Turkish Journal of Rheumatology - 2001; 16(3)

THE CORRELATION OF FUNCTIONAL DISABILITY INDEXES WITH DISEASE ACTIVITY DETERMINANTS IN WOMEN WITH ACUTE RHEUMATOID ARTHRITIS

Murat Birtane, Aral Hakg�der, Merih Eryavuz, Siranu� Kokino — 2001-06-01

Rheumatoid arthritis (RA) is a chronic inflammatory disease causing joint deformities and consequent functional disability. The aim of this cross-sectional study was to assess the possible correlations between some determinants of disease activity such as Ritchie articular index (RAI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and the functional disability questionnaires in women with acute RA, aged between 50 and 65. The functional status of 52 women with acute RA, diagnosed according to modified ARA criteria were assessed by Health Assessment Questionnaire (HAQ) and Lee Functional Index (LFI). Ritchie Articular Index values were determined with joint examination, ESR and CRP with laboratory techniques in blood samples. The relations between these disease activity determinants and functional scores were assessed by correlation analysis. A strong positive correlation was found between two functional indexes (r= 0.84, p < 0.0001). The significant correlations found between ESR, CRP and LFI ( r=0.33, p < 0.01; r=0.44, p < 0.001, respectively), were stronger than the positive correlations determined between the same variables and HAQ (r=0.25, p<0.05; r=0.30, p<0.05, respectively). RAI exhibited stronger correlations with HAQ and LFI when compared with those of laboratory variables with HAQ (r=0.49, p<0.01; r= 0.59, p< 0.001, respectively). The most related disease activity determinants with examined functional disability levels in women with acute RA were observed to be RAI, CRP and ESH, consecutively. The prediction values of joint symptoms seemed to be more prominent when compared with laboratory variables.

AN EFFECTIVE TREATMENT FOR PATIENTS WITH KNEE OSTEOARTHRITIS: INTRA- ARTICULER SODIUM HYALURONATE INJECTIONS COMBINED WITH HOME EXERCISE PROGRAM

Murat Ers�z, �enay Kahramanlar, �nci Yan�ko�lu, Feray K�z�ltepe — 2001-06-01

The purpose of this study was to compare the changes of clinical and functional parameters in intraarticular sodium hyaluronate injected knee osteoarthritis (OA) patient group and in injection plus home exercise program group. Twenty-three patients with knee osteoarthritis who fulfilled the clinical and radiological criteria of American College of Rheumatology (ACR) for OA were investigated (mean age: 59.52 + 8.56 (43-80), 6 male, 17 female). Thirteen randomly selected patients were given a home exercise program in addition to intra-articular injections. Home exercise program included isometric quadriceps exercises and straight leg rising while knee extended. The groups were similar in respect to demographic, clinical and functional parameters. All patients were reevaluated in the week following third injection. Weight-bearing pain, rest pain and night pain levels decreased significantly in both groups. The patient�s impression was rated as “better” or “much better” in 80% of injection group patients and % 84.6% of injection plus exercise group patients. There were significant improvements in 20 m. walking time, time to walk up and down one flight of stairs and time to rise from chair and sit down again for three times in injection plus exercise group. The improvements were not statistically significant in injection alone group. Intra-articular sodium hyaluronate injections combined with home exercise program improved clinical and functional parameters rapidly in knee osteoarthritis patients. This combination therapy seems to be an effective choice of treatment in this patient group.

HUMAN PARVOVIRUS B19 (HPVB19) IgG AND IgM LEVELS IN THE PATIENTS WITH RHEUMATOID ARTHRITIS

Ayhan Kamanl�, �lkkan �ala�yer, Arzu Kaya — 2001-06-01

Rheumatoid arthritis (RA) is a chronic multisystem disease with an unknown etiology. In this study, Human Parvovirus B19 (HPV B19) IgG and IgM antibodies were determined in 29 RA, 16 Reactive arthritis (ReA) patients and 32 healthy subjects with Enzyme Linked Immunosorbent Assay (ELISA). Anti-HPV B19 IgG antibodies were positive in 89.7 % of patients with RA, in 87.5 % of patients with ReA and in 71.9 % of control group. Anti-HPV B19 IgM antibodies were positive in 20.7 % of patients with RA and 6.3 % of healthy control group. There was no HPV B19 IgM positivity in patients with ReA. Consequently, there were no statistically significant differences between patients with RA and control groups with respect to HPV B19 IgG and IgM antibodies.

RADIOGRAPHIC CHANGES IN HAND AND WRIST OF THE PATIENTS WITH EARLY RHEUMATOID ARTHRITIS AT REMISSION: A ONE YEAR FOLLOW-UP STUDY

Mahir U�ur, Kaz�m �enel, Kadir Y�ld�r�m, Selami Suma — 2001-06-01

This study was carried out with the aim of determining the relationship between disease activation and radiographic progression in early rheumatoid arthritis (RA) and determining whether radiographic progression continues in hand and wrist joints of the patients at remission period throughout one year. In 45 patients with early active RA, hand and wrist radiographies were determined with Larsen Dale method in the activation phase and after a year of remission. Patients were treated with low-dose prednisolone (7.5mg/day) and disease-modifying antirheumatic drugs (methotrexate and/or sulphasalasine). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Ritchie Articular Index (RAI), indicators of disease activation, were recorded at routine follow-ups carried out in every month for a year, and annual means of these parameters were cummulatively (using time-integration) calculated. One year later, 36 patients went on remission during one year were evaluated. A significant change was obtained among Larsen scores of hand and wrist radiographies at onset and at the end of one year (p<0.01). Significant correlations were found between Larsen score at the onset and initial ESR (r = 0.32, p<0.05), initial CRP (r = 0.44, p<0.01) and initial RAI (r = 0.42, p<0.01) values. There was no significant correlation between the changes of Larsen scores and time-integrated parameters (p>0.05). In conclusion, we found that increased disease activation could be an indicator of the radiographic progression rate and that joint damage continued even at remission period throughout one year follow-up period.

PULMONER FUNCTION TESTS IN YOUNG PATIENTS WITH FIBROMYALGIA

2001-06-01

Fibromyalgia is a painful syndrome of nonarticular origin, unknow etiology, characterized by generalized musculoskeletal pain, multiple tender points at characteristic locations, fatigue, stiffness, sleep disturbance, and anxiety. The aim of the present study was to assess the pulmonary function tests in young patients with fibromyalgia syndrome. 38 patients fulfilling the American College of Rheumatology classification criteria for fibromyalgia and 23 healthy volunteers of the same age range and sex were included in the study. All the subjects were nonsmokers. Pulmonary functions test included: forced vital capacity (FVC), first second forced expiratory volume (FEV1), FEV1/FVC, mid expiratory flow rate (FEF 25-75), FEF 25, FEF 50, FEF 75 and peak expiratory flow (PEF). Compared with the control group, all the spirometric values among the patients group were found to be relatively low although not significant, except FEV1, FVC, PEF, and FEF 25 which were significantly decreased (p < 0.05). This results indicated restrictive pulmonary disorder. Our results suggest that restrictive pulmonary disorder observed in fibromyalgia patients may be related to severe pain, fatigue, physical inactivity and respiratory muscle weakness.

CORRELATION BETWEEN CROSS-SECTIONAL AREA of PARASPINAL MUSCLE and PHYSICAL PARAMETERS, OSWESTRY DISABILITY INDEX in PATIENTS WITH LOMBER DISC HERNIATION

Sava� G�rsoy, Akif �irik�i, Ercan Madenci, Metin Bayram — 2001-06-01

In this study, we aimed to investigate the presence of correlation between cross-sectional area and physical parameters such as, body mass index, age, sex and functional restriction score. Low back pain (LBP) is an important health problem. It is known that the paraspinal muscles were sensitive to different process such as facet degeneration and lomber disc herniation. However, the role of these muscles in LBP and in disc herniation has not been elucidated definitely. Fifty patients with back and leg pain and 25 subjects without back and leg pain were included in this study. While the patients' and controls' tomographic evaluation were performed, total area of psoas major, quadratus lumborum and erector spinea muscles at both side of level L2 were calculated as cm² . Oswestry disability index was calculated for the patients. Patients' and controls' body mass index were also calculated. Patients' cross-sectional area of paraspinal muscles were significantly smaller than that of controls. Cross-sectional area of paraspinal muscle in male patients were significantly greater than that of female patients. There was a significant and negative correlation (r: - 0.367 p: 0.009) between crosssectional area of paraspinal muscles and functional restriction score in the patients group.

RAPADILINO SYNDROME: A CASE REPORT

Canan �elik, G�knur Karahan, Melek G�ng�r, Belgin Karao�lan — 2001-06-01

RAPADILINO syndrome is described multimalformation syndrome with radial aplasia or hypoplasia, absence of thumbs, absent or hypoplastic patellae, dislocations of joints, unusual face, cleft or highly arched palate, diarrhea in infancy, small stature, and normal intelligence. A case of Rapadilino syndrome on a boy having absent radius and patellae, dislocated knees, short stature, slender nose and normal intelligence has been reported.

FIBRODYSPLASIA (MYOSITIS) OSSIFICANS PROGRESSIVA: TWO CASES REPORT

Sibel �zbudak Demir, G�knur Karahan, G�l�mser Ayd�n, F�sun K�seo�lu — 2001-06-01

Fibrodysplasia (myositis) ossificans progresiva (FOP) is a hereditary mesodermal tissue characterized by progressive ossification of striated muscle, tendon, ligament, fasciae, aponeurose and occasionally skin. The pattern of inheritance remains unknown. Indeed, most reported cases are the result of spontaneous mutations. In this article we present two cases with FOP and reviewed the literature.

CLINICAL FEATURES OF THE HYPERMOBILITY SYNDROME

Sezai �ahin, Vural Kavuncu — 2001-06-01

Hypermobility is a clinical syndrome, which is characterized by excessive movement of the joints without a demonstratable relationship with a systemic rheumatic disease. Joint laxity is seen in 5-15% of healthy individuals without any symptoms, however may cause chronic pain complaints in certain individuals. Hypermobility syndrome has an important role in the etiopathogenesis of the soft tissue rheumatism and temporomandibular joint dysfunction syndrome. Impaired joint proprioception and excessive mobility may lead to ligament and joint capsule trauma in hypermobile patients. In addition, it's been suqqested that hypermobile subject, have high risk of mitral valve prolapsus, hernia, gynecological complications and osteoporosis by the advance of age. Evaluation of hypermobility on routine clinical practice will prevent unnecessary diagnostic workup and treatment modalities. A new diagnostic criteria set (Brighton 1998 criteria) revised from the widely accepted and used Beighton criteria, has been published recently. In the present article, clinical features related with the musculoskeletal system and visceral organ involvements in hypermobile subjects and novel approaches in diagnosis and treatment of the syndrome were reviewed.

DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN THE TREATMENT OF RHEUMATOID ARTHRITIS

Birol Balaban, Kenan Tan, R�dvan Alaca — 2001-06-01

At present, there is no cure for rheumatoid arthritis. Its medical management is aimed at relieving symptoms and slowing disease progression. The medical treatment of rheumatoid arthritis contains nonsteroidal anti-inflammatory drugs (NSAIDs) initially, followed by corticosteroids and disease-modifying antirheumatic drugs (DMARDs) introduced only when earlier measures have been proven ineffective. Lots of studies concerning combination use of disease-modifying antirheumatic drugs and their using time in the treatment of rheumatoid arthritis have been carried out for many years. In this article the place of disease-modifying antirheumatic drugs in therapy and developments about them will be reviewed and the drugs which have been developed spesifically for the treatment of rheumatoid arthritis recently and their usage will be discussed.