Turkish Journal of Rheumatology - 2007; 22(4)

Quality of Life in Patients with Rheumatoid Arthritis: Relation with Disease Activity, Functional and Health Status

2007-12-01

Objective: To investigate the effects of disease activity, functional capacity and several dimensions of health status on the level of quality of life in patients with rheumatoid arthritis. Patients and Methods: Thirty-two patients (F/M=30/2) who fulfilled the American College of Rheumatology diagnostic criteria for rheumatoid arthritis were included in this study. Demographic characteristics of patients were recorded. Functional status, health status and quality of life were respectively measured by using Health Assessment Questionnaire (HAQ), Arthritis Impact Measurement Scale2 (AIMS2) and Rheumatoid Arthritis Quality of Life (RAQoL). Results: The mean of ages and disease duration were 51.0�11.8 (28-70) and 11.8�10.0 (1-40) years. There was a statistically significant relation between RAQoL and HAQ (r= 0.472, p= 0.008), mobility (r= 0.379, p= 0.039), walking (r= 0.515, p= 0.004), self care (r= 0.640, p<0.001) and household tasks (r= 0.640, p<0.001) subscales of AIMS2. HAQ correlated with mobility, self care and household tasks and pain subscales of AIMS2 (respectively r= -0.364, -0.559, 0.456, -0.671; p= 0.040, 0.001, 0.009, 0.001). The most important determinants of quality of life were determined as HAQ and walking subscale of AIMS2 (respectively β= 4.013, 1.041 p= 0.021, 0.031). Conclusion: It was shown that rather than disease activity, functional and health status were associated with quality of life. According to our data, amelioration of functional status must be the essential target while controlling pain and disease activity in the treatment of rheumatoid arthritis. (Rheumatism 2007; 22: 119-22)

The Effect of Body Mass Index On Patellofemoral and Tibiofemoral Osteoarthritis in Postmenopausal Women

Burcu Yan�k, Hakan Atalar, Asl� K�ktener — 2007-12-01

Objective: Osteoarthritis is an important health problem with a multifactorial etiology. In this study, the effect of body mass index on patellofemoral and tibiofemoral osteoarthritis was investigated in 71 postmenopausal women. Patients and Methods: Ages of the patients were recorded. The body weight and height of the patients were measured and body mass indexes were calculated. Anterior-posterior radiographs were taken with knees extended bearing full weight; lateral radiographs evaluated according to the Kellgren-Lawrence scale were taken in the lateral decubitus position. Scores of 2 or greater were accepted as osteoarthritis. Totally 142 knees of 71 patients were examined. Generalized Estimating Equations statistical method was used for both tibiofemoral and patellofemoral osteoarthritis. Results: Mean values of the age of the patients were 64.4�8.5, and mean values of body mass indexes were 30 � 5.2 idi. For each unit increase in body mass index, the increased likelihood of developing different OA traits (95% CI) was: tibiofemoral osteoarthritis 1.098 (1.006-1.1973) (P=0.0344) and patellofemoral osteoarthritis 1.096 (1.006- 1.1939) (P=0.0350). Conclusion: Obesity is an important risk factor for development of osteoarthritis at the tibiofemoral and patellofemoral joints of the knee. This emphasizes the potential importance of even minor weight reduction for prevention of knee osteoarthritis. (Rheumatism 2007; 22: 123-5)

Frequency Of Fibromyalgia Syndrome And Effects of the Pain Distribution on the Quality of Life In Hospitalized Cancer Patients

2007-12-01

Objective: Even though knowledge on palliative care cumulates, our experience on the symptoms affecting the quality of life among hospitalized cancer patients is still limited. Therefore, we planned to explore the frequency of Fibromyalgia Syndrome (FMS) among hospitalized cancer patients and address the relation between pain, fatigue and quality of life with regard to the extent of pain. Patients and Methods: One hundred and twenty two hospitalized cancer patients were included in this study. Data on demographics, pain (visual analog scale, verbal scale), sleep quality, disease impact (Fibromyalgia Impact Questionnaire -FIQ), fatigue (Brief Fatigue Inventory-BFI), quality of life (Short Form 36 [SF36], and the European Organization for Research and Treatment of Cancer [EORTC QLQ-C30]) were gathered using standard measures. According to the extent of pain, hospitalized cancer patients were divided into three groups; widespread pain, regional pain, no pain. Results: Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among the three pain groups, with respect to demographic characteristics (p>0.05). There were, on the other hand, significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, BFI, FIQ, physical function, bodily pain, general health, vitality, social function, and mental health sub-scores of SF36, and EORTC-QoL-C30 scores (p<0.05). Conclusions: In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relations between intensity of pain, fatigue, and quality of life with regard to the physical extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches. (Rheumatism 2007; 22: 126-31)

Paraoxonase and Arylesterase Activities in Patients with Rheumatoid Arthritis

2007-12-01

Objective: The aim of the study was to evaluate serum paraoxonase (PON) and arylesterase (ARE) activities as well as lipid hydroperoxide (LOOH) levels in patients with rheumatoid arthritis (RA). We also investigated serum total antioxidant status (TAS) and total oxidative status (TOS) to reveal whether there is an association between the PON/ARE activities and oxidative stress. Our hypothesis is that PON and ARE activities which related to the risk of developing coronary artery disease are low in RA patients. Patients and Methods: Twenty-five patients with RA and 26 healthy controls were included in the study. Serum PON and ARE activities were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with xylenol orange assay. TAS, TOS levels were determined by using a novel automated methods. Results: Paraoxonase and arylesterase activities were significantly lower in patients with RA, LOOH levels were significantly higher (p<0.001, p =0.02, p =0.006, respectively) in patients with RA than in healthy controls. In patients with RA, serum TOS was higher and serum TAS was lower when compared with those of healthy controls (p < 0.001). PON was negatively correlated with LOOH (r = -0.356, p = 0.01), ARE was positively correlated with TAS (r = 0.429, p = 0.002), LOOH was negatively correlated with TAS (r = -0.585, p = 0.001). Conclusion: Our results show that PON and ARE activities, which have antiatherogenic capability, are decreased in patients with RA. PON and ARE activities may be affected by oxidative stress which contribute to the pathogenesis of RA. (Rheumatism 2007; 22: 132-6)

Approach to Monoarthritis

Meltem Alkan Meliko�lu — 2007-12-01

Monoarthritis is among the common complaints encountered clinically and because of many possible causes the diagnosis can be difficult even for an experienced physician. An accurate differential diagnosis of monoarthritis depends on a good history and physical examination that are supplemented by the appropriate investigations. The physician must verify that the patient has arthritis, as manifested by joint swelling, and that the arthritis is limited to a single joint. Determining whether the arthritis is inflammatory or mechanical in nature and whether the disease is acute or chronic will then help the physician arrive at a presumptive diagnosis. Diagnostic investigations should include joint aspiration of synovial fluid and radiographs of the joint may also be required. A radio-nuclide scan, computed tomography or magnetic resonance imaging can be helpful in diagnosis. Treatment is based on the underlying diagnosis, but antibiotherapy is sometimes required until septic arthritis is excluded. (Rheumatism 2007; 22: 137-43)

Coexistance of Fibromyalgia Syndrome and Conversion Disorder: A Case Presentation

Saime Ay, Haydar G�k, Ye�im Kurtai�, Ay�e K��kdeveci, Hakan Kumbasar — 2007-12-01

Conversion is loss of function in motor or sensory organs without any underlying pathology. Psychological disturbances may simulate typical symptoms of musculoskeletal conditions and cause controversy in diagnosis and management. It should be remembered that despite the presence of an organic cause for musculoskeletal symptoms, conversion disorder may coexist and complicate the treatment. In this paper, a 17 years old female patient who had typical musculoskeletal symptoms and diagnosed to have fibromyalgia syndrome together with conversion disorder is presented. (Rheumatism 2007; 22: 144-6)

Lipoma Arborescens of the Knee: Case Report

Sibel �zbudak Demir, Sibel Kibar, Meltem Aras, F�sun K�seo�lu — 2007-12-01

Lipoma arborescens is a rare intra-articular lesion with unknown etiology. It is characterised by villous lipomatous proliferation of the sinovium and typically located in the knee. Gradual joint swelling, variable pain, intermittent effusion and a range of motion limitation are the symptoms that can be seen during the course of lipoma arborescens. It is important to make early diagnosis using magnetic resonance imaging. This diagnosis should be considered in the differential diagnosis of patients with chronic joint effusion. In this article, a case presenting unilateral knee swelling, limitation of range of motion and diagnosed lipoma arborescens by magnetic resonance imaging is reported. (Rheumatism 2007; 22: 147-50)

Juvenile Scleroderma: Apropos of Two Cases

Belde Kasap, Alper Soylu, Mehmet T�rkmen, Salih Kavuk�u — 2007-12-01

Scleroderma is a kind of autoimmune disease characterized by fibrosis and induration, the localized form of which is related only to the skin, while the systemic type is connected with of the other organs. Here, we report one case with localized and another with systemic type of scleroderma both of whom have unusual clinical properties. Case-1: A 19 months-old girl was admitted to our clinic with upper respiratory tract infection findings. By change in her physical examination, a 5 cm scarred area was observed. This was positioned at 1/3 upper thigh. It was learned that the lesion had been present since the age of 15 months. All laboratory findings were in normal ranges other than ANA positivity at 1/40 titer. Skin biopsy revealed plaque morfea and local steroid and vazeline were prescribed. The extention of the lesion was limited with the therapy. Case-2: A 12-year-old girl complained that for the last four months, she had been suffering from shiny skin at her face, hands and feet. In her physical examination, localized edema on the distal parts of her wrists, knees, and face was observed. ANA titer was 1/1280 and anti-centromer antibody was (+). Other laboratory findings and nailfold capillaroscopy were normal. After a low-dose steroid treatment for 8 months, she completely recovered and the medication was stopped. Conclusion: We reported two cases, one with a very early onset of localized scleroderma and another with systemic sclerosis who recovered with low-dose steroid prescribed at the initial phase of the disease. (Rheumatism 2007; 22: 151-5)