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Paravertebral muscles are affected in spondyloarthritis. Decreased mobility of spine may lead to atrophy and fatty degeneration of these muscles. The objective of this study was to compare the sonographic, electrophysiological and magnetic resonance imaging (MRI) features of paraspinal muscles between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). The patients who were diagnosed as AS with modified New York criteria and those as nr-axSpA with ASAS 2009 criteria were enrolled. Clinical evaluation, electrophysiological examination including nerve conduction studies and needle electromyography (EMG) for lower extremities and paraspinal mapping (PSM) were performed by the first examiner. The second examiner measured lumbar multifidus areas, graded the fatty degeneration of the muscle at different levels in T2 weighted axial MRI and also performed the ultrasonographic evaluation. A total of 19 patients with AS and 14 patients with nr-axSpA were evaluated. MRI of 2 patients with AS could not be obtained. Right lumbar multifidus area/vertebra area (MV ratio) was smaller in AS patients at L3 level (p 0,029); there were no significant differences in other levels. Fatty degeneration was also higher in AS patients in left multifidus at L5–S1 disc level (p 0,015). PSM scores that demonstrate the extent of denervation in paraspinal muscles were significantly higher in AS patients than in nr-axSpA patients (p < 0,001). Patients with AS have more fatty degeneration and denervation in paraspinal muscles. These processes may also contribute the severity of pain and disability. The relationship between paraspinal muscle denervation and progression of fatty degeneration should further be revealed.

Background Systemic sclerosis can affect peripheral nerves, but the extent and the nature of this involvement are not well defined. The aim of this study is to compare the sonoelastrographic measurements of median nerves in systemic sclerosis (SSC), idiopathic carpal tunnel syndrome (CTS) and healthy individuals. Methods The clinical, electrophysiological and ultrasonographic assessments were done. Patients with SSC and CTS were assessed with nerve conduction studies. The measurements of cross sectional areas (CSA) were performed at psiform and forearm level from axial US images. The elastic ratio is the ratio of strain distribution in two selected region of interests (ROI) done via comparing the median nerve to flexor digitorum superfcialis tendon. The ROIs were fixed to 2 mm. Results The study was completed with 47 hands of 24 patients with SSC, 53 hands of 27 patients with CTS and 38 hands of health controls. The CSA of CTS group was significantly higher than systemic sclerosis and control groups. The elastic ratio at psiform level and forearm levels of systemic sclerosis group were significantly higher than the CTS and control groups. Conclusion Median nerves lose the elasticity while the CSA’s are in the normal range in patients with SSC. These results suggested that the increased peripheral nerve involvement in SSC is about the increased stiffness of the nerves.

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.

Both conductive hearing loss (CHL) and sensorineural hearing loss (SNHL) have been reported in the literature in patients with AS.4,5 Ankylosing of joints and ossicular fixation lead to CHL.6 Alternatively, immunemediated inner ear problems could result in SNHL.7 It was speculated that hearing loss was one of the extraarticular involvements of AS.8 However, according to our best knowledge, there were no studies after the ASAS classification criteria. Detailed information was obtained about possible etiological factors leading to hearing loss (ototoxic drugs, noise exposure, ear surgery, perforated tympanic membrane, Meniere's disease, cranial trauma, metabolic diseases, and systemic disease). Hearing loss was defined as being present when the audiometric tests disclosed pure-tone thresholds >25 dB HL in two frequencies of the audiogram.6 Transient evoked otoacoustic emission measurements were performed with the Echoport ILO292 (Otodynamics, UK) instrument. According to the literature, mean values were determined as 23.9±18.1 in patient groups and 16.8±9.3 in healthy controls.6 The sample size was calculated for a significance level of 0.2 and 80% power.

Clinical and demographic data, including, age, sex, disease duration, body mass index (BMI), pain, patient's global assessment, physician's global assessment, Bath Ankylosing Spondylitis Disease Activity Index, Ankylosing Spondylitis Disease Activity Score, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, and Maastricht Enthesitis Score, were recorded. Additionally, the presence of comorbid conditions with SpA may decrease the tolerability of medications and indeed may influence the decision to use biological drugs.3 The extraarticular manifestations and comorbidities of SpA patients were found to increase disability and healthcare expenditures.4 The association of SpA with comorbid situations were previously evaluated.5\"8 Some of the recommendations/guidelines underline the importance of considering comorbid situations during the management of SpA.910 The main objective of this study was to evaluate the comorbid conditions of Turkish patients with SpA. The questionnaire contains questions about hypertension (HT), diabetes mellitus (DM) (including any complication related to DM), renal disease, chronic lung diseases (asthma or chronic obstructive pulmonary disease), pulmonary circulation disorders, thyroid dysfunction (hypo-or hyperthyroidism, any thyroid surgery, and consuming thyroid hormone replacement or suppressing medicine), cardiovascular system disorders (coronary artery disease, myocardial infarction, congestive heart failure, peripheral vascular events, and cardiac valve disease) gastrointestinal (GI) system disorders (peptic ulcer and GI bleeding), hepatic disorders, history of cancer, neurologic disorders (stroke, dementia, atlantoaxial instability, and spinal cord injury/cauda equina syndrome), psychiatric disorders (depression/psychosis). Three or more groups were compared by the Kruskal-Wallis test or analysis of variance (ANOVA) depending on their distribution.

The aim of this study was to determine the prevalence of joint hypermobility among high school students and to define the characteristics of patients with joint hypermobility. The students underwent complete history and physical examination. In order to designate marfanoid habitus, body weight, height, and span/height and upper/lower segment ratios were recorded. The degree of joint hypermobility was scored by the Beighton scoring system. The following features were also examined: arthralgia, myalgia, low back pain, sciatica, spinal deformities, temporomandibular joint pain and crepitus, effusion, swan neck deformity, arachnodactyly, joint dislocation, joint sprain, Raynaud's phenomenon, stria, varicose veins, abdominal and inguinal hernia, heart disease history, myopia, dropping eyelids, and antimongoloid slant. Eight hundred sixty-one students (433 females and 428 males) with a mean age of 15.4+/-1.1 years (range 13-19) were examined. Joint hypermobility was observed in 101 (11.7%) of the students. According to the Beighton scoring system, the majority of these (61.4%) were observed to score 4. Our results show that phenotype has no relation with joint mobility. Of the total number of students, there were 31 male (7.2%) and 70 female (16.2%) hypermobile subjects. The difference between sexes was highly significant (P=0.00005). Joint sprain was detected in 14 of hypermobile students (13.9%) and 50 of nonhypermobile students (6.6%). Its presence was the only significant parameter between hypermobile and nonhypermobile students (P=0.0094). Joint hypermobility was found in 11.7% of the students in our study, and the results are in harmony with the previous studies on Western populations. Although hypermobility does not seem to be very problematic in young people, as in our focus group, we believe that it is important for physicians to recognize this problem to ensure correct diagnosis and treatment, since it may lead to mimic rheumatic diseases in the future.

Objective: The aim of our study is to investigate the impact of cardiac rehabilitation on left ventricular (LV) diastolic function in acute coronary syndrome (ACS) patients.Patients and Methods: Patients were selected consecutively among ACS patients who underwent primary percutaneous intervention and were found eligible for cardiac rehabilitation program from May 2014 to May 2015. Forty-four patients were included in cardiac rehabilitation group and recruited to 30 sessions of Phase-3 cardiac rehabilitation program six weeks after discharge. Twenty consecutive patients were included as control group. LV diastolic functions were assessed by resting and stress echocardiography.Results: There were not any significant differences in characteristics between the groups. Resting and stress E velocities and resting lateral e’ velocity significantly increased after rehabilitation program. Left atrial volume index, resting and stress A velocities and average E/e’ ratios were significantly lower while stress lateral e’ velocity was significantly higher in rehabilitation group after program compared to controls. The number of patients with diastolic dysfunction decreased after rehabilitation program. Final resting and stress echocardiography revealed significantly lower frequency of diastolic dysfunction in rehabilitation group.Conclusion: Cardiac rehabilitation improves diastolic functions in ACS patients, which may be detected by stress echocardiography.

This study aimed to compare the short-term efficacy of splinting (S) and splinting plus low-level laser therapy (SLLLT) in mild or moderate idiopathic carpal tunnel syndrome (CTS) with a prospective, randomized controlled study. The patients with unilateral, mild, or moderate idiopathic CTS who experienced symptoms over 3 months were included in the study. The SLLLT group received ten sessions of laser therapy and splinting while S group was given only splints. The patients were evaluated at the baseline and after 3 months of the treatment. Follow-up parameters were nerve conduction study (NCS), Boston Questionnaire (BQ), grip strength, and clinical response criteria. Forty-five patients with CTS completed the study. Twenty-four patients were in S and 21 patients were in SLLLT group. In the third-month control, SLLLT group had significant improvements on both clinical and NCS parameters (median motor nerve distal latency, median sensory nerve conduction velocities, BQ symptom severity scale, and BQ functional capacity scale) while S group had only symptomatic healing (BQ symptom severity scale). The grip strength of splinting group was decreased significantly. According to clinical response criteria, in SLLLT group, five (23.8%) patients had full and 12 (57.1%) had partial recovery; four (19%) patients had no change or worsened. In S group, one patient (4.2%) had full and 17 (70.8%) partial recovery; six (25%) patients had no change or worsened. Additionally, applied laser therapy provided better outcomes on NCS but not in clinical parameters in patients with CTS.

Aims: Cardiac rehabilitation (CR) has shown to be an effective treatment, but the patient participation and referral rates are low both globally and in Turkey. This study aims to translate and show the consistency and validity of 'Cardiac Rehabilitation Barriers Scale' in Turkish. Methods: Cardiac Rehabilitation Barriers Scale has been translated into Turkish as Kardiyak Rehabilitasyonda Engeller Skalasi'(KRES). The translated version has been applied to 59 patients who have been referred to the Cardiopulmonary Rehabilitation unit after acute myocardial infarction but could not attend the sessions or missed their sessions. Results: In the statistical analyses, The Kaiser-Meyer-Olkin value was 0.668 and Barlett's test was significant (p<0.001). In factor analysis, 5 factors were identified: The first factor reflects extrinsic limitations on the patients' access. The second factor reflects problems about patients' information about CR. The third factor is logistical problems. The fourth factor reflects the perceived need for CR. The fifth factor consists of only one item 'other health problems prevent me from going'. Internal consistency of all subscales revealed satisfactory internal consistency (Cronbach's alpha >0.7). Conclusions: KRES is a valid and consistent tool in evaluating barriers in CR in Turkish patients. Keywords: Barriers, cardiac rehabilitation, reliability, validity.