Turkish Journal of Rheumatology - 2008; 23(2)

Assessment of Pulmonary Changes in Patients with Ankylosing Spondylitis with High Resolution Computed Tomography

2008-06-01

Objective: In this study, our aim was to investigate the pleural and parenchymal changes and their frequency in patients with ankylosing spondylitis using high resolution computed tomography. Patients and Methods: A total of 23 patients with the diagnosis of ankylosing spondylitis were included in the study. In all patients high resolution computed tomography of the lung was performed after maximum inspiration and expiration. Previous pulmonary findings of 11 cases were used for the analysis of the images. Results: Pulmonary changes were detected in 13 (57%) of 23 patients using high resolution computed tomography. No parenchymal changes were detected in the remaining 10 patients. The most frequently detected finding was parenchymal nodules seen in 11 (48%) patients. This was followed by parenchymal band formation in 9 (39%) patients. In addition, mosaic pattern in 6 (26%) patients, bronchiectasis in 5 (22%) patients, emphysema, interlobular septal thickening, pleural thickening and/or ground glass opacity in 3 (13%) patients, bronchial wall thickening in 2 (9%) patients and honeycomb lung in 1 (4%) patient, were detected. Conclusion: High resolution computed tomography of the lung is an effective method in demonstrating the pulmonary changes in patients with ankylosing spondylitis. (Rheumatism 2008; 23: 38-41)

Bone Mineral Density in Patients with Ankylosing Spondylitis

�zlem Alt�nda�, Mehmet Karako�, Neslihan Soran, Hasan Tabur, Ahmet Demirkol — 2008-06-01

Objective: Patients with inflammatory arthritis are at risk for osteoporosis and bone fractures. Inflammation and immobility contribute to bone loss in patients with ankylosing spondylitis (AS). The aim of this study was to determine bone mineral density (BMD) in patients with AS, and to compare the data of the AS patients with matched healthy controls. In addition, we sought to determine whether BMD values are related to disease activity in patients with AS or not. Patients and Methods: BMD measurements were performed with the use of Dual-Energy X-Ray Absorptiometry (DXA) in 62 AS patients and 36 healthy controls. BMD was measured in spine L2-4 (anterior-posterior view) and femoral neck by DXA. Results: The study showed that patients with AS have lower BMD values and t scores than healthy controls (p<0.001). Furthermore, total lomber BMD value negatively correlated with the length of disease duration in patients with AS (r=-0.322, p =0.01). Conclusion: We thought that evaluation and treatment of osteoporosis was helpful in especially late stages of AS . (Rheumatism 2008; 23: 42-5)

Clinical and Radiological Characteristics of Spondyloarthropathy

Yasemin Turan, Mehmet Tuncay Duru�z, Lale Cerraho�lu — 2008-06-01

Objective: The objective of this study is to determine the clinical characteristics of patients with spondyloarthropaties (SpA). Patients and Methods: One hundred -twenty patients that match European Spondyloarthropaties Study Group (ESSG) diagnostic criteria, were included in this study. There were 48 ankylosing spondylitis (AS), 42 reactive arthritis (ReA), 9 psoriatic arthritis (PsA), 3 enteropathic arthritis (EA) and 18 undifferentiated SpA (uSpA) patients. Demographic data, clinical parameters and grade of sacroiliitis were assessed. Enthesitis were evaluated by the Mander Enthesis Index (MEI). Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) evaluated disease activity and functional status in AS patients, respectively. Results: The most frequently seen symptom was night pain (55.1%) and the most frequently seen radiographic involvement was right sacroiliitis ( 95.8%). Epin calcanei was most frequently observed in PsA (55.5%) and EA (33.3%) patients. The incidence of enthesitis in patients with SpA was 86.7%. Uveitis and heel pain were most commonly found respectively in AS (16.7%), and ReA (47.6%) patients. Conclusion: Whereas patients with SpA had similar clinical symptoms, their most common complaint was night pain. We think that it should be keep in mind while medical treatment is put in order. (Rheumatism 2008; 23: 46-51)

Evaluation of Effectiveness of Leflunomide in the Treatment of Rheumatoid Arthritis

Filiz Eser, Hatice Bodur, Lale Akbulut Aktekin , �mit Se�kin — 2008-06-01

Objective: The aim of this study was to evaluate effects and side effects of LEF in Rheumatoid Arthritis (RA) patients. Patient and Methods: 51 RA patients taking LEF for mono-or combination therapy were investigated retrospectively. Dosage, period of use and other medical therapies were recorded. Erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) levels, number of tender joints and swollen joints were recorded at the beginning, at 6th and 12th months. If LEF stopped, the reasons were investigated. Disease activity scores were calculated with DAS 28 having 3 variables for patients. Results: Thirty one (61%) of RA patients were given monotherapy and 20 (39%) combination therapy. The median DAS 28 values were 4,41�1,3 for the beginning, 3,35�1,1 for 6th month and 3,47�0,9 for 12th month. The improvement of DAS 28 values between the start the 6th and 12th months was statisticaly significant (p= 0,001, p=0,001, respectively). Side effects tcausing medication to be stopped, was seen in 6 patients (11,7%). Elevation of transaminases was seen in 5 patients. These 5 patients were taking combination therapy. Conclusion: These results suggest that LEF is an effective and reliable DMARD for the treatment of RA patients. (Rheumatism 2008; 23: 52-5)

Pregnancy Induced Musculoskeletal Problems

Saime Ay — 2008-06-01

Many physiological changes occur in the body of the pregnant women. One of them is the changes of the musculoskeletal system. During pregnacy because of the increase in size and weight of the gravid uterus, postural changes that cause functional changes occur in the related muscles.Pre-existing musculoskeletal dysfunctions may be aggravated and new problems may be created by these changes. The earlier musculoskeletal system disorder diagnosis in pregnancy, the better the chance of succesful management of the condition. (Rheumatism 2008; 23: 56-9)

Prognostic Factors in Rheumatoid Arthritis

Asl� Gen�ay Can, Zafer G�nendi — 2008-06-01

Rheumatoid arthritis is a chronic, systemic, inflammatory disease that causes articular and extraarticular symptoms and affects quality of life. The clinical course of rheumatoid arthritis is variable. While a small percentage of patients with rheumatoid arthritis go into spontaneous remission, in approximately 20% of patients, chronic progressive disease may be developed despite treatment. Identification of prognostic factors may be predictive for assessing the prognosis and determining the patients who need early aggressive treatment. Either toxicity or high cost of treatment may also be prevented by avoiding over treatment in patients with rheumatoid arthritis who have good prognosis. High levels of acute phase reactants, seropositivity of rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptides), HLA-DR4B1*O4 alleles, female gender, insidious disease onset, chronic synovitis with long duration, extraarticular manifestations, low grade education, high level of serum cartilage oligomeric matrix protein, presence of CD4(+), CD28(-) T cells, high level of macrophage migration inhibitory factor and poor functional capacity measurements are reported as poor prognostic factors in rheumatoid arthritis. (Rheumatism 2008; 23: 60-2)

Ruptured Baker's Cycst Mimicking the Symptoms of Deep Vein Thrombosis in a Rheumatoid Arthritis Patient

Demet G��men Demir, Lale Altan, Nuray D�raz — 2008-06-01

A 50- year- old male patient who had a diagnosis of rheumatoid arthritis was admitted to our clinic with the complaint of sudden onset of severe pain and swelling in his right knee and calf. An initial diagnosis of deep vein thrombosis was made, however, ultrasound imaging revealed bilateral popliteal Baker's cysts. The cyst on the right side was ruptured. Both of the cysts were aspirated. Concomitant occurrence of rheumatoid arthritis and Baker's cyst which could be confused with deep venous thrombosis was discussed in this case presentation (Rheumatism 2008 23: 63-5)

Milwaukee Shoulder-Knee Syndrome: A Case Report

Berrin Leblebici, K�bra Usta�mer, Nuri �etin, Aysun U�uz — 2008-06-01

Basic calsium phospate crystals frequently may form asymptomatic deposits that may give rise to several clinical syndromes, including calsific periarthritis, tendinitis, bursitis, Milwaukee shoulder syndrome, osteoarthritis, calcific tendinitis and bursitis, and mixed crystal deposition in and around joints. Milwaukee shoulder syndrome is a well defined clinical entity that can be observed particular in older women. It is a destructive arthropathy associated with the deposition of cristals, rotator cuff tear, and joint instability. Clinical features include pain, swelling and progressive functional impairment. (Rheumatism 2008 23: 66-8)

Coexistence of Beh�et's Disease and Ankylosing Spondylitis: A Case Report

Filiz Eser, Hatice Bodur, �mit Se�kin — 2008-06-01

Whether Beh�et's disease (BD) is of the seronegative spondiloartropathy (SSpA) group has been a subject of debate for many years. On the other hand, the number of reported cases of coexisting BD and a disease of SSpA group has increased. Here we presented a patient with ankylosing spondylitis (AS) and BD to discuss the coexistence of these two diseases. (Rheumatism 2008 23: 69-71)