• ÖZ

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The diagnosis is based on 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 aimed to assess sensitivities of clinical symptoms, provocative tests and electrodiagnostic studies (EDS) in patients with idiopathic mild CTS. MATERIAL AND METHODS:The study included 90 han- ds of 75 patients with idiopathic mild CTS and 30 hands of 15 healthy volunteers. The patients were questioned for symptoms in the innervation area of the median ner- ve such as pain, paresthesia, weakness in the hand and numbness and pain worsening at night, relief from the symptoms by shaking hands. Tinel and Phalen tests were done. 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 radial nerve, 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 sensory distal latency and NCV to digits 1,2,3,4 and palm-wrist segments and sensitivities of the following comparative tests were detected; median-radial sensory distal latency difference (SDLD) to the first digit, median-ulnar SDLD to the 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 and Tinel’s tests were 67.8% and 56.7%, respectively. Among the EDS, first digit and palm-wrist sensorial NCV were the most sensitive tests (98.9%). Of the comparative tests, median-ulnar SDLD to digits 4-5 was the most sensitive one (93.3%). Median-ulnar F latency difference had the lowest 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 use of these tests, the diagnostic sensitivity of EDS may be increased in patients with mild CTS.

• ÖZ

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 quality of 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 included in the study. Demographic characteristics, erythrocyte sedimentation rates, C‐reactive protein, tender and 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 was determined by using 10 cm Visual Analog Scale‐Pain (VAS‐pain). HRQoL was evaluated by using Short Form 36 (SF 36). HAQ (Health Assessment Questionnaire) was used for evaluation of the functional status. Depression was 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 in RA patients. The mean BDS was 19.67±13.11 in RA group and 6.64±6.73 in the control group. RA patients scored significantly higher in BDS when compared with the controls (p<0.001). BDS was linearly related with 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 of SF36 (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 and pain. It negatively affects HRQoL in terms of vitality, and physical, social and emotional functioning.

• ÖZ

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.

• ÖZ

Aim: In this study, our aims were to identify vitamin D levels in rheumatoid arthritis (RA) individuals as compared to controls and the impact of vitamin D levels on both objective and subjective assessments in RA patients. Methods: The current study was a prospective case-control study conducted on 108 RA patients and 50 age-gender matched healthy controls. We first compared the levels of vitamin D among the RA patients and controls. Demographic and clinical data, parameters of disease activity, inflammatory markers, rheumatoid factor and anti-cyclic citrullinated peptide seropositivity and radiological damage scores were recorded in RA patients. These patients were also demanded to complete RA Quality of Life Questionnaire (RAQoL), fatigue severity scale (FSS) and Health Assessment Questionnaire (HAQ). Results: D vitamin levels in RA patients were significantly lower than healthy controls (p=0.001). Vitamin D deficiency was determined in 73% of the RA patients and 52% of the controls. Vitamin D deficiency was not associated with disease activity (p=0.862). There was no significant relationship among vitamin D levels and all subjective and objective assessments (p>0.05 for all ). Conclusion: Vitamin D deficiency was common in RA participants than normal population. However, it was not shown that there was a significant relationship between vitamin D levels and objective and subjective assessments of disease, including disease activity, inflammatory markers, rheumatoid factor and anti-cyclic citrullinated peptide seropositivity, radiological damage scores, RAQoL, FSS and HAQ.

• ÖZ

Objectives: This study aims to investigate the relationship between smoking and structural damage, autoimmune antibodies, and disability in rheumatoid arthritis (RA) patients. Patients and methods: This cross-sectional study included 165 RA patients (36 males, 129 females; mean age 52.4±12.8 years; range 21 to 82 years). Disease duration, age at disease onset, smoking habits, rheumatoid factor (RF), and anti-cyclic citrullinated peptide levels were recorded. Morning stiffness, pain with visual analog scale, Health Assessment Questionnaire Scores And Disease Activity Score 28 were calculated. Patients’ standard hand radiographs were evaluated. Results: Patients were divided into three groups according to their smoking habits. Ninety-nine patients (60%) were never smokers, 45 patients (27.3%) were long-term smokers and 21 patients (12.7%) were new smokers. Three groups were compared for disease activity. Disease activity score 28 scores were 3.2±1.2, 3.2±1.3, and 3.2±1.4, respectively (p>0.05). The erosion score (2.6±5.8, 7.1±10.9, and 11.1±19.2, respectively) and joint space narrowing score (9.9±7.3, 18.6±14.9, and 17.3±12.3, respectively) according to modified Sharp method were significantly lower in never smokers group than other groups (p<0.05). RF titrations were 55.2±58.9, 60.5±63.1, and 84.9±71.5, respectively, and levels of long-term smokers group were significantly higher than the other groups (p<0.05). Joint space narrowing score was 16.2±11.9 and 6.4±10.4 in RF (+) and RF (-) patients, respectively (p<0.05). There was no significant relationship between anti-cyclic citrullinated peptide levels and others parameters. Conclusion: Although smoking is known as a poor prognostic factor in RA, there was no correlation between disease activity and smoking in our study. However, less radiographic damage was found in never smokers. Smoking does not appear to correlate with RA disease activity but it may be effective in the long-term joint damage.