Turkish Journal of Rheumatology - 2001; 16(1)

THE EVALUATION OF PAIN CHARACTERISTICS OF PATIENTS WITH OSTEOPOROSIS

G�ne� Yavuzer, Serpil Sava�, Haydar G�k, G�lay Din�er, Peyman Yal��n — 2001-06-01

The most leading symptom of patients with osteoporosis is chronic pain, due to repeated microfractures. In this study, in order to help to differentiate the diagnosis of back pain, the pain characteristics of 40 osteoporotic patients and 40 non-porotic controls with the same age were compared. Pain duration, severity, localisation, radiation, aggrevating and relieving factors were assessed and no statistically significant difference was found between the groups. This result pointed that repeated fractures are not the only etiological factor for back pain, osteoarthritis, dysfunction of facet joints and disc pathologies are the common factors to initiate back pain for both of the groups.

PLASMA FIBRONECTIN AND URINE GLYCOSAMINOGLYCANE LEVELS IN PATIENTS WITH OSTEOARTHRITIS

Ali G�r, Kemal Nas, Remzi �evik, Ferda Erdo�an, Ay�eg�l Jale Sara� — 2001-06-01

Osteoarthritis is characterized by the progressive destruction of articular cartilage. There is a loss of cartilage proteoglycan content and disorganization of the collagen network, as well as an increase in non-collagenous protein such as fibronectin. In this study we investigate whether these connective tissue inter-components would help the diagnosis in determining degenerative changes, and to reveal their importance in distinguishing osteoarthritis and their follow up as well as the correlation between plasma fibronectin level and urinary glycosaminoglycan excretion. In this study, plasma fibronectin and urine glycosaminoglycane levels were determined spectrophotometrically in 65 osteoarthritis patients (mean age: 52,13�7,20 years), and 41 healthy (mean age: 46,21�9,85 years) control subjects. The mean levels of fibronectin (mg/ml) were 436,49� 115,51 in patients with osteoarthritis, 302,3 � 61,1 in the control group. The ratio of urine glycosaminoglycan excretion to creatinine (g/mol) was 2,76�1,15 in patients with osteoarthritis, 1,96�0,8 in the control group. Plasma fibronectin levels were significantly higher in osteoarthritis when compared to the control group (p<0,001). The ratio of urinary glycosaminoglycans excretion to creatinine levels in patients with osteoarthritis were significantly greater when compared with control group (p<0,001). There were significant correlation between the age and plasma fibronectin levels (r=0,41, p<0,01), urinary glycosaminoglcans excretion (r=-0,42, p<0,01) of patients with osteoarthritis . Our findings suggest that determination of urinary glycosaminoglycans excretion and plasma fibronectin might be an important parameter in degenerative diseases, especially in the diagnosis and followup of osteoarthritis.

ASSOCIATION BETWEEN EMOTIONAL VARIABLES AND DISEASE ACTIVITY PARAMETERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Meltem Say�n, Mehmet Ery�lmaz, Nehir Samanc�, Tiraje Tuncer — 2001-06-01

It is thought that the emotional status of the patients has an important role in both the etiopathogenesis and the prognosis of the rheumatoid arthritis. The aim of the study is to investigate the association between the disease activity parameters and the emotional variables. A total of 23 patients (19 female, 4 male) were included in the study. Mean age of the patients 46,16� 13,26. The mean duration of disease was 143,58 � 105,97 months. There was not any correlation between the emotional variables and the parameters such as age, duration of disease, morning stiffness, HAQ, grip strength, ESR,CRP and leucocyte. There was a significant correlation between joint swelling score and Hamilton Depression and State Anxiety Inventory; between joint tenderness score and the scores of State Anxiety Inventory; between VAS and Hamilton Anxiety and State Anxiety Inventory. There was a positive correlation between walking time and State Anxiety Inventory. This study shows that patients with rheumatoid arthritis do not display an obuiours depression and anxiety disorder. However, it was seen that the instantaneous anxiety of the patients and their joint tenderness, swelling and pain perception affected each other. Therefore during follow up of these patients, not only the physical parameters, but emotional parameters should also be considered and this may affect the success of the treatment positively.

THE ASSESMENT OF THE PHYSICAL FITNESS ON MENTALLY RETARDED CHILDREN

Necmiye �n, Fatih Erbah�eci, Nevin Ergun — 2001-06-01

This study designed to measure physical fitness on trainable mentally retarded children who do any kind of sports and those who don't along with healty ones; and also to find out the effect of sports on physical fitness has been carried out in A.�.B.�. K. Demir Physical Therapy and Rehabilitation, Ulus Anadolu Practical-Training School, G�lba�� Procting and Caring Trust of Mentally Retarded Children- Among the Subject Scovered by the study there were 20 nonretarded (I. Group), 20 trainable mentally retarded who don't do sports (II. Group), 20 trainable mentally retarded who do sports (III.Group). The avarage ages of subjects were determined as a 15,35 � 0,21 years in group I, 15,00 � 0,22 years in group II, 15,15 � 0,21 years group III. Physical structure and physical fitness of both nonretarded and mentally retarded children were evaluated. A statistically important difference was found in all physical fitness parameters except cardiovasculer endurance, body composition and pulling one's body up with arms parameters. (p<0,05). As a result, it has been concluded that sport is a valid and effective means of training which improves the levels of physical fitness and independence in activities of daily living of mentally retarded children.

THE EFFICACY OF INTRAARTICULAR TENOXICAM IN THE TREATMENT OF KNEE OSTEOARTHRITIS

Deniz Evcik, Bur�ak K�z�lay, G�khan Maralcan — 2001-06-01

Knee osteoarthritis is a degenerative disorder that can cause pain and limitation. In the treatment intraarticular injections are very popular in recent years. In this study we investigated the efficacy of intraarticular tenoxicam injections in knee osteoarthritis. Fifty patients with knee osteoarthritis were included the study and they were randomly assigned in two groups. Oral paracetamol, hot-pack and exercise therapy were applied both groups. Additionally patients in group 1, had intraarticular tenoxicam injection. Patients were evaluated for pain and fuctional capacity. Pain was assessed by Visual Analog Scale (VAS) and functional capacity was assessed by Lequesne Ð Samson index. After one month there were statistically significant improvement in both parameters in patients treated with intraarticular tenoxicam injections (p<0.001). Finally we think that tenoxicam which is a nonsteroidal antiinflamatory drug used orally in the treatment of osteoarthritis, seems to be effective in intraarticular form as well.

THE EFFECTS OF EXERCISE THERAPY IN THE TREATMENT OF PRIMARY FIBROMYALGIA PATIENTS

Deniz Evcik, F�sun Ayta� — 2001-06-01

Primary fibromyalgia sendrome (FMS) is a very common rheumatological diagnosis and there are various treatment modalities. The aim of this study is to investigate the effects of therapy (home and group therapy) in the treatment of FMS. A total of 62 primary fibromyalgia patients according to American College of Rheumatology (ACR) criteria were included the study. Their ages ranged between 32-60. Patients were randomly assigned in to three groups. None of them had a practice of daily simple exercise program or group aerobic therapy at least three years. Group 1 (n=21) were given home exercise program. Group 2 (n=21) joined the aerobic sessions with group therapy three times per week. Group 3 (n=20) were accepted as control group. Patients were evaluated by the number of tender points, Visuel Analog Scale (VAS) for pain and Fibromyalgia Impact Questionnaire (FIQ). After treatment, in group 2 there was statistically significant difference in the number of tender points, VAS and FIQ (p<0,001) Also in group 1 there was an improvement in VAS and FIQ but not in the number of tender points compared to the control group (p<0,01). Patients with FMS mostly complain about the pain and the difficulty in daily living activities. This study shows that exercise therapy either at home or in group sessions is effective in treating fibromyalgia patients. It is also a good motivating factor for patients who mostly spend their time at home, in a sedantery life style.

EVALUATION OF THE PRESENCE OF RISK FACTORS FOR FOOT ULCERATION IN PATIENTS WITH TYPE, 2 DIABETES MELLITUS

Serpil Sava�, Meltem �etin, H. Rifat Koyuncuo�lu, �. Ercan Tun� — 2001-06-01

The main risk factors for diabetic foot ulcers are peripheral sensory neuropathy with foot deformities and limited joint mobility. The aim of this study is to evaluate the risk factors for foot ulceration among the patients with type 2 diabetes mellitus. Thirty-seven patients and 30 sex and age matched controls were included in the study. Ankle and subtalar joint passive range of motion was measured in patients and controls for the presence of limited joint mobility. Standardized dorsoplantar and lateral weight-bearing radiographs of both feet of each participant were taken. Calcaneal inclination angle was used as an index of the height of the foot framework. Hallux valgus deformity was determined by the measurement of abduction of the hallux. Electroneuromyography (EMG) was performed for the diagnosis of the peripheral neuropathy. There were no difference in the ankle and subtalar joint passive range of motion between the patients and controls (p>0,05). Peripheral neuropathy was the most commonly detected risk factor in our patients and also a high number of hallux valgus and/or pes planus deformities were detected. The patients who have peripheral neuropathy and these deformities were accepted as having high risk for the development of foot ulcers. Education and wearing suitable shoes may prevent these patients from the diabetic ulcers.

AUTOANTIBODIES AND IMMUNOGLOBULINS IN NODAL GENERALIZED OSTEOARTHRITIS

Hilal Sarg�n, Melek G�ng�r, Sevim Orkun — 2001-06-01

The frequencies of auto antibiodies, including spesific rheumatoid factors, and levels of immunoglobulins were determined in 20 patients with nodal generalized osteoarthritis (NGOA), 20 patients with non-nodal large joint osteoarthritis (LJOA), and 10 non-osteoarthritic controls. Patients with NGOA had a higher frequency of IgG rheumatoid factor compared to LJOA and normal subjects. However, statistical analysis did not reach significance at the group level (p>0.05). IgA levels in the nodal patient group were found to be significantly lower when compared with the other two group but did not significance in statistical analysis. Thyroglobulin autoantibodies levels in the nodal patient group were found be significance higher when compared the control groups (p<0.05). These data support characterization of NGOA as a distinct subset of osteoarthritis, and suggest involvement of immune process in its pathogenesis.

ALGODYSTROPHY, SYMPATHECTOMY AND REGIONAL PAIN SYNDROME: A CASE REPORT AND REVIEW OF THE LITERATURE

Ayhan Kamanl�, Arzu Kaya, Sezai �ahin, Vural Kavuncu, �zge Ard��o�lu — 2001-06-01

Algodystrophy is an important pain syndrome characterized by variable dysfunction of musculoskeletal, skin and vascular systems, resulted from authonomic dysregulation. In this article, a 28 year-old female patient with reflex sympathetic dystrophy syndrome underwent sympathectomy has been reported, algodystrophy and its synonyms have been discussed under the light of current literature.

METHOTREXATE AND OSEOPATHY

Feride G�� — 2001-06-01

Compared to other immunomodulatory agents methotrexate has less side effects and it is an easy-touse anti-rheumatic drug. That is why it is widely preferred for the treatment of rheumatoid arthritis as well as other inflammatory arthritic conditions. Recently it has been proposed that along with its other side effects, methotrexate can also cause osteopathy. Although there are very few clinical studies on this subject, it is advised to prescribe methotrexate cautiously in elderly patients with severe arthritis and already established severe osteoporosis.