The efficacy of balance and proprioception exercises in female patients with knee osteoarthritis: A randomized controlled study.

OBJECTIVE: Loss of proprioception and balance disorders are commonly observed in patients with knee osteoarthritis. In this study, we aimed to investigate the effects of balance and proprioception exercises in patients with knee osteoarthritis. DESIGN: A single-center randomized trial with three parallel arms. SETTING: A tertiary health care facility in Turkey. PARTICIPANTS: Female patients with knee osteoarthritis aged 40-70 years. INTERVENTIONS: Ten-week exercise program in Biodex training, classical balance training and isometric strengthening groups. MAIN MEASURES: Dynamic balance (overall stability index and the modified Clinical Test of Sensory Interaction and Balance), pain (visual analogue scale), physical function (30-s chair stand test and 40-meter fast-paced walk test) and quality of life (Knee Injury and Osteoarthritis Outcome Score). RESULTS: Eighty-nine patients enrolled in the study. The Biodex training group, the classical training group, and the control group had overall stability index values of 1.0 ± 0.07, 1.4 ± 0.07 and 1.4 ± 0.07, and the Modified Clinical Test of Sensory Interaction and Balance - Condition-3 values of 0.7 ± 0.04, 0.9 ± 0.04 and 0.9 ± 0.04 respectively, at the end of treatment. In terms of pain scores on movement, each group showed significant improvement compared to their baseline, and the classical balance training group had better scores than the control group. No other significant difference was found between the groups. Physical function and quality of life outcomes showed significant main effects only in the time factor. CONCLUSIONS: Balance and proprioception exercises may have positive effects on dynamic balance and pain. The effects on physical function and quality of life should be investigated in further studies with larger sample.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis.

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

OBJECTIVES: To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). METHODS: A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. RESULTS: Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. CONCLUSIONS: Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

A randomized controlled trial of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in the treatment of fibromyalgia.

Background: In addition to pharmacological treatment, psychotherapeutic approaches are recommended for the treatment of fibromyalgia. There is a suggestion that eye movement desensitization and reprocessing (EMDR) therapy may be effective. This study aimed to investigate the impact of EMDR therapy on fibromyalgia symptoms, depression, sleep quality, and traumatic stress in fibromyalgia patients through a randomized controlled study (RCT). Materials and methods: The sample for this study comprised 79 individuals diagnosed with fibromyalgia. Participants were randomly assigned to two groups: the "Treatment as Usual" (TAU) group and the TAU + EMDR group. Prior to the study and at six different time points (before starting the study, at the end of the 5th, 10th, and 15th sessions, 1 month later, and 3 months later), participants completed assessments, including the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), Fibromyalgia ACR 2010 Diagnostic Criteria [Widespread Pain Index (WPI) and Symptom Severity Scale (SSS)], Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Trauma Symptom Checklist-40 (TSC-40). Results: There were no differences in the sociodemographic variables between the study and experimental groups. Analysis of variance revealed a statistically significant group effect on VAS (p = 0.019), WPI (p = 0.018), BDI (p = 0.019), and TSC-40 (p = 0.21). After applying Bonferroni correction, EMDR was found to be effective for VAS, WPI, SSS, BDI, PSQI, and TSC-40 (p <0.05). Conclusion: The results of the current study suggest that EMDR therapy is a viable alternative treatment for fibromyalgia. We believe these findings offer robust evidence supporting the efficacy of EMDR therapy in treating fibromyalgia, particularly in the context of a randomized controlled trial (RCT). The application of EMDR therapy for the treatment of patients with fibromyalgia is likely to be beneficial. Clinical trial registration: ClinicalTrials.gov, identifier NCT06265194.

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.

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.

Effects of an exercise program combining unsupervised home exercises and supervised group-based exercises on fall-related variables in older adults: a randomized controlled trial.

PURPOSE: The aim was to measure the effects of the home exercises supported with supervision on the fall-related variables in older people. METHODS: Seventy-five individuals over the age of 65 were enrolled. They were allocated to a "minimally supervised home exercise group" (group 1) or a "home exercise group" (group 2). Falls efficacy, fear of falling (FOF), fall risk, functional mobility, balance performance, and depression were assessed using the Falls Efficacy Scale International (FES-I), visual analog scale (VAS-FOF), the Elderly Falls Screening Test (EFST), the Timed Up and Go Test (TUGT), Tinetti's Balance Performance Oriented Mobility Assessment (BPOMA), and the Geriatric Depression Scale Short Form (GDS-SF), respectively. Participants performed a four-day weekly exercise program for eight weeks. Group 1 was supervised one day per week on a group basis. RESULTS: Results are based on 75 subjects (group 1 n = 37, group 2 n = 38). Analysis of variance revealed significant interactions only for FES-I, VAS-FOF, TUGT, and BPOMA. The difference between groups was significant only for TUGT score; group 1 had better scores at 8 weeks and 6 months. FES-I, VAS-FOF, and BPOMA were significantly improved in both groups. EFST and GDS improved in the total sample but not at the group level. CONCLUSION: Supervised home exercise seems to be superior only for functional mobility (TUGT). Further studies with a larger sample are needed to draw conclusions about depression and fall risk. The intervention was feasible and atendible. TRIAL REGISTRATION: ClinicalTrials.gov" NCT05337839. Retrospectively registered.

The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study.

Objectives: This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods: Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results: The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion: In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

Effects of home-based exercise program on the functional status and the quality of life in patients with rheumatoid arthritis: 1-year follow-up study.

We previously reported the efficacy of a 4-week home-based exercise therapy for patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether short-term improvements in the functional status and quality of life were maintained at 1 year. Patients who completed 4-week home-based exercise program were advised to maintain the same exercises for 1 year duration. Changes of functional status and quality of life in patients with RA were evaluated by the Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Scale (RAQoL). The change of the variables at the different time points (baseline, 4 weeks, and 1 year) was assessed by the repeated measure of ANOVA test with Geisser-Greenhouse correction. Pairwise ANOVA comparisons adjusted using the Bonferroni correction were conducted. Twenty-eight (63.6%) of 44 patients were available for follow-up at 1 year. The results of repeated measure ANOVA showed that there was a statistically significant difference between three assessments in the HAQ (P = 0.015) and RAQoL (P = 0.037) scores at the end of the follow-up. Improvements in the functional status and health-related quality of life at 4 weeks were maintained at 1-year follow-up. In conclusion, we observed significant improvements in the functional status and health-related quality of life by 4-week home-based exercise program. Furthermore, these improvements were maintained at 1-year follow-up. Further studies are needed to confirm the usefulness of the home-based exercise therapy.

Peer-led education or booklet for knowledge transfer about disease: A randomized-controlled trial with ankylosing spondylitis patients.

Objectives: This study aims to investigate whether peer-led group education + booklet is superior to booklet only to increase ankylosing spondylitis (AS) patients' knowledge about their disease. Patients and methods: A total of 56 patients (46 males, 10 females; mean age 41.9±9.2 years; range, 22 to 58 years) with a definite diagnosis of AS who were under follow-up in our outpatient clinic between August 2010 and January 2012 were included in this study. The patients were randomly allocated to the peer-led education + booklet (education group, n=27) and booklet only (control group, n=29). To assess the level of patients' knowledge, a patient knowledge questionnaire containing four domains was used. Evaluations were made at baseline, four weeks, and six months. The variables were "number of correct choices" (NoCC), "number of correct items" (NoCI) and percent of correct choices for each domain; the later one was resembled by the name of that domain (area A, area B, etc.). Results: The variables that improved in both groups were NoCC, NoCI, and "pharmacotherapy and physical therapy area" (area C). These improvements were similar between the groups (respectively, p=0.915, p=0.830, p=0.791). Conclusion: Reading a booklet alone is as successful as peer-led education + booklet for knowledge transfer about their disease in patients with AS. In this study, the most knowledge gain was achieved in "drug treatment and physical therapy" area.

Disability and health-related quality of life after breast cancer surgery: relation to impairments.

BACKGROUND: The aim of this study was to determine the prevalence of impairments relevant to upper extremity following breast cancer surgery and its impact on disability and health-related quality of life. METHODS: Sixty-seven female patients being treated with modified radical mastectomy or breast conserving surgery were included. They were evaluated for impairments (arm edema, loss of handgrip strength, limited shoulder joint range of motion, and pain), physical disability using the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and for health related quality of life by means of the functional assessment of cancer therapy-breast+4 (FACT-B+4). RESULTS: The most common impairment observed was arm pain on motion; the cause of 20% variance in disability score (r = 0.203, P = 0.000). Arm pain on motion, anterior chest wall pain, loss of grip strength, and shoulder flexion were significant factors in different domains of quality of life according to the FACT-B+4 questionnaire. CONCLUSION: Pain relief should be the priority of treatment along with the prevention of joint movement restriction to ensure a sufficient quality of life for surgically treated breast cancer patients.

Dextrose Prolotherapy Versus Normal Saline Injection for the Treatment of Lateral Epicondylopathy: A Randomized Controlled Trial.

Objective: To compare the effect of dextrose prolotherapy (DPT) with saline in the treatment of chronic lateral epicondylopathy (LE). Design: Triple-blinded randomized controlled trial. Setting: Physical medicine and rehabilitation outpatient clinic. Subjects: Sixty cases of chronic LE participants were included in the study. Methods: Participants were randomly divided into two groups as DPT and normal saline. Saline or hypertonic dextrose (15%) was injected at the baseline, and at the end of the 4th and 8th week. Assessments were performed at baseline, and at the end of the 4th, 8th, and 12th week. Outcome measures: Primary outcome measures were Visual Analog Scale (VAS) for pain, Patient Rated Tennis Elbow Evaluation (PRTEE-Total [PRTEE-T], PRTEE-Pain, PRTEE-Function); secondary outcome measures were Disabilities of the Arm, Shoulder, and Hand Score (DASH) and pain-free handgrip strength. Results: Intragroup analysis demonstrated that both groups significantly improved in VAS, PRTEE, DASH scores, and handgrip strength during the study period (p < 0.001, for all outcome measurements in both groups). Intergroup analysis showed that PRTEE-T score changes between baseline-4th and -12th week; VASrest change between baseline and 4th week in the DPT group were significantly higher than the saline group (p = 0.041, p = 0.038, p = 0.013 respectively). There was no significant difference between groups in VAS, DASH scores, and handgrip strength between any time points, in terms of improvement (p > 0.05). Conclusion: Our study results showed that DPT outperformed saline in PRTEE-T score. Although saline seems to be a comparable clinical effect with DPT, further studies comparing the effects of saline injection and DPT are necessary, in chronic LE.

Validation of the Turkish version of the foot and ankle outcome score.

The objective is to develop a Turkish version of the foot and ankle outcome score (FAOS) and to investigate its validity and reliability. The Turkish version of FAOS was developed after the translation and back-translation. The translated version was pretested on 20 patients with rheumatoid arthritis. Then, the Turkish FAOS was administered to 55 patients having foot and ankle problems. They were also evaluated by using the four subscales of the Turkish version of AIMS2, and the Turkish version of SF-36 questionnaire to test validity. Fifty patients filled out the FAOS for second time to determine test­retest reliability. Construct validity was investigated with use of Spearman's rank correlation coefficient. Test­retest reliability was assessed with use of the intraclass correlation coefficient (ICC) and Cronbach's alpha score. The psychometric properties of the Turkish FAOS were generally similar to the original FAOS. The random ICC for the five subscales ranged from 0.70 to 0.96. The Cronbach's alpha coefficient ranged from 0.79 to 0.97. Construct validity of the FAOS was good. The Turkish FAOS correlated with the SF-36 and AIMS2 scales. The Turkish version of FAOS was valid and reliable instrument to assess the foot and ankle related problems. However, to assess its responsiveness further studies are needed.

Kinesio taping versus dry needling in the treatment of myofascial pain of the upper trapezius muscle: A randomized, single blind (evaluator), prospective study.

BACKGROUND: Although a number of therapeutic interventions for trigger-point inactivation have been studied, it remains controversial which intervention is better. OBJECTIVE: To compare the effectiveness of the kinesio taping and dry needling methods in patients with trigger-point related myofascial pain syndrome of the upper trapezius muscle. METHODS: A total of 42 patients were randomly allocated to the kinesio taping group (n= 23) and dry needling group (n= 19). The patients were assessed for pain, pressure pain threshold (PPT), cervical range of motion (CROM), and function at baseline, at short- and medium-term stages after treatment. To investigate the effects of the interventions over time, two-way repeated measures analysis of variance (ANOVA) was used. RESULTS: There was a significant improvement in pain intensity at rest and cervical motion, in the PPT readings (p< 0.05), in CROM (p< 0.05), and in function (p< 0.05) in both groups, with no superiority either (p> 0.05). CONCLUSIONS: Kinesio taping may be a choice of trigger point inactivation in patients who do not want to be needled or who show contraindication(s) to treatments other than kinesio taping.

Assessment of subclinical atherosclerotic cardiovascular disease in patients with ankylosing spondylitis.

OBJECTIVE: The aim of the present study was to compare patients with ankylosing spondylitis (AS) with healthy controls with respect to subclinical atherosclerotic cardiovascular disease (CVD). METHODS: A total of 44 patients with AS with no history of CVD, diabetes mellitus, hypertension, chronic kidney disease, and lipid-lowering drug use were compared with 40 age- and sex-matched healthy controls with respect to carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), which are surrogate markers of subclinical atherosclerosis. Correlation analysis was also performed to examine the association between surrogate markers and disease activity with inflammation [Ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP)]. RESULTS: In addition to age and sex, both groups were comparable with respect to cigarette smoking, body mass index, and high-density lipoprotein cholesterol (p=0.425, p=0.325, and p=0.103, respectively). The level of total cholesterol was significantly lower in patients with AS (p=0.002). Nonsteroidal anti-inflammatory drug and tumor necrosis factor alpha inhibitor use ratios in patients with AS were 79.5% and 65.9%, respectively. There was no significant difference between both groups regarding PWV and CIMT (p=0.788 and p=0.253, respectively). In patients with AS, there was a significant correlation between ASDAS-CRP and CIMT (r=0.315, p=0.038), but the correlation between ASDAS-CRP and PWV was not significant (r=-0.183, p=0.234). CONCLUSION: The results of the present study could not provide sufficient evidence whether disease activity with inflammation caused subclinical atherosclerotic CVD in patients with AS without overt CVD. The increased atherosclerotic CVD risk is most probably multifactorial in patients with AS, but the extent of the contribution of disease activity with inflammation to increased atherosclerosis is controversial.

Management of Psoriatic Arthritis: Turkish League Against Rheumatism (TLAR) Expert Opinions.

OBJECTIVES: This study aims to establish the first national treatment recommendations by the Turkish League Against Rheumatism (TLAR) for psoriatic arthritis (PsA) based on the current evidence. PATIENTS AND METHODS: A systematic literature review was performed regarding the management of PsA. The TLAR expert committee consisted of 13 rheumatologists and 12 physical medicine and rehabilitation specialists experienced in the treatment and care of patients with PsA from 22 centers. The TLAR recommendations were built on those of European League Against Rheumatism (EULAR) 2015. Levels of evidence and agreement were determined. RESULTS: Recommendations included five overarching principles and 13 recommendations covering therapies for PsA, particularly focusing on musculoskeletal involvement. Level of agreement was greater than eight for each item. CONCLUSION: This is the first paper that summarizes the recommendations of TLAR as regards the treatment of PsA. We believe that this paper provides Turkish physicians dealing with PsA patients a practical guide in their routine clinical practice.

Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations.

OBJECTIVES: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. PATIENTS AND METHODS: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. RESULTS: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. CONCLUSION: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.

Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis.

OBJECTIVES: This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloArthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. PATIENTS AND METHODS: A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. RESULTS: Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. CONCLUSION: Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.

The relationship between severity and extent of spinal involvement and spinal mobility and physical functioning in patients with ankylosing spondylitis.

The present study was undertaken to determine the relationship between spinal radiological changes of ankylosing spondylitis (AS), spinal mobility, and physical functioning. Thirty-one patients diagnosed as AS according to the modified New York criteria for AS were included in this study. Three radiographic scoring methods were used to assess spinal damage. Severity of spinal involvement was assessed by using Stoke Ankylosing Spondylitis Spine Score (SASSS) and Bath Ankylosing Spondylitis Radiographic Index-Spine (BASRI-S). To assess the extent of spinal involvement, the total number of vertebrae showing radiological findings attributable to AS [number of vertebrae involved (NoVI)] was calculated according to the AS grading system defined by Braun et al. Statistical analysis, consisting of bivariate correlation, Spearman correlation, and multiple linear regression analysis, was performed using Windows Statistical Package for the Social Sciences 13.0. NoVI was negatively correlated with modified Schober and lateral spinal flexion and was positively correlated with occiput-to-wall distance and BASMI. SASSS was negatively correlated with the modified Schober. BASRI-S was negatively correlated with the modified Schober and positively correlated with BASMI. When BASMI and Bath Ankylosing Spondylitis Functional Index were taken as dependent variables, only the NoVI was found to be associated with BASMI. In our data, the extent of spinal involvement (NoVI) showed a more significant correlation with spinal measurements such as modified Schober and BASMI as compared with the other radiologic scores (SASSS and BASRI-S). Furthermore, because only the NoVI was found to be associated with BASMI, we can conclude that the extent of spinal involvement, which also includes thoracic vertebrae, affects spinal measurements.

Impact of peer-led group education on the quality of life in patients with ankylosing spondylitis.

OBJECTIVES: To determine the effect of peer-led group education on the quality of life and depression in patients with ankylosing spondylitis (AS). METHODS: Eighty patients with definite AS were allocated randomly to either the education or control group. The education group (n = 40) was subjected to a peer-led group education program about disease and was given an educational booklet, while the control group (n = 40) was given the educational booklet only. Levels of quality of life and depression were measured at baseline, immediately after education (fourth week) and at 6 months in both groups. RESULTS: The results are based on 56 (n = 27, education group; n = 29, control group) patients. The level of quality of life and depressive symptoms were not changed except for a deterioration in the social functioning subgroup of Short From (SF)-36 in both groups. When the groups were compared, there were no significant differences between changes in social functioning scores. CONCLUSIONS: Peer-led education did not alter quality of life levels and depression scores. However, because of the maintainance of quality of life levels, this type of intervention may be considered as a supplementary intervention to the standard medical care for management of AS.