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Objectives: In this study, we aimed to evaluate the factors associated with disability and quality of life (QoL) in Turkish patients with systemic sclerosis (SSc). Patients and methods: Between January 2018 and January 2019, a total of 256 SSc patients (20 males, 236 females; mean age: 50.9±12.4 years; range, 19 to 87 years) who were diagnosed with SSc were included in the study. Disability and health-related QoL (HRQoL) were evaluated by the Health Assessment Questionnaire (HAQ), scleroderma HAQ (SHAQ), Duruöz Hand Index (DHI), and Short Form-36 (SF-36). Linear regression analysis methods were used to describe factors associated with disability and QoL of the patients. Results: All disability scores were higher and HRQoL scores were lower in diffuse cutaneous SSc patients compared limited cutaneous SSc, and differentiations were significant (p=0.001 and p=0.007). In multiple regression, pain (VAS) was the strongest predictor for high disability and low QoL scores (p Conclusion: Clinicians should consider the management of the pain and its sources as a key to improve better functional state and quality of daily life in SSc.

Objectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p Conclusion: The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating 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.

To evaluate of hepatitis serology and reactivation frequency in patients with rheumatic disease receiving biologic agents. Our study included patients with inflammatory rheumatic diseases from 23 centers, who were followed up with biological therapy. Demographic and clinical characteristics of the patients, duration of drug use and hepatitis serology and the state of viral reactivation were analyzed. A total of 4060 patients, 2095 being males, were included in our study. Of the patients, 2463 had Ankylosing Spondylitis (AS), 1154 had Rheumatoid Arthritis (RA), 325 had Psoriatic Arthritis (PsA), and 118 had other inflammatory rheumatic diseases. When the viral serology of the patients was evaluated, 79 patients (2%) who were identified as HBs Ag positive, 486 (12%) patients who were HBs Ag negative and anti-HBc IgG positive and 20 patients (0.5%) who were anti-HCV positive. When evaluated on a disease-by-disease basis, the rate of HBsAg was found to be 2.5% in RA, 2% in AS and 0.9% in PsA. Viral reactivation was detected in 13 patients while receiving biologic agents. HBs Ag was positive in nine patients with reactivation and negative in four patients. Anti-HBc IgG, however, was positive. Six of these patients had AS, four had RA, and three had PsA. The development of hepatitis reactivation in 11.4% of HBs Ag positive patients and 0.82% of anti-HBc IgG positive patients due to the use of biologic agents is an important problem for this group of patients. Antiviral prophylaxis is recommended to be started especially in patients who are HBs Ag positive and who are using biologic agents due to viral reactivation. Therefore, it is important to carry out hepatitis screenings before biologic agent treatment and to carefully evaluate the vaccination and prophylaxis requirements. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Objectives: This study aims to investigate the prognosis of novel coronavirus disease-2019 (COVID-19) infection in patients with the chronic inflammatory-rheumatic disease and evaluate the effects of immunosuppressive drugs on the prognosis, clinical characteristics, laboratory findings and hospitalization periods of the rheumatic patients with COVID-19 infection. Patients and methods: Between April 2020 and March 2021, a total of 101 patients (30 males, 71 females; mean age: 48±14.4 years; range, 46 to 48 years) with the rheumatic diseases diagnosed with COVID-19 infection were included. A total of 102 age- and sex-matched patients (35 males, 67 females; mean age: 44±14.4 years; range, 28 to 44 years) who were diagnosed with COVID-19 infection and had no history of rheumatic disease in the same period were included as the control group. Data including demographic characteristics of the patients, presence of any symptoms of COVID-19 disease, laboratory data at the time of diagnosis, and treatments administered were collected. Results: The rate of hospitalization was higher in 38 (37%) patients without rheumatic diseases than in 31 (31%) patients with rheumatic diseases (p=0.324). The rate of lung infiltration on radiographic examination was higher in patients without rheumatic diseases (40% vs. 49%) (p=0.177). COVID-19 infection symptoms such as anosmia 45 (45%), ageusia 51 (50%), shortness of breath 45(45%), nausea 29 (29%), vomiting 16 (16%), diarrhea 25 (25%) and myalgia-arthralgia 81 (80%) were higher in patients with rheumatic diseases. In terms of laboratory values, lymphocyte count (p=0.031) was statistically higher in patients without rheumatic diseases. Hydroxychloroquine (35%), oseltamivir 10 (10%), antibiotics 27 (26%), acetylsalicylic acid 52 (51%), and supplementary oxygen 25 (25%) treatments which used to cure COVID 19 infection were administered more in patients without rheumatic diseases. The number of treatments administered was higher in patients without rheumatic diseases (p Conclusion: Patients with the chronic inflammatory-rheumatic disease have more symptoms due to COVID-19 infection, but the disease course is not poor and hospitalization rates are lower.

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

WOS:000626257900003 PMID: 33948539 Abstract Objectives: In this study, we aimed to investigate whether there was any difference in kinesiotaping (KT) application on the upper trapezius muscle between a trained and untrained physiatrist in the management of patients with myofascial pain syndrome (MPS). Patients and methods: Between April 2013 and July 2015, a total of 45 patients (44 females, 1 males; mean age 31.9 +/- 8.0 years; range, 18 to 55 years) with MPS were included in this prospective, single-blind, randomized-controlled study. The patients were randomly divided into two groups. The first group (intervention group, n=24) was administered KT band with the muscle in a tense condition according to the muscle technique performed by a trained physiatrist, from the muscle origo toward its insertion point. The second group (control group, n=21) received no technique and KT was applied to the painful area by an untrained physiatrist using a randomly selected method. Primary outcome measures were pain at rest, during activity (0-10 cm visual analog scale), and threshold measurement with algometry (kg/cm(2)). Secondary outcome measures were function (Neck Pain and Disability Scale), degree of palpable muscle spasm, and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, at three and six weeks after the treatment. Results: There were significant improvements in all parameters in both groups. There were no significant differences in any parameters at six weeks. We demonstrated that KT, which was applied on active trigger points on the upper trapezius muscle by trained and untrained physiatrists, improved pain, palpable muscle spasm, neck function, quality of life, and patient satisfaction degree in patients with MPS. Conclusion: Our study results show that KT, which is applied by trained and untrained physiatrists, improves pain, palpable muscle spasm, neck function, quality of life in patients with MPS.

Coronavirus disease 2019 (COVID-19) refers to the clinical picture of an important and severe infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Considering the current knowledge on the pathophysiology and clinical manifestations of COVID-19, it is safe to state that both COVID-19 and inflammatory rheumatic disorders cause a cytokine storm and merit treatment with anti-rheumatic drugs. Three patients, who were on regular follow-up due to the diagnosis of familial Mediterranean fever (FMF), contracted COVID-19 infection; and their pre-clinical and post-clinical data as well as laboratory, prognosis and treatment data were investigated. Effects of colchicine in FMF patients who contracted COVID-19 infection were presented in this study. All the cases recovered from COVID-19 without complications. The present study suggests that colchicine can positively affect the prognosis of COVID-19 in FMF patients; therefore, experience of rheumatologists in the use of anti-inflammatory drugs can be highly instrumental in management of COVID-19 patients.

Objectives: This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods: Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results: The DHI had significant correlations with VAS-pain (r=0.367, p0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p0.05 for all). Conclusion: In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

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.

Coronavirus disease 2019 is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2. Coronavirus disease 2019 leads to the rapid activation of innate immune cells, particularly in patients with severe disease. Psoriatic arthritis is a heterogeneous chronic inflammatory disease characterized by the association of psoriasis and arthritis. Similar to those with other viruses, patients with psoriatic arthritis are at a significant risk of infection with severe acute respiratory syndrome coronavirus 2. Patients with psoriatic arthritis are immunosuppressed owing to immune dysregulation during the active disease period or owing to immunosuppressive drugs administered during remission, and they are prone to infections. The severe acute respiratory syndrome coronavirus 2 is a threat to millions of people globally owing to the decline in immunity and because a significant number of people develop severe illness. In the period of coronavirus disease 2019 pandemic, we briefly present recommendations for the treatment of psoriatic arthritis. In this review, we briefly address the management options and treatment recommendations for patients with psoriatic arthritis during and after the coronavirus disease 2019 pandemic in light of recent scientific publications.

Objectives: This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients. Patients and methods: This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale. Results: The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT. Conclusion: Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

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

COVID-19 hayatimiza girdigi tarihten beri sosyal hayatimizi, calisma hayatimizi, yasayisimizi, hastabakim hizmetlerini, arastirmalarimizi ve hatta davranis tarzimizi etkiledi. Ustelik bu oyle bir salgin kisadece bir ulkede degil, butun dunya ulkelerinde ayni zamanda ve benzer yogunlukta etkilendi. Adetaulkelerin saglik sistemleri bircok sorunla sinanmistir. Salgin sirasinda bircok bilinmeyen denklem ic iceidi. Salgin basinda o kadar cok bilinmeyenimiz vardi ki hastalara nasil yaklastigimizi, nasil tedavi verecegimizive hangi ilaclarin verilmesi gerektigini henuz net bir sekilde bilmiyorduk. Gecen sure zarfindabircok arastirma ve bircok deneyim bizim hastaliga karsi nasil davranmamiz gerektigini ogretti.Salgin sirasinda bilgi kirliliginin ne kadar zarar verebilir oldugunu yasayarak ogrendik. Ayrica, salginbize asi savaslarini gosterdi. Salgindan kurtulmak icin kullandigimiz asilarin ne kadar degerli oldugunu,gelismis ulkelerin nasil asi savaslarina girdigini ve asilama ile beraber salgin dinamiklerinin nasil degistiginigorduk.2020 ve 2021 yillari salgin yillari olarak tanimlanacaktir. Bu salgin sirasinda saglik calisanlarinindogru bilgilere ulasmasinin cok degerli oldugunu gorduk. Elinizdeki bu kaynak, salgini bizzat yasayarakelde edilen tecrubelerini paylasip olusturulmaya calisilmistir. Kitabin olusturulmasinda emegi olan tumarkadaslarimiza icten tesekkurlerimizi arz ediyoruz. Bu kitabin okuyuculara fayda getirmesini diliyoruz.Bu kitabi, cani pahasina COVID-19 ile savasan ve hayatini kaybeden tum saglik calisanlarina armaganediyoruz.Saglicakla kalin. Prof. Dr. Oguz KARABAYDoc. Dr. Hamad DHEIRDoc. Dr. Selcuk YAYLACI

Şahin, Nilay (Balikesir Author), Objectives: This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey. Patients and methods: A total of 961 patients (346 males, 615 females; mean age: 46.9+/-12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and Short Form-36 scores were all recorded. Results: Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The Visual Analog Scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD. Conclusion: In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment.

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

Background C-reactive protein (CRP) is often normal in patients with psoriatic disease. Herein, we aimed to define markers of systemic inflammation in patients with monomorphic and polymorphic psoriatic skin, entheseal, and joint disease. Methods Three-step approach: (i) selection of serum markers elevated in psoriatic arthritis compared healthy controls from a panel of 10 different markers reflecting the pathophysiology of psoriatic disease; (ii) testing of these selected markers as well as C-reactive protein (CRP) in a larger cohort of 210 individuals- 105 healthy controls and 105 patients with psoriatic disease with either monomorphic skin (S), entheseal (E) or joint (A) involvement or polymorphic disease with various combinations of skin, entheseal and joint disease (SE, SA, EA, SEA); (iii) testing whether tumor necrosis factor (TNF) and interleukin (IL)-17 inhibitor therapy normalizes these markers. Results CRP was not elevated or was rarely elevated in the subgroups (S 0%, E 0%, A 20%, SE 7%, SA 33%, EA 27%, SEA 33%) despite active psoriatic disease. In sharp contrast, beta-defensin 2 and lipocalin-2 levels were elevated in the majority of patients with monomorphic skin (93% and 73%) and entheseal (both 53%), but not joint disease (27% and 20%). Conversely, elevations of calprotectin and IL-8 were found in the majority of patients with monomorphic joint disease (both 73%). IL-22 was elevated in all three monomorphic disease manifestations (S 60%, E 46%; A 60%). Furthermore, the vast majority of patients with polymorphic psoriatic disease (SE, SA, EA, SEA) showed widespread marker elevation. IL-17- and TNF inhibitor treatment significantly lowered all 5 markers of inflammation in PsA patients. Conclusions Systemic inflammation is detectable in the majority of patients with psoriatic disease, even if CRP is normal. The respective marker pattern depends on the manifestation of psoriatic disease with respect to skin, entheseal, and joint involvement.

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.

AMAÇ: Romatoid Artrit (RA), oryantasyon, dikkat vebellek zayıflığı gibi azalmış bilişsel işlevlere neden olur.Sunulan bu çalışmanın amacı RA’da bilişsel işlevlerin birbelirleyicisi olarak eklem yıkımını ve hastalığın diğer parametrelerinideğerlendirmektir.GEREÇ VE YÖNTEM: Bu kesitsel çalışma, 45 hasta ve 40sağlıklı kontrol içemektedir. RA’lı hastalarda radyolojikprogresyon skoru (≥0.5, modifiye Sharp / van der Heijdeskorları- MTS’ler), 28 eklemin hastalık aktivite skoru(DAS-28) ve 44 eklemin hastalık aktivite skoru (DAS-44)değerlendirildi. Mini Mental Test (MMSE) ve HastaneAnksiyete Depresyon Ölçeği (HADÖ) değerlendirildi.Sonuçlar, bilişsel işlevleri belirlemek için hasta ve kontrolgrubu arasında karşılaştırıldı.BULGULAR: MMSE skorları açısından gruplar arasındaistatistiksel olarak anlamlı fark vardı (p=0.003). RAve kontrol grupları arasında anksiyete ve depresyondüzeyleri açısından anlamlı farklılık yoktu. MMSEskoru; hastalık süresi (p=0.011, r=-0.371), Sharp skoru(p=0.018, r=-0.350) ve DAS-28(p=0.044, r=-0.296) skoruile ilişkilendirildi. Depresyon skoru da DAS ile ilişkiliydi(p=0.004, r=0.425). Romatoid faktör düzeyleri, antisikliksitrullinat peptid düzeyleri ve bilişsel işlev testleriarasında herhangi bir ilişki bulunamadı.SONUÇ: Sonuçlar, uzun süredir RA olan hastalardainflamatuar mediatörlere maruz kalmanın, eklemlerietkilediği sürece merkezi sinir sisteminde de bozulmayaneden olabileceğini göstermektedir. Bilişsel bozulma,hastalık şiddeti ve eklem yıkımı ile ilişkili idi. Dolayısıyla,radyografik eklem hasarı, RA’daki bu kronik süreç boyuncanöronal hasarın ve bilişsel bozulmanın boyutunu yansıtanpozitif bir ön belirteç olabilir., OBJECTIVE: Rheumatoid Arthritis (RA) cause poorcognitive functions including reduced memory,orientation and attention. The aim of the present studyis to evaluate joint destruction and other parameters ofdisease as a predictor of cognitive functions in RA.MATERIAL AND METHODS: This cross-sectional studyincluded forty five patients and forty healthy controls.Radiological progression score (≥0.5 the modified Sharp/van der Heijde scores- MTSs), disease activity scoreof 28 joints (DAS-28) and disease activity score of 44joints (DAS-44) were evaluated in patients with RA. MiniMental State Examination (MMSE) and Hospital AnxietyDepression Scale (HADS) were evaluated and the resultswere compared between patients and control groups todeterminate cognitive functions.RESULTS: There was a statistically significant differencebetween groups in terms of MMSE scores (p=0.003). Therewere no significant differences in terms of anxiety anddepression levels between RA and control groups. MMSEscore was correlated with disease duration (p=0.011, r=-0.371), Sharp score (p=0.018, r=-0.350) and DAS-28 score(p=0.044, r=-0.296). Depression score was also correlatedwith DAS (p=0.004, r=0.425). No relationship was foundbetween Rheumatoid factor levels, anti-cyclic citrullinatedpeptide levels and the cognitive function tests.CONCLUSIONS: The results indicate that exposureto inflammatory mediators in patients with longstanding RA may lead to deterioration on centralnervous system as long as affecting joints. Cognitivedeterioration was correlated with disease severityand joint destruction. Thus, the radiographic jointdestruction can be a positive predictor of reflectingthe extent of neuronal damage and cognitivedeterioration during this chronic process in RA.

Objectives: This study aims to investigate the association of pentraxin 3 (PTX3) with neutrophil/lymphocyte ratio (NLR) rather than the disease activity score 28 using C-reactive protein in rheumatoid arthritis (RA). Patients and methods: The study included 59 RA patients (11 males, 48 females; mean age 53.79±13.55 years; range 40 to 66 years) and 20 healthy controls (5 males, 15 females; mean age 50.41±6.11 years; range 43 to 56 years). Complete blood count tests were recorded and NLR and platelet/lymphocyte ratio were calculated. PTX3 and interleukin-6 levels were examined in serum samples. Disease activity of RA patients was assessed by disease activity score 28. Results: Demographic characteristics were similar between the two groups, with no statistically significant difference in terms of sex, age, and body mass index (p>0.05). NLR, PTX3 and interleukin-6 levels were higher in patients with RA than the control group (p

Purpose There are limited studies related to the rehabilitation of neglected Monteggia fracture-dislocations. This study reports the results of the rehabilitation of neglected Monteggia fractures and dislocations and the best treatment options available. Material and methods Thirteen children were rehabilitated between 2009 and 2012. A retrospective chart review was conducted to record the following: age, gender, anatomic region of fractures, time delay from symptom onset to fracture, Bado classification, Mayo Elbow Performance Index (MEPI) which includes pain, range of motion and daily life comfort, surgeries, length of hospitalization, location and pattern of fracture, length of follow-up and complications. Results The study group included thirteen children and adolescents; eleven males and two females with a mean age of 8.5 (range 2-15) years. According to the Bado classification, 11 patients had type 1, one had type 3 and one had type 4 fracture-dislocations. For Mayo Elbow Performance Index (MEPI) scales, patients that were less than ten years old had greater mean scores. Two patients had superficial infection, one had subluxation, one had osteoarthritis, one had delayed bone union and two had rigidity at the elbow. Conclusion The goals of elbow rehabilitation following Neglected Monteggia cases include restoring function by restoring motion and muscle performance; influencing scar remodeling and preventing joint contracture; and restoring or maintaining joint stability. Patients aged younger than 10 years and intervals of less than one-year, between trauma and diagnosis, as well as early and effective rehabilitation were found as important parameters regarding favorable outcomes.

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:Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire was developed to measure quality of life (QoL) in patients with psoriatic arthritis (PsA) (1).Objectives:The aim of the study was to assess validity and psychometric properties of the PsAQoL questionnaire.Methods:The translation-back translation method by a bilingual panel was used to translate the original PsAQoL into Turkish (2). Face and content validities were evaluated via cognitive debriefing interviews with 10 PsA patients. Then, patients with PsA according to CASPAR criteria were recruited to assess feasibility, missing data, floor and ceiling effect, reliability, and construct validity. Reliability was assessed by internal consistency. Construct validity was investigated by convergent and divergent validity by assessing the PsAQoL’s relations with QoL and non-QoL parameters. For this purpose, demographics, clinical characteristics (shown in Table 1), survey data including PsAQoL, Short form 36, visual analog scales for pain and fatigue, Health Assessment Questionnaire, and Hospital Anxiety and Depression Scale results were recorded.Results:One hundred and sixty-two patients were recruited and 74 of them had axial PsA. Cognitive debriefing showed the Turkish version of PsAQoL to be clear, understandable, and relevant. It was easy to complete and calculate, with the 3 minutes and 20 seconds, respectively. The Cronbach’s alpha coefficient for internal consistency was 0.930. The questionnaire presented no floor or ceiling effect (Conclusion:The Turkish version of the PsAQoL is a valid and disease-specific instrument with good psychometric characteristics to assess PsA-specific QoL.References:[1]McKenna SP, Doward LC, Whalley D, Tennant A, Emery P, Veale DJ. Development of the PsAQoL: a quality of life instrument specific to psoriatic arthritis. Ann Rheum Dis. 2004;63(2):162-169.[2]Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186-3191.Table 1.Spearman’s correlation coefficients of PsAQoL with the other parameters for construct validityConvergentDivergentSF-36 subscalesRhoClinical ParametersRhoSurveysRhoPhysical component-0.744**Age0.150BASDAI (n:74)0.355**Mental component-0.731**Disease duration0.014VAS Pain0.408**Physical functioning-0.629**Tender joint count0.262**VAS Fatigue0.447**Physical role limitations-0.640**Swollen joint count0.170*HAQ0.533**Emotional role limitations-0.576**MASES0.152HADS Anxiety0.535**Vitality-0.657**PASI-0.032HADS Depression0.517**Emotional well-being-0.590**DAPSA0.409**Social functioning-0.591**DAS280.322**Pain-0.535**BASMI (n: 61)0.032General health-0.536**** pPsAQoL: Psoriatic Arthritis Quality of Life, SF-36: Short Form 36, MASES: Maastricht Ankylosing Spondylitis Enthesitis Score, PASI: Psoriasis Area Severity Index, DAPSA: Disease Activity in PSoriatic Arthritis, DAS28: Disease Activity Score 28, BASMI: Bath Ankylosing Spondylitis Metrology Index, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, VAS: Visual analog scale, HAQ: Health Assessment Questionnaire, HADS: Hospital Anxiety and Depression Scale.Disclosure of Interests:None declared

Moleküler biyoloji alanında yaşanan gelişmeler romatolojik hastalıkların tedavisi için yeni yaklaşımların önünü açmıştır. Romatolojik hastalıkların patogenezlerinin daha iyi anlaşılması tedavide yeni hedefler ortaya çıkmasını sağlamıştır. Biyolojik ajanların kullanıma girmesi ile birçok romatolojik hastalığın tedavisinde remisyon artık daha gerçekçi bir hedef gibi görülmektedir. Biz bu yazıda, romatolojik hastalıklarda son yıllarda kullanımı giderek artan biyolojik ajanların etki mekanizmaları,klinik kullanımları, etkinlik ve güvenlik verilerini paylaşacağız.

Fibromyalgia syndrome (FMS) is a non-articular rheumatic disorder of unclear etiology, characterized by widespread body pain, fatigue and, psychological complaintsOBJECTIVES: To investigate the serum levels of neuron-specific enolase (NSE) in patients with FMS and to evaluate the relationship between cognitive function, quality of life and psychological state.Fifty-five female patients diagnosed with fibromyalgia according to the American College of Rheumatology (ACR) classification criteria, and 40 healthy female subjects were enrolled in the study. Life quality scale [(Fibromyalgia Impact Questionnaire (FIQ)], psychological state (Beck Depression Scale), and cognitive dysfunction (mini mental test, clock drawing test) scales were used for patients and control subjects. Serum NSE levels were studied using the ECLIA method.No significant differences were found in the serum NSE levels between the FMS patients and the control subjects (p0.05). Life quality and psychological state scores were found to be higher in FMS patients relative to the control group (p0.001). However, no significant differences were detected in cognitive function (p0.05). Significant correlations were not found between the serum NSE levels and quality of life, psychological state and cognitive functions (p0.05).No significant difference was determined between the groups in terms of NSE levels. Further studies, including larger series, should be carried out to clarify this relationship.

Background Lateral epicondylitis (LE) is a painful condition that affects the tendinous tissue of the lateral epicondyle of the humerus and leads to loss of function of the affected limb. Therefore it can have a major impact on the patient's social and personal life. Many treatments are recommended for lateral epicondylitis; unfortunately the evidence is limited. Objectives The aim of study was to investigate the effect of kinesio taping (KT) on pain, grip strength and function in patients LE. Methods Thirty-one (23 females, 8 males) patients with LE were included. KT was applied twice a week for 2 weeks. Pain at rest, activity of daily living (ADL), night and palpation on lateral epicondyle was evaluated with the visual analog scale (VAS 0-10 cm), and the grip strength was measured with a hand held dynamometer. The stage of the disease was evaluated by the Nirschl score and the functional status was assessed with Patient-Rated Forearm Evaluation Questionnaire (PRTEQ) score. These parameters were evaluated before, at 2 weeks and 6 weeks after treatment. Patients' satisfaction was also recorded on a Likert scale after treatment at 2 weeks and 6 weeks. Results The average age of the patients was 43.58 ± 9.02. The dominant limb was affected in 64.5% (20) of the patients. After the application of KT on lateral epicondyle, there was a significant improvement in all parameters in terms of pain, Nirschl score, hand grip strength, patient satisfaction, and PRTEQ scores at 2 and 6 weeks. Conclusions Kinesio taping can be an effective treatment method in LE. This application improves pain, grip strength and functional status of the patients with LE.

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

Background Psoriatic disease is composed of skin, entheseal and joint disease, which can manifest isolated or combined. Little is known about the systemic inflammation levels in psoriatic disease as a robust IL-6 signal is missing and therefore acute phase reactants such as C-reactive protein are often normal. Measuring systemic inflammation in the different manifestations of psoriatic disease is therefore a continuous unmet need. Objectives To better define systemic inflammation in patients with psoriatic disease limited to the skin (S), the entheses (E) or the joints (arthritis, A) or with a combination of these disease manifestations (SE, SA, EA, SEA). Methods Hypothesis-driven approach selecting markers that are (i) either targets of IL-23/IL-17 pathway activation (b-defensin 2, lipocalin 2, IL-22), (ii) associated with neutrophil/monocyte activation (calprotectin, IL-8) and (iii) achieve serum concentrations sufficient for reliable detection by standard ELISA. Parameters were assessed in 210 individuals comprising 105 healthy controls and 105 patients with psoriatic disease (each 15 for isolated (S, E, A) and composed disease manifestations SE, SA, EA, SEA). Results are expressed as percent positive patients with levels above three standard deviations over the mean level in healthy controls. In addition, 6-months sequential data on levels of these markers were collected in 20 patients treated with secukinumab or adalimumab to test treatment effects. Results CRP levels were normal in the majority of individuals. The respective percentages of patients with normal CRP ( 1.88 ng/mL) and lipocalin-2 (>24.7 ng/mL) were elevated in the majority of patients with isolated skin and entheseal, but not joint disease. Conversely, elevations of calprotectin (>3.58 mig/mL) and IL-8 (>10.3 pg/mL) were found in the majority of patients with isolated joint disease. IL-22 was elevated (>17.1 pg/mL) in all three manifestations of psoriatic disease. Reflecting a combination of the findings the vast majority of patients with composed disease manifestation (SE, SA, EA, SEA) showed widespread marker elevation. IL-17 and TNF inhibition differentially lowered and partially normalized elevated markers of inflammation. Conclusion Systemic inflammation is detectable in the majority of patients with psoriatic disease, even if CRP is normal. The respective marker pattern depends on the manifestation (skin, entheses, joints) of psoriatic disease, with beta-defensin 2 and lipocalin-2 reflecting skin and entheseal disease, calprotectin and IL-8 joint disease and IL-22 a combination of these disease manifestations. Disclosure of Interests Maria Sokolova Grant/research support from: M. Sokolova was a PARTNER Fellow, Celgene Sarl, Kemal Nas: None declared, Yubin Luo: None declared, David Simon Grant/research support from: Novartis, Consultant for: Lilly, Speakers bureau: Janssen, Yi Zhao: None declared, Jurgen Rech Grant/research support from: Bristol-Myers Squibb and Celgene (greater than $10,000), Consultant for: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Speakers bureau: Bristol-Myers Squibb, Celgene, Chugai, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Roche, Sanofi Aventis, and UCB (in total more than $10,000), Mario Zaiss: None declared, Georg Schett: 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

Aim The aim of this study was to investigate whether increased intra-abdominal pressure caused by pelvic inflammation and frequent use of the Valsalva maneuver increases the incidence of pelvic organ prolapse (POP) among female patients with ankylosing spondylitis (AS). Methods Thirty-nine patients diagnosed as having AS through the use of the modified New York criteria, 47 patients with chronic low-back pain (CLBP), and 38 healthy controls (HCs) were included in this study. All the patients and the HCs underwent thorough physical and gynecological examinations. Pelvic organ prolapse was graded blindly by a gynecologist. Presence or absence of cystocele (CS), rectocele (RC), and uterine prolapse (UP) was noted. Results The incidences of CS, RC, and UD were significantly higher among the AS patients compared with the HCs (p = 0.001, 0.026, and 0002, respectively). The incidences of CS (p = 0.042) and UD (p = 0.017) were significantly higher among the AS patients compared with the CLBP patients. Conclusions The incidence of POP is higher among patients with AS compared with normal population. These patients should be questioned about the symptoms of POP and recommended, if necessary, regular gynecological examinations, as well as specific exercises including those targeting AS.

The aim of this study was to investigate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6, insulin and HOMA-IR levels in patients with rheumatoid arthritis.This study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were measured. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). To evaluate quality of life, the Health Assessment Questionnaire disability index was applied.The serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were found to be higher than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively). A positive correlation was evident between the DAS 28 score and IL6 levels (r=0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p0.05). Fetuin A levels were positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032).Elevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of fetuin-A, insulin HOMA-IR, pentraxin-3, CRP and ESR were not associated with clinical severity of the RA.

Objective: Anxiety and depression are psychological disorders which frequently accompany and affect the course of rheumatic diseases. Quality of life is also affected by psychological status. In this study, we aimed to assess psychological status and quality of life in patients with ankylosing spondylitis (AS) and fibromyalgia (FM) and investigate their association with functional status, disease activity and physical limitation. Method: Thirty-seven patients with AS and thirty-four patients with FM were included in this study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were used for assessment of disease activity and physical functions respectively. The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire was used for disease-related quality of life in AS patients. Fibromyalgia Impact Questionnaire (FIQ) was used for assessment of functional status in FM patients. Nottingham Health Profile (NHP) and the Hospital Anxiety and Depression Scale (HADS) were, respectively, used for assessment of quality of life and psychological status in groups. Results: There was no significant difference between the groups in HADS-total, HADS-depression and HADS-anxiety scores (p>0.05). However, patients with FM had significantly higher NHP-total and NHP-pain scores compared to patients with AS (p

BACKGROUND Diseases causing disabilities lead to sexual dysfunction. However, studies that evaluate sexual functions in patients with traumatic lower limb amputations (LLA) are limited and controversial. OBJECTIVE The objective is to evaluate sexual functions in male patients with LLA and to identify factors that might contribute to sexual dysfunction. The hypothesis is that male patients with LLA would experience worse sexual and emotional functioning and consequently emotional impairment that consequently influenced the sexual function. METHODS Sixty men with traumatic LLA and 60 healthy men were assessed according to the International Index of Erectile Function (IIEF) scoring system. Emotional state was assessed by the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and the quality of life by the Short Form-36 Health Survey (SF-36). RESULTS Patients had significantly lower scores in the IIEF total score and subscores in comparison with the controls. Intercourse satisfaction scores were significantly higher (p< 0.05) in patients with trans-tibial amputation than in those with trans-femoral amputation. BDI and BAI scores negatively correlated with erectile function, sexual desire, intercourse satisfaction, overall satisfaction and total IIEF scores. The mental and physical scores of SF-36 significantly correlated with some of the sub scores and IIEF total scores. The power of statistical analysis for study population was 100% according to the given effect size (α= 0.01). CONCLUSION The present study suggests that the LLA leads to impairments in the sexual function and quality of life in male patients. Also, sexual dysfunction in patients is strongly associated with emotional state, pain, level of amputation and quality of life.

WOS: 000460934000017 PubMed ID: 29991120 AIM: Rheumatoid arthritis (RA) is a chronic disease of unknown etiology. Various cellular and molecular immunological factors are involved in the pathophysiology of RA. Recent studies suggest that neutrophils and alpha-defensins released from the neutrophils assume significant roles in the pathogenesis of RA. The aim of this study was to investigate the potential association between serum alpha-defensin levels and disease activity, functional status, radiological damage and several laboratory parameters in patients with RA. MATERIALS AND METHODS: A total of 42 patients with established RA who presented to the outpatient clinics of rheumatology of Dicle University Hospital and 38 healthy control subjects were included in this study. Disease activity was assessed by using the Disease Activity Scale 28 (DAS28). Quality of life was assessed by using the Rheumatoid Arthritis Quality of Life (RAQoL) Questionnaire and the Nottingham Health Profile (NHP). Functional status was assessed by using the Stanford Health Assessment Questionnaire (HAQ). Laboratory examinations included the following tests: CBC, ESH, CRP, and HNP 1-3. RESULTS: Patients with an active disease exhibited higher HNP 1-3 levels compared to patients in remission. At a cut off value of 708 pg/ml, sensitivity and specificity of the tests for HNP 1-3 were 72% and 70.6%, respectively. CONCLUSION: In the present study, patients with an active disease had significantly higher serum HNP 1-3 levels compared to patients in remission. In this respect, serum HNP 1-3 can be a useful marker in the assessment of disease activity and remission in patients with RA.

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