Association of pain and clinical factors on disability and quality of life in systemic sclerosis: A cross-sectional study from Turkish League Against Rheumatism Network.

Objectives: In this study, we aimed to evaluate the factors associated with disability and quality of life (QoL) in Turkish patients with systemic sclerosis (SSc). Patients and methods: Between January 2018 and January 2019, a total of 256 SSc patients (20 males, 236 females; mean age: 50.9±12.4 years; range, 19 to 87 years) who were diagnosed with SSc were included in the study. Disability and health-related QoL (HRQoL) were evaluated by the Health Assessment Questionnaire (HAQ), scleroderma HAQ (SHAQ), Duruöz Hand Index (DHI), and Short Form-36 (SF-36). Linear regression analysis methods were used to describe factors associated with disability and QoL of the patients. Results: All disability scores were higher and HRQoL scores were lower in diffuse cutaneous SSc patients compared limited cutaneous SSc, and differentiations were significant (p=0.001 and p=0.007). In multiple regression, pain (VAS) was the strongest predictor for high disability and low QoL scores (p<0.001) as HAQ (ß=0.397, 0.386, 0.452), SHAQ (ß=0.397, 0.448, 0.372), DHI (ß=0.446, 0.536, 0.389), PCS (ß=-0.417,-0.499, -0.408) and MCS (ß=-0.478, -0.441, -0.370) in combined, lcSSc and dcSSc patients respectively. The factors associated with high disability and low QoL scores were forced vital capacity for HAQ (ß=-0.172, p=0.002) and SF-36 PCS (ß=0.187, p=0.001); disease duration for HAQ (ß=0.208, p<0.001), DHI (ß=0.147, p=0.006), and SF-36 PCS (ß=-0.134, p=0.014); 6-minute walk test for HAQ (ß=-0.161, p=0.005) and SF-36 PCS (ß=0.153, p=0.009); and modified Rodnan skin score for SHAQ (ß=0.250, p<0.001) and DHI (ß=0.233, p<0.001) in SSc patients. Diffusing capacity of the lungs for carbon monoxide for HAQ (ß=-0.189, p=0.010) and SHAQ (ß=-0.247, p=0.002); erythrocyte sedimentation rate for DHI (ß=0.322, p<0.001); age for SF-36 PCS (ß=-0.221, p=0.003) and body mass index for SF-36 PCS (ß=-0.200, p=0.008) and MCS (ß=-0.175, p=0.034) were the other variables associated with high disability or low QoL scores in SSc subsets. Conclusion: Clinicians should consider the management of the pain and its sources as a key to improve better functional state and quality of daily life in SSc.

Central nervous system involvement in rheumatoid arthritis: possible role of chronic inflammation and tnf blocker therapy.

Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, which causes activation of proinflammatory pathways that bring about joint and systemic inflammation. Although peripheral nervous system anomalies are observed widely in RA, very few case reports on changes in the central nervous system (CNS) have been published. In recent years, the pathophysiology of CNS involvement that can occur in RA has attracted a great deal of attention. Emphasis has focused on the possibility that CNS involvement occurs due to blood-brain barrier (BBB) damage associated with chronic inflammation. The present study was performed to investigate the possible effects of BBB dysfunction and tumor necrosis factor (TNF) blocker therapy on BBB function, which may cause CNS damage in patients with RA. 58 RA patients [47 (81.0%) females, 11 (19.0%) males] and 34 healthy controls [24 (70.6%) females, 10 (29.4%) males] were included in the study. All RA patients were on synthetic DMARD therapy at the beginning. Thirty patients continued DMARD therapy, and 28 patients with high disease activity were started on TNF blocker therapy. All demographic characteristics of the patients were recorded. Disease activity was evaluated using the Disease Activity Score 28-joint count C reactive protein. The Mini-Mental State Examination was used to evaluate cognitive function, and the Fazekas scale was used to assess cranial lesions visualized by magnetic resonance imaging (MRI). Patients' peripheral blood S100ß, glial fibrillary acidic protein (GFAP), claudin, interleukin (IL)-17, and IL-1ß levels were measured at the beginning of the study and after 6 months. Demographic characteristics (including sex, age, and body mass index) were similar in the RA and control groups. S100ß and GFAP levels were significantly higher in the patient group than in the control group. In the group that was started on TNF blocker therapy, S100ß and GFAP levels were significantly decreased 6 months after commencement of treatment. No difference was observed between the RA and control groups in terms of hyperintense lesions seen on cranial MRI. The S100ß levels increased with lesions in the deep white matter seen on cranial MRI in patients with RA. In conclusion, next to decreasing disease activity and joint erosions by suppressing inflammation, anti-TNF therapy in RA can also suppress potential CNS involvement linked to BBB (blood-brain barrier) dysfunction. Further studies with broader participation and longer patient follow-up are needed to reinforce this hypothesis.

Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients.

OBJECTIVE: To determine the validity and reliability of the Turkish version of the Trunk impairment scale (TIS), used in the evaluation of somatic, motor, and coordination disturbances in stroke patients, and provide a culturally adapted version for use in the Turkish population. METHODS: A total of 80 patients who were either hospitalized at our facility and rehabilitated for stroke or admitted at our outpatient clinics were included in this study. Reliability was evaluated by the internal consistency (Cronbach α) and test reproducibility [intra-class correlation coefficient (ICCC)] methods, and validity was evaluated by the correlation between subgroups and the total scores of the TIS and Berg Balance Scale (BBS), Brunnstrom phases, Barthel index (BI), Rivermead mobility index (RMI), and Short Form-36 (SF-36) scores. RESULTS: The mean age of the patients was 63.00±12.1 years. Out of a total of 80 subjects, 34 were female and 46 were male. The reliability of the scale was evaluated by the internal consistency, inter- and intra-observer reliability, and test reproducibility. The findings showed that the Turkish form of the scale was reliable at a good level. The test values were as follows; Cronbach α: >0.70, ICCC: 0.969-1, subgroups and total score comparison: 0. The correlation between TIS and BBS was considerably high in the validity analysis (p<0.001). Further, significant associations among the BI, RMI, KF-36, Brunnstrom, and TIS scores were found (p<0.001), which indicate the structural validity of this scale. CONCLUSION: TIS is a scale used in measuring the motor derangement that develops after a stroke. It has sufficient reliability, internal consistency, and validity for use in clinical practice and stroke investigations. Our study has shown that TIS used for the evaluation of body balance is valid and reliable for the Turkish population.

Comparison of blood platelet distribution width and neutrophil-lymphocyte ratio in patients with different grades of knee osteoarthritis.

OBJECTIVE: The aim of this study was to compare platelet distribution width (PDW) and neutrophil to lymphocyte ratio (NLR) values in mild-to-moderate and severe knee osteoarthritis (OA). METHODS: This was a retrospective study of patients with knee OA according to the Kellgren-Lawrence (KL) grading system. Of 465 patients, 231 were excluded (62 due to not meeting the inclusion criteria and 169 due to the lack of simultaneous haemogram and radiographic evaluations). Demographic characteristics and PDW and NLR values were recorded. The patients were then divided into two groups: KL grade 1-3 (mild-to-moderate OA) and KL grade 4 (severe OA). RESULTS: In severe knee OA patients, blood PDW (13.44 ± 2.58, p= 0.01) and NLR values (2.16 ± 0.84, p= 0.04) were elevated as compared with those in mild-to-moderate knee OA patients. Blood PDW and NLR values of ⩾ 12.5 and ⩾ 2.1, respectively, were taken as cut-offs based on a receiver operating characteristics (ROC) curve analysis. In the ROC curve analysis, blood NLR ⩾ 2.1 had 60% sensitivity and 64.8% specificity, and PDW ⩾ 12.5 had 61% sensitivity and 58% specificity in predicting severe knee OA. In a univariate analysis, age (p< 0.001), PDW ⩾ 12.5 (p= 0.029) and blood NLR ⩾ 2.1 (p= 0.030) emerged as significant predictors of the severe knee OA. CONCLUSION: The results suggested that the blood PDW and NLR are novel inflammatory markers that can predict the radiographic severity of knee OA in clinical practice.

The Relationship Between Serum Pentraxine 3 Levels and Hematological Markers in Patients With Rheumatoid Arthritis.

OBJECTIVES: This study aims to investigate the association of pentraxin 3 (PTX3) with neutrophil/lymphocyte ratio (NLR) rather than the disease activity score 28 using C-reactive protein in rheumatoid arthritis (RA). PATIENTS AND METHODS: The study included 59 RA patients (11 males, 48 females; mean age 53.79±13.55 years; range 40 to 66 years) and 20 healthy controls (5 males, 15 females; mean age 50.41±6.11 years; range 43 to 56 years). Complete blood count tests were recorded and NLR and platelet/ lymphocyte ratio were calculated. PTX3 and interleukin-6 levels were examined in serum samples. Disease activity of RA patients was assessed by disease activity score 28. RESULTS: Demographic characteristics were similar between the two groups, with no statistically significant difference in terms of sex, age, and body mass index (p>0.05). NLR, PTX3 and interleukin-6 levels were higher in patients with RA than the control group (p<0.05). While erythrocyte sedimentation rate had a positive correlation with mean platelet volume, we found no correlation between NLR and other parameters of disease activity, PTX3, and interleukin-6. CONCLUSION: We found no correlation between PTX3 and disease activity score 28 or NLR, although PTX3 levels were higher in RA patients than the controls. As a result, we were unable to establish a relationship between PTX3 and disease activity, directly or indirectly. To our knowledge, our study was the first to investigate the relationship between PTX3 and NLR.

Relationship of work disability between the disease activity, depression and quality of life in patients with ankylosing spondylitis.

OBJECTIVES: In this study, our objective was to determine the work productivity and work disability of the patients with ankylosing spondylitis (AS) and to investigate the relation of these parameters with disease activity, anxiety, depression and quality of life. PATIENTS AND METHODS: Fifty patients with the diagnosis of AS and 30 healthy control were included in the study. In patients with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to evaluate the disease activity; Bath Ankylosing Spondylitis Metrology Index (BASMI) was used to evaluate the spinal mobility and Bath Ankylosing Spondylitis Functional Index (BASFI) was used to determine the functional status. In addition, the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and The Short Form (SF-36) Health Survey was used to evaluate the health status, Hospital Anxiety and Depression Scale (HADS) was used for the evaluation of depression and anxiety and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem v2.0 (WPAI:SHP) was used to evaluate the work productivity. RESULTS: In AS patients duration of disease at the diagnosis was 7.24 ± 6.23 years. The time lost at work due to the disease, decrease in the work productivity and impairment in the time off daily activities were worse in the patient group compared with the control group (p< 0.05). The impairment in the work productivity was correlated with BASDAI and depression; difficulty in time-off activities was correlated with BASFI and anxiety and depression was correlated with BASDAI (p< 0.05). While the impairment in work productivity was correlated with the subparameter vitality in SF-36, difficulty in time off activities was correlated with general health status, social functions, vitality and mental health (p< 0.05). CONCLUSION: In this study, we determined that AS had a significant influence on the working conditions and the factors related to the disease had a significant correlation with work productivity. Factors related to the psychology and the disease were also correlated with the working conditions.

Presence of enthesopathy in patients with primary Sjogren's syndrome: ultrasonographic study of a local cohort.

BACKGROUND: Musculoskeletal findings in Sjögren's syndrome are arthralgia, arthritis, myalgia, myositis, fibromyalgia, and chronic fatigue. Enthesis zones are important in the formation of pain in the musculoskeletal system. Musculoskeletal ultrasound (US) may show subclinical enthesitis in the synovial joints and in the axial skeleton before joint swelling in inflammatory diseases characterized by arthritis. OBJECTIVE: In this study, we aimed to determine the presence of enthesopathy using the Madrid sonographic enthesitis index (MASEI) in patients with primary Sjögren's syndrome (PSS). PATIENTS AND METHODS: Consecutive patients with PSS and age-matched healthy controls were included in this study. All the patients met the 2002 American College of Rheumatology/European League against Rheumatism classification criteria for PSS. The demographic characteristics of the patients were recorded. Six enthesis sites were evaluated using gray-scale and Doppler US with a linear transducer, and they were scored using the MASEI. They were assessed by the EULAR Sjögren's syndrome disease activity index (ESSDAI). RESULTS: We evaluated 40 patients with PSS (average age 48.67 ± 11.23 years) and 30 healthy controls (average age 45.40 ± 8.24 years). Patients with PSS had significantly higher MASEI scores than the healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendons were significantly thicker in the PSS group than in the healthy controls. The MASEI total score had a positive correlation with age. There was no correlation between MASEI total score and BMI and ESSDAI. CONCLUSION: In this study, it was shown that the MASEI scores assessed by US were significantly higher in patients with PSS than in healthy controls. Plantar fascia, Achilles tendon, and distal patellar tendon were significantly thicker in the PSS group than in the healthy controls. This result suggests that PSS may be one of the causes of musculoskeletal pain that can be seen in patients with PSS. Our study was the first study to use an enthesis index ultrasonographically in patients with PSS. In addition, it is the first study to investigate the relationship between the presence of enthesopathy and disease activity by means of US.

Comparison of 25-hidroksi Vitamin D serum concentrations in patients with psoriasis and psoriatic arthritis.

BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA), insulin-dependent diabetes mellitus (IDDM), inflammatory bowel disease, systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are some of the autoimmune diseases related to the decreases in Vitamin D levels. The same immunological properties as psoriasis, such as Th1/Th2 dysregulation, are seen in all of them. This study aims to compare 25-hidroksi Vitamin D (25-OHD) serum concentrations in patients with psoriasis and psoriatic arthritis. METHODS: This study includes 91 outpatients; 48 of these patients were chosen randomly among the psoriasis (PS) patients from the dermatology department of the researchers' hospital. Forty-three of them were chosen among the psoriatic arthritis (PsA) patients matching the age and gender criteria from the rheumatology department of the researchers' hospital. In this study, 25-OHD serum concentrations among the psoriasis and psoriatic arthritis patients were compared. RESULT: There are more patients in the PsA group with 25-OHD levels lower than 20 ng/ml; however, this finding is insufficient to obtain statistical significance (p= 0.09). PsA and psoriasis groups had similar numbers of patients with 25-OHD levels ranging from 20 to 30 mg/mL and those higher than 30 mg/mL (p> 0.05). CONCLUSION: The literature does not show significant differences between the PS and PsA groups in terms of serum 25-OHD levels and a prevalence of Vitamin D deficiency. Besides, PASI scores were higher in the PS group. CRP values in the PsA group were higher than in the PS group. There was a poor negative correlation between CRP and serum 25-OHD levels in the PsA group. This correlation was not found in the PS group.

Nailfold videocapillaroscopy results in patients with rheumatoid arthritis.

We aimed to analyse the nailfold capillaryscopy findings morphologically and examine their relationship with disease activity and demographic characteristics in patients with rheumatoid arthritis. In accordance with the 2010 ACR/EULAR classification criteria, 201 patients diagnosed with Romatoiad artrit (RA) and 50 healthy controls were included. We analysed capillaroscopic abnormalities such asmegacapillaries, haemorrhages, ramifications and avascular areas in patients affected with rheumatoid arthritis. The findings in our study are as follows: in 45.77% of the RA patients, there were nonspecific capillaryscopy findings. When compared to control group, the incidence of tortuosity, dilated capillary and bushy capillary was higher in RA patients (p values, respectively, 0.110, 0.330, 0.440 and 0.516). In RA patients with Raynaud's phenomenon, the incidence of nonspecific capillaryscopy findings was higher. While there is a weak relationship between tortuosity and the duration of disease, no significant relation was detected between capillaryscopy findings and parameters such as RF, anti-CCP positivity and disease activity score (DAS28). When compared to controls, we have detected that RA patients have more nonspecific capillaryscopic findings. We could not find a relationship between nonspecific capillaryscopic findings and RA'a clinical findings and laboratory parameters. There is a need for a long-term wider-scale follow-up study to investigate whether there is a capillaryscopic pattern that can be correlated with RA's clinical findings.

A rare case of neuro-Behçet's disease presenting with limbic encephalitis.

Behçet's syndrome is a recurrent systemic inflammation with an unknown etiology. The onset of the condition often occurs in the second decade of life and it is more common in males than in females. One of the most feared organ involvements associated with BS is neurological involvement, which often affects the brain stem, although hemispheric involvement may be primary in a limited number of patients. Parenchymal neurological involvement in BS affects the prognosis unfavorably, as it may result in severe sequelae or mortality. Early diagnosis and treatment is important to prevent sequelae. Herein, we report the first case of neuro-Behçet's disease presenting with limbic encephalitis who received early stage immunotherapy.

Levels of serum pentraxin 3, IL-6, fetuin A and insulin in patients with rheumatoid arthritis.

OBJECTIVE: The aim of this study was to investigate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6, insulin and HOMA-IR levels in patients with rheumatoid arthritis. METHODS: This study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were measured. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). To evaluate quality of life, the Health Assessment Questionnaire disability index was applied. RESULTS: The serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were found to be higher than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively). A positive correlation was evident between the DAS 28 score and IL6 levels (r=0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p<0.05). Fetuin A levels were positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032). CONCLUSION: Elevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of fetuin-A, insulin HOMA-IR, pentraxin-3, CRP and ESR were not associated with clinical severity of the RA.

The relationship between hand function, depression, and the psychological impact of trauma in patients with traumatic hand injury.

The aim of this study was to investigate the acute-stage and later-stage impacts of trauma on a patient, and to determine the relationship between the degree of the impact of the event and recovery of hand function in patients with traumatic hand injury. The functional status of patients was assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; psychological influence was assessed by the Beck Depression Inventory (BDI); and the impact of the event was assessed by the Impact of Event Scale-Revised (IES-R) both during the acute stage and at a later stage. Fifty-four patients completed the study. The DASH, BDI, and IES-R scores were significantly improved at a later stage compared with the acute stage (P<0.05). The DASH, BDI, and IES-R scores had significant positive correlations with each other in both the acute stage and later stage (P<0.05). In the linear regression analysis, the independent variables affecting the DASH score at a later stage were the DASH and IES-R scores in the acute stage (P<0.05), whereas depression scores had no effect on functional outcome (P>0.05). Our study suggests that depression status, functional status of the hand, and impact of the event improve at a later stage, and that the functional outcome at a later stage is affected by the degree of impact of the event, and the functional status of the hand in the acute stage, in patients with traumatic hand injury.

Blind or ultrasound-guided corticosteroid injections and short-term response in subacromial impingement syndrome: a randomized, double-blind, prospective study.

OBJECTIVE: The aim of this study was to compare the accuracy of blind vs. ultrasonography-guided corticosteroid injections in subacromial impingement syndrome and determine the correlation between accuracy of the injection location and clinical outcome. DESIGN: Forty-six patients with subacromial impingement syndrome were randomized for ultrasonography-guided (group 1, n = 23) and blind corticosteroid injections (group 2, n = 23). Magnetic resonance imaging analysis was performed immediately after the injection. Changes in shoulder range of motion, pain, and shoulder function were recorded. All patients were assessed before the injection and 6 wks after the injection. RESULTS: Accurate injections were performed in 15 (65%) group 1 patients and in 16 (70%) group 2 patients. There was no statistically significant difference in the injection location accuracy between the two groups (P > 0.05). At the end of the sixth week, regardless of whether the injected mixture was found in the subacromial region or not, all of the patients showed improvements in all of the parameters evaluated (P < 0.05). CONCLUSIONS: Blind injections performed in the subacromial region by experienced individuals were reliably accurate and could therefore be given in daily routines. Corticosteroid injections in the subacromial region were very effective in improving the pain and functional status of patients with subacromial impingement syndrome during the short-term follow-up.