Ayse Balkarli Sevket Balta Larisa Balykova Indranil Banerjee Dongsik Bang Xenofon Baraliakos Giuseppe Barilaro Jennifer Barton Ozge Basaran Gokalp Basbozkurt Ezgi Deniz Batu Olga Baydik Beate Bechter-Hugl Jose Antonio Bernal Emilio Besada Anthony Bewley Cengiz Beyan Minny Bhatty Sophie Blaise Francisco Blanco Mar Blasco Hatice Bodur Urs A Boelsterli Toshiyuki Bohgaki Alessandra Bortoluzzi Arturo Borzutzky Dimitrios Boumpas Pernille Boyesen Ann Bremander Nurlan Brimkulov Nina Brodin Juergen Brunner Nenad Bukvic Ruben Burgos-Vargas Fraser Burling Noha Abdel-Wahab Carlos Abud-Mendoza Yosser Achour Roberta Agabio Ekrem Akbulut Kenan Aksu Gulseren Akyuz Soham Al Snih Muhsen Al-Ani Begonya Alcacer-Pitarch Cayetano Alegre Hussein Al-Hakeim Hakan Alkan Mehmet Akif Altay Nezam Altorok Olga Amengual Paul Ames Ronald Anderson Mariano Andrés Stacy Ardoin Nevena Arsenovic-Ranin Kristina Areskoug Josefsson Wilbert Aronow Johan A Askling Sebnem Ataman Vasilios Athyros Tatsuya Atsumi Jerome Avouac Ali Aydeniz Onur Aydoğdu Christoph Baerwald Carolina Baeza-Velasco Eileen Baildam Ozlem Balbaloglu Gabor Bali Emilio Buschiazzo Noemi Busquets-Pérez Marisol Camacho-Lovillo Dario Camellino Juan Canete Laura Cano-García Francesco Paolo Cantatore Paola Caramaschi Mario Cardiel Patricia Carreira Hugo Carretero-Dios Jozelio Carvalho Santos Castañeda Gilberto Castaneda Hernandez Jose Dionisio Castillo-Ortiz Isabel Castrejon Patricia Castro Luis Catoggio Marco Cattalini Fatih Çay Reyhan Celiker Ricard Cervera Jen Chang Sandra Chartrand Krati Chauhan Lizhang Chen Shanying Chen Zhiping Chen Roy Cheung Laurent Chiche Sandra Chinchilla Arvind Chopra Marco Matteo Ciccone Rolando Cimaz Marco Cimmino Contributing reviewers

[Purpose] An easy-to-use, psychometrically validated screening tool for fibromyalgia is needed. This study aims to evaluate the reliability and validity of the Turkish version of the Fibromyalgia Rapid Screening Tool by correlating it with 2013 American College of Rheumatology alternative diagnostic criteria and the Hospital Anxiety and Depression Scale. [Subjects and Methods] Subjects were 269 Physical Medicine and Rehabilitation clinic outpatients. Patients completed a questionnaire including the Fibromyalgia Rapid Screening Tool (twice), 2013 American College of Rheumatology alternative diagnostic criteria, and the Hospital Anxiety and Depression Scale. Scale reliability was examined by test-retest. The 2013 American College of Rheumatology alternative diagnostic criteria was used for comparison to determine criterion validity. The sensitivity, specificity, and positive and negative likelihood ratios were calculated according to 2013 American College of Rheumatology alternative diagnostic criteria. Logistic regression analysis was conducted to find the confounding effect of the Hospital Anxiety and Depression Scale on Fibromyalgia Rapid Screening Tool to distinguish patients with fibromyalgia syndrome. [Results] The Fibromyalgia Rapid Screening Tool was similar to the 2013 American College of Rheumatology alternative diagnostic criteria in defining patients with fibromyalgia syndrome. Fibromyalgia Rapid Screening Tool score was correlated with 2013 American College of Rheumatology alternative diagnostic criteria subscores. Each point increase in Fibromyalgia Rapid Screening Tool global score meant 10 times greater odds of experiencing fibromyalgia syndrome. [Conclusion] The Turkish version of the Fibromyalgia Rapid Screening Tool is reliable for identifying patients with fibromyalgia.

Background Risk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. Objectives The aim of this study was to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. Methods Eighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last one year. Their demographics, disease characteristics including Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), AS Quality of Life Index (ASQoL), and risk factors for falls including Vitamin D levels and Short Physical Performance Battery (SPPB) Test results were recorded. Results Forty (13%) out of 306 patients reported at least one fall in the recent one year. Statistically significant differences were found between the patients with and without a history of falls regarding age (p=0,001), disease duration (p=0,001), history of fractures (p=0.035), fear of falls (p=0,000), hip involvement (p=0,032), BASMI (p=0,002), BASFI (p=0,000), and SPPB (p=0,000). No significant correlation were found between number of falls and gender, morning stiffness, polypharmacy, knee involvement, ankle involvement, usage of antidepressants or myorelaxants, AS related days of sick leave, BASDAI, ASQoL, sedimentation, CRP, and Vitamin D levels (p>0,05 for all parameters). Statistically significant correlations were found between number of falls and age (R=0,117, p=0,041), disease duration (R=0,160, p=0,005), AS related lost job (R=0,140, p=0,014), fear of falling (R=0,316, p=0,000), hip involvement (R=0,112, p=0,05), BASMI (R=0,234, p=0,000), BASFI (R=0,244, p=0,000), and SPPB (R=0,183, p=0,006). Conclusions The annual incidence of falls was higher among AS patients than that of normal population. Age, longstanding disease, hip joint involvement, fear of falls, history of fractures, reduced mobility, decreased function, impaired balance were found to be the factors that increase the risk of falls in AS patients. References Geusens P, Vosse D, Van der Linden S: Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 2007, 19:335-339. Sambrook PN, Geusens P: The epidemiology of osteoporosis and fractures in ankylosing spondylitis. Ther Adv Musculoskel Dis 2012, 4(4): 287-292. Disclosure of Interest None Declared

OBJECTIVE:Lumbar spinal stenosis (LSS) may result in neurogenic claudication (NC), which is thought to be a result of transient ischemia during exercise. In this study we evaluated the changes in F wave studies before and immediately after walking stress in patients with NC. DESIGN:Twenty-six patients with LSS who had signs and symptoms of NC and 20 healthy volunteers were included in this study. Routine motor and sensory nerve conduction studies and tibial F wave studies were performed in both groups. Immediately after walking stress test, tibial F wave studies were repeated. Exercise treadmill protocol was used for ambulation. Time to first symptoms and total ambulation time were recorded. RESULTS:After completion of the baseline electrophysiological examination, a walking stress test was performed using a treadmill, and 16 patients (61.5%) experienced neurogenic claudication during the trial. The mean time to first symptoms was 2.0 +/- 3.5 mins (minimum = 0, maximum = 14). In the control group 18 subjects (90%) completed the trial without any symptoms, and 2 (10%) subjects had to stop at an average of 10 mins because of generalized fatigue. Within 5 mins after the walking stress test, tibial F wave studies were repeated in both groups. There were significant increases in F latency values bilaterally in the patient group (P = 0.001 for both sides) but not in control subjects (P = 0.435 for right side and P = 0.122 for left side). CONCLUSION:Our data suggest that F wave studies after walking stress test provide more information for the diagnosis of NC.

The standard surgical approach for closed heart procedures in small infants and children is to use a posterolateral thoracotomy incision, which results in the division of the latissimus dorsi and serratus anterior muscles. The aim of our study was to determine the frequency and type of musculoskeletal deformities in children undergoing surgery with this approach for congenital cardiac disease. We included 49 children, 28 boys and 21 girls, in the study. Their mean age was 10.2 +/- 4.8 years, the mean age at the time of surgery was 3.8 +/- 4.0 years, and they were evaluated at an average of 6 years after the thoracotomy. Of the patients, 94% had various musculoskeletal deformities. Scoliosis was observed in 15 patients (31%) but only in two patients did the curves exceed 25 degrees. Of these patients, three-fifths had aortic coarctation. Elevation of the shoulder was seen in 61%, winged scapula in 77%; while 14% had asymmetry of the thoracic wall due to the atrophy of the serratus anterior muscle. Deformity of the thoracic cage was observed in 18%; and 63% had asymmetry of the nipples. Thus, we found that musculoskeletal deformities are frequent after thoracotomies in children with congenital cardiac disease. Patients who have undergone such procedures for cardiac or noncardiac surgery should be followed until their skeletal maturation is complete. Techniques sparing the serratus anterior and latissimus dorsi muscles should be preferred. These adverse effects of thoracotomy may be another reason for using interventional procedures in these cases.

Background Osteoarthritis (OA) is the most common cause of musculoskeletal diseases in the developed countries. The diagnosis of OA is usually dependent on clinical and radiological evaluations which have some limitations in measuring the outcome. Objectives The aims of this study were to evaluate the predictive role of bone scintigraphy in OA, and to study the relationship with age and severity of the disease. Methods Ninety-nine female subjects were included in this study. Conventional x-rays of the hand, knee, hip and lumbar regions were obtained from each subjects. According to Kellgren and Lawrence Grading System the radiological score of the joint which had the highest grade was accepted as the Maximum Radiological Score (MRS). A bone scan was performed for each subjects 4 h after the injection of 740 MBq of technetium ? 99m-MDP. Spot images of hand, knee, lumbar vertabrae and pelvis were acquired using a gamma camera (Toshiba GCA 601). Besides the increased or normal uptake of activity at the affected joints, the ratios of lesion/non-lesion were also calculated. In the areas where the increased uptake of activity were present, the maximum lesion/non-lesion ratio was accepted as Maximum Scintigraphic Score (MSS). According to the American College of Rheumatology- clinical and radiological ? criteria for diagnosis of OA 46 patients were included in OA group (Group 1) and 53 patients were included in control group (Group 2). The Lequesne Index was used to determine the severity of the disease. Results All patients in group 1 and 31 patients in group 2 had knee pain and the mean duration of pain was 51.6+77.5 months in group 1 and 23.4+46.5 months in group 2. The mean Body Mass Index (BMI) was 31.7+5.0 in group 1 and 36.7+4.0 in group 2. According to the results of scintigraphic evaluation, healthy controls were separated into two groups. In group 2A patients who had an increase in uptake at least one joint and in group 2B patients who had no uptake. The mean MSS was 4.2+1.4 in group 1 and 3.3+1.6 in group 2A. Also the mean MRS of the patients in group 1 were 2.9+0.9 and 0.6+0.5, 0.2+0.4 in group 2A and 2B respectively. The mean score of the Lequesne Index was 8,9+3,6 in group 1 patients. There was a positive correlation between age and MSS (p < 0,05) and BMI and MRS (p < 0,05). Also there was a strong correlation between Lequesne OA Severity Index Score the age of the patients in group 1 but no correlation with the MSS. According to the clinical and/or radiological criteria sensitivity of bone scintigraphy was 98.2%, specifity was 57.1%, positive predictive value was 76% and negative predictive value was 96%. Conclusion Our results suggest that 99 m technetium scintigraphy is a better quantifying method in assessing the changes of OA especially in early cases.

The purpose of this study was to compare the insulin-like growth factor-1 (IGF-1) levels and the growth hormone (GH) levels in osteoporotic and nonosteoporotic postmenopausal women. Eleven non-osteoporotic postmenopausal women and 9 women with untreated postmenopausal osteoporosis were included in the study. Bone mineral density (BMD) was assessed by dual energy X-ray absorbtiometry. Serum was assayed for calcium, phosphorus, alkaline phosphatase, bone-specific alkaline phosphatase, parathyroid hormone, IGF-1 and GH levels. IGF-1 levels were 98.8 +/- 43.5 ng/ml for osteoporotic women and 169.8 +/- 50.3 ng/ml for the women with normal BMD (p < 0.05). GH levels were 1.3 +/- 1.1 ng/ml and 1.3 +/- 1.0 ng/ml, respectively. When compared with normal postmenopausal women, IGF-1 levels were found to be lower in women with osteoporosis. IGF-1 seems to play an important role in the development of low bone mass and the present results suggest that IGF-1 is a useful predictor of the presence of osteoporosis.

The aim of this study was to evaluate children with chronic disorders like hemophilia and poliomyelitis from the psychological perspective, to determine the frequency of depression, to identify the risk factors and to investigate the relation between disability and depression. Thirty-five patients with disability due to poliomyelitis and 12 patients with hemophilic arthropathy were included in the study. Thirty-six healthy children from the district schools served as controls. The Children's Depression Inventory (CDI) was used to assess the extent of depression. For the hemophilia group, joint scores proposed by the World Federation of Hemophilia were used to assess the degree of joint involvement. The poliomyelitis group was evaluated according to the level of ambulation and the need for orthoses. The CDI score was 10.57 +/- 5.87 in the poliomyelitis group, 11.00 +/- 5.64 in the hemophilic arthropathy group and 8.39 +/- 3.78 in the control group, but the difference was not statistically significant. Four of 35 patients with poliomyelitis (11.4%) and two of 12 hemophilic arthropathy patients (16%) exhibited depression. None of the children in the control group had depression. Since depression interferes with both medical compliance and rehabilitation potential, early diagnosis and treatment is important. Therefore, evaluation of the psychological status of chronically ill children must be a part of the rehabilitation program.

The authors present two unsuccessful clinical cases of end-to-side neurorrhaphy. In the first patient the distal median nerve was coapted in an end-to-side manner to the intact ulnar nerve. In the other patient four cables of sural nerve graft were used to bridge the ulnar nerve and the intact median nerve by two end-to-side coaptations. Neurorrhaphies were performed via epineural sutures through epineural windows. Both of the cases failed to demonstrate any signs of regeneration either clinically or as evidenced by electromyography, Semmes-Weinstein monofilament test, or 256-Hz vibration tests at 18 and 21 months' follow-up respectively.

Bacillus Calmette–Guerin (BCG) is the most effective agent currently available for the treatment of superficial bladder cancer. However, this form of treatment is associated with some complications, including arthritis. In this report, we present a 69-year-old woman who developed inflammatory polyarthritis following BCG treatment for superficial bladder cancer. The arthritis resolved following treatment with a non-steroidal anti-inflammatory drug and chloroquinine.

Objectives: The aim of this study was to explore quality of life [QOL] in rheumatoid arthritis [RA] and fibromyalgia syndrome [FMS] patients.Methods: Twenty-six RA, 22 FMS patients and 25 control subjects were examined. The Nottingham Health Profile [NHP] was used to assess quality of life in the subjects.Results: All dimensions of the NHP in RA and FMS patients were significantly higher than in the control group. The physical activity and pain scores of the RA group were higher than in the FMS group, whereas energy, social isolation, sleep, and emotional reaction scores were higher in FMS patients.Conclusion: Quality of life as measured by the NHP confirms our expectation that individuals with increasing functional disability have a reduced QOL especially in the physical sections. But FMS patients suffering from widespread pain have a more decreased QOL except for the levels of disability.

The objective of the study was to examine the muscle performance, isokinetic muscle strength, muscle endurance ratio, and submaximal aerobic performance in fibromyalgia syndrome (FMS) patients, to evaluate the relation between muscle performance, pain severity, clinical findings, and physical activity level, and to compare the results with healthy control subjects. Twenty-four FMS patients and 15 control subjects participated in this study. Data were obtained about the symptoms, location and onset of pain, treatment, and associated symptoms. Patients and controls underwent an examination of isokinetic muscle strength of right quadriceps on a Cybex dynamometer, and submaximal aerobic performance tests (PWC-170) were done for all subjects. Maximal voluntary muscle strength of the quadriceps was significantly lower in patients compared with the control group. Endurance ratios showing the work capacity were not statistically different between two groups. Submaximal aerobic performance scores were higher in the control group. There was not a relation between the decreased muscle performance and clinical findings, including pain severity, number of tender points, and duration of the symptoms of FMS patients. We found a reduced quadriceps muscle strength and submaximal aerobic performance in patients with FMS, indicating that patients have impaired muscle function.

The aim of this study was to evaluate bone mineral density changes in patients with juvenile chronic arthritis (JCA) and to determine the most likely causes of osteoporosis in these patients. Eighteen (11 male, 7 female) patients suffering from JCA and 14 healthy controls (10 male, four female) were included in this study. The mean age of the patients and control groups were 11.0±3.2 and 10.9±2.9 years respectively. Disease activity was determined by clinical and laboratory evaluation and ‘Articular Disease Severity Score’ (ADSS). Bone mineral density (BMD) of the femoral neck and lumbar spine was measured by dual photon absorptiometry.

Fibromyalgia is a form of nonarticular rheumatism characterized by musculoskeletal aching and tenderness on palpation. The role of psychological factors in fibromyalgia has been controversial. The aim of this study was to evaluate the relationship of fibromyalgia to the intensity of anxiety and depression and to determine the correlation between psychological disturbances with disease duration and pain severity. Thirty-nine patients with fibromyalgia and 36 healthy controls were included in this study. Beck depression inventory, State and trait anxiety inventory and Beck hopelessness scale were used to evaluate psychological disturbances. Visual analog scale was used to determine pain intensity. We found a significant difference in the psychological status between patients with fibromyalgia and control subjects as measured by Beck depression inventory and trait anxiety inventory; 35.9% of the patients scored higher than the cut-off score on the Beck depression rating scale. Pain severity was found to be correlated with trait anxiety inventory scores. These results suggest that somatic expression of depression is an important difference between fibromyalgia and control groups. The difference between state and trait anxiety inventory reflects that current anxiety is not secondary to pain but trait anxiety is possibly causally related to pain.

Rickets can manifest with a wide variety of rheumatic symptoms. In this paper, a fifteen year old female patient with hypophosphatemic rickets presenting with symptoms suggesting sacroiliitis at disease onset is reported. The sacroiliac joint involvement in this case was attributed to the subchondral bone fractures due to the secondary hyperparathyroidism. Her symptoms resolved completely after treatment with calcitriol and phosphate solution for hypophosphatemic rickets.