Turkish Journal of Rheumatology - 2006; 21(1)

COMPARISON OF THE LOCAL ANESTHETIC INJECTION AND THE LOW POWER LASER TREATMENT IN FIBROMYALGIA SYNDROME

Reyhan Tuncay, Eda G�r�ay, Ece Alano�lu, G�her Yezer, Ayt�l �akc� — 2006-06-01

Objective: Fibromyalgia syndrome (FS) is a disease characterized by pain and tender points. Various physical therapy modalities and local anesthetic (LA) injection of the tender points are used in the treatment. The aim of this study was to investigate the effects of LA injection of the tender points and low power laser (LPL) treatment on pain and other symptoms in patients with FS. Patients and Methods: A total of 30 patients diagnosed as FS according to American College of Rheumatology (ACR) were included in the study and randomised in two treatment groups. In group I. LA injection, in group II. LPL treatment of the tender points were applied. Patients were evaluated for the pain, pain in the tender points, muscle spasm, morning stiffness, insomnia and fatigue, number of tender points and Fibromyalgia Impact Questionnaire (FIQ) at baseline and 2 weeks after treatment. Results: Demografic data of the patients were similar and there was no difference between the groups before treatment. In group II after 2 weeks of treatment pain (p=0.003), pain in the tender points (p=0.004), insomnia (p=0.18) and fatigue (p=0.015), number of tender points (p=0.003) and FIQ (p=0.039) values were lower than group I. In group I, all parameters except morning stiffness and in group II all parameters were significantly lowered. Conclusion: In FS patients LA injection and LPL treatment improve pain and other disease symptoms. When both treatment modalities compared, the LPL treatment seems to improve symptoms at an earlier phase. (Rheumatism 2006; 21: 1-4)

THE LONG TERM EFFECTS OF SULPHASALAZINE IN THE TREATMENT OF ANKYLOSING SPONDYLITIS; CLINICAL, LABORATORY AND SCINTIGRAPHIC STUDY

Hidayet Sar�, �ans�n T�z�n, �lk� Akar�rmak, �mdat �zkul, �lhami Uslu — 2006-06-01

Objective: We investigated the long term (1 year) effect of salazopyrine= sulphasalazine (SSZ) in 32 patient with ankylosing spondylitis (AS). Patients and Methods: Efficacy on clinical and laboratory findings and quantitative sacroiliac scintigraphy (QSS) changes were evaluated. Results: There was a statistically significant decrease in all clinical findings assessed by morning stiffness and night pain. Finger tip floor distance during lumbar anteflexion, chest expansion and lumbar Schober parameters and also laboratory findings like erytrocyte sedimentation rate improved after 1, 3, 6 ve 12 months of treatment with SSZ (p<0.01). In 15 patients, showing active sacroiliac joint inflammation according to sacroiliac index (SI index) in QSS, there was a significant decrease in SI index 6 months after treatment with SSZ (Right SI: p<0.05, Left SI: p<0.01). Conclusion: This decrease of progression of the disease activity in patients with ankylosing spondylitis during treatment with SSZ may show that SSZ prevents late complcations like ankylosis or provides long term remission in the activity of the disease. Finally, although the efficacy of SSZ in the patient with AS have been rather limited in recent studies, SSZ may be use as a disease modifying antirheumatic drug (DMARD) for patients with AS: (Rheumatism 2006; 21: 5-8)

THE ROLE OF DISEASE ACTIVITY IN THE DETERMINATION OF FUNCTIONAL STATUS AND QUALITY OF LIFE IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Taciser Kaya, Alt�nay G�ksel Karatepe, Rezzan G�nayd�n, Salih �rper — 2006-06-01

Objective: Disease activity in patients with AS is evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). BASDAI≥4 is accepted as active disease. The effect of disease activity on functional status and quality of life was investigated in this study. Patients and Methods: 37 patients who fulfilled the modified New York criteria for AS were included in this study. The patients were divided into two groups; group 1 (BASDAI<4) and group 2 (BASDAI≥4). Functional status [Bath Ankylosing Spondylitis Functional Index (BASFI)], physical stiffness [Health Assessment Question naire-Spondyloarthropathy (HAQ-S)] and quality of life [Ankylosing Spondylitis Quality of Life (ASQoL)] were evaluated in order to compare the groups. Results: There were 17 patients in group 1 (M/F= 16/1) and 20 patients in group 2 (M/F= 14/6). The mean of ages and disease duration were 38.1�12.4 year and 102.7�88.0 months in group 1 and 39.3�9.7 year and 98.6�74.6 months in group 2 (p=0.762, 0.879 respectively). Patients with a BASDAI ≥4 had a worse functional status evaluated with HAQ-S and BASFI than those who have a BASDAI of <4 (p=0.000). However there was no difference in respect to the level of quality of life between the groups (p=0.461). Conclusion: These results show that the cut off level of BASDAI≥4 choosen for determination of disease activity is discriminatory for functional status but not for quality of life. (Rheumatism 2006; 21: 9-12)

THE RELATIONSHIP OF RANGE OF MOTION AND GRIP STRENGTH OF THE HAND WITH DISEASE ACTIVITY, HAND FUNCTIONS AND DISABILITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

2006-06-01

Objective: Wrist and hand joints are the first and the most frequently involved joints in rheumatoid arthritis (RA). Hand involvement and functions are of the most important factors that determine the impact of the disease on daily living activities. The purpose of this study was to evaluate the relation of hand and wrist range of motion (ROM) and hand grip strength values with disease activity, hand function and disability. Patients and Methods: Thirty-eight patients (7 male, 31 female) who had been diagnosed as RA according to American Collage of Rheumatology (ACR) criterion were recruited to the study. The disease activity scores of all the patients were determined by using Disease activity score-28 (DAS-28). The ROM of the wrist and finger joints were measured both by using standard goniometry and finger goniometry. Palm to pinch distance was measured with a tape measure and noted in centimetres. Hand grip, key grip, palmar grip, tip grip (1st-3rd finger) strength were obtained by a pinchmeter and Jamar dynamometry. Hand functions of all patients were evaluated by Duruoz Hand Index (DHI). Disability was scored by using Health assessment questionnaire (HAQ). The relations between DAS-28, DHI and HAQ with ROM and grip strength values were analysed. Results: The average age of patients was 53.5�13.1. Average values of DAS-28, DHI, HAQ were found to be 3.5�1.6, 9.2�16.6, 0.7�0.7, consecutively. DAS-28 correlated positively with palm to pinch distance values of 2^nd -5^th fingers and negatively with total ROM values of 2^nd -5^th fingers of both hands, hand grip strength, key grip, palmar grip, tip grip strength (p<0.05). Similarly, DHI and HAQ scores correlated positively with palm to pinch distance values of 2^nd -5^th fingers and negatively with total ROM values of 2nd-5th fingers of both hands, hand grip strength, key grip, palmar grip, tip grip strength (p<0.05). Conclusion: Disease activity affects ROM values of hand and wrist joints and grip strength in RA. These two conditions cause a limitation in the usage of hand in daily living activities. (Rheumatism 2006; 21: 13-7)

CHANGES IN PROTEIN SULFHYDRYLS, PROTEIN CARBONYLS AND LIPID PEROXIDATION LEVELS IN SERA OF PATIENTS WITH RHEUMATOID ARTHRITIS: CORRELATION WITH DISEASE ACTIVITY

Mustafa Serteser, Deniz Evcik, T�lay K�ken, Ahmet Kahraman — 2006-06-01

Objective: Reactive Oxygen Species (ROS) play a major role in the generation of acute and chronic inflammatory processes one of which is rheumatoid arthritis (RA). Patients and Methods: This study was designed to investigate ROS and antioxidant affects in RA patients. The antioxidant activity was determined by measuring total protein sulfhydryl (SH) levels. ROS was indicated by measuring protein carbonyls and malondialdehyde (MDA) levels. A total of 29 RA patients aged between 31 to 68 years old were recruited. Also 20 control subjects were selected from healthy individuals Total protein SH, protein carbonyls and MDA levels were measured from sera of both groups. Results: Total protein SH levels of RA patients were found to be significantly decreased than those found in control group (396,26�42,33 mmol/L vs 677,21�59,98 mmol/L, p<0,001). Also the levels of protein carbonyls and MDA were found to be statistically increased in RA patients respectively (105,45�14,26 mmol/L vs 93,65�10,49 mmol/L, p<0,05, 14,51�2,28 mmol/L vs 5,56�1,25 mmol/L, p<0,001). Patients active in disease had higher levels of MDA and lower levels of total protein SH levels when compared to those patients in remission. A negative correlation was found between protein carbonyls and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (r=-0,415, p<0,05, r=-0,687, p<0,001) in RA patients. No correlation was found in patients active in disease but negative corelation was found between protein carbonyls and ESR and CRP in patients in remission. Conclusion: In conclusion the level of ROS seems to increase and measurement of these markers may give us information about inflammatory process in RA. (Rheumatism 2006; 21: 18-22)

PROPRIOCEPTION AND PROPRIOCEPTIVE EXERCISES

Ahmet Y�lmaz, Haydar G�k — 2006-06-01

The ability that transmit the sensation of body position, perception and interpretation of this data and giving an conscious or unconscious reaction resulting in approximate posture and movement is called proprioception. The impulses that come from skin receptors, joints, muscles and tendons are perceived and interpreted by the proprioceptor regions of the central nervous system which in turn sends the required excitatory or inhibitory efferent responses. Repetitive soft tissue injury, osteoarthritis and low back pain are frequently associated with propri oceptive weakness and it is possible to measure this weakness by evaluating the conscious submodalities of proprioception. Proprioceptive weakness can be improved with balance training, kinetic chain exercises, sport specific exercises as well as exercises focused on low back and shoulder. (Rheumatism 2006; 21: 23-6)

SCOLIOSIS

Saime Ay, S�reyya Ergin — 2006-06-01

In healty vertebral column the vertebrae lie in coronal and transverse plane. Scoliosis is a lateral deviation of the normal vertical line of the spine. Scoliosis is not a disease, a sign, a deformity and can be the result of many diseases. It can be grouped as structural and nonstructural. It is the most common deformity of the spine. For this reason it is important to have early diagnosis and treatment for the scoliosis. Early diagnosis and preoperative rehabilitation is crucial. (Rheumatism 2006; 21: 27-30)

FAMILIAL MEDITERRANEAN FEVER ASSOCIATED WITH ANKYLOSING SPONDYLITIS: A CASE REPORT

�enay �zdolap, Selda Sar�kaya, Erol Aktun� — 2006-06-01

Familial Mediterranean fever (FMF) is an autosomal recessive disease of unknown origin. A less common manifestation of joint involvement in FMF is spondylartropathy, which is almost always HLA B27 negative. In these patients, along with sacroiliitis, inflammatory neck and back pain is also present producing minimal or no radiographic changes on plain films of lumbar and cervical spine. In this report, we presented a patient with FMF whom had been diagnosed to be ankylosing spondilitis (AS) in the light of some clinical and radiological findings. (Rheumatism 2006; 21: 31-3)

CALCIUM PYROPHOSPHATE DIHYDRATE CRYSTAL DEPOSITION DISEASE (PSEUDOGOUT): CASE REPORT

Berna Y�ld�z, Hatice Bodur — 2006-06-01

Presence of intra-articular calcifications (chondrocalcinosis) is a common finding in older individuals. Patients with calcium pyrophosphate dihydrate deposition disease (CPPD) may present with a number of clinical presentations such as acute gout, rheumatoid arthritis, osteoarthritis, and neuropathic joint. The joints most frequently involved are the knee, wrist, elbow, and hip. The diagnosis of pseudogout may be based on the clinical presentation, pattern of joint involvement and radiographic intra-articular calcifications. Diagnosis is confirmed by the demonstration of CPPD crystals in microscopic examination of synovial fluid. In this report we present three cases with CPPD deposition disease. (Rheumatism 2006; 21: 34-6)