Turkish Journal of Rheumatology - 2008; 23(4)

Effect of Helicobacter Pylori Eradication Treatment on Disease Activity in Patients with Rheumatoid Arthritis

2008-12-01

Objective: Helicobacter pylori (H. Pylori) infection is related with gastroduodenal diseases, along with some autoimmune diseases like rheumatoid arthritis (RA). The present study investigated the affect of H. pylori eradication treatment on disease activity in patients with RA. Material and Methods: A total of 50 patients with RA were evaluated by the CLO test and histological examination and divided into 2 groups as H. pylori positive and negative. Eradication treatment was given to the H. pylori positive group for 14 days. Patients in both groups were evaluated in terms of disease activity initially and at the 6th month. Results: The H. pylori positive and negative group consisted of 19 and 31 patients, respectively and these groups were not statistically significantly different in terms of age, disease duration, and gastrointestinal complaints (p>0.05). The evaluation of initial and 6th month clinical and laboratory parameters revealed no significant difference between groups in terms of disease activity (p>0.05). Conclusion: The present study revealed no significant difference between H. pylori positive and negative patients in terms of dyspeptic complaints and disease activity. (Rheumatism 2008; 23: 109-13)

Correlation of IgA Accumulation with Clinical Findings in Children with Henoch-Schoenlein Nephritis

2008-12-01

Objective: Henoch-Schoenlein purpura (HSN), an IgA-mediated disease is the most common form of systemic vasculitis seen in childhood and long-term prognosis depends on renal involvement. We aimed to investigate the influence of renal IgA accumulation on clinical and histopathological findings in children with HSN. Materials and Methods: Seventeen patients who were diagnosed as HSN based on renal biopsy were included in the study. The clinical assessment at baseline and last visit were done according to a classification adapted from that of Goldstein et al and renal histopathological changes were graded according to the classification of International Study of Kidney Disease in Childhood. IgA accumulation was quantified as +1 to +4. Based on this, patients were divided into group 1 (+1 or +2 accumulation) and group 2 (+3 or +4 accumulation). All parameters were compared between the groups. Results: There was no significant difference between the groups with respect to clinical findings and histopathological changes. The amount of IgA accumulation was not correlated with clinical or histopathological status. Conclusion: The amount of renal IgA deposition is not associated with clinical or histological findings in our sample. These results need to be confirmed in larger samples. (Rheumatism 2008; 23: 114-7)

Levels of IGF-1 and Their Relationship with Bone Mineral Density in the Premenopausal Women with Fibromyalgia Syndrome

2008-12-01

Objective: The present study aims to compare bone mineral density (BMD) of healthy female patients with that of females with fibromyalgia syndrome (FMS), as well as to determine the relationship between insulin-like growth factor-1 (IGF-1) and BMD. Materials and Methods: Twenty-seven premenopausal women with FMS and 21 age-matched female controls were included in the study. Body mass index (BMI), IGF-1 and osteocalcin levels were assessed for all the cases. BMD measurements of the femoral neck and lumbar spine were done by using dual-energy X-ray absorptiometry. Results: Lomber and femoral bone mineral density were significantly lower in FMS patients compared with controls (p<0.001). Serum concentrations of IGF-1 were significantly lower in FMS than those in healthy females (p<0.01). There was a significant correlation between IGF-1 and BMD (trochanteric and lumbar spine) in FMS patients. No difference was found between the groups with respect to serum osteocalcine levels. Conclusions: The results of the present study shows that routine BMD measurements should be done in premenopausal FMS patients, especially who have low levels of IGF-1. (Rheumatism 2008; 23: 118-23)

Assessment of Radiologic Damage by Larsen Score in Adults With Juvenile Idiopathic Arthritis

Eda G�r�ay, Serdil Y�zer , Emel Ek�io�lu, Ajda Bal, Ayt�l �akc� — 2008-12-01

Objective: Juvenile idiopathic arthritis (JIA) is a heterogenous and chronic disease. The aim of this study was to evaluate radiologic damage, measured by Larsen score, in adults with JIA and to determine disease-related parameters correlated with this score. Materials and Methods: Overall 38 adults identified with JIA at 18 years of age or older with disease duration of at least 5 years were assessed by means of the Larsen hand score. Patients were divided into 3 groups according to disease duration; Group 1 (5-10 years), Group 2 (11-15 years and Group 3 (more than 16 years. Patients were classifed further according to JIA subtypes as seropositive polyarticular (group A), seronegative polyarticular (group B), and oligoarticular (group C). Radiologic damage, articular damage and functional disability were measured by Rheumatoid Arthritis Articular Damage (RAAD) score and Health Assessment Questionnaire (HAQ). Relationship between the Larsen score and disease duration, JIA subtypes, sex, age at onset of the disease, RAAD score and HAQ were investigated. Results: We observed significant difference in the Larsen scores of groups according to JIA subtypes (p<0.001) and female gender (p=0.001) but not in the groups according to disease duration (p>0.05). There was no significant correlation between the Larsen scores and age at onset of the disease (p>0.05). It was observed that the Larsen score correlated well with RAAD and HAQ (p<0.001). Conclusion: Female gender and seropositivity have negative effects on radiologic damage in adults with JIA. Especially for seropositive poliarticular JIA patients, regular follow-up visits and more aggressive treatment approach are recommended. (Rheumatism 2008; 23: 124-8)

Are Relieving Maneuvers Useful in Diagnosis of Carpal Tunnel Syndrome?

Haydar Gok, Saime Ay, Sehim Kutlay — 2008-12-01

Objective: Our aim was to assess and compare the diagnostic accuracy of the carpal tunnel syndrome relief maneuver (CTS-RM) and the Flick sign for the diagnosis of carpal tunnel syndrome (CTS) in female patients. Materials and Methods: This is a diagnostic test study with blind comparison to a reference criterion. A total of 87 consecutive female patients with typical symptoms for CTS referred for electrophysiological examination were included in the study. Normal limits of nerve conduction were obtained from 50 healthy female subjects. After the electrodiagnostic assessment clinical evaluation was performed by a physician and it included testing of all patients for the CTS-RM and Flick sign. The diagnostic accuracy was evaluated for each test alone and in combination and sensitivity was correlated with the electrophysiological severity of CTS. Main outcome measures included the estimates of sensitivity, specificity, positive and negative likelihood ratios (PLR, NLR). Results: After electrophysiological assessment, 58 patients (pre-test probability, 67%) have been diagnosed as CTS. The sensitivity and specificity estimates were %81,86 for the CTS-RM and %69, 79 for the Flick maneuver. Combining a positive CTS-RM and Flick sign improved the specificity to 93%. The PLRs of the CTS-RM and Flick sign were 3.3 and 5.9 and the NLRs were 0.39 and 0.22 respectively. Combining a positive CTS-RM and Flick sign had the PLR of 9.5 and the NLR of 0.37. When evaluating the subjects with CTS, the CTS-RM detected significantly more subjects compared to the Flick sign. Conclusions: Our study reveals that the accuracy of Flick sign is low in the diagnosis of CTS. While the CTS-RM alone is helpful in confirming the diagnosis in patients with typical symptoms, combination with the Flick sign further improves its predictive accuracy. (Rheumatism 2008; 23: 129-34)

Current Approaches in Therapeutic Management of Chronic Neuropathic Pain

�zlem Solak, Vural Kavuncu — 2008-12-01

Neuropathic pain is briefly defined as pain caused by a lesion in the nervous system and is common in clinical practice. Pharmacotherapy and neurostimulation therapy are the two most recommended therapies for the treatment of this condition. It is generally accepted that pharmacotherapy remains the mainstay of neuropathic pain management. First-line treatments include gabapentin, 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants. Neurostimulation techniques recommended in the treatment of neuropathic pain are transcutaneous electrical nevre stimulation (TENS), peripheral nerve stimulation (PNS), nerve root stimulation (NRS), spinal cord stimulation (SCS), deep brain stimulation (DBS), epidural motor cortex stimulation (MCS) and repetitive transcranial magnetic stimulation (rTMS). Treatment decisions for patients with neuropathic pain can often be difficult. Recently, growing interest in the mechanisms of chronic neuropathic pain has resulted in significant advances in treatment. In this review, recent knowledge on therapeutic management of chronic neuropathic pain is reviewed. (Romatizma 2008; 23: 135-42)

Pregnancy and Rheumatic Diseases

Hakan Terekeci, Cihan Top — 2008-12-01

Pregnancy is an issue that should be well discussed in all patients with rheumatic diseases in reproductive age groups. Pregnancies in women with rheumatic diseases require a multidisciplinary, carefully monitored, coordinated approach before, during and after pregnancy to ensure the best possible success for mother and baby. Infertility is rarely due to the disease but can be associated with cyclophosphamide therapy. Most rheumatic diseases that are well controlled prior to pregnancy do not deteriorate in pregnancy, providing that the patient continues with appropriate disease-modifying therapy. In contrast to systemic lupus erythematozus, antiphospholipid syndrome, vasculitis and systemic sclerosis there is little evidence for poor maternal or fetal outcomes in rheumatoid arthritis or other forms of inflammatory arthritis such as psoriasis and seronegative spondyloarthropathies. Some patients with inflammatory arthritis go in to remission during pregnancy. Patients with renal involvement may be at increased risk of disease flare. During pregnancy it is essential to monitor all aspects of disease activity such as renal involvement, as well as pregnancy complications such as intrauterine growth retardation, thrombo-embolic disease and preeclampsia, particularly in patients with systemic lupus erythematozus, antiphospholipid syndrome , vasculitis and systemic sclerosis. Post-partum flare is common in all the rheumatic diseases. (Romatizma 2008; 23: 143-50)

Pelvic Rib: Developmental Anomaly, A Case Report

2008-12-01

Pelvic rib is a rare and benign developmental abnormality. It typically appears as a rib or phalanx-like bone in radiological evaluation. Cortical type bone is pronounced in its structure and pseudo-articulation can exist. It is generally asymptomatic and does not require surgical treatment. In differential diagnosis, myositis ossificans and avulsion injury must be ruled out. In our case, this developmental abnormality was identified accidentally by radiographic evaluation of a patient who had trauma. Therefore, pelvic rib should be remembered in differential diagnosis of developmental skeletal abnormalities. (Rheumatism 2008; 23:151-3)

Lupus-Like Syndrome During Anti TNF-Alpha Therapy: A Case Report

�zlem Alt�nda�, Ali Aydeniz, Sava� G�rsoy, Erman Ya��z, �rfan Koca — 2008-12-01

Anti TNF-α therapy is considered as an important progress in the treatment of rheumatoid arthritis by slowing joint erosions and improving physical function. Patients treated with this therapy raised concerns for development of systemic autoimmune diseases such as systemic lupus erythematosus (SLE). Although new autoantibody formation is common with anti-TNF therapy, there are only rare reports of SLE, In this case report, we presented a 45-year-old woman who developed SLE under etanercept treatment. Etanercept induced lupus syndrome must be kept in mind in the presence of clinical findings suggestive of SLE in patients with rheumatoid arthritis. (Rheumatism 2008; 23: 154-6)

Can Isotretinoin Induce Sacroiliitis: Three Cases

�mit Din�er, Engin �akar, Mehmet Zeki K�ralp, Hasan Dursun — 2008-12-01

Our aim was to present three cases of retinoid-induced sacroiliitis demonstrated by magnetic resonance imaging and bone scintigraphy. Three patients with low back and hip pain, and lumbar stiffness after using isotretinoin for acne fulminans were described. Our cases were characterized by rapid resolution of pain and stiffness after isotretinoin treatment was discontinued. Although the association between isotretinoin therapy and sacroiliitis in arthritis patients was suggested in the literature it has not been clearly explained yet. Prospective studies are needed to reveal the causal relationship between isotretinoin and sacroiliitis. (Romatizma 2008; 23: 157-9)