Evaluation of the Role of Affective Temperamental Features, Automatic Thoughts, and Symptom Interpretation on Disease Activity in Patients with Axial Spondyloarthritis.

Objective: Axial spondyloarthritis is a systemic and chronic inflammatory disease. Psychological liability to depression and anxiety influences the disease process, prognosis, and treatment outcomes of other medical conditions. Early detection and treatment of these psychiatric conditions would also help in improving the physical functioning of patients with axial spondyloarthritis by reducing the patient's anxiety and depression symptoms. We evaluated the affective temperamental features, automatic thoughts, symptom interpretation, and their relationship with disease activity in patients with axial spondyloarthritis. Methods: A total of 152 patients diagnosed with axial spondyloarthritis are recruited. Axial spondyloarthritis disease activity was calculated by Bath Ankylosing Spondylitis Disease Activity Index. Depression and anxiety levels were screened with Hospital Anxiety and Depression Scale while affective temperament was evaluated with Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire version and automatic thoughts were screened with Symptom Interpretation Questionnaire, and Automatic thoughts questionnaire. Results: It was observed that 48% (n = 73) were female. The mean age was 43.5 (10.5) years, Bath Ankylosing Spondylitis Disease Activity Index score was 3.97 (1.14). According to the Bath Ankylosing Spondylitis Disease Activity Index scale, 53.30% (n = 81) of the patients were in high disease activity. We found that HAD-depression, HAD-anxiety, Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire version, Symptom Interpretation Questionnaire, and Automatic Thoughts Questionnaire scores were significantly higher in the high disease activity group. Conclusion: Patients' temperament characteristics and mood disorders may affect composite disease activity scores such as Bath Ankylosing Spondylitis Disease Activity Index. In patients with high disease activity scores despite receiving appropriate treatment, mood disorders may need to be evaluated. There is a need to develop disease activity scores unaffected by mood disorders.

HLA-B51 Impact on Clinical Symptoms in Behcet's Disease.

OBJECTIVE: To investigate the association of HLA-B51-positivity to clinical manifestations of Behçet's disease (BD). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Clinic of Rheumatology, Diskapi Education and Research Hospital, Health Sciences University, Turkey, from December 2018 to December 2020. METHODOLOGY: Patients who had HLA-B5 genetic results and fulfilled the international criteria for BD were included in the study. HLA-B51 status was determined and compared with the symptomatology. RESULTS: Mean age of 204 cases was 39.9±11.4 years. There were 52.5% female and 47.5% male patients. One hundred (61.7%) patients were HLA-B51-positive. The frequency of papulopustular lesions (PPL), ocular involvement, neurologic involvement, and vascular involvement was significantly higher in HLA-B51-positive patients compared to HLA-B51 negative patients (p=0.044, 0.012, 0.039, and 0.022 respectively). HLA-B51-positivity was found to be a significant risk factor for PPL (OR and 95% CI:1.946 and 1.044-3.629), ocular involvement (OR and 95% CI:2.399 and 1.165-4.938), and neurological involvement (OR and 95% CI:5.404 and 1.119-26.093). Significant risk factors for vascular involvement were male gender (OR and 95% CI:2.810 and 1.403-5.627) and low age of disease onset (OR and 95% CI:0.935 and 0.894-0.979). CONCLUSION: Ocular, vascular, and neurological involvements are more common in patients with BD with HLA-B51-positive. HLA-B51 was found to be an independent risk factor for papulopustular lesion, ocular and neurological involvement, while the male gender was found to be an independent risk factor for vascular involvement. KEY WORDS: Behcet syndrome / genetics, HLA-B51, Neurologic involvement, Ocular involvement, Vascular involvement, Vasculitis* / diagnosis.

Relationship between disease impact scores and C-reactive protein/albumin ratio in patients with psoriatic arthritis.

AIM: To evaluate the relationships between the C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and Disease Activity in Psoriatic Arthritis (DAPSA) and Psoriatic Arthritis Impact of Disease 12-item-questionnaire (PsAID-12) scores in patients with psoriatic arthritis (PsA). METHODS: This cross-sectional study involved 160 (121 female) patients with PsA who were >18 years old and treated in the rheumatology clinic of Diskapi Yildirim Beyazit Education and Research Hospital between January 2020 and January 2021. Demographic and clinical data, PsAID-12 and DAPSA scores, CRP, erythrocyte sedimentation rate (ESR), albumin level, neutrophil, lymphocyte, and platelet counts were recorded. RESULTS: The mean age was 46.49±11.12 years; median (min-max) disease duration was 2 years (0.5-34). The PsAID score was ≥4 (high disease impact) in 74.4% of patients. Patients with high disease impact had significantly higher CRP, ESR, CAR, NLR, PLR, neutrophil counts, and DAPSA scores (P<0.001). PsAID scores significantly highly correlated with CRP (rho 0.864, P<0.001), DAPSA significantly highly correlated with the CAR (rho 0.890, P<0.001). Receiver operating characteristic curve analysis showed that the CAR (area under the curve [AUC] 0.901, P<0.05, 95% confidence interval [CI] 0.855-0.947, NLR (AUC 0.759, P<0.05, 95% CI 0.680-0.838), and PLR (AUC 0.686, P<0.05, 95% CI 0.591-0.782) predicted high disease impact. The cut-off value for the CAR was 0.98. CONCLUSION: The CAR can be useful in daily practice as a simple and quick assessment method to evaluate disease impact in PsA.

Investigation of the correlation between mood disorder symptoms and disease activity and functional status in rheumatoid arthritis patients

Background/aim: To investigate the correlation between depressive-anxiety symptoms, mixed features, disease activity, and functional status in patients with rheumatoid arthritis (RA) in the light of the shared underlying etiology in both disorders. Materials and methods: The study included 556 patients with RA. RA disease activity was measured using the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), and the patients were evaluated by a Health Assessment Questionnaire (HAQ). The Hospital Anxiety and Depression Scale (HADS), Mood Disorder Questionnaire (MDQ), and Modified Hypomania Checklist (mHCL) were used to evaluate the mixed depression and bipolarity status of the patients. Results: Of the patients, 430 (77.3%) were female and 126 (22.7%) were male. The median age was 57 years, the median HAQ score was 0.55 points, and the median DAS28-CRP score was 4.1 points. The evaluation of the patients by DAS28-CRP revealed that 58.5% of the patients had moderate and severe disease activity, while only 23.4% of them were in remission. The group using the combination of synthetic disease-modifying anti-rheumatic drugs (sDMARD) and steroid therapy had significantly higher HAD-depression, HAD-anxiety, mHCL, DAS28-CRP, HAQ, and MDQ scores than the group using sDMARD alone. The grouping of the patients based on the DAS28-CRP cut-off scores showed that the patients with moderate and severe disease activity had significantly higher HADS, mHCL, MDQ scores than those in remission and those with mild disease activity (p < 0.001). Conclusion: Disease severity and functional status in RA can be affected by comorbid anxiety-depressive and mixed symptoms. Therefore, clinicians should consider screening the depressive-anxiety and mixed mood symptoms of RA patients. Moreover, patients who use steroid therapy are more susceptible to mood symptoms (anxiety, depression, bipolarity), which should also be considered during the follow-up of patients.

Are YouTube videos enough to learn anakinra self-injection?

Anakinra is a drug that can be administered subcutaneously as a self-injection in both children and adults. We aimed to evaluate the content, reliability, and quality of the videos most viewed on "anakinra self-injection" on YouTube, which is an easily accessible source of information. We performed a YouTube search using the keywords "anakinra", "anakinra injection", and "anakinra self-injection" in addition to the generic and commercial names of the biologic agent in September 2021. The quality and reliability of the videos were assessed according to the Global Quality Score (GQS) and DISCERN score. Video power index was used to assess both the view and the like ratio of the videos. A total of 51 videos were analyzed, a majority of which were uploaded by physicians (56.9%). The median GQS was 3 and total DISCERN score was 49. According to the GQS, 21.6% of the videos were of low quality, 35.3% were of fair quality, and 43.1% were of high quality. High-quality videos had higher DISCERN scores and longer duration of videos (p < 0.05). 41 (80.4%) videos were categorized as useful information, and 8 (15.7%) as useful as per patients' opinion. Further, GQS and DISCERN scores of videos that had useful information were significantly higher. There are numerous YouTube videos with helpful information that can be a source of knowledge on the safe and correct technique of daily anakinra self-injection for both adults and children. There was no significant difference in patient interaction between useful and misleading videos. This indicates that patients do not differentiate between high- and low-quality videos.

Could C-Reactive Protein/Albumin Ratio be an Indicator of Activation in Axial Spondyloarthritis?

OBJECTIVES:  To evaluate the relationship of C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in axial spondyloarthritis (Ax-SpA). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Clinic of Rheumatology, Diskapi Education and Research Hospital, Health Sciences University, Turkey during January 2020-2021. METHODOLOGY: One-hundred and nine patients aged >18 years were included. Age, gender, duration of disease, BASDAI scores were recorded. CRP, erythrocyte sedimentation rate (ESR), albumin values, leukocyte, neutrophil, lymphocyte, platelet counts were determined. RESULTS: The mean age and median disease duration of the patients were 45.03±10.63 and 5 (2-6.5) years, respectively. Among these, 28 (58.3%) female and 44 (72.1%) male patients were found to be HLA-B27 positive. BASDAI≥ 4 was observed in 61 (56%) patients and <4 in 48 (44%) patients. CRP, albumin, ESR, NLR and CAR values between the patient groups were significantly different. There was high correlation between BASDAI and CAR. There was a moderate correlation between CAR and BASDAI in the patient group with normal acute phase reactants. CONCLUSION: There is a significant correlation between CAR value and composite score such as BASDAI, which is commonly used to assess systemic inflammation in Ax-SpA. These methods are reliable, recognised by reimbursement institutions and include measurements that physicians can use practically in routine outpatient clinics. Key Words: Spondylitis, Ankylosing, HLA-B27 antigen, C-reactive protein/metabolism, Serum albumin/metabolism, Neutrophils, Lymphocytes, Platelet count.

Effects of Familial Mediterranean Fever on Cardiac Functions in Adults: A Cross-Sectional Study Based on Speckle Tracking Echocardiography.

OBJECTIVES: This study aims to evaluate the right ventricular (RV) and left ventricular (LV) systolic and diastolic functions with speckle tracking echocardiography in addition to routine echocardiographic measurements in adult familial Mediterranean fever (FMF) patients in order to detect cardiac functions. PATIENTS AND METHODS: Sixty FMF patients (23 males, 37 females; median age 35 years; interquartile range, 26 to 38 years) and 20 healthy subjects (10 males, 10 females; median age 31 years; interquartile range, 25 to 35 years) were included in the study. The diagnosis was established according to the Tel-Hashomer criteria. All patients were using regular colchicine and they were in the attack-free period. Laboratory examinations included complete blood count, creatinine, and inflammatory markers. In addition to routine echocardiographic examination, RV and LV global longitudinal strains were measured and compared. RESULTS: Erythrocyte sedimentation rate and C-reactive protein values were higher in FMF group. LV global longitudinal strain was similar among the groups. FMF patients had slightly lower early diastolic trans-mitral flow (E) values than controls. As similar as the mitral E flow, tricuspid E flow was slightly lower in FMF groups than controls. RV ejection fraction was similar and in normal ranges among the groups. RV global longitudinal strain was lower in FMF group than controls. RV Myocardial Performance Index (or Tei index) was higher in FMF group. CONCLUSION: The present study indicates low values of mean RV global longitudinal strain and higher Tei index in FMF patients. These results suggest that FMF may cause subclinical RV deterioration.

Diagnostic value of acustic radiation force impulse imaging in the assessment of salivary gland involvement in primary Sjögren's sydrome.

AIMS: The aim of this study is to investigate the diagnostic value of Acoustic Radiation Force Impulse (ARFI) imaging in the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS). MATERIAL AND METHODS: Twenty five patients with pSS and 25 healthy volunteers were included. First, echostructures and the thickness of the submandibular and parotid glands were evaluated by B-mode ultrasonography. Then, ARFI imaging with Virtual Touch Quantification® was performed. Ten independent shear wave velocity measurements were taken from each gland. Finally, the mean shear wavevelocity (SWV) values were calculated, and used for further analysis. RESULTS: The mean SWV values of parotid and submandibular glands were significantly higher in the pSS patients than in the healthy control group (p<0.001). The cut-off of SWV values were calculated to be 1.98 m/s for submandibular glands, and 1.93 m/s for parotid glands. In pSS patients, the mean SWV values of parotid glands were higher than those of the submandibular glands (p<0.001) and no statistically significant relationships between symptom duration or the degree of xerostomia and mean SWV values of parotid and submandibularglands were found (all p>0.005). CONCLUSIONS: Our findings indicate that ARFI imaging may provide a non-invasive, simple and fast means of assessment of glandular impairment as an alternative test when other salivary gland tests are inconclusive or cannot be performed. ARFI may be a valuable adjunct for the clinical diagnosis of pSS.

Spontaneous HBsAg seroconversion after severe flare of chronic hepatitis B infection.

The results of the acute exacerbations of hepatitis B virus are varied from silent to severe acute hepatitis. HBsAg seroconversion induced by either antiviral drugs or occurred spontaneously, as a targeted end point of HBV infection management is infrequent. The affect of the severe hepatitic flare on HBsAg seroconversion was reported before, however the predictive markers of HBsAg seroconversion are not clear yet. The reasons of the spontaneously HBV re-activations, or its usual results are not known well. We, herein reported a case, with the high serum HBV DNA titer during an acute spontaneously induced severe exacerbation of HBV infection which spontaneously resulted in total HBV recovery.