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.

Optimization of the Cross-Sectional Geometry of Auxetic Dowels for Furniture Joints.

In this study, the aim was to optimize the cross-sectional geometry of auxetic dowels for furniture joints. For this purpose, two different sizes of auxetic dowels were chosen, one for frame- and the other for panel-type furniture joints for designing the cross-sectional geometry. Auxetic patterns that are created on the cross-sectional area cause deficiency of the materials, and this phenomenon decreases the modulus of elasticity (MOE) and increases the member stress. Accordingly, maximum MOE values and minimum Poisson's ratio levels were determined for the optimum strength-auxetic behavior relation by means of a Monte Carlo method. Furthermore, Poisson's ratio of the optimized dowel's cross-section was confirmed with experimental tests, numerical analyses and analytical calculations. As a result, Poisson's ratio values were obtained as negative values and confirmed, which means the dowels designed in this study had auxetic behavior. In conclusion, it could be said that studies should be conducted on the performance of auxetic dowels in both frame and panel furniture joints.

Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study.

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

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.

Familial mediterranean fever: assessment of clinical manifestations, pregnancy, genetic mutational analyses, and disease severity in a national cohort.

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

Hemorheological parameters in patients with fibromyalgia syndrome.

AIM: To evaluate hemorheological parameters in patients with fibromyalgia syndrome (FMS) in order to elucidate the etiology of the disease. METHODS: Twenty-three adult FMS patients and 20 healthy controls were enrolled in the study. Diabetics, hypertensives and those with any rheumatological disorder or use drugs or smoking cigarette were excluded from the study. Following parameters were analyzed in each subject; erythrocyte deformability, erythrocyte aggregation, plasma viscosity, complete blood count, fasting blood glucose, fibrinogen, albumin, globulin and lipid profile. RESULTS: Erythrocyte elongation indices indicating deformability of erythrocytes were higher in FMS patients (0.564±0.002 at 16.87 mPa and 0.605±0.002 at 30 mPa shear rate) than controls (0.558±0.001 at 16.87 mPa and 0.600±0.003 at 30 mPa shear rate). Erythrocyte aggregation speed was higher in FMS patients (2.1±0.1 s) than controls (2.3±0.2 s). Erythrocyte aggregation index was also higher in FMS patients (65.5±1.3) than controls (62.9±1.5). Erythrocyte aggregation amplitude and plasma viscosity values were similar in both groups (both p > 0.05). Among the complete blood count and biochemical parameters, only albumin levels were lower in the FM patients than controls (p < 0.05). CONCLUSION: Our results indicate higher erythrocyte deformability and quicker erythrocyte aggregation in FM patients.

Ultrasonographic evaluation of the calf muscle mass and architecture in elderly patients with and without sarcopenia.

BACKGROUND/OBJECTIVES: To sonographically assess the muscle mass and architecture of sarcopenic elderly subjects, and to explore the utility of ultrasound (US) measurements in predicting sarcopenia. METHODS: One hundred elderly subjects were enrolled in this cross-sectional study. Mean age value of our study population was 73.08±6.18years. The diagnosis of sarcopenia was confirmed by measuring fat-free mass index (using bioelectrical impedance analysis) and handgrip strength. Calf circumference was measured and US evaluations comprised bilateral gastrocnemius muscle (MG) thickness, fascicle length and pennate angles; subcutaneous fat and dermis thicknesses in the calf. RESULTS: Bilateral muscle thickness and fascicle length values were significantly lower in patients with sarcopenia (both p<0.05). Sarcopenic and nonsarcopenic subjects had similar pennate angles, subcutaneous fat and dermis thicknesses. Median thickness ratio (100×t (MG)/[t (subcutaneous tissue)+t (dermis)+t (MG)]) values were 64% (40-88%) in the right and 64% (38-86%) in the left calf. Bilateral MG thickness and fascicle length values showed high sensitivity in predicting sarcopenia (all values>76.92%). CONCLUSIONS: Gastrocnemius muscle thickness and fascicle length values are lower in sarcopenic elderly and these two parameters can serve as alternative measurements for predicting/quantifying sarcopenia. Calf circumference measurements alone may not be appropriate for assessing sarcopenia. Instead, US imaging can conveniently be used to evaluate different compartments of the musculoskelal system in (sarcopenic) elderly.

Effects of Sono-feedback during aspiration of Baker's cysts: A controlled clinical trial.

OBJECTIVE: To determine whether (diagnostic and interventional) ultrasound imaging can be used to provide visual feedback affecting treatment outcome (pain and disability). DESIGN: Controlled clinical trial. SUBJECTS: A total of 52 patients with (ultrasonographically confirmed) symptomatic Baker's cysts were enrolled. METHODS: The cysts were drained under ultrasound guidance and, if necessary, corticosteroid injections were given on the follow-up visit. In group I (n = 26) the patients did not observe the procedures on the ultrasound (US) screen. In group II (n = 26) the US images/videos were shown and explained to the patients. The patients were included in one of the groups consecutively, unless they refused the protocol of that group. Treatment outcome was assessed via US measurements, aspirate volumes, visual analogue scale (VAS) (knee pain, procedure discomfort), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Rauschning-Lindgren Classification (RLC), Kellgren-Lawrence grading scale, Hospital Anxiety and Depression Scale, and paracetamol intake. RESULTS: The 2 groups were similar regarding US measurements, aspirate volume and paracetamol use (p-values > 0.05). In both groups all VAS (p < 0.001) and WOMAC (p < 0.05) scores decreased after treatment. Although initial VAS and WOMAC scores were similar between the groups, all VAS/WOMAC scores, except VAS-2, WOMAC-2 pain, and WOMAC-3 stiffness, were significantly lower in group II (all p < 0.05). Initial RLC scores were similar between the groups; however, group II had significantly lower scores at visits 2 and 3. CONCLUSION: In patients with Baker's cysts (diagnostic/interventional) US imaging can be used as a simple means of visual biofeedback, favourably affecting the treatment outcome (pain and disability).