Taciser Kaya

Serum leptin levels in rheumatoid arthritis and relationship with disease activity.

Objectives: This study was performed to evaluate serum leptin levels in rheumatoid arthritis (RA) patients and investigate the correlation with serum tumor necrosis factor alpha (TNF-α) levels and clinical and laboratory parameters of disease activity. Methods: Fifty patients with RA and 34 control subjects were included. Disease activity score 28 (DAS28) was calculated for each patient. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Immunoradiometric assay was used for measuring serum leptin levels (ng/mL). Serum TNF-α levels (pg/mL) were measured by sandwich enzyme-linked immunosorbent assay method in 41 of 50 RA patients and in 24 control subjects. Results: Age, sex and body mass index (BMI) did not show a statistically significant difference between RA and control subjects (P > 0.05). Serum leptin levels were higher in RA (P = 0.000). In RA patients, there were no correlations between serum leptin levels and disease duration, swollen and tender joint counts, DAS28, CRP, ESR, serum TNF-α levels, oral glucocorticoid and methotrexate usage (P > 0.05). There was no statistically significant serum leptin level difference between patients with high disease activity and mild and low disease activity (P = 0.892). Serum leptin levels positively correlated with BMI in both patient and control groups (P < 0.05). In both groups, mean serum leptin levels were higher in women than men. Conclusions: Even though serum leptin levels were found to be significantly higher in RA patients than in control subjects in this study, there was no correlation between serum leptin levels and TNF-α levels, clinical and laboratory parameters of disease activity. However serum leptin levels positively correlated with BMI in both patient and control groups. In RA, circulating leptin levels do not seem to reflect disease activity.

COMORBIDITY IN PATIENTS AFTER STROKE: IMPACT ON FUNCTIONAL OUTCOME

OBJECTIVE To evaluate the incidence of comorbid diseases and their impact on functional outcome in patients after stroke. DESIGN A prospective study. SUBJECTS A total of 140 patients after stroke. METHODS Comorbidities were assessed with the Liu comorbidity index. Functional independence was evaluated using the Functional Independence Measure (FIM). The relationship between comorbidities and functional outcomes were investigated. The impact of comorbidities on functional outcome was examined with multiple stepwise regression analysis. RESULTS Ninety-four (67%) of 140 patients completed the study. The most frequent comorbid condition was hypertension at the initial visit. The weighted comorbidity index at baseline was negatively correlated with the follow-up FIM score and functional gain. Multiple regression analysis revealed that follow-up FIM score could be best explained by FIM at admission and the contribution of the weighted comorbidity index to functional outcome was 3.1%. CONCLUSION Comorbid diseases are common among patients after stroke. They were shown to have a negative correlation with functional outcome; however, their impact on functional outcome was not clear. The proper evaluation of comorbid conditions should be included in stroke outcome research.

Validation of the Turkish version of the foot and ankle outcome score

The objective is to develop a Turkish version of the foot and ankle outcome score (FAOS) and to investigate its validity and reliability. The Turkish version of FAOS was developed after the translation and back-translation. The translated version was pretested on 20 patients with rheumatoid arthritis. Then, the Turkish FAOS was administered to 55 patients having foot and ankle problems. They were also evaluated by using the four subscales of the Turkish version of AIMS2, and the Turkish version of SF-36 questionnaire to test validity. Fifty patients filled out the FAOS for second time to determine test–retest reliability. Construct validity was investigated with use of Spearman’s rank correlation coefficient. Test–retest reliability was assessed with use of the intraclass correlation coefficient (ICC) and Cronbach’s alpha score. The psychometric properties of the Turkish FAOS were generally similar to the original FAOS. The random ICC for the five subscales ranged from 0.70 to 0.96. The Cronbach’s alpha coefficient ranged from 0.79 to 0.97. Construct validity of the FAOS was good. The Turkish FAOS correlated with the SF-36 and AIMS2 scales. The Turkish version of FAOS was valid and reliable instrument to assess the foot and ankle related problems. However, to assess its responsiveness further studies are needed.

Disability and health-related quality of life after breast cancer surgery: relation to impairments.

Background: The aim of this study was to determine the prevalence of impairments relevant to upper extremity following breast cancer surgery and its impact on disability and health-related quality of life. Methods: Sixty-seven female patients being treated with modified radical mastectomy or breast conserving surgery were included. They were evaluated for impairments (arm edema, loss of handgrip strength, limited shoulder joint range of motion, and pain), physical disability using the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and for health related quality of life by means of the functional assessment of cancer therapy-breast+4 (FACT-B+4). Results: The most common impairment observed was arm pain on motion; the cause of 20% variance in disability score (r2 = 0.203, P = 0.000). Arm pain on motion, anterior chest wall pain, loss of grip strength, and shoulder flexion were significant factors in different domains of quality of life according to the FACT-B+4 questionnaire. Conclusion: Pain relief should be the priority of treatment along with the prevention of joint movement restriction to ensure a sufficient quality of life for surgically treated breast cancer patients.

Determinants of quality of life (QoL) in elderly stroke patients: a short-term follow-up study.

The aim of this study was to determine the quality of life (QoL) at the third month after stroke and to identify the factors related with and determinants of QoL in geriatric stroke patients. Eighty of 122 patients who were assessed within the first week after stroke were reevaluated at the third month. Patients were divided into two groups as those of ≥65 years old (geriatric group) and those of <65 years old (non-geriatric group). The stroke severity, functional status, and ambulation level were assessed by the Canadian neurological scale (CNS), the functional independence measure (FIM), and the functional ambulation classification scale (FACS) within the first week of stroke, respectively. Depression and QoL levels were also determined at the third month using the Zung self-rating depression scale (ZDS) and both the Short Form-36 (SF-36) survey and the stroke-specific quality of life (SSQoL) scale, respectively. The QoL of 80 patients according to the SF-36 were lower than those of general population. No significant difference was found in stroke severity, functional status at baseline and third month, depression and QoL between geriatric and non-geriatric patients (p>0.05). The most influenced subscale of QoL was work/productivity in geriatric patients, and the main determinant of QoL was the functional status during the assessment. Stroke patients had an impaired QoL, and geriatric patients did not demonstrate a difference in terms of QoL compared to non-geriatric patients. The fact that the main determinant of QoL was functional status has been suggested that improving of physical function may be helpful to provide a better QoL for stroke patients.

The relationship between severity and extent of spinal involvement and spinal mobility and physical functioning in patients with ankylosing spondylitis.

The present study was undertaken to determine the relationship between spinal radiological changes of ankylosing spondylitis (AS), spinal mobility, and physical functioning. Thirty-one patients diagnosed as AS according to the modified New York criteria for AS were included in this study. Three radiographic scoring methods were used to assess spinal damage. Severity of spinal involvement was assessed by using Stoke Ankylosing Spondylitis Spine Score (SASSS) and Bath Ankylosing Spondylitis Radiographic Index–Spine (BASRI–S). To assess the extent of spinal involvement, the total number of vertebrae showing radiological findings attributable to AS [number of vertebrae involved (NoVI)] was calculated according to the AS grading system defined by Braun et al. Statistical analysis, consisting of bivariate correlation, Spearman correlation, and multiple linear regression analysis, was performed using Windows Statistical Package for the Social Sciences 13.0. NoVI was negatively correlated with modified Schober and lateral spinal flexion and was positively correlated with occiput-to-wall distance and BASMI. SASSS was negatively correlated with the modified Schober. BASRI–S was negatively correlated with the modified Schober and positively correlated with BASMI. When BASMI and Bath Ankylosing Spondylitis Functional Index were taken as dependent variables, only the NoVI was found to be associated with BASMI. In our data, the extent of spinal involvement (NoVI) showed a more significant correlation with spinal measurements such as modified Schober and BASMI as compared with the other radiologic scores (SASSS and BASRI–S). Furthermore, because only the NoVI was found to be associated with BASMI, we can conclude that the extent of spinal involvement, which also includes thoracic vertebrae, affects spinal measurements.

Foot deformities in patients with rheumatoid arthritis: the relationship with foot functions.

Aim:  The aim of this study was to investigate foot deformities in patients with rheumatoid arthritis (RA), to detect frequency of deformities and to assess the relationship between foot deformities and foot functions.

Comparison of the DAS28-CRP and DAS28-ESR in patients with rheumatoid arthritis.

To compare the Disease Activity Score with 28 joint (DAS28) using erythrocyte sedimentation rate (ESR) (DAS28‐ESR) and DAS28 using C‐reactive protein (CRP) (DAS28‐CRP) with thresholds validated for DAS28‐ESR in Turkish patients with rheumatoid arthritis.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

Impact of peer‐led group education on the quality of life in patients with ankylosing spondylitis

To determine the effect of peer‐led group education on the quality of life and depression in patients with ankylosing spondylitis (AS).