Hasan Fatih Çay

Which is the dominant factor for perception of rheumatic pain: meteorology or psychology?

It is believed that there is an association between the weather and rheumatic symptoms. We aimed to investigate what kind of association is present and what are the factors which determine the nature of this association. Fifty-six subjects with rheumatic disease (31 RA, 15 SpA, 10 OA) who live in Antalya were followed between December 2005 and July 2006. Patients were asked to fill diaries which contain questions regarding the symptoms of their rheumatic diseases everyday. In every monthly visit, disease activity measurement, laboratory assessment and Beck depression inventory assessment were recorded. The symptomatic and psychological measurements were matched with the meteorological data of Antalya Regional Directorate of Meteorological Service of Turkish State. Correlation of symptoms with weather variables was investigated. Contributory effect of weather and of psychologic factors on symptom scores were evaluated by stepwise multiple regression analysis. Eighty-four percent of subjects belive in an association between weather and rheumatism, while 57% claimed to have ability to forecast weather. The maximum correlation coefficient between weather and arthritis symptoms was −0.451 and the maximum contribution of weather on symptoms was 17.1%. Arthritis symptoms were significantly contributed by Beck depression score. The belief about presence of weather–arthritis association was found to be stronger than its statistical power. Our results did not prove or rule out the presence of weather–rheumatism association. As long as the scientific attempts result in failure, the intuitive support in favour of the presence of weather–arthritis association will go on forever.

Adverse effect of TNF-alpha blocker? Demyelination in an ankylosing spondylitis patient: a case report.

Anti‐tumour necrosis factor (TNF)‐alpha agents promise better disease control for treatment of inflammatory arthritides which are resistant to classical disease‐modifying treatment and provide better functional outcome. But these agents are not free of adverse events. The exact relationship between use of anti‐TNF drugs and development of demyelination cannot be established yet. Here we present a case of a 36‐year‐old man who developed demyelination in the cervical spinal cord while he was being treated with etanercept for ankylosing spondylitis.

Sacroiliac joint involvement in psoriasis

Psoriasis is a skin disorder that is associated with arthritis. Sacroiliac joint involvement is considered to be less frequent than the other types of psoriatic arthritis. Additionally, the psoriatic sacroiliitis is considered to be asymmetric in general. We aimed to define the frequency and type of sacroiliac involvement in patients with psoriasis. Patients with psoriasis were included the study. Characteristics of skin, nail and articular involvement were noted. Psoriasis area and severity index was calculated. Antero-posterior pelvic X-rays were obtained and graded by two rheumatologists and a radiologist independently. One hundred and thirty-three patients were included. Thirty-seven of patients (27%) have articular involvement symptomatically. The sacroiliac joint involvement was observed in 34 (26%) of patients. More than one-half of sacroiliac involvement was bilateral while less than one-half was in symptomatic patients regarding sacroiliitis. Fifty-seven percentages of all patients have psoriatic nail involvement. Sacroiliac joint involvement did not show any significant association with psoriatic nail involvement or the severity of skin disease. We found higher frequency of sacroiliac joint involvement and bilateral sacroiliitis in patients with psoriasis. This is in contrast to present information about the association of psoriasis and sacroiliitis. These findings need confirmation by further studies and with more sophisticated techniques such as magnetic resonance imaging.

Legg–Perthes disease-like joint involvement and diagnosis delay in Scheie syndrome: a case report

Mucopolysaccharidosis (MPS) type I is an inherited disease caused by the absence or malfunctioning of lysosomal enzymes. Three subtypes, based on severity of symptoms, were described, and Scheie syndrome (also called MPS I S) is the mildest form. Although there may be some typical extra-articular manifestations, musculoskeletal involvement may be the only presenting sign in the absence of other symptoms in the patients with less severe forms. The patients with MPS I S, especially in attenuated phenotypes, may be sometimes difficult to recognize for physicians not familiar with the disease. With this case presentation, it is aimed to draw attention to this disease, which could be delayed for the correct diagnosis. An increased awareness of the disease may contribute to more accurate diagnosis, and patients may benefit from early intervention.

A New Objective Parameter in Hydroxychloroquine-Induced Retinal Toxicity Screening Test: Macular Retinal Ganglion Cell-Inner Plexiform Layer Thickness

Objectives This study aims to detect hydroxychloroquine (HCQ)-induced retinal toxicity at an earlier stage through the use of spectral-domain optical coherence tomography device, especially by measuring macular retinal ganglion cell-inner plexiform layer (RGC-IPL) thickness. Patients and methods In this study, 92 eyes of 46 Caucasian female patients (mean age 53.6±8.1 years; range 32 to 69 years) who were taking HCQ were assigned to group 1, while 80 eyes of 40 age-matched Caucasian female control subjects (mean age 56.1±10.7 years; range 34 to 71 years) were assigned to group 2. RGC-IPL thickness and retinal nerve fiber layer thickness were measured in all subjects by Cirrus high-definition optical coherence tomography model 5000 device using macular cube 512¥128 and optic disc cube 200¥200 protocols. We performed an evaluation to see if there was any difference between the measured values of the groups. The correlation between average RGC-IPL thickness measures and cumulative dose of HCQ and duration of use was analyzed. Results Retinal ganglion cell-inner plexiform layer of group 1 was found to be statistically thinner than that of group 2 both on average and in all segments (superior, superonasal, inferonasal, inferotemporal and superotemporal) except inferior segment when segmented (p<0.05). Additionally, a statistically significant negative correlation was found between the average RGC-IPL thickness and cumulative dose of HCQ (r= -0.371, p=0.001) as well as the duration of use (r= -0.308, p=0.006). Conclusion Patients taking HCQ were found to have decreased RGC-IPL thickness at an early stage due to retinal toxicity induced by the drug. We think that measuring the RGC-IPL thickness may become an important objective in HCQ screening tests.

FRI0504 Retinotoxicity of hydroxychloroquine; is it possible to demonstrate by spectral domain optical coherence tomography before development? a cross sectional investigation

Background Hydroxychloroquine is an antimalarial drug, which has been used for the treatment of autoimmune disorders as rheumatoid arthritis, connective tissue disease and Sjögren’s syndrome. Potential retinotoxicity of the antimalarial drugs is the main limiting issue of their consumption. Objectives To evaluate the alterations of retinal layers in rheumatic patients, who have been treated with hydroxchloroquine without the signs or symptoms of retinopathy by using spectral domain ocular coherence tomography (SD-OCT). Methods The retinal layers of patients who have been treated with hydroxychloroquine for rheumatoid arthritis, Sjögren’s syndrome and connective tissue diseases and age matched healthy controls were evaluated with SD-OCT. The macular cube protocol, optic disc cube protocol and horizontal and vertical HD five line raster scan protocol were applied. The measured parameters were compared between hydroxychloroquine users and healthy controls and among different diagnostic groups. in addition, correlation of these parameters with drug consumption duration and dose parameters of hydroxychloroquine were performed. Results A total of 402 eyes of 201 subjects [114 hydroxychloroquine users;40 RA, 47 SjS, 27 CTD and 87 age-mathced healthy females] were evaluated. The central and perifoveal layers and superior and inferior quadrants of retinal nerve fiber layer (RNFL) of hydroxychloroquine users were thinner than of non-users. Connective tissue disease group had longer duration and higher cumulative dose of hydroxychloroquine than other diagnostic groups. This group had thinner mean RFNL values than the other groups as well. There were significant and negative correlations between cumulative dose of drug and first quadrant of full foveal thickness and inferior quadrant of RFNL. Parafoveal and perifoveal layers were correlated negatively with dose of drug per kg of body weight. Conclusions We did not encounter a significant finding consistent with hydroxychloroquine-induced retinotoxicity. This may be the result of relatively short duration and low cumulative dose of consumed hydroxychloroquine as well as the possible safety of the drug. Nevertheless, peroidic screening should not be ommitted in order to be sure of being not-involving by retinotoxicity. SD-OCT may be the golden standard technique for the follow up of antimalarial-induced retinotoxicity in future. We need further investigation concerning the evaluation of retinotoxicity by SD-OCT Disclosure of Interest None Declared

The Importance of Fragmented QRS in Systemic Sclerosis Patient's Early Diagnosis of Cardiac Involvement

PP-179 Systemic sclerosis (SSc) is autoimmune connective tissue disease that characterized with fibrosis and diffuse vascular lesions. Even though cardiac involvement is rarely in clinical, myocardial fibrosis is to be expressed in proportion of %50-80. When clinical symptomatic cardiac dysfunction