Evaluation of the Swallowing and Voice Functions in Ankylosing Spondylitis Patients.

This study aimed to evaluate the swallowing and voice functions in patients with ankylosing spondylitis. Thirty patients with ankylosing spondylitis (Group 1) and 30 healthy individuals (Group 2) were included in the study. Following the laryngoscopic evaluation of the patients, the fiberoptic endoscopic evaluation of swallowing was performed, and then, the penetration-aspiration score was determined. The participants were asked to fill the eating assessment tool form. Voice recordings obtained to evaluate sound disorders were measured acoustically and analyzed using the PRAAT program. In terms of swallowing, the penetration-aspiration score obtained as a result of the flexible endoscopic swallowing assessment and eating assessment tool score was found to be higher in Group 1 than in Group 2, and a statistically significant difference was noted (p ≤ 0.001). When analyzing the maximum phonation time (p < 0.001) and fundamental frequency (p = 0.408) values in phonation evaluation, a statistically significant difference was found between the two groups. Group 1 showed a deterioration in terms of jitter (p = 0.040) and shimmer (p = 0.007) compared to Group 2, and a statistically significant difference was noted. There was no statistically significant difference in the harmonic/noise ratio (mean ± standard deviation) between the two groups (p = 0.051). Swallowing and voice functions significantly affect quality of life. Therefore, approaches aimed to improve the associated symptoms have become increasingly important. In patients with ankylosing spondylitis, swallowing quality and phonation ability may be negatively affected. These patients should be monitored for hidden or overt food aspiration.Trial Registry: https://clinicaltrials.gov/ct2/show/NCT04437394.

Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue.

OBJECTIVES: The aim of this study is to evaluate psychiatric symptoms in patients with ankylosing spondylitis (AS) and to investigate the relationship of the disease activity, functional capacity, pain, and fatigue with psychiatric symptoms. METHODS: Eighty AS patients and 80 healthy controls were included in the study. Spinal pain by visual analog scale (pain VAS-rest), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), and fatigue by Multidimensional Assessment of Fatigue (MAF) were assessed in patients. Psychiatric symptoms were measured using the Symptom Checklist-90-R (SCL-90 R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and Rosenberg Self-Esteem Scale (RSES). RESULTS: SCL-90-R total and all subscale scores (except interpersonal sensitivity and psychoticism) and BDI scores were significantly higher in the AS group compared to control group. PSQI total and all subscale scores were significantly higher in the AS group. State anxiety scale score was significantly higher and RSES score was significantly lower in the AS group. Psychiatric symptoms (except Rosenberg Self-Esteem score) were significantly correlated with BASDAI, BASFI, pain VAS rest, and MAF scores. CONCLUSION: Psychiatric symptoms are often seen in patients with AS. Disease activity, functional capacity, pain and fatigue were correlated with psychiatric symptoms but self-esteem was not. Therefore, psychiatric symptoms should be taken into consideration in the management of AS.

A randomized placebo-controlled clinical trial of phonophoresis for the treatment of chronic neck pain.

The aim of this trial was to investigate and compare the effects of phonophoresis (PP), placebo PP and exercise therapies on pain, disability, sleep quality, and depression in the patients with chronic neck pain (CNP). This is a randomized, single-blind, placebo-controlled study. A total of 61 patients with definite CNP were included in this study. The patients were randomized into three groups. Group 1 (n = 21) received PP with capsaicin treatment and exercises. Group 2 (n = 20) received placebo PP with capsaicin and exercises. Group 3 (n = 20) was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale), disability (the neck pain disability index), depression (Beck Depression Inventory scores), and sleep quality (Pittsburgh Sleep Quality Index) of all participants were evaluated. Measurements were taken before and after treatment. All of the groups showed statistically significant improvements in pain, disability, sleep quality, and depression. While there was no difference between groups regarding depression and sleep quality, intergroup comparison showed significant differences in pain and disability among three groups. These differences were statistically significant in group 1 and 2 compared to group 3, and also in group 1 compared to group 2. We observed that PP treatment was effective in the treatment for patients with CNP. A combination of PP with exercises can be used to obtain optimal clinical results.

Functional capacity, strength, and quality of life in children and youth with familial Mediterranean fever.

PURPOSE: To examine functional capacity and muscle strength in children and youth with familial Mediterranean fever (FMF) as compared with controls, and to assess whether these factors influence quality of life (QOL) in FMF. METHODS: A total of 100 subjects with FMF and 55 control subjects (8-18 years old) without known health issues were enrolled in the study. The 6-Minute Walk Test (6MWT) was used to evaluate functional capacity. Quadriceps strength was measured with a hand-held dynamometer. Quality of life was evaluated with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). RESULTS: Significant differences were found between subjects with FMF and controls in the 6MWT and strength test. PedsQL scores of subjects with FMF were significantly lower than the scores of the controls. The 6MWT and quadriceps strength were weakly correlated with the PedsQL. CONCLUSION: Subjects with FMF displayed lower functional capacity and QOL than peers who are healthy. Decreased functional capacity was correlated with decreased QOL in those with FMF.

Frequency of fibromyalgianess in patients with rheumatoid arthritis and ankylosing spondylitis: A multicenter study of Turkish League Against Rheumatism (TLAR) network.

Objectives: This study aimed to evaluate the frequency of fibromyalgianess, fibromyalgia syndrome (FS), and widespread pain in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and their relationship with clinical and demographic parameters. Patients and methods: This cross-sectional multicenter trial was performed in 14 centers across Türkiye between June 2018 and November 2019. Out of 685 patients recruited from the accessible population, 661 patients (342 RA, 319 AS; 264 males, 397 females; mean age: 48.1±12.9 years; range, 17 to 88 years) met the selection criteria. In these cohorts, those who did not meet the criteria for FS and had widespread pain (widespread pain index ≥7) were evaluated as a separate group. Clinical status and demographic parameters of patients in both cohorts were evaluated as well as the evaluations of RA and AS patients with widespread pain (widespread pain index ≥7) and RA and AS patients with FS groups. In addition, correlations between polysymptomatic distress scale (PSD) scores and Visual Analog Scale (VAS), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and Disease Activity Score using 28 joint counts for RA patients and VAS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) for AS patients were analyzed. Results: Frequencies of patients with FS and patients who had PSD scores ≥12 were 34.1% and 44.4% in all RA patients, respectively. Moreover, FS and PSD scores ≥12 were found in 29.2% and 36.9% of all AS patients, respectively. PSD scores of RA patients with FS were higher than all RA patients and RA patients with widespread pain. SDAI and CDAI scores of RA patients with FS were higher than all RA patients and RA patients with widespread pain. Similarly, PSD scores of AS patients with FS were higher than all AS patients and AS patients with widespread pain. ASDAS-erythrocyte sedimentation rate and BASDAI scores of AS patients with FS were found higher than all AS patients and AS patients with widespread pain. Conclusion: Disease activity scores, including pain in RA and AS, were higher in the presence of FS or fibromyalgianess. It may be related to clinical parameters, but cohort studies with long-term follow-up are needed to reveal causality. Additionally, to avoid overtreatment, coexistence of fibromyalgianess should be kept in mind in patients who have inflammatory diseases such as RA and AS, particularly with intractable widespread pain.

Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial.

The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.

The efficacy of Kinesio taping on lymphedema following head and neck cancer therapy: a randomized, double blind, sham-controlled trial.

OBJECTIVE: The aim was to investigate the effectiveness of Kinesio taping for lymphedema following head and neck cancer therapy and its effect on patient compliance and quality of life. METHODS: A total of 66 patients with lymphedema following head and neck cancer therapy were randomly allocated to the therapeutic Kinesio taping group (n = 33) and the sham Kinesio taping group (n = 33). All participants received manual lymphatic drainage, Kinesio taping, and home exercises for the first four weeks, and only home exercises for the second four weeks. The tape measurements, a scale of external lymphedema, a scale of the internal lymphedema, and quality of life were evaluated in both groups. The perceived discomfort consisting of limitation of daily living activities, pain, tightness, stiffness, and heaviness were also recorded. RESULTS: When the group x time effect was evaluated, it was observed that external lymphedema was significantly reduced in both groups according to neck and face composite measurements (p < .001). However, in these measurements, a significant difference was found between the groups in favor of the KT group (p = .001, p = .032, respectively). At the end of the study, there was no significant difference in terms of internal lymphedema in both groups (p = .860). The quality of life parameters such as global health status and swallowing were significantly better in the Kinesio taping group (p < .001). There was no significant difference in the parameters of perceived discomfort between the two groups (p = .282, p = .225, p = .090, p = .155, p = .183, respectively). CONCLUSION: Kinesio taping is effective in tape measurements and positively affects the quality of life in lymphedema following head and neck cancer therapy.

Efficacy of Kinesio taping on Mutational Falsetto: A Double Blind, Randomized, Sham-controlled Trial.

OBJECTIVES: This study aimed to assess the efficacy of Kinesio taping on male patients with mutational falsetto undergoing voice therapy. DESIGN: Double blind, randomized, sham-controlled clinical trial. PARTICIPANTS: Interviews were conducted with thirty seven mutational falsetto patients. Included 32 participants were randomized and divided into two groups. Two were dropped out due to irregular attendance, 30 participants were included in final analysis. INTERVENTIONS: The study group was treated with voice therapy and applications of three different therapeutic Kinesio taping techniques with seven Kinesio tapes four times over two weeks, and the control group was treated with voice therapy, and applied to sham Kinesio taping. OUTCOME MEASURES: The values of fundamental frequency, jitter, shimmer, noise-harmonic ratio, maximum phonation time, Voice Handicap Index-10 scores, and Grade-Roughness-Breathiness-Asthenia-Strain Scale scores were recorded at the baseline and after the two weeks. RESULTS: There were significant differences between the study group and the control group with respect to the values of fundamental frequency (P = 0.011), jitter (P = 0.041), shimmer (P = 0.036), noise-harmonic ratio (P = 0.003), maximum phonation time (P ≤ 0.001), Voice Handicap Index-10 scores (P = 0.036), and Grade-Roughness-Breathiness-Asthenia-Strain Scale scores (P = 0.007; P ≤ 0.021; P = 0.022; P = 0.002; P = 0.021, respectively) at the end of the study. CONCLUSIONS: The study demonstrated that Kinesio taping with voice therapy is an efficient and effective technique for treating mutational falsetto patients.

Effectiveness of microwave diathermy on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome: a randomized placebo-controlled clinical study.

The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P < 0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P > 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.

Serum levels of soluble CD26 and CD30 and their clinical significance in patients with rheumatoid arthritis.

The aim of this study was to assess serum levels and clinical significance of soluble CD26 (sCD26) and soluble CD30 (sCD30) in patients with rheumatoid arthritis (RA). Forty-eight patients with RA and 30 healthy controls were enrolled. Serum sCD26 and sCD30 levels were measured using ELISA. Serum sCD26 levels were significantly lower (P = 0.011), whereas sCD30 levels were higher (P = 0.008) in patients with RA than controls. Serum levels of sCD30 correlated significantly with clinical and laboratory parameters of disease activity like erythrocyte sedimentation rate, C-reactive protein, disease activity scores-28 and health assessment questionnaire score; however, sCD26 levels did not correlate any of these activity parameters. These results suggest that serum sCD30 levels increased and correlated significantly with disease activity, indicating a novel follow-up parameter in RA. Serum levels of sCD26 may be lessen but not related to disease activity in RA.

Comparison of Pain, Muscle Strength, and Functional Status Following Unicompartmental Knee Arthroplasty, Total Knee Arthroplasty, and Conservative Management of Gonarthrosis.

BACKGROUND: Treatment options and surgical decision for grade 3-4 gonarthrosis remains controversial. We aimed to compare the pain level, muscle strength, physical performance, lower extremity functions, and other physical activity levels between patients who underwent arthroplasty and those who received conservative management for grade 3-4 gonarthrosis. METHODS: This prospective analytical observational study was conducted in a tertiary referral hospital. A total of 30 unicompartmental knee arthroplasty (UKA) and 30 total knee arthroplasty (TKA) patients as two different study groups and 30 patients were treated conservatively as the control group were included. The rehabilitation and complication rates were recorded. The values of the range of motion, quadriceps diameter, were measured and also the isokinetic muscle strength, pick-up, repeated sit-to-stand, stair ascending and descending, straight-line walking, timed up and go, and 20-m walk tests, the knee injury and osteoarthritis-outcome-score (KOOS), the hospital for special-surgery-knee-score (HSS), and Oxford-Knee-Score (OKS) were performed. RESULTS: Postoperative rehabilitation and complication rates were significantly higher in the TKA group compared to the UKA group (p = 0.029 and p = 0.026, respectively). Six months after the treatment, the knee extension muscle strength value at 180°/s, knee flexion degree, total work flexion, stair ascending, VAS at night, all KOOS symptom, pain and daily function and total scores in the UKA group was significantly different than the TKA and the control groups (p < 0.001). Total work extension values, knee flexion degree, in the control group were found to be significantly higher than the TKA group (p = 0.033, p < 0.001, respectively). CONCLUSIONS: The UKA was significantly superior to TKA and conservative treatment concerning pain, muscle strength, and quality of life. LEVEL OF EVIDENCE: IIa.

Validity and Reliability of the Turkish Version of the Sydney Swallow Questionnaire.

PURPOSE: This study aimed to assess the validity and reliability of the Turkish version of the Sydney Swallow Questionnaire (SSQ-T) and calculate a cutoff value to help clinicians to suspect/predict oropharyngeal dysphagia (OPD). METHOD: The original questionnaire was translated into Turkish by two bilingual English Turkish translators. The study included 170 Turkish adult subjects. Half of the participants were patients presenting with OPD, and half were healthy controls. Fiberoptic endoscopic evaluation of swallowing (FEES) was administered to all subjects. Patients were evaluated using the Turkish Penetration Aspiration Scale and the Yale Pharyngeal Residue Severity Rating Scale. Additionally, the final version of the SSQ-T questionnaire and the Turkish Eating Assessment Tool were administered to all subjects. RESULTS: Internal consistency was high on all questions (Cronbach's α = .974). Test-retest reliability was also high (intraclass correlation coefficient = .975, p < .001; 95% confidence interval [.948-.988]). The SSQ-T score range was 0-1,240 for all participants, 57-1,240 for the patients with OPD, and 0-152 for the healthy controls. The cutoff value was 174 with 85.96% sensitivity and 99.12% specificity. CONCLUSION: The SSQ-T was demonstrated to be a valid and reliable assessment to assess the self-perceived severity of OPD.

Is there any association between low level of serum nesfatin-1 and fibromyalgia syndrome?

OBJECTIVES: This study aims to investigate the relationship between serum level of nesfatin-1 and fibromyalgia syndrome (FMS) clinical parameters such as pain severity, disease activity, fatigue, emotional state, and sleep quality. PATIENTS AND METHODS: Forty-six female patients with FMS (median age 40 years; range, 18 to 53 years) and 46 healthy female controls (median age 36 years; range, 19 to 52 years) were included in the study. Severity of pain, disease activity, fatigue, sleep quality, and emotional status were evaluated by visual analog scale, Fibromyalgia Impact Questionnaire, Multidimensional Assessment of Fatigue (MAF), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI), respectively. Serum nesfatin-1 concentrations (pg/mL) were measured by enzyme-linked immunosorbent assay method. RESULTS: There was no significant difference with respect to demographic characteristics between the FMS patients and healthy controls. When clinical parameters were compared, MAF, BDI, BAI, and PSQI scores were significantly higher in FMS patients than controls (p<0.05). Serum nesfatin-1 concentration was significantly lower in patients with FMS (p<0.05). When compared to the FMS patients without anxiety, serum nesfatin-1 concentration was significantly increased in FMS patients with anxiety (p<0.05). Serum nesfatin-1 concentration was positively correlated with BAI scores in patients with FMS (p<0.05). CONCLUSION: Low nesfatin-1 serum levels may contribute to pathological changes in FMS. In addition, nesfatin-1 may also be involved in the mediation of anxiety-related responses in FMS.

Determination of the Prevalence From Clinical Diagnosis of Sacroiliac Joint Dysfunction in Patients With Lumbar Disc Hernia and an Evaluation of the Effect of This Combination on Pain and Quality of Life.

STUDY DESIGN: A prospective cross-sectional study. OBJECTIVE: To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination. SUMMARY OF BACKGROUND DATA: Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain. METHODS: Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale. RESULTS: 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ±â€Š11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02). CONCLUSION: Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments. LEVEL OF EVIDENCE: 2.

Prognostic value of anti-cyclic citrullinated peptide antibodies and rheumatoid factor in patients with rheumatoid arthritis.

OBJECTIVES: To determine the predictive value for radiological damage of anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) in patients with rheumatoid arthritis (RA). METHODS: Ninety patients with RA were enrolled in this study. All patients had symptom duration of at least one year. Anti-CCP and IgM-RF were evaluated with enzyme linked immunosorbent assay and nephelometry methods, respectively. Radiological damage was assessed by Larsen score. RESULTS: In forward stepwise logistic regression analysis, anti-CCP positivity and RF positivity were seen as significant independent predictors of the radiological outcomes (p = 0.01, p < 0.05, respectively). The combination of these antibodies had the highest risk for erosive joint damage (odds ratio = 25.71; 95% confidence interval, 4.7 to 140.13; p = 0.001). CONCLUSION: Our results suggest that the combined use of RF and anti-CCP has greater predictive value for erosive RA than anti-CCP or RF alone, and may facilitate to make a decision about the individual treatment in RA (Tab. 4, Ref. 37). Full Text (Free, PDF) www.bmj.sk.

Presence of Fibromyalgia Syndrome and Its Relationship with Clinical Parameters in Patients with Axial Spondyloarthritis.

BACKGROUND: Fibromyalgia syndrome (FMS) is a disorder with a population prevalence of 1% to 5%. There are insufficient data in the literature on the incidence of FMS in patients with axial spondyloarthritis (SpA), with only a limited number of studies conducted. OBJECTIVES: The aim of this study was to determine the presence of FMS in patients diagnosed with axial SpA and to investigate the effect of this coexistence on clinical and laboratory assessments in patients with ankylosing spondylitis. STUDY DESIGN: This research involved a retrospective analysis of prospectively collected data. SETTING: The research took place in an outpatient rheumatology clinic. METHODS: This study included 125 patients diagnosed with axial SpA according to the Assessment of Spondyloarthritis International Society criteria. The presence of FMS was investigated according to the 2010 American College of Rheumatology criteria. Pain during activity, resting, and at night was examined using the Visual Analog Scale. Ankylosing Spondylitis Disease Activity Scores were used for assessment of disease activity, Ankylosing Spondylitis Quality of Life Scale was used for quality of life, Bath Ankylosing Spondylitis Functional Index was used for functionality, and Pittsburgh Sleep Quality Index was used for sleep quality. RESULTS: Incidence of FMS was 29.6% in the study population, which consisted of patients who were all diagnosed with axial SpA. Comparison of patient groups with and without FMS revealed no statistically significant differences in age, weight, body mass index, marital status, family history, and smoking history (P > .05), with a higher rate of female patients in the group with FMS at 55% (P < .05). Ankylosing Spondylitis Disease Activity Score-C-Reaktif Protein, Ankylosing Spondylitis Disease Activity Score-Erythyrocyte Sedimentation Rate, Ankylosing Spondylitis Quality of Life Scale, Bath Ankylosing Spondylitis Functional Index, Pittsburgh Sleep Quality Index, and Visual Analog Scale pain scores were significantly higher in the group with FMS (P < .05). LIMITATION: The study involved a limited number of patients. CONCLUSIONS: FMS is observed in one-third of patients with axial SpA. The presence of FMS negatively affects quality of life, functional status, sleep quality, disease activity, and pain level of patients with ankylosing spondylitis. The possibility for coexistence of FMS should be kept in mind when determining the treatment protocols for patients with axial spondyloarthritis, and adjunctive treatment should be given if necessary. KEY WORDS: Disease activity, fibromyalgia, quality of life, spondyloarthritis, sleep quality.

The impact of the presence of fibromyalgia on fatigue in patients with psoriatic arthritis: comparison with controls.

BACKGROUND: Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls. METHODS: Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria. RESULTS: Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001). CONCLUSION: It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.

Association of work instability with fatigue and emotional status in patients with ankylosing spondylitis: comparison with healthy controls.

INTRODUCTION/OBJECTIVE: Ankylosing spondylitis (AS) is usually seen in among younger person of working age and carries a significant economic burden. It was aimed to explore the relation of work instability with fatigue, depression, and anxiety in working AS patients comparing with healthy controls. METHOD: This case-control study was conducted on working 61 AS patients and 40 sex-age-matched working healthy controls. The data were collected using Visual analogue scale-pain, Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index in patients; and Beck Depression Inventory, Beck Anxiety Inventory, Multidimensional Assessment of Fatigue, AS Work Instability Scale in all participants. Data were analyzed by SPSS, using chi-squared test, Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation analysis, and multivariate linear regression analysis. RESULTS: Depression, fatigue, and work instability scores were significantly higher in patients than controls (p < 0.05). Clinical parameters (except spinal mobility) showed a significant worsening across the levels of work instability in patients (p < 0.05) and work instability scores were positively correlated with all clinical parameters except spinal mobility (p < 0.001). There was a weak correlation between work instability and spinal mobility (p < 0.05). Fatigue (p < 0.001), pain, and functional capacity scores (p < 0.05) were found to be influential variables on work instability scores. CONCLUSION: The results of this study demonstrated that fatigue and depressive symptoms had negative effect on work instability beside pain, disease activity, and functionality in patients with AS. The recognition and improvement of fatigue and depression may lead to reduced risk of job loss in these patients.

The relationship of illness perceptions with demographic features, pain severity, functional capacity, disability, depression, and quality of life in patients with chronic low back pain.

OBJECTIVES: The aim of this study was to evaluate the relationship of illness perceptions (IPs) with demographic features, severity of pain, functional capacity, disability, depression, and quality of life in patients with chronic low back pain (CLBP). PATIENTS AND METHODS: Between January 2015 and July 2015, a total of 114 patients with non-specific CLBP (86 females, 28 males; mean age 47.1±15.2 years; range, 18 to 85 years) were included. Non-specific CLBP was defined as low back pain not attributable to a recognizable, known specific pathology such as infection, tumor, inflammation for ≥12 weeks. The IPs using the revised Illness Perception Questionnaire (IPQ-R), pain severity using the visual analog scale (VAS), functional capacity using the Six-Minute Walk Test (6MWT), disability using the modified Oswestry Disability Index (m-ODI), depression using the Beck Depression Inventory (BDI), and quality of life using the Short Form-36 (SF-36) were assessed. RESULTS: There was a significant, positive correlation between the age, body mass index, duration of disease, pain scores, and IPQ-R- consequences, timeline (acute/chronic), and emotional responses subunits, whereas there was a significant, negative correlation between the IPQ-R-personal and treatment control subunits (p<0.001). The IPQ-R-timeline (acute/chronic), consequences, and emotional response subunits were positively and personal and treatment controls and illness coherence subunits were negatively correlated with the BDI and m-ODI (p<0.001). The IPQ-R-consequences and emotional responses subunits were negatively and timeline (acute/chronic), personal and treatment controls, and illness coherence subunits were positively correlated with the SF-36 subunits (p<0.05). CONCLUSION: The IPs were negatively affected by advanced age, high body mass index, longer duration of disease, and increased severity of pain in CLBP patients. Based on these findings, positive IPs may be related with reduced disability and depression, and improved quality of life and functional capacity in this patient population. Developing new strategies for improving the negative IPs of patients with CLBP may be useful.

Alternative approach to evaluating lumbar lordosis on direct roentgenograms: projection area per length squared.

Several methods have been described to evaluate the degree of lumbar lordosis. However, suggested methods have used non-standardized terminology and landmarks to measure the degree of lumbar lordosis. In the present study a practical method for evaluating the degree of lumbar lordosis is described and, for this purpose, 24 lateral roentgenograms were obtained retrospectively from the archive of Department of Physical Medicine and Rehabilitation, Ondokuz Mayis University, Samsun, Turkey. The length between the superior and inferior angles of the first and fifth lumbar vertebral bodies, and the area behind the lumbar vertebral bodies, were estimated using the point counting and planimetry methods. A new unit, the projection area per length squared (PAL) was described on lateral roentgenograms. The planimetric approach was used as the gold standard in the present study. The point-counting method was also used to estimate the PAL and it was repeated three times to determine the variability of the technique. To evaluate the estimates' accuracy, the results of point-counting were compared with those of the planimetry methods. The PAL changed by between 3.93 and 13.59% for the examined subjects. A high correlation was also noted between the results of the point-counting and planimetry methods (r = 0.997). It is concluded that the PAL approach could provide accurate and reproducible data for evaluating the degree of lumbar lordosis and low back pain.