Turkish Journal of Rheumatology - 2003; 18(3)

COMPARISON OF AN ALTERNATIVE TECHNIQUE WITH THE STANDARD METHOD FOR THE DIAGNOSIS OF CARPAL TUNNEL SYNDROME

Haydar G�k, Saime Ay, �ehim Kutlay, Ye�im Kurtai� G�rsel — 2003-06-01

We aimed to determine the normal range of latency difference between second lumbrical (2L) and interossei (INT) muscles and to compare with standard electrophysiologic technique for the diagnosis of carpal tunnel syndrome (CTS) in this study. 100 patients complaining of pain and paresthesias in their hands were included in the study. Control group consisted of 48 healthy individuals. All of the patients were undergone standard electrophysiologic evaluation for the diagnosis for CTS. Using alternative technique, we evaluated the difference between the distal motor latencies of INT and 2L muscles in 42 patients diagnosed as CTS and 48 healthy controls according to the standard technique. Sensitivity and specifity of 2L-INT latency differece in the diagnosis of CTS were found to be high. It was concluded that due to involvement of 2L fibers as much as abductor pollicis brevis motor fibers, 2L-INT latency difference can be used as an alternative technique to the standard method in the diagnosis of CTS.

THE RELATIONSHIP OF RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS WITH HEPATITIS B VIRUS

Saliha Karatay, Kadir Y�ld�r�m, Meltem Alkan Meliko�lu, Kaz�m �enel — 2003-06-01

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are polyarthritic diseases which have multifactorial etiology. Also, it is reported that the hepatitis B virus (HBV) may be associated with polyarthritis. Therefore, 20 patients with RA, 26 patients with AS and 56 healthy controls were included in this study to investigate this relationship. Serological markers of HBV (Hbs Ag, Anti-Hbs, Anti-Hbc total, Anti- Hbc IgM, Hbe Ag and Anti-Hbe) were evaluated in all cases. No significant relation was found between these three groups for Hbs Ag and Anti-Hbs positivity (p> 0.05). The ratio of the coincide with HBV was increased in patients with RA when compared with healthy controls (45 % in the RA group, 21.4 % in the control group) (p< 0.05). As a result; it was concluded that the HBV may play a role in the etiology of RA.

THE EFFICACY OF HYALURONAN TREATMENT ON THE KNEE OSTEOARTHRITIS WITH EFFUSION: ONE YEAR PLACEBO CONTROLLED TRIAL

2003-06-01

The aim of the study was to investigate the efficacy of the intraarticular Hyaluronan (HA) treatment on the knee osteoarthritis (OA) with effusion. The study was one year duration, single blind, placebo controlled and randomized. Forty-one patients with primary knee OA were enrolled in the study. The patients were divided into two groups as drug and placebo groups. The patients in the drug group were administered intraarticular HA and the patients in the placebo group were administered intraarticular 0.9% NaCl, once a week, totally three times. Clinical efficacy was assessed by WOMAC pain, stiffness and physical function scores, 25 m walking time, knee flexion, effusion volume and measurement of knee circumference before the treatment, one week and one year after the treatment. While statistically significant decrease of the effusion was determined in the drug group (p=0.001), there was no difference in the placebo group (p=0.133) one week after the treatment. In the drug group in WOMAC stiffness score and measurement of knee circumference, statistically significant decrease were determined one year after treatment (p=0.001 and p=0.0001 respectively) but there was no difference in the placebo group (p=0.064 and p=0.349 respectively). In addition, 1 year after the treatment in the drug group in WOMAC physical function score, measurement of knee circumference and 25 m walking time, was found to be significantly better than placebo group except WOMAC pain score (p=0.317), and significant differences were found one year after the treatment (p<0.05). There was no any local or systemic reactions after the injections or in the follow-up period. Our study showed that HA treatment was superior to placebo in patients with knee OA with effusion, was safe and the efficacy lasted at least one year.

SECOND LINE DRUG THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Lale Y�lmaz, G�ney Aslan, Hatice Bodur — 2003-06-01

The aim of this study is to evaluate the impact of the second line drugs in patients with rheumatoid arthritis (RA). The analysis covered 117 female and 23 male with a total of 140 patients at the mean age of 50,71�13,49. The treatment monitored and analyzed retrospectively by anamnesis and by evaluating the records of the patients. In this study, the side effects necessitating discontinuation of the drug therapy were also examined. The most commonly used drug (58,2 percent 82 patients) was methotrexate (MTX). In total, the number of patients who halted using the drug because of its side effect was minimum (8,53 percent) in MTX users. The number was the highest (31,14) in the sulfasalazine (SSZ) users. The most common side effect (14,75 percent) was in the gastrointestinal system. The rate of discontinuation of the SSZ because of its ineffectiveness was determined as 14,75 percent. The rate of discontinuation of the drug due to ineffectiveness was the highest in the antimalarial therapy which was 23,8 percent for Hydroxychloroquine (HCQ) and 15,75 percent for Choloroquine (CL). Discontinuation due to its side effects was relatively low with antimalarial drugs. Retinopathy (1,74%), GIS side effects (3,5%), rash (1,74%), ototoxicity (1,74%) was observed in patients treated with CL, and 9,52 % of patients had ototoxic side effects in treatment with HCQ. No fatal and severe drug reactions were observed in any of the patients. In our results efficacy, toxicity and security profile were in accordance with the literature. MTX has higher efficacy and lower toxicity. Although antimalarial drugs are not the most effective drugs, they are relatively secure. These drugs preserve their importance, as the treatment and follow up are not so expensive. This study emphasizes the importance of careful monitorization of RA patients on second line drug treatment in order to recognize side effects.

THE EFFECTS OF IRON DEFICIENCY ANEMIA ON BONE MINERAL DENSITY AND LABORATORY DATA IN PATIENTS WITH OSTEOPOROSIS

Ferda �zdemir, �zlem T�kenmez, Nesrin Turan — 2003-06-01

Life style, eating habits, chronic diseases and therapy methods of these diseases might possibly cause bone density changes and osteoporosis (OP). Iron deficiency and iron deficiency anemia might be accepted as risk factors. In our study, we aimed to investigate whether there was any association between bone mineral density (BMD), laboratory values and iron deficiency / iron deficiency anemia among postmenopausal women and senile osteoporosis. One hundred forty-one women, who were enrolled in our osteoporosis outpatient clinic, were found to be eligible for this study. The demographic data of the patients were recorded. Total blood count, serum iron (Fe), total iron binding capacity (TIBC), transferrin saturation (TS), serum folic acid (FA) and vitamin B12 levels were measured. Fourteen women out of 141 postmenopausal women with osteoporosis were found to have anemia (9.93 %). There were significant differences in Ca, Mg, Fe, TS levels between two groups. There was a difference in TIBC levels between two groups but it wasn't significant. In this study, there was no significant difference in bone mineral densities between two groups. In the patient group with iron deficiency anemia, negative correlation was found between Fe and Ca levels. No association could not be found between anemia parameters and bone mineral densities in both groups. According to the results of this study, although there was a negative correlation between Fe and Ca levels in postmenopausal women with iron deficiency anemia and osteoporosis, it didn't make an obvious impact to the bone mineral density.

ANKYLOSING SPONDLITIS IN WOMEN: CASE REPORT

2003-06-01

Ankylosing spondilitis is a chronic systemic inflammatory disorder of uncertain aetiology that primarily affects the axial skleton. The underdiagnosis of AS among women is a common problem probably owing to the misconception that women rarely have AS. Besides, the diagnosis of AS before the occurence of irreversible damage is difficult, several years may pass between onset of symptoms and definite diagnosis. We present the case of a 49-year-old woman who was initially diagnosed as spondylodiscitis due to severe low back pain for the last 3 months and high erythrocyte sedimentation rate. She had a medical history of laminectomy 10 years ago and low back pain for more than 10 years. After a careful physical and radiological examination it was clear that she had ankylosing spondylitis. The diagnosis of AS should always be kept in mind in women with chronic low back pain .

BRUCELLA SPONDYLITIS IN A MARRIED COUPLE

Ajda Bal, Eda G�r�ay, Emel Ek�io�lu, Tahsin Edg�er, Reyhan Tuncay, Ayt�l �akc� — 2003-06-01

The frequency of brucella spondylitis has been reported to be of 9.1-58 %, in cases with brucella infection, involving the lumbar segment most frequently. Paravertal abscess is reported 16% of the cases. In this report, two simultaneous spondylitis cases secondary to Brucellosis in a married couple have been investigated. Both cases underwent medical treatment for brucellosis. Clinical, laboratory and Magnetic Resonance Imaging findings were found to be improved 10 months later. In conclusion, brucellosis may cause spondylitis and its attendant neurological complications. The possibility of more than one cases in the same family should always be kept in mind. The disease can be cured with proper treatment.

A CASE OF PARAPLEGIA DUE TO THORACAL SPINAL EPIDURAL ABSCESS

Serpil Sava�, Memduh Kerman, Ba�ak ��t — 2003-06-01

Spinal epidural abscess (SEA) is an uncommon spinal infectious disease. Clasically, SEA presents with severe back pain, local tenderness, and fever, progressively worsening radicular symptoms followed by neurologic deficits. The delayed diagnosis is associated with significant morbidity and mortality. In this case report, a patient who became paraplegic because of thoracal SEA is presented.

MASSAGE

Saime Sar�o�lu, G�lay Din�er — 2003-06-01

Massage is the application of systemic manipulation to the soft tissues of the body to effect the leucomotor, nervous systems, blood circulation and for theurapeutic purposes. The classic manipulations of massage are classified into five groups according to the application and resulting effects: effleurage, petrissage, friction, tapotement and vibration. Shiatsu and acupressure massage methods are based on the Japanese interpretation of the acupuncture theory. The connective tissue massage is based on the effects of the massage on otonom nervous system. The application to encourage lymph flow with using special hand techniques is known as lymphatic drenage. It helps the lymph flow from obstructed to obstructed areas.

HETEROTOPIC OSSIFICATION

Burcu Yan�k, Peyman Yal��n — 2003-06-01

Heterotophic ossification is a pathological new bone formation in the soft tissue. It generally occurs secondary to brain injury, spinal cord injury, cerebrovascular disease, bone fracture, dislocation and joint replacements. The diagnosis and the treatment of this complication in both neurological and orthopaedic rehabilitation are essential. Etiology, clinical features, diagnosis and the treatment of heterotopic ossification are discussed in this article.