Turkish Journal of Rheumatology - 2009; 24(4) - Current Issue

Ethics and Scientific Publication

Deniz Evcik — 2009-12-01

Chronic Low Back Pain, Risk Factors and Effects on Bone Mineral Density

Bedriye Mermerci Ba�kan, Filiz Sivas, Tuba G�ler, K�r�at �zoran — 2009-12-01

Objective: The aims of this study were to investigate bone mineral density (BMD) measurements and the strength of abdominal and dorsal muscles in premenopausal women with chronic low back pain (CLBP) and to determine the risk factors that could affect these parameters. Material and Methods: Fifty premenopausal women with CLBP were included in the study and the control group consisted of 30 healthy women. Physical examination and routine blood and urinary analyses were performed. Medical history consisted of questions regarding age, height, weight, educational level, duration of back pain, occupation, daily sports activities, consumption of cigarettes, alcohol, and caffeine, and number of children. The severity of back pain was measured by the Istanbul Back Pain Disability Index (IBPDI) and psychological status was evaluated by the Beck Depression Inventory (BDI). Muscle strength was evaluated using manual technique. BMD measurements were taken at the right forearm, hip, and lumbar vertebral regions. Results: There was no significant difference between groups in BMD values at all measurement sites. Abdominal and dorsal muscle strength was significantly higher in the control group than in the study group. In patients with CLBP, there was a significant relation between the body mass index (BMI) and BMD values of the Ward's triangle, femur neck and total forearm regions. In the patient group, there was a significant relation between the number of children and the BMD values of the femur neck and all forearm regions. There were significantly negative correlations between abdominal muscle strength and BMD values of the hip and femur neck. Conclusion: A comparison of BMD measurements between the two groups showed no significant difference. The authors believe that with implementation of exercise programs aimed at CLBP, a life standard with higher gratification levels and additional recoveries in terms of BMD levels will be obtained. (Turk J Rheumatol 2009; 24: 172-7)

Relation Between Clinical Parameters and Pulmonary Function in Ankylosing Spondylitis

Dilek Durmu�, F�rat Altay, O�uz Uzun, Ferhan Cant�rk — 2009-12-01

Objective: The aim of this study was to determine pulmonary function in ankylosing spondylitis (AS) patients and to assess the relationship with clinical parameters. Material and Methods: A total of 30 patients with definite AS (Group 1) and 20 age-matched healthy controls (Group 2) were recruited for the study. Patients and healthy controls were assessed according to visual analog scale (VAS) pain, 6 minute walk test (6MWT), chest expansion, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Functional Index (BASFI). Pulmonary function was assessed by forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and vital capacity (VC). Results: There was no statistically significant difference in age or body mass index between groups (p>0.05). There were significant differences in VAS pain, chest expansion, BASDAI and BASFI scores and pulmonary function parameters FVC, FEV1, VC and 6MWT between groups (p<0.05). There were significant correlations between all pulmonary function parameters and clinical and functional measures. Conclusion: Based on these results, we conclude that there is a correlation among functional performance, pulmonary capacities and clinical parameters in AS patients. (Turk J Rheumatol 2009; 24: 178-82)

Effect of Pulmonary Involvement on Bath Indexes, Quality of Life and Psychological Symptoms in Patients with Ankylosing Spondylitis

2009-12-01

Objective: Pain and stiffness disturb the psychological status and quality of life in ankylosing spondylitis (AS) patients, which may be further deteriorated by pulmonary involvement. Therefore, detection of pulmonary involvement in AS patients is important. In this study, we aimed to detect pulmonary involvement in AS patients and to assess the effects of pulmonary involvement on Bath indexes, quality of life and psychological symptoms. Material and Methods: The study included 26 AS patients (mean age: 47.5�10.8 years). Pulmonary status of the patients was assessed by spirometric measurements and radiographic methods (chest X-ray, high resolution computerized tomography [HRCT]); clinical status was assessed by Bath indexes (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], Bath Spondylitis Metrology Index [BASMI], Bath Ankylosing Spondylitis Radiology Index [BASRI]); quality of life was assessed by Nottingham Health Profile-1 (NHP) and St. George Respiratory Questionnaire (SGRQ); and psychological symptoms were assessed by Beck Depression Scale (BDS). Results: Respiratory function tests were impaired in 15.4% of the patients (n: 3/1, restrictive/obstructive). HRCT revealed pathologic findings in 20.9% of the patients (n: 5). A negative correlation was detected between forced expiratory volume in 1 second (FEV₁ %) and BASFI (r=-0.56, p<0.01). No significant correlation was observed between the other respiratory function tests and HRCT, duration of disease, Bath indexes (BASDAI, BASFI, BASMI, BASRI), NHP, SGRQ, and BDS (p>0.05). Conclusion: Our study showed that pulmonary involvement may be observed among non-smoker AS patients with longer duration of disease; however, pulmonary involvement is not related with clinical status, quality of life or psychological symptoms. (Turk J Rheumatol 2009; 24: 183-9)

Turkish Translation and Patient Evaluation of the ASAS/EULAR Recommendations-Patient Version for the Management of Ankylosing Spondylitis

Salih �zg��men, Mehmet Tuncay Duru�z — 2009-12-01

Objective: The aim of this study was to evaluate the Turkish translation of the patient version of the Assessment in Spondyloarthritis International Society (ASAS) and European League Against Rheumatism (EULAR) recommendations for the management of ankylosing spondylitis (AS) by the patients. Material and Methods: Twelve members of the Ankylosing Spondylitis Patient Society of Turkey participated in the study. All were patients suffering from AS and all items of the recommendations were evaluated for the exact Turkish wording, meaning and comprehensibility by Turkish AS patients. All items were discussed and scored by the patients. Results: The median age of the 12 patients (4 female and 8 male) was 39.5 and disease duration was 11.5 years. The median Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index were 4.0 and 3.42, respectively. Patients were agreed on each of the 10 items with a mean rate of >80%, and scored the overall recommendations with a mean score of 9.83�0.39. Conclusion: The patient version of the ASAS/EULAR recommendations for the management of AS has been successfully translated into Turkish and all of the patients reached an overall agreement on these recommendations. Treatment guidelines or recommendations that were composed using a medical language that could not be clearly understood by the patients should be translated into common vernacular in order to disseminate knowledge and maintain the patients' participation. (Turk J Rheumatol 2009; 24: 190-5)

Relation Between Pain, Disability and Depression in Patients with Knee Osteoarthritis

2009-12-01

Objective: The aim of this study was to investigate the relationship between pain, disability and depression in patients with knee osteoarthritis. We also aimed to examine the effects of depression treatment on pain and disability among patients with comorbid knee osteoarthritis and depression. Material and Methods: Fifty-six patients who fulfilled the American College of Rheumatology (ACR) clinical criteria for knee osteoarthritis were included in this study. A 10 cm visual analog scale was used to assess pain severity. Lequesne index and 5 m timed up & go test were used to assess disability. Beck Depression Inventory was used to diagnose and measure the severity of depression. All subjects participated in a 10-session standard physical therapy program. After the physical therapy program, the subjects whose Beck Depression Inventory score were greater than 13 were consulted to the Psychiatry Department for the definitive diagnosis and treatment of depression. All subjects were contacted by telephone at 6 months after the physical therapy program. Forty-nine subjects who returned for the 6-month follow-up were re-assessed using the same measurements. Results: According to the Beck Depression Inventory, the patients in the depressed group had higher disability scores according to the Lequesne index when compared to the non-depressed group (p=0.009). Pain severity was also higher in the depressed group but the difference was not statistically significant (p=0.051). At the 6-month follow-up assessment, a statistically significant decrease in disability and pain was found in all subjects (p=0.000). Depression scores were also reduced in all subjects, but this was not statistically significant (p=0.052). Conclusion: A positive relation between pain, disability and depression was found in patients with knee osteoarthritis; however, given the small number of depressed patients in our study, further research is needed to support this relation and to examine the effects of depression treatment on pain and disability. (Turk J Rheumatol 2009; 24: 196-201)

Metabolic Syndrome in Patients with Rheumatoid Arthritis

Ayla Akbal, Bar�n Sel�uk, Aysel G�rcan, Aydan Kurtaran, Murat Ers�z, M�fit Aky�z — 2009-12-01

Objective: The aim of this study was to investigate the prevalence of metabolic syndrome (MS) and components of MS and to evaluate the relation between MS and functional state in patients with RA. Material and Methods: A total of 138 patients (71 with rheumatoid arthritis, 67 controls) were included in this study. The diagnosis of rheumatoid arthritis was made according to the criteria of the American College of Rheumatology (ACR) for Rheumatoid Arthritis, and the diagnosis of MS was made according to the diagnostic criteria of the American Medical Association Summary of the National Cholesterol Education Program Adult Treatment Panel III Report (NCEP ATP III). The functional status of patients was determined according to Steinbrocker functional classification. Results: MS was found in 28 (28.4% and 16% in rheumatoid arthritis patients and control group, respectively). No differences between these two groups were determined. According to Steinbrocker functional classification, 93% of cases with rheumatoid arthritis were in stage 1 or stage 2. Systolic blood pressure levels and triglycerides were found significantly higher in patients with rheumatoid arthritis. No differences among the other MS components were determined. Although the fasting blood glucose levels and erythrocyte sedimentation rates were found higher in the patients that had been using corticosteroids, this use of the drug did not cause any significant increase in MS prevalence. Conclusion: Although the systolic blood pressure levels and triglyceride levels were found higher in patients with rheumatoid arthritis, no differences in the prevalence of MS between the two groups was determined. A positive correlation between prevalence of MS and worsening of functional status was found in patients with RA. (Turk J Rheumatol 2009; 24: 202-5)

Biomaterials and Tissue Engineering for Regenerative Repair of Articular Cartilage Defects

K�z�m Tur — 2009-12-01

Articular cartilage defects heal very poorly and lead to degenerative arthritis. Existing medications cannot promote healing process; cartilage defects eventually require surgical replacements with autografts. As there is not enough source of articular cartilage that can be donated for autografting, materials that promote cartilage regeneration are important in both research and clinical applications. Tissue engineering involves cell growth on biomaterial scaffolds in vitro. These cells are then injected into cartilage defects for biological in vivo regeneration of the cartilage tissue. This review aims first to provide a brief introduction to the types of materials in medicine (biomaterials), to their roles in treatment of diseases, and to design factors and general requirements of biomaterials. Then, it attempts to sum up the recent advances in engineering articular cartilage; one of the most challenging area of study in biomaterials based tissue engineering, as an example to the research on regenerative solutions to musculoskeletal problems with an emphasis on the biomaterials that have been developed as scaffolds for cartilage tissue engineering. The definitive goal on cartilage regeneration is to develop a system using biomimetic approach to produce cartilage tissue that mimics native tissue properties, provides rapid restoration of tissue function, and is clinically translatable. This is obviously an ambitious goal; however, significant progress have been made in recent years; and further advances in materials design and technology will pave the way for creating significantly custom- made cellular environment for cartilage regeneration. (Turk J Rheumatol 2009; 24: 206-17)

Current Advances in the Genetic Basis of Rheumatoid Arthritis

Berrin Y�ksel-Konuk, Volkan Baltac� — 2009-12-01

Rheumatoid arthritis (RA) is a heterogeneous and complex disease where both genetic and environmental risk factors are involved. Reviewing the increased familial incidence and increased disease susceptibility demonstrated in twin studies, RA clearly has a genetic component. More evidence for a strong inherited component in RA is supported by association studies of RA with variants in the human leukocyte antigen (HLA) region, particularly the HLA-DRB1 gene in a wide range of populations. After the discovery of HLA associations, traditional linkage and association studies have identified new RA risk loci. In the last few years, the demonstration of genetic associations through the use of genome-wide association studies (GWAS) with a technical capacity to genotype hundreds of thousands of single nucleotide polymorphisms (SNPs) in a cost-effective manner proceeded to uncover new RA susceptibility genes. We review herein recent progress made in the field of RA genetics. (Turk J Rheumatol 2009; 24: 218-21)

Cervical Spine Involvement in Rheumatoid Arthritis: Case Report

Ali Aydeniz, �zlem Alt�nda�, Sava� G�rsoy — 2009-12-01

Cervical spine involvement occurs in over half of the patients with rheumatoid arthritis. The destruction of the spine ranges from minimal subluxation to atlantoaxial dislocation and compression of the spinal cord and brainstem, and hence may result in sudden death. In this paper, we present a case of seronegative rheumatoid arthritis with cervical involvement, and we review cervical involvement in view of the related literature. (Turk J Rheumatol 2009; 24: 222-4)

Atypical Psoriatic Arthritis: A Case Report

Yasemin Turan, �mer Faruk �endur, I��l Karata�-Berkit, Ay�e �n�bol — 2009-12-01

Psoriatic arthritis (PsA) is chronic inflammatory rheumatic disease characterized by of peripheral arthritis, enthesitis, spondylitis and psoriasis. The mean age at onset of PsA is in the range of 30-50 years. In clinically, approximately 17% of patients develop arthritis before the onset of psoriasis. Osgood Schlatter syndrome presents in growing children (boys, 12-15 years; girls, 8-12 years) with local pain, swelling and tenderness over the tibial tuberosity. In this paper, Osgood Schlatter syndrome causing bilateral knee pain during the fallow-up of a patient with atypical PsA is reported. (Turk J Rheumatol 2009; 24: 225-7)

Multiple Congenital Joint Contractures, Arthrogryposis Multiplex Congenita: A Case Report

�zg�n �akmak Ba�er, Saime Ay, �ebnem Kolda� Do�an, Deniz Evcik — 2009-12-01

Arthrogryposis multiplex congenita is a syndrome characterized by non-progressive multiple congenital joint contractures. The exact etiology of arthrogryposis is unknown. It may be due to neuropathic or muscular pathologies, connective tissue disorders, conditions limiting the uterine space, intrauterine vascular abnormalities, or maternal diseases. In the early period of the disease, establishment of the correct diagnosis is crucial for determining the prognosis and initiation of the appropriate therapy. Herein, a 69-year-old female patient initially admitted with shoulder pain and later diagnosed to have both shoulder lesion and multiple joint contractures is presented. (Turk J Rheumatol 2009; 24: 228-31)

A Rare Cause of Chronic Low Back Pain: Osteoblastoma of the Lumbar Spine

Can Solako�lu, Selahattin �zy�rek, Osman Rodop, Erkan Kaya, Murat Durusu — 2009-12-01