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

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

Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study.

[Purpose] The purpose of this study is to compare effectiveness of extracorporeal shock wave therapy (ESWT), ultrasound (US) and sham ESWT in the treatment of myofascial pain syndrome (MPS). [Subjects and Methods] Sixty MPS patients aged 18-60 years were included in the study. The patients were randomized equally into 3 groups. Group 1 received ESWT for 4 session with 3 day-intervals. Group 2 received 4 sessions of sham ESWT. US was applied to Group 3 for 10 sessions. All patients were recommended an exercise program. The patients were evaluated before-post and 6 weeks after treatment. Measurements were made using pressure pain threshold (PPT), pain score (PS) and visual analogue scale (VAS). Patients were evaluated by using SF-36 and HADS (hospital anxiety and depression scale). [Results] A significant posttreatment difference was found in VAS, PPT and SF-36 subparameters in group 1. In group 2, a significant difference was not found in any parameter. In group 3, a significant difference was detected in parameters of VAS and PPT. A significant difference was found between groups 1 and 2 as for subtitles of PPT, VAS, SF-36. [Conclusion] These results suggest that ESWT is as effective as US. ESWT and US are significantly more effective than sham ESWT.

Lipocalin 2 as a clinical significance in rheumatoid arthritis.

AIM OF THE STUDY: In this study, serum lipokalin 2 (LCN-2) levels and its clinical and radiological significance in patients with rheumatoid arthritis was evaluated. MATERIAL AND METHODS: The study enrolled 37 patients with RA and 34 healthy controls. Serum LCN-2 level was measured using ELISA method. Patients with DAS 28 scores ≤ 3.2, and > 3.2 were allocated into lower and high/moderate disease activity groups, respectively. Additionally patients were divided into 2 groups as early RA (disease duration ≤ 2 years) and established RA (duration of the disease ≥ 2 years). Functional disability was evaluated using Health Assessment Questionnaire (HAQ). Radiographs were scored using the modified Larsen score. RESULTS: Serum LCN-2 (p = 0.029) levels were significantly higher in patients with RA than in the controls. Serum LCN-2 level did not correlate with laboratory and clinical parameters of disease activity like erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), DAS 28, Health Assessment Questionnaire Score (HAQ) and Nottingham Health Profile (NHP). Similarly, any correlation could not be found between structural joint damage and serum LCN2 levels. CONCLUSIONS: These results indicate that serum LCN-2 levels may be used as an indicator for structural damage like erosions in the early stage of the disease but do not able to be used to monitor disease activity.

Affective temperament profile in ankylosing spondylitis patients using TEMPS-A.

[Purpose] This study aimed to compare the most common dominant affective temperaments in Ankylosing Spondylitis patients and investigate the relationship between the dominant affective temperaments and pain levels, disease activity, quality of life, current depression, and anxiety level in Ankylosing Spondylitis patients. [Subjects and Methods] Fifty-one patients diagnosed with axial spondiloartropathy and forty-two age- and gender-matched control subjects were included in this study. Disease duration, erythrocyte sedimentation rate, serum C-reactive protein, pain by the Visual Analog Scale, disease activity by the Bath Ankylosing Spondylitis Disease Activity Index, functional status by the Bath Ankylosing Spondylitis Functional Index; psychological status by the Beck Depression Inventory, Beck Anxiety Inventory and overall health assessment by the Ankylosing Spondylitis Quality of Life Scale were assessed in patients. The Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire was used to determine the dominant affective temperament. [Results] There was no statistical difference in the distribution of temperament subtypes between patients with Ankylosing Spondylitis and the controls. Depressive, anxious, and cyclothymic temperament scores were higher in patients with high values on the Bath Ankylosing Spondylitis Functional Index and Visual Analog Scale. There was a correlation between anxious subtypes of affective temperament scores and the value of Ankylosing Spondylitis Quality of Life Scale. Correlation analysis also found depressive, cyclothymic, irritable, and anxious temperament and psychiatric symptoms to be significantly related. [Conclusion] Affective temperament may contribute to symptoms of depression and anxiety in patients with Ankylosing Spondylitis and may increase disease activity and may reduce their quality of life.

Sleep Quality Is Related to Disease Activity in Patients With Ankylosing Spondylitis: A Polysomnographic Study.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease that is associated with poor sleep quality. OBJECTIVES: The present study aimed to investigate the relationship between disease activity and sleep quality in patients with AS and to evaluate the potential effect of anti-tumor necrosis factor (TNF) treatment on sleep quality and pattern. METHODS: Fifty-nine patients with AS were consecutively included in the study. Twenty-eight patients (47.5%) were receiving anti-TNF, and 31 (52.5%) patients were receiving only nonsteroidal anti-inflammatory drugs (NSAIDs). Demographic and treatment characteristics, spinal mobility measurements, disease activity measurements, and sleep questionnaire results of each patient were recorded. Each patient underwent a polysomnography examination for the evaluation of sleep patterns. RESULTS: When compared with the patients on NSAID treatment, patients receiving anti-TNF treatment had significantly greater total sleep time and sleep efficiency (P = 0.003 and P < 0.001, respectively). They had a significantly lower (better) Pittsburgh Sleep Quality Index, sleep onset latency, number of awakenings, and arousal index (P < 0.001, for all). Moreover, they had a significantly shorter superficial sleep period (stage 1) and a significantly longer rapid eye movement sleep period (P < 0.001 and P = 0.02, respectively). Higher indexes of disease activity (Bath AS Disease Activity Index, Bath AS Functional Index, and visual analog scale) were reflecting poorer sleep quality. CONCLUSIONS: Sleep quality and pattern was markedly better in patients with AS on anti-TNF compared with the patients on NSAID treatments. Increased disease activity can impair the quality of sleep in AS. Improved sleep quality and pattern in patients on anti-TNF treatment may be related to improved disease activity.

Evidence for inflammation-induced bone loss in non-radiographic axial spondyloarthritis.

OBJECTIVES: Non-radiographic axial SpA (nr-axSpA) comprises those patients who may have clinical and laboratory features of SpA but do not have definite radiographic sacroiliitis. Bone loss (osteopenia or osteoporosis) is well recognized in AS, however, bone status in nr-axSpA is unclear. The aims of this study were to investigate BMD in patients with nr-axSpA and compare them with age- and sex-matched patients with mechanical low back pain (mLBP). The relationship between inflammation on MRI of the lumbar spine and BMD was also assessed in nr-axSpA. METHODS: Patients with chronic LBP were consecutively recruited. Patients who met the Assessment of SpondyloArthritis International Society (ASAS) criteria for axial SpA but without definite radiographic sacroiliitis were defined as nr-axSpA. Spinal and femoral BMD was assessed with DXA. Lumbar spinal MRI was examined for the presence of bone oedema (BO; inflammatory lesions). RESULTS: Forty-six patients with nr-axSpA had worse spinal but similar hip BMD, T and Z scores compared with 29 patients with LBP. 25(OH)D3 and parathyroid hormone levels and thyroid function tests were similar between groups. Twenty nr-axSpA patients with inflammation on lumbar MRI had worse spinal and femoral BMD, T and Z scores compared with the patients without inflammation. CONCLUSION: Patients with nr-axSpA had significant bone loss at the lumbar spine compared with patients with mLBP. Inflammation on MRI is closely associated with low bone mass in patients who are in the very early stage of the disease.

Serum Endothelin-1 Level Can Reflect the Degree of Lumbar Degeneration: A Cross-Sectional Study.

Background Endothelin-1 (ET-1) is an agent closely associated with inflammation and has recently been recognized as a significant factor in degenerative processes. This study aimed to investigate the correlation between serum ET-1 level and radiological and clinical manifestations of lumbar disc herniation (LDH) and intervertebral disc degeneration (IDD) pathologies. Methodology The study was conducted with 50 healthy controls and 50 LDH patients. The pain level of the patients was analyzed with the Visual Analog Scale (VAS), and their functionality was analyzed with the Oswestry Disability Index (ODI). The disc degeneration and disc herniation grades were determined using magnetic resonance imaging. Serum ET-1 levels of the participants were measured using the enzyme-linked immunosorbent assay method. Results ET-1 level was significantly higher in the patient group compared to the controls (p < 0.01). A positive correlation was determined between serum ET-1 level and Pfirrmann grade in the patient group (p < 0.01). No correlation was determined between the MacNab grade, VAS, and ODI scores and ET-1 (p = 0.397, p = 0.137, and p = 0.208, respectively). There was no significant difference between the serum ET-1 levels of the patients with or without neurological deficits (p = 0.312). Conclusions The correlation between the serum ET-1 levels and IDD grade suggested that the former could serve as a biomarker to determine the degree of degeneration in the future. However, further research is required to determine the underlying mechanisms.

MR-defined fat infiltration of the lumbar paravertebral muscles differs between non-radiographic axial spondyloarthritis and established ankylosing spondylitis.

OBJECTIVE: The aim of our study was to compare the magnetic resonance imaging (MRI)-defined cross-sectional area and semi-quantitative grading of fatty degeneration of lumbar paravertebral muscles in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and established ankylosing spondylitis (AS). METHODS: Cross-sectional area (CSA) of lumbar paravertebral muscles, including the right and left multifidus (MF), erector spina (ES), psoas (PS), vertebral body and muscle:vertebra ratio (MVr), was measured. Fat infiltration of the paravertebral muscles was graded semi-quantitatively. RESULTS: The CSA of the MF, ES and PS muscles and the MVr (at the L2, L3, L4 and L5 levels) were quite similar between patients with nr-axSpA (n = 14) and AS (n = 22). However, patients with AS had higher grades of fat infiltration than those with nr-axSpA (Right L4 grading of MF + ES muscles: 1.4 ± 0.73 vs. 0.51 ± 0.52, respectively, p = 0.001; left L4 grading: 1.36 ± 0.65 vs. 0.38 ± 0.50, respectively, p < 0.0001). This difference remained significant after adjusting for age and symptom duration. The inter-rater reliability was good (intraclass correlation coefficient 0.75 and 0.85). CONCLUSIONS: This is first study demonstrating that MRI-defined fatty degeneration differs between patients with nr-axSpA and established AS. Semi-quantitative grading is reliable, and fatty degeneration of paravertebral muscles seems to be related to chronicity and spinal functions in patients with nr-axSpA and AS.

Unusual unilateral presentation of pachydermodactyly: a case report.

Pachydermodactyly is a rare digital fibromatosis characterized by asymptomatic fusiform soft-tissue swellings of the proximal interphalangeal joints of the hands. It usually affects healthy adolescent males with a negative family history. As a rule, clinical presentation of the disease is bilateral and symmetrical enlargement of the joints. So it can be misdiagnosed with inflammatory rheumatic diseases, especially with juvenile chronic arthritis. A prompt clinical diagnosis of the disease would prevent inappropriate treatment with immunosuppressive agents or steroids and unnecessary expensive diagnostic procedures such as biopsy or magnetic resonance imaging. Once diagnosed, patients should be advised in order to avoid repetitive traumas of the hands, rubbing and cracking of the fingers, obsessive-compulsive use of computer and video games. The joint outcome is always benign. Here, we report a case of pachydermodactyly differs from the typical clinical picture of pachydermodactyly in the unilateral distribution of the lesions.

Serum netrin-1 and netrin receptor levels in fibromyalgia and osteoarthritis.

Objectives: This study aims to define serum levels of netrin-1 and netrin receptors in patients with fibromyalgia (FM) and osteoarthritis (OA). Patients and methods: This cross-sectional study was conducted with a total of 150 female participants (mean age: 47.2±16.1 years; range, 18 to 89 years) at Firat University between June 2016 and December 2016. The participants were evaluated in three groups: the FM group with 50 patients, the OA group with 50 patients, and the control group, which included 50 healthy volunteers. Netrin-1, netrin receptors (DCC, UNC5B, and UNC5D), interleukin (IL)-6, IL-10, and IL-17 levels were analyzed by the enzyme-linked immunosorbent assay from the serum samples of the participants. Results: The level of serum netrin-1 was significantly lower in the FM group than in the control and OA groups (p<0.01 and p<0.001, respectively). However, the difference between patients with OA and healthy controls in terms of netrin-1 was not statistically significant (p>0.05). In addition, serum levels of netrin receptors and cytokines in the FM group were similar to the control group (p>0.05). However, serum DCC, UNC5D, IL-6, and IL-10 levels were higher in the OA group compared to the control group (p<0.001, p<0.05, p<0.01, and p<0.001, respectively). Conclusion: Serum netrin-1 level is suppressed in FM, which suggests that netrin-1 is influential in FM pathogenesis.