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Familial Mediterranean fever (FMF) is a chronic debilitating and inflammatory disease affecting primarily the populations of Mediterranean origin including Non-Ashkenazi Jews, Armenians, Turks, and Arabs.1,2 It is a lifelong disease with harmful effects on all aspects of quality of life (QoL) due to the presence of recurrent attacks and side effects of medical treatment.3 The concept of health-related QoL is known as the measurement of physical symptoms, functional status, and effects of the disease on psychological and social functioning.2 As in other chronic diseases, the problems in relation to QoL for FMF patients have become an important health topic particularly during the last decades.1,2,4 It has been thought that not only QoL itself, but its measurement is also regarded as the main controversial issue for ongoing publications.4 Besides, the issue of QoL has different perspectives including pain, fatigue, mood disorders such as anxiety and depression, and sleep quality that cause difficulty in evaluating their impacts on FMF patients.5,6 Patient-reported outcome measures have been used for the assessment of QoL in patients with chronic disabling diseases.7 These measurements help physicians and health policymakers to determine psychosocial problems in patients with chronic diseases and to perform a standardized assessment of these problems.1,8 For that purpose, some scales or indices have been used including Short Form 36 (SF-36), Hospital Anxiety Depression Scale (HADS), the World Health Organization Quality of Life Scale Short Form (WHOQOL-BREF), the Health Assessment Questionnaire (HAQ), and the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale for the measurement of QoL in rheumatological diseases and FMF patients.1,5,8-11 In addition, Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale as a new, valid, and reliable scale has been also proposed.12 However, there is no consensus on the use and application of these scales or indices due to difficulties such as lack of quantitative measures and application in a busy clinical setting.10 In this study, we aimed to evaluate the effectivity of FMF-QoL Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients. Patients with lack of clinical data, a new acute FMF attack within the last seven days, pregnancy, known psychological and neurological disorders, sleep disorders, chronic fatigue syndrome, chronic pain syndrome, and fibromyalgia were excluded. [...]a total of 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years) were included. Sociodemographic characteristics of the patients including age, sex, educational status (illiteracy or primary education, secondary education, university or higher education), monthly income (US$<150, US$150 to 300, US$301 to 450 and US$>450), the status of employment, habits of smoking and alcohol, history of FMF in the first degree relatives, and disease-related variables including duration of FMF, age of onset (grouped as <5 years, five to 10 years, 11 to 20 years and >20 years), number of attacks per month (grouped as >2, one to two and <1), disease severity score developed by Pras et al.,14 (range, 2 to 19 points) and grading as mild (=5 points), moderate (6 to 10 points) and severe (=10 points), use of colchicine, and visual analog scale patient global assessments (PGA-VAS) were recorded using online data entry. In FACIT, a self-administered instrument, the total range for scores was 0 to 52 indicating the worst possible fatigue as 0 and no fatigue as 52.11 Statistical analysis Evaluation of demographic and clinical features on the FMF-QoL Scale score was regarded as the main outcome.

Background: Physical modalities have been safely used for decades for pain relief and for reducing physical disability in the conservative treatment of knee osteoarthritis (OA). However, patients’ response to treatment is highly variable, which may be related to certain patient-related factors such as pain catastrophizing and depression. Objectives: This study aimed to evaluate the effects of pain catastrophizing and depression on physical therapy outcomes and to identify the baseline factors predictive of poor outcomes in patients with knee OA. Study Design: This research used a prospective, cohort, observational study design. Setting: The research took place in an outpatient physical therapy unit within a tertiary hospital in Ankara, Turkey. Methods: Eighty-nine patients with knee OA underwent 10 sessions of physical therapy. At baseline, depression and pain catastrophizing were evaluated using the Beck Depression InventoryII (BDI-II) and the Pain Catastrophizing Scale (PCS). The therapeutic efficacy of physical therapy was assessed based on the level of pain and disability using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Changes in the VAS score and WOMAC were evaluated at 2 and 6 weeks following physical therapy. A multivariate logistic regression analysis was conducted to identify the predictors of poor outcomes. Results: Patients with low pain-catastrophizing and low depression scores tended to demonstrate better improvement at weeks 2 and 6. The results of a multivariate logistic regression analysis showed that the significant outcome predictor for both pain and function at week 6 was the baseline PCS score. The baseline depression score was not an independent predictor of a clinically poor outcome. Limitations: This study is limited owing to the combined use of several physical therapy modalities and short follow-up. Conclusions: This study suggests that the baseline PCS score is a predictive factor of poor response to physical therapy in patients with knee OA. Considering this factor before therapy and taking the necessary precautions may improve the outcomes of physical therapy. Key Words: Catastrophization, central nervous system sensitization, depression, disability evaluation, knee osteoarthritis, pain, physical therapy modalities, transcutaneous electric nerve stimulation.

The aim of this study was to analyze the pregnancy process, especially the Familial Mediterranean fever (FMF) disease course and attack types during pregnancy, and to examine the relationship between disease-related factors and female infertility in FMF patients. The study, which was planned in a multicenter national network, included 643 female patients. 435 female patients who had regular sexual intercourse were questioned in terms of infertility. Pregnancy and delivery history, FMF disease severity and course during pregnancy were evaluated. The relationship between demographic and clinical findings, disease severity, genetic analysis results and infertility was investigated. 401 patients had at least 1 pregnancy and 34 patients were diagnosed with infertility. 154 patients had an attack during pregnancy. 61.6% of them reported that attacks during pregnancy were similar to those when they were not pregnant. The most common attack symptoms were fever, fatigue and abdominal pain-peritonitis (96%, 87%, and 83%, respectively) in the pregnancy period. The disease-onset age, disease activity score, gene mutation analyses, and regular colchicine use (> 90%) were similar between the fertile and infertile groups, while the frequency of previous appendectomy and alcohol consumption rates were higher in individuals with infertility. Our results indicated no significant change in the frequency and severity of attacks during pregnancy. The low rate of infertility (7.8%) in our patients was noted. It has been suggested that the risk of FMF-related infertility may not be as high as thought in patients who are followed up regularly and received colchicine.

Objectives: This study aims to investigate temporomandibular joint (TMJ) involvement and dysfunction in patients with rheumatoid arthritis (RA) clinically and ultrasonographically (USG). Patients and methods: Between May 2021 and November 2021, a total of 51 patients with RA (16 males, 35 females; mean age: 53.0+10.4 years; range, 18 to 65 years) and 51 age- and sex-matched healthy controls (16 males, 35 females; mean age: 51.3+6.9 years; range, 18 to 65 years) were recruited. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) form was applied to both groups. Pain intensity for both TMJs was measured with the Visual Analog Scale (VAS). The Health Assessment Questionnaire (HAQ) was used to measure the functional capacities. Disease activity of patients with RA was evaluated with the Disease Activity Score-28 (DAS28). All participants included in the study underwent TMJ USG examination. Results: According to the DC/TMD diagnostic decision tree, pain disorder was detected in 22 (43.1%) patients with RA and 12 (23.5%) in the healthy control group. Joint disorder was diagnosed in 14 (27.5%) of the RA patients and five (9.8%) of the healthy control group. Since the disc thickness was found to be significantly higher in patients with TMJ pain disorders in our USG evaluations, we performed receiver operating characteristic (ROC) analysis to determine the diagnostic cut-off value. As a result of ROC analysis, we determined the disc thickness cut-off value as 1.55 mm for the diagnosis of temporomandibular dysfunction (TMD). Conclusion: These findings support that USG, which is non-invasive, without X-ray exposure, applied from a single source and easily accessible, is a viable method in the diagnosis of TMD.

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.

According to medications, no significant difference was seen between the groups in terms of patients' characteristics, DPI, and laboratory tests and there was no correlation between DPI, TAS, TOS, and OSI. Conclusion: Lower DPI and lower n-3 fatty acid and vitamin C intake in patient group demonstrated that patients with AS should pay more attention to their diet to increase serum antioxidant status. Dietary patterns have been reported as confounding factors in disease etiologies such as rheumatoid arthritis and cardiovascular diseases.6,7 According to previous study results, diets rich in phytochemicals, fiber, and antioxidant provide chronic disease risk reduction.8 Additionally, phytochemicals which are abundantly found in plant foods, act as antioxidant, balance the inflammation, and protect against the development of insulin resistance, glucose abnormalities, and lipid disorders.8 These data have led investigators to evaluate the importance of diet in other inflammatory pathologies such as AS. The enzymatic (glutathione peroxidase, superoxide dismutase, catalase, glautathione-S-transferase, glutathione reductase) and the non-enzymatic (vitamin A, vitamin C, glutathione) components play an important role in this system.11 An increase in oxidant molecules or a decrease in antioxidant molecules (such as low dietary intake of antioxidant foods) would disrupt this balance toward oxidative stress.12 Under this abnormal condition, increased stress biomarkers may harm nucleic materials, carbohydrates, proteins and, consequently, intensify existing oxidative stress.11 It is also assumed that already activated inflammatory cells (macrophages or T cells) may contribute to cytokine production and synovitis.13 Phytochemicals are known as plant-derived bioactive substances including phenolic parts (e.g., phenolic acids, flavonoids, lignans, tyrosol esters), organosulphur compounds, and isoprenoids.14,15 Phytochemicals are found in vegetables, fruits, whole grains, legumes and nuts and in other plant-based foods.

The study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) in patients with familial Mediterranean fever (FMF) and to assess the relationships between FMF characteristics and severe COVID-19 outcomes such as hospitalization. The study was planned within a national network of 21 different centers. Demographics, FMF-related clinical and genetic characteristics, and COVID-19 outcomes were obtained. A total of 822 patients with FMF (mean age of 36 years) were included in the study. Fifty-nine of them (7%) had a COVID-19 diagnosis confirmed by real-time PCR test or chest CT findings. Most FMF patients with COVID-19 (58) had mild and moderate disease activity. All patients were on colchicine treatment. However, 8 of them (13.6%) were not compliant with colchicine use and 9 of them (15.3%) were colchicine resistant. Twelve FMF patients with COVID-19 were hospitalized. There were 4 patients requiring oxygen support. COVID-19 related complications were observed in 2 patients (1 thromboembolism, 1 acute respiratory distress syndrome). Hospitalized COVID-19 patients with FMF were older than non-hospitalized patients (median ages: 51 and 31 years, respectively; p: 0.002). Other FMF-related characteristics were similar between the groups. FMF-related characteristics were not found to be associated with poor outcomes in COVID-19. Thus, FMF may not be a risk factor for poor COVID-19 outcomes.

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.

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily involves the axial skeleton but may also present with peripheral joint involvement and extra-articular involvement. The present study aims to quantitatively analyze posture, balance, and gait parameters in patients with axSpA and and assess associated factors. This cross-sectional case-control study included 51 axSpA patients (30 males, 21 females; mean age 40.94 ± 10.48 years) and 51 age- and sex-matched healthy controls. In patients with axSpA, the Ankylosing Spondylitis Disease Activity Score CRP, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Maastrich Ankylosing Spondylitis Enthesitis Score (MASES), and the Ankylosing Spondylitis Quality of Life (ASQoL) scale were used. For postural analysis, DIERS formetric (Diers GmbH, Schlangenbad, Germany) videoraster- stereography device was utilized. HUR SmartBalance BTG4 (HUR-labs Oy, Kokkola, Finland) balance platform was used for postural balance and limit of stability (LOS) measurement. Participants were evaluated using Berg Balance Scale (BBS), Functional Reach Test (FRT) and Timed Up and Go Test (TUG). The Zebris FDM type 3 (Zebris Medical GmbH, Germany) walking platform was used to measure the spatiotemporal parameters of the participants. Comparison of postural parameters showed that sagittal imbalance and cervical depth distance were increased in the axSpA group than in the healthy participants (p < 0.004). Comparison of functional balance parameters showed that BBS and FRT scores were significantly lower (p < 0.001) in the axSpA group than in the control group, while TUG scores were significantly higher (p < 0.001). The LOS values, which evaluate dynamic balance were significantly lower, indicating impairment, in the axSpA group. In the measurement of postural sway, which indicates static balance, all 23 subparameters were found to be similar. When analyzing the spatiotemporal gait parameters, in the axSpA group compared with those in the control group; Foot angles (p= 0.028) and stride width (p = 0.004) were increased, whereas step lengths (p = 0.004) and stride lengths (P = 0.004) were decreased. In the axSpA group the gait speed was decreased (p = 0.004). When axSpA was analyzed separately as radiographic and nonradiographic axSpA, similar findings were observed in posture, balance, and gait parameters. No significant difference was observed. We found that the clinical assessments most closely associated with posture, balance, and gait analyses were BBS, FRT, TUG, and BASFI.