Turkish Journal of Rheumatology - 2002; 17(2)

THE RELATIONSHIP BETWEEN ECHOCARDIOGRAPHIC FEATURES OF MITRAL VALVE AND ELASTIC PROPERTIES OF AORTIC WALL AND BEIGHTON HYPERMOBILITY SCORE IN PATIENTS WITH MITRAL VALVE PROLAPSE

2002-06-01

The present study was designed to investigate the incidence of benign joint hypermobility syndrome (BJHMS) in mitral valve prolapse (MVP) and correlation between echocardiographic features of mitral valve and elastic properties of aortic wall and Beighton hypermobility score (BHS) in patients with MVP and BJHMS. Forty-six patients with nonrheumatic, uncomplicated and isolated mitral anterior leaflet prolapse (7 men and 39 women, mean age :26.1� 5.9) and 25 healthy subjects (3 men and 22 women, mean age 25.4 � 4.3) were studied. Patients were divided into two groups according to their BHS (Group I, BHS ≥5; 5; Group II, BHS< 5). Individuals with accompanying cardiac or systemic disease were excluded. Echocaroliographic examination was done to all of the subjects. Presence of BJHMS was evaluated according to Beighton's criteria. The incidence of BJHMS in patients with MVP was found significantly higher than controls (45.6%, (21/46) vs. 12 % (3/25), p<0.0001). Group I (MVP+BJHMS) had significantly increased anterior mitral leaflet thickness (AMLT, 5.7� 0.6 ve 4.1� 0.5; p<0.001,) maximal leaflet displacement (MLD, 3.8 � 0.7 vs. 2.9� 0.5; p<0.005) and degree of mitral regurgitation (DMR,17.1 � 7.2 ve 11.2� 4.4 ;p<0.002) than those of group II. However, index of aortic stiffness (IAOS) was found to be lower ( 17.6� 6.9 vs. 23.9� 7.6; p<0.001) and aortic distensibility (AOD) was found to be higher (0.0035� 0.007 vs. 0.0024� 0.005; p<0.001) in group I. There was significant correlation between AMLT, MLD and DMR and BHS (r=0.57/p=0.007, r=0.55/p<0.009, r=0.51/p<0.01, respectively). In additon, AOD correlated positively with HMS (r=0.53/p<0.005), but index of aortic stifness correlated inversely with HMS (r=-0.49/p<0.007). Conclusion: The incidence of BJHMS in patients with MVP was more frequent than normal population and there was a significant correlation between severity of BJHMS (according to BHS) and echocardiographic features of mitral leaflet and elastic properties of aortic wall .

OSTEOARTICULAR COMPLICATIONS OF BRUCELLOSIS

Erdal Gilgil, B�lent B�t�n — 2002-06-01

Brucellosis is a widely spread zoonosis in Turkey, as is in the Middle East. It may lead to protean and severe osteoarticular complications, so it seems essential to identify the clinical features of osteoarticular brucellosis to reach a clear diagnosis. Forty-three cases of osteoarticular brucellosis were included in this study. All of the patients underwent direct radiography and radionuclide bone scanning. CT and/or MRI of the involved area were performed if needed. Of 43 patients, 26 were females and 17 were males; mean age was 45,2 � 15,2 years. The osteoarticular complications were classified as: spondylitis in 25 patients, sacroiliitis in 10 patients, peripheral arthritis in 21 patients, osteomyelitis in 1 patient, bursitis in 1 patient and tendinitis in 1 patient. The peripheral joint involvement was usually of mono- or oligoarticular pattern. The most commonly affected peripheral joints were hips and knees, respectively. In the endemic areas, brucellosis must be taken into consideration in the patients with rheumatic manifestations, especially in those with inflammatory low back pain and/or mono-oligoarthritis.

REHABILITATION OUTCOMES IN ARTHROGRYPOSIS MULTIPLEX CONGENITA

Sibel �zbudak Demir, Z. Aydan Kurtaran, F�sun K�seo�lu, M�fit Aky�z — 2002-06-01

Arthrogryposis Multiplex Congenita is a non progressive syndrome which is characterized by multiple joint contractures. Its etiology has been unknown. Viral infections and autosomal dominant transitions have been blamed for it. The aim of the study was to evaluate clinic and demographic characteristics and to investigate the progress of joint limitations and ambulation ability during rehabilitation. Prenatal, natal, postnatal features and progresses of the patients involved in this study have been noted. The localication and degree of the joint contractures been identified. Their ambulation ability and treatment applied have been assessed. The average age of the patients (7 male, 3 female) was 5,72�3,43. The length of stay at the rehabilitation center was 72,23�0,22 days. Breech presentation in 6 (%60) of the patients was established. 4 (%40) of the patients had congenital hip dislocation and 3 (%30) of them had genital anomaly. The joints in which contracture were the most frequenty localized were knee (%90), ankle (%80) and hip (%70) joints. At the end of the rehabilitation programme passive range of motion and ambulation degree increased.

EVALUATION OF H REFLEX AND F RESPONSE IN QUANTITATIVE MEASUREMENT OF SPASTICITY AND THEIR RELATION WITH CLINICAL MEASUREMENT METHODS IN PATIENTS WITH SPINAL CORD INJURY

Serap Tomruk, G�l�mser Ayd�n, I��k Kele�, �. Sibel Demir — 2002-06-01

In this study, the parameters of H reflex and F response were evaluated in 21 patients with spinal cord injury and in a group of 20 healthy volunteers and compared between the groups. Also in patient group the relations of the electrophysiological parameters with the results of patients� self reports of spasticity and the clinical spasticity measurement methods based on physical examination were investigated. In statistical analysis, amplitude ratio of H_max /M_max was increased, and the amplitudes of F_max , F_mean , Mmax were decreased significantly in the patient group. When clinical and electrophysiological parameters obtained from the same side were analyzed statistically, mean deep tendon reflex score was found to be correlated positively with mean amplitude of H_max . The increase in amplitude ratio of H_max /M_max in the patient group indicates that the excitability of alfa motorneurons is increased in patients with spinal cord injury. Besides, variations in F response and H reflex parameters were not parallel to each other, suggesting that H reflex is influenced not only from the excitability of alfa motorneurons but also the other pathophysiological mechanisms of spasticity. Clinical and electrophysiological methods showed weak correlation, which might be due to the reason that spasticity is a combination of neural pathophysiological mechanisms and while its clinical findings reflect this combination, each electrophysiological method assesses only one aspect of spasticity. Finally, these results suggest that more specific clinical tests should be developed for more accurate evaluation of spasticity.

THE EFFECTIVITY OF BIOFEEDBACK ON REESTABLISHING POSTURAL SYMMETRY IN HEMIPLEGIC PATIENTS

G�ldal Funda Nakipo�lu, Ay�e Karamercan, Aynur Karag�z, Ne�e �zgirgin — 2002-06-01

In the rehabilitation of hemiplegic patients resulting from cerebrovasculer accident (CVA); two of the most commonly faced problems are not being able to control the posture and bearing of weight symmetrically. In this study, we planned to investigate the efficacy of biofeedback in the improvement of symmetric weight bearing and posture control in hemiplegic patients. Sixty patients were grouped into two randomly. Thirty patients participated the program of rehabilitation by the biofeedback and conventional methods and the other thirty patients had conventional weight bearing and postural control therapy. Sitting balance, sitting to standing, walking scales of Modified Motor Assesment Scale (MMAS) and Trunk Control Test (TCT) were applied and percentage of Postural Symmetry (PS) of patients were calculated. The group of patients who received biofeedback and conventional methods showed a statistically significant decrease in the percentage of PS, and an increase in the scores of MMAS and TCT when compared with the group of patient who received conventional methods only. According to the results of our study; we suggest that in the regaining of postural control and symmetric weight bearing in hemiplegic patients resulting from CVA, conventional methods with biofeedback treatment establish more effectiveness than conventional methods only.

THE ASSOCIATION OF SERUM PROLACTIN LEVELS WITH DISEASE ACTIVITY IN THE PATIENTS WITH RHEUMATOID ARTHRITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS

Cahit Ka�ar, Erdal Gilgil, Tiraje Tuncer — 2002-06-01

Hormonal factors are blamed in the etiopathogenesis of both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Prolactin (PRL) is supposed to be amongst those factors. The aim of this study is to investigate the association of serum PRL levels with disease activity of RA and SLE. Twenty-five patients with RA and 14 patients with SLE and 16 healthy controls for RA and 10 healthy controls for SLE, matched for age and sex, were enrolled in the study. Blood samples were drawn from the all participants in the morning for the analysis of PRL and other relevant laboratory measures. Disease activity in the patients with RA was determined by tender joint score, swollen joint count, pain assessment by visual analogue scale (VASpain), duration of morning stiffness, erythrocyte sedimentation rate and C-reactive protein (CRP) levels. Disease activity in the SLE patients was evaluated by SLE disease activity index (SLEDAI). PRL levels were higher in the RA group(p<0.05). Hyperprolactinemic patients with RA showed higher CRP and rheumatoid factor levels, VASpain and tender joint scores compared to normoprolactinemic RA patients (p<0.05) and mean age of hyperprolactinemic RA patients was significantly lower than of the normoprolactinemic ones. No association was found between SLEDAI and PRL. It is suggested that PRL plays a role in the pathogenesis of RA and is associated with disease activity in those patients. As PRL has no associaton with SLE, it can be hypothesized that SLE and RA should have different etiopathogenetic profiles.

EFFECTS OF INTRAARTICULAR HYALURONIC ACID AND METHYL PREDNISOLONE ACETATE ON CARTILAGE IN A MODEL OF EXPERIMENTAL ARTHRITIS IN RATS

2002-06-01

This experimental study was performed to determine the effects of intraarticular hyaluronic acid (HA) and methyl prednisolone acetate (MPA) in degenerative osteoarthritis. 0.2 ml 1% formaline were injected to the posterior right knee joints of 40 male rats. One week after the injections, 10 rats were killed and arthritis was determined histopathologically. The remained 30 rats were divided to three groups. First group received intraarticularly 0.05 ml HA (HA group), second group 0.05 ml MPA (MPA group) and third group 0.05 ml saline as controls. The injections were performed at 7., 14. and 21. days after the arthritis. 15 days after the end of these treatments, rats were killed and sections were examined histopathologically. There was no significantly difference in cartilage healing between MPA and control groups (p>0.05). However cartilage healing was significantly high in HA group compared to MPA and control groups (p<0.05). It was concluded that HA is more useful than MPA in the treatment of arthritis intraarticularly because of its positive effects on cartilage tissue.

THE CASE REPORT OF A REBELLIOUS REFLEX SYMPATHETHIC DYSTROPHY SYNDROME: THE RELATIONSHIP OF RSD AND PSYCHOLOGIC FACTORS

P�nar Borman, Hatice Bodur, �i�dem Aydemir — 2002-06-01

Reflex sympathetic distophy syndrome (RSDS) is a painful and disabling neurovascular condition. The treatment of RSDS is difficult and there is not a definite effective regimen. The review of the recent literature support that the personality traits, stressful life events and conflicts are important for the development of RSDS and psychiatric help may influence the progression and severity of the disease. Herein a case of RSDS who was resistant to standart therapies but responded to psychotherapy, is reported and the role of psychological factors in the development of RSDS was discussed.

A CASE REPORT: OSTEOPOIKILOSIS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DISEASE, LIVEDOID VASCULITIS AND ANTIPHOSPHOLIPID SYNDROME

Alev Kazanc�, �ebnem Ataman, Nurben S�ld�r, Mesut Birol Atay — 2002-06-01

Osteopoikilosis, which belongs to the group of osteosclerotic diseases, has an autosomal dominant inheritance. Having typical radiological findings and asymptomatic clinical course, 15-20% of cases may experience mild articular tenderness and effusions. Osteopoikilosis associated with a connective tissue disease and/or livedoid vasculitis and/or antiphospholipid syndrome has not been reported yet. Here, a patient with undifferentiated connective tissue disease, livedoid vasculitis, antiphospholipid syndrome and osteopoikilosis will be discussed.

CRAMPS

Erdal Gilgil, B�lent B�t�n — 2002-06-01

Cramp is the painful, involuntarily contraction of the skeletal muscle. Idiopathic nocturnal muscle cramp is the most frequent form, though there are many other clinical conditions, leading to painful muscle contractions, that should be taken into consideration for a favourable diagnosis and management. Most of the idiopathic cramps last for a few minutes. Episodes with a duration of longer than ten minutes necessitate further investigations. For a proper differential diagnosis, it should be elucidated whether the muscle spasm is associated with rest or exertion, the muscle responds to percussion and what like the relaxation of the muscle is.