Divergent perspectives: exploring the relationships between St. George's Respiratory Questionnaire and outcome measures in systemic sclerosis-associated interstitial lung disease

INTRODUCTION/OBJECTIVES

Controversy exists regarding the concordance of patient-reported outcome measures (PROMs) with other assessment parameters in systemic sclerosis-associated interstitial lung disease (SSc-ILD). This study aims to explore the association between the St. George's Respiratory Questionnaire (SGRQ) and various outcome measures in patients with SSc-ILD within a real-world cross-sectional setting.

METHOD

Patients with SSc-ILD were consecutively recruited from our SSc cohort. Simultaneous administration of SGRQ, scleroderma Health Assessment Questionnaire (sHAQ), respiratory visual analog scale (R-VAS), pulmonary function tests (PFTs), and the 6-min walking test (6-MWT) was conducted. The total extent of lung fibrosis was quantified using high-resolution computed tomography (HRCT) images. Relationships between SGRQ and functional, radiographic, and other patient-reported outcome measures were analyzed.

RESULTS

The total SGRQ score demonstrated correlations with forced vital capacity (FVC) and R-VAS (r =  - 0.397, p = 0.016 and r = 0.418, p = 0.027, respectively). Symptom score correlated with ILD-extension (r = 0.430, p = 0.005); activity score correlated with FVC and R-VAS (r =  - 0.502, p = 0.002 and r = 0.395, p = 0.038, respectively); impact score correlated with R-VAS (r = 0.386, p = 0.043). In patients with fibrosis extent exceeding 20%, total SGRQ score was associated with sHAQ and R-VAS (r = 0.398, p = 0.049; r = 0.524, p = 0.021, respectively), activity score with R-VAS (r = 0.478, p = 0.038), and impact score with 6-MWT-D and R-VAS (r =  - 0.489, p = 0.034; r = 0.545, p = 0.016, respectively). The symptom score and activity score demonstrated optimal performance in identifying patients with interstitial lung disease (ILD) extent exceeding 20% and forced vital capacity (FVC) less than 70% (area under the curve [AUC] 0.799, p = 0.002, and AUC 0.792, p = 0.03, respectively).

CONCLUSIONS

Our study reveals varying degrees of correlation between SGRQ and distinct outcome measures. Given the incomplete alignment of SGRQ with other outcome measures, an integrative approach utilizing existing criteria as complementary tools is recommended. Key Points • Patient-reported outcome measures (PROMs) derive from patients' subjective evaluations of the impact of the disease on their daily activities, social interactions, and psychological well-being. • PROMs frequently serve as outcome measures in randomized controlled trials, yet conflicting findings have emerged in relation to primary outcomes. • This study aims to assess the appropriateness and interrelation of PROMs with both radiological and functional outcome measures, providing insight into the current state of our patients in a real-life context. The investigation delves into the compatibility of these measures with each other.

Radiological progression and predictive factors in psoriatic arthritis: insights from a decade-long retrospective cohort study

OBJECTIVES

Radiological alterations in psoriatic arthritis (PsA) are an established phenomenon frequently observed throughout the disease course. Our goal was to investigate the changes in the bone structure of PsA patients by conventional radiography.

METHODS

This study designed as a retrospective cohort study and cross-sectional evaluation for disease activity. The disease activity and the severity of skin and nail involvement were assessed. The Simplified Psoriatic Arthritis Radiographic Score (SPARS) was used to investigate the radiological progression. Logistic regression analysis was used to determine the predictors of radiological changes.

RESULTS

Joint space narrowing and bone proliferation in hands (p = 0.001 and p = 0.001, respectively) and joint space narrowing in feet (p = 0.047) were more common at the final evaluation than at the baseline assessment. Total scores of joint space narrowing and bone proliferation in hands and feet were higher at the last visit than at the initial assessment (p < 0.001). Male gender (p = 0.030, OR 4.32 (95%CI 1.15-16.15)], older age (for joint space narrowing [p = 0.026 OR 1.08 (95%CI 1.01-1.56)] and for proliferation [p = 0.025 OR 1.08 (95%CI 1.01-1.44)]), high Disease Activity index for Psoriatic Arthritis (DAPSA) scores at baseline [p = 0.032 OR 6.21 (95%CI 1.17-32.92)], and symmetrical polyarticular involvement at baseline [p = 0.025 OR 5.3 (95% CI 1.23-22.4)] were found as predictors of structural changes.

CONCLUSION

By the end of the decade, joint space narrowing and proliferation were observed to be more common than erosion. Male gender, older age, higher initial DAPSA scores, and initial polyarticular involvement were identified as predictors of radiological damage. Key Points • The radiological changes of Psoriatic arthritis are a well-known entity. However, studies investigating the progression of joint involvement over time are scarce. • This study reveals that joint space narrowing and proliferation are the most prominent radiological alterations in Psoriatic Arthritis patients at the end of the decade. • Male gender, older age, higher baseline DAPSA scores, and initial polyarticular involvement are predictive factors influencing the progression of bone destruction  in Psoriatic Arthritis patients.

Disease severity and genotype-phenotype correlation in adult patients with familial Mediterranean fever

OBJECTIVES

To assess the relationships of disease severity with genotype and phenotype in adult familial Mediterranean fever patients.

METHODS

Two-hundred seventy-five patients included in the study were divided into four groups according to their mutations: Group 1, M694V homozygous; Group 2, M694V-other; Group 3, other-other; and Group 4, no meaningful gene variants. Disease severity was evaluated using the Pras disease severity score. The association between Pras scores and other possible predictors was assessed by the multiple linear regression analysis.

RESULTS

In this study, 12.4% of all patients were in Group 1, 55.3% were in Group 2, 26.5% were in Group 3, and 5.8% were in Group 4. Pras scores were higher in Group 1 than in Groups 2, 3, and 4 (post hoc pairwise comparisons; P = .001, P < .001, and P = .001, respectively). Age at disease onset and age at diagnosis were found moderately and strongly correlated with Pras scores. Patients with moderate and severe disease were intensely involved in Group 1.

CONCLUSIONS

Higher Pras scores, earlier age of symptoms and diagnosis, more frequent arthritis and erysipelas-like erythema, and higher colchicine dose are closely associated with M694V homozygous familial Mediterranean fever patients. These patients also have mostly moderate and severe disease severity.

Serum markers in systemic sclerosis with cardiac involvement

Cardiac involvement in systemic sclerosis is a common clinical entity that may range from subclinical to life-threatening complications. The classification of cardiac involvement may be expressed as either primary or secondary involvement. Primary systemic sclerosis heart involvement (SSc-pHI) refers to cardiac pathologies primarily ascribed to systemic sclerosis rather than concomitant conditions like ischemic heart disease and pulmonary hypertension. The timely recognition of cardiac involvement holds significant clinical relevance. Therefore, numerous screening or diagnostic tools have been evaluated to forecast the likelihood of cardiac involvement, particularly in the absence of clinically evident cardiac symptoms. Of these modalities, serum biomarkers are often preferred due to their expeditiousness and non-invasive nature. Hence, the crucial goal of this narrative review is to review serum biomarkers that can be a valuable or promising tool in diagnosing cardiac involvement, especially SSc-pHI, in the early stages or predicting disease prognosis.

INTERSTITIAL CYSTITIS AS A PLAUSIBLE CAUSE OF OVERACTIVE BLADDER IN SYSTEMIC SCLEROSIS: A HYPOTHESIS

Patients with chronic inflammatory disease of the bladder, known as interstitial cystitis (IC), tend to have autoimmune diseases, such as Sjogren’s syndrome, systemic lupus erythematosus (SLE), rheumatoid arthritis and, rarely, systemic sclerosis (SSc). SLE patients with IC are prone to present with overactive bladder (OAB) symptoms. Lower urinary tract involvement is less usual in SSc but OAB symptoms are quite common among SSc patients with lower urinary tract involvement. The underlying mechanisms of lower urinary tract involvement, including OAB, in SSc could be as follows: i) vasculopathy, ii) fibrosis and/or sclerosis of bladder wall, iii) systemic sclerosis-associated myopathy, and iv) autonomic dysfunction. However, the role of IC leading to OAB is unclear. This hypothesis suggests that in patients with SSc, OAB may be associated with IC.

AB0821 The frequency of lumbosacral transitional vertebras in patients with ankylosing spondylitis

Background

Lumbosacral transitional vertebras (LSTVs) are anatomic variations observed at L5-S1 junction (1). The prevalence of LSVT ranges from 3.9% to 35.6%, indicating that this congenital anomaly is common in general population. LSVTs are well-defined anatomical differences causing low back pain and pelvic trauma (2). However, the studies assessing the influence of abnormal lumbosacral anatomy on low back pain and sacroiliac joints in patients with ankylosing spondylitis (AS) are scarce (3).

Objectives

The current study aimed to investigate the frequency of LSVTs and the their effects on clinical variables in AS patients.

Methods

The study was designed as a prospective cross-sectional study. 113 patients were included in the study. Demographic data, clinical variables, laboratory results were recorded. Disease activity (ASDAS-CRP and ASDAS-ESR), patients’ functionality (BASFI, BASMI), enthesitis (Leeds enthesitis index) and quality of life (SF-36, visual analogue scale) were evaluated. The baseline pelvic conventional radiographs and the sacroiliac magnetic resonance imaginings at the diagnosis were screened and assessed by two independent physicians. LSTVs were classified via Castellvi classification. Kappa coefficient was used to find the interobserver reliability.

Results

LSVTs were observed in 38 (33.6%) patients. Castellvi type Ia, Ib, IIa, IIb, IIIa, IIIb, and IV were found in 10 (8.8%), 7 (6.2%), 7 (6.2%), 6 (5.3%), 4 (3.5%), 1 (0.9%), and 3 (2.7%) patients, respectively. The kappa value for interobserver reliability was 0.69. There were not any differences between AS patients with and without LSVTs in terms of disease activity, functionality, and quality of life (Table 1). No statistically significant correlation was found between LSVTs identified by conventional radiography and sacroiliitis determined by MRI. When compared the patients according to Castellvi classification, visual analogue scale was higher in patients with IIIa than in patients with IV (p=0.013). Disease duration was longer in patients with Ib than in patients with Ia (p=0.029). ASDAS-CRP and ASDAS-ESR were higher in patients with IIIa than in patients with IV (p=0.008 and p=0.007).

Table 1.

The comparison of clinical characteristics between patients with and without LSVTs

Patients without LSVTs (n=75)Patients with LSVTs (n=38)pVAS3.0 (2.0−5.0)3.4 (1.0−6.0)0.734Disease duration (month)122.0 (60.0−180.0)120.0 (57.0−183.0)0.834ASDAS-CRP1.8 (1.2−2.5)1.8 (1.2−2.9)0.855ASDAS-ESR1.6 (1.2−2.5)1.6 (1.0−2.7)0.976CRP1.8 (0.8−5.3)2.5 (1.0−6.1)0.471BASMI2.9 (2.0−4.4)3.0 (2.1−4.0)0.796BASFI1.8 (0.7−4.6)2.1 (0.7−3.0)0.768SF-36Physical function80.0 (55.0−95.0)80.0 (63.8−95.0)0.765Role physical45.6 (0−100.0)50.0 (25.0−100.0)0.280Role emotional66.7 (0−100.0)33.0 (0−100.0)0.267Energy/fatigue50.0 (35.0−70.0)60.0 (38.8−71.3)0.201Mental health64.0 (48.0−76.0)68.0 (52.0−80.0)0.330Social functioning62.5 (50.0−87.5)75.0 (50.0−100.0)0.252Body pain67.5 (45.0−80.0)67.5 (45.0−90.0)0.751General health45.0 (35.0−65.0)50.0 (40.0−71.3)0.411

Values are given as median (interquartile range)

Conclusion

In AS patients, the frequency of LSVT is 33.6%, which is consistent with the general population. Type I, also known as a dysplastic transverse process, is the most observed type of LSVT. The presence of LSVTs is associated neither with clinical variables nor with sacroiliitis.

References

[1]Heaps BM, Feingold JD, Swartwout E, et al. Lumbosacral Transitional Vertebrae Predict Inferior Patient-Reported Outcomes After Hip Arthroscopy. Am J Sports Med. 2020;48(13):3272-3279

[2]Matson DM, Maccormick LM, Sembrano JN, Polly DW. Sacral Dysmorphism and Lumbosacral Transitional Vertebrae (LSTV) Review. Int J Spine Surg. 2020;14(Suppl 1):14-19. Published 2020

[3]Carvajal Alegria G, Voirin-Hertz M, Garrigues F, et al. Association of lumbosacral transitional vertebra and sacroiliitis in patients with inflammatory back pain suggesting axial spondyloarthritis. Rheumatology (Oxford). 2020;59(7):1679-1683.

Disclosure of Interests

None declared

AB0794 Hopelessness in patients with ankylosing spondylitis

Background

Ankylosing spondylitis (AS) is a chronic inflammatory disease leading to loss of function that is strongly related to impaired psychological status. Therefore, depression and anxiety are frequently investigated in these patients (1). However, hopelessness, regarded as a valuable psychological factor characterized by negative expectations and negative emotional states, was not well studied in AS patients(2).

Objectives

The aim of the study is to investigate the frequency of hopelessness in patients with AS and its relationship with clinical parameters and disease activity indices.

Methods

The study was designed as a prospective cross-sectional study. 113 AS patients were included in the study. Demographic data, clinical variables, laboratory results were recorded. Disease activity (ASDAS-CRP and ASDAS-ESR), patients’ functionality (BASFI, BASMI), enthesitis (Leeds enthesitis index) and quality of life (SF-36) were assessed. Hopelessness was evaluated by Beck hopelessness scale (BHS). The relation of BHS scores with the clinical variables was assessed. The strength of the correlations were regarded as very weak(0–0.19), weak(0.2–0.39), moderate(0.40–0.59), strong(0.6–0.79) and very strong(0.8-1). Multiple linear regression analysis was performed to find the association between BHS scores and other clinical variables.

Results

Minimal, mild, moderate, and severe hopelessness were observed in 46 (40.7%), 36 (31.9%), 22 (19.5%), and 9 (8.0%) patients, respectively. Disease duration (p=0.025), ASDAS-CRP (p=0.033), ASDAS-ESR (p=0.015), visual analogue scale (p=0.030), all SF-36 subscales (all p<0.025), BASFI (p=0.024), and BASMI (p=0.009) were statistically different among the groups. BHS scores were higher in patients with high and very high disease activity (p=0.027) (in pairwise comparison, inactive disease vs. high disease activity, p=0.035) (Figure 1). BHS scores showed weak correlation with ASDAS-CRP, ASDAS-ESR, visual analogue scale, BASMI, Leeds enthesitis index, and BASFI. Moreover, negative moderate correlations were detected between BHS scores and SF-36 subscales except social functioning and body pain, which were found weak correlation. In multiple linear regression analysis, BASMI-maximal intermalleolar distance, SF-36 energy, SF-36 mental health, and SF-36 general health were found associated with BHS scores (Table 1).

Table 1.

Multiple linear regression analysis to find predictors related to the Beck hopelessness scale scores

B95% CIpASDAS-CRP-0.063(-1.939) to 1.2820.687VAS-0.085(-0.722) to 0.3960.564BASMILateral spinal flexion0.311(-0.299) to 1.4790.191Tragus to wall distance0.157(-0.404) to 1.6020.239Modified Schober0.298(-0.114) to 1.3680.096Maximal intermalleolar distance0.2280.076 to 0.5570.010Cervical rotation0.092(-0.665) to 1.0850.635Total-0.730(-5.572) to 1.0420.177SF-36Physical function-0.024(-0.056) to 0.0460.840Role physical-0.114(-0.046) to 0.0170.364Role emotional-0.019(-0.029) to 0.0240.870Energy/fatigue-0.283(-0.125) to (-0.005)0.035Mental health-0.306(-0.142) to (-0.022)0.008Social functioning0.022(-0.033) to 0.0410.822Body pain0.182(-0.018) to 0.0860.192General health-0.344(-0.125) to (-0.030)0.002BASFI-0.085(-0.606) to 0.2480.408Figure 1.

Beck hopelessness scale scores according to disease activity subgroups

Conclusion

Higher level of hopelessness is strongly related to higher disease activity in AS patients. Furthermore, higher BHS scores are negatively correlated with SF-36 subscales. Especially, lower energy and impaired mental health are associated with higher level of hopelessness.

References

[1]Zhang L, Wu Y, Liu S, Zhu W. Prevalence of Depression in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Psychiatry Investig. 2019;16(8):565-574. doi:10.30773/pi.2019.06.05

[2]Balsamo M, Carlucci L, Innamorati M, Lester D, Pompili M. Further Insights Into the Beck Hopelessness Scale (BHS): Unidimensionality Among Psychiatric Inpatients. Front Psychiatry. 2020;11:727. Published 2020 Jul 31. doi:10.3389/fpsyt.2020.00727

Disclosure of Interests

None declared

AB0717 Developing a Deep Learning Model on Conventional X-Rays in the Diagnosis of Axial Spondyloarthritis

Background

Plain pelvic radiographs are the most common imaging modality used in the first line for diagnosis of axial Spondyloarthritis (axSpA). However, evaluation of the sacroiliac joint on two-dimensional plain radiographs may lead to misinterpretation among the evaluators.

Objectives

To investigate the diagnostic power of deep learning models in conventional radiographs of the patients with axSpA.

Methods

The study included 320 axSpA patients and 348 healthy controls (age; 34.5±15.3/38.2±10.6, p=0.072; gender (male) 53.8%/46.3%, p=0.064). Sacroiliitis was confirmed on sacroiliac MRI according to the Assessment of Spondyloarthritis International Society (ASAS) definition. The contrast equalization was preprocessed with the Clahel (Contrast-Limited Adaptive Histogram Equalization) filter. Then, classification was performed with Alexnet, VGG16, resnet101 and resnet50 models. As a result of the trials, the best result was achieved with resnet50. Four different filtering scenarios were applied (Clahel filter cliplimit 0.25, Clahel filter cliplimit 0.50, clahel filter 1.00 and no filter).Two different cropping processes were performed on the direct radiographs, and uncropped, cropped at pelvic borders, cropped images close to the sacroiliac joint were applied to the deep learning model. Meanwhile, all images were also evaluated by 3 rheumatologists for the presence of sacroiliitis.

Results

According to the results of 4 different scenarios studied with the Resnet50 model, the best result was obtained with the RESNET50 Model + Clahel filter clipLimit 0.50. With this model, after applying the clahel filter with a coefficient of 0.5 to the full resolution data, we achieved 0.8135 success in the separation of AS and normal. A kappa error of 0.0561, Cohen’s Kappa Error = 0.6267, Fscore 0.8022 (AS), 0.8253 (normal) were obtained. After applying the clahel filter with a coefficient of 0.5 with Resnet50 to the pelvic data, we achieved 0.625 success in separation of AS and normal. Kappa error 0.0694, Cohen’s Kappa Error=0.2400, Fscore 0.5399 (AS), 0.6838 (normal) values ​​were obtained. After applying the Clahel filter with a coefficient of 0.5 with Resnet50 to the sacroiliac data, we achieved 0.61 success in the separation of AS and normal. Kappa error 0.0696, Cohen’s Kappa Error=0.2131, Fscore 0.5517 (AS), 0.6549 (normal) values ​​were obtained. As a result of the evaluation of the radiographs by the clinician, Cohen’s kappa was 0.452 and accuracy was 0.73 for the first rheumatologist; Cohen’s kappa 0.132 and accuracy 0.56 for the second rheumatologist and Cohen’s kappa 0.362 and accuracy 0.68 for the third rheumatologist were found.

Conclusion

Application of RESNET50 Model + Clahel filter (‘clipLimit’, 0.5, ‘Distribution’, ‘rayleigh’) on uncropped images showed higher precision in diagnosing sacroiliitis from conventional radiographs compared to other filtering scenarios. Our results were found to have higher accuracy than the evaluation of three rheumatologists.

Table 1.

Precision and kappa values of Resnet50 model, 4 different filtering scenarios and 2 different clipping operations

AccuracyCohen’s kappa (CI)*RESNET50+no filter0.73060.4509 (0.3234-0.5785)*RESNET50 Model+ Clahel filter (0,25)0.69430.3889 (0.2590-0.5189)*RESNET50 Model+ Clahel filter (0,50)0.81350.6267 (0.4186-0.7555)*RESNET50 Model+ Clahel filter (1,00)0.68390.3552 (0.2213-0.4890)**RESNET50 Model+ Clahel filter (0,50)0.6250.2400 (0.1523-0.3245)***RESNET50 Model+ Clahel filter (0,50)0.6100.2131 (0.1121-0.3430)

* Uncropped sacroiliac X-Rays; ** Cropped X-Rays at the pelvic margins; *** Cropped X-Rays close to the sacroiliac joints

Figure 1.

Steps of deep learning model in X-Ray images

Disclosure of Interests

None declared

The Efficacy of a Home-Based, Self-Administered Hand Exercise Program for Patients With Systemic Sclerosis: A Randomized Controlled, Evaluator-Blind, Clinical Trial

BACKGROUND

For patients with systemic sclerosis (SSc), hand involvement is an underrated clinical manifestation. Therefore, the aim of this study was to investigate the efficacy of a hand exercise program and to demonstrate its effect on hand function, quality of life, anxiety, and depression in patients with SSc.

METHODS

This study was designed as a single blind, randomized controlled comparative study. Sixty-two female patients with SSc were randomized into an exercise group (n = 32) or a control group (n = 30). After some were lost to follow-up, 25 patients were analyzed in each group. In the exercise group, the 8-week intervention consisted of isometric hand exercises and self-administered stretching repeated 10 times/2 sets per day. All patients were assessed using the Hand Mobility in Scleroderma (HAMIS) test, the Duruoz Hand Index (DHI), grip strength, the 36-item short form, Health Assessment Questionnaire-Disability Index (HAQ-DI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and then again 4 and 8 weeks later. Within-group comparisons over time were analyzed using the Friedman test. Post hoc analysis was performed using the Wilcoxon signed rank test. A multiple linear regression analysis was used to define the impact of exercise on clinical status.

RESULTS

Of the 50 total patients, the median age and the median body mass index were 55.5 years and 25.9 kg/m2. The median disease duration was 10.0 years. Thirty-four patients (68.0%) were diffuse cutaneous systemic sclerosis (dcSSC), whereas 16 (32.0%) were limited cutaneous systemic sclerosis (lcSSc). The primary outcome of handgrip strength, as well as the HAMIS, DHI, HAQ-DI, and BDI, significantly improved over time (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.005, respectively). The between-group comparison indicated significant improvement in DHI, handgrip strength, HAQ-DI, BAI, and BDI in the exercise group (p = 0.02, p = 0.013, p < 0.001, p = 0.015, and p = 0.036, respectively). In the multiple linear regression analysis, exercise was found to be the most efficient factor affecting the improvement in HAMIS, DHI, HAQ-DI, and grip strength.

CONCLUSIONS

The 8-week intervention composed of isometric hand exercises and self-administered stretching provided a significant improvement in handgrip strength, general health, quality of life, and psychological status for patients with SSc.

The role of lactate dehydrogenase-to-albumin ratio in clinical evaluation of adult-onset Still's disease

OBJECTIVES

The aim of the study is to evaluate the importance of lactate dehydrogenase-to-albumin ratio (LAR) in patients with adult-onset Still's disease (AOSD) and to investigate the relationship between this ratio and clinical laboratory variables.

METHODS

The study design was retrospective cross-sectional. The demographic and clinical data, laboratory results and imaging findings were documented. Univariate and multinomial logistic regression analyses were performed to find the predictors, which could be useful to define the ferritin level and organ involvement. Receiver-operating characteristic (ROC) analysis was used to clarify the diagnostic ability of the LAR for ferritin level and organ involvement.

RESULTS

Fifty-eight patients with AOSD were evaluated. When patients were divided into two groups according to the serum ferritin level with a cut-off of 1500 ng/dL, lymphocyte count and albumin level were significantly less in patients who had higher ferritin levels (P = .015 and P = .005). In multinominal logistic regression analysis, AST, LDH and LAR were found as predictors for ferritin levels. When we compared LAR between patients with and without organ involvement, higher LAR was found in patients with HM, SM, serositis and MAS. Also, LAR was significantly higher in patients with higher ferritin levels (≥1500 ng/dL) than those without (P < .001). In ROC analysis, the cut-off point of LAR predicting the ferritin level was determined as 80.75 with 83.7% sensitivity and 80.0% specificity (AUC = 0.89, 95% CI 0.79-0.98, P < .001).

CONCLUSION

LAR can be a valuable inflammatory marker to determine AOSD patients with organ involvement and higher ferritin level.

Static foot posture and its relation to clinical variables in ankylosing spondylitis

AIM

Postural abnormalities of the foot are common in rheumatic diseases. Static foot posture is a poorly studied clinical parameter in ankylosing spondylitis (AS). The aim of the study was to evaluate static foot posture in patients with AS and to determine the potential impact of clinical variables on foot posture.

METHOD

Fifty patients with AS and 40 age- and sex-matched healthy controls were enrolled in the study. Disease activity was measured using the Ankylosing Spondylitis Disease Activity Score. Axial mobility was evaluated with the Bath Ankylosing Spondylitis Metrology Index three-point answer scale. Functional status was assessed by the Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire-Disability Index. Enthesitis and foot posture were evaluated by the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Foot Posture Index-6, respectively.

RESULTS

Patients with AS revealed significantly higher scores of foot posture index when compared with controls (P = 0.005). Abnormal foot posture (pronated and supinated) was more common in the patient group (P < 0.01). According to the multinomial logistic regression analysis, a higher MASES score was associated with supinated foot posture in AS patients (odds ratio 1.47, 95% confidence interval 1.03-2.09, P = 0.035). In addition, supinated foot posture was associated with enthesitis of the Achilles tendon (P = 0.002).

CONCLUSION

Enthesitis is related to deteriorated static foot posture in patients with AS. Enthesitis of the Achilles tendon is closely associated with the supinated foot posture.

PELVIC FLOOR MUSCLE EXERCISE AND PHYSICAL THERAPY MAY IMPROVE SYSTEMIC SCLEROSIS-ASSOCIATED FECAL INCONTINENCE

Gastrointestinal involvement in systemic sclerosis (SSc) is observed in up to 90% of patients. Resolution of some of these gastrointestinal complications is challenging without the support of physical therapy and rehabilitation. One of these complications, SSc-associated fecal incontinence, which can be devastating for those affected, is seen in up to 39%. Studies focusing on fecal incontinence and its treatment are scarce. The hypothesis presented herein suggests that pelvic floor muscle exercise, biofeedback therapy, and neuromodulation methods might be effective and safe treatment strategies for patients affected by this debilitating complication.

Risk factors of avascular necrosis in Takayasu arteritis: a cross sectional study

Takayasu arteritis (TA) is a large-cell vasculitis, and is not usually associated with avascular necrosis (AVN). The objective of the study was to investigate any association between TA and AVN, including the possible pathogenic effect of glucocorticoid (GCs) use. The study design was retrospective and cross sectional. TA patients were enrolled in the study. Demographic variables, disease activity, treatments, physician global assessment, Indian Takayasu Clinical activity score 2010, and Kerr criteria were recorded. Logistic regression analysis was performed to identify predictors of AVN. A total of 29 patients were assessed. AVN was observed in four (13.8%) patients with TA. Male gender and elevated C-reactive protein (CRP) were found to be significantly associated with AVN (p = 0.001 and p = 0.006, respectively). While type IIb TA was more common in patients with AVN (n = 2, 50%), type V was more likely in the absence of AVN (n = 13, 52%). Descending aorta and thoracic aorta were usually involved in patients with AVN (both, n = 3, 75%). In multivariate logistic regression, increased CRP levels were the only predictor for AVN (OR = 1.183, 95% Cl = 1.025-1.364, p = 0.021). No association was identified between AVN in TA patients and either duration or cumulative dose of GCs. The present study found that higher CRP levels and male gender were associated with AVN in patients with TA.

AB0896-HPR THE EVALUATION OF TYPE D PERSONALITY AND SELF-ESTEEM IN PATIENTS WITH FIBROMYALGIA

Background:

Fibromyalgia (FM) is a condition characterized by chronic widespread pain, fatigue, sleep disturbances. Etiopathogenesis remains unclear; however, growing data regarding the effect of psychosocial factors on disease etiopathogenesis have drawn attention. Psychosocial elements such as type D personality and low level of self-esteem might increase disease burden (1). Accordingly, many researchers so far, have examined psychological parameters in FM and a limited number of studies focused on the personality type among patients with FM (2-5).

Objectives:

The current study aimed to investigate type D personality and self-esteem in patients with FM.

Methods:

Female patients with fibromyalgia and age-matched healthy controls were enrolled in this cross-sectional study. Type D personality was evaluated by using the type D scale (DS-14). The Rosenberg self-esteem scale (RSES) was used to assess self-esteem and psychosomatic symptoms. Psychological status was evaluated by the Beck Depression and Beck Anxiety Inventories. Fibromyalgia Impact Questionnaire (FIQ) was performed to assess functional impairment and health status in patients with FM. The potential confounders of type D personality were evaluated by binary logistic regression analysis.

Results:

Seventy patients with FM and 60 controls were included. Type D personality was observed in 58.6% of the patients and in 21.7% of the control group (p<0.001). When compared to patients with non-type D personality, those with type D personality revealed lower self-esteem and poorer health status (p<0.05 for both), higher anxiety and depression scores (p<0.001 for both). According to binary logistic regression analysis, depression (β=1.178, Cl 95% 1.055−1.316, p=0.004) and lower education level (β=0.818, Cl 95% 0.682−0.982, p=0.031) were significantly related to type D personality in FM (Table 1).

Conclusion:

Type D personality is more common in female patients with FM when compared to healthy women. Patients with type D personality have lower level of self-esteem when compared to those with non-type D personality. Depression and lower education level are potential confounders of type D personality in FM.

References:

[1]Bazzichi L, Giacomelli C, Consensi A, Giorgi V, Batticciotto A, Di Franco M, Sarzi-Puttini P (2020) One year in review 2020: fibromyalgia. Clin Exp Rheumatol 38 Suppl 123(1):3-8.

[2]Conversano C, Marchi L, Ciacchini R, Carmassi C, Contena B, Bazzichi LM, Gemignani A (2018) Personality Traits in Fibromyalgia (FM): Does FM Personality Exists? A Systematic Review. Clin Pract Epidemiol Ment Health 14:263.

[3]Türkoğlu G, Selvi Y (2020) The relationship between chronotype, sleep disturbance, severity of fibromyalgia, and quality of life in patients with fibromyalgia. Chronobiol Int 37(1):68-81.

[4]Garip Y, Güler T, Bozkurt Tuncer Ö, Önen S (2019) Type D Personality is Associated With Disease Severity and Poor Quality of Life in Turkish Patients With Fibromyalgia Syndrome: A Cross-Sectional Study. Arch Rheumatol 35(1):13-19.

[5]Ablin JN, Zohar AH, Zaraya-Blum R, Buskila D (2016) Distinctive personality profiles of fibromyalgia and chronic fatigue syndrome patients. PeerJ 4:e2421.

Table 1.

Binary logistic regression analysis for the evaluation of potential confounders of type D personality in patients with fibromyalgia.

WaldSEβ (95%CI)pEducation (years)4.6640.0930.818 (0.682−0.982)0.031Occupation duration (years)0.1160.0371.013 (0.942−1.089)0.733Self-esteem scale (D1)0.3690.4230.774 (0.338−1.771)0.544BDI8.4460.0561.178 (1.055−1.316)0.004BAI0.7890.0321.029 (0.966−1.095)0.374

BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, SE: standard error, CI: confidence interval

Disclosure of Interests:

None declared

Long-Term Effectiveness of Combined Intermittent Pneumatic Compression Plus Low-Level Laser Therapy in Patients with Postmastectomy Lymphedema: A Randomized Controlled Trial

Background: Upper limb lymphedema may be revealed after breast cancer and its treatment. Among different treatment approaches, intermittent pneumatic compression (IPC) therapy and low-level laser therapy (LLLT) are reported as effective modalities in the treatment of postmastectomy upper limb lymphedema (PML). The aim of the current study is to investigate the long-term effectiveness of combined IPC plus LLLT versus IPC therapy alone in patients with PML. Methods and Results: The patients were allocated into two groups in this single-blinded, controlled clinical trial. Group I received combined treatment with IPC plus LLLT (n = 21) and group II received only IPC (n = 21). IPC treatment was given 5 sessions per week for 4 weeks (20 sessions). LLLT was also performed 5 sessions per week for 4 weeks (20 sessions). Clinical evaluations were performed before and after the treatment at the 3, 6, and 12-month follow-up visits. According to within-group analysis, statistically significant improvements in the circumference difference (C_diff) and grip strength were observed in both groups (for C_diff, p = 0.018 and p = 0.032, respectively; for grip strength, p = 0.001 and p = 0.046, respectively). Visual analog scale values for arm pain and shoulder pain during motion were decreased only in group I. Conclusion: Both interventions have positive effects on lymphedema, grip strength, and pain. Long-term effects of combined therapy, especially on pain, are slightly superior to the pneumatic compression alone.

AB0562 SLEEP HYGIENE: COULD IT BE A CONFOUNDING FACTOR FOR SLEEP QUALITY IN SYSTEMIC SCLEROSIS?

Background:

Sleep disturbances have been described in Systemic Sclerosis (SSc). Confounding factors related to sleep quality are also investigated. Although sleep hygiene plays an important role in sleep quality, as far as we know, there are not enough data to show the effect of sleep hygiene on sleep quality of SSc.

Objectives:

To investigate sleep hygiene, its impact on sleep quality, and its association with demographic-clinical factors in patients with SSc, rheumatoid arthritis (RA), and healthy controls.

Methods:

The study was designed as cross-sectional. Forty-nine patients with SSc who fulfilled the 2013 ACR/EULAR classification criteria for SSc, 66 patients with RA who fulfilled 1987 revised classification criteria, and 30 healthy controls were included in the study. All participants were female. Demographic and clinical variables were documented. Disease activity index of both SSc and RA was calculated. SSc patients were assessed by questionnaires including Short Form 36 (SF-36), The Health Assessment Questionnaire Disability Index (HAQ-DI), Beck Anxiety and Beck Depression Inventory, Pittsburg Sleep Quality Index (PSQI), Sleep Hygiene Index (SHI). Additionally, RA patients and healthy controls were estimated by HAQ-DI, Beck Anxiety and Beck Depression Inventory, PSQI, and SHI. Logistic regression analysis was used to determine the predictors of sleep quality.

Results:

Preliminary results of the study were given. The baseline demographics were similar among groups. When comparing groups according to HAQ-DI, Beck Anxiety and Beck Depression Inventory, PSQI, and SHI, we found higher scores in SSc and RA rather than healthy controls (p<0.001, p=0.001, p=0.001, p<0.001, p=0.003; respectively). While depression and sleep hygiene were determined as the risk factors of sleep quality in SSc in univariate analysis, depression (OR=1.380, 95%CI: 1.065−1.784, p=0.015) and sleep hygiene (OR=1.201, 95%CI: 1.003−1.439, p=0.046) were also found in multivariate logistic model. In RA patients, while health status, depression, and anxiety were found as risk factors according to the univariate analysis, depression (OR=1.120, 95%CI: 1.006−1.245, p=0.038) was the only factor according to multivariate logistic model (Table).

Conclusion:

Although depression is a well-known clinical variable impacting on sleep quality, sleep hygiene should also be kept in mind as a confounding factor.

References:

[1]Milette K, Hudson M, Körner A, et al. Sleep disturbances in systemic sclerosis: evidence for the role of gastrointestinal symptoms, pain and pruritus. Rheumatology (Oxford). 2013 Sep;52(9):1715-20.

[2]Sariyildiz MA, Batmaz I, Budulgan M, et al. Sleep quality in patients with systemic sclerosis: relationship between the clinical variables, depressive symptoms, functional status, and the quality of life. Rheumatol Int. 2013 Aug;33(8):1973-9.

Table

Univariate logistic regression analysis of clinical variables to assess predictors of sleep quality

Systemic sclerosisRheumatoid arthritisOR (95% CI)pOR (95% CI)pHAQ-DI1.019 (0.882−1.177)0.8011.089 (1.011−1.173)0.025BDI score1.293 (1.082−1.547)0.0051.129 (1.036−1.230)0.006BAI score1.080 (0.997−1.169)0.0591.122 (1.038−1.214)0.004SHI1.200 (1.060−1.357)0.0041.048 (0.965−1.137)0.264Disease activitya0.707 (0.439−1.138)0.1531.446 (0.839−2.492)0.185

aDisease activity was calculated by Valentini disease activity index for SSc and DAS28-CRP for RA.

Disclosure of Interests:

None declared

They have got the blues: patient's mood- and disease activity-related psychological burden of rheumatoid arthritis on caregivers

Objective: Rheumatoid arthritis (RA), as a long-lasting disease, not only affects the musculoskeletal health but also deteriorates the psychological well-being of the patient. What about their caregivers? There exist a limited number of studies on this issue. The objectives of the present study were (i) to evaluate the psychological health among caregivers of RA patients and (ii) to determine the confounding factors playing role on their psychological status. Methods: Fifty-three RA patients and their caregivers were included in this cross-sectional study. Disease activity was assessed by using the disease activity score 28 based on C-reactive protein (DAS28-CRP) and rheumatoid arthritis disease activity index-5 (RADAI-5), while disability was evaluated by disability of the arm, shoulder, and hand (DASH) questionnaire. Psychological status was tested by Beck's depression and anxiety inventories (BDI and BAI). Results: A total of 53 patients with RA were included in the study. Caregivers' depression score was weakly correlated with disease activity variables including DAS28-CRP, RADAI and DASH scores (rs = .304, rs = .392 and rs = .301, respectively); and moderately correlated with patients' depression score and caregivers' comorbidity (rs = .407 and rs = .451, respectively). Conclusions: The psychological impact of RA on caregivers appears to be associated with patients' mood, disease activity and upper extremity functionality.

An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy

OBJECTIVES

The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups.

METHOD

The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH).

RESULTS

Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x² = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16-9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61-9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00-1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021).

CONCLUSION

High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases.

Posture of the foot: Don't keep it out of sight, out of mind in knee osteoarthritis

BACKGROUND

There are many contributors of knee osteoarthritis including the postural abnormalities of the adjacent joints. The relationship between foot posture and the clinical-radiological parameters of knee osteoarthritis is poorly understood.

RESEARCH QUESTION

Is foot posture related to the clinical and radiological parameters in patients with knee osteoarthritis?

METHODS

Patients diagnosed with primary clinical and radiographic medial tibiofemoral knee osteoarthritis were included in the study. Anteroposterior knee radiographs were staged by using the Kellgren-Lawrence grading system. Computer-based measurements of the medial joint space width (mJSW), condylar angle, anatomical axis angle, tibial plateau angle and condylar plateau angle were performed on digital anteroposterior knee radiographs. The Western Ontario and Mc Master University Osteoarthritis Index (WOMAC) questionnaire was used to assess pain and the functional status of the patients. Foot posture was assessed by the Foot Posture Index (FPI) system and feet were categorized into three (pronated, neutral and supinated).

RESULTS

The study included 150 patients (150 knees and feet at one side) with a mean age of 61.2 ± 10.1 years. In terms of foot posture groups; percentages for supination, neutral and pronation were 22.66%, 68.66% and 8.66%, respectively. In the group with supinated FPI; WOMAC total score, pain and function subscale scores were higher (p < 0.001), mJSW was narrowed (p = 0.038) and the condylar plateau angle was increased (p = 0.009). In the FPI pronation group; anatomic axis angle values were found to change in the varus direction (p = 0.012).

SIGNIFICANCE

The potential postural dysfunction of the foot should be taken into consideration during the assessment and/or management of a patient with knee osteoarthritis.

Comparative short-term effectiveness of ibuprofen gel and cream phonophoresis in patients with knee osteoarthritis

The objective of the present study was to compare the effectiveness of gel and cream ibuprofen phonophoresis in patients with knee osteoarthritis. A single-blinded, randomized, comparative design was applied. Patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were included in the study. After obtaining written informed consent, patients were randomized into ibuprofen gel and cream phonophoresis groups. Each patient was treated five sessions per week for 2 weeks (ten sessions). Main outcome measures were 100 mm visual analogue scale (VAS) for pain and the disease-specific questionnaire; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Sixty-one knee osteoarthritis patients with a mean age of 57.9 ± 9.7 years were included in the study. Baseline VAS and WOMAC scores were similar between gel (n = 30) and cream (n = 31) phonophoresis groups (p > 0.05 for both). Following the treatment, both groups showed improvement compared to baseline measures including VAS pain and WOMAC scores. In the gel phonophoresis group, the improvement in VAS score was higher than that observed in the cream phonophoresis group (p < 0.001). Similarly, the improvement in WOMAC total score was also higher in the gel phonophoresis group (p < 0.001). Ibuprofen phonophoresis is clinically effective in patients with knee osteoarthritis. Phonophoresis using the gel form of ibuprofen is associated with more clinical improvement than that using the cream form of the same molecule.