Turkish Journal of Rheumatology - 2007; 22(2)

Muscle Performance in Patients with Fibromyalgia Syndrome

Halim Y�lmaz, Hatice U�urlu, Ali Sall� — 2007-06-01

Objective: To compare muscle performance of women with Fibromyalgia syndrome (FMS) to that of healthy women. Patients and Methods: A hundred women applying with common body pain and diagnosed with FMS, and fifty healthy women were included into the study. In all participants, dominant hand grip strength with a hand manometer, maximal knee flexion, extension and shoulder abduction and adduction muscle strength at 60 and 180º/sec angle velocity, 180º/sec angle velocity, dynamic muscle endurance with 30 time repeated maximal isokinetic knee flexion and extension knee flexion and extension with isokinetic device, and static muscle endurance with maintaining the stable position were measured. Relative values were provided by dividing muscle performance parameters which are isokinetically defined to the body weight of the patients. In the patients' group, general pain experienced and regional pain felt after a static endurance tests were determined using Visual Analogue Scale (VAS). Results: When compared with healthy controls, all parameters of muscle performance were significiantly lower in the patients with FMS (33% at hand grip strength, 26-40% at isokinetic measurements and 55-71% at static muscle endurance). Relative isokinetic muscle performance parameters were also significantly decreased (22-36%). Conclusion: In this study, insufficiency in muscle performance was found in patients with FMS. �nsufficiency was more defined in activities requiring prolonged static contraction. These findings suggest the importance of exercises which require prolonged static contractions in the treatment of FMS. (Rheumatism 2007; 22: 43-7)

Performance of Risk Assessment Indices for the Prediction of Postmenopausal Osteoporosis

Rezzan G�nayd�n, Alt�nay G�ksel Karatepe, Taciser Kaya, U�ur Karl�ba� — 2007-06-01

Objective: To evaluate the performance of osteoporosis risk assessment indices in identifying women with osteoporosis. Patients and Methods: One-hundred eighty-six postmenopausal women aged 45 years and older were included in the study. The subjects were evaluated in terms of the risk for osteoporosis by using Osteoporosis Screening Tool (OST), Simple Calculated Osteoporosis Risk Estimation (SCORE), Osteoporosis Risk Assessment Instrument (ORAI), and Osteoporosis Index of Risk (OSIRIS). Bone mineral densities (BMD) at the lumbar spine and the proximal femur were measured by dual energy X-ray absorptiometry (DXA). The performance of indices in identifying subjects with osteoporosis (T-score ≥ -2.5) at the L2-4 spine or the femoral neck were evaluated using Receiver Operating Characteristic analysis and the areas under the curve (AUC) were calculated. Results : When the defined cut-off values (<2 for OST, >7 for SCORE, >8 for ORAI and <1 for OSIRIS) were used to send the patients for DXA testing, the sensitivity of the risk indices to identify osteoporosis at the femoral neck ranged from 72% to 86%, the specificity from 38% to 54%. At the lumbar spine, these values ranged from 58% to 73% for sensitivity and from 38% to 53% for specificity. The AUC values of indices ranged from 0,718 to 0,733 for osteoporosis at the femoral neck and from 0,541 to 0,579 for osteoporosis at the lumbar spine. Conclusion: It was observed that all four indices showed similar performance for identifying women with osteoporosis, and were more effective for identifying femoral neck osteoporosis. Utilization of these indices, because of their high negative predictive values, provide safe exclusion of healthy women who have a normal BMD and do not need a DXA testing, thus saving the DXA cost. It was concluded that the OST index could be preferred in clinical practice due to its ease of application. (Rheumatism 2007; 22: 48-54)

The Efficacy of Peloidotherapy on Knee Osteoarthritis

Ufuk �en, M.Zeki Karag�lle, Mine Karag�lle — 2007-06-01

Objective: This study was designed to evaluate the efficacy of peloid application(mud pack therapy) in patients with knee osteoarthritis. Patients and Methods: In this study, we included 20 patients with diagnosed as having osteoarthritis of the knee according to the American College of Rheumatology (ACR). The mean age was 56.95 (45-67) years;15 females and 5 males. The osteoarthritis of the knees were bilateral in all patients. The Mud pack orginated from Sarayk�y, Denizli. The Mud pack was applied at 45ºC for 30 minutes and continued once a day for 12 days. All patients were evaluated using VAS, WOMAC and SF-36 scores. Results: All parameters were administered three times (at the baseline, the end of the treatment and the end of the third month). With regard to our results, an excellent improvement was observed in terms of VAS, WOMAC and physical function, limitation of physical role, pain, general health, vitality and mental health of SF-36 scores (p<0.0001), while a medium improvement was seen in terms of social function and emotional role of SF-36 scores (p<0.05). Conclusion: We conclude that mud pack therapy gives satisfatory results in the early period for patients with knee osteoarthritis and that is a time and quality of life saving procedure, which can be safely applied for the elderly patients. (Rheumatism 2007; 22: 55-9)

DNA Damage and Oxidative Stress in Patients with Osteoarthritis: a Pilot Study

�zlem Alt�nda�, Abdurrahim Ko�yi�it, Necla �elik, Hakim �elik, Neslihan Soran — 2007-06-01

Objective: We aimed to investigate the effect of osteoarthritis on basal levels of DNA strand breaks and on the oxidative/anti-oxidative status of patients with osteoarthritis, and healthy subjects. Patients and Methods: The study population contained 29 patients with knee osteoarthritis and 26 healthy controls. We used single-cell gel electrophoresis (also called comet assay) to measure DNA strand breaks in peripheral blood mononuclear leukocytes. Plasma levels of total antioxidant status (TAS) and total oxidative status (TOS) were determined, and oxidative stress index OSI was calculated using a novel automated measurement method. Results: The mean values of DNA damage, plasma TOS and OSI were significantly higher in patients with osteoarthritis than in controls (p < 0.001, for all). Plasma TAS level was lower in patients than in healthy controls (p < 0.001). There was a significantly positive correlation between OSI and DNA damage (r = 0.530, p < 0.001). Conclusion: The findings indicated that Reactive Oxygen Species produced in the progression of the disease may induce oxidative damage in normal cells. (Rheumatism 2007; 60-3)

Infectious Arthritis

Semra Tun�bilek — 2007-06-01

Infectious arthritis is bacterial, viral, fungal, mycobacterial, or parasitic infection of single or multiple joints. The most common cause of acute bacterial arthritis is Staphylococcus aureus, and the most common risk for this is rheumatoid arthritis. Viruses cause nonsuppurative arthritis affecting multiple joints. Chronic fungal and mycobacterial arthritis are generally presents as monoarthritis and the differential diagnosis with other monoarticular arthritis is made by microbiological diagnostic methods. The main principle for the treatment of bacterial arthritis is articular drainage and antimicrobial treatment. (Rheumatism 2007; 22: 64-71)

Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE): A Case Report

�ebnem Kolda� Do�an, Birkan Sonel Tur, Safiye Tuncer, B�lent Se�kin — 2007-06-01

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a disease that affects the elderly and has a sudden onset of edema with swelling on the dorsum of the hands, synovitis on the elbows and flexor tendinitis on the fingers. Serologic tests are negative and radiographic joint destruction does not occur. Etiology of RS3PE syndrome is not known but environmental and infectious agents may play a role in its development. Being a benign syndrome responding to low dose corticosteroid and undergoing to remission in one year, RS3PE syndrome can also be associated with diseases like malignance, polimyalgia rheumatica or amiloidosis. Presented below is the case of a 63-year-old female patient with the complaint of swelling, warming and pain in her wrist, ankle and dorsum of the hands which had suddenly started 9 months previously. (Rheumatism 2007; 22: 72-5)

Reflex Sympathetic Dystrophy Syndrome of the Ankle in Pregnancy

Mehmet Karako�, �zlem Alt�nda�, Neslihan Soran — 2007-06-01

Reflex sympathetic dystrophy (RSDS) is a type of arthropathy combining a painful syndrome with regional trophic disturbances. The condition primarily affects women during pregnancy, but it also affects middle-aged men. Although hip involvement is the most common form of the disease in pregnancy, other joints such as knee and ankle may be involved. Diagnosis is based on typical clinical and radiological observations. Pain may persist for six months or longer. Fracture is the major risk for the disease. Treatment consists of analgesics, protection against stress fractures, and the prevention of contractures. Reflex sympathetic dystrophy does not appear to affect the course of pregnancy but conclusion of the pregnancy is necessary for cure. We described a patient with pain and local osteopenia of the ankle occurring in the third trimester of pregnancy. We prefer the name reflex sympathetic dystrophy for this condition and we discussed the different terms which determine the same condition. (Rheumatism 2007; 22: 76-9)

Hereditary Calcium Pyrophosphate Crystal Deposition Disease Simulating Spondyloarthropathy: Case Report

Ebru Umay, Alev �evikol Demirel, Ayt�l �akc� — 2007-06-01

Familial calcium pyrophosphate crystal deposition disease (CPPD); is a deposition disease characterized with deposition of calcium pyrophosphate in soft tissue, joint capsule and fibrous and hyaline cartilage that can be seen in more than one clinical appearance, inflammatory, degenerative and sometimes with destructive joint and vertebra invasion (neurological complications related to this can occur) and that can rarely lead to tophustumoural soft tissue calcifications. The disease has two forms; primary and secondary. A small part of primary form is hereditary and majority of it is idiopathic form. In the hereditary form, clinical initiation is generally poliarticular together with progression signs in the 3rd and 4th decades. There is a severe disease course, progression, deformity in joints and spoondyloarthropathy which rarely cause ankylosis in comparison to sporadic disease. Autosomal dominant inheritance has been demonstrated in studies performed in United Kingdom and United States of America. It is generally characterized with mutation in the short arm of the 5th chromosome (5p15.1 gene locus), or disorders in the pyrophosphate metabolism of the chondrocytes. ANKH gene codes the membrane protein responsible for the transmembranous transport of the synovial inorganic pyrophosphate in the chondrocytes. In the ANKH gene mutation, micro crystal forms appear in the extracellular matrix of the tendons and cartilages as a result of the increase of the extracellular inorganic pyrophosphate on a genetic basis. Sporadic form occurs with olygoarticular preference (knee and hand joints) in the 6th and 7th decade. Secondary form is associated with endocrine and metabolic diseases (hyperparathyroidism, hypothyroidism, hypomagnesemia, hypophosphatasia, hemochromatosis) trauma and surgical procedures. Here, we present a case followed up with the diagnosis of Ancylosing Spondylitis because of complaints regarding the spina and joints, and used various drugs, which was in fact a case of hereditary calcium pyrophosphate crystal deposition disease. (Rheumatism 2007; 22: 80-3)