Fatma Gül Yurdakul

Isotretinoin-induced arthritis mimicking both rheumatoid arthritis and axial spondyloarthritis.

Isotretinoin is used for the treatment of various acne lesions that are resistant to other treatments. The most frequent rheumatologic side effect of isotretinoin is transient muscle and/or joint pains. Here, we report a case with bilateral wrist and metacarpophalangeal joint arthritis and unilateral sacroiliitis associated with isotretinoin usage to attract attention, particularly from physiatrists, rheumatologists and dermatologists, to this rare adverse effect of isotretinoin.

On the Severity of Carpal Tunnel Syndrome: Diabetes or Metabolic Syndrome

Background and Purpose Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Although its etiology is unknown, certain conditions are commonly associated with CTS, such as obesity, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, and sarcoidosis. We aimed to determine the association between metabolic syndrome and CTS, and we compared the severity of CTS between patients with diabetes (and no concomitant metabolic syndrome) and patients with metabolic syndrome. Methods Two hundred patients with a clinically and electrophysiological confirmed diagnosis of CTS were included in the study. Their demographic characteristics and severity of CTS were analyzed according to the presence or the absence of metabolic syndrome. Differences in the electrophysiological findings were evaluated between the following four groups: 1) metabolic syndrome alone (n=52), 2) diabetes alone (n=20), 3) combined metabolic syndrome and diabetes (n=44), and 4) no metabolic syndrome or diabetes (n=84). Results CTS was more severe in the patients with metabolic syndrome than those without this syndrome. The electrophysiological findings were worse in patients with metabolic syndrome alone than in those with diabetes alone and those without diabetes and metabolic syndrome. Conclusions CTS appears to be more severe in patients with metabolic syndrome than patients with diabetes. Diabetes is one of the well-known risk factors for CTS, but other components of metabolic syndrome may have a greater effect on the severity of CTS.

FRI0439 Psychiatric disorders associated with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spinal and/or peripheral involvement, enthesitis, dactylitis, and several extra-articular manifestations. Chronic inflammation often leads to reduced spinal mobility and functional disability. The frequency of fatigue, sleep disturbance, and psychological problems has increased in AS patients (1,2). Objectives Although there are studies investigating depression and anxiety frequency in AS patients, different psychiatric disorders such as impulsivity, alexithymia and eating disorders have not been evaluated. The aim of this study is to investigate the frequency of different psychiatric disorders in AS patients, and to evaluate the relationship between these disorders with disease activity and functional status. Methods Patients with AS (n=70) and healthy controls (n=56) were included in the study. The Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index (BASMI), pain visual analog scale, Beck depression scale, Beck anxiety scale, Barrat impulsiveness scale, Toronto alexithymia scale, Eating attitude test, fatigue, Ankylosing spondylitis quality of life, and Nothingam health profile were administered. Results The frequency of depression, anxiety and non planning impulsiveness were higher in patients with AS than in healthy controls (p<0.05), although no difference was found in terms of alexithymia, fatigue, and eating attitude. Depression and anxiety were correlated with high disease activity, fatigue, impaired physical functioning, and lower quality of life in the patients with AS. Non planning impulsiveness was correlated with fatigue and lower quality of life while there was no correlation with disease activity and functional impairment. BASMI scores were not associated with psychiatric disorders.Table 1. Demographic characteristics and Psychiatric disorders in Ankylosing spondylitis and healthy controls Ankylosing spondylitis patients Healthy controls p (n=70) (n=56) Age (year) 42.85±10.46 44.75±10.04 0.363 Male (%) 57.14% 51.78% 0.548 Beck depression score 13.88±8.99 9.78±8.34 0.006* Beck anxiety score 14.58±10.02 10.53±8.99 0.014* Barrat impulsiveness - attentional score 15.68±3.25 15.21±2.72 0.590 Barrat impulsiveness - motor score 19.62±4.28 18.92±4.23 0.301 Barrat impulsiveness - non planning score 26.00±4.57 24.78±3.77 0.021* Toronto alexithymia score 54.84±12.86 54.32±11.12 0.644 Eating attitude score 21.74±11.18 22.01±13.24 0.488 *P<0.05. Conclusions Depression and anxiety were associated with disease activation, while impulsivity frequency was increased independently of disease activity. Reducing in the quality of life and functional competence due to the psychiatric disorders indicates that, AS patients may require a psychological care approach during the follow up. References Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis.Xu X, Shen B, Zhang A, Liu J, Da Z, Liu H, Gu Z. Patient Prefer Adherence(2016) 20;10:879–85. doi: 10.2147/PPA.S86612. Relationship between psychiatric status, self-reported outcome measures, and clinicalparameters in axial spondyloarthritis. Kilic G, Kilic E, Ozgocmen S. Medicine (Baltimore) (2014) doi: 10.1097/MD.0000000000000337. Disclosure of Interest None declared

Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis

Objectives This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloArthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Patients and methods A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.

OP0078 Is the efficacy of physical therapy related to the pain in the patient’s mind?

Background The degree of improvement in functionality and pain after physical therapy in the patients with knee osteoarthritis (OA) may be due to various peripheral factors and used modalities. Additionally, in some patients, modifiable psychological factors such as pain catastrophizing and depression may influence the therapy outcome.1 Objectives The aim of this study was to investigate the impact of pain catastrophizing and depression on pain and functionality in the patients with knee OA who were treated with physical therapy. Methods The prospective cohort study participants were 89 patients with knee OA who underwent 10 sessions of physical therapy consist of hot-pack, transcutaneous electrical nerve stimulation (TENS), and ultrasound (US). Socio-demographic and clinical data were initially recorded. At baseline, pain catastrophizing and depression were measured with the standardised questionnaires including Pain Catastrophizing Scale (PCS) and Beck Depression Inventory-II (BDI-II).The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analogue scale (VAS) were performed at baseline, at the end of therapy and at first month after therapy. Results The patients’ mean age was 60.38 (0.97), 82% were women, and 58.4% were not working. At baseline, the mean VAS and WOMAC scores were 7.39 (1.07) and 43.03 (19.47), respectively. 47.20% of the patients had clinically proper catastrophizing. The baseline demographic and clinical characteristics, except BDI-II score, VAS, and WOMAC were not different among the low catastrophizing and high catastrophizing groups (table 1). The patients who had high scores on pain catastrophizing had a lower improvement in VAS and WOMAC scores at the end of therapy and at first month after therapy (figure 1).Abstract OP0078 – Table 1 Demographic data of all patients Low catastrophizing (n:47) High catastrophizing (n:42) Total (n:89) p Age, mean±SD (years) 58.93±9.68 62.00±8.54 60.38±0.97 0.11 Gender n (%)FemaleMale 37 (78.7)10 (21.3) 36 (85.7)6 (14.3) 73 (82)16 (18) 0.39 BMI, mean±SD 29.18±3.62 29.51±3.72 29.34±0.38 0.52 BDI-II, mean±SD 9.19±5.69 16.30±8.41 12.55±7.91 <0.001* Employment Status n (%)Not workingLabourersRetail tradingRetiredGovernment employee 21 (44.7)3 (6.4)6 (12.8)13 (27.7)4 (8.5) 31 (73.8)1 (2.4)3 (7.1)5 (11.9)2 (4.8) 52 (58.4)4 (4.5)9 (10.1)18 (20.2)6 (6.7) 0.096 Initial VAS, mean±SD 6.97 (1.01) 7.85 (0.95) 7.39 (1.07) <0.001* Initial WOMAC, mean±SD 31.63 (15.03) 55.78 (15.65) 43.03 (19.47) <0.001* PCS: Pain Catastrophizing Scale, VAS:Visual Analogue Scale, WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index. High catastrophizing was described as total PCS score ≥30. Low catastrophizing was described as total PCS score <3 * Statistically significant value (p<0.05)Abstract OP0078 – Figure 1 The comparing of differences of VAS and WOMAC scores among low catastrophizing and high catastrophizing groups. Conclusions We suggest that high levels of initial PCS score may cause lower improvement on pain and functional levels in the patients who underwent physical therapy. Screening for pain catastrophizing and depression in the patients who receive physical therapy and taking necessary precautions may improve outcomes. Reference [1] Deutscher D, Horn SD, Dickstein R, Hart DL, Smout RJ, Gutvirtz M, Ariel I. Associations between treatment processes, patient characteristics, and outcomes in outpatient physical therapy practice. Arch Phys Med Rehabil2009Aug;90(8):1349–63. Disclosure of Interest None declared

Spondyloepiphyseal Dysplasia Tarda with Progressive Arthropathy Associated with Osteoporosis and Cataract: A Case was Misdiagnosed as Juvenile Idiopathic Arthritis

Spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA) is rare hereditary disorder with autosomal recessive, X-linked recessive or autosomal dominant inheritance. Because of joint involvement SEDT-PA may be confused with juvenile idiopathic arthritis and SEDT-PA also called progressive pseudorheumatoidarthropathy of childhood. The present case had been misdiagnosed as juvenile arthritis and received unnecessary treatments for years. A 21-year-old male patient admitted with swelling and deformity in the fingers of hands, walking disturbance and common joint paint. Anteroposterior X-ray of the hip joint revealed widened and flattened epiphyses of the femoral head and bilateral narrow and irregular joint spaces. Bilateral tibiofemoral and patellofemoral joint spaces were narrowed in knee radiograph and there was osseous enlargement of the tibiofemoral joints. X-ray of the hands showed periarticular osteoporosis, significant narrowing of the joint spaces of proximal interphalengial and distal interphalangeal joints and osseous enlargement of the basis of the metacarpal, proximal and distal phalengeal bones. In lateral vertebral radiograph there was generalized osteopenia, platyspondyly with loss of weight in vertebral bodies, increased kyphosis in lateral thoracic spine and increased lordosis in lateral lumbal spine. He was diagnosed as SEDT-PA with osteoporosis and cortical cataract. Clinical features and joint involvement of SEDT-PA are similar to the JIA. Early diagnosis of SEDT-PA recovers patients from inappropriate and unnecessary treatments. Osteoporosis and ocular anomalies should be considered in patients diagnosed with SEDT-PA.