Shoulder proprioception changes in postmastectomy patients: an observational study.

PURPOSE: Breast cancer surgery can cause changes in the anatomical structure of the shoulder and in shoulder mobility, leading to the increased possibility of long-term arm morbidity such as lymphedema. This study aims to evaluate the active shoulder joint position sense (AJPS) with and without lymphedema in postmastectomy patients. METHODS: A total of 66 women, including 22 patients with lymphedema, 22 patients without lymphedema, and 22 healthy controls, were enrolled in the study. Pain severity was evaluated with the Numeric Pain Scale and edema severity was measured with circumferentially at 10 cm intervals. The normal range of motion of the shoulder joint was evaluated with the universal goniometer and the AJPS was assessed by active position repetition testing at 55°, 90°, and 125° shoulder flexion targets using the smartphone application "Clinometer." RESULTS: AJPS at 55°, 90°, and 125° shoulder flexion target angles with and without lymphedema were different in all target angles compared to healthy controls (p < 0.01). There was a difference between the absolute error value of AJPS at 55° flexion (p < 0.05), and no difference at 90° and 125° flexion between the with and without lymphedema groups (p > 0.05). CONCLUSION: This study shows that the AJPS was negatively affected in with and without lymphedema postmastectomy patients compared to healthy controls. This result emphasizes the importance of adding personalized methods for the restoration of joint position sense in addition to rehabilitation programs generally applied to the patient group.

Best Practice Recommendations for Dysphagia Management in Intensive Care Unit (ICU): A Delphi Study from Multidisciplinary Experts in Turkey.

There is no study about all aspects of oropharyngoesophageal (OPE) dysphagia from diagnosis to follow-up in a multidisciplinary manner in the world. In order to close this gap, we aimed to create a recommendation study that can be used in clinical practice, addressing all aspects of dysphagia in the ICU in detail with the opinion of experienced multidisciplinary experts. This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-modified Delphi round via e-mail. Firstly, 15 open-ended questions were created, and then detailed recommendations including general principles, management, diagnosis, rehabilitation, and follow-up were created with the answers from these questions, Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation), and divergent consensus (not recommended).In the first Delphi round, a questionnaire consisting of 413 items evaluated with a scale of 0-10 was prepared from the opinions and suggestions given to 15 open-ended questions. In the second Delphi round, 55.4% were accepted and revised suggestions were created. At the end of the third Delphi round, the revised suggestion form was approved again and the final proposals containing 133 items were created. This study includes comprehensive and detailed recommendations, including a broad perspective from diagnosis to treatment and follow-up, as detailed as possible, for management of dysphagia in patients with both oropharyngeal- and esophageal-dysphagia in ICU.

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.

The clinical and demographical characteristics of Turkish pediatric lymphedema patients: a multicenter study.

BACKGROUND: Reducing lymphedema-associated burden and disability in the pediatric setting requires improved awareness and understanding clinical properties of the lymphedema. The aim of this study was to evaluate the clinical and demographic characteristics of patients with pediatric lymphedema presented to different lymphedema centers in Turkey. METHODS: The socio-demographic and clinical characteristics of the children including age, gender, presence of genetic syndromes, duration of edema, site and stage of lymphedema and the received therapies were determined. Parental and children education on self-management techniques were recorded. RESULTS: A total of 122 children (female: 66, male: 56) with a mean age of 120.7 ± 71.2 months were included from 7 centers. Of them; 92% had primary, 8% had secondary lymphedema mostly due to infection and trauma. Lymphedema was part of a syndrome in 18% of the children. The most common site of involvement was the lower extremity, followed by upper extremity and genital involvement. Lymphedema was complicated in 17 % of children, mainly with a clinical picture of cellulitis, infection, and pain. The median duration of lymphedema was 41 (5-216) months. Although most of the children had stage 2 lymphedema, only 40% of them received treatment. The most commonly received treatment was compression therapy. No family or child was educated for self- care management before. DISCUSSION: In conclusion, pediatric lymphedema has a comparable gender distribution and usually involves the lower extremities. Although most of the children had advanced disease, more than half of the patients did not receive any treatment indicating the unmet need for management of lymphedema. The education of patients and/or children about self-management methods were lacking. We suggest educational activities for both families of children with lymphedema and health care providers, in order to facilitate early reference to lymphedema units and to receive prompt preventive and therapeutic approaches for this suffering condition.

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).

Effect of Home-Based Exercise Program on Physical Function and Balance in Older Adults With Sarcopenia: A Multicenter Randomized Controlled Study.

In the prospective, randomized, controlled multicenter study, 100 patients who were clinically diagnosed with sarcopenia were assigned to either a home-based exercise group or a control group. The home-based training program included exercises with gradually increasing intensity comprising posture, stretching and upper- and lower-extremity muscle-strengthening exercises, balance and coordination exercises, and gait training. Before and 3 months after the exercise program, all the patients were evaluated. The 6-min walking test and Berg Balance Scale scores increased significantly after 3 months in the home-based exercise group compared with the controls. There was also a significant decrease in timed up and go test scores and a significant improvement in quality of life in the exercise group compared with the control group. Our findings indicated that a home-based exercise program can have a positive effect on physical function, balance, and quality of life in patients with sarcopenia.

Evaluation of the effects of ß1-selective beta-blockers on bone mineral density and fracture risk in postmenopausal women

Background/aim: ß1-selective beta-blockers (BBs) are sympatholytic agents, and discerning their effects on bone health would be of great importance. This study aimed to investigate the influence of ß1-selective BBs on bone mineral density (BMD) and fracture risk. Materials and methods: This study included postmenopausal women who used ß1-selective BBs (BB group) and control group. Sociodemographic characteristics, BMD and previous fragility fractures were recorded. Additionally, the 10-year probability of a major osteoporotic and hip fracture was calculated using the fracture risk assessment tool (FRAX). Results: A total of 60 participants were included in the study. L1-4 and L2-4 BMD values were significantly higher in BB group than control group (P = 0.015 and P = 0.025, respectively). Moreover, T-scores of lumbar and femur total were significantly higher in the BB group. Two patients in BB and 6 patients in control group had previous fragility fracture. No statistically significant intergroup difference was noted regarding FRAX. Conclusion: Based on our results, ß1-selective BB usage was associated with higher BMD at the lumbar region in postmenopausal women.

Evaluation of effects of urinary incontinence subtypes on women's sexual function using the Golombok-Rust Inventory of Sexual Satisfaction.

AIM: The aim of this study was to compare the effects of urinary incontinence (UI) and subtypes, including urinary stress incontinence (USI), urinary urge incontinence (UUI), and urinary mixed incontinence (UMI), on sexual function and quality of life (QoL) of women. METHODS: Sexually active premenopausal consecutive women (n = 153) with UI were enrolled in this study. Sexual function was assessed with the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), and QoL was assessed with the Urogenital Distress Inventory Short Form and the Incontinence Impact Questionnaire Short Form. RESULTS: The patient population (n = 153) was composed of women with USI (n = 20), UUI (n = 21), UMI (n = 40), and a control group (n = 72) assessed for only routine gynecological evaluation. Infrequency, dissatisfaction, avoidance, and anorgasmia were significantly higher in the UI group compared to the control group (P < 0.05). When we compared the USI, UUI, and UMI groups in terms of the subscales of the GRISS, dissatisfaction was significantly higher in the UMI group (P = 0.001). Scores for the Urogenital Distress Inventory Short Form and the Incontinence Impact Questionnaire Short Form were significantly higher in the UMI group compared with the UUI group (P < 0.05). CONCLUSION: UI has an adverse affect on sexual function and QoL of women. UMI has the greatest impact on sexual function in terms of dissatisfaction compared with USI and UUI. We suggest routine assessment of sexually active women with UI using specific questionnaires to diagnose and treat sexual dysfunction.

Dissociative features of fibromyalgia syndrome.

OBJECTIVE: To assess the relationships between the dissociative features of FMS and the pain, psychological status, and functional status. METHODS: Twenty-seven women with fibromyalgia syndrome (FMS) and 24 controls from the Istanbul Physical Medicine and Rehabilitation Hospital (2013-2015) were included in this cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders Structured Clinical Interview for Axis I Disorders was used to evaluate the participants. A visual analogous scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to assess the levels of pain, quality of sleep and functional and psychological statuses. The Dissociative Experiences Scale (DES) was used to evaluate the dissociative features. RESULTS: The BDI, BAI and DES scores were statistically significantly higher in the cases of FMS. There were remarkable associations between all but 2 of the DES and FIQ scores, while positive correlations were found between the DES and, VAS pain and sleep quality scores. The prevalences of current and lifelong dysthymia, and major depressive disorder; not otherwise specified, common anxiety and somatoform disorders were higher in the cases of FMS. CONCLUSION: Pain, physical function and emotional status appear to be associated with dissociative features in FMS. Further studies are required to define these relationships and improve treatment.

Sex differences in the radial grooves in the first extensor compartment.

OBJECTIVE: De Quervain tenosynovitis affects the first extensor compartment of the wrist and occurs more frequently in females. This high prevalence could not be explained by soft tissue. As the osseous anatomy has been mostly neglected, we aimed to compare the distal radius between the sexes. MATERIALS AND METHODS: We evaluated the presence of a bony ridge on the floor of the first extensor compartment on CT images with multiplanar imaging. RESULTS: We included 244 wrists (72 females, 172 males) in the study. A bony ridge was present in 58 (23.8 %) and absent in 186 (76.2 %) wrists. A ridge was present in 24 (33.3 %) wrists among females and 34 (19.8 %) wrists among males. A groove with a bony ridge was statistically associated with females. CONCLUSION: We observed two tendon groove morphologies for the first extensor compartment. A groove with a bony ridge occurs more frequently in females. Further research is needed to clarify the relationship between the high frequency of a bony ridge and increased prevalence of de Quervain tenosynovitis in females.

Evaluation of personality profile in patients with fibromyalgia syndrome and healthy controls.

OBJECTIVES: Fibromyalgia syndrome (FMS) is associated with widespread musculoskeletal pain disorder characterized by various symptoms. Our aim was to compare the personality profiles and psychological aspects between FMS patients and control subjects. Additionally, we evaluated the FMS symptoms, pain and functional status. A total of 72 female patients with FMS and 64 age- and sex-matched healthy controls were included. METHODS: Visual Analog Scale (VAS), to assess pain and sleep quality, and Fibromyalgia Impact Questionnaire (FIQ), to evaluate the functional status, were used in both groups. We assessed the psychological status with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the personality profiles were evaluated with Minnesota Multiphasic Personality Inventory (MMPI). RESULTS: Total BDI and BAI scores of FMS patients were higher than control subjects (p < 0.01, p < 0.01). In terms of psychopathology, hysteria parameters of MMPI were significantly higher in FMS. MMPI parameters except lie, infrequency, masculinity femininity and hypomania parameters (p > 0.05) were significantly higher in FMS group than the control group. CONCLUSIONS: The results of the present study suggest that there is a relationship between the psychological state and personality characteristics in FMS. Much more research is needed to better define the role of personality characteristics in the pathogenesis and symptoms of FMS.

Evaluation of the effectiveness of an aerobic exercise program and the personality characteristics of patients with fibromyalgia syndrome: a pilot study.

[Purpose] The aim of this study was to assess the effectiveness of a 6-week aerobic exercise program on pain, physical function, and psychological status, and to evaluate the personality characteristics of fibromyalgia syndrome (FMS) patients. [Subjects and Methods] Fourteen women with FMS were enrolled. They were trained for a 6-week home-based aerobic exercise program. The Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the visual analog scale of pain and sleep quality were measured at baseline and at the end of week 6. The personality profiles were evaluated using the Minnesota Multiphasic Personality Inventory (MMPI). [Results] After the exercise program, significant improvements were determined in pain, sleep quality, physical function, depression and FMS symptoms compared to baseline. In addition, the hysteria item (71.21±8.84) of the MMPI was significantly higher in FMS. [Conclusion] Our findings indicate that home-based aerobic exercise may be a useful treatment in the management of FMS. Personality characteristics should be considered during the planning process of the treatment of FMS. Personality is a filter between life events and psychological responses. It is defined to be the integration of effective and behavioral patterns. Long-term studies involving larger clinical samples are needed to define the role of personality characteristics in FMS.

Vaginal cone therapy in patients with stress urinary incontinence.

PURPOSE: The aim of this study is to assess the effectiveness of the vaginal cone usage in patients with stress urinary incontinence (SUI) treated by hormone replacement therapy (HRT). METHODS: In this prospective controlled study, vaginal cone therapy is proposed to 22 postmenopausal patients with SUI having HRT who were admitted to Istanbul University, Faculty of Medicine Urogynecology Division. The vaginal cone therapy protocol consisted of one 40-min session per day over a 12-week period at standing position, and to push back the vaginal cone if they feel it slide for 15 times. Control group consisted of ten postmenopausal patients receiving only HRT. For the two groups, perineometry value, pad test, and 3 days average number of incontinence were assessed at the beginning and after 2 months of treatment. RESULTS: In the vaginal cone group, in all parameters a statistically significant difference was observed toward improvement as compared to baseline (p < 0.01); there were no significant differences (p > 0.05) in the HRT group. While comparing between the mean differences of two groups, the average number of urinary leakage was decreased and perineometry value was statistically increased (t = 3.74, p < 0.001; t = 3.24, p < 0.01) in vaginal cone group rather than in the HRT group which was calculated from the urinary diary. CONCLUSIONS: Vaginal cone could be an effective method of treatment in patients with SUI and may be a preferable treatment for patients who have problem to come to hospital and want to work independently at home.

The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye.

Objectives: The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. Patients and methods: This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). Results: The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Conclusion: Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Changes in the gut microbiota of morbidly obese patients after laparoscopic sleeve gastrectomy.

Aims: Permanent treatment of morbid obesity with medication or diet is nearly impossible. Laparoscopic sleeve gastrectomy (LSG) is becoming a widely accepted treatment option. This study profiled and compared gut microbiota composition before and after LSG. Methods & results: A total of 54 stool samples were collected from 27 morbidly obese individuals before and after LSG. The gut microbiota was profiled with 16S amplicon sequencing. After LSG, patients demonstrated a significant decrease (p < 0.001) in BMI and an increase in bacterial diversity. An increased Firmicutes/Bacteroidetes ratio was also noticed after LSG. The families Prevotellaceae and Veillonellaceae predominated in preoperative samples but were markedly lowered after LSG. A marked increase in Akkermansia, Alistipes, Streptococcus, Ruminococcus and Parabacteroides was observed after LSG. Conclusion: In addition to lowering BMI, LSG remodeled gut microbiota composition.

Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H.

BACKGROUND: Dysphagia is a geriatric syndrome. Changes in the whole body that occur with aging also affect swallowing functions and cause presbyphagia. This condition may progress to oropharyngeal and/or esophageal dysphagia in the presence of secondary causes that increase in incidence with aging. However, no study has been published that provides recommendations for use in clinical practice that addresses in detail all aspects of the management of dysphagia in geriatric individuals. This study aimed to answer almost all potential questions and problems in the management of geriatric dysphagia in clinical practice. METHODS: A multidisciplinary team created this recommendation guide using the seven-step and three-round modified Delphi method via e-mail. The study included 39 experts from 29 centers in 14 cities. RESULTS: Based on the 5W and 1H method, we developed 216 detailed recommendations for older adults from the perspective of different disciplines dealing with older people. CONCLUSION: This consensus-based recommendation is a useful guide to address practical clinical questions in the diagnosis, rehabilitation, and follow-up for the management of geriatric dysphagia and also contains detailed commentary on these issues.

Functional evaluation of patients with mastectomy lymphedema.

OBJECTIVES: In this study, we aimed to investigate the availability of the Timed Up and Go (TUG) test in daily practice instead of the Tampa Scale for Kinesiophobia (TSK) test for the evaluation of fear of movement and to assess the functionality of the upper extremity in postmastectomy lymphedema patients. PATIENTS AND METHODS: Between March 2018 and July 2018, a total of 30 female patients (mean age 53.8±12.3 years; range, 35 to 80 years) with postmastectomy lymphedema were included in this study. The severity of lymphedema of the patients was measured circumferentially at 5-cm intervals. All patients were evaluated for upper extremity functionality using the Timed Functional Arm and Shoulder Test, hand grip strength using a hand dynamometer, and pinch strength using a pinchmeter. The TSK test was used for the evaluation of fear of movement and TUG test was used for the evaluation of functional status of lower extremity. RESULTS: There was a significant difference in functionality between the affected and unaffected side of upper extremity (p<0.05). According to the TSK results, all patients described themselves as kinesiophobic, and advanced fear of movement was found in 66.67% of the patients. However, according to the TUG scores, lower extremity functionality of all patients was normal. CONCLUSION: Our study results showed that, independently of the severity of lymphedema, fear of movement was seen in every patient and functionality of upper extremity decreased on the affected side. On the other hand, the TUG test may not be useful to asses fear of movement in daily practice regarding to functional scores of these patients.

Could Computed Tomography Hounsfield Unit Values of Lumbar Vertebrae Detect Osteoporosis?

BACKGROUND: Dual-energy X-ray absorptiometry (DEXA) scanning has several disadvantages determining osteoporosis, especially for the degenerative spine. INTRODUCTION: This study aims to determine spinal osteoporosis in patients suffering from lumbar degenerative disease using computed tomography (CT). METHODS: A total of 547 subjects that underwent DEXA and abdominal CT within a period of three months were examined retrospectively and separated into groups based on lumbar degenerative alteration on the CT scan. The subjects that showed degenerative severity at L1-L4, in at least two levels, were graded and placed in the degenerative group (Group D, n=350). In contrast, the other subjects constituted the control group (Group C, n=197). The Hounsfield unit (HU) of the vertebral body trabecular bone, the T-score, and bone mineral density (BMD) of L1-L4 and hips were determined from the CT images. CT-HU parameters for osteoporosis acquired from the control group were used to ascertain undiagnosed osteoporosis. RESULTS: The CT-HU was positively correlated with T-score and lumbar BMD for both groups (P<0.001), while the L1-L4 correlation was higher in Group C than in Group D. Based on linear regression, the T-score and CT-HU for L1-L4 osteoporosis were 129, 136, 129 and 120 HU, respectively in Group C. Undiagnosed spinal osteoporosis was greater in Group D compared to the controls (44.2% vs. 9.6%, respectively) based on the CT-HU thresholds. CONCLUSION: Lumbar spine degeneration can augment BMD and T-score, resulting in the underestimation of lumbar osteoporosis. The osteoporosis threshold determined by CT-HU may be a valuable technique to determine undiagnosed spinal osteoporosis.

Prevalence, etiology, and biopsychosocial risk factors of cervicogenic dizziness in patients with neck pain: A multi-center, cross-sectional study.

OBJECTIVES: This study aims to investigate the prevalence, etiology, and risk factors of cervicogenic dizziness in patients with neck pain. PATIENTS AND METHODS: Between June 2016 and April 2018, a total of 2,361 patients (526 males, 1,835 females; mean age: 45.0±13.3 years; range, 18 to 75 years) who presented with the complaint of neck pain lasting for at least one month were included in this prospective, cross-sectional study. Data including concomitant dizziness, severity, and quality of life (QoL) impact of vertigo (via Numeric Dizziness Scale [NDS]), QoL (via Dizziness Handicap Inventory [DHI]), mobility (via Timed Up-and-Go [TUG] test), balance performance [via Berg Balance Scale [BBS]), and emotional status (via Hospital Anxiety- Depression Scale [HADS]) were recorded. RESULTS: Dizziness was evident in 40.1% of the patients. Myofascial pain syndrome (MPS) was the most common etiology for neck pain (58.5%) and accompanied with cervicogenic dizziness in 59.7% of the patients. Female versus male sex (odds ratio [OR]: 1.641, 95% CI: 1.241 to 2.171, p=0.001), housewifery versus other occupations (OR: 1.285, 95% CI: 1.006 to 1.642, p=0.045), and lower versus higher education (OR: 1.649-2.564, p<0.001) significantly predicted the increased risk of dizziness in neck pain patients. Patient with dizziness due to MPS had lower dizziness severity scores (p=0.034) and milder impact of dizziness on QoL (p=0.005), lower DHI scores (p=0.004), shorter time to complete the TUG test (p=0.001) and higher BBS scores (p=0.001). CONCLUSION: Our findings suggest a significant impact of biopsychosocial factors on the likelihood and severity of dizziness and association of dizziness due to MPS with better clinical status.

Mini-Review: Human Microbiome and Rheumatic Diseases.

Rheumatoid arthritis and spondyloarthropathy are the most common inflammatory rheumatic diseases. As the human microbiome is involved in the immune homeostasis, it has the potential to be a key factor in the development of autoimmune diseases and rheumatic diseases. In this article, we review the role of various human microbiota on the pathogenesis of rheumatic diseases, focusing on spondylarthritis and rheumatoid arthritis.