The relationship between inadequate response to physical therapy and central sensitization in patients with knee osteoarthritis: A prospective cohort study.

Objectives: This study aims to investigate the relationship between physical therapy response and the presence of central sensitization (CS) in patients with painful knee osteoarthritis (OA). Patients and methods: Between May 2019 and March 2020, a total of 84 patients with knee OA (12 males, 72 females; mean age: 60.7±7.7 years; range 50 to 74 years) and 30 age and sex-matched controls (6 males, 24 females; mean age: 59.2±8.9 years; range 50 to 75 years) were included in this study. Knee pain and functional status were evaluated by Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Structural damage was assessed by knee radiography. The Central Sensitization Inventory (CSI), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), Pain Catastrophizing Scale (PCS), and PainDETECT Questionnaire (PDQ) were applied at baseline. Pain pressure thresholds (PPTs) of the patients were measured and compared with the control group. All patients underwent a total of 15 sessions of physical therapy program for five sessions/weekly. After treatment, the patients were divided into two groups as responders and non-responders according to the Osteoarthritis Research Society International (OARSI) criteria. Results: The CSI score of the patients in non-responder group was significantly higher compared to the responder group (p=0.004). Using a cut-off value of ≥40, the proportion of patients with CSI scores of ≥40 was significantly lower in the responder group compared to non-responder group (p=0.021). The PPT measurement values were significantly lower in the non-responder group compared to the responder and control groups (p <0.01). There was a significant difference in the frequency of hyperalgesia between the groups (p=0.021). Central sensitization and depression were the most significant predictors of non-response to physical therapy (p=0.045 and p=0.024, respectively). Conclusion: Our study results suggest the presence of CS and depression may result in an inadequate response to physical therapy in patients with knee OA. Clinicians should consider the findings of CS and depression in treatment planning.

Developing a common metric using current scales for assessing functioning in patients with knee osteoarthritis.

Objectives: Various scales exist to assess different domains of functioning in knee osteoarthritis (OA). This study aimed to explore whether it is possible to develop a common metric (CM) from the frequently used scales to assess functioning in knee OA. Patients and methods: The methodological study evaluated 411 patients (81 males, 330 females; mean age: 61.8±10.5 years; range, 41 to 88 years) with knee OA. Data from the Health Assessment Questionnaire, Oxford Knee Score, Medical Outcomes Study Short Form 36, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Arthritis Index, and the Nottingham Health Profile were used, and the items focusing on self-care, mobility, and domestic activity domains based on the activities and participation component of the International Classification of Functioning, Disability, and Health were included. Concurrent calibration was performed to combine the items of the scales. The CM parameters were estimated using the Rasch measurement model. Reliability was assessed using the person separation index. The CM was utilized to generate a transformation table to convert the scale scores to each other based on the reference metric score. Results: Each scale fitted the Rasch model. Item invariance was achieved for the CM (p=0.775). The CM had a person separation index of 0.827. Age, sex, and disease duration did not cause difference in item functions. The CM satisfied the assumptions of unidimensionality and local independence. Conclusion: A reliable CM was created from the commonly used scales to measure functioning in individuals with knee OA. Thus, clinicians and researchers can refer to the transformation table to directly compare scores of those scales and use them interchangeably.

Validation of the Pediatric Quality of Life Inventory 3.0 Cerebral Palsy Module (Parent Form) for use in Türkiye.

Objectives: This study was planned to test the reliability and validity of the Turkish version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 cerebral palsy (CP) module (parent form) in children with CP. Patients and methods: In the validation study conducted between June 2007 and June 2009, 511 children (299 normal children, 212 children with CP) were assessed by the seven scales of PedsQL [daily activities (DA), school activities (SA), movement and balance (MB), pain and hurt (PH), fatigue (F), eating activities (EA), and speech and communication (SC)]. Reliability was tested by internal consistency and person separation index (PSI); internal construct validity by Rasch analysis and external construct validity by correlation with the Gross Motor Function Classification System (GMFCS) and Functional Independence Measure for Children (WeeFIM). Results: Only 13 children with CP completed the inventory by themselves and thus were excluded. Consequently, 199 children with CP (113 males, 86 females; mean age: 7.3±4.2 years; range, 2 to 18 years) and 299 normal children (169 males, 130 females; mean age: 9.4±4.0 years; range, 2 to 17 years) were included in the final analysis. Reliabilities of the seven scales of the PedsQL 3.0 CP module were adequate, with Cronbach's alphas between 0.66 and 0.96 and the PSI between 0.672 and 0.943 for the CP group. In Rasch analysis, for each scale, items showing disordered thresholds were rescored; then testlets were created to overcome local dependency. Internal construct validity of the unidimensional seven scales was good with the mean item fit of -0.107±1.149, 0.119±0.818, 0.232±1.069, -0.442±0.672, 0.221±0.554, -0.091±0.606, and -0.333±1.476 for DA, SA, MB, PH, F, EA, and SC, respectively. There was no differential item functioning. External construct validity of the instrument was confirmed by expected moderate to high correlations with WeeFIM and GMFCS (Spearman's r=0.35-0.89). Conclusion: Turkish version of the PedsQL 3.0 CP module is reliable, valid, and available for use in clinical setting to evaluate health-related quality of life of children with CP.

Imputation of missing values within WHODAS 2.0 data collected from low back pain patients using the response function approach.

PURPOSE: To investigate the impact of missing data and imputation with the response function (RF) approach on bias and precision of disability estimates as well as reliability of scale of WHO Disability Assessment Schedule 2.0. MATERIAL AND METHODS: Data were collected by face-to-face interviews and self-report surveys from 284 respondents with low back pain. Hypothetical datasets were created by using person and item parameters of real data. A simulation study was devised to assess the ability parameters and reliability measures on incomplete and imputed datasets. Rasch model was used to evaluate latent trait levels. Imputation was carried out using the response function method. RESULTS: Almost the same level of bias and MSE was reached. While the missing rate increases, the Person separation index slightly reduced, still exceeded 0.94 and Cronbach alpha values have similar mean values of 0.99 with larger variations. After deletion of four items of "work or school activities" in domain 5, reliability measures reduced the lowest. CONCLUSION: Construct validity is preserved. Problems regarding the compliance of the items with the target group still persist. When researchers encounter missingness in data collected with WHODAS 2.0, the response function can be usefully implemented to impute missing values to improve the reliability of disability level estimates.Implications for rehabilitationThe Turkish version of the 36-item WHODAS is reliable and valid for assessing health and disability status in patients with low back pain.A critical issue is a systematic nonresponse was highly observed in items related to "work/school life activities" which are allowed to be skipped and excluded from the scoring according to WHODAS 2.0 training manual.Imputation of missing values within four items of "work or school activities" in domain 5 using the response function approach showed satisfactory reliability for the estimation of disability in adults with low back pain.This study showed missing data imputations with response function can be implemented by a statistician as contribute to a missing data management process better tailored to clinicians' interpretations.

Dark Side of the COVID-19 Pandemic; 'Long COVID'.

Objective: Besides its morbidity and mortality all over the world, SARS-CoV-2 infection maintains its importance with prolonged symptoms after acute disease. The post-infectious period including a heterogeneous group of symptoms is named 'long COVID'. This study aimed to describe persisting symptoms three months after COVID-19 and risk factors associated with 'long COVID'. Materials and Methods: This cross-sectional retrospective study included COVID-19 patients diagnosed with SARS-CoV-2 PCR positivity in the first 18 months of the COVID-19 pandemic, between March 2020 and September 2021. We conducted a survey in 2022 to inquire about the participants' symptoms that lasted three months or more after their own COVID-19 period. All patients were employees of one of the biggest national banks in Turkey. Participants answered a total of 31 questions over the phone. The presence of one or more symptoms persisting ≥3 months was defined as 'long COVID'. The risk factors associated with 'long COVID' were determined. Results: A total of 1301 patients were included in our study. The median age of patients was 40 (22-57), and 558 (42.9%) were women. 257 (19.8%) patients had 'long COVID' symptoms. The most prevalent symptoms were myalgia (14.3%), arthralgia (14.1%), and back pain (13.8%). Female gender ( p=0.000, OR=2.19 [95% CI=1.655-2.904]) and diabetes mellitus ( p=0.016, OR=2.43 [95% CI=1.177-5.017]) were found as independent risk factors for 'long COVID' by multivariant logistic regression analysis. Conclusion: Female gender and diabetes mellitus are risk factors for 'long COVID'. Detecting patients with a high risk for developing 'long COVID' is crucial for their management during the COVID and post-COVID periods.

Effectiveness of pulsed electromagnetic field therapy in the management of complex regional pain syndrome type 1: A randomized-controlled trial.

Objectives: This study aims to investigate whether pulsed electromagnetic field (PEMF) therapy in addition to a conventional rehabilitation program is effective on pain and functioning in patients with type 1 complex regional pain syndrome (CRPS-1) of the hand. Patients and methods: Between March 2013 and January 2015, a total of 32 patients (16 males, 16 females; mean age: 50.1±13.1 years; range, 25 to 75 years) were included. The patients were randomly allocated into two groups. The control group (n=16) received a conventional rehabilitation program consisting of physical modalities, exercises, and occupational therapy, whereas the PEMF group (n=16) received additional PEMF (8 Hz, 3.2 mT) to the affected hand. The primary outcome measure was pain intensity using the Numeric Rating Scale (NRS). Secondary outcome measures were grip and pinch strength, hand edema, hand dexterity, and hand activities. All patients received 20 therapy sessions (five sessions/week, four weeks in total) and were evaluated before and after the therapy and at the first-month follow-up. Results: Both groups showed significant improvements in primary and secondary outcomes (p<0.05) after the therapy and at follow-up. When the groups were compared in terms of improvements in assessment parameters, no statistically significant difference was found between the two groups in any of the outcomes (p>0.05). Conclusion: The PEMF in addition to conventional rehabilitation program did not provide additional benefit for pain and hand functions in CRPS-1. Future studies using different application parameters such as frequency, intensity, duration, and route may provide a better understanding of the role of PEMF in CRPS-1 treatment.

The efficacy and safety of extracorporeal shock wave therapy on plantar fasciitis in patients with axial spondyloarthritis: a double-blind, randomized controlled trial.

The efficacy and safety of extracorporeal shock wave therapy (ESWT) on chronic plantar fasciitis (PF) in patients with axial spondyloarthritis (axSpA) remain unclear. To investigate the efficacy and tolerability of ESWT in patients with PF in axSpA. In this double-blind, randomized controlled trial, 22 axSpA patients with PF who had heel pain above 5 according to visual analog scale (VAS) over 3 months were randomly divided into 2 groups: ESWT and sham-ESWT. Both groups received a total of three treatments at 1-week intervals. All patients were assessed by the VAS, heel pressure algometry, Foot Function Index (FFI), and plantar fascia ultrasonography (thickness and morphology) at baseline, 1 week after each session, 4th and 8th week after the last therapy. The mean ± SD ages of the ESWT and sham-ESWT groups were 43.8 ± 8.2 and 48.5 ± 7.6 years, respectively. Significant time effects between the time points were observed in both groups in terms of VAS, pressure algometry, and FFI. There was a statistically significant decrease in pain, an increase in perceived pressure algometry values, and an improvement in activity restriction in the ESWT group compared to the sham-ESWT group. There was not a change in the plantar fascia thickness before and after the intervention in both groups. No side effects were observed during the treatment and follow-up. ESWT appears to be a safe and well-tolerated physical therapy modality for improving chronic refractory heel pain due to PF in patients with axSPA. This trial was registered to The Australian New Zealand clinical trial with the registration number ACTRN12618001954213. The enrollment began in 15/12/2018 and data collection stopped in 29/05/2020.

Assessment of nocturnal polyuria in patients with spinal cord injury at three different mobilization phases: A multicenter cross-sectional study.

OBJECTIVE: To determine the prevalence of nocturnal polyuria (NP) in patients with spinal cord injury (SCI) during three different particular phases, and investigate the impact of injury level and injury type on the prevalence of NP. DESIGN: A cross-sectional study. SETTING: Neurogenic Bladder Study Group from six different rehabilitation centers across the country. PARTICIPANTS: 40 patients with SCI. OUTCOME MEASURES: Patients were divided into three groups according to mobilization phase; 1st group included patients confined to bed (n = 14), 2nd group included patients sitting on a wheelchair (n = 19) and 3rd group included patients standing with an assistive ambulation device (n = 7). NP was assessed by nocturnal polyuria index (NPi) and nocturnal urine production (NUP) indexes. RESULTS: No significant difference was found between the groups (P = 0.312 for NPi and P = 0.763 for NUP) in terms of the presence of NP according to their mobilization phase. The night and 24-hour urine volumes showed no significant difference between the groups (P = 0.907 and P = 0.395 respectively). The NPi and NUP values did not show a significant difference between male and female patients (P = 0.826, P = 0.364 respectively), patients with the injury level of ≥T6 and

Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades.

INTRODUCTION: The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection. METHODS: The study included a systematic search for PROMs that have been in use over the period 2000-2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base. RESULTS: 125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence. CONCLUSION: There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model.

Is it possible to develop a new measurement tool to assess the functional status in patients with rheumatoid arthritis?

OBJECTIVES: This study aims to develop measurement tools for assessing patients' functional status with rheumatoid arthritis (RA) in terms of upper and lower extremity function and to evaluate the tools' construct validities with classical and modern psychometric approaches. PATIENTS AND METHODS: Between April 2010 and April 2012, a total of 300 patients with RA (77 males, 223 females; mean age: 52.3±11.5 years; range, 18 to 82 years) who answered items from a range of widely used instruments were included. After examining initial dimensionality with exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Rasch analysis were used to evaluate the tools' construct validities. The data-model fit was evaluated with goodness-of-fit (GoF) statistics in CFA, while the tools were examined in terms of item and person fit, unidimensionality and differential item functioning (DIF) from the perspective of Rasch analysis. RESULTS: According to EFA, two dimensions were identified and named as "self-care-mobility-household activities related to lower extremity" and "self-care-mobility-household activities related to upper extremity" taking into account the factor loadings and the clinical classifications. While the clinical classification was tested with CFA, all items were loaded on their pre-defined dimensions with the factor loadings of ≥0.40 and GoF statistics were within the acceptable ranges. When the "self-care-mobility-household activities related to upper extremity" and "self-care-mobility-household activities related to lower extremity" tools were evaluated via the Rasch analysis, both tools were found to fit the Rasch model expectations, with a mean item fit statistics of -0.528 logit (standard deviation [SD]: 1.365) and -0.213 (SD: 1.168; mean person fit statistics of -0.412 logit (SD: 1.160) and -0.303 logit (SD: 0.859), respectively. CONCLUSION: For the evaluation of a scale's construct validity, it is recommended to use the Rasch analysis in tandem with factor analytic methods, as the Rasch analysis explores a scale's construct validity in terms of item and person fit, DIF and unidimensionality which is the only aspect of the factor analysis.

Does extracorporeal shock wave therapy decrease spasticity of ankle plantar flexor muscles in patients with stroke: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle. DESIGN: Randomized controlled trial. SETTING: Inpatient neuro-rehabilitation clinic of a university hospital. PARTICIPANTS: Stroke patients with ankle flexor spasticity. INTERVENTIONS: Patients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation. MAIN MEASURES: The primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up. RESULTS: Fifty-one participants were enrolled (active therapy n = 17, sham n = 17, control n = 17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47 ± 0.72 to 1.41 ± 0.62) compared to sham (from 2.19 ± 1.05 to 2.06 ± 1.12) and control (from 2.06 ± 0.85 to 2.00 ± 0.73) groups immediately after the treatment (P < 0.001). Tardieu results were also in concordance (P < 0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index (P < 0.001). However, there was no difference among the groups in terms of improvement in elastography. CONCLUSION: Radial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.

Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.

Cross-diagnostic scale-banking using rasch analysis: Developing a common reference metric for generic and health condition-specific scales in people with rheumatoid arthritis and stroke.

OBJECTIVES: To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions. DESIGN: Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Health Assessment Questionnaire (HAQ) and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model. PARTICIPANTS: Secondary analysis was performed on data from 487 people; 61.4% with rheumatoid arthritis and 38.6% with stroke. RESULTS: Three sub-domains of the WHODAS 2.0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created. CONCLUSION: This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2.0).

Effects of spasticity and hemiplegic posture on median nerve and carpal tunnel in stroke patients: Electrophysiological and ultrasonographic evaluation.

This study aims to evaluate whether the upper extremity spasticity and hemiplegic posture have any effect on the morphology of the carpal tunnel and median nerve in stroke patients. Nerve conduction studies (NCS) were performed in 46 stroke patients and compared to those of 30 healthy controls. The cross-sectional area (CSA) of the carpal tunnel (CT) and median nerve (wrist/mid-forearm levels) was assessed by ultrasonography. The mean ages of the stroke and control group were 55.6 ± 13.5 and 56 ± 12.1 years, respectively. The median spasticity score of the forearm pronators and wrist flexor muscles was 2 (0-4) according to the Modified Ashworth Scale (MAS). The compound muscle action potential (CMAP) of the median nerve was reduced (10,093 ± 4,451 mV) when compared to non-paretic side (11,615 ± 4,397 mV) (p:0.02) and the CSA of the CT was thinner on the paretic side (1.9 ± 0.3 cm2 vs 2.08 ± 0.2 cm2) (p:0.03). Pronator spasticity had no significant effect on the CSA of the median nerve and NCS at the forearm level. The CSA of the median nerve at the wrist was significantly thicker in patients with the wrist flexor spasticity graded II (MAS) and above compared to those with spasticity graded I and below (9.5 ± 1.7 mm2 and 8.7 ± 1.7 mm2 respectively) (p:0.03). However, the thickening of the median nerve didn't cause significant abnormalities in NCS. This study shows that in stroke patients, wrist flexor spasticity and hemiplegic wrist posture can cause explicit morphological changes in the CT and median nerve albeit normal findings on NCS.

Spontaneous Spinal Epidural Hematoma During Simultaneous Tocilizumab and Warfarin Use in a Patient With Rheumatoid Arthritis: Is There a Drug Interaction Between Tocilizumab and Oral Anticoagulants?

Interleukin 6 (IL-6) plays a main role in the immunopathogenesis of rheumatoid arthritis (RA). Tocilizumab (TCZ) is a humanized immunoglobulin G1 monoclonal antibody against the human IL-6. Warfarin sodium is an oral anticoagulant that is primarily metabolized by cytochrome P450 2C9 (CYP2C9). Impaired metabolism of this low therapeutic index drug is important as it may result in serious bleeding. In this article, we present a 56-year-old female patient with RA, treated with TCZ and warfarin sodium and presented spontaneous spinal epidural hematoma (SSEH) of thoracic spine although international normalized ratio levels were in normal ranges. One week after decompressive surgery for hematoma, a cervical spine abscess developed which resulted in her death. To the best of our knowledge, this is the first case of RA developing SSEH while taking TCZ and warfarin sodium together. Although it is difficult to attribute the severe bleeding to TCZ treatment, clinicians should be aware that concomitant use of oral anticoagulants and TCZ might result in potentially fatal complications in patients with RA.

Biomarkers of Cardiovascular Disease in Patients With Ankylosing Spondylitis.

OBJECTIVES: This study aims to evaluate the inflammatory status and clinical and vascular alterations using tonometry and B-mode sonography in patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: The study included 71 AS patients (57 males, 14 females; mean age 40.1±10.8 years; range, 29 to 51 years) without cardiovascular disease and 30 healthy controls (24 males, 6 females; mean age 41.2±9.3 years; range, 32 to 50 years). We evaluated participants' clinical, biological and functional status along with laboratory data and measured both the arterial stiffness using carotid-femoral pulse wave velocity (PWV) measured by applanation tonometry and carotid intima-media thickness (CIMT) as a preclinical atherosclerosis marker. RESULTS: The mean disease duration of AS patients was 10.6±4.2 years. CIMT (p=0.03) and PWV (p=0.04) data showed significant differences between AS patients and healthy controls. Multiregression analysis showed that PWV correlated with age (r2=0.42; p=0.03) and disease duration (r2=0.31; p=0.04), while CIMT correlated with disease duration (r2=0.37; p=0.03) and Bath Ankylosing Spondylitis Disease Activity Index (r2=0.3; p=0.04). CONCLUSION: This study demonstrated an increase in early preclinical atherosclerosis in AS patients without cardiovascular (CV) disease compared to healthy controls. Therefore, screening AS patients with noninvasive methods for atherosclerosis and subclinical vasculopathy would allow us to take primary prevention measures. We found that the major determinant for increased CV risk was the disease duration, while there was no difference between different treatment modalities.

Complete Decongestive Therapy Is an Option for the Treatment of Rosacea Lymphedema (Morbihan Disease): Two Cases.

BACKGROUND AND PURPOSE: Morbihan disease, also known as rosacea lymphedema, is a rare persistent form of lymphedema that is associated with the disease rosacea. Even though acne rosacea responds well to standard medical treatment, the lymphedema component of the disease is resistant to both medical and surgical therapy. Complete decongestive therapy (CDT) can be considered as a conservative alternative option for treatment of rosacea lymphedema. To date, there is no report on the use of CDT in treating facial lymphedema secondary to acne rosacea. CASE DESCRIPTION: We present 2 cases of women with a diagnosis of Morbihan disease and chronic facial lymphedema that remained resistant to drug treatment for many years before CDT was offered. The treatment program included 4 components: manual lymphatic drainage, compression bandaging, exercises to enhance lymphatic drainage, and patient education. OUTCOMES: Following 10 to 15 sessions of CDT, the first patient's facial edema had almost completely resolved. The second patient's response to treatment was assessed as moderate. DISCUSSION: To the best of our knowledge, these 2 cases of Morbihan disease treated with CDT are the first of their kind to be presented in the literature. As the treatment options for Morbihan disease remain inadequate, we believe that CDT should be considered as a treatment option in those patients who do not benefit from or refuse drug treatment, before moving on to more invasive procedures. Prospective studies should be designed to demonstrate the efficacy of CDT and provide management details.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study.

OBJECTIVES: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. MATERIAL AND METHODS: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. RESULTS: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). CONCLUSION: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties.

INTRODUCTION: Patient-reported outcome measures (PROM) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task. METHODS: The study included a systematic search for PROMs that have been in use over 17 years (period 2000-2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion. RESULTS: 78 PROMs were identified with psychometric evidence available. The domains of pain, self-care, mobility and work dominated, whereas domains such as cleaning and laundry and leisure, together with psychological and contextual factors, were poorly served. The most frequently used PROMs included the Western Ontario McMaster Osteoarthritis Index, the Short Form 36 and the Knee Disability and Osteoarthritis Outcome Score which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence. CONCLUSION: A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored.