Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) > or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

Comparison of functional disability scales and their relevance to radiological progression in patients with rheumatoid arthritis in remission.

OBJECTIVE: To look for any correlations between radiological scores and hand functions evaluated with two different methods in patients with rheumatoid arthritis in remission. METHODS: Forty-two patients diagnosed with rheumatoid arthritis (RA) in remission according to ACR criteria were assessed for their hand functions with Duruöz's Hand Index (DHI), and with Sollerman Function Test (SHFT) as well as with Health Assessment Questionnaire (HAQ). Hand X-rays were evaluated according to Modified Sharp Index; joint space narrowing score (JSNS), erosion score (ES), and total score (TS) were calculated. The X-rays were assessed by the same rheumatologist three times. RESULTS: Mean HAQ score, mean DHI score and mean SHFT scores were 0.88+/-0.68, 17.74+/-17.81, 72.24+/-9.23 respectively. Radiologic scores were as follows: JSN 35.04+/-28.14, ES 25.19+/-36.23, TS 60.26+/-66.21. Intraobserver reliability was high (r=0,98). There was a positive correlation between HAQ and DHI (p<0.001), a negative correlation between SHFT. There was also a negative correlation between DHI and SHFT. The correlations between JSNS, ES and TS with respect to HAQ and SHFT were strong (p<0.0001) along with DHI (p<0.05). CONCLUSION: HAQ was found correlated with DHI and SHFT. Modified Sharp scores were found correlated with the general disability and hand functions. SHFT, with respect to DHI, takes a longer period of time, depends on equipment and needs an observer. On the contrary, DHI offers a more practical and economical way of assessment.

Protracted febrile myalgia of familial Mediterranean fever.

Protracted febrile myalgia (PFM) includes severe myalgia of the upper and lower extermities accompanied by fever lasting up to 6 weeks, an elevated erythrocyte sedimentation rate and leucucytosis. We report a 13-year-old girl with PFM, and discuss the magnetic resonance imaging findings of the involved calf muscles. To our knowledge these are the only images of the pathology in the literature.

Coexistence of ankylosing spondylitis and Behcet's disease. Two cases with atypical presentation and course.

The prevelance of ankylosing spondylitis or sacroiliitis in Behcet's disease has been the subject of debate for some time. Two cases with atypical presentation and course are discussed. The first patient was a young woman with Behcet's disease whose primary complaint was neck pain. X-ray examination showed severe cervical involvement, characteristic of the type seen in women with ankylosing spondylitis. She subsequently developed anterior uveitis. The second patient was a man suffering from back pain and limited movement of his neck and back. When he was referred to our outpatient clinic, his severe anemia became the subject of the whole investigation. He was diagnosed with Behcet's disease with ankylosing spondylitis accompanied with amyloidosis and an end-stage renal failure.