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Background Approximately 80% of all proximal humeral fractures (PHFs) are non-displaced or minimally displaced fractures, which can be treated with conservative treatment. This study investigated the effect of interferential current (IFC) added to orthopedic rehabilitation on shoulder function, pain, and disability in patients with PHF. Methods This study was a prospective, double-blind, randomized, placebo-controlled conducted in physical medicine and rehabilitation outpatient clinic. Thirty-five patients were randomly separated into the IFC group ( n  = 18) and the sham group ( n  = 17). The orthopedic rehabilitation program was applied to all patients by the same physiotherapist three times a week for four weeks. Patients in the IFC group received the intervention for 20 minutes 3 times a week before the exercise. The same pads were performed for the sham group, but no electrical stimulation was applied. Constant-Murley score (CMS) for shoulder function, visual analog scale (VAS) activity pain, disabilities of the arm, shoulder, and hand (DASH) score, and paracetamol intake were recorded post-treatment, at 6 weeks and 18 weeks post-treatment. Results The demographic and fracture characteristics were not different between the groups. Significant differences were observed in the IFC and sham group in intragroup comparisons of total CMS, VAS activity pain, DASH score, and paracetamol intake over time ( p  < 0.001). Significant improvement over time was valid for all pairwise comparisons in both groups. However, no significant differences were detected between the IFC and sham group. Conclusion IFC added to orthopedic rehabilitation could not appear to be an electrotherapy modality that could potentially benefit shoulder function and disability in patients with PHF.

Introduction This study aimed to assess the incidence of hematologic malignancy (HM) among inflammatory arthritis (IA) patients receiving tumor necrosis factor inhibitors (TNFi) compared with the general Turkish population. Methods HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single-center biological disease-modifying anti-rheumatic drug (bDMARD) registry since 2005. Patients with IA, including rheumatoid arthritis, spondyloarthritis, or psoriatic arthritis who had at least one visit after the TNFi were screened from 2005 to November 2021. Standardized incidence rates (SIR) were calculated after adjustment for age and gender and compared with the 2017 Turkish National Cancer Registry (TNCR). Results Of the 6139 patients registered in the HUR-BIO, 5355 used any TNFi at least once. The median follow-up duration was 2.6 years for patients receiving TNFi. Thirteen patients developed a HM on follow-up. In these patients, the median age at the IA onset was 38 (range, 26–67), and the median age at the HM diagnosis was 55.5 (range, 38–76). Patients using TNFi had an increased HM incidence (SIR 4.23, 95% confidence interval (CI) 2.35–7.05). Ten patients with HM were under 65 years of age. In this group, there was a higher incidence of HM in both men (SIR 5.15, 95% CI 1.88–11.43) and women (SIR 4.76, 95% CI 1.74–10.55). Conclusions The risk of HMs in inflammatory arthritis patients receiving TNFi was four times higher than in the general Turkish population.

Biosimilars offer cost-effective and safe treatment options both for patients and healthcare systems. CT-P10 is the first biosimilar of rituximab approved in Europe for use in all indications of originator rituximab (oRTX). This study aimed to provide real-life data on treatment changes and adverse events in patients who received oRTX or CT-P10. We retrospectively reviewed treatment-related adverse events [infusion-related reactions (IRRs), infections, hypogammaglobulinemia] in patients treated with at least one dose of oRTX (MabThera®) or CT-P10 (Truxima®) between 2020 and 2021 and had at least 6 months follow-up after rituximab infusion in a rheumatology clinic. The switches between oRTX and CT-P10 were performed according to drug availability at the hospital pharmacy at the time of infusion according to the local hospital procedure. Physicians were not involved in the decision of biosimilar selection. A total of 128 patients (CT-P10, n = 64; oRTX, n = 64) were included. CT-P10 was switched in 52 (40.6%) patients who had previously used oRTX, and 48 (37.5%) patients remained on oRTX. We demonstrated no difference between patients treated with oRTX or CT-P10 in the rates of IRRs, in which all reactions were grade 1 and 2. Comparable rates of infections (p > 0.05) and the rate of hypogammaglobulinemia (p > 0.05) were found in both groups with no significant difference. CT-P10 provides a safe treatment alternative in patients who require rituximab therapy. The rational use of biosimilars can be supported by evolving evidence on interchangeability and switching in real-life settings, which will help clinicians in decision-making.

ObjectivesTo assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population.MethodsIn this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). ‘Active enthesitis’ was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas).ResultsIn the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses.ConclusionsThis large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.

Eosinophilic granulomatosis with polyangiitis (EGPA) is defined the disease as having two subgroups, ANCA (+) and ANCA (–). We aimed to compare EGPA subgroups in terms of clinical features, outcomes, and treatments. A multidisciplinary team was established under our vasculitis centre since October 2014. Totally 50 EGPA patients were enrolled. Clinical features, treatments, and outcomes (FFS, VDI, relapse) were reviewed. For relapse-free survival analysis, time to first relapse was compared according to ANCA phenotype by Kaplan–Meier survival analysis and log-rank test. 17 (34%) patients were in ANCA (+), 33 (66%) patients were in ANCA (–) group. ANCA (–) patients were significantly younger at the diagnosis time (37.9 ± 14.3 vs 53.8 ± 16.3; p = 0.001) and had more nasal polyposis (45.5% vs 11.8%; p = 0.017). ANCA (+) patients had higher BVAS (17[13] vs 9[4]; p = 0.002), renal involvement and peripheral neuropathy were more common in this group, while cardiac involvement was seen only in ANCA (–) group (n = 3). Biological agents (mepolizumab or rituximab) were prescribed to nine patients in ANCA (–) and two patients in ANCA (+) group. The median duration of follow-up was 47 (IQR 69.9) months. ~ 40% of patients had at least one relapse, but relapse-free survival rate was similar between the groups. However, the predictor of first relapse was elevated Ig E level [OR (95% CI): 6.5 (1.09–38.63) p = 0.04]. Consequently, both clinical features, disease activity, and treatments appear to be significantly different between EGPA subgroups. The relapse risk was similar although clinical features and treatment strategies were different. Also, elevated Ig E levels may be a precursor for the relapse.

Objectives Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease related to several comorbidities . Anxiety is an important comorbidity in PsA and the data is scarce. We aimed to understand the rates before biologic agents and change in anxiety with the treatment. Methods PsA patients from the Hacettepe University biologic database (HUR-BIO) were assessed for the high anxiety level (score ≥ 4) using the patient self-reported measure of anxiety on a 0–10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12). The rate and scores of anxiety were determined before starting biologic agents, at the first visit within 6 months. Changes in anxiety scores were assessed according to favorable treatment responses, and the correlation was evaluated by Spearman correlation analysis. Results From 520 patients registered, 147 [mean (SD) age 43.3 (12.4) years, 70.7% female] had anxiety score both at baseline and first visit within 6 months. Both the frequency of high anxiety level and mean (SD) scores decreased at the first visit [63.9% vs. 41.4%, 4.8 (3.4) vs. 3.2 (3.1) respectively, p  < 0.001 for both] after a mean (SD) follow-up of 105.7 (22.2) days. There was also a positive correlation between the change in anxiety scores and all parameters tested for treatment response: pain, PGA, BASDAI, HAQ-DI, DAS-28, and also PsAID-12. Conclusion Anxiety is a more frequent problem at biologic initiation than rates observed in the general PsA population. The rates show a decreasing trend and correlates with treatment response but is still high within 6 months under treatment. Key Points • As high as 65% of patients had a high anxiety levels before the initiation of bDMARDs. • The disease activity control is essential in reducing anxiety; however, rates are still high within 6 months. • Decreased anxiety scores and rates of the high anxiety level are linked to better outcomes.

Objective: Kidney biopsy may unusually show non-lupus nephritis (LN) causes in patients with systemic lupus erythematosus (SLE). This study aimed to reveal the causes of non-LN and to compare the clinical and laboratory features of LN and non-lupus renal disease in patients with SLE. Methods: Patients with SLE followed between 2014 and 2020 at Hacettepe University Hospitals and who had kidney biopsy were the subject of the study. One hundred thirty four patients' kidney biopsies were evaluated retrospectively and grouped as LN and non-LN. Clinical characteristics, laboratory values at the time of kidney biopsy, and renal outcome were recorded. Results: Of 134 (107 females, 27 males) patients, 116 (86.6%) were in the LN group, and 18 (13.4%) were in the non-LN group. The most common diagnosis was focal segmental glomerulosclerosis (n=6) in the non-LN group. The median (interquartile range) biopsy age of LN patients was young [21 (17.7) vs. 36.5 (17), p<0.001], and high titer antinuclear antibody positivity over 1/320 at SLE diagnosis was more frequent in this group (50.9% vs 22.2%, p=0.02). Non-renal SLE involvement was similar in both groups. Anti-dsDNA positivity, low C3-4, and presence of active urinary sediment were significantly higher in LN patients, while serum creatinine, albumin, and proteinuria were not different between the groups at the time of kidney biopsy. Additionally, median renal SLEDAI was more elevated in LN patients. Conclusion: Anti-dsDNA positivity, low C3-C4, active urinary sediment, and high renal SLEDAI scores may give us some clues regarding renal disease in patients with SLE. However, it should be kept in mind that these serological abnormalities may also occur in non-lupus renal disease. Keywords: Systemic lupus erythematosus, renal biopsy, non-lupus nephritides, lupus nephritis Amac: Bobrek biyopsisi, nadiren de olsa sistemik lupus eritematozus (SLE) hastalarinda lupus nefrit (LN) disi nedenleri gosterebilir. Bu calismada, SLE hastalarinda lupus disi nefrit nedenlerinin ortaya Cikarilmasi ve LN ile LN disi renal hastaligin klinik ve laboratuvar ozelliklerinin karsilastirilmasi amaclandi. Yontem: 2014-2020 yillari arasinda Hacettepe Universitesi Tip Fakultesi Hastaneleri'nde takip edilen ve bobrek biyopsisi yapilan SLE'li hastalar calismaya alindi. Yuz otuz dort hastanin bobrek biyopsisi retrospektif olarak degerlendirildi ve hastalar LN ve LN disi renal hastalik olarak gruplandirildi. Hastalarin klinik ozellikleri, bobrek biyopsisi sirasindaki laboratuvar degerleri ve renal son durumlari hastane tibbi kayitlarindan elde edildi. Bulgular: Yuz otuz dort (107 kadin, 27 erkek) hastanin 116'si (%86,6) LN grubunda, 18'i (%13,4) LN olmayan gruptaydi. LN olmayan grupta en sik tani fokal segmental glomeruloskleroz (n=6) idi. LN hastalarinin medyan (ceyrekler acikligi) biyopsi yasi daha gene [21 (17,7) vs. 36,5 (17), p<0,001] olup SLE tanisinda 1/320'nin uzerinde yuksek titre antinukleer antikor pozitifligi bu grupta daha sikti (%50,9 vs. %22,2, p=0,02). Bobrek disi SLE tutulumu her iki grupta da benzerdi. Renal biyopsi sirasinda LN hastalarinda anti-dsDNA pozitifligi, dusuk C3-4 ve aktif idrar sedimenti varligi anlamli olarak yuksek iken serum kreatinin, albumin ve proteinuri gruplar arasinda farkli degildi. Ayrica medyan renal SLEDAI skoru LN hastalarinda daha yuksekti. Sonuc: Anti-dsDNA pozitifligi, dusuk C3-C4, aktif idrar sedimenti ve yuksek renal SLEDAI skorlari, SLE hastalarinda bobrek hastaligi ile ilgili bize bazi ipuclari verebilir. Ancak bu serolojik anormalliklerin lupus disi bobrek hastaliginda da ortaya cikabilecegi unutulmamalidir. Anahtar Kelimeler: Sistemik lupus eritematosuz, renal biyopsi, lupus disi nefritler, lupus nefriti

Objective: Kidney biopsy may unusually show non-lupus nephritis (LN) causes in patients with systemic lupus erythematosus (SLE). This study aimed to reveal the causes of non-LN and to compare the clinical and laboratory features of LN and non-lupus renal disease in patients with SLE. Methods: Patients with SLE followed between 2014 and 2020 at Hacettepe University Hospitals and who had kidney biopsy were the subject of the study. One hundred thirty four patients’ kidney biopsies were evaluated retrospectively and grouped as LN and non-LN. Clinical characteristics, laboratory values at the time of kidney biopsy, and renal outcome were recorded. Results: Of 134 (107 females, 27 males) patients, 116 (86.6%) were in the LN group, and 18 (13.4%) were in the non-LN group. The most common diagnosis was focal segmental glomerulosclerosis (n=6) in the non-LN group. The median (interquartile range) biopsy age of LN patients was young [21 (17.7) vs. 36.5 (17), p<0.001], and high titer antinuclear antibody positivity over 1/320 at SLE diagnosis was more frequent in this group (50.9% vs 22.2%, p=0.02). Non-renal SLE involvement was similar in both groups. Anti-dsDNA positivity, low C3-4, and presence of active urinary sediment were significantly higher in LN patients, while serum creatinine, albumin, and proteinuria were not different between the groups at the time of kidney biopsy. Additionally, median renal SLEDAI was more elevated in LN patients. Conclusion: Anti-dsDNA positivity, low C3-C4, active urinary sediment, and high renal SLEDAI scores may give us some clues regarding renal disease in patients with SLE. However, it should be kept in mind that these serological abnormalities may also occur in non-lupus renal disease.