The frequency and factors affecting anxiety and depression in patients with rheumatoid arthritis.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease. Anxiety and depression are important problems in patients with RA. The aim of this study was to determine the frequency and the factors affecting depression and anxiety in patients with RA. Material and methods: One hundred and eighty-two patients with RA, aged 18-85 years, were included in this study. The diagnosis of RA was established according to ACR/EULAR RA classification criteria from 2010. Psychosis, pregnancy, breastfeeding and malignancy were exclusion criteria. The demographic data as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), Health Assessment Questionnaire (HAQ) score and the Hospital Anxiety and Depression Scale (HADS) were the parameters used in the analysis. Results: Depression symptoms were present in 50.3%, anxiety in 25.3% of the studied patients. In patients with depression and/or anxiety HAQ and DAS28 scores were higher than other studied RA patients. Depression was determined at significantly higher rates in females, housewives and those with a low education level. Anxiety was determined significantly more often in blue-collar workers. Conclusions: In the present study, depression and anxiety were observed at high rates in patients with RA. These results confirm the real problem in RA patients in comparison to the general population. This points to the relationship between inflammation and depression and anxiety. Psychiatric evaluations and mental status assessment should not be forgotten together with physical examinations of RA patients.

Evaluating the relationship between ankylosing spondylitis and periodontal disease: a case-control study.

OBJECTIVES: This study aimed to determine the possible relationship between periodontal disease and ankylosing spondylitis (AS) by evaluating clinical periodontal measurements and gingival crevicular fluid (GCF) levels of sclerostin, interleukin-1ß (IL-1ß), and matrix metalloproteinase-8 (MMP-8) levels. MATERIALS AND METHODS: Twenty-eight patients with AS (AS group) and 28 systemically healthy controls (C group) were enrolled in this study. Full-mouth periodontal measurements: plaque index, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were obtained from all patients. AS-related parameters were included in the data analyses. An enzyme-linked immunosorbent assay determined GCF IL-1ß, MMP-8, and sclerostin levels. RESULTS: There were no significant differences in the clinical periodontal measurements between the two groups (p > 0.05). Interestingly, patients with AS had significantly lower GCF sclerostin levels than the C group (p < 0.05). But there were no statistical differences in the GCF levels of IL-1ß and MMP-8 between the two groups (p > 0.05). Serum C-reactive protein (CRP) levels strongly correlated with both BOP (r = 0.497, p < 0.05) and PPD (r = 0.570, p < 0.05) in the AS group. Bath AS Metrology Index (BASMI) also positively correlated with both BOP (r = 0.530, p < 0.05) and CAL (r = 0.568, p < 0.05). Similarly, Maastricht Ankylosing Spondylitis Enthesis Score (MASES) strongly correlated with both BOP (r = 0.487, p < 0.05) and CAL (r = 0.522, p < 0.05). CONCLUSION: These results suggest that the patient's systemic condition may influence local sclerostin levels in GCF, and the strong correlations between periodontal measurements and AS-related parameters may indicate an interrelationship between inflammatory periodontal disease and AS. CLINICAL RELEVANCE: The present study provides important information concerning the relationship between periodontal disease and ankylosing spondylitis. TRIAL REGISTRATION: Thai Clinical Trials.gov (TCTR20200908001) (08. September 2020).

Relationship between periodontal status and disease activity in patients with ankylosing spondylitis.

OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the spine and sacroiliac joints, characterized by enthesitis. Recent studies have investigated the relationship between AS and periodontitis. The aim of this study was to evaluate the periodontal status of patients with AS and to determine the factors affecting this. MATERIAL AND METHODS: The study included 200 AS patients, of which 129 were taking anti-tumour necrosis factor (TNF) drugs and 71 were taking non-steroid anti-inflammatory drugs (NSAID). Patients did not change their medication during the study. Disease activity was evaluated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), mobility with the Bath Ankylosing Spondylitis Metrology Index (BASMI), functional status with the Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis with the integrated Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and quality of life with the Ankylosing Spondylitis Quality of Life (ASQoL) scale. Data related to erythrocyte sedimentation rate, and C-reactive protein were recorded from the hospital information system. The plaque index (PI), gingival index (GI), pocket depth (PD), attachment level (CAL) measurements, and bleeding index (BOP) were measured. RESULTS: The results showed that 35.5% of the AS patients had periodontitis, at a lower rate in the anti-TNF group than in the NSAID group, but the difference was not statistically significant. Periodontitis-related factors were found to be age, BASFI and BASMI. A significant relationship was found between MASES and BOP and GI. CONCLUSIONS: This suggests that periodontitis may be an enthesis in AS. Nevertheless, further studies are needed to explain the mechanism of periodontitis in AS patients.

The course of COVID-19 in patients with Behçet's disease.

OBJECTIVES: To evaluate the frequency and clinical course of coronavirus disease 2019 (COVID-19) in patients with Behçet's disease (BD). MATERIAL AND METHODS: The study included patients diagnosed with BD according to the International Study Group for BD criteria who were being followed up in the Dermatology and Rheumatology clinics. Patients who applied to Rheumatology and Dermatology clinics and were not diagnosed with any rheumatological disease were taken as the control group. The medical records of the patients were examined retrospectively. A record was made of age, gender, additional systemic disease, for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), colchicine treatment dose, whether or not a polymerase chain reaction (PCR) test was performed, disease course in patients diagnosed with COVID-19, length of stay in hospital, and the need or not for intensive care unit (ICU) admission. RESULTS: Evaluation was made of 203 BD patients and a control group of 200 individuals. No difference was determined between the groups in respect of age and gender (respectively p = 0.348, p = 0.828). A polymerase chain reaction test for the SARS-CoV-2 was applied to 56 patients in the BD group, and 18 were reported positive, and to 80 subjects in the control group, of which 32 were determined positive. No difference was determined between the groups in terms of PCR test positivity (p = 0.321). No significant difference was determined between the groups in length of stay in hospital, lung involvement, ICU admissions, and mortality rates (respectively p = 0.684, p = 1.000, p = 0.503, p = 1.000). In the BD patient group, in all the parameters there was no significant difference between those who were positive or negative for COVID-19. CONCLUSIONS: The results of this study showed no increased risk for BD patients compared to the normal population in respect of the frequency of SARS-CoV-2 infection, length of hospital stay, lung involvement, ICU admission and mortality.

Accelerated Nodulosis in a Patient With Rheumatoid Arthritis.

In patients with rheumatoid arthritis (RA), subcutaneous nodules are the most frequently seen extra-articular findings that are seen in areas of extensor pressure. In this article, we present the case of a RA patient with accelerated nodulosis that started with the use of methotrexate and exacerbated with etanercept and leflunomide treatment.

Laugier-Hunziker syndrome in a patient with rheumatoid arthritis.

Laugier-Hunziker syndrome is a rare benign idiopathic condition characterized by acquired macular pigmentation of the lips and buccal mucosa, often accompanied by melanonychia. Although the etiopathogenesis is not fully known, tyrosine is thought to be responsible for the pathogenesis of enzyme hyperactivity in melanin biosynthesis. We present the case of a 66-year-old woman diagnosed with Laugier-Hunziker syndrome and rheumatoid arthritis.

Coexistence of ankylosing spondylitis and discoid lupus: A case report.

Coexistence of ankylosing spondylitis with connective tissue diseases is very rare. Here, in this study, we describe a coexistence of ankylosing spondylitis and discoid lupus erythematosus in a 35-year-old man. He presented with a 5-year history of low back pain and concurrent development of a discoid rash. Inflammatory low back pain, HLA-B27 positivity and bilateral active sacroiliitis confirmed the diagnosis of ankylosing spondylitis. Discoid lupus erythematosus was diagnosed based on a skin biopsy. There are reports of discoid lupus associated with medications, particularly with tumour necrosis factor-alpha (TNF-α) blocking drugs. However, the patient presented here had coexistence of ankylosing spondylitis and discoid lupus before starting such treatments.

Reactive arthritis following tetanus vaccination: a case report.

We report a case of reactive arthritis following tetanus vaccination. A healthy 55-year-old woman presented with pain and acute swelling of the right knee two days after receiving a tetanus vaccination. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor and human leukocyte antigen B-27 were negative. Her arthritis improved with the administration of nonsteroidal anti-inflammatory drugs. One week later the knee swelling and pain had settled. Reactive arthritis may occur after tetanus vaccination.