Turkish Journal of Rheumatology - 2007; 22(1)

Comparison of Effectiveness of Intra-articular Corticosteroid Injection and Splinting in the Treatment of Rhizarthrosis

M�nevver Fatma �a�maz, G�knur Karahan, Canan �elik — 2007-06-01

Objective: This study aims to compare the effectiveness of intra-articular corticosteroid injection and splinting on pain and hand function in the treatment of rhizarthrosis. Patients and Methods: Thirty patients diagnosed with rhizarthrosis were included in this study. The patients were randomly divided into two equal groups. An injection of a single intra-articular corticosteroid was made into the 1. carpometacarpal joint (CMC) of the patients of the first group. A wrist spica splint supporting the thumb was given to the patients of the second group. The study covered a 6 week period. The hand joints protection programme was taught to both groups. The patients of both groups were evaluated at the beginning and at the end of the third and sixth weeks. The parameters used to evaluate the patients include the following; visual analog scale (VAS), the number of swollen and painful joints, range of motion (ROM), grip strength, pinch strength and Duru�z hand scale. Eleven patients were eliminated from the study due to their absence at the control evaluations, thus the study was completed with nineteen patients. Results: The study revealed no significant differences (p>0.05) among the two groups in terms of age, gender, body mass index, suffering period and affected side. The study also pointed out that patients in both injection and splint treatment groups exhibited lowered pain, decreased VAS values (relaxed, in motion and with pressure) without statistical difference to each other (p >0.05). Although evaluations at the beginning, third week and sixth week resulted in no significant differences in the number of swollen and painful joints, ranges of flexion, extension and adduction of 1. CMC joint, grip and pinch strength in both groups (p>0.05), there was significant improvement on the abduction ROM and Duru�z hand scale (p=0.006 and p=0.002 respectively) in the injection group. But no significant difference was found between significant difference between corticosteroid injection and splint treatment groups about all parameters. Conclusion: In the treatment of rhizarthrosis, it is considered that there is no difference between an intra-articular corticosteroid injection and splinting, but in the injection group, there is significant improvement in the abduction ROM and functional status. (Rheumatism 2007; 22: 1-5)

Treatment with 100 Mg Weekly Leflunomide in Rheumatoid Arthritis-An Open Study

Halil Koyuncu, Neval Bozok, Se�il Yalg�n, Fatma Kumbasar, Haluk Aksoy — 2007-06-01

Objective: To investigate the efficacy and safety of leflunomide using 100 mg / week in rheumatoid arthritis. Patients and Methods: Patients having active rheumatoid arthritis according to the American Collage of Rheumatology criteria were included. Following of a loading dose of 100 mg of leflunomide for three days they continued with 100 mg of leflunomide weekly. Efficacy and side effects were evaluated. Results: Seven patients mean age was 50.5�6.1 years and the mean duration of the disease was 8.0�5.8 years.All patients had previously taken Disease Modifiying Antirheumatic Drug (DMARDs).There were no who were left the treatment. Pain score was 6.5�0.9 before treatment and 4.1�1.0 after treatment. The number of tender joints 12.7�2.1 at the beginning and 8.5�1.6 at the end of 6 months.The number of the swollen joints was 12.5�3.5 at the beginning of the study and 8.7�2.4 at the end of the study. These differences were statistically significant (p< 0.05). Stanford scala was 45.4�7.8 before treatment and 32.8�6.1 after treatment. General health status mean was 5.0�1.1 at the beginning and 7.4�1.3 at the end.The last both changed significant, also (p<0.05). Arterial tension was at normal limits at the beginning and end of treatment. Erytrocyte sedimentation rate was 62.8�25.6 mm /hour at the beginning and 43.4�11.6 mm/hour at the end of the study. CRP levels were found 39.2�17.5 IU at the beginning and 26.2�10.8 IU at the end. The decreases were significant (p<0.05). ALT were 20.8�8.4 IU and 26.4�9.8 IU at the beginning and the end. The increases were not significant (p>0.05).Side effects were not clinically seen. Trombocytopenia was on 14.3 percent of patients,it was transient and mild. Erosion on x-ray was on 71.4 percent of patients,it did not increase at the end of treatment. At the end of treatment, global effectiviness mean was 2.5�0.7 Conclusion: The present study is an open, noncontrolled and noncomparable preliminary trial. The results were positive and compatible with literature.At the end of six months, side effects were no clinically seen. The patient's adaptation was full.Weeky usage had provided ease. The benefits of these treatments will have to be supported with longterm, randomized controlled blind study and these trials will have to be done. (Rheumatism 2007; 22: 6-10)

Evaluation of Pain Pressure Threshold and Frequency of Fibromyalgia in Patients with Dysmenorrhea

2007-06-01

Objective: To evaluate the pain pressure threshold and the frequency of fibromyalgia syndrome (FMS) in patients with primary dysmenorrhea. Patients and Methods: Thirty-three woman with dismenorrhea (mean age 22.23�5.59 years) and age and body mass index matched 18 healthy woman were enrolled in this study. Patient and control groups were asked for common fibromyalgia symptoms such as sleep disturbances, subjective soft tissue swelling, irritabl bowel syndrome. In both groups, pain pressure threshold were measured on 18 tender points and 4 control points (thumb nail and volar side of forearm bilaterally). Total myalgic score (TMS - sum of 18 Tender Point + 4 Control Point), control point score (CPS -sum of 4 Contro Point) and mean tender point count (TPC) were calculated. Beck depression scale (BDS) was used in both groups. Results: In the dysmenorrhea group, only two patients were satisfied the diagnostic criteria of FMS (6.06%). But, widespread pain and common fibromyalgia symptoms were more frequent in the rest of the patients who had not 11/18 tender points compared to the control patients (p<0.05). In the patient and control group, the mean TMS was 136.91�19.77 and 160.15�8.81, CPS was 25.32�4.65 and 29.56�2.67, TPC was 4.54�3.44 and 1.55�1.29, respectively. The values of TMS and CPS were significantly lower and TPC was significantly higher in the patient group than control group (p<0.05). The mean pain pressure threshold value of tender point (2.97�0.72) and the mean pain pressure threshold value of all tender point and control point of the patient group were significantly lower than the mean values of the control group (3.80�0.93 and 7.58�0.41, respectively) (p<0.05). In the patient and control group the mean BDS was 20.81�8.46 and 12.88�14.33, respectively. In patient group, BDS score was significantly higher than control group (p<0.05). Conclusion: Although dysmenorrheic women didn't satisfy the diagnostic criteria of FMS, they had lower PPT values and increased frequency of fibromiyalgia symptoms. We thought that multidisciplinary treatment approach, similar to FMS treatment, may be useful in the treatment of dysmenorrhea. (Rheumatism 2007; 22: 11-4)

Metacarpal Bone Density in Carpal Tunnel Syndrome Patients Without Thenar Atrophy

2007-06-01

Objective: Bone loss due to thenar atrophy was reported in the metacarpal bones in premenopausal patients with carpal tunnel syndrome (CTS). The present study was designed to assess bone density in the metacarpal bones in patients with CTS without thenar atrophy and to correlate the metacarpal bone density with the electrophysiological findings, hand strength and Boston Questionnaire (BQ). Patients and Methods: Thirty premenopausal patients with CTS without thenar atrophy were enrolled in this study. Thirty-two consecutive premenopausal women were included in the study as controls. The severity of symptoms and the functional status of CTS patients were assessed with Boston Questionnaire (BQ). Muscle strength of both hands was tested first with a Jamar dynamometer followed lateral pinch using a manual pinch meter in both groups. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) at the second to fourth metacarpal bones of right hand. Electrodiagnostic testing was performed in CTS group. Results: BMD values at the metacarpal bones did not differ between the CTS group and controls (0.49�0.07 gr/cm² vs 0.50�0.07 gr/cm² respectively, p>0.05). Hand grip strength (23.98� 5.50 kg vs 23.88�3.76 kg respectively, p>0.05) and lateral pinch strength (6.70�1.44 vs 6.99�1.17 kg respectively, p>0.05) of CTS group and controls was similar. Electrophysiological findings, hand strength and BQ were not correlated with the bone density at the metacarpal bones in patients with CTS without thenar atrophy (p>0.05). Conclusion: Thenar atrophy seems be the most important predicting factor for the low bone density at the metacarpal region in patients with CTS. (Rheumatism 2007; 22: 15-9)

Serum Levels of (25) 0H Vitamin-D and Hyperparathyroidism in Healthy Postmenopausal Women

2007-06-01

Objective: 25-hydroxyvitamin D hypovitaminosis and low intake of calcium are believed to be the main reasons of secondary hyperparathyroidism in healthy postmenopausal women as well as in the elderly. In this study 25-hydroxyvitamin D deficiency and its effects on serum parathyroid hormone levels were investigated in postmenopausal women. Patients and Methods: Forty-one postmenopausal women were included into the study. Serum calcium, phosphor, creatinine, alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D levels, calcium and creatinine levels in 24 hour urine were measured, the calcium/creatinine ratio was calculated in all subjects. All cases were divided into two groups as having normal or high parathyroid hormone levels (respectively group 1 and 2). Age, body mass index, serum levels of calcium and 25-hydroxyvitamin D were compared between groups. Furthermore, the relationship between these parameters was investigated. Results: Hyperparathyroidism was determined in 23 patients (%56.1). Serum 25-hydroxyvitamin D level showed a statistically significant difference between group 1 and 2 (p=0.030). Threshold value of 25-hydroxyvitamin D level leading to elevation in parathyroid hormone level was determined as 18.6 nmol/l. There was inverse relationship between the serum parathyroid hormone and the 25-hydroxyvitamin D levels (r=-0.357, p= 0.022). Conclusion: Secondary hyperparathyroidism due to 25-hydroxyvitamin D deficiency was detected in more than half of our cases. Thus, from this point of view we believe that it is essential to follow up not only senile but postmenopausal women as well. (Rheumatism 2007; 22: 20-3)

Complementary-Alternative Medicine in Rheumatoid Arthritis

Demirhan D�ra�o�lu — 2007-06-01

Diagnostic, therapeutic and preventive applications that contribute to general medical techniques and conceptually not included in classical medicine, are called Complementary-Alternative Medicine (CAM). Recently, CAM has been used in the treatment and rehabilitation of rheumatoid arthritis (RA) adjunct to classical medical techniques. In this article, the role of CAM techniques in RA treatment and rehabilitation in the light of objective scientific data was discussed. More frequently preferred CAM techniques in RA patients are herbal medicine, dietary supplements, special diets, tai chi, yoga, acupuncture, homeopathy, relaxation techniques, manipulation, massage, spritual healing and meditation. According to statistical data CAM applications are accepted by the patients as a back up to modern medical techniques rather than an alternative to them. It was observed in some controlled studies that CAM techniques, which are special diets, supplements, herbal medicine and homeopathy, have positive effects on RA. But there is still a need for more well designed studies for each specific CAM technique in order to get scientific proof of their value, and thus their use in routine daily practice. (Rheumatism 2007; 22: 24-30)

Stress Fractures: Evaluation of Three Patients and Review of the Literature

Hakan Atalar, Burcu Yan�k, Onur Polat, Birkan Sonel Tur — 2007-06-01

Stress fractures occur due to mechanical overload of bones. Generally pain in the affected bone increases with activity and decreases with rest and tenderness in bone tissue is apparent on physical examination. They are frequently seen in the tibia, hip region and foot bones. In the early period, direct radiography is generally normal. Diagnosis is based on a detailed history, physical examination and advanced imaging methods. In this article, three patients with stress fractures in different anatomical regions are evaluated and similar cases in the literature are summarized. (Rheumatism 2007; 22: 31-5)

Familial Mediterranean Fever Complicated by Avasculer Necrosis of the Femoral Head, Spondiloarthropathy and Osteoporosis: Case Report

2007-06-01

Familial Mediterrenean Fever (FMF) is a hereditary disease characterized by recurrent atacks of fever and serositis. In the clinical course of the disease also locomotor system symptoms frequently occur. In these patients seronegative spondiloartropathy, osteoporosis, arthritis and rarely avasculer necrosis of the femoral head may be seen. Although the relationship of FMF and spondyloarthropathy is a well established situation, there is not enough information about concomitance of FMF and avascular necrosis. In this report a case which has all locomotor system complications of FMF including avascular necrosis is discussed in the light of relevant literature. (Rheumatism 2007; 22: 36-9)

Brucella Arthritis of Hip: A Case Report

�zlem Alt�nda�, Fatma S�rmatel, �cal S�rmatel — 2007-06-01

Brucellosis is a zoonosis that may affect almost any organ, notably the musculo-skeletal, cardiovascular and central nervous systems, sometimes with serious complications. Osteoarticular involvement is the most common complication of brucellosis. However, it can be difficult to diagnose it due to its nonspecific manifestations in musculoskeletal system. The painful limitation of movement may be the only articular sign in the involvement of the joint in Brucellosis. In this study we described a child with hip involvement of brucellosis who did not have any other systemic symptoms of brucellosis. It is suggested that brucellosis should be considered for those patients who have live in endemic regions. (Rheumatism 2007; 22: 40-2)