Turkish Journal of Rheumatology - 2008; 23(1)

Depression Level and Relation with Clinical Parameters in Fibromyalgia Syndrome

Neslihan Soran, �zlem Alt�nda�, Ahmet Demirkol — 2008-06-01

Objective: Fibromyalgia is a chronic pain syndrome characterized by widespread pain. Fibromyalgia may be frequently associated with psychiatric disorders especially depression. However, there were few studies indicating the relationship between the level of depression and disability in fibromyalgia. The aim of this study was to investigate the relationship between level of depression and clinical findings in fibromyalgia. Patients and Methods: A total of 29 patients diagnosed with fibromyalgia and 38 healthy patients were included in the study. Severity of the pain, depression level, disability and severity of disease were evaluated by Visual Analogue Scale (VAS), Hamilton Depression rating scale (HAM-D), Health Assessment Questionnaire (HAQ), Fibromyalgia ‹mpact Questionnaire (FIQ) respectively. Tender point number was determined by physical examination. Results: There were no differences between patients and controls in respect to HAQ [median (minimum-maximum) score: 1.5 (1.1-1.7) and 1.4 (1.1-1.8) respectively]. VAS, FIQ and Ham-D scores were significantly higher in patient group (p<0,001). Further, Ham-D scores were positively correlated with FIQ scores and VAS in the patient group (r=242, p = 0.04; r=296, p=0.01). Conclusion: Our results indicated that the level of depression was higher in patients and depression level was related to severity of disease. We suggest that evaluation and management of psychiatric disorders, especially depression may have additional effects in the treatment of fibromyalgia syndrome (Rheumatism 2008; 23: 1-4)

Relationship Between Handgrip Strength and Isokinetic Shoulder Abduction-Adduction Muscle Strength in Primer Fibromyalgia

Ali Sall�, Halim Y�lmaz, Hilal Kocaba�, Hatice U�urlu — 2008-06-01

Objective: To compare grip strength and isokinetic shoulder abduction- adduction maximal muscle strength and to assess the correlation between hand grip strength (HGS) and shoulder strength in primer fibromyalgia patients with healthy controls. Patients and Methods: One hundred patient and 50 healthy women were included in this study. The patient's complaint duration and number of tender points were recorded. The visual analog scale was used for the assessment of pain. Beck depression scale and Fibromyalgia Impact Questionnaire (FIQ) were calculated. Handgrip strength was measured using a handgrip dynamometer and the highest value of sequential 3 measurements was recorded. Isokinetic shoulder abduction-adduction maximal muscle strength was measured at 60 and 180 degrees/sec. All patients' dominant side was assessed. The strength was calculated as the mean of five consantric isokinetic repetations. Results: There was no statistical difference between patients and the control group in age and body mass index (BMI). The mean HGS was 0,41�0,10 and 0,62�0,13 in the fibromyalgia and the healthy group respectively. The mean HGS and shoulder abduction-adduction maximal muscle strength were significantly lower in the fibromyalgia group than the healthy subjects (p<0,001). Whereas a positive correlation was found between HGS and age, BMI and shoulder abduction- adduction maximal muscle strength, a negative correlation was recorded between complaint duration, VAS and FIQ. Conclusion: Hand grip strength may be a simple and effective method to determine muscle performance of the upper extremity. (Rheumatism 2008; 23: 5-8)

Comparison of Effects of Combined Physical Therapy Program and Exercise on Corrupted Balance Functions in Patient with Knee Bilateral Osteoarthritis

�mit Din�er, Engin �akar, Baki �zdemir, Mehmet Zeki K�ralp, Hasan Dursun — 2008-06-01

Objective: The aim of this study was to evaluate the effects of physical therapy and rehabilitation programs on corrupted balance function in patients with bilateral knee osteoarthritis and to determine any additional superior treatment other than quadricep and the hamstring muscle strengthening exercises. Patient and Methods: Forty patients aged between 59-84 years old, diagnosed with bilateral knee osteoarthritis according to American College of Rheumatology criteria participated in this study. Patients were randomized into two groups. The first group was applied 15 session physical therapy (therapeutic ultrasound and TENS) combined with exercise to both knees; the second group was given 15 session of only strengthening exercise to quadriceps and hamstring muscles. The patients were evaluated before and after two weeks treatment. WOMAC-total, WOMAC-pain and Berg Balance Scale were used to evaluate to disability and balance function. Results: In the inter-groups comparison after 15 session, there were statistically significant differences between two groups and the results of the first group was higher than those of second group in WOMAC-total, WOMAC-pain and Berg scale (p<0.05). There were statistically significant improvement in both groups in WOMAC-total, WOMAC-pain and Berg scale (p<0.05). Conclusion: According to this study we conclude that a physical therapy and rehabilitation program combined with exercise has more beneficial effects than only strengthening exercise program on balance restoration in bilateral knee osteoarthritis (Rheumatism 2008; 23: 9-13)

Effectiveness of Pain, Disease Severity and Radiological Grading on Disability of Daily Living Activities in Knee Osteoarthritis

Saime Ay, Deniz Evcik — 2008-06-01

Objective: In this study we planned to investigate the effects of pain, disease severity, and radiological grading on the disability of daily living activities in knee osteoarthritis (OA) patients, and to find out the determinative factors. Patients and Methods: A total of 50 knee OA patients who were admitted to the outpatient clinic of Physical Medicine and Rehabilitation clinic were included this study. The diagnosis was based on the American College of Rheumatology (ACR) criteria. Patients were evaluated according to pain, disease severity, radiological grading, and disability in daily living activities parameters. Pain was assessed by using Visual Analogue Scale (VAS; 0-10cm), disesae severity was measured by Lequesne severity index, radiologic grading was based on Kellgren and Lawrence OA criteria and disability was assessed by using the Health assessment Questionnaire (HAQ). Results: The mean age of the patients was 52.88 (�10.60) years and the mean disease duration was 72.41 (�61.00) months. A statistically significant relation was found between disease severity and age (r=0.66), disease duration (r=0.76), pain (r=0.83) and radiological grading (r=0.53) (p<0.01). However no significant relationship was observed between radiological findings and disability (p>0.05). The most significant correlation was found between disability, the Lequesne disease severity index and pain (p<0.01, r=0.55; p<0.01, r=0.50). Conclusion: Pain and disease severity affect the level of disability in daily activities. Therefore in additional to radiological grading, asssesment of disability which is of major importance to patients should also be taken into consideration during the follow-up period of knee OA. (Rheumatism 2008; 23: 14-7)

Rehabilitation of Patellofemoral Pain Syndrome

Duygu �ubuk�u, Ay�e Sarsan — 2008-06-01

The term ‘patellofemoral pain syndrome (PFPS)' is used for the clinical presentation with anterior knee pain related to changes in the patellofemoral articulation. Most of the patients with PFPS can be successfully treated once contributing factors are identified concerning the disease history and physical examination. Patellar malalignment is the most common cause. Factors which cause patellar malalignment include an increase in the Q angle, patella alta, an excessive pronation of subtalar joint, vastus medialis insufficiency and muscle tightness. Vastus medialis obliqius education, stretching exercises, the use of patellar taping, correction of abnormal pronation in subtalar joint and education of patients are the basic methods of rehabilitation of PFPS. (Rheumatism 2008; 23: 18-23)

Nutrition in Sportsmen

Banu B. Kalpak��o�lu — 2008-06-01

Everyday we are made aware of the need for proper preparation to maximize performance in sport, and this no longer applies only to the elite. In the 17th century the notion of nutrition and diet changed in European countries (Manz, 2001). First chemical experiments relied on the idea that salts resulted from a union of acids and bases, and digestion was no more regarded as a process of cooking but a succession of fermentations controlled by a balanced production of acids and alkali. Consequently, life seemed to depend on the equilibrium of acids and alkalis. In the 19th century food was systematically analyzed for the content of energy and macronutrients and the first scientifically based nutritional standards were then formulated. New methods to determine the concentration of nutritional elements promoted physiological and clinical research within acid-base metabolism after the 1950s. In this review basic answers to potential questions regarding the nutrition of sportsmen are given. (Rheumatism 2008; 23: 24-7)

Cervical Spinal Cord Injury with a Minor Trauma in A Patient with Ankylosing Spondylitis: A Case Report

Serpil Sava�, Erdem �lg�n, A�k�n G�rg�l�, Ahmet Ye�ilda� — 2008-06-01

Patients with advanced ankylosing spondylitis are prone to fractures of cervical spine following minor injuries. In this case report, we present a case of ankylosing spondylitis where the patient sustained cervical spinal cord injury after a minor traffic accident. (Rheumatism 2008 23: 28-30)

Transient Osteoporosis of the Hip

Nurdan Kotevo�lu, F�sun �ahin, Emel Deniz, �ule Ta�p�nar , Banu Kuran — 2008-06-01

We report two cases which we diagnosed as transient osteoporosis of the hip. We aimed to discuss the steps of diagnosing the disease and importance of different imaging procedures besides presenting the images of healed hip of the first case. Keeping this disease in mind is important during differential diagnosis. (Rheumatism 2008 23: 31-4)

Oral Ulcers Caused by Alendronate use

Hakan Cinemre, Cemil Bilir, Feyzi G�kosmano�lu, Necip �. Aytu� — 2008-06-01

Bisphosphonates are the drugs which modulate bone turnover and reduce bone reabsorbsion. Hence, they are used in postmenopausal osteoporosis , multiple myeloma or osteolisis associated with malign cancer. The rare complications are appearing more often now because of their wide use in treatments. Most important possible adverse effects belong to gastrointestinal systems; esophagitis, gastric ulcers, dyspepsia, heartburn and rarely oral ulcers, osteonecrosis on jaws and esophagial stricturs are illustrated (Rheumatism 2008 23: 35-7)