COVID-19 pandemisinin önceden var olan omuz problemlerine etkisi: Telerehabilitasyon fizik tedavi için yararlı bir araç mıdır?

To the Editor, On March 11, 2020, the world health organization announced coronavirus disease 2019 (COVID-19) outbreak as a pandemic.[1] During this global crisis, worldwide governments set up severe rules limiting individual freedom and keeping social distancing to avoid the deterioration of national health-care systems. Patients who had specific life-threatening conditions or suffering from severe COVID-19 needing high-intensity levels of care (e.g., intensive care units) were permitted to refer to hospitals. Furthermore, physical therapy and rehabilitation programs were postponed to provide better care for inpatients with severe COVID-19. In an Italian survey, during the pandemic, more than 50% of stroke patients have reported a reduction in seeking treatment in the hospital, possibly in fear of being infected or being denied seeing their families after hospitalization. [2] What can we say about the patients with painful musculoskeletal problems

Coexistence of Peripheral Spondyloarthritis and Familial Adenomatous Polyposis: A Rare Case Report with Treatment Contradictions and Review of the Literature

BACKGROUND: The coexistence of familial adenomatous polyposis and spondyloarthritis is rarely defined in literature. The primary aim of this presentation is to report a development of peripheral arthritis in 3 years following colon surgery with the diagnosis of familial adenomatous polyposis (FAP). The secondary aim is to discuss the challenge of in treatment of refractory arthritis, which needs to be treated with biologics. However, it is not yet known well about their safety on patients who have risks for cancer development.CASE DETAILS: A 25-year-old female patient was admitted to the rheumotology outpatient clinic. The patient had undergone total colectomy and ileoanal anastomosis because of FAP three years ago. On her physical examination, there was arthritis on her left ankle and enthesitis on both Achilles tendons.CONCLUSION: This case report presents a 25-year-old female patient with Ankylosing spondylitis (AS) and FAP whose treatment with biologics is critical due to the risk of cancer development due FAP. Although the potential risk of development of malignancies with TNF-blocking therapy seems to be no more than TNF-naïve patients and general population. But the safety of these drugs on patients with risks for cancer development is still unknown.KEYWORDS: Spondyloarthtritis, familial adenomatous polyposis, nonsteroid anti-inflammatory drugs, disease modifying anti-rheumatic drugs, biologic

Spondiloartrit hastalarının fizik aktivitesi ve egzersiz algısı: Kesitsel bir çalışma

Objective: Exercise is a cornerstone in the management of spondyloarthritis (SpA). The aim of this research was to compare the levels of physical activity (PA) and perceived advantages and barriers to exercise of SpA patients with population controls.Methods: In this cross-sectional study 200 patients (118 males, 82 females) and 100 controls (50 males, 50 females) were included. Levels of PA were evaluated using the International Physical Activity Questionnaire-Short Form and perceptions of exercise were assessed using Exercise Benefits and Barriers Scale. Fatigue, psychological status and quality of life of all participants were questioned. Disease activity, functions and mobility of the patients were also assessed. Correlations were analyzed between disease parameters and perceptions of exercise.Results: PA levels were similar on both groups. Of the patients 65% met recommended amount of exercise. Deterioration of psychological status and quality of life were associated with decreased PA levels of the patients. Patients reported fatigue and lack of time barriers more than controls. When disease activity, functionality, mobility, fatigue, psychological status and quality of life of the patients deteriorated, perceived barriers to exercise increased.Conclusion: Health professionals should focus on personal barriers to improve exercise behavior in SpA patients.Amaç: Egzersiz spondiloartritlerin (SpA) yönetiminde bir köşe taşıdır. Bu araştırmanın amacı, SpA hastalarının fiziksel aktivite (PA) düzeylerini ve egzersizden algılanan avantajları ve engelleri popülasyon kontrolleriyle karşılaştırmaktır. Yöntemler: Bu kesitsel çalışmaya 200 hasta (118 erkek, 82 kadın) ve 100 kontrol (50 erkek, 50 kadın) dahil edildi. PA seviyeleri Uluslararası Fiziksel Aktivite Anketi-Kısa Form ile değerlendirildi ve egzersiz algıları Egzersiz Faydaları ve Engeller Ölçeği ile değerlendirildi. Tüm katılımcıların yorgunluğu, psikolojik durumu ve yaşam kalitesi sorgulandı. Hastaların hastalık aktivitesi, fonksiyonları ve mobilitesi de değerlendirildi. Hastalık parametreleri ve egzersiz algıları arasındaki korelasyonlar incelendi. Bulgular: PA seviyeleri her iki grupta da benzerdi. Hastaların %65’i tavsiye edilen egzersiz miktarını karşıladı. Psikolojik durumun ve yaşam kalitesinin bozulması, hastaların PA düzeylerinin azalması ile ilişkiliydi. Hastalar yorgunluk ve zaman yokluğu bariyerini kontrollere göre daha fazla bildirdi. Hastaların hastalık aktivitesi, işlevselliği, hareketliliği, yorgunluğu, psikolojik durumu ve yaşam kalitesi kötüleştiğinde, egzersizin önündeki algılanan engeller arttı. Sonuç: Sağlık çalışanları, SpA hastalarında egzersiz davranışını iyileştirmek için algılanan kişisel engellere odaklanmalıdır

Agreement of Turkish Physiatrists with the Assessment in Spondyloarthritis International Society and the European League Against Rheumatism Recommendations for the Management of Ankylosing Spondylitis and Rheumatoid Arthritis

Background: New developments in the field of targeted therapies or biologic agents led more effective management of ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Recommendations for the management of rheumatic diseases propose to reduce inappropriate use of medications, minimize variations among countries, and enable cost-effective use of health care resources. Objective: The aim this study was to evaluate conceptual agreement of ASsessment in SpondyloArthritis International Society (ASAS) and the EUropean League Against Rheumatism (EULAR) recommendations for the management of AS and EULAR recommendations for RA and to assess the rate of application among Turkish physiatrists in daily clinical practice. Methods: An online survey link has been sent to 1756 Turkish physiatrists with e-mails asking to rate agreement on 11-item ASAS/EULAR AS recommendations and 15-item EULAR RA recommendations with synthetic and biological disease-modifying anti-rheumatic drugs. Also barriers and difficulties for using biologic agents were assessed. Results: Three hundred nine physiatrists (17.5%) completed the survey. The conceptual agreement with both recommendations was very high (Level of agreement; mean 8.35±0.82 and 8.90± 0.67 for RA and AS recommendations, respectively), and the self-declared application of overall recommendations in the clinical practice was also high for both RA and AS (72.42% and 75.71%, respectively). Conclusion: Turkish physiatrists are in good conceptual agreement with the evidence-based recommendations for the management of AS and RA. These efforts may serve to disseminate the knowledge and increase the current awareness among physicians who serve to these patients and also implementation of these recommendations is expected to increase as well.PubMedScopu

Evaluation of Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios in Rheumatoid Arthritis

Objective: The purpose of this study is to investigate the relationship of disease activity with Neutrophil-Lympho­cyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) and red blood cell distribution width (RDW). Methods: Seventy seven RA patients and 97 healthy sub­jects were examined retrospectively. People with chronic and systemic diseases were excluded from control group of the study. The disease activity scores (DAS 28) of pa­tient group, hematologic parameters and inflammation parameters of both groups were analyzed statistically us­ing independent t-test and spearman correlation test. Results: Age and gender was not found different be­tween groups. CRP and ESR levels were significantly higher in RA group (p<0.001). Hemoglobin and platelet count were lower (p<0.001 and p=0.022), while RDW, NLR, PLR and MPV levels were significantly higher in RA group (p<0.001, p<0.001. p<0.001, p<0.001, respec­tively). In patient group, ESR (p<0.001), lymphocytes (%) (p= 0.042), absolute neutrophil (p=0.047), and platelets (p= 0.019) were positively, whereas lymphocytes were negatively affected by improvement disease activity (DAS 28) scores. PLR levels significantly negatively correlated with MPV levels (r= -0.386) but showed a significant posi­tive correlation with RDW (r= 0.354) and NLR levels (r= 0.618). Conclusion: NLR and PLR are important and promising factors for disease activity estimation of rheumatoid ar­thritis and may be used in clinical practice. In our opinion, larger studies consisting larger group will help determina­tion of disease activity of RA by more specific indices us­ing these parameters

Demographic and clinical characteristics of patients with sustained and switching treatments using biological and targeted synthetic disease-modifying antirheumatic drugs: A multicenter, observational cross-sectional study for rheumatoid arthritis

Introduction Rheumatoid arthritis is a chronic inflammatory disease with different disease activity grades. Several registries have been designed to determine the appropriate regimens of disease-modifying antirheumatic drugs to obtain sustained clinical remission. We examined epidemiological and clinical characteristics of rheumatoid arthritis patients using a clinical registry database (BioSTaR) and analyzed the differences in patients with sustained and switched therapies. Methods A multicenter, observational cross-sectional study for rheumatoid arthritis was performed between February 2019 and September 2020 using the BioStaR-RA registry. Demographic and clinical characteristics were prospectively recorded into a specifically designed electronic database. The patients were divided into three groups due to the heterogeneity of the study cohort. Patients were grouped as Group I (Initial; within the first 6 months of treatment with biological/targeted synthetic drugs), Group ST (Sustained Treatment; any first drug lasting for at least 6 months without any change), and Group S (Switch; any switching to another drug). Comparative analysis was performed between sustained treatment (Group ST) and drug switching (Group S) groups. Results The study included a total of 565 patients. The mean age was 53.7 +/- 12.8 years, and the majority were female (80.4%). There were 104, 267, and 194 patients in Groups I, ST, and S, respectively. Erosive arthritis and hematological extra-articular involvement were more frequently detected in Group S than Group ST (p = 0.009 and p = 0.001). The patients in Group S had significantly higher disease activity scores (DAS28-CRP, CDAI, and SDAI) (p = 0.025, p = 0.010, and p = 0.003). There were significantly more patients with moderate disease activity in Group S (p < 0.05). Conclusions The groups with sustained treatment and switching included patients with different disease activity status, although higher disease activity was determined in switchers. Overall, moderate disease activity and remission were the most common disease activity levels. Lower disease activity scores, lower hematologic manifestations, better functional status, and lesser radiographic damage are associated with sustained treatment.Turkish Medicine and Medical Devices Agency ; Ankara Numune Egitim ve Arastirma Hastanes

Türkiye Romatizma Araştırma ve Savaş Derneği ankilozan spondilit ulusal tedavi önerileri

Objectives: To develop Turkish League Against Rheumatism (TLAR) National Recommendations for the management of ankylosing spondylitis (AS). Materials and methods: A scientific committee of 25 experts consisting of six rheumatologists and 19 physical medicine and rehabilitation specialists was formed by TLAR. Recommendations were based on the 2006 ASsessment in Ankylosing Spondylitis International Working Group(ASAS)/European League Against Rheumatism (EULAR) recommendations and a systematic review of associated publications between January 2005 and September 2010. A Delphi process was used to develop the recommendations. Twelve major recommendations were constructed for the management of AS. Voting using a numerical rating scale assessed the strength of each recommendation. Results: The 12 recommendations include patient assessment, patient follow-up along with pharmacological and non-pharmacological methods. Some minor additions and changes have been made to the ASAS/EULAR recommendations. All of the recommendations had sufficient strength. Conclusion: National recommendations for the management of AS were developed based on scientific evidence and consensus expert opinion. These recommendations will be updated regularly in accordance with recent developments.Türkiye Romatizma Araştırma ve Savaş Derneği᾽nin (TRASD) Ankilozan Spondilit (AS) için ulusal tedavi önerilerinin oluşturulmasıdır. Gereç ve yöntemler: TRASD tarafından altı Romatoloji ve 19 Fiziksel Tıp ve Rehabilitasyon uzmanı olmak üzere toplam 25 kişiden oluşan bir bilimsel kurul oluşturuldu. Önerilerde 2006 yılında yayınlanan Ankilozan Spondilit Değerlendirme Uluslararası Çalışma Grubu (ASAS)/Romatizmaya karşı Avrupa Ligi (EULAR) önerileri ve Ocak 2005 - Eylül 2010 arasında yayınlanmış olan ilişkili yayınlar konusundaki sistematik bir inceleme temel alındı. Öneriler oluşturulurken Delphi süreci kullanıldı. Ankilozan spondilit tedavisi ile ilgili 12 ana öneri oluşturuldu. Oylama yapılarak önerilerin güçlülük düzeyi bir nümerik derecelendirme skalası ile belirlendi. Bulgular: On iki öneri hasta değerlendirilmesini, hasta takibini ve farmakolojik ve non-farmakolojik yöntemleri içermektedir. ASAS/EULAR önerilerine bazı ilaveler ve önerilerde bazı küçük değişiklikler yapılmıştır. Tüm öneriler yeterli kuvvete sahipti. Sonuç: Bilimsel kanıtlar ve uzmanların görüş birliği ile AS tedavisine yönelik ulusal öneriler oluşturulmuştur. Bu öneriler, yeni gelişmeler doğrultusunda düzenli olarak güncellenmelidi

Can ultrasound be an assessment tool for sagittal spine mobility and chest expansion in patients with ankylosing spondylitis?

WOS: 000449373500099PubMed ID: 30278577We aimed to examine whether ultrasound (US) is useful for evaluating spinal mobility and chest expansion in ankylosing spondylitis (AS) patients and determine a cutoff value to identify reduced sagittal lumbar mobility. Our cross-sectional study included 50 AS patients and 50 controls. Metric measurements and Bath AS indices were measured in AS patients. The distance between C6-C7, T11-T12, and L4-L5 vertebrae was measured, and the difference and percentage of difference between erect position and maximal cervical and lumbar flexion was calculated (T11-T12(dif), T11-T12%, L4-L5(dif), L4-L5%, T+L-dif, T+L%). Intercostal divergence was measured 1.5cm away on the left from the sternocostal space during maximum inhalation and maximum exhalation, and the difference and percentage of difference between them was calculated (ICdif, IC%). All metric measurements were lower in the AS group except for tragus-to-wall distance. T11-T12(dif), T11-T12%, L4-L5(dif), T+L-dif, and T+L% values were higher in the control group, while other US measurements did not differ between the groups. All US measurements except ICdif and IC% correlated with the Bath AS Metrology Index. Thus, US may be used for assessing spinal mobility in patients with AS. T11-T12(dif) <0.79cm may show decreased lumbar sagittal mobility

Infertility improved by etanercept in ankylosing spondylitis

The effect of TNF-α and TNF-α antagonists on semen quality in men is controversial. TNF-α levels are usually low in seminal plasma, but they tend to increase in inflammatory and infectious diseases. Etanercept is a highly-specific antagonist of TNF-α. In this report, we describe the development of pregnancy in a couple with a previously infertile husband, who received etanercept for ankylosing spondylitis

Periodontal disease and associated factors in patients with rheumatoid arthritis

Introduction: Periodontitis (PD) and rheumatoid arthritis (RA) are chronic inflammatory diseases that share complex multi-factorial pathologic processes, including genetics, environmental and inflammatory factors. This study aims to evaluate the periodontal status and its association with sociodemographic and clinical factors in patients with RA.Methods: This study included 51 patients with RA; the mean age was 49.75±9.79 years old and 10.59±6.37 years of disease duration. Sociodemographic data and the rheumatologic assessment included detailed profiling of the disease and serol-ogy were noted. A full mouth periodontal examination, including the Gingival index, Plaque index, Pocket probing depth and clinical attachment level, was carried out by a periodontist. The periodontal status was classified according to the Cen-ters for Disease Control-American Academy of Periodontology clinical case definitions.Results: Forty-five patients (88.2%) were female. 37.3% of patients had DAS28>3.2. All patients had PD, in mild (54.9%) to moderate (45.1%) severity. Aging, impaired oral hygiene, smoking, secondary Sjögren’s syndrome and high disease activity were associated with moderate PD.Discussion and Conclusion: This study results identified a serious need to pay particular attention to oral health in patients with RA and refer these patients for periodontal evaluation and treatment. Future studies are needed to better investigate whether if efforts to prevent periodontal disease may also help prevent RA