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Purpose: This study aims to investigate the superiority of different exercise modalities, including isotonic and isometric strengthening for quadriceps, over each other and their effect on pain, quality of life and functional capacity in patients diagnosed with chondromalacia patellae (CMP). Material and Methods: This study was designed as a prospective study in 30 patients (15 patients in isometric, 15 patients in isotonic group) and 15 healthy volunteers aged 20-50 years who were diagnosed with CMP based on physical examination and magnetic resonance imaging and had pain complaints. Pain level was evaluated with Visual Analogue Scala (VAS), functional capacity with Lysholm scale, and quality of life with Short Form-36(SF-36). Q-angle, and thigh circumference were evaluated before and after exercise in all patients. Results: In patients with CMP, there were significant differences in Q-angle, pain, functional capacity, and some subcomponents of the SF-36 quality of life after performing isometric or isotonic exercises compared with the control group (p0,05). In the evaluation of the isotonic and isometric exercise groups, there were no significant difference in the assessment of Q-angle, thigh circumference, pain, functional capacity, and quality of life of patients with CMP (p>0,05). Conclusion: Isometric and isotonic quadriceps strengthening exercises are not superior to each other in terms of pain, functional capacity, and quality of life in CMP treatment.

Objective: It is known that in vitamin D deficiency, people suffer extensive musculoskeletal pain. In this study, the relationship between vitamin D deficiency and myofascial pain syndrome (MPS) and the effect of vitamin D on pain, disability, quality of life, sleep and psychological condition were examined.Method: In this study, 180 cases were examined. Of the cases, 120 were patients, and 60 were in the control group. The cases were compared in terms of 25(OH)D level and quality of life. The patients were also divided into two subgroups based on their 25(OH)D levels. Their scores on the visual pain scale, the neck pain and disability scale, the short form-36 (SF-36) quality of life index, Pittsburgh sleep quality index, Beck anxiety inventory and Beck depression inventory, which were tested for validity and reliability in Turkish, were recorded.Results: The average 25(OH)D level of the patient group was 12.8±7.3 ng/mL, while that of the control group was 22.8±14.3 ng/mL, and there was a significant difference. Physical parameters of SF-36 quality of life index were higher in the control group than in the patient group. In the patient group with a deficiency in 25(OH)D levels, depression and anxiety levels were significantly higher and the mental parameters of the SF-36 quality of life index were significantly lower.Conclusion: In our study, 25(OH)D levels were significantly lower in the patients diagnosed with MPS compared to the healthy people in the control group, and vitamin D deficiency was shown to have a negative effect on mental functions and mood. Amaç: D vitamini eksikliğinde yaygın kas iskelet ağrısı olduğu bilinmektedir. Bu çalışmada D vitamini eksikliği ile myofasiyal ağrı sendromu (MAS) arasındaki ilişki ve D vitamininin ağrı, özürlülük, yaşam kalitesi, uyku ve psikolojik durum üzerindeki etkisi değerlendirilmiştir. Yöntem: Çalışmada 120’si hasta ve 60’ı kontrol olmak üzere 180 olgu değerlendirildi. Olgular 25(OH)D düzeyi ve yaşam kalitesi yönünden karşılaştırıldı. Aynı zamanda hastalar 25(OH)D düzeyine göre iki alt gruba ayrılarak, vizuel ağrı skalası, Türkçe geçerlilik ve güvenilirlik çalışmaları yapılmış boyun ağrısı ve özür göstergesi, kısa form-36 (SF-36) yaşam kalitesi kısa formu, Pittsburgh uyku kalitesi indeksi, Beck anksiyete ölçeği ve Beck depresyon ölçeği skorları kaydedildi. Bulgular: Hasta grubun 25(OH)D düzeyi 12,8±7,3 ng/mL iken kontrol grubunun 22,8±14,3 ng/mL olup, anlamlı farklılık vardı. Kontrollerde SF36 yaşam kalitesi indeksinin fiziksel parametreleri hasta grubuna göre yüksek düzeyde idi. Hastaların 25(OH)D düzeyine göre eksikliği olan grupta depresyon ve anksiyete düzeyleri anlamlı daha yüksek ve SF-36 yaşam kalitesi indeksinin mental parametreleri anlamlı düşük idi. Sonuç: Çalışmamızda MAS tanılı hastalarda sağlıklı kontrollere göre 25(OH)D düzeyi anlamlı düşük saptanmıştır ve D vitamini eksikliğinin mental fonksiyonlar ve duygu durumu üzerinde olumsuz etki oluşturduğu gösterilmiştir.

WOS:000476606000009 PubMed: 31258639 The aim of the present study was to investigate the effects of etanercept (ETA), a tumor necrosis factor (TNF) inhibitor, on human cell cultures prepared from intact intervertebral disc tissue. ETA is used as a treatment for cases of rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and ankylosing spondylitis accompanied by moderate or severe joint pain. ETA was applied to primary cell cultures [annulus fibrosus and nucleus pulposus (NP) from intact intervertebral disc tissue]. Cell cultures without ETA treatment served as the control group. Morphological and quantitative molecular analyses of the two groups were performed. The number of viable cells and cell proliferation decreased in the ETA-treated cultures as compared with those in the control group. Furthermore, in the treatment group, the chondroadherin gene, an NP-specific marker, was not expressed after 24 h. By contrast, the cartilage oligo matrix protein was expressed 24, 48 and 72 h post-ETA treatment, while its expression was significantly lower than that in the control group. In addition, the expression of interleukin-1 beta, as well as matrix metallopeptidase-7 and -19, was markedly decreased. Overall, the cell proliferation and gene expression in the ETA-treated cells were significantly different from those in the control group (P

[No Abstract Available]

BackgroundBehçet syndrome (BS) is a unique vasculitis that can affect arteries and veins of all sizes. Thrombosis is an important component of vascular involvement in BS. Although several studies were conducted to highlight the mechanism of thromboinflammation in BS, it is still not fully understood.ObjectivesWe performed a systematic review and meta-analysis of studies investigating thrombotic, fibrinolytic, and endothelial factors in BS.MethodsWe searched PubMed and EMBASE with the keyword “Behcet*” in four languages (English, German, French and Turkish) from their inception up to April 2020. Titles and/or abstracts of all studies were screened independently by two reviewers (GGO and BY) and conflicts were solved by a third reviewer (GH). Studies comparing BS patients with and without thrombosis and studies comparing BS patients with thrombosis and patients with thrombosis due to other causes were analyzed separately. The pooled odds ratios (OR) with 95%CI were calculated for binary outcomes and standardized mean differences (MD) were calculated for continuous outcomes using RevMan 5.3. We categorized the factors into 4 groups based on acting mechanism 1- those that decrease anticoagulant activity 2- those that increase procoagulant activity 3- those that decrease the activity of fibrinolytic system 4- pathogenetic/endothelial factors.ResultsOf 15548 articles, 15157 were excluded due to duplication and inappropriate study design after reviewing titles and abstracts. Full text review of the remaining 391 articles yielded 103 papers meeting our predetermined inclusion criteria.Factors significantly associated with BS thrombosis compared to BS without thrombosis were high frequency of factor V Leiden mutation (15 studies, OR 2.55, 95%CI 1.66-3.93), high homocysteine level (14 studies, MD: 4.27, 95%CI 2.31-6.22), high protein C level (5 studies, SMD: 0.80, 95%CI 0.15-1.45) and high alpha1-antitrypsin level (1 study, MD: 3.00, 95%CI 0.15-5.85) in Group 1; high factor 8 level (4 studies, MD: 17.17, 95%CI 7.79-6.55), high thrombin level (1 study, MD: 35.90, 95%CI 12.40-59.40), high neutrophil/lymphocyte ratio (2 studies, MD: 1.37, 95%CI 0.24-2.50) and high platelet/neutrophil complex level (1 study, MD: 10.50, 95%CI 0.76-20.24) in Group 2; high TAFI activity (1 study, MD: 28, 95%CI 4.12-51.88) in Group 3; high VEGF level (2 studies, SMD: 1.63, 95%CI 0.21-3.05), high CEC concentration (2 studies, SMD: 1.00, 95%CI 0.22-1.77), high MCP-1 level (1 study, MD: 74.16, 95%CI 61.29-87.03), high anti-C1q level (1 study, MD: 9.11, 95%CI 0.51-17.71), high platelet microaggregate formation (1 study, MD: 75.00, 95%CI 7.62-142.38), high frequency of P-selectin glycoprotein ligand 1 gen polymorphism (heterozygous (AB+AC+BC)) (1 study, OR: 1.88, 95%CI 1.07-3.31), high ADMA level (1 study, MD: 0.16, 95%CI 0.08-0.24), high sICAM-1 level (1 study, MD: 59.30, 95%CI 3.35-115.25) and low brachial artery flow-mediated (endotelium-dependant) dilatation (1 study, MD: -3.22, 95%CI -5.18--1.26) in Group 4.Factors that were associated with BS thrombosis compared to thrombosis due to other causes including JAK-2 mutation, circulating endothelial cells, activated protein C resistance, tPA, and PAI were assessed in 1 study each. Among these, tPA levels (MD: -6.00, 95%CI -10.99--1.01), APCR (OR: 0.09, 95%CI 0.01-0.73) and JAK-2 mutations (OR: 0.01, 95%CI 0.00-0.06) were significantly less in patients with BS thrombosis compared to patients with thrombosis due to other causes.ConclusionSeveral factors were identified that may potentially be associated with thrombosis in BS. However, the cut-offs used for defining the normal level for these factors, time of blood collection (during acute or chronic stage of thrombosis, use of anticoagulants) and the type of thrombosis (arterial, venous, or cerebral sinus) were not uniform across the studies. Studies investigating these factors together, in a large number of patients, and together with appropriate controls are needed to confirm these results.Disclosure of InterestsNone declared

Background:Osteochondral injuries constitute an entity that is widespread and can be seen in patients of all ages. Actual treatment modalities aim to relieve pain, obtain full range of movement of the joint, and improve the quality of life. There are many slow-acting chondroprotective agents prevalently used in the United States that are classified as nutritional support but not as medicines . This study presents the importance of clinical adverse effect profiles as well as the pharmacological mechanism of action and application of combinations of drugs that are widely prescribed and not subjected to control.Methods:Electronic databases were searched with keywords about the chondroprotective drugs without any language restriction. Evaluations of the descriptive statistics were representedviaMicrosoft Office Excel 2010 lists in the form of a mean±standard deviation or frequency (%). The first evaluation showed that 1502 studies were potentially relevant. Following exclusion of the 1277 studies which were not clinical, full versions of the remaining 225 studies were subjected to further evaluation. No controlled, blinded, randomized and/or comparative studies met the inclusion criteria of the study, and no studies evaluated the comparative clinical results of the hyaluronan of different molecular weights.Results:The findings of this study concluded that especially when prescribing drugs with ingredients like GS and CS, many patients’ pre-existing conditions must be considered, such as whether the patient has a glucose intolerance or not. Additionally, mineral toxication should be considered since the drugs contain minerals, and after the application of injected hyaluronan, complications should be considered.Conclusion:Clinical, controlled and comparative studies about the use of chondroprotective drugs must be performed to define the benefits of these drugs, if any, in order to determine the most suitable time for operative intervention.

Aims: In this study, we aimed to investigate whether serum S100A8, S100A9 and S100A12 levels were markers of acute coronary syndrome (ACS). Materials & methods: Patients who underwent coronary angiography and/or percutaneous coronary interventions between June 2015–October 2015 were consecutively recruited in this study and categorized three groups each containing 30 patients (normal coronary arteries, stable coronary artery disease, and acute coronary syndrome). Baseline characteristics, including co- morbidities and medications, were recorded and serum S100A8, S100A9, S100A12, and C- reactive protein levels were measured besides routine laboratory tests. Results: A total of 90 patients (63.00 [56.00–73.00] years, 62.89% male) have been included. None of the groups differed from each other regarding baseline characteristics (p > 0.05). S100A9 levels were elevated in ACS when compared with the normal coronary arteries (p = 0.033) and S100A12 levels were found to be elevated in ACS when compared with both patients with normal coronary arteries and stable coronary artery disease (p = 0.001). S100A12 was identified as an independent associate of ACS (p = 0.002). Conclusion: These results suggest that S100A12 may serve as a marker of coronary plaque instability, and may have a therapeutic implication in ACS treatment.

Background The usual onset of Behcet syndrome (BS) is in the 3. decade. Older age-onset defined as fulfilling the ISG criteria after 40 years of age is rare. One study from our center had reported the severity of eye disease was not different between early onset (≤ 24 years) and late onset (≥ 25 years) group. (1). While there is ambiguity in the definition of older onset, a few case series (2,3) coming mostly from ophthalmology or dermatology settings describe a similar or less severe clinical picture among late onset patients (pts) compared to early onset. Objectives To evaluate clinical characteristics of older onset pts and to compare them with classic onset pts. Methods The charts of 3335 BS pts who were registered between 2000 and 2010 were reviewed retrospectively. Pts who fulfilled ISG criteria for BS after 40 years of age were defined as older onset, while those who fulfilled the criteria before 30 as classic onset. For each older onset chart, 2 consecutively registered early onset charts were selected. Only clinical manifestations at presentation were recorded. A clinical activity index (1) was modified and calculated. Results There were only 134(70 M/64 F) pts with older onset BS, which gave a prevalence of 4% in the whole cohort. Age of onset was 40-44 years of age in 54 pts, 45-49 years in 47 and 50+ in the remaining 32. As controls 268(163 M/105 F) classic onset pts were selected. Demographic and clinical characteristics among older and classic onset pts are described for males and females separately, in Table. The frequency of skin manifestations, arthritis and eye disease as well as the mean clinical activity scores were significantly higher among male classic onset pts compared to older onset male pts. Interestingly, the frequency of those with positive pathergy test, vascular involvement and severe eye involvement did not seem to be different among older and classic onset male pts. On the other hand, clinical characteristics and total activity scores were similar between older and classic onset groups among females (Table). The main limitation is that the information was based solely on patient’s charts and outcome information was not available. Conclusion Compared to classic onset pts, males tend to be less frequent in older cohort. At presentation, older onset male pts had significantly less frequent skin, joint, eye disease, and significantly lower total activity scores compared with classic onset pts. There was no difference between the classic and older onset group, among females. References [1] Yazici H, et al. Ann Rheum Dis.1984. [2] Tsai J, et al. J Eur Acad Dermatol Venereol.2008. [3] Citirik M, et al. Ophthalmologica. 2011. Disclosure of Interests Gul Guzelant Ozkose: None declared, Yilmaz Ozyazgan Speakers bureau: ABBVIE, Cem Mat: None declared, Vedat Hamuryudan Consultant for: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Hasan Yazici: None declared, Emire Seyahi: None declared

Background While thrombosis in Behcet’s Syndrome (BS) is considered to be mainly caused by inflammation in the vessel wall, several prothrombotic factors have been studied with inconsistent results. Objectives We aimed to perform a systematic review of clinical studies investigating the thrombophilic factors in BS. Methods The online database of PubMed was searched with the keyword “Behcet*” in four languages (English, German, French and Turkish) from inception up to May 2018. Titles and/or abstracts of all studies were screened independently by two reviewers (GG and BY) for studies reporting on thrombosis, fibrinolysis, endothelial factors and comparing BS patients with and without thrombosis. Conflicts were solved by a third reviewer (GH). The pooled odds ratios (OR) with 95%CI were calculated for binary outcomes and standardized mean differences (MD) were calculated for continuous outcomes by using RevMan 5.3. Results Of 9937 articles, 9373 were excluded due to repetition and inappropriate study design after reviewing titles and abstracts. Full text review of the remaining 564 articles yielded 86 papers meeting our predetermined inclusion criteria. Several factors such as protein C, protein S, active protein C resistance, anti-thrombin III, plasminogen, plasminogen activator inhibitor, fibrinogen, factor 7, factor 12, thrombin activatable fibrinolysis inhibitor, anticardiolipin antibodies, antis2 Glycoprotein1 antibodies and methylenetetrahydrofolate reductase gene C677T mutation were not different in BS patients with thrombosis compared to those without thrombosis. On the other hand, vascular endothelial growth factor levels, P-selectin glycoprotein ligand-1, platelet-activating factor seemed to be more frequent in BS patients with thrombosis in the few studies reporting on these, including a small number of patients. Among the 11 parameters with controversial results across studies, meta-analysis showed significantly higher homocysteine levels, higher factor 8 levels, more frequent Factor V Leiden mutations and higher von Willebrand factor levels in BS patients with thrombosis, whereas the pooled difference was not significant for mean platelet volume, tissue plasminogen activator, prothrombin gene mutations, lupus anticoagulant, P-selectin level, erythrocyte aggregation and thrombomodulin level (Table). Conclusion Among the several prothrombotic factors that were studied in BS patients, factor V Leiden mutation, high homocysteine levels, factor 8 levels and von Willebrand factor levels may be associated with thrombosis in BS. Studies investigating these factors together in a large number of patients together with appropriate controls are needed to confirm these results. MD: mean difference, OR: odds ratio, tPA: tissue plasminogen activator Disclosure of Interests: Gul Guzelant Ozkose: None declared, Berna Yurttas: None declared, Sinem Nihal Esatoglu: None declared, Vedat Hamuryudan Consultant for: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Hasan Yazici: None declared, Gulen Hatemi Consultant for: Abbvie, Amgen, BMS, Janssen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB

Annual European Congress of Rheumatology (EULAR) -- JUN 12-15, 2019 -- Madrid, SPAIN WOS:000472207103048 [No abstract available] European League Against Rheumatism

Annual European Congress of Rheumatology (EULAR) -- JUN 12-15, 2019 -- Madrid, SPAIN WOS:000472207101483 [No abstract available] European League Against Rheumatism

Background:Even though corticosteroids and cDMARDs are effective for inducing remission in patients with Adult-Onset Still Disease (AOSD), relapse is common. Hence, maintaining the clinical stability is challenging. Almost all of the patients face side effects because of high dose steroid treatment. Biological DMARDs have been reported to be effective in refractory patients.Objectives:We aimed to evaluate the patients’ outcomes who were diagnosed with AOSD and treated with at least one bDMARDs in our tertiary center.Methods:Patients with AOSD who were followed in our clinic between 2007 and 2020 were screened retrospectively. For the diagnosis of AOSD, all of the patients fulfilled Yamaguchi criteria. The demographic characteristics, baseline and post-treatment clinical findings and outcomes were reported.Results:Twenty-eight patients (21 F, 7 M) were screened (Figure 1). The mean disease duration of the first bDMARD was 21,76 ± 28,05 months (mean ± SD). The mean duration of bDMARD treatment was 37,04 ± 30,75 months. The reasons for starting a bDMARD were systemic symptoms (%80) and chronic arthritis (%20). All of the patients used methotrexate (MTX) except one. This patient had macrophage activation syndrome during diagnosis and was treated with cyclosporine. All of the patients were treated with corticosteroids (34,28 ± 26,70 mg/d) and a cDMARD at initiation (22 of them MTX, 1 of them azathioprine, 2 of them cyclosporine and 1 of them IVIg). Anakinra was the most preferred biologic as a first-line treatment modality (TNF inhibitors=5, tocilizumab=4). The main reason for switching was loss of efficacy (8/22). Tocilizumab was the most used agent in 2nd line and canakinumab was in 3rd line. Twenty-two patients were in remission at last visit. Also, 15 patients were steroid-free, 14 patients were MTX-free. Patient global visual analogue scale, acute phase reactants and daily steroid dose were reduced significantly at last visit compared to the initial visit (Table 1).Table 1.Comparison of important laboratory findings and the mean steroid doseClinical findingAt initiation of bDMARDmean ± SDAt the last visitmean ± SDPG-VAS9.8 ± 0.82.3 ± 2.3ESR (mm/h)34,28 ± 33,9518.82 ± 11.60CRP (mg/l)70,76 ± 67,8013.44 ± 27.33Ferritin (ng/mL)1662 ± 1239275.7 ± 381.4Daily steroid dose (prednisolone, mg/d)34.28 ± 26.705.60 ± 8.60Figure 1.Presenting signs and the symptoms of the patientsbDMARD treatment was terminated in 5 patients due to complete remission (n=2) and side effects (1 of them pneumonia, 1 of them EBER (+) Hodgkin Lymphoma and 1 of them tuberculosis). Six patients experienced local injection site reaction, none of them stopped treatment. Also, one patient died while she was in remission under anakinra treatment with an unknown cause.Conclusion:The most common presenting symptoms in our cohort were fever and salmon-colored rash. Tocilizumab is an alternative treatment modality in cases with chronic arthritis and IL-1 inhibitors are an alternative for systemic course of disease. bDMARDs, especially IL-1 inhibitors are highly effective for refractory patients with AOSD.Disclosure of Interests:None declared

The aim of the present study was to increase awareness regarding the rational use of medicines. The data were obtained via the Material Resources Management System Module of the Ministry of Health. For the appropriateness of treatments, the Global Initiative for Asthma, the Global Initiative for Chronic Obstructive Lung Disease, and the guidelines for the rational use of medicines were used. We also investigated whether any de-escalation method or physical exercise was performed. Statistical analyses were performed using descriptive statistics to determine the mean, standard deviation, and frequency. The results showed that healthcare providers ignored potential drug reactions or adverse interactions, and reflecting the lack of adherence to the current treatment guides, 35.8% irrational use of medicines was recorded. Thus, de-escalation methods should be used to decrease costs or narrow the antibiotic spectrum, antibiotic selection should consider the resistance patterns, culturing methods should be analyzed, and monotherapy should be preferred over combination treatments. (C) 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.

Objective: The effect of vitamin D on bone metabolism has been well known for a long time. Recently, various hormonal and immunity related effects has have been obtained. Additionally, the deficiency of vitamin D is thought to be related with various pain syndromes. In this study, we aimed to investigate the main musculoskeletal symptoms of patients with vitamin D deficiency admitting to physical medicine and rehabilitation clinics. Materials and Methods: The data were retrospectively investigated in patients with myalgia, arthralgia, regional pain, widespread body pain (WBP) and in whom vitamin D levels were measured. Patients over 50 years old and with known osteoporosis/osteomalacia diagnosis, endocrinological pathology, and inflammatory rheumatological disease were excluded. Results: The data of 571 patients were investigated and totally 214 of them were included in the study. There were 178 females (83.2%), 36 males (16.8%). The mean age of the patients was 39.19 +/- 9.58 years. Of the patients, 100 (46.7%) were in severe deficiency, 68 (31.8%) were in deficiency, 46 (21.5%) were in insufficient group. The symptoms were regional pain in 65 (30.3%), WBP in 63 (29.4%), arthralgia in 49 (23%), and myalgia in 37 (17.3%) patients. Conclusion: Vitamin D deficiency may be encountered as musculoskeletal problems. In the presence of persistent joint-muscle pain, regional pain and fibromiyalgia, vitamin D deficiency should be kept in mind.

The p-value is commonly misused. We hypothesised that a close cooperation with a statistician would go along with a more proper use of p-values. We considered a close cooperation present, when a statistician was a coauthor, or a formal statistical help was acknowledged in a study report.Randomised controlled trials published in 2015-16 in 4 widely read rheumatology journals were searched for a close cooperation with a statistician, the inclusion of effect sizes, confidence intervals, exact rather than relative p-values and the omission of p-values in tables depicting trial entry data.There were only 28/133 (21%) articles in which a formal statistical help was acknowledged (Group I). The rest (Group II) gave no acknowledgement of a close cooperation. Reporting of effect sizes (96% vs. 71%) and exact p-values (88% vs. 69%) were more in Group I (p=0.01, and p=0.08, respectively).While a formal acknowledgement of a close cooperation was notably infrequent at 21%, this went along with improvement in some aspects of p-value reporting. If substantiated by further studies, we propose that a formally acknowledged statistical help should improve p-value reporting. Like all professionals, statisticians would like their name/office to be formally associated with their good work.

Excess visceral fat accumulation results in altered release of adipokines. The aim of this study was to examine the relationship between new adipokines (omentin-1 and vaspin), insulin resistance, and serum inflammatory markers in obese subjects with metabolic syndrome (MS).The study included a total of 121 obese children (79 females and 42 males, aged 12-17 years old). The obese subjects were divided into two groups based on the presence or absence of MS criteria (MS group and non-MS group). Serum omentin-1, vaspin, and high-sensitivity C-reactive protein (CRP) were measured in addition to the other glucose metabolism parameters.MS was diagnosed in 45 obese children and 76 children did not meet the MS criteria. Serum omentin-1 (289.5 ± 51.9 ng/mL vs. 268.2 ± 60 ng/mL, P = 0.03) levels were significantly lower in the MS group compared to the non-MS group. Serum vaspin levels (1058.3 ± 118 pg/mL vs. 1178.6 ± 158 pg/mL, P = 0.02) were higher in the MS group than the non-MS group. CRP levels correlated well with both the adipokines (r = -0.236, P = 0.04 for omentin-1 and r = 0.296, P = 0.008 for vaspin), although these adipokines did not show statistically significant correlations with fasting glucose-insulin levels, homeostasis model assessment of insulin resistance, and 2 hr postload glucose level.Higher vaspin and lower omentin-1 levels were determined in obese MS children compared to non-MS children and these adipokines were significantly correlated with high CRP values. These data support the view that adipokines in MS children contribute to increased inflammation markers before abnormal glucose metabolism.

Background The quality of statistical analysis and reporting are wanting even in our most prestigious journals.1 It stands to reason that active participation of biostatisticians in data analysis and reporting would improve the situation. Objectives We aimed to test the hypothesis that more close cooperation with biostatisticians would improve the quality of reporting randomised clinical trials in rheumatology. We defined a close cooperation as the inclusion of a formal biostatistician among the co-authors and/or a declaration of formal statistical help in the study reports. Methods Two independent observers screened both by reading and, when applicable, electronic scanning the texts of all randomised controlled trials (RCT) in Annals of the Rheumatic Diseases, Arthritis Care and Research, Arthritis and Rheumatology, Rheumatology Oxford published in 2015 and 2016. Using a prepared worksheet, the observers specifically tabulated, the presence of a biostatistician among the co-authors and/or formal acknowledgement of statistical help in the methods, the inclusion of effect sizes (whether they were specifically indicated as such, could be calculated or not given at all) and the corresponding confidence intervals. The instances in which an effect size was given as a number needed to treat (NNT) and number needed to harm (NNH) were separately sought. In addition at the number of times separate p values were reported for interdependent comparisons (like DAS28-CRP and DAS28-ESR), and the presence of a Bayesian analysis in the methods. Results The total RCT number in these four journals was 134. In 26 trials, there was a biostatistician or an epidemiologist as a co-author and in 3, statistical help was acknowledged in the text. In the remaining 105 papers (78%) no statistical help was declared. The tabulation of effect sizes, confidence intervals and giving separate p values for interdependent variables are given in the table 1. In giving the effect sizes it is to be noted that the presence of a statistician made did not improve the explicit announcement of an effect size but made it more calculable. None of the trials used Bayesian methods for analysis. Only in one trial NNT and in another NNH (both with no acknowledged biostatistical help) were given. Conclusions The inclusion of a biostatistician improved the reporting of effect sizes, at least rendering them calculable. The same cannot be said for reporting confidence intervals and separate p values for interdependent variables. It was interesting that Bayesian analyses and giving NNT and NNH, rather intuitive ways of expressing effect sizes, were not popular. There were 2 main limitations. The sample size was relatively small and many authors could have obtained statistical help without acknowledging it. Reference [1] Chavalarias D, et al. JAMA. 2016,315(11):1141–8 Disclosure of Interest None declared

Background Despite methotrexate and steroid treatment, in cases of Adult-onset Still’s disease (AOSD) it is usually difficult to maintain clinic stability. In refractory cases, Anakinra treatment has been reported to be efficacious.1 Objectives In this retrospective review, it is aimed to evaluate the AOSD cases treated with anakinra in our centre. Methods Fourteen AOSD patients (11 female,3 male) who were being followed in our outpatient clinic were reviewed retrospectively. The demographic characteristics, pre- and post-treatment clinical findings were reported. Results The mean follow-up period of the patient population was 33.5±30.07 months (mean ±SD). Initial prednisolone dose was 37.3 mg/day. Except for one, all of our patients were exposed to methotrexate before being treated with anakinra. This patient was being treated with cyclosporine instead, since she had concomitant Macrophage Activation Syndrome. The other medications, the patients were previously treated with, were Etanercept (n=2), Tocilizumab (n=3), Infliximab (n=1) and Adalimumab (n=1). All patients were on 100 mgs of Anakinra, daily, except for the one treated with 200 mg/day. The mean duration of Anakinra therapy was 11.4 months. Among 7 patients in whom anakinra therapy was terminated, 1 had drug induced urticaria, 1 was primary irresponsive, 4 were secondary irresponsive and the other had severe pneumonia. Primary irresponsiveness is the lack of response to the therapy since the drug was first introduced, whereas in secondary irresponsiveness the case responds to the medication for a while and starts to flare again after asymptom-free period on the medication. Among 14, 7 of our patients are still on 100 mg/d Anakinra. The mean level of C reactive protein (CRP) measures was reduced from 64.38±61.95 mg/L to 34.3±24.3 mg/L with Anakinra therapy(p=0.003). Similarly, mean Erythrocyte Sedimentation Rate (ESR) was dropped to 33±22 mm/h from 59±35 mm/h by the help of the therapy(p Conclusions Adult-onset Still’s disease is a challenging disorder, lacking a sufficient long-time clinical control. In order to obtain a full remission, various efforts have been spent so far. One of these approaches is to treat refractory cases with Anakinra, an IL-1 blocking agent. According to our clinical experience we state that, anakinra has a relatively high efficacy in controlling refractory cases. Reference [1] Ortiz-Sanjuan F, et al. Efficacy of Anakinra in RefractoryAdult-OnsetStill’sDisease: MulticenterStudyof 41 PatientsandLiteratureReview. Medicine(Baltimore)2015Sep;94(39):e1554. Disclosure of Interest None declared

Background In Adult-onset Still’s disease (AOSD), cases refractory to typical DMARDs, Canakinumab (an anti-IL-1s monoclonal antibody) has been reported to be effective in a limited number of refractory cases.1 Objectives The aim of this retrospective study was to represent AOSD patients treated with Canakinumab in 3 centres. Methods The follow up data of 10 AOSD patients (8 female, 2 male), who were followed up in outpatient clinics of 3 tertiary centres were reviewed retrospectively. The initial characteristics and follow up findings were reported. Results The mean timespan between the initial diagnosis and Canakinumab treatment 45.2±29 months (mean ±SD). Before the onset of Canakinumab therapy, all patients were exposed to methotrexate, 1 to leflunomide, 8 to Tocilizumab and 8 to Anakinra. As for the biologic agents, 3 patients were also treated beforehand with Infliximab, 2 with Adalimumab, 2 with Etanercept and 2 with Rituximab. Canakinumab therapy was initiated in all patients with the indication of refractory disease under other medications, except for the one in whom neutropenia became evident under anakinra. The mean number of Canakinumab injections was 9.3±8. The mean follow-up period of patients treated with Canakinumab was 43.1±33 months. Seven out of 10 patients are still being treated with Canakinumab of 150 mg/month and one of 150 mg/every 2 months. One patient had a single injection and was fully controlled. The mean ferritin measure of 9 patients was reduced from 1292.3±1530 ng/ml to 354±530.2 ng/ml following the Canakinumab therapy (p=0.035). The mean of patient-reported global visual analogue scale (PG-VAS) scores was reduced from 7.4±2.4 to 2.3±2.2 with Canakinumab (p Conclusions Canakinumab treatment seems to be effective in refractory AOSD patients who were previously treated with various agents. We state that an IL-1 blocking agent, Canakinumab is a relatively safe and effective alternative in managing refractory AOSD cases. On the other hand, randomised controlled trials are needed to further investigate the role of Canakinumab in these cases as well as its use as the first choice of biologic agents. Reference [1] Kontzias A, Efthimiou P. The use of Canakinumab, a novel IL-1β long-acting inhibitor, in refractory adult-onset Still’s disease. Semin Arthritis Rheum2012;42(2):201–5. Disclosure of Interest None declared

We described disease characteristics, management and outcome of a group of Behcet's syndrome (BS) patients who underwent pulmonary lobectomy, segmentectomy or various pleura interventions for complications due to pulmonary artery or descending aorta involvement. There were 9 patients with BS (8 M/1 F; mean age: 24.8 ± 7.5 and mean disease duration: 4.3 ± 3.8 years) who underwent lung surgery from 2000 to 2017. Their medical files including operation details and radiological and pathological studies were reviewed retrospectively. Lobectomy was done in 6 patients, decortications and pleura interventions in the remaining 3. The reason for the surgical procedures were giant pulmonary arterial aneurysms refractory to the medical treatment (n = 4), pneumothorax due to large cavities (n = 2), pleural effusions refractory to the medical treatment (n = 1), a bronchopleural fistula after embolization (n = 1) and bronchiectasis (n = 1). All patients received medical treatment with cyclophosphamide and corticosteroids before the surgical interventions. The histological examination in patients with pseudo-aneurysms showed destruction of medial elastic fibers, inflammatory cell infiltration of adventitial tissues and penetration into the adjacent bronchi with adherent thrombi. Two patients died: one due to Budd-Chiari syndrome 1 year after the surgery, another because of a massive hemoptysis 3 months after lobectomy. The remaining 7 patients are still alive with a median follow-up of 8 years (inter-quartile range [IQR]: 4–11). Lobectomies in BS patients with giant pulmonary aneurysms refractory to medical treatment can be done with favorable outcome. Also, complications such as large cavities causing pneumothorax, refractory pleural effusions, bronchiectasis, and embolization complications can be managed effectively with surgical interventions.

Background In recent years, vitamin D deficiency has been suggested as a risk factor for ischemic stroke and stroke severity in both animal models and clinical studies. In this retrospective study, we investigated the relationship between 25-hydroxyvitamin D [25(OH)D] levels and functional outcomes in stroke patients during neurological rehabilitation program. We also investigated whether there is an association between 25(OH)D levels and cognitive impairment. Methods The study included the medical records of 120 stroke patients who participated in a neurological rehabilitation program. The motor and cognitive components of the Functional Independence Measurements of all patients at admission and discharge were recorded. The Functional Ambulatory Scale was used to assess motor functional status, and the Turkish-validated version of the minimental state examination test was used to assess cognitive status. Results A significant correlation was found between 25(OH)D level and cognitive impairment among patients who had ischemic strokes. High levels of 25(OH)D were associated with greater functional gain during the rehabilitation program in both ischemic stroke patients and hemorrhagic stroke patients. Conclusions High 25(OH)D levels might be associated with greater functional improvement and with less cognitive impairment in stroke patients.

Menstruation triggers several conditions such as migraine, recurrent aphthous stomatitis and acne vulgaris in healthy individuals. There is evidence that Behçet's syndrome (BS) and familial Mediterranean fever (FMF) may exacerbate during menstruation. The aim is to assess whether BS and FMF patients experience menstrual flares.Females of reproductive age with BS and FMF seen consecutively at the outpatient clinic of Cerrahpasa Medical Faculty at Istanbul, as well as apparently healthy hospital workers were studied using a standardised questionnaire. BS patients were asked whether they experienced increased skin-mucosa lesions during the menstrual period. A similar questionnaire assessing this time the frequency of abdominal pain, chest pain and fever attacks was given to the patients with FMF. The healthy controls received both questionnaires.A total of 200 BS patients, 240 FMF patients and 250 healthy controls were studied. The most commonly reported symptom among both BS patients (51%) and healthy controls (62%) was the acneiform lesion. At least 79% patients with FMF reported attacks with menstruation, notably abdominal pain which, majority thought, could be differentiated from dysmenorrhea. Additionally, 76% of healthy controls reported having abdominal pain consistent most probably with dysmenorrhea.This survey showed that, in 68% of the patients with BS at least one skin mucosa lesion was exacerbated with menstruation, this was most commonly acneiform lesion. Menstruation had a slightly stronger effect on FMF, triggering at least one symptom in 79%. The main limitation of the study was the self-reported assessment methodology.

The prognosis of uveitis in Behçet's syndrome (BS) has improved over decades. Whether this is related to the use of more aggressive management strategies is not known.This is a retrospective study of BS patients who received infliximab (IFX) for refractory eye disease between 2003-2015. The patients were divided into two groups according to the date of onset of in IFX treatment as before and after 2013. We compared the two groups in terms of disease characteristics at the onset of IFX treatment and response to treatment.There were 43 patients in the old and 14 patients in the new group. The duration of uveitis and previous immunosuppressive treatment before the initiation of IFX were significantly shorter in the new group compared to the old group (p=0.043 and p=0.028, respectively). The baseline visual acuity (VA) at the initiation of IFX was better in the new group, but this was only significant for the left eye. Treatment with IFX was effective in both groups in preserving VA and this was more pronounced in the new group. Attack frequency under IFX was significantly lower in the new group (p0.001).IFX seems to be initiated earlier and also in less severe cases during the course of BS uveitis than before. Despite the few numbers of patients and relatively short duration of follow-up, our results give a hint that this change has improved the outcome.

Background Vascular calcification has been found to be associated with increased risk of cardiovascular (CV) morbidity and mortality. Various bone-associated proteins have been suggested to be related with this process. In this study, we aimed to evaluate whether serum levels of bone morphogenic protein-4 (BMP-4) and matrix Gla protein (MGP) differed in patients who were found to have normal epicardial coronary arteries or a culprit lesion in the coronary angiography leading to acute coronary syndrome (ACS). Methods Patients admitted to emergency department with the diagnosis of ACS who underwent primary percutaneous coronary intervention (PCI) between October 2015 and April 2016 were consecutively recruited as the patient group. Age and gender-matched subjects who underwent coronary angiography following non-invasive ischemia assessment made the control group. Results A total of 90 subjects (63.00±14.02 years, 70% male) were included in this study. MGP (

Background The diagnosis of FMF (Familial Mediterranean Fever) can be missed or delayed even in a country like Turkey, one of the most prevalent places for FMF (1). Objectives We compared the duration of delay in diagnosis before and after year 2000, and assessed the problems related with the diagnosis of FMF. Methods We studied 143 (102 F, 41 M) consecutive patients with FMF seen at the rheumatology outpatient clinic, between November 2016 and January 2017. Patients completed a self-administered questionnaire that assesses initial symptoms, previous diagnosis and treatments received before the formal diagnosis of FMF. Patients were divided in 2: as Group 1, which includes 70 patients seen for the first time by a physician before 2000 and Group 2, which includes 73 patients seen after 2000. Results The median age of the patients was 34 years [IQR:27–45]. The F/M ratio was 2.4. The initial symptom was abdominal pain in the majority (n=134, 89%), followed by fever (n=114, 75%), arthritis (n=66, 44%), pleuritic pain (n=21, 14%), arthralgia (n=11, 7%) and other complaints (n=14, 9%). The median age at initial symptom was 10 years (IQR:6–23). The median delay in diagnosis was 8 years [IQR:2–15]. This was significantly shorter in Group 2 (median: 4 years [IQR:0–11]) than that observed in Group 1 (median: 10 years [IQR:6–17]), as shown in Table. A total of 110 patients (73%) were diagnosed with one or more diseases or syndromes other than FMF. These were appendicitis (n=50, 45%), gastro-intestinal diseases (n=44, 40%), acute rheumatic fever (n=36, 33%), inflammatory arthritis (n=18, 16%), gynecological diseases (n=11, 10%) kidney stones (n=9, 8%) and others (n=34, 31%). As shown in Table, the frequency of patients with misdiagnosis, was significantly lower in Group 2 (66%) compared to Group 1 (84%). A total of 59 patients (39%) received other long-term treatments, mainly monthly penicillin (n=28), prior to colchicine. There were 41 surgical interventions in 36 patients (24%), before the diagnosis of FMF, the most common being appendectomy in 31, gyneacological operations in 5, cholecystectomy in 3 and others in 2 occasions. It was noted that, the frequency of surgical operations was significantly decreased in Group 2 (12%) compared to Group 1 (27%) (Table). The presence or absence of MEFV mutations was assessed in 69 patients (46%) before the diagnosis or after to reinforce the diagnosis. As expected, this was significantly more frequent in Group 2 (59%) compared to Group 1 (33%) (Table). Seventy patients (46%) were diagnosed as FMF only after someone else in the family (n=44) or a friend (n=26) had a similar diagnosis. The frequency of these patients was similar when Group 1 and 2 were compared. Conclusions Although there is considerable decrease in delayed diagnosis of FMF, there is still significant amount of misdiagnoses after the year 2000, even in a geography where FMF is highly prevalent. Table: Demographic and clinical characteristics of Group 1 (patients seen before 2000) and Group 2 (patients seen after 2000) References Tunca M et al; Turkish FMF Study Group.Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study. Medicine (Baltimore). 2005 Jan;84(1):1–11. Disclosure of Interest None declared