Topuk dikeni tedavisinde ekstrakorporeal şok dalga tedavisinin etkinliği

Amaç: Topuk dikeni klinikte sıkça karşılaşılan, kronik plantar topuk ağrısına neden olan klinik bir tablodur. Hastalara uygulanan kortikosteroid enjeksiyonu, steroid olmayan antiinflamatuvar ilaçlar ve çeşitli fizik tedavi modaliteleri gibi seçeneklerin yanında, ‘Extracorporeal Shock Wave Therapy’ (ESWT) cerrahi olmayan yöntemler arasında yerini almıştır. Bu prospektif kontrollü çalışmanın amacı klinik ve radyolojik olarak topuk dikeni tanısı alan hastalarda ESWT tedavisinin etkinliğini araştırmaktır. Gereç-Yöntem: Çalışmaya klinik ve radyolojik olarak topuk dikeni tanısı konan 49 hasta alındı. Hastalar randomize olarak iki gruba ayrıldı. Grup 1 (n=25) dört gün aralıkla 3 seans boyunca 8 Hz frekans ile her seans 1000 atım olacak şekilde ESWT tedavisi aldı. Grup 2 (n=24) ise kontrol grubu olarak kabul edildi ve sadece silikon tabanlık kullandı. Ağrı şiddeti gece ağrısı, sabah ilk basma sırasındaki ağrı, hareket ile ağrı, istirahat ağrısı, engebeli zeminde ağrı ve gün sonunda ağrı olmak üzere Görsel Analog Skala (GAS) ile ve ayak aktiviteleri ile ilgili fonksiyonel düzey ise Foot Ankle Outcome Score (FAOS) indeksi ile değerlendirildi. Ölçümler hastalar tedaviye alınmadan önce ve 4 haftalık izlem sonrasında yapıldı. Bulgular: Tedavi sonrasında her iki grupta tüm parametrelerde istatistiksel olarak anlamlı iyileşme saptandı (p<0,05). Gruplar arası değerlendirmede ise tedavi sonrasında GAS ile hesaplanan gece ağrısı ve sabah ilk basma sırasındaki ağrıda (p<0,05) ESWT grubu lehine olacak şekilde anlamlı düzelme olduğu gözlemlendi. Diğer parametrelerde ise her iki grup arasında anlamlı fark bulunmadı (p>0,05). Sonuç: Çalışmamızın sonuçları; ESWT uygulamasının topuk dikeni tedavisinde etkili olduğunu ve diğer konservatif yöntemler arasında etkin bir seçenek olabileceğini desteklemektedir

Adiponectin: is it a biomarker for assessing the disease severity in knee osteoarthritis patients?

AimThe results of previous studies regarding the role of adiponectin in the pathogenesis of osteoarthritis (OA) are controversial. The aim of this study is to investigate the relation of plasma adiponectin levels with clinical and radiological disease severity in knee OA patients. MethodSixty patients with knee OA and 25 healthy controls were included in the study. Patients were divided into two subgroups: lean (Group 1, n = 30) and obese (Group 2, n = 30). Healthy controls were accepted as Group 3 (n = 25). Pain intensity was measured with a visual analogue scale (VAS), functional disability with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Quality of Life (QoL) with Short Form-36 (SF-36). Also all patients were radiologically evaluated and graded according to Kellgren-Lawrence (KL) scale. Plasma concentrations of adiponectin levels were measured by enzyme-linked immune-sorbent assay (ELISA). ResultsSerum adiponectin levels were higher in OA patient subgroups than those in the control group but the difference did not reach a significant level after adjustments for age, gender and body mass index (P = 0.078). There was a positive correlation between adiponectin concentration and KL grading scores. Additionally, there was a positive correlation between adiponectin levels and clinical variables (VAS and WOMAC total scores) in patient subgroups (r = 0.326 P = 0.012, r = 0.583 P < 0.001, respectively). SF-36 scores were inversely associated with adiponectin levels. ConclusionPlasma adiponectin concentrations were associated with both clinical and radiological disease severity in knee OA patients. Thus, adiponectin hormone might be a potential clinically useful biomarker while assessing disease severity in the future.Turkish League Against Rheumatism (TLAR)This study was funded by Turkish League Against Rheumatism (TLAR)

Effectiveness of extracorporeal shock wave therapy in the treatment of epin calcanei

Amaç: Topuk dikeni klinikte sıkça kars?ılas?ılan, kronik plantar topuk ag?rısına neden olan klinik bir tablodur. Hastalara uygulanan kortikosteroid enjeksiyonu, steroid olmayan antiinflamatuvar ilaçlar ve çes?itli fizik tedavi modaliteleri gibi seçeneklerin yanında, Ekstrakorporeal Şok Dalga Tedavisi (Extracorporeal Shock Wave Therapy - ESWT) cerrahi olmayan yöntemler arasında yerini almıs?tır. Bu prospektif kontrollü çalıs?manın amacı klinik ve radyolojik olarak topuk dikeni tanısı alan hastalarda ESWT tedavisinin etkinlig?ini aras?tırmaktır. Gereç-Yöntem: Çalıs?maya klinik ve radyolojik olarak topuk dikeni tanısı konan 49 hasta alındı. Hastalar randomize olarak iki gruba ayrıldı. Grup 1 (n=25) silikon tabanlık kullandı ve dört gün aralıkla 3 seans boyunca 8 Hz frekans ile her seans 1000 atım olacak s?ekilde ESWT tedavisi aldı. Grup 2 (n=24) ise kontrol grubu olarak kabul edildi ve sadece silikon tabanlık kullandı. Ag?rı s?iddeti gece ag?rısı, sabah ilk basma sırasındaki ag?rı, hareket ile ag?rı, istirahat ag?rısı, engebeli zeminde ag?rı ve gün sonunda ag?rı olmak üzere Görsel Analog Skala (GAS) ile ve ayak aktiviteleri ile ilgili fonksiyonel düzey ise Ayak ve Ayak Bileği Sonuç Skoru (Foot and Ankle Outcome Score - FAOS) indeksi ile değerlendirildi. Ölçümler hastalar tedaviye alınmadan önce ve 4 haftalık izlem sonrasında yapıldı. Bulgular: Tedavi sonrasında her iki grupta tüm parametrelerde istatistiksel olarak anlamlı iyiles?me saptandı (p0.05). Sonuç: Çalıs?mamızın sonuçlarına göre ESWT uygulaması topuk dikenine bağlı ağrı semptomunu azaltmada efektif bir konservatif yöntem olarak görülmektedir.Objective: Epin calcanei is a common clinical problem with chronic plantar heel pain. ‘Extracorporeal Shock Wave Therapy (ESWT)’ is a non-surgical method administered to patients along with a variety of other options such as corticosteroid injections, non-steroidal antiinflammatory drugs and physical therapy mo dalities. The aim of this prospective controlled study is to investigate the efficacy of ESWT in patients with clinical and radiological diagnosis of epin calcanei. Materials-Methods: The study included 49 patients diagnosed with epin calcanei according to the clinical and radiological criteria. Patients were randomly divided into two groups. Group 1 (n=25) used silicone insoles and received ESWT treatment as 1000 shots in each session at a frequency of 8 Hz, 3 sessions in total with intervals of four days. Group 2 (n=24) was accepted as the control group and used silicone insoles alone. The severity of pain was evaluated using the pain Visual Analog Scale (VAS) as pain at night, pain in the morning, on the first step, pain on motion, pain at rest, pain on uneven ground and pain at the end of the day. The functional level of activity of the foot was evaluated by the Foot and Ankle Outcome Score (FAOS) index. Measurements were taken before treatment and after 4 weeks of follow-up. Results: After treatment, both groups showed statistically significant improvement in all parameters (p0.05). Conclusion: According to the results of our study, ESWT application is seen as an effective conservative method in decreasing pain related to heel spur

Adiponectin: Is it a biomarker for assessing the disease severity in knee osteoarthritis patients?

Aim: The results of previous studies regarding the role of adiponectin in the pathogenesis of osteoarthritis (OA) are controversial. The aim of this study is to investigate the relation of plasma adiponectin levels with clinical and radiological disease severity in knee OA patients. Method: Sixty patients with knee OA and 25 healthy controls were included in the study. Patients were divided into two subgroups: lean (Group 1, n = 30) and obese (Group 2, n = 30). Healthy controls were accepted as Group 3 (n = 25). Pain intensity was measured with a visual analogue scale (VAS), functional disability with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Quality of Life (QoL) with Short Form-36 (SF-36). Also all patients were radiologically evaluated and graded according to Kellgren–Lawrence (KL) scale. Plasma concentrations of adiponectin levels were measured by enzyme-linked immune-sorbent assay (ELISA). Results: Serum adiponectin levels were higher in OA patient subgroups than those in the control group but the difference did not reach a significant level after adjustments for age, gender and body mass index (P = 0.078). There was a positive correlation between adiponectin concentration and KL grading scores. Additionally, there was a positive correlation between adiponectin levels and clinical variables (VAS and WOMAC total scores) in patient subgroups (r = 0.326 P = 0.012, r = 0.583 P < 0.001, respectively). SF-36 scores were inversely associated with adiponectin levels. Conclusion: Plasma adiponectin concentrations were associated with both clinical and radiological disease severity in knee OA patients. Thus, adiponectin hormone might be a potential clinically useful biomarker while assessing disease severity in the future

Beyond expectations: disease duration and psychological burden in psoriatic arthritis

This study aims to investigate the relationship between disease duration and psychological burden in PsA and to identify the risk factors associated with psychological distress. Patients with PsA who met CASPAR classification criteria enrolled by Turkish League Against Rheumatism (TLAR)-Network. Patients were categorized into three groups based on disease duration: early stage (< 5 years), middle stage (≥ 5, < 10 years), and late stage (≥ 10 years). All patients underwent clinical and laboratory assessment using standardized protocol and case report forms. The associations between psychological variables and clinical parameters were assessed by a multivariate analysis. Of the 1113 patients with PsA (63.9% female), 564 (%50.7) had high risk for depression and 263 (%23.6) for anxiety. The risk of psychological burden was similar across all PsA groups, and patients with a higher risk of depression and anxiety also experienced greater disease activity, poorer quality of life, and physical disability. Multivariate logistic regression revealed that female gender (OR = 1.52), PsAQoL (OR = 1.13), HAQ (OR = 1.99), FiRST score (OR = 1.14), unemployment/retired (OR = 1.48) and PASI head score (OR = 1.41) were factors that influenced the risk of depression, whereas the current or past enthesitis (OR = 1.45), PsAQoL (OR = 1.19), and FiRST score (OR = 1.26) were factors that influenced the risk of anxiety. PsA patients can experience a comparable level of psychological burden throughout the course of their disease. Several socio-demographic and disease-related factors may contribute to mental disorders in PsA. In the present era of personalized treatment for PsA, evaluating psychiatric distress can guide tailored interventions that improve overall well-being and reduce disease burden

Does Behcet's disease associate with neuropathic pain syndrome and impaired well-being?

Previously peripheral neuropathy signs have been reported in inflammatory chronic diseases but the presence of neuropathic pain syndrome (NPS) in Behcet's disease (BD) is unclear. The aim of this study was to investigate the association of BD with NPS and impaired quality of life and sleep quality. A total of 111 patients diagnosed as BD and 52 healthy controls were included. Pain severity was assessed by visual analogue scale (VAS) in rest and during activity. The NPS was diagnosed according to the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) index. The well-being and sleep disturbances of the groups were evaluated with Psychological General Well-Being (PGWB) Scale and Pittsburg Sleep Quality Index (PSQI). Although there were no one with NPS in healthy controls, the proportion of NPS in patients with BD was 19.8 % (p = 0.001). The VAS scores both in activity and at rest were higher in BD (p < 0.001). There was statistically significant decrease in total PGWB score in BD patients compared to healthy controls (p < 0.001). And significant increase in LANSS score was observed in patients with BD compared to healthy controls (p = 0.000). The total LANSS scores showed significant positive correlation with PSQI scores (r = 0.322) and negative correlation with total PGWB scores (r = -0.672) in patients with BD. We observed a positive correlation between LANSS and VAS (rest and activity) scores (r = 0.44, r = 0.42 respectively). The NPS seems to be associated with BD which should be taken into consideration in patients with neuropathic signs. The quality of life (QoL) and quality of sleep of the patients with BD were found to be impaired and this may be due to the presence of NPS

Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs

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

Enthesitis and its relationship with disease activity, functional status, and quality of life in psoriatic arthritis: A multi-center study

Psoriatic arthritis (PsA) is an inflammatory arthritis with distinct phenotypic subtypes. Enthesitis is assigned as a hallmark of the disease, given its significant relations to disease activity and quality of life. Our objective is to evaluate the prevalence of enthesitis and its association with some clinical parameters, particularly quality of life, using data from a national registry. Patients with PsA meeting ClASsification criteria for Psoriatic Arthritis (CASPAR) were enrolled by means of a multi-centre Turkish League Against Rheumatism (TLAR) Network Project. The following information was recorded in web-based case report forms: demographic, clinical and radiographic data; physical examination findings, including tender and swollen joint counts (TJC and SJC); nail and skin involvement; Disease Activity Score-28 for Rheumatoid Arthritis with Erythrocyte Sedimentation Rate (DAS 28-ESR); Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Maastricht Ankylosing Spondylitis Enthesitis Score (MASES); Psoriasis Area Severity Index (PASI); Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s); Health Assessment Questionnaire (HAQ); Bath Ankylosing Spondylitis Functional Index (BASFI); Health Assessment Questionnaire for the spondyloarthropathies (HAQ-s); Psoriatic arthritis quality of Life scale (PsAQoL); Short Form 36 (SF-36); Hospital Anxiety Depression Scale (HADS); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Fibromyalgia Rapid Screening Tool (FiRST) scores. The patients were divided into two groups, namely with and without enthesitis, based on the triple Likert-type physician-reported statement of ‘active enthesitis’, ‘history of enthesitis’ or ‘none’ in the case report forms. Patients with active enthesitis were compared to others in terms of these clinical parameters. A total of 1130 patients were enrolled in this observational study. Of these patients, 251 (22.2%) had active enthesitis according to the clinical assessment. TJC, HAQ-s, BASDAI, FiRST and PsAQoL were significantly higher whereas the SF-36 scores were lower in patients with enthesitis (p < 0.05). Chronic back pain, dactylitis, and tenosynovitis were more frequent in the enthesopathy group (59.4%/39%, 13.1%/6.5% and 24.7%/3.4%, respectively). Significant positive correlations between the MASES score and the TJC, HAQ, DAS 28-ESR, BASDAI, FiRST and PsAQoL scores, and a negative correlation with the SF-36 score were found. When linear regression analysis was performed, the SF-36 MCS and PCS scores decreased by − 9.740 and − 11.795 units, and the FiRST scores increased by 1.223 units in patients with enthesitis. Enthesitis is an important involvement of PsA with significant relations to quality of life determined with PsAQoL and SF-36 scores. Our study found higher frequency of dactylitis and chronic back pain, and worse quality of life determined with SF-36 and PsAQoL scores in patients with enthesitis

The impact of fatigue on patients with psoriatic arthritis: A multi-center study of the TLAR-network

Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia