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.

The efficacy of EMG-biofeedback training on quadriceps muscle strength in patients after arthroscopic meniscectomy.

AIMS: In 40 patients, we attempted to investigate the efficacy of electromyography-biofeedback (EMG-B) on quadriceps muscle strength after arthroscopic meniscectomy. METHODS: The patients were randomly divided into two groups each consisting of 20 subjects. For the control group, a classical exercise program was given (five sessions of EMG-B application for 2 weeks postoperatively). Range of motions, Lysholm knee score, EMG electrical activity values of vastus medialis obliques (VMO), and vastus lateralis (VL) were measured pre- and postoperatively on the 3rd and 14th day, and at the 6th week. RESULTS: When the ranges of motion values were compared, a significant difference (for average values of knee flexion angle) was found on the 14th day and 6th week in favour of biofeedback group (p<0.05). When Lysholm knee scores on the 14th day and 6th week were compared in the control and biofeedback groups, and maximum contraction and average contraction values of VMO, VL muscles were compared with operated/non-operated %age ratios, there was a statistically significant difference in favour of the biofeedback group (p<0.05). CONCLUSIONS: Our results showed that EMG-B was an effective treatment modality in improving quadriceps muscle strength after arthroscopic meniscectomy surgery.