Turkish Journal of Rheumatology - 2013; 28(4) - Current Issue

Pitfalls and Progress in the Assessment of Function and Functioning in Ankylosing Sponylitis

Murat B�RTANE — 2013-12-01

The Diagnostic Performance of the 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Yu-Hui ZHANG, Wei-Min SONG, Jian-Hong SUN, Jia-Chuan XIONG, Guixiu SHI — 2013-12-01

Objectives: This study aims to assess the diagnostic performance of the 2010 American College of Rheumatology (ACR) European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA). Patients and methods: Between January 2010 and November 2012, an electronic search was conducted using MEDLINE (via PubMed), EMBASE, and Cochrane CENTRAL to find studies related to the diagnostic performance of the 2010 ACR/EULAR classification criteria for RA in patients with inflammatory synovitis. Subgroup analyses were performed according to the adopted gold standards. The sensitivity and specificity of the 2010 criteria were extracted or calculated. Summary receiver operating characteristic (sROC) curves were drawn to evaluate the differences between the 2010 and 1987 criteria. Results: We found 10 studies which were eligible for inclusion. Based on the 2010 criteria, the pooled information showed a sensitivity of 0.804 (95% confidence interval [CI]; range 0.737 to 0.857) and a specificity of 0.556 (95% CI; range 0.417 to 0.687) in the methotrexate (MTX) group, a sensitivity of 0.706 (95% CI; range 0.585 to 0.803) and a specificity of 0.691 (95% CI; range 0.583 to 0.782) in the disease-modifying antirheumatic drug (DMARD) group, and a sensitivity of 0.901 (95% CI; range 0.856 to 0.933) and a specificity of 0.539 (95% CI; range 0.429 to 0.645) in the expert group. The sensitivity and specificity were pooled under the bivariate binomial mixed model in this review due to the heterogeneous nature of the data. Compared to the 1987 criteria, the 2010 criteria showed a higher sensitivity, lower specificity and similar accuracy rate with more accuracy rate in the MTX group, compared the DMARD and expert groups. Conclusion: The 2010 ACR/EULAR criteria for RA have a better discriminative and diagnostic ability, higher sensitivity, and lower specificity than the 1987 criteria; therefore, we believe that it cannot be substituted for the 1987 criteria.

The Relationship Between Generalized Joint Hypermobility and Adhesive Capsulitis of the Shoulder

Yeliz TERZ�, Kenan AKG�N, �lknur AKTA�, Deniz PALAMAR, G�nay CAN — 2013-12-01

Objectives: This study aims to investigate the possible relationship between generalized joint hypermobility (GJH) and adhesive capsulitis (AC) of the shoulder. Patients and methods: A total of 240 patients were enrolled in this study, including 120 patients diagnosed with AC in a study group and 120 patients diagnosed with primary subacromial impingement syndrome in the control group. We evaluated the pain severity, range of motion of the shoulder joint, functional status, disability, and hypermobility in both groups. The Beighton score was used to evaluate the GJH while the revised Brighton criteria were utilized for the patients with benign joint hypermobility syndrome (BJHS). Results: In the adhesive capsulitis group, GJH was significantly rare (p<0.05) with only one patient (0.08%) whereas BJHS was not found. In the control group, nine patients (7.5%) had GJH, and five (4.2%) had BJHS. Conclusion: Our study results suggest that GJH may be a protective or preventive factor in the development of AC. In clinical practice, we believe that in GJH patients we can be more optimistic regarding the concern of the conversion of shoulder pain to AC. If this has already taken place, then these patients may respond more positively to treatment in cases involving GJH.

Systemic Sclerosis is Not Associated with Increased Coronary Artery Calcium Deposition

2013-12-01

Objectives: This study aims to compare the coronary artery calcium scores (CACS) between female systemic sclerosis (SSc) patients and healthy subjects and to investigate whether SSc alone is an independent risk factor for increased coronary artery calcium deposition. Patients and methods: Between January 2007 and December 2009, 41 female SSc patients and 123 age- and gender-matched healthy subjects who were admitted to a tertiary healthcare center in South Korea were retrospectively analyzed. The CACS were measured using multidetector computed tomography (MDCT) and categorized as either absent (CACS=0), minimalto- mild (CACS=1-100), or moderate-to-severe (CACS≥101). We also collected data from each patient related to conventional cardiovascular risk factors. Results: There was no significant difference in the CACS and the proportion of minimal-to-mild and moderate-to-severe coronary calcium deposition between the two groups (p=0.519 and p=0.242, respectively). Multivariable logistic regression analysis revealed that SSc was not independently associated with the presence of coronary calcium deposition (CACS >0) after confounding factors were adjusted. Although SSc was more likely to have a higher category of CACS in the multivariable ordinal logistic regression model (OR 2.79, 95% CI 0.92-8.49, p=0.07), this did not reach statistical significance. Among traditional risk factors, only older age was significantly associated with increased coronary calcium deposition. Conclusion: Our study results suggest that SSc is not an independent risk factor for atherosclerosis.

An Evaluation of Mean Platelet Volume and Serum Lipid Profile in Patients with Fibromyalgia Syndrome

Ay�e �Y�YAPICI �N�BOL, G�lnur TA�CI BOZBA�, Mustafa �N�BOL, G�lcan G�RER — 2013-12-01

Objectives: This study aims to evaluate the mean platelet volume (MPV) and serum lipid profile in patients with fibromyalgia syndrome (FMS). Patients and methods: This retrospective study was comprised of 156 patients with FMS and 118 healthy controls who were admitted to three centers between January 2011 and December 2011. The patients' fasting blood glucose, total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride levels and complete blood count, and MPV values were recorded. The Mann-Whitney U test and Student's t-test were used according to the distribution of the data for statistical analysis. Results: The experimental power of the study was found to be 100% (0.00063), when the effect size was taken as 0.6. The MPV value was 8.75�1.15 fL in the patient group and 8.13�0.73 in the healthy controls (p<0.001). The serum triglyceride levels were significantly increased in the patients with FMS compared with the healthy controls (p=0.003). Conclusion: We found that the MPV, one of the early markers of atherosclerosis, was significantly high in the FMS patients.

The Frequency of the Clinical Risk Factors in Postmenopausal Osteoporosis

2013-12-01

Objectives: This study aims to identify the frequency of clinical risk factors associated with osteoporosis in postmenopausal women. Patients and methods: In this cross-sectional, observational, multicenter study, a total of 730 postmenopausal women were assessed for risk factors associated with osteoporosis. The assessment included a standardized questionnaire which recorded the following clinical risk factors: family and personal histories of fractures, prolonged immobilization, sun exposure, lifelong sedentary lifestyle, smoking history, low calcium intake in childhood and adulthood, excessive caffeine intake, high sodium intake, inadequate protein intake, number of pregnancies, age at menopause, the presence of premature menopause, primary and secondary amenorrhea, medical conditions, and chronic use of prescription drugs. Results: The most frequent clinical risk factors for osteoporosis were inadequate sun exposure (53.3%), current sedentary lifestyle (52.9%), low calcium intake in adulthood (45.1%) and childhood (41.9%), and sedentary lifestyle in adolescence (27.9%). A total of 707 patients (96.5%) described more than one risk factor, while 74.3% of the patients reported one clinical risk factor at least for secondary osteoporosis. Conclusion: Adequate sun exposure and proper intake of dietary calcium beginning in childhood combined with lifelong daily physical activity may play a role in preventing osteoporosis in postmenopausal women. In addition, physicians should be aware of the high probability of secondary osteoporosis in this patient group.

Churg-Strauss Syndrome Accompanied by Acute Coronary Syndrome in the Absence of Coronary Atherosclerosis

2013-12-01

Herein, we report a 35-year-old female case who was admitted to our emergency department with chest pain along with a past history of asthma and pleural effusion. Her laboratory findings revealed high levels of cardiac biomarkers [troponin I (TnI) and creatine kinase-MB isoenzyme (CK-MB)] without significant ST segment and T wave (ST-T) changes in the electrocardiogram. Transthoracic echocardiography showed hypokinesis of the anterior wall with an ejection fraction of 48% and minimal pericardial effusion. Coronary arteriography revealed a distally occluded left anterior descending coronary artery. Churg-Strauss syndrome with acute coronary syndrome was diagnosed. The patient was administered systemic corticosteroid therapy. Our patient subsequently made an uneventful recovery.

Is There a Bridge Between Systemic Lupus Erythematosus and Thymomas?

Xie QIBING, Yin HENG, Tao YE, Chen XI, Yin GENG — 2013-12-01

In this report, we describe a 21-year-old male patient who developed a type C thymoma (undifferentiated carcinoma) after five years of stabilized systemic lupus erythematosus (SLE) activity. The patient remained stable even after chemoradiotherapy for the thymoma, and at the one-year follow-up, treatment had no effect on the progression of the SLE. Previous data regarding the coexistence of SLE and thymomas suggested that interaction occurs between these two diseases through some implicit mechanisms. However, we believe that no interaction takes place between two diseases, based on our experience and related literature data.

A Pre- and Postoperative Evaluation of Multiple Joint Involvement as the Initial Finding of Cervical Syringomyelia and Neuropathic Arthropathy

Ay�in KISABAY, Sinem ZEYBEK, Serpil SARI, Aliye TANYEL�, Deniz SEL�UK� — 2013-12-01

Syringomyelia is a progressive, degenerative disorder, in which a longitudinal cyst forms within the spinal cord. Neuropathic arthropathy can be seen in the late phases of the disease, with the most frequent involvement being in the shoulder. Herein, we present a 42-year-old female case who was diagnosed with syringomyelia as well as Arnold-Chiari Syndrome and neuropathic arthropathy. Her initial complaints were painless edema in the right shoulder and elbow, wounds on the tips of her fingers and amputations. She was evaluated both pre- and postoperative periods. It should be kept in mind that neuropathic arthropathy may develop as the initial symptom in spinal cord lesions which progress slowly.

Multidrug-Resistant Disseminated Nocardia Farcinica Infection in a Systemic Lupus Erythematosus Patient

�zt�rk ATE�, Havva C�LAN, Sema OYMAK, Orhan YILDIZ, Oktay OYMAK — 2013-12-01

Herein, we present a 40-year-old female case who was admitted to our hospital with the complaints of fever and a painful left leg. She had a five-month history of treatment with azathioprine and prednisolone for lupus nephritis. The patient was diagnosed with disseminated nocardiosis (nodular cutaneous lesions, bacteremia, brain abscesses, and a reticulonodular miliary tuberculosis-like infiltration) associated with Nocardia farcinica and was treated using linezolid, netilmicin, and ceftriaxone. This case is important as treatment of Nocardia infections remains week particularly when they involve the central nervous system and when they are sustained by highly drugresistant species such as Nocardia farcinica.

Caution Should Be Observed Against the Last Observation Carried Forward Analysis in Opioid Trials

2013-12-01

Colchicine as a Possible Alternative Treatment for Chronic Recurrent Multifocal Osteomyelitis

Mahmut ALPAYCI — 2013-12-01