The frequency of sarcopenia in haemophilia patients: Effects on musculoskeletal health and functional performance

INTRODUCTION

In patients with haemophilia A, chronic arthropathy develops over time as a result of recurrent joint bleeds, which leads to restricted mobility and disability in the affected joints. There are limited studies in the literature evaluating sarcopenia in patients with haemophilia. The present study aims to determine the prevalence of sarcopenia in severe haemophilia-A patients and to evaluate musculoskeletal health and functional performance.

METHODS

Thirty haemophilia-A patients and 26 adult male volunteers were enrolled in the study. For detection of sarcopenia, the appendicular skeletal muscle mass (ASM) obtained by bioelectrical impedance analysis (BIA) was divided by height squared (m2 ) to obtain the appendicular skeletal muscle mass index (ASMI) value. The thighs of both lower extremities were measured using the Modified Sonographic Tight Adjustment Ratio (STAR) method, which was obtained by adding the bilateral rectus femoris and vastus intermedius muscle thicknesses measured by ultrasound. Hand and quadriceps muscle strength (MS) were measured with a dynamometer. Physical performance was determined using the walking speed (WS), timed up-and-go test (TUGT), 5-repetition sit-to-stand test (5RSTS), and 6-min walk test (6MWT). Haemophilia Joint Health Score (HJHS) and Haemophilia Early Arthropathy Detection-Ultrasonography (HEAD-US) were also used to assess the musculoskeletal system.

RESULTS

According to the modified STAR values calculated based on body mass index, sarcopenia was present in 15 (50%) of 30 patients. However, based on the ASMI-BIA values, sarcopenia was present in only two (6.6%) patients. A weak correlation was found between ASMI and HJHS, HEAD-US, WS, TUGT, and hand MS (left), while a moderate correlation was found with knee MS (right), knee MS (left), and 5RSTS. A strong correlation was found between the modified STAR score and HEAD-US, HJHS, knee MS (left), 5RSTS, TUGT, and WS, while a moderate correlation was found with hand MS (left), hand MS (right), and knee MS (right).

CONCLUSION

This study showed muscle loss, joint mobility restrictions, and decreased functional capacity in haemophilia patients and demonstrated the presence of sarcopenia in these patients. The STAR measurement method showed stronger relationships with MS and functional performance values than ASMI measurements in terms of evaluating sarcopenia.

Frequency of idiopathic intracranial hypertension with ultrasound in patients with fibromyalgia: Relation with function, central sensitization, and neuropathic pain

OBJECTIVE

The purpose of this study was to evaluate the prevalence of idiopathic intracranial hypertension (IIH) in fibromyalgia (FMS) patients by utilizing ultrasound to measure the optic nerve sheath diameter (ONSD), a marker of elevated intracranial pressure and also to investigate the relationship with function, fatigue, quality of life (QOL), central sensitization (CS) and neuropathic pain.

METHODS

The study encompassed 80 female FMS patients and 75 healthy controls. Ultrasound was employed to measure the average ONSD in both groups. Conditions potentially elevating intracranial pressure were ruled out following neurological assessments. Pain (via visual analog scale, VAS), function (revised Fibromyalgia Impact Questionnaire, r-FIQ), QOL (Short Form-36, SF-36), fatigue (fatigue severity scale, FACIT), CS (Central Sensitization Scale), and neuropathic pain (Douleur Neuropathique-4) were evaluated.

RESULTS

The average ONSD was significantly higher in the patient group than the control group. Patients with ONSD >5.5 mm consistent with IIH were categorized as Group 1 (n = 54, 67.5%), while those with a diameter of 5.5 mm and below-formed Group 2. VAS pain (p = .033) and FIQ-R scores (p = .033) were significantly higher in Group 1 than Group 2. Headache was found more common in Group 1.

CONCLUSION

This study unveils a substantial occurrence (67.5%) of IIH in FMS patients, suggesting shared pathophysiological mechanisms contributing to symptoms like fatigue, headache, and cognitive dysfunction. Additionally, these findings implicate heightened functional impairment, CS, headache, and fatigue in FMS patients with IIH.

The effect of polypharmacy on rheumatoid and psoriatic arthritis treatment: retrospective study

Background

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic, progressive inflammatory diseases that can be accompanied by other diseases. In recent years, with the increase in the lifespan of individuals, the concept of polypharmacy has become more prominent. We aimed to show the prevalence of polypharmacy and the effects of polypharmacy on disease activity in RA and PsA.

Methods

This study included PsA patients who had peripheral joint involvement and, RA patients. Since PsA has a heterogeneous clinical picture, only patients with peripheral joint involvement were included in the study and patients with inflammatory low back pain or radiological sacroiliitis or spondylitis, dactylitis or enthesitis were not included in the study due to homogeneity concerns. The numbers of medications used by the patients at the onset of their treatment and at sixth months into their treatment were recorded. Polypharmacy was accepted as the simultaneous use of at least five medications by the person. The Disease Activity Score 28 joints C-Reactive Protein (DAS-28 CRP) was used to assess disease activity for both disease. The modified Charlson Comorbidity Index (CCI) scores of the patients were calculated based on their chronic diseases.

Results

The sample of the study included 232 RA and 73 PsA patients. Polypharmacy was present at the treatment onset in 115 (49.6%) of the RA patients and 28 (38.4%) of the PsA patients. At the sixth month of treatment, polypharmacy was present in the sixth month of the treatment in 217 (93.5%) RA and 61 (83.6%) PsA patients. The mean ages of the RA and PsA patients who were receiving polypharmacy treatment at the beginning were significantly older than the mean ages of those who were not receiving polypharmacy treatment. In both the RA and PSA groups, the patients with polypharmacy at the beginning had statistically significantly higher DAS-28 CRP scores at six months of treatment than those without polypharmacy at the beginning (p < 0.001).

Conclusion

Polypharmacy was present both at the time of diagnosis and in the treatment process in the RA and PsA patients, and the presence of polypharmacy at the beginning of the treatment was among the factors that affected the treatment of these patients by significantly affecting their 6th-month DAS-28 CRP values.

Familial Mediterranean fever: perspective on female fertility and disease course in pregnancy from a multicenter nationwide network

The aim of this study was to analyze the pregnancy process, especially the Familial Mediterranean fever (FMF) disease course and attack types during pregnancy, and to examine the relationship between disease-related factors and female infertility in FMF patients. The study, which was planned in a multicenter national network, included 643 female patients. 435 female patients who had regular sexual intercourse were questioned in terms of infertility. Pregnancy and delivery history, FMF disease severity and course during pregnancy were evaluated. The relationship between demographic and clinical findings, disease severity, genetic analysis results and infertility was investigated. 401 patients had at least 1 pregnancy and 34 patients were diagnosed with infertility. 154 patients had an attack during pregnancy. 61.6% of them reported that attacks during pregnancy were similar to those when they were not pregnant. The most common attack symptoms were fever, fatigue and abdominal pain-peritonitis (96%, 87%, and 83%, respectively) in the pregnancy period. The disease-onset age, disease activity score, gene mutation analyses, and regular colchicine use (> 90%) were similar between the fertile and infertile groups, while the frequency of previous appendectomy and alcohol consumption rates were higher in individuals with infertility. Our results indicated no significant change in the frequency and severity of attacks during pregnancy. The low rate of infertility (7.8%) in our patients was noted. It has been suggested that the risk of FMF-related infertility may not be as high as thought in patients who are followed up regularly and received colchicine.

Infodemiology of Bell's palsy: Tracing the seasonality of facial paralysis

BACKGROUND

Although there are a few studies on the seasonality of facial paralysis, no studies have utilized internet data for this purpose. The use of internet data to investigate diseases and user-contributed health-related content is increasingly prevalent, and has earned the name "infodemiology".

OBJECTIVE

This study aims to use Google Trends data to investigate whether there is a seasonal variation in facial paralysis.

METHODS

In this observational study, the search volume for the terms "facial paralysis" and "Bell's palsy" for a total of 19 countries was queried from Google Trends, selecting the time interval between January 2004 and October 2020.

RESULTS

In the Cosinor analysis of data from a total of 19 countries, from both northern and southern hemisphere, a statistically significant seasonality was found in the search volume of facial paralysis. It was observed that facial paralysis searches peaked in spring in the northern hemisphere and in winter in the southern hemisphere.

CONCLUSION

Internet search query data showed that facial paralysis has a seasonal variation, with peaks in spring for the northern hemisphere and winter for the southern hemisphere. Further studies are needed to understand the deviation between hemispheres and the cause of the peak in winter-spring season.

AB0773 Serum VEGF level may be have a role in the evaluation of treatment response and disease activity during TNFi therapy in patients with AxSpA

Background

Patient reported outcomes (BASDAI and BASFI) are used to evaluate disease activity in axial spondylarthritis (axSpA), however, apart from C-reactive protein (CRP) there are no widely used serum biomarkers to assess disease activity and treatment responce.

Objectives

In this study, we aimed to evaluate the relationship between serum biomarkers (serum leptin, VEGF, MMP-3) and disease activity as well as the changes of those biomarker levels during TNFi treatment.

Methods

Patients with axSpA who put on their first TNFi and had serum samples at baseline and 6th month of therapy were included in the analysis The demographic, clinical and laboratory characteristics disease activity and function parameters (BASDAI, BASFI, ASDAS-CRP, serum CRP levels) at baseline and 6th months were recorded. Levels of serum leptin, VEGF and MMP-3 were studied by ELISA method. The relationship between serum biomarkers and disease activity scales in addition CRP levels were tested by correlation analysis. The factors affecting the change in seruml biomarkers level in 6th month were also analyzed by GEE which is a longitudanal analysis method.

Results

A total of 74 patients (mean age (SD) 48.7 (12.8) years, 54.1% male, 68.9% with AS) were included in this study. Baseline median BASDAI scores (IQR) were 5.8 (2.4), ASDAS scores (IQR) 3.7 (1.5) and median CRP levels (IQR) 12 (23). Disease activity parameters (BASDAI, BASFI, ASDAS-CRP) were significantly decreased at 6th month of therapy (p<0,001, p<0,001, p<0,001, respectively). The correlation between baseline serum biomarker levels (leptin, MMP3, VEGF) and between biomarkers level and disease activity were eveluated and only serum MMP-3 levels were found to be associated with baseline ASDAS-CRP (p=0.02). Serum VEGF level decreased significantly compared to the baseline at the 6 th month of TNFi treatment (p<0.001), however, serum leptin and MMP-3 levels were not associated with disease activity and affected by biologic treatment (p=0.89, p=0.50, respectively). In the longitudinal analysis, serum VEGF level were significantly associated with gender, hip involvement, delay in diagnosis in addition to disease activity (Table 1).

Table 1.

The factors associated with serum VEGF levels longitudinally

Univariate analizBASDAİ+CRP ModelASDAS -CRP ModelB (%95 CI)pB (%95 CI)pB (%95 CI)pHip involvement181.74 (12.71- 350.77)0.035357.04(112.35- 601.73)0.04338.36 (102.40-574.3)0.005Duration of delay in diagnosis-6.91 (-14.05- 0.24)0.058-13.93 (-24.56 to -3.31)0.01-14.36 (-24.68 to -4.03)0.006Gender-216.88 (-390.6 to -43.2)0.014-154.23 (-336.94- 28.48)0.09-162.6(-336.70- 11.4)0.006HLA-B27 positivity-233.4 (-440.67 to -26.11)0.027-135.78(-326.08- 54.52)0.16-126.54(-309.2- 56.1)0.17BASDAI4.12 (1.06- 7.18)0.0085.60 (2.16- 9.05)0.001ASDAS-CRP110.04 (58.18- 161.88)<0.001132.31(74.70- 189.92)<0.001Serum CRP level5.86 (1.02- 10.7)0.0184.09 (-0.99- 9.183)0.11

Conclusion

TNFi treatment is not only effectively control disease activity but also cause significant decrease in serum VEGF levels in patients with axSpA. Considering the role of VEGF in radiographic progression it could be a promising biomarker in axSpA

Disclosure of Interests

None declared

AB0212 COMPARISON OF THE EFFECTS OF POLYPHARMACY IN THE TREATMENT OF RHEUMATOID ARTHRITIS PATIENTS AND PSORIATIC ARTHRITIS PATIENTS WITH PERIPHERAL JOINT INVOLVEMENT

Background

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic, progressive inflammatory diseases that can be accompanied by other diseases. These patients use several medications, especially due to their comorbidities and widespread pain. In recent years, with the increase in the lifespan of individuals, the concept of polypharmacy has become more prominent. Accordingly, in our study, we aimed to present the prevalence of polypharmacy and its effects on these diseases.

Objectives

Demonstrating the prevalence of polypharmacy in RA and PsA, which are among the most frequently encountered inflammatory arthritides, and the effects of polypharmacy on disease activity.

Methods

This study included PsA patients with only peripheral joint involvement and no distal interphalangeal joint involvement and RA patients. The numbers of medications used by the patients at the onset of their treatment and in the sixth month of their treatment were recorded. Non-prescribed (over the counter), topical and herbal/homeopathic medications were excluded. Polypharmacy was accepted as the simultaneous use of at least five medications by the person. Disease activity score in 28 joints C-reactive protein (DAS-28 CRP) was used for disease activity for both diseases. In addition to these, the scores of the patients who attended their follow-ups in the 12th month were calculated and analyzed. The Charlson Comorbidity Index (CCI) scores of the patient were calculated based on their chronic diseases.

Results

The sample of the study included 232 RA and 73 PsA patients. Demographic and some clinical characteristics are shown in Table 1. The mean numbers of medication used by the patients at the onset of their treatment were respectively 5.09±2.89 and 4.03±2.7 for the RA and PsA patients, whereas these mean numbers were found consecutively as 8.67±3.58 and 7.71±3.3 in the sixth month of their treatment. Polypharmacy was present in the sixth month of the treatment in 217 (93.5%) RA and 61 (83.6%) PsA patients.

Table 1.

Demographic and some clinical features

RA (n=232)PSA (n=73)Age (mean±SD)55.2±13.6648.4±13.43Age Group<65 years171(73.7)65(89)≥65 years61(26.3)8(11)SexFemale, n (%)172(74.1)50(68.5)Male, n (%)60(25.9)23(31.5)Current smoker, n (%)82(35.3)33(45.2)The numbers of medication used8.67±3.587.71±3.3Polypharmacy at the Beginning of Treatment115(49.6)28(38.4)Polypharmacy in the sixth month of treatment217(93.5)61(83.6)CCI (n=232/72) (mean±SD)1.25±0.881.31±0.710th month DAS-28 CRP (mean±SD)4.91±1.284.68±1.036th month DAS-28 CRP (mean±SD)3.14±1.062.86±0.9912th month DAS-28 CRP (n=83/29) (mean±SD)2.73±1.182.8±1.12

While the mean ages of the RA and PsA patients who had polypharmacy treatment at the beginning were respectively 59.21±12.65 and 53.5±13.81, their ages were significantly higher than the ages of those who did not receive polypharmacy treatment (respectively, 51.26±13.53 and 45.22±12.3).

In RA ve PsA patients, the status of polypharmacy is higher in the groups in the groups aged 65 and over than those under 65 years of age, and it is statistically significant (p=0.001 and p=0.048, respectively). The risk of polypharmacy in people over 65 years of age in RA patients was 8.2 times, and the risk of polypharmacy in people over 65 years old in PSA patients was increased 6.3 times (p=0.015).

In both the RA and PSA groups, patients with baseline polypharmacy had statistically significantly higher DAS-28 CRP scores at 6 months of treatment than those without baseline polypharmacy. (p<0.001). While the higher DAS-28 CRP score was maintained at 12 months in the RA group with polypharmacy at baseline (p=0.006), this was not significant in the PSA group (p=0.07).

Conclusion

Polypharmacy was present both at the time of diagnosis and in the treatment process in the RA and PsA patients, and the presence of polypharmacy at the beginning of the treatment was among the factors that affected the treatment of these patients by significantly affecting their 6th-month DAS-28 CRP values.

Disclosure of Interests

None declared

AB0865 The Factors affecting patient global assesment in patients with Axial Spondyloarthritis

Background

The BASDAI is one of the basic scales used in the measurement of disease activity in patients with spondyloarthritis and allows the evalution of various aspects of the disease (axial and peripheral disease as well as inflammation). The patient global assesment (PGA) is a one-dimensional scale in which patients evaluate how their illness affects their health.

Objectives

In this study, we planned to test and review the possible determinants of PGA and its relation with BASDAI components, BASFI scores and disease-related features both at first visit and at the 2 year follow-up.

Methods

Patients with axSpA whose baseline BASDAI and PGA scores were complated, were included in the analysis. The demographic, clinical and laboratory characteristics of the patients were recorded. The relation between PGA scores and BASDAI sub-score, BASFI score and other patient and disease characteristics were tested both univariate and multivariate analysis methods. The factors affecting the change in the PGA score over 2-year follow-up were also analyzed with GEE analysis method.

Results

In total 313 patients (56.5% of male, 61.7% AS, mean age at diagnosis 34.3±11 years) were included in the analysis. Sperman’s rho test was used for correlation analysis. Baseline PGA scores were in correlation with the BASDAI total score (rho:0.71, p<0.001). PGA scores of female patients were found to be significantly higher (p=0.037) and each BASDAI indivual score and BASFI scores were moderately/well correlated with PGA (Table 1). Multivariate analysis revealed that spinal pain (BASDAI Q2), the severity of morning stiffness (BASDAI Q5) and BASFI scores were the main determinants in the global health assesments of patients with axSpA (Table 1). GEE analysis was performed to evaluate the factors affecting the 2 year change in the PGA of the patients, fatigue (BASDAI Q1) (B:1.575, CI%95: [0.241- 2.922]; p=0.021), enthesis (BASDAI Q4) (B:0.888, CI95% [0.049-1.727]; p=0.038) severity of morning stiffness (BASDAI Q5) (B: 2.663, CI%95 [1.447-3.878]; p<0.001),and BASFI scores (B: 2.909, CI95% [1.806-4.011]; p<0.001) were independent determinants of PGA in longitudinal analysis.

Table 1.

Baseline PGA related factors

Sperman AnalysisModel 1Model 2rhopB (%95 CI)pB (%95 CI)psex0.120.037-3.183 (-8.903; 2.538)0.27-3.612 (-9.372; 2.148)0.22BASDAI Q10.59<0.0010.614 (-0.936;2.175)0.440.861 (-0.686; 2.406)0.27BASDAI Q20.66<0.0013.168 (1.536; 4.800)<0.0013.231 (1.587; 4.874)<0.001BASDAI Q30.43<0.0010.619 (-0.613; 1852)0.320.538 (-0.703; 1.779)0.39BASDAI Q40.43<0.0010.374 (-0.741;1.489)0.510.529 (-0.587; 1.645)0.35BASDAI Q50.60<0.0012.088 (0.542; 3.634)0.008BASDAI Q60.43<0.001-0.697(-2.053;0.660)0.31BASDAI (Q5+Q6)/20.56<0.0011.195 (-0.218; 2.608)0.097BASFI0.62<0.0012.097 (0.273-3.921)0.022.263 (0.433; 4.094)0.016BASMI0.28<0.001-0.321 (-1.879;1.237)0.69-0.319(-1.891; 1.253)0.69Serum CRP level0.23<0.0010.066 (-0.100;0.233)0.430.073 (-0.094; 0.241)0.39

Conclusion

The study shows that the patients with axSpA mainly rely on morning stiffness and spinal pain in deciding their global health status. Fatigue, enthesis and morning stiffness were found to be effective factors in the PGA changes of the patients under treatment. Although PGA is unidimentional, its well correlation with the BASDAI total score may be another proof of the validity of both scales.

Disclosure of Interests

None declared

Familial Mediterranean fever: Health-related quality of life and associated variables in a national cohort

Objectives

This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients.

Patients and methods

This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale.

Results

The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$<300), smoking, late-onset FMF (>20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT.

Conclusion

Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

Immunohistochemical investigation of P16, P53 and Ki-67's prognostic values in diffuse large B-Cell lymphomas

AIM

The aim of this study is to determine the immunohistochemical properties of Ki-67, P53 expression and loss of P16, and to assess their relationship with both clinical parameters and patient survival in DLBCL.

METHOD

Forty patients, diagnosed at the Pathology Department of our institute with nodal DLBCL were selected as the study group. The relationship between P16, P53, Ki-67 expressions and clinical and laboratory parameters like age, gender, performance status, Eastern Cooperative Oncology Group (ECOG), clinical stage, presence of B-symptoms, bone marrow involvement, International Prognostic Index (IPI) score, lactate dehydrogenase (LDH) level, extranodal extension, relapse, C-reactive protein (CRP), sedimentation, number of leukocytes in patients and patient survival were then statistically evaluated.

RESULTS

Our results display no statistically significant correlation between P53 expression and loss of P16, Ki-67 proliferation index and clinical parameters and overall survival (p > 0.05). The only statistically significant relationship was between loss of P16 and stage (p 0.05).

CONCLUSION

According to the results of our study, the loss of P16, P53 gene expression and Ki-67 proliferation index have no effect on life expectancy of patients with DLBCL (Tab. 2, Fig. 2, Ref. 29).