The prevalence and clinical spectrum of post-Covid syndrome in patients with rheumatic diseases: a single-center experience.

Post-coronavirus disease (COVID) syndrome (PCS) is a term used to describe the clinical condition of patients who have recovered from COVID-19 but are still experiencing prolonged effects of infection or persistent symptoms for longer than expected. Although PCS has been previously studied in the general population, it has not been investigated in a specific population of patients with inflammatory rheumatic disease (IRD). This study aims to evaluate the presence and frequency of PCS among our rheumatology outpatients. This is a cross-sectional study of patients with IRD whose symptoms persisted for 12 weeks after the detection of COVID-19 infection. The patients were assessed with a survey form during their routine clinic follow-up or by contacting them by phone. Patients' demographics, diagnosis, medication, comorbidities, outcome of COVID-19, and symptoms related to PCS were collected. Fifty-three patients with IRD and COVID (mean age: 48.5 13.99 years, 71.7% women) were included. PCS was observed in 36 (67.9%) patients. Twenty-two (41.5%) of them had three or more symptoms; 14 (26.4%) had one or two symptoms. Although more than 30 symptoms were detected, the most frequent were fatigue and weakness. No significant relationship was detected between the development of PCS and gender, age, disease duration, presence of COVID-related complications, and the need for oxygen support, except for smoking which showed a protective effect (p=0.008). PCS was detected in more than half of the patients. There was no independent risk factor for the development of PCS, except smoking.

Elaboration of the preliminary Rheumatoid Arthritis Impact of Disease (RAID) score: a EULAR initiative.

BACKGROUND: Current response criteria in rheumatoid arthritis (RA) usually assess only three patient-reported outcomes (PROs): pain, functional disability and patient global assessment. Other important PROs such as fatigue are not included. OBJECTIVE: To elaborate a patient-derived composite response index for use in clinical trials in RA, the RA Impact of Disease (RAID) score. METHODS: Ten patients identified 17 domains or areas of health relevant for inclusion in the score, then 96 patients (10 per country in 10 European countries) ranked these domains in order of decreasing importance. The seven most important domains were selected. Instruments were chosen for each domain after extensive literature research of psychometric properties and expert opinion. The relative weight of each of the domains was obtained from 505 patients who were asked to "distribute 100 points" among the seven domains. The average ranks of importance of these domains were then computed. RESULTS: The RAID score includes seven domains with the following relative weights: pain (21%), functional disability (16%), fatigue (15%), emotional well-being (12%), sleep (12%), coping (12%) and physical well-being (12%). Weights were similar across countries and across patient and disease characteristics. Proposed instruments include the Health Assessment Questionnaire and numerical ratings scales. CONCLUSION: The preliminary RAID score is a patient-derived weighted score to assess the impact of RA. An ongoing study will allow the final choice of questionnaires and assessment of validity. This score can be used in clinical trials as a new composite index that captures information relevant to patients.

Prevalence of IgA-antiendomysial antibody in a patient cohort with idiopathic low bone mineral density.

AIM: To investigate the frequency of serum IgA-antiendomysial antibody positivity in patients with low bone mineral density and to assess the risk group for screening of celiac disease. METHODS: One hundred and thirty-five patients (14 male, 121 female) with idiopathic low bone mineral density were evaluated. The median age was 57.2 years (24-81). Antiendomysial antibody was determined by the immunofluorescence method using a commercial kit (INOVA Diagnostics Inc., CA, USA), which employs a 5 microm thin cryostat section of monkey esophagus as a substrate. RESULTS: Of the 135 patients evaluated, 13 were found to have positive IgA antiendomysial antibody test (9.6%) response. None of the patients had IgA deficiency. Endoscopic appearance and histological examination were normal in all of these patients. Seropositive patients had significantly lower age (48.9 +/- 4.3 vs 59.2 +/- 6.2, P < 0.05), higher ratio of male gender (61.5% vs 4.9%, P < 0.01) and pre-menopausal status (8.7% vs 1.3%, P < 0.01). Lumbar spine and femoral neck z-scores, but not t-scores were significantly lower in seropositive patients. Seropositive patients had lower serum 25 (OH) vitamin D, calcium and higher serum parathormone levels than seronegative patients. CONCLUSION: The screening of celiac disease in idiopathic osteoporosis should be restricted to patients without classical risk factors (younger, pre-menopausal, male gender) for osteoporosis. Bone mineral density measurements using z-scores should be considered for identifying risk groups for celiac disease.

The effects of early aerobic exercise after single-level lumbar microdiscectomy: a prospective, controlled trial.

AIM: Although several rehabilitation programs to improve functioning and pain after lumbar microdiscectomy have been suggested, little is known about the most effective exercise program. We aimed to investigate the effects of aerobic exercise program starting one month after single-level lumbar microdiscectomy on pain and functioning. DESIGN: Prospective, non-randomized, controlled trial. SETTING: Outpatient clinic. POPULATION: Forty patients with single-level first-time lumbar microdiscectomy were included in the study. Eighteen patients were allocated to the aerobic exercise group while 22 patients to the control group. METHODS: Both groups were given the same home exercise program. The exercise group received 20 sessions of treadmill exercise one month after the surgery in addition to the home exercise program. Low back pain and leg pain of the patients were evaluated by Visual Analogue Scale score (VAS), functioning was evaluated by Roland-Morris Disability Index (RMDI), anxiety and depressive symptoms were evaluated by Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Patients were evaluated within the last week before surgery, at the postoperative II and VIII month. RESULTS: Significant improvements of low back pain VAS, leg pain VAS, functioning score, BAI score, BDI score were found in both groups after surgery (P<0.05). There was no significant difference in pain score, BAI score, BDI score change at II and VIII months between the groups (P>0.05). Functional improvement was significantly more pronounced in the aerobic exercise group than in the control group at the end of the aerobic exercise program (P<0.05). However, there was no significant difference in the numeric change of RMDI scores at VIII month (P>0.05). CONCLUSION: The results of this study showed that aerobic exercise starting one month after first time single-level lumbar microdiscectomy resulted in a more pronounced functional improvement than the home exercise program during the exercise sessions. It was seen that functional recovery did not last when exercise program was discontinued. CLINICAL REHABILITATION IMPACT: We suggest that suitable patients with single-level microdiscectomy should be encouraged to participate in aerobic exercise program one month after the surgery to regain functioning.