Turkish Journal of Rheumatology - 2005; 20(1)

COMPARISON THE EFECTIVENESS OF PHYSICAL THERAPY AND CORTICOSTEROID INJECTION FOR SUBACROMIAL IMPINGEMENT SYNDROME

Funda Levendo�lu, Halim Y�lmaz, Hatice U�urlu — 2005-06-01

Objective: We compared the effectiveness of corticosteroid injections with physical therapy for the treatment of subacromial impingement syndrome. Methods: Fifty-two patients with subacromial impingement syndrome were enrolled in the study. Patients were randomly divided into two groups. Corticosteroid injection consisted of an injection of 1 ml of 40 mg/ml triamcinolone acetonide in combination with 4 ml of %1 lidocain . Corticosteroid injection was given from the lateral side to the subacromial region in the first group. Physical agents consisting of ultrasound, TENS, hotpack were performed to the second group. Codman and strengthening exercises were given to the both groups. All patients were reviewed at 15 day, 1 and 3 months after the beginning of the therapy. For the evaluation of pain intensity Visual Analogue Scale (VAS), for the assessment of maximal muscle strength isokinetic measurement, for the assessment of shoulder function American Shoulder and Elbow Surgery (ASES) Shoulder Index Scale were utilized. Results: There was a significant reduction in patient's pain scores in both treatment groups. But, pain reduction was significantly higher in injection group when compared the physical therapy group (p<0.05). Comparison of the other parameters between injection group and physical therapy group found no statistical difference at 15 day, 1 and 3 months (p>0.05). Conclusion: There was a greater pain reduction in patients with treated steroid injections. But, both physical therapy and local steroid injections were of similar effectiveness for shoulder functions.

EFFECT OF HORMONE REPLACEMENT THERAPY ON PATELLA CARTILAGE VOLUME

�zlem Baysal, Z�hal E Altay, T�lay �ner, Tamer Baysal, Feza Burak, Saim Yolo�lu — 2005-06-01

It has been shown that symptomatic knee osteoarthritis (OA) may often be related to patellofemoral OA. Patellofemoral OA is more common in women than men, suggesting that differences in sex hormones may modulate the disease. Although some epidemiological data suggests that hormone replacement therapy (HRT) has an effect on the incidence and prevalence of OA in postmenopausal women, little is known about the effect on patellofemoral OA. In this study, our aim was to determine the effect of HRT on patellar cartilage volumes in postmenopausal non HRT user (control group) and HRT user women. The patellar cartilage volumes of 23 non HRT user women (control group) and 21 HRT user women (less than 5 years), 15 HRT user women (more than 5 years) were calculated by means of magnetic resonance imaging (MRI). Statistical difference was found between the patellar cartilage volume measurement of HRT user ( > 5 years) and non-user postmenopausal women (p=0.001). The data in this study indicates that especially long term HRT may have preventive effect on the patellar cartilage.

DEMOGRAPHIC DATA OF THE OUTPATIENTS ABOVE 65 YEARS OLD ABOUT OSTEOPOROSIS AND THE RISK FACTORS IN ATAT�RK BALNEOTHERAPY AND REHABILITATION CENTER

Alev Ay, Zeynep Sa��rkaya, Merih Yurtkuran — 2005-06-01

The aim of this retrospective study is to determine the rates of osteoporosis and fractures in men and women older than 65 years and to see the correlations between demographic and densitometric data. 208 outpatients (men and women) above the age of 65 years were examined and interrogated by a questionnaire about demographic characteristics of age, sex, education, preexisting diseases, nutrition habits, physical activity level, fracture story and medical therapy effecting calcium metabolism. Thoracolumbar and pelvis X-rays and T scores of BMD (Bone Minoral Density) by Dual Energy Xray Absorptiometry (DEXA) were evaluated. Education level of the male population was higher and the BMIs were lower than the females. Peripheric Fracture (PF) rate was 7% and compression fracture (CF) rate was 13%. There was positive correlation between PF and CF, tea drinking habbit and femur BMD and also T scores of spine BMD and femur BMD in men. CF and femur BMD T scores, physical activity level and VAS of the dorsolumbar region and physical activity level and CVS disfunction were were negatively correlated in women. Tea drinking habbit and femur BMD T scores were positively, physical activity level and CVS disfunction were negatively correlated in men. In conclusion, physical activity level, preexisting fracture, tea drinking habbit and femur BMD have effects on the outcome of the fractures and pain which are the components of osteoporosis.

IS LEPTIN A DETERMINANT OF BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS?

G�n�ah �ahin, Hayal G�ler, Melek Sezgin, G�rb�z Polat — 2005-06-01

In this study, we aimed to investigate the serum leptin level whether it is a determinant of bone mineral density (BMD) in osteoporotic postmenopausal women. Forty (40) osteoporotic female patients (screened according to WHO criteria, tscore < 2.5SD, at lumbar region or femoral neck region) and forty (40) age and body mass index matched healthy female subjects(served as control group;t score >-1.0 ) were studied. All the women were at post-menopausal period. Serum concentrations of leptin after an overnight fast were measured by radioimmunoassay. BMD values were measured by dual energy X-ray absorptiometry (DEXA, NORLAND XR-46 ) at the lumbar spine, femoral neck and total body. There was no significant difference between groups regarding serum leptin levels (P=0.599). Our study showed that there was no statistically significant difference concerning serum leptin levels in osteoporotic and non-osteoporotic postmenopausal women . However, at a local tissue level, leptin may effect bone. For this reason, leptin related studies at the bone micro-environment are promising.

THE EFFECTIVENESS OF NASAL CALCITONIN AND CALCITRIOL COMBINATION THERAPY IN POSTMENOPAUSAL OSTEOPOROSIS

Saime Sar�o�lu Ay, Haydar G�k, Peyman Yal��n — 2005-06-01

This study was prepared to investigate the efficacy of calcitonin nasal spray and calcitriol combination therapy in the treatment of postmenopausal osteoporosis. 520 women between 45-70 years of age were enrolled for assessment. Among them, 200 patients who were suitable according to medical history, physical examination, laboratory parameters and bone mineral density (BMD) measurements were recruited and randomized into 4 seperate treatment groups. The first group was treated with 200 IU/day nasal calcitonin and calcitriol 0.25 �gx2, the second group with 200 IU/day nasal calcitonin, the third group with calcitriol 0.25 �gx2, and fourth group with 1000 mg/day calcium alone. The first three groups were also given 1000 mg/day calcium. Patents were assessed at baseline and 6 months intervals. Overall follow-up duration was 2 years. Markers of bone formation and resorption were measured at 6 months intervals. Measurement of BMD values were done at the onset and at the end of first and second year. The increase in the measurements of lumbar spine and femoral neck BMD was higher in the combination group. We concluded that combination therapy in the form of nasal calcitonin, calcitriol and calcium was more effective in increasing BMD values as opposed to the nasal calcitonin or calcitriol therapy alone in the treatment of postmenopausal osteoporosis.

CASE REPORT: POSTINFECTIOUS BROWN S�QUARD PLUS SYNDROME

Dilek Karaku�, Canan �elik, Nesrin Yaraman, Belgin Karao�lan, Hilmi Uysal — 2005-06-01

In this case report we present a 17 year old female patient who has developed postinfectious tetraplegia. It was diagnosed as an atypical form of myelitis which was called Brown Sequard Plus Syndrome (BSPS). BSPS is rare but has better prognosis than other myelitis form.

COEXISTENCE OF FAMILIAL MEDITERRANEAN FEVER AND ANKYLOSING SPONDILITIS: A CASE REPORT

Sevtap K�ksal Avc�, Nesibe Do�an, Hikmet Ko�yi�it, Alev G�rgan — 2005-06-01

Familial Mediterranean fever (FMF) is a recurrent and self-limiting genetic disease characterized by irregular attacks of fever, peritonitis, pleurisy, arthritis and erysipelas-like rash. The most common type of articular involvement is acute monoarthritis. Arthritic episodes may be prolonged in about 5% of patients and hip and knee joints are frequently affected. Sacroiliitis and seronegative spondyloarthropathy (SNSA) may develop in some patients with FMF. A 23-year old man with FMF who was concomitantly diagnosed as ankylosing spondylitis according to the modified New York criteria is presented. Also the coexistence of FMF and SNSA, its treatment and amyloidosis which is the most serious complication of FMF is discussed with a review of the literature. As a result, we think that the possibility of development of SNSA during the follow-up of FMF patients should be kept in mind and symptoms should be evaluated carefully in this convern. Additionaly, the importance of daily regular use of colchicine and consideration of amyloidosis in the regular follow-up of FMF patients whether they have sacroileiitis or not have been emphasized.

OSTEOPOIKILOSIS: TWO CASE REPORTS

2005-06-01

Osteopoikilosis is an uncommon osteosclerotic dysplasia. There is no exact evidence of its etiology and pathogenesis. Usually, it is an asymptomatic disease and the diagnosis is made incidentally from radiographs which show multiple, small, well-defined, variably shaped and widely distributed sclerotic areas over the skeleton. Herein we report two cases of osteopoikilosis admitted with low back pain complaints and discuss the atypical case versus typical case with literature.

QUALITY OF LIFE AND HEALTH OUTCOME ASSESSMENT QUESTIONNAIRES

Sibel Ba�aran, Rengin G�zel, Tunay Sarpel — 2005-06-01

Quality of life (QOL) is an important outcome measure for health condition and the evaluation of treatments. Health related quality of life is the component of overall quality of life that is determined primarly by the person's health and which can be influenced by clinical interventions. The International Classification of Impairment, Disability and Handicap (ICIDH) published by World Health Organisation (WHO) was revised in 2001 as International Classification of Functioning, Disability and Health (ICF). In ICF, the view of "components of health" or "interactions between components" was accepted instead of the old causal view. Since the new ICF framework also defines the personal factors, it can be used to obtain more information about QOL. In this review, ICF framework and frequently used generic and disease spesific questionnaires for evaluating QOL and health outcomes are overviewed.

CHILDHOOD SARCOIDOSIS

Alper Soylu, Mehmet Atilla T�rkmen, Salih Kavuk�u — 2005-06-01

Sarcoidosis is a systemic noncaseating granulomatous disorder of unknown origin. It is rare in children. There are two forms of juvenile sarcoidosis according to the age of onset. The early-onset form in the first 4-5 years of life is usually characterized by the triad of uveitis, arthritis and rash. The older children and adolescents have a form of sarcoid that is similar to the adult one with pulmonary infiltrates, hilar adenopathy, and systemic features such as weight loss and fever. The diagnosis of sarcoidosis is based on the demonstration of non-caseating granulomata in one or more organs in the setting of consistent radiographic or clinical findings. The most commonly involved organ systems are respiratory tract, lymphatic system, skin, eyes, nervous system, kidney, liver, heart and blood vessels and musculoskeletal system. Symptoms of early onset sarcoidosis characterized by arthritis, uveitis and skin eruptions mimic those of systemic type juvenile rheumatoid arthritis. Skin biopsy may be useful for differential diagnosis. Corticosteroids and methotrexate are usually used as therapeutic agents for juvenile sarcoidosis.