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Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily involves the axial skeleton but may also present with peripheral joint involvement and extra-articular involvement. The present study aims to quantitatively analyze posture, balance, and gait parameters in patients with axSpA and and assess associated factors. This cross-sectional case-control study included 51 axSpA patients (30 males, 21 females; mean age 40.94 ± 10.48 years) and 51 age- and sex-matched healthy controls. In patients with axSpA, the Ankylosing Spondylitis Disease Activity Score CRP, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Maastrich Ankylosing Spondylitis Enthesitis Score (MASES), and the Ankylosing Spondylitis Quality of Life (ASQoL) scale were used. For postural analysis, DIERS formetric (Diers GmbH, Schlangenbad, Germany) videoraster- stereography device was utilized. HUR SmartBalance BTG4 (HUR-labs Oy, Kokkola, Finland) balance platform was used for postural balance and limit of stability (LOS) measurement. Participants were evaluated using Berg Balance Scale (BBS), Functional Reach Test (FRT) and Timed Up and Go Test (TUG). The Zebris FDM type 3 (Zebris Medical GmbH, Germany) walking platform was used to measure the spatiotemporal parameters of the participants. Comparison of postural parameters showed that sagittal imbalance and cervical depth distance were increased in the axSpA group than in the healthy participants (p < 0.004). Comparison of functional balance parameters showed that BBS and FRT scores were significantly lower (p < 0.001) in the axSpA group than in the control group, while TUG scores were significantly higher (p < 0.001). The LOS values, which evaluate dynamic balance were significantly lower, indicating impairment, in the axSpA group. In the measurement of postural sway, which indicates static balance, all 23 subparameters were found to be similar. When analyzing the spatiotemporal gait parameters, in the axSpA group compared with those in the control group; Foot angles (p= 0.028) and stride width (p = 0.004) were increased, whereas step lengths (p = 0.004) and stride lengths (P = 0.004) were decreased. In the axSpA group the gait speed was decreased (p = 0.004). When axSpA was analyzed separately as radiographic and nonradiographic axSpA, similar findings were observed in posture, balance, and gait parameters. No significant difference was observed. We found that the clinical assessments most closely associated with posture, balance, and gait analyses were BBS, FRT, TUG, and BASFI., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The aim of this study was to analyze the pregnancy process, especially the Familial Mediterranean fever (FMF) disease course and attack types during pregnancy, and to examine the relationship between disease-related factors and female infertility in FMF patients. The study, which was planned in a multicenter national network, included 643 female patients. 435 female patients who had regular sexual intercourse were questioned in terms of infertility. Pregnancy and delivery history, FMF disease severity and course during pregnancy were evaluated. The relationship between demographic and clinical findings, disease severity, genetic analysis results and infertility was investigated. 401 patients had at least 1 pregnancy and 34 patients were diagnosed with infertility. 154 patients had an attack during pregnancy. 61.6% of them reported that attacks during pregnancy were similar to those when they were not pregnant. The most common attack symptoms were fever, fatigue and abdominal pain-peritonitis (96%, 87%, and 83%, respectively) in the pregnancy period. The disease-onset age, disease activity score, gene mutation analyses, and regular colchicine use (> 90%) were similar between the fertile and infertile groups, while the frequency of previous appendectomy and alcohol consumption rates were higher in individuals with infertility. Our results indicated no significant change in the frequency and severity of attacks during pregnancy. The low rate of infertility (7.8%) in our patients was noted. It has been suggested that the risk of FMF-related infertility may not be as high as thought in patients who are followed up regularly and received colchicine., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The association between spondyloarthritis and cardiovascular (CV) diseases is complex with variable outcomes. This study aimed to assess the prevalence rates of CV diseases and to analyze the impact of CV risk factors on CV disease in patients with spondyloarthritis. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group's prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461-6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631-7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189-28.810, p = 0.030) were the independent predictors for CV disease. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group's prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461-6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631-7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189-28.810, p = 0.030) were the independent predictors for CV disease. The prevalence rate of CV disease was 3.0% in patients with spondyloarthritis. Hypertension, dyslipidemia, and cancer history were the independent CV risk factors for CV disease in patients with spondyloarthritis., (© 2024. The Author(s).)

Case reports of plexopathy after prostate cancer are usually neoplastic. Radiation-induced lumbosacral plexopathy and insufficiency fractures have clinical significance due to the need to differentiate them from tumoral invasions, metastases, and spinal pathologies. Certain nuances, including clinical presentation and screening methods, help distinguish radiation-induced plexopathy from tumoral plexopathy. This case report highlights the coexistence of these two rare clinical conditions. Herein, we present a 78-year-old male with a history of radiotherapy for prostate cancer who developed right foot drop, severe lower back and right groin pain, difficulty in standing up and walking, and tingling in both legs over the past month during remission. The diagnosis of lumbosacral plexopathy and pelvic insufficiency fracture was made based on magnetic resonance imaging, positron emission tomography, and electroneuromyography. The patient received conservative symptomatic treatment and was discharged with the use of a cane for mobility. Radiation-induced lumbosacral plexopathy following prostate cancer should be kept in mind in patients with neurological disorders of the lower limbs. Pelvic insufficiency fracture should also be considered if the pain does not correspond to the clinical findings of plexopathy. These two pathologies, which can be challenging to diagnose, may require surgical or complex management approaches. However, in this patient, conservative therapies led to an improvement in quality of life and a reduction in the burden of illness.

Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular (CV) comorbidities. The association of CV diseases (CVD) and traditional CV risk factors has been debated, depending on patient and RA characteristics. This study aimed to find the prevalence of CVD and CV risk factors in patients with RA. A multi-center cross-sectional study was performed on RA patients using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) in September 2022. Socio-demographic, clinical, and follow-up data were collected. Myocardial infarction, ischemic heart disease, peripheral vascular disorders, congestive heart failure, ischemic stroke, and transient ischemic attack were regarded as major adverse cardiovascular events (MACEs). CVD was defined as the presence of at least one clinical situation of MACE. Group 1 and Group 2 included patients with and without CVD. Prevalence rates of CVD and traditional CV risk factors were the primary outcomes. Secondary outcomes were the differences in the clinical characteristics between patients with and without CVD. An analysis of 724 patients with a mean age of 55.1 ± 12.8 years diagnosed with RA was conducted. There was a female preponderance (79.6%). The prevalence rate of CVD was 4.6% (n = 33). The frequencies of the diseases in the MACE category were ischemic heart disease in 27, congestive heart failure in five, peripheral vascular disorders in three, and cerebrovascular events in three patients. The patients with CVD (Group 1) were significantly male, older, and had higher BMI (p = 0.027, p < 0.001, and p = 0.041). Obesity (33.4%) and hypertension (27.2%) were the two CV risk factors most frequently. Male sex (HR = 7.818, 95% CI 3.030-20.173, p < 0.001) and hypertension (HR = 4.570, 95% CI 1.567-13.328, p = 0.005) were the independent risk factors for CVD. The prevalence of CVD in RA patients was 4.6%. Some common risk factors for CVD in the general population, including male sex, older age, and hypertension, were evident in RA patients. Male sex and hypertension were the independent risk factors for developing CVD in patients with RA., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Peripheral neuropathy may cause serious complications such as foot ulcers and Charcot joint which can prevent by early diagnosis. We aimed to analyze the diagnostic value of ultrasonographic measurements of nerves and muscles in distal symmetric axonal polyneuropathy (DSAP). Study included 51 DSAP patients and 51 controls. Nerve conduction studies were performed. Median, ulnar, tibial, superficial peroneal, and sural nerves and the abductor pollicis brevis (APB), abductor digiti minimi (ADM), first dorsal interosseous (FDI), extensor digitorum brevis (EDB), abductor hallucis (AH) and tibialis anterior (TA) muscles were evaluated with ultrasound. The Toronto clinical scoring system (TCSS) was used to assess the severity of neuropathy. The median, ulnar, and tibial nerve cross-sectional areas (CSA) were higher in the DSAP group (p = 0.025, p = 0.011, p < 0.001 respectively) while superficial peroneal and sural nerve CSAs were not differed. Only AH and EDB ultrasonographic findings from the muscles differed between the two groups. Effect of diabetes and DSAP on sonographic findings were assessed with two-way ANOVA. Results indicated that only DSAP had a significant effect on sonographic nerve and muscle examination. The area under the ROC curve was 0.831 ± 0.042 for tibial nerve CSA (p < 0.001) with a cut-off value of 15.5 mm 2 (sensitivity 74% and specificity 83%). Median, ulnar and tibial nerve CSAs were found to be larger in polyneuropathy patients and they were associated with the clinical and electrophysiological severity of polyneuropathy. ROC analysis showed that tibial nerve CSA may have a predictive value in the diagnosis of DSAP., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This study is primarily aimed to determine whether transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) treatments have any effect on central sensitization (CS) in patients with knee osteoarthritis (OA) and to investigate which treatment is more effective., Methods: In this randomized controlled trial, 80 patients were randomized into four treatment groups: TENS, Plasebo-TENS, IFC, and Plasebo-IFC. All interventions were applied 5 times a week for 2 weeks. Primary outcome was pressure pain threshold (PPT), which is accepted as the objective indicator of CS, at the painful knee and at the shoulder as a painless distant point. Other outcome measures were the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index, Timed Up and Go Test, pain catastrophizing scale, Beck Depression Inventory, and Tampa Scale of Kinesiophobia., Results: All assessment parameters were improved, without a significant difference among the groups except PPT. PPT scores were significantly improved in TENS and IFC groups when compared with the sham groups at 2 weeks and 3 months. In addition, this improvement was even more pronounced in the TENS group. Multivariable logistic regression analysis showed that the patient's inclusion in the TENS group, an initial high PPT, and an initial low VAS score were independent risk factors for improvement in the PPT., Conclusions: This study shows that TENS and IFC reduced pain sensitivity as compared to placebo groups in patients with knee OA. This effect was more pronounced in the TENS group.

Autoimmune rheumatic diseases have their own specific clinical presentation, and can affect multiple systems. Neurological involvement of autoimmune rheumatic diseases may involve both the central and peripheral nervous systems. Inflammation of neural tissue, autoantibody-mediated reactions, and small vessel vasculitis may be effective in the pathogenesis of neuropathy in autoimmune rheumatological diseases. Autoimmune rheumatic disease with pure motor neuron involvement is very rare in the literature. The case is here presented of a 58-year-old female patient who presented with the complaints of increasing pain and weakness in the extremities and was diagnosed with lower motor neuron disease and overlap syndrome. The patient was treated with cyclophosphamide, pulse steroid, hydroxychloroquine and intravenous immunoglobulin. After 3 months of treatment, a significant improvement was observed in the patient's clinical complaints and laboratory parameters. In conclusion, some patients with undiagnosed autoimmune rheumatic diseases may have neurological complaints. Clinicians should investigate patients with such neurological complaints for autoimmune rheumatic diseases., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Considering that the comorbid situations during the management of Spondyloarthritis (SpA) have been underlined in several recommendations, the main objective of this study was to evaluate the comorbid conditions of Turkish patients with SpA., Patients and Methods: This cross-sectional observational study was conducted with 1,242 SpA patients (844 males, 398 females; mean age: 43.9±11.0 years; range, 19 to 81 years) diagnosed according to the modified New York criteria for ankylosing spondylitis or the Assessment of SpondyloArthritis International Society (ASAS) criteria. The patient data were collected from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStar) between February 1, 2019, and December 29, 2020. Clinical and demographic data, including, age, sex, disease duration, body mass index (BMI), pain, patient's global assessment, physician's global assessment, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, and Maastricht Enthesitis Score, were recorded. Comorbid conditions were recorded by filling out a questionnaire according to the clinical history or medical records. Charlson Comorbidity Index and Rheumatic Disease Comorbidity Index scores were calculated from the gathered comorbidity information., Results: Nine hundred thirteen patients had radiographic axial SpA, 153 had nonradiographic axial SpA, and 176 had peripheral SpA. The most common comorbidities were hypertension (HT) (n=167, 13.4%), diabetes mellitus (DM) (n=83, 6.7%), thyroid disorders (n=64, 5.6%), and depression (n=61, 4.9%). The comorbidities and the calculated comorbidity indices were significantly higher in females, in those with a BMI >25 kg/m 2 , and those over 60 years of age. No relationship was found between smoking and alcohol use and comorbidities. A significantly higher prevalence of HT and DM in peripheral SpA patients and a lower prevalence of thyroid disorders in radiographic axial SpA patients were observed., Conclusion: The most commonly reported comorbidities were HT, DM, thyroid disorders, and depression in SpA patients according to the BioStar database. The frequency of comorbidities and composite comorbidity scores were higher among females, older (>60 years) patients, and overweight (BMI >25 kg/m 2 ) patients., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2023, Turkish League Against Rheumatism.)

Objectives: Factors associated with disease activity of axial spondyloarthritis (axSpA) and switching of biologic disease-modifying anti-rheumatic drugs have not been clearly defined. We aimed to evaluate clinical characteristics of patients with axSpA, factors related to remission in treat to target era and predictive factors for biologic disease-modifying anti-rheumatic drug switching., Method: A multicenter, observational cross-sectional study was performed between February 2019 and August 2019. We included all consecutive patients ≥ 18 years with axSpA. Demographic and clinical variables were prospectively recorded. Clinical tools included Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)., Results: There were 969 patients with a mean age of 43.4 ± 10.8 years. There were 143 patients (14.8%) with remission and 223 (23.1%) patients with low disease activity. Male sex (p = 0.021), positive family history (p = 0.036), and human leukocyte antigen-B27 (p = 0.011) were predictors of remission by ASDAS-CRP. There were 654 patients (67.5%) who did not switch to another drug. The highest BASMI and MASES scores were calculated in patients with very high disease activity (p < 0.05). In patients with drug switching, the disease duration was significantly higher (p < 0.001) and the age at diagnosis was significantly lower (p = 0.016). There were significantly more patients with uveitis and higher scores of MASES and BASMI in patients who switch to another biologic disease-modifying anti-rheumatic drugs (p = 0.003, p = 0.009, and p = 0.004, respectively)., Conclusions: In patients with axSpA, male sex, younger age, and HLA-B27 positivity are associated with remission, while longer disease duration and accompanied uveitis appear to be related with drug switching., Clinical Trial Registration Number and Date: NCT04139954/25.10.2019., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45-70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2- and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6.64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401)., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Rheumatoid arthritis is a chronic inflammatory disease with different disease activity grades. Several registries have been designed to determine the appropriate regimens of disease-modifying antirheumatic drugs to obtain sustained clinical remission. We examined epidemiological and clinical characteristics of rheumatoid arthritis patients using a clinical registry database (BioSTaR) and analyzed the differences in patients with sustained and switched therapies., Methods: A multicenter, observational cross-sectional study for rheumatoid arthritis was performed between February 2019 and September 2020 using the BioStaR-RA registry. Demographic and clinical characteristics were prospectively recorded into a specifically designed electronic database. The patients were divided into three groups due to the heterogeneity of the study cohort. Patients were grouped as Group I (Initial; within the first 6 months of treatment with biological/targeted synthetic drugs), Group ST (Sustained Treatment; any first drug lasting for at least 6 months without any change), and Group S (Switch; any switching to another drug). Comparative analysis was performed between sustained treatment (Group ST) and drug switching (Group S) groups., Results: The study included a total of 565 patients. The mean age was 53.7 ± 12.8 years, and the majority were female (80.4%). There were 104, 267, and 194 patients in Groups I, ST, and S, respectively. Erosive arthritis and hematological extra-articular involvement were more frequently detected in Group S than Group ST (p = 0.009 and p = 0.001). The patients in Group S had significantly higher disease activity scores (DAS28-CRP, CDAI, and SDAI) (p = 0.025, p = 0.010, and p = 0.003). There were significantly more patients with moderate disease activity in Group S (p < 0.05)., Conclusions: The groups with sustained treatment and switching included patients with different disease activity status, although higher disease activity was determined in switchers. Overall, moderate disease activity and remission were the most common disease activity levels. Lower disease activity scores, lower hematologic manifestations, better functional status, and lesser radiographic damage are associated with sustained treatment., (© 2021. The Author(s).)

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O 2 ) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m 2 . The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O 2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O 2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O 2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The rheumatoid arthritis impact of disease (RAID) score was developed as a patient-derived composite response index for the evaluation of the disease impact on cases with rheumatoid arthritis (RA). The aim of this study was to evaluate the psychometric properties and performance of RAID score in the real-life settings. Cases with RA from our multi-center, nationwide registry called Biologic and targeted Synthetic antirheumatic drugs Registry RA (BioStaR RA) were included in this cross-sectional observational study. Demographic data, disease duration, pain, patient's global assessment (PGA) and physician's global assessment (PhyGA) were recorded. DAS28-ESR, DAS28-CRP, the simplified disease activity index (SDAI) and the clinical disease activity index (CDAI) were assessed as disease activity evaluations. The health assessment questionnaire-disability index (HAQ-DI) and RAID were completed by all the participants. The construct validity was tested by the analysis of correlations between RAID score and scores of PGA, disease activity indexes and HAQ-DI. We also evaluated the discriminatory ability of RAID to distinguish patients with different levels of disease activity and disability and the cut-off values were calculated by ROC analysis. 585 cases with RA were included in this investigation. The RAID score was significantly positively correlated with PGA, all disease activity indexes and HAQ-DI (p < 0.001). The discriminatory ability of RAID score in different disease activity and disability groups was also demonstrated (p < 0.001). To estimate DAS28-ESR (remission/low + moderate + high), RAID score cut-off points were 2.88 (sensitivity 73%, specificity 62%), 3.23 (sensitivity 75%, specificity 60%) and 3.79 (sensitivity 74%, specificity 58%), respectively. Our study indicated that RAID was a reliable tool in daily clinical practice by presenting its correlations with disease activity and disability assessments and by showing its discriminatory ability in these parameters in the real-life experiences., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study aims to investigate the relationship between disease activity, dietary phytochemical index (DPI), and serum total oxidant status (TOS) and total antioxidant status (TAS) in patients with ankylosing spondylitis (AS)., Patients and Methods: Between August 2020 and January 2021, a total of 37 patients (23 males, 14 females; mean age: 39.3±9.4 years; range, 21 to 61 years) with AS and 36 age-, sex-, and body mass index-matched healthy individuals (24 males, 12 females; mean age: 37.9±8.9 years; range, 20 to 60 years) were included. Serum TAS (μmoLTroloxEq/L) and TOS (μmoL H2O2Eq/L) measurements were performed and the oxidative stress index (OSI) was calculated. Dietary evaluation was made from a one-day dietary record and DPI was calculated., Results: Serum TAS level in AS patients was significantly lower than the healthy group (p=0.003). Serum TOS level was similar in both groups. The OSI of patients was significantly higher than the controls (p=0.035). The mean DPI, polyunsaturated fatty acid, n-3 fatty acid, and vitamin C intake of patients were significantly lower than controls (p=0.042, p=0.033, and p=0.022, respectively). A moderate positive correlation was found between the TAS level and DPI of the control group (r=0.352, p=0.035). According to medications, no significant difference was seen between the groups in terms of patients' characteristics, DPI, and laboratory tests and there was no correlation between DPI, TAS, TOS, and OSI., Conclusion: Lower DPI and lower n-3 fatty acid and vitamin C intake in patient group demonstrated that patients with AS should pay more attention to their diet to increase serum antioxidant status., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2022, Turkish League Against Rheumatism.)

The study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) in patients with familial Mediterranean fever (FMF) and to assess the relationships between FMF characteristics and severe COVID-19 outcomes such as hospitalization. The study was planned within a national network of 21 different centers. Demographics, FMF-related clinical and genetic characteristics, and COVID-19 outcomes were obtained. A total of 822 patients with FMF (mean age of 36 years) were included in the study. Fifty-nine of them (7%) had a COVID-19 diagnosis confirmed by real-time PCR test or chest CT findings. Most FMF patients with COVID-19 (58) had mild and moderate disease activity. All patients were on colchicine treatment. However, 8 of them (13.6%) were not compliant with colchicine use and 9 of them (15.3%) were colchicine resistant. Twelve FMF patients with COVID-19 were hospitalized. There were 4 patients requiring oxygen support. COVID-19 related complications were observed in 2 patients (1 thromboembolism, 1 acute respiratory distress syndrome). Hospitalized COVID-19 patients with FMF were older than non-hospitalized patients (median ages: 51 and 31 years, respectively; p: 0.002). Other FMF-related characteristics were similar between the groups. FMF-related characteristics were not found to be associated with poor outcomes in COVID-19. Thus, FMF may not be a risk factor for poor COVID-19 outcomes.

This study aimed to investigate the carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compare the electrophysiological and ultrasonographic findings and evaluate related variables. Cut-off value of median nerve cross-sectional area (MCSA) was determined for the diagnosis of CTS. 70 RA patients, 39 PsA patients, a control group of 70 healty people were included in this study. Demographic characteristics, disease activity and functional status were recorded. Patients were referred for nerve conduction studies performed according to the American Academy of Neurology standards. Sonographic examination was carried on for MCSA evaluation. The mean age of patients was 51.87 ± 8.47, 50.61 ± 11.33, 49.75 ± 10.52 years and female ratio was 72.9%, 71.8%, 75.7% in RA, PsA and controls, respectively. Electrophysiologically, CTS frequency was found to be 13.2%, 15.4%, 3.5% in RA, PsA, control group, respectively, and a significant difference was found compared to the control group (p < 0.05). Ultrasonographically MCSA was measured as 8.52 ± 2.19 mm 2 , 8.97 ± 2.41 mm 2 , 7.09 ± 1.83 mm 2 in RA, PsA, control group, respectively, a significant difference was observed compared to the control group (p < 0.05). As a result of the Receiver Operating Characteristics analysis, the thereshold value of MCSA for CTS was determined as 10.5 mm 2 .The frequency of CTS was found to be 30% in RA and 41% in PsA. The frequency of CTS with both ENMG and USG (MCSA) were higher in patients with RA and PsA as compared to the control group. Although it was not statistically significant, CTS frequency was higher in PsA than RA. To our knowledge this is the first study assessing CTS in patients with PsA, and adressing MCSA cut off value for CTS diagnosis in RA and PsA.

Objectives: This study aims to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in carpal tunnel syndrome (CTS) compared to the wrist splint treatment., Patients and Methods: Between April 2016 and March 2017, a total of 189 patients (22 males, 167 females, mean age 48.8±9.5 years, range, 24 to 70 years) with mild-to-moderate CTS were included in this double-blind, prospective, randomized, placebo-controlled study. The patients were divided into four treatment groups using stratified randomization: splint group (Group 1, n=47), splint+ESWT (Group 2, n=47), ESWT (Group 3, n=45), and splint+placebo ESWT (Group 4, n=50). All patients were evaluated at baseline, and one and three months. Pain using the Visual Analog Scale (VAS), finger pinch strength, Boston Carpal Tunnel Questionnaire (BCTQ), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and electrophysiological examination were assessed., Results: A total of 168 patients completed the study. There was no significant difference among the four groups in terms of age, sex, comorbid diseases, symptom duration, VAS-pain, BCTQ, and LANSS scores (p>0.05). Pain and functionality significantly improved in all groups (p<0.05). In the group with ESWT and using wrist splint combined, a greater improvement of the hand function and electrophysiological measures was observed., Conclusion: Our study results show that ESWT is a valuable and reliable treatment modality for mild-to-moderate CTS., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish Society of Physical Medicine and Rehabilitation.)

The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is used as a new instrument in measuring the function, disability and health of patients with spondyloarthritis (SpA). However, the real-world evidence of ASAS HI is very limited. In the present study, our objective is to evaluate the psychometric properties and performance of ASAS HI in the real-world setting as well as comparing ASAS HI with the current instruments to assess the construct validity and determine the cut-off points in patients with both ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). A total of 991 patients with axSpA who fulfilled either the ASAS classification criteria for axial SpA (axSpA) or the Modified New York Criteria (mNY) for AS were recruited from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStaR) SpA. The construct validity of ASAS HI against the Bath Ankylosing Spondylitis Disease Activities Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) the Bath Ankylosing Spondylitis Functional index (BASFI) was performed. Using the receiver operating characteristic (ROC) curves analysis, the cut-off points were calculated. Of all the recruited patients, 851 (85.9%) were AS and 140 (14.1%) were nr-axSpA. The difference in the mean ASAS HI scores of the patients with AS and the ones with nr-axSpA were not statistically significant (6.12 ± 4.29 and 6.42 ± 4.86, respectively). The mean ASAS HI score was significantly higher in females and small city residents. The ASAS HI had a strong construct validity against ASDAS-CRP, BASDAI and BASFI. A cut-off point of ≤ 4 was determined to discriminate good and moderate, as well as ≥ 12 to discriminate moderate and poor health status. In conclusion, ASAS HI is a reliable instrument to evaluate health and functioning for both patients with AS and nr-axSpA in clinical practice.

Fibromyalgia (FM) is known a common painful syndrome and its frequency is increased in inflammatory rheumatic diseases. We aimed to assess FM frequency in axial spondyloarthritis (AxSpA) patients and age- and sex-matched healthy controls with the 2011 ACR FM criteria. We evaluated the association between receiving biologic disease-modifying antirheumatoid drugs (bDMARD) and presence of FM. 127 patients with Ax-SpA and 73 age- and sex-matched controls were included. Individuals were assessed according to modified 2011 ACR diagnostic criteria for FM. The pain was evaluated by visual analog scale (VAS). Disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activation Score (ASDAS). Spinal limitation, quality of life, and functionality were assessed. Drug therapies were noted. AxSpA and control group had similar FM rates. 43 (33.9%) patients in AxSpA group and 22 (30.1%) patients in control group had FM diagnosis (p = 0.589). Age, gender, BMI, and CRP values were similar in the AxSpA patients with and without FM, while global VAS and ASDAS scores were higher in patients with FM. Biologic DMARD use was higher in the AxSpA patients with FM; however, the difference was not statistically significant. In conclusion, FM frequency does not increase in AxSpA patients as compared to healthy controls. FM awareness is one of the key points to determine the appropriate treatment due to the influence on disease activity.

Background: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients' response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression., Objectives: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA., Study Design: This research used a prospective, cohort, observational study design., Setting: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey., Methods: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression Inventory-II (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes., Results: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome., Limitations: This study is limited owing to the combined use of several physical therapy modalities and short follow-up., Conclusions: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy., Key Words: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.

Background: This single-center, retrospective study aims to analyze the sociodemographic, injury characteristics, and the total number of lost working days of patients undergoing hand flexor tendon repair and to identify factors predicting reoperation., Methods: Hand flexor tendon repairs conducted using a four-strand modified Kessler core suture with early rehabilitation from January 2013 to December 2016 were included in this study. The variables evaluated in this study were patient sociodemographic and injury characteristics, number of lost working days, and reoperations because of rupture and/or adhesion formation. Injury severity was determined using Modified Hand Injury Severity Scoring (MHISS). Binary logistic regression analysis was conducted to identify the predictors of reoperation., Results: A total of 194 patients were included in this study, who had experienced 329 tendon injuries. Participants were young (mean age, 31.8), mostly male (79.4%), and mostly blue-collar workers (50.0%). Most patients had a zone 2 injury affecting a single digit of the dominant hand. The mean MHISS value was 46.6, and the mean time to return to work was 114.0 days. A total of 37 (19.1%) patients required reoperation because of rupture and/or adhesion formation. Smoking, zone 2 injury, and high MHISS value were negative predictors of reoperation., Conclusion: To minimize the need for reoperation, surgeons and rehabilitation teams should take special care of patients with zone 2 injuries, high MHISS values, and smoking history.

The aims of this study were to investigate the main clinical and laboratory features, including pregnancy and genetic analysis, of Turkish Familial Mediterranean Fever (FMF) patients and to analyze the relationships between genotypic features, age of disease onset, clinical findings, and disease severity. A study was planned within a national network of 22 different centers. Demographics, clinical and laboratory findings, attack characteristics, drugs, pregnancy and birth history, disease severity, and gene mutation analyses were evaluated. Disease severity, assessed using a scoring system developed by Pras et al., was evaluated in relation to gene mutations and age of disease onset. A total of 979 patients (643 females and 336 males; mean age: 35.92 ± 11.97 years) with FMF were included in the study. Of a total of 585 pregnancies, 7% of them resulted in preterm birth and 18.1% resulted in abortions. During pregnancy, there was no FMF attack in 61.4% of patients. Of the MEditerranean FeVer (MEFV) mutations, 150 (24.3%) cases were homozygous, 292 (47.3%) cases were heterozygous, and 175 (28.4%) were compound heterozygous. Patients with homozygous gene mutations had more severe disease activity, earlier age of disease onset, higher rates of joint and skin involvement, sacroiliitis, and amyloidosis. Patients with compound heterozygous genotype displayed severe disease activity in close resemblance to patients with homozygous mutation. In addition, patients with compound heterozygous mutations had higher rates of protracted febrile myalgia and elevated fibrinogen levels. In 63.9% of compound heterozygous patients, age of onset was < 20 years, with greater disease severity, and high rates of attack frequency and colchicine resistance. Our results suggest that indicators for disease severity include early onset of disease and homozygous gene mutations. Furthermore, patients with compound heterozygous mutations displayed significant presentations of severe disease activity.

Objectives: This study aims to assess early changes in physical activity and function after total hip arthroplasty (THA) using both subjective and objective methods, and to identify predictors of outcomes of THA., Patients and Methods: Between October 2014 and October 2015, a total of 50 patients (14 males, 36 females; mean age 57.1±13.0 years; range, 31 to 75 years) with end-stage primary hip osteoarthritis who were scheduled for THA and 50 age- and sex-matched controls (10 males, 40 females; mean age 52.9±9.3 years; range, 36 to 75 years) were included in the study. Pain was evaluated using the Numeric Rating Scale (NRS), physical function using the Lequesne Index, physical capacity using the Six-Minute Walking Test (6MWT), and physical activity using both International Physical Activity Impact Questionnaire Short Form (IPAQ-SF) and step count monitor. Data at baseline and six weeks and six months were recorded., Results: Pain severity was significantly lower after THA at six weeks and six months (NRS scores: 2.83 and 0.82, respectively; p<0.001), compared to baseline. Physical function, capacity, and activity significantly improved after THA at six weeks and six months with a mean Lequesne Index score of 2.62 and 1.02, respectively. The mean 6MWT distance was 272.62 at six weeks and 326.16 at six months. The mean IPAQ and 6MWT results were similar between the patient and control groups at six weeks and six months. Age, presence of comorbidities, and baseline Lequesne Index score were found to be effective on functional outcomes of THA. Age and baseline 6MWT scores were correlated with physical capacity after THA., Conclusion: Our study showed a significant early improvement in pain severity and physical activity and function at six weeks and six months after THA, compared to baseline values. Baseline values and age were the positive predictors of improved postoperative function and physical capacity., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2019, Turkish Society of Physical Medicine and Rehabilitation.)

Background: Vacuum-assisted suspension systems provide better suspension than non-vacuum systems, but data are limited on whether they improve physical activity levels and quality of life for people with amputation., Objectives: To compare the physical activity and quality of life levels of people with transtibial amputation using PIN/LOCK suspension system or vacuum-assisted suspension systems with those of able-bodied controls and to investigate parameters associated with physical activity levels., Study Design: A cross-sectional observational study., Methods: Fifty-one people with amputation and 51 controls participated. The International Physical Activity Questionnaire Short Form and Short Form 36 were used to measure the physical activity and quality of life, respectively., Results: The total physical activity and Short Form 36 scores were significantly lower in the participants with amputation than the controls. There were no significant differences between the two types of suspension systems in terms of physical activity levels and quality of life. The vacuum-assisted suspension system users reported significantly more bodily pain on the Short Form 36 questionnaire than the controls ( p  = 0.003). The only parameter that correlated significantly with the total physical activity was the Short Form 36 physical functioning subscale ( r  = 0.302, p  = 0.031)., Conclusion: Contrary to our expectations, vacuum-assisted suspension system users compared to PIN/LOCK users did not report greater levels of physical activity or improved quality of life or levels closer to comparable controls., Clinical Relevance: A better understanding of the effects of different prosthetic suspension systems on physical activity and quality of life may help clinicians when prescribing prostheses, as well as setting appropriate prosthetic expectations. This study suggests that vacuum-assisted suspension systems and PIN/LOCK suspension systems provide equal benefit to users with regards to physical activity and quality of life.

Objectives: This study aims to identify adherence rate and risk factors of poor adherence in patients with tightly controlled rheumatoid arthritis (RA) based on the treat-to-target (TTT) strategy., Patients and Methods: In this cross-sectional, observational study, a total of 103 patients (22 males, 81 females; mean age 58.6±9.5 years; range, 35 to 76 years) with tightly controlled RA between November 2016 and May 2017 were included. The patients were evaluated in terms of sociodemographic features, smoking and alcohol drinking status, body mass index (BMI), Disease Activity Score 28 (DAS28), and clinical and medication data. They filled out a series of standardized questionnaires including the Morisky 8-item Medication Adherence Scale (MMAS-8), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE), and Health Assessment Questionnaire-Disability Index (HAQ-DI). Multiple multivariate linear regression analysis was used to identify variables which were possibly associated with the MMAS-8., Results: Of the patients, 53 (51.5%) were non-adherent and 50 (48.5%) were adherent to medication. The DAS28-erythrocyte sedimentation rate, mean DAS28, HAQ, BDI scores, and the number of visits were higher and the MMSE scores were lower in non-adherent patients than adherent patients. In the linear multivariate analysis, significant associations were found between the MMAS-8 and MMSE, BDI, DAS28, and mean DAS28 scores., Conclusion: Our study results show that the medication adherence rate is significantly higher compared to previous studies and high disease activity, depression, and cognitive dysfunction significantly affect medication adherence in this patient population., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2019, Turkish Society of Physical Medicine and Rehabilitation.)

Objectives: This study aims to evaluate psychological disorders such as impulsivity, alexithymia, depression, and anxiety and to analyze the relationship between psychiatric disorders and disease activity, fatigue and quality of life in ankylosing spondylitis (AS) patients., Patients and Methods: Between May 2016 and January 2017, a total of 70 AS patients (30 females, 40 males; mean age 42.9±10.5 years; range, 22 to 70 years) and 56 healthy controls (27 females; 29 males; mean age 44.8±13.0 years; range, 21 to 70 years) were included. Demographic characteristic, laboratory analyses, disease activity, quality of life, functionality, fatigue, and psychological disorders were assessed. The Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Nottingham Health Profile (NHP) and Ankylosing Spondylitis Quality of Life (ASQOL), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Toronto Alexithymia Scale (TAS-20), Eating Attitude Test (EAT), and Barratt Impulsiveness Scale-11 (BIS-11) were used. Significant predictors for anxiety, depression and impulsiveness were evaluated using multivariate analyses., Results: The BDI (13.88±8.99; 9.78±8.34), BAI (14.58±10.02; 10.53±8.99), and non-planning impulsivity (26.00±4.57; 24.28±3.77) scores were higher in the AS group than controls (p=0.01; p=0.01; p=0.02 respectively). Non-planning impulsivity was correlated with fatigue, social isolation, and depression (p=0.03; p=0.01; p=0.01 respectively). Multivariate analyses showed that fatigue scores were positively associated with non- planning impulsiveness., Conclusion: Impulsivity may be one of the psychiatric disorders associated with AS, such as the more commonly known anxiety and depression. Fatigue is considered as a critical target for increased impulsivity., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

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., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objectives: This study aims to evaluate fibromyalgia syndrome (FMS) incidence based on 2010 American College of Rheumatology (ACR) criteria in rheumatoid arthritis (RA) patients and the association between FMS with disease activity, functional status and quality of life (QoL)., Patients and Methods: The study included 151 RA patients (32 males, 119 females; mean age 52.4±12.7 years; range 21 to 82 years) and 77 controls (13 males, 64 females; mean age 53.7±10.2 years; range 33 to 73 years). Individuals were classified into four groups based on presence of RA and FMS. Group 1 included patients with both RA and FMS (n=53), group 2 included patients with RA and without FMS (n=98), group 3 included controls with FMS (n=15), and group 4 included controls without FMS (n=62). Demographic characteristics, morning stiffness (MS), pain, Disease Activity Score 28 (DAS28), functional and QoL scores were compared among the groups., Results: No significant differences were found between the four groups as regards the mean age and gender distribution (p>0.05). Higher pain, MS, DAS28, and QoL scores in the groups with FMS drew attention. While FMS was found in 8.1% of RA patients with remission, it was found in 53.9% of patients with active RA, and in 19.5% of controls., Conclusion: Although FMS incidence in patients with RA was higher compared to controls without inflammatory disease, FMS evaluated with 2010 ACR diagnostic criteria was found to be common in the general population. DAS28 and inflammatory markers were higher in RA patients with FMS; thus, it has been concluded that sleep disorder and widespread pain caused by active disease may facilitate the diagnosis of FMS., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

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., Patients 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., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objectives: This study aims to investigate the relationship between smoking and structural damage, autoimmune antibodies, and disability in rheumatoid arthritis (RA) patients., Patients and Methods: This cross-sectional study included 165 RA patients (36 males, 129 females; mean age 52.4±12.8 years; range 21 to 82 years). Disease duration, age at disease onset, smoking habits, rheumatoid factor (RF), and anti-cyclic citrullinated peptide levels were recorded. Morning stiffness, pain with visual analog scale, Health Assessment Questionnaire Scores And Disease Activity Score 28 were calculated. Patients' standard hand radiographs were evaluated., Results: Patients were divided into three groups according to their smoking habits. Ninety-nine patients (60%) were never smokers, 45 patients (27.3%) were long-term smokers and 21 patients (12.7%) were new smokers. Three groups were compared for disease activity. Disease activity score 28 scores were 3.2±1.2, 3.2±1.3, and 3.2±1.4, respectively (p>0.05). The erosion score (2.6±5.8, 7.1±10.9, and 11.1±19.2, respectively) and joint space narrowing score (9.9±7.3, 18.6±14.9, and 17.3±12.3, respectively) according to modified Sharp method were significantly lower in never smokers group than other groups (p<0.05). RF titrations were 55.2±58.9, 60.5±63.1, and 84.9±71.5, respectively, and levels of long-term smokers group were significantly higher than the other groups (p<0.05). Joint space narrowing score was 16.2±11.9 and 6.4±10.4 in RF (+) and RF (-) patients, respectively (p<0.05). There was no significant relationship between anti-cyclic citrullinated peptide levels and others parameters., Conclusion: Although smoking is known as a poor prognostic factor in RA, there was no correlation between disease activity and smoking in our study. However, less radiographic damage was found in never smokers. Smoking does not appear to correlate with RA disease activity but it may be effective in the long-term joint damage., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objectives: This study aims to investigate the effect of serum levels of 25 hydroxyvitamin D (25(OH)D) in patients with primary knee osteoarthritis (OA) and to assess its relationship with the radiographic grading and functional status., Patients and Methods: Serum 25(OH)D levels were measured in 107 patients (90 females, 17 males; mean age 63.0±9.6 years; range, 40 to 86 years) with primary knee OA. Radiographic grading was based on the Kellgren-Lawrence Grading Scale and the Osteoarthritis Research Society International (OARSI) Atlas Grading Scale, while the functional status was assessed using the Lequesne indices and Turkish version of the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-Form (KOOS-PS). Pain was evaluated using the Visual Analog Scale for Pain (VAS-Pain). Data including age, sex, disease duration, body mass index (BMI), and pain severity were recorded., Results: The mean 25(OH)D level was 13.4±10.6 ng/mL, and 90 patients (84.1%) had vitamin D deficiency. The presence of severe osteophytes was observed in 67 patients (62.6%) and 85 patients (79.4%) had Grade 2-3 joint space narrowing (JSN). The mean KOOS-PS and Lequesne scores were 40.1±12.3 and 12.9±3.6, respectively. There was no correlation between serum 25(OH)D levels and functional status., Conclusion: Our study results show that serum 25(OH)D level is not related to the severity of the radiographic knee OA grading or to the functional assessment. Age and BMI are the factors affecting the radiological knee OA severity, while age, sex, BMI, and pain severity are the main determinants of the functional status., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

In this case, a young male patient diagnosed as hypophosphatemic osteomalacia and ankylosing spondylitis (AS) will be assessed by literature. A 32-year-old male patient who had been previously diagnosed as ankylosing spondylitis and hypophosphatemic osteomalacia was admitted to our clinic. In the beginning of the disease, he complained of pain on the first metatarsal bone and low back. Sacroiliac magnetic resonance (MR) images were interpreted as sacroiliitis. He was diagnosed as AS, and referred to many hospitals and received several therapies. He did not benefit from the treatment and his complaints worsened. The human leukocyte antigen (HLA) B-27 test was negative and alkaline phosphatase level was high. Old femur fractures were reported in the whole body bone scintigraphy. In addition, the patient was diagnosed with osteomalacia. While the patient was receiving vitamin D, oral phosphate, anti-tumor necrosis factor therapy was added. Patient's diagnosis was reevaluated. His final diagnosis was hypophosphatemic osteomalacia instead of ankylosing spondylitis.

Objective: The aim of this study is to investigate the relation between vitamin D levels, vertebral deformities, functional status, quality of life, acute phase reactants and enthesopathy in patients with psoriatic arthritis (PsA)., Patients and Methods: Fifty-two patients with PsA and 52 controls were enrolled to the study. Routine blood tests and serums 25-(OH)D3 were measured. The thoracic and lumbar vertebrae deformities identified in the radiographies were evaluated by a radiologist. Psoriatic Arthritis Quality of Life (PSAQoL) was used for evaluating quality of life and disease activity parameters for PsA were assessed. In PsA patients, correlations was performed between the 25(OH)-D3 levels and PGE (patient global assessment), PHGE (Physician global assessment), tender JC (joint count), HAQ-S (Health Assessment Questionnaire for the Spondyloarthropathies), PSAQoL, MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and BASDAI(Bath Ankylosing Spondylitis Disease Activity Index) values., Results: The results showed that 25(OH)-D3 levels was not correlated with these values. (p>0.05 for r = -0.171, r = -0.167, r=-0.069, r=-0.236, r=-0.062, r= -0.058 and r = -0.106 respectively). It was determined that the PSAQoL score had a positive and statistically significant correlation with the DGD, swollen JC, CRP, HGD, tender JC, VAS-pain, HAQ-S, MASES and BASDAI values in PsA patients. (p>0.05 for r=0.291, r=0.324, r=0.346, r=0.312; and p=0.001 for r=0.472, r=0.380, r=0.565, r=0.696, r=0.359, r=0.633, respectively) Statistical analyses demonstrated that PsA patients with vertebral deformities had higher numbers of tender joints, more prolonged periods of morning stiffness, higher DAS28-ESR (Disease Activity Score) scores, and higher levels of vitamin D (p<0.05, p<0.05, p=0.05 and p<0.05, respectively). The multiple logistic regression analysis indicated that the only factor which had an effect on the development of vertebral deformities was the use of steroids., Conclusions: This result has demonstrated that psoriatic arthritis has a considerable effect on patient quality of life. Most significant factors that affecting quality of life were physical pain and disability while vertebral deformities and 25-(OH)D3 had no significant effect.

Isotretinoin is used for the treatment of various acne lesions that are resistant to other treatments. The most frequent rheumatologic side effect of isotretinoin is transient muscle and/or joint pains. Here, we report a case with bilateral wrist and metacarpophalangeal joint arthritis and unilateral sacroiliitis associated with isotretinoin usage to attract attention, particularly from physiatrists, rheumatologists and dermatologists, to this rare adverse effect of isotretinoin., (© 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)