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Background/aimsThe purpose of the study was to evaluate the retinal and choroidal changes via optical coherence tomography angiography (OCTA) in patients who received hydroxychloroquine (HCQ).MethodsSixty eyes of 60 female patients who received HCQ were included in the study. Patients were categorized into two groups as high-risk (≥ 5 years) and low-risk (< 5 years) in terms of HCQ-induced retinal toxicity. Spectral domain-OCT, OCTA, and visual field tests were performed. Retinal thickness, vascular density, flow rates, choroidal thickness (CT), and visual field parameters were compared between the groups, and the correlation between total HCQ cumulative dose, duration of use, and these parameters was assessed.ResultsCompared to low-risk group, patients in the high-risk group had vascular density loss (p < 0.05). In this group, foveal avascular zone (FAZ) was found to be wider (p < 0.05). Retinal and choroidal flow rates were found to be decreased markedly in the high-risk group (p < 0.05). CT was found to be thinner in the high-risk group (p < 0.05). HCQ cumulative dose and duration of use had a negative significant correlation with all vascular density, flow rate, CT parameters, and positive significant correlation with FAZ parameters (p < 0.05). In visual field tests, mean defect (MD) was found to be increased in the high-risk group (p < 0.05). Moreover, MD had a positive correlation with HCQ cumulative dose and duration of use (p < 0.05).ConclusionsEvaluation of microvascular changes via OCTA may contribute to the early detection of HCQ-induced retinal toxicity, which cannot be detected through other imaging devices, at the stage when it is reversible.

The rheumatoid arthritis impact of disease (RAID) score was developed as a patient-derived composite response index for the evaluation of the disease impact on cases with rheumatoid arthritis (RA). The aim of this study was to evaluate the psychometric properties and performance of RAID score in the real-life settings. Cases with RA from our multi-center, nationwide registry called Biologic and targeted Synthetic antirheumatic drugs Registry RA (BioStaR RA) were included in this cross-sectional observational study. Demographic data, disease duration, pain, patient’s global assessment (PGA) and physician’s global assessment (PhyGA) were recorded. DAS28-ESR, DAS28-CRP, the simplified disease activity index (SDAI) and the clinical disease activity index (CDAI) were assessed as disease activity evaluations. The health assessment questionnaire-disability index (HAQ-DI) and RAID were completed by all the participants. The construct validity was tested by the analysis of correlations between RAID score and scores of PGA, disease activity indexes and HAQ-DI. We also evaluated the discriminatory ability of RAID to distinguish patients with different levels of disease activity and disability and the cut-off values were calculated by ROC analysis. 585 cases with RA were included in this investigation. The RAID score was significantly positively correlated with PGA, all disease activity indexes and HAQ-DI (p < 0.001). The discriminatory ability of RAID score in different disease activity and disability groups was also demonstrated (p < 0.001). To estimate DAS28-ESR (remission/low + moderate + high), RAID score cut-off points were 2.88 (sensitivity 73%, specificity 62%), 3.23 (sensitivity 75%, specificity 60%) and 3.79 (sensitivity 74%, specificity 58%), respectively. Our study indicated that RAID was a reliable tool in daily clinical practice by presenting its correlations with disease activity and disability assessments and by showing its discriminatory ability in these parameters in the real-life experiences.

The aims of this study were to investigate the main clinical and laboratory features, including pregnancy and genetic analysis, of Turkish Familial Mediterranean Fever (FMF) patients and to analyze the relationships between genotypic features, age of disease onset, clinical findings, and disease severity. A study was planned within a national network of 22 different centers. Demographics, clinical and laboratory findings, attack characteristics, drugs, pregnancy and birth history, disease severity, and gene mutation analyses were evaluated. Disease severity, assessed using a scoring system developed by Pras et al., was evaluated in relation to gene mutations and age of disease onset. A total of 979 patients (643 females and 336 males; mean age: 35.92 ± 11.97 years) with FMF were included in the study. Of a total of 585 pregnancies, 7% of them resulted in preterm birth and 18.1% resulted in abortions. During pregnancy, there was no FMF attack in 61.4% of patients. Of the MEditerranean FeVer (MEFV) mutations, 150 (24.3%) cases were homozygous, 292 (47.3%) cases were heterozygous, and 175 (28.4%) were compound heterozygous. Patients with homozygous gene mutations had more severe disease activity, earlier age of disease onset, higher rates of joint and skin involvement, sacroiliitis, and amyloidosis. Patients with compound heterozygous genotype displayed severe disease activity in close resemblance to patients with homozygous mutation. In addition, patients with compound heterozygous mutations had higher rates of protracted febrile myalgia and elevated fibrinogen levels. In 63.9% of compound heterozygous patients, age of onset was < 20 years, with greater disease severity, and high rates of attack frequency and colchicine resistance. Our results suggest that indicators for disease severity include early onset of disease and homozygous gene mutations. Furthermore, patients with compound heterozygous mutations displayed significant presentations of severe disease activity.

The incidence of intervertebral disc degeneration (IDD) is 10% in the patients at age 50 but increases up to 60% around 70 years of age.4 These degenerative changes in the lumbar spine are a major etiological factor in the development of LBP and disability in the elderly population.5 Intervertebral disc degeneration is strongly related to LBP, and while it is asymptomatic in most cases, it may give rise to sciatalgia in some cases and to spinal stenosis in the long term, which is an important cause of pain and disability particularly in elderly patients.6-7 The clinical picture in LS patients include discomfort in the lower back, radiating leg pain, and neurogenic intermittent claudication (NIC).8 Lumbar spondylosis diagnosis is made by clinical examination and imaging methods. Detection of degenerative changes in the lumbar X-rays, such as osteophytes, intervertebral narrowing, and subchondral sclerosis, support the diagnosis.9 Magnetic resonance imaging (MRI) is the best imaging tool for the assessment of detailed structural changes in the spinal canal, the ligaments, the discs, and the nerve roots.10 However, in studies examining MRI findings in asymptomatic individuals, it was reported that a significant proportion of patients had bulging, annular tears, facet arthropathies, and it was emphasized that degenerative changes increased with age.11 Weiner et al.12 have pointed to the excessive diagnostic tests in elderly patients with LBP and emphasized unnecessary employment of MRI in most of the patients, which contributed substantially to the increased health costs. Visual Analog Scale (VAS) values for pain during the day (at rest and with movement) and at night, presence of radiating pain, Roland Morris disability questionnaire (RMDQ) for functional status evaluation, straight leg raise test (SLRT) for sciatalgia, deep tendon reflexes (DTRs; as hypoactive, normal, or hyperactive), NIC findings, and motor strength and sensory loss were recorded. According to the MRI reports, 245 (76.8%) had disc hernia, 285 (89.3%) had IDD, 149 (46.7%) had root compression, 256 (80.3%) had osteophytes, and 119 (37.3%) showed SS findings (Table 2).

The symptoms are often intermittent and affect target joints (distal and proximal interphalangeal joints, index and middle metacarpophalangeal joints, and thumb base), and the Heberden's nodes, Bouchard's nodes and bony enlargement are the clinical hallmarks of hand OA.6 Radiographic evaluation is widely used to evaluate the structural damage of hand OA. [...]the evidence for the relationship between radiographic hand OA and hand function ranges from none to moderate.9 Symptomatic hand OA is associated with weak grip strength and impaired hand function, and it seems to be mediated by pain.4,10,11 Furthermore, Heberden's and Bouchard's nodes can affect hand function and lead to poor cosmesis.10,12 In the present study, we aimed to determine the clinical, functional, and radiological features of hand OA and to evaluate their relationships in different geographic samples of the Turkish population. The demographic and clinical characteristics of the patients, body mass index (BMI), and dominant hand finger ratio (second to fourth finger length) were evaluated. [...]DHI scores were found to be significantly higher in patients with Bouchard nodes in the fourth finger of the right hand (p = 0.016) and the third (p = 0.033) and fourth fingers (p=0.024) of the left hand.

It is believed that there is an association between the weather and rheumatic symptoms. We aimed to investigate what kind of association is present and what are the factors which determine the nature of this association. Fifty-six subjects with rheumatic disease (31 RA, 15 SpA, 10 OA) who live in Antalya were followed between December 2005 and July 2006. Patients were asked to fill diaries which contain questions regarding the symptoms of their rheumatic diseases everyday. In every monthly visit, disease activity measurement, laboratory assessment and Beck depression inventory assessment were recorded. The symptomatic and psychological measurements were matched with the meteorological data of Antalya Regional Directorate of Meteorological Service of Turkish State. Correlation of symptoms with weather variables was investigated. Contributory effect of weather and of psychologic factors on symptom scores were evaluated by stepwise multiple regression analysis. Eighty-four percent of subjects belive in an association between weather and rheumatism, while 57% claimed to have ability to forecast weather. The maximum correlation coefficient between weather and arthritis symptoms was −0.451 and the maximum contribution of weather on symptoms was 17.1%. Arthritis symptoms were significantly contributed by Beck depression score. The belief about presence of weather–arthritis association was found to be stronger than its statistical power. Our results did not prove or rule out the presence of weather–rheumatism association. As long as the scientific attempts result in failure, the intuitive support in favour of the presence of weather–arthritis association will go on forever.

Macular RGC-IPL thickness measured by SD-OCT can be used to evaluate the structural changes in RGCs. [...]in this study, we aimed to detect HCQ-induced retinal toxicity at an earlier stage through the use of SD-OCT device, especially by measuring macular RGC-IPL thickness. According to the ophthalmological examination protocol, all patients were subjected to visual acuity test using Snellen chart; ocular tension measurement using Goldmann applanation tonometer; biomicroscopic examination; central 10-degree visual field test using Octopus 900 (Interzeag AG, Schlieren-Zurich, Switzerland); fundus autofluorescence photography and color fundus photograph examination using Visucam NM/FA (Carl Zeiss, Germany), and macular RGC-IPL thickness and peripapillary retinal nerve fiber layer (RNFL) thickness measurements using Cirrus high-definition OCT, model 5000 (Carl Zeiss Meditec Inc., Jena, Germany). [...]if the drug is used more than five years and the total cumulative dose exceeds 1000 grams, the toxicity rate exceeds 1%.16 Drug dose of higher than 6.5 mg/kg/day (or 400 mg/day), drug use for more than five years, and a cumulative dose higher than 1000 g are considered as high risk factors for HCQ-induced retinopathy.17 Toxicity can be evaluated by subjective tests such as visual acuity score, corneal slit lamp examination, fundus examination and automated central perimetry 10-2 test.4 Amsler grid testing, color vision testing, fluorescein angiography, electrooculogram and full-field ERG are no longer recommended as screening tests.17 Fundus autofluorescence photography, multifocal ERG and SD-OCT macular measurements are considered as objective tests.4 It is recommended to use at least one objective test in addition to the subjective tests for screening.18 In order to discontinue the treatment in patients who are suspected to have HCQ-induced retinal toxicity, it must be confirmed with at least two screening tests including minimum one objective screening test.19 Spectral-domain optical coherence tomography images show localized thinning of retinal layers in the parafoveal zone, and may reveal retinal toxicity at an earlier stage before visual field loss occurs.6,11,20-22 Majority of the previous studies were related to the pathologies associated with the outer retinal segment involving retinal pigment epithelium and photoreceptors.13,21,23 However, some other studies also demonstrated HCQassociated damage in the inner retinal segment.11,19 In our study, we also found statistically significant thinning of RGC-IPL, which is a part of the inner retina; average RGC-IPL thickness, and all segments except inferior segment in the group of patients who were taking HCQ compared to the controls who were not taking the drug. [...]the cumulative dose and duration use of HCQ were found to have a statistically significant negative correlation with average RGC-IPL thickness. [...]we suggest that the measurement of RGC-IPL thickness may become an important objective in screening tests for HCQ-induced retinal toxicity.

Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by fibrosis. The prognosis of the disease is bad when clinically symptomatic cardiac dysfunction is occurred, therefore early detection of cardiac dysfunction is important in patients with SSc. The aim of this study was to investigate the frequency of fQRS in superficial electrocardiography in cardiacally asymptomatic patients with SSc and its relation to the systolic pulmonary artery pressure (sPAP). This study included 31 cardiacally asymptomatic patients with SSc (23 females, 40.4±9.2 years) and 41 healthy volunteers as the control (31 females, 38.2±11.8 years). The ECGs with 12 derivations and transthoracic echocardiographies of the patients were evaluated. The presence of fQRS in the superficial ECG, and its relation to systolic pulmonary artery pressure (sPAP) were investigated. The mean sPAP value in the SSc group was observed to be higher than that of the control group (26 mm Hg and 20 mm Hg, respectively, p<0.001). The presence of fQRS in the SSc group was more frequent than the control group (55% and 10%, respectively, p<0.001). In SSc patients presence of fQRS become relevant with ≥24 mm Hg sPAP by 88% sensitivity and 79% specificity. In our study, the presence of fQRS in SSc patients, were more frequent than in the normal population. Since pulmonary hypertension is the primary cause of mortality in patients with SSc, the correlation of fQRS with sPAP should also be considered.

Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular (CV) comorbidities. The association of CV diseases (CVD) and traditional CV risk factors has been debated, depending on patient and RA characteristics. This study aimed to find the prevalence of CVD and CV risk factors in patients with RA. A multi-center cross-sectional study was performed on RA patients using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) in September 2022. Socio-demographic, clinical, and follow-up data were collected. Myocardial infarction, ischemic heart disease, peripheral vascular disorders, congestive heart failure, ischemic stroke, and transient ischemic attack were regarded as major adverse cardiovascular events (MACEs). CVD was defined as the presence of at least one clinical situation of MACE. Group 1 and Group 2 included patients with and without CVD. Prevalence rates of CVD and traditional CV risk factors were the primary outcomes. Secondary outcomes were the differences in the clinical characteristics between patients with and without CVD. An analysis of 724 patients with a mean age of 55.1 ± 12.8 years diagnosed with RA was conducted. There was a female preponderance (79.6%). The prevalence rate of CVD was 4.6% (n = 33). The frequencies of the diseases in the MACE category were ischemic heart disease in 27, congestive heart failure in five, peripheral vascular disorders in three, and cerebrovascular events in three patients. The patients with CVD (Group 1) were significantly male, older, and had higher BMI (p = 0.027, p < 0.001, and p = 0.041). Obesity (33.4%) and hypertension (27.2%) were the two CV risk factors most frequently. Male sex (HR = 7.818, 95% CI 3.030–20.173, p < 0.001) and hypertension (HR = 4.570, 95% CI 1.567–13.328, p = 0.005) were the independent risk factors for CVD. The prevalence of CVD in RA patients was 4.6%. Some common risk factors for CVD in the general population, including male sex, older age, and hypertension, were evident in RA patients. Male sex and hypertension were the independent risk factors for developing CVD in patients with RA.

The association between spondyloarthritis and cardiovascular (CV) diseases is complex with variable outcomes. This study aimed to assess the prevalence rates of CV diseases and to analyze the impact of CV risk factors on CV disease in patients with spondyloarthritis. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group’s prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461–6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631–7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189–28.810, p = 0.030) were the independent predictors for CV disease. A multi-center cross-sectional study using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) database was performed on patients with spondyloarthritis. Socio-demographic, laboratory, and clinical data were collected. Patients with and without major adverse cardiovascular events (MACE) were grouped as Group 1 and Group 2. The primary outcome was the overall group’s prevalence rates of CV disease and CV risk factors. The secondary outcome was the difference in socio-demographic and clinical characteristics between the groups and predictive risk factors for CV disease. There were 1457 patients with a mean age of 45.7 ± 10.9 years. The prevalence rate for CV disease was 3% (n = 44). The distribution of these diseases was coronary artery disease (n = 42), congestive heart failure (n = 4), peripheral vascular disorders (n = 6), and cerebrovascular events (n = 4). Patients in Group 1 were significantly male (p = 0.014) and older than those in Group 2 (p < 0.001). There were significantly more patients with hypertension, diabetes mellitus, chronic renal failure, dyslipidemia, and malignancy in Group 1 than in Group 2 (p < 0.05). Smoking (36.7%), obesity (24.4%), and hypertension (13.8%) were the most prevalent traditional CV risk factors. Hypertension (HR = 3.147, 95% CI 1.461–6.778, p = 0.003), dyslipidemia (HR = 3.476, 95% CI 1.631–7.406, p = 0.001), and cancer history (HR = 5.852, 95% CI 1.189–28.810, p = 0.030) were the independent predictors for CV disease. The prevalence rate of CV disease was 3.0% in patients with spondyloarthritis. Hypertension, dyslipidemia, and cancer history were the independent CV risk factors for CV disease in patients with spondyloarthritis.