 123 FS patients and 105 healthy controls enrolled for the study. In the study, fibromyalgia impact questionnaire (FIQ), Montgomery-Asberg Depression Rating Scale (MADRAS), and level of expressed emotion (LEE) and expressed emotion (EE) were recorded. Results: LEE in FS was significantly higher than that in healthy controls [15 vs. 11 ; p0.05). After linear hierarchical regression analysis was done to determine to the interaction of EE on the relationship of LEE and FIQ scores, there was no statically significant interaction of EE on the relationship of LEE and FIQ scores (p>0.05). Conclusions: The findings of this study support the value of assessment of EE from the perspective of patients and their spouses during the management of FS. To improve the psychological function of FS patients, in clinical practice, considering the role of spouses may provide an important advantage and increase the success of management of FS.

Romatoid artrit (RA) nüfusun yaklaşık %0,3-1,5’inde görülen etiyolojisi bilinmeyen, eklemlerden iç organlara kadar vücudun farklı bölgelerinde tutulumla karakterli kronik otoimmün bir hastalıktır. Plöropulmoner tutulum ikinci sıklıkla görülen tutulum olup en başta gelen mortalite nedenidir. Plöropulmoner tutulum RA tanısı almadan önce ortaya çıkarsa, ayırıcı tanıda düşünülmeyip gözden kaçabilir. Başlangıç semptomu olarak plevral efüzyon, solunum sıkıntısı ve son altı aydır devam eden göğüs ağrısı şikâyetleri ile gelen ve takibinde RA tanısı alan olguyu literatür bilgileri ışığında sunmayı amaçladık., Rheumatoid arthritis (RA) is a chronic autoimmune disease with unknown aetiology which effects a variety from joints to internal organs and other sites of organism. It's seen in 0.3-1.5% of population. Pleuropulmonary involvement which is the second frequent involvement is the major cause of mortality. If the pleuropulmonary involvement exists before the diagnosis of rheumatoid arthritis, it may be overlooked. We aimed to present a case with pleural effusion, respiratory distress and chest pain lasting for 6 months as initial symptoms and diagnosed as rheumatoid arthritis in follow up on the light of literature data.

WOS: 000376607900010, PubMed ID: 27146618, Objectives: To investigated serum cortisol and serum dehydroepiandrosterone-sulphate (DHEA-S) levels between fibromyalgia (FMS) patients and a control group, and the effect of balneotherapy (BT) on these hormones. Methods: Seventy-two patients with FMS and 39 healthy volunteers were included in the study. This prospective and cross-sectional study was carried out in the Medical Faculty, Physical Medicine and Rehabilitation Clinic, Cumhuriyet University, Cumhuriyet, Turkey between June 2012 and June 2013. Patients were divided into 2 groups. There were 40 patients in the first group, consisting of BT and physical therapy (PT) administered patients. There were 32 FMS patients in the second group who were only administered PT. Thirty-nine healthy volunteers were enrolled as a control group. Result: Cortisol was observed to be lower in FMS patients compared with the controls (10.10 +/- 4.08 mu g/dL and 11.78 +/- 3.6 mu g/dL; p= 0.033). Serum DHEA-S level was observed to be lower in FMS patients compared with the controls (89.93 +/- 53.96 mu g/dL and 143.15 +/- 107.92 mu g/dL; p= 0.015). Average serum cortisol levels of patients receiving BT were determined to be 9.95 +/- 3.20 mu g/dL before treatment and 9.06 +/- 3.77 mu g/dL after treatment; while average serum DHEA-S levels were 77.60 +/- 48.05 mu g/dL before treatment, and 76.84 +/- 48.71 mu g/dL after treatment. No significant changes were determined in serum cortisol and DHEA-S levels when measured again after BT and PT. Conclusion: Low levels of serum cortisol and DHEA-S were suggested to be associated with the physiopathology of FMS.

WOS: 000372275200005, PubMed ID: 26713300, Background: Balneotherapy (BT) is a treatment modality that uses the physical and chemical effects of water, including thermomineral, acratothermal, and acratopegal waters. It has many effects on cardiovascular system. Aim: The aim of the study is to investigate the effects of 3-week BT on blood pressure of osteoarthritis (OA) patients with no hypertension (HT), and controlled or uncontrolled HT. Materials and Methods: The OA patients (n = 270) were divided into three groups: No HT, controlled HT, and uncontrolled HT. All the groups received BT in the facilities of our university hospital at the same time every day (10: 00-11: 30 AM) for 10 min per day, 5 days per week, for a total duration of 15 days in a 3-week period. Systolic and diastolic blood pressures and pulse rates were measured before and after BT on daily basis. Results: Overall, (1) the pulse rates of study groups measured after BT were significantly increased compared to before BT; (2) the systolic blood pressures of study groups measured before and after BT were found as comparable; and (3) the diastolic blood pressures of no HT and controlled HT groups measured before and after BT were not statistically significant (P > 0.05); however, in the uncontrolled HT group, the diastolic blood pressure showed a decreasing trend after BT (P < 0.05). Conclusions: In patients with OA, BT can be safely used without resulting in any meaningful changes in systolic and diastolic blood pressures in patients with normal and controlled HT but a decrease in diastolic blood pressure of patients with uncontrolled HT. This may be an advantage in OA patients having HT as comorbid disease.

WOS: 000276859300003, Objective: Differentiation of rheumatoid arthritis (RA) from other diseases with joint involvement such as hepatitis-C virus (HCV) infection represents a diagnostic problem. In addition to the rheumatoid factor (RF), more specific and sensitive auto-antibodies are under evaluation in recent years with conflicting results. In this study, we tested the diagnostic value of rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin (anti-MCV) in distinguishing RA from hepatitis C patients. Materials and Methods: Sera of 34 RA patients and 30 hepatitis C patients were tested for RF, anti-CCP anti-MCV. Disease activity was determined by disease activity score (DAS-28) 28 in RA and by modified Knodell score in hepatitis C patients. Extra-articular involvement in RA and rheumatologic involvement in hepatitis C patients were documented. Results: In roc analysis, area under curve (AUC) was the highest in anti-CCP. Sensitivity and specificity was 82% and 53%, 79%, and 96% and 70%, and 73% for RF, anti-CCP and anti-MCV respectively. DAS-28 has a weak correlation with RF (r=0.406), anti-CCP (r=0.433), and anti-MCV (r=0.453). There was no difference between the patients in autoantibody levels regarding extra-articular involvement and DAS-28 in RA, and joint involvement in hepatitis C patients. Conclusion: Anti-MCV antibodies may be useful in distinguishing RA however it seems to have no additional value over anti-CCP or RF in hepatitis C patients. Anti-CCP antibodies are more reliable in diagnosis of RA due to their high specificity. (Turk J Rheumatol 2010; 25: 19-23)

SUMMARYObjective: The aim of this study is to assess presence of MEFV (MEditerranean FeVer) gene mutations and relationship between those mutations and disease activity in ankylosing spondylitis (AS).Method: Study group was consisted of 34 patients with AS, and 35 healthy volunteers enrolled to study as control group. 12 MEFV gene mutations were screened by Stripe-Assay technique. Patients with AS were divided into 2 subgroups according to whether they are MEFV gene positive or negative. Demographic data of study group were questioned. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and The Bath Ankylosing Spondylitis Metrology Index (BASMI), peripheral joint involvement, and drug use were used as clinical parameters; Visual Analog Scale (VAS) was used to assess pain, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were assessed as laboratory parameters.Results: Among 34 patients with AS, it was found that 5 patients (35.7%) were positive for E148Q, 2 patients (14.2%) for M694V, 2 patients (14.2%) for A744S, 2 patients (14.2%) for V726A and 1 patient (7.1%) for each of the M680I, R761H, P369S. Among 35 individuals in control group, E148Q was detected in two (5.7%) and M694V was detected in another two (5.7%). When MEFV gene mutations were compared between study group and control group, there was no significant difference (p>0.05). There was significant difference between MEFV carriers and non-carriers regarding BASDAI, CRP and ESR values and positive family history whereas no difference was found in BASMI, BASFI, VAS, disease duration and biological agent use.Conclusions: It was thought that MEFV mutation frequency in AS patients was similar with control group but disease should have more progressive course in MEFV positive AS patients. To address this issue, further studies with large series are needed.Keywords: Anklyosing spondylitis, MEFV gene mutations, disease activityÖZETAmaç: Ankilozan Spondilit (AS) hastalarında MEFV (MEditerranean FeVer) gen mutasyonlarının varlığını ve bunun hastalık aktivitesi ile olan ilişkisini değerlendirmektir.Yöntem: AS tanısı olan 34 hasta ve 35 sağlıklı gönüllülerden oluşan kontrol gurubu alındı. Strip-assay tekniği ile 12 adet MEFV gen mutasyonuna bakıldı. AS hastaları MEFV mutasyonu pozitif ve negatif olarak iki gruba ayrıldı. Her iki grubun demografik verileri sorgulandı. Klinik parametre olarak, Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAİ), Bath Ankilozan Spondilit Fonksiyonel İndeksi (BASFİ), Bath Ankilozan Spondilit Metroloji İndeksi (BASMİ), ağrı için Vizüel Analog Skala (VAS), periferik eklem tutulumu, ilaç kullanımı, labaratuvar olarak eritrosit sedimantayon hızı (ESH) ve C-Reaktif Protein (CRP) değerlendirildi.Bulgular: AS’li 34 hastanın 7’sinde (%20,6) E148Q, 4’ünde (%11,8) M694V, 2’sinde (%5,9) A744S, 2’sinde (%5,9) V726A, 1’er hastada da (%2,9) M6801, R761H, P369S pozitif olarak bulundu. Kontrol grubundaki 35 bireyden 2’sinde (%5,7) E148Q, 2’sinde (%5,7) M694V tespit edildi. Hasta ve kontrol grubundaki MEFV mutasyonları karşılaştırıldığında farklılık önemsizdi (p>0,05). MEFV mutasyonu pozitif olan 14 AS’li hastanın 7’sinde (%50,0) E148Q, 4’ünde (%28,6) M694V tespit edilmiş olup bu oran istatiksel olarak anlamlı bulundu (p

Amaç: RA tanısının erken konulması, tedavi ile eklem dokusundaki hasarın önüne geçilebilmesi açısından çok önemlidir. Laboratuar testleri, RA aktivitesinin izlenmesinde ve tedaviye yanıtın değerlendirilmesinde oldukça önemlidir. RA şüphesi olan vakalarda bugüne kadar en yaygın kullanılan test romatoid faktördür, RA'ya duyarlı olmasına rağmen özgül olmayan bir parametredir. Şüpheli vakalarda ya da düşük RF sevyeli vakalarda otoantikor ölçümü tanı koymada yardımcı olabilir. Anti RA-33 otoantikor ölçümü RA'lı hastalarda kullanılan otoantikor testlerinden biridir. Bu çalışmanın amacı sağlıklı bireyler ile RA'lı bireylerin Anti-RA 33 seviyesini karşılaştırmak ve Anti-RA 33 seviyesinin RA tanısında önemini değerlendirmektir. Yöntem: American College of Rheumatology (ACR) RA klasifikasyon kriterlerine göre belirlenmiş hastalık süresi en az iki yıl olan 28 i bayan,12 si erkek toplam 40 RA'li hasta ile aynı sayıda kontrol grubu sağlıklı kişiler çalışmaya alındı. Bulgular: RA'li hasta grubunda AntiRA-33 düzeyi 12,47±49,76 U/ml, sağlıklı kontrol grubunda AntiRA-33 düzeyi 1,96±1.82 U/ml olup gruplar arası istatiksel olarak bir fark bulunmadı. Sonuç: RA'lı hastalarda AntiRA-33 düzeyi ile sağlıklı kontrol grubu arasında anlamlı bir fark bulunamadı., Objective: The early diagnosis of Rheumatoid Arthritis (RA) is of due significance for the prevention of possible damage to the joint tissue by means of treatment. Laboratory tests are very important for monitoring RA activity and for the evaluation of the patients' response to the treatment. Rheumatoid factor, so far the most commonly used test for the cases with suspected RA, is not a specific parameter despite its sensitivity to RA. The measurement of other autoantibodies might be helpful to the diagnosis particularly for the cases with low RF titer or with suspected diagnosis. The measurement of anti-RA33 autoantibodies is one of the tests used in the diagnosis of the RA cases. The present study was conducted to compare anti-RA33 levels of healthy individuals with long-term RA cases and to evaluate the value of anti-RA33 test for the RA diagnosis. Method: Total 40 patients (28 female and 12 male) identified with RA at least for the last five years according to the classification criteria of American College of Rheumatology (ACR) reviewed in 1987 and 40 healthy controls included in the present study. Results: AntiRA-33 level was determined as 12.47±4.97 U/mL for the patients with RA and as 1.96±1.82 U/mL for the healthy controls, and there is no statistically significant difference between the groups. Conclusions: As a result AntiRA-33 level was evaluated in RA patients and no difference was found compared to control group.

It has been suggested that Mediterranean fever (MEFV) gene mutations are also seen in certain autoimmune diseases and are related to severity of the disease activity. As most of the clinical symptoms of these inflammatory diseases are related to autoantibody positivity, we assessed autoantibody prevalence in patients with Familial Mediterranean fever (FMF) and investigated the relationship between clinical involvement of FMF and the autoantibodies. There are a few studies on this subject with conflicting results.Fifty patients with FMF without attack and 27 healthy controls were enrolled to the study. Clinical characteristics of the patient group were questioned. Rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) values, Fluorescent antinuclear antibody (ANA), extractable nuclear antigen (ENA) profile was studied in both groups.No statistically significant difference was found in ANA, ENA profile, anti-CCP, and RF positivity between the groups (p0.05). There was no relationship between the autoantibodies and the clinical status in patients with FMF. MEFV gene mutations were identified in 98% of the FMF patients.In conclusion, autoantibody positivity is similar to the healthy population in FMF. Although MEFV mutations affect clinical course in other autoantibody mediated diseases, it is not related to autoantibody formation in FMF.

Cumhuriyet University, Faculty of Medicine, Objective: The aim of the present study is to apply cardiac rehabilitation (CR) to the sedentary cases with cardiovascular disease (CVD) risk, and to investigate the effect of CR on the various blood parameters and aerobic capacity of the cases. Method: The study included 106 individuals with sedentary life. Age, smoking history, presence of anxiety, CVD and DM history, pulmonary disease history, alcohol use, dietary habits, lipid profile, ECHO test of the patients were determined before the cardiac rehabilitation application. Furthermore, body mass index (BMI) values, weight, waist-hip-thigh circumference, lipid profile, Metabolic Equivalent of Task (MET), and VO2 Max of all patients were measured. The patients who had a sedentary lifestyle were then put to respiratory function test, submaximal exercise test, and ECG-CB monitoring and treadmill-ergometric stress tests. The patients who responded well to the tests were included in an aerobic program for 12 weeks (30-50 min of aerobic exercise, 5 days/3 weeks) based on the exercise tolerance test according to their clinical condition. Besides, the parametric measurements, which had been conducted prior to the aerobic program, and the results of the pre and post tests were evaluated and compared at the end of the 12th week. Results: There were meaningful improvements in body weights, BMI, waist and hip and EKO measurements of the individuals included in the study (p, Hayta, E.; Department of Physical Medicine and Rehabilitation, Cumhuriyet University, Faculty of MedicineTurkey; email: dremay@gmail.com

Romatoid artrit (RA) ile Lyme hastalığı klinik olarak farklılıklar göstermektedir. Lyme artriti RA'dan belirgin farklılıklar göstermesine ragmen, benzer bir şekilde kronik proliferatif sinovitise bağlı olarak eklem yerlerinde erozyona neden olabilmektedir. Literatürde her iki hastalığın birlikte görüldüğü olguda bildirilmiştir. Biz bu makalede el küçük eklemlerinde simetrik artriti ve el bileklerinde artraljisi olup RA'yı taklit eden ancak öykü, klinik ve laboratuvar olarak Lyme Hastalığı tanısı koyduğumuz ve tedavisi tamamlanan bir vakayı sunmayı amaçladık., Clinically, there are some differences between rheumatoid arthritis (RA) and Lyme disease. Although Lyme arthritis exhibits marked differences from RA, it can cause erosion at joint due to chronic proliferative synovitis as similar to RA. In the literature, a case was reported where both entities were seen together. In this manuscript, we aimed to present a case with symmetric arthritis at small hand joints and arthralgia at wrist that mimicked RA but diagnosed as Lyme disease by history, clinical presentation and laboratory findings, and successfully treated.

Introduction: Piezogenic pedal papules (PPP), which are forms of responses to internal mechanical pressure, appear on the wrists and especially on feet. Repeated trauma or an inherent collagen defect mainly as Ehlers–Danlos syndrome can cause pain symptoms in heels. The PPP are mostly asymptomatic and noticed incidentally. Case Reports: Unlike the majority of PPP cases, two patients (both housewives), who took part in the present study, were older and they had severe pain associated with PPP. One injection of a solution of equal amounts of betamethasone and prilocaine was applied in treatment of pain in both patients. Conclusion: During follow-ups the patients did not report any clinical complaints considering the PPP and their VAS score remained significantly low. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 2, February 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(2):81–84. www.ijcasereportsandimages.com Hayta et al. 81 CASE REPORT OPEN ACCESS Pain in heels: Two cases with piezogenic pedal papules Emrullah Hayta, Sibel Berksoy Hayta, Melih Akyol, Ozlem Sahin, Sedat Ozcelik

Introduction: traffic accidents appear to be one of the frequently encountered causes of spinal cord injury (sPI) in patients with ankylosing spondylitis. the risk of spinal cord injury is 11.4 times higher in patients with As compared to the healthy population. Although the fractures might be seen in any part of the spine, they most frequently occur in cervical region. case report: Our subject in this case is a 62-year-old patient diagnosed with As who had isolated muscle strength loss following a traffic accident. the patient was provided skull traction treatment having sustained a fracture in his c7 in a traffic accident, and he developed tetraplegia as a result. conclusion: Our objective with this case report is to emphasize that stress loading treatment methods such as skull traction which apply force to bone in fractures arising from traumas in patients with As could lead to extremely severe neurological injuries.

Osteomalazi, D vitamini aktivitesindeki yetersizlik sonucu kemik mineralizasyonunun bozulması ile ortaya çıkan metabolik bir kemik hastalığıdır. Malabsorbsiyon durumları, vitamin D ve kalsiyumdan fakir diyetle beslenme, güneş ışığına yetersiz maruziyet ve doğum sayısının fazla olması vitamin D eksikliğinin başlıca nedenlerindendir. Gluten enteropatisi malabsorbsiyonun sık sebeplerinden birisidir.Gluten enteropatisi klasik olarak diyare, şişkinlik, kilo kaybı ve malasorbsiyon ile karşımıza çıkar. Bununla birlikte nonspesifik gastrointestinal semptomlarla da karşımıza çıkabileceği gibi nongastrointestinal semptom ve bulgularlada karşımıza çıkar. Biz burada osteomalaziye bağlı yürüme bozukluğu ve kalça ağrısı ile gelen ve Gluten enteropatisi tanısı alan olguyu sunduk., Osteomalacia is a metabolic bone disease, which occurs due to impaired bone mineralization resulted from insufficient activity of vitamin D. Main reasons for vitamin D deficiency include malabsorptive states, diet with poor vitamin D and calcium content, insufficient sunlight exposure and higher numbers of birth. Gluten sensitive enteropathy is one of the most common causes of malabsorption. Gluten sensitive enteropathy is classically manifested with diarrhea, flatulence, weight loss and malabsorption. However, it can also present with non-gastrointestinal symptoms and signs, as it can be recognized by non-specific gastrointestinal symptoms. We presented a case that referred with gait abnormality and hip pain due to osteomalacia and was diagnosed as gluten- sensitive enteropathy.

WOS: 000293062500007, PubMed ID: 21886066, Objectives: Balneotherapy has been widely used for treatment of chronic low back pain recently. However there are only a few clinical controlled trials on balneotherapy. The aim of the present study was to evaluate the effects of balneotherapy in patients with chronic low back pain. Methods: Sixty patients with lumbar spondylosis were included in the study. In Group 1, patients received both balneotherapy and physiotherapy and in Group 2, patients received only physiotherapy for three weeks. The intensity of the pain was evaluated by Visual Analog Scale (VAS) and functional disability was scored according to Revised Oswestry Index (ROI). Spinal mobility was assessed by the Schober and lateral flexion tests. Variables were evaluated before and after the three weeks of treatment. Results: The groups were comparable regarding age (P = 0.970) and sex (P = 0.357). There was no statistically significant difference between the two groups for baseline VAS (P = 0.838), Schober test (P = 0.226), and right (P = 0.642) and left (P = 0.674) lateral flexion measurements, and ROI scores (P = 0.798). At the end of the therapy, all clinical parameters significantly improved in patients in both of the groups (P < 0.05). VAS, Schober test, and ROI scores after the therapy were clearly superior in Group 1 in comparison to Group 2 (P < 0.05). Conclusion: The results of the present study reiterate that besides conventional physiotherapy, balneotherapy may be effective in the treatment of patients with chronic low back pain.

WOS: 000306827500034, PubMed ID: 21739129, The aim of this study was to evaluate the bone mineral density (BMD) in familial Mediterranean fever (FMF) and to search the effects of genetic factors, family history of FMF and types of clinical attacks on BMD. Forty-four attack-free patients with FMF and 36 healthy voluntary subjects were included in the study. BMD measurements of lumbar spine and left proximal femur were performed by dual energy X-ray absorptiometry (DEXA). There was no statistically significant difference between patient and control groups regarding median values of lumbar BMD (P = 0.06), lumbar T (P = 0.08) and Z (P = 0.12) scores, femoral neck BMD (P = 0.13), femoral T (P = 0.22) and Z (P = 0.16) scores and total femur BMD (P = 0.14), T (P = 0.19) and Z (P = 0.27) scores. Patients with negative FMF family history had significantly lower femoral neck BMD (P = 0.018), femoral neck T (P = 0.009) and Z (P = 0.01) scores and total femur BMD (P = 0.033) than patients with positive FMF family history. There was no significant difference among the groups regarding mutation characteristic and types of attacks in lumbar BMD, T and Z scores, femoral neck BMD, T and Z scores and total femur BMD, T and Z scores (P > 0.05). We found that the bone loss of patients with FMF is not different from that of the controls. The increased bone loss in the patients with negative family history for FMF should be further investigated with larger patient groups taking into consideration of the risk factors related to family history for osteoporosis.

Amaç: Bu çalışmanın amacı RA'li hastalarda hastalık aktivitesi, radyolojik eklem hasarı, fonksiyonel bozukluk veekstraartiküler tutulum ile RF izotipleri ve Siklik Sitrulin Peptit antikoru (anti- CCP) arasındaki ilişkiyi araştırmaktır.Materyal ve Metod: Çalışmaya RA tanılı 45 gönüllü hasta ile diz osteoartrit tanılı 41 gönüllü hasta dahil edildi.Çalışmaya alınan tüm olguların akut faz reaktantları, RF, RF izotipleri (RF- IgA, RF- IgG, RF- IgM) ve anti- CCPdeğerleri çalışıldı. RA' lı hastalarda hastalık aktivitesi, radyolojik eklem hasarı, fonksiyonel bozukluk ve ekstraartiküler tutulum değerlendirildi.Bulgular: RA'lı hasta grubunda anti- CCP %71,1'lik oranla ve RF %57,8'lik oranla pozitif bulundu. RF- IgM, ensık gözlenen RF izotipi olup, RA'lı hastaların % 66,7'de pozitif bulundu. RA tanısı için RF ve anti- CCP'nin özgüllüğü %98'di ve RF izotiplerinin özgüllüğünden yüksekti. Anti- CCP'nin duyarlılığı %71'lik oranla en yüksekti. RF,RF- IgM RF- IgA ve RF- IgG'nin duyarlılıkları sırayla %58, %67, %42 ve %53'dü. RA'lı hasta grubu hastalıkaktivitesi, fonksiyonel bozukluk, radyolojik eklem hasarı ve ekstraartiküler tutulum varlığına göre gruplandırıldığında otoantikor değerleri açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu (P>0.05).Sonuçlar: Anti- CCP ve RF- IgM, RA tanısı için yüksek özgüllüğe sahip olsalar da, otoantikorlar hastalık prognozunu belirlemede etkili bulunmamışlardır. Bu nedenle hastalık tanısı konulduğunda otoantikor pozitifliğinigözönünde bulundurmaksızın tedavinin planlanması gerektiğini düşünmekteyiz, Objective: The aim of the study was to search the relationship of rheumatoid factor (RF) isotypes and anti- cyclic citrullinated peptide (anti- CCP) with disease activity, radiological joint damage, functional impairment and extra- articular involvement in patients with rheumatoid arthritis (RA).Materials and Methods:Volunteer 45 patients with RA and 41 patients with knee osteoarthritis were included in the study. RF, RF isotypes (RF- IgA, RF- IgG, IgM), anti- CCP and acute phase reactants werestudied in all subjects. Disease activity, radiological joint damage, functional impairment and extra- articularinvolvement were evaluated in patients with RA. Results: Anti- CCP and RF were found 71.1 % and 57.8%, respectively in patients with RA. RF- IgM, the mostfrequent RF isotype, was found in 66.7% of patients. The specificities of RF and anti- CCP were 98% and werehigher than the specificities of RF isotypes for the diagnosis of the disease. The sensitivity of anti- CCP was thehighest with a ratio of 71%. Sensitivities of RF, RF- IgM, RF- IgA and RF- IgG were 58%, 67%, 42% and 53% respectively. When the patients were grouped according to the severity of disease activity, functional impairment, radiological joint damage, and thepresence of extra- articular involvement, there was no statistically significant difference between the groups regarding autoantibody levels (P>0.05).Conclusion:Though some of them have high specificities like anti- CCP and RF- IgM, these autoantibodies were not found effective in predicting the prognosis so we suggest that, aggressive treatment should be planned as far as RA is diagnosed without taking the presence ofthe autoantibodies into account.

WOS: 000343521300016, …

Background Due to its effect on the immune system and antioxidant features melatonin (MLT) has attracted a great deal of attention in recent years. Its role in pathogenesis of chronic inflammatory diseases have been studied. However only few studies have investigated its role in Ankylosing Spondylitis (AS). Objectives The aim of this study is to investigate the circadian rhythm of MLT and its relationship with disease activity, quality of life and enthesitis score in AS patients. Methods Sixteen AS patients diagnosed according to the Modified New York 1984 criteria and 16 age and sex matched healthy controls were enrolled in the study. Serum MLT levels were measured at 20:00, 03:00 and 08:00 via melatonin direct radioimmunoassay kit (LDN BA R-3300) in both groups. Bath AS Disease Activity Score (BASDAI), Bath AS Functional Index (BASFI), Maastricht AS Enthesitis Score (MASES) and AS Quality of Life (ASQoL) were calculated in AS group. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured, duration of morning stiffness was questioned Results The mean morning (08:00) and evening (20:00) MLT levels were significantly higher in the patient group (34.00±13.51 pg/ml versus 24.88±7.10 pg/ml and 34.25±7.92 pg/ml versus 27.75±8.25 pg/ml respectively) (p Conclusions Ankylosing Spondylitis patients have higher melatonin levels and the melatonin levels of AS patients are associated with the duration of morning stiffness, disease activity, quality of life and enthesitis scores. We suggest that our results should be supported by studies performed in wider study populations also involving patients with non-radiographic axial spondyloarthritis as a subgroup and with more frequent melatonin measurements performed especially at night in order to assess the exact circadian rhythm of melatonin in spondyloarthritis. References Cutolo M, Maestroni GJ,Otsa K, Aakre O, Villaggio B, Capellino S et al. Circadian melatonin and cortisol levels in rheumatoid arthritis patients in winter time: a north and south Europe comparison. Ann Rheum Dis 2005;64:212-216 Senel K,Baykal T, Melikoglu MA, Erdal A, Karatay S, Karakoc A, Ugur M. Serum melatonin levels in ankylosing spondylitis: correlation with disease activity. Rheumatol Int 2011;31:61-63 Senna MK, Olama SM, El-Arman M. Serum melatonin level in ankylosing spondylitis: is it increased in active disease. Rheumatol Int 2012;32:3429-3433. Disclosure of Interest None declared