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Background:Piriformis syndrome, a significant non-discogenic cause of sciatica, results from the irritation or compression of the sciatic nerve by the piriformis muscle. This neuromuscular condition leads to hip and buttock pain, sometimes radiating down the leg, significantly impacting patients’ quality of life. The etiology of piriformis syndrome is multifactorial, with sacroiliitis, often linked to rheumatic diseases, being a notably influential factor. Axial spondyloarthritis (axSpA), characterized by the involvement of the spine and sacroiliac joint, is a primary rheumatic cause of inflammatory sacroiliac joint involvement.Objectives:This study pioneers the investigation into the relationship between piriformis syndrome and axSpA. It aims to comprehensively examine sacroiliac magnetic resonance imaging (MRI) scans of patients diagnosed with axSpA, with a specific focus on identifying and analyzing indicators of piriformis syndrome.Methods:The study included 100 patients diagnosed with axSpA, divided into two groups of 50 each - one with radiographic axSpA (r-axSpA) and the other with non-radiographic axSpA (nr-axSpA). Participants were selected from those who received care at the Rheumatology outpatient clinic of Selcuk University Medical Faculty and had undergone sacroiliac MRI examinations. The MRI scans were analyzed by an experienced radiologist. The size and signal intensity of the piriformis muscle were assessed, with asymmetry exceeding 8 mm deemed abnormal. The presence of sciatic neuritis was evaluated based on the enlargement of the sciatic nerve and increased signal intensity on T2-weighted or STIR imaging.Results:In this study, we initially observed no significant differences in demographic characteristics and smoking habits between patients with r-axSpA and nr-axSpA axial spondyloarthritis. The median ages were similar (r-axSpA: 40.14 years; nr-axSpA: 38.94 years, p=0.608), as were the gender distributions (r-axSpA: 56% male; nr-axSpA: 46% male, p=0.424). Additionally, the proportion of smokers in both groups was not significantly different (r-axSpA: 42%; nr-axSpA: 26%, p=0.139), suggesting comparable demographic and lifestyle factors. Regarding the prevalence of specific conditions, 8% of r-axSpA patients showed signs of sciatic neuritis, slightly higher than the 4% in the nr-axSpA group (p=0.678), with 66.7% of these cases being bilateral. Piriformis asymmetry greater than 8 mm was noted equally in 4% of both groups. The incidence of radiological signs indicative of piriformis syndrome was slightly higher in r-axSpA cases (12%) compared to nr-axSpA cases (8%), but this difference was not statistically significant (p=0.739). Focusing on patients with and without MRI evidence of piriformis syndrome, the median ages were 43.1(11.47) years and 39.14 (11.62) years, respectively, showing no significant difference (p=0.309). Gender distribution was also similar across both groups (60% female in the piriformis syndrome group vs. 47.8% in the other group, p=0.521). Crucially, when assessing BASDAI, BASFI, and BASMI scores, significant differences emerged. While BASDAI (p=0.119) and BASMI (p=0.130) scores showed no significant divergence between the groups, BASFI scores were notably higher in patients with piriformis syndrome compared to those without, indicating a statistically significant increase in functional impairment (5.45 (2.76, 6.4); 2.7 (1.5, 4.5) p = 0.041). This highlights the significant impact of piriformis syndrome on patient functionality, a key finding of this study.Conclusion:This study reveals a 10% incidence of piriformis syndrome in patients with axSpA, highlighting its significant impact on patient functionality, particularly as measured by BASFI scores. These findings suggest the importance of considering piriformis syndrome in the differential diagnosis of chronic back pain in axSpA and underscore the need for further research to improve management strategies for patients with these coexisting conditions.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

The incidence of psoriasis in patients with rheumatoid arthritis (RA) is higher than in the general population. In addition, psoriasis may negatively affect the severity of rheumatological diseases in patients with autoinflammatory or autoimmune diseases. In this study, we evaluated the effect of psoriasis or a family history of psoriasis on the characteristics of RA. This is a cross-sectional study. We included 737 RA patients who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) RA Classification Criteria, but did not meet the CASPAR psoriatic arthritis criteria. Subsequently, we compared disease activity, the need for biologic therapy, the number of conventional synthetic disease-modifying anti-rheumatic drugs taken, the frequency of erosive disease and extra-articular involvement, glucocorticoid doses and the Stanford Health Assessment Questionnaire scores between patients with and without a history of psoriasis, and patients with and without a family history of psoriasis. Thirteen (1.8%) patients had psoriasis, while 58 (7.9%) had a family history of psoriasis in first- or seconddegree relatives. All outcome parameters were found to be similar between the groups. We show that concomitant psoriasis has no effect on the evaluated disease characteristics of RA.

Background:Carpal tunnel syndrome(CTS) is the most common form of entrapment neuropathies,caused by compression of the median nerve in the carpal tunnel at the wrist. But there is no gold standard technique for diagnosing CTS. Electrodiagnostic studies (EDS) are generally used but have some limitations. Recent years, magnetic resonance imaging(MRI) and ultrasonography(US) have facilitated the diagnosis of CTS. The median nerve cross section area(CSA) measured by US or MRI has been found to be associated with CTS[1]][2].CTS is usually idiopatic but it can be seen more in some disease. Psoriatic arthritis(PsA) occurs in up to 30% of people with psoriasis and can have serious debilitating effects on the peripheral joints, spine, tendon insertions, and fingers[3]. Because of arthritis, steroid use and flexor tenosynovitis play an important role in the pathogenesis of CTS, we think that CTS can be seen more in PsA patients.Objectives:We aimed to investigate the CTS in PsA patients with EDS, US and MRI than compare them with healthy controls.Methods:68 people, including 39 PsA (according to CASPAR criteria) and 28 healthy volunteers were included in study within 1 year. EDS, US and MRI were performed within maximum 2 weeks, and measurements were made by different doctors who were blind to other measurments. EDS was started with median and ulnar nerve motor conduction study than continued with sensory conduction studies. CTS diagnose was made according to the routine laboratory standards. The CSA measurement was made from the inner border of the hyperechoic ring around median nerve by using continuous tracing method at psiform bone level. US examinations were performed with a high frequency linear transducer (4-14 MHz), MRI examinations were performed on a 3-T imaging system. The statistical analyses were performed with Statistical Package for the Social Science Program Version 22. Descriptive statistics, T tests, chi-square test, Pearson correlation test were used.Results:No statifically significant difference was found between the groups for demographic characteristics. 12 (30.76%) of 39 PsA patients had CTS, whereas CTS was not detected in the control group(p= 0.001). US and MRI show larger CSA in PsA patients compared to the healthy control group(9,49 ± 3,00 mm2 vs 8,30 ±1,73mm2 p=0,005, 11,24 ± 3,41mm2 vs 9,35 ± 1,81mm2 p<0,001); in patients with CTS compared to others(11,63 mm2 ± 3,25 vs 8,60 ± 2,26mm2 p=0,002, 13,37 ± 3,37 mm2 vs 9,90 ± 1,58mm2 p<0,001) and in PsA patients which have CTS compared to PsA patients with normal EDS(11,63 ± 3,25 mm2 vs 8,87 ± 2,64 mm2 p=0,001, 13,37 ± 3,37 mm2 vs 10,52 ±3,15 mm2 p=0,003). When the CSA compared PsA patients which have normal EDS and healthy volunteers; US (8,87 ± 2,64 vs 8,30 ±1,73 p=0,180) and MRI (10,52 ±3,15 vs 9,35 ± 1,81 p=0,026) show larger CSA in PsA patients. But differance isn’t statistically significant for US measurments. The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (P<0,001).Conclusion:CTS is more common in patients with PsA. The relationship between CTS diagnosed by EDS and CSA measured by US or MRI was observed in both PsA patients and all participants. Diagnosis can be supported by US or MRI in patients who can not undergo EDS or who do not accept EDS. For PsA patients, cut off values obtained from normal people should not be used. The limitations of our study were that our CTS population was small and most of them was mild. We think that this study will be the precursor of CTS studies in PsA patients.References:[1]M. S. Cartwright et al., “Evidence-based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome,” Muscle and Nerve, vol. 46, no. 2, pp. 287–293, Aug. 2012.[2]M. Ikeda, M. Okada, M. Toyama, T. Uemura, K. Takamatsu, and H. Nakamura, “Comparison of median nerve cross-sectional area on 3-T MRI in patients with carpal tunnel syndrome,” Orthopedics, vol. 40, no. 1, pp. e77–e81, Jan. 2017.[3]C. T. Ritchlin, R. A. Colbert, and D. D. Gladman, “Psoriatic Arthritis,” N. Engl. J. Med., vol. 376, no. 10, pp. 957–970, Mar. 2017.Disclosure of Interests:None declared.

Background:Frailty can have deleterious effects on health status, including an increased risk of adverse outcomes such as falls, hospitalization, and mortality. Additionally, decreased physical function and frailty are also associated with psychological symptoms such as depression and anxiety. Frailty status is a dynamic process that may change after a certain period; therefore, periodic evaluation is important to prevent potential adverse health outcomes [1,2].Objectives:To investigate the effects of frailty on self-reported physical functioning, psychosocial symptoms, and functional performance in patients with axial spondyloarthritis (axSpA).Methods:Consecutive patients with axSpA underwent frailty screening based on Fried’s criteria by evaluating grip strength, gait speed, physical activity level, exhaustion, and weight loss. The Short Physical Performance Battery was used to assess physical performance, including 4-meter-walking, chair stand, and balance tests. Self-reported physical functioning was evaluated with Bath Ankylosing Spondylitis Functional Index (BASFI) and psychosocial symptoms were assessed using Hospital Anxiety and Depression Scale (HADS). Validated cut-off values were used to determine impaired physical performance. Patients were classified as frail, pre-frail, and robust, and outcome measures were compared between the groups. Binary logistic regression was used to investigate the association of frailty, self-report functioning, physical performance, depression, and anxiety.Results:A total of 160 patients (46.3 % males) were include with a mean age of 49.18±7.57 years and a mean disease duration of 7.93±7.18 years. Based on Fried’s criteria, frail, pre-frail, and robust patients were 17.5 %, 50.0 %, and 32.5 %, respectively. Frail and prefrail patients were older, had more physical impairment, and lower grip strength than robust patients (p<0.05). Moreover, frail adults had more depression symptoms and lower self-reported functionality than pre-frail and robust patients (p<0.05) (Table 1). Binary logistic regression revealed that depression (odds ratio [OR] = 1.14, 95% CI = 1.00 – 1.29) and grip strength (OR = 0.93, 95 % CI = 0.89 – 0.96) were significantly associated with being frail/pre-frail compared to being robust.Conclusion:The heightened prevalence of frailty among patients with axSpA is closely linked to an elevated risk of impaired functionality. It is crucial to address frailty through appropriate interventions including exercise therapy, focusing on improving not only physical function but also psychological health, to enhance the overall well-being of this population.REFERENCES:[1] Hoogendijk et al. Lancet. 2019;1365-1375.[2] Zhao et al. Journal of Clinical Epidemiology. 2023;159 (300-308).Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Frailty commonly affects the older population, reflecting an increased risk of mortality and negative health outcomes. Individuals with rheumatic diseases may be more prone to frailty due to chronic inflammation, a high risk of comorbidities, and decreased physical capacity. Functional performance tests, such as handgrip strength, gait speed, and chair stand test are associated with all-cause mortality and can have diagnostic value in screening frailty status in the various populations.Objectives:To investigate the usefulness and thresholds of gait speed and chair stand test performance in detecting frailty in patients with axial spondyloarthritis (axSpA).Methods:This cross-sectional study included patients with axSpA aged between 40 to 70 years. Fried’s criteria were used to categorize participants according to their frailty status, assessing grip strength, gait speed, physical activity level, exhaustion, and weight loss. Gait speed was evaluated with a 4-meter-walk test, and chair stand performance was assessed with Five Times Sit to Stand (FTSTS) test. A handheld dynamometer was used to assess grip strength in the dominant extremity. Physical activity status was determined using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Receiver operating analysis (ROC) was utilized, with an area under curve (AUC) of 0.70 defined as acceptable, to examine the ability of the gait speed and the FTSTS test to predict frailty assessed by Fried’s phenotype. Binary logistic regression was employed to investigate the association of frailty, chair stand test performance, handgrip strength, and gait speed.Results:A total of 160 patients (74 men) with an average of 49.18±7.57 years were included. According to Fried’s criteria, 69.4 % of them were frail/prefrail. In ROC curves, optimal cut-off scores for gait speed and FTSTS test were ≥5.4 s (area under the curve, 0.76; sensitivity, 65.77 %; specificity, 67.35 %) and ≥14 s (area under the curve, 0.63; sensitivity, 79.31 %; specificity, 42.47 %), respectively (Table 1 and Figure 1). Gait speed (odds ratio [OR] = 2.47, 95% CI = 1.59 – 3.83) and handgrip strength (OR = 0.94, 95 % CI = 0.90 – 0.97) were significantly associated with frailty status determined by Fried’s criteria.Conclusion:Compared to chair stand test performance, gait speed had a higher diagnostic value for frailty, with a satisfactory performance and an association with frailty status. Gait speed, as a single measure, seems to be a promising first-step frailty screening tool in patients with axSpA.REFERENCES:[1] White et al. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. (2013): 456-464.[2] Kim, Miji, and Chang Won Won. Journal of the American Medical Directors Association (2022): 1375-1382.[3] Öztürk, Özgül, et al. International Journal of Rheumatic Diseases (2023): 519-530.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Sjögren’s syndrome is associated with numerous extra-glandular symptoms such as fatigue, pain, and sleepiness, which can impact quality of life and are linked to depression. Additionally, Sjögren’s syndrome patients with psychological symptoms may experience decreased physical activity levels, reduced therapy compliance, and loss of work productivity. Impaired function is associated symptoms such as pain, fatigue, and depression in patients with primary Sjögren’s syndrome [1,2].Objectives:To investigate the effects of depression on disease symptoms and physical functionality in patients with Sjögren’s syndrome and determine the relationship between the depression, anxiety, patient-reported symptoms, and physical function.Methods:This cross-sectional multicentral study included patients with Sjögren’s syndrome aged 20 to 70 years. The presence of psychological symptoms was determined using the Hospital Anxiety and Depression Scale (HADS). The EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) was utilized to assess severity of pain, fatigue, and dryness. The Health Assessment Questionnaire (HAQ) was employed to assess self-reported physical function. Patients were compared based on the presence of depression regarding disease symptoms and physical functionality. The possible correlations between HADS-depression, HADS-anxiety, ESSPRI scores, and HAQ score were investigated.Results:A total of 100 patients (96 female) with a mean age of 54.62±9.70 years and a mean disease duration of 5.70±4.49 years were included. According to HADS-depression and HADS-anxiety cut-off values (≥8), 42% and 36% of the patients had depression and anxiety, respectively. Comparison of patients with and without depression showed that more depressive symptoms resulted in poorer physical function, higher pain levels, and total symptom scores (p<0.05). Fatigue and dryness symptoms did not differ regarding the presence of depression symptoms (p>0.05) (Table 1). Additionally, there were significant correlations among ESSPRI-pain, ESSPRI fatigue, ESSPRI total score, HAQ, HADS-anxiety, and HADS-depression (p<0.05) (Table 2).Conclusion:Nearly half of patients displayed increased depression levels associated with patient-reported symptoms and physical impairment. Therefore, addressing depression in patients with Sjögren’s syndrome may positively impact their physical function and perceived symptoms. Understanding the relationship between depressive symptoms and physical impairment is crucial to enhancing the functional status of patients with Sjögren’s syndrome.REFERENCES:[1] Hackett et al. Arthritis care & research. 2012: 1760-1764.[2] Cui et al. BMC psychiatry. 2018: 1-8.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Familial Mediterranean Fever (FMF) is a condition marked by recurring episodes of polyserositis, and some patients may experience joint involvement either during attacks or in a chronic form. The presence of Spondyloarthropathy (SpA) and its common features alongside FMF is often observed study. In certain instances, chronic arthritis or other SpA findings does not show a response to colchicine treatment.Objectives:In this study, we explored the connection between SpA, its musculoskeletal features, chronic arthritis, and resistance to colchicine in our FMF patient group.Methods:We enrolled 243 adult patients with Familial Mediterranean Fever (FMF) in our study, all of whom met the Tel-Hashomer Criteria. Various data, including demographic information, disease-related features, smoking habits, and comorbidities, were collected. Additionally, we utilized The International Severity Scoring System for FMF (ISSF) scores to assess the severity of the disease. Colchicine resistance was identified in patients who continued to experience one or more attacks per month despite receiving the maximum tolerated dose for at least 6 months and/or ongoing subclinical inflammation. In our research, we categorized patients into two groups based on whether they exhibited resistance to colchicine. We initially compared FMF-related features between these groups. Next, we examined the variables that showed significance in the initial analysis using a more comprehensive multivariate approach to understand their relationship with colchicine resistance.Results:Colchicine resistance was present in 54 (%22.2) of 243 patients included in the study. There was no difference between patients with and without colchicine resistance in terms of age (p=0.36), gender (p=0.94), disease duration (p=0.76), frequency of SpA (p=0.37), Charston comorbidity score (p=0.22), smoking (p=0.87), presence of musculoskeletal system findings (p=0.11), erysipelas-like rash (p=0.32), sacroiliitis (p=0.34), enthesitis (p=0.56) and presence of exon 10 MEFV mutation (p=0.05). However, the frequency of attacks (p<0.001), ISSF score (p<0.001), amyloidosis (p<0.001) and chronic arthritis (p=0.001) were more frequent in the colchicine resistant group. Mean colchicine dose was found to be higher in the resistant group (p=0.001). In multivariate analysis, ISSF score (p=0.003), attack frequency (p=0.03), resistant arthritis (p=0.002) and amyloidosis (p<0.001) were found to be associated with colchicine resistance (Table 1).Table 1.FMF features related to colchicine resistanceOR%95 CIPAmyloidosis7.72.6-22.8<0.001ISSF score3.51.5-8.00.003Attack frequency1.11.0-1.40.03Chronic arthritis6.01.8-19.30.002ISSF: The International Severity Scoring System for FMFConclusion:The study revealed that the occurrence of colchicine resistance is linked to the presence of chronic arthritis, along with amyloidosis,attack frequency and ISSF score, while no such association was identified with SpA or all other SpA features.REFERENCES:NIL.Acknowledgements:NIL. NoneDisclosure of Interests:None declared.

Background:Most studies on the unsuccessful treatment of gout suggest that knowledge gaps and inadequate physician interventions are the major contributors. However, no research has investigated to what extent patients educated by physicians with sufficient knowledge and experience about gout adhere to these recommendations.Objectives:This study aims to assess the treatment compliance of gout patients who received adequate information about diet, target serum uric acid levels, and gout from rheumatologists in university rheumatology clinics. The evaluation includes examining the impact of regular follow-up visits and medication adherence on achieving the target uric acid level and controlling the clinical manifestations of the disease.Methods:In this study, 302 gout patients initiating treatment in tertiary rheumatology centers and adequately informed about their condition were screened. A total of 198 patients meeting the study criteria were included. Compliance with treatment was assessed through self-reports, and the achievement of the target uric acid level was determined using medical records.Results:Regular follow-up visits and adherence to prescribed medications significantly influenced the attainment of the target uric acid level. The median serum uric acid level decreased from 8.85 mg/dL (IQR: 1-15 mg/dL) before treatment to 6.5 mg/dL (IQR: 2.1-13.2 mg/dL) after treatment. Of the patients informed by rheumatologists and consistently taking medication, 68.5% were compliant even after a median of 7 years. Those attending regular follow-ups had a higher treatment goal achievement rate (90.6%) compared to those who did not (29.4%).Conclusion:Achieving an acceptable level of treatment adherence and success in gout patients is contingent on adequate disease knowledge and appropriate education. Regular follow-up visits and consistent medication use, as recommended by physicians, significantly contribute to reaching the treatment goals and controlling clinical manifestations of gout over the long term.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:An incereased frequency of venous thromboembolism (VTE) in ANCA- associated vasculitis (AAV) has been reported previously [1,2]. However it is not clear yet which AAV patient would benefit prophylactic anticoagulant treatment.Objectives:The aim of the present study is to evaluate the occurence and the associated factors with VTE in a multicenter large national AAV cohort of TR-VAS.Methods:In this nationwide study, we included patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and unclassified AAV (uAAV) according to the European Medicines Agency algorithm from TRVaS, multicenter, and e-database of Turkey. Data recorded in the TRVaS database (baseline demographic, disease related characteristics [including organ/system involvements, data regarding disease activity and severity], comorbidities, serologic and other laboratory data as well as the treatment initiated for AAV, the development of end-stage renal disease and the survival status during follow up were withdrawn. Additionally, data about VTE were collected from participating centers by using a structured questionnaire. A venous thromboembolic events that occurred within the three months prior the diagnosis of AAV and during the follow up was included in the current analysis. Presence of classical risk factors for VTE (immobilization, trauma, major surgery, malignancy, pregnancy, oral contraceptive use, hormone replacement therapy, heart failure, presence of hematologic disease that may cause thrombosis, smoking history, presence of atrial fibrillation, diagnosis of diabetes mellitus and family history of VTE), disease activity at the time of VTE (BVAS score), antiaggregant/anticoagulant usage were also recorded. The analysis was performed by using the statistical package program [Statistical Package for the Social Science; SPSS 16.0]. A p value of <0.05 was considered statistically significant.Results:In total, 521 (239 female [45.8], mean age 54.4±1.08 years) patients with AAV were included in the analysis. The majority of the patients was diagnosed as GPA (357/521 [68.5%]) and as expected 60.4% (265/443) of them were PR3-ANCA positive. The demographic and main clinical characteristics of the patients with AAV was summarized in Table 1. In total 43 (8.3%) patients suffered from VTE. When we compared AAV patients with and without VTE (Table 1) we showed that cutaneous and eye involvement was statistically significantly higher (P<0.05) in patients with VTE. Baseline BVAS score was significantly higher in patients with VTE (15.7 ±1.5 vs 13.3 ±0.6 and P=0.002). Although we saw that renal involvement was tended to be higher in patients with VTE this was not reached statistically significance. AAV patients with VTE had higher baseline risk factors for the development of VTE. In multivariate analysis we revealed that baseline BVAS score was the only independent risk factor (OR=1.059, 95% CI 1.008-1.113) for the development of VTE in our AAV patients.Conclusion:The results of the present study showed that beside well-known risk factors AAV patients with high baseline disease activity, patients in particular with the cutaneous, eye and renal involvement could have higher risk for the devlopment of VTE. The determination of AAV patients with increased risk of VTE would be important to timely start anticoagulant treatment.REFERENCES:[1] Liapi M, Jayne D, Merkel P, Segelmark M and Mohammad JA. Venous tromboembolism in ANCA-associated vasculitis: a population-based cohort study. Rheumatology 2021; 00:1-8.[2] Moiseev, Sergey, et al. “Association of venous thromboembolic events with skin, pulmonary and kidney involvement in ANCA-associated vasculitis: a multinational study.” Rheumatology 60.10 (2021): 4654-4661.Acknowledgements:NIL.Disclosure of Interests:None declared.

Immunoglobulin A (Ig A) nephropathy is the most frequent primary glomerulonephritis. Renal limited disease is the most widespread clinical form of the disease. Pulmonary involvement may also be seen concomitantly and capillaritis with pulmonary hemorrhage is the most frequent pulmonary involvement. In this paper, for the first time in literature, we describe an Ig A nephropathy patient with multiple pulmonary cavities as one of the presenting features of the disease. Also, no other etiology for the cavities was found other than Ig A nephropathy. Herein, possible pathogenesis might be capillaritis or deposition of immune complexes. As a result, it should be kept in mind that pulmonary cavity may be the presenting feature of Ig A nephropathy especially with other frequent signs of the disease.