Pandemic of the century: COVID-19 in inflammatory rheumatic diseases of a national cohort with 3,532 patients.

Objectives: This study aimed to assess the clinical outcomes and risk factors for severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic disease (IRD) of a national cohort. Patients and methods: The multicenter cross-sectional study was carried out between July 15, 2020, and February 28, 2021. Data collection was provided from a national network database system, and 3,532 IRD patients (2,359 males, 1,173 females; mean age: 48.7±13.9 years; range; 18 to 90 years) were analyzed. Demographics, clinics about rheumatic disease, comorbidities, smoking status, being infected with COVID-19, and the course of the infection were questioned by rheumatology specialists. Results: One hundred seventeen patients were infected with COVID-19, the hospitalization rate due to COVID-19 was 58.9%, and the mortality rate was 1.7%. There was no difference between the COVID-19 positive and negative groups in terms of rheumatic disease activities and receiving drugs. It was observed that patients with COVID-19 had worse compliance with isolation rules, and bacillus Calmette-Guérin (BCG) vaccination was less common. The mean age and the rate of smoking of hospitalized COVID-19 patients were higher than those without hospitalization. Conclusion: In this cohort, in which real-life data were analyzed, COVID-19 rates in IRD patients were similar to the general population for the same period. Compliance with the isolation rules and BCG vaccination attracted attention as components that reduce the risk of COVID-19 infection. The risk factors for hospitalization were older age and smoking.

The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia.

Objectives: This study aimed to compare the prevalence and musculoskeletal ultrasonography (US) findings of rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM) according to the 1990 American College of Rheumatology (ACR) FM classification criteria or the 2016 ACR FM diagnostic criteria. Patients and methods: This cross-sectional study included 63 patients (17 males, 46 females; mean age: 48.2±7.1 years; range, 18 to 62 years) with RA. Medical history and laboratory data were obtained from electronic records. Clinical examination, composite disease activity measures, functional status, and the German 7-joint ultrasound score were assessed to evaluate disease activity and synovial inflammation. The patients were divided into three groups: patients who met only the 2016 ACR criteria, patients who met only the 1990 ACR criteria, and patients who met both criteria. Results: In patients with RA, concomitant FM prevalence was 34.9% according to the 2016 ACR FM diagnostic criteria versus 23.8% according to the 1990 ACR FM classification criteria. Rheumatoid arthritis patients with FM had high tender joint count and disease activity scores, while musculoskeletal US findings were similar. Patients who met only the 2016 ACR FM diagnostic criteria had significantly higher gray-scale US and power Doppler US synovitis scores than patients who satisfied only ACR 1990 FM classification criteria (p=0.03 and p=0.02, respectively). Conclusion: Synovial inflammation is a prominent sign in RA patients diagnosed with FM according to the 2016 ACR FM diagnostic criteria. The higher disease activity seen in the presence of FM in RA patients is associated with FM rather than synovitis.

Comparison of the median and ulnar nerves of rheumatoid arthritis patients and healthy subjects by ultrasound.

Objectives: In this study, we aimed to investigate ulnar and median nerve cross-sectional areas (CSAs) by ultrasonography in RA patients who had no signs or symptoms of neurologic involvement. Patients and methods: This case-control study was conducted with 76 participants (72 females, 4 males; mean age: 53.2+10.9 years; range, 18 to 65 years) between April 2011 and April 2013. Of the participants, 38 were RA patients without any signs or symptoms of ulnar or median nerve involvement, and 38 were healthy subjects. All participants were evaluated with ultrasound. The median and ulnar nerve CSAs were measured at the proximal inlet of the carpal tunnel using the pisiform bone as a landmark. Results: There were no statistically significant differences between patients and controls in terms of median and ulnar CSAs (p>0.05). There were no correlations between median and ulnar CSAs of the dominant hand and age, height, weight, and disease duration. The median nerve CSA was >10 mm2 in 24% of the RA patients and 14% of controls, but the difference was not statistically significant (p=0.20). Conclusion: Similar median and ulnar CSAs were detected in RA patients and healthy controls. These findings cannot rule out a subclinical neurologic involvement.

Familial Mediterranean fever: perspective on female fertility and disease course in pregnancy from a multicenter nationwide network.

The aim of this study was to analyze the pregnancy process, especially the Familial Mediterranean fever (FMF) disease course and attack types during pregnancy, and to examine the relationship between disease-related factors and female infertility in FMF patients. The study, which was planned in a multicenter national network, included 643 female patients. 435 female patients who had regular sexual intercourse were questioned in terms of infertility. Pregnancy and delivery history, FMF disease severity and course during pregnancy were evaluated. The relationship between demographic and clinical findings, disease severity, genetic analysis results and infertility was investigated. 401 patients had at least 1 pregnancy and 34 patients were diagnosed with infertility. 154 patients had an attack during pregnancy. 61.6% of them reported that attacks during pregnancy were similar to those when they were not pregnant. The most common attack symptoms were fever, fatigue and abdominal pain-peritonitis (96%, 87%, and 83%, respectively) in the pregnancy period. The disease-onset age, disease activity score, gene mutation analyses, and regular colchicine use (> 90%) were similar between the fertile and infertile groups, while the frequency of previous appendectomy and alcohol consumption rates were higher in individuals with infertility. Our results indicated no significant change in the frequency and severity of attacks during pregnancy. The low rate of infertility (7.8%) in our patients was noted. It has been suggested that the risk of FMF-related infertility may not be as high as thought in patients who are followed up regularly and received colchicine.

Natural Course of Muscular Strength, Physical Performance, and Musculoskeletal Symptoms in Hospitalized Patients With COVID-19.

OBJECTIVE: To investigate the course of muscle strength, musculoskeletal symptoms and physical performance over time in hospitalized COVID-19 patients, and their relation with disease severity at admission. DESIGN: Prospective cohort study. SETTING: Pandemic clinic of Gazi University Hospital, Ankara, Turkey. PARTICIPANTS: 76 adult COVID-19 patients (aged >18 years) were enrolled in the study between March 2021 and May 2021 (N=76). The participants were grouped as "mild," "moderate," and "severe" according to clinical and radiological findings. MAIN OUTCOME MEASURES: The fraction of inspired oxygen (FiO2), oxygen saturation (SpO2), hand grip strength (HGS), 5-times sit and stand test (5XSTS), modified Borg scale at rest (mBorg-rest), modified Borg scale during activities of daily living (mBorg-ADL), Barthel index, and visual analog scale for myalgia (myalgia-VAS) values were recorded on the first day of hospitalization and in the first, third, and 12th weeks. Outcome measures were compared between disease severity groups. In addition, the changes in these outcome measures over time were also examined. RESULTS: There were 15 (19.7%) participants in the mild, 20 (26.3%) in the moderate, and 41 (53.9%) in the severe groups. At the baseline evaluation, SpO2 (P<.001), FiO2 (P<.001), 5XSTS (P=.002), mBorg-rest (P=.016), and mBorg-ADL (P<.001) were different in 3 groups, but there were no differences for HGS, Barthel index, and myalgia-VAS score. HGS, 5XSTS, myalgia-VAS, and mBorg-ADL scores improved significantly over time in all the groups (P<.001, P≤.001, and P<.001, respectively). At the end of 12 weeks, only 5XSTS was different between the groups. 5XSTS was significantly longer in the severe group (P=.010). CONCLUSION: Although significant improvement was observed in the muscle strength, physical performance, and musculoskeletal symptoms of patients with COVID-19 over time, the physical performance of these patients did not reach normal standards. We conclude that post-COVID-19 rehabilitation programs are needed to optimize the physical performance of the patients.

Comparison of the effectiveness of instrument-assisted soft tissue mobilization and extracorporeal shock wave therapy in myofascial pain syndrome.

Background/aim: To compare the effectiveness of instrument-assisted soft tissue mobilization (IASTM) and extracorporeal shock wave therapy (ESWT) used in myofascial pain syndrome (MPS) and to determine whether they are superior to conservative treatment (CT). Materials and methods: A total of 42 female patients (aged 18-60 years) diagnosed with MPS were enrolled and randomly assigned to either the CT (n = 14), CT+IASTM (n = 14), or CT+ESWT group (n = 14). All of the groups received treatment for 3 weeks (CT: 5 sessions per week, 15 sessions in total, ESWT and IASTM: 2 sessions per week, 6 sessions in total). Neck stretching exercises were given to all of the patients as a home program. The pain intensity of the patients was determined using the visual analog scale (VAS). The pressure pain threshold (PPT) was measured with an algometer. Cervical joint range of motion (ROM) was measured with a cervical ROM (CROM) device. Pain, cervical disability, quality of life, and sleep disturbances were evaluated with the Neck Outcome Score (NOOS). Depression and anxiety parameters were evaluated with the Hospital Anxiety and Depression Scale (HADS). Evaluations were made before treatment and 3 days after the last treatment session. Results: The CT+IASTM group was more successful than the other groups in terms of pain intensity, PPT, and improvements in the ROM parameters (p < 0.05). No significant difference was found between the NOOS and HADS scores of the groups when the posttreatment changes were compared to pretreatment (p > 0.05). Conclusions: All 3 of these treatments can be used to alleviate the negative effects of MPS. IASTM treatment can be preferred primarily in the creation of combined treatment programs for patients with ROM limitations and low PPTs.

The relationship between upper extremity functional performance and anthropometric features and the quality criteria of cardiopulmonary resuscitation.

Objectives: This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil. Patients and methods: This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed. Results: Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001). Conclusion: The power score combination of upper extremity functionality and the rescuer's weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.

Comparison of the Effects of Myofascial Meridian Stretching Exercises and Acupuncture in Patients with Low Back Pain.

Background: Acupuncture and myofascial meridians show great anatomical and clinical compatibility. Objectives: We aimed to compare the effects of myofascial meridian stretching exercises and acupuncture in patients with low back pain. Methods: We randomized 81 subjects with acute/subacute low back pain into three groups: an acupuncture (A) group, a myofascial meridian stretching (MMS) group, and a control (C) group. We recorded the Numerical Rating Scale (NRS) and Roland- Morris Disability Questionnaire (RMQ) scores at baseline and weeks two and six. We evaluated posterior pelvic tilt and transversus abdominis muscle strenghth with a pressure biofeedback unit, back extensor muscle strength by the Sorenson test, and lumbar range of motion (ROM) with an inclinometer. Group A received acupuncture (BL 57 and BL 62 acupoints) and stretching exercises according to the posterior superficial line were applied to the MMS group. Results: Improvements in the NRS score were more prominent in group A than in group C (p = 0.004). The RMQ score improvement between baseline and weeks two and six was more prominent in groups A and MMS (p < 0.001, p = 0.001, respectively). The Sorenson test showed significant improvement between the baseline and week two in groups A and MMS (p = 0.004, p < 0.001, respectively). The increase in lumbar ROM measurement in the MMS group between baseline and week two was significantly higher than in groups A and C (p = 0.009, p < 0.001, respectively). Conclusion: Stretching exercises according to the myofascial meridian system and acupuncture contributed to improved symptoms in the first two weeks in patients with acute/subacute low-back pain.

Immunogenicity and safety of the CoronaVac and BNT162b2 Covid-19 vaccine in patients with inflammatory rheumatic diseases and healthy adults: comparison of different vaccines.

OBJECTIVES: To determine the seroconversion (SC) rate after CoronaVac and BNT162b2 vaccines in adults with inflammatory rheumatic disease (IRD). METHODS: Patients who were followed up with IRD and who received two doses of either CoronaVac or BNT162b2 vaccines were included in this prospective observational single-center study. Subjects with two doses of CoronaVac or BNT162b2 without known IRD were included in the healthy controls. The blood samples were taken at a minimum of two and a maximum of 12 weeks after the second dose of vaccine. RESULTS: A total of 81 patients with IRD (61 CoronaVac, 20 BNT162b2) and 100 healthy controls (70 CoronaVac, 30 BNT162b2) were included. The SC rate was slightly lower among patients with IRD versus controls (84 vs 97%, p = 0.002). The SC rate was 100% in all participants who received BNT162b2 both in the patient and control group. The IgG antibody level after CoronaVac in the patient group was significantly lower than both the BNT162b2 (p = 0.031) and the healthy group (p < 0.001). Among patients with IRD, those on rituximab (RTX) (12/81,14.8%) had significantly less SC rate (5/12, 41.7%). The median neutralizing antibody titers were significantly higher in patients with BNT162b2 compared with CoronaVac (1.97 vs. 16.34, p < 0.001). CONCLUSIONS: This study showed that all patients with BNT162b2 vaccine developed immunogenicity in patients with IRD, while there was a decreased antibody response with CoronaVac vaccine compared to that of BNT162b2. In particular, RTX significantly reduces the SC rate.

The evaluation of muscle strength and architecture in type 1 diabetes mellitus: a cross-sectional study.

BACKGROUND: The aim of this study is to compare muscle strength and architecture between type 1 diabetes patients and healthy volunteers and to assess whether there is an ultrasonographic structural change in this population. METHODS: Thirty-two patients with T1D (23 female, 9 male) with an age average of 31.3 ± 8.7 years, matched in terms of age, gender, height, weight and physical activity were included in the study. In the T1D and control group, ultrasonographic measurements of quadriceps femoris muscle (RF, VI, VM, VL) and pennate angle (VI, VM, VL) were performed. Muscle strength values were measured using isokinetic dynamometer system at angular velocities of 60º/s and 180º/s in both groups. RESULTS: Initially, both groups were similar in demographic and clinical characteristics (p > 0.05). In the T1D group, there was a statistically significant difference in flexion/extension peak torque measurements at an angular velocity of 60º/s compared to the control group (p < 0.05). In support of these isokinetic measurements, RF, VI, VM, VL muscle thicknesses and VI, VM pennate angle measurements in T1Ds were significantly lower (p < 0.05). When the T1D group was subgrouped according to HbA1C and diabetes duration, there was no significant difference in ultrasonographic and isokinetic measurements between the two groups (p > 0.05). When the T1D group was subgrouped, in the group that used insulin pump RF, VI, VM muscle thickness measurements were significantly higher (p < 0.05) than the group using subcutaneous insulin. CONCLUSIONS: This study supports that muscle strength and architecture are adversely affected in the T1D patient group, insulin deficiency is a risk factor for sarcopenia and this can be shown through ultrasonography. It can also be said that insulin pump use has more positive effects in terms of diabetic myopathy than subcutaneous insulin, and diabetic myopathy develops independently of other diabetic complications. As a result, the muscle architecture of T1D people is adversely affected by insulin deprivation, so regular physical activity should be an integral part of diabetes treatment.

Prevalence of peripheral spondyloarthritis among patients with ultrasound-confirmed enthesitis: Single-center cross-sectional study.

OBJECTIVE: The primary goal of this study was to determine the prevalence of peripheral spondyloarthritis (pSpA) in patients with ultrasonography (USG)-confirmed enthesitis. The secondary aim of the study was to reveal the demographic, clinical, and ultrasonographic differences of patients diagnosed with pSpA. METHODS: Fifty-nine patients with USG-confirmed enthesitis were evaluated by a rheumatologist to evaluate if they met the Assessment of SpondyloArthritis International Society (ASAS) criteria for pSpA. Elementary lesions assessed by USG were based on the definition of the Outcome Measures in Rheumatology in Clinical Trials group which included hypoechogenicity, thickening, Doppler signal within 2 mm of bone, enthesophytes, bone erosions, and calcifications. For all patients, clinical and demographic data included: age, gender, smoking habits, body mass index, comorbid diseases, symptom duration, enthesitis region, the presence of bilateral enthesitis, entheseal pain visual analog scale (0-10), standardized enthesitis count following Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and SPondyloArthritis Research Consortium Canada (SPARCC) enthesitis index. RESULTS: Eight (13.6%, 95% CI 6.0% to 25.0%) of 59 patients were diagnosed with pSpA according to the ASAS classification criteria. Participants diagnosed with pSpA had a longer duration of symptoms (54 vs 12 months), were more likely to present bilateral enthesitis (87.5% vs 49%) with higher SPARCC (11 vs 3) and MASES (6.5 vs 2) scores and higher C-reactive protein (7 vs 3.2 mg/L) concentrations. Entheseal Doppler signal and hypoechogenicity were also more frequently observed (50% vs 0% and 100% vs 49% respectively). CONCLUSION: Peripheral SpA is not uncommon among patients presenting with enthesitis and more likely in cases with prolonged, extensive, and bilateral enthesitis with entheseal hypoechogenicity and Doppler signal. Musculoskeletal ultrasonography can facilitate the diagnosis of pSpA in patients presenting with enthesitis.

The effect of supervised dynamic exercise program on somatosensory temporal discrimination in patients with fibromyalgia syndrome.

OBJECTIVES: This study aims to investigate the effect of a supervised dynamic exercise program on somatosensory temporal discrimination (STD) which indicates the central sensory processing ability. PATIENTS AND METHODS: Forty-eight patients (mean age: 43 years; range, 19 to 64 years) with fibromyalgia syndrome (FMS) were included in this prospective, randomized study between April 2018 and October 2018. Demographics and clinical measurements were recorded. The STD threshold was measured by a researcher blinded to the treatment groups. After baseline assessments, the patients were randomized into two groups: the supervised exercise group (SEG) and the home exercise group (HEG) as the control group. The SEG performed submaximal aerobic exercise and low-medium resistant isotonic exercises under the supervision of a physiotherapist, 1-h per day, three days in a week for four weeks. The HEG was given a home-based exercise program consisting of low-to-medium resistance isotonic exercises and aerobic exercises 1-h per day, three days in a week for four weeks. After exercise program, clinical assessments and STD threshold measurement were repeated. RESULTS: Clinical and STD threshold measures improved significantly after four-week exercise program in both groups. The improvements in clinical measures were significantly higher in the SEG. However, there was no difference in the STD threshold improvement between the groups. No correlation was found between the STD threshold measure and clinical features in any patients. CONCLUSION: Although a significant improvement was achieved in impaired STD threshold with SEG, it was not found to be superior to the amelioration observed with HEG.

Familial Mediterranean fever: Health-related quality of life and associated variables in a national cohort.

OBJECTIVES: This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients. PATIENTS AND METHODS: This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale. RESULTS: The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$<300), smoking, late-onset FMF (>20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT. CONCLUSION: Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

Exercise capacity in axial spondyloarthritis and associated factors: A cross-sectional controlled study.

OBJECTIVE: To examine the associations between exercise capacity (EC), cardiovascular (CV) risk factors and disease-related variables in axial spondyloarthritis (AxSpA) patients. METHODS: In this cross-sectional controlled study, CV risk profile data, physical activity, 10-year CV event risk estimated by the Framingham model and Ankylosing Spondylitis Disease Activity Score - C-reactive protein were recorded. A maximal treadmill exercise test by Bruce protocol was administered. Analyses of covariance were performed with adjustments for age, smoking status and physical activity level. Linear regression analysis was performed to study the association between EC and related CV risk factors. RESULTS: Thirty-eight patients and 38 age-gender matched controls were recruited between May and October 2014. Patients had significantly lower EC than controls (MD 2.2; metabolic equivalents 0.91-3.49; P = .001). The difference remained significant after adjustments (P = .001). There were significant correlations between EC and age, 10-year CV event risk, body mass index (BMI) and waist circumference for patients and controls (P < .001 and P < .05, respectively). There was a significant relationship between EC and total cholesterol, triglycerides and heart rate recovery (HRR) in patients (P = .04, P < .001 and P = .006, respectively). High-density lipoprotein - cholesterol was significantly higher, and BMI was significantly lower in nonradiographic AxSpA patients (P = .026 and P = .03 respectively). Age and triglyceride levels were found as the significant predictors for EC in the AxSpa group (for age ß = -.105, P = .003; for triglycerides ß = -.016 P = .003). CONCLUSION: Exercise capacity was significantly lower and attenuated HRR was significantly associated with low EC and high 10-year CV event risk in AxSpA patients.

Clinical outcomes of Covid-19 in patients with rheumatic diseases and the effects of the pandemic on rheumatology outpatient care: A single-centre experience from Turkey.

OBJECTIVE: The aim of the study was to detect the frequency and course of coronavirus disease 2019 (Covid-19) infection among our rheumatology outpatients and to investigate how patient follow-up differed during Covid-19 pandemic in a tertiary University Hospital in the capital of Turkey. PATIENTS AND METHOD: Patients with inflammatory rheumatic diseases (IRDs) registered in our rheumatology clinic were assessed during their routine outpatient follow-up control or contacted via phone between July and December 2020. Patients' demographics, diagnosis, medication, comorbidities, frequency of going outside during the pandemic, work status, whether patients could attend their routine follow-up, treatment changes, access to drugs during the pandemic, and the incidence of Covid-19 infection were collected. RESULTS: A total of 320 patients with IRD were analysed; 114 (35.6%) patients were treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (methotrexate/leflunomide/sulfasalazine), 93 (29.1%) patients with biologic DMARDs (bDMARDs), 113 (35.3%) patients with glucocorticoids, and 103 (32.2%) patients with hydroxychloroquine (HCQ). A total of 15.9% of patients on HCQ experienced problems in medication supply. Only 87 (27.2%) patients presented for their routine follow-up appointment, and 38 (11.9%) of the patients changed their treatment without professional health advice. While 53 (57%) patients on biological agents continued their treatment, 31 patients (33.3%) interrupted the treatment with doctor's recommendation and 9 patients (9.6%) on their initiative, and 23 of these 31 patients had to restart treatment because of disease activation. The nasopharyngeal swab collected from 30 patients with a suspected Covid-19 contact but without any symptoms was negative. In total, there were 33 patients diagnosed with Covid-19; none of whom had severe respiratory complications or death. CONCLUSIONS: Many patients with rheumatic diseases are left without disease monitoring during the pandemic. There was no increased risk of severe Covid-19 infection among patients with IRD.

The impact of COVID-19 on familial Mediterranean fever: a nationwide study.

The study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) in patients with familial Mediterranean fever (FMF) and to assess the relationships between FMF characteristics and severe COVID-19 outcomes such as hospitalization. The study was planned within a national network of 21 different centers. Demographics, FMF-related clinical and genetic characteristics, and COVID-19 outcomes were obtained. A total of 822 patients with FMF (mean age of 36 years) were included in the study. Fifty-nine of them (7%) had a COVID-19 diagnosis confirmed by real-time PCR test or chest CT findings. Most FMF patients with COVID-19 (58) had mild and moderate disease activity. All patients were on colchicine treatment. However, 8 of them (13.6%) were not compliant with colchicine use and 9 of them (15.3%) were colchicine resistant. Twelve FMF patients with COVID-19 were hospitalized. There were 4 patients requiring oxygen support. COVID-19 related complications were observed in 2 patients (1 thromboembolism, 1 acute respiratory distress syndrome). Hospitalized COVID-19 patients with FMF were older than non-hospitalized patients (median ages: 51 and 31 years, respectively; p: 0.002). Other FMF-related characteristics were similar between the groups. FMF-related characteristics were not found to be associated with poor outcomes in COVID-19. Thus, FMF may not be a risk factor for poor COVID-19 outcomes.

The Effect of Virtual Reality Exercises on Pain, Functionality, Cardiopulmonary Capacity, and Quality of Life in Fibromyalgia Syndrome: A Randomized Controlled Study.

Objective: To investigate the effect of motion-controlled videogames on pain, functionality, cardiopulmonary capacity, and quality of life in women with fibromyalgia. Materials and Methods: Forty women with fibromyalgia were randomized into virtual reality group (VRG) and conventional training group (CTG). The CTG performed aerobic exercise (cycling, 3 days per week, 20 minutes per day) and conventional exercises (muscle strengthening, balance, and flexibility, 3 days per week, 15 minutes per day) for 4 weeks. The VRG performed virtual reality exercise (volleyball, Microsoft Xbox Kinect®, 3 days per week, 15 minutes per day) together with cycling exercise for 4 weeks. After the exercise program, both groups received the same home exercise program for 4 weeks. All patients were evaluated at baseline, fourth, and eighth weeks. Primary outcome measure was Fibromyalgia Impact Questionnaire. Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale, Fatigue Severity Scale (FSS), Symptom Severity Scale, EuroQol-Five Dimensions Index Scale/Visual Analogue Scale (EQ-5D-index/VAS) and Six Minute Walk Test (6MWT) were used as secondary outcome measures. Results: Thirty-four patients (17 VRG, 17 CTG) were evaluated at the eighth week. After 4 weeks, all outcome measures improved significantly in both groups (P < 0.05). However, there was no statistically significant difference in all outcome measures between fourth and eighth weeks. Group and time interactions for 6MWT (P = 0.043), FSS (P = 0.026), EQ-5D-Index Scale (P = 0.014), and EQ-5D-VAS (P = 0.049) were significant only for the VRG. In addition, median individual's satisfaction was significantly higher in the VRG (P < 0.001). Conclusion: Virtual reality exercises along with aerobic exercise increase cardiopulmonary capacity and quality of life in fibromyalgia syndrome. In addition, they increase patient satisfaction and may improve patient compliance to exercise.

Somatosensory Temporal Discrimination in Autism Spectrum Disorder.

Sensory differences are common in Autism Spectrum Disorder (ASD). While there is no well-accepted method to measure sensory differences objectively, there is accumulating evidence from recent years concerning sensory perception, including data concerning temporal discrimination thresholds of individuals with ASD as measured by different measures. The somatosensory temporal discrimination (STD) test measures the threshold at which an individual can temporally discriminate multiple tactile stimuli delivered in succession. We aimed to investigate tactile perception in ASD and hypothesized that children with ASD have impaired STD related to their subjective sensory symptoms and daily difficulties. Thirty adolescents with ASD and 30 typically developed subjects were recruited. The Childhood Autism Rating Scale, Strengths and Difficulties Questionnaire, and Adolescent/Adult Sensory Profile were implemented before STD evaluation. Average somatosensory detection (1.48 ± 0.42) and discrimination thresholds (112.70 ± 43.45) of the children with ASD were significantly higher (P = 0.010, P = 0.001, respectively) than those of the controls (1.18 ± 0.42, 79.95 ± 31.60, respectively). Sensory seeking scores of the ASD group (40.8 ± 7.60) were significantly lower (P = 0.024) than those of the control group (45.83 ± 9.17). However, the psychophsycal thresholds did not have any statistically significant relationships with subjective sensory symptoms or daily difficulties. This study demonstrates impaired sensory processing in ASD evaluated by STD and its lack of relationship with subjective sensory symptoms and daily difficulties. This psychophysical evidence of increased STD thresholds and decreased sensory seeking profile supports the disturbances in the regulation of sensory processing in ASD. LAY SUMMARY: Sensory differences are common in autism; however, there is no well-accepted method to measure them objectively. This study aims to investigate somatosensory differences and their relation with sensory and emotional/behavioral difficulties of children with autism. We show that autistic children have higher tactile discrimination thresholds and fewer sensory seeking behaviors. This supports the presence of impairments in sensory processing in autism. Measuring the sensory differences may help understanding clinical symptoms and neurobiological underpinings of autism. Autism Res 2021, 14: 656-667. © 2021 International Society for Autism Research and Wiley Periodicals LLC.

Ultrasonographic evaluation of shoulder tendons in patients with Hashimoto's disease.

OBJECTIVES: To investigate the thickness of the shoulder tendons and the measurement of acromiohumeral distance (AHD) in patients with Hashimoto's disease (HD). MATERIAL AND METHODS: Twenty-eight patients with subclinical hypothyroid HD, 40 patients with euthyroid HD, and 51 healthy subjects were included. The thicknesses of biceps brachii, subscapularis, supraspinatus, infraspinatus tendons at both shoulders were evaluated with ultrasonography. Serum levels of thyroid stimulated hormone (TSH), free tri-iodothyronine, free thyroxine (FT4), anti-thyroid peroxidase (TPO) and anti-thyroglobulin (anti-TG) antibodies levels were measured. RESULTS: Height, weight, body mass index (BMI), free T3 and free T4 levels were similar between the three groups (P = .839, P = .205, P = .374, P = .430 and P = .497, respectively). Biceps brachii, supraspinatus and infraspinatus tendon thicknesses in dominant arm and biceps brachii, subscapularis and infraspinatus tendon thicknesses in non-dominant arm were significantly increased in euthyroid HD compared to healthy controls (P = .003, P = .030, P < .001; P = .035, P = .042, P < .001, respectively). Biceps brachii tendon thickness in dominant arm and subscapularis and supraspinatus tendon thicknesses in non-dominant arms were significantly increased in subclinical hypothyroid HD compared to healthy controls (P = .025; P = .046, P = .017, respectively). However there was no such difference between euthyroid HD and subclinical hypothyroid HD groups (P < .05). There was low correlation between biceps brachii tendon thickness and free T4 level in non-dominant shoulder in patients with HD (r = .272 P = .030). For the rest of the tendons, there was no correlation between TSH, anti-TPO, anti-TG levels and tendon thicknesses in patients with HD. CONCLUSIONS: This study suggests that thyroid autoimmunity in HD may lead to an increase in thickness of shoulder tendons.

Familial mediterranean fever: assessment of clinical manifestations, pregnancy, genetic mutational analyses, and disease severity in a national cohort.

The aims of this study were to investigate the main clinical and laboratory features, including pregnancy and genetic analysis, of Turkish Familial Mediterranean Fever (FMF) patients and to analyze the relationships between genotypic features, age of disease onset, clinical findings, and disease severity. A study was planned within a national network of 22 different centers. Demographics, clinical and laboratory findings, attack characteristics, drugs, pregnancy and birth history, disease severity, and gene mutation analyses were evaluated. Disease severity, assessed using a scoring system developed by Pras et al., was evaluated in relation to gene mutations and age of disease onset. A total of 979 patients (643 females and 336 males; mean age: 35.92 ± 11.97 years) with FMF were included in the study. Of a total of 585 pregnancies, 7% of them resulted in preterm birth and 18.1% resulted in abortions. During pregnancy, there was no FMF attack in 61.4% of patients. Of the MEditerranean FeVer (MEFV) mutations, 150 (24.3%) cases were homozygous, 292 (47.3%) cases were heterozygous, and 175 (28.4%) were compound heterozygous. Patients with homozygous gene mutations had more severe disease activity, earlier age of disease onset, higher rates of joint and skin involvement, sacroiliitis, and amyloidosis. Patients with compound heterozygous genotype displayed severe disease activity in close resemblance to patients with homozygous mutation. In addition, patients with compound heterozygous mutations had higher rates of protracted febrile myalgia and elevated fibrinogen levels. In 63.9% of compound heterozygous patients, age of onset was < 20 years, with greater disease severity, and high rates of attack frequency and colchicine resistance. Our results suggest that indicators for disease severity include early onset of disease and homozygous gene mutations. Furthermore, patients with compound heterozygous mutations displayed significant presentations of severe disease activity.