Turkish Journal of Rheumatology - 2005; 20(2)

EVALUATION OF THE ISOKINETIC TRUNK MUSCLE STRENGTHS' OF OPERATED LOMBER DISCOPATHY AND HEALTHY SUBJECTS AND THE FACTORS INFLUENCING MUSCLE STRENGTH

Cevriye Karaca, Ece Aydo�, Ajda Bal, Ece �nl�, Ayt�l �ak�� — 2005-06-01

Objectives: The primary aim of this study is to compare the isokinetic trunk muscle strength of subjects who had been operated due to lomber disc hernia (LDH) and healthy subjects. The secondary objective is to investigate the effects of age, sex, height, weight, Body Mass Index (BMI), spinal mobility, pain and disability on the isokinetic trunk muscle strength of the operated LDH patients. Methods: Fifty five subjects (30 males, 25 females) who had been operated due to LDH and who have no difference of age, height, weight, BMI, and having similar smoking, alcohol and exercise habits were compared with a healthy control group of 20 subjects (11 males, 9 females). For the purpose of evaluating the lomber spinal mobility, modified Schober test (MST) and finger-to-floor distance (FFD) were measured for the operated subjects. For the low back-leg pain, VAS (0-10 cm) and for the functionality, Oswestry Disability Questionnaire (ODQ) were performed. For all the operated and healthy subjects the trunk flexor and extensor muscle strengths were measured at semi standing position using the isokinetic system (Biodex Medical Systems, Shirley, NY) at 60 o, 90 o and 120 o /sec speeds. Results: For the operated subjects, at 60o /sec and 120o /sec, statistically significant decreases in the extension peak torque/body weight (PT/BW) values were found. On the other hand, only at 60 o /sec speed, statistically significant higher values of F/E peak torque ratios were observed (p<0.05). It was also found that a statistically significant correlation exists between the trunk muscle strengths of the operated subjects and the independent variables such as MST, BMI, height, sex and smoking habits. A multiple regression analysis showed that for these patients trunk muscle strength are affected by MST, BMI and height. Conclusions: The trunk muscle strengths of the subjects operated for lomber discopathy are weak and this weakness is more emphasized for the extensor muscles. Spinal mobility and BMI are important factors on the muscle strength.

RELATIONSHIP BETWEEN ANTI-CCP ANTIBODIES AND DISEASE ACTIVITY, RADIOLOGICAL DAMAGE IN PATIENTS WITH RHEUMATOID ARTHRITIS

2005-06-01

Recently, clinical value of antibodies against cyclic citrullinated peptide (Anti-CCP) was studied in the patients with rheumatoid arthritis (RA). Positivity of Anti-CCP antibodies showed a relation with erosive arthritis and radiological damage. The aim of this study was to investigate the relationship between Anti-CCP antibodies and disease activity and radiological damage in patient with RA. Thirty seven patient (12 M/ 25 F) with RA enrolled in this study. After physical examination, all patient were evaluated for clinical, radiological and laboratory parameters. Clinical parameters included the visual analog scale (VAS) and disease activity score(DAS) 28. In laboratory; erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) and Anti-CCP levels were measured. Radiological damage was assessed by using modified Larsen score. RF were positive in 15 patients (%40,5) and negative in 22 (%59,5) patients. Anti-CCP were positive in 24 patient(%64,9) and were negative in 13 (%35,1) patients. There were no statistically significant differences between the mean values of ESR, CRP, DAS 28 and VAS scores, modified Larsen scores of the Anti-CCP positive and negative patients (p>0,05). As a result, although we could not find any significant relation between Anti-CCP antibodies and clinical and radiological parameters of RA, further studies with larger groups are needed to investigate this association.

INVESTIGATION OF FACTORS ASSOCIATED CHRONIC MECHANIC NECK PAIN

Mustafa Y�ld�z, Hakan Tuna, Burcu Toku�, Siranu� Kokino — 2005-06-01

Although there are many investigations about chronic low back pain associated factors, there are few investigations about chronic neck pain associated factors in our country. Therefore, this study was aimed to the chronic neck pain data in our country was gathered through this investigation. The correlation of the characteristic values, psychosocial status, working factors, exercise habit, the current intensity of pain, duration of pain, and localization of maximum pain, factors that relieve or exacerbate pain were investigated in 100 patients with chronic neck pain. Physical load was highest (%49) in pain exacerbate factors. On the other hand drugs were highest (%66) in pain relieve factors. The exacerbate and/or initial chronic neck pain factors were detected to the body position included bending (%34), arising (%29), walking (%29) and the head motion included left bending (%41), right bending (%40), back bending(%40). In conclusion, further studies results about chronic mechanic neck pain associated factors would provide to contents in patient education programmes.

THE EFFECTS OF RALOXIFENE ON BONE TURNOVER, BMD AND SERUM LIPID PROFILE IN WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS

Mehmet Fatih Uzun, G�knur Karahan, Canan �elik, Belgin Karao�lan — 2005-06-01

Using several pharmacological agents in osteoporosis treatment, it is possible to affect inherent pattern of disease and decrease the incidence of fractures. The aim of this study was to examine the effects of raloxifene treatment on bone turnover, bone mineral density and serum lipid profile. Total 39 healthy postmenopausal women with a bone mineral density T-score of lumbar spine or femoral neck below -2.5 were randomly assigned to two groups. 22 women received 60 mg/day raloxifene, 1200 mg/day calcium and 800 iu/day cholecalciferol, 17 women received only 1200 mg/day calcium and 800 iu/day cholecalciferol. Subjects were treated for 1 year. Biochemical marker of bone turnover and serum lipids were measured at baseline, third month and first year. Bone mineral density was measured at baseline and first year. There was no significant difference in baseline characterictics between two groups. The mean values of lumbar BMD were increased by first year in both groups (% 7,638 and % 2,403 respectively). The increment was significant in treatment group (p<0,001), but it was not in control group (p>0,05). There was also a significant dfference between two groups (p<0,05). However there were no significant changes in femoral neck and total hip BMD in both groups (p>0,05). The mean values of urinary N-telopeptides were significantly decreased by third month and by first year. The difference between mean changes by third month and first year of two groups was also significant (p<0,001). Urinary calcium excretion for 24 hours was decreased by third month and first year in treatment group, but not significant (p>0,05). In control group, urinary calcium excretion for 24 hours was increased by third month and first year. During the study; there were no statisticaly significant changes in cholesterol and LDL levels in both groups compared with baseline (p>0,05). Triglyseride levels were significantly increased by first year in both groups (p<0,05), but these changes were not significant comparing with each other (p>0,05). By first year, serum HDL level was significantly increased in raloxifene group compared with baseline (p<0,05), but this increment was not significant comparing with control group (p>0,05). This study demonstrates the favorable effects of raloxifene on lumbar spine bone mineral density and bone turnover in women with postmenopausal osteoporosis.

THE EFFECT OF THE PHYSICAL THERAPY ON PAIN AND ACTIVITY OF DAILY LIFE IN THE KNEE OSTEOARTHRITIS

G�lcan G�rer, �. Faruk �endur, Cavidan Ay — 2005-06-01

This study was performed to research the effects of physical therapy agents on pain and disability in patients with knee osteoarthritis. Eighty one patients (40 study group;41 control group) with bilateral primary knee osteoarthritis were enrolled in this study. Physical therapy agents (hot pack, conventional TENS, ultrasound [1 watt/cm2] and isometric exercises of their quadriseps muscles) were applied to the patients of the study group ten sessions during two weeks and diclofenac sodium 100 mg/day were given to every patient. The same medications without physical therapy were given to control group patients. Kellgren-Lawrence Scale was used to evaluate the knee X-rays of the patients. The pain levels were measured with visual analog scale and activity of daily life was evaluated by using Lequesne index. Painless walking distances of the patients were measured and recorded. These evaluations were performed three times before, middle and after therapy. In conclusion significant improvement was determined when all parameters were evaluated in both groups after therapy (p<0.001). Furthermore, more improvement was determined in the study group when compared with control group after therapy (p<0.05).

EVALUATION OF DYNAMIC BALANCE IN KNEE OSTEOARTHRITIS PATIENTS WITH SIGNIFICANT VARUS DEFORMITY

Ece Aydo�, Duygu Yazar, Ajda Bal, Emel Ek�io�lu, Ece �nl�, Ayt�l �ak�� — 2005-06-01

Objective: The aim of this study was to investigate dynamic balance in bilateral knee osteoarthritis (KO) patients with varus deformity in relation to the functional disability. Methods: Fifty-eight patients (54 women and 4 men) with KO with significant varus deformity and thirty-five (31 women and 4 men) controls of same age, gender,weigth, heigth and body mass index group were tested using Biodex Stability System (Biodex medical systems, Shirley, NY). Anterior / Posterior Index (AP), Medial / Lateral Index (ML) and Overall Index (OA) were obtained with bilateral stance at a platform stability of 8. Subjects were tested with "eyes open" all times. Lequesne index was used for the assessment of disability in the patients with knee OA. Results: Overall, Anterior/Posterior, and Medial/Lateral indices in KO group were significantly higher than control group. For OA index, the results were 4.02 � 1.48 in KO, 3.12� 1.42 in the control group (p:0.001). For AP index, the results were 3.01 � 1.09 in KO, 2.52 � 1.24 in the control group (p:0.012). For ML index, the results were 2.76� 1.27 in KO and 2.09 � 1.10 in the control group (p: 0.003). Statistically significant correlation was found between Lequesne pain score and ML stability index (r:0.266 p:0.042). A similar correlation was determined between Lequesne daily living activities score and OA and AP stability indices ( respectively; r:0.276 p:0.033; r:0.305 p:0.18). However, a positive correlation was not detected between total Lequesne index score and postural balance for all of three stability indices. Conclusion: KO with significant varus deformity has negative effect on the postural stability. Results suggest the importance of balance training in this population.

SOULDER PARESIS DUE TO HERPES ZOSTER NEURITIS: A CASE REPORT

Canan T�k�z, Hatice Mavio�lu, Timur P�r�ldar, �i�dem T�z�n — 2005-06-01

In this case report, a patient with the diagnosis of segmental motor paresis (SMP) following herpes zoster (HZ) infection which involved C5-6 roots was presented. The muscle weakness was prominent at the muscles of the right shoulder and his daily activities were significantly restricted. Electrophysiological study revealed neuritis in the upper brachial plexus. After application of physical rehabilitation, significant improvement was observed in symptoms and electrophysiological findings. Our aim to present this case is to review the literature published until now in this regard and to emphasize that post-herpetic neuritis may involve in the etiology of shoulder disorders.

A RARE DISEASE IN DIFFERANTIAL DIAGNOSIS OF DIFFUSE PAIN AND FATIGUE: WALDENSTROM MAKROGLOBULINEMIA

Zafer G�nendi, G�l�in Kaymak Karata�, Vesile Sepici — 2005-06-01

Waldenstr�m makroglobulinemia is a B cell neoplasm commonly seen in adults between 6th and 7th decade. The incidence of Waldenstr�m makroglobulinemia is as low as 2,5/ million/ year and constitutes %2 of hematologic malignancies. It presents with constitutional symptoms such as pain, fatigue and weight loss. Here, a case presenting with diffuse pain, fatigue and high sedimentation rate diagnosed Waldenstr�m makroglobulinemia after excluding other diseases is reported.

OSTEOPOROSIS IN PATIENTS WITH SPINAL CORD INJURY

Kurtulu� Kaya, Sibel �nsal,Sumru �zel — 2005-06-01

Calcium loss from bone in a short time after injury is one of the result of spinal cord injury (SCI). Sequence of the events that results with bone loss is not known exactly. The main findings in patients with spinal cord injury are; dramatic increase in bone degradation after a short time from the beginning and decrease in osteoblastic activity. Bone mass loss occurs as a consequence of increase in remodelling and bone resorbtion that passes bone formation. Even though this problem is known approximately for 50 years, cause of osteoporosis in spinal cord injured patients is not completely understood. It is considered that the events appears with deafferantation of the sympathic nerve system causedby the neurologic lesion may take an important role at immobilization.

CURRENT THERAPY OF THE RESTLESS LEGS SYNDROME

Suat Acar, Ahmet Murat Gencer — 2005-06-01

RLS (Restless legs syndrome) is a sensorimotor disorder characterized by an urge or need to move the limbs usually associated with sensory and motor symptoms, chronic progressive or relapsing remitting course and prevalance increase with age. The treatment of RLS include the treatment of secondary causes such as iron deficiency anemia, periferic neuropathy, diabetes, �remia. L-DOPA (L-Dihydroxyphenylalanine) is the first line drugs for treatment of both primary and secondary RLS patients. % 50 percent of patients may develop augmentation (worsening of RLS symptomps in the course of therapy) by L-DOPA therapy. Dopamine agonists such as pergolide, pramipexole, ropinirole, cabergoline are dopaminergic agents used in the treatment of RLS. Opioids, benzodiazepines and anticonvulsants such as gabapentin can be considered when dopamine agonists not respond or not tolerable by patients. The current therapy of RLS include drugs which are effective on longterm usage and yet have minimal adverse events and safety.