Turkish Journal of Rheumatology - 2008; 23(3)

Quality of Life, Pain and Depression in Patients with Hemodialysis

Berna Tander, Dilek Durmu�, Ye�im Akyol, Ferhan Cant�rk — 2008-06-01

Objective: We aimed to evaluate the quality of life, severity of pain and psychological states of patients with end stage chronic renal disease undergoing hemodialysis and to make a correlation analysis between subitems of Short Form-36 (SF-36) and severity of pain and depression. Materials and Methods: Fifty-two patients with hemodialysis and 54 controls were enrolled in the study. The social and demographic characterictics of the patients were evaluated by semi structured form. All of the patients and control cases underwent Visual Analog Scala (VAS), Beck Depression Inventory (BDI) and SF-36. Results: There was no statistical difference between the patients and control cases according to demographical data (p>0.05). The SF-36 scores of the study patients were significantly lower than controls except in the Physical Role (PR) score (p<0.05). The subparameters of the SF-36 measurements were negative correlated to the BDI score except PR (r=-0.06, p>0.05) score (p<0.01). The pain by VAS score was found to negative correlate with the SF- 36 subitems of PR (r=-0.37, p<0.01), Pain (r=-0.35, p<0.05) and Social Function (r=-0.35, p<0.01). Furthermore, it was found that a negative correlation between duration of dialysis and Physical Function score (r=-0.42, p<0.01) and positive correlation between duration of dialysis and vitality score (r= 0.35, p<0.05). Conclusion: The follow-up criteria of the patients with hemodialysis should be questioned by quality of life and emotional states. Depression should be evaluated and if present it should be treated properly. (Rheumatism 2008; 23: 72-6)

Medical Students' Knowledge of Osteoporosis in Ege University Faculty of Medicine

Sibel Eyig�r, Hale Karapolat, Berrin Durmaz — 2008-06-01

Objective: Osteoporosis is a major public health problem in many countries. Educating healthcare providers about osteoporosis may play a pivotal role in improving osteoporosis management. However, there are very few studies at the physicians' level of knowledge on this matter. Our aim was to determine as future physicians, Turkish medical students' knowledge and attitudes to the management and prevention of osteoporosis. Materials and Methods: A total of 375 medical students from each grade were asked to fill in a questionnaire about osteoporosis. Results: 98.9% of the students surveyed thought they were somewhat familiar with osteoporosis. Only 0.3% of the medical students who completed the questionnaire answered all the questions on the risk factors for osteoporosis correctly. The fact that supplementary medications in addition to calcium are needed for the management of osteoporosis was known by 45.9% of the medical students. With 10.7%, very few students knew that osteoporosis is directly responsible of hip fractures. On the other hand, 18.9% of the students knew that the disease could result in fatality. Conclusion: The results of the present study show that medical students know the definition of osteoporosis but their knowledge on complications and preventive measures were insufficient in all classes. During their medical education, medical students should be furnished with necessary information on risk factors for osteoporosis and preventive measures that are applicable to the community and this knowledge should allow them to plan effective ways of using information. (Rheumatism 2008; 23: 77-81)

The Relationship Between Bath Indexes and Osteoporosis in Male Patients with Axial Ankylosing Spondylitis

2008-06-01

Objective: Osteoporosis is a common complication of patients with ankylosing spondylitis (AS). There is no avaible data for the indications of bone mineral density (BMD) measurement related to osteoporosis diagnosis at AS patients. The aim of this study is to investigate the relationship between Bath indexes and BMD in patients with AS. Materials and Methods: 45 male AS patients (mean age: 46.96�13.58 years) and 41 healthy male controls (mean age: 48.93�6.86 years) were enrolled in the study. Patients with AS were evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Spondylitis Metrology Index (BASMI) and Bath Ankylosing spondylitis Radiology Index (BASRI). The BMD of AS and control group patients were assessed at hip (femoral neck, Ward's triangle and femur trochanter) and lumbar area. Results: We have found a significant difference at the femoral ward triangle and lomber spine BMD and T scores in favour of AS patients (p<0.05). BASMI scores were negatively correlated with femoral neck and femoral ward triangle (p<0.05). BASDAI, BASFI scores were not correlated with BMD and T scores of any measured regions. Conclusion: We found that femur ward triangle may be appropriate to evaluate bone loss in patients with AS. BASMI score is a useful tool to determine BMD in patients with AS. (Rheumatism 2008; 23: 82-6)

Ankylosing Spondylitis and Postural Balance

Mehmet Adam, Berrin Leblebici, Alper Nabi Erkan, Selda Ba��, Mahmut Nafiz Akman — 2008-06-01

Objective: In this study, we aimed to investigate that, due to postural changes, the patients with ankylosing spondyilitis (AS) have poorer postural balance than healthy subjects. Materials and Methods: Thirty patients with AS (19 female, 11 male) and 20 healthy subjects (13 female, 7 male) were tested by using the Tetrax Interactive Balance System. The general stability, Fourier analysis showing patterns of sway intensity within eight frequency bands between 0.1 and 3 Hz, and weight distribution index (WDI) were evaluated. Data were also compared with disease duration and finger-floor distance, occiput-wall distance and Schober test. Statistical analyses were performed using SPSS 11.0 for Windows program. Mann-Whitney U test was used to compare groups and Pearson Correlation analysis was used for correlation. Results: There was no statistically significant difference on general stability, Fourier analysis scores, WDI between patients with AS and healthy subjects. A negative correlation was found between Schober test and general stability score. (r=-0,390 p=0,03). No other correlations were found between stability scores, Fourier analyses scores, WDI and occiput-wall distance, finger-floor distance and disease duration. Conclusion: The patients with AS have good postural balance. Disease duration and quantitative measurements of posture do not affect postural balance. (Rheumatism 2008; 23: 87-90)

Causes of Mortality in Rheumatoid Arthritis

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

Patients with rheumatoid arthritis have a shorter total life expectancy than the general population of the same age and sex. Generally, mortality due to rheumatoid arthritis occurs 8-10 years after the disease onset. Mortality risk decreases with use of disease modifying antirheumatic drugs. The most common causes of mortality in rheumatoid arthritis are cardiovascular system diseases and infections. Patients with rheumatoid arthritis have a two-fold increase in cardiovascular mortality. Atherosclerosis which is triggered by systemic inflammation is an important factor in the development of cardiovascular disease. The other causes of mortality in rheumatoid arthritis are pulmonary system diseases, renal diseases, drug side effects, amyloidosis, malignancy, vasculitis, crycoarytenoid arthritis, catastrophic antiphospholipid syndrome, Felty's syndrome and atlantoaxial subluxation. (Rheumatism 2008 23: 91-6)

Novel Diagnostic Autoantibodies in Rheumatoid Arthritis

Burcu Yan�k, Duygu Geler K�lc� — 2008-06-01

Early diagnosis and early treatment can prevent joint damage in rheumatoid arthritis (RA); but the lack of appropriate diagnostic criteria hinders early diagnosis. There are not many disease-specific serological markers for the diagnosis of the disease. Highly sensitive and specific markers are needed in the early stages of the disease. The autoantibodies which probably play an importanat role in the pathogenesis of RA and have increasingly been examined in recent years, will be reviewed, discussed, and examples given of the work done. (Romatizma 2008; 23: 97-9)

A Case of Mixed Connective Tissue Disease Associated with Graves' Disease

M.Erkan Kozano�lu, �lke Co�kun Benliday�, Murat Sert — 2008-06-01

A 23-year-old housewife admitted to hospital complained swelling, pain and skin color changes in both hands, and generalized arthralgia and myalgia. She had a butterfly malar rash, puffy hands, arthritis affecting the right second and third proximal interphalangeal and left knee joints. Anti-nuclear antibody was positive, anti-ribosomal nuclear protein antibody titer was found to be increased, C-reactive protein and erythrocyte sedimentation rate were slightly higher. Mixed connective tissue disease was diagnosed on the basis of the findings of synovitis, Raynaud's phenomenon and positive anti-ribosomal nuclear protein antibody and the patient was administered on a combination of oral prednisolone and methotrexate. After one year, a significant increase in the serum free T3 and free T4 and a suppression in thyroid stimulating hormone levels were noted. Both anti-microsomal and anti-thyroglobulin antibodies were also found to be increased. Thyroid scintigraphy with Tc-99 pertecnatat revealed a diffuse uptake pattern. The patient was diagnosed with Graves' disease and treated with anthythyroid drugs for 6 months and then radioactive iodine-131 ablation. In conclusion, here we report a case with mixed connective tissue disease associated with Graves' disease which is an uncommon data in literature. (Rheumatism 2008; 23: 100-2)

Fatal Interstitial Pneumonia as an Advers Reaction in Patient with Rheumatoid Arthritis: A Case Report

Sedat Kaya, Selim Turhano�lu, Ay�e Dicle Turhano�lu — 2008-06-01

Acute interstitial pneumonia developed three weeks after the administration of leflunomide(LEF) in a 53-year-old woman with rheumatoid arthritis. She developed nausea and diarrhea as well as dyspnea before coming to the hospital and LEF treatment was stopped. She suddenly experienced severe dyspnea and her chest x-ray showed reticular shadows in her lower lung fields which had not been detected before. Partial oxygen pressure of her arterial blood fell all of a sudden, which necessitated an emergency admission to the intensive care unit. After endotracheal intubation, mechanical ventilation support was started due to acute respiratory failure. The patient died of respiratory failure 7 days after the onset of acute interstitial pneumonia (Rheumatism 2008; 23: 103-5)

Triggering Role of Trauma on Initiation of SAPHO Syndrome: A Case Report

�mit Din�er, Bar�� Nac�r, Engin �akar, Mehmet Zeki K�ralp, Hasan Dursun — 2008-06-01

SAPHO is a clinical syndrome characterized by Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis. Since the time it was first described, it has been diagnosed at an ever increasing rate. Although cases associated with palmoplantar pustulosis (PPP) have been reported, the relationship of the SAPHO syndrome and spondyloarthropathies with trauma remains poorly understood. While there are case reports in the literature which describe spondyloarthropathies following physical trauma, information exists indicating that psychological trauma and stress can also trigger or exacerbate palmoplantar pustulosis and psoriasis. Our case had PPP which arose 3 months after experiencing trauma on her shoulder and neck regions. In addition, she had low back pain and anterior chest wall pain which appeared after a short time following the onset of PPP. Unilateral sacroiliitis and bilateral sternoclavicular joint involvement were established in the patient. (Romatizma 2008; 23: 106-8)