Turkish Journal of Rheumatology - 2010; 25(2) - Current Issue

Editorial

2010-08-01

Short-Term Effectiveness of Ultrasound Treatment in Patients with Lateral Epicondylitis: Randomized, Single-Blind, Placebo-Controlled, Prospective Study

Ceyda Ak�n, �znur �ken, B. F�sun K�seo�lu — 2010-08-01

Objective: We aimed to assess the effectiveness of ultrasound treatment in patients with lateral epicondylitis and to compare with placebo ultrasound treatment. Materials and Methods: Sixty patients (40 female, 20 male, mean age�SD 46.7�8.1, range 25-62) with lateral epicondylitis were included. All of the patients were randomized to two groups as: ultrasound (US) group (n=30) and placebo US group (n=30). Continuous US was applied to the patients in the US group whereas placebo US was applied to those in the placebo group for 5 minutes over three weeks (totally 15 sessions). All patients used a static splint at night for the three weeks. Patients were assessed before the treatment (baseline), at the end of the treatment (3^rd week) and after 15 days follow-up (5^th week). The following parameters were evaluated: pain with the visual analog scale (VAS), hand grip strength using a hand dynamometer, activities of daily living using the Turkish version of Disabilities of the Arm, Shoulder and Hand (DASH-T) questionnaire, and quality of life using the Short-Form (SF)-36 questionnaires. In addition, patient satisfaction was examined. Results: VAS at rest and during motion had significantly improved in both groups at the end of treatment (3^rd week) and in the follow-up (5^th week), while improvement in the VAS was observed only in the 3^rd week in placebo group (p<0.01). Pain with motion was significantly decreased in the 3^rd and 5^th weeks in the US group while it was increased in the 5^th week in the placebo group (p<0.01). Hand grip strength were improved in the 3^rd and 5^th weeks in both groups (p<0.008). There was no significant difference between the two groups (p>0.05). No difference between the two groups was found in terms of general DASH-T scores at the end of the treatment and follow-up. However, improvement in DASH scores in the US group at the 3^rd and 5^th weeks was significantly higher than in the placebo group (p<0.017). Patient satisfaction scores increased in both groups, but satisfaction of patients in the US group was significantly higher than of those in the placebo group (p<0.001). Conclusion: In this study, it was found that US treatment for lateral epicondylitis improved pain and activities of daily living and resulted in high patient satisfaction. (Turk J Rheumatol 2010; 25: 50-5)

Measurement of Foot Bone Mineral Density in Rheumatoid Arthritis: Its Application and Clinical Relevance

2010-08-01

Objective: Hand and foot joints are the primary targets in rheumatoid arthritis (RA) and decrease in the periarticular bone mineral density (BMD) is one of the earliest and considerable change in the affected joint. This study aimed to assess the relationship between foot bone mineral density (fBMD) measured by Dual Energy X-ray absorptiometry (DEXA) and BMD at axial sites, disease activity, functional status and quality of life in patients with RA Materials and Methods: 50 patients with RA, 40 age- and sex-matched patients with osteoarthritis (OA) and 14 voluntary healthy individuals were included in the study. C-reactive protein, erythrocyte sedimentation rate (ESR), Ritchie Articular Index (RAI), Health Assesment Questionnare (HAQ), and Foot Function Index (FFI) were measured. X-ray of the feet was scored by Larsen and Sharp/van der Heijde methods. Axial and fBMD were measured by DXA. Results: The results of the present study revealed that Turkish patients with RA carrying SE with HLA-DRB1 genes is significantly related with the production of anti-CCP. The diagnostic sensitivity and specificity of anti-CCP for RA is determined as 73.3% and 100% respectively. Conclusion: These results suggest for the first time that foot BMD measurement by DEXA is a useful and precise method. Foot BMD may reflect both localized and generalized bone loss and may be a potential outcome measure particularly in patients with marked foot involvement. (Turk J Rheumatol 2010; 25: 56-62)

Correlation of Fatigue with Clinical Parameters and Quality of Life in Rheumatoid Arthritis

2010-08-01

Objective: We aimed to investigate fatigue and its relationship with disease activity, radiological findings and quality of life in patients with rheumatoid arthritis (RA). Materials and Methods: 41 patients who were diagnosed as RA according to criteria of ACR and 38 healthy controls were enrolled to this study. Patients were asked to record the severity of rest pain (Visual Analog Scale) and duration of morning stiffness. Fatigue was evaluated by the Multidimensional Assessment of Fatigue (MAF) test. Disease activity and quality of life were assessed respectively with DAS-28 and Short Form-36 (SF-36). Radiologic involvement was evaluated according to modified Larsen's grading system. Results: The mean age of patient and control groups were 50.9�13.4 years and 50�10.1 years, respectively. Two groups were similar with respect age (p=0.744). The median MAF total score was higher in patients with RA (38.5, min-max: 4-50) than in control subjects (22.5, min-max: 0-42) (p<0.001). There were significant correlations between MAF and DAS-28 scores (r=0.478, p=0.004), rest pain (r=0.491, p=0.001), ACR functional scale (r=0.563, p<0.001) and four dimensions of SF36; physical role (r=-0.504, p=0.014), bodily pain (r=-0.416, p=0.048), vitality (r=-0.522, p=0.011), emotional role (r=-0.523, p=0.011). Conclusion: Fatigue symptom may be quite disabling for patients with rheumatoid arthritis. It is affected by disease activity and pain but not by disease duration and radiologic score. Therefore, it is concluded that fatigue is essentially related with disease activity rather than the chronic inflammatory process in RA. (Turk J Rheumatol 2010; 25: 63-7)

Relationship Between Lumbar Muscle Strength and Proprioception After Fatigue in Men with Chronic Low Back Pain

2010-08-01

Objective: To evaluate the relationship between lumbar position sense and trunk muscle strength, to investigate the effect of fatigue on this relationship, and the effect of fatigue on proprioception in patients with chronic low back pain (CLBP). Materials and Methods: A cross-sectional study was conducted to determine lumbar position sense and trunk muscle strength in 19 males with low back pain and in 20 healthy controls. After neurological examination every subject was evaluated for repositioning error (RE) with Cybex Norm isokinetic dynamometer using the trunk extension-flexion modular component. Then, every subject underwent a concentric/concentric exercise program including extension and flexion exercises performed actively for 15 times with the velocity of 60� / second. Finally, the RE test was repeated. Results: Differences in RE between the groups were significant before and after fatiguing exercise procedure. After fatigue, changes in RE were found significant in both groups. Differences in flexion peak torque and total work between the groups were significant. Second RE measurement was found to be correlated with flexion peak torque and total work in control group. Conclusion: The results of this study reveals that flexor muscle strength is significantly lower in patients with CLBP. RE was significantly higher in patients compared to the healthy controls. We found that abdominal muscle strength was moderately correlated with position sense in healthy population after fatigue, whereas there was no correlation in patient group. (Turk J Rheumatol 2010; 25: 68-71)

Factors Affecting the Age of Admission of Postmenopausal Women to an Osteoporosis Outpatient Clinic

Ferda �zdemir, �enay Demir Yaz�c�, Derya Demirba� Kabayel, Necdet S�t — 2010-08-01

Objective: In the present study, the factors that may potentially affect the age of admission of postmenopausal women to an osteoporosis (OP) outpatient clinic were evaluated. Materials and Methods: Two hundred and twenty-six postmenopausal women admitted to our OP outpatient clinic were studied retrospectively. The level of education, occupation, age at menopause, duration of menopause, history of hormone replacement therapy (HRT), exercise routine, history of medication use that may cause secondary OP, and family history of OP were questioned. Lumbar spine and femur bone mineral density (BMD) measurements were performed by dual energy x-ray absorptiometry (DEXA). The data were analyzed by linear regression. Results: The mean age of the patients was 58.8�8.7 years (range, 37-82 years) and the mean age at menopause was 45.2�5.8 years. Multiple backward stepwise linear regression was performed. When factors which could potentially affect the age of admission to OP outpatient clinic were included in the model, only 2 factors (age at menopause and duration of menopause) were shown to affect the age of admission. These two variables explained 98.9% of the variation (adjusted R2) in admission age (p < 0.001). Conclusion: The most important factors affecting the age of admission of postmenopausal women to the OP outpatient clinic were determined to be the age at menopause and the duration of menopause. (Turk J Rheumatol 2010; 25: 72-6)

Associated Factors with Pain and Disability in Patients With Knee Osteoarthritis

Duygu Geler K�lc�, Burcu Yan�k, Hakan Atalar, G�l�in G�l�en — 2010-08-01

Objective: To assess factors associated with pain and functional level in patients with knee osteoarthritis (OA). Materials and Methods: Patients with knee OA (n=161), with a mean age of 62.4� 8.7 yrs were studied. Age, sex, body mass index (BMI), education level, smoking habit, regular physical activity habit, symptom duration were recorded. Kellgren-Lawrence scores were calculated in anterio-posterior and lateral knee radiographs. Functional level of patients were assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and pain severity of the patients were assessed by Visual Analoge Scale (VAS). Results: The BMI was positively correlated with mean scores of WOMAC pain, joint stiffness and daily living activities subscores (r=0.592, r=0.634, and r=0.749, respectively). Education level was inversely correlated with mean scores of WOMAC pain, joint stiffness and daily living activities subscores (r=-0.394, r=-0.345, and r=-0.352, respectively). Kellgren-Lawrence scores of anterior-posterior and lateral view radiographs were found to be correlated with age and symptom duration (r=0,263, p=0,001 and r=0,339, p=0,016, respectively). No relationship was found between pain VAS scores and any assessed factors.When WOMAC subscale scores and VAS scores were compared according to gender, WOMAC pain scores were found higher in females (p=0.024). No correlation was found between remainder factors and scores of the three sections of WOMAC. Conclusion: The BMI is the most important factor associated with functional level and pain severity of patients with KOA. Patients must be encouraged to loose weight in order to decrease symptom and disease severity. (Turk J Rheumatol 2010; 25: 77-81)

Syndrome of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE)

Fatma Paksoy, Turgay Ula�, Emrah Erkan Maz�, Ayda Batuan Damar, Fatih Borlu — 2010-08-01

RS3PE (remitting seronegative, symmetric synovitis with pitting edema) is a benign, seronegative syndrome, with an acute onset of pitting edema on the dorsum of both hands and feet, which affects predominantly peripheral joints such as wrists and ankles symmetrically. A 58-year-old man presented with acute symmetrical polysynovitis of the wrists and ankles associated with pitting edema on the dorsum of the both hands and feet. He responded well to low-dose corticosteroids. There was no evidence of erosion radiologically. The clinical manifestations of the patient were consistent with RS3PE syndrome. Here, we present a case of RS3PE and review the literature. (Turk J Rheumatol 2010; 25: 88-90)

Psoriasis Induced by Tumor Necrosis Factor-Alpha Antagonist Therapy: Case Series and Literature Overview

Tunay Sarpel, Sibel Ba�aran, Filiz Do�an Ak�am, Suhan G�na�t�, Ya�arg�l Denli — 2010-08-01

Although tumor necrosis factor-alpha (TNF-α) antagonists are shown to be effective in the treatment of psoriasis, induction of psoriatic skin lesions have been seen in patients with different rheumatic conditions who were treated with TNF-α antagonists. In this case series, we report four cases that developed psoriatic lesions; in one of the cases, psoriasis was associated with two different TNF-α antagonists. Case 1: A 31-year-old man with ankylosing spondylitis developed erythematous and squamous lesions on his extremities in the 2nd week of infliximab treatment. Two months later he began to receive etanercept, and psoriatic skin lesions developed on the entire trunk and extremities, and predominantly on the scalp after one month. Case 2: A 53-year-old female with rheumatoid arthritis developed psoriatic skin lesions in the ankle region after two months' treatment with etanercept. Case 3: A 34-year-old female with ankylosing spondylitis developed psoriatic lesions on her palms after 10 months' treatment with infliximab. Case 4: A 40-year-old female with ankylosing spondylitis developed pustular lesions on her palms and soles after two years' treatment with infliximab. The patients had no personal or family history of psoriasis. The diagnosis of psoriasis was confirmed by skin biopsy in three of the cases. Psoriatic skin lesions can be induced as a result of treatment with TNF-α antagonists in patients with rheumatoid arthritis, ankylosing spondylitis and other spondyloarthropathies. The most common form is plaque or pustular pattern with palmoplantar distribution. (Turk J Rheumatol 2010; 25: 91-4)

Anti-CCP Antibody and Rheumatoid Factor Positivity in a Case of Tuberculosis Arthritis

2010-08-01

Tuberculosis (TB) can affect vertebras and joints bearing weight. It can resemble clinic signs, radiological and laboratory findings of rheumatoid arthritis (RA) involving peripheral joints. TB can make rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) positive, which are used in the diagnosis of RA arthritis. Therefore, this causes some difficulties in clinic diagnosis. Additionally, the diagnostic problems in TB arthritis can be more complicated. We aimed to attract attention to this situation by presenting a case of TB arthritis in which anti-CCP and RF are positive. (Turk J Rheumatol 2010; 25: 95-8)

Effects of Therapeutic Ultrasound on Pain, Disability, Walking Performance, Quality of Life, and Depression in Patients with Chronic Low Back Pain: A Randomized, Placebo Controlled Trial

Dilek Durmu�, Ye�im Akyol, K�van� Cengiz, T�lay Terzi, Ferhan Cant�rk — 2010-08-01

Objective: The aim of the current study was to evaluate the effects of therapeutic ultrasound on pain, disability, walking performance, quality of life (QOL) and depression in patients with chronic low back pain (CLBP). Materials and Methods: Forty-two patients with CLBP were randomly allocated into two groups. Patients in group 1 received therapeutic ultrasound, exercise, and hot packs, while patients in group 2 received sham ultrasound, exercise, and hot packs. All treatment programs (ultrasound, sham ultrasound, hot packs, and exercise) were performed 5 days a week for 3 weeks. Patients were evaluated by the following parameters: pain (visual analog scale [VAS]), disability (Modified Oswestry Low Back Pain Disability Questionnaire and Pain Disability Index), functional performance (6-Minute Walk Test [6MWT]), QOL (Short Form 36 [SF-36]), and depression (Beck Depression Inventory [BDI]). Results: A significant improvement was noted in both groups in pain, disability, walking performance, QOL and depression after treatment. Significantly greater improvement was observed in group 1 compared to group 2 in pain, emotional and physical role functioning, functional performance, and depression. Conclusion: Therapeutic ultrasound was shown to be effective on pain, some particular parameters of QOL, functional performance, and depression in patients with CLBP. (Turk J Rheumatol 2010; 25: 82-7)