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In this study, some thiazole-based pyrrolidine derivatives were synthesized, characterized by FT-IR and 1H NMR spectroscopic techniques, and evaluated as potential antibacterial agents. Their antibacterial activities were evaluated by broth microdilution method and expressed as minimum inhibitory concentration; against Escherichia coli, Salmonella typhimurium, Bacillus cereus, and Staphylococcus aureus. Cytotoxicity studies of synthesized compounds were also conducted to minimize the toxic effects on healthy mammalian cells. From synthesized compounds, 4-F-phenyl derivative compound (11) has been found to inhibit Gram-positive bacteria with minimum toxicity selectively.

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

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.

Aim: The aim of this study is to investigate the relationship between left ventricular function and red cell distribution width (RDW) measured by myocardial performance index in patients with Ankylosing Spondylitis (AS). Patients and Methods: The study included 35 patients with AS and 38 controls. Control group was consisted of age and gender matched individuals without any cardiologic complaint and systemic disease. Laboratory parameters including RDW tests and transthoracic echocardiographic evaluation were conducted consecutively on the entire cohort of ankylosing spondylitis patients and healthy individuals. Results: In our study, no statistically significant difference was found between two groups, in terms of general properties such as age, gender, Body Mass Index (BMI), body surface area, systolic and diastolic blood pressure, smoking, serum lipid levels and blood glucose levels. ESR and CRP levels of AS group were found to be significantly higher compared to that of control group. EF and FS, which are among the parameters of systolic function, were normal in all individuals of both groups and there was no significant difference between two groups. However, myocardial performance index (MPI ) was higher in patients with AS than in controls. In addition, we showed a significant positive correlation between RDW and MPI (r: 0.372 , p: 0.001). Conclusion: Myocardial performance index may be useful for the early diagnosis of potential heart failure, by providing an earlier diagnosis of left ventricular dysfunction in patients with ankylosing spondylitis. Also , red cell distribution width was significantly correlated with myocardial performance index in these patients.

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

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

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

Objectives To evaluate the radiological, clinical and functional properties of hand osteoarthritis and to assess their relationship in a Turkish population. Methods The subjects with hand OA recruited into the study from the multi-centre national osteoarthritis cohort by the Turkish League Against Rheumatology (TLAR–OA). The demographic characteristics, body mass index (BMI), smoking, finger ratio,(2nd to 4th finger lenght), grip strengths with Jamar dynamometer, hand pain duration (month), hand pain severity (visual analogue scale; 0–100 mm) were evaluated. The radiological stage of hand OA was assessed according to the Kellgren Lawrence OA staging. The hightest stage among the joints involvement was noted as the OA stage of the hand. The functional disability concerning to hand involvement was assessed with Duruoz Hand Index (DHI). The SPSS 24.0 statistical package was used for analysis. The descriptive analysis was performed for all parameters. Spearman’s correlation coefficient was used to assess the relation between quantitative variables. Results A total of 364 subjects (330 female, 34 male) from 15 centres with mean of age 62.96 (SD: 10.22) were recruited into the study. The mean of BMI was 29.54 (SD: 4.51) and the percentage of smoking person was 6.3%. The mean of 2nd finger to 4th finger ratio of the patients was 0.96 (SD: 0.05). The mean of grip strengths of the right hand and left hand were respectively 15.55 kg (SD: 12.88) and 14.13 kg (SD: 11.39), which is lower than normal population.1 The median pain duration of hand was 24 months (min-max: 1–480 months). The mean VAS score of pain was 5.05 (SD: 2.33). The mean DHI score was 16.82 (SD: 15.53). The patients’ radiological OA involvement stages (2,3 and 4) of right and left hands were respectively 26.1% and 23.6% (stage 2); 22.5% and 20.9% (stage 3); 13.2% and 12.4% (stage 4) according to the Kellgren Lawrence scoring. The radiological stages of right and left hands respectively had poor correlation with VASpain (rho=0.152, p=0.010; rho=0.158, p=0.009); low but significant correlations with Duruoz Hand Index (rho=0.257, p 0.05). Conclusions Although the subjects with hand OA had pain, low grip strenght and hand disability; the radiological findings had meaningful relations with only functional involvement and pain duration in our population. Reference [1] Massy-Westropp N, et al. Hand grip strenght: age and gender stratified normative data in a population-based study. BMC Res Notes2011;4:127. Disclosure of Interest M. T. Duruoz Grant/research support from: ABVIE, Consultant for: NOVARTIS, Speakers bureau: ABDI IBRAHIM, D. Erdem: None declared, T. Tuncer: None declared, L. Altan: None declared, F. Ayhan: None declared, A. Bal: None declared, L. Cerrahoglu: None declared, E. Capkin: None declared, R. Cevik: None declared, D. Dulgeroglu: None declared, S. Gursoy: None declared, S. Hizmetli: None declared, C. Kacar: None declared, E. Kaptanoglu: None declared, T. Kaya: None declared, H. Kocabas: None declared, K. Nas: None declared, S. Ozcakir: None declared, D. Sindel: None declared, O. Sahin: None declared, G. Tasci Bozbas: None declared, C. Tikiz: None declared, H. Ugurlu: None declared

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.

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

Abst ract Polyarthritis and panniculitis can be the presenting manifestations of pancreatitis. Early recognition of this triad is critical because of the high mortality rate from pancreatic disease when the diagnosis is delayed. Although this association can be seen at any age, its frequency peaks around the fifth decade of life. We report this case because of the rarity of the association and the high morbidity and mortality in these patients. (Turk J Rheumatol 2010; 25: 221-4)

Psoriasis is a skin disorder that is associated with arthritis. Sacroiliac joint involvement is considered to be less frequent than the other types of psoriatic arthritis. Additionally, the psoriatic sacroiliitis is considered to be asymmetric in general. We aimed to define the frequency and type of sacroiliac involvement in patients with psoriasis. Patients with psoriasis were included the study. Characteristics of skin, nail and articular involvement were noted. Psoriasis area and severity index was calculated. Antero-posterior pelvic X-rays were obtained and graded by two rheumatologists and a radiologist independently. One hundred and thirty-three patients were included. Thirty-seven of patients (27%) have articular involvement symptomatically. The sacroiliac joint involvement was observed in 34 (26%) of patients. More than one-half of sacroiliac involvement was bilateral while less than one-half was in symptomatic patients regarding sacroiliitis. Fifty-seven percentages of all patients have psoriatic nail involvement. Sacroiliac joint involvement did not show any significant association with psoriatic nail involvement or the severity of skin disease. We found higher frequency of sacroiliac joint involvement and bilateral sacroiliitis in patients with psoriasis. This is in contrast to present information about the association of psoriasis and sacroiliitis. These findings need confirmation by further studies and with more sophisticated techniques such as magnetic resonance imaging.

Skeletal muscle weakness is a frequent symptom of thyroid dysfunction. Both hypothyroidism and hyperthyroidism may cause signs and symptoms of neuromuscular dysfunction. It has been reported in previous studies that muscle strength recovers after treatment of thyroid dysfunction. The aim of the current study was to evaluate knee extensors and flexors strength in patients with thyroid dysfunction before and after medical treatment and compare the data with those of a matched control group. For this purpose 11 hyperthyroid, 9 hypothyroid patients and 27 healthy controls were recruited. All were tested isokinetically on the dominant side. The results suggest that return of thyroid hormone concentrations to their reference ranges, significantly increases muscular strength in hyperthyroid patients. However there was no significant recovery in the hypothyroid group. Nevertheless in both groups post-treatment muscle strength was significantly lower than in the control group. The findings suggest that patients with thyroid dysfunction, especially with hypothyroidism, should train for muscle strengthening after establishing euthyroidism to obtain optimum life conditions.

STUDY DESIGN A reliability and validity study of a translated, culturally adapted questionnaire. OBJECTIVE The aims of the present study were to translate the Quebec Back Pain Disability Scale (QDS) into Turkish, to perform its cross-cultural adaptation for Turkish patients with LBP, and to investigate its validity and test-retest reliability. SUMMARY OF BACKGROUND DATA As a widely used scale in the evaluation of patients with low back pain (LBP), the QDS awaits formal translation and validation into Turkish to achieve an equivalent questionnaire and to allow comparability of data. METHODS The translation and cross-cultural adaptation of the original questionnaire were performed in accordance with published guidelines. Translation and retranslation of the English version of the QDS was performed blindly and independently by 4 different individuals, and adapted by a team. Hundred patients with LBP were included in our study. The physical examinations were evaluated and the Schober test was assessed for a mobility measurement of the spine. The patients were asked to complete a questionnaire booklet containing the Turkish versions of the modified Oswestry Disability Index (ODI) and QDS, and Visual Analog Scale (VAS) measure of pain. All assessments were repeated 24 hours later for all of the patients. Reliability was evaluated using internal consistency and the intraclass correlation coefficient (ICC). Concurrent validity was measured by comparing the Turkish version of the QDS results to VAS and the Schober test scores. Also, for construct validity, the results of the scale were compared with the Turkish version of modified ODI. RESULTS The QDS showed excellent test-retest reliability as evidenced by the high ICC for 2 test occasions (ICC = 0.9221, P < 0.000). Also, internal consistency was found to be adequate at both assessments with Cronbach's alpha (0.9405 and 0.9537 at day 0 and 1, respectively). There was a positive correlation between QDS and VAS both for day 0 (r = 0.368; P < 0.000) and for day 1 (r = 0.441; P < 0.000). There was no correlation determined in the comparison of the QDS sum scores with Schober testing for day 0; however, significant negative correlations in these parameters were observed for day 1 (r = -0.249 P = 0.014). Also significantly positive correlations were deter- mined between the Turkish version of the QDS and the Turkish version of the modified ODI for both day 0 and day 1 (r = 0.666, P < 0.000, r = 0.681; P < 0.000, respectively). CONCLUSION The results of our study show that QDS as a functional status questionnaire has been translated into Turkish without losing the psychometric properties of the original version. The Turkish version of the QDS has good comprehensibility, internal consistency, and validity and is an adequate and useful instrument for the evaluation of disability in patients with LBP.

Objective: The aim of the present study was to evaluate and compare the role of dual energy X-ray absorptiometry and three-phase bone scintigraphy in the diagnosis of complex regional pain syndrome type I of upper extremity. Methods: Five male and nineteen female patients diagnosed with complex regional pain syndrome type I (CRPSI) were included in this study. Three-phase bone scintigraphy (TPBS), bone mineral density (BMD) and bone mineral content (BMC) of wrist, metacarpophalangeal joint (MCP) and proximal interphalangeal (PIP) area in the affected and unaffected hands of patients were measured simultaneously using dual energy X-ray absorptiometry (DEXA). The time passed between the precipitating event and clinical onset of CRPSI was also recorded. Results: TPBS findings were in agreement with CRPSI diagnosis in 96% of the patients (23 of 24 patients). Periarticular BMD and BMC values in wrist, MCP, and PIP joints were statistically lower in affected hands than in unaffected hands for all three regions. Moreover, we found no correlation between BMD or BMC values with the sex, age, dominant hand, and the duration between the clinical onset of CRPSI and its precipitating event. Conclusion: The present study suggests that beside TPBS, a valuable tool in the early diagnosis of CRPSI, DEXA can also be used in the determination of early demineralization of bones in CRPSI patients. DEXA is an accurate, noninvasive, rapid, and safe device for quantitative assessment of unilateral bone loss caused by upper limb CRPSI.

Wegener's granulomatosis (WG) is a multiorgan system disease of unknown etiology characterized by granulomatous inflammation, tissue necrosis, and variable degrees of vasculitis in small- and medium-sized blood vessels. In patients with WG, the musculoskeletal system can be involved before other typical symptoms of the disease. Also in WG, pneumothorax can develop as a rare complication. In this paper, we report a case with WG who had early articular involvement in the absence of classic features of illness and had pneumothorax which resulted from the rupture of the sub-pleural nodule. The aim of this work is to increase the awareness of early articular involvement in WG and the pneumothorax possibility especially in cases with cavitated nodules closure to pleura. This case emphasizes that early diagnosis and treatment is very important in avoiding further complications.

WOS:000366027100001, Objectives: This study aims to report Turkish League Against Rheumatisms assessment on the compliance of European League Against Rheumatism 2013 treatment recommendations for rheumatoid arthritis with practices in Turkish rheumatology clinics and adaptations for Turkey. Patients and methods: Members of Turkish League Against Rheumatism and one rheumatoid arthritis patient voted for the 2013 recommendations of the European League Against Rheumatism for treatment of rheumatoid arthritis in two sessions. An item was changed and voted again only if at least 70% of participants wanted a change. Strength of recommendations was calculated for the items. Strength of recommendations for the changed items in the first and second voting rounds was compared by Wilcoxon signed-rank test. In case of significant difference, the item with higher strength of recommendation was accepted. In case of no difference, the changed item was selected. Results: Three overarching principles and fourteen recommendations were assessed among which the three overarching principles were changed emphasizing the importance of physiatrists as well as rheumatologists for taking care of the patients. Third item was changed by adding composite indices for assessing disease activity. In the ninth recommendation, rituximab was suggested as a first line drug independent of situations like latent tuberculosis or lymphoma, etc. In the 11th recommendation, unlike European League Against Rheumatism, our committee did not suggest any thought about tofacitinib, as then it had not been approved in Turkey. Remaining principles were accepted as the same. Conclusion: Expert opinion of Turkish League Against Rheumatism for treatment of rheumatoid arthritis patients was formed for practices in Turkish clinics. Conflict of Interest The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. Financial Disclosure The authors received no financial support for the research and/or authorship of this article.

Secondary amyloidosis (type AA) is rarely encountered but can be a significant complication of ankylosing spondylitis (AS) and may lead to proteinuria and renal dysfunction. Anti-tumor necrosis factor-alpha (anti-TNFα) agents may be used to induce clinical remission by suppressing systemic inflammation in secondary amyloidosis. The patient described , with the diagnosis of AS, was diagnosed with secondary amyloidosis, despite treatment with disease modifying anti-rheumatic medication. He developed marked proteinuria, renal dysfunction and low levels of serum albumin. Diagnosis of amyloidosis was confirmed by renal biopsy. During a 2-year treatment period with etanercept, an anti-TNFα agent, a definite improvement was determined in all parameters. This case illustrates that in the treatment of secondary amyloidosis related to AS, etanercept, an anti-TNF α agent, can be considered an effective therapeutic option.

kesikburun, serdar/0000-0001-9400-4683; Ozgocmen, Salih/0000-0002-4860-452X; Ozgocmen, Salih/0000-0002-4860-452X; WOS: 000336458300002 PubMed: 24284270 BACKGROUND AND OBJECTIVES: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population. The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. METHODS: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). RESULTS: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p < 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. CONCLUSION: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

Hyperostosis frontalis interna (HFI) is a disorder characterized by progressive symmetric thickening of the inner table of the frontal bone of the human skull. HFI may be accompanied by headache and some neuropsychiatric diseases such as epilepsy and dementia. Giant cell arteritis (GCA), also called temporal arteritis, is a systemic inflammatory vasculitis of unknown etiology that affects medium- and large-sized arteries. It affects elderly people and may result in a wide variety of systemic, neurologic and ophthalmologic complications. As no association of HFI and GCA was encountered in the literature, we found it interesting to report a case with both of these clinical entities.

Bu araştırmada ülkemizdeki romatizmal hastaların alkol kullanım alışkanlıkları değerlendirildi.Hastalar ve yöntemler: Romatoid artrit (RA), ankilozan spondilit (AS) hastalarından ve sağlıklı kontrollerden oluşan toplam 332 denek [185 erkek, 147 kadın; yaş ortalamaları sırası ile 41.2 (%95 GA 39.5-43.0) ve 45.2 (%95 GA 43.4-47.1) yıl], alkol kullanım alışkanlığı olup olmadığına yönelik olarak sorgulandı. Alkol kullanım alışkanlığı olanlardan Michigan Alkolizm Tarama Testi'nin (MATT) Türkçe versiyonunu yanıtlamaları istendi.Bulgular: Deneklerin toplam %37.3'ü alkol kullanıyordu. Erkeklerin yaklaşık %50'si, kadınların ise %20'si alkol tüketim alışkanlığına sahipti. En düşük alkol kullanım oranı RA grubunda (%23.0), en yüksek oran ise sağlıklı kontrol grubunda (%45.6) idi. Ortalama MATT skoru, RA ve AS grupları için sırasıyla 3.02 (%95 GA: 2.36-3.69) ve 3.13 (%95 GA: 1.76-4.5) olarak bulundu ve her iki değer de kontrol grubuna ait değerden istatistiksel olarak anlamlı oranda küçüktü [4.94 (95% GA: 4.14-5.73) p, In this study, we aimed to evaluate alcohol consumption of Turkish rheumatic patients. Patients and methods: A total of 332 subjects [185 males and 147 females; mean ages of 41.2 (95% CI 39.5- 43.0) and 45.2 (95% CI 43.4-47.1) years, respectively] with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and healthy controls were questioned regarding their alcohol habits. Alcohol consumers were asked to fill out the Turkish version of the Michigan Alcoholism Screening Test (MAST). Results: A total of 37.3% of all subjects were alcohol consumers. Nearly 50% of males and 20% of females drank alcohol. Rheumatoid arthritis group had the lowest rate of alcohol consumption (23.0%), while healthy controls had the highest rate (45.6%). The mean MAST scores were 3.02 (95% CI: 2.36-3.69) and 3.13 (95% CI: 1.76-4.5) for the AS and RA groups, respectively, indicating statistically lower rate compared to the healthy controls [4.94 (95% CI: 4.14-5.73) (p

Resistin is a recently described adipokine which is a member of cysteine-rich secretory protein family. Although it has been primarily defined in human adipocytes, it has been identified that its level was higher in mononuclear leukocytes, macrophages, spleen, and bone marrow cells. Because ankylosing spondylitis is an inflammatory disease, it is suspected that upregulation of proinflammatory cytokines is effective in its immunopathogenesis. The aim of our study is to determine the serum resistin levels in patients with AS and to research the relationship with disease activity markers. A total of 30 patients with AS and 30 healthy controls were included in this study. Serum resistin concentrations, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath AS Disease Activity Index (BASDAI) were evaluated. In results resistin levels in ankylosing spondylitis group were significantly higher than in control group. But, there was no correlation between resistin and ESR, CRP, BASDAI. In conclusion, higher serum resistin levels in patients with AS compared to healthy subjects give clues that resistin could have a role in the pathogenesis of AS.

Acromegaly is a chronic and slowly developing endocrinopathy caused by hypersecretion of growth hormone and consequently of insulin like growth factor-1. The arthropathy in acromegaly can affect both axial and peripheral joints and it may present as the earliest clinical symptom of the disease. Patients with acromegaly may have high prevalence of joint related comorbidity and a reduced self perceived quality of life. An early diagnosis is crucial to obtaining the optimal treatment due to the potential reversibility of the lesions in an early stage. The aim of this case report is to draw attention to the possible articular involvement of acromegaly.

In recent years, biological agents have emerged as the most popular drugs for the treatment of rheumatoid arthritis (RA). The most frightening side effects of biological agents are infections, with tuberculosis being the leader. On account of the fact that biological agents have been used widespread, a number of algorithms have been developed to search latent tuberculosis. Among these algorithms, the most popular is the purified protein derivatives (PPD) test which is based upon late sensitivity reaction. The objective of this trial is to investigate the relevance of PPD response for the disease in RA patients. A total of 149 subjects (80 patients, 69 healthy), 35 RA patients who have not been treated before, 23 RA and 22 AS patients who are candidates for biological agents and being treated with immunosuppressive drugs, and 69 healthy subjects, have been included in this trial. Swelling joints, number of tender joints, visual analog scale, erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor were recorded. PPD was performed using the Mantoux method and was measured 72 h later. Statistically significant lower PPD values were determined in untreated RA patients compared to PPD values of treated RA and AS patients and healthy subjects. No correlation was determined between disease activity score 28 activity and PPD values in untreated and treated groups. Similarly, there was no correlation between acute phase reactants and PPD. Lower PPD responses in patients not being treated with immunosuppressive are due to the disease itself, rather than to the drugs being used. It is also important to interpret PPD results in early RA patients with suspicion, when it is intended to start anti tumor necrosis factor therapy.

Behcet's disease is a multisystemic disorder that the main pathological defect is vasculitis and superior vena cava syndrome (SVCS) caused by vasculopathy is a rare manifestation of the disease. Although successful results of endovascular surgery were observed in some cases, medical therapy may have priority among the treatment alternatives because of the high risk of surgery due to the lesional localization of the vessel. In this report, a Behcet's disease case with SVCS and 18 months' follow-up data with medical therapy is presented.

Sarcoidosis is an inflammatory multi-system disease, which may cause articular involvement. By causing sacroiliitis, it may mimic spondyloarthropathies. A case with a co-occurrence of sarcoidosis and late-onset of typical ankylosing spondylitis was presented and a possible association between these two entities was discussed.

Mucopolysaccharidosis (MPS) type I is an inherited disease caused by the absence or malfunctioning of lysosomal enzymes. Three subtypes, based on severity of symptoms, were described, and Scheie syndrome (also called MPS I S) is the mildest form. Although there may be some typical extra-articular manifestations, musculoskeletal involvement may be the only presenting sign in the absence of other symptoms in the patients with less severe forms. The patients with MPS I S, especially in attenuated phenotypes, may be sometimes difficult to recognize for physicians not familiar with the disease. With this case presentation, it is aimed to draw attention to this disease, which could be delayed for the correct diagnosis. An increased awareness of the disease may contribute to more accurate diagnosis, and patients may benefit from early intervention.