Archives of rheumatology最新文献

Background/aims: This study aimed to evaluate the effectiveness of therapeutic exercises in improving muscle strength, functional status, and quality of life in patients receiving high-dose glucocorticoid therapy, which is known to cause muscle weakness and atrophy.

Materials and methods: This randomized, controlled, single-center study included 40 participants aged 18-65 years who received high-dose glucocorticoids due to chronic rheumatologic conditions, and the patients were divided into 2 groups: an exercise group and a control group. The exercise group performed lower-extremity resistance exercises for 3 months. The exercise program consisted of squats, seated leg extensions, seated leg curls, hip abductions, and seated calf raises performed 5 days per week. Functional assessments included the 6-minute walk test, the Five Times Sit To Stand Test, and the Timed Up and Go Test. Muscle strength was measured using a dynamometer, quality of life was assessed with the Short Form Health Survey questionnaire, and the cross-sectional area (CSA) of the rectus femoris muscle was evaluated via B-mode ultrasound. Patients were assessed at baseline and after 3 months of treatment.

Results: Twenty patients were included in each group, with no significant differences in baseline characteristics. Compared with the control group, a significant increase was observed in knee extension strength (P = .00 for right and left knees) and quality of life in terms of physical function in the exercise group. However, no significant differences were found in the 6-minute walk test, the Five Times Sit To Stand Test, the Timed Up and Go Test, or the rectus femoris muscle CSA.

Conclusion: In patients with rheumatologic diseases treated with highdose glucocorticoids, resistance exercise therapy can increase knee extension strength and quality of life in terms of physical function. Cite this article as: Karacaatlı M, Abacar K, Karabacak M, et al. The impact of resistance exercise program on muscle strength, functional performance, and quality of life in patients with rheumatologic disease receiving high-dose glucocorticoids treatment: A randomized trial. ArchRheumatol. 2026;41(1):40-46.

Background/aims: To evaluate the distal femoral cartilage thickness (FCT) and talar cartilage thickness (TCT) and the frequency of neuropathic pain (NeP) in patients with early rheumatoid arthritis (RA) and to investigate their relationships with each other and other domains of health.

Materials and methods: The study included 35 patients with RA, who had a maximum disease duration of up to 1 year and 35 healthy controls (HCs) with demographic characteristics similar to the patients. Bilateral FCT and TCT of all participants were measured using ultrasonography. Pain, disease activity, level of functioning, quality of life (QoL), and anxiety and depression were evaluated with appropriate scales/questionnaires. Additionally, the presence of NeP was assessed with the painDETECT questionnaire.

Results: Distal FCT (central, medial, and lateral regions) and TCT in the right and left extremities were not different between patients with early RA and HCs. Cartilage thicknesses were largely similar between the active and inactive patient subgroups. Patients with RA exhibited a significantly higher frequency of NeP than HCs (17.2% vs. 0%) (P = .012). There was a weak positive correlation between some parameters measuring disease activity and unilateral and/or bilateral FCT/TCT values. Conversely, C-reactive protein showed a weak negative correlation with right extremity (medial and lateral) FCT. No clear relationship was observed between cartilage thickness and NeP, functional status, QoL, or anxiety and depression. In addition, NeP showed significant associations with pain, most disease activity scores, anxiety, and QoL; however, it was not associated with swollen joint counts, acute phase reactants, or functional status.

Conclusion: The findings indicate that distal FCT and TCT may not be affected in the early stages of RA. However, there is an increase in the frequency of NeP compared to the HCs. The presence of NeP seems to be associated with disease activity, QoL, and mental health, but not with cartilage thickness. Cite this article as: Kaplan H, Cengiz G, Akay R, Köksal M, Talay Çalış H. Simultaneous evaluation of distal femoral and talar cartilage thicknesses and neuropathic pain in patients with early rheumatoid arthritis: Is there any relationship with other domains of health?. ArchRheumatol. 2026;41(1):47-56.

Background/aims: This study aims to assess serum levels of calcitonin gene-related peptide (CGRP) in patients with rheumatoid arthritis (RA), compare these levels with those of healthy controls, and analyze their correlation with disease activity.

Materials and methods: This cross-sectional, case-controlled study involved 80 individuals diagnosed with RA based on the American College of Rheumatology/The European Alliance of Associations for Rheumatology (ACR/EULAR) 2010 criteria and 40 healthy individuals serving as the control group. Demographic data, along with clinical and laboratory findings of the participants, were documented for analysis. C-reactive protein (CRP), CGRP, and erythrocyte sedimentation rate (ESR) levels were measured in both the RA and control groups. Disease activity among patients with RA was assessed using the Visual Analog Scale (VAS), Disease Activity Score- 28 (DAS-28), and Health Assessment Questionnaire (HAQ). Logistic regression was performed to identify significant predictors, and the optimal cut-off value was established through receiver operating characteristic (ROC) analysis.

Results: The median serum CGRP level in patients with RA (91.1 pg/mL) was significantly higher than that of the control group (40.8 pg/mL) (P < .001). The median serum CGRP level was significantly greater in seropositive patients with RA (118.7 pg/mL) compared to seronegative patients (66.1 pg/mL) (P = .017). The ROC analysis identified 61.78 pg/mL as the optimal CGRP cut-off to distinguish patients with RA from controls, with 70% sensitivity and 87.5% specificity (Area Under the Curve (AUC): 0.839, P < .001). A significant correlation was observed between CGRP levels in patients with RA and the scores of DAS-28, HAQ, VAS-Patient, and VASPhysician (P = .001, P = .006, P < .001, P = .001). Logistic regression analyses demonstrated that increases in CGRP (P = .002) and CRP (P = .011), as well as CGRP (P = .001) and ESR (P < .001), were each significantly associated with higher odds of active disease.

Conclusion: The findings suggest that higher serum CGRP levels may contribute to the pathophysiology of RA, potentially indicating disease progression, joint damage, and supporting prognosis in the management of RA. Cite this article as: Dede Akpınar M, Ataoğlu S, Cangür Ş. A crosssectional study on elevated serum calcitonin gene-related peptide levels in rheumatoid arthritis patients and their relationship with disease activity. ArchRheumatol. 2026;41(1):29-39.

Background/aims: Carpal tunnel syndrome (CTS) may be overlooked in patients with fibromyalgia (FM) due to the high prevalence of paresthesia and hand pain. This study aimed to determine the presence of CTS in patients with FM compared to healthy controls and to identify potential associations between clinical parameters and ultrasound (US).

Materials and methods: This study included 40 patients with FM (80 wrists) and 36 healthy controls (72 wrists). The presence of paresthesia, sensory/motor deficits, and Tinel/Phalen test results was recorded. All participants underwent US to assess the median nerve cross-sectional area (CSA), distal/proximal ratio, and intraneural power Doppler signal (PDS). Electrodiagnostic studies were conducted in the presence of any CTS-related symptom. The Boston Carpal Tunnel Syndrome Questionnaire symptom severity (BCTQs) and functional status (BCTQf) scale, and the Fibromyalgia Impact Questionnaire (FIQ) were recorded for all FM patients.

Results: Carpal tunnel syndrome was identified in 18 wrists (22.5%) of 14 patients (35%) in the FM group, whereas it was present in only 2 wrists (2.8%) of a single participant (2.8%) in the control group (P < .001). No statistically significant differences were observed in the median nerve CSA, distal/proximal ratio, and PDS between the groups (P = .727, P = .270, and P = .058, respectively). Median nerve CSA was moderately correlated with BCTQs, BCTQf, and FIQ (r = 0.557, r = 0.599, r = 0.553; all P < .001) in patients with FM. Median nerve CSA was greater in moderate (1.31 [1.30-1.47]) than mild CTS (1.13 [1.00-1.20]) (P < .001).

Conclusion: Carpal tunnel syndrome appears to be a common clinical manifestation of FM. Ultrasonographic evaluation demonstrated significant correlations with clinical scales, highlighting its value as a complementary tool in evaluating CTS in FM. Cite this article as: Akkaya S, Saglam Akkaya G, Alisar K, Cetinkaya Alisar D, Karakullukcu S. Presence of carpal tunnel syndrome and its impact on clinical and ultrasonographic evaluations in patıents with fibromyalgia. ArchRheumatol. 2026;41(1):64-71.

Background/aims: Glucocorticoids (GCs) and disease-modifying antirheumatic drugs (DMARDs) are commonly used drugs in the treatment of immunoglobulin G4-related disease (IgG4-RD). However, no broad consensus is available on their intervention effects. Therefore, the efficacy and safety of different medication protocols in the treatment of IgG4-RD were assessed in this systematic review and network meta-analysis.

Materials and methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RStudio and Stata 15.1 were used for data analysis.

Results: The results showed that in terms of improvement of remission rates, GCs + DMARDs had the strongest overall efficacy [surface under the cumulative ranking curve (SUCRA) = 82.9%], and DMARDs were the most effective within 12 months during follow-up (SUCRA = 82.5%), while GCs + DMARDs were the most effective over 12 months during follow-up (SUCRA = 83.2%). In terms of reduction of relapse rates, the overall efficacy of GCs + DMARDs was the strongest (SUCRA = 83.5%), and GCs + DMARDs performed the best both within and over 12 months during follow-up. The adverse reaction rates were 38.9%, 5.3%, and 33.3%, respectively, among patients treated with GCs + DMARDs, DMARDs, and GCs.

Conclusion: The GCs + DMARDs are recommended for short-term improvement of remission rates and reduction of relapse rates, as well as for achieving long-term efficacy. Cite this article as: Liu Y, Fu X, Zhang Y, et al. Comparison of efficacy and safety of different medication protocols in patients with immunoglobulin G4-related disease based on follow-up time: A systematic review and network meta-analysis. ArchRheumatol. 2026;41(1):3-13.

Background/aims: Psoriatic arthritis (PsA) and psoriasis (PS) are chronic inflammatory disorders characterized by significant systemic involvement and comorbidities. This study investigated the occurrence of periodontitis among PS and PsA patients and evaluated its associations with clinical and demographic factors.

Materials and methods: Comprehensive evaluations were performed, including the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) for all participants, along with PsA-specific assessments such as Psoriatic Arthritis and Composite Psoriatic Disease Activity Index (CPDAI). Dermatological and periodontal clinical parameters were recorded. The participants were organized into 2 groups: those with periodontitis and those without.

Results: The study included 128 participants: 62 with PS and 66 with PsA. Although the prevalence of periodontitis was higher among PsA patients compared with those with PS (46.97% vs 30.65%), this difference did not reach statistical significance (P = .058). Elevated CPDAI (odds ratio [OR]: 1.38; P = .001) and MASES (OR: 1.39; P < .001) scores were significantly associated with the presence of periodontitis in PsA patients.

Conclusion: In this study, patients with periodontitis demonstrated higher disease activity scores, underscoring the importance of incorporating periodontal assessment into the multidisciplinary management of psoriatic disease, particularly in patients with active disease. Cite this article as: Akyuz B, Durmus H, Baytımur H, et al. Periodontal status and disease activity in psoriatic arthritis and psoriasis: A cross-sectional study. Arch Rheumatol. 2026;41(1):14-21.

Background/aims: This study compared the mid-term effectiveness of ultrasoundguided (USG) vs. landmark (LM)-guided corticosteroid injections in patients with moderate carpal tunnel syndrome (CTS), evaluating symptom severity, functional status, sonographic and electrophysiological parameters, and complications over 6 months.

Materials and methods: A prospective, randomized, double-blind trial was conducted on 168 wrists (84 participants) with bilateral moderate CTS. Participants were divided into LM-guided and USG injection groups. Primary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Secondary outcomes were grip strength (GS), median nerve cross-sectional area (MNSA), median nerve flattening ratio (MNFR), and electrophysiological parameters. Assessments were performed at baseline, 1 month, and 6 months post injection.

Results: Both groups showed significant improvements in BCTQ-SSS, BCTQ-FSS, GS, MNSA, MNFR, and electrophysiological parameters at 1 and 6 months (P < .05). No significant differences were observed between the 2 techniques in efficacy. However, hypopigmentation occurred more frequently in the LM group (11% vs. 3%, P = .04). No severe complications were reported.

Conclusion: The USG and LM-guided corticosteroid injections are equally effective for moderate CTS over 6 months. While USG may reduce minor complications like hypopigmentation, both methods are safe and viable options when performed by experienced clinicians. Cite this article as: Topcu-Altın N, Sarı MH, Bilgilisoy-Filiz M, et al. Efficacy of ultrasound versus landmark-guided steroid injections for carpal tunnel syndrome: A randomized doubleblind trial. ArchRheumatol. 2026;41(1):22-28.

 Background/Aims: This study aimed to evaluate the diagnostic performance of ChatGPT in grading sacroiliitis on pelvic radiographs according to the modified New York criteria.

Materials and methods: This retrospective study included 266 individuals with or without radiographic sacroiliac joint involvement according to the modified New York criteria (231 with ankylosing spondylitis and 35 without radiographic evidence of sacroiliitis). Two experts independently graded all radiographs based on the modified New York criteria, with disagreements resolved by a third reviewer. ChatGPT-5o (OpenAI, 2025) was prompted to classify each radiograph using a standardized English-language instruction. ChatGPT's grading outputs were compared with expert consensus.

Results: A statistically significant association was found between ChatGPT and expert gradings, but agreement remained slight (κ = 0.136). Multi-class performance was limited (overall accuracy = 30%), while binary analysis showed higher apparent accuracy (78%) due to a strong positive bias. Sensitivity was 0.796, specificity was 0.696, positive predictive value was 0.946, and negative predictive value was 0.338. Per-grade area under curve values ranged from 0.52 to 0.75, with the highest for Grade 0.

Conclusion: ChatGPT demonstrated only limited agreement with expert assessments and showed poor ability to distinguish between sacroiliitis stages, performing adequately only for normal joints. These findings suggest that large language models like ChatGPT are unsuitable for direct radiographic interpretation without integration into specialized, vision-based diagnostic frameworks. Cite this article as: Güngör Demir U, Demir AN, Uysal A. Evaluation of the diagnostic performance of ChatGPT in radiographic staging of sacroiliitis according to the modified New York criteria. ArchRheumatol. 2026;41(1):57-63.

Background/aims: Fibromyalgia (FM) is a chronic pain condition in which patients experience diffuse musculoskeletal discomfort accompanied by marked fatigue, non-restorative sleep patterns, and cognitive complaints. Individuals with FM exhibit elevated inflammatory cytokines. The aim was to investigate the prevalence of FM in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) and to evaluate the effects of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) on FM.

Materials and methods: Patients were enrolled in the study, including spondyloarthritis and RA patients. Disease activity in RA patients was assessed using the Disease Activity Score-28 scores. For SpA patients, the Bath Ankylosing Spondylitis Disease Activity Index and the Bath Ankylosing Spondylitis Metrology Index were used to evaluate disease activity and structural damage. Patients were evaluated for FM according to the 1990 American College of Rheumatology classification criteria. The Fibromyalgia Impact Questionnaire was administered for FM severity.

Results: There was no significant difference in the prevalence of FM between the RA and SpA groups (P = .942). The prevalence of FM was significantly higher among patients not receiving b/tsDMARDs compared to those who were (P = .033). In the SpA subgroup, no significant difference in FM prevalence was observed between patients using and not using b/ tsDMARDs (P = .314). However, in the RA subgroup, FM prevalence was significantly higher among patients not receiving b/tsDMARDs (P = .030).

Conclusion: The findings suggest that the use of b/tsDMARDs appears to be associated with a reduced prevalence of FM among patients with RA. It is believed that this study provides a window for future studies. Cite this article as: Caglayan M, Oktayoglu P, Celik Y, et al. Assessment of the concomitance of fibromyalgia in patients with axial spondyloarthritis and rheumatoid arthritis. ArchRheumatol. 2026;41(1):72-80.

Background/aims: To investigate the relationship between food composition and patterns and disease activity in psoriatic arthritis (PsA) patients.

Materials and methods: This cross-sectional study evaluated patients with PsA (n = 73). Sociodemographic and disease-related parameters, including the duration of illness, Disease Activity Index for PsA (DAPSA), C-reactive protein, erythrocyte sedimentation rate (ESR), the Health Assessment Questionnaire (HAQ), and Mediterranean Diet Compatibility Scale were assessed. Nutrient intake was recorded over 3 days and analyzed using a standard nutritional analysis program. Processed food consumption was classified according to the NOVA system.

Results: Among the patients with PsA, 71.2% of patients were female, 42.5% were obese, and 72.6% had low adherence to the Mediterranean diet (MD). The body mass index (BMI) and HAQ scores were higher in those with moderate-severe disease (DAPSA ≥ 15) than in those in remission or with mild disease (DAPSA ≤ 14) (P = 0.006 and P = 0.008, respectively). The MD adherence score was negatively correlated with the DAPSA, HAQ, and ESR (P = .025, P = .015, and P = .006, respectively). Higher adherence to the MD was associated with a lower risk of moderate-to-severe disease, while increases in cholesterol intake, sodium intake, and BMI were associated with a higher risk of disease severity.

Conclusion: Obesity negatively affects disease progression in PsA. A protein-rich and a low-sodium diet appear to support remission, while poor adherence to the MD and high cholesterol intake may contribute to increased disease activity. These findings emphasize the importance of nutrition in the clinical course of PsA. Cite this article as: Varkal G, Akarca NN, Türk İ, Yetişir A, Mete B. Effect of nutritional ingredients on disease activation in psoriatic arthritis. Arch Rheumatol. 2025;40(4):459-464.