Ozan Volkan Yurdakul

Background/Objectives: To compare lower-limb muscle architecture and strength between men with radiographic axial spondyloarthritis (r-axSpA) and controls. Methods: In this controlled cross-sectional study, 30 men with r-axSpA and 30 age-matched healthy men underwent bilateral ultrasound assessment of the vastus lateralis (VL), gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and tibialis anterior (TA). Fascicle length was derived trigonometrically. Strength was assessed using hand-held dynamometry. Results: Differences represent r-axSpA minus controls, with 95% confidence intervals. VL, GM, and GL thickness differences were −0.32 (−0.50 to −0.13), −0.18 (−0.34 to −0.02), and −0.21 (−0.36 to −0.05) cm, respectively. Pennation-angle differences were −2.38 (−3.48 to −1.28), −1.99 (−3.35 to −0.63), −2.46 (−3.69 to −1.23), and 0.26 (−0.68 to 1.22) degrees for VL, GM, GL, and the TA superficial region, respectively. TA superficial-region thickness and derived fascicle length were greater: +0.53 (0.29 to 0.78) and +2.40 (1.36 to 3.45) cm, respectively. Knee extensor, ankle dorsiflexor, and ankle plantar flexor strength differences were −86.3 (−123.6 to −48.8), −52.0 (−78.2 to −26.6), and −57.9 (−92.3 to −24.1) N, respectively. Conclusions: Men with r-axSpA showed greater TA superficial-region thickness and derived fascicle length alongside lower dorsiflexion strength. These preliminary findings require confirmation in independent studies using validated measurement methods.

Background: Psoriatic arthritis (PsA) is associated with hepatic risk, but longitudinal data during methotrexate (MTX) and biologic therapy are limited. We evaluated two-year changes in age-fixed FIB-4 and APRI and their associations with cumulative MTX exposure and biologic class. Methods: This retrospective cohort included 74 patients receiving continuous biologic therapy for 24 months. Baseline age was used to calculate FIB-4 at both time points. Logistic regression assessed factors associated with FIB-4 ≥ 1.3 at follow-up. Results: Forty-five patients received anti-TNF therapy and 29 received an IL-17 inhibitor. Age-fixed FIB-4 increased from 1.26 ± 0.44 to 1.72 ± 0.73 (p < 0.001); APRI did not change significantly (0.21 ± 0.08 to 0.23 ± 0.15; p = 0.155). No significant differences in either index were detected between biologic groups. Each 500-mg increase in documented cumulative MTX exposure was associated with higher odds of FIB-4 ≥ 1.3 (OR 2.164, 95% CI 1.04–4.41; p = 0.038). Conclusions: Greater documented cumulative MTX exposure was associated with FIB-4 ≥ 1.3 in an exploratory model. The findings neither establish a causal MTX effect nor demonstrate equivalence between biologic classes and require prospective validation against elastography or histology.

Psoriasis (PsO), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) are chronic inflammatory disorders classified as immune-mediated inflammatory diseases (IMIDs). Although these diseases share common pathogenic mechanisms, they can affect different parts of the body. Nail involvement is important in PsO. However, nail findings in RA and AS have not been extensively investigated despite their inflammatory presentation, similar to PsO. This study aimed to investigate clinical and onychoscopic nail findings in patients with RA and AS and compare their distribution and patterns with those observed in patients with PsO and PsA. One hundred patients (25 in each group) with confirmed diagnoses of PsO, PsA, AS, and RA and at least 1 clinically detectable nail finding were included. A total of 1000 fingernails were examined clinically, and 200 fingernails were examined onychoscopically. The distributions of clinical and onychoscopic findings were assessed and compared across the 4 disease groups. Demographic data, laboratory findings (C-reactive protein, human leukocyte antigen B27, rheumatoid factor, anti-cyclic citrullinated peptide), PsO Area and Severity Index, and Nail PsO Severity Index were recorded. Pitting and onycholysis were the most common findings in PsO and PsA, leukonychia predominated in AS, and vertical ridges/trachyonychia were frequent in RA. Onychoscopy showed that clustered dotted vessels were significantly more frequent in PsO and PsA, whereas parallel dotted/short linear vessels (“fish school-like pattern”) were significantly more frequent in RA. Megacapillaries, microhemorrhagic dots, and coiled and tortuous capillaries were numerically more frequent in AS. Some vascular findings were associated with elevated C-reactive protein, human leukocyte antigen B27 positivity, and rheumatoid factor positivity. Nail findings in patients with IMIDs may reflect underlying inflammatory and vascular changes. Richer nail findings in PsO and PsA may be linked to keratinocyte-driven inflammation, whereas vascular alterations may play a more prominent role in the nail findings observed in RA and AS. Differences in clinical and onychoscopic nail patterns across disease groups suggest that detailed nail examination and onychoscopy may provide supportive clinical clues and aid in the clinical differentiation of IMIDs.

Objective: This study aimed to evaluate the reliability and readability of publicly available online information on lymphedema across different website typologies. A Google search was performed using the keyword “lymphedema,” and the first 200 results were screened. Eligible websites providing patient-oriented information were assessed for typology, reliability, readability, and content coverage. Reliability was evaluated using the Journal of the American Medical Association (JAMA) benchmark criteria, and readability was assessed using established readability formulas. Content analysis examined the presence of essential clinical information, including etiology, symptoms, diagnosis, and treatment options such as medication, exercise, rehabilitation, surgery, and prevention. Non-text pages, duplicates, advertisements, and inaccessible websites were excluded. Methods: A total of 143 websites were analyzed, of which 45 (31.5%) demonstrated high reliability (JAMA ≥3). Readability scores showed no meaningful differences across website typologies, although government and professional websites tended to have slightly easier reading levels. High-reliability websites exhibited marginally lower readability ease; however, these differences were not statistically significant. Content analysis revealed significant variation among website categories in the reporting of surgery (P=.02) and prevention (P=.01). No significant differences were identified between the top 10 search results and the remaining websites regarding reliability or readability. Health portal websites provided the most comprehensive clinical information, whereas other website types showed incomplete coverage in at least one informational domain. Results: Overall, variability in readability among website categories was limited, and no specific typology consistently offered superior accessibility. Compared with previous research that evaluated narrower website samples, this cross-sectional analysis provides a comprehensive assessment of reliability, readability, and informational completeness. Conclusion: These findings indicate that a substantial proportion of online lymphedema information remains suboptimal in reliability and clarity. Improving digital patient education requires coordinated efforts from healthcare professionals, academic institutions, and professional organizations to ensure that online resources are accurate, understandable, and accessible.

Self-efficacy plays a key role in managing chronic conditions such as knee osteoarthritis (KOA), and reliable tools are needed to assess it in different languages and cultures. The arthritis self-efficacy scale-8 (ASES-8) is a widely used measure, but a validated Turkish version is not yet available. This study aimed to develop a Turkish version of the ASES-8 and evaluate its validity and reliability. The ASES-8 questionnaire was translated into Turkish following a standardized cross-cultural adaptation process. Initially, the clarity and comprehensibility of the Turkish version were tested in a sample of 10 patients with knee osteoarthritis (KOA). Subsequently, the final version was administered to an additional 80 KOA patients. All participants completed the questionnaire again 7 days later to assess test–retest reliability. Floor or ceiling effects were considered present if more than 15% of participants obtained the lowest (1) or highest (10) possible score on the scale. Construct validity was assessed in accordance with COSMIN guidelines by testing predefined a priori hypotheses regarding correlations between the ASES-8 and related measures, and structural validity through confirmatory factor analysis, testing a 1-factor (unidimensional) model. Reliability was evaluated through internal consistency (Cronbach’s α), test–retest reliability (intraclass correlation coefficient), and measurement error (SEMagreement and individual-level smallest detectable change). Confirmatory factor analysis supported the 1-factor structure, showing excellent fit indices (using the relative chi-square index, the goodness-of-fit index, the Tucker–Lewis index, and the normed fit index). The internal consistency was excellent, with a Cronbach’s α of 0.968. The test–retest reliability demonstrated strong stability for both the total scores and the individual items. Hypothesis testing for construct validity was established through strong positive correlations with the pain self-efficacy questionnaire and strong negative correlations with the Tampascale of kinesiophobia; the pain catastrophizing scale; the Western Ontario and McMaster Universities Osteoarthritis Index; and the depression, anxiety, and stress subscales of the depression anxiety and stress scale-42 ( r = −0.80 to 0.91). No ceiling effect and minimal floor effect were observed at the total score level. The Turkish version of the ASES-8 has demonstrated evidence of validity and reliability for assessing self-efficacy in patients with knee osteoarthritis.

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: 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.

Our aim is to evaluate serum Raftlin levels as a biomarker for diagnosing and monitoring disease activity in patients with axial spondyloarthritis (axSpA) and Psoriatic arthritis (PsA). This trial included 40 axSpA patients, 40 PsA patients, and 40 healthy participants as the control group. Disease activity was assessed with Ankylosing Spondylitis Disease Activity Score for axSpA patients and The Disease Activity Index for Psoriatic Arthritis for PsA patients. The Spondyloarthritis Research Consortium of Canada index, health assessment questionnaire-disability index, and numeric rating scale were used to evaluate the enthesitis severity, disability, and pain status of all patients. Serum Raftlin levels were determined using the ELISA method. The 3 groups had no statistical differences regarding gender, age, weight, height, BMI, educational status, and exercise habits. The axSpA group had higher Raftlin levels than the PsA and control groups, and Raftlin levels were statistically significant in predicting the likelihood of axSpA. We found no statistically significant differences between the PsA and control groups. We found no statistically significant difference in Raftlin levels in HLA-B27 positive versus HLA-B27 negative patients in both axSpA and PsA groups. Our results also did not detect any correlation of Raftlin levels with Ankylosing Spondylitis Disease Activity Score, C-reactive protein, erythrocyte sedimentation rate, health assessment questionnaire-disability index, numeric rating scale, and Spondyloarthritis Research Consortium of Canada index in axSpA patients. Receiver operating characteristic analysis determined that Raftlin level ≥ 6.31 ng/mL discriminates axSpA from normal individuals with 92.5% sensitivity, 59% specificity, and an area under the curve of 0.738. Our results demonstrate that although serum Raftlin levels are elevated in axSpA patients, Raftlin cannot be used as an alone diagnostic marker for axSpA. Furthermore, it was not found to be related to the monitoring of disease activity, the level of pain, disability, or severity of enthesitis. This study is prospectively registered at www.clinicaltrials.gov (ID: NCT05771389).