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Objectives: This study aims to investigate the correlations between clinical features and mouth opening in patients with systemic sclerosis (SSc). Patients and methods: Eighty patients with SSc (13 males, 67 females; mean age 53.4±11.7 years; range, 31 to 76 years) followed in our clinic were enrolled in the study. Skin involvement was assessed using the modified Rodnan skin score (mRSS), joint/tendon involvement with fingertip to palm (FTP) distance and interstitial lung disease (ILD) was evaluated with clinical and radiologic methods. The interincisal distance (ID) measurement was used to assess the maximal mouth opening capacity. We examined associations between the ID and clinical features of SSc. Results: The ID was lower in females compared with males, and in diffuse type compared with the limited type (p<0.001 and p<0.001, respectively). A significant negative correlation was found between the ID with mRSS and FTP distance (p<0.001 and p=0.001, respectively). The ID was lower in patients with ILD than in patients without ILD (p=0.006). A formula was constituted to predict the maximal mouth opening of the patient with regression analysis. According to the formula, being male was associated with an increase of 6.14 mm, the presence of ILD with a decrease of 3.19 mm, every 10 mm increment in mRSS with a decrease of 3.72 mm and FTP distance >0 mm with a decrease of 5.13 mm in mouth opening. Conclusion: Microstomia is associated with low quality of life in patients with SSc. In our study, sex, ILD, mRSS, and FTP distance were observed to be the most important factors that were related with mouth opening in patients with SSc.

Reduced CT in SSc patients supports the hypothesis of widespread vascular injury, including the ocular microcirculation.

Objectives: This study aims to evaluate the effect of a home-based orofacial exercise program on the oral aperture (OA) of systemic sclerosis (SSc) patients. Patients and methods: This single-blind prospective randomized controlled study performed between March 2017 and January 2019 included 56 SSc patients (3 males, 53 females; mean age 52.9±10.6 years; range, 31 to 70 years) with an OA of <40 mm. Patients were divided into two groups. Group 1 (n=28, mean age 53.8±9.6 years) was given orofacial exercise program twice a day for one month in addition to oral hygiene care advices, followed by no activity for the next month. Group 2 (n=28, mean age 50.0±11 years) received oral hygiene care advices for the first month followed by the same exercise program for the next month. Patients' OA was measured at baseline, and at first and second months. Results: After the first month, OA increased in Group 1 (p<0.001), whereas no change was observed in Group 2 (p=0.579). At the end of two months, there was no additional increase in Group 1 (p=0.352), while there was a significant increase in Group 2 (p<0.001). There was no difference between OAs of the groups at the end of the trial (p=0.564). Conclusion:Our results suggest that home-based orofacial exercise program improves OA of SSc patients.

Osteoarthritis is no longer considered a degenerative disease. The presence of underlying low-grade inflammation has been well demonstrated. Although osteophytes are used to determining the radiological stage, the development mechanism is not fully understood. The aim of this study is to separately evaluate the relationship between various inflammation parameters associated with complete blood count with osteophytes and radiological stage. Methods:Patients who met the American College of Rheumatology clinical knee osteoarthritis criteria, retrospectively selected. Kellgren-Lawrence grading scale was used for disease severity and Osteoarthritis research society international grading was used for osteophyte size evolution. Red blood cell distribution width, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, neutrophil to monocyte ratio, lymphocyte to monocyte ratio, and mean platelet volume obtained from complete blood count, and C-reactive protein levels were recorded. The relationship between inflammation markers and osteophytes and disease stage was evaluated by logistic regression analysis. Results:A significant correlation was shown between CRP and PLR in the early stage of the disease. No correlation was found in advanced stage. No correlation was found between osteophyte progression and inflammatory markers in the analysis based on osteophyte size. Conclusion:In this study, we have shown that there is a relationship between systemic low-grade markers of inflammation and early stages of knee osteoarthritis, but this relationship was not detected in advanced stages. There was not a relation between osteophyte progression and these markers. Even though it seems to be running together, we can assume that the progression of the disease and osteophyte formation have different mechanisms.

Pain is one of the most common symptoms in systemic sclerosis (SSc) patients, yet not considered in the assessment of disease severity. This study aimed to investigate the frequency of neuropathic pain (NP) and to evaluate its interference with the quality of life (QoL) in SSc patients. Diffuse and Limited SSc patients diagnosed by American College of Rheumatology 2013 criteria were included in the study. Pain was evaluated with Visual Analogue Scale (VAS); presence of NP was screened with The Leeds Assessment of Neuropathic Symptoms and Signs (LANNS) questionnaire; disease activity was evaluated with modified Medsger Severity Scale (MSS) and QoL with short-form 36 (SF-36). One hundred twenty patients were included in the study (mean age 53.64 ± 11.44 years, female/male 83.3-16.7%). Total pain frequency was found 69.2% and NP was 35.9% in the entire patient group. Pain was most frequently seen in wrist-hand (50.6%) and ankle-foot (43.4%) regions; albeit, NP rates were highest in face (94.4%), lower leg (87.5%), and hip-thigh (78.6%) regions. SF-36 scores were significantly lower in patients with NP than the patients without NP (P < 0.05). The most associated factors with NP were MSS score for muscle involvement and drug consumption of the patient. According to our results, high frequency of NP is seen in SSc patients, and NP is associated with low QoL. Differential diagnosis of NP is important to consider right treatment options and accurate management of pain in all rheumatologic diseases including SSc.

Background This article presents a patient who was initially diagnosed as having granulomatosis with polyangiitis (GPA), and was later diagnosed as having chronic granulomatous disease (CGD) in adulthood. We aimed to raise awareness of CGD, which can be confused with rheumatic diseases. Case Report We present a 33‐year‐old male patient with CGD with recurrent opportunistic bacterial and fungal infections who was diagnosed as having GPA, and had a history of recurrent lung infections and brain abscesses since childhood. The patient, who had cavitary lesions in the lung and mucosal lesions in the nose, was diagnosed as having GPA based on antineutrophil cytoplasmic antibody positivity. CGD was suspected in his last hospitalization after the patient underwent a nitro blue tetrazolium test. Accordingly, neutrophil oxidative function was tested using a dihydrorhodamine assay, which confirmed CGD. Molecular analysis of the patient revealed that the NCF1 gene had a GT deletion at the beginning of exon 2. Our patient was diagnosed as having late‐onset CGD; he is currently well and taking antibiotic prophylaxis. Conclusion As a result of the altered humoral immune response in CGD, there is unregulated inflammation and sustained antigen stimulation. This excessive inflammatory response can be confused with autoimmune diseases and cause delays in diagnosis. This case is important in the differential diagnosis of CGD in adult patients with recurrent opportunistic infections.

To identify the determinants of central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Central Sensitization Inventory (CSI) was used to determine CS frequency. Disease-related variables including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP/-ESR), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and Numeric Rating Scale (NRS) GLOBAL were assessed. Biopsychosocial variables were evaluated by the Multidimensional Scale of Perceived Social Support (MSPSS), Brief Illness Perception Questionnaire (B-IPQ), Hospital Anxiety and Depression Scale (HADS) and subscales for Anxiety (HADS-A) and Depression (HADS-D), and Jenkins Sleep Evaluation Scale (JSS). To determine the predictors of the development and severity of CS, multiple linear and logistic regression analyses were performed. The frequency of CS was 57.4% in the study population ( n = 108). CSI score was correlated with the duration of morning stiffness, BASDAI, ASDAS-CRP, ASDAS-ESR, NRS GLOBAL , BASFI, MASES, ASOoL, JSS, HADS, and B-IPQ total scores ( ρ ranged from 0.510 to 0.853). Multiple regression analysis indicated that BASDAI (OR: 10.44, 95% CI: 2.65–41.09), MASES (OR: 2.47, 95% CI: 1.09–5.56) and HADS-A (OR: 1.62, 95% CI: 1.11–2.37) were independent predictors of the development of CS. Additionally, higher NRS GLOBAL , JSS, HADS-D, and HADS-A scores appeared to determine the severity of CS. This study confirms that worse disease activity, more enthesal involvement, and anxiety independently predict the development of CS. Additionally, higher patient-perceived disease activity, sleep impairment and poor mental health significantly contribute to the severity of CS.