Turkish Journal of Rheumatology - 2007; 22(3)

Sex Hormone Status in Women with Rheumatoid Arthritis

2007-09-01

Objective: Sex hormones seem to play an important role as modulators and perpetuators of rheumatic disorders with autoimmune involvement such as rheumatoid arthritis (RA). The aim of this study was to investigate the levels of sex hormones in patients with RA. Patients and Methods: In this study we measured the serum total testosterone (TT), dehydroepiandrosterone- sulfate (DHEA-S), follicle stimulating hormone (FSH), luteinizing hormone (LH), progesteron, prolactin (PRL) and estradiol levels of 26 patients with RA and compared with 22 healthy control subjects. All hormone parameters concentrations were determined by electrochemiluminesans assay on Elecsys^� Systems E170 Modular Analytics autoanalyser using commercial kits (Roche Diagnostics GmbH, Mannheim, Germany). Results: The patients with RA presented significantly decreased values of FSH, DHEA-S, progesterone ve TT levels (p=0.03, p< 0.001, p=0.03, p<0.001, respectively) with respect to the control group. Estradiol levels were also higher in RA group (27.92�13.1 pg/ml) compared with control subjects (21.17�11.4 pg/ml) but the difference was not significant (p>0.05). Upon comparison of the RA and control groups, the RA group had significantly higher levels of PRL (p<0.001). There were insignificant correlations between hormone levels and clinical data in patients (p>0.05). Conclusion: Our results support the hypothesis that sex hormones may be a risk factor for the development of RA. For definitive role of sex hormones in RA further studies are needed. (Rheumatism 2007; 22: 84-7)

Lipid Profile in Female Patients with Rheumatoid Arthritis

2007-09-01

Objective: To investigate the lipid profile in patients with rheumatoid athritis Patients and Methods: The levels of total serum cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-chol), low density lipoprotein cholesterol (LDL-chol), sedimentation, C reactive protein (CRP) and rheumatoid factor (RF) in 40 postmenopausal female patients diagnosed as Rheumatoid Arthritis according to ACR criteria were compared with 40 postmenopausal healthy women at the same age group. Results: The mean age, menopausal status and body mass index were similar in both groups (p>0.05). In RA group, the levels of erythrocyte sedimentation rate and CRP were significantly higher than the control group (p=0.005, p=0.041 respectively). Levels of total cholesterol, triglycerides, LDL-chol levels did not show a significant difference between the groups (p>0.05). Serum HDL-chol levels were higher in RA patients but this difference was not significant (p=0.059). Conclusion: According to this study no significant difference was found in lipid levels between the RA patients and control group. (Rheumatism 2007; 22: 88-90)

Comparison of Effectiveness of Hydrotherapy and Amitriptyline in Fibromyalgia Treatment

Hilal Kocaba�, Gamze Y�lmaz, Hatice U�urlu — 2007-09-01

Objective: Fibromyalgia (FM) is a nonarticular rheumatic disorder with an unknown etiology which is characterized by diffuse musculoskeletal pain, tenderness on specific anatomical points and psychological discomfort. There isn't any standardized treatment regime. In recent years some nonpharmacological applications have been come in prominence. These are, hydrotherapy, balneotherapy and massage. In this study, we compared effectiveness and side effects of amitriptyline and hydrotherapy which were used in the treatment of fibromyalgia. Patients and Methods: A total of 51 female patients with FM were included. They were randomly divided into two groups. Group 1 (n=20) took 15 session hydrotherapy along three weeks, group 2 took (n=31) 10 mg/day amitriptyline for eigth weeks. Both groups were examined at the beginning and at the end of the treatment, third and sixth month. The number of tender points (NTP) were evaluated by digital pressure. Likert scoring system were used to assess pain intensity, morning stiffness, skin sensitivity, sleep disturbances, fatigue and muscle spasm. Hamilton Depression Scale (HDRS) and Fibromyalgia Impact Questionnaire (FIQ) were used to evaluate psychologic condition and physical and functional capacity, respectively. Results: In group 2, significant improvement was found in pain, sleep disturbance, fatigue, NTP, FIQ and HDRS values at the end of the treatment. In group 1 significant improvement was obtained in all measurements except skin sensitivity and HDRS. This improvement prolonged up to 3 months in pain, morning stiffness, fatigue, NTP and FIQ. When the two groups were compared there was a significant improvement in hydrotherapy group in pain, sleep disturbance and FIQ at the end of the treatment. Conclusion: Effectiveness of hydrotherapy is more and longer than amitriptyline. When the adverse effects of tricyclic antidepressants are considered, it will be useful to prefer any regimen which has no advers effect. (Rheumatism 2007; 22: 91-6)

Pulmonary Involvement in Rheumatoid Arthritis

Zeynel G�ldo�an, Emel Ek�io�lu, Hikmet F�rat, Ayt�l �akc� — 2007-09-01

Objective: Pulmonary involvement is a frequent extraarticular finding in Rheumatoid arthritis (RA). Lungs of 81 RA patients were evaluated in this cross-sectional study. Patients and Methods: Symptoms, clinical and laboratory parameters, Ig levels, Health Assessment Questionnaire (HAQ), functional exercise level for daily living activities (six minute walk test), pulmonary function tests (PFT) and high resolution com puter tomography findings (HRCT) were investigated. Results: The HRCT and PFT was abnormal in 56.8% and 29.7% patients respectively. HRCT was abnormal in males, the elderly, late onset of the disease and in patients with a high erythrocyte sedimentation rate , C- reactive protein and Ig A levels. Coughing and sputum were frequent in HRCT abnormal patients. Statistical significance was found between HAQ and PFT and PFT and HRCT findings. No significant difference was found between the six minutes walk test and PFT and HRCT. Conclusion: Pulmonary involvement was more common with late onset of disease, and high Ig A levels but it did not decrease the functional exercise level for daily living activities. (Rheumatism 2007; 97-103)

Fibromyalgia Management: Rehabilitation Approaches

Murat Zinnuro�lu — 2007-09-01

Fibromyalgia is characterized by long-lasting, widespread pain and generalized tenderness, usually accompanied by fatigue. There are fewer studies on the efficacy of non-pharmacologic rehabilitative treatment approaches compared with pharmacologic treatment choices. In this review, particularly randomized controlled studies on rehabilitative techniques which are indispensable for fibromyalgia treatment have been overviewed. The efficacy of aerobic exercises, patient education, self management techniques and cognitive-behavioral therapies is more when compared with other treatment modalities. Main beneficial exercise types are whole body aerobic exercises, cycling, dance, walking, pool exercises, stretching and strengthening exercises. The most important member of a successful management team is a well-educated patient who has the ability to maintain the treatment program and make appropriate arrangements according to fluctuations in symptoms. The most efficient education programs emphasize self-efficacy and the patients who get beter results are those having more self-efficacy thus adapting more easily. Consequently, we must consider that fibromyalgia syndrome is characterized by multisystem symptoms and so multidisciplinary (multimodal) therapies should be preferred as it has been shown with many previous studies. (Rheumatism 2007; 22: 104-9)

Anklyosing Spondylitis Together with Familial Mediterranean Fever: A Concomitant Disease or a Feature of FMF?

�zlem Alt�nda�, Mehmet Karako�, Neslihan Soran — 2007-09-01

Familial Mediterranean Fever (FMF) is an autosomal recessive disease characterized with self-limited recurrent episodes of fever and serositis. The association of FMF with ankylosing spondylitis (AS) was reported in previous studies as a rare condition and the mechanism of this association still remains unknown. The possible forms of joint involvement in FMF are acute or chronic mono-oligoarthritis and seronegative spondyloarthropathy. We described a case of FMF with AS in the case of a patient who had been diagnosed as having acute rheumatic fever (ARF) 20 years ago. We suggest that FMF with AS must be kept in mind in the presence of articular symptoms in patients with FMF. (Rheumatism 2007; 22: 110-13)

Osteonecrosis of the Knee Due to Hypertriglyceridemia and Hyperuricemia: A Case Report

Duygu Geler K�lc�, Safiye Tuncer — 2007-09-01

Osteonecrosis is a pathologic process which results with the death of bone and bone marrow elements. The main predisposing factors (trauma, glucocorticosteroids, alcoholism and connective tissue disorders) should be carefully sought but osteonecrosis can also be idiopathic in origin. We report a patient who developed osteonecrosis of the knee with hypertrigliceridemia and hyperuricemia. Knee osteonecrosis combined with hypertriglyceridemia is a rare condition. This case draws attention to the association between osteonecrosis and metabolic disorders. (Rheumatism 2007; 22: 114-6)

Romatoid Arthritis Like Hand Deformities Associated with the Parkinson's Disease: A Case Report

Bengi �z, Serpil Bal, Asuman Memi�, Alev G�rgan — 2007-09-01

We present a case diagnosed as Parkinson's disease that had hand deformities resembling the deformities of romatoid arthritis. Hand deformities can develop secondary to Parkinson disease and they might be similar to deformities of Romatoid arthritis. It was reported that swan neck deformity, ulnar deviation and hiperextension of metacarpophalangeal joints were associated with Parkinson's disease. As these deformities can be observed in romatoid arthritis, careful differential diagnosis is mandatory. (Rheumatism 2007; 22: 117-9)