Turkish Journal of Rheumatology - 2004; 19(1)

HAND BONE DENSITOMETRY AND BIOCHEMICAL MARKERS OF BONE TURNOVER IN RHEUMATOID ARTHRITIS

Sabire Ak�n, Oya G�le�, Mehmet Beyazova, Feza Korkusuz — 2004-06-01

Objective: The aim of this study was to assess hand bone mineral status with bone mineral densitometry (BMD) and biochemical markers such as osteocalcin (OC) and N-telopeptides (NTX) in women with rheumatoid arthritis (RA) and healthy controls. Materials and methods: Forthy-one female patients with RA [pre-menopausal (pre-RA) n=20; post-menopausal (post-RA) n=21) ] and 50 healthy controls [ pre-menopausal (pre-CON) n=26; post-menopausal (post-CON) n=24] were studied. Hand BMD was measured with dual energy x-ray absorptiometry (DEXA). Results: Hand BMD values were significantly lower in the pre-RA patients than the pre-CON (p=0.002) but there was no difference betweeen post-RA and post-CON subjects (p>0.05). Hand BMD values were significantly reduced in the post-CON subjects when compared with the pre-CON subjects (p=0.001). In RA patients the difference between pre-RA and post-RA was not significant (p>0.05). Serum OC and NTX values did not show any significant difference among groups (p>0.05). Conclusion: Results indicated that significant decrease in hand BMD in the patients with RA is present during the earlier years of the disease but later the situation becomes similar to age and sex matched controls. Hand BMD measurement by DEXA proves to be a useful indicator of periarticular bone loss. The earlier use of DMARDs may be beneficial in preventing bone loss and bone destruction by retarding disease progression.

ANXIETY AND DEPRESSION IN RHEUMATOID ARTHRITIS PATIENTS

Lale Altan, �mit Bing�l, Zeynep Sa��rkaya, Asl� Sarand�l, Merih Yurtkuran — 2004-06-01

Objective: To compare the incidence of anxiety and depressive disorder in rheumatoid arthritis (RA) patients with healthy control group and to investigate the correlation between psychiatric disorder level and activation parameters of rheumatologic disease. Method: One group of 50 consecutive RA patients and another group of 60 healthy control individuals were asked to fill ‘Symptom Checklist 90 (SCL-90-R)', ‘Beck Depression Inventory (BDI)' and ‘Hospital Anxiety and Depression Inventory (HAD)' to investigate psychiatric symptoms. The values obtained in both groups were compared using Student t-test and Mann Whitney-U test. Then, correlations between depression and anxiety symptoms and the parameters of disease duration, daytime and nocturnal pain, morning stiffness, global evaluation of the patient and physician, Steinbrocker functional classification, the number of swollen and tender joints were assessed in RA patients using Pearson correlation coefficient. Results: The points obtained by BDE were above 17 (the cut-off point) in 28% of RA patients and in 9.4% of the control group. According to HAD, depression and anxiety symptoms existed in 54% and 38% of the RA patients,respectively, while these rates were 24.5% for depression and 14.3% for anxiety in the control group. Global symptom Index (GSI) points were above 1 (the cut –off point) in 38% of RA patients and in 34% of the control group. The comparison of the two groups showed significant difference for total HAD score, HAD anxiety (p<0.01), and depression score and BDE parameters while there was no significant difference for the values obtained by SCL-90 index. It was found that HAD depression score was in significant correlation with nocturnal pain and the number of swollen and tender joints. Anxiety score was also correlated with Steinbrocker functional classification, global evaluation of patient and the number of tender joints in RA patients. Correlation was also significant between BDE-nocturnal pain), and global evaluation of patient. GSI and Positive Symptom Distress Index (PSDI) were significantly correlated with nocturnal and daytime pain and morning stiffness, the number of swollen and tender joints. Positive symptom total (PST) was significantly correlated with nocturnal and daytime pain, the number of swollen and tender joints.

RELIABILITY OF BACK CONCENTRIC ISOKINETIC MUSCLE TESTING USING BIODEX ISOKINETIC DYNAMOMETER

Sabire Ak�n, �zlem �ner, Nisa �zberk — 2004-06-01

Objective: The aim of this study is to determine the test-retest reliability of back extensor and flexor concentric muscle strength using Biodex isokinetic dynamometer. Material and Methods: 49 healthy men and women volunteers were included. Evaluation was carried out with a Biodex System 3 Pro isokinetic dynamometer. Tests were performed in 3 sessions at a 7 day interval. Intraclass-Correlation-Coefficients were calculated to establish day-to-day repeatability. The protocol consisted of 5 isokinetic concentric contractions at a velocity of 60�/sec and 10 repetitions at a velocity of 120�/sec. Results: Results show very good reproducibility in both movement directions at both velocities. ICC for the back flexor muscle strength at 60 �/sec were 0.88 and ICC for the extensor muscle strength were 0.84; ICC for the back flexor muscle strength at 120 �/sec were 0.85, ICC for the extensor muscle strength were 0.84. Conclusion: The results indicate that isokinetic concentric flexor and extensor muscle strength evaluation with this test protocol is reliable. Biodex isokinetic dynamometer is a reliable tool in the evaluation of back muscular performance.

DEPRESSION LEVELS AND IT'S RELATION WITH CLINICAL SYMPTOMS IN YOUNG WOMEN WITH CHRONIC FATIGUE SYNDROME

Remzi �evik, Suat Acar, Ali G�r, Kemal Nas, A. Jale Sara� — 2004-06-01

Chronic Fatigue Sydrome (CFS) is a chronic, disabling, musculoskeletal system illness which lasts more than six months with fatigue and musculoskeletal pain, psychiatric symptoms and mostly occured in women. Depression is a psychiatric disorder which is often seen with CFS. The objective of this study was to investigate depression levels in premenapousal female patients with CFS; and to define its' relation with symptomatic features and number of tender points acount. Sixty one (61) premenapousal female patients identified with CFS and thirty five (35) healthy women were taken in this study according to Atlanta CDC (Center for Disease and Control) criteria in 1994. Beck depression scales of these two groups were measured and patients were examined according to their symptomatic features, tender points and widespread musculoskeletal aching. In our study, symptomatic features, Beck scores and number of tender points were higher in the patient group comparing with control group (p<0.001). There were significant differences between patients who had Beck scores ≥17 and <17 in number of tender points, arthralgia and sleep disturbences(p<0.05 and p<0.01). There were significant correlation between Beck scores and tender point account, sleep disturbences, sore throat, arthralgia and muscle weakness (p<0.001 ve p<0.05 ). Our study indicates that patients with CFS have high depression level and tender point count. Patients with high depression level have higher tender point count, sleep disturbences and arthralgia rates compared patients with low depression level. Depression and fibromyalgia should be taken into consideration in diagnosis and managing of CFS.

THE PREVALENCE OF ANKYLOSING SPONDYLITIS AMONG UNIVERSITY STUDENTS

Ay�e G�rler, Ece Kaptano�lu, Hasan Elden, Vedat Nacitarhan, Sami Hizmetli — 2004-06-01

Ankylosing spondylitis is a common form of seronegative spondyloarthropathies which may lead to disability. However, there are not satisfactory data concerning the prevalence in our country just as in many others. So we aimed at searching the prevalence of ankylosing spondylitis among our university students. A sample of 712 cases representing 10161 students attending to Cumhuriyet University were given a questionnaire form and those 74 students answered positively were invited for clinical and radiological examination. Classification of ankylosing spondylitis was made according to the modified New York criteria. The prevalence and sex-specific (male) prevalence of ankylosing spondylitis among the university students were found to be 0.14% and 0.24%, respectively.

INFLUENCE OF DISEASE ACTIVITY AND CHRONICITY ON BONE MINERAL DENSITY IN ANKYLOSING SPONDYLITIS

�enay �zdolap, Selda Sar�kaya, Beyza Akda� — 2004-06-01

In this study we aimed to examine the relationship between disease activity/duration and bone mineral density (BMD) on 37 patients with ankylosing sponylitis. Patients were classified according to disease activity and duration. We have used dual-energy x-ray absorptiometry (DEXA) to measure bone mineral density of lumbar spine, hip and forearm. A comparison of BMD between patients with active and inactive disease did not reveal a significant difference on all of the regions measured. Concerning disease duration, lumbar spine BMD was significantly reduced in early disease subject.

THERAPEUTIC ACTIVITY OF ULUDAG UNIVERSITY ATAT�RK BALNEOTHERAPY AND REHABILITATION CENTER IN THE LAST DECADE

Alev Ay, M. Mustafa Ert�rk , �mit Bing�l, Lale Altan, Merih Yurtkuran — 2004-06-01

In Atat�rk Balneotherapy and Rehabilitation Center, orthopedic, neurological and mainly rheumatological diseases are treated and rehabilitated on outpatient and inpatient basis. There are 31 beds for the outpatients who participate in daytime hospital and 24 beds for the inpatients. Physical therapy, training of the medical students, academical activity and scientific researches are carried on in the center. The objective is to report the therapeutic activity of the center in the last decade.

A CASE WITH VERTEBRAL HYDATID DISEASE SHOWING MULTIPLE RELAPSES

A. Salim G�ktepe, Ay�e Sarsan, Bilge Y�lmaz, R�dvan Alaca, �nsal Co�kun — 2004-06-01

Vertebral hydatid disease is relatively common in our country while it is very rare in western countries. It may lead to serious complications; besides its morbidity, it is reported to have 14-58% of mortality rate. Paraple-gia or spinal root compression may occur in 25-84% of the patients. Surgical excision of the cyst is reported to be the treatment of choice. However, the rate of relapse is known to be high. In this article, a case with vertebral hydatid disease having paraplegia and experiencing relapses after several operations is being reported.

VESTIBULER DISORDERS AND VESTIBULER REHABILITATION

Arzu Susin, Zeliha �nl� — 2004-06-01

There's a growing evidence about the efficiency of the vestibuler rehabilitation in the patients with peripheral vestibuler disorders and other conditions causing vertigo. Therapeutic exercises for the head and eyes and balance exercises help the functional recovery in these patients. Functional recovery is much more better in the patients with peripheral vestibuler disorders. However there is noticeable functional recovery in the patients with vertigo due to central etiology albeit complete recovery is rare.

ADULT ONSET STILL DISEASE

Faruk �endur, G�lcan G�rer, Ali Aydeniz — 2004-06-01

Adult onset Still's disease (ASD) is a systemic inflammatory disorder of unknown etiology and pathogenesis. It is suggested that infectious agents and genetical factors may play a role in etiology of the disease. A few diagnostic criteria was developed in order to make diagnosis of ASD. NSAID, corticosteroids and immun-mod�led drugs are used for it's treatment. In this review, current literatures about ASD are overviewed and briefly summarized.