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Objectives: This study was aimed to evaluate the frequency of fibromyalgianess, fibromyalgia syndrome (FS) and widespread pain in patients with Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS) and their relationship with clinical and demographic parameters. Patients and Methods: This cross-sectional multicenter trial was performed in 14 centers across Türkiye. 661 patients (342 RA, 319 AS) have been recruited for the study. In these cohorts those who did not meet the criteria for FS and had widespread pain (widespread pain index≥7) were evaluated as a separate group. Clinical status and demographic parameters of patients in both cohorts were evaluated as well as the evaluations of RA and AS patients with widespread pain (widespread pain index≥7) and RA and AS patients with FS groups. In addition, correlations between Polysymptomatic Distress Scale (PSD) scores and visual analogue scale (VAS), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Disease Activity Score using 28 joint counts (DAS 28) for RA patients and VAS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) for AS patients were analyzed. Results: Frequencies of patients with FS and patients who had PSD scores≥12 were 34.1% and 44.4% in all RA patients respectively. Moreover, FS and PSD scores ≥12 were found as 29.2% and 36.9% in all AS patients respectively. PSD scores of RA patients with FS were higher than all RA and RA with widespread pain patients’. SDAI and CDAI scores of RA patients with FSwere higher than all RA and RA with widespread pain patients’as well. Similarly,PSD scores of AS patients with FS were higher than all AS and AS with widespread pain patients’. ASDAS-ESR and BASDAI scores of AS patients with FS were found higher than all AS and AS with widespread pain patients’. Conclusion: Disease activity scores including pain in RA and AS patients’ were seemed higher in the presence of FS or fibromyalgianess. It may be related to clinical parameters, but cohort studies with long-term follow-up are needed in order to reveal causality. Additionally, in order to reduce overtreatment, coexistence of fibromyalgianess should be kept in mind in patients who had inflammatory diseases like RA and AS especially with intractable widespread pain.

AMAÇ: Bu randomize kontrollü çalışmada lateral epikondilitte lokal steroid enjeksiyonu ile terapötik pulse ultrason ve parafin tedavisinin etkinliklerini karşılaştırma amaçlandı. GEREÇ VE YÖNTEMLER: Otuz altı lateral epikondilit teşhisi konulan hasta randomize olarak 18’er kişilik iki gruba ayrıldı. 1. gruba lokal steroid enjeksiyonu uygulanırken, 2. gruba pulse ultrason ve parafin tedavisi verildi. Hastalar başlangıçta, 3. haftada ve 6. haftada değerlendirildi. Başlangıçta ve takiplerdeki ağrı düzeyleri, istirahat ve aktivitede Vizüel Analog Skala ve Likert skalası ile sorgulandı. Kontrollerde; basınçla ve dirence karşı el bileği ekstansiyonu ile gelişen ağrı, elin sıkma gücü, hasta ve hekimin global değerlendirmesi kaydedildi. BULGULAR: Tedavilerin sonunda her iki grupta da tüm ağrı parametlerinde azalma ve el kavrama gücünde artış izlendi. 3. ve 6. haftalardaki tespit edilen iyileşme bakımından gruplar arası anlamlı fark görülmedi. SONUÇ: Lateral epikondilitte steroid enjeksiyonu ve ultrason ile parafin tedavileri etkin bir şekilde kullanılabilir. Ağrıda hızlı azalma için ucuz ve pratik olan steroid enjeksiyonu tercih edilebilir.

Aim: Previous publications have described various therapeutic modalities for symptomatic cysts, including non-steroidal anti-inflammatory drugs, cystostomy, physical therapy, and exercises. The objective of thise study was to elucidate the effectiveness of shrinking the cyst without steroidal injection and to compare aspiration with classic physiotherapy and exercises. Material and Method: This randomized, controlled trial involved 40 patients with Baker’s cyst. The participants were randomized into two groups, (I) an aspiration group (n=20) and (II) a control group (n=20). In the aspiration group, Baker’s cyst content was aspirated percutaneously under USG guidance, while no aspiration was performed in the control group. Pain was evaluated with a visual analog scale, while the Lysholm knee scoring scale and Cincinnati knee rating system were employed to determine functional status. Quality of life and disability were evaluated using the Nottingham Health Profile and the Western Ontario and McMaster Universities Arthritis Index . Results: Differences were observed in USG measurements (width, length, and area) and clinical parameters before and after treatment in both groups. However, although these differences were greater in the aspiration group, they were not statistically significant. Conclusion: Our results indicate that cyst aspiration performed with USG provides no additional effect to those of physical exercises and cold application. Exercise therapy and cold application should be considered before proceeding with an invasive procedure.

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

Avascular necrosis, which is caused by non-traumatic factors, is not a specific disease entity but the final common result of many conditions leading to death of bone cells by the impairment of blood supply. Although associated diseases and conditions (steroid administration, alcoholism, systemic lupus erythematosus, etc.) are well known, avascular necrosis is thought to arise from a multifactorial etiology of mechanical, hormonal and hematologic factors. The goals of treatment are to maintain range of motion, to stop the progression of disease, and to reduce symptoms. If conservative treatment fails, arthroscopic debridement, core decompression, grafting, and arthroplasty are surgical alternatives according to the stage of disease.

Background: Recent recommendations have established clinical remission ideally or low disease activity (LDA) as therapeutic targets in all patients with rheumatoid arthritis (RA). Controlled studies of biologic agents have primarily assessed treatment effects in patients with severe RA; patients with moderate disease activity, whoconstitute a larger group, have received far less attention. In Period 1 of the PRESERVE trial, the proportion of subjects with moderately active RA achieving LDA or remission were evaluated after treatment with etanercept 50mg once weekly (QW) plus methotrexate for 36 weeks.Methods: Subjects with DAS28 >3.2 and ≤5.1 despite stable doses of oral methotrexate received open-label etanercept 50mg QW plus methotrexate (screening dose permitted to be titrated up to 25 mg/wk through week 28) for 36 weeks.Results: 834 subjects received treatment and were analyzed. Subjects were mostly female (83%), Caucasian (74%), RFþ (73%), and aCCPþ (78%), with a mean age of 48 years and disease duration of 7 years. Mean baseline DAS28 was 4.4; SDAI, 19.1; ESR, 22.2 mm/hr; and CRP, 12.3 mg/L. Efficacy results from Period 1 are shown in the table. The most commonly reported adverse events (AEs) were headache (6.1%), nasopharyngitis (5.4%), and upper respiratory tract infection (4.4%). Twenty-two subjects (2.6%) discontinued due to AEs.Conclusions: Substantial proportions of subjects with moderately active RA who received etanercept 50mg QW plus methotrexate for 36 weeks achieved LDA (85%-86%), DAS28 remission (67%), or SDAI remission (25%). Therefore, these ambitious goals can be achieved realistically in a high percentage of patients with moderate disease activity.

A 29-year-old male patient presented to our clinic with progressively worsening bilateral hip pain, right knee pain and swelling. The hip and knee pain started about 3 months ago and increased over time. Pain of the hip joints was spreading bilaterally to the trochanteric regions. The characteristic of the pain was mechanical. He did not feel pain while sleeping. Prolonged sitting or standing caused the hip to lock. Previously, he had received analgesic medications but there had been no significant improvement. There was no pain in any other joint, and there was no history of disease or trauma associated with the hip and knee. Physical examination revealed an antalgic gait and the patient had visibly swollen right popliteal fossa. The motion of the right hip joint was limited and painful in all directions, whereas lumbar and left hip joint motions were unrestricted. He could fully extend his knee, but flexion was restricted to only 120 degrees. Radiography of the pelvis and knee indicated a narrowing joint space, and there were erosions on the acetabular side of the joint and multiple soft tissue calcifications outside the joint capsule of the right knee. Magnetic resonance imaging (MRI) of the bilateral hip revealed findings consistent with synovial chondromatosis, which filled the joint space completely and MRI of the knee revealed expanded sinovium that contained osteochondromas, which were hypointense in all sequences (Figure 1). Orthopedic surgical procedures including arthroscopic debridement were planned with symptomatic right hip and right knee joints. Synovial osteochondromatosis is a rare benign condition characterized by the formation of multiple nodules of hyaline cartilage within the sub-synovial connective tissue (1). The condition is generally monoarticular and involves the knee in more than 50% of the cases (2). The other common joints involved are hip, elbow, shoulder and ankle. In the literature, Kose et al. (3) presented a unilateral hip joint synovial osteochondromatosis case, Mackenzie et al. (4) presented Fatih Bagcier, Ayhan Kul, Emine Esra Ergul, Akin Erdal

Yaz›flma Adresi/Address for Correspondence: Fatih Bagcier MD, Ataturk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Erzurum, Turkey Tel.: +90 442 344 70 87 E-posta: bagcier_42@hotmail.com Gelis Tarihi/Received: 15.08.2015 Kabul Tarihi/Accepted: 01.09.2015 To the Editor; A 82-year-old male patient presented to our clinic with progressively worsening left shoulder pain. The pain started about 6 months ago, increased over time, spreading to the chest region. The characteristic of the pain was mechanical. He did not feel pain while sleeping. Previously, he had received analgesic medications but there was no significant improvement. There was no pain in any other joint, and there was no history of disease or trauma. Physical examination revealed the motion of the left shoulder joint was limited and painful in all directions. Neer’s impingement sign, Hawkins-Kennedy test, Yergasons tests were positive. There were no neurological deficits of the upper extremities. Serological and biochemical markers were normal. Impingement syndrome was diagnosed with physical examination. Magnetic resonance imaging (MRI) of the left shoulder revealed findings consistent with synovial chondromatosis (SC), which filled the subscapuler muscle region (Figure 1). Orthopedic surgical procedures including arthroscopic debridement were planned with symptomatic left shoulder. SC is a rare arthropathy of unknown etiology. The disease is generally monoarticular, usually occurs unilaterally in the large joints like the knee, hip, and elbow characterized by proliferation of the synovium with cartilaginous metaplasia (1). However any joint may be involved. Symptomatic presentation is quoted in the current literature mainly at the ages of 30 to 50 of a patient’s life. The diagnosis of SC is given after a thorough history, physical examination, and radiographic examination. Chronic, progressive pain, swelling, loss of motion and locking are more commonly seen symptoms, and soft-tissue swelling, crepitation, palpable loose bodies, and limited range of motion are the most common physical signs. It is beneficial to carry out computed tomography and MRI scans to identify and localize the lesions, and they also help to differentiate between other differential diagnoses. As radiotherapy and chemotherapy have no effect on SC, surgical removal of the affected synovium and the loose bodies is the preferred treatment (2). In the literature Kose et al. (3) presented a case with unilateral hip joint synovial osteochondromatosis, Giannetti et al. (4) presented a case with unilateral elbow joint synovial osteochondromatosis, Shearer et al. (5) presented a case with bilateral ankle joint synovial osteochondromatosis. Synovial osteochondromatosis was present in our case uncommon shoulder pain etiology in old man.