Ilker Yagci

Objectives: This study was aimed at determining the prevalence of difficult-to-treat (D2T) axial spondyloarthritis (axSpA) and identifying main associated factors for D2T axSpA. Method: This multicenter observational cross-sectional study included axSpA patients from the BioSTaR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) from February 1, 2019, to January 1, 2025. Data from 1800 axSpA patients who have previously used or are currently using at least one biologic/targeted synthetic disease-modifying antirheumatic drug were analyzed. Patient data included demographic characteristics, body mass index (BMI), marital status, smoking and alcohol use, family history of SpA, and presence of comorbidities. The parameters related to SpA such as disease duration, type of axSpA (radiographic/non-radiographic), HLA-B27 status, the presence of extra-musculoskeletal manifestations (uveitis, psoriasis, and inflammatory bowel disease), arthritis, enthesitis, and dactylitis were also recorded. Comorbidities including hypertension, cardiovascular disease, diabetes, obesity, and hyperlipidemia were recorded, and Charlson Index scores were evaluated. Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and disease activity in means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) were also recorded. All medication history and currently used medications for axSpA and other diseases were noted. D2T and non-D2T axSpA patients were classified according to the suggested extrapolated definition. Results: Of the 1800 axSpA patients recorded in the BioSTaR database, 204 (11.3%) were classified as D2T axSpA. Data of these patients were compared to the data from 1596 non-D2T axSpA patients. Disease duration was longer in D2T patients ( p = 0.025). The presence of radiographic disease was more frequent in the D2T group ( p = 0.047). In means of MASES and ASDAS-CRP, higher scores were recorded in the D2T group (both p < 0.001). Enthesitis and psoriasis were more frequent in the D2T group ( p = 0.002 and p = 0.006). Regarding comorbidities, hypertension and cardiovascular diseases were more frequent in the D2T group ( p < 0.001 and p = 0.009). The risk of D2T axSpA increased 2.37-fold with the presence of r-axSpA ( p = 0.018), 1.92-fold with the presence of hypertension ( p = 0.006), 2.12-fold with the presence of obesity ( p = 0.024), and 3.63-fold with the presence of psoriasis ( p = 0.004). Every 1-point increase in MASES increased D2T risk 1.08-fold ( p = 0.017), and every 1-point increase in ASDAS-CRP increased D2T risk 1.62-fold ( p < 0.001). Conclusions: In conclusion, 11.3% of patients with axSpA met the proposed criteria for D2T axSpA. This subgroup was characterized by longer disease duration, higher frequency of r-axSpA, enthesitis, and psoriasis, as well as elevated MASES, CRP, ASDAS-CRP, and BASDAI scores. Hypertension and cardiovascular comorbidities were also significantly more prevalent among D2T patients. These parameters represent potential contributors to treatment complexity and should be carefully considered in therapeutic decision-making. In cases of suboptimal treatment response, reassessment and optimal management of comorbidities are essential, as comorbid conditions can increase disease burden and diminish therapeutic efficacy. Comprehensive care for axSpA should therefore include targeted management of accompanying comorbidities in parallel with disease-specific therapy. Monitoring blood pressure, optimizing body weight, and encouraging smoking cessation are particularly important. Additionally, concomitant rheumatic diseases such as psoriasis, uveitis, or inflammatory bowel disease should be actively evaluated and treated, given their association with more severe disease and reduced treatment response. Key Points • Prospectively collected data of 1800 axial spondyloarthritis patients were assessed for this cross-sectional study .• 11.3% of axial spondyloarthritis patients were identified as difficult-to-treat .• Longer disease duration and presence of radiographic axial spondyloarthritis, enthesitis, and psoriasis are more prevalent in difficult-to-treat axial spondyloarthritis patients .• Factors and comorbidities complicating axial spondyloarthritis treatment should be considered in treatment plans .

Background/Aims: This study aimed to evaluate the effectiveness of therapeutic exercises in improving muscle strength, functional status, and quality of life in patients receiving high-dose glucocorticoid therapy, which is known to cause muscle weakness and atrophy. Materials and Methods: This randomized, controlled, single-center study included 40 participants aged 18-65 years who received high-dose glucocorticoids due to chronic rheumatologic conditions, and the patients were divided into 2 groups: an exercise group and a control group. The exercise group performed lower-extremity resistance exercises for 3 months. The exercise program consisted of squats, seated leg extensions, seated leg curls, hip abductions, and seated calf raises performed 5 days per week. Functional assessments included the 6-minute walk test, the Five Times Sit To Stand Test, and the Timed Up and Go Test. Muscle strength was measured using a dynamometer, quality of life was assessed with the Short Form Health Survey questionnaire, and the cross-sectional area (CSA) of the rectus femoris muscle was evaluated via B-mode ultrasound. Patients were assessed at baseline and after 3 months of treatment. Results: Twenty patients were included in each group, with no significant differences in baseline characteristics. Compared with the control group, a significant increase was observed in knee extension strength (P = .00 for right and left knees) and quality of life in terms of physical function in the exercise group. However, no significant differences were found in the 6-minute walk test, the Five Times Sit To Stand Test, the Timed Up and Go Test, or the rectus femoris muscle CSA. Conclusion: In patients with rheumatologic diseases treated with highdose glucocorticoids, resistance exercise therapy can increase knee extension strength and quality of life in terms of physical function. Cite this article as: Karacaatlı M, Abacar K, Karabacak M, et al. The impact of resistance exercise program on muscle strength, functional performance, and quality of life in patients with rheumatologic disease receiving high-dose glucocorticoids treatment: A randomized trial. ArchRheumatol. 2026;41(1):40-46.

Spondyloarthritis (SpA) represents a group of chronic inflammatory diseases primarily affecting the axial skeleton, peripheral joints, and entheses. Early diagnosis and interdisciplinary management are essential for improving patient outcomes. Physical and Rehabilitation Medicine (PRM) specialists play a pivotal role in non-pharmacological and functional management strategies. This paper provides an overview of current management guidelines for SpA and emphasizes the multifaceted role of PRM specialists in assessment, rehabilitation, patient education, and long-term follow-up. Spondyloarthritis (SpA) encompasses a spectrum of inflammatory rheumatic diseases, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and enteropathic arthritis. These conditions share clinical, radiologic, and genetic features, such as the presence of HLA-B27 and sacroiliitis. Given the progressive nature and functional impairment associated with SpA, comprehensive management that includes pharmacologic, physical, and rehabilitative interventions is critical. SpA is broadly classified into axial and peripheral types. According to ASAS (Assessment of SpondyloArthritis International Society) criteria, early diagnosis hinges on clinical presentation, imaging (MRI or X-ray), and laboratory markers.

The Impact of Obesity and Overweight on Rheumatoid Arthritis Patients: Real-World Insights from a Biologic and Targeted Synthetic DMARDs Registry. The management of rheumatoid arthritis (RA) has advanced with biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). However, obesity, a common comorbidity, impacts treatment and disease progression efficacy. This article examines the association between body weight, activity of the disease and the effectiveness of b/tsDMARDs in RA patients. This multicenter observational cohort study, conducted as part of the BioSTAR Registry, involved a total of 856 patients diagnosed with RA (168 males and 688 females). Patients were separated into groups based on BMI: Group 1 (“normal BMI: ≥18.5 to < 25 kg/m² or underweight BMI: 2”) and Group 2 (“overweight BMI: ≥25 to < 30 kg/m² or obese BMI: ≥30 kg/m²”). Baseline socio-demographic and clinical data, medication use, switching status, and total glucocorticoid dose (mg-year) were collected. Age, disease duration, disease activity scores were considerably higher in obesity/overweight patients. Remission rates were lower in obese/overweight patients (35.6% and 25.9% in group 1 and 2 respectively; p = 0.026). The cumulative steroid doses, number of biologics and switches were similar between groups, regardless of pharmacological mechanisms. Regression analysis indicated that BMI was one of the factors affecting DAS28-CRP. The obesity/overweight rate is as high as 70.4% in RA patients. While obesity/overweight is related to enhanced disease activity, lower remission rates in RA, its effect on the choice and switch rates of b/tsDMARDs appears minimal. Clinical effectiveness remains consistent across drug classes, regardless of BMI.

Calcific tendinitis, which mostly involves the supraspinatus and rotator cuff tendons, may very rarely involve the long head of the biceps brachii (LHBB). Arthroscopy is the first choice in cases of calcific tendinitis accompanied by a rotator cuff tear but in cases where the rotator cuff is intact, there are different treatment methods, such as non-steroidal anti-inflammatory drugs (NSAID), steroid injection, Extracorporeal Shock Wave Therapy (ESWT), and Radial Shock Wave Therapy (RSWT). A 28-year-old male presented at the outpatient clinic with right shoulder pain which had been ongoing for 6 months. The patient, who was a licensed table tennis player and amateur bodybuilder, had no systemic diseases. After clinical and radiological evaluation, ultrasonography showed calcification at the level of the greater tuberculum of the right humerus. The patient was diagnosed with calcific tendinitis of the bicipital tendon. Magnetic resonance imaging (MRI) was then performed to investigate any rotator cuff pathology or glenohumeral joint pathology. No additional pathology was observed. The patient was managed with the standard RSWT protocol of four sessions. 0.25 mJ/mm² 3 bar 2000 beats administered with an electromagnetic lithotriptor. Before RSWT, the VAS score was 9 over 10 and Constant score was 37, and after the first session of RSWT, the VAS score of the patient had decreased to 6. After the 4th session, treatment was terminated as the patient was completely pain-free. At the 1-year follow-up examination, the patient was still pain-free during daily activities and sports activities, and had full range of motion. In this case report, RSWT is presented as an effective treatment option for LHBB calcific tendinitis. RSWT may be a priority option over ultrasound-guided or arthroscopic barbotage in patients without tendon rupture.

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.

Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular (CV) comorbidities. The association of CV diseases (CVD) and traditional CV risk factors has been debated, depending on patient and RA characteristics. This study aimed to find the prevalence of CVD and CV risk factors in patients with RA. A multi-center cross-sectional study was performed on RA patients using the BioSTAR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) in September 2022. Socio-demographic, clinical, and follow-up data were collected. Myocardial infarction, ischemic heart disease, peripheral vascular disorders, congestive heart failure, ischemic stroke, and transient ischemic attack were regarded as major adverse cardiovascular events (MACEs). CVD was defined as the presence of at least one clinical situation of MACE. Group 1 and Group 2 included patients with and without CVD. Prevalence rates of CVD and traditional CV risk factors were the primary outcomes. Secondary outcomes were the differences in the clinical characteristics between patients with and without CVD. An analysis of 724 patients with a mean age of 55.1 ± 12.8 years diagnosed with RA was conducted. There was a female preponderance (79.6%). The prevalence rate of CVD was 4.6% (n = 33). The frequencies of the diseases in the MACE category were ischemic heart disease in 27, congestive heart failure in five, peripheral vascular disorders in three, and cerebrovascular events in three patients. The patients with CVD (Group 1) were significantly male, older, and had higher BMI (p = 0.027, p < 0.001, and p = 0.041). Obesity (33.4%) and hypertension (27.2%) were the two CV risk factors most frequently. Male sex (HR = 7.818, 95% CI 3.030–20.173, p < 0.001) and hypertension (HR = 4.570, 95% CI 1.567–13.328, p = 0.005) were the independent risk factors for CVD. The prevalence of CVD in RA patients was 4.6%. Some common risk factors for CVD in the general population, including male sex, older age, and hypertension, were evident in RA patients. Male sex and hypertension were the independent risk factors for developing CVD in patients with RA.

Objectives: Considering that the comorbid situations during the management of Spondyloarthritis (SpA) have been underlined in several recommendations, the main objective of this study was to evaluate the comorbid conditions of Turkish patients with SpA. Patients and methods: This cross-sectional observational study was conducted with 1,242 SpA patients (844 males, 398 females; mean age: 43.9±11.0 years; range, 19 to 81 years) diagnosed according to the modified New York criteria for ankylosing spondylitis or the Assessment of SpondyloArthritis International Society (ASAS) criteria. The patient data were collected from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStar) between February 1, 2019, and December 29, 2020. 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. Comorbid conditions were recorded by filling out a questionnaire according to the clinical history or medical records. Charlson Comorbidity Index and Rheumatic Disease Comorbidity Index scores were calculated from the gathered comorbidity information. Results: Nine hundred thirteen patients had radiographic axial SpA, 153 had nonradiographic axial SpA, and 176 had peripheral SpA. The most common comorbidities were hypertension (HT) (n=167, 13.4%), diabetes mellitus (DM) (n=83, 6.7%), thyroid disorders (n=64, 5.6%), and depression (n=61, 4.9%). The comorbidities and the calculated comorbidity indices were significantly higher in females, in those with a BMI >25 kg/m2 , and those over 60 years of age. No relationship was found between smoking and alcohol use and comorbidities. A significantly higher prevalence of HT and DM in peripheral SpA patients and a lower prevalence of thyroid disorders in radiographic axial SpA patients were observed. Conclusion: The most commonly reported comorbidities were HT, DM, thyroid disorders, and depression in SpA patients according to the BioStar database. The frequency of comorbidities and composite comorbidity scores were higher among females, older (>60 years) patients, and overweight (BMI >25 kg/m2 ) patients.

Background: Subacromial impingement syndrome (SIS) and adhesive capsulitis (AC) are the most common causes of shoulder pain. It is known that patients with both disorders have impaired sleep quality and increased levels of anxiety and depression. This study aimed to compare the sleep, disability, and affective states of patients with untreated AC and SIS. Method: Patients with shoulder pain for more than three months and diagnoses of AC and SIS were included in the study. Pain was assessed by visual analog scale (VAS), disability by shoulder pain and disability index (SPADI), sleep quality by Pittsburgh sleep quality index (PSQI), and anxiety and depression by hospital anxiety and depression scale (HADS). Results: The study included 65 patients (n=24 AC, n=41 SIS. Sleep was affected in both of the groups. The patients with AC had worse scores than patients with SIS including SPADI pain, SPADI-total, sleep latency, sleep duration, sleep disturbance, using sleep mediation (pConclusions: Despite the patients with SIS had higher SPADI-pain levels, the patients with AC had higher scores of SPADI-disabilities. Both of the groups had nocturnal pain and sleep problems but patients with AC had higher amount of sleep problems and depression mood compared to patients with SIS.

Objectives: Hearing loss has been described in patients with radiographic axial spondyloarthropathies (R-AxSpA) but has not been studied in patients with non-radiographic axial spondyloarthropathies (NR-AxSpA); accordingly, the aim of the study was to compare hearing loss in patients with NR-AxSpA, R-AxSpA, and healthy individuals. Patients and methods: This cross-sectional observational study was conducted with 68 participants (30 males, 38 females; mean age: 39.8±7.4 years) between March 2021 and March 2022. Of the participants, 16 were patients with NR-AxSpA, 15 were patients with R-AxSpA, and 37 were healthy controls. Disease activity and radiological and audiological features were analyzed. The audiological assessment included pure-tone audiometric tests at octave frequencies of 250 to 8000 Hz and transient evoked otoacoustic emissions. Results: Hearing loss was found in three (8%) in the healthy group, five (31.3%) in the NR-AxSpA group, and 10 (66.7%) in the R-AxSpA group. The chi-square analysis showed a statistical significance (p=0.001). Values of audiometric tests yielded significant differences between the control and R-AxSpA group and also the control and NR-AxSpA group. For the air conduction studies, the statistical significance began at 1000 Hz in the R-AxSpA group. It was found that in the NR-AxSpA group, the statistical difference started in higher frequencies. The bone conduction audiometric studies were similar to air conduction studies. Transient evoked otoacoustic emission studies showed that the R-AxSpA group was significantly affected compared to the control and NR-AxSpA groups. There was no statistical difference between the control and NR-AxSpA groups. Conclusion: Both NR-AxSpA and R-AxSpA patients had hearing loss; however, in pure-tone audiometric tests, the abnormalities began in lower frequencies in the R-AxSpA group than in the NR-AxSpA group.