Sjogren's Syndrome is a systemic autoimmune disease that mainly affects the exocrine glands.1 The most common clinical symptoms of Sjogren's syndrome are dry mouth and eyes. Vaginal dryness and dyspareunia may be seen in the disease, as the female genital mucosa is also affected.2
Objectives
To compare the results by using the female sexual function scale in patients with Sjögren's Syndrome with and without depression, anxiety, and fibromyalgia and to evaluate the patients in terms of sexual dysfunction.
Methods
Twenty-five female patients diagnosed with Sjögren's Syndrome, according to the 2016 ACR-EULAR criteria, followed in the Internal Medicine, Rheumatology Clinic of Sakarya University Faculty of Medicine, were included in the study after their consent was obtained. Beck Depression Inventory, Beck Anxiety Inventory, and Female Sexual Function Scale were administered simultaneously to the patients. The presence of fibromyalgia was evaluated according to the 2016 Modified ACR diagnostic criteria. The relationship between depression, anxiety scale scores, the presence of fibromyalgia, and female sexual function was investigated.
Results
The mean age of the patients was 49±8.1 years, and the median duration of the disease was four years. 15 (60%) patients were primary school graduates, 2 (8%) patients were secondary school graduates, 4 (16%) patients were high school graduates, and 4 (16%) patients were university graduates. 11 (44%) of the patients were in menopause. Sexual dysfunction was found in 21 (84%) patients diagnosed with Sjögren's Syndrome. There was no statistically significant difference in sexual function scale scores between those with and without menopause. No statistical difference was found in disease duration, age, and scale scores in the presence of fibromyalgia. Sexual dysfunction was more pronounced in those with depression and anxiety (p=0.003; p=0.045, respectively) (Table 1).
Conclusion
Depression and anxiety cause lower sexual function scores in female patients diagnosed with Sjogren's syndrome. The effect of fibromyalgia has not been demonstrated, but due to the limited number of patients, studies with a larger population will be more enlightening.
References
[1]Priori R, Minniti A, Derme M, Antonazzo B, Brancatisano F, Ghirini S, et al. Quality of sexual life in women with primary Sjögren Syndrome. J Rheumatol. 2015 Aug;42(8):1427-31. doi:10.3899/jrheum.141475 [2]Piccioni MG, Merlino L, Deroma M, Del Prete F, Tabacco S, Monti M, Benedetti Panici P. The impact of primary Sjogren's syndrome on female sexual function. Minerva Ginecol. 2020 Feb;72(1):50-54. DOI: 10.23736/S0026-4784.20.04494-9.
Background: Axial spondyloarthritis has characteristic clinical features such as enthesitis, sacroiliitis and spondylitis, and extra-articular manifestations(1). Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is used to detect early sacroiliitis(2). Health institutions in our country carry out some of the radiology reporting services by outsourcing for reasons such as high cost and insufficient number of radiologists(3). Objectives: We decided to evaluate the interobserver agreement in active MRI findings of SI between radiologist of outsourcing radiology services and local/expert radiologist in musculoskeletal diseases. Methods: Between the years of 2015 and 2019, 8100 sacroiliac MRIs were taken at our center. The MRI of 1150 patients who were reported as active or chronic sacroiliitis from these sacroiliac MRIs or whose MRI was considered by the primary physician in favor of sacroiliitis was included in the study. Concordance between Evaluation and Service Procurement was examined using Kappa (k) coefficients. Mc Nemar test was used to compare the evaluation result between two observers. A p-value <0.05 was considered significant. Analyses were performed using commercial software (IBM SPSS Statistics, Version 23.0. Armonk, NY: IBM Corp.) Results: Of the 1150 patients examined in the study, 526 (45.7%) were male and 624 (54.3%) were female. The general average age is 37.20 ± 11.65 and the average age of men and women is 34.98 ± 11.19 and 39.07 ± 11.71 respectively. A statistically significant difference was found between the expert radiologists and outsourcing radiologist reports. In other words, a high level of compatibility was not found among the evaluators (p <0.001). When the consistency between expert radiologist and outsourced radiologist reports was examined, it was observed that there was a medium level of concordance (k = 0.589). Conclusion: The diagnosis of a spondyloarthropathy may be delayed for some reasons. In addition to the insidious course of the disease, being contented with an outsourced radiologist report may delay diagnosis. If the patient’s clinic and MRI report are not consistent, the patient should not be removed from follow-up. References: [1]Braun J. ‘Axial spondyloarthritis including ankylosing spondylitis’ Rheumatology (Oxford). 2018 1;57(suppl_6):vi1-vi3 [2]Jans L, Egund N, Eshed I, Sudoł-Szopińska I, Jurik AG. Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity. Semin Musculoskelet Radiol. 2018;22: 180–188. [3]Quélin B, Duhamel F. Bringing Together Strategic Outsourcing and Corporate Strategy: European Management Journal. 2003. pp. 647–661. doi:10.1016/s0263-2373(03)00113-0 OUTSOURCING RADIOLOGIST REPORTS TOTAL p NOT ACTIVE SACROILIITIS ACTIVE SACROILIITIS EXPERT RADIOLOGIST REPORTS NOT ACTIVE SACROILIITIS 508 178 686 <0.001 0.589 ACTIVE SACROILIITIS 59 405 464 TOTAL 567 583 1150 Disclosure of Interests: None declared
Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropathy that usually follows infection process. Gastrointestinal, genitourinary and respiratory tract infections generally provoke reactive arthritis. Also, reactive arthritis can be seen after vaccination. Reactive arthritis cases have been reported after tetanus, combined diphteria-poliomyelitis-tetanus toxoid, hepatitis B or influenza vaccination. Although reactive arthritis is more common in youngs, healthcare workers should be aware of the development of post inactivated COVID-19 vaccine reactive arthritis in older patients. We present two cases with ReA induced by inactivated coronavirus 2019 (COVID-19) vaccination (CoronaVac, Sinovac). Both patients in our study were over 70 years old and presented with polyarthritis that developed after vaccination. Rheumatoid factor and anti-nucleer antibody were negative and patients responded well to short-term steroid therapy, arthritis were not resistant.
Familial Mediterranean Fever (FMF) is a condition marked by recurring episodes of polyserositis, and some patients may experience joint involvement either during attacks or in a chronic form. The presence of Spondyloarthropathy (SpA) and its common features alongside FMF is often observed study. In certain instances, chronic arthritis or other SpA findings does not show a response to colchicine treatment.
Objectives:
In this study, we explored the connection between SpA, its musculoskeletal features, chronic arthritis, and resistance to colchicine in our FMF patient group.
Methods:
We enrolled 243 adult patients with Familial Mediterranean Fever (FMF) in our study, all of whom met the Tel-Hashomer Criteria. Various data, including demographic information, disease-related features, smoking habits, and comorbidities, were collected. Additionally, we utilized The International Severity Scoring System for FMF (ISSF) scores to assess the severity of the disease. Colchicine resistance was identified in patients who continued to experience one or more attacks per month despite receiving the maximum tolerated dose for at least 6 months and/or ongoing subclinical inflammation. In our research, we categorized patients into two groups based on whether they exhibited resistance to colchicine. We initially compared FMF-related features between these groups. Next, we examined the variables that showed significance in the initial analysis using a more comprehensive multivariate approach to understand their relationship with colchicine resistance.
Results:
Colchicine resistance was present in 54 (%22.2) of 243 patients included in the study. There was no difference between patients with and without colchicine resistance in terms of age (p=0.36), gender (p=0.94), disease duration (p=0.76), frequency of SpA (p=0.37), Charston comorbidity score (p=0.22), smoking (p=0.87), presence of musculoskeletal system findings (p=0.11), erysipelas-like rash (p=0.32), sacroiliitis (p=0.34), enthesitis (p=0.56) and presence of exon 10 MEFV mutation (p=0.05). However, the frequency of attacks (p<0.001), ISSF score (p<0.001), amyloidosis (p<0.001) and chronic arthritis (p=0.001) were more frequent in the colchicine resistant group. Mean colchicine dose was found to be higher in the resistant group (p=0.001). In multivariate analysis, ISSF score (p=0.003), attack frequency (p=0.03), resistant arthritis (p=0.002) and amyloidosis (p<0.001) were found to be associated with colchicine resistance (Table 1).
Conclusion:
The study revealed that the occurrence of colchicine resistance is linked to the presence of chronic arthritis, along with amyloidosis,attack frequency and ISSF score, while no such association was identified with SpA or all other SpA features.
Chronic pancreatitis is a condition that results from episodes of acute pancreatitis. It is difficult to diagnose chronic pancreatitis in the early stages and to recognize complications. Recognizing duct rupture, one of the complications of chronic pancreatitis, is important for initiating treatment. A 75-year-old woman presented to the emergency department with abdominal pain. Amylase and lipase levels were 65 u/L and 75 u/L, respectively. Computed tomography performed in the emergency department revealed ductal rupture and the patient was hospitalized in the gastroenterology service. Treatment included endoscopic examination followed by pancreatic rest, hydration and proton pump inhibitors. Pancreatic duct rupture, which is rarely encountered in the emergency department, should be considered as an alternative diagnosis in patients presenting with abdominal pain and a previous pancreatitis attack.
Background: Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is used to detect early sacroiliitis(1). There can be an interobserver disagreement in MRI findings of SI joints of spondyloarthropathy patients between a rheumatologist, a local radiologist, and an expert radiologist(2). Artificial Intelligence and deep learning methods to detect abnormalities have become popular in radiology and other medical fields in recent years(3). Search for “artificial intelligence” and “radiology” in Pubmed for the last five years returned around 1500 clinical studies yet no results were retrieved for “artificial intelligence” and “rheumatology”. Objectives: Artificial Intelligence (AI) can help to detect the pathological area like sacroiliitis or not and also allows us to characterize it as quantitatively rather than qualitatively in the SI-MRI. Methods: Between the years of 2015 and 2019, 8100 sacroiliac MRIs were taken at our center. The MRIs of 1150 patients who were reported as active or chronic sacroiliitis from these sacroiliac MRIs or whose MRIs were considered by the primary physician in favor of sacroiliitis was included in the study. 1441 MRI coronal STIR sequence of 1150 patients were tagged as ‘’active sacroiliitis’’ and trained to detect and localize active sacroiliitis and provide prediction performance. This model is available for various operating systems. (Image1) Results: Precision score, the percentage of sacroiliac images of the trained model, is 87.1%. Recall, the percentage of the total sacroiliac MRIs correctly classified by the model, is 82.1% and the mean average precision (mAP) of the model is 89%. Conclusion: There are gray areas in medicine like sacroiliitis. Inter-observer variability can be reduced by AI and deep learning methods. The efficiency and reliability of health services can be increased in this way. References: [1]Jans L, Egund N, Eshed I, Sudoł-Szopińska I, Jurik AG. Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity. Semin Musculoskelet Radiol. 2018;22: 180–188. [2]B. Arnbak, T. S. Jensen, C. Manniche, A. Zejden, N. Egund, and A. G. Jurik, “Spondyloarthritis-related and degenerative MRI changes in the axial skeleton—an inter- and intra-observer agreement study,” BMC Musculoskeletal Disorders , vol. 14, article 274, 2013. [3]Rueda, Juan C et al. “Interobserver Agreement in Magnetic Resonance of the Sacroiliac Joints in Patients with Spondyloarthritis.” International journal of rheumatology (2017). Image1. Bilateral active sacroiliitis detected automatically by AI model (in right sacroiliac joint 75.6%> (50%), in left sacroiliac joint 65% (>50%)) Disclosure of Interests: None declared
Background: Ankylosing Spondylitis (AS) is an inflammatory rheumatic disease that affects the spine and sacroiliac joints (SIJ). Non-steroidal anti-inflammatory drugs (NSAIDs), modifying antirheumatic drugs (DMARDs), and recently anti-TNF blockers, which are more costly than NSAIDs but used in resistant cases, are generally used in its treatment (1). Objectives: While SIJ-MRI is one of the imaging methods in the diagnosis of the disease, it is not yet used in its follow-up (2). We wanted to define when the activated SIJ-MRI findings, which showed early sacroiliitis, regressed according to the treatment option. Methods: Among the 8100 SIJ-MRIs taken in our hospital in the last 5 years, those that were reported normally were excluded from the study. Among the remaining 1150 patients with active or chronic SIJ findings, a total of 87 patients who were diagnosed with AS and had active SIJ findings in the first imaging and had a second SIJ-MRI examination for any reason were included in our retrospective, cross-sectional and observational study. According to the treatment option, how long the active SIJ-MRI findings disappeared was calculated in months using the Kaplan-Meier method. Results: Of the 87 patients examined in the study, 41 were women and 46 were men. The average age is 32.7. Active SIJ-MRI findings disappeared in a mean of 30.6 months for 11 of 24 patients who did not use any medication, in a mean of 33.9 months for 6 of 16 patients using NSAIDs, in a mean of 40.7 months for 14 of 34 patients using sulfasalazine, in a mean of 28.2 months for 3 of 6 patients using adalimumab, in a mean of 24.4 months for 3 of 5 patients using methotrexate, 11.9 month for 2 of 1 patient using certolizumab. There was no statistically significant difference between the groups. Conclusion: The signs of active sacroiliitis disappeared in less time in patients who did not receive any treatment than those using NSAIDs and sulfasalazine. Patients using anti-TNF blockers had earlier results than those using no medication. The reason for this may be the progressive course of patients who are switched to the next level of treatment and their late response to treatment, as well as the mechanism of the disease (2-3). This situation brings to the agenda the tendency of physicians to over-treat the disease. More randomized controlled studies are needed regarding new treatment options. References: [1]Braun J. ‘Axial spondyloarthritis including ankylosing spondylitis’ Rheumatology (Oxford). 2018 1;57(suppl_6):vi1-vi3. [2]Braun J, Baraliakos X, Golder W, Brandt J, Rudwaleit M, Listing J, Bollow M, Sieper J, van der Heijde D. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab. Arthritis & Rheumatism Vol. 48, No. 4, April 2003, pp 1126–1136. [3]Jee WH, McCauley TR, Lee SH, Kima SH, Ima SA, Had KY. Sacroiliitis in patients with ankylosing spondylitis: association of MR findings with disease activity. Magnetic resonance imaging 2004:22;245–250. Disclosure of Interests: None declared
Sjögren's syndrome (SjS) is an autoimmune disease characterized by exocrine gland inflammation (1). Extraglandular manifestations are common in SjS. Some articles reported neuropathic pain in 40% of patients with SjS (2). Autoantibodies (SS-A, SS-B, Anti Ro-52) and salivary gland biopsy are used to diagnose SjS. The relationship between autoantibody, salivary gland biopsy results, and neurological involvement is unclear.
Objectives
In this study, autoantibody positivity and salivary gland biopsy results were compared with the frequency of neuropathic pain.
Methods
Patients with a diagnosis of Primary SjS who visited the rheumatology outpatient clinic of Sakarya University between August 2021 and August 2022 were included in the study. The results of salivary gland biopsy and autoantibody (ANA, SS-A, SS-B, Anti-Ro 52) were analyzed. The LANSS (The Leeds Assessment of Neuropathic Symptoms and Signs) pain scale was used to define neuropathic pain. Obtained data were evaluated with Chi-Square and Mann-Whitney U test.
Results
Sixty-six patients were included in the study. Patients' age (mean): 53.5±11.3 years; genders were 3 (4.5%) male and 63 (95.5%) female. While 18 (27.3%) patients have neuropathic pain, 48 (72.7%) patients did not have neuropathic pain. No statistically significant difference was found between neuropathic pain and disease duration (p=0.584). There was no difference in neuropathic pain in terms of gender (p=0.178). While the rate of neuropathic pain was 25.6% in patients with a focus on biopsy, it was 45.5% in patients without focus, and the difference was not statistically significant (p=0.270). No statistically significant correlation was found between anti-SSA, Anti-SSB, and Anti-Ro52 positivity and neuropathic pain. In ANA-negative patients, the increase in the frequency of neuropathic pain was statistically significant (p=0.031).
Conclusion
In this study, we did not find a relationship between antibody positivity, focus score, and the frequency of neuropathic pain.
References
[1]Segal BM, Pogatchnik B, Henn L, Rudser K, Sivils KM. Pain severity and neuropathic pain symptoms in primary Sjögren's syndrome: a comparison study of seropositive and seronegative Sjögren's syndrome patients. Arthritis Care Res (Hoboken). 2013;65(8):1291-1298. doi:10.1002/acr.21956 [2]Omdal R, Mellgren SI, Norheim KB. Pain and fatigue in primary Sjögren's syndrome [published online ahead of print, 2019 Feb 27]. Rheumatology (Oxford). 2019;kez027. doi:10.1093/rheumatology/kez027
Intramuscular hemorrhages and hematomas are a complication of anticoagulation in patients using warfarin as an anticoagulant. Hematomas may be due to trauma or may develop spontaneously. Neuropathies due to direct compression of hematomas or hemorrhage around the nerve may rarely occur. We aimed to present a case of spontaneous hematoma in the triceps muscle and associated radial nerve deficit in a patient taking warfarin for valvular disease. The hematoma was evacuated after prothrombin complex concentrate and vitamin K. The patient's nerve deficit improved in the follow-up. Early evacuation of the haematoma may be important for favorable outcomes.
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