Relationship Between Smoking and Structural Damage, Autoimmune Antibodies, and Disability in Rheumatoid Arthritis Patients.

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.

Neuropathic pain in pregnant Turkish women with lumbopelvic pain and its impact on health-related quality of life.

OBJECTIVES: To investigate the prevalence of neuropathic pain in pregnant women and to state its influence on the functional status and health-related quality of life (HRQoL) in terms of physical, social, and emotional functioning. METHODS: A total of 90 pregnant women with lumbopelvic pain (LPP) and non-pregnant and healthy controls were included. The presence of neuropathic pain was determined using the Leeds assessment of neuropathic symptoms and signs (LANNS) questionnaire. The HRQoL was assessed using the Nottingham Health Profile (NHP), and the functional status was evaluated using the Oswestry Disability Index (ODI). The severity of pain was measured using a visual analog scale. RESULTS: The LANNS score was ≥12 in 34 pregnant women (37.8%). The prevalence of neuropathic pain was higher in pregnant women with LPP (odds ratio=6.22; 95% confidence interval=2.68-14.44) (p<0.001) than in controls. The LANNS score was found to be correlated with the physical mobility subgroup in the NHP at high levels (p=0.002, r=0.32) and with the ODI and pain subgroup in the NHP at moderate levels (p=0.013, r=0.26 and p=0.038, r=0.22, respectively). CONCLUSION: The present study is the first to demonstrate that neuropathic pain is associated with pregnancy-related LPP and strongly correlated with functional impairment and deterioration in the HRQoL. A better understanding of neuropathic pain mechanisms in pregnancy-related LPP will help us find more effective treatment strategies.

Exploring the relationship between vitamin D and mania: correlations between serum vitamin D levels and disease activity.

BACKGROUND: Several studies suggest an association between hypovitaminosis D and mood disorders including major depressive disorder, seasonal affective disorder and premenstrual dysphoric disorder. On the other hand, there is not enough study about acute manic episode and hypovitaminosis D. This data insufficient zone led us to study on whether vitamin D deficiency is associated with acute manic episode and has an impact on disease activity Methods: Thirty-one patients with bipolar disorder in remission, 26 patients with acute manic episode and 40 healthy controls with no major psychopathology were recruited in this study. Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS) and the Clinical Global Impression - Severety scale (CGI-S) were used to evaluate disease activity. Total vitamin D (D2 + D3) values were measured. RESULTS: Patients in acute manic episode had significantly lower (p = .002) vitamin D serum concentrations than healthy controls (respectively 15.16 ± 7.48 and 22.31 ± 8.8) but remission group's serum concentrations (18.40 ± 7.30) did not differ significantly from healthy controls or acute manic episode patients (p > .05). We observed negative and moderate correlations between vitamin D levels and YMRS scores (r: -0.641, p < .001), vitamin D levels and CGI scores (r: -0.559, p= .003). CONCLUSIONS: Our results contribute to the idea that vitamin D deficiency and acute manic episode may have interactions with many pathways. Future trials may investigate this association with longer follow up. We recommend that serum vitamin D levels should be measured in patients with bipolar disorder especially in long term care.

Diagnosing fibromyalgia in rheumatoid arthritis: The importance of assessing disease activity.

OBJECTIVES: This study aims to evaluate fibromyalgia syndrome (FMS) incidence based on 2010 American College of Rheumatology (ACR) criteria in rheumatoid arthritis (RA) patients and the association between FMS with disease activity, functional status and quality of life (QoL). PATIENTS AND METHODS: The study included 151 RA patients (32 males, 119 females; mean age 52.4±12.7 years; range 21 to 82 years) and 77 controls (13 males, 64 females; mean age 53.7±10.2 years; range 33 to 73 years). Individuals were classified into four groups based on presence of RA and FMS. Group 1 included patients with both RA and FMS (n=53), group 2 included patients with RA and without FMS (n=98), group 3 included controls with FMS (n=15), and group 4 included controls without FMS (n=62). Demographic characteristics, morning stiffness (MS), pain, Disease Activity Score 28 (DAS28), functional and QoL scores were compared among the groups. RESULTS: No significant differences were found between the four groups as regards the mean age and gender distribution (p>0.05). Higher pain, MS, DAS28, and QoL scores in the groups with FMS drew attention. While FMS was found in 8.1% of RA patients with remission, it was found in 53.9% of patients with active RA, and in 19.5% of controls. CONCLUSION: Although FMS incidence in patients with RA was higher compared to controls without inflammatory disease, FMS evaluated with 2010 ACR diagnostic criteria was found to be common in the general population. DAS28 and inflammatory markers were higher in RA patients with FMS; thus, it has been concluded that sleep disorder and widespread pain caused by active disease may facilitate the diagnosis of FMS.