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.

[Hyperbaric oxygen treatment in sudden hearing loss after unsuccessful medical treatment]. / Medikal tedavinin basarisiz oldugu ani isitme kayipli olgularda hiperbarik oksijen tedavisi.

OBJECTIVES: We evaluated the efficacy of hyperbaric oxygen (HBO) treatment in patients with sudden hearing loss unresponsive to medical treatment. PATIENTS AND METHODS: Fifty-one patients (37 males, 14 females; mean age 37 years; range 9 to 63 years) with sudden hearing loss were treated with HBO following unsuccessful medical treatment. Time elapsed from the occurrence of sudden hearing loss ranged between 15 to 45 days. Treatment included two sessions daily for the first three days, followed by a single daily session, to make 20 sessions of 90 minutes. Treatment was discontinued because of early recovery in two patients. Audiometric examinations were made at the end of every five sessions. The patients were classified according to age, gender, and audiogram curves. RESULTS: The mean hearing thresholds were 75.3 dB and 65.6 dB before and after treatment, respectively. Recovery was rated as complete in two patients (3.9%), moderate in two patients (3.9%), mild in 19 patients (37.25%), and as no recovery in 28 patients (54.9%). No significant differences were found between the patient groups in terms of improvement and hearing gain (p>0.05). CONCLUSION: We propose that HBO be resorted to when other means of medical treatment prove unsuccessful in patients with sudden hearing loss.