Diagnostic delay in psoriatic arthritis: insights from a nationwide multicenter study

This study aimed to investigate the duration of diagnostic delay in patients with psoriatic arthritis (PsA) and identify potential contributing factors using a comprehensive, population-based approach. Data were obtained from the Turkish League Against Rheumatism (TLAR)-Network, involving patients who met the CASPAR criteria. Diagnostic delay was defined as time interval from symptom onset to PsA diagnosis, categorized as ≤ 2 years and > 2 years. Temporal trends were assessed by grouping patients based on the year of diagnosis. Various factors including demographics, clinical characteristics, disease activity, quality of life, physical function, disability, fatigue, and well-being were examined. Logistic regression models were used to identify factors associated with diagnostic delay. Among 1,134 PsA patients, mean diagnostic delay was 35.1 months (median: 12). Approximately 39.15% were diagnosed within 3 months, and 67.02% were diagnosed within 24 months. Patients experiencing longer delays had higher scores in Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), patient's global assessment (PtGA) and physician's global assessment (PhGA). Diagnostic delay has decreased over time, with median delay falling from 60 to 24 months throughout pre-2010 and 2015-2019 terms. Several factors were identified as significant contributors to delayed diagnosis, including lower levels of education (OR = 2.63), arthritis symptoms preceding skin manifestations (OR = 1.72), low back pain at first visit (OR = 1.60), symptom onset age (OR = 0.96), and psoriasis subtype (OR = 0.25). Timely diagnosis of PsA is crucial for effective management and improved outcomes. Despite recent improvements, about one-third of PsA patients still experience delays exceeding 2 years. By identifying influential factors such as education level, arthritis symptoms preceding skin manifestations, initial visit symptoms, age of symptom onset, and psoriasis subtype, healthcare practitioners may create specific techniques to help in early detection and intervention.

Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosis

Objectives

The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients.

Patients and methods

This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings.

Results

Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200).

Conclusion

The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.

Familial Mediterranean fever: perspective on female fertility and disease course in pregnancy from a multicenter nationwide network

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.

Beyond expectations: disease duration and psychological burden in psoriatic arthritis

This study aims to investigate the relationship between disease duration and psychological burden in PsA and to identify the risk factors associated with psychological distress. Patients with PsA who met CASPAR classification criteria enrolled by Turkish League Against Rheumatism (TLAR)-Network. Patients were categorized into three groups based on disease duration: early stage (< 5 years), middle stage (≥ 5, < 10 years), and late stage (≥ 10 years). All patients underwent clinical and laboratory assessment using standardized protocol and case report forms. The associations between psychological variables and clinical parameters were assessed by a multivariate analysis. Of the 1113 patients with PsA (63.9% female), 564 (%50.7) had high risk for depression and 263 (%23.6) for anxiety. The risk of psychological burden was similar across all PsA groups, and patients with a higher risk of depression and anxiety also experienced greater disease activity, poorer quality of life, and physical disability. Multivariate logistic regression revealed that female gender (OR = 1.52), PsAQoL (OR = 1.13), HAQ (OR = 1.99), FiRST score (OR = 1.14), unemployment/retired (OR = 1.48) and PASI head score (OR = 1.41) were factors that influenced the risk of depression, whereas the current or past enthesitis (OR = 1.45), PsAQoL (OR = 1.19), and FiRST score (OR = 1.26) were factors that influenced the risk of anxiety. PsA patients can experience a comparable level of psychological burden throughout the course of their disease. Several socio-demographic and disease-related factors may contribute to mental disorders in PsA. In the present era of personalized treatment for PsA, evaluating psychiatric distress can guide tailored interventions that improve overall well-being and reduce disease burden.

The impact of nail psoriasis on disease activity, quality of life, and clinical variables in patients with psoriatic arthritis: A cross-sectional multicenter study

AIM

Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA).

METHOD

This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the χ² test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables.

RESULTS

In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05).

CONCLUSION

We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.

The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study

Objectives

This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population.

Patients and methods

Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA.

Results

The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all).

Conclusion

In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

Inconsistencies of the Disease Activity Assessment Tools for Psoriatic Arthritis: Challenges to Rheumatologists

OBJECTIVE

Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA.

METHODS

The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed.

RESULTS

The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA).

CONCLUSION

Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes.

Familial Mediterranean fever: Health-related quality of life and associated variables in a national cohort

Objectives

This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients.

Patients and methods

This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale.

Results

The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$<300), smoking, late-onset FMF (>20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT.

Conclusion

Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

Impact of obesity on quality of life, psychological status, and disease activity in psoriatic arthritis: a multi‑center study

This article aims to evaluate the possible effect of obesity on quality of life, psychological status, and other clinical variables in Psoriatic arthritis (PsA). PsA patients have been recruited by the Turkish League Against Rheumatism-Network from various centers in Turkey in this cross-sectional study. Patients with a body mass index (BMI) ≥ of 30 kg/m² were considered obese. Differences among patients with regard to obesity status were assessed with health-related quality of life measures (PsA Quality of Life Questionnaire [PsAQoL]), psychological status (Hospital Anxiety and Depression Scale [HADS]), and disease activity parameters (the Disease Activity index for PSoriatic Arthritis [DAPSA], Disease Activity Score 28-C-reactive protein [DAS28-CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Psoriasis Area and Severity Index [PASI]), physical functions (Ankylosing Spondylitis Functional Index [BASFI], Health Assessment Questionnaire [HAQ], and Health Assessment Questionnaire for the spondyloarthropathies [HAQ-S]). Pain was assessed using visual analog scale of pain (VAS-P), and fatigue was evaluated using visual analog scale of fatigue (VAS-F) and Functional Assessment of Chronic Illness Therapy (FACIT). A total of 1033 patients with PsA, 650 (62.9%) non-obese and 383 (37.1%) obese were included in the study. The PsAQoL, HADS-Anxiety, HADS-Depression, DAPSA, DAS28-CRP, BASDAI, BASFI, HAQ and HAQ-S scores of the obese group were higher than the non-obese group (p < 0.05). VAS-P and PASI scores were similar between group of patients with and without obesity. Obese patients had higher median scores of VAS-F and FACIT than non-obese patients (p < 0.05). Linear regression analysis showed that BMI affects the quality of life, depression, and disease activity. Consequently, obesity has significant associations with higher disease activity, lower QoL, risk of anxiety, depression, and fatigue. Therefore, obesity should also be taken into account in the management of PsA patients.

POS1359 REGIONAL DIFFERENCES IN DISEASE CHARACTERISTICS OF FAMILIAL MEDITERRANEAN FEVER IN TURKEY: PRELIMINARY REPORT

Background:

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease accompanied by recurrent attacks of fever and serositis. It is prevalent among Mediterranean populations, mainly Turks, Armenians; Jews and Arabs. As genetic factors are variable in the population, environmental factors can also affect phenotypic characteristics.

Objectives:

This study aimed to determine the geographic differences in disease characteristics and burden in patients with FMF in Turkey.

Methods:

Patients diagnosed with FMF according to the Tel-Hashomer criteria were included in this multi-center study. Patients were included from the different regions of Turkey. Demographic features and clinic characteristics of the patients including disease duration, medications, comorbid conditions, attack characteristics, amyloidosis, acute phase reactants, FMF gene mutations, arthritis, sacroiliitis, and febrile myalgia were recorded. PRASS disease activity score, FMF-QoL, HAD, and HAQ were assessed. Patients from different parts of Turkey were divided into 3 groups the Central Anatolia, Western, and Eastern. Disease activity, characteristics and burden were also investigated among 3 distinct geographic regions.

Results:

A total of 281 patients with FMF (195 women, 86 men) were enrolled in this study. The mean age of the patients was 34.9 (SD:12.3) years. While the patients in the eastern areas of Turkey were diagnosed earlier age (p<0.001), the patients in the western area had a longer diagnostic delay time (p<0.001). Patients enrolled from western regions tended to have higher ESR and PRASS scores than those from eastern and central Anatolian regions, but attack numbers per 6 months were similar among the regions. The highest proportion of patients who were M694V/M694V homozygous patients were in western, and then eastern and central Anatolia (19.5%, 18%, and 5.4%). While fever and arthritis were more common in the eastern, pleuritis and sacroiliitis were more common in the central anatolia. Peritonitis and erysipelas like erythema rates were similar among the regions. The majority of patients were receiving colchicine treatment in all three regions. FMF-QoL scores were highest in the eastern and lowest in the western (p=0.006). Patients enrolled in the central Anatolia region experienced more functional disability than those from the western and eastern regions (p=0.009). Anxiety and depression scores were similar between groups (p=0.385 vs p=0.549).

Conclusion:

These findings suggest that patients with FMF have diversity concerning the age at diagnosis, diagnostic delay time, disease activity, quality of life, and functional disability among the 3 regions. In the genotypic analysis, the M694V mutation is the most common pathogenic mutation in all regions. Regional genetic and environmental varieties may explain the areal differences. These relationships can occur more clearly in larger patient populations.

References:

[1]Ureten K,et al. Demographic, clinical and mutational characteristics of Turkish familial Mediterranean fever patients: results of a single center in Central Anatolia. Rheumatol Int. 2010;30(7):911-915.

Table 1.

Clinical and demographic characteristics of patients by geographic region

Western, n=107Central, n=74Eastern,n=100pAge37.7 (12.5)36 (12.6)31.2 (10.9)<0.001Sex, female79 (73.8%)58 (78.4%)58 (%58)0.007Age at the symptom onset, year16.8 (11.3)20.4 (13.2)18.5 (11)0.229Age at the diagnosis, year29.6 (13.4)27.7 (13.3)22.1 (12.1)<0.001Diagnostic delay time, year12.3 (12.9)7.3 (10.5)3.6 (5.3)<0.001ESR, mm/hr26.8 (18.9)15.5 (12)13.1 (13.1)0.003PRASS41 (55.4%)0.577 Low50 (46.7%)28 (37.8%)51 (51%) Moderate48 (44.9%)45 (45%) High9 (8.4%)5 (6.8%)4 (4%)Fever83 (77.6%)60 (81.1%)96 (96%)0.001Peritonitis98 (91.6%)64 (86.55)92 (92%)0.412Pleuritis35 (32.7%)27 (36.5%)18 (18%)0.013Arthritis18 (16.8)16 (21.6)36 (36%)0.005Sacroiliitis8 (7.5%)14 (18.9%)1 (1%)0.000Erysipelas like erythema2 (1.9%)7 (9.5%)7 (7%)0.075

Data are presented as mean (SD), median (min-max), and n (%)

Disclosure of Interests:

None declared

POS1354 GENDER DIFFERENCES IN CLINICAL FEATURES AND BURDEN IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: PRELIMINARY REPORT

Background:

Familial Mediterranean fever (FMF) is the most common hereditary auto-inflammatory disease, which is more common in groups in the Mediterranean basin, characterized by recurrent attacks of febrile peritonitis, pleuritis and arthritis.

Objectives:

The aim of this study is to investigate the gender differences in clinical and demographic features in patients with familial Mediterranean fever (FMF).

Methods:

Patients with FMF diagnosed according to Tel-Hashomer criteria were included in this multi-center study. Data about age, sex, disease duration, symptom duration, age at diagnosis, comorbid diseases and medications were noted. All patients were screen with Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaires (HAQ), Short Form 36 (SF-36). The severity of FMF was assessed by the PRASS scoring system.

Results:

Of the 286 patients, 199 (69,6%) were female with the mean age 36,2(SD:12.32) years and 87 (30,4%) were male with the mean age 32,9(SD:12,6) years (p=0,017). Age of diagnosis in male patients was lower than in females (p=0,008). The most common genetic mutation in both genders was M694V gene mutation. Homozygous M694V positivity was higher in males (31,79% vs 17,4%). More than 90% of patients were receiving colchicine,10 (3,5%) patients were receiving anakinra and 5(1,75%) patients were receiving canakinumab. Among the patients regularly taking colchicine, 86.2% were females and 86% were males (p=0,981). There were no differences between male and females in terms of clinical findings, frequency and duration of attacks, presence of colchicine resistance, and the presence of amyloidosis (p>0.05). ESR was detected higher in female group (p=0,011). Headache (p=0,001), migraine (p=0,031), and concomitant diseases (p=0,017) were also more common in females than males. Anxiety and depression scores were higher in females (p<0,05). The PRASS activity scores were similar between genders (p>0,05). All parameters of SF-36 were higher in male patients, while HAQ score was higher in females (p<0,05).

Conclusion:

Although clinical findings, disease severity and treatment compliance are similar in both genders, males are diagnosed with FMF earlier than females, but findings such as anxiety, depression, migraine, and headache are more common in female patients.

References:

[1]Doğan HO, Koca Y, Erden G, Karaaslan Y, Bozat H. Evaluating MEFV mutation frequency in Turkish familial Mediterranean fever suspected patients and gender correlation: a retrospective study. Mol Biol Rep. 2012 May;39(5):6193-6.

Table 1.

Demographic and clinical features between female and male FMF patients.

Female (n:199)Male (n:87)PDemographic features, mean (SD) Age36,2 (12.32)32,9 (12,6)0,017 BMI26,87(5,73)25,79(5,28)0,177 Educational level, years8,77(4,36)12,08(3,23)0,000 Age at diagnosis28 (13,31)23,7 (13,42)0,008 Age at onset of disease19,2 (12,6)17 (10,6)0,265Clinical features, n (%) Fever166 (83,4)77 (88,5)0,268 Abdominal pain180 (90,5)78 (89,7)0,835 Chest pain62 (31,2)20 (23)0,160 Erysipelas like erythema12 (6)4 (4)0,628 Arthritis46 (23,1)24 (24)0,419 Arthralgia102 (51,3)42 (48,3)0,643 Myalgia101 (50,8)47 (54)0,611MEVF mutations, n (%)  M694V/M694V24 (12.3)19 (22)0.047  M694V heterozygous38 (19,5)14 (16,3)0.523 M694V/any25 (12,8) 15 (17,4)0.307PRASS disease severity, n (%)0,813 Mild99(49,7)46(52,9) Moderate88(44,2)35(40,2) Severe12(6)6(6,9)ESR, mm/hour, mean (SD)23,77(16,27)18,25(18,41)0,011HAQ, mean (SD)0,49 (0,63)0,16 (0,43)0,000HAD, mean (SD)  Anxiety8,4 (4,4)6,7 (3,44)0,003  Depression7,1 (4,27)5,7 (3,81)0,006SF-36, mean (SD) Physical functioning63,56 (23,81)79,93 (19,32)0,000 Physical role limitation45,78 (40,95)61,41 (39,14)0,003 Emotional role limitation47,36 (42,04)66,20 (40,69)0,020 Energy/fatigue42,50 (20,64)53,64 (19,82)0,000 Emotional well-being51,61 (18,47)58,74 (18,30)0,003 Social functioning57,06 (23,09)70,52 (23,82)0,000 Pain51,66 (24,05)65,72 (24,51)0,000 General health39,53 (20,01)52,46 (23,83)0,000

Disclosure of Interests:

None declared

Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study

OBJECTIVE

This study sought to compare disease activity, clinical features, and patient-reported outcomes concerning anxiety, depression, fatigue, function, quality of life, and fibromyalgia between female and male patients with peripheral PsA in a Turkish population.

METHODS

This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1038 patients (678 females, 360 males) diagnosed with peripheral PsA according to the CASPAR criteria. The demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28 and cDAPSA. Remission, minimal disease activity (MDA), and very low disease activity (VLDA) were determined. Health Assessment Questionnaire (HAQ), Short-Form-36 (SF-36), Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid ScreeningTool (FiRST) were used. Disease activity and patient-reported outcomes were compared in male and female patients, and the predictors of MDA for both genders were analyzed.

RESULTS

The patients' mean age was 47.6years (SD: 12) for females and 46.3years (SD: 12.3) for males. In terms of DAS28 and cDAPSA, female patients had significantly higher disease activity scores, while male patients had significantly higher remission rates (P<0.05). There was a significant difference in the rate of MDA in favor of males (P<0.05), but not in VLDA. The incidences of dactylitis, enthesitis, tenosynovitis, and inflammatory bowel disease were similar in male and female patients, except for spondylitis, which was higher in males (P<0.05). Overall, although there was no significant between-group difference in age and disease duration, female patients had significantly higher BMI and late-onset disease (P<0.05). Female patients had higher HAD, HAQ, and FiRST and lower SF-36 scores than males (P<0.05). In both male and female patients, the disease activity score of cDAPSA was significantly correlated with the scores of FiRST, HAD, VAS-F, and HAQ (P<0.05). In regression analysis, tender joint count, swollen joint count, PASI, pain VAS, and enthesitis were the MDA predictors in both genders.

CONCLUSION

In patients with peripheral PsA, males are more likely to develop spondylitis while other extraarticular manifestations are similar. Female patients appear to have lower rates of remission and MDA and higher levels of disease activity. Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations. The predictors of MDA, i.e., tender joint count, swollen joint count, PASI, pain VAS, and enthesitis are similar between the two genders.

The effect of gender on disease activity and clinical characteristics in patients with axial psoriatic arthritis

OBJECTIVES

In this study, we aimed to evaluate the effect of gender on clinical findings, disease activity, functional status and quality of life in patients with axial involvement in Turkey.

METHODS

Patients with PsA who met the CASPAR classification criteria were enrolled consequently in this cohort. Turkish League Against Rheumatism (TLAR)-Network was formed with the participation of 25 centres. The demographic variables, fatigue, diagnostic delay, the beginning of peripheral arthritis, enthesitis, dactylitis and spine involvement, inflammatory low back pain, BASFI, HAQ, HAQ-s, visual analogue scale-pain (VAS-pain), anxiety, depression and disease activity parameters (ESR, DAS28, BASDAI) were recorded. Axial involvement was assessed according to clinical and radiological data according to modified New York (MNYC) or Assessment of SpondyloArthritis international Society (ASAS) criteria.

RESULTS

A total of 1018 patients with PsA were included in this study. Of the 373 patients with axial involvement, 150 were male (40.2%) and 223 (59.8%) were female. Spondylitis was detected in 14,7% of men and 21,9% of women in all patients. Pain score (VAS) (p < .002), fatigue (p < .001), ESR (p < .001), DAS28 (p < .001), BASDAI score (p < .001), PsAQoL (p < .001), HAQ score (p < ,01), HAQ-S score (p < .001), anxiety (p < .001), depression (p < .024), FACIT (p < .001) and FiRST (p < .001) scores were statistically significantly worse in women than males with axial PsA. However, quality of life was better (p < .001) and PASI score (p < .005) were statistically worse in male patients than in female patients with axial involvement.

CONCLUSION

This study has shown that the burden of disease in axial PsA has significant difference between genders. Disease activity, physical disability, functional limitation, depression and anxiety scores were higher in female patients, while quality of life were better and PASI score were higher in male patients. Therefore, we suggest that new strategies should be developed for more effective treatment of axial PsA in female patients.

Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs

Objectives

This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey.

Patients and methods

A total of 961 patients (346 males, 615 females; mean age 46.9±12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients’ demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and short form-36 scores were all recorded.

Results

Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The visual analog scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD.

Conclusion

In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment.

High levels of cathepsin S and cystatin C in patients with fibromyalgia syndrome

OBJECTIVES

Although the etiopathogenesis of fibromyalgia syndrome (FM) is not yet clear, central sensitization is thought to be responsible for the pathogenesis of FM. The aim of this study was to compare the serum cathepsin S (CatS) and cystatin C (CysC) levels between patients with FM and healthy control subjects.

METHODS

This study was conducted in the Physical Medicine and Rehabilitation Clinic between January 2019 and October 2019. The study included 145 FM patients newly diagnosed with primary FM according to the 2010 American College of Rheumatology criteria and 129 healthy volunteers. The age, gender, and body mass index (BMI) of the participants were recorded. Venous blood samples were collected from both groups for the measurement of the levels of serum CatS and CysC. The functional status of FM patients was evaluated using the Fibromyalgia Impact Questionnaire (FIQ).

RESULTS

No statistically significant difference was determined between the patient and control groups in terms of age, gender, and BMI (P > .05). A comparison of the serum CatS and CysC levels of the FM and control groups revealed a statistically significant difference (P = .001). No correlation was determined between FIQ and serum CatS and CysC levels (P > .05).

CONCLUSION

Serum CatS and CysC levels were found to be higher in FM patients. However, there was no correlation between the functional status of FM patients and serum CatS and CysC levels. These results can be of guidance for further clinical studies of the etiopathogenesis and treatment of FM.

Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics

OBJECTIVE

A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas.

METHODS

The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used.

RESULTS

Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies.

CONCLUSIONS

The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Validity, reliability, and factor structure of the Istanbul Low Back Pain Disability Index in axial spondyloarthritis

OBJECTIVE

To investigate the validation and reliability of Istanbul Low Back Pain Disability Index (ILBPDI) in axial spondyloarthritis (Ax-SpA).

METHODS

Patients with Ax-SpA according to The Assessment of SpondyloArthritis International Society criteria were recruited. The validation was assessed by face, content, and construct (convergent and divergent) validities, whereas the reliability was assessed by internal consistency and test-retest reliability. Factor analysis was performed. Convergent validity was assessed by correlations of ILBPDI with functional parameters (The Bath Ankylosing Spondylitis Functional Index, The Dougados Functional Index, and The Health Assessment Questionnaire). Divergent validity was assessed by correlations of ILBPDI with non-functional parameters.

RESULTS

Two hundred forty patients were recruited. Cognitive debriefing showed ILBPDI to be clear, relevant, and comprehensive. Cronbach's alpha coefficient was 0.953. The test-retest reliability was good with the intraclass correlation coefficient of 0.870. ILBPDI was represented by three-factor groups of activity: axial bending, sitting/rest, and standing activities. ILBPDI had good correlations with the functional parameters (rho changes between 0.809 and 0.580), and it had poor or non-significant correlations with the non-functional parameters (absolute rho changes between 0.669 and 0.001).

CONCLUSION

ILBPDI is a practical, accurate, and non-time-consuming scale which is valid and reliable to evaluate the functional disability in patients with Ax-SpA.

Association Between Familial Mediterranean Fever and Cachexia in Females

Objectives

This study aims to investigate the association between familial Mediterranean fever (FMF) and cachexia in females.

Patients and methods

The study included 32 female FMF patients (median age 27.50 years; range, 18 to 50 years) and 30 female healthy controls (median age 32 years; range, 18 to 50 years). Patients were classified according to Tel-Hashomer criteria. Circumference of arm, waist, and thigh was recorded. Short form 36 (SF-36) and Multidimensional Assessment of Fatigue (MAF) scale were applied. Composition of the body was measured with dual X-ray absorption. Muscle strength was measured with an isokinetic dynamometer, and strength of hand grip was measured from dominant hand with a hand dynamometer. C-reactive protein, erythrocyte sedimentation rate, fibrinogen and serum creatinine kinase (CK) levels were recorded.

Results

Body mass index was significantly higher in controls. Twelve patients and one control had cachexia. CK level was significantly higher in patients than controls. Mass of muscle without fat was significantly higher in patients than controls. Peak torque values of extension and flexion at the velocity of 60°/second [Newton meter (Nm)], and value of total work during extension at the velocity of 240°/second (Nm) in isokinetic measures were significantly higher in controls. MAF score was significantly higher in patients with cachexia than patients without cachexia where the subscale scores of SF-36, except the vitality score, were significantly lower in patients with cachexia. However, Tel-Hashomer score was significantly higher in patients with cachexia.

Conclusion

This study pointed at a significant association between cachexia and FMF in females. Muscle endurance was not affected in FMF patients with cachexia; however, decreased muscle strength, impaired quality of life and increased fatigue were observed in these patients.

Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: a multi-center study

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

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

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

Serum cortisol and dehydroepiandrosterone-sulfate levels after balneotherapy and physical therapy in patients with fibromyalgia

Objectives:

To investigated serum cortisol and serum dehydroepiandrosterone-sulphate (DHEA-S) levels between fibromyalgia (FMS) patients and a control group, and the effect of balneotherapy (BT) on these hormones.

Methods:

Seventy-two patients with FMS and 39 healthy volunteers were included in the study. This prospective and cross-sectional study was carried out in the Medical Faculty, Physical Medicine and Rehabilitation Clinic, Cumhuriyet University, Cumhuriyet, Turkey between June 2012 and June 2013. Patients were divided into 2 groups. There were 40 patients in the first group, consisting of BT and physical therapy (PT) administered patients. There were 32 FMS patients in the second group who were only administered PT. Thirty-nine healthy volunteers were enrolled as a control group.

Result:

Cortisol was observed to be lower in FMS patients compared with the controls (10.10±4.08 μg/dL and 11.78±3.6 μg/dL; p=0.033). Serum DHEA-S level was observed to be lower in FMS patients compared with the controls (89.93±53.96 μg/dL and 143.15±107.92 μg/dL; p=0.015). Average serum cortisol levels of patients receiving BT were determined to be 9.95±3.20 μg/dL before treatment and 9.06±3.77μg/dL after treatment; while average serum DHEA-S levels were 77.60±48.05 μg/dL before treatment, and 76.84±48.71 μg/dL after treatment. No significant changes were determined in serum cortisol and DHEA-S levels when measured again after BT and PT.

Conclusion:

Low levels of serum cortisol and DHEA-S were suggested to be associated with the physiopathology of FMS.

Sarcopenia in women with rheumatoid arthritis

OBJECTIVE

To assess sarcopenia status in women with rheumatoid arthritis (RA).

MATERIAL AND METHODS

Thirty female patients with RA and 30 female controls without RA were enrolled in this study. Sarcopenia status in patients with RA was evaluated by assessing body composition using dual X-ray absorptiometry (DXA). C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) were measured, and body mass index (BMI) and Disease Activity Score (DAS28) were calculated. Because sarcopenia differs between men and women, the study groups comprised only females.

RESULTS

It was found that skeletal muscle index (SMI) was lower in patients with RA (5.83±0.807) than in controls (7.30±1.640). Sarcopenia (in females with an SMI of ≤5.75 kg/m2) was more common in the RA group and the difference was statistically significant (p=0.004). Sarcopenia was more common in patients with RA who were normal or overweight than in those who were obese according to their BMI. There was no relationship between sarcopenia and DAS28 in the RA group (p=0.530), whereas CRP levels were significantly higher in patients with sarcopenia (p=0.230). No relationship was found between drug use and sarcopenia in the RA group.

CONCLUSION

It was found that SMI was decreased and sarcopenia risk was elevated in patients with RA and the risk was higher in non-obese patients.

Mutation in the HTRA1 gene in a patient with degenerated spine as a component of CARASIL syndrome

AIM

To show the mutation in HTRA1 gene in a patient suffering from CARASIL syndrome with degenerated spine as a component of the disease.

MATERIAL AND METHODS

We identified a family that one of the members had CARASIL syndrome in eastern Turkey and collected venous blood from available persons. The HTRA1 gene sequenced in all family members.

RESULTS

C to T transition at position 1108 (c.1108 C > T) in exon 6, causing stop codon formation (R370X) was seen in the HTRA1 gene in a homozygous state in the CARASIL patient whereas it was heterozygous in other healthy family members.

CONCLUSION

We demonstrated homozygous c.1108 C > T mutation in the HTRA1 gene causing a very rare syndrome, especially in the non- Japanese population, called CARASIL. Patients with degenerated spine and progressive clinical symptoms must be evaluated or reevaluated for other central nervous system symptoms and signs to rule out other diseases or syndromes.

Differentiation of Rheumatoid Arthritis From HCV Infection: Rheumatoid Factor, Anti-Cyclic Citrullinated Peptide or Anti-Mutated Citrullinated Vimentin?

Objective: Differentiation of rheumatoid arthritis (RA) from other diseases with joint involvement such as hepatitis-C virus (HCV) infection represents a diagnostic problem. In addition to the rheumatoid factor (RF), more specific and sensitive auto-antibodies are under evaluation in recent years with conflicting results. In this study, we tested the diagnostic value of rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin (anti-MCV) in distinguishing RA from hepatitis C patients.

Materials and Methods: Sera of 34 RA patients and 30 hepatitis C patients were tested for RF, anti-CCP anti-MCV. Disease activity was determined by disease activity score (DAS-28) 28 in RA and by modified Knodell score in hepatitis C patients. Extra-articular involvement in RA and rheumatologic involvement in hepatitis C patients were documented.

Results: In roc analysis, area under curve (AUC) was the highest in anti-CCP. Sensitivity and specificity was 82% and 53%, 79%, and 96% and 70%, and 73% for RF, anti-CCP and anti-MCV respectively. DAS-28 has a weak correlation with RF (r=0.406), anti-CCP (r=0.433), and anti-MCV (r=0.453). There was no difference between the patients in autoantibody levels regarding extra-articular involvement and DAS-28 in RA, and joint involvement in hepatitis C patients.

Conclusion: Anti-MCV antibodies may be useful in distinguishing RA however it seems to have no additional value over anti-CCP or RF in hepatitis C patients. Anti-CCP antibodies are more reliable in diagnosis of RA due to their high specificity. (Turk J Rheumatol 2010; 25: 19-23)

Coexistence of familial Mediterranean fever and juvenile idiopathic arthritis with osteoporosis successfully treated with etanercept

Familial Mediterranean fever (FMF) is an autoinflammatory disorder characterized by recurrent febrile polyserositis and arthritis attacks. Accompanying seronegative spondyloarthropathy has been reported in FMF in addition to its own joint involvement. However, the coexistence of FMF with juvenile idiopathic arthritis (JIA) is very rare, only three cases with severe joint involvement and mortal outcome have been reported in the literature. Here, we present another case with FMF and JIA with osteoporosis, successfully treated with etanercept with a four-year follow-up.

Polypharmacy in the elderly: a multicenter study

OBJECTIVE

The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients.

DESIGN

Cross-sectional

SETTING

Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces.

PARTICIPANTS

A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included.

MEASUREMENTS

Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement.

RESULTS

The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly.

CONCLUSIONS

Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.

Are plasma and synovial fluid leptin levels correlated with disease activity in rheumatoid arthritis ?

Leptin is an adypocyte derivated peptide hormone that plays a major role in preventing obesity development by the effects at the hypothalamic level. In our study leptin levels of 41 rheumatoid arthritis (RA) patients and 25 healthy subjects as control group were assessed. Synovial fluid from 21 RA patients were collected to detect leptin levels. Synovial fluid and plasma leptin levels were analysed and correlated with RA duration, ESR, CRP, X ray changes (erosive or non-erosive disease) and negative or positive test for rheumatoid factor. There wasn't any significant difference at plasma leptin levels between RA patients (3.91 +/- 6.15) and control group (4.94 +/- 6.44) (p > 0.05). Plasma leptin levels were correlated with body mass index (BMI) in both healthy subjects and RA patients (r = 0.37; p = 0.018). Therefore in RA patients, plasma and synovial fluid leptin levels were not correlated with disease duration, ESR, CRP, negative or positive test for rheumatoid factor and erosive or non-erosive disease (p > 0.05). In conclusion leptin is correlated with BMI both in RA patients and healthy individuals but no considerable relation with disease activity.

Sympathetic skin responses in reflex sympathetic dystrophy

This study was performed to determine the utility of sympathetic skin response (SSR) in evaluating the sympathetic function and to follow up the effects of sympathetic blockade in reflex sympathetic dystrophy (RSD). Thirty patients having RSD with upper extremity involvement were randomly divided into two groups. Besides medical therapy and exercise, physical therapy agents were applied to both the groups. In addition to this treatment protocol, stellar ganglion blockade was done by diadynamic current in Group II. The normal sides of the patients were used for the control group. SSRs were measured in all the patients before and after the therapy. The amplitude was found to be increased and the latency was found to be decreased in the affected side in both the groups before the therapy. After the therapy, the amplitude was decreased and latency was increased in both the groups. But, the differences in amplitude (P = 0.001) and latency (P = 0.002) before and after the therapy were significantly higher in Group II. (Before the treatment, SSRs were significantly different between the normal and the affected sides in both the groups. The observed change in SSRs after the treatment was higher in Group II.) It was concluded that, SSR can be a useful and noninvasive method in diagnosing the sympathetic dysfunction in RSD and can be used for evaluating the response to sympathetic blockade and other treatment modalities.

Investigation of genotoxic effect of ultrasound in cases receiving therapeutic ultrasound by using micronucleus method

In 1991, reported that therapeutic ultrasound (US) did not induce sister chromatid exchanges (SCEs) in patients whereas, in 1984, reported that each of 10 patients exposed to therapeutic US had a statistically significant increase in SCEs. The present study was planned to investigate if there was chromosomal damage resulting from therapeutic US by using a micronucleus (MN) method, and to counter the lack of reports in this area over the past 10 years. A total of 20 female volunteers were included in the study; 10 of them with low back pain (mechanical low back pain and facet syndrome) were treated with US and 10 healthy cases constituted the control group. Patients with low back pain received 10 sessions of US therapy at an intensity of 2 W/cm(2) and a frequency of 1 MHz for 10 min and patients in the control group received sham US therapy for 10 min. Peripheral blood taken before and after the fifth and tenth applications of US therapy was cultured for MN frequencies both for the treatment and the control groups. The scores of MN assessed before the therapy were compared with those at the end of the fifth session and the end of the tenth session in the treatment and the control groups. Pretreatment, end of the fifth session and end of the tenth session MN frequencies were compared between the treatment and the control groups. There was no statistically significant difference in MN frequencies between pretreatment and fifth session or pretreatment and tenth session in both groups. Nor was there any significant difference in the MN frequencies of the treatment and control groups between pretreatment, fifth session and tenth session evaluations. In conclusion, we observed that therapeutic US did not induce increases in MN frequency, which are a sign of cytogenetic damage.

The effects of infrared laser and medical treatments on pain and serotonin degradation products in patients with myofascial pain syndrome. A controlled trial

In this controlled study of 46 patients with myofascial pain syndrome, we investigated the effects of infrared (IR) laser application to trigger points and medical treatment on pain reduction and serotonin and its degradation products. Retaining double-blind trial principles, the patients were randomly assigned to two groups. The treatment group received IR laser treatment, whereas the control group received sham laser. However, both groups received medical treatment. In the treatment group, laser was applied once a day for 10 consecutive days at a dose of 1.44 J/cm2. The effect of the laser treatment on pain was evaluated by visual analog scale. Urinary excretion of 5-hydroxy indole acetic acid (5-HIAA) and serotonin + 5-hydroxy tryptophan (5-HT+5-HTP) was studied by column chromatography. At the end of the treatment, there was a statistically significant difference between the VAS values of the treatment and control groups. The 24-h urinary excretion of the 5-HIAA and 5-HT+5-HTP was significantly higher in the laser treatment group than in the placebo group. In conclusion, IR laser is an effective modality in the treatment of MPS which increases an important mediator of pain inhibition, serotonin.

The effect of different doses of calcitonin on bone mineral density and fracture risk in postmenopausal osteoporosis

A total of 107 patients were included in the study to determine the effects of different doses of intranasal calcitonin on bone mineral density and fracture risk in postmenopausal osteoporosis. Patients were randomly divided into three groups. All three groups were given 1000 mg/day calcium and vitamin D in adequate doses. Two of the groups, the exception being the placebo group, were also given either 50 IU or 100 IU of calcitonin. The data of 81 patients who completed the 24 months of regular study treatment and controls were evaluated. When compared, both of the calcitonin groups were superior to the placebo group regarding increase in bone mineral density and decrease in fracture rate.

Relapsing significant bacteriuria: effect on urinary tract infection in patients with spinal cord injury

OBJECTIVE

To evaluate whether there is a relation between relapsing significant asymptomatic bacteriuria (ASB) and symptomatic urinary tract infection (UTI), and to determine the frequency rate of UTI in patients with spinal cord injury (SCI) using indwelling catheters (IC).

DESIGN

Cohort study. Patients were followed up for 24 to 270 days (mean, 66.3 +/- 42.2).

SETTING

A department of physical therapy and rehabilitation in a research hospital of a university referral center.

PATIENTS

Fifty patients with SCI using IC. Patients with severe concurrent illness, known vesicouretheral reflux, urinary calculi, and severely disturbed renal function were excluded.

MAIN OUTCOME MEASURE

Symptomatic UTI, relapsing ASB, and recurrent significant ASB.

RESULTS

There was significant difference between relapsing ASB and recurrent ASB with regard to occurring symptomatic UTI (chi 2, 4.92; p < .03). Symptomatic UTI was observed at a rate of 9.35, relapsing ASB 35.59, and recurrent ASB 55.80 per 1,000 patient-days.

CONCLUSION

Relapsing ASB is an important factor in the development of symptomatic UTI.