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.

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.

Effect of tocilizumab on intensive care patients with Covid-19 pneumonia, a retrospective cohort study.

BACKGROUND: In this study, the efficacy of an IL-6 antagonist, Tocilizumab, administered in the early period was studied in intensive care patients with COVID-19 pneumonia followed by hypoxic and systemic inflammation not receiving mechanical ventilation support. METHODS: Patients with COVID-19 pneumonia who have signs of hypoxia and systemic inflammation and/or who have acute bilateral infiltrates on chest radiograph and who received tocilizumab treatment were compared with the patients who received standard medical therapy. Patients who were followed up with COVID-19 pneumonia and respiratory failure between March 2020 and March 2021 were retrospectively evaluated in the study. A 400 mg - 800 mg iv dose (depending on weight) of Tocilizumab was administered. The primary endpoint was determined as intensive care unit mortality. RESULTS: A total of 213 patients who were admitted with respiratory failure associated with COVID-19 to our third-level intensive care unit were evaluated. Of these patients, the study was conducted with 50 patients in the tocilizumab treatment group and 92 patients in the standard treatment group. During the intensive care period, 26 patients (28.3%) in the standard treatment group and 12 patients (24%) in the group receiving tocilizumab died. The adjusted hazard ratio for mortality in the tocilizumab group was 0.39 (95% confidence interval [CI], 0.186 to 0.808; p = 0.001 by log-rank test). During the intensive care period, 22 patients (24.8%) in the standart treatment group and 16 patients (32%) in the tocilizumab group were intubated. The adjusted hazard ratio for a primary outcome intubation in the tocilizumab group was 0.71 (95% confidence interval [CI], 0.355 to 1.424; p = 0.184 by log-rank test).

Residual symptoms and disease burden among patients with psoriatic arthritis: is a new disease activity index required?

The aim of this study was to investigate residual symptoms or disease burden among patients with psoriatic arthritis (PsA) in remission or low disease activity (LDA) according to different outcome measures. A total of 126 patients with PsA were included and the following variables were assessed: Tender joint count (TJC), swollen joint count (SJC), patient's global assessment, physician's global assessment, pain, extra-articular manifestations, Psoriasis Area and Severity Index, Health Assessment Questionnaire, fatigue, Short Form-36, psoriatic quality of life, Hospital Anxiety and Depression Scale and C-reactive protein (CRP). Disease activity was measured using three different outcome measures including minimal disease activity (MDA), disease activity score for 28 joints (DAS28-CRP) and disease activity in psoriatic arthritis (DAPSA). The number (%) of patients who achieved remission or LDA was 9(14.1), 34(27.0) and 67(53.2) according to MDA, DAPSA and DAS28-CRP criteria, respectively, under usual care. SJC > 1 was seen in 3(8.8%) and 13(19.4%) of patients in remission or LDA as defined by the DAPSA and DAS28-CRP respectively. TJC > 1 was found at least 32.4% of patients with PsA in remission or LDA by any definition. 22.2-49.3% of patients with PsA in remission or LDA still suffered from clinically important fatigue. No patients in MDA had a substantial functional impairment while 2.9-19.4% of patients fulfilling remission or LDA according to the DAPSA and DAS28-CRP experienced functional disability. At least 22.2% of patients with PsA in remission or LDA by any description had higher risk for depression, and at least 11.1% for anxiety. Despite patients with PsA in remission or LDA by various definition, they may continue to experience pain, tender or swollen joints, fatigue, physiologic distress as well as functional impairment suggesting that there is a significant unmet need with regard to definition of remission or LDA in PsA.

Gender specific differences in patients with psoriatic arthritis.

OBJECTIVES: To assess gender related differences in a cohort of patients with psoriatic arthritis (PsA). METHODS: Consecutively recruited patients were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms. RESULTS: Women (n = 115) with PsA had higher symptom duration and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), Erythrocyte sedimentation rate (ESR) and poorer physical activity and fatigue than men (n = 72) with PsA. Psoriasis area and severity index (PASI) were higher in male patients. However quality of life (SF36 physical and mental component scores), articular pattern, extra-articular features (including uveitis, iritis) and family history for psoriasis, spondyloarthritis (SpA) (PsA and ankylosing spondylitis [AS]) were quite similar between men and women. CONCLUSIONS: Some of the clinical and laboratory variables tend to be different between men and women with PsA. The extent of quality of life and articular pattern seem to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations.

Discriminant validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis: a cohort study.

The aim of this study was to assess discriminant validity of Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (-CRP) and ASDAS-erythrocyte sedimentation rate (-ESR) and to compare with The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) as clinical tools for the measurement of disease activity in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Also, the cut-off values for ASDAS-CRP in nr-axSpA and AS is revisited. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and were assessed for disease activity, quality of life and functional measures. The discriminatory ability of ASDAS-CRP and ASDAS-ESR was assessed using standardized mean differences and receiver operating characteristic (ROC) curves analysis. Optimal cut-off values for disease activity scores were calculated. Two hundred and eighty-seven patients with axSpA (nr-axSpA:132, AS:155) were included in this study. Two ASDAS versions and BASDAI had good correlations with patient's and physician's global assessment in both groups. Discriminatory ability of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in patients with nr-axSpA and AS when the patients were assigned into low and high disease activity according to the ASAS partial remission, patient's and physician's global assessment scores (based on the comparison of ROC curves). ASDAS cut-off values are quite similar between groups indicating that ASDAS-CRP works similarly well in nr-axSpA and AS. The performance of ASDAS to discriminate low and high disease activity and cut-off values are quite similar in patients with AS and non-radiographic axial SpA.

Presence of enthesopathy demonstrated with ultrasonography in systemic sclerosis.

OBJECTIVE: The aim of this study was to sonographically assess the presence and distribution of enthesopathy in systemic sclerosis (SSc). METHODS: Consecutive patients with SSc and age-matched healthy controls were included in this study. All of the patients met the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for SSc. Six entheses sites were evaluated using gray scale and Doppler ultrasonographies (USs) with a linear transducer and were scored using the Madrid Sonography Enthesitis Index (MASEI). RESULTS: We evaluated 52 patients with SSc (46.10 ± 13.42 years) and 41 healthy controls (49.59 ± 9.35 years). Patients with SSc had significantly higher MASEI scores than the healthy controls. Except for plantar aponeurosis, the tendons and ligaments were thicker in the SSc group. In the SSc group, there were 25 (48.1%) diffuse cutaneous SScs and 22 (42.3%) limited cutaneous SScs. Variables such as age, BMI, disease duration, diagnostic delay and MASEI scores were similar in subgroups of SSc. There was a positive correlation between MASEI score and age, modified Rodnan's skin score and dyspnea grade, and a negative correlation with handgrip strength. CONCLUSION: To the best of our knowledge, this is the first study showing the presence of enthesopathy in patients with SSc using US. Enthesopathy should be kept in mind in symptomatic patients with SSc; additionally, it can be easily identified with US.

Development of Anti-idiotypic Monoclonal Antibody Mimicking SARS-CoV-2 Receptor Binding Domain.

Using the hybridoma technique, we developed a panel of anti-idiotypic monoclonal antibodies (aId-mAb) that mimic The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Receptor-Binding Domain (RBD) molecule against Fragment antigen-binding (Fab) of anti-SARS-CoV-2 (S1, RBD) antibodies. Investigated the in vivo and in vitro effects of these aId-mAbs we developed and examined their antigenic mimicry abilities. Among these 12 antibodies, 6 aId-mAbs (designated FY1B4, FY2A6, H9F3, E6G7, FY7E11, and FY8H3) were selected for further characterization in a series of experiments. First, competitive receptor binding assay results confirmed that six aId-mAbs could specifically bind to the ACE2 receptor in target cells and block the interaction between the RBD molecule and the ACE receptor. Moreover, we examined the immunological activities of these aId-mAbs in female BALB/c and showed that E6G7, H7E11, and H8H3 aId-mAbs induce an antibody response by mimicking RBD and stimulating the immune system. It is considered that these three aId-mAbs will be evaluated as SARS-CoV-2 vaccine candidate molecules in future studies.

Gender disparities in Behçet's syndrome: identifying distinct phenotypes through cluster analysis.

Behçet's syndrome (BS) is a complex, multi-systemic disorder with a global occurrence, notably concentrated along the Silk Road. This study aimed to investigate gender-specific expressions and clinical phenotypes in BS patients within the Eastern Black Sea Region of Turkey. A total of 290 BS patients were retrospectively analyzed between January 2013 and December 2023. Demographic characteristics, clinical manifestations, medical treatment, and pathergy test results were obtained from a review of medical records. The mean age was 45.79 ± 13.05, with a male-to-female ratio of 48.6:51.4. Male patients had higher papulopustular lesions (p < 0.001) and ocular involvement (p = 0.036), while females showed more frequent genital ulcers (p = 0.032). Medication usage showed gender-based variations, notably higher corticosteroid, azathioprine, and tumor necrosis factor-alpha inhibitor (TNFi) use in males (p < 0.001). Cluster analysis revealed five distinct clusters, each with unique features and gender predominance. Cardiovascular type, ocular type, and skin type predominantly featured male patients, while joint involvement type and neurologic and mucosal involvement type were more prevalent among female patients with BS. This research contributes valuable insights into the gender-related clinical variations of BS within a specific geographic region, fostering a more comprehensive understanding of this challenging syndrome. The identification of distinct clinical phenotypes facilitates the development of tailored treatment strategies, potentially leading to improved outcomes for patients with BS.

Pancreas-specific deletion of Prox1 affects development and disrupts homeostasis of the exocrine pancreas.

BACKGROUND & AIMS: The exocrine portion of the pancreas functions in digestion and preserves pancreatic homeostasis. Learning how this tissue forms during embryogenesis could improve our understanding of human pancreatic diseases. Expression of the homeobox gene Prox1 in the exocrine pancreas changes throughout development in mice. We investigated the role of Prox1 in development of the exocrine pancreas in mice. METHODS: Mice with pancreas-specific deletion of Prox1 (Prox1(ΔPanc)) were generated and their pancreatic tissues were analyzed using immunohistochemistry, transmission electron microscopy, histologic techniques, quantitative real-time polymerase chain reaction, immunoblotting, and morphometric analysis. RESULTS: Loss of Prox1 from the pancreas led to multiple exocrine alterations, most notably premature acinar cell differentiation, increased ductal cell proliferation, altered duct morphogenesis, and imbalanced expression of claudin proteins. Prox1(ΔPanc) mice also had some minor alterations in islet cells, but beta-cell development was not affected. The exocrine congenital defects of Prox1(ΔPanc) pancreata appeared to initiate a gradual process of deterioration that resulted in extensive loss of acinar cells, lipomatosis, and damage to ductal tissue in adult mice. CONCLUSIONS: Pancreas-specific deletion of Prox1 causes premature differentiation of acinar cells and poor elongation of epithelial branches; these defects indicate that Prox1 controls the expansion of tip progenitors in the early developing pancreas. During later stages of embryogenesis, Prox1 appears to regulate duct cell proliferation and morphogenesis. These findings identify Prox1 as an important regulator of pancreatic exocrine development.

The Effect of Vestibular Rehabilitation on Balance and Quality of Life in Patients with Bilateral Vestibular Hypofunction.

This study aims to investigate the effectiveness of vestibular rehabilitation on balance, dynamic visual acuity, and quality of life in patients with bilateral vestibular hypofunction (BVH). 20 patients diagnosed by videonystagmography were included in the study. Balance tests, Visual Analogue Scale (VAS), testing of Dynamic Visual Acuity (DVA), Dizziness Handicap Inventory (DHI), Computer-modified Clinical Test of Sensory Interaction in Balance (m-CTSIB), and Limits of Stability Test were applied before and 3 and 6 months after the treatment. Physiotherapy sessions were given at two-week intervals. According to the development of the patients, they were asked to perform a home exercise program with 10 repetitions 3 times a day. After 6 months of vestibular rehabilitation, improvements in balance and quality of life parameters were observed in the patients. VAS, DVA, DHI, all static balance parameters except Romberg, Semi-tandem eyes open were significant (p < 0.005). In computerized M-CTSIB, while no significant results were obtained on the hard surface with the eyes open (p = 0.126), statistically significant improvement was observed on the hard surface with the eyes closed and on a foam surface with eyes open and close. LOS results showed significant improvement in velocity, reaching the endpoint, and maximal deviation in all directions except the right posterior. While significant results were found in the right, posterior, left anterior, and left posterior directions in the reaction time section, there was no statistical significance in any of the direct control sections (p < 0.005). Trial registration number: NCT05231109, Date of registration:27/01/2022 (Retrospectively registered).

Comparison of the Efficacy of Vestibular Rehabilitation and Pharmacological Treatment in Benign Paroxysmal Positional Vertigo.

Aim: The aim of the study is to compare the effects of vestibular rehabilitation and pharmacological treatment in benign paroxysmal positional vertigo (BPPV). Materials and methods: Thirty patients (40.93 ± 8.66 years old) diagnosed with BPPV were recruited. Patients were equally divided into pharmacological control group and vestibular rehabilitation group. The pharmacological control group was further divided into Group A (n = 8, 2 doses/day, 24 mg betahistine) and Group B (n = 7, 1 dose/day, 50 mg dimenhydrinate in addition to betahistine). Patients in the rehabilitation group underwent repeated head and eye movements, and Epley or Barbecue Roll Maneuvers were applied for 4 weeks. Subjective assessment of vertigo was measured with the visual analog scale. Static balance parameters were measured with the tandem, one-legged stance, and Romberg tests. Dynamic visual acuity was measured with a Snellen chart, and vestibular dysfunction was measured with the Unterberger (Fukuda stepping) test. All parameters were evaluated before and after treatment. Results: Vestibular rehabilitation resulted in greater improvement in severity of vertigo, balance parameters except Romberg test, and vestibular dysfunction than pharmacological therapy (p < 0,001). There was no significant difference in dynamic visual acuity between groups (p = 0,24). The effects of medication with the active ingredients betahistine and dimenhydrinate were similar (p > 0,05). Conclusion: The vestibular rehabilitation method can positively change the severity of vertigo, balance ability, and vestibular dysfunction compared to pharmacological therapy. Dimenhydrinate administered in combination with betahistine was not superior to betahistine alone but can be recommended for its antiemetic effect. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03598-4.

Degenerative changes of lumbar spine and their clinical implications in patients with axial spondyloarthritis.

The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specific mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfirrmann classification), endplate changes (Modic, types 1, 2, and 3), annular fissure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI findings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis (AS). Degenerative changes were more prevalent in patients with mLBP (n = 105) than axSpA. Disk degeneration was the most prevalent MRI finding, followed by annular fissure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR = 6.455), lumbar disk herniation (OR = 2.278), annular fissure (OR = 2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR = 2.225), and advanced age (OR = 31.556) were factors associated with an increased risk of DD in axSpA. Coexisting DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaints and should not been overlooked in patients with axSpA.

SARcopenia Assessment in Hypertension: The SARAH Study.

OBJECTIVES: The aims of the study were to investigate the relationship between sarcopenia and renin-angiotensin system-related disorders and to explore the effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on muscle mass/function and physical performance. DESIGN: This multicenter, cross-sectional study was performed using ISarcoPRM algorithm for the diagnosis of sarcopenia. RESULTS: Of the 2613 participants (mean age = 61.0 ± 9.5 yrs), 1775 (67.9%) were hypertensive. All sarcopenia-related parameters (except chair stand test in males) were worse in hypertensive group than in normotensive group (all P < 0.05). When clinical/potential confounders were adjusted, hypertension was found to be an independent predictor of sarcopenia in males (odds ratio = 2.403 [95% confidence interval = 1.514-3.813]) and females (odds ratio = 1.906 [95% confidence interval = 1.328-2.734], both P < 0.001). After adjusting for confounding factors, we found that all sarcopenia-related parameters (except grip strength and chair stand test in males) were independently/negatively related to hypertension (all P < 0.05). In females, angiotensin-converting enzyme inhibitors users had higher grip strength and chair stand test performance values but had lower anterior thigh muscle thickness and gait speed values, as compared with those using angiotensin II receptor blockers (all P < 0.05). CONCLUSIONS: Hypertension was associated with increased risk of sarcopenia at least 2 times. Among antihypertensives, while angiotensin-converting enzyme inhibitors had higher muscle function values, angiotensin II receptor blockers had higher muscle mass and physical performance values only in females.

The Effects of Vestibular Rehabilitation on Kinesiophobia and Balance with Individuals Who has Vestibular Hypofunction.

 The study aimed to examine the effects of vestibular rehabilitation on kinesiophobia, quality of life, dynamic visual acuity, and balance. Thirty vestibular hypofunction patients aged 18-65 years who were diagnosed by videonystagmography (VNG) voluntarily participated in the study. Before and after treatment Tampa Kinesiophobia Scale, World Health Organization Quality of Life Scale-Turkish Short Form, Tandem Stance Test, Dynamic Visual Acuity, Visual Analog Scale to measure dizziness, Subjective Visual Vertical and Subjective for verticality and horizontality perception Visual Horizontal tests were applied. The exercise program was applied for 8 weeks. Patients were observed in the hospital every two weeks. The exercises given in the session were given as home exercises, 3 times a day, for 10 repetitions. As a result of the study, statistical correlations were found tandem stance test, subjective visual vertical and subjective visual horizontal tests for the perception of verticality and horizontality, visual analog scale to measure the severity of dizziness, dynamic visual acuity, quality of life and tampa kinesiophobia scales (p < 0.05). It can be said that vestibular rehabilitation improves the quality of life, balance, dynamic visual acuity, and overcomes kinesiophobia in patients. Trial registration number: NCT05070936, Date of registration:10/06/2021 (Retrospectively registered).

Gender differences in the discriminative value of inflammatory low back pain criteria.

BACKGROUND/PURPOSE: Inflammatory low back pain (IBP) is the leading symptom in axial spondyloarthritis (axSpA) and its assessment is crucial for the diagnosis. Our aim was to assess gender specific differences in the discriminative ability of the items and criteria sets in a specific patient population consisting patients with axSpA and other causes of chronic low back pain (LBP). METHODS: Patients with chronic LBP with an onset less than 45 years were included and screened for the Assessment of Spondyloarthritis International Society (ASAS) axSpA criteria. Items of IBP, according to Calin, Berlin and ASAS expert criteria were evaluated in patients with axSpA and non-SpA LBP by a blinded researcher. Discriminative ability of the single items and sets were assessed in terms of sensitivity, specificity and area under the curve (AUC) analysis in male and female patients and compared between genders. RESULTS: Single IBP items performed similarly well in men and women, as well as criteria sets. Despite similar discriminative performance of IBP items and criteria sets in both genders, women tend to have slightly better performance. Our results revealed similar sensitivity but slightly lower specificity for most of the single items and criteria sets compared to previous reports. CONCLUSION: Gender may have an influence on the discriminative performance of some of the IBP items and criteria sets as well. Calin criteria seem to perform slightly better in both genders than Berlin and ASAS criteria sets. KEY WORDS: Inflammatory, back pain, gender, axial spondyloarthritis.

Are GRIK3 (T928G) gene variants in schizophrenia patients different from those in their first-degree relatives?

We examined whether the GRIK3 (T928G) polymorphic variants in patients with schizophrenia are different from those of their first-degree relatives and healthy controls. The study population was composed of 256 patients with schizophrenia, 305 first-degree relatives of schizophrenia patients and 242 healthy control subjects. The GRIK3 (T928G) polymorphism was determined by restriction fragment length polymorphism. The frequency of the TT genotype was predominant, whereas the GG genotype was rare among all groups. The frequencies of GRIK3 (T928G) genotype distributions in the patients with schizophrenia were similar to those of their relatives. The frequency of the GG genotype was significantly higher in patients than in healthy controls. Similarly, GG genotype distribution in relatives was elevated compared with that in controls, but this value did not reach statistical significance. On the other hand, the subgroups of schizophrenia patients did not show a significant association with the GRIK3 (T928G) gene. It appears that the patients share the same (GRIK3) T928G gene variants with their relatives. One interpretation of our findings is that the relatives are at risk for the development of schizophrenia in the future.

Effect of the methylenetetrahydrofolate reductase gene polymorphisms on homocysteine, folate and vitamin B12 in patients with bipolar disorder and relatives.

We investigated the effect of polymorphic variants of c.1298A>C (Glu429Ala) and c.677C>T (Ala222Val) in methylenetetrahydrofolate (MTHFR) gene on the total homocysteine (tHcy), folate and B12 levels in patients with bipolar disorder, first-degree relatives of patients, and controls. The c.677C>T and c.1298A>C polymorphisms in MTHFR were determined by polymerase chain reaction-restriction fragment length polymorphism in 197 bipolar patients, 278 relatives and 238 controls. tHcy and folate and vitamin B12 levels were measured by Fluorescence Polarization Immunoassay and Electrochemiluminescence, respectively. The tHcy was significantly increased in patients and relatives. In contrast, folate and B12 were significantly lower in patients and relatives. Gender was not considered as a significant determinant in the multivariate analysis. Genotypes of c.1298A>C and c.677C>T were correlated with tHcy, folate and B12. Patients and relatives carrying TT and/or AA and AC genotypes had elevated tHcy and reduced folate and B12 levels. High tHcy but low folate and vitamin B12 levels may be a risk factor for development of bipolar disorder.

Extra-articular manifestations and burden of disease in patients with radiographic and non-radiographic axial spondyloarthritis.

OBJECTIVE: Although the prevalence of peripheral and extra-articular disease in ankylosing spondylitis (AS) has been assessed in many studies, data on non-radiographic axial spondyloarthritis (nr-axSpA) is scanty. The aim of this study was first, to compare radiographic-axSpA/AS (r-axSpA/AS) and nr-axSpA concerning peripheral arthritis and extra-articular manifestations (EAMs), and second, to assess potential differences between patient subgroups with or without EAMs regarding disease burden. METHODS: Data was extracted from our single center axSpA database. Patients having at least one of the EAMs (uveitis and/or inflammatory bowel disease (IBD) and/or psoriasis) were compared to those who did not have EAMs. Patients' clinical data including disease activity, functional and psychological status, physical limitations, quality of life (QoL) and magnetic resonance imaging of sacroiliac joints (SIJ MR) were evaluated. RESULTS: Patients with nr-axSpA (n=193) were younger, had female predominance, better functional and physical status, higher frequency of bone edema in SIJ MR and peripheral arthritis but similar QoL, prevalence of HLA B27 and EAMs compared to r-axSpA/AS (n=352). The prevalence of current or ever uveitis (14.5 vs 15.3%, p=0.791), psoriasis (6.2 vs 5.4%, p=0.689) or IBD (4.1 vs 3.4%, p=0.663) in nr-axSpA and r-axSpA/AS were similar. In both subgroup of patients, EAMs positive and negative patients had similar functional status and QoL, as well as disease activity and laboratory parameters. CONCLUSION: Patients with nr-axSpA and r-axSpA/AS have similar prevalence of EAMs and clinical burden of disease. Having EAMs does not have a major influence on clinical parameters and patient reported outcome measures in nr-axSpA and r-axSpA/AS.