Frequency of fibromyalgianess in patients with rheumatoid arthritis and ankylosing spondylitis: A multicenter study of Turkish League Against Rheumatism (TLAR) network.

Objectives: This study aimed to evaluate the frequency of fibromyalgianess, fibromyalgia syndrome (FS), and widespread pain in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and their relationship with clinical and demographic parameters. Patients and methods: This cross-sectional multicenter trial was performed in 14 centers across Türkiye between June 2018 and November 2019. Out of 685 patients recruited from the accessible population, 661 patients (342 RA, 319 AS; 264 males, 397 females; mean age: 48.1±12.9 years; range, 17 to 88 years) met the selection criteria. In these cohorts, those who did not meet the criteria for FS and had widespread pain (widespread pain index ≥7) were evaluated as a separate group. Clinical status and demographic parameters of patients in both cohorts were evaluated as well as the evaluations of RA and AS patients with widespread pain (widespread pain index ≥7) and RA and AS patients with FS groups. In addition, correlations between polysymptomatic distress scale (PSD) scores and Visual Analog Scale (VAS), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and Disease Activity Score using 28 joint counts for RA patients and VAS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) for AS patients were analyzed. Results: Frequencies of patients with FS and patients who had PSD scores ≥12 were 34.1% and 44.4% in all RA patients, respectively. Moreover, FS and PSD scores ≥12 were found in 29.2% and 36.9% of all AS patients, respectively. PSD scores of RA patients with FS were higher than all RA patients and RA patients with widespread pain. SDAI and CDAI scores of RA patients with FS were higher than all RA patients and RA patients with widespread pain. Similarly, PSD scores of AS patients with FS were higher than all AS patients and AS patients with widespread pain. ASDAS-erythrocyte sedimentation rate and BASDAI scores of AS patients with FS were found higher than all AS patients and AS patients with widespread pain. Conclusion: Disease activity scores, including pain in RA and AS, were higher in the presence of FS or fibromyalgianess. It may be related to clinical parameters, but cohort studies with long-term follow-up are needed to reveal causality. Additionally, to avoid overtreatment, coexistence of fibromyalgianess should be kept in mind in patients who have inflammatory diseases such as RA and AS, particularly with intractable widespread pain.

Oxidative modification of carbonic anhydrase by peroxynitrite trigger immune response in mice and rheumatic disease patients.

BACKGROUND: Carbonic anhydrases (CA) are metalloenzymes with wide tissue distribution, involved in many important physiological processes, and in some rheumatic diseases, autoantibodies are formed against these enzymes. Recent studies have suggested that oxidative stress triggers anti-CA antibody formation. In this study, we aimed to investigate the effects of modification with oxidative/nitrosative stress end products on CA antigenicity in mice and the relationship between the modified CA autoantibodies and oxidant-antioxidant status in patients with rheumatoid arthritis (RA) and Sjögren's syndrome (SjS). METHODS: CA I and CA II isoenzymes were isolated from human erythrocytes and modified with 4-hydroxynonenal (4-HNE), malondialdehyde (MDA), and peroxynitrite (PN). Balb-c mice were immunized with these agents to determine the effects of modification on CA antigenicity. The autoantibody titers of modified CA isoenzymes were detected in patients. In addition MDA, 4-HNE, 3-nitrotyrosine (3-NT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activities were measured to assess the oxidant-antioxidant status in patients. RESULTS: Modifications of carbonic anhydrase with oxidative stress end products, HNE, MDA and PN, lead to alterations in the immune response to these enzymes in mice. It was found that HNE and MDA decreased the antigenicity while PN increased. In addition, PN-modified CA autoantibody levels were found to be significantly different in both RA and SjS patients compared to their controls (p<0.05). CONCLUSIONS: PN modifications can also trigger an immune response against CA isoenzymes in mice, and PN-modified CA I and CA II autoantibody titers were found at a significantly high level in both RA and SjS patients.

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.

Infliximab therapy provides beneficial effects for choroidal thickness increase in patients with active ankylosing spondylitis: A possible mechanism mediating the suppressing of uveitis attacks.

OBJECTIVES: This study aims to quantitatively assess the profile of the choroidal thickness (ChT) in patients with ankylosing spondylitis (AS) using optical coherence tomography (OCT), and to examine whether the posterior eye segment abnormalities in active AS patients are reversible by infliximab therapy. PATIENTS AND METHODS: October 2014 and March 2016 Thirty-one patients with AS (22 males, 9 females; mean age 39.6±12.3 years; range, 22 to 68 years) and 24 healthy controls (16 males, 8 females; mean age 40.8±8.9 years; range, 35 to 61 years) were enrolled. Patients' clinical and demographic characteristics were recorded. Using OCT, we performed retinal nerve fiber layer (RNFL) thickness, ganglion cell complex, and ChT measurements in AS patients before and six months after the initiation of infliximab therapy, and in healthy controls. RESULTS: At baseline, patients with AS had higher ChT (mean±standard deviation: 347.5±114.4 µm) compared to healthy controls (322.1±62.8 µm), although this did not reach statistical significance level (p=0.283). At six months after the first measurement, the mean ChT was significantly decreased (under infliximab therapy: 326.5±99.7 µm vs. before: 347.5±114.4 µm, p=0.018) in AS group, while no significant change was observed in the control group (p=0.102). RNFL thickness in the AS group was significantly decreased after six months of treatment with infliximab (p=0.008). CONCLUSION: By evaluating the posterior eye segment of patients with AS using OCT, this study has demonstrated that active AS patients had higher ChT. The significant reduction in this ChT after infliximab therapy may be mediating the established effective suppressing action of infliximab on uveitis attacks.

Associations between cytokine gene polymorphisms and rheumatoid arthritis in Turkish population.

OBJECTIVE: Various cytokine polymorphisms have been associated with genetic risk factors predisposing to Rheumatoid Arthritis (RA) in different populations. To predict the clinical outcome as well as response to therapy in RA, studies aimed to describe genetic markers. The present study aims to search for polymorphisms of 13 cytokine coding genes in the Eastern Black Sea Region of Turkey. METHODS: DNAs of 49 patients and 96 healthy bone marrow and kidney donors were isolated from peripheral blood samples. Genotyping was performed using the Heidelberg Cytokine Typing Tray kit. PCR products were visualized on an agarose gel, and results were analyzed using the interpretation scheme provided with the kit. Arlequin 3.5 software was used for statistical analysis. RESULTS: No positive association was found between allele frequencies and the disease. However, a negative association was found for the IL-A -889 C allele (p=0.02, OR=0.533, Wald's 95% CI=0.318-0.893). IL-12 -1188 CC (p=0.01, OR=3.667, Wald's 95% CI=1.246-10.786), IL-4 -1098 GT (p=0.02, OR=2.405, Wald's 95% CI=1.129-5.125) genotypes were found positively associated with the RA, while IL-4 -590 CT (p=0.02, OR=0.422, Wald's 95% CI=0.201-0.886) was found negatively associated with the disease. In addition, IL-6 GG haplotype was found positively associated with the RA (p=0.02, OR=1.880, Wald's 95% CI=1.086-3.254). CONCLUSION: Our findings suggest that some polymorphisms of the IL-1A, IL-2, IL-4, IL-6 and IL-12 could be responsible for the susceptibility or protective to RA in our study population. Multi-centered and large numbers of subjects containing studies that search for cytokine polymorphisms will gather more information regarding the susceptibility to RA of Turkish patients.

Comparison of clinical outcomes of ultrasonography-guided and blind local injections in facet syndrome: A 6-week randomized controlled trial.

BACKGROUND: Facet syndrome is defined as pain that arises from any structure of the facet joints, including the fibrous capsule, synovial membrane, hyaline cartilage, and bone. OBJECTIVES: To compare the effectiveness of US-guided and blind injections on clinical outcome in facet syndrome. MATERIALS AND METHODS: Forty-seven patients with the diagnosis of facet syndrome were included. Patients were consecutively randomized into one of the two groups. The patient's history, physical examination and routine laboratory parameters were obtained and diagnose was established based on physical findings. Two injections (mixture of 2 ml of 1% lidocaine hydrochloride and 20 mg of triamcinolone, to a single or maximum two sites depending on the clinical characteristics of the facet joint) were performed with 15 days apart, as blinded or US-guided manner. Clinical outcome assessments were carried out at 0, 2nd and 6th weeks, using Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and State-Trait Anxiety Inventory (STAI). RESULTS: The patients' initial VAS and ODI were not significantly different. When the two groups were compared in the 6th week in terms of VAS scores, improvement was more pronounced in the US-guided injection group (US-guided group (n= 23) before 7.6 (2.2) cm, after 3.0 (1.7) cm, P= 0.0001 vs blind group (n= 24) before 7.2 (1.3) cm, after 5.2 (2.0) cm, P= 0.0001). The improvement in initial and 6th week ODI was statistically significant in the US-guided injection group (P= 0.006). Except STAI I for US-group, trait anxiety scale scores were significant in both groups. CONCLUSION: The US-guided local injections offer better clinical outcome in the treatment of facet syndrome.

Diagnostic efficacy of routine contrast-enhanced abdominal CT for the assessment of osteoporosis in the Turkish population

Background/aim: This study aimed to evaluate the diagnostic efficacy of vertebral Hounsfield unit (HU) values on routine contrast- enhanced abdominal computed tomography (CT) scans for the assessment of osteoporosis using dual-energy X-ray absorptiometry (DXA) T-scores as a reference standard. Materials and methods: A total of 111 consecutive patients who underwent contrast-enhanced abdominal CT examination for any indication and DXA within a 6-month period were retrospectively analyzed. The CT attenuation values of trabecular bone in HUs were measured in axial and sagittal planes from lumbar vertebrae 1­4 (L1­L4). The correlation between the DXA T-scores and HU values measured on the CT scans was evaluated by Pearson's correlation test. Areas under the curves (AUCs) were calculated by receiver operating characteristic analysis for diagnostic proficiency, and threshold values were determined. Paired t-test and Bland­Altman plot test were used to evaluate the correlation between axial and sagittal HU values. Results: There was a strong correlation between the DXA T-scores and HU values of all the lumbar vertebrae (P < 0.001). The highest correlation was for the L3 vertebra; L3 was thus chosen for additional analyses. The mean axial and sagittal L3 attenuations were 133.7 HU and 131.9 HU, respectively. The axial measurements were not significantly different from the sagittal measurements, with a mean difference of 1.8 HU (P > 0.05). The L3 axial CT attenuation threshold for 90% sensitivity was 170 HU and that for 90% specificity was 102 HU for distinguishing osteoporosis from osteopenia and normal bone mineral density (BMD). To distinguish the low BMD group from the normal group, the L3 axial CT attenuation threshold for approximately 90% sensitivity was 102 HU and for 90% specificity was 165 HU. Conclusion: The HUs derived from routine contrast-enhanced abdominal CT scans can be used for the evaluation of osteoporosis, without additional radiation exposure and cost.

A prospective clinical investigation of the effects of anti-TNF alpha therapy on exercise capacity in patients with ankylosing spondylitis

Background/aim: The purpose of this study was to investigate possible effects of anti-TNF alpha therapy on cardiorespiratory fitness and physical functional capacity of patients with ankylosing spondylitis (AS). Materials and methods: Twenty-eight AS patients meeting the modified New York criteria with active disease state and an equivalent number of healthy individuals as the control were prospectively enrolled. Physical working capacity and aerobic exercise capacity of the participants were determined by using cardiopulmonary exercise tests, performed before and 4 months after initiation of anti-TNF alpha therapy. Results: The mean age of the patients was 37 ± 9.1 years, and mean duration of disease was 8.9 ± 7.6 years. Patients with AS exhibited significantly lower aerobic exercise capacity (VO2peak: 21.2 ± 5.5 vs. 27.2 ± 6.6 ml/kg/min, P = 0.001), maximum power output (110.4 ± 34.8 vs.153 ± 39.8 W, P = 0.0001), and exercise duration (16.3 ± 2.6 vs. 19.6 ± 2.9 min, P = 0.0001) than the healthy controls. When patients were reevaluated after 4 months of anti-TNF alpha therapy, significant improvement was obtained in patients' aerobic capacity, maximum power output, and exercise duration. Conclusions: Results from this study indicate that in addition to inflammatory parameters and quality of life index, even short-term anti-TNF alpha therapy results in significant improvement in cardiopulmonary health status as objectively reflected by peak VO2,maximum work rate, and exercise duration.

Sexual Dysfunction and Childhood Trauma In Female Patients With Fibromyalgia.

BACKGROUND: Fibromyalgia (FM) is a rheumatological diseases characterized by diffuse pain and stiffness accompanied with fatigue, insomnia and headache. Physical and psychological factors were implicated in sexuality of patients with FM. There are few studies investigating the effect of childhood trauma on sexuality of patients with FM. The aim of this study is to investigate effect of childhood trauma on sexuality of FM. METHODS: Thirty-six patients with FM and 29 healthy females were included in this study. The patients with FM and healthy controls were assesed in terms of sociodemographic and clinical variables, sexual function and childhood traumas. RESULTS: The healthy controls had significantly longer duration of marriage with higher rate of marriage by arrangement. Communication subscale score was significantly higher in patients with FM. General and emotional trauma scores were significantly higher in patients with FM. There was no correlation between the scores of GRSSS, CTQ and FIQ. CONCLUSION: The type of marriage and duration of marriage were important sociodemographic variables concerning sexuality in FM. This study indicated that childhood trauma was not a related factor in sexuality of FM.

Carbonic anhydrase I and II autoantibodies in Behçet's disease.

BACKGROUND: Behçet's disease is a vasculitis, seen more frequently around the Mediterranean and the Far East, and evinces with oral and genital ulcerations, skin lesions and uveitis. Carbonic anhydrase (CA) is a metalloenzyme which is widely distributed in the living world, and it is essential for the regulation of acid-base balance. Anti-CA antibodies have been reported in many disorders, such as systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, endometriosis, idiopathic chronic pancreatitis, type 1 diabetes and Graves' disease. The goal of this study was to investigate CA I and II autoantibodies in Behçet's disease (BD). METHODS: 35 patients with BD and 29 healthy controls were included in the study and CA I and II autoantibody levels were investigated by ELISA. RESULTS: The CA I and II autoantibody levels of BD group were significantly higher than the healthy group (p=0.013, p inf 0.0001, respectively). A cut-off value of 0.250 ABSU for anti-CA I was associated with 34 % sensitivity and 100 % specificity and a cut-off value of 0.171 ABSU for anti-CA II was associated with 54 % sensitivity and 100 % specificity for predicting BD. CONCLUSION: The CA I and II autoantibody levels in patients with BD were found higher compared to control group and the results suggest that CA I and II autoantibodies may be involved in the pathogenesis of BD.

Gender specific differences in patients with psoriatic arthritis.

OBJECTIVES: To assess gender related differences in a cohort of patients with psoriatic arthritis (PsA). METHODS: Consecutively recruited patients were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms. RESULTS: Women (n = 115) with PsA had higher symptom duration and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), Erythrocyte sedimentation rate (ESR) and poorer physical activity and fatigue than men (n = 72) with PsA. Psoriasis area and severity index (PASI) were higher in male patients. However quality of life (SF36 physical and mental component scores), articular pattern, extra-articular features (including uveitis, iritis) and family history for psoriasis, spondyloarthritis (SpA) (PsA and ankylosing spondylitis [AS]) were quite similar between men and women. CONCLUSIONS: Some of the clinical and laboratory variables tend to be different between men and women with PsA. The extent of quality of life and articular pattern seem to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations.

The performance of psoriatic arthritis classification criteria in Turkish patients with psoriatic arthritis.

OBJECTIVES: To investigate performance of some of the published psoriatic arthritis (PsA) classification criteria as well as Assessment of Spondyloarthritis International Society (ASAS) criteria for peripheral spondyloarthritis (SpA) in Turkish patients with PsA (in early and late disease subgroups). METHODS: Patients were recruited using case report forms and physical examination methods proposed by the Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD). The Moll and Wright (MW), modified Fournie (MF), modified McGonagle (mMG), Vasey and Espinoza (VE), classification of PsA (CASPAR) criteria and ASAS criteria were assessed in patients with PsA who were diagnosed based on expert opinion. RESULTS: One hundred and twenty-eight patients with PsA (58 male, 70 female, mean age 41.8 years) were included. Thirty patients were in the early PsA and 98 patients were in the late PsA groups. Diagnostic delay was 2.6 years. In the 15.6% of patients arthritis developed before the skin findings. The proportion of patients fulfilling the MW, MF, mMG, VE, CASPAR and ASAS criteria were at a ratio of 90.6%, 82.8%, 62.5%, 84.4%, 96.1% and 76.5%, respectively. In early PsA (< 12 months disease duration) the proportions were 93.4%, 83.3%, 76.7%, 76.7%, 96.7% and 66.6%, respectively. On the other hand, in late PsA the proportions were 89.8%, 82.6%, 57.1%, 86.7%, 95.9%, 79.5%, respectively. CONCLUSIONS: Even though the sensitivity of PsA classification criteria in Turkish patients changes, the CASPAR criteria seems to be more prominent among all criteria for both early and late cases with its high sensitivity.

The relationship between serum YKL-40 levels and arterial stiffness in patients with ankylosing spondylitis.

OBJECTIVE: Serum YKL-40 plays roles in inflammatory and vascular processes. Our aim was to evaluate serum YKL-40 levels in patients with ankylosing spondylitis (AS) and to investigate their potential relationship with arterial stiffness based on carotid-femoral pulse wave velocity (CF-PWV). METHODS: Forty-three patients with AS and 41 healthy controls with no history or current signs of cardiovascular disease were included in the study. All patients were administered nonsteroidal anti-inflammatory drugs (NSAIDs), and none were prescribed anti-tumor necrosis factor agents. Serum YKL-40 levels were measured. CF-PWV and intima-media thickness of the common carotid artery (IMT-C) were evaluated. RESULTS: The mean age of AS patients was 34.6 ± 10.2 years and of controls was 36.3 ± 9.0 years. CF-PWV was significantly higher in AS patients than in controls (8.2±2.7 vs.7.0±1.6 m/s, respectively; P=0.015). However, the IMT-C was not significantly different between AS patients and controls (0.6±0.3 vs. 0.5±0.2 mm, P=0.501). YKL-40 levels were significantly higher in AS patients than in controls (78.9±37.9 vs. 58.4±21.2 ng/mL, P=0.003) and were strongly correlated with CF-PWV (r=0.773, P < 0.001) and IMT-C (r=0.548, P < 0.001). A multiple linear regression analysis revealed that CF-PWV could be explained by serum YKL-40 levels and IMT-C (adjusted R²= 0.707, P=0.013 and P=0.001, respectively). AS patients with a higher disease activity score had higher YKL-40 levels, IMT-C, and CF-PWV than did those with a lower disease activity score (P < 0.001, P=0.008, and P < 0.001, respectively) Conclusion: AS patients had higher serum YKL-40 levels, CF-PWV, and IMT-C than did healthy controls. Additionally, there was an association between increased CF-PWV and serum YKL-40 levels. Therefore, we conclude that CF-PWV and YKL-40 levels may be used for early diagnosis of atherosclerosis in AS patients.

Ultrasonographic evaluation of femoral cartilage thickness in patients with psoriatic arthritis.

BACKGROUND: Psoriatic arthritis (PsA) is a common form of arthritis that may vary from asymmetric oligoarthritis to symmetric polyarthritis and spondyloarthritis. OBJECTIVES: To evaluate femoral cartilage thickness using ultrasonography in patients with PsA. METHODS: Thirty-three patients (24 female, 9 male) with a diagnosis of PsA and 31 age-, sex- and body mass index-similar healthy subjects were enrolled in this study. Demographic and clinical characteristics of the patients were recorded, including disease duration, morning stiffness and medications. The femoral cartilage thicknesses of both knees (while held in maximum flexion) were measured with a 7-12 MHz linear probe. Three mid-point measurements were taken from both knees (at the lateral condyle, intercondylar area and medial condyle). RESULTS: Cartilage thicknesses were similar between PsA patients and healthy control subjects. However, there were significant correlations between cartilage thickness and the Maastricht Ankylosing Spondylitis Enthesitis Score, Bath AS functional index and Bath AS disease activity index scores. CONCLUSION: Femoral cartilage thickness is similar between PsA patients and healthy controls. The femoral cartilage thickness in PsA patients is associated with disease activity, functional inadequacy, and enthesopathy scores.

Arterial stiffness is associated with left ventricular dysfunction in patients with rheumatoid arthritis.

Arterial stiffness (AS) has a detrimental effect on cardiovascular system particularly on left ventricle (LV). The aim of the study was to evaluate the impact of AS on LV functions in patients with rheumatoid arthritis (RA). Forty patients with RA and 25 age-sex matched control subjects (mean age 48.5 ± 6.3 vs. 45.1 ± 6.9 years, respectively, p = 0.06) were enrolled in study. AS was assessed by carotid-femoral pulse wave velocity (CF-PWV) and heart rate corrected augmentation index (AIx@75) measured by applanation tonometry (SphygmoCor). LV function was evaluated using tissue Doppler-derived myocardial performance index (MPI) from lateral mitral annulus. CF-PWV (28.3 ± 10.3 vs. 21.8 ± 9.3 m/s, p = 0.03), AIx@75 (10.2 ± 2.3 vs. 9.2 ± 1, %, p = 0.01) and MPI (0.46 ± 0.12 vs. 0.36 ± 0.1, p < 0.001) were significantly higher in patients with RA than in controls. LV MPI was found to be significantly positive correlated with CF-PWV, AIx@75, and ESR (r = 0.360, p = 0.005; r = 0.334, p = 0.009; r = 0.293, p = 0.023, respectively). Arterial stiffness parameters including CF-PWV and AIx@75 are associated with subclinical left ventricular dysfunction in patients with RA.

Education and Visual Information Improves Effectiveness of Ultrasound-Guided Local Injections on Shoulder Pain and Associated Anxiety Level: A Randomized Controlled Study.

OBJECTIVE: Local injections are widely used in patients with a painful shoulder. The aim of this study was to evaluate the possible impact of patients' visual information on the effectiveness of ultrasound (US)-guided local injections on anxiety levels and shoulder pain. DESIGN: A total of 151 patients, scheduled for local injection owing to shoulder pain, were randomly assigned into two groups in a consecutive order. Patients in group I (n = 72) were provided information related to US findings and allowed to watch the procedures from the monitor, whereas patients in group II (n = 79) received the injection only without any collaboration. Data were collected from both groups immediately before and after injections through visual analog scale and questionnaire (the State-Trait Anxiety Inventory [STAI] forms 1 and 2). RESULTS: US-guided local injections provided significant improvement of anxiety and pain in both groups, irrespective of providing visual information. Group I and group II comparisons with respect to the visual analog scale, STAI 1, and STAI 2 yielded significant difference only for postinjection STAI 2 in group I (P = 0.006). Intragroup comparisons revealed significant differences between preinjection and postinjection values (group I: visual analog scale, P = 0.001; STAI form 1, P = 0.001; STAI form 2, P = 0.002; group II: visual analog scale, P = 0.001; STAI form 1, P = 0.002; STAI form 2, P = 0.042). There was no significant difference between the groups in terms of postinjection satisfaction levels from the procedures (P = 0.824). CONCLUSIONS: Performing US-guided shoulder injections with patient visual information provides positive contributions to coping with pain and anxiety. In particular, the patient collaboration-based US-guided injections have positive consequences on patients' long-standing "trait-anxiety" levels.

Comorbidities in patients with psoriatic arthritis: a comparison with rheumatoid arthritis and psoriasis.

AIM: Psoriatic arthritis (PsA) is a chronic, inflammatory disease. The purpose of this study was to examine the association between PsA and comorbid conditions. This is the first study to investigate comorbid diseases in PsA in Turkey. METHODS: This study was performed under the auspices of the Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD) and involved participation by six university research hospitals. Patients diagnosed with and treated for PsA on the basis of clinical, radiological and laboratory findings and expert opinion were monitored using standardized examination methods and jointly prepared forms. Clinical status, accompanying systemic diseases and surgical history were recorded. RESULTS: One hundred and seventy-three patients with PsA (75 male, 98 female, mean age 41.8) and 138 patients with rheumatoid arthritis (RA) (17 male, 121 female, mean age 48.6) and 67 with psoriasis (PsO) (43 male, 24 female, mean age 36.1) were included in the study. No accompanying disease was determined in 72.8% of PsA, 50.0% of RA and 80.6% of PsO groups. In regression analysis, patients with PsA had higher risk for cataract/glaucoma surgery (odds ratio [OR] = 11.99; 95% CI 1.36-105.4, P = 0.025) compared to patients with RA, and higher risk for hypertension (HT) (OR = 4.26; 95% CI 1.27-14.23, P = 0.018) compared to the patients with PsO. CONCLUSION: Patients with PsA have relatively lower frequency of comorbidities like diabetes mellitus, HT and cataract/glaucoma surgery compared to the patients with RA. The increased risk for having cataract/glaucoma surgery in RA compared to PsA may be particularly attributed to the more prevalent glucocorticoid use in RA.