Mehmet Tuncay Duruöz

Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures

Objective. The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. Methods. The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. Results. Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. Conclusion. Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.

Assessment of Hand Functions

The accurate assessment of hand function is very important for establishing strategies to maximize functional potential and evaluating treatment and progress of disease. The International Classification of Impairments, Disabilities, and Handicaps and International Classification of Functioning, Disability, and Health are two accepted models to make description of the relationship between pathology and functional consequences of diseases. The pinch grip, full hand grip (grasp), nonprehension hand function, and bilateral prehension are four main items to classify and assess the grip. Daily activities are generally the combinations of these different types of grips. There are three main pinch functions of hand such as tip pinch, tri-digit (Chuck) pinch, and lateral (key) pinch. The dexterity (finger and manual) is a very important functional property of the hand. Speed and precision are the criteria used to measure this skill, and the tests require high-level hand–eye coordination as well as fine motor control of the hand. Impairment, disability, and handicap are complementary aspects of function, and we have to assess all three domains separately to have a complete information about hand function in patients with hand involvement. Grasp and pinch strengths can be measured with a dynamometer. There are several scales to assess the hand function. The Duruoz Hand Index; Michigan Hand Outcome Questionnaire; Disability of the Arm, Shoulder, and Hand Index; and Arthritis Hand Function Test are some of the most widely used scales in clinical practices. The primary concern of hand functional disability questionnaires is the patient’s perception of ability.

The validity and reliability of Systemic Lupus Erythematosus Quality of Life Questionnaire (L-QoL) in a Turkish population:

Background Systemic lupus erythematosus (SLE) may have a profound impact on quality of life. There is increasing interest in measuring quality of life in lupus patients. The purpose of this study was to investigate the validity and reliability of SLE Quality of Life Questionnaire (L-QoL) in Turkish SLE patients. Methods SLE according to 2012 Systemic Lupus International Collaborating Clinics Classification Criteria were recruited into the study. Demographic data, clinical parameters and disease activity measured with the Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K); were noted. Nottingham Health Profile and Health Assessment Questionnaire were filled out in addition to the Turkish L-QoL (LQoL-TR). Internal consistency, test–retest reliability, and convergent and discriminant validity were evaluated. Results The mean age of participants was 43.55 ± 14.33 years and the mean disease duration was 89.8 ± 92.1 months. The patients filled out LQoL-TR in 2.5 min. Strong correlation of LQoL-TR with all subgroups of the Nottingham Health Profile and the Health Assessment Questionnaire were established showing the convergent validity. The highest correlation was demonstrated with emotional reactions (rho = 0.72) and sleep component (rho = 0.65) of the Nottingham Health Profile scale (p < 0.0001). Its poor and not significant correlation with nonfunctional parameters (age, disease duration, perceived general health, SLEDAI-2K) showed its discriminative properties. LQoL-TR demonstrated good internal reliability with a Cronbach’s α of 0.93 and test–retest reliability with intraclass correlation coefficient of 0.87. Conclusion The LQoL-TR is a practical and useful tool which demonstrates good validity and reliability.

The evaluation of the static and dynamic balance disorders in patients with psoriatic arthritis

To evaluate the static and dynamic balances in psoriatic arthritis (PsA) and to investigate their relationship with clinical and functional parameters. Patients diagnosed with PsA and healthy controls were recruited consecutively into the study. The demographic variables such as age, sex, body mass index of the subjects were noted. Radiographic images were examined for the detection of foot deformities. ‘Foot and Ankle Outcome Score’ (FAOS) was used to assess foot function. The dynamic and static balance of the patients was evaluated by ‘Berg Balance Scale’ (BBS) and ‘Neurocom Balance Master’ device. The fatigue (Multidimensional Assessment of Fatigue: MAF), depression (Beck Depression Inventory: BDI) and sleep disorders (Pittsburgh Sleep Quality Index: PSQI) of all patients were evaluated. This study included 50 PsA patients and 50 healthy controls with mean ages of 45.02 (SD 12.81) and 45.12 (SD 10.56), respectively. Demographic data of both groups were similar. Concerning the balance tests, there were significant differences (p < 0.05) between patient and control groups about the all tests of sway velocity (except on foam surface eyes closed test), end sway of tandem walk test, movement time of bilateral step up over test and lift up index of left step up over test. There was no significant correlation between static and dynamic balance parameters with MAF, BDI, PSQI, foot deformities and FAOS. The static and dynamic balance impairments are seen in PsA. As the balance parameters had no significant correlation with functional and clinical data, they are acceptable as independent parameters during the course of the disease.

The Validity and Reliability of Turkish Version of the Jenkins Sleep Evaluation Scale in Rheumatoid Arthritis

Objectives This study aims to assess the validity and reliability of the Jenkins Sleep Evaluation Scale (JSS) when applied to a Turkish population with rheumatoid arthritis. Patients and methods The Turkish version of JSS (JSS-TR) was obtained after translation from English into Turkish, according to standard guidelines. The study included 61 patients of rheumatoid arthritis (13 males, 48 females; mean age 50.5 years; range 19 to 72 years) as defined by the American College of Rheumatology 2010 criteria. The internal consistency (Cronbachs alpha) was assessed for reliability. Content and construct validity (convergent and divergent validities) were evaluated. The relationships between the JSS-TR and the Pittsburgh Sleep Quality Index, the Multidimensional Assessment of Fatigue scale, subgroups of the Nottingham Health Profile, and the Stanford Health Assessment Questionnaire were assessed for convergent validity. In addition, the relationships between the JSS-TR and age, disease duration, visual analog scale patient global score, and disease activity score 28 were assessed for divergent validity. Results The Cronbachs alpha of JSS-TR was 0.80. All questions and the answer choices for the scale were understood well and related to some dimension of sleep demonstrating good content validity. The JSS-TR had good correlations with functional parameters (which are convergent), and poor or insignificant correlations with non-functional parameters (which are divergent). This implies that the JSS-TR had good construct validity in the context of this study. Overall, the JSS-TR had the best correlation with the Pittsburgh Sleep Quality Index (Spearmans rank correlation coefficient=0.76). Conclusion The JSS-TR is a valid and reliable instrument. It is a simple and effective tool which can be used to evaluate sleep disturbances in rheumatoid arthritis patients in both daily practice and clinical research.

Duruöz Hand Index: Is it valid and reliable in children with unilateral cerebral palsy?

ABSTRACT Purpose: To investigate the validity and reliability of the Duruöz Hand Index (DHI) in patients with unilateral cerebral palsy (CP). Methods: Assessments of patients (n = 23) were performed using the Modified Ashworth Scale (MAS), the Manual Ability Classification System (MACS), the grip and pinch strength tests, and DHI. Following the data collection, retest of DHI was administered telephonically within a 2-week period. Results: Test–retest reliability and internal consistency of DHI were found to be excellent with a Cronbach’s alpha value of 0.93 and an intraclass correlation coefficient value of 0.94. The correlation between the DHI and MACS was detected significantly high (r = 0.840, p = < 0.010). The DHI also correlated with grip and pinch strength in the affected side (r = −0.459, p = < 0.050; r = −0.509, p = < 0.050). Conclusions: DHI is a valid and reliable questionnaire for patients with unilateral CP.

THU0428 Validation of the Toronto Psoriatic Arthritis Screen II (Topas II) Questionnaire in a Turkish Population

Background The Toronto Psoriatic Arthritis Screen II (ToPAS II) questionnaire was developed and validated in Canada. It is simple index which is very good at classifying those who are not diagnosed with Psoriatic Arthritis (PsA) and those who are diagnosed with PsA. Objectives To assess the validity of ToPAS II questionnaire in a Turkish population. Methods The Turkish translation of ToPAS was sent us by the developer authors of the original index. Subjects were recruited from Psoriasis (Dermatology), Psoriatic Arthritis (PsA), Physical and Rehabilitation Medicine (PRM) and Rheumatology (non PsA) clinics. All subjects were assessed by a rheumatologist according to a Standard protocol which includes demographic parameters, physical examination, ToPAS questionnaire and CASPAR criteria. Receiver Operating Characteristics (ROC) assessed to obtain sensitivty and specificity of Turkish version of ToPAS II questionnaire. Results One hundred and fifty subjects were recruited in all groups. The mean of age was 41.07 years (SD:12,60) and the 58% of subjects were female. There were 46 subjects from psoriasis group, 43 subjects from PsA group, 41 subjects PRM group and 20 subjects from rheumatology (non-PsA) group. The area under the ROC curve was 0,985 which means as good predictor. An observed overall sensitivity and specificity, based on a single cut point of 81.2% and 99.0%. Conclusions The Turkish version of ToPAS II has high sensitivity and specificity to screen subjects for PsA. It is very practical, not time consuming and accurate index. References Gladman DD, Schentag CT, Tom BDM et al. Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS). Ann Rheum Dis 2009;68:497-501. Disclosure of Interest None declared

AB0117 Evaluation of serum levels of interleukin(il)-17a, il-17b, il-17c, il-17f and il-23 levels in psoriatic arthritis

Objectives Our aim was to evaluate serum IL-17A, IL-17B, IL-17C, IL-17F and IL-23 levels in Psoriatic Arthritis (PsA) patients and to explore the relationships between serum IL levels and clinical and laboratory findings and disease activity indices. Methods 40 patients fulfilling CASPAR criteria for PsA were consecutively selected for this study. Patients with disease which may be effect interleukine levels were excluded. Control group consisted of 27 healthy volunteers. Demographic, clinical and laboratory data of the patients were recorded. The Body Mass Index (BMI), severity of pain (VAS), global assessment of general health (VAS), morning stiffness, disease duration were evaluated. Quality of life was assessed with PsAQoL, SF-36 and Notthingham Health Profile. Maastricht Ankylosing Spondylitis EnthesitisScore (MASES) was used for evaluation of enthesitis. Patients and control group serum IL -17A, IL-17B, IL-17C, IL-17F and IL-23 levels were evaluated by ELISA method. Mann-whitney U test, independent sample t test, Spearman rho test were used in statistical analysis. p <0.05 was accepted as statistically significant. Results 40 patients (14 men, 26 women) and age and sex matched 27 healthy volunteers (12 men, 15 women) were recruited into the study. The mean age and BMI of patients and control group were 46,14 (SD:10,54), 49,96 (SD:6,35) years and 30,57 (SD:5,66), 28,96 (SD:5,84) kg/m2 respectively ( p=0,102; p=0,277 ). The median duration of psoriatic arthritis was 8 months (min: 1, max: 144, interquartile range: 1-36). The median morning stiffness duration was 30 minutes (interquartile range: 0-35). The patients’ scores (mean ± SD) were; VAS pain 41,67 (SD:28,45) mm; VAS general health status: 41,72 (SD:26,69) mm. There was a statistically significant difference between PsA and control groups for IL-17A and IL-17C serum levels (p=0,012, p=0,003 respectively). There was not any difference in PsA group for IL levels between smokers and nonsmokers. There was a significant negative correlation between IL-17C levels and VAS pain, VAS general health (p=0,015, r=-0,439; p=0,037, r=-0,369 respectively). There was not any statistically significant correlation between serum IL-17A, IL-17B, IL-17C, IL-17F and IL-23 levels and morning stiffness, duration of PsA, thoracal and lomber schöbers, ESR, PASI scores, MASES, NHP and PsAQoL scores. When analyzed according to smoking status, in control group, IL-17C level was found to be sigificantly higher in smokers group. We could not find such a relation for IL-17A, IL-17B, IL-17C, IL-17F and IL-23 levels in either groups Conclusions Interleukin-17A level was significantly higher in PsA patients compared to healthy subjects concordant with the literature. Interestingly IL-17C serum levels were significantly higher in healthy controls. There was a significant negative correlation between IL-17C levels and VAS pain, VAS general health. There was not any significant relation between interleukine levels and clinical and functional parameters in PsA patients. The role of IL-17A in pathogenesis of PsA, and probable effect of smoking on IL levels and inflammation should be evaluated in large series. Disclosure of Interest None Declared

SAT0025 The Association Serum Interleukin 17 and Interleukin 23 Levels with Clinical and Radiological Parameters in Rheumatoid Arthritis Patients

Background Rheumatoid arthritis (RA) is a chronic, inflammatory disease which causes symmetrical destructive changes in diartrodial synovial joints (1). Cytokines play an important role in RA pathogenesis. Th 17 cells are T lymphocytes which produce IL-17. Th 17 cells express the IL 23 receptor on their membrane and are dependent on this cytokine for their survival and expansion (2). Objectives In this study, our aim was to determine serum levels of IL-17A, IL-17B, IL-17C, IL-17F and IL-23 in RA patients and to investigate the association of these cytokines with clinical, laboratory and radiological parameters in RA. Methods Seventy RA patients fulfilling 1987 ACR criteria and control group of 41 volunteers (20 OA patients and 20 healthy subjects) were enrolled in the study. Patients and control group serum IL-17A, IL-17B, IL-17C, IL-17F and IL-23 levels were measured with ELISA method. RA patients’ plain radiographic images of bilateral hands were scored (modified Sharp Van der Heijde method) also edema and erosion scores (RA MRI scoring (RAMRIS) system) of hand and wrist MRI scans of the most affected side were calculated. The association between serum levels of IL-17 and IL-23 with clinical, laboratory and radiological findings in RA were evaluated. Results Serum IL-23 levels of RA patients were significantly higher than control group. There was no significant difference for serum IL-17(A-C,F) levels between RA patients and control group. No significant difference could be found between IL-17(A-C,F) levels of control subjects and RA patients when grouped for DAS 28 score (remission, low, moderate and high disease activity). On the other hand serum levels of IL-23 were significantly higher in all RA groups compared with controls. No correlations were found between IL-17(A-C,F) and IL-23 levels and disease duration, quality of life and functional status scores, Sharp Van der Heijde score and laboratory parameters. There was a moderate positive correlation between IL-17A, IL-17C levels and both wrist and total edema MRI scores. When RA patients were divided into two groups according to MRI edema scores it was found that levels of IL-17A and IL-17F were significantly higher in the group with higher edema scores. Conclusions Our results showed that, inspite of being a useful marker to support the diagnosis of RA, IL-23 does not give additional information about disease activity in RA patients. It is known that IL-17 is higher at early phases and acute attacks rather than late phases in RA patients. We also found that serum levels of IL-17A, IL-17B, IL-17C, IL-17F were similar between patients most of whom had established RA and control group. On the other hand, our data showing that patients with higher IL-17A and IL-17F levels had higher MRI edema scores, allowed us to think that these cytokines could be used as a marker of acute attacks and a parameter for prediction of preerosive and destructive changes and rapid disease progression. References Kvien T, Scherer HU, Burmester G. Rheumatoid Arthritis. In: Bijlsima JWJ editors. Eular Compendium on Rheumatic Diseases. 1st ed. Italy: BMJ publishing group;2009. p. 61-80. Lubberts E. Th17 cytokines and arthritis. Semin Immunopathol 2010;32:43-53 Disclosure of Interest None Declared