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

Objectives: This study aims to investigate whether peer-led group education + booklet is superior to booklet only to increase ankylosing spondylitis (AS) patients’ knowledge about their disease. Patients and methods: A total of 56 patients (46 males, 10 females; mean age 41.9±9.2 years; range, 22 to 58 years) with a definite diagnosis of AS who were under follow-up in our outpatient clinic between August 2010 and January 2012 were included in this study. The patients were randomly allocated to the peer-led education + booklet (education group, n=27) and booklet only (control group, n=29). To assess the level of patients’ knowledge, a patient knowledge questionnaire containing four domains was used. Evaluations were made at baseline, four weeks, and six months. The variables were “number of correct choices” (NoCC), “number of correct items” (NoCI) and percent of correct choices for each domain; the later one was resembled by the name of that domain (area A, area B, etc.). Results: The variables that improved in both groups were NoCC, NoCI, and “pharmacotherapy and physical therapy area” (area C). These improvements were similar between the groups (respectively, p=0.915, p=0.830, p=0.791). Conclusion: Reading a booklet alone is as successful as peer-led education + booklet for knowledge transfer about their disease in patients with AS. In this study, the most knowledge gain was achieved in “drug treatment and physical therapy” area.

Objective Loss of proprioception and balance disorders are commonly observed in patients with knee osteoarthritis. In this study, we aimed to investigate the effects of balance and proprioception exercises in patients with knee osteoarthritis. Design A single-center randomized trial with three parallel arms. Setting A tertiary health care facility in Turkey. Participants Female patients with knee osteoarthritis aged 40–70 years. Interventions Ten-week exercise program in Biodex training, classical balance training and isometric strengthening groups. Main measures Dynamic balance (overall stability index and the modified Clinical Test of Sensory Interaction and Balance), pain (visual analogue scale), physical function (30-s chair stand test and 40-meter fast-paced walk test) and quality of life (Knee Injury and Osteoarthritis Outcome Score). Results Eighty-nine patients enrolled in the study. The Biodex training group, the classical training group, and the control group had overall stability index values of 1.0 ± 0.07, 1.4 ± 0.07 and 1.4 ± 0.07, and the Modified Clinical Test of Sensory Interaction and Balance – Condition-3 values of 0.7 ± 0.04, 0.9 ± 0.04 and 0.9 ± 0.04 respectively, at the end of treatment. In terms of pain scores on movement, each group showed significant improvement compared to their baseline, and the classical balance training group had better scores than the control group. No other significant difference was found between the groups. Physical function and quality of life outcomes showed significant main effects only in the time factor. Conclusions Balance and proprioception exercises may have positive effects on dynamic balance and pain. The effects on physical function and quality of life should be investigated in further studies with larger sample.

The aim was to measure the effects of the home exercises supported with supervision on the fall-related variables in older people.Seventy-five individuals over the age of 65 were enrolled. They were allocated to a "minimally supervised home exercise group" (group 1) or a "home exercise group" (group 2). Falls efficacy, fear of falling (FOF), fall risk, functional mobility, balance performance, and depression were assessed using the Falls Efficacy Scale International (FES-I), visual analog scale (VAS-FOF), the Elderly Falls Screening Test (EFST), the Timed Up and Go Test (TUGT), Tinetti's Balance Performance Oriented Mobility Assessment (BPOMA), and the Geriatric Depression Scale Short Form (GDS-SF), respectively. Participants performed a four-day weekly exercise program for eight weeks. Group 1 was supervised one day per week on a group basis.Results are based on 75 subjects (group 1 n = 37, group 2 n = 38). Analysis of variance revealed significant interactions only for FES-I, VAS-FOF, TUGT, and BPOMA. The difference between groups was significant only for TUGT score; group 1 had better scores at 8 weeks and 6 months. FES-I, VAS-FOF, and BPOMA were significantly improved in both groups. EFST and GDS improved in the total sample but not at the group level.Supervised home exercise seems to be superior only for functional mobility (TUGT). Further studies with a larger sample are needed to draw conclusions about depression and fall risk. The intervention was feasible and atendible.ClinicalTrials.gov" NCT05337839. Retrospectively registered.

Amaç: Egzersiz tedavisi, kronik non-spesifik bel ağrısı (NSKBA) tanısı alan hastalarda en yaygın önerilen tedavi şeklidir. Ancak bir egzersiz yönteminin başka bir egzersiz yöntemine üstün olup olmadığı tartışmalıdır. Gereç ve Yöntem: Bu çalışmada NSKBA olan hastalar deney grubu (gözetimli aerobik egzersiz + ev egzersizi) ve kontrol grubu (sadece ev egzersizi) olmak üzere iki gruba randomize edildi. Hastalar tedavi öncesi, tedavi bitimi ve tedavi bitiminden üç ay sonra ağrı şiddeti, spinal mobilite, lomber ektansör kas dayanıklılığı, depresif semptom varlığı ve şiddeti, özürlülük ve yaşam kalitesi bakımından değerlendirildi. Bulgular: Deney grubunda tüm değerlendirmelerde anlamlı düzelme saptanırken kontrol grubunda, ağrı, spinal mobilite ve yaşam kalitesinin fiziksel komponentinde anlamlı düzelme saptandı. Kontrol grubuna göre, deney grubunda değerlendirme parametrelerinde zamanla meydana gelen olumlu değişim anlamlı olarak daha yüksekti. Sonuç: Aerobik egzersiz, NSKBA olan hastaların yetersizliklerinin düzeltmesine, aktivite düzeylerinin ve katılım düzeylerinin arttırılmasına katkı sağlayabilir. Ancak hangi aerobik egzersiz tipinin (sıklığının, süresinin ve yoğunluğunun) daha etkili olduğuna yönelik çalışmalara ihtiyaç vardır., Purpose: Exercise therapy is the most commonly recommended form of treatment for patients diagnosed with non-specific chronic low back pain (NSCBP). However, it is controversial whether an exercise method is superior to other ones. Materials and Methods: In this study, patients with NSCBP were randomized into two groups as experimental group (supervised aerobic exercise + home-based exercise) and control group (home-based exercise alone). The patients were evaluated in terms of pain severity, spinal mobility, lumbar extensor muscle endurance, presence and severity of depressive symptoms, disability, and quality of life at the time points of before treatment, treatment ends, and three months after treatment ends. Results: In the experimental group, there was a significant improvement in all assessments, while in the control group, there was a significant improvement in pain severity, spinal mobility, and the physical component of quality of life. In the experimental group, the positive change in assessment parameters over time was significantly higher than in the control group. Conclusion: Aerobic exercise may contribute to correcting the impairments, increasing activity and participation levels of patients with NSCBP. However, studies are needed to determine which type of aerobic exercise (frequency, duration, and intensity of that type) is more effective.

Objective: To compare the effect of dextrose prolotherapy (DPT) with saline in the treatment of chronic lateral epicondylopathy (LE). Design: Triple-blinded randomized controlled trial. Setting: Ph...

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.

Although a number of therapeutic interventions for trigger-point inactivation have been studied, it remains controversial which intervention is better.To compare the effectiveness of the kinesio taping and dry needling methods in patients with trigger-point related myofascial pain syndrome of the upper trapezius muscle.A total of 42 patients were randomly allocated to the kinesio taping group (n= 23) and dry needling group (n= 19). The patients were assessed for pain, pressure pain threshold (PPT), cervical range of motion (CROM), and function at baseline, at short- and medium-term stages after treatment. To investigate the effects of the interventions over time, two-way repeated measures analysis of variance (ANOVA) was used.There was a significant improvement in pain intensity at rest and cervical motion, in the PPT readings (p0.05), in CROM (p0.05), and in function (p0.05) in both groups, with no superiority either (p0.05).Kinesio taping may be a choice of trigger point inactivation in patients who do not want to be needled or who show contraindication(s) to treatments other than kinesio taping.

Spontaneous bilateral quadriceps rupture is rarely seen in systemic diseases. Although the underlying mechanism in tendon rupture is not clearly understood, β2-amyloidosis, chronic acidosis, impaired collagen metabolism, accumulation of uremic toxins and secondary hyperparathyroidism are held to be responsible. The patients with bilateral spontaneous quadriceps rupture can be able to achieve significant functional improvement with the postoperative rehabilitation program. In this article, we aimed to present a patient with hemodialysis who developed spontaneous bilateral quadriceps and unilateral triceps rupture and discuss in company with the literature.

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: 000438624900001, PubMed ID: 29777340, In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

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

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

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.

Aim To compare the Disease Activity Score with 28 joint (DAS28) using erythrocyte sedimentation rate (ESR) (DAS28-ESR) and DAS28 using C-reactive protein (CRP) (DAS28-CRP) with thresholds validated for DAS28-ESR in Turkish patients with rheumatoid arthritis. Method The DAS28 data of 112 patients with rheumatoid arthritis followed in a local outpatient clinic were used. First, the correlation between DAS28-CRP and DAS28-ESR and the correlation between their unique components ([0.36 × In (CRP + 1) + 0.96] and [0.70 × In (ESR)]) were analyzed. Second, a Bland–Altman plot was constructed for the evaluation of the level of agreement between DAS28-CRP and DAS28-ESR. Lastly, the agreement between these two methods was analyzed by κ coefficient. Results Although there was a strong correlation between DAS28-CRP and DAS28-ESR, the correlation between their unique components was fair. Although more than 95% of the point data fall between the upper and lower bounds of the limit of agreement, the percentage error (46%) was higher than the acceptable proportion of 30%. The κ coefficient of agreement between DAS28- ESR and DAS28-CRP with validated thresholds for DAS28-ESR was 0.42, which was close to the lower boundary for moderate agreement. Conclusion The results of this study demonstrated that there is discordance between DAS28-ESR and DAS28-CRP with the validated thresholds for DAS28-ESR. Using the DAS28-CRP with threshold values validated for DAS28-ESR may lead to errors in the determination of disease activity and therefore may lead to errors in the management of patients with rheumatoid arthritis.

KAYDOK, ERCAN/0000-0003-2262-7261; Salbas, Ender/0000-0001-7460-2889; Basaran, Sibel/0000-0003-3228-3909; karahan, ali yavuz/0000-0001-8142-913X; yumusakhuylu, yasemin/0000-0001-6843-1614; Baygutalp, Fatih/0000-0002-7344-584X WOS: 000419743500005 Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH) D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain.

Objectives This study aims to explore current disease activity status and simultaneous pharmacological therapies in patients with established rheumatoid arthritis (RA) to determine the extent to which treatment targets are achieved. Patients and methods One hundred patients (7 males, 93 females; median age 57 years; range 31 to 76 years) with established RA receiving any conventional synthetic disease modifying anti-rheumatic drug (DMARD) and/or biological DMARD for at least three months were enrolled. Disease activity was determined by using the Simplified Disease Activity Index. First, patients were categorized into four groups as remission, low disease activity, moderate disease activity, and high disease activity. Then, they were divided into two subgroups, namely a remission/low disease activity subgroup and moderate disease activity/high disease activity subgroup. Results Fifty-one percent of the patients had remission or low disease activity. The most frequently used conventional synthetic DMARDs were methotrexate (50%) and leflunomide (34%). Forty-five percent of patients were receiving glucocorticoid therapy. In patients receiving only conventional synthetic DMARDs, the proportion of remission and low disease activity was 54% (42/78). Forty-two percent (8/19) of the patients receiving biological DMARDs were in remission or had low disease activity. A comparison of subgroups revealed that median age and sulfasalazine use were significantly higher in the moderate disease activity/high disease activity subgroup. Conclusion The results of this study demonstrated that half of patients with established RA had moderate or high disease activity in our local outpatient clinic. Some barriers might be responsible for the difficulties in controlling disease activity. Determining such barriers might result in a better clinical response during the management of patients with established RA in real-life practice.

Background: Recent recommendations have established clinical remission ideally or low disease activity (LDA) as therapeutic targets in all patients with rheumatoid arthritis (RA). Controlled studies of biologic agents have primarily assessed treatment effects in patients with severe RA; patients with moderate disease activity, whoconstitute a larger group, have received far less attention. In Period 1 of the PRESERVE trial, the proportion of subjects with moderately active RA achieving LDA or remission were evaluated after treatment with etanercept 50mg once weekly (QW) plus methotrexate for 36 weeks.Methods: Subjects with DAS28 >3.2 and ≤5.1 despite stable doses of oral methotrexate received open-label etanercept 50mg QW plus methotrexate (screening dose permitted to be titrated up to 25 mg/wk through week 28) for 36 weeks.Results: 834 subjects received treatment and were analyzed. Subjects were mostly female (83%), Caucasian (74%), RFþ (73%), and aCCPþ (78%), with a mean age of 48 years and disease duration of 7 years. Mean baseline DAS28 was 4.4; SDAI, 19.1; ESR, 22.2 mm/hr; and CRP, 12.3 mg/L. Efficacy results from Period 1 are shown in the table. The most commonly reported adverse events (AEs) were headache (6.1%), nasopharyngitis (5.4%), and upper respiratory tract infection (4.4%). Twenty-two subjects (2.6%) discontinued due to AEs.Conclusions: Substantial proportions of subjects with moderately active RA who received etanercept 50mg QW plus methotrexate for 36 weeks achieved LDA (85%-86%), DAS28 remission (67%), or SDAI remission (25%). Therefore, these ambitious goals can be achieved realistically in a high percentage of patients with moderate disease activity.

Aim: The aim of this study was to investigate foot deformities in patients with rheumatoid arthritis (RA), to detect frequency of deformities and to assess the relationship between foot deformities and foot functions. Methods: Anteroposterior and lateral radiographs of 40 patients and 40 control subjects were studied. The hallux valgus (HV) angle, intermetatarsal angle between first and second metatarsals, intermetatarsal angle between first and fifth metatarsals, and calcaneal pitch were measured on radiographs. Foot functions were measured by the Foot and Ankle Outcome Score (FAOS). Results: The frequency of foot deformities in RA patients was determined as 78.8%. The most frequent foot deformity in RA patients was HV (62.5%), followed by metatarsus primus varus (MPV) (41.3%). MPV and splaying of the forefoot deformities were significantly more frequent in RA patients than the control group (P

Background The aim of this study was to determine the prevalence of impairments relevant to upper extremity following breast cancer surgery and its impact on disability and health-related quality of life. Methods Sixty-seven female patients being treated with modified radical mastectomy or breast conserving surgery were included. They were evaluated for impairments (arm edema, loss of handgrip strength, limited shoulder joint range of motion, and pain), physical disability using the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and for health related quality of life by means of the functional assessment of cancer therapy-breast+4 (FACT-B+4). Results The most common impairment observed was arm pain on motion; the cause of 20% variance in disability score (r = 0.203, P = 0.000). Arm pain on motion, anterior chest wall pain, loss of grip strength, and shoulder flexion were significant factors in different domains of quality of life according to the FACT-B+4 questionnaire. Conclusion Pain relief should be the priority of treatment along with the prevention of joint movement restriction to ensure a sufficient quality of life for surgically treated breast cancer patients.

We previously reported the efficacy of a 4-week home-based exercise therapy for patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether short-term improvements in the functional status and quality of life were maintained at 1 year. Patients who completed 4-week home-based exercise program were advised to maintain the same exercises for 1 year duration. Changes of functional status and quality of life in patients with RA were evaluated by the Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Scale (RAQoL). The change of the variables at the different time points (baseline, 4 weeks, and 1 year) was assessed by the repeated measure of ANOVA test with Geisser-Greenhouse correction. Pairwise ANOVA comparisons adjusted using the Bonferroni correction were conducted. Twenty-eight (63.6%) of 44 patients were available for follow-up at 1 year. The results of repeated measure ANOVA showed that there was a statistically significant difference between three assessments in the HAQ (P = 0.015) and RAQoL (P = 0.037) scores at the end of the follow-up. Improvements in the functional status and health-related quality of life at 4 weeks were maintained at 1-year follow-up. In conclusion, we observed significant improvements in the functional status and health-related quality of life by 4-week home-based exercise program. Furthermore, these improvements were maintained at 1-year follow-up. Further studies are needed to confirm the usefulness of the home-based exercise therapy.

The objective is to develop a Turkish version of the foot and ankle outcome score (FAOS) and to investigate its validity and reliability. The Turkish version of FAOS was developed after the translation and back-translation. The translated version was pretested on 20 patients with rheumatoid arthritis. Then, the Turkish FAOS was administered to 55 patients having foot and ankle problems. They were also evaluated by using the four subscales of the Turkish version of AIMS2, and the Turkish version of SF-36 questionnaire to test validity. Fifty patients filled out the FAOS for second time to determine test–retest reliability. Construct validity was investigated with use of Spearman’s rank correlation coefficient. Test–retest reliability was assessed with use of the intraclass correlation coefficient (ICC) and Cronbach’s alpha score. The psychometric properties of the Turkish FAOS were generally similar to the original FAOS. The random ICC for the five subscales ranged from 0.70 to 0.96. The Cronbach’s alpha coefficient ranged from 0.79 to 0.97. Construct validity of the FAOS was good. The Turkish FAOS correlated with the SF-36 and AIMS2 scales. The Turkish version of FAOS was valid and reliable instrument to assess the foot and ankle related problems. However, to assess its responsiveness further studies are needed.

To evaluate the incidence of comorbid diseases and their impact on functional outcome in patients after stroke.A prospective study.A total of 140 patients after stroke.Comorbidities were assessed with the Liu comorbidity index. Functional independence was evaluated using the Functional Independence Measure (FIM). The relationship between comorbidities and functional outcomes were investigated. The impact of comorbidities on functional outcome was examined with multiple stepwise regression analysis.Ninety-four (67%) of 140 patients completed the study. The most frequent comorbid condition was hypertension at the initial visit. The weighted comorbidity index at baseline was negatively correlated with the follow-up FIM score and functional gain. Multiple regression analysis revealed that follow-up FIM score could be best explained by FIM at admission and the contribution of the weighted comorbidity index to functional outcome was 3.1%.Comorbid diseases are common among patients after stroke. They were shown to have a negative correlation with functional outcome; however, their impact on functional outcome was not clear. The proper evaluation of comorbid conditions should be included in stroke outcome research.

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

In this paper, we present the case of a 27-year-old male patient who was admitted to our clinic with bilateral drop foot and spastic paraplegia after the ingestion of organophosphate (chlorpyrifos) and diagnosed with organophosphate induced delayed neuropathy (OPIDN). Patellar deep tendon reflexes were hyperactive, Achilles reflexes were absent, and patellar clonus were present bilaterally at the neurological examination. The results of electrophysiological studies were compatible with motor axonal polyneuropathy. The patient was admitted to the neurological rehabilitation program and was able to ambulate using a pair of plastic ankle-foot orthosis and walker. Six months after the baseline, Botulinum toxin type A was injected bilaterally to adductor magnus (100 U) and adductor longus (50 U) muscles. After the Botulinum toxin injection, spasticity of the hip adductor muscles was decreased from grade 4 to grade 3 according to the modified Ashworth scale. By the end of seven-month follow-up period, partial improvement was observed in the muscle strength of the patient, and he became independent in his daily activities. In this article, we discuss possible mechanisms of OPIDN, on the basis of clinical features and the rehabilitation process of a 27-year-old male patient diagnosed with OPIDN, with a review of the current literature.

Objectives: This study aims to report Turkish League Against Rheumatism s 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.

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.

In this study, we evaluated the relationship between the severity of enthesitis and outcome of measurement indices, clinical and laboratory parameters in patients with ankylosing spondylitis (AS). Thirty-three patients who fulfilled the modified New York criteria for AS were included in this study. Patients were asked to record the severity of current pain, night pain and morning stiffness on a 10-cm visual analogue scale. Stoke Enthesitis Index (SEI) was used to measure the severity of enthesitis. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) were calculated. SEI was correlated positively only with BASDAI (r = 0.370, P = 0.034). There was no relation between SEI and laboratory parameters (Erythrocyte Sedimentation Rate and C Reactive Protein). Our data suggest that using an enthesitis index such as SEI can be a valuable tool in the evaluation of disease activity in patients with AS. However, evaluation of enthesitis severity is based on information given by patient and should be combined with objective parameters such as spinal measurements when assessing disease activity.

Radiographically detected vertebral fractures (VF) are a hallmark of osteoporosis. Several approaches to describe VF have been proposed. The objective of this study was to evaluate the intra- and interobserver variability of semiquantitative Kleerekoper's method in osteoporotic VF assessment. Sixty-seven postmenopausal osteoporotic (L2-4 T-scoreor =-2.5) women with a mean age of 65.2+/-7.51 years were included into the study. Lateral radiographs of thoracic and lumbar spine were evaluated in all patients. Kleerekoper's method was used to define VF. Two observers evaluated all radiographs independently. To investigate intraobserver reproducibility, the first observer reevaluated all radiographs a month later on a separate occasion. Intra- and interobserver agreement was calculated using the kappa statistic. The agreement between two readings for the first observer was 86.3% with a corresponding kappa score of 0.573 (95% confidence limits of kappa score were 0.505-0.642). Interobserver agreement was 87.7% with a corresponding kappa score of 0.660 (95% confidence limits were 0.602-0.718). We observed a moderate agreement for Kleerekoper's method in vertebral fracture assessment. There is no gold standard or standardized measurement or description for VF. Quantitative assessment of VF is essential in epidemiologic studies and in clinical drug trials, but a semiquantitative technique, which is done by experienced observers, should also be added to evaluate the entire spectrum of visible features that are helpful in identifying deformities.

Ayhan, Fikriye Figen/0000-0001-6906-991X; Duruoz, Mehmet Tuncay/0000-0003-3584-2788; Ataman, Sebnem/0000-0003-3570-3825; Sahin, Gunsah/0000-0002-4215-6957; Gur, Ali/0000-0001-9680-6268; WOS: 000338636500018 PubMed: 24252034 Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 +/- 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS. Pfizer Company The authors express their gratitude to all members of the TRASD-IP AS Study group for their cooperation and to Pfizer Company for the registry sponsorship.

Objectives To determine the effect of peer-led group education on the quality of life and depression in patients with ankylosing spondylitis (AS). Methods Eighty patients with definite AS were allocated randomly to either the education or control group. The education group (n = 40) was subjected to a peer-led group education program about disease and was given an educational booklet, while the control group (n = 40) was given the educational booklet only. Levels of quality of life and depression were measured at baseline, immediately after education (fourth week) and at 6 months in both groups. Results The results are based on 56 (n = 27, education group; n = 29, control group) patients. The level of quality of life and depressive symptoms were not changed except for a deterioration in the social functioning subgroup of Short From (SF)-36 in both groups. When the groups were compared, there were no significant differences between changes in social functioning scores. Conclusions Peer-led education did not alter quality of life levels and depression scores. However, because of the maintainance of quality of life levels, this type of intervention may be considered as a supplementary intervention to the standard medical care for management of AS.

WOS: 000302270900002, Objectives: Knee osteoarthritis (OA) is a common disease which causes pain, disability and great socioeconomic burden as a result. Turkish League Against Rheumatism (TLAR) initiated a project to prepare national, "evidence-based recommendations for the management of knee osteoarthritis" supported by expert-opinion in order to assist the physicians who are interested in knee OA in their daily clinical practice. Materials and methods: The expert committee was composed of 25 academicians, 23 of whom were physical medicine and rehabilitation (PM&R) specialists (three also had rheumatology subspeciality) and two were orthopedic surgeons. At the first meeting, the previous guidelines were discussed, and 2008 Osteoarthritis Research Society International (OARSI) recommendations were decided to be taken as the fundamental template for national recommendations. Databases of the Pubmed, Embase, Cochrane, and Turkish Medical Index were used to search the literature, and this was carried out for the period between 2009-2010 for international publications since studies up to 2009 were present in the 2010 OARSI update. No limit was applied for searching of national publications. The selected relevant publications were graded according to evidence level and quality, and were sent to the members who were then asked to suggest propositions according to their experiences, knowledge, and review of the literature. After amalgamation and editing of new proposals, Delphi rounds were started. After five Delphi rounds, the propositions on which the members were in consensus, were discussed with regard to evidence and the "strength of recommendation" was determined by measuring on visual analog scale (VAS) for each proposal at the final meeting. Results: Nineteen propositions (one for general principles, nine for non-pharmacologic treatments, seven for pharmacologic treatments, and two for surgical treatments) were accepted as the "TLAR Evidence-Based Recommendations for the Management of Knee OA" in consensus as a result of Delphi rounds. Conclusion: Evidence-based recommendations for the management of knee OA were developed by TLAR for the first time in our country. The recommendations should be updated regularly according to new evidence and insights. It is expected that physicians who are interested in knee OA will benefit greatly from this report in their daily clinical practice.

The aim of this study was to assess the quality of life (QoL) in patients with multiple sclerosis (MS), and to evaluate its association with disability and psychosocial factors especially depression and fatigue.Demographic characteristics, education level, disease severity, and disease duration were documented for each patient. QoL, fatigue level, cognitive status, and depression level of patients were assessed by Multiple Sclerosis Quality of Life-54, Fatigue Severity Scale, Mini Mental State Scale, and Beck Depression Inventory, respectively.Seventy-nine patients with MS were included in the study. There was a moderate degree of impairment in the QoL scores of MS patients. The most affected parts of QoL were included: role limitation-related physical and emotional problems and physical and social functions. Both physical and mental health components of QoL showed a positive correlation with the educational level and employment status; a negative correlation with the level of disability, fatigue, and depression. Depression, disability level, and fatigue were the strongest variables associated with QoL, and the most important predictor of QoL was depression.Our results have shown that both physical and mental health components of QoL were negatively affected by MS. The most important predictor of QoL was depression followed by disability and fatigue. To improve the QoL for MS patients, in addition to physical disability, the influences of depression and fatigue on QoL should be taken into consideration.

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

Amaç: Türkiye Romatizma Araştırma ve Savaş Derneği?nin (TRASD) Ankilozan Spondilit (AS) için ulusal tedavi önerilerinin oluşturulmasıdır.Gereç ve yöntemler: TRASD tarafından altı Romatoloji ve 19 Fiziksel Tıp ve Rehabilitasyon uzmanı olmak üzere toplam 25 kişiden oluşan bir bilimsel kurul oluşturuldu. Önerilerde 2006 yılında yayınlanan Ankilozan Spondilit Değerlendirme Uluslararası Çalışma Grubu (ASAS)/Romatizmaya karşı Avrupa Ligi (EULAR) önerileri ve Ocak 2005 - Eylül 2010 arasında yayınlanmış olan ilişkili yayınlar konusundaki sistematik bir inceleme temel alındı. Öneriler oluşturulurken Delphi süreci kullanıldı. Ankilozan spondilit tedavisi ile ilgili 12 ana öneri oluşturuldu. Oylama yapılarak önerilerin güçlülük düzeyi bir nümerik derecelendirme skalası ile belirlendi.Bulgular: On iki öneri hasta değerlendirilmesini, hasta takibini ve farmakolojik ve non-farmakolojik yöntemleri içermektedir. ASAS/EULAR önerilerine bazı ilaveler ve önerilerde bazı küçük değişiklikler yapılmıştır. Tüm öneriler yeterli kuvvete sahipti.Sonuç: Bilimsel kanıtlar ve uzmanların görüş birliği ile AS tedavisine yönelik ulusal öneriler oluşturulmuştur. Bu öneriler, yeni gelişmeler doğrultusunda düzenli olarak güncellenmelidir Objectives: To develop Turkish League Against Rheumatism (TLAR) National Recommendations for the management of ankylosing spondylitis (AS). Materials and methods: A scientific committee of 25 experts consisting of six rheumatologists and 19 physical medicine and rehabilitation specialists was formed by TLAR. Recommendations were based on the 2006 ASsessment in Ankylosing Spondylitis International Working Group (ASAS)/European League Against Rheumatism (EULAR) recommendations and a systematic review of associated publications between January 2005 and September 2010. A Delphi process was used to develop the recommendations. Twelve major recommendations were constructed for the management of AS. Voting using a numerical rating scale assessed the strength of each recommendation. Results: The 12 recommendations include patient assessment, patient follow-up along with pharmacological and non- pharmacological methods. Some minor additions and changes have been made to the ASAS/EULAR recommendations. All of the recommendations had sufficient strength. Conclusion: National recommendations for the management of AS were developed based on scientific evidence and consensus expert opinion. These recommendations will be updated regularly in accordance with recent developments

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

The Modified Ashworth Scale (MAS) is commonly used in clinical practice for grading spasticity. However, it was modified recently by omitting grade ‘1+’ of the MAS and redefining grade ‘2’. The aim of this study was to investigate the inter-rater reliability of MAS and modified MAS (MMAS) for the assessment of poststroke elbow flexor spasticity. Sixty-four patients with poststroke hemiplegia were enrolled. The mean age and time since the stroke were 60.5±11.9 years and 15.7±10.2 weeks, respectively. The patients were tested by two raters having equal experience in applying MAS. They were not subjected to any training for administering MMAS. After performing no more than two test movements, the raters graded the resistance felt, according to the MAS and MMAS, respectively based on same stretch. The degree of agreement was analyzed using the weighted kappa (kw) statistic. Inter-rater agreements were very good for both MAS and MMAS, with weighted kappa values of 0.868 and 0.892, respectively. The highest agreements were observed for grade ‘0’ in applying MAS and for grade ‘2’ in applying MMAS; on the other hand, the lowest agreements were observed for grade ‘2’ in applying MAS and for grade ‘3’ in applying MMAS. According to our results, MAS and MMAS have very good inter-rater reliability for assessment of poststroke elbow flexor spasticity. Neither of the scales is superior to each other when using them to grade spasticity in patients with hemiplegia for this muscle group. Die modifizierte Ashworth-Skala (MAS) wird in der klinischen Praxis ublicherweise zur Einstufung von Spastizitat eingesetzt. Sie wurde unlangst jedoch abgeandert, indem Grad 1+ der MAS gestrichen und Grad 2 neu definiert wurde. Ziel dieser Studie war die Untersuchung der Inter-Rater-Reliabilitat der MAS und der modifizierten MAS (MMAS) zwecks Messung der Spastizitat des Ellbogenbeugers bei Schlaganfallpatienten. An der Studie nahmen insgesamt 64 halbseitig gelahmte Schlaganfallpatienten teil. Das Durchschnittsalter und die nach dem Schlaganfall verstrichene Durchschnittszeit betrugen jeweils 60.5±11.9 Jahre bzw. 15.7±10.2 Wochen. Die Patienten wurden von zwei Begutachtern untersucht, die bei der Anwendung der MAS die gleichen Kenntnisse haben. Sie erhielten kein Training bzgl. der Anwendung der MMAS. Nach der Durchfuhrung von maximal zwei Prufbewegungen werteten die Begutachter den verspurten Widerstand nach der MAS und der MMAS am jeweils gleichen Abschnitt des Beugers aus. Das Ausmas der Ubereinstimmung wurde mit Hilfe der gewichteten Kappa-Statistik (kw) analysiert. Die Inter-Rater-Ubereinstimmungen erwiesen sich bei der MAS und der MMAS als sehr gut; die gewichteten Kappa-Werte lagen bei jeweils 0.868 bzw. 0.892. Die hochsten Ubereinstimmungen wurden bei der Anwendung von Grad 0 der MAS und bei der Anwendung von Grad 2 der MMAS beobachtet; die geringsten Ubereinstimmungen andererseits bei der Anwendung von Grad 2 der MAS und bei der Anwendung von Grad 3 der MMAS. Unsere Ergebnisse belegen, dass die MAS und MMAS eine sehr gute Inter-Rater-Reliabilitat bei der Messung der Spastizitat des Ellbogenbeugers bei Schlaganfallpatienten haben. Keine der beiden Skalen hat sich als die uberlegenere Skala bei der Gradierung der Spastizitat bei dieser Muskelgruppe bei halbseitig gelahmten Patienten erwiesen. La escala de Ashworth modificada (EAM) se utiliza frecuentemente en la practica clinica para la clasificacion de la espasticidad. Sin embargo, esta escala fue modificada recientemente mediante la omision del grado ‘1+’, en la EAM, y la redefinicion del grado ‘2’. El objetivo de este estudio fue investigar la fiabilidad interevaluadores para la EAM y la EAM modificada (EAMM) en la valoracion de la espasticidad de los musculos flexores del codo tras un accidente cerebrovascular. En el estudio participaron 64 pacientes con hemiplejia causada por accidente cerebrovascular. La media de las edades y del tiempo transcurrido desde el accidente cerebrovascular fueron de 60.5±11.9 anos y 15.7±10.2 semanas, respectivamente. Los pacientes fueron evaluados por dos evaluadores con igual experiencia en la aplicacion de la EAM, y que no habian recibido adiestramiento para la aplicacion de la EAMM. Despues de realizar no mas de dos pruebas de movimientos, los evaluadores determinaron el grado de resistencia percibida, mediante la EAM y la EAMM, respectivamente, en la misma aplicacion de fuerza de oposicion. El grado de concordancia se analizo mediante el coeficiente estadistico kappa ponderado (Kw). La concordancia interevaluadores fue muy buena, tanto en la EAM como en la EAMM, con valores de kappa ponderado de 0.868 y 0.892, respectivamente. La mayor concordancia se observo para el grado ‘0’ en la aplicacion de la EAM y para el grado ‘2’ en la aplicacion de la EAM; por el contrario, la menor concordancia se observo para el grado ‘2’ en la aplicacion de la EAM y para el grado ‘3’ en la aplicacion de la EAMM. Segun nuestros resultados, la fiabilidad interevaluadores es muy buena tanto en el caso de la EAM como en el de la EAMM para la valoracion del grado de espasticidad de los flexores del codo tras un accidente cerebrovascular. Ninguna de estas escalas es superior a la otra cuando se las utiliza para determinar el grado de espasticidad en pacientes con hemiplejia de dicho grupo de musculos. L'echelle d'Ashworth modifiee (MAS - Modified Ashworth Scale) est couramment utilisee en pratique clinique pour le classement de la spasticite. Toutefois, elle a recemment ete modifie, en omettant le grade ‘1+’ et en redefinissant le grade ‘2’. Cette etude avait pour objet d'etudier la fiabilite inter-evaluateurs de l'echelle MAS et de l'echelle MAS modifiee (MMAS) pour l'evaluation de la spasticite des flechisseurs du coude post AVC. Soixante-quatre patients presentant une hemiplegie post AVC ont ete recrutes. L'âge moyen et le temps ecoule depuis l'accident vasculaire cerebral etait de 60.5±11.9 ans et 15.7±10.2 semaines, respectivement. Les patients ont ete testes par deux evaluateurs ayant une experience dans l'application de l'echelle MAS. Ces derniers n'avaient pas suivi de formation a l'administration de l'echelle MMAS. Apres n'avoir pas effectue plus de deux mouvements d'essai, les evaluateurs ont classe la resistance ressentie selon les echelles MAS et MMAS, respectivement basees sur le meme allongement. Le degre d'accord a ete analyse avec la statistique kappa ponderee (kw). Les accords entre les evaluateurs ont ete tres nets pour MAS et MMAS, avec des valeurs kappa ponderees de 0.868 et 0.892, respectivement. Le plus haut degre d'accord a ete observes pour la classe ‘0’ dans l'application de l'echelle MAS et de grade ‘2’ dans l'application de l'echelle MMAS ; d'autre part, les taux d'accord les plus bas ont ete observes pour le grade ‘2’ dans l'application de l'echelle MAS et de grade ‘3’ dans l'application de MMAS. Selon nos resultats, les echelles MAS et MMAS presentent une tres bonne fiabilite inter-evaluateurs pour l'evaluation de la spasticite des flechisseurs du coude post AVC. Ni l'une ni l'autre de ces echelles n'est superieure a l'autre lorsqu'elles sont utilisees pour classer la spasticite chez les patients presentant une hemiplegie pour ce groupe musculaire.

The aim of this study was to investigate foot deformities in patients with rheumatoid arthritis (RA), to detect frequency of deformities and to assess the relationship between foot deformities and foot functions.Anteroposterior and lateral radiographs of 40 patients and 40 control subjects were studied. The hallux valgus (HV) angle, intermetatarsal angle between first and second metatarsals, intermetatarsal angle between first and fifth metatarsals, and calcaneal pitch were measured on radiographs. Foot functions were measured by the Foot and Ankle Outcome Score (FAOS).The frequency of foot deformities in RA patients was determined as 78.8%. The most frequent foot deformity in RA patients was HV (62.5%), followed by metatarsus primus varus (MPV) (41.3%). MPV and splaying of the forefoot deformities were significantly more frequent in RA patients than the control group (P0.05). Mild to moderate effect on FAOS subscales was observed in RA patients. There was a slight, but significant correlation between the foot deformities and the FAOS subscales except for quality of life subscale.In this study, it has been shown that foot deformities are frequent in patients with RA and that there is slight deterioration in foot functions related to RA. Our results indicated that foot deformities have small, but clinically important changes on foot functions. There is a need for more studies, which evaluates the foot deformities, to further explore the relationship between the foot deformities and foot function in patients with RA.

The aim of this study was to determine the quality of life (QoL) at the third month after stroke and to identify the factors related with and determinants of QoL in geriatric stroke patients. Eighty of 122 patients who were assessed within the first week after stroke were reevaluated at the third month. Patients were divided into two groups as those of ≥65 years old (geriatric group) and those of65 years old (non-geriatric group). The stroke severity, functional status, and ambulation level were assessed by the Canadian neurological scale (CNS), the functional independence measure (FIM), and the functional ambulation classification scale (FACS) within the first week of stroke, respectively. Depression and QoL levels were also determined at the third month using the Zung self-rating depression scale (ZDS) and both the Short Form-36 (SF-36) survey and the stroke-specific quality of life (SSQoL) scale, respectively. The QoL of 80 patients according to the SF-36 were lower than those of general population. No significant difference was found in stroke severity, functional status at baseline and third month, depression and QoL between geriatric and non-geriatric patients (p0.05). The most influenced subscale of QoL was work/productivity in geriatric patients, and the main determinant of QoL was the functional status during the assessment. Stroke patients had an impaired QoL, and geriatric patients did not demonstrate a difference in terms of QoL compared to non-geriatric patients. The fact that the main determinant of QoL was functional status has been suggested that improving of physical function may be helpful to provide a better QoL for stroke patients.