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Objective: Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA. Methods: The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed. Results: The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA). Conclusion: Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes. © 2021 Société française de rhumatologie

Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaints and should not been overlooked in patients with axSpA The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specifc mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfrrmann classifcation), endplate changes (Modic, types 1, 2, and 3), annular fssure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI fndings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis (AS). Degenerative changes were more prevalent in patients with mLBP (n=105) than axSpA. Disk degeneration was the most prevalent MRI fnding, followed by annular fssure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR=6.455), lumbar disk herniation (OR=2.278), annular fssure (OR=2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR=2.225), and advanced age (OR=31.556) were factors associated with an increased risk of DD in axSpA. Coexisting * Gamze Kilic gkilic.md@hotmail.com 1 Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey 2 Department of Radiology, Sevgi Hospital, Kayseri, Turkey 3 Department of Physical Medicine and Rehabilitation, Ministry of Health Kayseri City Hospital, Kayseri, Turkey 4 Department of Rheumatology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey 5 Department of Rheumatology, Gaziosmanpasa Hospital, Istinye University, Istanbul, Turkey 6 Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Trakya University, Edirne, Turkey DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. 35922576

This article aims to evaluate the possible effect of obesity on quality of life, psychological status, and other clinical variables in Psoriatic arthritis (PsA). PsA patients have been recruited by the Turkish League Against Rheumatism-Network from various centers in Turkey in this cross-sectional study. Patients with a body mass index (BMI) ? of 30 kg/m2 were considered obese. Differences among patients with regard to obesity status were assessed with health-related quality of life measures (PsA Quality of Life Questionnaire [PsAQoL]), psychological status (Hospital Anxiety and Depression Scale [HADS]), and disease activity parameters (the Disease Activity index for PSoriatic Arthritis [DAPSA], Disease Activity Score 28-C-reactive protein [DAS28-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Psoriasis Area and Severity Index [PASI]), physical functions (Ankylosing Spondylitis Functional Index [BASFI], Health Assessment Questionnaire [HAQ], and Health Assessment Questionnaire for the spondyloarthropathies [HAQ-S]). Pain was assessed using visual analog scale of pain (VAS-P), and fatigue was evaluated using visual analog scale of fatigue (VAS-F) and Functional Assessment of Chronic Illness Therapy (FACIT). A total of 1033 patients with PsA, 650 (62.9%) non-obese and 383 (37.1%) obese were included in the study. The PsAQoL, HADS-Anxiety, HADS-Depression, DAPSA, DAS28-CRP, BASDAI, BASFI, HAQ and HAQ-S scores of the obese group were higher than the non-obese group (p < 0.05). VAS-P and PASI scores were similar between group of patients with and without obesity. Obese patients had higher median scores of VAS-F and FACIT than non-obese patients (p < 0.05). Linear regression analysis showed that BMI affects the quality of life, depression, and disease activity. Consequently, obesity has significant associations with higher disease activity, lower QoL, risk of anxiety, depression, and fatigue. Therefore, obesity should also be taken into account in the management of PsA patients. © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

The aim of this study was to investigate residual symptoms or disease burden among patients with psoriatic arthritis (PsA) in remission or low disease activity (LDA) according to different outcome measures. A total of 126 patients with PsA were included and the following variables were assessed: Tender joint count (TJC), swollen joint count (SJC), patient’s global assessment, physician’s global assessment, pain, extra-articular manifestations, Psoriasis Area and Severity Index, Health Assessment Questionnaire, fatigue, Short Form-36, psoriatic quality of life, Hospital Anxiety and Depression Scale and C-reactive protein (CRP). Disease activity was measured using three different outcome measures including minimal disease activity (MDA), disease activity score for 28 joints (DAS28-CRP) and disease activity in psoriatic arthritis (DAPSA). The number (%) of patients who achieved remission or LDA was 9(14.1), 34(27.0) and 67(53.2) according to MDA, DAPSA and DAS28-CRP criteria, respectively, under usual care. SJC > 1 was seen in 3(8.8%) and 13(19.4%) of patients in remission or LDA as defined by the DAPSA and DAS28-CRP respectively. TJC > 1 was found at least 32.4% of patients with PsA in remission or LDA by any definition. 22.2–49.3% of patients with PsA in remission or LDA still suffered from clinically important fatigue. No patients in MDA had a substantial functional impairment while 2.9–19.4% of patients fulfilling remission or LDA according to the DAPSA and DAS28-CRP experienced functional disability. At least 22.2% of patients with PsA in remission or LDA by any description had higher risk for depression, and at least 11.1% for anxiety. Despite patients with PsA in remission or LDA by various definition, they may continue to experience pain, tender or swollen joints, fatigue, physiologic distress as well as functional impairment suggesting that there is a significant unmet need with regard to definition of remission or LDA in PsA.

OBJECTIVE This study was performed to evaluate the effect of inferior turbinate reduction on nasal function. MATERIALS AND METHODS A total of 32 patients who underwent septorhinoplasty (SRP) operation were included in the study and assigned into 2 groups as group I who received inferior turbinate reduction during SRP operation consisted of 17 patients and the group II who consisted of 15 patients without inferior turbinate reduction. For 2 groups before and after surgery, visual analogue score and findings of the acoustic rhinometry were recorded both before and after decongestion of the nasal mucosa. RESULTS Postoperative mean visual analogue scale (VAS) scores revealed a statistically significant reduction compared with preoperative values on right and left side of the nasal cavity, both before and after topical decongestion in group I (P

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.

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

Background: Psoriatic arthritis (PsA), a chronic rheumatic disease associated with reduced quality of life. Obesity is an important clinical problem which may interfere with loss of functioning and quality of life. Obesity is usually an overlooked entity in patients with PsA. Several studies were invastigated prevalence and the impact of obesity on disease activity in patients with PsA, however relationship between psychological status and quality of life have not been evaluated comparatively. Objectives: To assess the impact of obesity on quality of life, psychological status and clinical parameters in patients with PsA. Methods: Patients with PsA were recruited who met CASPAR classification criteria enrolled by Turkish League Against Rheumatism-NETWORK (TLAR-NETWORK) derived from 24 different centers of our country.Patients with BMI ≥30 kg/m2 were considered obese. Differences among patients with or without obesity were assessed.VAS fatigue, psychological status and health related quality of life measures [SF-36; HAQ; Psoriatic arthritis quality of life (PsAQoL); Hospital Anxiety and Depresson Scale], FACIT-Fatigue, DAS28, BASDAI, BASFI, BASMI, Maastrich Ankylosing Spondylitis Enthesitis Score (MASES) and Psoriasis area severity index (PASI) scores were compered between this groups. Results: A total 1130 patients with PsA (36.0% male, 64.0% female) included in this study. In this cohort 37.6% obese and 62.4% non-obese. The presence of peripheral arthritis, enthesitis, dactylitis, uveitis and spine involvement, PASI scores as well as MASES scores were quite similar between patients with and without obesity. Obese patients had significantly higher scores in VAS fatigue and disease activity, poorer QoL and physical functions compared to non-obese patients (p Conclusion: Obesity associated with the risk of depression and anxiety, fatigue, poorer QoL and higher disease activity.These findings suggest that obesity should be considered while assessing patients with PsA. References [1] Li W,Han J,Qureshi AA.Obesity and risk of incident psoriatic arthritis in US women.Ann Rheum Dis.2012Aug;71(8):1267-72. [2] Klingberg E,Bilberg A,Bjorkman S, et al.Weight loss improves disease activity in patients with psoriatic arthritis and obesity:an interventional study.Arthritis Res Ther.2019Jan11;21(1):17 Disclosure of Interests: Kevser Gok: None declared, Kemal Nas: None declared, Erkan Kilic: None declared, Betul Sargin: None declared, Sevtap Acer Kasman: None declared, Hakan Alkan: None declared, Nilay Sahin: None declared, Gizem Cengiz: None declared, Nihan Cuzdan: None declared, Ilknur Albayrak Gezer: None declared, Dilek Keskin: None declared, Cevriye Mulkoglu: None declared, Hatice Resorku: None declared, Ismihan Sunar: None declared, Ajda Bal Hasturk: None declared, Mehmet Tuncay Duruoz Grant/research support from: Abvie, Speakers bureau: Novartis, AMGEN, Abdi Ibrahim, Ilko, Okan Kucukakkas: None declared, Ozan Volkan Yurdakul: None declared, Meltem Alkan Melikoglu: None declared, Yildiray Aydin: None declared, Figen Ayhan: None declared, Hatice Bodur: None declared, Mustafa Calis: None declared, Erhan Capkin: None declared, Gul Devrimsel: None declared, SAMI HIZMETLI: None declared, Ayhan Kamanli: None declared, Yasar Keskin: None declared, Hilal Kocabas: None declared, Oznur Kutluk: None declared, Nesrin Sen: None declared, Omer Faruk Sendur: None declared, ibrahim tekeoglu: None declared, Murat Toprak: None declared, Sena Tolu: None declared, Tiraje Tuncer: None declared

Background: Psoriatic arthritis (PsA) can lead to significant mental burden affecting several aspects of life in majority of patients. Mental health problems, such as depression and anxiety may result in poor treatment adherence and difficulty in coping with disease burden. Objectives: The aim of this study is to determine the risk factors associated with clinically significant depression and anxiety in patients with PsA. Methods: The data from 1128 patients with PsA who met CASPAR classification criteria enrolled by Turkish League Against Rheumatism (TLAR)-Network derived from 25 investigating centers. All of the patients underwent clinical, radiological and also laboratory assessment by using standardized protocol. The associations between psychological variables and clinical parameters were assessed by univariate and multivariate analyses. Results: Of the 1128 patients with PsA (the mean age 46.9 ±12.2,%64 F), 574 (%50.9) had high risk for depression (HADS-D score ≥7) and 270 (%23.9) for anxiety (HADS-A score ≥10). By univariate analysis, the highest odds ratio (OR) associated with both depression and anxiety were SF36-MCS Conclusion: This large nationwide database indicated that higher disease activity, functional disability, fibromyalgia (FMS), poor health related quality of life as well as structural damage were estimated as the important risk factors for mental disorders in PsA. Disclosure of Interests: Gamze Kilic: None declared, Kemal Nas: None declared, Erkan Kilic: None declared, ibrahim tekeoglu: None declared, Betul Sargin: None declared, Sevtap Acer Kasman: None declared, Hakan Alkan: None declared, Nilay Sahin: None declared, Gizem Cengiz: None declared, Nihan Cuzdan: None declared, Ilknur Albayrak Gezer: None declared, Dilek Keskin: None declared, Cevriye Mulkoglu: None declared, Hatice Resorlu: None declared, Sebnem Ataman: None declared, Ajda Bal: None declared, Mehmet Tuncay Duruoz Grant/research support from: Abvie, Speakers bureau: Novartis, AMGEN, Abdi Ibrahim, Ilko, Okan Kucukakkas: None declared, Ozan Volkan Yurdakul: None declared, Meltem Alkan Melikoglu: None declared, Yildiray Aydin: None declared, Figen Ayhan: None declared, Hatice Bodur: None declared, Mustafa Calis: None declared, Erhan Capkin: None declared, Gul Devrimsel: None declared, SAMI HIZMETLI: None declared, Ayhan Kamanli: None declared, Kevser Gok: None declared, Yasar Keskin: None declared, Hilal Kocabas: None declared, Oznur Kutluk: None declared, Nesrin Sen: None declared, Omer Faruk Sendur: None declared, Murat Toprak: None declared, Sena Tolu: None declared, Tiraje Tuncer: None declared

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

Progressive pseudorheumatoid dysplasia is a rare hereditary skeletal disease characterized by bone and cartilage dysplasia, progressive arthropathy without sign of systemic or synovial inflammation. Relapsing polychondritis (RP) is a rare autoimmune disease associated with inflammation in cartilaginous and other proteoglycan rich structures. An associated autoimmune and/or hematologic disorder is seen in over 30% of patients with RP. To our knowledge, coexistence of progressive pseudorheumatoid dysplasia and RP has not been previously reported. In this article, we describe an unusual case of coexisting progressive pseudorheumatoid dysplasia with RP. Physicians should be aware of this possible association.

Objective: Although the prevalence of peripheral and extra-articular disease in ankylosing spondylitis (AS) has been assessed in many studies, data on non-radiographic axial spondyloarthritis (nr-axSpA) is scanty. The aim of this study was first, to compare radiographic-axSpA/AS (r-axSpA/AS) and nr-axSpA concerning peripheral arthritis and extra-articular manifestations (EAMs), and second, to assess potential differences between patient subgroups with or without EAMs regarding disease burden. Methods: Data was extracted from our single center axSpA database. Patients having at least one of the EAMs (uveitis and/or inflammatory bowel disease (IBD) and/or psoriasis) were compared to those who did not have EAMs. Patients’ clinical data including disease activity, functional and psychological status, physical limitations, quality of life (QoL) and magnetic resonance imaging of sacroiliac joints (SIJ MR) were evaluated. Results: Patients with nr-axSpA (n=193) were younger, had female predominance, better functional and physical status, higher frequency of bone edema in SIJ MR and peripheral arthritis but similar QoL, prevalence of HLA B27 and EAMs compared to r-axSpA/AS (n=352). The prevalence of current or ever uveitis (14.5 vs 15.3%, p=0.791), psoriasis (6.2 vs 5.4%, p=0.689) or IBD (4.1 vs 3.4%, p=0.663) in nr-axSpA and r-axSpA/AS were similar. In both subgroup of patients, EAMs positive and negative patients had similar functional status and QoL, as well as disease activity and laboratory parameters. Conclusion: Patients with nr-axSpA and r-axSpA/AS have similar prevalence of EAMs and clinical burden of disease. Having EAMs does not have a major influence on clinical parameters and patient reported outcome measures in nr-axSpA and r-axSpA/AS.

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

Objective In vivo measurement of articular cartilage thickness is a significant marker of structural joint damage in many inflammatory or noninflammatory diseases including rheumatoid arthritis or osteoarthritis. The aim of this study was to assess the diurnal variation of femoral condylar cartilage thickness (FCT) in young adults by using ultrasonography. Design The thickness of femoral articular cartilage was measured in healthy volunteers at 8:00-9:00 a.m. and 4:00-5:00 p.m. on the same day using standard sonographic methods. Three midpoint measurements were taken from each knee at the lateral femoral condyle, femoral intercondylar area, and medial femoral condyle. Results The FCT significantly decreased in all the areas assessed. The maximal decrease (in millimeters) in the mean (standard deviation) FCT was in the right lateral femoral condyle (0.21 [0.24]) and left medial femoral condyle (0.21 [0.21]) followed by the right medial femoral condyle (0.19 [0.23]), left lateral femoral condyle (0.19 [0.19]), left femoral intercondylar area (0.13 [0.30]), and right femoral intercondylar area (0.11 [0.33]). The mean diurnal change in FCT from a.m. to p.m. reached up to 10.6%. Conclusions This study suggests that the FCT significantly decreased in all of the measured areas from a.m. to p.m. Future studies, particularly those assessing the effect of any pharmacologic or nonpharmacologic applications on cartilage thickness in the weight-bearing joints, should be designed bearing in mind that cartilage thickness has diurnal variations. Assessment of diurnal variation in cartilage thickness in elderly osteoarthritic or nonosteoarthritic populations warrants further research.

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

Aim To assess bone mass in women with systemic sclerosis (SSc) in comparison to age and sex-matched patients with rheumatoid arthritis (RA), and to evaluate factors influencing bone mineral density (BMD). Methods Patients were consecutively recruited and assessed for BMD at the lumbar spine and hip by dual-energy X-ray absorptiometry (DEXA) using a densitometer. In SSc, the extent of skin involvement, modified Rodnan skin thickness score (mRSS) and Medsger disease severity index were assessed. Results Forty-three patients with SSc and 38 age-matched patients with RA were included. There was no difference in BMD measurements between patients with diffuse or limited SSc. Patients with SSc had similar risk factors associated with osteoporosis (OP) or low bone mass except for low body mass index (BMI) and low vitamin D levels compared to patients with RA. Lumbar spinal BMD and T score were similar between groups. Total hip and femoral neck BMD and T score at femoral neck and total hip were significantly lower in patient with SSc versus RA. There was significant association between mRSS, Medsger severity score (peripheral vascular involvement and skin) and femoral BMD. Conclusion There is an increased risk for bone loss in patients with SSc and the risk of OP is associated with disease severity, prolonged menopause and disease duration. The complex pathophysiology of bone metabolism as well as complex pathogenesis of the SSc pose some difficulty reaching clear-cut conclusions on the causal relationship between SSc and bone loss.

Ankylosing spondylitis is a systemic inflammatory disease characterized by involvement of sacroiliac joints, spine and entheses. In the last two decades a lot of progress has been made both in the diagnosis and management of axial spondyloarthritis, including nonradiographic axial spondyloarthritis. Nonsteroidal anti-inflammatory drugs and TNF inhibitors reduce pain and improve quality of life in most patients. However, the radiologic progression seems to continue, probably due to the interacting pathways of inflammation and bone turnover. Despite pharmacological advances, nonpharmacological therapies including rehabilitation, exercise, spa or balneotherapy, and occupational therapy are still an integral part of the management of patients with ankylosing spondylitis. Although the duration and intensity of nonpharmacological therapies are not conclusive and the compliance for these therapies is low, effective pharmacological therapies seem to motivate and improve the compliance of the patients. Furthermore...

Bulgular: Literaturde Turkiye'den biyolojik ajana bagli yan etki gorulen romatizmal hastalikli toplam 53 olgu (21 erkek, 32 kadin) bildirilmistir. Yas ortalamasi 39.0±15.6 yil ve ortalama hastalik suresi 10.6±8.2 yil idi. Biyolojik ajanlara baslanmasi ile yan etkinin ortaya cikmasi arasindaki gecen sure ortalama 8.8±9.2 aydi. Biyolojik ajan kullanimina bagli olarak en sik gorulen yan etki ankilozan spondilit (AS) ve romatoid ar trit (RA) hastalarinda gozlendi. En sik bildirilen yan etki 14 hastada (%26.4) tuberkuloz idi. Diger yan etkiler psoriyazis (%15.1), solid tumor (%7.6), lenfoma (%5.7), ilaca bagli lupus (%3.8) ve menstruel kanama (%3.8) idi. Yan etki gelisen olgularin toplam %77.4’unde biyolojik tedaviler sonlandirildi.

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

Aim To assess the validity of Assessment in Spondyloarthritis International Society (ASAS) endorsed Ankylosing Spondylitis Disease Activity Score (ASDAS) C-reactive protein (-CRP) and ASDAS erythrocyte sedimentation rate (-ESR) in axial spondyloarthritis (axSpA) and to estimate the cut-off values for male and female patients with axSpA. Methods Patients with axSpA were assessed for disease activity, functions, mobility and AS Quality of Life (ASQoL) and pain. The discriminant ability of ASDAS versions was assessed using standardized mean differences. Optimal cut-off values of ASDAS versions were calculated. Results Patients with axSpA were included (196 AS, 164 non-radiographic axSpA). ASDAS versions and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) had good correlations with patient's global (PtG) and physician's global (PhG) assessment in both groups; however, men had relatively higher coefficients. Women had significantly higher pain, ASQoL, ASDAS-ESR, BASDAI item scores, PtG, PhG and ESR. Discriminant abilities of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in men and women regarding low and high disease activity. ASDAS cut-offs are quite similar in both genders and in accordance with predefined values. The cut-offs for ASDAS-ESR were relatively lower than ASDAS-CRP and women tend to have higher cut-offs than men. Conclusion The construct validity of ASDAS-CRP to discriminate low and high disease activity and cut-off values are similar in male and female patients with axSpA; however, cut-offs for ASDAS-ESR need to be defined.

Objectives: This study aims to investigate the effects of aerobic exercise on low density lipoprotein receptor related protein 5 (LRP5) gene messenger ribonucleic acid expression and evaluate the relationship between the clinical parameters and gene expression in patients with postmenopausal osteoporosis (OP). Patients and methods: Seven patients with postmenopausal OP (mean age 60.0 +/- 5.3 years; range 51 to 66 years) were included in the study. An exercise protocol/program consisting of treadmill exercising for 30 minutes three days a week for six weeks was performed at a moderate intensity. LRP5 gene expression levels were evaluated before the onset of the exercise program and then four hours after the end of the first session and 12th (fourth week) and 18th (sixth week) sessions of exercise. Results: Our results demonstrated variable changes in the LRP5 gene expression after the aerobic exercise sessions. Excluding one patient, the LRP5 gene expression levels showed a slight tendency to increase. In spite of this tendency, gene expression differences during the exercise sessions were not significant. Conclusion: Our results suggest that interindividual variations of LRP5 gene expression exist after moderate intensity aerobic exercises in patients with postmenopausal OP. Despite of this variability, LRP5 gene expression levels increased slightly, except in peripheral blood in one patient. Future studies with larger sample sizes and different sampling time/tissues are required to shed more light on the impact of exercise at molecular level in OP.

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

Several studies have suggested that Ras-associated binding 25 protein (Rab25) is involved in the pathogenesis of human cancer. Although it has been demonstrated that the development of head and neck squamous cell carcinoma (HNSCC) is the result of an accumulation of multiple sequential genetic and epigenetic alterations in key genes with important functions in cell growth and the cell cycle, recent studies have indicated that HNSCC is a complex and heterogenous disease. To the best of our knowledge, there is no data regarding the regulation of the Rab25 gene at the mRNA or protein level in HNSCC. Furthermore, available data on Rab25 expression in other types of cancer are conflicting. The aim of the present study was to investigate whether Rab25 is involved in the development and/or progression of HNSCC, and to analyze the mechanisms underlying its effects in this type of cancer. The expression of Rab25 mRNA in HNSCC tissues and adjacent non-tumor tissue samples was measured using reverse transcription-quantitative polymerase chain reaction, while the level of the Rab25, Akt1 and phosphorylated-Akt1 proteins was measured using western blotting. Expression of Rab25 mRNA and protein was downregulated in 69.1% and 56.1% of tumor tissue samples, respectively. This downregulation was associated with an increase in p-Akt1 expression, in the absence of a change in total Akt1 protein levels, in tumor tissues compared with normal tissues. The current findings suggest that Rab25 acts as a tumor suppressor in HNSCC.

The aim of this study was to sonographically assess the presence and distribution of enthesopathy in systemic sclerosis (SSc).Consecutive patients with SSc and age-matched healthy controls were included in this study. All of the patients met the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for SSc. Six entheses sites were evaluated using gray scale and Doppler ultrasonographies (USs) with a linear transducer and were scored using the Madrid Sonography Enthesitis Index (MASEI).We evaluated 52 patients with SSc (46.10 ± 13.42 years) and 41 healthy controls (49.59 ± 9.35 years). Patients with SSc had significantly higher MASEI scores than the healthy controls. Except for plantar aponeurosis, the tendons and ligaments were thicker in the SSc group. In the SSc group, there were 25 (48.1%) diffuse cutaneous SScs and 22 (42.3%) limited cutaneous SScs. Variables such as age, BMI, disease duration, diagnostic delay and MASEI scores were similar in subgroups of SSc. There was a positive correlation between MASEI score and age, modified Rodnan's skin score and dyspnea grade, and a negative correlation with handgrip strength.To the best of our knowledge, this is the first study showing the presence of enthesopathy in patients with SSc using US. Enthesopathy should be kept in mind in symptomatic patients with SSc; additionally, it can be easily identified with US.

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

Inflammatory myofibroblastic tumor (IMT) of the oral cavity is an extremely rare clinical and pathological disease entity. It was originally described in the lung but has recently been reported in a variety of locations including lungs, mesentery, omentum, retroperitoneum and other sites. IMT is an unusual tumor composed of differentiated myofibroblastic spindle cells usually accompanied by numerous plasma cells and lymphocytes. We report such a case of inflammatory myofibroblastic tumor of the retromolar trigon in a 11-year-old girl. The patient presented with a soft tissue mass in the retromolar trigon. Histologically, the lesion is dominated by differentiated spindle cells with aprominent collagenous stroma and an inflammatory component including plasma cells and lymphocytes, and with positive immunoreactivity for smooth muscle actin (SMA) and vimentin. The absence of cytologic atypia helps differentiate this lesion from malignant spindle cell tumors.

The aim of this study was to assess discriminant validity of Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (-CRP) and ASDAS-erythrocyte sedimentation rate (-ESR) and to compare with The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) as clinical tools for the measurement of disease activity in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Also, the cut-off values for ASDAS-CRP in nr-axSpA and AS is revisited. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and were assessed for disease activity, quality of life and functional measures. The discriminatory ability of ASDAS-CRP and ASDAS-ESR was assessed using standardized mean differences and receiver operating characteristic (ROC) curves analysis. Optimal cut-off values for disease activity scores were calculated. Two hundred and eighty-seven patients with axSpA (nr-axSpA:132, AS:155) were included in this study. Two ASDAS versions and BASDAI had good correlations with patient's and physician's global assessment in both groups. Discriminatory ability of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in patients with nr-axSpA and AS when the patients were assigned into low and high disease activity according to the ASAS partial remission, patient's and physician's global assessment scores (based on the comparison of ROC curves). ASDAS cut-off values are quite similar between groups indicating that ASDAS-CRP works similarly well in nr-axSpA and AS. The performance of ASDAS to discriminate low and high disease activity and cut-off values are quite similar in patients with AS and non-radiographic axial SpA.

Developments in digital ultrasonography (US) technology and the use of high-frequency broadband transducers have increased the quality of US imaging, particularly of superficial tissues. Thus, US, particularly color US or power Doppler US, in which high-resolution transducers are used, has become an important imaging modality in the assessment of rheumatic diseases. Furthermore, therapeutic interventions and biopsies can be performed under US guidance during the assessment of lesions. In this era of effective treatments, such as biologics, improvements in synovial inflammation in rheumatoid arthritis as well as changes in enthesitis in spondyloarthropathies, including ankylosing spondylitis and psoriatic arthritis, can be monitored effectively using gray-scale and/ or power Doppler US. US is also a good imaging modality for crystal arthropathies, including gout and pseudogout, in which synovitis, erosions, tophi, and crystal deposition within or around the joint can be visualized readily. Vascular and tenosynovial structures, as well as the salivary glands, can be assessed with US in vasculitis and connective tissue disorders, including systemic lupus erythematosus and Sjögren’s syndrome. Current research is focused on improving the sensitivity, specificity, validity, and reproducibility of US findings. In this review, we summarized the role of US, particularly power Doppler US, in rheumatic diseases and inflammation in superficial tissues.

Background Systemic sclerosis (SSc), or scleroderma, is a severe connective tissue disease. Although musculoskeletal involvement is frequent and causes significant functional disability in patients with SSc, articular cartilage thickness has not been previously investigated. The aim of this study was to compare the femoral cartilage thickness (FCT) in patients with SSc with that of controls who were matched for age, body mass index and osteoarthritis prevalence. Methods The thickness of femoral articular cartilage was measured by ultrasonography in patients and controls. Three midpoint measurements were taken from each knee: lateral femoral condyle (LFC), femoral intercondylar area and medial femoral condyle (MFC). Results Forty female patients with SSc and 85 female controls were included. In patients with SSc, 18 (45.0%) had diffuse SSc, 18 (45.0%) had limited SSc, 1 (2.5%) had overlap (polymyositis) and 3 (7.5%) had SSc sine scleroderma. The mean FCT measurements of patients with SSc at MFC of the right and left knees (1.86 and 1.84 mm, respectively) and LFC of the left knee (1.93 mm) were statistically lower than in the controls (right and left MFC, 2.23 and 2.25 mm, respectively, P P = 0.026). Conclusions Patients with SSc had thinner femoral cartilage compared with controls. The underlying possible mechanisms of thin FCT may be multifactorial, and there may be many influencing factors like immune activation, vasculopathy, oxidative stress and synovial fibrosis or markers of cartilage degradation. The possible factors influencing the change in cartilage thickness or metabolism in patients with SSc require further research.

Objective Colchicine is the mainstay treatment for Familial Mediterranean Fever (FMF). However 5% to 10% of the patients with FMF are unresponsive or intolerant to colchicine. Biologics are efficient in many rheumatic diseases, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, cryopyrin-associated periodic syndromes. We performed a systematic review to analyze patients with FMF, including juvenile patients who received treatment with biologics. Methods A MEDLINE search, including articles published in English language between 1990 and May 2012, was performed. Patients who had Mediterranean fever variants but could not be classified as FMF according to Tel-Hashomer criteria were excluded. Results There is no controlled trial on the efficacy and safety of biologics in FMF. Fiftynine (32 female and 27 male) patients with FMF who had been treated with biologics (infliximab, etanercept, adalimumab, anakinra, and canakinumab) were reported in 24 single reports and 7 case series. There were 16 children and 43 adults (7- to 68-year olds). Five patients were reported to have colchicine intolerance or had adverse events related to colchicine use, and the rest 54 were unresponsive to colchicine treatment. Conclusions The current data are limited to case reports, and it is difficult to obtain a quantitative evaluation of response to biologic treatments. However, on the basis of reported cases, biologic agents seem to be an alternative treatment for patients with FMF who are unresponsive or intolerant to colchicine therapy and seem to be safe. Controlled studies are needed to better evaluate the safety and efficacy of biologics in the treatment of patients with FMF.

Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis. The differences between homemaker (HM) and working at paid work (PW) in women were not assessed. Objectives The aim of this study was to assess differences between being HM and working in PW in female patients with PsA related to clinical findings, quality of life and difficulties at working. Methods Female 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 three different universities outpatient9s clinics. Female patients with PsA were divided into age matched two group as a HM or working in PW. Patients who were HM or PW were asked to mark their level of difficulty during household works or office works respectively, on a 0–10 Likert scale. 0, indicated no difficulty during household/office works; 10, unable to do household/office works because of PsA and high scores indicated more difficulty. Results A total of 115 female patients with PsA (mean age 41.9±11.9 year) were included. Mean symptom duration was 10.7±9.3 year. Out of 86 (74.8%) patients with PsA were HM and 29 (25.2%) were working at a regular PW. Homemaker had higher body mass index than PW (25.1±7.4 vs 29.7±6.6 p=0.012). Dactylitis (current or having history) were higher in PW (58.6 vs 31.4% p=0.014) whereas enthesitis (current or having history) were higher in HM (27.6 vs 52.3% p=0.021). Disease activity measures (acute phase reactants, BASDAI, DAS28, VAS-pain, physician9s and patient9s global assessment, tender and swollen joint count), functional status and health related quality of life assessments (BASFI, BASMI, Duruoz hand index, SF-36, Nottingham health profile, psoriatic arthritis quality of life, hospital anxiety and depression scale, fatigue severity scale) were similar between HM and PW patients with PsA (p>0.05). Level of difficulties in working at household works were 5.2±2.6 in HM and level of difficulties in office works were 5.3±2.3 (p=0.804) in PW. Depression risk (HAD-depression ≥7) was relatively higher in PW (59.3 vs 43.7%), but anxiety risk (HAD-anxiety ≥10) was relatively higher in HW (26.8 vs 22.2%) (p>0.05). Fatigue severity scale score≥36 was associated with depression risk in all women with PsA by using univariate logistic regression analysis (OR: 5.1, 95% CI: 2.0–12.8 p Conclusions Women with PsA who were homemakers or working in paid work do not differ from each other in terms of disease burden, health related quality of life, difficulties at homework or at office work.Furthermore, increased fatigue may be associated with depression risk in female patients with PsA. Disclosure of Interest None declared

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are first line therapies in patients with axial spondyloarthritis (axSpA). Patients with axSpA frequently response to NSAIDs and good response to NSAIDs is an important clinical feature. However, nearly 20–50% of patients with ankylosing spondylitis may have active disease despite NSAID treatment. NSAIDs acts through cyclooxygenase (COX) inhibition and inter-individual variability in response to NSAIDs may be related to genetic factors that regulate COX enzymes. Objectives We hypothesized that incomplete inhibition of COX enzymes as a consequence of genetic variability in the regulatory region of the COX genes may influence the response to NSAIDs. To examine this hypothesis, we investigated the association between selected polymorphism in COX-1 and COX-2 genes and NSAIDs response in axSpA. Methods Patients with axSpA who were followed by our outpatient clinic and met ASAS classification criteria for axSpA were enrolled. Healthy controls were recruited from hospital staff and visitors. Patients and controls were assessed for clinical and laboratory data. Inadequate response (IR) to NSAID therapy was defined either as persistence of symptoms despite maximal dosage of NSAIDs therapy or as persistent disease activity with a BASDAI>4 or an ASDAS >2 during NSAID therapy. Promoter variant of COX-2 -765G>C that is located in a putative binding site for the Sp1 transcription factors plays significant role as a positive activator of COX2 transcription. The Pro17Leu variant of COX-1–50C/T is associated with changed prostaglandin production and coxib selectivity. The DNA was isolated from blood samples the frequency of both COX-2- 765G/C (rs20417) and COX-1–50C/T (rs3842787) polymorphisms were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods using the Faul restriction enzyme and appropriate primers. Results A total of 177 patients with axSpA (108M, 69F; mean age, 37.5±9.6 yrs) and 103 healthy controls (60M, 43F; mean age, 33.0±7.6 yrs) were included. Genotype distribution is given in the table. We did not found any significant differences in genotype of COX polymorphism regarding good/inadequate response to NSAIDs in patients with axSpA. Also there was no significant difference in the allele frequency distributions of COX-2–765G/C and COX-1–50C/T between patients and healthy controls. Conclusions The current study is the first to investigate the possible role of genetic variation of COX genes in the NSAID response in axSpA. Our results suggest that genetic polymorphism of COX-1–50C/T and COX-2 -765 do not play a significant role in NSAID response in axSpA. Further studies are needed to confirm these finding in patients with axSpA from different ethnic population. Acknowledgement Many thanks to Erciyes University Scientific Research Project Department who supported our project (TTU-2013–4882) Disclosure of Interest None declared

Metaplasia is the conversion of one adult tissue or cell type into another tissue or cell type. Although osseous metaplasia has been described in many parts of the body, it is rarely encountered in the head and neck region, especially in nasal polyps. This article reports a case of unilateral sinonasal polyp containing areas of osseous metaplasia in a 44-year-old woman presenting with nasal obstruction. Also included are a brief discussion of osseous metaplasia in the head and neck region and a literature review.

Basal cell carcinoma (BCC) is the most common skin cancer with a high propensity for local recurrence. The incidence of metastases from BCC is rare. We report a 65-year-old man who had BCC of the medial canthus of the left eye. In the 10-year period, he had been operated on approximately 12 times because of local recurrences. Three years after the last operation, he had a suspicious lesion on the operated area and a lumbar pain. Radiologic examination showed multiple metastatic skeletal and liver lesions. He was referred to the oncology department for radiation therapy and chemotherapy.

We aimed to investigate the effects of local anesthetics soaked in Merocel nasal packs on hemorrhage and pain after septoplasty. The methodology includes a prospective double-blind study that was conducted in patients undergoing septoplasty because of nasal septal deviation. The study included 143 patients. The patients were divided into four groups. Each group received 1% lidocaine + 0.000625% adrenalin, 0.375% ropivacaine, 0.25% bupivacaine as study groups or 0.9% sodium chloride as a control group in their Merocel packs postoperatively. The local anesthetics or sodium chloride were reapplied at the eighth postoperative hour. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. The statistical analysis was performed using two sided t test on each patient group at each time point. The results included the patients in the control group needing rescue drug most often. There was no statistically significant difference between bupivacaine and lidocaine plus adrenalin in the patients who requested rescue drug. The patients in the ropivacaine group requested rescue drug more frequently than the bupivacaine and lidocaine plus adrenalin groups. Bupivacaine group had significantly better pain scores versus control group at all intervals except for the first postoperative hour.The bupivacaine group had better pain scores versus ropivacaine and lidocaine plus adrenalin groups in the 4th, 8th and the 24th hours. The bupivacaine group had better pain scores versus lidocaine plus adrenalin in the 12th, 16th and the 20th hours. The ropivacaine group had significantly better pain scores versus control group in the 8th, 12th, 16th, 20th and 24th postoperative hours. The ropivacaine group scored better than lidocaine plus adrenalin group just in the 16th hour. The lidocaine plus adrenalin group had significantly better pain scores versus control group in 4th and 12th hours. There was no statistically significant difference between the study groups in terms of postoperative hemorrhage. We concluded that bupivacaine use in nasal surgery provides better analgesia at least in the first 8 h period and does not cause more bleeding. Topical bupivacaine application to nasal packs should be considered after septoplasty.

Follicular dendritic cell sarcoma is a rare neoplasm of low to intermediate malignant potential. It can occur in any location where follicular dendritic cells reside, and nearly all the cases reported in clinical notes have occurred as primary lymph node tumors. Carcinosarcoma or true malignant mixed tumor of the salivary gland is a tumor composed of both carcinomatous and sarcomatous elements. It is an exceedingly rare tumor of the salivary glands, and only approximately 60 clinical notes have been reported. In this report, we describe a recurrent carcinosarcoma of the parotid gland that contained an unusual mesenchymal component (follicular dendritic cell sarcoma) in a 42-year-old woman with cytohistologic and immunohistochemical findings. The predominant sarcomatous component made the diagnosis in the current report difficult because only one clinical note on follicular dendritic cell sarcoma in the parotid gland has been previously reported in the English literature. During the 12-year follow-up period, 6 local recurrences were also detected.

Background Systemic sclerosis (SSc) is a chronic autoimmune inflammatory disease characterized by vascular and fibrotic changes in the skin and internal organs. Aberrant accumulation of the extracellular matrix (ECM) is a well characterized feature of SSc. A major component of most ECM is hyaluronan (HA), a glycosaminoglycan. HA is a large polysaccharide produced by three hyaluronan synthase (HAS1-3) and degraded by predominantly 2 major hyaluronidase 1-2 (HYAL 1-2). HYAL1 degrades high molecular weight HA, whereas HYAL 2 degrades low molecular weight HA. HA is known to play critical roles in response to tissue injury, inflammation, and remodeling according to molecular weight. Objectives This study aimed to assess serum and tissue levels of hyaluronan in skin biopsies of patients with SSc and also to investigate the type of HASs and HYALs expression in the skin tissue. Methods Women who met 2013 ACR/EULAR criteria for the classification of SSc and age matched healthy controls were included into the study. Serum samples of the patients and controls were obtained. Punch biopsies of the effected skin were obtained in 10 patients and 4 healthy controls from the same skin region. Serum levels of hyaluronan were assessed by ELISA technique and skin levels were semiquantitatively assessed by immunofluorescence staining. Hematoxylin eosin staining of tissue was also obtained. First, HYALs and HASs mRNA expression were assessed by conventional PCR, then positive expressions were confirmed by real-time PCR. Results Twenty-five patients were included (13 (52%) had diffuse cutaneous, 10 (40%) had limited cutaneous and 1 (4%) had SSc sine scleroderma). Mean symptom duration was 10.2±9.5 years and mean modified Rodnan skin score was 13.2±7.0. Serum levels of hyaluronan were 82.3±50.1 ng/ml in patients with SSc and 26.6±17.4ng/ml in controls (p Conclusions Our study revealed that serum and tissue levels of hyaluronan increased in SSc and the increase in tissue samples might be related with the increased HAS-2 enzyme activity and decreased HYAL-2 enzyme activity. The role of HAS-2 inhibitors and HYAL-2 enzyme activity to prevent fibrosis in patients with SSc needs to be further investigated. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) has been defined as an inflammatory arthritis associated with psoriasis. Gender specific differences regarding the clinical picture and burden of the disease is unclear in PsA. Objectives To assess gender related differences in a cohort of patients with PsA. Methods Consecutively recruited patients (from five university hospitals) who met CASPAR criteria, age more than18 years were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms. Results A total of 187 patients with PsA (72 male; 115 female) were analyzed. Women with PsA had higher symptom duration (beginning of articular symptoms) and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), ESR, physical activity and fatigue component scores of Nottingham Health Profile (NHP) scores than men with PsA (Table). Psoriasis area and severity index (PASI) was higher in male patients. However quality of life (SF36 physical and mental component scores) and psychological distress measures were quite similar between men and women. Some of the extra-articular features (including uveitis, iritis) and family history for psoriasis, PsA and ankylosing spondylitis did not differ between genders. Articular involvement patterns were not different between men and women (in %, asymmetrical oligoarthritis 51.4 vs 48.7, symmetrical polyarthritis 15.3 vs 17.4, DIP 6.9 vs 13.9, arthritis mutilans 5.6 vs 5.2, axial 20.8 vs 14.8, respectively, p=0.547). Conclusions Some of the clinical and laboratory variables tent to be different between men and women with PsA. The extent of psychological distress, pain, quality of life and pattern of joint involvement tent to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations. Disclosure of Interest None declared

This article aims to compare the risks of depression and anxiety in patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and investigate the relationship among self-reported outcome measures, clinical parameters, and physical variables of patients with axSpA. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort. The patients met Assessment of Spondyloarthritis International Society classification criteria for axial SpA and were assessed in a cross-sectional study design for visual analog scale (VAS) pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), and Ankylosing Spondylitis Disease Activity Score–C-reactive protein (ASDAS-CRP). Psychological status was evaluated using the hospital anxiety and depression scale (HADS). Multivariate logistic regression analysis was applied to determine the associations between psychological variables and clinical parameters after adjusting for confounding variables. Of the 316 patients (142 nr-axSpA, 174 AS), 139 (44%) had high risk for depression (HADS-D score ≥7) and 71 (22.5%) for anxiety (HADS-A score ≥10). HADS-D and HADS-A scores were similar between patients with AS and nr-axSpA. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI, and ASDAS-CRP, and also poorer scores in VAS pain and ASQoL. Multivariate logistic regression analysis showed that the ASDAS-CRP, ASQoL, BASDAI, as well as educational level were factors associated with the risk of depression whereas the ASQoL and educational level were factors associated with the risk of anxiety. Patients with nr-axSpA and AS have similar burden of psychological distress. The quality of life (ASQoL) and educational level were factors associated with the risk of both depression and anxiety whereas disease activity (BASDAI and ASDAS-CRP) was the independent risk factor associated with depression but not anxiety in axSpA. These findings suggest that psychological status should be examined while assessing patients with axSpA including AS and nr-axSpA.

An inflammatory myofibroblastic tumor, previously known as an inflammatory pseudotumor, is an uncommon neoplasm. This tumor, which has characteristic morphologic and immunohistochemical features, is mostly seen in the lung. We present a rare case of an inflammatory myofibroblastic pseudotumor of the parotid gland. A 45-year-old woman presented with a 4-month history of a swelling in her right parotid region. A partial parotidectomy with preservation of the facial nerve branches was performed. The incidence of inflammatory myofibroblastic tumor in the parotid gland is low, and local resection is currently the best treatment. A prolonged postoperative follow-up period is necessary for patients with inflammatory myofibroblastic tumor. Inflammatory myofibroblastic tumor of the parotid gland is discussed with a brief literature review.

Amyloidosis is a disease of unknown etiology characterized by the accumulation of an amorphous proteinaceous material in various organs and tissues of the body. Amyloid goiter is an exceedingly rare pathologic condition due to massive amyloid infiltration of the thyroid tissue. Amyloid goiter occurs in association with both primary and secondary systemic amyloidosis, more commonly in the latter. Preoperatively, it simulates a multinodular goiter, and surgical intervention is often necessary to establish a diagnosis and to relieve compressive symptoms of a neck mass. We present the case of an 85-year-old female patient who presented with a rapidly enlarging goiter. Histologic examination confirmed amyloid goiter.

Background Systemic sclerosis (SSc) is a chronic, autoimmune and progressive connective tissue disease characterized by widespread vascular and fibrotic changes in the skin and internal organs. Musculoskeletal involvement is frequent in patients with SSc and may be the presenting manifestation of the disease which may also causes significant functional disability. Enthesitis is characteristic feature of spondyloarthritis including ankylosing spondylitis and psoriatic arthritis however the prevalence and clinical relevance of enthesitis is not known in patients with SSc. Objectives The aim of this study was to investigate the presence of enthesitis in patients with SSc by using Doppler ultrasonography. Methods Patients met 2013 ACR/EULAR classification criteria for SSc were included. All patients were female. Patients and age-matched healthy women underwent ultrasonographic examination using Logic P5 (GE Medical Systems, UK) with a linear probe (7–12 MHz). The Madrid Sonography Enthesitis Index (MASEI) was used to score 6 entheses sites. Results We evaluated 6 entheses in 40 patients with SSc (mean age 48±12.8 years) and 40 healthy controls (49.3±9.3 years). Mean disease duration and diagnostic delay was 10.1 and 6.0 years, respectively. In SSc group, there was 20 (50%) diffuse cutaneous SSc, 16 (40%) limited cutaneous SSc, 2 (2.5%) sine SSc and 2 (2.5%) overlap syndromes. Demographic and clinical features were similar between dcSSc and lcSSc. Patients had higher mean MASEI score compared to controls (16.1±9.7 vs 2.0±2.3, p Conclusions To the best of our knowledge this is the first study showing the high prevalence of enthesitis in patients with SSc assessed by Doppler ultrasonography. Enthesitis is an important musculoskeletal manifestation in patients with SSc and could be identified by using Doppler ultrasonography. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4937