Kinesiophobia in rheumatoid arthritis patients: Relationship with quadriceps muscle strength, fear of falling, functional status, disease activity, and quality of life.

OBJECTIVES: This study aims to determine the frequency of kinesiophobia in rheumatoid arthritis (RA) patients and to evaluate the relation of kinesiophobia with the knee range of motion (ROM), quadriceps muscle strength, fear of falling, functional status, disease activity, depression, and quality of life. PATIENTS AND METHODS: Between September 2018 and September 2019, a total of 100 RA patients (25 males, 75 females; mean age: 56.1±9.3 years; range, 32 to 69 years) and 50 healthy controls (14 males, 36 females; mean age: 54.6±9.8 years; range, 30 to 69 years) were included. Disease activity was evaluated using the Disease Activity Score 28 (DAS28), and functional status using the Health Assessment Questionnaire (HAQ). Pain severity was measured using the Visual Analog Scale (VAS). Tampa Kinesiophobia Scale (TKS) was used to evaluate kinesiophobia. Quadriceps muscle strength and knee ROM measurements of two extremities were recorded. Depression was evaluated using the Beck Depression Inventory (BDI), fear of falling by Falls Efficacy Scale (FES) and quality of life using the Short Form-36 (SF-36). RESULTS: The rate of kinesiophobia was 70% in RA patients and 12% in controls, indicating a higher rate in RA patients, compared to controls (odds ratio [OR] = 44.861, 95% confidence interval [CI]: 42.571-49.052; p<0.05). This rate was 76% in females and 52% in males. Regression analysis revealed that the number of swollen and tender joints, DAS28, VAS-pain, and HAQ scores were positively associated with the TKS scores (p<0.05). Quadriceps muscle strength and knee flexion were negatively associated with the TKS scores (p<0.05). The TKS was significantly correlated with FES and BDI (p<0.05). The TKS was negatively correlated with SF-36 subscales (p<0.05). CONCLUSION: Kinesiophobia is common in RA patients. Our study is the first to evaluate the frequency of kinesiophobia in RA patients and to show pain level, disease activity, functional status, knee flexion ROM, and quadriceps muscle strength are effective on kinesiophobia. Kinesiophobia is also associated with fear of falling and depression, negatively affecting the quality of life in terms of physical, emotional, social and mental functions. Therefore, evaluating kinesiophobia and developing targeted treatment approaches seem to be useful in increasing the quality of life in RA.

Type D Personality is Associated With Disease Severity and Poor Quality of Life in Turkish Patients With Fibromyalgia Syndrome: A Cross-Sectional Study.

OBJECTIVES: This study aims to investigate the rate of type D personality in Turkish patients with fibromyalgia (FM) and evaluate its associations with clinical parameters of FM as well as its effects on health-related quality of life (HRQoL). PATIENTS AND METHODS: The study included 100 patients with FM (14 males, 86 females; mean age 34.6±7.4 years; range, 22 to 49 years) fulfilling 1990 American College of Rheumatology diagnostic criteria and 50 healthy controls (9 males, 41 females; mean age 32.6±6.5 years; range, 21 to 50 years). Type D personality was assessed using the type D scale-14 (DS-14). FM disease severity was determined by Fibromyalgia Impact Questionnaire (FIQ), functional status by Stanford Health Assessment Questionnaire (HAQ), and HRQoL by Nottingham Health Profile (NHP). Severity of pain and fatigue were measured by visual analog scale (VAS). RESULTS: The frequency of type D personality was 33% in FM patients and 12% in controls (odds ratio=3.612, 95% confidence interval 1.398-9.333) (p=0.006). Type D FM patients scored higher in tender point count (TPC), FIQ, HAQ, VAS-pain and all NHP subgroups except energy (p<0.01). Type D personality was found to be correlated with FIQ, TPC, HAQ, VAS-pain and NHP subgroups except energy (p<0.01). CONCLUSION: Based on our findings, assessment of personality characteristics of patients with FM may hold the key for the treatment of the disease. Besides, a better understanding of personality-related pain in FM patients may provide a more targeted approach to pain treatment.

The Role of Pain Catastrophizing and Depression in the Outcomes of Physical Therapy in a Prospective Osteoarthritis Cohort.

BACKGROUND: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients' response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression. OBJECTIVES: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA. STUDY DESIGN: This research used a prospective, cohort, observational study design. SETTING: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey. METHODS: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression Inventory-II (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes. RESULTS: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome. LIMITATIONS: This study is limited owing to the combined use of several physical therapy modalities and short follow-up. CONCLUSIONS: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy. KEY WORDS: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.

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 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.

Turkish Version of Evaluation of Ankylosing Spondylitis Quality of Life Questionnaire in Patients With Ankylosing Spondylitis: A Validation and Reliability Study.

OBJECTIVES: This study aims to translate the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) into the Turkish language and test its validity and reliability. PATIENTS AND METHODS: A total of 100 AS patients (74 males; 26 females; mean age 38.2±9.9 years; range 21 to 63 years) were included. The mean disease duration was 115.9±91.6 months. EASi-QoL was translated from English into Turkish, and synthesis, back translation, revision, and pretest stages were performed. All patients were asked to complete the Turkish version of EASi-QoL. The internal consistency of EASi-QoL was determined with Cronbach's alpha coefficient, and test-retest reliability was assessed by calculating the intra-class correlation coefficient. Confirmatory and explanatory factor analyses were performed to assess structural validity. Construct validity was also investigated by comparing the results of EASi-QoL with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Disease Activity Score, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and AS-specific QoL scale. RESULTS: Cronbach's alpha coefficient was 0.910 in the physical function category, 0.893 in the disease activity category, 0.935 in the emotional well- being category, and 0.930 in the social contribution category (α>0.7). Factor loadings of all items in EASi-QoL were higher than 0.7, indicating the high reliability of the questionnaire. There was also a strong positive correlation between all subcategories of EASi-QoL (physical function, disease activity, emotional well-being and social participation) and AS-specific QoL scale, BASDAI, Bath BASFI, patient's global assessment and pain severity. MASES and BASMI showed a moderate correlation with emotional well-being and social participation categories of EASi-QoL. CONCLUSION: Turkish version of EASi-QoL is a reliable and valid scale that can be used in clinical practice to evaluate QoL in detail in patients with AS.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning.

OBJECTIVE: To determine the impact of postpolio-syndrome on quality of life in polio survivors. METHODS: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. RESULTS: Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. CONCLUSIONS: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning / Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós-pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional

ABSTRACT Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors. Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. Results: Total manual muscle testing score was 26.19 ± 13.24 (median: 29) in postpolio-syndrome group and 30.08 ± 8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

RESUMO Objetivo: Determinar o impacto da síndrome pós-pólio na qualidade de vida nos sobreviventes da pólio. Métodos: Quarenta sobreviventes da pólio foram incluídos no estudo. Participaram do grupo de síndrome pós-pólio 21 pacientes que atenderam aos critérios de síndrome pós-pólio de Halstead. Os 19 restantes formaram o grupo não síndrome pós-pólio. O grupo controle foi composto por 40 indivíduos saudáveis. A qualidade de vida foi avaliada pelo Nottingham Health Profile, a depressão pela Escala de Depressão de Beck e a fadiga pelo Inventário de Sintomas de Fadiga. A força muscular isométrica foi medida por teste muscular manual. Resultados: O escore total do teste muscular manual foi 26,19 ± 13,24 (mediana: 29) no grupo de síndrome pós-pólio e 30,08 ± 8,9 (mediana: 32) no grupo não síndrome pós-pólio. Escores totais de teste muscular manual de grupo não síndrome pós-pólio foram significativamente maiores do que os do grupo de síndrome pós-pólio. Os pacientes com síndrome pós-pólio relataram níveis significativamente maiores de fadiga e qualidade de vida reduzida em termos de mobilidade física, dor e energia quando comparados com pacientes sem síndrome pós-pólio e grupo controle. Não se relatou uma diferença estatisticamente significativa no funcionamento social e emocional e na qualidade do sono entre grupos de síndrome pós-pólio, não síndrome pós-pólio e controle. Além disso, não se encontrou diferença estatisticamente significativa nos escores da Escala de Depressão de Beck entre os grupos. Conclusões: A síndrome pós-pólio tem um impacto negativo na qualidade de vida em termos de estado funcional, gravidade da dor e energia. A identificação, o reconhecimento precoce e a reabilitação dos pacientes com síndrome pós-pólio podem resultar em uma melhoria da qualidade de vida.

Fatigue in the mothers of children with cerebral palsy.

PURPOSE: To evaluate fatigue in the mothers of children with cerebral palsy (CP), and to determine its associations with clinical parameters of CP, depression and quality of life (QoL). METHOD: Ninety children (50 girls and 40 boys) with spastic CP and their mothers were included. Control group comprised mothers of healthy children. Gross motor function classification system (GMFCS) was used for determining functional status. Spasticity was evaluated by using modified Ashworth scale. Fatigue symptom inventory (FSI) was used for assessing maternal fatigue, Nottingham health profile (NHP) for maternal QoL, and Beck Depression Scale (BDS) for maternal depression. RESULTS: Mothers of children with CP scored significantly higher in all FSI subgroups (intensity of fatigue, duration of fatigue and interference with QoL), all NHP subgroups and BDS (p < 0.05) when compared with controls. FSI was found to be correlated with BDS and all subgroups of NHP (p <  0.01). No association was found between FSI and clinical parameters of children with CP including age, gender, type of CP, tonus and functional impairment (p > 0.05). CONCLUSIONS: Our findings indicate that fatigue levels of mothers with CP children are higher than those with healthy children and associated with depression and deterioration in QoL in terms of physical, social and emotional functioning. This should be considered while designing a family centred rehabilitation programme for children with CP. Implications for Rehabilitation Caring for a child with cerebral palsy has psychological, social and financial impacts on familiesand is associated with increased levels of fatigue among mothers. The capacity of current programs and services needs to be strengthened to accommodate theneeds of children with CP and their mothers in order to reduce fatigue of mothers. New programs need to be developed to provide psychosocial support for the mothers andto reduce their fatigue as they continue to care for their children. Provision of assistive technology devices (particularly suitable wheelchairs) will be useful inreduction of fatigue levels of mothers.

Coexistence of familial Mediterranean fever and Behçet's disease: a case report.

Behçet's disease (BD) is a chronic, multi-systemic vasculitis, characterized by a triad of recurrent aphthous stomatitis, genital aphthae, and uveitis. It is common in the Eastern Mediterranean, Middle East, and Eastern Asian countries. Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder, which is common seen in the Turkish, Armenian, Arabic, and Sephardic Jewish populations. It is characterized by recurrent episodes of fever, peritonitis, pleuritis, arthritis, and erysipelas-like skin lesions. Behçet's disease and FMF have common clinical features and geographic distribution. Herein, we present a 19-year-old female patient with coexistence of FMF and BD in the light of literature data.

Comorbidities in Turkish patients with rheumatoid arthritis: association with the health-related quality of life in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning.

AIMS: The aim of our study was to investigate the comorbidities in Turkish RA patients and evaluate the impact of comorbidities on health-related quality of life (HRQoL) in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning. METHODS: In a cross-sectional setting, a total of 160 RA patients who were admitted to our outpatient clinic between December 2013 and February 2014 were consecutively enrolled in the study. Comorbidities were recorded. Disease activity was measured by using Disease Activity Score-28 (DAS28). Stanford Health Assessment Questionnaire (HAQ) was used for determining functional status, Nottingham Health Profile (NHP) for HRQoL, and modified Sharp Score for radiological damage. MAJOR RESULTS: Comorbidities were reported in 107 patients (66.88 %). The most common was peptic ulcer (31.25%). This was followed by osteoporosis (21.25%), dyslipidemia (15.63%), depression (15%), hypertension (13.75%), diabetes mellitus (13.13%), thyroid disorders (%8.13), lung diseases (%6.88), cardiovascular diseases (6.25%), and cancers [(1 breast cancer, 1 malign melanoma, 3 lung carcinoma), 3.13%], respectively. Patients with comorbidities scored significantly higher in DAS28, HAQ, pain, energy and physical mobility subgroups of NHP (p<0.05). It was not recorded any statistical significant difference in modified Sharp scores and sleep, social isolation and emotional reactions subgroups of NHP between the patient groups with and without comorbidities (p>0.05). CONCLUSIONS: Comorbid conditions of RA are common and associated with more active and severe disease and functional impairment. Comorbidities should be detected and treated earlier to reduce its negative impact on outcome in RA.

Prevalence of fibromyalgia in Turkish geriatric population and its impact on quality of life.

OBJECTIVES: The aim of the present study was to examine the presence of fibromyalgia (FM) in elderly adults and to evaluate the impact of the severity of FM on quality of life. METHODS: A total of 100 patients between 65 and 80 years of age were included. The main admission diagnosis of the patients was recorded. Presence of FM was evaluated based on 1990 American College of Rheumatology (ACR) diagnostic criteria. The FM group was comprised of 31 patients fulfilling these criteria, and the remaining 69 patients composed the non-FM group. Tender point count (TPC) and common symptoms were recorded. FM disease severity was assessed using Fibromyalgia Impact Questionnaire (FIQ). Nottingham Health Profile (NHP) was used to evaluate quality of life. Pain severity was measured using Visual Analog Scale (VAS). RESULTS: Rate of FM was found to be 31%. FM patients scored significantly higher on pain, sleep, social isolation, and emotional reactions subgroups of NHP when compared to controls (p<0.05). TPC and FIQ were not affected by gender difference (p>0.05), but reduced with increasing age (p<0.01). FIQ and TPC were found to be correlated with only the pain and emotional reactions subgroups of NHP (p<0.01). There was no statistically significant correlation between FIQ and TPC and the physical mobility, sleep, energy, and social isolation subgroups of NHP (p>0.05). CONCLUSION: Although FM is known as a disease of young and middle-aged women, our study indicates that its prevalence increases with age. FM is associated with poor quality of life in terms of pain, sleep, social, and emotional functions.

Dry eye in vitamin D deficiency: more than an incidental association.

AIM: The aim of this article is two-fold: (i) to demonstrate the relation between vitamin D deficiency and dry eye and impaired tear function; and (ii) to investigate the possible associations among clinical parameters of hypovitaminosis D with dry eye parameters. METHOD: Fifty premenopausal women with vitamin D deficiency (serum vitamin D levels < 20 ng/mL) and 48 controls were included. Participants were assessed by Schirmer's test, tear break-up time test (TBUT), ocular surface disease index (OSDI), Stanford Health Assessment Questionnaire (HAQ), fatigue severity scale (FSS), and visual analogue scale-pain (VAS-pain). RESULTS: Lower scores in Schirmer's test and TBUT, and higher in OSDI were detected in patients with vitamin D deficiency than in controls (P < 0.05). FSS was negatively correlated with Schirmer's test (r = -0,29; P = 0.038) and TBUT scores (r = -0,43; P = 0.002); VAS-pain was negatively correlated with TBUT scores (r = -0.32; P = 0.023). HAQ scores showed no significant correlation with dry eye parameters (P > 0.05). Vitamin D level was negatively correlated with OSDI (r = -0.49; P < 0.001), and positively with Schirmer's test (r = 0.45; P = 0.001) and TBUT scores (r = 0.30; P = 0.029). CONCLUSION: Dry eye and impaired tear function in patients with vitamin D deficiency may indicate a protective role of vitamin D in the development of dry eye, probably by enhancing tear film parameters and reducing ocular surface inflammation. Patients with vitamin D deficiency should be evaluated for dry eye syndromes.

Coexistence of Familial Mediterranean Fever With Ankylosing Spondylitis and Sjogren's Syndrome: A Rare Occurrence.

Familial Mediterranean fever is an autosomal recessive disease characterized by recurrent episodes of fever, peritonitis, synovitis, pleuritis, and erysipelas-like skin lesions. Sjogren's syndrome is a chronic autoimmune disorder characterized by dry eyes, dry mouth, and musculoskeletal involvement. Ankylosing spondylitis is an autoinflammatory rheumatic disease which affects mainly the axial skeleton. To our knowledge, coexistence of familial Mediterranean fever with ankylosing spondylitis and Sjogren's syndrome has not been reported previously in the literature. In this article, we report an unusual case of three autoinflammatory diseases in one patient.

[Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning]. / Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós-pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional.

OBJECTIVE: To determine the impact of postpolio-syndrome on quality of life in polio survivors. METHODS: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. RESULTS: Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. CONCLUSIONS: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

Osteomalacia in Crohn's disease.

UNLABELLED: Osteomalacia is a metabolic bone disorder characterized by impaired mineralization of the bone matrix. Vitamin D deficiency due to malabsorption syndromes may cause osteomalacia. This is a case of a patient with a 6-year history of seronegative spondyloarthropathy associated with Crohn's disease who was admitted to our outpatient clinic with symptoms of osteomalacia. INTRODUCTION: Osteomalacia is a metabolic bone disease characterized by an impaired mineralization of the bone matrix, frequently caused by disorders in vitamin D or phosphate metabolism. Vitamin D deficiency due to malabsorption syndromes (e.g., Crohn's disease, ulcerative colitis, celiac disease, and jejuno-ileal bypass for obesity) may cause osteomalacia. CASE REPORT: A 43-year-old male presented with fatigue, low back pain, and morning stiffness. He had a 6-year history of seronegative spondyloarthropathy associated with Crohn's disease. Laboratory findings revealed low serum calcium, low 25-hydroxy vitamin D3, normal phosphorus, elevated parathyroid hormone, and alkaline phosphatase levels. Radiographs revealed grade IV sacroiliitis and Looser zones. He was diagnosed with osteomalacia due to the malabsorption of vitamin D. His symptoms and signs were relieved with supplements of vitamin D and calcium. CONCLUSIONS: Osteomalacia should be considered in differential diagnosis when assessing low back pain in the patients with chronic inflammatory bowel disease. Vitamin D deficiency should be treated with vitamin D supplementation in patients with Crohn's disease to prevent osteomalacia.

Health-related quality of life in Turkish patients with ankylosing spondylitis: impact of peripheral involvement on quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning.

Ankylosing spondylitis (AS) affects sacroiliac joints at early stages and may involve the axial skeleton at later stages of disease. Peripheral involvement usually occurs in lower extremities. When it develops early in the disease course, it is a predictor of more aggressive disease. The aim of this study is to evaluate health-related quality of life (HRQoL) in AS and to assess the impact of peripheral involvement on HRQoL domains in terms of disease activity, functional status, pain, and social and emotional functioning. Seventy-four AS patients were included. Peripheral involvement was present in 51.35 % of the patients. In 65.79 % of these cases the hips, in 31.58 % the knees, in 18.42 % the shoulders and in 13.16 % the ankles were affected. Patients were evaluated by Ankylosing Spondylitis Quality of Life (ASQoL), Short Form-36 (SF-36), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Functional Index (BASFI). ASQoL was strongly correlated with ASDAS, BASDAI, BASFI, and Bath Ankylosing Spondylitis Metrology Index (BASMI), severity of total pain, night pain, fatigue, morning stiffness and ESR. ASDAS and BASDAI showed the strongest correlation with ASQoL. Severity of total pain, functional status and severity of night pain followed it, respectively. Patients with peripheral involvement scored significantly lower in all subgroups of SF36 and significantly higher in ASDAS, BASDAI, BASFI, BASMI and ASQoL scores and levels of pain, night pain, fatigue and morning stiffness. Peripheral involvement is associated with more active disease and functional disability and has a negative influence on HRQoL including physical, social and emotional functioning.

Extraarticular manifestations in Turkish patients with rheumatoid arthritis: impact of EAMs on the health-related quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning.

The aim of our study was to investigate extraarticular manifestations (EAMs) in Turkish patients with rheumatoid arthritis (RA) and also assess the impact of EAMs on various health-related quality of life (HRQoL) domains, including physical, social, emotional, mental functioning, and bodily pain. A total of 150 patients were included in the study. EAMs were identified clinically. Pulmonary involvement was confirmed by using pulmonary function tests (PFT) and high-resolution computed tomography (HRCT), atlantoaxial subluxation by cervical spine X-rays. Peripheral neuropathy, rheumatoid nodules, and Sicca symptoms were picked up on clinical examination. Peripheral neuropathy was also confirmed by electroneurophysiologic studies. Patients were evaluated by Rheumatoid Arthritis Quality of Life (RAQoL), and Short form-36 (SF36). The quadrivariate Disease Activity Score- 28 (DAS28) was used for measuring disease activity. Functional status was evaluated by using the Stanford Health Assessment Questionnaire (HAQ). The severity of pain was documented by using 10-cm Visual Analog Scale-Pain (VAS-pain). EAMs were observed in 50 patients (33.3%). These were pulmonary involvement (28.7%), rheumatoid nodules (14.7%), Sicca Syndrome (8%), peripheral neuropathy (2.7%), and atlantoaxial subluxation (0.7%), respectively. It was not recorded any statistically significant difference in HAQ, DAS28, VAS-pain, and RAQoL scores between the patient groups with and without EAMs. Patients with EAMs scored significantly lower in physical functioning, role-physical, and role-emotional subgroups of SF36 (P < 0.01). Presence of EAMs is not directly associated with disease activity and functional status, but influences negatively HRQoL including physical and emotional functioning.

Clinic and ultrasound findings related to pain in patients with knee osteoarthritis.

The aim of this study was to determine clinical and US factors associated with pain in patients with knee osteoarthritis (OA). The study included 143 patients. Patients were divided into two groups: group 1 consisted of 94 patients with unilateral or bilateral knee pain ≥3 cm during physical activity for at least 48 h prior to inclusion, measured by the visual analog scale from 0 to 10 cm. Group 2 consisted of 49 patients with knee OA without knee pain at least 1 month prior to inclusion. In both knees, range of motion was measured by goniometry and anteroposterior, and lateral knee radiographs were taken during weight-bearing. OA grading was performed in accordance with the Kellgren-Lawrence criteria by a specialist in radiology experienced in this field. A knee ultrasound (US) examination was performed in all patients by a blinded radiologist. Women were more often symptomatic than men (p < 0.005). Patients in group 1 tended to have a higher body mass index (BMI; p<0.001). Radiographic grades III (52.1%) and II (37.2%) were most frequently found in group 1, whereas I (30.6%), II (46.9%), and III (22.4%) were found in group 2. When radiographic grades in both groups were compared, group 1 had greater radiographic grades than group 2 (p<0.001). US findings in group 1 were effusion of the suprapatellar pouch (72.3%), Baker's cyst (42.6%), protrusion of the anterior horn of the medial meniscus associated with medial collateral ligament displacement (9.6%), and loose body (9.6%). In group 2, the only US finding was Baker's cyst (6.1%). Regression analysis revealed that BMI, degree of knee flexion, and thickness of the quadriceps tendon were factors that were related with pain in the knee. Increased BMI, decrease in the degree of knee flexion, and decreased quadriceps tendon thickness are factors that increase the risk of pain in knee OA.

Fatigue in rheumatoid arthritis: association with severity of pain, disease activity and functional status.

OBJECTIVE: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis causing progressive joint destruction and disability. Major patient complaints are pain, disability and fatigue. The aim of this study is to assess fatigue and its association with disease-specific variables (severity of pain, disease activity, and functional status) in patients with RA. PATIENTS AND METHODS: A total of 160 RA patients were included in the study. Fatigue was measured by using Fatigue Symptom Inventory (FSI). The quadrivariate Disease Activity Score-28 (DAS28) was used for evaluating disease activity and Health Assessment Questionnaire (HAQ) for determining functional status. Severity of pain was measured by using 10 cm Visual Analog Scale-Pain (VAS-pain). RESULTS: Intensity items of FSI (most fatigue, least fatigue, average fatigue, current fatigue) were strongly correlated with DAS28, HAQ, and VAS pain (p=0.000). When the correlation coefficients were analyzed, current fatigue showed the highest correlation with VAS-pain (r: 0.96). This was followed by DAS28 and HAQ, respectively (r: 0.77 and 0.70) (p=0.000). Duration items of FSI (number of days fatigued, amount of time fatigued) were significantly correlated with DAS28, HAQ, and VAS pain (p=0.000). Also there were significant positive correlations between interference scale of FSI and DAS28, HAQ, and VAS-pain (r: 0.68, 0.61 and 0.67, respectively) (p=0.000). None of FSI subgroups showed statistically significant correlation with di­sease duration. CONCLUSIONS: Fatigue is strongly associated with severity of pain, disease activity and functional status. Fatigue should be included in clinical practice and clinical trials as a RA outcome measure.