Turkish Journal of Rheumatology - 2000; 15(2)

THE CLINICAL AND METABOLIC EFFECTS OF CALCITRIOL IN THE TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS

G�ne� Yavuzer, Serpil Sava�, Peyman Yal��n, G�lay Din�er, Atilla Elhan — 2000-06-01

Osteoporosis is the most common metabolic disease of bone whose management is controversial. To evaluate the efficacy and safety of calcitriol (1,25-dihydroxyvitamin DJ in postmenopausal osteoporosis, this prospective, randomized, one-year clinical trial was planned. Seventy patients aged between 45-69 years were randomly assigned to receive either calcitriol (0.25gr twice daily) or supplemental calcium (1gr/day) for one year. Lumbar spine and femoral neck bone mineral density (BMD) values, pain intensity and disability measure scores and bone turnover markers J$erum osteocalcin and urinary hydoxyproline levels) were used as outcome parameters of treatment. The groups were similar with regard to age, body mass index, years since menopause, baseline bone mineral measurements, pain intensity and disability measure scores initially. In calcitriol group, lumbar spine BMD values, pain intensity and urinary hydroxyproline levels were significantly improved at the end of the trial whereas no change was observed in femoral neck BMD values, disability measures and serum osteocalcin levels. No significant changes of outcome parameters were found in calcium group. The compliance to treatment protocols was high and no clinical or laboratory side effect of drugs was observed. As a conclusion calcitriol treatment was found to be effective and safe in the treatment of postmenopausal osteoporosis.

COMPARISON OF IMAGING TECHNIQUES IN THE EARLY DIAGNOSIS OF SACROILIITIS*

2000-06-01

Sacroiliitis is usually the first and main feature of seronegative spondyloarthropathies. But the sacroiliac joints present a problem to the diagnostician because of their deep seated location and lack of motion. This forces us to rely heavily on imaging modalities to diagnose diseases of this joint. Therefore, many imaging techniques such as computed tomography (CT); single photon emission computed tomography (SPECT) bone scanning, and magnetic resonance imaging (MRI) have been studied. In our study MRI was performed in 48 patients with clinical evidence of sacroiliitis. MRI findings were compared with those at CT and SPECT. Of these patients 35 had abnormal CT seans (73%), 36 had abnormal SPECT seans (75%), and 44 had abnormal MRI scans(91,6%). We concluded that MR imaging provide the best objective and complementary evidence of sacroiliitis in patients with clinical features of inflammatory spinal disease.

TERMINAL LATENCY INDEX AND RESIDUAL LATENCY IN CAR PAL TUNNEL SYNDROME

Metin Karata�, Seyhan S�zay, Meral Bayramo�lu — 2000-06-01

Carpal tunnel syndrome (CTS) has been extensively studied by different electrophysiological techniques for early and accurate diagnosis, but no single measure has adequate diagnostic sensitivity and specificity. Terminal latency index (TLI) and residual latency (RL) are the calculated parameters used to determine abnormality in the distal segment of motor nerve. They adjust the median distal motor latency (MDL) for the terminal distance and the proximal nerve conduction velocity. Three hundred eighty seven hands of 283 patients clinically diagnosed to have CTS were studied. Diagnostic sensitivity of conventional electrophysiological techniques, TLI and RL were analysed compared with each other. While TLI was abnormal in 187 hands (48.3%), MDL was upon normal limits in 145 hands (37.5%). Palmwrist sensory nerve conduction velocity (PLNCV) was the second most sensitive measurement and abnormal in 179 hands (46.3%). Diagnostic sensitivity of TLI was higher significantly from all other measurements, except PLNCV. RL was not superior to conventional electrophysiological techniques. In 13 patients TLI was the only abnormality. In conclusion, TU can be considered as a useful parameter that increases the diagnostic sensitivity in CTS, especially for demonstrating mildly affected motor fibers.

EVENT RELATED ENDOGEN POTENTIAL (P300) IN FIBROMYALGIA

�zlem Baysal, Cemal �zcan, Y�ksel Ersoy, Zuhal Erg�nay Altay — 2000-06-01

Fibromyalgia is a non-articular rheumatic disorder characterized by chronic vvidespread musculoskeletal pain and tenderness. Cognitive dysfunctions, especially difficulty in concentration, short term memory and sleep disturbances are also common in these patients. P300 being one of the event related endogen potential is used in the evaluation of the cognitive functions. �t is a long latency potential used in some neurologic diseases such as dementia and Parkinson disease and also in psychiatric diseases such as schizophrenia and depression. In this study, we evaluated P300 potential in 14 patients diagnosed as fibromyalgia according to the American College of Rheumatology 1990 criteria. The control group included 13 healthy subjects. To test the P300 response, two different tones of click sound are given both patients and control group. There was no statistically significant difference betvveen the average latency of P300 in the patients (317.8+32.4 ms) and controls (335.4�34.6 ms). |n addition, no statistical difference was observed in the average amplitude of P300 in either group (12.9+7.8 mV, 12.9�6.8 mV, respectively).

LATENCY AND AMPLITUDE OF HAND REFLEX IN THE ACTIVE SPORTSMEN

2000-06-01

The evaluation of proximal segments using classical electrophysiological methods for nerve conduction velocities is not sufficient. In this study, the effects of regular exercise on H-reflex and T-refiex amplitude and latency was investigated. H-reflex and T-reflex amplitude and latency values of 20 subjects (test group, 10 football player, and 10 volleyball player) who nave been regularly exercising for 8.73�4.45 years and 20 students (control group) who have not been regularly exercised were measured. The H-reflex amplitude and latency values of test and control group were 3.71 �1.6 mV and 27.98�2.16 ms; 6.83�2.23 mV and 27.69�2.0 msec, respectively. There was no statistically difference betvveen the two groups in relation with H-reflex latencies (p>0.05). The amplitude of H-reflex was significantly higher in the control group (p<0.05). The T-reflex amplitude and latency values of test and control groups were 3.78�1.99 mV and 32.08�2.04 ms; 4.31 �1.43 mV and 31.52�2.27 msec, respectively. Despite the amplitude of T-reflex was higher in the control group, the difference between the two groups with respect to amplitude and latency was not significantly different (P>0.05). There was no sign�'ficant difference betvveen volleyball and football players vvith respect to H and T-reflex amplitude and latency. In conclusion, the H-reflex amplitude recorded from trained muscle was significantly low and this could be due to lower number of motor neurones stimulated by type la fibers. This may be due to less efficency of type la excitatory afferents on motor interneurones in trained subjects. Therefore, the level of exercise should be considered as an influencing parameter when evaluating the amplitude of H and T reflexes.

THE EFFECTIVENESS OF ULTRASOUND TREATMENT IN MYOFASCIAL PAIN SYNDROME

Selda K�sao�lu, H.Rana Erdem, G�n�l G�nc�, Z. Rezan Yorganc�o�lu — 2000-06-01

Myofascial pain syndrome (MPS) is a skeletal muscle disorder vvhich is characterized by taut bands in one or more muscle groups and hypersensitive referred pain areas from these bands called trigger points. Primary aim of the treatment is to interrupt the pain cycle by inactivating the trigger points. The purpose of this study is to evaluate the efficacy of ultrasound therapy by using objective parameters in MPS. Forty female patients with the diagnosis of MPS were included in this study (mean age 30 � 8,4 years) and patients were randomly distributed into two equal groups. Hotpack and ultrasound therapy were applied to the first group (ultrasound treatment group) and only hotpack was applied to the second group (control group). Duration of therapy was 10 days for both groups. �n ultrasound treatment group the increase in pressure pain threshold and tissue compliance values (p<0,05) and the decrease in VAS values (p<0,05) were statistically significant after the therapy. Though a little increase in the tissue compliance and pressure pain threshold values in the control group was detected, it vvasn't statistically significant (p>0,05). �n the comparison of two groups, alterations in VAS, tissue compliance and pressure pain threshold values were statistically more significant in ultrasound treatment group (p<0,05). As a result we determined the efficacy of ultrasound treatment vvhich is one of the counterstimulation techniques that can sometimes be used in MPS treatment, by using objective parameters and su�gested this technique as an important choice in appropriate cases.

EVALUATION OF FUNCTIONAL INTEGRITY OF NEUROMUSCULAR JUNCTION BY SINGLE F�BER ELECTROMYOGRAPHY �N HEMIPLEGIC PA TIENTS

Metin Karata�, Seyhan S�zay, Meral Bayramo�lu, R�dvan �zker — 2000-06-01

Muscle wasting in hemiplegia and degenerative changes in lower motor neurons contrlateral to cerebral lesions have been well documented. But the electrophysiological features and pathogenesis of hemiplegic muscle atrophy remains unexplained. A transneuronal degeneration of corticospinal fibres have been suggested to explain these features. �n the present study, the functional integrity of neuromuscular transmission was assessed by stimulated single fibre electromyography with axonal microstimulation (stim-SFEMG) in Extansor Digitorum Communis (EDC) muscle contrlateral to cerebral lesions of stroke patients. Neuromuscular jitter was measured in 24 hemiplegic patients with normal peripheral nere conduction studies and in whom the disease duration from the onset of stroke until the examination was longer than 6 months. Although mean of mean jitter values in whole group was vvithin normal limits, there were incresed jitter values for at least 2 individual muscle fiber which supports a neuromuscular transmission disorder in 6 patients. There was no relationship betvveen motor recovery stages of hemiplegic upper extremity and disease duration with neuromuscular jitter values, but mean neuromuscular jitter values was negatively correlated with the degree of finger and vvrist extensor muscle tonus. Such changes in neuromuscular transmission may be related to transsynaptic degeneration of lower motor neurons as a consequences of the interruption of corticospinal tract. These findings suggested that neuromuscular transmission disorder in some of the hemiplegic patients can be demonstrated not only in the earlier phases of denervation-reinervation process, but also in long standing cases.

ACCELERATED NODULOSIS DUE TO METHOTREXATE THERAPY IN A PATIENT WITH RHEUMATOID ARTHRITIS

�mit Se�kin, P�nar Borman, Hatice Bodur, �zge Han, Banu G�n — 2000-06-01

We describe a patient with rheumatoid arthritis (RA) whom developed new subcutaneus nodules at right and left metacarpophalangeal joints during methotrexate (MTX) therapy in addition to the ones, on both olecranon and extensor surfaces of the left arm. Physicians treating RA patients with MTX must be avare of accelerated nodulosis as an extraarticular side effect of this drug.

SCHVVANNOMA �N THREE PATIENTS WITH LOWBACK PAIN

Halil U�an, �mit Se�kin, G�lseren Ak — 2000-06-01

Spinal schvvannoma is rare, benign tumors arising from the sheath of the spinal nerve roots. Lovv back pain alone or associated radicular pain has been the initial symptom. Today MRI imaging is the most valid early diagnostic technique. Here we report 3 patients vvith lovv back pain, vvhose investigation presented intradural extramedullary tumors of the spine and their postoperative pathologic examination shovved schvvannomas

GLUCOCORTICOID INDUCED OSTEOPOROSIS

Peyman Yal��n — 2000-06-01

Glucocorticoids have serious adverse effects on bone metabolism. Long term corticosteroids treatment indu- , ces osteoporosis. The effects of corticosteroids on bone turn �ver are well known and timingly appropriate preventive approachs may reduce osteoporosis and fractures. �n this revievv glucocorticoids effects on bone metabolism, prophylaxis and treatment are discussed.