Objective: We aimed to determine muscle strength in patients with rheumatoid arthritis (RA) and several factors including structural
joint damage that may affect decrease in muscle strength. The relations between muscle strength and quality of life and functional disability were examined. Material and Methods: Seventy five RA patients and 51 controls
were involved. Demographic characteristics, body mass index, waist circumference, 25-hydroxy vitamin D, and patient global assessments of disease activity (PGA) were documented. Disease Activity Score-28 (DAS28),
Visual Analog Scale-Pain (VAS-pain), Health Assessment Questionnaire
(HAQ) and the Rheumatoid Arthritis Quality of Life Questionnaire
(RAQoL) were calculated. Radiographs of the hands were evaluated by van
der Heijde modified Sharp score (vdHSS). Grip strength of both hands was
measured by Jamar dynamometer. Results: Demographics (age, gender)
were not different between RA patients and control group. Grip strength of
patients with RA (22.79±18.58) was lower than control group (26.00±11.25,
p=0.04). There was a significant correlation with grip strength and disease
duration, tender joint count, VAS-pain, PGA, DAS28, HAQ, RAQoL, erosion and narrowing score (p<0.05). DAS28 and erosion score were associated
with grip strength in multivariate analyses p<0.05). Conclusion: This study
showed that RA obtains decreased muscle strength, impaired function and
quality of life. Joint space narrowing and disease activity are the main parameters that affect muscle strength.
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Objectives: This study aims to investigate the relationship between disease activity, dietary phytochemical index (DPI), and serum total oxidant
status (TOS) and total antioxidant status (TAS) in patients with ankylosing spondylitis (AS).
Patients and methods: Between August 2020 and January 2021, a total of 37 patients (23 males, 14 females; mean age: 39.3±9.4 years;
range, 21 to 61 years) with AS and 36 age-, sex-, and body mass index-matched healthy individuals (24 males, 12 females; mean age: 37.9±8.9 years;
range, 20 to 60 years) were included. Serum TAS (μmoLTroloxEq/L) and TOS (μmoL H2O2Eq/L) measurements were performed and the oxidative
stress index (OSI) was calculated. Dietary evaluation was made from a one-day dietary record and DPI was calculated.
Results: Serum TAS level in AS patients was significantly lower than the healthy group (p=0.003). Serum TOS level was similar in both groups. The
OSI of patients was significantly higher than the controls (p=0.035). The mean DPI, polyunsaturated fatty acid, n-3 fatty acid, and vitamin C intake of
patients were significantly lower than controls (p=0.042, p=0.033, and p=0.022, respectively). A moderate positive correlation was found between
the TAS level and DPI of the control group (r=0.352, p=0.035). According to medications, no significant difference was seen between the groups in
terms of patients’ characteristics, DPI, and laboratory tests and there was no correlation between DPI, TAS, TOS, and OSI.
Conclusion: Lower DPI and lower n-3 fatty acid and vitamin C intake in patient group demonstrated that patients with AS should pay more attention
to their diet to increase serum antioxidant status.
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HATİCE BODUR ,
Fatma Gül YURDAKUL ,
Tuncay DURUÖZ ,
Fatih ÇAY ,
Ülkü UÇAR ,
Yaşar KESKİN ,
Betül SARGIN ,
Gülcan GÜRER ,
Ozan Volkan YURDAKUL ,
Mustafa ÇALIŞ ,
Hülya DEVECİ ,
Yıldıray AYDIN ,
Sami HİZMETLİ ,
Remzi ÇEVİK ,
Ali Yavuz KARAHAN ,
Şebnem ATAMAN ,
Hilal ECESOY , Zafer GÜNENDİ,
Murat TOPRAK ,
Nesrin ŞEN ,
Duygu ALTINTAŞ ,
A. Kıvanç CENGİZ ,
Gökhan ÇAĞLAYAN ,
Ali Nail DEMİR ,
Hüseyin KAPLAN ,
Sertaç KETENCİ ,
Meltem ALKAN MELİKOĞLU ,
Mehmet NAYİMOĞLU ,
Kemal NAS ,
Banu SARIFAKIOĞLU ,
İlhan SEZER
Objectives: This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients.Patients and methods: This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale.Results: The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$<300), smoking, late-onset FMF (>20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT.Conclusion: Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.
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Yaşar KESKİN ,
Kemal NAS ,
Erkan KILIÇ ,
Betül SARGIN ,
Sevtap ACER KASMAN ,
Hakan ALKAN ,
Nilay ŞAHİN ,
Gizem CENGİZ ,
Nihan CÜZDAN ,
İlknur ALBAYRAK GEZER ,
ESRA DİLEK KESKİN ,
Cevriye MÜLKOĞLU ,
Hatice REŞORLU ,
Şebnem ATAMAN ,
Ajda BAL ,
Tuncay DURUÖZ ,
Okan KÜÇÜKKAŞ ,
Ozan Volkan YURDAKUL ,
Meltem ALKAN MELİKOĞLU ,
Yıldıray AYDIN ,
Fikriye Figen AYHAN ,
HATİCE BODUR ,
Mustafa ÇALIŞ ,
Erhan ÇAPKIN ,
Gül DEVRİMSEL ,
Kevser GÖK ,
Sami HİZMETLİ ,
Ayhan KAMANLİ ,
Hilal ECESOY ,
Öznur KÜTÜK ,
Nesrin ŞEN ,
Ömer Faruk ŞENDUR ,
İbrahim TEKEOĞLU ,
Sena TOLU ,
Murat TOPRAK ,
Tiraje TUNCER
Objectives: This study aims to compare the clinical characteristics, disease activity, and quality of life (QoL) of patients with psoriatic arthritis (PsA) who use biological and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in a nationwide cohort throughout Turkey. Patients and methods: A total of 961 patients (346 males, 615 females; mean age: 46.9±12.2 years; range, 18 to 81 years) with PsA according to the classification criteria for PsA were included in the study. The patients’ demographic and clinical characteristics, physical examination results, Disease Activity Score 28, Disease Activity Index for Psoriatic Arthritis and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, Psoriatic Arthritis Quality of Life (PsAQoL), and Short Form-36 scores were all recorded. Results: Of the patients, 23% underwent biological DMARD (bDMARD) monotherapy, 42% underwent conventional synthetic DMARD (csDMARD) monotherapy, 10% underwent a csDMARD combination therapy, and 10% underwent a combination bDMARD and csDMARD treatment. The Visual Analog Scale (VAS pain), patient global assessment, physician global assessment, and BASDAI scores were found to be lower among patients using combination treatment of csDMARD and bDMARD, while the swollen joint count was found to be lower among patients using bDMARD. The PsAQoL score was found to be the lowest among patients not using any medication and the highest among those using bDMARD. Conclusion: In our study, patients with PsA were successfully treated with both csDMARD and bDMARD monotherapy. When the biological treatments used for PsA were compared with csDMARD, it was found that biological treatments had a positive effect on both disease activity and the QoL. Combinations of csDMARDs and bDMARDs were preferred in cases in which the disease activity was still high or increased. Because of the highest efficacy of the combined treatment, we highly suggest increasing the number of patients on combined treatment.
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OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The diagnosis is basedon the history, clinical signs and symptoms of the patient,but electrodiagnostic studies are done to confirm the di- agnosis and to manage the treatment. This study aimedto assess sensitivities of clinical symptoms, provocativetests and electrodiagnostic studies (EDS) in patients withidiopathic mild CTS.MATERIAL AND METHODS:The study included 90 han- ds of 75 patients with idiopathic mild CTS and 30 handsof 15 healthy volunteers. The patients were questionedfor symptoms in the innervation area of the median ner- ve such as pain, paresthesia, weakness in the hand andnumbness and pain worsening at night, relief from thesymptoms by shaking hands. Tinel and Phalen tests weredone. The EDS included; motor, mixed and sensorial (di- gits 1-2-3-4 and palm) nerve conduction studies (NCS)for median nerve; motor, mixed and sensorial (fifth digit)NCS for ulnar nerve, sensorial NCS (first digit) for radialnerve, median and ulnar F waves. The values for distal la- tency and nerve conduction velocity (NCV) were calcula- ted for all studied nerves. Sensitivities of median sensorydistal latency and NCV to digits 1,2,3,4 and palm-wristsegments and sensitivities of the following comparativetests were detected; median-radial sensory distal latencydifference (SDLD) to the first digit, median-ulnar SDLD tothe fourth digit, median-ulnar SDLD to the digits 2-5, 3-5,4-5 and median-ulnar F latency difference.RESULTS: The most common symptoms in patients with idiopathic mild CTS were paresthesia (95.6%) and noc- turnal numbness (88.8%). The sensitivity of Phalen’s andTinel’s tests were 67.8% and 56.7%, respectively. Amongthe EDS, first digit and palm-wrist sensorial NCV were themost sensitive tests (98.9%). Of the comparative tests,median-ulnar SDLD to digits 4-5 was the most sensitiveone (93.3%). Median-ulnar F latency difference had thelowest sensitivity (38.9%).CONCLUSIONS: The most sensitive EDS were first digit and palm-wrist sensorial NCV. Median-ulnar SDLD to di- gits 4-5 was more sensitive than the other tests. With useof these tests, the diagnostic sensitivity of EDS may beincreased in patients with mild CTS.
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Objectives: This study aims to assess early changes in physical activity and function after total hip arthroplasty (THA) using both subjectiveand objective methods, and to identify predictors of outcomes of THA.Patients and methods: Between October 2014 and October 2015, a total of 50 patients (14 males, 36 females; mean age 57.1±13.0 years;range, 31 to 75 years) with end-stage primary hip osteoarthritis who were scheduled for THA and 50 age- and sex-matched controls(10 males, 40 females; mean age 52.9±9.3 years; range, 36 to 75 years) were included in the study. Pain was evaluated using the NumericRating Scale (NRS), physical function using the Lequesne Index, physical capacity using the Six-Minute Walking Test (6MWT), and physicalactivity using both International Physical Activity Impact Questionnaire Short Form (IPAQ-SF) and step count monitor. Data at baselineand six weeks and six months were recorded.Results: Pain severity was significantly lower after THA at six weeks and six months (NRS scores: 2.83 and 0.82, respectively; p<0.001),compared to baseline. Physical function, capacity, and activity significantly improved after THA at six weeks and six months with a meanLequesne Index score of 2.62 and 1.02, respectively. The mean 6MWT distance was 272.62 at six weeks and 326.16 at six months. The meanIPAQ and 6MWT results were similar between the patient and control groups at six weeks and six months. Age, presence of comorbidities,and baseline Lequesne Index score were found to be effective on functional outcomes of THA. Age and baseline 6MWT scores were correlatedwith physical capacity after THA.Conclusion: Our study showed a significant early improvement in pain severity and physical activity and function at six weeks and sixmonths after THA, compared to baseline values. Baseline values and age were the positive predictors of improved postoperative functionand physical capacity.
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Objective: The aim of this study was to identify the frequency of intensive care unitacquired paresis (ICU-AP) and predisposing factors for muscle weakness in our ICU patients.Materials and Methods: A prospective observational study was conducted in a 25-bed ICU ofa tertiary hospital. Patients who were cooperated with muscle strength examination, stayed inICU more than three days and had no preexisting neuromuscular disorder were included in thestudy. The diagnosis of hospitalization, need for mechanical ventilation, comorbidities, length of ICUstay, mobilization level, discharge status, and Sequential Organ Failure Assessment (SOFA) wererecorded. Manual muscle strength test was assessed according to Medical Research Council scale.Handgrip and finger pinch strength values were recorded.Results: Forty-two patients completed muscle strength examination. ICU-AP was determined in16 (38.09%) patients. Length of ICU stay, mechanical ventilation rate, SOFA score and frequency ofdecubitus ulcers were higher in patients with ICU-AP (p<0.05). There was a significant relationshiponly between mechanical ventilation and ICU-APConclusion: ICU-AP is a common problem in critically ill patients and influences outcomes ofpatients. Patients without mechanical ventilation may develop ICU-AP and mechanical ventilationcan be determined as one of the risk factors for muscle weakness.
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HATİCE BODUR , Fatma GÜL YURDAKUL,
ŞEBNEM ATAMAN , Yeşim GARİP,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK ,
MEHMET TUNCAY DURUÖZ ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU , Ece KAPTANOĞLU,
MELTEM ALKAN MELİKOĞLU , Erhan ÖZDEMİREL, Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , İsmihan SUNAR,
TUFAN GÜRKAN YILMAZ
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. Materials 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.
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Fatma GÜL YURDAKUL, Yeşim Garip ÇİMEN, Ayşegül KILIÇARSLAN, Aslı ÇALIŞKAN UÇKUN,
HATİCE BODUR
Fatma GÜL YURDAKUL, Yeşim Garip ÇİMEN, Ayşegül KILIÇARSLAN, Aslı ÇALIŞKAN UÇKUN,
HATİCE BODUR
Objectives: The aim of our study is to evaluate the depression rate in patients with rheumatoid arthritis(RA) and its association with pain, disease activity, functional status, and various health related qualityof life (HRQoL) domains in terms of functional status, vitality, social and emotional functioning.Materials and Methods: A total of 90 RA patients and 50 sex and age matched controls were includedin the study. Demographic characteristics, erythrocyte sedimentation rates, C‐reactive protein, tenderand swollen joint count, patient and physician global assessment of disease activity were recorded.Disease Activity Score‐28 (DAS28) was used for measuring disease activity. The severity of pain wasdetermined by using 10 cm Visual Analog Scale‐Pain (VAS‐pain). HRQoL was evaluated by using ShortForm 36 (SF 36).HAQ (Health Assessment Questionnaire) was used for evaluation of the functional status. Depressionwas evaluated by using Beck Depression Scale (BDS).Results: Mean age was 54.51±12.54 in RA (75 women, 15 men) group and 51.94±9.69 in the control group(41 women, 9 men). Mean VAS‐pain was 55.85±26.24; HAQ was 1.27±0.81 and DAS28 was 5.04 ±2.44 inRA patients. The mean BDS was 19.67±13.11 in RA group and 6.64±6.73 in the control group. RA patientsscored significantly higher in BDS when compared with the controls (p<0.001). BDS was linearly relatedwith DAS28 and VAS‐pain at a high level and negatively correlated with physical function, physical role,bodily pain, general health, vitality, mental health, social functioning and emotional role subgroups ofSF36 (p<0.001). There was no statistically significant relation between BDS and HAQ (p=0.431)Conclusion: Depression is common in the patients with RA and associated with disease activity andpain. It negatively affects HRQoL in terms of vitality, and physical, social and emotional functioning.
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ŞEBNEM ATAMAN , İsmihan SUNAR, Gürkan YILMAZ,
HATİCE BODUR ,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK , Yeşim Garip ÇİMEN, M. Tuncay DURUÖZ,
ATİLLA HALİL ELHAN ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU ,
MELTEM ALKAN MELİKOĞLU , Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , Fatma GÜL YURDAKUL
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.
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