Publications by authors named "Sinan Kardeş"

22 Publications

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Public interest in musculoskeletal symptoms and disorders during the COVID-19 pandemic : Infodemiology study.

Z Rheumatol 2021 Mar 29. Epub 2021 Mar 29.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Topkapı, Turgut Özal Millet Cd, 34093, Fatih/İstanbul, Turkey.

Objective: The goal was to assess public interest in a wide range of musculoskeletal symptoms and disorders during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: We searched Google Trends for 118 search queries within the United States. We compared two timeframes of 2020 (March 15-July 4 and July 5-October 31) to similar timeframes over the four prior years (2016-2019).

Results: In the early pandemic, March 15-July 4, a statistically significant decrease in relative search volume of the majority of queries (60%) was detected, with a significant increase in only 2 queries (i.e. myalgia and toe swelling). In the phase July through October, a statistically significant decrease was detected in only 22% of search queries; there was no difference for 60% of search queries between 2020 and 2016-2019 suggesting a return to their prior levels for most of search queries. Interestingly, the search volume of 18% of search queries (i.e. fatigue, joint pain, muscle pain, myalgia, spondylosis, radiculopathy, myelopathy, neck pain, neck strain, lower back strain, sciatica, shoulder pain, frozen shoulder, elbow pain, lateral epicondylitis, wrist pain, carpal tunnel, hand pain, finger pain, trigger finger, and Morton's neuroma) was significantly increased compared with the four prior years.

Conclusion: Public interest focused on COVID-19 and sought online information for COVID-19 symptoms in the early pandemic. In the period July through October, there was an upward trend in musculoskeletal symptoms and some colloquial terms/well-known musculoskeletal conditions coupled with a downward trend in general musculoskeletal disorder terms and certain specific diagnoses. This information may help rheumatologists understand public interest in musculoskeletal symptoms and disorders and address the needs of patients to mitigate the negative impact of the pandemic on outcomes.
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http://dx.doi.org/10.1007/s00393-021-00989-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006118PMC
March 2021

Public interest in dermatologic symptoms, conditions, treatments, and procedures during the COVID-19 pandemic: Insights from Google Trends.

Dermatol Ther 2021 Mar 25;34(2):e14895. Epub 2021 Feb 25.

Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.

Coronavirus disease 2019 (COVID-19) pandemic had substantial effect both on daily life and medical practice. Internet data have been used to analyze the trends in public interest in various medical conditions and treatments. The aim of this study is to analyze the public interest in dermatologic symptoms, conditions, treatments, and procedures during the COVID-19 pandemic. Google Trends was queried for a total of 120 dermatological search queries. Three periods of 2020 ([March 15-May 9], [May 10-July 4], and [July 5-October 31]) were compared with the previous 4 years (2016-2019). A significantly decreased interest in skin cancers and certain dermatologic conditions (eg, pityriasis rosea and scabies) was observed throughout the study period. Whereas a significant increase of interest in dry skin, hair shedding, oily hair, atopic dermatitis, and hand eczema was detected during the study. An initial decrease in interest was followed by a significant increase for acne, comedones, melasma, rosacea, botox, dermaroller, and peeling. The study demonstrated a significant impact of the COVID-19 pandemic on the public interest in dermatology. The present results would help to create healthcare policies and information sources, which can meet the public demand. The reasons for the observed trends and their effect on patient outcomes might be of interest for future studies.
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http://dx.doi.org/10.1111/dth.14895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995005PMC
March 2021

Public interest in spa therapy during the COVID-19 pandemic: analysis of Google Trends data among Turkey.

Authors:
Sinan Kardeş

Int J Biometeorol 2021 Jan 13. Epub 2021 Jan 13.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

In Turkey, spas are widely used and preferred by patients who are seeking relief from their disability and pain. The spa therapy program is partly reimbursed by the national health insurance system. The objective of the present study was to leverage Google Trends to elucidate the public interest in spas in Turkey during the COVID-19 pandemic. Google Trends was queried to analyze search trends within Turkey for the Turkish term representing a spa (i.e., kaplıca) from January 01, 2016, to September 30, 2020. The relative search volume of "kaplıca" was statistically significantly decreased in the March 15-May 30, 2020 (- 73.04%; p < 0.001); May 31-July 25, 2020 (- 41.38%; p < 0.001); and July 26-September 19, 2020 (- 29.98%; p < 0.001) periods compared to similar periods of preceding 4 years (2016-2019). After June 1, 2020, the relative search volume was shown to have a moderate recovery, without reaching the level of 2016-2019. Public interest in spas showed an initial sharp decline between mid-March and May, with a moderate increase during the June-August period. This finding might be indicative of public preference in undertaking spa therapy during the COVID-19 period. In Turkey, spas might be used to increase places providing rehabilitation for both non-COVID-19 patients and survivors of COVID-19 with long-term symptoms during the pandemic.
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http://dx.doi.org/10.1007/s00484-021-02077-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805426PMC
January 2021

Spa therapy (balneotherapy) for rehabilitation of survivors of COVID-19 with persistent symptoms.

Authors:
Sinan Kardeş

Med Hypotheses 2021 01 23;146:110472. Epub 2020 Dec 23.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.mehy.2020.110472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758027PMC
January 2021

Chemical and mineralogical characteristics of peloids in Turkey.

Environ Monit Assess 2020 Dec 2;192(12):805. Epub 2020 Dec 2.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey.

To investigate the physical, chemical, and mineralogical characteristics of peloids, which are being used traditionally and historically across Turkey, and evaluate their suitability and potential for use in peloidotherapy. Five peloid samples were gathered from their places of origin, namely Gölemezli, Dalyan, Köprüköy, Gökçeada, and Dikili. Mineral analysis and physical and chemical analyses including electrical conductivity, density, cations, anions, trace elements, organic matters, and water retention capacity at 105 °C were performed. The peloids contained a combination of clay minerals (mainly montmorillonite, kaolinite, and muscovite) and non-clay minerals (mainly quartz, calcite, dolomite, and albite) except for Gölemezli peloid, which was dominated by calcite. The other minerals (i.e., chloride-serpentine, sphalerite, pyrite, magnesium calcite, cristobalite) were also found in some peloids. Gölemezli, Dalyan, and Köprüköy peloids had high total organic matters, mainly humic substances. The water retention capacity was high in Dalyan, Köprüköy, and Dikili peloids. All peloids had a pH value slightly greater than 7 (range 7.93-8.69). Dalyan, Köprüköy, and Dikili peloids had a high water retention capacity. Dalyan and Gökçeada peloids had a high electrical conductivity, 22.040 and 9.020 μS/cm, respectively. The density of peloids was ranged between 1.240 (Gölemezli) and 1.450 (Gökçeada) g/cm. Total mineralization of investigated peloids was greater than 1000 mg/L: Köprüköy, 2754.8 mg/L; Gölemezli, 3092.8 mg/L; Dikili, 4044.6 mg/L; Gökçeada, 6576.6 mg/L; and Dalyan, 11782.9 mg/L, mainly sodium, magnesium, calcium, chloride, sulfate, bicarbonate, and metasilicic acid. The levels of trace elements were low (≤ 2.0 mg/L) in all peloids. The peloids contained various amounts of clay minerals (mainly montmorillonite, kaolinite, and muscovite), non-clay minerals (mainly quartz, calcite, dolomite, and albite), organic matters (mainly humic acid), cations (mainly sodium, magnesium, and calcium), anions (mainly chloride, sulfate, and bicarbonate), and insoluble compounds (mainly metasilicic acid). The physical, chemical, and mineralogical properties of peloids suggest their suitability and potential for use in peloidotherapeutic applications.
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http://dx.doi.org/10.1007/s10661-020-08777-2DOI Listing
December 2020

Population-level interest in anti-rheumatic drugs in the COVID-19 era: insights from Google Trends.

Clin Rheumatol 2020 Oct 31. Epub 2020 Oct 31.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey.

Introduction/objective: The general public may utilize online information through search engines for implications and risks of some anti-rheumatic drugs. These drugs have been used in the management of coronavirus disease 2019 (COVID-19) and associated inflammatory sequelae or cytokine storm of infection. Therefore, the objective of this study was to investigate the population-level interest in anti-rheumatic drugs during the COVID-19 era, by analyzing changes in Google search frequency data.

Method: To obtain the relative search volume (RSV) of anti-rheumatic drugs, we queried Google Trends for 78 search terms representing non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, antigout agents, conventional disease-modifying anti-rheumatic drugs (DMARDs), immunosuppressants, biologics, and Janus kinase (JAK) inhibitors within the USA. Three 8-week periods in 2020 (March 15-May 9), (May 10-July 4), and (July 5-August 29) representing the initial- and short-term periods were compared to overlapping periods of the preceding 3 years (2017-2019).

Results: We found statistically significant increases in RSV for colchicine, hydroxychloroquine, tocilizumab (and its brand name-Actemra), and anakinra, and statistically significant decreases among brand names of immunosuppressive agents (i.e., mycophenolate mofetil, azathioprine, cyclophosphamide, tacrolimus, cyclosporine) during both the initial- and short-term COVID-19 periods as compared to overlapping periods of the preceding 3 years.

Conclusion: There were significant increases in RSV of colchicine, hydroxychloroquine, tocilizumab, and anakinra during both initial- and short-term COVID-19 periods when compared to overlapping periods of the preceding 3 years reflecting a heightened level of information-seeking on these drugs during the pandemic. Rheumatologists should address this increase in informational demand. Further research assessing medium- and long-term interest in anti-rheumatic drugs is required to increase our knowledge on this new pandemic. Key Points •This study was aimed to investigate the population-level interest in anti-rheumatic drugs in the COVID-19 era, by analyzing changes in Google search frequency data. •Significant increases were seen in relative searches for colchicine, hydroxychloroquine, tocilizumab, and anakinra during both initial and short-term COVID-19 periods when compared to similar periods of 2017-2019 reflecting a heightened level of information-seeking on these drugs during the pandemic. •Rheumatologists should address this increase in informational demand for colchicine, hydroxychloroquine, tocilizumab, and anakinra.
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http://dx.doi.org/10.1007/s10067-020-05490-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603411PMC
October 2020

Public interest in rheumatic diseases and rheumatologist in the United States during the COVID-19 pandemic: evidence from Google Trends.

Rheumatol Int 2021 02 18;41(2):329-334. Epub 2020 Oct 18.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey.

To evaluate the public interest in rheumatic diseases during the coronavirus disease 2019 (COVID-19) pandemic. Google Trends was queried to analyze search trends in the United States for numerous rheumatic diseases and also the interest in a rheumatologist. Three 8-week periods in 2020 ((March 15-May 9), (May 10-July 4), and (July 5-August 29)) were compared to similar periods of the prior 4 years (2016-2019). Compared to a similar time period between 2016 and 2019, a significant decrease was found in the relative search volume for more than half of the search terms during the initial March 15-May 9, 2020 period. However, this trend appeared to reverse during the July 5-August 29, 2020 period where the relative volume for nearly half of the search terms were not statistically significant compared to similar periods of the prior 4 years. In addition, this period showed a significant increase in relative volume for the terms: Axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren's syndrome, antiphospholipid syndrome, scleroderma, Kawasaki disease, Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis, and rheumatologist. There was a significant decrease in relative search volume for many rheumatic diseases between March 15 and May 9, 2020 when compared to similar periods during the prior 4 years. However, the trends reversed after the initial period ended. There was an increase in relative search for the term "rheumatologist" between July and August 2020 suggesting the need for rheumatologists during the COVID-19 pandemic. Policymakers and healthcare providers should address the informational demands on rheumatic diseases and needs for rheumatologists by the general public during pandemics like COVID-19.
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http://dx.doi.org/10.1007/s00296-020-04728-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568841PMC
February 2021

Retractions in Rehabilitation and Sport Sciences Journals: A Systematic Review.

Arch Phys Med Rehabil 2020 11 10;101(11):1980-1990. Epub 2020 May 10.

Department of Medical Ecology and Hydroclimatology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey.

Objective: To identify the characteristics of retracted publications in rehabilitation and sport sciences journals.

Data Sources: The Web of Science, PubMed, and Retraction Watch databases were searched from inception to August 2019.

Study Selection: Retracted publications published in rehabilitation or sport sciences journals, indexed in the Science Citation Index Expanded (SCIE) and Social Sciences Citation Index (SSCI) were included.

Data Extraction: One author extracted the data. Two other authors checked the data.

Data Synthesis: A total of 37 and 52 retracted publications and their retraction notices were identified for rehabilitation and sport sciences, respectively. The majority of retracted publications (68% of all retracted papers in rehabilitation and 54% of all retracted papers in sport sciences) were published in the past decade. Retracted publications in rehabilitation and sport sciences were published in 21 and 22 different journals and originated from 18 and 21 different countries, respectively. The full-text of the retracted publications was available with a retraction watermark or note for 59% of cases in rehabilitation and 58% in sport sciences. The reasons for the retractions were more often attributed to misconduct (79% and 61%) than to honest error (21% and 39%) in rehabilitation and sport sciences, respectively. However, a reason was not stated for 15% of the publications. The median time interval between publication and retraction was 622 days in rehabilitation and 607 days in sport sciences publications.

Conclusions: The total number of retracted publications in rehabilitation and sport sciences journals was small. The retracted publications have been published in a variety of rehabilitation and sport sciences journals and came from different countries across the world. Several retracted publications and retraction notices failed to adhere to The Committee on Publication Ethics guidelines in the handling of full-text (retain with a watermark or note) or stating the underlying reasons for the retraction.
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http://dx.doi.org/10.1016/j.apmr.2020.03.010DOI Listing
November 2020

Comment on "Efficacy of duloxetine and gabapentin in pain reduction in patients with knee osteoarthritis".

Authors:
Sinan Kardeş

Clin Rheumatol 2019 11 1;38(11):3315. Epub 2019 Aug 1.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34093, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s10067-019-04647-6DOI Listing
November 2019

Comment on "Seasonal variations of Google searches for joint swelling: implications for patient-reported outcomes".

Authors:
Sinan Kardeş

Clin Rheumatol 2019 08 11;38(8):2283-2284. Epub 2019 Jun 11.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa, 34093, Istanbul, Turkey.

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http://dx.doi.org/10.1007/s10067-019-04623-0DOI Listing
August 2019

Seasonal variation in the internet searches for psoriasis.

Authors:
Sinan Kardeş

Arch Dermatol Res 2019 Aug 25;311(6):461-467. Epub 2019 Apr 25.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey.

Some researches with different designs investigated the seasonal pattern of psoriasis; however, the seasonal variation in public interest in psoriasis has not yet been examined. The monitoring of internet search activity has increasingly been used to gain insights into public interest in health-related topics. The aim of the investigation is to employ the Google Trends datasets to evaluate whether a seasonal trend exists in the internet searches of psoriasis by the general public. In the observational investigation, the Google Trends was queried for the [psoriasis] in the United States, the United Kingdom, Canada, Ireland, Australia, and New Zealand between January 2004 and December 2018. The cosinor analysis demonstrated a statistically significant seasonal pattern of searches for [psoriasis] in the United Kingdom (p < 0.001), Canada (p = 0.002), Ireland (p < 0.001), Australia (p < 0.001), and New Zealand (p < 0.001), and a trend towards a seasonal variation in searches in the United States (p = 0.079), with the zenith in late winter/early spring and through in late summer/early fall. A zenith in late winter/early spring and valley in late summer/early fall presented an approximately 6-month difference between hemispheres. Public interest in seeking psoriasis information through internet searches displayed a seasonal pattern, with the highest interest in the late winter/early spring. If a more comprehensive study validated the association of psoriasis flares with patterns in online searches, beyond investigating only seasonality in public interest, the internet data could be used to guide public health interventions and to manage the care of patients with psoriasis.
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http://dx.doi.org/10.1007/s00403-019-01921-0DOI Listing
August 2019

Seasonality of bruxism: evidence from Google Trends.

Sleep Breath 2019 Jun 21;23(2):695-701. Epub 2019 Feb 21.

Department of Pediatric Dentistry, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.

Objective: Seasonality of bruxism and its symptoms has not been tested and reflects a major niche in our understanding and the epidemiology of bruxism. Our aim is to use the Google Trends data to examine whether there was a seasonal pattern in the Google search volumes of bruxism and its symptoms on a population basis.

Methods: In the observational, ecological research, we interrogated Google Trends for the following query terms: [bruxism] and [teeth grinding + teeth clenching] to obtain the internet search query volume. These queries were searched within the USA, the UK, Canada, and Australia from January 2004 to December 2017.

Results: The cosinor analysis showed statistically significant seasonal patterns in [bruxism] in the USA (amplitude {A} = 1.91, p = 0.003), Canada (A = 1.91, p < 0.001), and Australia (A = 2.25, p < 0.001), and a trend towards a seasonal variation in the UK (A = 1.11, p = 0.032), with a peak in the winter months and trough in the summer months. Similarly, a statistically significant seasonal variation was found in [teeth grinding + teeth clenching] in the USA (A = 5.54, p < 0.001), the UK (A = 4.36, p < 0.001), and Australia (A = 3.11, p < 0.001), and a trend towards a seasonal variation in Canada (A = 1.53, p = 0.034). The peaks in winter and troughs in summer were reversed by 6 months in countries of northern hemisphere compared to Australia. Time series plots emphasized the consistency of seasonal trend that was ascertained in the cosinor analysis, by repeating in nearly all years.

Conclusion: The preliminary evidence showed a seasonal variation in bruxism and its symptoms, with a peak in the winter months. This novel finding in bruxism epidemiology requires to be verified with clinical studies, and further researches are necessary to elucidate the potential mechanism behind seasonal variation in bruxism.
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http://dx.doi.org/10.1007/s11325-019-01787-6DOI Listing
June 2019

Seasonal variation in the internet searches for gout: an ecological study.

Authors:
Sinan Kardeş

Clin Rheumatol 2019 Mar 29;38(3):769-775. Epub 2018 Oct 29.

Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Çapa, 34093, İstanbul, Turkey.

Introduction/objective: While few studies with various types of outcomes and methodology have investigated the seasonality of gout, no internet data has been used in any study. This novel methodology may complement and extend the previous traditional data sources and has increasingly been used in investigating the seasonality of health conditions. Therefore, the objective of this study was to utilize the Google Trends data to test whether there is a seasonal variation in the internet searches for gout on a population basis.

Methods: In this observational ecological study, the Google Trends was searched for the [gout] within the USA, the UK, Canada, Ireland, Australia, and New Zealand from January 01, 2004, to December 31, 2017, utilizing the "health" category.

Results: The cosinor analyses revealed a statistically significant seasonal variation in relative search volume of the [gout] in the USA, the UK (p < 0.001), Canada (p < 0.001), Ireland (p < 0.001), Australia (p < 0.001), and New Zealand (p < 0.001), with a peak in the late spring/early summer months and trough in the late fall/early winter months. The peaks in late spring/early summer and troughs in late fall/early winter were out of phase by 6 months in the northern compared to the southern hemisphere countries.

Conclusion: Another line of evidence from internet search query data showed a seasonal variation in gout, with a peak in the late spring/early summer months. Further studies aimed at elucidating the possible mechanisms behind seasonality in gout are needed.
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http://dx.doi.org/10.1007/s10067-018-4345-2DOI Listing
March 2019

Outpatient balneological treatment of osteoarthritis in older persons : A retrospective study.

Z Gerontol Geriatr 2019 Mar 24;52(2):164-171. Epub 2018 Jan 24.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Çapa, 34093, İstanbul, Turkey.

Objective: To evaluate the effectiveness and safety of outpatient balneological treatment consisting of hydrotherapy and peloid therapy in elderly patients with osteoarthritis.

Methods: In this retrospective observational study all patients aged ≥65 years with any type of osteoarthritis who received balneological treatment (hydrotherapy and peloid therapy) at our clinic between 2007 and 2016 were included. Hydrotherapy was applied as head-out immersion in a tap water pool at 36-38 °C for 20 min and then peloid therapy was applied as a local peloid pack on the painful region or joint at 42-43 °C for 20 min, on each weekday for 2 weeks. Patients were evaluated before and after the treatment and outcome measurements were pain, patient's global assessment, physician's global assessment, Western Ontario and McMaster Universities index, Lequesne hip index, Waddell index, neck pain and disability scale, and health assessment questionnaire.

Results: In total, 235 osteoarthritis patients comprising 61 generalized, 91 knee, 6 hip; 32 lumbar, 12 cervical, 1 foot and 32 hand osteoarthritis, were included in the analysis. We found significant improvements in pain and function scores in generalized, knee, lumbar, cervical and hand osteoarthritis. Patient's global assessment was also improved in all subtypes except hip (p = 1.000) and hand (p = 0.132) osteoarthritis subtypes. The majority of patients (59.1%) fulfilled the outcome measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. The treatment demonstrated a good safety profile.

Conclusion: Study results provide initial evidence for the potential beneficial effects and safety of outpatient balneological treatment (hydrotherapy and peloid therapy) in the management of older patients with osteoarthritis. Future randomized controlled studies are needed to confirm these results.
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http://dx.doi.org/10.1007/s00391-018-1370-3DOI Listing
March 2019

Long-term efficacy of spa therapy in patients with rheumatoid arthritis.

Rheumatol Int 2018 Mar 11;38(3):353-362. Epub 2018 Jan 11.

Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Çapa, 34093, Istanbul, Turkey.

Our previous crossover randomized trial suggested that spa therapy added to usual pharmacotherapy provides benefits that lasted 6 months over pharmacotherapy alone in rheumatoid arthritis patients. We now extend, and report the long-term results of that study. In the crossover trial, patients were randomized to spa therapy first group or control first group (first assignment, period 1, 6 months); after this period and washout phase (9 months), they crossed over to the other arm (second assignment, period 2, 6 months). In this long-term study, we now analyze the 15-month results of the first assignment, and 12-month results of the second assignment in the opposite side with a 6-month extension of the follow-up period. The clinical outcome measures were pain, patient and physician global assessment, Health Assessment Questionnaire, and Disease Activity Score-28. The 15-month results of first assignment revealed no statistically significant differences between the groups in any of the efficacy outcomes (p > 0.05 for all). The 12-month results for the second assignment after crossover revealed a statistically significant decrease between the groups regarding the patient global assessment scores (p = 0.016), physician global assessment scores (p = 0.003) and swollen joints counts (p = 0.030); however, no statistically significant difference was found between the groups in any of the other efficacy outcomes (p > 0.05 for all). The short- and medium-term beneficial effects of the 2-week spa therapy added to the usual pharmacotherapy observed through the initial 6-month evaluation period may be maintained mildly to moderately to the 12-month mark in rheumatoid arthritis patients receiving conventional disease-modifying antirheumatic drugs. Further studies with a larger sample size are needed for the confirmation of the study results.
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http://dx.doi.org/10.1007/s00296-017-3926-8DOI Listing
March 2018

Association of oxidative stress with clinical characteristics in patients with rheumatoid arthritis.

Eur J Clin Invest 2018 Jan 8;48(1). Epub 2017 Dec 8.

Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey.

Background: Few studies examining the association between oxidative stress and clinical parameters or disease activity in patients with rheumatoid arthritis (RA) are available. Therefore, the objective of this study was to test whether oxidative stress has any association with clinical parameters and disease activity in patients with RA.

Materials And Methods: In this post hoc cross-sectional study, 45 patients with RA treated with traditional disease-modifying antirheumatic drugs (DMARDs) ± low-dose glucocorticoids ± nonsteroidal analgesics for at least 3 months were analysed. Oxidative stress parameters were malondialdehyde (MDA), superoxide dismutase (SOD), antioxidant potential (AOP) and nonenzymatic superoxide radical scavenger activity (NSSA). Clinical parameters were pain, patient global assessment, physician global assessment, Health Assessment Questionnaire (HAQ), and disease activity score (DAS28).

Results: Plasma NSSA levels were significantly inversely correlated with tender joints count (r = -.304; P = .042), swollen joints count (r = -.342; P = .021) and DAS28 (r = -.396; P = .009). There were no significant correlations between MDA/SOD/AOP and any of clinical parameters or DAS28 (P > .05 for all). Multiple regression analysis revealed that NSSA was an independent variable of DAS28 (β=-.243, P = .016).

Conclusion: The preliminary results demonstrate that plasma NSSA levels were inversely correlated with tender and swollen joints count and DAS28 and that NSSA was independently associated with DAS28, in patients with RA treated with traditional DMARDs; and provide initial support that NSSA may be used as a biomarker of disease activity in patients with RA.
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http://dx.doi.org/10.1111/eci.12858DOI Listing
January 2018

Spa therapy adjunct to pharmacotherapy is beneficial in rheumatoid arthritis: a crossover randomized controlled trial.

Int J Biometeorol 2018 Feb 7;62(2):195-205. Epub 2017 Sep 7.

Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey.

This study aims to investigate whether 2-week spa therapy, as an adjunct to usual pharmacological therapy, has any beneficial effect in patients with rheumatoid arthritis (RA). In this single-blind crossover study, 50 patients were randomly assigned in a 1:1 manner to receive usual pharmacological therapy plus 2-week spa therapy or usual pharmacological therapy alone (period 1.6 months); after a 9-month washout, patients were crossed over to the opposite assignment (period 2.6 months). Spa therapy program included a daily saline balneotherapy session at 36-37 °C for 20 min except Sundays. The clinical outcomes were evaluated at baseline, after spa therapy (2 weeks) and 3 and 6 months after the spa therapy in both period and were pain (Visual Analogue Scale (VAS)), patient and physician global assessments (VAS), Health Assessment Questionnaire (HAQ), and Disease Activity Score (DAS28). Spa therapy was superior to control therapy in improving all the assessed clinical outcomes at the end of the spa therapy. This superiority persisted significantly in physician global assessment (p = 0.010) and with a trend in favor of spa group in patient global assessment (p = 0.058), function (p = 0.092), and disease activity (p = 0.098) at 3 months. Statistically significant improvements were found in spa therapy compared to control in disease activity (p = 0.006) and patient (p = 0.020) and physician global (p = 0.011) assessments, and a trend toward improvements in pain (p = 0.069) and swollen joints (p = 0.070) at 6 months. A 2-week spa therapy adjunct to usual pharmacological therapy provided beneficial clinical effects compared to usual pharmacological therapy alone, in RA patients treated with traditional disease-modifying antirheumatic drugs. These beneficial effects may last for 6 months.
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http://dx.doi.org/10.1007/s00484-017-1441-yDOI Listing
February 2018

Comment on CONCEPT by Reginster : are the authors' interpretations supported by the data analysis?

Authors:
Sinan Kardeş

Ann Rheum Dis 2018 02 10;77(2):e10. Epub 2017 Aug 10.

Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

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http://dx.doi.org/10.1136/annrheumdis-2017-212115DOI Listing
February 2018

Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients.

Int J Biometeorol 2017 Nov 30;61(11):1945-1956. Epub 2017 May 30.

Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey.

The objective of this study is to determine the use and efficacy of spa therapy in patients with a wide spectrum of rheumatic and musculoskeletal diseases under real-life clinical practice circumstances. In this retrospective observational study at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, the records of all adult patients with rheumatic and musculoskeletal diseases who were prescribed a spa therapy in various health resorts in Turkey between 2002 and 2012 were analyzed. Patients sojourned to and stayed at a health resort and followed a usual 2-week course of spa therapy. The patients were examined within a week before and after the spa therapy at the department by the physicians and outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index (WOMAC), Waddell Index (WI), Neck Pain and Disability Scale (NPDS), Shoulder Disability Questionnaire (SDQ), Fibromyalgia Impact Questionnaire (FIQ), and Beck's Depression Inventory (BDI). In total, 819 patients were included in the analysis. The diagnoses were 536 osteoarthritis; 115 fibromyalgia; 50 lumbar disc herniation; 34 cervical disc herniation; 23 nonspecific low back pain; 22 ankylosing spondylitis; 16 rheumatoid arthritis; 9 rotator cuff tendinitis; and 14 other conditions/diseases including scoliosis, stenosing flexor tenosynovitis, congenital hip dislocation in adult, Behçet's disease, de Quervain tendinopathy, psoriatic arthritis, osteoporosis, fracture rehabilitation, and diffuse idiopathic skeletal hyperostosis. Statistically significant decrease in pain scores was found in all patients except hip osteoarthritis (p = 0.063) and rheumatoid arthritis (p = 0.134) subgroups; and statistically significant improvement in function in all patients except hip osteoarthritis (p = 0.068), rheumatoid arthritis (p = 0.111), and rotator cuff tendinitis (p = 0.078) subgroups. In daily clinical practice, spa therapy is prescribed and practiced mainly for osteoarthritis, then fibromyalgia, lumbar/cervical disc herniation, and nonspecific low back pain; and less for ankylosing spondylitis, rheumatoid arthritis, and rotator cuff tendinitis. The study results suggest that real-life spa therapy may be effective in a variety of rheumatic and musculoskeletal diseases by improving pain and function.
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http://dx.doi.org/10.1007/s00484-017-1384-3DOI Listing
November 2017

Effect of spa therapy with saline balneotherapy on oxidant/antioxidant status in patients with rheumatoid arthritis: a single-blind randomized controlled trial.

Int J Biometeorol 2017 Jan 21;61(1):169-180. Epub 2016 Jun 21.

Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih, Capa, 34093, İstanbul, Turkey.

Oxidative stress has been shown to play a contributory role in the pathogenesis of rheumatoid arthritis (RA). Recent studies have provided evidence for antioxidant properties of spa therapy. The purpose of this study is to investigate whether spa therapy with saline balneotherapy has any influence on the oxidant/antioxidant status in patients with RA and to assess clinical effects of spa therapy. In this investigator-blind randomized controlled trial, we randomly assigned 50 patients in a 1:1 ratio to spa therapy plus standard drug treatment (spa group) or standard drug treatment alone (control group). Spa group followed a 2-week course of spa therapy regimen consisting of a total of 12 balneotherapy sessions in a thermal mineral water pool at 36-37 °C for 20 min every day except Sunday. All clinical and biochemical parameters were assessed at baseline and after spa therapy (2 weeks). The clinical parameters were pain intensity, patient global assessment, physician global assessment, Health Assessment Questionnaire disability index (HAQ-DI), Disease Activity Score for 28-joints based on erythrocyte sedimentation rate (DAS28-4[ESR]). Oxidative status parameters were malondialdehyde (MDA), nonenzymatic superoxide radical scavenger activity (NSSA), antioxidant potential (AOP), and superoxide dismutase (SOD). The NSSA levels were increased significantly in the spa group (p = 0.003) but not in the control group (p = 0.509); and there was a trend in favor of spa therapy for improvements in NSSA levels compared to control (p = 0.091). Significant clinical improvement was found in the spa group compared to the control in terms of patient global assessment (p = 0.011), physician global assessment (p = 0.043), function (HAQ-DI) (p = 0.037), disease activity (DAS28-4[ESR]) (0.044) and swollen joint count (0.009), and a trend toward improvement in pain scores (0.057). Spa therapy with saline balneotherapy exerts antioxidant effect in patients with RA as reflected by the increase in NSSA levels after spa therapy; whether this antioxidant effect contributes to the clinical improvements observed remains to be verified.
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http://dx.doi.org/10.1007/s00484-016-1201-4DOI Listing
January 2017

Comment on: Clinical Efficacy of Mudpack Therapy in Treating Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Studies.

Am J Phys Med Rehabil 2017 01;96(1):e9-e10

Department of Medical Ecology and Hydroclimatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.

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http://dx.doi.org/10.1097/PHM.0000000000000551DOI Listing
January 2017

Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis.

Int J Biometeorol 2016 Oct 26;60(10):1481-1491. Epub 2016 Jan 26.

Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Tıbbi Ekoloji ve Hidroklimatoloji A.B.D. İstanbul Tıp Fakültesi Fatih/Capa, İstanbul, 34093, Turkey.

Very few studies tested the effectiveness of spa therapy in older patients with osteoarthritis. Therefore, we aimed to evaluate the short-term effects of spa therapy in patients aged 65 years and older with generalized, knee, hip, and cervical and lumbar spine osteoarthritis. In an observational retrospective study design at the Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty, we analyzed the records of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were prescribed a spa therapy course in some spa resorts in Turkey between 7 March 2002 and 31 December 2012. They travelled to a spa resort where they stayed at a thermal spa hotel and followed the usual therapy packages for 2 weeks. Patients were assessed by an experienced physician within a week before the spa journey and within a week after the completion of the spa therapy. Compared with baseline in whole sample, statistically significant improvements were observed in pain (visual analog scale, VAS), patient and physician global assessments (VAS), Health Assessment Questionnaire disability index (HAQ-DI), Lequesne algofunctional index (LAFI) for knee, Western Ontario and McMaster Universities index (WOMAC), Waddell disability index (WDI), and Neck Pain and Disability Scale (NPAD). According to Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) Set of Responder Criteria, responder rate were 63.8 % (51/80) in generalized, 52 % (13/25) in knee, 50 % (2/4) in hip, 66.7 % (8/12) in lumbar, and 100 % (6/6) in cervical osteoarthritis subgroups. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knee. This improvement was clinically important in majority of the patients. To confirm the results of this preliminary study, there is a need of a randomized controlled clinical study comparing spa therapy with usual care in the elderly population with osteoarthritis.
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http://dx.doi.org/10.1007/s00484-016-1138-7DOI Listing
October 2016