Turkish Journal of Rheumatology - 2002; 17(1)

VERTEBRAL BONE MINERAL DENSITY IN ANKYLOSING SPONDYLITIS

G�l�in Kaymak Karata�, Fatma Atalay — 2002-06-01

In this study, lumbar bone mineral density (BMD) of 19 male patients with ankylosing spondylitis (AS) who were classified as mild and severe AS according to their vertebral involvement were evaluated by dual energy x-ray absorptiometry (DEXA) and quantitative computed tomography (Q-CT). Antero-posterior (AP) lumbar BMD values of mild AS patients were lower than the severe ones. Lateral L3 BMD values were higher in patients with severe AS. BMD of patients with severe AS were found to be higher than the ones with mild disease by Q-CT. There was a positive correlation between the BMD values of the L3 vertebrae measured by AP DEXA and Q-CT in patients with mild disease while a negative correlation was found in patients with severe AS. A positive correlation was found between lateral DEXA and Q-CT values in both groups. As a result; it was concluded that lateral lumbar DEXA and Q-CT techniques reflect BMD of axial skeleton correctly and both are valid methods in patients with AS.

CARIPAL TUNNEL SYNDROME IN PATIENTS WITH FIBROMYALGIA SYNDROME

Mehmet Tosun, Ha�im �ak�rbay, Cavit Boz, Mustafa G�ler — 2002-06-01

Fibromyalgia syndrome (FMS) and carpal tunnel syndrome (CTS) are two diseases that cause symptoms like pain, numbness, tingling, stiffness and subjective swelling in upper extremities. Because some symptoms are common in these two conditions, they can easily be mistaken for each other and this leads to misdiagnosis. In this study 28 patients diagnosed as FMS according to American Collage of Rheumatology (ACR) criteria were compared to 30 healthy controls on the grounds of median nerve conduction rate as measured by the standard neurophysiologic methods. Findings congruent with CTS have been obtained in the patient group for 3 cases bilaterally and one left and one right unilaterally, totally 8 extremities; in healthy controls same findings were obtained in 1 case bilaterally and 1 unilaterally, totally in 3 extremities. There was no statistically significant difference between the two groups (p>0.05).

GRIP STRENGTH: EFFECT OF GENDER AND HAND DOMINANCE

2002-06-01

Grip strength provides an objective index for the functional integrity of upper extremity. Aim of this study was to investigate the differences between gender for hand grip stength and to evaluate grip strengths of right and left handed male and female participants. There was statistically significant difference between grip strengths of dominant and nondominant hands in favor of the dominant hand for the whole group. Besides, men were found to be stronger for both dominant and nondominant sides. 13.23% of male and 8.33 % of female right handed participants had stronger nondominant grips. The percentage of stronger nondominant hands for left handed men (46.15%) was significantly higher than left handed women (12.5%). We concluded that the hypothesis of left handed people having stronger nondonminant hands than right handed people cannot be generalized.

THE RELATIONSHIP OF THORACIC KYPHOSIS WITH PULMONARY FUNCTIONS IN PATIENTS WITH OSTEOPOROSIS

G�l�in Kaymak Karata�, G�l G�rsel, Nadide Torlak Koca — 2002-06-01

In this study, the relationships of thoracic kyphosis with pulmonary function tests and respiratory muscle strength were investigated in patients with osteoporosis. Twenty women, whose mean age was 68 � 6 years, were included in the study. Localisation and number of thoracal vertebral fractures were determined and Cobb angle was measured. Forced expiratory volume in 1 second (FEV₁ ), forced vital capacity (FVC), FEV₁ /FVC, forced expiratory volume between 25% and 75% of the forced vital capacity (FEF_25-75 ), peak expiratory flow (PEF), vital capacity (VC), residual volume (RV), total lung capacity (TLC), RV/TLC, functional residual capacity (FRCN2), expiratory residual volume (ERV), inspiratory capacity (IC), carbon monoxide diffusion capacity of the lung (DLCO), maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured. Pulmonary function tests were within normal limits, and mouth pressures were low. A negative correlation between Cobb angle and FVC%, and a positive correlation between Cobb angle and FEV₁ /FVC were determined (Pearson r: -0.46 and r: 0.46, respectively, p<0.05). A negative correlation was determined between fracture number and FVC%, FEV₁ %, VC%, MIP, MIP% (Spearman r: -0.56, -0.59, -0.55, -0.58 and -0.57, respectively, p<0.05). When patients were divided into group-I (<2 vertebral fracture) and group-II (≥2 vertebral fractures), results of pulmonary function tests and respiratory muscle strength were lower in group-II. But the difference between the groups was significant only in FVC%, FEV₁ %, VC%, MIP and MIP% (p<0.05). In this study; the most prominent finding in vertebral fracture and kyphosis secondary to osteoporosis was the decrease in inspiratory muscle strength. Our results has demonstrated the importance of inspiratory muscle strengthening exercises in patients with osteoporosis.

ASSESSMENT OF PULMONARY INVOLVEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS BY USING HIGH RESOLUTION COMPUTERIZED TOMOGRAPHY AND PULMONARY FUNCTION TESTING

Necip G�der, Mehmet �nl�, Nurhan Do�an — 2002-06-01

In our study, we aimed to search the prevalence of pulmonary involvement in rheumatoid arthritis (RA), and the relation of clinical parameters with these involvement by using high resolution computed tomography (HRCT) of thorax and pulmonary function test (PFT). We also aimed to evaluated the relation between HRCT and PFT findings. For these purposes, 37 patients with RA diagnosed by using American Rheumatism Association (ARA) criteria were included in the study. As a control group 18 patients without any pulmonary system pathology were randomly selected from patients with knee osteoarthritis. RA group and control group were evaluated by using HRCT and PFT. In addition, RA patients were compared within the group for treatment modalities, disease activity parameters and clinical parameters to evaluate if there is any relation between these parameters and pulmonary involvement. As a result, pulmonary pathologies were diagnosed, using HRCT, frequently in RA patients as 56,8%. High resolution computed tomography showed a range of abnormalities among patients thought to have interstitial lung disease. Interstitial septal thickening was found in 3 patients. Ground glass opacification was present in five, while basal honey combing was also evident in two patients. Bronchiectasis was identified in two patients. These finding were not clinically significant in most cases, however increasing intensity of these pathologies could impair physiologic functions of lung. Pulmonary function tests were found abnormal in 55.6%. It was observed that there was statistically significant decline in peak expiratory flow rate, forced expiratory volume in one second and forced expiratory volume in one second/ forced expiratory volume (p<0.05). We concluded that; HRCT or PFT were not found adequate techniques by themselves for the evaluation of pulmonary system. High resolution computed tomography, in comparison to PFT is not fully adequate to clarify small airway involvement.

INTRA-ARTICULAR INJECTION OF SODIUM HYALURONATE IN THE TREATMENT OF KNEE OSTEOARTHRITIS

B�lent B�t�n, Cahit Ka�ar, Deniz Evcik — 2002-06-01

Objective: To determine the effects of intra-articular hyaluronan on the symptoms of knee osteoarthritis (OA). Methods: Twenty-eight patiets with bilateral knee OA (ACR criteria) were included in this double-blind, randomised and placebo-controlled trial. All of them (total 56 knees) had grade II or III degeneration radiologically according to Kellgren-Lawrence method. One knee for every patient was assigned randomly by active treatment and applied 2 ml solution of sodium hyaluronate intra-articularly (15 mg/ml) and the contralateral knee was accepted as placebo and injected 2 ml physiological saline, within the same procedure, once a week for 3 consecutive weeks. Efficacy on pain, function, stiffness, motion, activity and tolerability were evaluated with detailed parameters at weeks 1, 2, 3 and 5. Results: No side effects developed during a 5 week period. Both groups, according to patients, were improved at 5 week compared with baseline but there was no statistically significant difference between two groups. The efficacies of hyaluronan and saline solutions were similar on the all parameters. Conclusion: It is concluded that sodium hyaluronate offers no significant benefit over plcebo during a 5 week treatment period.

BERIBERI NEUROPATHY SECONDARY TO SLIMMING DIET: A CASE REPORT

G�l�in Kaymak Karata�, Aliye Kapuk�ran Tosun, Reha Kuruo�lu — 2002-06-01

The most common cause of thiamine deficiency is chronic alcoholism. It may also occur in patients with impaired nutrition from other causes. Dry beriberi that is characterized with peripheral neuropathy is one of the clinical feature of thiamine deficiency. In this case report we present a patient whose peripheral neuropathy was attributed to thiamine deficiency because of a hard slimming diet.

SPINAL EPIDURAL HEMATOMA: A CASE REPORT

Nur Turhan, Ay�e Dilek, Metin Karata� — 2002-06-01

Spinal hematoma is a rare entity among the causes that result in a clinical picture of acute spinal cord compression. Spinal hematomas are frequently localized to the epidural space and less frequently to the subdural space. Spinal hematomas are usually caused by trauma, anticoagulant therapy, vascular anomalies and blood dyscrasias. Prognosis of such hematomas has been reported to be favourably good. We reported a case with spinal epidural hematoma. The case was of interest for its possible etiologic factor, prognosis and anatomic localization. This 71 year old man had become scoliotic due to a previous pulmonary operation the hematome has been localized to the epidural space very close to the apex of the scoliotic curve and his functional state after 2 months from the onset was wheelchair level.

NON-PHARMACOLOGIC APPROACHES IN THE TREATMENT OF RHEUMATOID ARTHRITIS

Birol Balaban, A. Kenan Tan, R�dvan Alaca — 2002-06-01

Primary goal of treatment in rheumatoid arthritis (RA) is restraining inflamation of joints and other tissues, reducing pain and preventing disease progression. Although, there is no cure for RA, many treatment modalities have been improved to obtain efficacy mentioned above. In addition to medical treatment, nonpharmacologic measures must be applied at the same time to obtain dynamic and suitable treatment of disease. However, there are different applications according to acute and chronic phase activity of disease. Medical rehabilitation includes regular procedures and helps patients to realize their functional and occupational activities. Fundamental rehabilitation therapy of rheumatoid arthritis comprises treatment approach which prevents functional loss and provides functional adequacy.

SPASTICITY

Rah�an Kamilo�lu, Ay�e Bilgi� — 2002-06-01

Spasticitiy is one of the most important disporders in people with disease of central nervous system. It is a motor neuron disorder which is a component of upper motor neuron syndrom and results from hyperexcitability of stretch reflexes characterized by an increased muscle tone. A variety of diseases which damage descending motor pathways at cortical or subcortical levels, brainstem or spinal cord may cause spasticity. Among these disease are stroke, degerenative lesions, multiple sclerosis, brain injuries due to trauma, cerebral palsy, spinal cord injuries, space-occupying lesions and transverse myelitis.