Search

Objectives: This study was aimed to evaluate the frequency of fibromyalgianess, fibromyalgia syndrome (FS) and widespread pain in patients with Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) and their relationship with clinical and demographic parameters. Patients and Methods: This cross-sectional multicenter trial was performed in 14 centers across Türkiye. 661 patients (342 RA, 319 AS) have been recruited for the study. In these cohorts those who did not meet the criteria for FS and had widespread pain (widespread pain index≥7) were evaluated as a separate group. Clinical status and demographic parameters of patients in both cohorts were evaluated as well as the evaluations of RA and AS patients with widespread pain (widespread pain index≥7) and RA and AS patients with FS groups. In addition, correlations between Polysymptomatic Distress Scale (PSD) scores and visual analogue scale (VAS), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Disease Activity Score using 28 joint counts (DAS 28) for RA patients and VAS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) for AS patients were analyzed. Results: Frequencies of patients with FS and patients who had PSD scores≥12 were 34.1% and 44.4% in all RA patients respectively. Moreover, FS and PSD scores ≥12 were found as 29.2% and 36.9% in all AS patients respectively. PSD scores of RA patients with FS were higher than all RA and RA with widespread pain patients’. SDAI and CDAI scores of RA patients with FSwere higher than all RA and RA with widespread pain patients’as well. Similarly,PSD scores of AS patients with FS were higher than all AS and AS with widespread pain patients’. ASDAS-ESR and BASDAI scores of AS patients with FS were found higher than all AS and AS with widespread pain patients’. Conclusion: Disease activity scores including pain in RA and AS patients’ were seemed higher in the presence of FS or fibromyalgianess. It may be related to clinical parameters, but cohort studies with long-term follow-up are needed in order to reveal causality. Additionally, in order to reduce overtreatment, coexistence of fibromyalgianess should be kept in mind in patients who had inflammatory diseases like RA and AS especially with intractable widespread pain.

© 2022 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.Aim: Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). Method: This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the χ2 test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. Results: In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). Conclusion: We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.

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

Objective: We aimed to compare the effects of low level laser therapy, kinesio-taping and manual lymphatic drainage on the affected arm volume, quality of life, arm function, neuropathic pain and shoulder mobility in patients with stage II breast cancer related lymphedema.Materials and Methods: Forty-five breast cancer patients with stage II lymphedema were included in the study. The randomized patients in three groups were treated with manual lymphatic drainage, kinesio-taping and low-level laser therapy. After these different therapeutic modalities, all patients have received the application of multilayer compression bandage, lymphedema remedial exercises, skin care, and patient education program by the same lymphedema therapist. All treatments were applied 5 days a week for three weeks. The lymphedema compression garments has been prescribed to all patients and follow-up visits have been planned at the end of the treatment, 4thand 12th weeks. The efficacy of the treatments was evaluated by volumetric calculations of circumferential measurements using truncated cone formula, in addition to goniometric assessments for shoulder joint range of motion, and questionnaires of quick-DASH for arm disability, pain-detect for neuropathic pain, and quality of life for arm lymphedema (LYMQOL-Arm).Results: The baseline patient and disease characteristics, and outcome measures were similar between groups. All treatment modalities were found to be effective on decreased arm volume, quality of life, upper extremity disability and neuropathic pain. The percentage of decreased arm volume or treatment success was better in kinesio-taping group than MLD group at the end of the treatment, 4th and 12th weeks after treatment (p=0.009, p=0.039, and p=0.042, respectively). Conclusions: We found that kinesio-taping led to better results than manual lymphatic drainage and similarly effective with low-level laser in stage II breast cancer related lymphedema at 12th weeks follow-up. Kinesio-taping and low-level laser should be considered as alternative treatments in early-moderate stage of lymphedema. Following these modalities, multi-layer compression and compression bandaging are cornerstone of lymphedema treatment.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psycological and generalised systemic dysfunction. The severity of disease ranges from an asymptomatic infection, mild illness, mild or severe pneumonia with respiratory failure, acute respiratory distress syndrome and/or death. COVID-19 affects the pulmonary system crucially. There is a lack of knowledge about the longterm outcomes of the disease and the possible sequeles and rehabilitation, as well. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and is developed in the light of the guides on the diagnosis and treatment of COVID-19 provided by World Health Organisation and Turkish Republic Ministery of Health, and recently published scientific literature, PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with health care providers, and the evidence about possible benefits of PR were taken into consideration., Coronavirus Hastalığı 2019 (COVID-19) solunumsal, fiziksel, psikolojik ve yaygın sistemik işlev bozukluğuna yol açabilen bulaşıcı bir hastalıktır. Hastalığın ciddiyeti asemptomatik enfeksiyondan, hafif hastalık, pnömoni, ciddi pnömoni, akut solunum sıkıntısı sendromu, solunum yetmezliği ve ölüme kadar değişebilmektedir. COVID-19 solunum sistemi önemli şekilde etkilenmektedir. Hastalığın uzun dönem sonuçları ve muhtemel sekellerine ilişkin yeterli bilgi olmadığı gibi, rehabilitasyonu konusunda da henüz kanıt yoktur. Bu klinik uygulama rehberi erişkin COVID-19 hastaları için pulmoner rehabilitasyon önerileri içermektedir ve Dünya Sağlık Örgütü ile T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü tarafından hazırlanan COVID-19 tanı ve tedavi rehberleri, yakın zamanlı bilimsel yayınlar, uzman görüşü olarak yayınlanan COVID-19 için pulmoner rehabilitasyon önerileri ışığında ve pulmoner rehabilitasyonun temel prensipleri doğrultusunda hazırlanmıştır Bu öneriler geliştirilirken, COVID-19’un bulaşıcılığı, sınırlı sayıda personelin hasta ile teması ilkeleri ile pulmoner rehabilitasyonun sağlayacağı yararların düzeyi göz önünde bulundurulmuştur.

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.

BACKGROUND: The aim of this study is to evaluate dysfunctional high-density lipoprotein cholesterol (HDL) by measuring myeloperoxidase (MPO) / paraoxonase 1 (PON1) ratio in patients with rheumatoid arthritis (RA)and to investigate the relationship between dysfunctional high-density lipoprotein (HDL) and cardiovascular disease (CVD) in RA patients. METHODS: Sixty-seven healthy individuals and 130 RA patients were included in the study. Routine lipid panels (triglyceride (TG), low-density lipoprotein cholesterol (LDL), HDL, total cholesterol (TC), PON1 and MPO levels were measured. Disease activity scores-28 (DAS28) of RA patients were calculated. Cardiological examination records of the patients were assessed to detect patients who also have CVD. RESULTS: There were no significant differences between RA and control groups in routine lipid profiles (p> 0.05 for all). MPO/PON1 ratio were significantly elevated in the RA group compared to control group (p

Background: This study aimed to compare the effects of awareness and knowledge on demographic and clinical factors in patients with breast cancer-related lymphedema (BCRL) and gynecologic cancer-re...

WOS: 000574427300001 Objectives: This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLAR recommendations for the management of hand OA under guidance of the current literature. Materials and methods: The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULAR recommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mail process which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Research and Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum and maximum and comparisons of 2018 EULAR recommendations were performed. Results: Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendations with lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revised forms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Except for the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLAR hand OA recommendations. The 11th recommendation about paraffin bath was added. Conclusion: The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological (topical non-steroidal anti-inflammatory drugs as the first choke), and interventional procedures (only for refractory cases) based on shared decision between the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULAR hand OA management recommendations, which are widely approved among the TLAR experts.

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.

PubMed ID: 31446538 Objective: This study explored the role of central sensitization (CS) pain in patients with various rheumatic diseases using the CS inventory (CSI). Methods: A total of 193 patients of mean age 50.72 ± 9.65 years were included; they were divided into four different groups in terms of their rheumatic diseases. Patients with rheumatoid arthritis (RA), spondyloarthropathy (SpA), osteoarthritis (OA), and fibromyalgia syndrome (FMS) were evaluated in tertiary care rheumatology/pain medicine settings. Disease duration and activity, the Bath Ankylosing Spondylitis Disease Activity Index, the Disease Activity Score-28, and pain severity (evaluated using a visual analog scale) were assessed, and the Turkish version of the CSI administered. Results: CS syndromes were present in almost half the patients (45% of SpA, 41% of RA, 62% of OA, and 94% of FMS patients). We found no significant relationship between disease activity and the CSI-A scores in SpA or RA patients (p = 0.731 and p = 0.390, respectively). As expected, the CSI-A scores were highest in the FMS group (p = 0.000), but were similar in the other groups (p < 0.05). CS-related syndromes (CSI-B conditions) were present at similar frequencies in the RA, SpA, and OA groups, but were less common in the FMS group (p = 0.000). Conclusions: The CSI usefully detects CS pain in patients with rheumatic diseases. Treatment of such pain can enhance the quality of daily life in patients with rheumatic diseases.Key Point• Central sensitization pain is common in patients with rheumatic diseases including rheumatoid arthritis, spondyloarthropathies, and osteoarthritis. © 2019, International League of Associations for Rheumatology (ILAR).

Background Central sensitisation (CS) is a new phenomenon associated with several medical diagnoses, including post-cancer pain, low back pain, osteoarthritis (OA), whiplash, and fibromyalgia (FMS).1 Central sensitisation inventory (CSI) suggest the tool generates reliable and valid data that quantify the severity of several symptoms of CS.2 Objectives To the best of our knowledge, there is no study to evaluate CS pain in patients with Spondylarthritis (SpA). The aim of this study was to show the role of CS pain in patients with painful spine of SpA, OA, and FMS. Methods Totally 137 patients with chronic spinal pain (42 SpA, 45 OA and 50 FMS) were included. CSI consists of 2 parts1,2: CSI-A and CSI-B (restless leg, chronic fatigue, FMS, temporomandibular disorders, migraine/tension type headache, irritable bowel, multiple chemical sensitivity, whiplash, anxiety/panic attack, and depression). Results Only 4 patients (9.52%) had active SpA (BASDAI≥4). Twelve patients (28.57%) have used anti-TNF drugs. Age, BASDAI and VAS-pain scores were not related with SS-A or SS-P positivity. Spine in patients with SpA was less painful compared with them of OA and FMS (p=0.001). The CS pain was detected in most with FMS, compared with OA, and SpA patients (p Conclusions Central sensitisation should be considered in patients with chronic persistent pain, not only having FMS, but also half of the patients having SpA and OA. It is not a rare phenomenon and if it is exists, effective pain management strategies could be needed in addition to the specific pharmacologic treatment. References [1] O’Leary H, et al. Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review. Pain Pract2017;17(2):249–266. [2] Neblett R, et al. The Central Sensitization Inventory (CSI): The Journal of Pain2013;14(5):438–45. [3] Duzce E. SS Olceginin Turkce Gecerlilik&Guvenilirligi. Trakya FTR AD Uzmanlik Tezi2017. Disclosure of Interest None declared

Background Modern pain medicine divided chronic pain as nociceptive, neuropathic, central sensitisation (CS) and mixed pain. CS syndromes are a group of disorders characterised by chronic non-neuropathic and non-nociceptive pain(.1 Central sensitisation inventory (CSI) suggest the tool generates reliable and valid data that quantify the severity of several symptoms of CS.2 Objectives Hand pain in RA, OA, and FMS have different features. The aim of this study was to show the role of CS pain in these patients. Methods Totally 151 patients with chronic hand pain (56 RA, 45 OA, and 50 FMS) were included. CSI was used for evaluation of CS.2,3 CSI consists of 2 parts: CSI-A scoring 0–100 and CSI-B including 10-CS related syndromes (restless leg, chronic fatigue, fibromyalgia, temporomandibular disorders, migraine/tension type headache, irritable bowel, multiple chemical sensitivity, whiplash, anxiety/panic attack, and depression). Results Sixteen patients (28.57%) had active (DAS28 ≥2.6) RA. Disease activity was not related with CSI-A and CSI-B scores. Rheumatoid hands was less painful compared with them of OA and FMS (p 0.05). CS-related syndromes were also detected in both RA and OA groups, but less than FMS group (p Conclusions Central sensitisation should be considered in patients with chronic persistent pain, not only having FMS, but also half of the patients having RA and OA. It is not a rare phenomenon and if it is exists, effective pain management strategies could be needed in addition to the specific pharmacologic treatment. References [1] O’Leary H, et al. Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: Pain Pract2017;17(2):249–266. [2] Neblett R, et al. The CSI. The Journal of Pain2013;14(5):438–45. [3] Duzce E. SS Olceginin Turkce Gecerlilik&Guvenilirligi. Trakya FTR Uzmanlik Tezi2017. Disclosure of Interest None declared

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

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

Background Fear avoidance behavior which is caused by painful injury resulting precision and extreme fear is defined as kinesiophobia. Rheumatoid arthritis (RA) is a chronic, inflammatory and systemic disease with symmetrical arthritis and visceral involvement. Ankylosing spondylitis (AS) is a chronic, inflammatory disease with involvement of the spine or peripheral joints. Objectives In our study, we aimed to evaluate the relationships between kinesophobia and disease activity, quality of life (QoL), level of physical activity and emotional status in RA and AS patients. Methods We included 42 patients with RA (8 males-M, 34 females-F) (group 1), 49 patients with AS (34 M, 15 F) (group 2) and 29 healthy controls (9 M, 20 F) (group 3) in our study. The QoL was assessed using the health assessment questionnaire (HAQ), kinesiophobia was assesed with Tampa scale of kinesiophobia (TSK), pain was assesed with visual analog scale (VAS), fatigue was assesed with VAS and emotional status was assesed with Beck depression inventory (BDI). Disease activity was assesed with Bath ankylosing spondylitis disease acitivity index (BASDAI) and functional status was assesed with Bath ankylosing spondylitis functional index (BASFI) in patients with AS. Disease activity was assesed with DAS28 in patients with RA. Results The mean age was 46.2 in group 1, 43.2 in group 2 and 40.17 in group 3. There was no difference among groups with respect to mean age (p>0.05). Kinesiophobia was present in 37 patients in group 1, 22 patients in group 2 and 7 patients in group 3. Statistically significant differences were found among groups with respect to the number of patients with kinesiophobia and to mean scores of pain intensity, fatigue, HAQ and BDI (p Conclusions In our study, patients with RA and AS had higher rates of kinesiophobia. We found that kinesiophobia was related with pain severity, fatigue, depression, disease activity and QoL of the patients. The QoL can be improved through controlling kinesiophobia by reducing pain, depression and fatigue. Disclosure of Interest None declared

Background Methotrexate (MTX) is the anchor drug for the treatment of rheumatoid arthritis (RA). There are important guidelines suggesting mono-MTX treatment at first for pharmacologic treatment of RA (1,2). We thought that these recommendations should be evaluated in different geographic regions and ethnic groups because of genetic factors. Objectives Therefore, we aimed to compare the efficacy and adverse effect profile of mono-MTX and combined-MTX treatments in patients with DMARDs-naive Turkish patients with seropositive RA. Methods Hundred patients with seropositive RA (mean age: 47.4±12.0 years, 63 females and 37 males) were included. Patients were excluded the past history of using for synthetic or biologic DMARDs or moderate-high dose steroid (>10mg/day), viral hepatitis, transaminase elevations, and other contra-indications for MTX. Then they were divided as mono-MTX (n=57) and combined-MTX (n=43) groups. Results There was no difference between groups in age (p=0.34), sex (p=0.104), age of onset (p=0.10), MTX-weekly dose (p=0.228), the score of DAS28 (p=0.783), RF level (p=0.473), and CCP level (p=0.592) at the beginning. Patients of combined-DMARDs group used higher dose of prednisolone than patients of mono-MTX group (p=0.011). The change of DAS28 scores was not different between groups. CRP levels of combined-MTX group were higher than mono-MTX group both beginning and at 6th month. The frequencies of adverse events were not different between groups. GI adverse events are the first line in both groups (28% vs.16.3%). The frequencies of dose decrease (7% vs. 14%) or stop (7% vs. 4.7%) for MTX were also not different between groups (p=0.288, p=0.257). The frequencies of other adverse effects were less than 5%. MTX dose decrease or stop have been moderately correlated with pulmonary involvement (r=0.4, p=0.02). Conclusions Both mono-MTX and combined-MTX treatment had similar efficacy and safety profile in Turkish patients with seropositive RA as reported in studies of other countries suggesting no any advantage of combined MTX compared to mono-MTX (3). The frequency of MTX-stopping in our study was similar to this systematic review (9%). As a conclusion, MTX should also be the first choice of the treatment of RA in our country. Pulmonary adverse events should not be ignored. References Singh JA, Saag KG, Bridges SL J, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1–26. Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73(3):492–509. Katchamart W, Trudeau J, Phumethum V, et al. Methotrexate monotherapy versus methotrexate combination therapy with non-biologic disease modifying anti-theumatic drugs for RA. Cochrane Database od Systematic Reviews 2010;Issue 4.Art.No.:CD008495. Disclosure of Interest None declared

Background Work disability (WD) is the final stage of work problems and may be prevented by effective treatment and ergonomic interventions in earlier stage of work productivity loss and work instability. Contextual factors, disease related factors and local social security systems may also affect WD. Objectives We aimed to determine the predictive factors of work productivity and work stability in Turkish patients with ankylosing spondylitis Methods One-hundred patients with ankylosing spondylitis (31 females and 69 males) were included into this study. Demographics, working state, Bath scores of disease activity, functional and radiologic state, quality of life, cardiopulmonary functions (echocardiography, exercise stress test and pulmonary function test) and general work impairments (work productivity impairment and work instability) were recorded. WPAI and AS-WIS were selected as work outcomes. The most predictive factors were analyzed in work productivity and work instability. SPSS 14.0 statistics (descriptives, pearson correlation, and stepwise regressions were used for statistical analyses. Results Thirty-two patients (mean age: 42,6±11.7) were unemployed. Unemployed patients showed more female, less educated, low disease activity, and low fitness profile. The percentages of absenteeism (WPAI-1), presenteeism (WPAI-2), regular activity impairment (WPAI-3) and overall work impairment (WPAI-4) were determined as 8, 44, % 47, and % 37, respectively, in employee group. When affecting factors assessed with multiple stepwise linear regression analysed; the only determinant for absenteeism (WPAI-1) was the working day loss due to ilness at last year. Chest mobility, annual income level, AS quality of life (ASQoL), work change and co-morbid diseases were the determinants of presenteeism (WPAI-2), regular activity impairment (WPAI-3) and overall work impairment (WPAI-4). The score of mean work instability (AS-WIS) was 11.5±5.8, and 42.6% of patients had low and 57,4% of patients had moderate-high work instability. Multiple stepwise linear regression analysis showed that most predictive factors for work instability were regular activity impairment (WPAI-3) and AS-QoL. The factors affecting non-work status were older age, female sex and low annual income level in stepwise logistic regression. Conclusions The common predictive factor of work productivity and work stability was quality of life. For evaluation of work productivity; socioeconomic factors such as annual income level and frequent work change were determinative as well as clinical datas (chest expansion and comorbid diseases). We suggested both pharmacologic and nonpharmacologic interventions to improve quality of life should be enabled in early period to improve work productivity. Disclosure of Interest None declared

Objective: The most common cognitive problem is attentional impairment in fibromyalgia syndrome [FMS]. We aimed to evaluate the physical, mental and psychological symptoms and to determine the predictor[s] of attentional impairment in premenopausal women with two chronic painful diseases [FMS and rheumatoid arthritis [RA]] and to compare them with healthy pain-free controls [HNCs].Methods: This study was designed to involve patients with FMS or RA. Healthy normal controls [HNC] were recruited for comparison. Stroop color and word interference test was selected as cognitive measure. Questionnaires regarding FMS symptoms [100 mm visual analog scale], quality of life [Fibromyalgia Impact Questionnaire], sleep disorders [Pittsburgh Sleep Quality Index] and anxiety and depression [Hospital Anxiety and Depression Scale] were also applied to all groups.Results: Ninety-eight age- and education-matched premenopausal female patients were recruited. The evaluation groups were FMS [n = 40, mean age: 36.2 ± 7....

Aims: Work impairment is one of the most important exploration and one of the aims of rheumatologists. We aimed to determine the risk factors for employment state and predictive factors of work outcomes using multi-dimensional measures in patients with ankylosing spondylitis (AS) in this comprehensive study. Methods: One hundred patients with AS (31 females and 69 males) were included into this study. Demographic properties, local factors, disease activity (BASDAI), functionality (BASFI), spinal mobility (BASMI), radiologic stage (BASRI), quality of life (AS-QoL), cardiopulmonary involvement, exercise stress test and work outcomes were investigated and compared in employed and un-employed patients. The work instability scale (AS-WIS) and work productivity activity impairment scale (WPAI:SpA) were selected as work outcomes. The predictive factors were analyzed using multiple stepwise linear regressions. Results: Thirty-two patients (mean age: 42,6 +/- 11.7) were unemployed and the risk factors for unemployment state were female sex, lower annual income le vel, and older age. Work disability was detected only in 5% of patients. Decreased chest mobility (beta:-0.398, p

PubMed ID: 27511483 Background/aim: The role of hip muscles in the rehabilitation of patellofemoral pain syndrome has recently received interest. The aim of this study was to compare the efficiencies of hip exercises alongside knee exercises versus only knee exercises on pain, function, and isokinetic muscle strength in patients with this syndrome. Materials and methods: Fifty-five young female patients (mean age: 34.1 ± 6.2 years; mean BMI: 25.9 ± 3.9 kg/m2) with patellofemoral pain syndrome were included. The patients were randomized into groups of hip-and-knee exercises and knee-only exercise programs for 6 weeks with a total of 30 sessions at the clinic. Both groups were evaluated before therapy, after 6 weeks of a supervised exercise program, and after 6 weeks of an at-home exercise program. The outcome measures were muscle strength, pain, and both subjective and objective function. Results: The improvements of the patients in the hip-and-knee exercise group were better than in patients of the knee-only exercise group in terms of scores of pain relief (P < 0.001) and functional gain (P = 0.002) after 12 weeks. Conclusion: We suggest additional hip-strengthening exercises to patients with patellofemoral pain syndrome in order to decrease pain and increase functional status. © TÜBİTAK.

Several studies showed an increase in the frequency of MEFV mutations among children with vasculitic and rheumatic diseases. Association between seronegative enthesopathy and arthropathy syndrome, and familial mediterranean fever has not been reported previously. The present case report may therefore be of interest.

Objectives: This study aims to investigate the prevalence of obesity in patients with rheumatoid arthritis (RA) and associations with disease outcomes. Patients and methods: The study population comprised of 1,038 patients with RA (198 males, 840 females; mean age 56.1±12.6 years; range 19 to 94 years) who had been included in National RA-Registry. RA disease activity measures, physical function, quality of life, joint destruction, laboratory tests, as well as pain, fatigue, general health, and patient and physician global health assessments on a visual analog scale were collected. Results: Our patients had established RA with mean disease duration of 10.2±8.8 years and moderate disease activity (disease activity score in 28 joints: mean 3.7±1.6). According to the body mass index (BMI), 70% of the patients were overweight (n=362, 34.9%) or obese (n=364, 35.1%). These patients had higher disease activity scores in 28 joints, visual analog scale-pain and visual analog scale-patient global scores, and higher levels of fasting blood glucose; however, they had lower radiographic scores than normal-BMI patients (p

Amaç: Türkiye Romatizma Araştırma ve Savaş Derneği (TRASD) romatoid artrit tedavisindeki yeni gelişmeleri ve ülkemizin ekonomik koşullarını göz önünde bulundurarak, RA tedavisine yönelik ulusal tedavi önerileri geliştirmeyi amaçlamıştır ve bu amaçla, fikirlerini almak için ulusal uzmanlara danışmıştır.Gereç ve yöntemler: Bu alanda deneyimli olan sekiz romatolog ve 15 fizik tedavi uzmanı TRASD'nin RA tedavisi önerilerinin geliştirilmesine katkıda bulunmuştur. Uzmanlar kurulu, EULAR 2010'da yer alan RA'nın sentetik ve biyolojik hastalık modifiye edici antiromatizmal ajanlarla (DMARD'ler) tedavi önerilerini baz alarak, uzman görüşlerinin de yer aldığı bir "Türkiye RA Tedavi Önerileri" oluşturulmasını planlamıştır. Toplantının ardından, Medline ve Cochrane, Embase ve Türk Tıp Dizini veritabanlarında farmakolojik tedavi önerileri için 2009 ile 2010 yılları arasını, non-farmakolojik tedavi için ise 2007 ile 2010 yılları arasını kapsayan aramalar gerçekleştirilerek sistematik bir literatür taraması yürütülmüştür. Bu işlem EULAR 2010 önerilerine dahil edilen çalışmalara ilave olarak yapılmıştır. Tüm makaleler incelenmiştir, içerikler özetlenmiştir, kanıt seviyeleri belirlemiştir ve Delphi işlemi başlatılmıştır.Bulgular: Beş ana prensip ve bir non-farmakolojik tedavi yöntemiyle birlikte 16 genel öneri sıralanmıştır. Tüm öneriler konusunda uzlaşıya varılmıştır ve önerilerin kuvvet seviyeleri oylanmıştır.Sonuç: Türkiye'deki RA tedavisine yönelik öneriler oluşturulmuştur. Bu ulusal önerilerin fizik tedavi ve rehabilitasyon uzmanlarına (fizyatri uzmanlarına) romatologlara ve aile hekimlerine yönelik bir kılavuz olarak işlev görmesi amaçlanmıştır ve önerilerin düzenli şekilde güncellenmesi gerekmektedir. Objectives: Taking new developments in the management of rheumatoid arthritis (RA) and the economic conditions of our country into account, the Turkish League Against Rheumatism (TLAR) aimed to develop national treatment recommendations for the management of RA; thus, they consulted with national experts for their opinions. Materials and methods: Eight rheumatologists and 15 physiatrists experienced in the field contributed to the development of the TLAR recommendations for the management of RA. The expert committee planned to develope "Recommendations for the Management of RA in Turkey" based on EULAR 2010 recommendations for the management of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) in light of expert opinions. Following the meeting, a systematic literature review was performed by searching the Medline and Cochrane, Embase, and Turkish Medical Index databases between 2009 and 2010 for pharmacological treatment recommendations and between 2007 and 2010 for non-pharmacological treatment recommendations. This was done in addition to the studies included in the EULAR 2010 recommendations. All articles were examined, their contents were summarized, their levels of evidence were determined, and the Delphi process was initiated. Results: Sixteen general recommendations were listed along with five main principles and one non-pharmacological treatment method. A consensus was reached for all recommendations, and their strength levels were voted upon. Conclusion: Recommendations were formed for the management of RA in Turkey. These national recommendations are intended to guide physical medicine and rehabilitation specialists (physiatrists), rheumatologists, and family physicians and should be regularly updated.

Background Enhancing quality of life (QoL) in older adults with physical limitations is a significant challenge for healthcare providers. One of the first steps to improving quality of life in older adults with osteoarthritis (OA) is developing a better understanding of the set of factors that coexist and influence QoL. Objectives To determine the predictors of disease-specific QoL in a sample of knee and hip OA in a tertiary care hospital and to evaluate physical activity, mental health, social functioning and social support components of OA-specific-QoL questionnaire in addition to score of pain, ESR, CRP, x-ray, and co-morbid conditions. Methods A cross-sectional, methodological exploration from an inpatient sample (N=100) of adults (mean age: 64.51±8.78, 83 female) with OA of the knee (N=78) and hip (N=22) according to the ACR- clinic and radiograhic knee OA or hip OA classification criteria was performed. Clinical, laboratory and radiographic datas were analysed using SPSS15.0. The osteoarthritis knee and hip quality of life questionnaire (OAKHQOL) consisting of 43 items in five dimensions and three independent items were fullfilled by patients (1). Results Means of pain-VAS scores at rest and movement were moderately high (5.14 and 6.64). Twenty patients were in stage I, 36 patients were stage II, 30 patients were in stage III and remaining 14 patients were in stage IV OA according to the Kellgren-Lawrence system. All of the patients were overweight or obese. Related comorbidities were common such as 48 hypertensive, and 33 diabetic.Lineer regression analyses showed that mental health ( R 2 =0.668, p =.000), pain ( R 2 =0.591, p =.000), and vehichle-transfer difficulties ( R 2 =0.572, p =.000) were the most important predictors for OA-specific-QOL. Conclusions The findings of this study provide a foundation or targeted interventions to improve QoL and the importance of mental health older adults with OA of the knee and hip. The individual problem solving including both mental and physical approaches may help these patients to improve OA-specific-QoL. Mental health and cognitive approaches should be incorporated to OA management. References Rat AC, Coste J, Pouchot J, Baumann M, Spitz E, Retel-Rude N, Le Quintrec JS, Dumont-Fischer D, Guillemin F. OAKHQOL: a new instrument to measure quality of life in knee and hip osteoarthritis. J Clin Epidemiol. 2005 Jan;58(1):47-55. Disclosure of Interest None declared

Background Obesity is a mild, long-lasting inflammatory disease and, as such, could increase the inflammatory burden of rheumatoid arthritis (RA). Objectives We aimed to estimate the prevalence of underweight, overweight and obese in Turkish patients with RA and its relationships with disease activity, functional disability, quality of life, structural damage, and laboratory parameters Methods The study population compromised 1,038 of patients with RA (mean ± SD age 56.09±12.63 years, 81% women) who had been included in TRASD (Turkiye Romatizma Arastirma ve Savas Dernegi)-IP Registry. DAS28, CDAI, SDAI, BMI (kg/m2), acute-phase reactants, IgM-RF, anti-CCP antibody, complete blood count, and blood biochemistry values were collected. Other parameters were Sharp-vanderHeijde score, physical function (HAQ), quality of life (RAQoL), as well as pain, fatigue, general health, patient and physician global health assessed on a visual analog scale. Results Patients have 10.23±8.78 (1-53) years of disease duration and 3.67±1.56 of mean DAS28 (0.42-7.91) scores. The mean score of HAQ was 0.99±0.72 (0.17-3). And mean score of the RA quality of life (RAQoL) was 12.28±10.08 (0-30). According to the BMI, 1.25% (n=13) of patients were underweight, 28.23% (n=293) patients were in normal limits, 34.87% (n=362) patients were overweight, and 35.07% (n=364) of patients were obese. Obese patients had higher scores of DAS28, pain, and patient global, and higher level of fasting blood glucose, but lower radigraphic score of Sharp vdH than normal patients in multiple comparisons of ANOVA (p