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Osteomalacia is a metabolic bone disease characterized by demineralization of the newly formed osteoid in adults. Vitamin D deficiency due to insufficient vitamin D intake, inadequate exposure to sunlight, and malabsorption of vitamin D are the most widespread cause of osteomalacia. Here,we present the case of 18 year old female patient who presented to our hospital with complaints of low back pain. Sacral bone pseudofracture was detected by magnetic resonance imaging due to osteomalacia. Patient was treated with vitamin D.

Objective: This study aimed to evaluate the effects of added kinesiology taping treatment on pain, functional status, and hand grip strength in patients with carpal tunnel syndrome (CTS). Material and Methods: Eighty patients aged 18 years and over who were diagnosed with mild to moderate CTS by physical examination and electrophysiological findings were included in the study. Of these, 16 (20%) were males and 64 (80%) were females. Visual analogue scale (VAS), Boston KTS Questionnaire (BCTQ) and hydraulic hand dynamometer (Jamar) scores were used for the evaluation. The patients were randomly divided into two groups as splint (S) and Splint+Kinesiotape (SKT) treatment groups. Patients in the S group only received a volar-assisted splint in the neutral position. The patients were asked to wear the splints, especially during the night for three weeks. The SKT group was treated with kinesiology taping in addition to splinting. The taping process was repeated by the same person twice a week for three weeks. Results: The mean age of the patients was 47.0±11.4 for the S group and 50.2 ± 11.9 for the SKT group. In both groups, VAS, BCTQ-symptom severity scale (SSS), functional capacity scale (FDS), and hand dynamometer (kgf) measurements were statistically significant at three weeks post-treatment (p0.05). Conclusion: In the conservative treatment of CTS, splint therapy has been shown to have a positive effect on VAS, BCTQ-SSS, BCTQ-FDS, and hand muscle strength. The superiority of splint therapy with kinesio taping, over splint therapy alone could not be demonstrated in the short-term.

Aim: Ankylosing spondylitis (AS) is a systemic chronic inflammatory disease that has various adverse effects on cardiac autonomicfunctions. On the other hand, there is no data regarding the effects of cardiac rehabilitation on cardiac autonomic functions in ASpatients. In this study, we aimed to investigate the effects of cardiac rehabilitation on cardiac autonomic nervous system parametersin patients with AS.Materials and Methods: This study was designed as a prospective randomized controlled trial. The study was carried out in December2015 - August 2016. 34 patients who fulfilled the modified New York criteria were enrolled in the study. Patients were randomlyassigned into case and control groups each consisting of 17 patients. The cardiac rehabilitation program was applied to the casegroup for eight weeks. Patient evaluation with clinical assessment, echocardiography, and exercise stress testing was performedbefore and after treatment.Results: A total of 34 patients made the final study population (37.35± 5.22 years, 55.9% male). There were no significant differencesregarding the baseline characteristics between case and control groups. Patients in the case group had better MET levels, exercisetime, resting heart rate, and chronotropic reserve than the control patients following cardiac rehabilitation.Conclusion: Our results indicate that significant improvement in cardiac autonomic functions can be obtained in AS patients whenthe cardiac rehabilitation program is combined with the medical treatment.

Objectives To evaluate the radiological, clinical and functional properties of hand osteoarthritis and to assess their relationship in a Turkish population. Methods The subjects with hand OA recruited into the study from the multi-centre national osteoarthritis cohort by the Turkish League Against Rheumatology (TLAR–OA). The demographic characteristics, body mass index (BMI), smoking, finger ratio,(2nd to 4th finger lenght), grip strengths with Jamar dynamometer, hand pain duration (month), hand pain severity (visual analogue scale; 0–100 mm) were evaluated. The radiological stage of hand OA was assessed according to the Kellgren Lawrence OA staging. The hightest stage among the joints involvement was noted as the OA stage of the hand. The functional disability concerning to hand involvement was assessed with Duruoz Hand Index (DHI). The SPSS 24.0 statistical package was used for analysis. The descriptive analysis was performed for all parameters. Spearman’s correlation coefficient was used to assess the relation between quantitative variables. Results A total of 364 subjects (330 female, 34 male) from 15 centres with mean of age 62.96 (SD: 10.22) were recruited into the study. The mean of BMI was 29.54 (SD: 4.51) and the percentage of smoking person was 6.3%. The mean of 2nd finger to 4th finger ratio of the patients was 0.96 (SD: 0.05). The mean of grip strengths of the right hand and left hand were respectively 15.55 kg (SD: 12.88) and 14.13 kg (SD: 11.39), which is lower than normal population.1 The median pain duration of hand was 24 months (min-max: 1–480 months). The mean VAS score of pain was 5.05 (SD: 2.33). The mean DHI score was 16.82 (SD: 15.53). The patients’ radiological OA involvement stages (2,3 and 4) of right and left hands were respectively 26.1% and 23.6% (stage 2); 22.5% and 20.9% (stage 3); 13.2% and 12.4% (stage 4) according to the Kellgren Lawrence scoring. The radiological stages of right and left hands respectively had poor correlation with VASpain (rho=0.152, p=0.010; rho=0.158, p=0.009); low but significant correlations with Duruoz Hand Index (rho=0.257, p 0.05). Conclusions Although the subjects with hand OA had pain, low grip strenght and hand disability; the radiological findings had meaningful relations with only functional involvement and pain duration in our population. Reference [1] Massy-Westropp N, et al. Hand grip strenght: age and gender stratified normative data in a population-based study. BMC Res Notes2011;4:127. Disclosure of Interest M. T. Duruoz Grant/research support from: ABVIE, Consultant for: NOVARTIS, Speakers bureau: ABDI IBRAHIM, D. Erdem: None declared, T. Tuncer: None declared, L. Altan: None declared, F. Ayhan: None declared, A. Bal: None declared, L. Cerrahoglu: None declared, E. Capkin: None declared, R. Cevik: None declared, D. Dulgeroglu: None declared, S. Gursoy: None declared, S. Hizmetli: None declared, C. Kacar: None declared, E. Kaptanoglu: None declared, T. Kaya: None declared, H. Kocabas: None declared, K. Nas: None declared, S. Ozcakir: None declared, D. Sindel: None declared, O. Sahin: None declared, G. Tasci Bozbas: None declared, C. Tikiz: None declared, H. Ugurlu: None declared

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease that predominantly affects the spine and may cause serious functional impairment. The prevalence of AS is approximately 0.1% of the Caucasoid population. Treatment of AS includes use of antiinflammatory drugs to reduce pain and stiffness. In addition, patients are advised to exercise daily and to engage in weekly group physical therapy to maintain mobility of the spine and peripheral joints. Objectives To evaluate the effects of physical therapy on pain, disease activity, functional and emotional status and quality of life in patients with AS. Methods Thirty one patients diagnosed with AS and followed up in outpatient clinic were conducted into the study. Routine physical examination of musculosceletal and neurological system of all patients has been performed. Patients divided into two groups (physical therapy group and control group) as random. 15 seance physical therapy (hotpack, ultrasound, TENS and hydrotherapy) exercise and medical treatment performed for the physical therapy group and only home exercise programme and medical treatment for control group. All patients received medical therapy which was not changed during the study. We evaluated all patients with visual analogue scale (VAS) at night and rest for pain, Bath Ankylosing Spondylitis Functional Index (BASFI) for functional status, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity and modified Schober, finger floor distance (FFD), lateral flexion of the lumbar spine, cervical rotation, intermalleolar distance, tragus wall distance, chest expansion, cheek manibrium distance and Bath Ankylosing Sponylitis Metrology Index (BASMI) for spinal mobility measurements at the begining, 2nd and 6th weeks. Also Beck Depression Inventory (BDI) and short form 36 (SF-36) were fullfilled by all patients at the begining and 6th week. Results Between the groups there was no difference in demographic data.We showed significant improvement in all parameters except lateral flexion, tragus wall distance measurements for spinal mobility and beck depression index scores at second week (p Conclusions Physical therapy may have benefical effects on pain, spinal mobility and quality of life in patients with AS. References [1] Khan MA. Clinical features of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (Eds.), Rheumatology. Mosby, Philadelphia 2003;2:1161–81. [2] Ince G, Sarpel T, Durgun B. Effects of a multimodal exercise program for people with ankylosing spondylitis. Physical Therapy2006;86(7):924–35. [3] Van Tubergen A, Landewe R, van der Heijde D, et al. Combined spa-exercise therapyis effective in patients with ankylosing spondylitis: a randomized controlled trial. ArthritisRheum2001;45:430–8. Disclosure of Interest A. Unal Enginar Shareholder of: none, Grant/research support from: none, Consultant for: none, Employee of: none, Paid instructor for: none, Speakers bureau: none, H. Ugurlu Shareholder of: none, Grant/research support from: none, Consultant for: none, Employee of: none, Paid instructor for: none, Speakers bureau: none

WOS: 000438624900001, PubMed ID: 29777340, In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

WOS: 000398230800006, PubMed: 27860257, Aim: The objective of this study is the evaluation of the effect of vitamin D replacement treatment on musculoskeletal symptoms and quality of life in patients with chronic widespread musculoskeletal pain (CWP) including fibromyalgia (FM) and vitamin D deficiency. Method: Patients with nonspecific CWP and vitamin D deficiency (25-OH D3

Objective: To determine the short- and long-term effectiveness of the muscle energy technique (MET) compared with corticosteroid injections (CSIs) for chronic lateral epicondylitis (LE). Design: Randomized controlled trial with 1 year of follow-up. Setting: Outpatient clinic of a university’s department of physical medicine and rehabilitation. Participants: Patients with chronic LE (NZ82; 45 women, 37 men). Interventions: Eight sessions of MET, or a single CSI was applied. Main Outcome Measures: Grip strength, pain intensity, and functional status were assessed using the pain-free grip strength (PFGS), a visual analog scale (VAS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, respectively. Measurements were performed before beginning treatment and at 6, 26, and 52 weeks afterward. Results: When the baseline PFGS, VAS, and DASH scores were compared with the scores at the 52-week follow-up, statistically significant improvements were observed in both groups over time. The patients who received a CSI showed significantly better effects at 6 weeks according to the PFGS and VAS scores, but declined thereafter. At the 26- and 52-week follow-ups, the patients who received the MET were statistically significantly better in terms of grip strength and pain scores. At 52 weeks, the mean PFGS score in the MET group was significantly higher (75.08�26.19 vs 62.24 �21.83; PZ.007) and the mean VAS score was significantly lower (3.28�2.86 vs 4.95 � 2.36; PZ.001) than those of the CSI group. Although improvements in the DASH scores were more pronounced in the MET group, the differences in DASH scores between the groups were not statistically significant. Conclusions: This study showed that while both MET and CSI improved measures of strength, pain, and function compared with baseline, subjects receiving MET had better scores at 52 weeks for PFGS and the VAS for pain. We conclude that MET appears to be an effective intervention in the treatment of LE. Archives of Physical Medicine and Rehabilitation 2013;94:2068-74 a 2013 by the American Congress of Rehabilitation Medicine

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

The objective of this study was to assess the prevalence of fibromyalgia (FM) in patients with episodic migraine and to evaluate the relationship between migraine characteristics and FM. One hundred and eighteen consecutive patients (mean age = 38 years, 75 % women) fulfilling the International Classification of Headache Disorders-II criteria for migraine with (n = 22) and without (n = 96) aura from an outpatient headache clinic of a university hospital were evaluated. The diagnosis of FM was made based on the 1990 American College of Rheumatology classification criteria. Participants completed some self-administered questionnaires ascertaining sociodemographics, headache severity, frequency and duration, headache-related disability (Headache Impact Test [HIT-6]) and Migraine Disability Assessment Scale, widespread musculoskeletal pain (visual analog scale), depression (Beck depression inventory), anxiety (Beck anxiety inventory), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Assessment of Fatigue), and quality of life (Short Form-36 Health Survey [SF-36]). In patients with FM, the tender point count and the Fibromyalgia Impact Questionnaire were employed. FM was diagnosed in 37 (31.4 %) of the patients. FM comorbidity was equally distributed across patients with and without aura. Severity of migraine headache, HIT-6, and anxiety were especially associated with FM comorbidity. Patients suffering from migraine plus FM reported lower scores on all items of the SF-36. This study indicates that the assessment and management of coexisting FM should be taken into account in the assessment and management of migraine, particularly when headache is severe or patients suffer from widespread musculoskeletal pain.

A candidate identification questionnaire (CIQ) was tested to determine its predictive value for patient-reported satisfaction in patients switched from once-weekly or once-daily treatment with a bisphosphonate to once-monthly dosing. This was a prospective, open-label, multicenter international study in patients with postmenopausal osteoporosis who had been receiving once-daily or once-weekly alendronate or risendronate for at least 3 months. Patients completed a CIQ, then commenced 150 mg monthly ibandronate for 6 months. Patients completed the Osteoporosis Patient Satisfaction Questionnaire (OPSAT-QTM) at baseline for 6 months. Scores were converted to composite satisfaction scores (CSS, scale 0 - 100). Totally 677 patients completed a CIQ, 645 were enrolled in the treatment phase and comprised the intent-to- treat (ITT) population, and 630 completed the study. In the ITT population, 68.1% patients answered “yes” to one or more CIQ questions. OPSAT-Q scores increased for the convenience, quality of life and overall satisfaction domains (p < 0.001). Decreases in scores for the side effects domains were significant (p < 0.001) in the CIQ “yes” group, but not for the degree of bother (decrease in mean of 0.1 points, p = 0.50) or duration (no change, p = 0.84) of non- gastrointestinal side effects. Of 638 patients who completed the preference questionnaire, 93.0% of patients preferred the once-monthly dosing schedule and 563 patients (90.7%) found it more convenient. The most common adverse events were dyspepsia (1.9%), nausea (1.1%), and upper abdominal pain (0.9%). Patients are likely to prefer treatment with monthly ibandronate to a weekly or monthly bisphosphonate irrespective of their stated preference before switching treatment.

The purpose of this study is to evaluate the efficacy of surface electrical stimulation on the spasticity occurring in the wrist flexor muscles after a cerebrovascular event.Hemiplegic patients with stage 2-3 spasticity in the wrist muscles based on the Ashworth scale were divided into two groups. Both groups were applied stretching. One group was additionally administered neuromuscular electrical stimulation (NMES) to the wrist extensors, in the form of pulsed current, 100 Hz, with a pulse duration of 0.1 msec, and a resting duration of 9 seconds, for 15 minutes to provide the maximum muscular contraction. The efficacy of the treatment was evaluated using the following: modified Ashworth scale (MAS), Fmax/Mmax ratio, Hmax/Mmax ratio, wrist extension range of motion (ROM). The daily activities were assessed by Functional Independence Measurement (FIM) and the motor recovery was evaluated by Brunnstrom motor staging.Both groups revealed a significant recovery after the treatment based on the MAS, the electrophysiological evaluation results, wrist ROM, FIM and Brunnstrom motor staging. The group receiving the combined treatment showed a better recovery in terms of MAS, wrist ROM, FIM and Brunnstrom motor staging compared to the group doing the stretching alone.The results of this study showed that NMES given together with stretching of the wrist extensor muscles was more effective than stretching of the wrist extensor muscles alone in reducing spasticity.

ObjectivesThe aim of this study is to compare the efficacies of different therapeutic transcutaneous electrical nerve stimulation [TENS] types and placebo TENS on pain syndrome in cervical myofascial pain syndrome [MPS] and to determine the superior method.MethodsPatients recruited in the study were randomized into four groups. Group 1 was treated with a conventional TENS with a frequency of 100 Hz, 40 µs duration, low amplitude; Group 2 with an acupuncture-like TENS with a frequency of 4 Hz, 250 µs duration, high amplitude; Group 3 with burst TENS with high [100 Hz] and low [2 Hz] frequency, 40 µs and high amplitude. Group 4 was treated with an electrical stimulation until the patient felt it. Then the electrical current was interrupted, but the patient was told the current was proceeding and he/she did not feel it any more since he/she had gotten used to it. All groups were treated with a total of 10 therapies with 30-minute sessions three times a week. Patients were assessed with a visual analog scale ...

We aimed to investigate the effects of isometric and combined concentric-eccentric (C-E) isokinetic types of exercise applied to the knee muscles in patients with knee osteoarthritis (OA) in an attempt to identify which type of exercise would be most effective in terms of pain relief, functional status, quality of life, and muscular strength. This was a controlled trial in which 71 patients were randomized into three groups. The first group was assigned to C-E, the second group to isometric isokinetic exercises, while the third, control group, was only given paracetamol. A visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short From-36 (SF-36) for functional status and quality of life, and the isokinetic test for muscular strength were evaluated. Significant improvements were recorded in all groups for pre and post-treatment pain, the WOMAC and the SF-36 (P < 0.001). Among the exercise groups, improvement was significantly better in the C-E, isokinetic exercise group as compared with the isometric exercise group (P < 0.001). Isokinetic exercises are recommended as a treatment modality. However, the long-term effects of these exercises on pain and osteoarthritis progression need to be investigated.

The aim of this study was to evaluate VMO and VL EMG activation onset times (AOT) during isometric contractions at various degrees of knee flexion and to explore the effects of a 6-w isokinetic exercises program on pain, quality of life, muscle strength and, if observed, on the difference in AOT, in patients with patellofemoral pain syndrome (PFPS). Twenty two female patients suffering from anterior knee pain and diagnosed with PFPS were recruited. The main outcome measures consisted of AOT and maximal isometric contraction of VMO and VL muscle and Medical Outcomes Study (SF36) and VAS scores. Compared to control knees, pre-exercise measurements revealed significant delay only in VMO at knee flexion angles of 15°, 30°, 45°. Post-exercise measurements showed improvement in the delay at 15°, 30°, 45° and also in the other pain, health quality and muscle strength measurements. In conclusion; VMO is activated later than VL in PFPS patients while exercise results in improvements in both symptoms and delay in VMO.

WOS: 000279533200003, Objective: The aim of this study was to investigate intensity of the central pain after a cerebrovascular episode and its effect on functional status. Materials and Methods: Forty-five patients complaining of pain, numbness, and tingling in the hemiplegic side were admitted to our stroke clinic and the functional status and intensity of pain were evaluated. The pain in the hemiplegic side was assessed by: patient history, visual analogue scale (VAS), physical examination, and activities of daily living using the Functional Independence Measure (FIM). Results: The mean age of the patients was 59.98 +/- 15.19 years-24 females and 21 males. Intensity of pain by VAS is 6.75 +/- 1.22. Significant relationship was found between central pain and some subitems of the FIM i.e.self-care, transfers, social cognitions and total FIM (p

We aimed at comparing the elderly adults and normal subjects with regard to their disability, psychological status, and quality of life (QOL). One hundred and twenty-five dialysis patients and 61 controls were recruited in the study. Depression and anxiety symptoms of the patients were evaluated with the Psychological Symptom Screening List (SCL 90-R). For evaluating the disability, the Rivermead mobility index (RMI) was utilized. For evaluating the QOL, we used the short form-36 (SF-36) scale. The Rivermead mobility index of the patients (9.6 +/- 3.4) was found. When compared with controls, dialysis patients had higher levels of disability (p = 0.0001). Depression and anxiety symptom scores of these patients were also significantly higher than that of the controls (p < 0.05). There was a correlation between the disability and depression symptom scores (r: 0.171, p = 0.037). Both physical and mental capacity scores of the dialysis patients were lower than those of the controls (p < 0.05 and p < 0.05) QOL scores for elderly hemodialysis patients were found to be lower. Their disability was higher, making them dependable on others during their daily lives. Specific exercise programs should be developed for these patients. Even the smallest effort in this regard will result in improvements in physical functioning while bringing them significant benefits.

Behcet’s disease (BD) is a disease which has effects on different systems. Genital ulcer, aphthous stomatitis and iritis are characterized by triple symptom complex of BD. BD is considered to be a systemic vasculitis. BD was previously accepted in spondyloarthropathy (SSpA) group, but there are many reasons for not classifying BD as one of SSpA group. Ankylosing spondylitis (AS) is a prototype of seronegative spondyloarthropathy, and mainly axial skeleton is affected. In this paper, we aimed to present a-33-year old female patient with coexistence of BD and AS. In addition, the coexistence was aimed to be discussed.

Objectives: To investigate the relationship between the proximal femoral bone mineral density and bone resorption markers, determinants of calcium metabolism and vitamin D levels in elderly stroke patients. Design: A total of 80 patients and 20 controls were enrolled in the study. Bone mineral density measurements were obtained at the proximal femur. In all subjects, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, intact parathyroid hormone, osteocalcin, deoxypyridinoline, and ionized calcium concentrations were measured. Barthel Index and Motricity Index Leg Score were recorded all patients. Results: The serum concentrations of deoxypyridinoline, intact parathyroid hormone, and the mean serum ionized calcium levels were significantly higher in patients with stroke than that of the control subjects. The mean serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations in patients were significantly lower than those of the control group (P < 0.05). The bone mineral density of proximal femurs of paretic limbs was decreased significantly compared with those of the control group (P < 0.05). There were significant correlations between the Z score of the hemiplegic side and the patients' Barthel Index, Motricity Index Leg Score, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, calcium, and deoxypyridinoline. Conclusions: This study provides clear evidence that decreased mobility, vitamin D status, and bone turnover variables in patients after stroke are important factors in the greater bone loss in the paretic leg.

The aim of the present study was to evaluate cardiac involvement in patients with active rheumatoid arthritis (RA). Forty patients with active RA participated. All were submitted to standard Doppler echocardiography and myocardial performance index (MPI) grading. There were left and right ventricular diastolic function abnormalities in RA patients. Left ventricular MPI was also significantly higher than in controls (P

Ayhan, Fikriye Figen/0000-0001-6906-991X; Duruoz, Mehmet Tuncay/0000-0003-3584-2788; Ataman, Sebnem/0000-0003-3570-3825; Sahin, Gunsah/0000-0002-4215-6957; Gur, Ali/0000-0001-9680-6268; WOS: 000338636500018 PubMed: 24252034 Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 +/- 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS. Pfizer Company The authors express their gratitude to all members of the TRASD-IP AS Study group for their cooperation and to Pfizer Company for the registry sponsorship.

Objective To determine the current prevalence of Axis I and Axis II psychiatric disorders in patients with fibromyalgia. Method The study sample includes 103 patients with fibromyalgia and 83 control subjects. Axis I and Axis II disorders were determined by structured clinical interviews. Results The rate of any Axis I psychiatric disorder (47.6% vs. 15.7%), major depression (14.6% vs. 4.8%), specific phobia (13.6% vs. 4.8%), any Axis II disorder (31.1% vs. 13.3%), obsessive–compulsive (23.3% vs. 3.6%) and avoidant (10.7% vs. 2.4%) personality disorders were significantly more common in the patient group compared to the control group. Conclusion Our results suggest that a considerable proportion of patients with fibromyalgia also present with Axis I and Axis II psychopathologies.

Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown.To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis.Randomized clinical trial.Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia.After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p0.05).Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

To evaluate sexual function in women with rheumatoid arthritis (RA) and compare them with healthy controls.Ninety-five patients with RA and 108 healthy controls were included in the study. Depression levels and sexual functions of all participants were evaluated by the Beck Depression Inventory (BDI) and Index of Female Sexual Function (IFSF), respectively. Morning stiffness in women with RA, pain (Visual Analog Scale--VAS), disability rate (Health Assessment Questionnaire--HAQ), and disease activity score (DAS-28) were defined.Total IFSF and mean of IFSF subgroup scores and significance of sexual life score were lower in patients with RA than controls, whereas mean BDI score was higher. The mean of the total IFSF scores was significantly lower in patients with RA with BDI≥17 than that of patients with BDI17. The mean of the total IFSF score decreased as disease severity increased. There was a strong negative correlation between total IFSF and DAS-28 scores, a moderate negative correlation between total IFSF score and HAQ, BDI, VAS score, age, and morning stiffness, and weak negative correlation between total IFSF and body mass index.RA is observed to have negative effects on sexual functions of women. Presence of depressive symptoms with RA and increased disease severity increase the degree of sexual dysfunction. Women patients with RA should also be asked about their sexual lives while being evaluated.

Introduction Fibromyalgia may have negative effects on sexual function in women. Aims To evaluate the sexuality of women with fibromyalgia and healthy control subjects, and to investigate the relation between sexuality and clinical parameters of fibromyalgia. Main Outcome Measures Female Sexual Function Index (FSFI), Tender Points Count (TPC), Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire (FIQ), and Visual Analog Scale (VAS). Methods Clinical evaluation and surveys were done with 126 women with fibromyalgia and 132 healthy women. Results Patients with fibromyalgia had higher BDI scores and lower frequency of sexual intercourse than control subjects. The mean FSFI scores (total and all domains) were significantly lower in patients with fibromyalgia than control subjects. Mean FSFI scores (total and most domains) were significantly lower in patients with fibromyalgia who had BDI score ≥ 17 than those who had BDI score Conclusions Fibromyalgia has negative effects on female sexual function that are aggravated by depression. Yilmaz H, Yilmaz SD, Polat HAD, Salli A, Erkin G, and Ugurlu H. The effects of fibromyalgia syndrome on female sexuality: a controlled study. J Sex Med 2012;9:779–785.

The purpose of this study was to investigate the effect of ultrasound (US) on the spasticity occurring in the ankle plantar flexor muscles after a cerebrovascular event. According to the modified Ashworth scale (MAS), the hemiplegic patients with stage 2-3 spasticity on the ankle plantar flexor muscles were enrolled in the study and divided into two groups. Passive stretching exercise was applied to both groups. Additionally, 10-minute US was applied to one of the groups, using the mode of continuous wave of 1.5w/cmformula^{2}/formulato the calf muscles before stretching. In order to monitor the efficacy of the treatment in the patients, MAS, Hmax/Mmax ratio, the ankle range of motion (ROM), Functional Independence Measure and Brunnstrom Motor Recovery Stage were evaluated. While a significant recovery was monitored in the MAS and ankle ROM measurements after treatment in both groups, no change was obtained in the other parameters. No significant difference was detected in any of the measurements between the groups. In this study, US treatment applied in combination with the ankle plantar flexor muscles passive stretching exercise was determined to have no effect on the stretching treatment in minimizing the spasticity.

Objective of this study is to asses the relationship between tender point count (TPC) and the severity of disease in patients with primary fibromyalgia (FM). One hundred and seven female patients with FM diagnosis according to ACR criteria were included to the study. Main outcome measures were fibromyalgia impact questionnaire (FIQ), Beck depression inventory (BDI), visual analog scale (VAS) and tender point assessment. Mean TPC was 14.66 ± 2.50 and mean VAS was 6.6 ± 1.2 cm. Mean total FIQ score and BDI was 62.75 ± 15.57 and 16.17 ± 7.12, respectively. TPC was correlated positively with FIQ and VAS scores. There was no correlation between TPC and age and duration of symptoms. In conclusion, TPC is a simple and noninvasive examination finding that can supply information about the disease severity and the depression in FM.

WOS: 000283674900008, Objective: In recent years, increasing attention has been given to the role of reactive oxygen metabolites in the pathogenesis of inflammatory diseases such as rheumatoid arthritis (RA). The aim of this study was to elucidate plasma and especially erythrocyte oxidant and antioxidant status in RA patients and to assess the relationship between disease activity scores (evaluated by Disease Activity Score (DAS) 28 as mild, moderate and severe) and antioxidant status Materials and Methods: Fasting blood samples were obtained from 50 RA patients and 26 control subjects. DAS28 was used to evaluate the activity. Plasma and erythrocyte levels of malondialdehyde (MDA), xanthine oxidase (XO) and superoxide dismutase (SOD) were investigated in both groups. Results: The plasma levels of MDA and XO and erythrocyte levels of MDA and SOD were significantly higher in RA patients than in control subjects Although increases in plasma MDA levels in mild and moderate and erythrocyte MDA levels in mild activity groups of RA were not significant (p>0.05), plasma MDA levels in severe (p=0.001) and erythrocyte MDA levels in moderate and severe activity groups of RA were significantly higher (p

Little is known about the long-term effects of chronic exposure to ionizing radiation. Studies have shown that spine surgeons may be exposed to significantly more radiation than that observed in surgery on the appendicular skeleton. Computer-assisted image guidance systems have been shown in preliminary studies to enable accurate instrumentation of the spine. Computer-assisted image guidance systems may have significant application to the surgical management of spinal trauma and deformity. The objective of this study was to compare C-arm fluoroscopy and computer-assisted image guidance in terms of radiation exposure to the operative surgeon when placing pedicle screw-rod constructs in cadaver specimens.Twelve single-level (2 contiguous vertebral bodies) lumbar pedicle screw-rod constructs (48 screws) in 4 fresh cadavers were placed using standard C-arm fluoroscopy and computer-assisted image guidance (Stealth Station with Iso-C(3D)). Pedicle screw-rod constructs were placed at L1-L2, L3-L4, and L5-S1 in 4 fresh cadaver specimens. Imaging was alternated between C-arm fluoroscopy and computer-assisted image guidance with StealthStation Iso-C(3D). Radiation exposure was measured using ring and badge dosimeters to monitor the thyroid, torso, and index finger. Postprocedure CT scans were obtained to judge accuracy of screw placement.Mean radiation exposure to the torso was 4.33 +/- 2.66 mRem for procedures performed with standard fluoroscopy and 0.33 +/- 0.82 mRem for procedures performed with computer-assisted image guidance. This difference was statistically significant (P= 0.012). Radiation exposure to the index finger and thyroid was negligible for all procedures. The accuracy of screw placement was similar for both techniques.Computer-assisted image guidance systems allow for the safe and accurate placement of pedicle screw-rod constructs with a significant reduction in exposure to ionizing radiation to the torso of the operating surgeon.

We report a case of reactive arthritis following tetanus vaccination. A healthy 55-year-old woman presented with pain and acute swelling of the right knee two days after receiving a tetanus vaccination. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor and human leukocyte antigen B-27 were negative. Her arthritis improved with the administration of nonsteroidal anti-inflammatory drugs. One week later the knee swelling and pain had settled. Reactive arthritis may occur after tetanus vaccination.

WOS: 000261426000008, PubMed: 19086709, Background/Objective: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects on quality of life (QoL) using the Life-Satisfaction Check List. Methods: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI (Sexual Health Inventory-Male score

The first aim is to show if there is a disorder in proprioception in cases with benign joint hypermobility syndrome (BJHS) when compared to healthy subjects. The second aim is to evaluate the effect of proprioception exercise in BJHS cases. To evaluate the proprioceptive sensibility of the knee joint with 40 BJHS and 30 healthy subjects enrolled in the study. Then, cases with BJHS were randomized into two groups; proprioceptive exercises were applied to 15 patients for 8 weeks in clinic and 25 patients were taken as controls. Outcome measures included proprioceptive sensation, AIMS2 and VAS. Proprioception is significantly impaired in cases with BJHS. In BJHS group, significant decreases in VAS levels were detected in cases who did exercise compared with cases who did not, and statistically significant improvements were detected in occupational activity. For this reason proprioception exercises cause decrease in pain and improvement of functional status in BJHS group.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 283.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ)or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) wasor =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAIor =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

Benign joint hypermobility syndrome (BJHS) is a syndrome with musculoskeletal pain originating from the increased laxity of the joints and the ligaments. The study was to compare the isokinetic strength of knee extensor/flexor muscles of BJHS patients with healthy controls. Forty patients diagnosed as having BJHS with Brighton criteria and 45 years of age, height and weight-matched healthy controls were recruited for the study. Isokinetic testing was performed with isokinetic dynamometry of Biodex System 3Pro and measurements were recorded at knee extension/flexion pattern concentrically at 60, 180, and 240 degrees/s angular velocities. The study group was also evaluated for functional impairment and pain by HAQ and VAS respectively. Knee extensor muscle strength was significantly lower in the patient group compared with the controls. It was hypothesized that the muscle weakness in the study group was related to lengthening of the quadriceps muscle and pain-related inactivity as well as joint instability and proprioception defect.

STUDY DESIGN: Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. OBJECTIVES: To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. SUMMARY OF BACKGROUND DATA: Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. METHODS: A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. RESULTS: All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05). CONCLUSIONS: Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.

WOS: 000188766800007, PubMed: 14765143, Study design: Prospective analysis. Objectives: To investigate the colonization of the distal urethra and bladder during the initial stages of rehabilitation in acute spinal-cord injury(SCI) and to examine the association between bacteriuria and colonization of the distal urethra. Setting: Selcuk University Meram Faculty of Medicine, Konya, Turkey. Methods: A total of 27 patients with SCI (13 females and 14 males) and 40 controls without evidence of disease of the urinary tract were studied. Cultures were taken from the patients who applied clean intermittent catheterization and compared with normal subjects. Results: Escherichia coli was predominantly isolated from the urine and urethral cultures of both female and male SCI patients. Colonization of other bacteria in the urine and urethral cultures was similar in both female and male patients, except for Pseudomonas, which was colonized in male patients. In all, 72% of patients who had E. coli positive urethral cultures also had E. coli colonization in their simultaneous urine cultures. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.82). When urethral cultures collected 1 week before were evaluated in patients with E. coli positive urine cultures (n=24 cultures), 15 of these urethral cultures also had E. coli colonization. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.66). Conclusions: Our study suggested that urethral. ora was a significant source for the development of urinary infection in spinal cord-injured patients.

The objective is to present the possibility of an association between spinal epidural abscess and IgG deficiency. Spinal epidural abscess is a rare but potentially devastating condition. Review of the literature showed no reported acknowledgment about the relationship between spinal epidural abscess and IgG deficiency. This report discusses the case of a 16-year-old boy who developed progressive paraplegia within 24 hours. Clinical and neuroradiologic features are reported. Serum quantitative total IgG, IgA, and IgM concentrations were measured by nephelometry. Thoracic magnetic resonance imaging showed epidural abscess between T6 and T11 compressing the cord posteriorly. IgG subclasses (IgG ) were found abnormal. The possible importance of immunologic evaluation in the patients with spinal epidural abscess when no source of infection could be find is discussed.(4) (4) (4)