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Palindromik romatizma (PR), eklemlerde kalıcı hasara neden olmaksızın alevlenmeler şeklinde ağrı, şişlik ve eritem ile karakterize klinik bir sendromdur. Literatürde, PR hastalarının %39-68’inde Romatoid faktör (RF) ve antisiklik sitrüline peptid (anti-CCP) antikor pozitifliği bulunmaktadır. Literatürde seropozitif ve seronegatif PR hastalarının klinik özelliklerini karşılaştıran çok az çalışma olup hala aydınlatılmamış birçok nokta vardır. Bu çalışmada kliniğimizde takipli PR tanılı hastaların demografik ve klinik özelliklerinin değerlendirilmesi, seropozitif ve seronegatif PR hastalarının karşılaştırılması planlandı. Çalışma retrospektif, kesitsel bir çalışma olarak tasarlandı. Otuz bir hasta tarandı ve dahil etme ve dışlama kriterlerini karşılayan 21 hasta çalışmaya alındı. Hastaların ortanca yaşı 43 yıl, ortanca takip süreleri 18 ay ve ortanca alevlenme süresi 3 gündü. Seronegatif grupta 12 hasta yer alırken seropozitif grupta 9 hasta mevcuttu. Seropozitif grubun ortanca yaş değeri daha yüksekti (55 yıl vs 42 yıl, p=0,023). Alevlenme süresi ve sigara içme süresi seropozitif grupta daha uzun olmasına rağmen istatistiksel olarak anlamlı bulunmadı (Sırasıyla, 4 gün vs 2 gün ve 28,3 paket/yıl vs 9,7 paket/yıl). Eşlik eden komorbideteler seronegatif hastalarda daha fazla olmasına rağmen istatistiksel olarak anlamlı değildi. Ortalama lenfosit değerleri ise seropozitif grupta anlamlı daha yüksekti (p=0,037). Sonuç olarak, seropozitif PR hastalarının ortanca yaşları negatif olan hastalara göre daha yüksek olduğu ve ortalama lenfosit değerlerinin seropozitif hastalarda daha yüksek olduğu bulundu., Palindromic rheumatism (PR) is a clinical entity, which is characterized by remittent flares of pain, swelling and erythema around the joints that do not lead to persistent damage. In the literature, the frequencies of rheumatoid factor (RF) positivity and anti-cyclic citrullinated peptide (anti-CCP) antibody positivity have been reported as 39-68% in patients with PR. To our knowledge, studies investigating the comparison of clinical features of seronegative and seropositive patients are scarce. We aimed to assess demographic data and clinical characteristics of PR patients who followed in our clinic and to compare these features between seronegative and seropositive patients. The current study was designed as retrospective and cross-sectional. Thirty-one patients were screened and 21 patients who met the inclusion and exclusion criteria were included in the study. The median age, median follow-up duration, and median flare duration were 43 years, 18 months, and 3 days, respectively. Twelve patients were in seronegative group while 9 patients were in seropositive group. The median age was higher in seropositive patients than in seronegative patients (55 vs. 42 years, p=0.023). Even though the duration of flare and smoking cigarette were higher in seropositive group, there was not statistically significant difference between groups (4 vs. 2 days and 28.3 vs. 9.7 packs/years, respectively). Comorbidities were common in seronegative patients but there was not statistically significant difference between groups. Mean lymphocyte count was statistically significantly higher in seropositive group (p=0.037). In conclusion, the median age and mean lymphocyte count were higher in seropositive group than in seronegative group.

Background: Upper limb lymphedema may be revealed after breast cancer and its treatment. Among different treatment approaches, intermittent pneumatic compression (IPC) therapy and low-level laser t...

AIM Postural abnormalities of the foot are common in rheumatic diseases. Static foot posture is a poorly studied clinical parameter in ankylosing spondylitis (AS). The aim of the study was to evaluate static foot posture in patients with AS and to determine the potential impact of clinical variables on foot posture. METHOD Fifty patients with AS and 40 age- and sex-matched healthy controls were enrolled in the study. Disease activity was measured using the Ankylosing Spondylitis Disease Activity Score. Axial mobility was evaluated with the Bath Ankylosing Spondylitis Metrology Index three-point answer scale. Functional status was assessed by the Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire-Disability Index. Enthesitis and foot posture were evaluated by the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Foot Posture Index-6, respectively. RESULTS Patients with AS revealed significantly higher scores of foot posture index when compared with controls (P = 0.005). Abnormal foot posture (pronated and supinated) was more common in the patient group (P

Objectives This study aims to evaluate the association of serum vitamin D level with proximal muscle strength, tone, elasticity, and stiffness in elderly. Patients and methods Between September 2017 and January 2018, a total of 109 participants (21 males, 88 females; mean age: 71.2±4.6 years; range, 65 to 85 years) were included in the study. The proximal muscle strength was evaluated by MicroFET® 3 device. The muscle tone, elasticity, and stiffness were measured using the MyotonPRO® digital palpation device. Serum 25-hydroxyvitamin D [25(OH)D] level was tested by high-performance liquid chromatography. A receiver operating characteristic (ROC) curve was performed to evaluate the potential role of MicroFET® 3-measured proximal muscle strength in the quantification of vitamin D status. Results Vitamin D sufficient participants had a higher proximal muscle strength (p

Although musculoskeletal system involvement is a well-known manifestation in systemic lupus erythematosus (SLE), the probability of sacroiliac joint involvement and its effect on patients might be ignored. The aim of the study was to investigate the association between SLE and sacroiliitis and to evaluate the relationship between clinical parameters and sacroiliitis in SLE. The study was designed as a case-control study. A total of 63 patients with SLE and 31 age- and sex-matched healthy controls were included in the study. The clinical and demographic variables of the study population were documented. The sacroiliac joints of patients and controls were evaluated with sacroiliac magnetic resonance imaging. Human leukocyte antigen (HLA) B27 was assessed using flow cytometry (Beckman Coulter Navios-model 3, Beckman Coulter Inc., Brea, CA, USA). Multinomial logistic regression analysis was used to determine the clinical risk factors related to sacroiliitis. Among the 63 patients, acute sacroiliitis was found in 25 patients (39.7%) and chronic sacroiliitis was found in 21 patients (33.3%). Sacroiliitis was higher in patients than in controls (p = 0.001). Acute sacroiliitis was more frequently observed in patients when compared with the control group (p = 0.001). Higher C‑reactive protein (CRP) concentrations (odds ratio = 1.75, 95% confidence interval: 1.30–2.35; p

BACKGROUND For patients with systemic sclerosis (SSc), hand involvement is an underrated clinical manifestation. Therefore, the aim of this study was to investigate the efficacy of a hand exercise program and to demonstrate its effect on hand function, quality of life, anxiety, and depression in patients with SSc. METHODS This study was designed as a single blind, randomized controlled comparative study. Sixty-two female patients with SSc were randomized into an exercise group (n = 32) or a control group (n = 30). After some were lost to follow-up, 25 patients were analyzed in each group. In the exercise group, the 8-week intervention consisted of isometric hand exercises and self-administered stretching repeated 10 times/2 sets per day. All patients were assessed using the Hand Mobility in Scleroderma (HAMIS) test, the Duruoz Hand Index (DHI), grip strength, the 36-item short form, Health Assessment Questionnaire-Disability Index (HAQ-DI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and then again 4 and 8 weeks later. Within-group comparisons over time were analyzed using the Friedman test. Post hoc analysis was performed using the Wilcoxon signed rank test. A multiple linear regression analysis was used to define the impact of exercise on clinical status. RESULTS Of the 50 total patients, the median age and the median body mass index were 55.5 years and 25.9 kg/m2. The median disease duration was 10.0 years. Thirty-four patients (68.0%) were diffuse cutaneous systemic sclerosis (dcSSC), whereas 16 (32.0%) were limited cutaneous systemic sclerosis (lcSSc). The primary outcome of handgrip strength, as well as the HAMIS, DHI, HAQ-DI, and BDI, significantly improved over time (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.005, respectively). The between-group comparison indicated significant improvement in DHI, handgrip strength, HAQ-DI, BAI, and BDI in the exercise group (p = 0.02, p = 0.013, p < 0.001, p = 0.015, and p = 0.036, respectively). In the multiple linear regression analysis, exercise was found to be the most efficient factor affecting the improvement in HAMIS, DHI, HAQ-DI, and grip strength. CONCLUSIONS The 8-week intervention composed of isometric hand exercises and self-administered stretching provided a significant improvement in handgrip strength, general health, quality of life, and psychological status for patients with SSc.

PubMedID: 30176381 Background: There are many contributors of knee osteoarthritis including the postural abnormalities of the adjacent joints. The relationship between foot posture and the clinical-radiological parameters of knee osteoarthritis is poorly understood. Research question: Is foot posture related to the clinical and radiological parameters in patients with knee osteoarthritis? Methods: Patients diagnosed with primary clinical and radiographic medial tibiofemoral knee osteoarthritis were included in the study. Anteroposterior knee radiographs were staged by using the Kellgren-Lawrence grading system. Computer-based measurements of the medial joint space width (mJSW), condylar angle, anatomical axis angle, tibial plateau angle and condylar plateau angle were performed on digital anteroposterior knee radiographs. The Western Ontario and Mc Master University Osteoarthritis Index (WOMAC) questionnaire was used to assess pain and the functional status of the patients. Foot posture was assessed by the Foot Posture Index (FPI) system and feet were categorized into three (pronated, neutral and supinated). Results: The study included 150 patients (150 knees and feet at one side) with a mean age of 61.2 ± 10.1 years. In terms of foot posture groups; percentages for supination, neutral and pronation were 22.66%, 68.66% and 8.66%, respectively. In the group with supinated FPI; WOMAC total score, pain and function subscale scores were higher (p < 0.001), mJSW was narrowed (p = 0.038) and the condylar plateau angle was increased (p = 0.009). In the FPI pronation group; anatomic axis angle values were found to change in the varus direction (p = 0.012). Significance: The potential postural dysfunction of the foot should be taken into consideration during the assessment and/or management of a patient with knee osteoarthritis. © 2018 Elsevier B.V.

Amaç: Ortalama trombosit hacmi (mean platelet volume-MPV), platelet büyüklüğünü ve aktivitesi gösteren bir belirteçtir. MPV’nin, proinflamatuvar ve protrombik durumları yansıttığı bilinmektedir. Bazı çalışmalarda, MPV seviyelerinin, sinovitli hastalarda inflamasyon ve eritrosit sedimentasyon hızı (ESH) ile negatif ilişkili olduğu saptanmıştır. Bu bilgiler doğrultusunda, çalışmamızda dizde osteoartrit (OA) bulunan hastalarda MPV düzeyinin, radyolojik evre, klinik durum ve inflamatuvar belirteçler ile ilişkisinin araştırılması planlanmıştır.Gereç ve Yöntem: Çalışmamıza Ocak 2016-Mart 2016 tarihleri arasında polikliniğimize başvuran ve diz OA tanısı ile takip edilen 160 hasta dahil edildi. Hastaların MPV, ESH ve C-reaktif protein (CRP) değerleri kaydedildi. Hastaların ağrı şiddetini ölçmek için vizüel anolog skala (VAS), fonksiyonel durumlarını değerlendirmek için Western Ontario ve McMaster Üniversiteleri Osteoartrit İndeksi (WOMAC) formu kullanıldı. Anteroposterior diz radyografilerinde Kellgren-Lawrence (KL) yöntemine göre radyolojik evreleme yapıldı.Bulgular: MPV değeri ile ESH, CRP, total WOMAC skoru ve vizüel anolog skala (VAS) arasında korelasyon saptanmazken, MPV ile platelet sayımı negatif korele idi (r=-0.374). MPV seviyeleri, KL gruplarına (KL 1-4) göre analiz edildiğinde, gruplar arasında fark gözlenmedi (p=0.090). Hastalar hafif (KL 1-2) ve orta-ileri evre (KL 3-4) OA olarak değerlendirildiğinde, gruplar arasında MPV seviyeleri açısından anlamlı fark saptanmadı (p=0.066).Sonuç: Diz OA’lı hastalarda, MPV seviyesi; radyolojik evreden bağımsız olup, klinik durum, ESH ve CRP düzeyleri ile de ilişkili bulunmamıştır. MPV’nin osteoartrit aktivitesindeki olası rolünün değerlendirilebilmesi için daha kapsamlı çalışmalara ihtiyaç vardır., Aim: Mean platelet volume (MPV) is a marker that indicates platelet volume and activation as well as inflammatory conditions such as osteoarthritis with synovitis, rheumatoid arthritis and ankylosing spondylitis. The aim of the present study was to investigate the relationship between MPV level and the variables of physical examination, laboratory tests, and radiographic measurements in patients with knee osteoarthritis (OA).Material and Methods: In this cross-sectional study, 160 patients with knee OA admitted to the Physical Medicine and Rehabilitation Department between January 2013 and November 2015 were included. MPV levels, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of patients were obtained from electronic database of the hospital. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to evaluate patients’ symptoms and disability. Also, patients’ pain was scored by visual analog scale (VAS). Knee OA was graded according to the Kellgren-Lawrence (KL) classification system on plain anteroposterior knee radiographs.Results: No correlation was found between MPV and the parameters including ESR, CRP, visual analog scale score and WOMAC score. MPV was negatively correlated with platelet count (r=-0.374). When MPV level was analyzed with regard to the KL grades, no difference was found among groups (p=0.090). When patients were divided into two groups as mild OA (KL grade 1-2) and moderate-severe OA (KL grade 3-4), there was no difference between the groups in terms of MPV level (p=0.066).Conclusion: No association was detected between MPV level and the parameters. Further studies are needed to evaluate the role of MPV level in disease activity among patients with knee osteoarthritis.

Amaç: Bu çalışmanın amacı, ankilozan spondilit hastalarında diyastolik disfonksiyonun saptanmasında presistolik dalganın önemini değerlendirmektir.Gereç ve Yöntem: Kesitsel çalışmamıza 59 hasta ve 65 sağlıklı kontrol dahil edildi. Ankilozan Spondilit Hastalığı Aktivite Skoru, Bath Ankilozan Spondilit Metrology indeks, Maastricht Ankilozan Spondilit Entesit Skoru ve Bath Ankilozan Spondilit Fonksiyonel İndeksi değerlendirildi. Doppler doku görüntüleme ve presistolik dalga ölçümleri yapıldı.Bulgular: Hastaların % 37.3'ünde ve kontrol grubunun % 16.9'unda olmak üzere tüm çalışma popülasyonunun% 26.6'sında presistolik dalga saptandı. Hasta ve kontrol grupları presistolik dalganın varlığına veya yokluğuna göre iki gruba ayrıldığında; miyokardiyal performans indeksi, transmitral E dalga hızı, E/A oranı, sol ventrikül çıkış yolu velositesi ve septal e 'dalga hızı, her iki grupta da presiktolik dalgası olanlarda istatistiksel olarak anlamlı oranda farklıydı. Tek değişkenli modelde, yüksek c-reaktif protein seviyesi, artmış BASMI ve BASFI skorları ve artmış miyokard performans indeksi, ankilozan spondilit hastalarında presistolik dalga varlığı için risk faktörü olarak belirlenmiştir.Sonuç: Ekokardiyografik incelemede presistolik dalganın varlığı, ankilozan spondilit hastalarında prognostik önemi olan sol ventrikül diyastolik fonksiyonu hakkında önemli bilgiler sağlayabilir., Purpose: The aim of this study was to evaluate the clinical significance of presystolic wave in the detection of diastolic dysfunction in ankylosing spondylitis patients. Materials and Methods: In this cross-sectional study, 59 patients and 65 healthy controls were included in the study. Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Metrology Index, Maastricht Ankylosing Spondylitis Enthesitis Score and Bath Ankylosing Spondylitis Functional Index was eveluated. The Doppler tissue-imaging and presystolic wave measurements were performed by same cardiologist who was blinded to study details. Results: Presystolic wave was detected in 26.6% of the whole study population; in 37.3% of patients and 16.9% of the control group. When the patient and control groups were divided into two subgroups according to the presence or absence of presystolic wave; myocardial performance index, transmitral E wave velocity, E/A ratio, left ventricular outflow tract velocity and septal e’ wave velocity were statistically significant in subjects with presence presystolic wave in both groups. In the univariate model, high c-reactive protein level, increased BASMI and BASFI scores and elevated myocardial performance index were determined as risk factors for the presence of presystolic wave in ankylosing spondylitis patients. Conclusion: The assessment of presystolic wave on echocardiography examination may provide important information about the left ventricul diastolic function, which has a prognostic impact for ankylosing spondylitis patients.

Background: Scleroderma is a connective tissue disease that is characterized by fibrosis of the skin.The modified Rodnan Skin Score (mRSS) is a measure generally used to assess the skin thickness in patients with scleroderma.Data on the effectiveness of the mRSS training courses differ in the literature. Objectives: The objective of our study was to evaluate the effectiveness of the mRSS training course in rheumatology fellows in the rheumatology departments. Methods: The study included 6 fellows from the departments of rheumatology.Participants were given a 1-hour-long theoretical training, including dermal involvement, and mRSS assessment by 3 rheumatology experts experienced in scleroderma, which was followed by an applied training on 4 patients for one-hour.Participants scored two patients before and after training on a form, which included 17 domains with a total score-range between “0” and “51”. Then using the SPSS15 software program, inter-rater reliability was assessed with intraclass correlation(ICC) analysis for both pre- and post-training mRSS.Fleiss’ kappa was used to measure the degree of agreement according to 12 Rodnan score areas before and after the training. Results: The ICC value for pre-training and post-training total Rodnan scores was 0.867 (95% CI-0.625-1.00, P=0.05), and 0.905(95% CI 0.045-1.00, P=0.02), respectively. Individual analysis of score areas showed that after the training there was an increase in degree of agreement in some of these areas, while there was no difference in one area, and it decreased in others (Table 1). Conclusion: Several studies have demonstrated the applicability, reliability, and validity of mRSS, a measure of dermal involvement, and that evaluation of the score requires experience, and an attentive learning process.In the literature, the inter-rater ICC values during previous training courses are reported to range between 0.378 and 0.92(1). These studies show differences in terms of the number and experience of participants, number of patients, course-length, and repeated courses. Similar to the observation by Ionescu et al(2), the pre-training inter-observer ICC value was very high(0.867), and it increased to 0.905 after the training. Presence of an increase in some areas, and reduction in some others in individual analysis of areas after the training may suggests the need for repeated training. Our limitations were low number of participants and patients. We obtained very good inter-rater ICC values in the mRSS training course given to rheumatology fellows; however we may benefit from new studies for optimization of these conclusions by increasing the numbers of trainees, patients, and the lenght of courses. References [1] Czirjak, L., et al., the EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis. Ann Rheum Dis, 2007. [2] Ionescu, R., et al., Repeated teaching courses of the modified Rodnan skin score in systemic sclerosis. Clin Exp Rheumatol, 2010. Disclosure of interests: None declared

Background:Fibromyalgia (FM) is a condition characterized by chronic widespread pain, fatigue, sleep disturbances. Etiopathogenesis remains unclear; however, growing data regarding the effect of psychosocial factors on disease etiopathogenesis have drawn attention. Psychosocial elements such as type D personality and low level of self-esteem might increase disease burden (1). Accordingly, many researchers so far, have examined psychological parameters in FM and a limited number of studies focused on the personality type among patients with FM (2-5).Objectives:The current study aimed to investigate type D personality and self-esteem in patients with FM.Methods:Female patients with fibromyalgia and age-matched healthy controls were enrolled in this cross-sectional study. Type D personality was evaluated by using the type D scale (DS-14). The Rosenberg self-esteem scale (RSES) was used to assess self-esteem and psychosomatic symptoms. Psychological status was evaluated by the Beck Depression and Beck Anxiety Inventories. Fibromyalgia Impact Questionnaire (FIQ) was performed to assess functional impairment and health status in patients with FM. The potential confounders of type D personality were evaluated by binary logistic regression analysis.Results:Seventy patients with FM and 60 controls were included. Type D personality was observed in 58.6% of the patients and in 21.7% of the control group (pConclusion:Type D personality is more common in female patients with FM when compared to healthy women. Patients with type D personality have lower level of self-esteem when compared to those with non-type D personality. Depression and lower education level are potential confounders of type D personality in FM.References:[1]Bazzichi L, Giacomelli C, Consensi A, Giorgi V, Batticciotto A, Di Franco M, Sarzi-Puttini P (2020) One year in review 2020: fibromyalgia. Clin Exp Rheumatol 38 Suppl 123(1):3-8.[2]Conversano C, Marchi L, Ciacchini R, Carmassi C, Contena B, Bazzichi LM, Gemignani A (2018) Personality Traits in Fibromyalgia (FM): Does FM Personality Exists? A Systematic Review. Clin Pract Epidemiol Ment Health 14:263.[3]Türkoğlu G, Selvi Y (2020) The relationship between chronotype, sleep disturbance, severity of fibromyalgia, and quality of life in patients with fibromyalgia. Chronobiol Int 37(1):68-81.[4]Garip Y, Güler T, Bozkurt Tuncer Ö, Önen S (2019) Type D Personality is Associated With Disease Severity and Poor Quality of Life in Turkish Patients With Fibromyalgia Syndrome: A Cross-Sectional Study. Arch Rheumatol 35(1):13-19.[5]Ablin JN, Zohar AH, Zaraya-Blum R, Buskila D (2016) Distinctive personality profiles of fibromyalgia and chronic fatigue syndrome patients. PeerJ 4:e2421.Table 1.Binary logistic regression analysis for the evaluation of potential confounders of type D personality in patients with fibromyalgia.WaldSEβ (95%CI)pEducation (years)4.6640.0930.818 (0.682−0.982)0.031Occupation duration (years)0.1160.0371.013 (0.942−1.089)0.733Self-esteem scale (D1)0.3690.4230.774 (0.338−1.771)0.544BDI8.4460.0561.178 (1.055−1.316)0.004BAI0.7890.0321.029 (0.966−1.095)0.374BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, SE: standard error, CI: confidence intervalDisclosure of Interests:None declared

Amaç: Bu çalışmanın amacı, romatoid artritli hastalarda eozinofili sıklığının belirlenmesi, eozinofil sayısının hastalık aktivitesi değerlendirilmesidir. Gereç ve Yöntem: Ocak 2016-Mart 2016 tarihleri arasında Fiziksel Tıp ve Rehabilitasyon polikliniğine başvuran romatoid artrit tanılı hastalar çalışmaya dahil edildi. Hastaların demografik ve klinik özelliklerine ek olarak, laboratuvar verilerinden; periferik kandaki mikrolitre başına düşen eozinofil sayısı, eozinofil yüzdesi, eritrosit sedimentasyon hızı (mm/s) ve C-reaktif protein (mg/dL) düzeyleri kaydedildi. Mikrolitrede 500 ve üzerindeki eozinofil değerleri "eozinofili" olarak kabul edildi. Hastalık aktivitesi Hastalık Aktivite Skoru 28 (DAS28)-CRP ile belirlendi. Bulgular: Çalışmaya yaş ortalamaları 54,0±12,2 yıl olan 62 hasta (54 kadın, 8 erkek) dahil edildi. Eozinofil sayısı ve eozinofil yüzdesi için ortanca (minimum-maksimum) değerleri sırasıyla 0,19 (0,01-0,8)/mikrolitre ve %2,45 (0,27,5) olarak hesaplandı. Çalışma grubunun %4,8'inde (n=3) eozinofili mevcuttu. Eozinofil sayısı ile DAS28-CRP skoru, eritrosit sedimentasyon hızı ve C-reaktif protein düzeyi arasında korelasyon saptanmadı. Sonuç: Eozinofili romatoid artritte nadir gözlenen bir durumdur. Romatoid artritli hastalarda, periferik kandaki eozinofil sayısının, hastalık aktivitesi ve inflamatuvar belirteçlerle ilişkisi saptanmamıştır. Purpose: The aim of this study is to determine the frequency of eosinophilia among rheumatoid arthritis patients, as well as to evaluate the relation of eosinophil count to disease activity and inflammatory markers. Material and Methods: Patients with rheumatoid arthritis who had admitted to the Physical Medicine and Rehabilitation out-patient clinic between January2016March 2016 were included in the study. The demographic and clinical variables, along with the peripheral eosinophil count per microliter, eosinophil percentage, erythrocyte sedimentation rate (mm/h) and C-reactive protein level were recorded. Eosinophil count >= 500/microliter was regarded as eosinophilia. The disease activity was determined via the Disease Activity Score 28 (DAS28)CRP. Results: Sixty-two rheumatoid arthritis patients (54 female, 8 male) with a mean age of 54.0±12.2 years were included in the study. The median (minimum-maximum) value for eosinophil count and eosinophil percentage were 0.19 (0.01-0.8)/microliter and 2.45%(0.2-7.5), respectively. Eosinophilia was detected in 4.8% (n=3) of the patients. Eosinophil count showed no correlation with DAS28CRP score, erythrocyte sedimentation rate and C-reactive protein level. Conclusion: Eosinophilia is a rare occasion in rheumatoid arthritis. Peripheral blood eosinophil count appears not to be correlated with the disease activity or the inflammatory markers among patients with rheumatoid arthritis.

PubMedID: 30039721 Objective: Rheumatoid arthritis (RA), as a long-lasting disease, not only affects the musculoskeletal health but also deteriorates the psychological well-being of the patient. What about their caregivers? There exist a limited number of studies on this issue. The objectives of the present study were (i) to evaluate the psychological health among caregivers of RA patients and (ii) to determine the confounding factors playing role on their psychological status. Methods: Fifty-three RA patients and their caregivers were included in this cross-sectional study. Disease activity was assessed by using the disease activity score 28 based on C-reactive protein (DAS28-CRP) and rheumatoid arthritis disease activity index-5 (RADAI-5), while disability was evaluated by disability of the arm, shoulder, and hand (DASH) questionnaire. Psychological status was tested by Beck's depression and anxiety inventories (BDI and BAI). Results: A total of 53 patients with RA were included in the study. Caregivers' depression score was weakly correlated with disease activity variables including DAS28-CRP, RADAI and DASH scores (rs =.304, rs =.392 and rs =.301, respectively); and moderately correlated with patients' depression score and caregivers' comorbidity (rs =.407 and rs =.451, respectively). Conclusions: The psychological impact of RA on caregivers appears to be associated with patients’ mood, disease activity and upper extremity functionality. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

WOS: 000454634500010 Introduction: Vitamin D is known as an anti-inflammatory, antitumor, and immune-modulating hormone, which plays an important role in common diseases in the geriatric population, such as hypertension and cerebrovascular disorders. Vitamin D deficiency has been linked to various diseases in the literature. However, the association between vitamin D and multiple comorbidities remains unclear due to limited published data. The aim of the present study was to evaluate the association between vitamin D levels and multiple comorbidities in elderly patients. Materials and Method: The study design was cross-sectional. Geriatric patients (aged >= 65 years) who underwent serum 25(OH)D evaluation to determine the vitamin D status during the last 3 months were assessed for eligibility. Demographic data and 25(OH)D levels of patients were obtained from the electronic database of the hospital and a telephonic interview. In addition, a comorbidity questionnaire was completed via telephonic interviews. The correlation between comorbidity scores, demographic data, and vitamin D levels in elderly patients was analyzed. Results: Data on 25(OH)D levels in 685 geriatric patients was obtained. Among these patients, 211 (169 female, 42 male) who were contacted over telephone were enrolled. The mean values for age, vitamin D level, and comorbidity scores were 70.4 +/- 5.0 years, 16.8 +/- 9.2 ng/ml, and 11.3 +/- 4.7, respectively. A moderate-good negative correlation was found between 25(OH)D levels and comorbidity scores (r=-0.503). Conclusion: Low vitamin D levels were associated with total comorbidity status in geriatric patients. This result suggests that vitamin D deficiency may be a risk factor for comorbidities in geriatric patients.

PubMedID: 30712127 Objectives: The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups. Method: The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH). Results: Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x 2 = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16–9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61–9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00–1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021). Conclusion: High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases. © 2019, International League of Associations for Rheumatology (ILAR).

Amaç: Ortalama trombosit hacmi (mean platelet volume-MPV), platelet büyüklüğünü ve aktivitesi gösteren bir belirteçtir. MPV’nin, proinflamatuvar ve protrombik durumları yansıttığı bilinmektedir. Bazı çalışmalarda, MPV seviyelerinin, sinovitli hastalarda inflamasyon ve eritrosit sedimentasyon hızı (ESH) ile negatif ilişkili olduğu saptanmıştır. Bu bilgiler doğrultusunda, çalışmamızda dizde osteoartrit (OA) bulunan hastalarda MPV düzeyinin, radyolojik evre, klinik durum ve inflamatuvar belirteçler ile ilişkisinin araştırılması planlanmıştır. Gereç ve Yöntem: Çalışmamıza Ocak 2016-Mart 2016 tarihleri arasında polikliniğimize başvuran ve diz OA tanısı ile takip edilen 160 hasta dahil edildi. Hastaların MPV, ESH ve C-reaktif protein (CRP) değerleri kaydedildi. Hastaların ağrı şiddetini ölçmek için vizüel anolog skala (VAS), fonksiyonel durumlarını değerlendirmek için Western Ontario ve McMaster Üniversiteleri Osteoartrit İndeksi (WOMAC) formu kullanıldı. Anteroposterior diz radyografilerinde Kellgren-Lawrence (KL) yöntemine göre radyolojik evreleme yapıldı. Bulgular: MPV değeri ile ESH, CRP, total WOMAC skoru ve vizüel anolog skala (VAS) arasında korelasyon saptanmazken, MPV ile platelet sayımı negatif korele idi (r=-0.374). MPV seviyeleri, KL gruplarına (KL 1-4) göre analiz edildiğinde, gruplar arasında fark gözlenmedi (p=0.090). Hastalar hafif (KL 1-2) ve orta-ileri evre (KL 3-4) OA olarak değerlendirildiğinde, gruplar arasında MPV seviyeleri açısından anlamlı fark saptanmadı (p=0.066). Sonuç: Diz OA’lı hastalarda, MPV seviyesi; radyolojik evreden bağımsız olup, klinik durum, ESH ve CRP düzeyleri ile de ilişkili bulunmamıştır. MPV’nin osteoartrit aktivitesindeki olası rolünün değerlendirilebilmesi için daha kapsamlı çalışmalara ihtiyaç vardır. Aim: Mean platelet volume (MPV) is a marker that indicates platelet volume and activation as well as inflammatory conditions such as osteoarthritis with synovitis, rheumatoid arthritis and ankylosing spondylitis. The aim of the present study was to investigate the relationship between MPV level and the variables of physical examination, laboratory tests, and radiographic measurements in patients with knee osteoarthritis (OA). Material and Methods: In this cross-sectional study, 160 patients with knee OA admitted to the Physical Medicine and Rehabilitation Department between January 2013 and November 2015 were included. MPV levels, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of patients were obtained from electronic database of the hospital. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to evaluate patients’ symptoms and disability. Also, patients’ pain was scored by visual analog scale (VAS). Knee OA was graded according to the Kellgren-Lawrence (KL) classification system on plain anteroposterior knee radiographs. Results: No correlation was found between MPV and the parameters including ESR, CRP, visual analog scale score and WOMAC score. MPV was negatively correlated with platelet count (r=-0.374). When MPV level was analyzed with regard to the KL grades, no difference was found among groups (p=0.090). When patients were divided into two groups as mild OA (KL grade 1-2) and moderate-severe OA (KL grade 3-4), there was no difference between the groups in terms of MPV level (p=0.066). Conclusion: No association was detected between MPV level and the parameters. Further studies are needed to evaluate the role of MPV level in disease activity among patients with knee osteoarthritis.

WOS: 000353480500013 Soft-tissue calcification is characterized by the accumulation of calcium in damaged collagen fibrils. The pathogenesis of calcium deposition is not fully understood. Inflammatory changes, trauma, and rheumatological diseases have been reported as possible risk factors. Pellegrini-Stieda syndrome (PSS) is post-traumatic calcification or ossification of the medial collateral ligament with a nonspecific etiology. It may occur after trauma or inflammation or it could be idiopathic. Here we present a case of posttraumatic intraligamentous calcification of the medial collateral ligament (MCL) mimicking Pellegrini-Stieda syndrome (PSS) and review the current related literature.

Objectives: In this study, we aimed to evaluate the relationship of serum magnesium (Mg) with the radiological severity and inflammation in the patients with knee osteoarthritis (OA).Patients and methods: A total of 75 patients (61 females, 14 males; mean age 67.5±9.9 years; range 44 to 92 years) with the Kellgren-Lawrence Grade 1-4 knee OA were included in the study. Serum Mg levels (mg/dL) and inflammatory markers including erythrocyte sedimentation rate (ESR; mm/h) and C-reactive protein (CRP; mg/dL) were recorded. Serum Mg levels of the patients with mild OA and severe OA were compared. The correlation between Mg and both inflammatory markers was analyzed.Results: Severe OA group had significantly lower Mg levels than the mild OA group (p=0.044). Serum Mg level was not found to be correlated with either inflammatory biomarkers.Conclusion: Although serum Mg is associated with the radiological severity of knee OA, it is not associated with inflammatory biomarkers including ESR and CRP Objectives: In this study, we aimed to evaluate the relationship of serum magnesium (Mg) with the radiological severity and inflammation in the patients with knee osteoarthritis (OA).Patients and methods: A total of 75 patients (61 females, 14 males; mean age 67.5±9.9 years; range 44 to 92 years) with the Kellgren-Lawrence Grade 1-4 knee OA were included in the study. Serum Mg levels (mg/dL) and inflammatory markers including erythrocyte sedimentation rate (ESR; mm/h) and C-reactive protein (CRP; mg/dL) were recorded. Serum Mg levels of the patients with mild OA and severe OA were compared. The correlation between Mg and both inflammatory markers was analyzed.Results: Severe OA group had significantly lower Mg levels than the mild OA group (p=0.044). Serum Mg level was not found to be correlated with either inflammatory biomarkers.Conclusion: Although serum Mg is associated with the radiological severity of knee OA, it is not associated with inflammatory biomarkers including ESR and CRP

Objectives: This study aims to evaluate the relationship between biological markers and quadriceps muscle strength, the correlation of clinical variables with quadriceps muscle strength, and the results according to the radiological severity in patients with knee osteoarthritis.Patients and methods: A total of 152 patients (22 males, 130 females; mean age 57.3±7.5 years; range 40 to 70 years) with primary knee osteoarthritis were included in the study. We evaluated biological markers of C-telopeptide of type I collagen, C-telopeptide of type II collagen, leptin, and osteocalcin along with 25-hydroxy vitamin D. We measured quadriceps muscle strength both by manual muscle tester and computerized isokinetic dynamometer. We evaluated pain and functional status of the patients by visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index. We analyzed the correlation between biological markers and quadriceps muscle strength along with clinical variables. We classified the strength of correlations as no-very weak, weak-moderate, moderate-strong, and excellent.Results: Of the patients, 76.9% (n=117) were obese. Quadriceps muscle strength measures were significantly lower in females than that in males. There was no-very weak correlation between biological marker levels and quadriceps muscle strength. However, weak-moderate correlations were found between clinical variables (pain and Western Ontario and McMaster Universities Osteoarthritis Index scores) and quadriceps muscle strength measures.Conclusion: Among the measured biological markers, none had any influence on quadriceps muscle strength in patients with knee osteoarthritis. However, pain and functional status of the patients might affect quadriceps muscle strength. Objectives: This study aims to evaluate the relationship between biological markers and quadriceps muscle strength, the correlation of clinical variables with quadriceps muscle strength, and the results according to the radiological severity in patients with knee osteoarthritis.Patients and methods: A total of 152 patients (22 males, 130 females; mean age 57.3±7.5 years; range 40 to 70 years) with primary knee osteoarthritis were included in the study. We evaluated biological markers of C-telopeptide of type I collagen, C-telopeptide of type II collagen, leptin, and osteocalcin along with 25-hydroxy vitamin D. We measured quadriceps muscle strength both by manual muscle tester and computerized isokinetic dynamometer. We evaluated pain and functional status of the patients by visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index. We analyzed the correlation between biological markers and quadriceps muscle strength along with clinical variables. We classified the strength of correlations as no-very weak, weak-moderate, moderate-strong, and excellent.Results: Of the patients, 76.9% (n=117) were obese. Quadriceps muscle strength measures were significantly lower in females than that in males. There was no-very weak correlation between biological marker levels and quadriceps muscle strength. However, weak-moderate correlations were found between clinical variables (pain and Western Ontario and McMaster Universities Osteoarthritis Index scores) and quadriceps muscle strength measures.Conclusion: Among the measured biological markers, none had any influence on quadriceps muscle strength in patients with knee osteoarthritis. However, pain and functional status of the patients might affect quadriceps muscle strength.

Amaç: Bu çalışmada nörolojik hastalıkları olan hastalarda alt ekstremite ortezlerinin kullanımı ve memnuniyet derecesi araştırıldı.Hastalar ve yöntemler: Ocak-Aralık 2007 ve Ocak-Haziran 2013 tarihleri arasında, 231 reçete yazılan toplam 193 hasta (109 erkek, 84 kadın; ort. yaş 26.5±22.8 yıl; dağılım 1-80 yıl) çalışmaya alındı. Alt ekstremite ortezlerine ait reçetelere, kayıtlardan ulaşıldı. Reçete tarihinden yaklaşık altı ay sonra hastalarla telefon görüşmesi yapıldı ve tedarik, kullanım, kompliyansları ve memnuniyet dereceleri sorgulandı. Memnuniyetleri beş puanlık Likert ölçeği ile değerlendirildi.Bulgular: Hastalar tarafından 231 reçetenin 198'inin (%85.7) yaptırıldığı bildirildi. Başlıca yaptırılmama nedenleri hastanın/bakıcının ilgisizliği, hastalığın kötüleşmesi/iyileşmesi, etkili olmayacağına inanma ve maliyet/sosyal güvence hususları idi. Yaptırılan cihazların %16.7'sinin hiç kullanılmadığı, %22.7'sinin düzensiz olarak kullanıldığı veya bırakıldığı ve geri kalan %60.6'sının ise düzenli olarak kullanıldığı bildirildi. Reçete edilen cihazların başlıca kullanılmama nedeni, cihazın zaman içerisinde uygunsuz hale gelmesi ile ilgili idi. Kullanıcılar arasında genel memnuniyet skoru 2.48±1.0 idi. Düzenli ve düzensiz kullanıcılar arasında memnuniyet derecesi açısından istatistiksel olarak anlamlı bir fark gözlendi (2.7±0.9 vs 1.8±1.1, p=0.000).Sonuç: Hastalar reçete edilen ortezleri genellikle yaptırırlar ve kompliyansları iyi düzeydedir. Genel memnuniyetleri ise, orta derecededir. Hastaların memnuniyetini artırmak için, hekimler ve bakıcılar cihazların uygun kullanımı, düzenli takip, hasta eğitimi ve kullanıcıların müdahil edilmesi gibi konulara daha fazla önem vermesi gerekmektedir Objectives: This study aims to investigate the use and degree of satisfaction of lower extremity orthoses in patients with neurological disorders.Patients and methods: Between January and December 2007 and January and June 2013, a total of 193 patients (109 males, 84 females; mean age 26.5±22.8 years; range 1 to 80 years) with 231 prescriptions were included. The prescriptions of lower extremity orthoses were extracted from the registers. Patients were interviewed via telephone call about six months after the prescription date and the acquirement, usage, compliance, and degree of satisfaction were questioned. The satisfaction was assessed using a five-point Likert scale .Results: Of the 231 prescriptions, 198 (85.7%) were reported being purchased. The main reasons for not purchasing were a lack of interest of the caregivers/patients, worsening/improving of the disease, belief of ineffectiveness, and cost/social security concerns. Among the devices which were purchased, 16.7% were reported to be never used, 22.7% were being used irregularly or quitted, and the rest 60.6% were being used on a regular basis. The main reason for not using the prescribed devices was related to the unsuitableness of the device over time. Overall satisfaction score was 2.48±1.0 among the users. A statistically significant difference in the degree of satisfaction between the regular and irregular users was observed (2.7±0.9 vs. 1.8±1.1, p=0.000).Conclusion: The patients usually purchase the prescribed orthoses and the compliance is favorable. Overall satisfaction is moderate. To fulfill the gratification of the patients, physicians and caregivers should pay more attention to certain issues including the proper usage of the devices, regular follow-ups, patient education, and engagement of the users

Eş zamanlı iki taraflı fasiyal paralizi, nadir bir hastalıktır. İdiyopatik veya Lyme hastalığı, Guillain-Barre sendromu, sarkoidoz, viral enfeksiyonlar, sifiliz, pontin gliomlar ve lösemi gibi çeşitli hastalıklarla ilişkili olabilir. Altmış üç yaşında erkek hasta tam kan sayımında aşırı lökositoz ve yüzün sağ tarafında iki haftadır süren güçsüzlük ile hematoloji kliniğine başvurdu. Hastane yatışının yedinci gününde, yüzünün sol tarafında da güçsüzlük gelişti. Hasta iki taraflı fasiyal paralizi tanısı ile Fiziksel Tıp ve Rehabilitasyon kliniğine sevk edildi. Elektroterapi, el masajı ve egzersizden oluşan bir rehabilitasyon programına başlandı. Her iki taraftaki yüz kaslarına haftada üç seans galvanik akım uygulandı. Dört haftalık elektroterapi, günlük masaj ve egzersiz ile 12 seans sonunda, yüzün her iki tarafında da, duyu ve yüz kası kuvveti bakımından anlamlı iyileşme elde edildi. Takip sırasında 12. haftada ilave iyileşme kaydedildi. Bu yazıda, düşük gradlı B hücreli lenfomaya bağlı iki taraflı fasiyal paralizi olan son derece nadir bir olgu ve elektroterapi ve rehabilitasyon teknikleri ile elde edilen iyileşme sunuldu Simultaneous bilateral facial paralysis is an uncommon condition. It may be idiopathic or associated with various disorders including Lyme disease, Guillain-Barre syndrome, sarcoidosis, viral infections, syphilis, pontine gliomas, and leukemia. A 63-year-old male was admitted to the Hematology clinic with a complete blood count showing excessive leukocytosis and a two-week history of right-sided complete facial weakness. On the seventh day of hospitalization, he also developed facial weakness on the left side. The patient with a diagnosis of bilateral peripheral facial paralysis was referred to the Physical Medicine and Rehabilitation department. He was started on a rehabilitation program including electrotherapy, manual massage, and exercise. Galvanic current was applied to the facial muscles of both sides as three sessions per week. After 12 sessions of electrotherapy, daily massage, and exercise for four weeks, a significant improvement was achieved on both sides in terms of sensation and facial muscle strength. Further improvement was noted at 12 weeks during follow-up. In this report, we present an extremely rare case of bilateral peripheral facial paralysis due to B-cell low grade lymphoma and the improvement with electrotherapy and rehabilitation techniques

Remitting seronegative symmetrical synovitis with pitting edema is a rare rheumatological disorder that presents with symmetrical hand and/or foot edema resembling rheumatoid arthritis. It is generally seen in male patients in older age, but atypical cases in different age groups have been documented. Although no clear mechanism has been described, certain genetic and environmental factors have been suggested for etiopathogenesis. Medical treatment is mainly focused on glucocorticoid therapy. This article aims to discuss the Remitting seronegative symmetrical synovitis with pitting edema syndrome and to review the current literature. Tekrarlayıcı seronegatif pitting ödemli simetrik sinovit sendromu, romatoid artriti andıran simetrik el ve/veya ayak ödemi ile prezente olan nadir görülen bir hastalıktır. Genellikle ileri yaş erkek hastalarda görülür fakat farklı yaş gruplarında görülen atipik vakalar da bulunmaktadır. Net bir mekanizma tanımlanmamış olmasına rağmen, etiyopatogenezde belli genetik ve çevresel faktörler öne sürülmektedir. Tedavi, esasen glukokortikoid tedavisi üzerine odaklanmaktadır. Bu derlemede Tekrarlayıcı seronegatif pitting ödemli simetrik sinovit sendromunun tartışılması ve literatürün gözden geçirilmesi amaçlanmıştır.

Osteoarthritis is the most common type of arthritis and knee is the most frequently affected joint. Several risk factors including age, gender, body mass index and quadriceps muscle strength may contribute to knee osteoarthritis. Quadriceps muscle is the dynamic stabilizer of the knee. Besides the studies arguing that quadriceps muscle weakness might lead to knee osteoarthritis, there are also studies suggesting that muscle weakness might occur due to knee osteoarthritis. Authors, arguing that quadriceps muscle weakness has a deteriorating affect on knee osteoarthritis, also come to a conclusion that strengthening this muscle has a beneficial effect on knee osteoarthritis. Isometric, isotonic and isokinetic exercises are used in order to strengthen this muscle. Quantitative measurement of the muscle strength, as well as isokinetic exercises can be performed with the help of isokinetic devices. Isokinetic evaluation and isokinetic exercises in knee osteoarthritis are overviewed in this review., Osteoartrit, en sık görülen artrit tipi olup, diz, osteoartritten en sık etkilenen eklemdir. Yaş, cinsiyet, vücut kütle indeksi ve kuadriseps kas kuvveti gibi birçok risk faktörü diz osteoartriti gelişimine katkıda bulunabilmektedir. Kuadriseps kası dizin dinamik bir stabilizatörüdür. Kuadriseps kas kuvvetsizliğinin diz osteoartritine neden olabileceğini savunan çalışmaların yanında diz osteoartritine bağlı olarak kas kuvvetsizliği gelişebileceğini ileri süren yazılar da bulunmaktadır. Kuadriseps kas kuvvetsizliğinin diz osteoartritine olumsuz etkisi olduğunu savunan yazarlar bu durumu temel alarak kas kuvvetlendirmenin diz osteoartriti üzerinde faydalı olabileceği kanaatine varmışlardır. Kas kuvvetini artttırmak için izometrik, izotonik ve izokinetik egzersizler kullanılmaktadır. İzokinetik cihazlar yardımıyla hem kas kuvvetinin niceliksel ölçümü hem de izokinetik egzersiz yapılmaktadır. Bu derlemede, diz osteoartritinde, izokinetik değerlendirme ve izokinetik egzersizler gözden geçirilmiştir.