Ajda Bal

Rheumatoid arthritis (RA) is a symmetrical joint inflammation, whereas Crohn's disease (CD) is characterized by granulomatous inflammation. Combining seropositive RA with axial spondyloarthritis (SpA) and human leukocyte antigen (HLA)-B27 positive CD is a rare occurrence. We report the case of a 64-year-old male patient with RA and axial SpA experienced diarrhea recently. He had previously experienced joint pain, swelling, and inflammatory type neck, back, and bilateral hip pain. The patient had discontinued treatment and failed to attend follow-up appointments. He had swollen joints, abdominal distension, tenderness, and inflammatory bowel disease. Colonoscopy revealed numerous linear ulcers in the terminal ileum and aphthous ulcers in the ileocecal valve and sigmoid colon. Histopathological examination indicated active ileitis signs consistent with CD. The patient responded well to subcutaneous anti-tumor necrosis factor (TNF) alpha therapy. This case emphasizes that skeletal involvement in CD can develop before bowel complaints, and patients with axial SpA experiencing bowel symptoms should be closely monitored for potential signs of inflammatory bowel disease.

To identify clinical and demographic predictors associated with the timing of transition from psoriasis (PsO) to psoriatic arthritis (PsA), and to compare the characteristics of patients with concurrent PsO-PsA onset versus those with prolonged transition. A multi-center, observational study was conducted using data from the Turkish League Against Rheumatism (TLAR) network including PsA patients fulfilling CASPAR criteria. Patients were categorized into two groups: Group 1 (concurrent PsO and PsA onset within ± 1 year) and Group 2 (prolonged transition to PsA, > 1 year after PsO). Demographic, clinical, and laboratory characteristics, disease activity, and patient-reported outcomes were compared between groups. Logistic regression was employed to determine independent predictors of prolonged transition. Among 799 patients (mean age 46.8 ± 12.3 years), 237 (29.7%) had concurrent onset and 562 (70.3%) had a prolonged transition, with a mean PsO-to-PsA interval of 12.9 ± 9.6 years. Depression (p = 0.005) and fatigue levels (p = 0.011) were significantly higher in patients with prolonged transition to PsA. Multivariate analysis revealed that scalp psoriasis (OR = 7.162), nail psoriasis (OR = 3.270), family history of PsO (OR = 1.813), and enthesitis ever (OR = 2.187) were associated with prolonged transition. Conversely, family history of PsA (OR = 0.421) and older age at PsO onset (OR = 0.957) predicted shorter transition. Prolonged transition from PsO to PsA is influenced by distinct clinical and demographic factors. Scalp/nail psoriasis, family history of PsO, and enthesitis ever may signal higher risk for prolonged PsA onset. Recognizing these markers can support timely referral and intervention, minimizing diagnostic delay and improving long-term patient outcomes.

Objectives: This study aims to examine whether aerobic exercises, in addition to home-based exercise (HBE) program, had anti-inflammatory effects, evaluated by disease activity, acute phase reactants, and cytokine levels in axial spondyloarthropathy (axSpA). Patients and methods: This two parallel-group, unblinded, 12-week, prospective, randomized-controlled trial (RCT) included a total of 54 participants who were followed for axSpa and the patients were equally allocated to the aerobic exercise group or HBE group. The aerobic exercise group included 27 patients (8 males, 19 females, mean age: 43.9±9.0 years; range, 27 to 58 years) and the HBE group included 27 patients (8 males, 19 females, mean age: 42.4±10.5 years; range, 23 to 63 years). The patients were evaluated using the Ankylosing Spondylitis Disease Activity Score (ASDAS), Visual Analog Scale (VAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion measurement, 6-Min Walk Test, and Ankylosing Spondylitis Quality of Life (ASQoL), Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tumor necrosis factoralpha (TNF-α) and interleukin-17 (IL-17) levels at the beginning of the study and after treatment completion. The HBE group was provided conventional exercise program. The second group ran on the treadmill in addition to their HBE program. Exercise sessions were performed three times a week for a period of 12 weeks. Results: After treatment, only the aerobic exercise group showed a significant improvement in disease activity (p

Objectives: The study aimed to investigate and compare clinical features, disease activity, and the overall disease burden among psoriatic arthritis (PsA) patients across seven distinct geographic regions in Türkiye. Patients and methods: A multicenter cross-sectional study involving 1,134 PsA patients from 25 referral centers across seven regions was conducted. Demographic and clinical characteristics, comorbidities, joint involvement, extra-articular manifestations, and disease activity measures were evaluated across regions. Results: A total of 1134 PsA patients from seven different geographic regions in Türkiye participated in this study. The highest number of participants was from the Marmara region (n=409), with subsequent representation from Central Anatolia (n=370), Aegean (n=139), Mediterranean (n=60), Black Sea (n=60), Eastern Anatolia (n=60), and Southeastern Anatolia (n=36) regions. There were significant variations in demographic profile, including age, body mass index, age of disease onset, educational status, comorbidities, and family history of both psoriasis and PsA. Clinical features, such as enthesitis, dactylitis, uveitis, and joint involvement, demonstrated significant variation across regions. Additionally, disease activity measures, including pain, patient and physician global assessments, acute phase reactants, disease activity indices, quality of life, and functional status, displayed considerable regional differences. Conclusion: This nationwide study revealed substantial regional diversity in demographic data, clinical characteristics, disease activity, and quality of life among PsA patients in Türkiye. These findings stress the need to customize treatment approaches to address regional needs and to conduct further research to uncover reasons for disparities. It is crucial to enhance region-specific approaches to improve patient care and outcomes for PsA.

Introduction. The coronavirus disease (COVID-19) pandemic has the potential to impact disease activity and psychological well-being in people with rheumatic diseases. This study aimed to compare ankylosing spondylitis (AS) patients with and without COVID-19 history in terms of treatment, disease control, quality of life and psychological status by providing a cross-sectional look at treatment, disease control, quality of life and psychological status in patients with AS during the COVID-19 pandemic. Methods. The study included 74 AS patients, in two groups based on COVID-19 history. Demographic data and clinical characteristics were recorded. Treatment, disease control, functional status, and quality of life were evaluated using Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index (BASFI), and impact of COVID-19 on quality-of-life scales. Psychological status was assessed using the Beck Depression Inventory, Beck Hopelessness Scale, and COVID-19 anxiety scale. Results. Of the 74 patients diagnosed with AS, 44 were female and 34 were male. The mean age was 47.3 years. In total, 35 patients (47.3%) had COVID-19. We found that the group without COVID-19 had significantly higher levels of hypothyroidism than the other group (p = 0.008). The BASFI value was significantly higher in the COVID-19 group (p = 0.031). The group with COVID-19 had a substantially higher rate of continuing non-anti-rheumatic drug use than the other group (p = 0.02). Conclusion. During COVID-19 pandemic period, the majority of patients continued their medication, so treatment and disease control were not negatively affected. Having COVID-19 did not cause a significant difference psychologically.

Objectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p

Here, a 36-year-old female patient with inflammatory sacroiliitis and simple bone cyst of the ipsilateral iliac bone is presented. Simple bone cysts occur in the developing skeleton, usually asymptomatic; however, they are benign lytic bone lesions that can cause pathological fractures. The prevalence of simple bone cysts in the whole body has been reported as 0.30/100000. Only 2% of these rare cysts are found in the pelvis, and according to our knowledge, it is the first case in which iliac simple bone cyst is seen together with sacroiliitis on the same side.