Turkish Journal of Rheumatology - 2004; 19(2)

ANTIOXIDANT ENZYMES CAPACITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: THE RELATIONSHIP WITH DISEASE ACTIVITY SCORE

2004-06-01

The aims of this study were to check the alterations in serum levels of antioxidant enzyme activities and to assess whether the disease activity scores are reflected by serum antioxidant enzyme capacity in patients with RA. The levels of erythrocyte CuZn superoxide dismutase (CuZnSOD) and glutathione peroxidase (GSH-Px) were assessed in 20 patients with rheumatoid arthritis (RA) and 20 healthy control subjects. Disease activity score (DAS28) was calculated for all patients. Erythrocyte CuZnSOD activity levels in RA patients and control subjects were 13.8 � 2.5 (U/mg. protein) and 8.62 � 1.8 (U/mg. protein), respectively. There was a significant difference between the groups (p<0.001). The mean erythrocyte GSH-Px values were 27.6 � 9.3 (�mol NADPH oxidized/min/mg.protein) and 14.5 � 3.3 (�molNADPH oxidized/min/mg.protein) for the RA patients and controls subjects, respectively. There was a significant difference with respect to erythrocyte GSH-Px activity values between the groups (p<0.001). The mean DAS 28 score in RA patients was 3.44 � 1.23. There was a significant positive correlation between each of erythrocyte CuZnSOD and GSH-Px levels and DAS28 scores for the RA patients (r= 0.80, p<0.001; r= 0.81, p<0.001 respectively). Positive correlation between erythrocyte CuZnSOD and GSH-Px activity values and CRP (r=0.68, p<0.001; r=0.76, p<0.001), was not detected with ESR. The present study indicated that increased erythrocyte CuZnSOD and GSH-Px levels that might play a role in the tissue damage and inflammation process of this disease may be a useful marker for evaluating of the disease activity in patients with RA.

ERYTHROCYTE SEDIMENTATION RATE AND C-REACTIVE PROTEIN LEVELS IN OSTEOARTHRITIS: ASSOCIATION WITH CLINICAL AND RADIOLOGICAL FINDINGS

Cahit Ka�ar, Sevgi Urhan, Erdal Gilgil, Tiraje Tuncer — 2004-06-01

This study was planned to investigate the association of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels with clinical and radiological findings of osteoarthritis. Forty-nine consecutive female patients with osteoarthritis of the knee enrolled in the study. Pain assessment was done using a visual analogue scale. Walking distance without pain, any joint deformity, Heberden and/or Bouchard nodules and body mass index (BMI) were recorded. All patients filled the Western Ontario and McMaster Universities Osteoarthritis Index. Laboratory investigations, including hemoglobin, ESR and CRP, were performed. Anteroposterior and lateral radiograms of the knee and posteroanterior radiograms of the hand were obtained. Osteoarthritis of the knee was scored according to the method of Kellgren-Lawrence. Mean age of the patients was 58.6�8.4 years. The mean values of ESR, CRP and BMI were 15,2�10 mm/h, 0.43�0.58 mg/dl (range 0-2.98), 30.64�4.43 kg/m² , respectively. A positive correlation was found between BMI and Kellgren-Lawrence score. There was no association between ESR and CRP levels with clinical findings. Neither clinical nor radiological findings demonstrated an association with ESR and CRP levels.

COMPARISON OF RADIOGRAPHIC PATTERNS OF KNEE OSTEOARTHRITIS IN TURKISH AND BRITISH PATIENTS: RELATIONSHIP BETWEEN SYMPTOMS AND DISABILITY

Nurdan Kotevo�lu, Nesrin Canik, Afitap ��a�as�o�lu — 2004-06-01

Osteoarthritis, with different risk factors and classifications is a heterogenous disease. Symptoms poorly correlate with structural damage as seen on plain radiographs. Cultural ( lifestyle ) differences between the populations may also account for some of the differences. In a group of hospital referred British patients with knee OA , bilateral knee joints with the involvement of more than one compartment was observed. Severe and multicompartmental radiographic changes were associated with calcium pyrophosphate crystal deposition, nodal changes, and polyarticular interphalangial ostoearthritis. With a similarly designed study, radiographic patterns of 165 patients were analyzed and looked for associations with clinical findings and disability; besides the results were compared with those of British patients. Presence of nodal changes, chondrocalcinosis, effusions and the presence of previous trauma were more frequent in women. 96 patients (61.2 %) had bilateral knee OA whereas 62 (39.4 %) had unilateral involvement. Isolated patellofemoral involvement was rare with the lowest ratio in lateral OA. Bicompartmental involvement was the most common form both in unilateral and bilateral clinical presentations. Osteophyte was present in 93.9 % of radiographs. On univariate analysis, WOMAC had a correlation with female sex (p<0.05), chondrocalsinosis (p<0.05), night pain (p<0.05) and inactivity stiffness (p<0.05). On multivariate analysis there was a correlation with WOMAC and activity pain (p<0.01), night pain (p<0.01), rest pain (p<0.01), inactivity stiffness (p<0.01), older age (p<0.05) and female sex (p<0.05). Radiographic features were not found associated with any clinical finding or disability. This is an observational study and reflects the characteristics of hospital referred patients, so epidemiological studies will give more data on the clinical, radiological presentations of knee osteoarthritis and possible associations.

EVALUATION OF THE EFFECT OF LOCAL CORTICOSTEROID INJECTION AND WRIST SPLINTING WITH CLINICAL SIGNS, ELECTROPHISYOLOGIC STUDY AND ULTRASONOGRAPHY IN CARPAL TUNNEL SYNDROME

Sevgi Urhan, Cahit Ka�ar, Emel Alimo�lu, Erdal Gilgil — 2004-06-01

This study was planned to evaluate the effect of local corticosteroid injection and wrist splinting in carpal tunnel syndrome (CTS). 31 patients (41 hands) who had paresthesia in the hand and diagnosed clinically and electrophysyologically as CTS were included in the study. Patients who had diabetes mellitus were treated with wrist splinting, the others were randomly divided into two groups. First group was treated with corticosteroid injection and the second with wrist splinting. Phalen, reverse Phalen and Tinel signs, sensorial examination, visual analogue scale (VAS) for pain and paresthesia, median nerve cross-sectional area at the carpal tunnel inlet, median nerve echogenity, median nerve distal motor and sensory latencies, compound muscle action potential and sensory amplitudes and sensory nerve conduction velocity were evaluated before treatment and three weeks after the treatment. At the end of the study; significant reduction was seen in VASparesthesia and median nerve distal motor latency in the wrist splinting group compared to the injection group, but improvement in median nerve echogenity was higher in the injection group. There was difference in the other variables between two groups. A significant decrease was seen in median nerve cross-sectional area in ultrasonography. In conclusion, both treatment modalities were found as effective in CTS in short-term followup. Besides, ultrasonography was found to be a useful tool for screening of median nerve and evaluation of the treatment efficacy.

THE EFFECT OF ULTRASOUND AND MICROWAVE DIATHERMY IN SHOULDER PERIARTHRITIS

2004-06-01

Physical agents are widely and reliably used in conservative management of shoulder periarthritis (SP). The aim of this study was to compare the effectiveness of mostly used modalities such as ultrasound (US) and microwave diathermy (MWD) in the management of SP. Fifty-six patients were recruited in this study and separated randomly in two groups as US or MWD therapy. The efficacy of US and MWD was evaluated by clinical findings, level of functional limitation and ultrasonographic findings. Pain at night, pain at daytime (VAS) and range of motion improved in both of the treatment groups, though more significantly in US group. We found that both US and MWD, and therapeutic exercise led to both clinical and ultrasonographic improvement.

FACTORS ASSOCIATED WITH DISABILITY IN SYMPTOMATIC KNEE OSTEOARTHRITIS

Funda Levendo�lu, Ali Sall�, Hatice U�urlu — 2004-06-01

Objectives: The aim of this study was to assess the impact of clinical and psychosocial variables on disability in knee osteoarthritis (OA). Methods: The subjects (n=82) were outpatients. Self-reported disability was measured by the Western Ontario and McMaster universities (WOMAC 3.0) OA index. Pain was measured by the Visual analog scale and the WOMAC pain questionnaire. Depression was assessed with Beck Depression Inventory. Quality of life were measured by Nottingham Health Profile 1. A detailed knee examination was performed. Results: The mean age was 56.3 � 8.0 year with a mean symptom duration of 5.6 � 5.0 yr. There were significant relationship between physical function score of WOMAC and pain, depression and quality of life scores (p<0.05). The mean WOMAC disability score for obese subjects (BMI>30) was significantly higher than the non-obese(p<0.05). Pain on motion, joint line tenderness and tenderness on patellofemoral compression, crepitus and instability of ligaments were also associated with increased WOMAC disability scores (p<0.05). Conclusions: Disability is related to pain severity, BMI, depression and quality of life. Health interventions in OA, primary focused on pain and weight reduction, could be supplemented with psychologic support to enhance health outcomes.

ULTRASONOGRAPY AND MAGNETIC RESONANCE IMAGING IN PATIENTS WITH SHOULDER PAIN

Ahmet �zg�l, M. Ali Ta�kaynatan, Ajda Bal, T. Alp Kalyon — 2004-06-01

The aim of this study was to put forward the possible etiology in shoulder pain with ultrasonography (USG). In patients with magnetic resonance imaging (MRI), the results of both imaging studies were compared, and the harmony of them was investigated. 96 patients with shoulder pain were examined prospectively with USG. The results of USG were compared with MRI findings in patients who had both imaging studies. The relation in all assessment parameters other than bicipital tendonitis/tenosynovitis (p>0.05) was statistically significant (p<0.05) when USG and MRI results were compared. The relation of bicipital tendonitis/tenosynovitis with supraspinatus partial and complete tear, subacromial bursitis and impingement in USG, and with only supraspinatus partial tear in MRI were statistically significant (p<0.05). As a conclusion, we suggest that USG is an effective and valid imaging method in diagnosis and follow up of shoulder pain. USG should be the first study in shoulder pathologies. MRI may be ordered in uncertain cases and if the patient is a surgery candidate.

RUPTURED BAKER CYST IN GOUT DISEASE: CASE REPORT

Hakan Tuna, Mustafa Y�ld�z, Erc�ment �nl�, �lk� Sarpkaya, Siranu� Kokino — 2004-06-01

A 54 year old male patient who had a diagnosis of Gout disease for 2 years was admitted to our clinic with the complaint of pain and swelling in his posterior right knee and cruris. An initial diagnosis of ruptured Baker's cyst was made, on the other hand the differential diagnosis as deep vein thrombosis was thought, further laboratory investigation including ultrasonography and magnetic resonance imaging revealed a ruptured Baker's cyst. Popliteal cysts which rupture to mimic a deep vein thrombosis can be seen in such as inflammatory arthritis. The report of a case is ruptured baker's cyst in gout. Pertinent literature on the subject is also reviewed.

KNEE TUBERCULOSIS UNDER ANTITUBERCULOUS CHEMOTHERAPY; A CASE REPORT

Duygu Geler, Nurben S�ld�r, �ebnem Ataman, Mesut Birol Atay, �ebnem K. Ayva — 2004-06-01

Tuberculosis of the knee is the third common site of skeletal tuberculosis after the spine and the hip. In this case, a patient, who was previously operated due to Mall de Pott, has developed tuberculous arthritis in her right knee under antituberculous chemotherapy. In such cases a drug resistance should not be forgetten and in differential diagnosis, tuberculosis should not be underestimated.

MULTIPLE CONGENITAL CONTRACTURES (ARTHROGRYPOSIS MULTIPLEX CONGENITA)

Canan ��nar, Melek Sezgin, Ece Aydo�, Ayt�l �akc� — 2004-06-01

Arthrogryposis multiplex congenita (AMC) is a term that is used to describe the presence of multiple joint contractures that are present at birth. It can be seen in isolation or in association with other congenital abnormalities as part of a syndrome with or without central nervous system involvement. The exact pathogenesis of arthrogryposis is unknown. The common factor causing congenital arthrogryposis is lack of fetal movements. It may be due to a large number of disorders. They may be neuropatic, affecting the brain, the spinal cord, or the peripheral nerves; they may be abnormalities of the muscles; they may be diseases of the connective tissues; or they may be conditions which limit the space within the uterus; they may result from abnormal intrauterin environment. Trying to define a cause is important to give reliable genetic advice to the parents and also to establish a prognosis. Treatment must be by physiotherapy, splinting, serial casting and by orthopedic surgery. Physical therapy is a lifelong process and should be initiated early in the neonatal period. The purpose of this article is to provide an overview of the AMC syndrome, specifically, clinical features, etiology, classification, diagnosis, therapeutic intervention and prognosis.