Turkish Journal of Rheumatology - 2001; 16(2)

EVALUATION OF PERIARTICULAR TISSUES BY ULTRASONOGRAPHY IN PATIENTS WITH KNEE PAIN

Meltem Say�n, Nehir Samanc�, Altan Kesici, Tiraje Tuncer — 2001-06-01

The purpose of this study was to investigate the periarticular lesions in patients who were admitted to our outpatient clinic with the complaint of knee pain. Ninety-one patients ( 17 male, 74 female) with no known metabolic or inflammatory articular disease were included in the study. All patients were undergone physical examination and knee ultrasonography (US). Mean age of the patients was 51,3 � 14,1. US revealed 25% of the patients as normal. The patients had tendinitis (17.5%), Baker's cysts (16.4%), synovial hypertrophy (15,3%), bursitis(15,3%), synovial effusion (14,2%), and (13%) other findings such as synovial impingement, vascular changes, soft tissue mass. In addition, soft tissue lesions were detected by US in 11 (78%) of the 14 patients with the clinical and radiological diagnosis of knee osteoarthritis. In conclusion, assessment of periarticular tissues is useful for the diagnosis and treatment of patients with the complaint of knee pain. US, which is a nanivasive and inexpensive diagnostic method can be chosen for this purpose.

SERUM COPPER, ZINC AND SELENIUM LEVELS IN RHEUMATOID ARTHRITIS

Mesut �olak, Nam�k Kemal Bing�l, O�uz Ayhan, �enel Avc�, Vedat Bulut — 2001-06-01

The objective of this study was to measure the alterations in some important serum trace elements, including selenium (Se), zinc (Zn), copper (Cu), in patients with rheumatoid arthritis (RA). In the study, serum trace elements were determined by using Atomic Absorption Spectrophotometer in sera of patients with RA (n=32), and statistically compared with healthy individuals (n=52). Serum Cu concentration was found significantly higher in patients group than those of healthy individuals (26,06�4,.71 and 17,74�3,30 �mol/L, respectively) (p<0,001). In contrary, Se and Zn levels were lower in patients (0,18�0,05 �mol/L and 6,58�3,14 �mol/L, respectively) according to the healthy subjects (0,21�0,06 �mol/L and 11.44�6,00 �mol/L, respectively). Our results showed that serum trace elements (Se, Zn and Cu) concentrations are altered in RA patients. The changes may be a part of autoimmune process in organism induced by cytokines. In conclusion, we suggest that decrease in Zn and Se levels and elevation in Cu levels are probably responsive to inflammation and resulted from defence strategies of organism and mediated by the hormone-like substances.

THE RELATIONSHIP AMONG PAIN, DISEASE SEVERITY, RADIOLOGICAL FEATURES AND DISABILITY IN PATIENTS WITH OSTEOARTHRITIS OF THE KNEE

Sevim Ak�avu�, Aynur Karag�z, Canan Aybay, Canan �elik, Metin Y�cel — 2001-06-01

One hundred two cases having an avarage age of 67,7�8,9 (89 female, 13 male) diagnosed as knee osteoarthritis according to American Collage of Rheumatism (ACR) criteria were included into this study. Pain (knee pain scale), disease severity (Lequesne severity index), radiographic features (Kellgren-Lawrence) and disability (HAQ) were measured by objective methods and the relationship among them were investigated. Although pain severity was not related with radiographic features (p>0,05), there was a weak relationship between frequency and radiographic features (p=0,05). There was no correlation between radiographic features and disability (p>0,05). General disability was found to be related with both pain and Lequesne severity index (p<0,01).

THE EFFECT OF HETEROTOPIC OSSIFICATION ON THE FUNCTIONAL STATUS OF SPINAL CORD INJURIED PATIENTS

�nci Ayg�n, Canan �elik, Selma Atas� — 2001-06-01

The aim of this study was to compare the functional status of the spinal cord injuried patients having heterotopic ossification (HO) with the patients not having HO. Following spinal cord injury, twenty patients with HO ( 5 female, 15 male) and twenty patients without HO (7 female, 13 male) were evaluated. According to Frankel, the difference between the neurologic levels of two groups was not statistically significant ( p>0,05). The functional status of the patients was measured using Functional Independence Measure (FIM). The average of the FIM scores for the group with HO was 62,9�12 at admission and 78,5�11.7 at discharge. On the otherhand the FIM score results of the patients without HO were 71,4�13 and 90,8 �11,6. The FIM scores at the group with HO were found to be significantly low when compared with the patients not having HO (admission:p<0,05, discharge:p<0,01).The findings of our study suggested that functional status of the patients during rehabilitation program was affected by HO which caused loss of range of motion. However, significant improvement was observed due to FIM scores in both groups (p<0,05).

THE COMPARISON OF THE EFFECTIVENESS OF SULPHASALASINE IN PATIENTS WITH PERIPHERAL AND AXIAL INVOLVEMENT

Ece Kaptano�lu, ��nar Y�ld�r�m, Cahit Ka�ar, Tiraje Tuncer, Aker Akyoku� — 2001-06-01

Sulphasalasine (SS) is known to be an effective and safe disease modifying drug in seronegative spodyloarthropathies (SpA). This study was planned to investigate the effectiveness of SS on peripheral and axial involvement. A total of 41 patients were involved in the study, being 11 female and 30 male. The diagnosis of the patients, family history, extra-articular involvement, early morning stiffness, VAS, adverse drug reactions of the SS, compliance of the patients to SS, the ratio of the patients' benefit from SS, and the other drugs were recorded. The affected and active joints were determined by physical examination. The laboratory parameters like complete blood count, ESR, CRP, liver and kidney function tests, urinary analysis and HLA-B27 tissue antigen which could reflect the activity of the disease and adverse drug reactions were studied. Physical examination and laboratory evaluation were performed before the SSwas given and at the 4^th month of the treatment. Regarding the whole group, clinical effectiveness was supported by the statistically significant differences between the values of active joint count, early morning stiffness, and VAS (p<0,05) before the treatment and at the 4^th month of treatment. Among the 17 patients with peripheral involvement, there was improvement in the active joint count, early morning stiffness, and VAS after the treatment whereas there was improvement in active joint count and VAS in the group without peripheral involvement (p<0,05). In conclusion; SSZ seems to be effective in patients either with or without peripheral involvement.

THE EFFICACY OF EXERCISE AND CALCIUM TREATMENT IN POSTMENOPAUSAL OSTEOPOROSIS

2001-06-01

This study was planned to examine whether there is a role of exercise in improving bone mineral density (BMD) in female with postmenopausal osteoporosis. 14 female with postmenopausal osteoporosis participated in the study. L_2-4 BMD of the subjects was measured by DEXA. The subjects performed exercise three days a week for six months. Exercise sessions consisted of 15-20 minutes of warm-up, 25-30 minutes of abdominal and back muscle strengthening exercises and 10 minutes of cool down periods. In addition to exercise 1000 mg of calcium was given to all subjects. At the end of six months control BMD was measured. Initial and control BMD values were compared by Wilcoxon test. The BMD of L_2-4 at the beginning was between 0,728 gr/cm² and 0,982 gr/cm² and the BMD values at the end of six months were between 0,769 gr/cm² and 1,029 gr/cm² . The BMD values were increased in all of the patients and the difference was statistically significant (p=0,001). The results of this study indicate that regular exercise and calcium intake had a positive effect on BMD.

KINEMATIC GAIT ANALYSIS IN HEMIPLEGIC PATIENTS

�enay �zdolap, Aynur Karag�z, Ay�e Karamercan, Ne�e �zgirgin — 2001-06-01

In this study, kinematic gait analysis was performed in 46 (22 male, 24 female) hemiplegic patients. We investigated the effects of clinical characteristics, lower extremity motor status, functional ambulation category, type of ambulation aid and orthosis on temporal-distance (TD) variables. The age of patients, sex, hemiplegic side, aetiology and disease duration were not related to these parameters but lower extremity motor status, functional ambulation category, type of ambulation aid and orthosis were related significantly to TD variables.

EARLY ONSET CHRONIC TOPHACEOUS GOUT: CASE REPORT

O. Hakan G�nd�z, Lale Y�lmaz, Hatice Bodur, Nalan Aky�rek — 2001-06-01

The typical gout patient is easily recognized: There is a sudden onset of severe pain and redness in the toe of a middle-aged and obese man, who is fond of eating and alcohol. It has been known since the time of Hippocrates that gout is very rare in young men and premenopausal women. Development of gout in a male patient under 30 years of age may indicate an enzyme defect that results in overproduction of purines or a hereditary renal tubular disease. Early recognition of these cases is important for preventing complications like nephrolithiasis and renal failure. In this report we presented a young male patient with gout, who had his first attack at the age of 15, and discussed early onset chronic tophaceous gout in the light of the literature.

REHABILITATION OF GUILLAIN BARRE SYNDROME

Sibel �zbudak Demir, G�l�mser Ayd�n — 2001-06-01

Guillain Barre Syndrome is an acute autoimmune disease of peripheral nervous system. The main feature is rapidly evolving motor weakness combined in many patients with sensory loss. After a plateau phase, spontaneus recovery starts, but it is not always complete. Approximately %40 of patients who are hospitalized with GBS will require admission to inpatient rehabilitation. Ventilatory support has been correlated with longer length of stay and increased cost for inpatient rehabilitation. Other factors that affect rehabilitation are dysautonomia, cranial nerve involvement and various medical complications. Deafferent pain syndrome is common in early stage of recovery. Multipl medical complications, including deep venous trombosis, joint contractures, hypercalcemia due to immobilization and pressure sores may develop. Overfatiguing the affected motor unit has been clinically associated with paradoxical weakness and may impede recovery. Little is known known about the long term outcomes of disability caused by GBS. Rehabilitation programme is similar to that performed in postpolio syndrome and spinal cord injury.

BIO MECHANICS OF THE KNEE

G�lcan G�rer, B�lent Se�kin — 2001-06-01

The biomechanics of the knee joint should be learned well in order to understand the pathogenesis of the diseases of the bissest joints of the body. In this article anatomy and the functions of the knee joint and the stresses which play a role on the knee joint was discussed briefly.