We aimed to determine in psoriatic arthritis (PsA) patients the Toll-like receptor (TLR) 4 and C-reactive gene (CRP) polymorphisms and allele frequency and to investigate the relationship between clinical parameters and gene polymorphisms. We enrolled in this study 31 PsA and 41 healthy control subjects. PsA diagnosis was according to CASPAR criteria. Bath ankylosing spondylitis diseases activity index, Maastricht ankylosing spondylitis enthesitis score, and Bath ankylosing spondylitis functional index were measured. C, A, and T alleles of CRP and A and G alleles of TLR 4 were determined using the analysis of melting curves after real-time PCR. CRP A, C, and T allele frequency in controls was 26.8, 73.2, and 36.6%, respectively. In the PsA patient group, A, C, and T allele frequency was 9.7, 87.1, and 12.9%, respectively. Between control and PsA groups, there was a significant difference in A, C, and T allele frequency (P = 0.008, 0.038, and 0.001, respectively). The frequency of CRP gene polymorphisms (CA, AA, CT, TA, and TT alleles) in the control group was 56.1% and in the PsA group was 22.6%. There was a significant difference between the two groups (P = 0.004). The absence of a CRP gene polymorphism was a risk factor for PsA (odds ratio 4.3, 95% CI; 1.5-12.4, P = 0.005). TLR gene haploid frequency was investigated, and all control subjects had the wild-type AA allele. PsA patient GA allele frequency was 6.5%. There was no significant difference between the two groups (P = 0.182). GA mutant allele frequency was related to PsA (odds ratio 7.03, 95% CI; 0.32-151.9, P = 0.214). We have shown that CRP gene polymorphisms are higher in control subjects than PsA patients, and TLR 4 gene polymorphisms were found to be related to PsA.

Objectives: This study aims to evaluate subclinical atherosclerosis using the Ankle-Brachial Index (ABI) in patients with psoriatic arthritis (PsA). Patients and methods: This case-control study included 51 PsA patients (24 males, 27 females; median age 47; range, 41 to 52 years) recruited at our hospital's outpatient clinics between October 2016 and January 2017 and 50 healthy controls (24 males, 26 females; median age: 48.5; range, 40.7 to 56 years). Anthropomorphic measurements and laboratory results were recorded. In patients, the 66 swollen/68 tender joints count, dactylitis score, Leeds Enthesitis Index, Health-related Quality of Life, the Psoriasis Area and Severity Index, and Dermatology Life Quality Index were evaluated. Ankylosing Spondylitis Quality of Life and Bath Ankylosing Spondylitis Disease Activity Index were applied to patients with axial disease. Then, Composite Psoriatic Disease Activity Index was determined. A Doppler probe and a standard blood pressure cuff were used to calculate the ABI values for each participant. Results: Patients had lower right ABI (median, 1.05 vs. 1.1, p<0.01), lower left ABI (1.04 vs. 1.09, p<0.01) and lower overall ABI (1.03 vs. 1.09, p<0.01) compared with healthy subjects. Twelve (23.5%) patients had borderline ABI, but none of the controls (p<0.01). Patients with borderline ABI had a longer duration of psoriasis (25 vs. 15 years, p=0.03). The distribution of borderline ABI value was statistically significant between patients with axial disease and peripheral disease only (42.1% vs. 12.5%, p=0.02). Disease activity was found as an independent risk factor for borderline ABI in a binary logistic regression (odds ratio 6.306, 95% confidence interval 1.185 to 33.561, p=0.031). Conclusion: Lower ABI was found in PsA patients than healthy controls even in those matched with traditional cardiovascular risk factors. All participants with borderline ABI were in the patient group. Borderline ABI was associated with disease activity and disease duration.

Background: Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. Methods: This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. Results: A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. Conclusions: Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.

Background:The Istanbul Low Back Pain Disability Index (ILBPDI) was developed to assess the disability in patients with mechanical low back pain with 18 daily activities questions (1).Objectives:The aim of this study is to investigate the validity and reliability of the İstanbul Low Back Pain Disability Index in lumbar radiculopathy.Methods:Patients who were diagnosed with radiculopathy due to lumbar spinal stenosis and/or disc herniation by physical examination and imaging methods were included in the study. Data about age, sex, body mass index (BMI), disease duration (month) were noted. Short Form 36 (SF-36) was used to assess the quality of life. Disability due to low back pain was assessed with Oswestry Low Back Disability Questionnaire. The severity of low back pain and extremity pain due to radiculopathy were assessed on the Visual Analogue Scale (VAS).The reliability of ILBPDI was determined by internal consistency (Cronbach’s alpha coefficient). The construct validity (convergent and divergent validities) was evaluated. The correlations of the ILBPDI with SF-36, Oswestry Low Back Disability Questionnaire, and the VAS scores of the low back pain and radiculopathy were assessed for convergent validity. The relations of the ILBPDI with age, BMI, and disease duration were assessed for divergent validity. The construct validity of the ILBPDI scale was determined by Spearman’s correlation coefficient. The descriptive analysis was done for demographic data. P<0.05 accepted as significant. SPSS 20.0 (Statistical package for social sciences for Windows 20.0) program was used for the statistical analysis.Results:The mean age of 82 patients (44 female, 38 male) with lumbar radiculopathy was 45.45 (SD: 11.96) years. The median (min-max) duration of disease was 5 (1-120) months. The mean BMI of patients was 29.09 (SD: 5.04). The mean score of ILBPDI was 30.73 (SD: 17.04) ant the mean score of Oswestry Low Back Disability Questionnaire was 52.73 (SD: 16.98).The Cronbach’s alpha coefficient of the ILBPDI for internal consistency was 0.764. The ILBPDI score had moderate and significant positive correlations with Oswestry Low Back Disability Questionnaire (rho: 0.610, p<0.005). Statistically significant but low correlation was detected between ILBPDI and the VAS score of radiculopathy (rho: 0.285, p: 0.010), but there was no correlation with the VAS score of low back pain (p>0.05). As for the correlations between the ILBPDI total score and SF-36 subgroups, significant negative correlations were detected with physical functioning (rho: -0.672, p<0.005), physical role limitation (rho: -0.230, p: 0.038), bodily pain (rho: -0.546, p<0.005), general health (rho: -0.262, p: 0.017), and social function (rho: -0.337, p<0.005) subgroups of the SF-36. There were no significant correlations between ILBPDI and age, disease duration, and BMI (p>0.05).Conclusion:The Istanbul Low Back Pain Disability Index is a valid and reliable instrument in patients with lumbar radiculopathy. This is a preliminary study. The study will continue for th...

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