Turkish Journal of Rheumatology - 2000; 15(3)

THE RESULTS OF THE REHABILITATION PROGRAM APPLIED AFTER FLEXOR AND EXTENSOR TENDON INJURIES OF THE HAND

�mit Se�kin, P�nar Borman, Mihriban Aky�z, Hatice Bodur, B�lent Erdo�an — 2000-06-01

We aimed to present our results of the rehabilitation program applied in patients with flexor and extensor tendon injuries of the hand. Twenty-five patients (25 hands, 40 tendons) with a mean age of 27.6 � 13.4 years were included in the study. The intensity of spontaneous pain and pain with motion, range of motion in joints, alterations in total active motion (TAM), grip strength, pinch and lateral pinch strength were assessed before and after the rehabilitation program. At the end of the therapy, our results according to TAM system were excellent and good in 40 % of the flexor tendon injury group and 70 % of extensor tendon injury group. The mean TAM value was 190� and 230� in flexor and extensor tendon injury groups respectively. Grip strength was found to be good in 73 % of patients in extensor tendon group and 64 % in flexor tendon group. The values for the pinch strength were found to be good in 100 % and 83 % whereas lateral pinch strength were found to be 82 % and 90 % in groups of extensor and flexor tendon injuries respectively. All the parameters were significantly improved at the end of therapy on the 3^rd month. In conclusion, the results of our rehabilitation program in extensor and flexor tendon injuries of the hands were found to be good and effective.

EFFICACY OF FLURBIPROFEN IN THE TREATMENT OF CHRONIC LOW BACK PAIN: A DOUBLE BLIND PLACEBO-CONTROLLED STUDY

Zeynep G�ven, Demet Ofluo�lu, Nadire �zaras, �nder Kayhan — 2000-06-01

Chronic low back pain is major challenge for all societies because of its increasing incidence, social and medical implications. This condition continues to affect a significant proportion of working population among the young and middle-age adults. Forty patients diagnosed as chronic low-back pain were enrolled in a double blind, randomized trial designed to investigate the clinical efficacy of flurbiprofen. Each group consisted of 20 patients receiving either 100 mg flurbiprofen tablets twice daily (BID) or placebo respectively. Clinical evaluation was realized by the patient on a pain visual analogue scale (VAS), four point verbal rating scale for general (both for patient and physician) well-being, Arthritis Impact Measurement Scale (AIMS) and Beck Depression Scale (BDS) at baseline and on weeks 1 and 4. Adverse events and laboratory assessments were documented. The affect subgroup of AIMS questionnaire and both patient's and physician's verbal rating scale scores showed statistically significant differences in favor of flurbiprofen group on week 4 but no difference on week 1. This study shows that the use of flurbiprofen in chronic low back pain has no effect on depression scores. But due to its analgesic and symptomatic effect, it may help to restore the functional status of the chronic low back pain patients.

INVESTIGATING PRESENCE OF CORRELATIONS AMONG FUNCTIONAL STATUS, DISEASE DURATION, ESR, VALUE OF BMD, LEVEL OF OSTEOCALCIN AND CRP IN PATIENTS WITH RHEUMATOID ARTHRITIS

Sava� G�rsoy, Mehmet Adam — 2000-06-01

Aim of the study was to investigate the correlation of functional status (FS), disease duration (DD), menopause duration (MD), level of osteocalcin, CRP, ESR, and value of bone mineral density (BMD) in patients with RA Patients� functional status can be defined with Steinbrocker criteria. Disease duration, vertebrae and femur BMD were measured. Level of the serum osteocalcin (OC), CRP and ESR were measured in 20 patients with RA. In study, we found that vertebra BMD was negatively corelated with menopause duration (r: - 0.46), age (r: - 0.43) and height (r: - 0,5). We also found a significant correlation among FS, CRP, ESR and disease duration (F: 3.52 p<0.05) We observed an insignificant correlation among level of the serum OC,CRP and ESR.

QUALITY OF LIFE IN OSTEOPOROSIS

Deniz Ad�g�zel, O. Hakan G�nd�z, Hatice Bodur, Metin Y�cel — 2000-06-01

Osteoporosis is a disease characterized by low bone mass and micro-architectural deterioration of bone tissue with increased fracture risk. It effects large numbers of individuals worldwide, especially the postmenopausal women. Pain, limitation of motion, and vertebral or non-vertebral fractures from osteoporosis makes daily life difficult. Due to pain, limitation of motion, and deformities patients have difficulty in being satisfied with their roles, and meeting their expectations in social relations. In this study we aimed at evaluating the effects of osteoporosis on the quality of life. One hundred thirty postmenopausal women were included to the study. To exclude other diseases, which may have an effect on bone mineral density (BMD), routine biochemical, hematological, and when necessary, hormonal tests were performed. Patients with abnormal results were excluded. According to BMD measurements and World Health Organization criteria, 33 women were normal (mean age 49,18�6,01; mean duration of menopause 3,42�3,99), 51 were osteopenic (mean age 54,03�7,81; mean duration of menopause 7,22�0,95), and 46 were osteoporotic (mean age 62,39�8,15; mean duration of menopause 13,77�8,17). Osteoporotic patients were further grouped according to presence of decrease in body height and history of non-vertebral fractures. Nottingham Health Profile (NHP) quality of life measurement scale was applied to each individual, and 6 scores (pain, physical activity, energy level, sleep, social isolation and emotional reaction) were evaluated. All groups of postmenopausal patients, including the normal BMD group revealed interestingly higher scores in NHP scores. That is, �quality of life' was lower in all postmenopausal patients. BMD was negatively correlated with the NHP scores; that is, quality of life was correlated with BMD results. Among the subscores, pain and physical activity scores were particularly correlated with BMD. Normal BMD group had lowest scores in general, except the emotional reaction score. In our study we frequently encountered extreme scores on both lower and higher sides in NHP, and we think that NHP was affected by the characteristics of the study group to a large extent. Therefore in future studies of quality of life measurements in osteoporosis, we think that, selection of a scale that is prepared for �osteoporosis' itself, would be more suitable. In spite of all these, NHP may be reliably used in postmenopausal osteoporosis, since it is easy to apply, and also it includes sections that effectively evaluate the clinical consequences like pain, limitation of physical activity together with emotional effects of the disease.

THE ASSOCIATION OF BOWEL DYSFUNCTION AND FIBROMYALGIA SYNDROME

Birkan Sonel, Deniz Evcik — 2000-06-01

Fibromyalgia (FS) is a rheumatological syndrome that affects 1-5% of the population. Irritable bowel syndrome (IBS) is a complex of symptoms and mostly associate with FS. This study investigated the relation of FS with IBS. Fifty (34 women,16 men) patients with primary FS according to 1990 ACR criteria and 50 (37 women,13men) healthy subjects as control group were included in the study. A detailed questionnaire about bowel dysfunction was used. Bowel dysfunction was observed in 30 FS patients whereas none in controls. Thirty-three of the FS patients had abdominal distension as compared to 11 of the controls. In FS group 19 patients had constipation and 18 had diarrhea whereas 2 (p=0.011) had constipation and 4 (p=0.03) had diarrhea in control group.Thirty-five patients reported stress-related bowel dysfunction in FS group and only 1 in healthy control(p=0.00001). There was no statistically difference in laxative use between two groups (p>0.05). As a result according to self-administered questionnaire 29 of FS group had IBS (p=0.00001). In conclusion bowel dysfunction should be carefully assessed and appropriate medical therapy should be given to IBS patients with FS.

PS�R�AZ�SL� HASTALARDA EKLEM TUTULUMUNUN KL�N�K VE RADYOLOJ�K OLARAK DE�ERLEND�R�LMES�

Serpil Sava�, P�nar Ba�ak, Meltem �etin — 2000-06-01

The aim of this study is to evaluate the joint symptoms clinically and radiologically in a group of patients with psoriasis living in Isparta region and to determine the ratio of peripheral joint, temporomandibular joint (TMJ) and sacroiliac joint involvement. For this purpose, 30 patients with psoriasis were included in the study. Peripheral arthritis occurred in 8 patients (26.7%). Six patients (20%) had asymptomatic sacroiliitis. When the patients with arthritis was classified according to Glandman's categories, we have found that 5 patients (16.7%) had symmetric polyarthritis, 4 patients (13.3%) had spondylarthropathy, 1 patient (3.3%) had asymmetric oligoarthritis, 1 patient (3.3%) had distal interphalangial joint involvement and spondylarthropathy, 1 patient (3.3%) had symmetric polyarthritis and spondylarthropathy. Two patients (6.7%) had TMJ involvement clinically and radiologically. We detected a high number of joint involvement in our patients with psoriasis. We suggest that the dermatologists and the physiatrists should work together in the evaluation of the patients with psoriasis.

ETIOLOGICAL ASSESSMENT OF OUR CHRONIC LOW BACK PAIN PATIENTS

Ali G�r, Kemal Nas, Remzi �evik, Ferda Erdo�an, A. Jale Sara� — 2000-06-01

Low back pain is an extremely common condition, affecting 80% of individuals at some point in their lifetime. Most episodes of acute low back pain resolve spontaneously, regardless of the type of therapy chosen. However, a small percentage of these acute cases, 5-10% in most series, progress to develop chronic low back pain. Epidemiologic studies have established demographic characteristics and risk factors for the development of low back pain. This study was carried out on 312 cases refering to the Univers�ty of Dicle, Faculty of Medicine, Physical Medicine and Rehabilitation department with chronic low back pain. The patients were classified according to etiology, age, sex, profession, duration and localization of pain, clinical and radiological findings.

SCAPHOID OSTEONECROSIS: AN UNUSUAL SITE FOR OSTEONECROSIS

G�n�ah �ahin, �zlem B�lgen �imen, Selda Ba��, Hayal G�ler — 2000-06-01

Osteonecrosis is defined as the death of bone from repeated interruptions or a single massive interruption of the blood supply to the bone. In this article, we presented a 60 year old woman diagnosed as having polymyalgia rheumatica who developed scaphoid osteonecrosis because of taking corticosteroid for long period. The patient was reported because of unusual localisation for osteonecrotic bone involvement.

BACK SCHOOLS

�ehim Kutlay — 2000-06-01

Back school is a therapeutic intervention aimed at treating low back pain in a conservative way, through prevention and rehabilitation.

ROMATOLOJ�K HASTALIKLARDA GEN TEDAV�S�N�N YER�

Feride G�� — 2000-06-01

The therapeutic use of genes is of quite recent origin. Studies for the treatment of monogenetic and poligenetic diseases are continuing on human and animal models. Genes encoding anti-arthritic products can be transferred to intra or extra-articular sites. Promising data have resulted from the application of these strategies. In this review, principles and application of gene therapy for rheumatic diseases are summarised.