Turkish Journal of Rheumatology - 2006; 21(3)

Effect of Traction Therapy in Knee Osteoarthritis: A Prospective Controlled Study

�enay �zdolap, Selda Sar�kaya, �lk� Ko�, Aynur Ba�aran — 2006-06-01

Objective: To investigate the effect of traction therapy on knee osteoarthritis. Patients and Methods: Forty-three patients diagnosed knee osteoarthritis were included in this study. Knee radiographies of patients were taken and classified according to Kellgren-Lawrence classification. Twenty-four patients were treated with traction, hot pack, microwave and isometric exercises while 19 patients in control group were treated with hot pack, microwave and isometric exercises for 15 sessions. Traction was applied intermittently with 15 kg for 20 minutes while patients were sitting position, their legs fully extended. Range of motion of knee was measured with goniometry. The patient's functional status was determined with Lequesne Functional Index and pain levels in rest and motion evaluated with visual analog scale (VAS) before and after 15 therapy sessions. Results: There was statistically significant decreasing in VAS (rest) (p<0.05), VAS( motion) (p<0.05) and Lequesne Funtional Index (p<0.05) in traction group. Conclusion: We suggest traction therapy has beneficial effects on pain and functional status in knee osteoartrhritis. (Rheumatism 2006; 21: 84-6)

Demographic Features of the Patients with Chronic Low Back Pain and Effectiveness of Back School

2006-06-01

Objective: In this study, 44 patients with chronic low back pain, who have attended back school program, have been evaluated for effectiveness of this program, and their socioeconomic and low back pain features. Patients and Methods: In our series 72.7% of cases were females (47.7% were housewives), 40.9 had primary school education and 45.4% were between 35-44 years of age. Patients were evaluated before and 1 and 3 months after the back school training by the following parameters; Intensity of pain by Visual Analogue Scale (VAS), clinical assessment of lumbar region ((lumbar schoeber (cm), lumbar range of motion (ROM), straight leg raising test (SLRT)) , hand floor distance. Moreover, functional disability was assessed by the revised Oswestry Pain Questionnaire. Results: The results of pain intensity (VAS), lumbar ROM and functional disability after the back school were found to be significantly improved (p<0.05). Conclusion: It could be concluded that female sex and low educational level are important risk factors for back pain and back school is an effective adjunctive procedure in alleviating subjective and objective symptoms of patients with chronic low back pain. Also it may be concluded that back school be an alternative treatment procedure to other physical therapy modalities as it is a cost effective method. (Rheumatism 2006; 21: 87-90)

The Relationship Between the Change of Parathyroid Hormone Level in Patients Under Bisfosfonates Treatment and DXA

Ferda �zdemir, Derya Demirba� Kabayel, Esra Esen, Dilek Kurto�lu — 2006-06-01

Objective: We aimed to investigate the relationship between the level of parathyroid hormone (PTH) and T score obtained by Dual energy X-ray absorptiometry (DXA) in patients with diagnosed and treated as postmenopausal and senile osteoporosis in our osteoporosis (OP) clinic. We also evaluated the evaluation of the difference between dressing styles and changes of PTH level according to season in these patients. Patients and Methods: In this retrospective study, the patients who were administered bisphosphonat as antiresorptive treatment as well as calcium and Vit D were chosen, after the scanning of 1625 patients. Inclusion criteria were a) had normal level of PTH values before treatment, b) had no systemic disease to cause high PTH level. Demographic characteristics of the patients, PTH and T scores of lomber spine and hip measured by DXA were recorded at the beginning and after one year treatment. At the second evaluation after one year treatment, 47 patients who had increased PTH levels were named as the first group and 52 patients who had normal PTH levels were named as the second group. T scores of both groups were compared. Results: In pre-treatment period, no difference was found between the PTH levels and T scores of both groups. A statistically significant difference was found between DXA evaluations carried out at the beginning and one year after the treatment. However, when the groups were compared with each other, no difference was found between the DXA values recorded one year later. Conclusion: It was concluded that high PTH levels in patients with OP has no effect on DXA values, which may result from the protective effect of the regular treatment in patients with OP. (Rheumatism 2006; 21: 91-4)

The Relation of Pain and Disability with Radiographic and Pedobarographic Parameters in Adult Pes Planus

Kaan Uzunca, Nurettin Ta�tekin, Murat Birtane — 2006-06-01

Objective: Pes planus is characterized by the absence or collaps of medial longitudinal arc of the foot. Clinically, the pain symptom can be seen while standing and during walking. In this study, we aimed to investigate the relation of foot pain and disability with foot plantar pressure values and radiological findings in adult pes planus patients. Patients and Methods: Thirty patients with pes planus who had foot pain and functional limitations were evaluated by using to the pain and disability sections of “Foot functional index” that are pain and disability sections. The static and dynamic plantar pressure values of all the patients were measured by using pedobarographic investigations. The numeric value of calcaneal pinch angle was measured on lateral foot radiography. The relation of pressure and the calcaneal pinch angle with pain and disability was investigated. Results: Although there was no correlation between pain and disability with pressure values obtained from static evaluation in patients with pes planus (p>0.05), pain was negatively correlated with foot pressures of anterior-lateral and medium region of foot in dynamic evaluation (p<0.05). A positive correlation was found between disability and plantar contact area (p<0.05). Calcaneal pinch angle values were negatively correlated with pain and disability scores (p<0.05). Conclusion: Absence or collapse of medial longitudinal arc in pes planus patients impairs shock absorbance effect of the arc and accompany pain during walking and disability. (Rheumatism 2006; 21: 95-9)

Impact of Ankylosing Spondylitis on Sexual and Vocational Life

Fatma Peker, M. Ali Ta�kaynatan, Ahmet �zg�l, T. Alp Kalyon — 2006-06-01

Objective: Although work place difficulties and sexual problems are not uncommon in ankylosing spondilitis (AS), there has been insufficient emphasis on them. The aim of this study was to reveal the effects of AS in work life and sexual functions. Patients and Methods: 94 young male AS patients fulfilling modified New York criteria, with the mean age of 24.33 years and mean disease duration of 2.53�0.96 years, were included in the study. Standard questionnaires addressing sexual and vocational lives were applied to all patients. Results were assessed with Likert type scale. Sexual desire, intercourse frequency and finding pleasure in intercourse were questioned for the assessment of sexual life. Status of being on work or out of work, unemployment or retirement reason and work satisfaction were questioned for the assessment of vocational life. Results were compared with the results of specific questionnaires for the assessment of AS, BASFI, BASDAI, BAS-G and BASMI which assess the disease activity and outcome. Results: There were statistically significant correlations between sexual life parameters and indices of BASFI and BASDAI. Correlations between vocational life parameters and AS indices of BASFI, BASDAI, BAS-G and BASMI were found statistically significant. Conclusion: As a result, we concluded that vocational and sexual life of the patients with AS are being influenced negatively by the disease's impact on functional status and activities of daily living. (Rheumatism 2006; 21: 100-4)

Pain: Peripheral and Central Sensitization

Ahmet Y�lmaz, S�reyya Ergin — 2006-06-01

Various intracellular substances are secreted from macrophages, lymphocytes and mast cells in response to inflammatory process in damaged tissue. The nociceptive stimulus by itself may induce a neurogenic inflammatory response and cause secretion of substance P, neurokinin A, calcitonine gene related peptid. Secretion of these peptides stimulates the high threshold nociceptors thereby establishing peripheral sensitization. The events that occur in the periphery after trauma induce peripheric sensitization and primary hyperalgesia. Any mechanical stimulation which is painless normally may induce pain sensation (allodynia). These changes after trauma are related to the events that occur in dorsal horn of spinal cord and called as central sensitization. (Rheumatism 2006; 21: 105-10)

The Rupture of the Rectus Abdominis Muscle: An Atypical Abdominal Pain

Tu�ra Yan�k, Burcu Yan�k, Mehmet Y�r�bulut — 2006-06-01

The rupture of the rectus abdominis muscle is rare in sedantary people. Clinically, pain in the lower abdominal region and localized tenderness can be obtained. These patients are incorrectly sent to different specialists, and are exposed to unnecessary invasive examinations and treatments. A patient is presented here with low abdominal pain which began after a football match and later was diagnosed as rupture in the rectus abdominis muscle and this case is discussed with in literature. (Rheumatism 2006; 21: 111-3)

Coexistence of Ankylosing Spondylitis and Multiple Sclerosis: A Case Report

2006-06-01

The neurological symptoms are rarely seen in patients with ankylosing spondylitis. Underlying reasons usually include progressive arachnoiditis, cauda equina syndrome, atlanto-axial subluxation and spinal fractures. In addition, the observation of multiple sclerosis-like symptoms and signs in some patients with ankylosing spondylitis has drawn attention to the coexistence of these two diseases. In this paper, an ankylosing spondylitis patient who developed the typical symptoms of multiple sclerosis during the follow-up was presented and the comorbidity was discussed in the view of current literature. (Rheumatism 2006; 21: 114-7)

Serological Diagnosis of Subclinical Gluten Enteropathy: A Case Presented As Treatment Resistant Osteomalacia

Aynur Ba�aran, K�ymet �kbal Karadavut, Ece Aydo�, Ayt�l �akc� — 2006-06-01

Gluten enteropathy is frequently presented with minimal symptoms and signs. Atypical clinical presentation and treatment resistant osteomalacia should be screened for gluten enteropathy. Current serologic diagnostic methods have a high sensitivity and specificity. Serologic screening is recommended even in the absence of clinical symptoms and presence of minor histopathologic findings. In this case we report a patient with treatment resistant osteomalacia due to subclinical gluten enteropathy that responded to gluten free diet. (Rheumatism 2006; 21: 118-20)

Postoperative Spondylodiscitis: A Case Report

�afi Edemci, F�gen Oktay, Canan �elik — 2006-06-01

Postoperative spondylodiscitis (POS) occurs most often after disc surgery and is regarded as a serious and significant clinical problem. There are no hematologic, biochemical, or imaging findings that are unequivocally diagnostic of this process. The diagnosis of POS must be considered after any invasive procedure performed on the spine with a history of worsening back pain in the absence of constitutional symptoms. In this case report, a patient who had spondylodiscitis and bilateral polyradiculopathy after lumbar disc sugery was presented. (Rheumatism 2006; 21: 121-4)