Sacroiliac joint (SIJ) anatomical variants are common on MRI and may complicate interpretation by mimicking inflammatory sacroiliitis; however, their relationship with inflammatory back pain (IBP)-like symptom patterns is not well defined in patients without axial spondyloarthritis (axSpA). To characterize inflammatory back pain (IBP)-like symptom patterns and accompanying MRI findings that may mimic sacroiliitis in patients with chronic low back pain (CLBP) and sacroiliac joint (SIJ) anatomical variants who did not fulfill classification criteria for axial spondyloarthritis (axSpA). In this cross-sectional study, consecutive patients younger than 45 years at the time of SIJ MRI/clinical evaluation, with chronic low back pain lasting at least 3 months, who underwent SIJ MRI between September 2023 and September 2025 were retrospectively screened for predefined SIJ anatomical variants and lumbosacral transitional anomalies. Patients with lumbosacral transitional anomalies were excluded at the screening stage. Those with at least one SIJ anatomical variant were invited for a standardized clinical assessment in which IBP features were captured using a single questionnaire covering the Calin, Rudwaleit (Berlin), and ASAS IBP criteria. All participants were systematically assessed against the ASAS classification criteria for axial spondyloarthritis (axSpA), and those who fulfilled these criteria were excluded from the final analysis. SIJ MRIs were read independently by two radiologists blinded to clinical data; agreement for variant detection was almost perfect (κ = 0.90). Bone marrow edema (BME) was evaluated according to the ASAS/OMERACT definition of MRI findings highly suggestive of active sacroiliitis, and structural changes were also recorded. Of 260 screened patients with CLBP, SIJ anatomical variants were identified in 108/260 (41.5

This study aimed to assess autonomic dysfunction in patients with Familial Mediterranean Fever (FMF), and to explore its association with disease characteristics and comorbidities. Thirty FMF patients and 30 healthy controls were enrolled in this cross-sectional study. Disease features and quality of life were recorded using the Familial Mediterranean Fever Quality of Life Scale (FMF-QoL). The Composite Autonomic Symptom Score-31 (COMPASS-31), Hospital Anxiety and Depression Scale (HADS), Fatigue Severity Scale (FSS), Jenkins Sleep Scale (JSS), and Fibromyalgia Rapid Screening Tool (FiRST) were noted. Parasympathetic nervous system was evaluated by R-R interval variability (RRIV) during normal and deep breathing and 30:15 ratio tests with electromyography, while the sympathetic nervous system was assessed by sympathetic skin response (SRR), blood pressure response to standing and sustained handgrip tests. FMF patients had higher total median COMPASS-31 scores than controls (15.09 vs. 5.12, p = 0.001), with significantly higher secretomotor, gastrointestinal, bladder, and pupillomotor subdomain scores (p < 0.05). RRIV during normal breathing was lower in the FMF group compared with controls (17.29 vs. 21.27, p = 0.015). No between-group differences were observed in sympathetic function tests (p > 0.05). In correlation analyses, RRIV during normal breathing correlated negatively with CRP (r = − 0.378, p = 0.04). Sympathetic parameters showed negative correlations with CRP (left plantar SSR latency: r = − 0.398, p = 0.03; blood pressure response to handgrip: r = − 0.405, p = 0.026) and with annual attack frequency (left plantar SSR amplitude: r = − 0.449, p = 0.01). Total COMPASS-31 scores correlated with FMF-QoL (r > 0.5, p < 0.001), HADS-anxiety (r = 0.550, p = 0.002), HADS-depression (r = 0.633, p < 0.001), FSS (r = 0.600, p < 0.001), JSS (r = 0.705, p < 0.001), and FiRST (r = 0.598, p < 0.001). FMF patients showed predominant parasympathetic dysfunction, while sympathetic findings were limited to correlations suggesting possible subclinical involvement. These autonomic alterations may contribute to reduced quality of life and associated symptoms such as fatigue, depression, and sleep disturbance.

This study was aimed at determining the prevalence of difficult-to-treat (D2T) axial spondyloarthritis (axSpA) and identifying main associated factors for D2T axSpA. This multicenter observational cross-sectional study included axSpA patients from the BioSTaR (Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Registry) from February 1, 2019, to January 1, 2025. Data from 1800 axSpA patients who have previously used or are currently using at least one biologic/targeted synthetic disease-modifying antirheumatic drug were analyzed. Patient data included demographic characteristics, body mass index (BMI), marital status, smoking and alcohol use, family history of SpA, and presence of comorbidities. The parameters related to SpA such as disease duration, type of axSpA (radiographic/non-radiographic), HLA-B27 status, the presence of extra-musculoskeletal manifestations (uveitis, psoriasis, and inflammatory bowel disease), arthritis, enthesitis, and dactylitis were also recorded. Comorbidities including hypertension, cardiovascular disease, diabetes, obesity, and hyperlipidemia were recorded, and Charlson Index scores were evaluated. Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and disease activity in means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) were also recorded. All medication history and currently used medications for axSpA and other diseases were noted. D2T and non-D2T axSpA patients were classified according to the suggested extrapolated definition. Of the 1800 axSpA patients recorded in the BioSTaR database, 204 (11.3

Introduction: This study aimed to evaluate the diagnostic distribution, demographic characteristics, and medication adherence of elderly patients with rheumatic diseases (RD) and to contribute to improving adherence rates and patient outcomes in this demographic group by examining the factors affecting treatment adherence. Methods: This cross-sectional observational study included 108 patients aged >65 years diagnosed with RD. Data on demographic characteristics, disease characteristics, comorbidities, and medication use were collected. Medication adherence was assessed using the Morisky Medication Adherence Scale-8 and the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression levels. Results: The median age of the participants was 70.5 years, with 69.4% female predominance. The most common diagnoses were rheumatoid arthritis (41.67%), gout (14.81%), and polymyalgia rheumatica (11.11%). Good adherence was associated with higher social support [odds ratio (OR): 4.99, 95% confidence interval (CI): 1.45-17.11], lower medication count (OR: 0.78, 95% CI: 0.63-0.95), and lower HADS scores (OR: 0.93, 95% CI: 0.87-0.98). Forgetfulness was the leading cause of non-adherence, as reported by 40.7% of patients. Conclusion: This study highlights that social support, polypharmacy, and mental health significantly affect medication adherence in elderly patients with RD. Medication adherence remains an important factor in the effective management of RD, and demographic factors, such as comorbidities and socioeconomic status, play influential roles.

The Impact of Obesity and Overweight on Rheumatoid Arthritis Patients: Real-World Insights from a Biologic and Targeted Synthetic DMARDs Registry. The management of rheumatoid arthritis (RA) has advanced with biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). However, obesity, a common comorbidity, impacts treatment and disease progression efficacy. This article examines the association between body weight, activity of the disease and the effectiveness of b/tsDMARDs in RA patients. This multicenter observational cohort study, conducted as part of the BioSTAR Registry, involved a total of 856 patients diagnosed with RA (168 males and 688 females). Patients were separated into groups based on BMI: Group 1 (“normal BMI: ≥18.5 to < 25 kg/m2 or underweight BMI: <18.5 kg/m2”) and Group 2 (“overweight BMI: ≥25 to < 30 kg/m2 or obese BMI: ≥30 kg/m2”). Baseline socio-demographic and clinical data, medication use, switching status, and total glucocorticoid dose (mg-year) were collected. Age, disease duration, disease activity scores were considerably higher in obesity/overweight patients. Remission rates were lower in obese/overweight patients (35.6

The aim of this study was to translate and culturally validate the Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) into Turkish and to evaluate its reliability and validity in patients with psoriatic arthritis (PsA). A total of 162 PsA patients diagnosed according to CASPAR criteria were recruited from two rheumatology clinics. The PsAQoL was translated and culturally adapted into Turkish using a standardized forward-backward translation method. Internal consistency was assessed using Cronbach’s alpha. Construct validity was evaluated by correlating PsAQoL scores with quality of life (SF-36), functional (HAQ), emotional (HADS), and clinical disease activity indices (DAPSA, BASDAI, DAS28). The Turkish version of the PsAQoL was found to be clear, concise, and well understood by patients. The average time to complete the questionnaire was 3.3 ± 0.9 min. Internal consistency was good (Cronbach’s α = 0.930). Strong correlations were found with SF-36 physical (r = − 0.744) and mental components (r = − 0.731), indicating convergent validity. Moderate correlations were observed with HAQ (r = 0.533), VAS pain (r = 0.408), HADS-Anxiety (r = 0.535), and HADS-Depression (r = 0.517), while correlations with unrelated clinical parameters such as age and PASI were weak or insignificant, indicating divergent validity. No floor or ceiling effects were detected, and there were no missing responses. The Turkish version of the PsAQoL is a valid, reliable, and practical tool for assessing disease-specific quality of life in PsA. Its ease of use and psychometric strength support its application in both clinical practice and researchs.

While the roles of self-compassion and cognitive emotion regulation in mental health are increasingly acknowledged, their specific impact on fibromyalgia (FM) remains understudied. Given the substantial psychological burden associated with FM, this study aimed to examine these constructs in relation to emotional distress and resilience. Specifically, we sought to: (1) compare self-compassion and emotion regulation strategies between FM patients and healthy controls; (2) explore their associations with depression, anxiety, pain intensity, and resilience; and (3) identify predictors of psychological distress, focusing on self-compassion and emotion regulation. The study included 160 participants (80 FM patients and 80 age- and gender-matched healthy controls) who completed validated instruments, including the Self-Compassion Scale (SCS), Cognitive Emotion Regulation Questionnaire (CERQ), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Toronto Alexithymia Scale (TAS-20), Brief Resilience Scale (BRS), and Visual Analog Scale (VAS). Group comparisons were conducted using Student's t tests. Pearson correlations assessed associations among psychological variables. Mediation analyses, performed using PROCESS macro with 5000 bootstrap resamples, tested whether resilience mediated the relationships between self-compassion and clinical outcomes. FM patients reported significantly lower self-compassion and greater use of maladaptive emotion regulation strategies—particularly rumination and catastrophizing—compared to healthy controls (p < 0.001). Self-compassion was negatively correlated with depression and anxiety, while resilience was positively associated with self-compassion and inversely related to psychological distress. Regression analyses showed that self-compassion, rumination, catastrophizing, resilience, and pain intensity significantly predicted depression and anxiety. Resilience mediated the relationship between self-compassion and both depressive and anxiety symptoms, though no significant mediation was observed for pain intensity. FM patients experience heightened psychological distress, characterized by reduced self-compassion and increased use of maladaptive emotion regulation strategies. Self-compassion and emotion regulation emerged as key predictors of depression and anxiety, with resilience playing a mediating role in depressive symptoms. These findings underscore the potential of interventions that cultivate self-compassion and strengthen adaptive emotion regulation to improve psychological well-being in individuals with FM and support a more integrative approach to treatment.

OBJECTIVES:The Flare-OA questionnaire is a self-reported instrument developed to assess flare in individuals with knee and/or hip osteoarthritis. This study aimed to translate and culturally adapt both the original and short versions of the Flare-OA into Turkish. METHODS:The Turkish version of the questionnaire was obtained through a process of cross-cultural adaptation and translation. Patients aged 45 years or older with clinically and radiologically confirmed OA of the knee or hip were recruited. The Flare-OA scale, originally consisting of 33 items, was shortened to 19 items and then to a final 16-item version through Rasch analysis. The internal consistency of the Flare-OA was measured using Cronbach's alpha, and its stability over time was tested by evaluating test-retest reliability over a 15-day interval in patients with no clinical changes. The sensitivity to change was determined by calculating the standardized response mean (SRM) in those who reported symptom variation during the follow-up. Convergent validity was assessed by analyzing the correlations between the scale and previously validated measures, including the Hip Disability and Osteoarthritis Outcome Score (HOOS-PS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Mini-Osteoarthritis Knee and Hip Quality of Life Questionnaire (Mini-OAKHQOL). RESULTS:The study included 185 participants, of whom 71.9% were women, with a mean age of 63.2 years (SD:9.1). Of these, 160 patients (86.5%) had knee OA and 25 (13.5%) had hip OA. In the past four weeks, 70 patients (37.8%) reported a worsening of symptoms in the affected joint. Cronbach's alpha coefficient was 0.987 (95% CI 0.984-0.990) for the 33-item and 0.972 (95% CI 0.966-0.978) for the 16-item. The intraclass correlation coefficient was 0.913 and 0.912 for the test-retest reliability (n=79) of the 33- and 16-item tests, respectively. Sensitivity to change was good in 9 patients with flare improvement [SRM 1.2 (95% CI 0.6-1.7), SRM 1 (95% CI 0.5-1.5), for 33- and 16-items, respectively] over the period. Discriminant validity was supported by statistically significant score differences between patients with and without flare for both the 33-item [36.2; 95% CI 29.9-42.6; SEM: 8; p<.0001] and the 16-item [36.7; 95% CI 30.3-43.0; SEM: 8.1; p<.0001] versions. There was a significant and negative correlation between the Flare-OA score and KOOS and mini-OAKHQOL (p<0.05). 16-item Rasch modeling allowed us to reduce the questionnaire to a 16-item version with good fit and a satisfactory interval scale. CONCLUSION:The Turkish versions of the Flare-OA questionnaires (33- and 16-item) showed high reliability, validity, and clinical utility in evaluating flares in knee and hip OA. The 16-item version appears especially useful for routine use, although further validation is needed due to the limited sample size in the hip OA subgroup.

Objective This study aims to explore the relationship of obesity with clinical manifestations and disease burden including biologic/targeted DMARD (btDMARD), SpA-related surgery, work productivity loss, and patient-reported health status. Methods An ancillary analysis of the Assessment of Spondyloarthritis International Society PerSpA (PERipheral involvement in SpA) cross-sectional study from 24 participating countries. The PerSpA study included the data of clinical characteristics, btDMARD use and history (number of btDMARD kinds ever-prescribed, number of discontinuation, and the reasons for discontinuation), SpA-related surgery, work productivity and activity impairment, and patient-reported health status (ASAS Health Index, Bath Ankylosing Spondylitis Functional Index, and global wellbeing). Patients were divided into three groups according to the current BMI (BMIc) and comparisons between the obese patients, overweights, and normal weights were performed for the above-mentioned parameters. The study population was also divided into different three groups according to their 20-year-old BMI (BMI20y) and they were compared in itself. Results Among the 4449 patients, 34.6% were overweight, 21% obese, and 44.4% normal-weight. Obese/overweight patients had a higher btDMARD burden, btDMARD inefficacy, work impairment, and worse patient-reported health (p <0.05 for all). The differences were preserved in comparisons adjusted for age, gender, and smoking. When the patients were compared according to their BMI20y, similar differences were also found. Conclusions Obesity invites a biological therapy burden, work productivity loss, and worse patient-reported health status in patients with SpA.

To examine the pneumococcal, haemophilus influenza, hepatitis A virus (HAV), and hepatitis B virus (HBV) vaccine rates and and predictors of vaccination among a Türkiye population of rheumatoid arthritis (RA) patients. In this multicenter, cross-sectional study, vaccination levels and related factors were questioned by face-to-face survey method during routine clinical examination of patients with RA followed in different regions of Türkiye. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software package, version 26. A total of 715 patients (mean age 53.1 ± 13 years), of whom 552 (77.2

Objective: The Duruöz Hand Index (DHI) is a self-report questionnaire originally developed to assess hand function in rheumatoid arthritis patients and validated for various rheumatic conditions. The aim of the study is to evaluate the validity and psychometric features of the DHI in patients with systemic sclerosis (SSc). Methods: SSc patients diagnosed using EULAR/ACR 2013 criteria were included in study. Hand functionality was assessed using the DHI, Hand Functional Index (HFI) and visual analog scales (VAS) for disability and handicap. Overall disability and quality of life were measured using the Health Assessment Questionnaire (HAQ) and Short Form-36 (SF-36). Reliability (Cronbach’s alpha and ICC) and validity (face, content, convergent and divergent) were also analyzed and correlations with other measures assessed for construct validity of the DHI were examined. Results: Seventy-three patients were included in the study, 78.1% were female. The baseline mean DHI score was 31.2 (SD: 20.2). Completion and calculation of the questionnaire were easy and took 5 min and 30 s, respectively. The Cronbach’s alpha coefficient for internal consistency was 0.973 and the ICC for test-retest reliability was 0.993 (95%CI 0.981–0.997), suggesting that the DHI has high internal consistency and a high degree of reliability. Cognitive debriefing showed that the DHI is clear, understandable, relevant, and covers many domains of daily life, indicating good face and content validity. The DHI demonstrated good to moderate correlations with functional measures indicating convergent validity and moderate to non-significant correlations with non-functional parameters that supported divergent validity. Cronbach’s alpha was 0.973, indicating excellent internal consistency. Conclusion: In SSc patients, specific tools for assessing hand function are lacking. The DHI is a practical, reliable and valid measurement tool for both clinical assessment and research in this disease affecting skin, tendons, subcutaneous tissue and arthritis.

Hand and foot involvement is a major determinant of disability in patients with late-onset rheumatoid arthritis (LORA). While inflammatory disease activity has traditionally been regarded as the primary driver of functional impairment, increasing evidence indicates that hand and foot function in older patients is also influenced by additional factors. Age-related physiological changes, sarcopenia, structural joint damage, comorbidities, biomechanical alterations, and psychosocial factors may substantially contribute to functional decline, often independently of measurable inflammation. Elderly patients frequently experience reduced muscle strength, deformities, heightened pain, frailty, and impaired coping capacity, which together exacerbate limitations in daily activities and mobility. Although foot involvement has been less extensively studied than hand dysfunction, it contributes further to gait disturbance, pain, and reduced quality of life. This hypothesis article proposes that functional impairment in LORA is multifactorial rather than being driven solely by disease activity indices. Recognizing multiple determinants may help explain persistent disability despite controlled inflammation, justifying comprehensive functional and geriatric assessment strategies in LORA.

Objectives: Spondyloarthritis (SpA) is a chronic inflammatory arthritis that mainly affects the sacroiliac joints and spine. Despite effective biological treatments, persistent pain is common in SpA patients, potentially due to central sensitization (CS), a condition of heightened central nervous system responsiveness. The purpose of this study was to investigate the link between disease activity and CS in SpA patients on biological therapy. Patients and Methods: One hundred and twenty SpA patients with at least six months of treatment with biological agents were included in this cross-sectional study. Patients’ demographic, clinical, and functional information were collected. The assessment of CS was conducted using the Central Sensitization Inventory (CSI), whereas disease activity and quality of life were evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP), and Ankylosing Spondylitis Quality of Life (ASQoL). Statistical analyses included correlation assessments and logistic regression to identify predictors of CS. Results: CS (CSI ≥ 40) was present in 40.8% of patients. Disease activity was significantly higher and quality of life was lower in patients with CS. BASDAI and ASQoL scores were strongly correlated with CS (r = 0.774 and r = 0.839, respectively). Logistic regression identified ASQoL and BASDAI scores as independent predictors of CS. ROC curve analysis demonstrated that ASQoL had the highest discriminative ability for predicting CS (AUC = 0.97). Conclusions: CS is significantly associated with higher disease activity and poorer quality of life in SpA patients receiving biological therapy. Incorporating CS assessment into routine clinical practice may enhance our understanding and management of persistent symptoms in SpA, improving patient outcomes.

Peripheral joint disease (PJD) is the most common peripheral manifestation in spondyloarthritis (SpA) patients. This study aimed to determine PJD characteristics and associated factors in patients with axial SpA (AxSpA) and peripheral SpA (pSpA). This cross-sectional and multicenter study involved 13 different rheumatology and physical medicine rehabilitation clinics, and patients diagnosed with axSpA or pSpA were included in the study. PJD was defined as the ‘ever’ related to SpA according to the physician. Multivariable analyses were conducted to identify factors associated with PJD. A total of 394 patients were enrolled in the study (57.6

Objective: The purpose of this study was to explore the relationship between vitamin D deficiency (VDD) and fatigue severity, as well as its relationship with sleep quality, in subjects with systemic sclerosis (SSc). Method: Our cross-sectional research included 98 subjects who were diagnosed with SSc according to EULAR/ACR 2013 classification criteria. Demographic, clinical, and laboratory data, including vitamin D (VitD) levels, were collected. Sleep quality was investigated with the Pittsburgh sleep quality index (PSQI) and fatigue severity with the multidimensional assessment of fatigue (MAF) scale. Results: Subjects with VDD exhibited significantly poorer sleep quality as indicated by PSQI scores (12 vs. 8; p<0.001) and higher MAF scores (34.5 vs. 22.4; p<0.001). Multivariate analysis identified MAF score [odds ratio (OR): 1.204, 95% confidence interval (CI): 1.116-1.298, p<0.001] and disease symptom duration (OR: 1.009, 95% CI: 1.002-1.016, p=0.001) as independent predictors of VDD. ROC analysis demonstrated that an MAF score ≤27.7 and PSQI score ≤10.5 were optimal cut-off values for predicting VDD. Significant negative correlations were observed between VitD levels and MAF (r=-0.610, p<0.01) and PSQI (r=-0.346, p<0.01). Conclusion: VDD is significantly associated with increased fatigue and poorer sleep quality in subjects with SSc. These signs indicate that addressing VDD through routine screening and supplementation may alleviate fatigue, enhance sleep quality, and raise the quality of life in SSc subjects.