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.

Antiphospholipid antibodies in COVID-19-associated pneumonia patients in intensive care unit.

OBJECTIVES: Antiphospholipid antibodies (APAs) increase the risk of excessive blood clotting, but their role in COVID-19 remains unclear. We aimed to investigate the presence of conventional APAs used in the classification of antiphospholipid antibody syndrome in patients with severe lung infection with SARS-CoV-2 and to compare these results with non-COVID-19 critically ill patients. METHODS: Thirty-one COVID-19 patients (COVID group) and 28 non-COVID-19 critically ill patients (non-COVID group), were included in the study. Anti-cardiolipin (ACA) (IgG, IgM), anti-ß2-glycoprotein 1 (Anti-ß2GPI) (IgG, IgM, and IgA), and if the patient had not received any anti thrombotic agent before blood collection, lupus anticoagulant (LAC) tests were studied from the plasma of the patients. For testing ACA and Anti-ß2GPI, ELISA method was used, while fully automated coagulometer device was used for LAC test. RESULTS: APAs were positive in 25.81% in the COVID group (8/31) and 25% in the non-COVID group (7/28). LAC was the most common APA present in 23.08% of the COVID-19 group, who underwent measurement (6/26), while 3.57% of the non-COVID group was LAC positive (1/28) (p = .047). In the COVID group, ACA IgM, and IgG were positive in 6.45% and 0%, respectively (2/31 vs 0/31). In the non-COVID group, ACA IgM was not positive in any patient, while ACA IgG was positive in 7.14% (2/28). Anti-ß2GPI IgG and IgM tests were not positive in any patient in either the COVID or the non-COVID group. Anti-ß2GPI IgA were positive in 6.45% and 14.29%, respectively (2/31 vs 4/28). CONCLUSION: In this study, APAs were equally positive in critically ill patients among COVID-19 or non-COVID-19 patients. Only LAC was more observed in COVID-19 patients.

The effect of long-term hydroxychloroquine use on the corneal endothelium in patients with systemic lupus erythematosus.

PURPOSE: To evaluate the effect of long-term effects of hydroxychloroquine (HCQ) use on the corneal endothelium in patients with systemic lupus erythematosus (SLE). METHODS: The study included 30 eyes of 15 patients who used HCQ for at least five years and were followed up in the rheumatology clinic for SLE and 29 eyes of 15 patients newly diagnosed with SLE who had not taken any medication. All patients underwent complete ophthalmologic examinations, central corneal thickness measurements, endothelial cell counts and endothelial morphological examinations by specular microscopy. RESULTS: The mean age was 41.25 ± 6.89 years in group 1 and 41.81 ± 5.78 years in group 2 (p = 0.737). The mean corneal endothelial cell density was 2662 ± 184 cells/mm2 in group 1 and 2649 ± 315 cells/mm2 in group 2 (p = 0.843). The percentage of cell hexagonality was 46.6 ± 11.8% in group 1 and 48.7 ± 13.8% in group 2 (p = 0.625). A difference was noted in endothelial cell variation in both groups, at 36.7 ± 6.9% in group 1 and 39.9 ± 6.2% in group 2 (p = 0.057) but not statistically significant. No difference was observed between the two groups in terms of central corneal thickness. The duration of HCQ use was negatively correlated with hexagonality (r = -0.564, p = 0.001) CONCLUSION: Long-term use of HCQ in SLE patients had no negative effect on endothelial cell density and cell variation, but a negative correlation existed between the duration of HCQ usage and hexagonality.

Comparison of Pain Characteristics in Patients with Rheumatoid Arthritis and Systemic Sclerosis with Particular Reference to the Neuropathic Pain Component: Cross-Sectional Study.

OBJECTIVE: The aim of the study was to compare characteristics of pain in terms of neuropathic pain (NeP) and to assess the association between the neuropathic component and quality of life (QoL) in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). SUBJECTS AND METHODS: Fifty-four patients (47 females, 7 males) with SSc and 53 patients (46 females, 7 males) with RA were assessed for outcome measures including disease activity, physical functions, mental condition and health-related QoL (HRQoL) measures (Short Form-36; Hospital Anxiety and Depression Scale), and pain. NeP was assessed by the Douleur Neuropathique 4 (DN4) and PainDetect questionnaires in this cross-sectional study. RESULTS: The patients had similar education, smoking status, functioning, and HRQoL. However, the patients with RA declared a more severe visual analogue scale of pain and a higher BMI than those with SSc. The NeP component was detected in 42.6% (n = 23) of the SSc patients and in 45.3% (n = 24) of the RA patients (p > 0.05) according to DN4. On PainDetect, possible NeP was detected in 13.0% (n = 7) versus 15.1% (n = 8), whereas 16.7% (n = 9) versus 17.0% (n = 9) were likely to have NeP in SSc and RA, respectively (p > 0.05). Most of the NeP characteristics were similar in SSc and RA, except for numbness and painful cold, which were notably more common in patients with SSc. Having the NeP component (according to DN4) had no influence on functioning and HRQoL in SSc; however, the NeP component revealed a heavier burden of disease regarding functional status, HRQoL, and psychometric components in RA. CONCLUSION: The NeP component was similar between patients with SSc and RA. However, NeP was associated with a heavier burden of disease in patients with RA.

Neuropathic Pain Component in Axial Spondyloarthritis and the Influence on Disease Burden.

OBJECTIVES: Patients with nonradiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA/ankylosing spondylitis (AS) have similar burden of disease; however, the potential influence of pain characteristics including the neuropathic pain (NeP) component has not been assessed yet. The aim of this study was first to assess frequency of NeP component in patients with axSpA and second to assess the potential influence of NeP on burden of disease. METHODS: Adult patients who met the Assessment of SpondyloArthritis International Society classification criteria for axSpA were consecutively recruited. Patients were evaluated using the Douleur Neuropathique en 4 Questions interview and painDETECT questionnaire and subgrouped as patients with and without NeP. RESULTS: Neuropathic pain component was present in 31.4% of patients with axSpA categorized according to Douleur Neuropathique en 4 Questions (31.6% in nr-axSpA vs 31.3% in AS, P = 0.964) and in 33.5% of patients categorized according to painDETECT (35.1% in nr-axSpA vs 32.8% in AS, P = 0.762). Pain characteristics were quite similar between patients with nr-axSpA and AS. Women tented to have more frequent NeP. Patients with NeP component had significantly higher scores in visual analog scale of pain, patient and physician global, fatigue, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score using C-reactive protein, depression, anxiety scores, and physical functions; poorer quality of life (QoL); and similar frequency of fibromyalgia compared with patients without NeP component. In multivariable analysis, having NeP was associated with QoL measures (Ankylosing Spondylitis Quality of Life and Short-Form 36 physical component score) and visual analog scale of fatigue. CONCLUSIONS: Nearly one third of patients with axSpA may have NeP component regardless of having nr-axSpA or AS. Neuropathic pain component may contribute worsened QoL and poorer patient-reported outcome data and should be kept in mind during patient evaluation.

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.

Piriformis syndrome as an overlooked cause of pain in a patient with axial spondyloarthritis: a case report.

Piriformis syndrome is a neuromuscular disorder characterized by hip, buttock, and leg pain. Axial spondyloarthritis is a rheumatic disease primarily affecting the sacroiliac joint and the spine. Due to their anatomical proximity, the potential relationship between piriformis syndrome and sacroiliitis has been discussed for some time. However, literature review revealed that there is no study on piriformis syndrome in individuals with axial spondyloarthritis. Here, we present the case of a 30-year-old female with axial spondyloarthritis who developed severe low back, hip, and buttock pain that persisted despite initial treatment for axial spondyloarthritis. We first re-evaluated her condition through physical examination, magnetic resonance imaging, and an injection test for piriformis syndrome. Following a comprehensive assessment, the patient was diagnosed with both axial spondyloarthritis and piriformis syndrome. Subsequently, a tailored treatment plan was devised, addressing both conditions, and after a 3-month course of treatment, we obtained significant reduction in pain of the patient. This is the first case report in literature, where we used injection test to confirm the diagnosis of the piriformis syndrome in a patient with axial spondyloarthritis. We therefore strongly advocate considering piriformis syndrome as a potential etiology for pain in individuals with axial spondyloarthritis consistently. This recognition is important as piriformis syndrome does not respond adequately to non-steroidal anti-inflammatory drugs and may lead to unnecessary use of biological disease-modifying antirheumatic drugs. Timely identification and intervention are imperative in ensuring optimal patient care.

Utility of shear wave elastography for diagnosing carpal tunnel syndrome with psoriatic arthritis.

BACKGROUND: Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients. AIMS: The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not. METHODS: To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated. RESULTS: Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001). CONCLUSIONS: We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients.

Haglund syndrome with pump bump.

Haglund's syndrome, which is an inflammation of the bursa and a bony enlargement on the back of the heel that most often leads to painful bursitis, is a rare cause of retrocalcaneal pain. The clinical diagnosis is often confusing as the clinical picture may mimic other causes of hindfoot pain such as isolated retrocalcaneal bursitis or hindfoot involvement from more systemic disorders such as seronegative spondyloarthropathies (Reiter's syndrome, ankylosing spondylitis) or rheumatoid arthritis. This report is of a 60-year-old woman with a painful swelling of the right heel, who was diagnosed with Haglund syndrome. The characteristic clinical photograph (showing the prominent 'pump bump'), radiographical and magnetic resonance imaging features are presented.

Fatigue, anxiety and depression in patients with prediabetes: a controlled cross-sectional study.

Objective: We aimed to determine fatigue, depression, anxiety levels, and quality of life (QoL) in patients with prediabetes (PD) and to compare them with healthy subjects. Materials and methods: A controlled, cross-sectional study was conducted. The patients, aged 18-65, were recruited from a tertiary care hospital. A total of 105 patients with newly diagnosed untreated PD and 48 normoglycemic subjects were included in the study. Participants did not know the diagnosis of PD and did not give psychological distress to the newly diagnosed. All participants were evaluated for body mass index (BMI), oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), Short Form-36 (SF-36). Results: Age, gender, BMI were similar between groups. The scores of psychological measures were significantly worse in patients with PD compared with normoglycemic subjects (FSS median score: 4.33 vs. 2.22, HADS-anxiety mean score: 7.53 vs. 2.64, HADS-depression mean score: 6.33 vs. 2.79, SF-36 total median score: 52.81 vs. 79.89). The FSS, HADS and SF-36 scores showed a weak but statistically significant relationship with BMI. OGTT, HbA1c and HOMA-IR did not show any relationship with these scores. Conclusion: Psychosocial problems may present in the prediabetic stage before the onset of diabetes.

Frequency of carpal tunnel syndrome and hand dysfunction in prediabetes: A cross-sectional, controlled study.

Objectives: This study aims to evaluate the frequency of carpal tunnel syndrome (CTS), to investigate the impairment of hand functions in patients with prediabetes (PD), and to compare laboratory findings of PD patients with and without CTS. Patients and methods: Between June 2018 and January 2019, a total of 115 patients (29 males, 86 females; mean age: 51.4±11.8 years; range, 24 to 78 years) who were recently diagnosed with PD and a total of 54 healthy participants (17 males, 37 females; mean age: 48.4±13.2 years; range, 21 to 78 years) as the control group were included. Demographic and clinical data of the patients including oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) were recorded, and both groups were examined for the presence of CTS. Clinically suspected CTS was confirmed by electrodiagnostic studies. The hand grip strength (HGS) was measured and hand functions were evaluated using the Duruöz Hand Index (DHI). Results: There were no significant differences in the age, sex, occupation, body mass index (BMI), or insulin resistance between the groups. A total of 24 (20.9%) patients with PD and eight (14.8%) healthy controls had CTS (p=0.349). Hand functions were worse in the PD patients than the control group (p=0.044). Age, occupation, BMI, insulin resistance, OGTT at 0 and 2 h, and HbA1c values were similar between the PD patients with or without CTS. Conclusion: Our study, for the first time, reveals that CTS is slightly more common and hand functions are impaired in PD compared to the healthy individuals. Based on these findings, we suggest that hand functions should be evaluated in PD patients.

Gender differences in the discriminative value of inflammatory low back pain criteria.

BACKGROUND/PURPOSE: Inflammatory low back pain (IBP) is the leading symptom in axial spondyloarthritis (axSpA) and its assessment is crucial for the diagnosis. Our aim was to assess gender specific differences in the discriminative ability of the items and criteria sets in a specific patient population consisting patients with axSpA and other causes of chronic low back pain (LBP). METHODS: Patients with chronic LBP with an onset less than 45 years were included and screened for the Assessment of Spondyloarthritis International Society (ASAS) axSpA criteria. Items of IBP, according to Calin, Berlin and ASAS expert criteria were evaluated in patients with axSpA and non-SpA LBP by a blinded researcher. Discriminative ability of the single items and sets were assessed in terms of sensitivity, specificity and area under the curve (AUC) analysis in male and female patients and compared between genders. RESULTS: Single IBP items performed similarly well in men and women, as well as criteria sets. Despite similar discriminative performance of IBP items and criteria sets in both genders, women tend to have slightly better performance. Our results revealed similar sensitivity but slightly lower specificity for most of the single items and criteria sets compared to previous reports. CONCLUSION: Gender may have an influence on the discriminative performance of some of the IBP items and criteria sets as well. Calin criteria seem to perform slightly better in both genders than Berlin and ASAS criteria sets. KEY WORDS: Inflammatory, back pain, gender, axial spondyloarthritis.

Portal hypertension in familial Mediterranean fever patients.

INTRODUCTION: Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by polyserositis and arthritis attacks, which are mediated by increased plasma levels of cytokines. Our hypothesis was that the increase in specific cytokines can also lead to portal hypertension, even in the absence of overt hepatic steatosis. METHODS: We designed a comparative cross-sectional study with 41 patients and 30 healthy individuals to show if there is a relationship between portal hypertension and FMF. B mode ultrasound and Doppler ultrasound were utilized to evaluate liver echogenicity, portal vein diameter, peak portal blood flow velocity, and portal vein flow direction, which are important diagnostic criteria for portal hypertension. RESULTS: Spleen and liver sizes and portal vein diameters of the FMF patients and the healthy controls were not significantly different. Imaging of 4 patients revealed periportal cuffing and one patient with periportal cuffing also had a fine granular appearance of the liver. The peak portal blood flow velocity of the FMF patients was lower than that of the control group (p<0.007). CONCLUSION: The FMF group had significantly lower peak portal blood flow velocity than the control group, indicating the existence of portal hypertension. However, the differences between the other findings that correlate with portal hypertension were not significant.

Comparison of "burden of disease" in elderly and non-elderly patients with pre-diabetes: A cross-sectional study.

OBJECTIVE: There are a lot of studies comparing elderly and adult patients with diabetes but not pre-diabetes systematically. We aimed to compare the discrepancies of clinical status and burden of disease in elderly (≥60 years old) versus non-elderly (18-59 years old) adult pre-diabetics. METHODS: A total of 126 pre-diabetic patients were included in the study and were compared as two groups; the elderly (n=32) and non-elderly (n=94). Fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) levels, body mass index (BMI), the homeostasis model assessment of insulin resistance (HOMA-IR), health-related quality of life using the short form-36 (SF-36) questionnaire, and disability using the health assessment questionnaire (HAQ) were evaluated. RESULTS: Gender, BMI, the presence of obesity, the ratio of HOMA-IR, FPG, and plasma glucose in the 2nd h oral glucose tolerance test were similar in non-elderly patients with pre-diabetes compared to the elderly ones. However, HbA1c levels were higher in elderly subjects in our study. According to the SF-36 questionnaire and HAQ score, there were no significant differences between groups. The median total HAQ scores were 0.125 (non-elderly) and 0.250 (elderly) for groups and there was no significant difference (p=0.099). CONCLUSION: In the similar gender and BMI groups, pre-diabetes in the elderly gives different outcomes according to HbA1c. Since SF-36 questionnaire and HAQ scores were not statistically different in both pre-diabetic groups, the burden of disease is thought to be basically due to the presence of the disease rather than aging.

Bone mineral density and fracture risk in prediabetes: a controlled cross-sectional study.

OBJECTIVES: There is comparatively scarce data on bone health in prediabetes (PD). This study aimed to evaluate osteoporosis, fracture risk, and to determine related factors in adults with PD comparing them with healthy participants. MATERIALS AND METHODS: A controlled, observational, cross-sectional study was conducted. All post-menopausal women and men aged over 65 years were recruited from a tertiary care hospital. A total of 120 participants (90 prediabetic, 30 control group) were enrolled in the study. All participants were screened for clinical status, Dual-Energy X-ray Absorptiometry(DEXA) was used to assess for osteoporotic fracture risk factors, and then the Fracture Risk Assessment Tool (FRAX) was calculated. RESULTS: Age, gender, body mass index (BMI), presence of obesity and insulin resistance, and risk factors for osteoporotic fracture were similar between groups. Frequency of osteoporosis was higher in the PD group (p=0.045). Bone mineral density (BMD) and T scores of the lumbar and femoral neck regions were lower in the PD group (p=0.042, p=0.039, p=0.039, and p=0.042, respectively). Although there were statistically significant differences in BMD and T scores, 10-year probability of hip fracture and major osteoporotic fracture were similar in both groups. In the femoral neck region, BMD and T scores were weakly and negatively correlated with age. FRAX-major was correlated positively and weakly with age and FRAX-hip was positively and weakly correlated with age and negatively weakly correlated with BMI. CONCLUSIONS: Almost one quarter of the post-menopausal prediabetic women had osteoporosis and osteoporosis was more common in the prediabetics than in the normoglycemic control group participants. While evaluating prediabetics, it is important to assess bone mineral density.

Fatigue Is Common and Predicted by Female Gender and Sleep Disturbance in Patients with Chronic Spontaneous Urticaria.

BACKGROUND: Fatigue is a common and disabling symptom in chronic inflammatory diseases. To the best of our knowledge, there are no studies evaluating fatigue thoroughly in patients with chronic spontaneous urticaria (CSU). OBJECTIVES: To evaluate fatigue and its drivers in patients with CSU, and to compare patients with healthy controls in terms of fatigue. METHODS: One hundred and three patients with CSU and 35 age- and gender-matched healthy control subjects were evaluated for fatigue with the Fatigue Severity Scale (FSS) and visual analog scale-fatigue. Patients were also assessed for their duration, activity, and control of disease, as well as anxiety, depression, and quality of life (QoL). RESULTS: There were no significant associations between disease activity, disease control scores, and FSS (P > .05). Although there were no significant differences in terms of antinuclear antibody positivity and IgE levels between fatigued and nonfatigued patients with CSU, C-reactive protein levels were higher in fatigued patients (P = .009). A significant correlation was noted between total FSS score and both Chronic Urticaria-QoL (r = 0.246, P = .013) and Dermatology Life Quality Index (r = 0.302, P = .002) in patients with CSU. In regression analyses, female gender and the presence of disturbed sleep were found to be significant predictors of fatigue in patients with CSU (P = .008; odds ratio [OR]: 9.02, and P = .001; OR: 8.35). CONCLUSION: Fatigue is a common and important symptom in patients with CSU and adversely affects QoL. While evaluating patients with CSU, it is important to assess fatigue, especially in female gender patients and in those having sleep disturbance.

Tofacitinib Induced Psoriasiform Lesion in a Patient With Rheumatoid Arthritis.

Paradoxical psoriasis or psoriasiform lesion is an adverse effect, represented by the occurrence of a psoriasiform lesion or exacerbation of psoriasis caused by the drugs normally used for the management of psoriasis. In this article, we present the first case of a 45-year-old male patient with rheumatoid arthritis who developed psoriasiform lesions following treatment with tofacitinib, and highlight the possible pathogenetic mechanisms involved in such an occurrence.

Sexual Functioning Is Frequently and Markedly Impaired in Female Patients with Chronic Spontaneous Urticaria.

BACKGROUND: Chronic spontaneous urticaria (CSU) is common, chronic, and debilitating, and has serious effects on quality of life and mental health. Three of 4 patients with CSU are women. The impact of CSU on female sexual functioning remains largely unknown. OBJECTIVE: To determine the prevalence of sexual dysfunction in female patients with CSU and to characterize their impairment of sexual functioning and its drivers. METHODS: Fifty-six female patients with CSU and 55 female aged-matched healthy control subjects were evaluated for sexual functioning with the Female Sexual Function Index. Patients were also assessed for their duration, activity, and control of disease, as well as angioedema, anxiety, depression, fatigue, and quality-of-life impairment. RESULTS: Sexual functioning, that is, total Female Sexual Function Index scores and all subscores, was markedly reduced in female patients with CSU versus control subjects, and 2 of 3 patients (67.9%) had sexual dysfunction. Impaired sexual functioning was linked to high disease activity and poor disease control. Sexual dysfunction was more common in patients with CSU with angioedema and vice versa. Angioedema was a significant predictor of sexual dysfunction in female patients with CSU (odds ratio, 7.3). Reduced sexual functioning was associated with anxiety, depression, and fatigue and significantly linked to impaired quality of life, more so in patients with angioedema as compared with those without. CONCLUSIONS: CSU has strong negative effects on female sexual function, especially in patients with angioedema. Additional studies on sexual health in patients with CSU are needed and should focus on the impact of effective treatment on sexual functioning.

Hand functions in systemic sclerosis and rheumatoid arthritis and influence on clinical variables.

AIM: Hand joints are the main target in rheumatoid arthritis (RA) and hand involvement in terms of thickening of the skin and contractures are also well known in systemic sclerosis (SSc). Assessment of hand function in SSc is generally an overlooked entity with respect to RA. Therefore the aim of this study was to compare hand functions and potential influence of functional loss on patients' overall physical functions, health-related quality of life (HRQoL) and psychological status in RA and SSc. METHODS: Age- and gender-matched adult patients with SSc and RA were consecutively recruited. Patients' hand functions were evaluated by using the Duruöz Hand Index (DHI), and hand span and hand grip strength were measured. Patients were evaluated for disease-specific and generic outcome measures including disease activity parameters and HRQoL measures. RESULTS: Fifty patients (44 female, six male) with SSc and 51 (45 female, six male) with RA were included. Despite similar functioning and HRQoL, patients with RA had higher visual analog scale-pain and body mass index. In both groups DHI revealed similar functional loss and correlated with various measurements related to HRQoL. In SSc, hand span, grip strength and modified Rodnan skin score had major influences on hand functions. CONCLUSION: Assessment of hand function is an important component in the clinical evaluation of patients with RA and SSc. Loss of hand functions is an important feature contributing negatively to the overall physical status and HRQoL in patients with SSc and may be more frequent and important than expected.