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.

Beyond expectations: disease duration and psychological burden in psoriatic arthritis.

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

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

AIM: Nail involvement is common in psoriatic arthritis. This study assesses clinical characteristics, nail psoriasis prevalence, and impact of nail psoriasis on disease activity in patients with psoriatic arthritis (PsA). METHOD: This cross-sectional multicenter study was conducted by the Turkish League Against Rheumatism using PsA patients recruited from 25 centers. Demographic and clinical characteristics of PsA patients, such as disease activity measures, quality of life, and nail involvement findings were assessed during routine follow-up examinations. Patients were divided into two groups according to the presence or absence of nail psoriasis and compared using the χ2 test or Fisher exact test for categorical variables and the t-test or Mann-Whitney U test for continuous variables. RESULTS: In 1122 individuals with PsA, 645 (57.5%) displayed nail psoriasis. The most frequent features of fingernails were ridges (38%), followed by pitting (21%) and onycholysis (19%). More females were present in both groups (with and without nail psoriasis; 64% vs 67%, P < 0.282). Patients with nail psoriasis were older, indicated more pain and fatigue, experienced greater swelling, tender joint counts, and skin disease severity, and had a higher disease activity score compared with those without nail psoriasis (all P < 0.05). CONCLUSION: We demonstrate an increased prevalence of nail psoriasis observed in patients with psoriatic arthritis. Patients with nail involvement experience increased disease activity, lower quality of life, and diminished mental and physical status compared with those without nail involvement.

YouTube English videos as a source of information on arm and shoulder exercise after breast cancer surgery.

PURPOSE: To examine the reliability, quality and content of YouTube videos on exercises that can be performed after breast cancer (BC) surgery. METHODS: Videos selected from YouTube using the search terms 'shoulder exercise and BC surgery', 'arm exercise and BC surgery' and 'physiotherapy/physical therapy and BC surgery' were categorised as useful or misleading by a surgeon and a physiotherapist. The videos were analysed using the 5-point DISCERN scale for reliability, the Global Quality Scale for quality and a 10-item scale for comprehensiveness. RESULTS: Of the 180 videos initially analysed, 82 were included in the study, and 42 (51.2%) were classified as having misleading information and 40(48.8%) as having useful information. The reliability, quality and content scores of the videos containing useful information were higher (p < 0.001). Most of the videos in the useful information group (80%) were uploaded by universities/professional organisations/physicians/physiotherapists, while the majority of those in the misleading information group (47.6%) were uploaded by websites providing independent healthcare information. CONCLUSION: YouTube can be an important instrument to protect patients from musculoskeletal system complications after BC treatment and improve existing complications. Universities, physicians and physiotherapists should be encouraged to prepare more videos containing full and accurate information on this subject.

Sleep disturbances and non-cyclical breast pain: where to break the vicious cycle?

PURPOSE: This study aimed to assess the sleep quality of patients with the complaint of non-cyclical breast pain (NCBP), compare them to a healthy control group, and analyze the interrelationship of sleep quality with pain, anxiety, depression, and quality of life. METHODS: This cross-sectional study was conducted in consecutive women presenting to the general surgery clinic between May 2020 and December 2020. Patients diagnosed with NCBP formed one group for study and 44 receiving routine well-woman care formed the control group. Evaluations were undertaken using the Nottingham Health Profile (NHP), short-form McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI). RESULTS: Of 160 consecutive patients, 116 were diagnosed with NCBP and 44 controls. Poor sleep quality (PSQI > 5) was present in 59% (n = 69) of the women with NCBP and 38% (n = 17) of the controls (p = 0.018). According to PSQI global score, overall sleep quality was significantly lower in the NCBP group compared to the control group (p < 0.007). Sleep latency, sleep duration, and daytime dysfunction were the major components determining the PSQI global score (p = 0.004, p = 0.004, and p < 0.001, respectively). The correlation matrix revealed a statistically significant correlation between the HAD-A, HAD-D, and SF-MSQ and NHP subgroups and PSQI global score in the NCBP group (p < 0.001) whereas this significant correlation was detected with only the NHP subgroups among the controls. CONCLUSIONS: A considerable proportion of NCBP patients, regardless of sensory or affective characteristics and trajectory of pain, experience significant sleep disturbances. Further studies should be conducted to evaluate the existence of central sensitization syndrome in NCBP patients to determine the required pharmacological treatment.

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

OBJECTIVE: Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA. METHODS: The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed. RESULTS: The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA). CONCLUSION: Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes.

Impact of obesity on quality of life, psychological status, and disease activity in psoriatic arthritis: a multi­center study.

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

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

OBJECTIVES: This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey. PATIENTS AND METHODS: A total of 961 patients (346 males, 615 females; mean age 46.9±12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients' demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and short form-36 scores were all recorded. RESULTS: Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The visual analog scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD. CONCLUSION: In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment.

Factors Affecting the Femoral Cartilage Thickness After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: This study aimed to evaluate the changes in the distal femoral cartilage thickness in patients that underwent anterior cruciate ligament reconstruction (ACLR) and to analyze their association with concomitant meniscal surgery, knee muscle strength, kinesophobia, and physical activity level. METHODS: The demographic characteristics and surgical data of 47 male patients that underwent unilateral ACLR (mean, 27.55 ± 5.63; range, 18-40 years) were evaluated. The patients were assessed in three groups depending on surgery: isolated ACLR (n = 15), ACLR + partial medial meniscus resection (ACLR&M) (n = 16), and ACLR + medial meniscus repair (ACLR&MR) (n = 16). The medial (MCCT), intercondylar (ICCT), and lateral (LCCT) femoral cartilage thicknesses on both limbs were measured using ultrasonography. The extensor and flexor muscles strength of the knees was assessed using an isokinetic dynamometer at 60°/s. The physical activity level was evaluated by the International Physical Activity Questionnaire (IPAQ) short form and Tegner Activity Scale (TAS). The fear of movement was assessed by the Tampa Scale for Kinesiophobia Questionnaire (TSKQ). RESULTS: The postoperative mean follow-up duration was 32.24 ± 9.17 months. MCCT and LCCT were significantly decreased in the ACLR&M group (p < 0.001 and p = 0.019, respectively). MCCT, ICCT and LCCT were significantly decreased in the ACLR&MR group (p = 0.017, p = 0.011, and p = 0.004, respectively). No significant change was found in the ACLR group. Cartilage thickness changes were not significantly correlated with the knee muscle strength, IPAQ, TAS and TSKQ scores in all groups (p > 0.05). CONCLUSION: The results showed partial meniscectomy and meniscus repair at the time of ACLR as important risk factors for decreased chondral thickness.

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

OBJECTIVE: This study sought to compare disease activity, clinical features, and patient-reported outcomes concerning anxiety, depression, fatigue, function, quality of life, and fibromyalgia between female and male patients with peripheral PsA in a Turkish population. METHODS: This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1038 patients (678 females, 360 males) diagnosed with peripheral PsA according to the CASPAR criteria. The demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28 and cDAPSA. Remission, minimal disease activity (MDA), and very low disease activity (VLDA) were determined. Health Assessment Questionnaire (HAQ), Short-Form-36 (SF-36), Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid ScreeningTool (FiRST) were used. Disease activity and patient-reported outcomes were compared in male and female patients, and the predictors of MDA for both genders were analyzed. RESULTS: The patients' mean age was 47.6years (SD: 12) for females and 46.3years (SD: 12.3) for males. In terms of DAS28 and cDAPSA, female patients had significantly higher disease activity scores, while male patients had significantly higher remission rates (P<0.05). There was a significant difference in the rate of MDA in favor of males (P<0.05), but not in VLDA. The incidences of dactylitis, enthesitis, tenosynovitis, and inflammatory bowel disease were similar in male and female patients, except for spondylitis, which was higher in males (P<0.05). Overall, although there was no significant between-group difference in age and disease duration, female patients had significantly higher BMI and late-onset disease (P<0.05). Female patients had higher HAD, HAQ, and FiRST and lower SF-36 scores than males (P<0.05). In both male and female patients, the disease activity score of cDAPSA was significantly correlated with the scores of FiRST, HAD, VAS-F, and HAQ (P<0.05). In regression analysis, tender joint count, swollen joint count, PASI, pain VAS, and enthesitis were the MDA predictors in both genders. CONCLUSION: In patients with peripheral PsA, males are more likely to develop spondylitis while other extraarticular manifestations are similar. Female patients appear to have lower rates of remission and MDA and higher levels of disease activity. Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations. The predictors of MDA, i.e., tender joint count, swollen joint count, PASI, pain VAS, and enthesitis are similar between the two genders.

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

OBJECTIVES: In this study, we aimed to evaluate the effect of gender on clinical findings, disease activity, functional status and quality of life in patients with axial involvement in Turkey. METHODS: Patients with PsA who met the CASPAR classification criteria were enrolled consequently in this cohort. Turkish League Against Rheumatism (TLAR)-Network was formed with the participation of 25 centres. The demographic variables, fatigue, diagnostic delay, the beginning of peripheral arthritis, enthesitis, dactylitis and spine involvement, inflammatory low back pain, BASFI, HAQ, HAQ-s, visual analogue scale-pain (VAS-pain), anxiety, depression and disease activity parameters (ESR, DAS28, BASDAI) were recorded. Axial involvement was assessed according to clinical and radiological data according to modified New York (MNYC) or Assessment of SpondyloArthritis international Society (ASAS) criteria. RESULTS: A total of 1018 patients with PsA were included in this study. Of the 373 patients with axial involvement, 150 were male (40.2%) and 223 (59.8%) were female. Spondylitis was detected in 14,7% of men and 21,9% of women in all patients. Pain score (VAS) (p < .002), fatigue (p < .001), ESR (p < .001), DAS28 (p < .001), BASDAI score (p < .001), PsAQoL (p < .001), HAQ score (p < ,01), HAQ-S score (p < .001), anxiety (p < .001), depression (p < .024), FACIT (p < .001) and FiRST (p < .001) scores were statistically significantly worse in women than males with axial PsA. However, quality of life was better (p < .001) and PASI score (p < .005) were statistically worse in male patients than in female patients with axial involvement. CONCLUSION: This study has shown that the burden of disease in axial PsA has significant difference between genders. Disease activity, physical disability, functional limitation, depression and anxiety scores were higher in female patients, while quality of life were better and PASI score were higher in male patients. Therefore, we suggest that new strategies should be developed for more effective treatment of axial PsA in female patients.

The impact of fatigue on patients with psoriatic arthritis: a multi-center study of the TLAR-network.

Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia.

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

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

Evaluation of the effects of neural therapy in patients diagnosed with fibromyalgia.

OBJECTIVES: This study aims to compare the effects of neural therapy and exercise on pain, quality of life, depression, anxiety, and functioning status in patients diagnosed with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: This multi-center study included a total of 72 patients (60 females, 12 males; mean age: 39.2±9.5 years; range, 22 to 53 years) who were diagnosed with FMS according to the 1990 American College of Rheumatology (ACR) criteria between January 2015 and June 2015. The patients were randomly divided into two groups: the first group (n=30) received an exercise program (strengthening, stretching, relaxation, and aerobic exercises, three days a week), and the second group (n=42) received a total of six sessions of neural therapy as one session a week in addition to the same exercise program. Pain severity was assessed with the Visual Analog Scale (VAS), emotional state with the Beck Depression Scale (BDS) and Beck Anxiety Inventory (BAI), quality of life with Short Form-36 (SF-36), and functioning status with the Fibromyalgia Impact Questionnaire (FIQ). The patients were evaluated at the end of treatment (week 6) and one month after the end of treatment. RESULTS: The mean disease duration was 34.3±9.3 months, the mean VAS score was 7.3±2.2, and the mean FIQ score was 58.4±13.2. There were significant improvements in the VAS, FIQ, SF-36, BDS, and BAI scores after the treatment in both groups (p<0.05). Post-treatment BDS and VAS scores were significantly lower in the neural therapy group (p=0.038; p=0.049; p<0.05). There was no significant difference in any parameter one month after the treatment between the groups (p>0.05). CONCLUSION: When neural therapy is combined with exercise in FMS patients, it may be advantageous in terms of pain and depression, compared to exercise alone.

Etanercept-induced Crohn's disease in ankylosing spondylitis: a case report and review of the literature.

Tumor necrosis factor (TNF)-α is a cytokine that plays a well-established, key role as a central mediator of inflammation and immune regulation. TNF-α and its receptors are suggested to play a critical role in a number of chronic inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (AS), juvenile chronic arthritis, and inflammatory bowel disease (IBD). TNF-α inhibitors are currently used in the treatment of these diseases. We report a 29-year-old male with AS who developed Crohn's disease while taking etanercept. Etanercept treatment was interrupted and a switch to a monoclonal antibody-based anti-TNF treatment using adalimumab was started, which induced a prompt improvement of the gastrointestinal symptoms. We indicate the immunodysregulatory and proinflammatory effects of etanercept and discuss the potential pathogenic mechanisms of the paradoxical effect of TNF-α inhibitors. We also review the related literature on new-onset IBD following anti-TNF treatment for AS.

English-language videos on YouTube as a source of information on self-administer subcutaneous anti-tumour necrosis factor agent injections.

The aim of this study was to evaluate the reliability, content, and quality of videos for patients available on YouTube for learning how to self-administer subcutaneous anti-tumour necrosis factor (TNF) injections. We searched for the terms Humira injection, Enbrel injection, Simponi injection, and Cimzia injection. Videos were categorised as useful information, misleading information, useful patient opinion, and misleading patient opinion by two physicians. Videos were rated for quality on a 5-point global quality scale (GQS; 1 = poor quality, 5 = excellent quality) and reliability and content using the 5-point DISCERN scale (higher scores represent greater reliability and more comprehensive videos). Of the 142 English videos, 24 (16.9%) videos were classified as useful information, 6 (4.2%) as misleading information, 47 (33.1%) as useful patient opinion, and 65 (45.8%) as misleading patient opinion. Useful videos were the most comprehensive and had the highest reliability and quality scores. The useful information and useful patient opinion videos had the highest numbers of views per day (median 8.32, IQR: 3.40-14.28 and 5.46, IQR: 3.06-14.44), as compared with 2.32, IQR: 1.63-6.26 for misleading information videos and 2.15, IQR: 1.17-7.43 for misleading patient opinion videos (p = 0.001). Almost all (91.5%) misleading videos were uploaded by individual users. There are a substantial number of English-language YouTube videos, with high quality, and rich content and reliability that can be sources of information on proper technique of anti-TNF self-injections. Physicians should direct patients to the reliable resources of information and educate them in online resource assessment, thereby improving treatment outcomes.

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study.

BACKGROUND: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. METHODS: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. RESULTS: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. CONCLUSION: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.

Comparison of subacromial tenoxicam and steroid injections in the treatment of impingement syndrome.

OBJECTIVES: This study aims to assess and compare the efficacy of subacromial tenoxicam and steroid injections in treating patients with shoulder impingement syndrome. PATIENTS AND METHODS: Forty patients having shoulder impingement syndrome with findings of rotator cuff tendinitis or subacromial bursitis on magnetic resonance imaging were included in the study. Patients were randomized into two subacromial injection groups: patients in the first group (10 males, 10 females; mean age 45.3 years; range 32 to 67 years) were administered 20 mg tenoxicam three times by weekly intervals, and patients in the second group (8 males, 12 females; mean age 46.5 years; range 29 to 73 years) were administered 40 mg methylprednisolone acetate just for once. Visual analog scale (VAS), active range of motion (ROM) of the shoulder joint, and Disabilities of Arm, Shoulder and Hand (DASH) questionnaire scores were evaluated at baseline, six weeks after treatment, and first year. RESULTS: Visual analog scale, DASH, and active ROM scores in both groups were statistically significantly improved. No statistically significant difference was detected between subacromial tenoxicam and steroid injections in terms of post-treatment VAS, DASH, and active ROM scores. Mean pre- and post-treatment VAS scores in tenoxicam group were 7.8 (range, 3-9) and 2.6 (range, 2-4), respectively. Mean pre- and post-treatment VAS scores in steroid group were 6.2 (range, 3-10) and 3.6 (range, 0-7), respectively. Mean pre- and post-treatment DASH scores in tenoxicam group were 59.4 (range, 45-80) and 14.7 (range, 8.3-25.8), respectively. Mean pre- and post-treatment DASH scores in steroid group were 56.7 (range, 33.3-85.8) and 18.1 (range, 0-69.2), respectively. Although the improvement in active ROM was higher in the steroid group, difference between two groups was not statistically significant. CONCLUSION: Both subacromial tenoxicam and steroid injections may be successfully used in the treatment of patients with impingement syndrome. Subacromial tenoxicam injection may be preferred as a first-line intervention in these patients thanks to its safe profile.