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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. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to investigate the effect of grip strength on dominant and non-dominant forearm, hip and lumbar bone mineral density (BMD) measurements in postmenopausal women.Material and Methods: A total of 93 postmenopausal women (age range: 50-70 years) were included in the study. The dominant extremity was determined by querying patients regarding which hand they use while eating or performing a task. Following measurements regarding height and body weight for body mass index (BMI), grip strength was measured in all patients using the Jamar hand dynamometer device. BMD measurements were determined in the dominant and non-dominant forearm ultradistal end (UDE), 1/3 radius distal end (RDE) and forearm total, and dominant and non-dominant side femur neck, total hip, and lumbar L1-4 regions.Results: When the hand grip strengths of dominant and nondominant extremities were compared along with the forearm BMD values, only the hand grip strength of the dominant side was significantly higher than the non-dominant side. There was a significant correlation between the dominant and nondominant extremity RDE, UDE, and forearm total BMD measurements and the grip strength of the same side. The multivariate regression analyses revealed that the determining effect of grip strength on the forearm BMD measurements of the dominant and non-dominant extremities was weak. There was also a correlation between L1-4 total, dominant and non-dominant extremity femur neck and total hip BMD values and the hand grip strengths. However, the regression analyses revealed that grip strength did not have a determining effect on L1-4 total and dominant and non-dominant extremity hip BMD values. The factors affecting BMD values of these regions were detected as BMI, age and duration of menopause.Conclusion: The present study concluded that the effect of muscle strength on BMD measurements in postmenopausal sedentary women was site-specific rather than systemic. [ABSTRACT FROM AUTHOR]

Objective: Helicobacter pylori (H. Pylori) infection is related withgastroduodenal diseases, along with some autoimmune diseaseslike rheumatoid arthritis (RA). The present study investigated theaffect of H. pylori eradication treatment on disease activity inpatients with RA.Material and Methods: A total of 50 patients with RA were evaluatedby the CLO test and histological examination and divided into2 groups as H. pylori positive and negative. Eradication treatmentwas given to the H. pylori positive group for 14 days. Patients inboth groups were evaluated in terms of disease activity initiallyand at the 6th month.Results: The H. pylori positive and negative group consisted of 19and 31 patients, respectively and these groups were not statisticallysignificantly different in terms of age, disease duration, and gastrointestinalcomplaints (p>0.05). The evaluation of initial and 6thmonth clinical and laboratory parameters revealed no significantdifference between groups in terms of disease activity (p>0.05).Conclusion: The present study revealed no significant differencebetween H. pylori positive and negative patients in terms of dyspepticcomplaints and disease activity. [ABSTRACT FROM AUTHOR]

Purpose: The clinical effects of axillary nerve injury in the deltoid splitting approach are controversial. This study investigated the axillary nerve function with clinical and electrophysiologically in proximal humeral fracture patients with internal fixation using the deltoid split approach. We also aimed to investigate the effects of this damage on deltoid muscle volume and discuss the effects of volumetric changes and nerve damage on patients' clinical outcomes., Methods: study designed prospectively with 25 consecutive patients who received open reduction and internal fixation of proximal humerus fracture through a deltoid splitting approach. We performed clinical, electrophysiological, and radiological examinations during minimum follow-up time of 24 months. Electrophysiological examination comprised electromyoneurography (EMNG). Functional results followed by Constant-Murley and Disabilities of the Arm, Shoulder, and Hand scores. Deltoid volumes were evaluated with magnetic resonance imaging., Results: Twenty-five patients operated on with open reduction internal fixation were prospectively observed. In the EMNG measurements of the patients on the 45th postoperative day, partial degeneration was observed in the anterior part of the axillary nerve in all cases (100%). In the control EMNG measurements performed at the 12th month, normal values were obtained for 15 (60%) of the patients, while findings of ongoing regeneration were detected for 10 (40%) of the patients and normal values at all patients at the 24th month. The difference between abnormal and normal EMNG groups' on 12th month Constant-Murley scores was not statistically significant in any period. Only anterior muscle thickness was statistically higher in the normal patient group than with abnormal EMNG results., Conclusions: In proximal humeral fractures treated with the deltoid split approach, there may be iatrogenic damage of the anterior branch of the axillary nerve. Axillary nerve damage does not affect the patients' clinical scores in the early and mid-terms., Level of Evidence: LEVEL III., Competing Interests: None., (© 2022 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O 2 ) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m 2 . The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O 2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O 2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O 2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: This study aims to determine the frequency of kinesiophobia in rheumatoid arthritis (RA) patients and to evaluate the relation of kinesiophobia with the knee range of motion (ROM), quadriceps muscle strength, fear of falling, functional status, disease activity, depression, and quality of life., Patients and Methods: Between September 2018 and September 2019, a total of 100 RA patients (25 males, 75 females; mean age: 56.1±9.3 years; range, 32 to 69 years) and 50 healthy controls (14 males, 36 females; mean age: 54.6±9.8 years; range, 30 to 69 years) were included. Disease activity was evaluated using the Disease Activity Score 28 (DAS28), and functional status using the Health Assessment Questionnaire (HAQ). Pain severity was measured using the Visual Analog Scale (VAS). Tampa Kinesiophobia Scale (TKS) was used to evaluate kinesiophobia. Quadriceps muscle strength and knee ROM measurements of two extremities were recorded. Depression was evaluated using the Beck Depression Inventory (BDI), fear of falling by Falls Efficacy Scale (FES) and quality of life using the Short Form-36 (SF-36)., Results: The rate of kinesiophobia was 70% in RA patients and 12% in controls, indicating a higher rate in RA patients, compared to controls (odds ratio [OR] = 44.861, 95% confidence interval [CI]: 42.571-49.052; p<0.05). This rate was 76% in females and 52% in males. Regression analysis revealed that the number of swollen and tender joints, DAS28, VAS-pain, and HAQ scores were positively associated with the TKS scores (p<0.05). Quadriceps muscle strength and knee flexion were negatively associated with the TKS scores (p<0.05). The TKS was significantly correlated with FES and BDI (p<0.05). The TKS was negatively correlated with SF-36 subscales (p<0.05)., Conclusion: Kinesiophobia is common in RA patients. Our study is the first to evaluate the frequency of kinesiophobia in RA patients and to show pain level, disease activity, functional status, knee flexion ROM, and quadriceps muscle strength are effective on kinesiophobia. Kinesiophobia is also associated with fear of falling and depression, negatively affecting the quality of life in terms of physical, emotional, social and mental functions. Therefore, evaluating kinesiophobia and developing targeted treatment approaches seem to be useful in increasing the quality of life in RA., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2021, Turkish League Against Rheumatism.)

Fibromyalgia (FM) is known a common painful syndrome and its frequency is increased in inflammatory rheumatic diseases. We aimed to assess FM frequency in axial spondyloarthritis (AxSpA) patients and age- and sex-matched healthy controls with the 2011 ACR FM criteria. We evaluated the association between receiving biologic disease-modifying antirheumatoid drugs (bDMARD) and presence of FM. 127 patients with Ax-SpA and 73 age- and sex-matched controls were included. Individuals were assessed according to modified 2011 ACR diagnostic criteria for FM. The pain was evaluated by visual analog scale (VAS). Disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activation Score (ASDAS). Spinal limitation, quality of life, and functionality were assessed. Drug therapies were noted. AxSpA and control group had similar FM rates. 43 (33.9%) patients in AxSpA group and 22 (30.1%) patients in control group had FM diagnosis (p = 0.589). Age, gender, BMI, and CRP values were similar in the AxSpA patients with and without FM, while global VAS and ASDAS scores were higher in patients with FM. Biologic DMARD use was higher in the AxSpA patients with FM; however, the difference was not statistically significant. In conclusion, FM frequency does not increase in AxSpA patients as compared to healthy controls. FM awareness is one of the key points to determine the appropriate treatment due to the influence on disease activity.

Objectives: This study aims to evaluate physical activity, sleep, depression, quality of life, and musculoskeletal problems pre- and postoperatively in morbidly obese patients who underwent bariatric surgery and analyze the factors that are strongly associated with physical activity., Patients and Methods: This prospective study conducted between January 2016 and May 2017 included 27 patients (4 males, 23 females; mean age 37.1±10.4 years; range, 18 to 52 years) who underwent bariatric surgery and 20 healthy controls (3 males, 17 females; mean age 32.0±5.7 years; range, 26 to 46 years). All patients were evaluated by using the short form of International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and short form 36 (SF-36). Patients were evaluated for regional musculoskeletal pain including back, waist, hip, knee, ankle, heel, and metatarsal pain using Visual Analog Scale. Presence of pes planus was recorded. The examinations and tests performed in the preoperative period were repeated at postoperative six months and the results were compared with the control group., Results: The body mass index was 46.2±5.2 kg/m 2 preoperatively and 33.8±5.0 kg/m 2 postoperatively (p<0.001). The total IPAQ was 345.4±172.8 metabolic equivalent (MET)-min/week preoperatively and 672.8±227.8 MET-min/week postoperatively (p<0.001). Pittsburgh Sleep Quality Index was 7.6±3.0 preoperatively and 3.5±2.4 postoperatively, whereas BDI was 20.2±8.5 preoperatively and 9.9±7.4 postoperatively. The results were statistically significant (p<0.001, p<0.001, respectively). A statistically significant improvement was found in all subsections of the SF-36. Pre- and postoperative results of the 27 patients were compared with those of the control group., Conclusion: Obesity is significantly associated with joint pain, physical function impairment, depression, and sleep disorders. Significant weight loss after bariatric surgery improves functional recovery and patient's psychology in a short time., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish Society of Physical Medicine and Rehabilitation.)

Objectives: This study aims to assess early changes in physical activity and function after total hip arthroplasty (THA) using both subjective and objective methods, and to identify predictors of outcomes of THA., Patients and Methods: Between October 2014 and October 2015, a total of 50 patients (14 males, 36 females; mean age 57.1±13.0 years; range, 31 to 75 years) with end-stage primary hip osteoarthritis who were scheduled for THA and 50 age- and sex-matched controls (10 males, 40 females; mean age 52.9±9.3 years; range, 36 to 75 years) were included in the study. Pain was evaluated using the Numeric Rating Scale (NRS), physical function using the Lequesne Index, physical capacity using the Six-Minute Walking Test (6MWT), and physical activity using both International Physical Activity Impact Questionnaire Short Form (IPAQ-SF) and step count monitor. Data at baseline and six weeks and six months were recorded., Results: Pain severity was significantly lower after THA at six weeks and six months (NRS scores: 2.83 and 0.82, respectively; p<0.001), compared to baseline. Physical function, capacity, and activity significantly improved after THA at six weeks and six months with a mean Lequesne Index score of 2.62 and 1.02, respectively. The mean 6MWT distance was 272.62 at six weeks and 326.16 at six months. The mean IPAQ and 6MWT results were similar between the patient and control groups at six weeks and six months. Age, presence of comorbidities, and baseline Lequesne Index score were found to be effective on functional outcomes of THA. Age and baseline 6MWT scores were correlated with physical capacity after THA., Conclusion: Our study showed a significant early improvement in pain severity and physical activity and function at six weeks and six months after THA, compared to baseline values. Baseline values and age were the positive predictors of improved postoperative function and physical capacity., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2019, Turkish Society of Physical Medicine and Rehabilitation.)

Background: Vacuum-assisted suspension systems provide better suspension than non-vacuum systems, but data are limited on whether they improve physical activity levels and quality of life for people with amputation., Objectives: To compare the physical activity and quality of life levels of people with transtibial amputation using PIN/LOCK suspension system or vacuum-assisted suspension systems with those of able-bodied controls and to investigate parameters associated with physical activity levels., Study Design: A cross-sectional observational study., Methods: Fifty-one people with amputation and 51 controls participated. The International Physical Activity Questionnaire Short Form and Short Form 36 were used to measure the physical activity and quality of life, respectively., Results: The total physical activity and Short Form 36 scores were significantly lower in the participants with amputation than the controls. There were no significant differences between the two types of suspension systems in terms of physical activity levels and quality of life. The vacuum-assisted suspension system users reported significantly more bodily pain on the Short Form 36 questionnaire than the controls ( p  = 0.003). The only parameter that correlated significantly with the total physical activity was the Short Form 36 physical functioning subscale ( r  = 0.302, p  = 0.031)., Conclusion: Contrary to our expectations, vacuum-assisted suspension system users compared to PIN/LOCK users did not report greater levels of physical activity or improved quality of life or levels closer to comparable controls., Clinical Relevance: A better understanding of the effects of different prosthetic suspension systems on physical activity and quality of life may help clinicians when prescribing prostheses, as well as setting appropriate prosthetic expectations. This study suggests that vacuum-assisted suspension systems and PIN/LOCK suspension systems provide equal benefit to users with regards to physical activity and quality of life.

Objectives: Determining neuropathic pain component (NPC) among patients with chronic low back pain-radicular pain (CLBP-RP) and the adjustment between scales of neuropathic pain., Material-Methods: One hundred and one patients with CLBP-RP were included in the study. The severity of CLBP-RP was evaluated by visual analogue scale (VAS). The Douleur Neuropathique 4 Questions (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs Scales (LANSS) were used to evaluate the NPC., Results: The mean score of CLBP-RP assessed by VAS was 80 mm. NPC was detected a rate of 65.3% by DN4 and 40.6% by LANSS. NPC was 75.4% in females and 47.2% in males according to DN4, and 52.3% in females and 19.4% in males according to LANSS. The female gender, occupation, and VAS scores were determined to be significant factors contributing to presence of NPC according to logistic regression analyses (p< 0.01, p< 0.05, p< 0.05). A medium degree accordance was established between DN4 and LANSS scales according to kappa coefficient (Kappa = 0.532, p< 0.05)., Conclusion: CLBP is among the diseases causing mixed type pain accompanied by nociceptive and neuropathic pain. NPC was detected in a considerable part of patients with radicular pain. Identifying the character of radicular pain is significant to develop proper management strategies.

Objectives: This study aims to investigate the relationship between smoking and structural damage, autoimmune antibodies, and disability in rheumatoid arthritis (RA) patients., Patients and Methods: This cross-sectional study included 165 RA patients (36 males, 129 females; mean age 52.4±12.8 years; range 21 to 82 years). Disease duration, age at disease onset, smoking habits, rheumatoid factor (RF), and anti-cyclic citrullinated peptide levels were recorded. Morning stiffness, pain with visual analog scale, Health Assessment Questionnaire Scores And Disease Activity Score 28 were calculated. Patients' standard hand radiographs were evaluated., Results: Patients were divided into three groups according to their smoking habits. Ninety-nine patients (60%) were never smokers, 45 patients (27.3%) were long-term smokers and 21 patients (12.7%) were new smokers. Three groups were compared for disease activity. Disease activity score 28 scores were 3.2±1.2, 3.2±1.3, and 3.2±1.4, respectively (p>0.05). The erosion score (2.6±5.8, 7.1±10.9, and 11.1±19.2, respectively) and joint space narrowing score (9.9±7.3, 18.6±14.9, and 17.3±12.3, respectively) according to modified Sharp method were significantly lower in never smokers group than other groups (p<0.05). RF titrations were 55.2±58.9, 60.5±63.1, and 84.9±71.5, respectively, and levels of long-term smokers group were significantly higher than the other groups (p<0.05). Joint space narrowing score was 16.2±11.9 and 6.4±10.4 in RF (+) and RF (-) patients, respectively (p<0.05). There was no significant relationship between anti-cyclic citrullinated peptide levels and others parameters., Conclusion: Although smoking is known as a poor prognostic factor in RA, there was no correlation between disease activity and smoking in our study. However, less radiographic damage was found in never smokers. Smoking does not appear to correlate with RA disease activity but it may be effective in the long-term joint damage., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objectives: This study aims to investigate the effect of serum levels of 25 hydroxyvitamin D (25(OH)D) in patients with primary knee osteoarthritis (OA) and to assess its relationship with the radiographic grading and functional status., Patients and Methods: Serum 25(OH)D levels were measured in 107 patients (90 females, 17 males; mean age 63.0±9.6 years; range, 40 to 86 years) with primary knee OA. Radiographic grading was based on the Kellgren-Lawrence Grading Scale and the Osteoarthritis Research Society International (OARSI) Atlas Grading Scale, while the functional status was assessed using the Lequesne indices and Turkish version of the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-Form (KOOS-PS). Pain was evaluated using the Visual Analog Scale for Pain (VAS-Pain). Data including age, sex, disease duration, body mass index (BMI), and pain severity were recorded., Results: The mean 25(OH)D level was 13.4±10.6 ng/mL, and 90 patients (84.1%) had vitamin D deficiency. The presence of severe osteophytes was observed in 67 patients (62.6%) and 85 patients (79.4%) had Grade 2-3 joint space narrowing (JSN). The mean KOOS-PS and Lequesne scores were 40.1±12.3 and 12.9±3.6, respectively. There was no correlation between serum 25(OH)D levels and functional status., Conclusion: Our study results show that serum 25(OH)D level is not related to the severity of the radiographic knee OA grading or to the functional assessment. Age and BMI are the factors affecting the radiological knee OA severity, while age, sex, BMI, and pain severity are the main determinants of the functional status., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors., Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing., Results: Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups., Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life., (Copyright © 2015 Elsevier Editora Ltda. All rights reserved.)

Objective: The aim of this study is to investigate the relation between vitamin D levels, vertebral deformities, functional status, quality of life, acute phase reactants and enthesopathy in patients with psoriatic arthritis (PsA)., Patients and Methods: Fifty-two patients with PsA and 52 controls were enrolled to the study. Routine blood tests and serums 25-(OH)D3 were measured. The thoracic and lumbar vertebrae deformities identified in the radiographies were evaluated by a radiologist. Psoriatic Arthritis Quality of Life (PSAQoL) was used for evaluating quality of life and disease activity parameters for PsA were assessed. In PsA patients, correlations was performed between the 25(OH)-D3 levels and PGE (patient global assessment), PHGE (Physician global assessment), tender JC (joint count), HAQ-S (Health Assessment Questionnaire for the Spondyloarthropathies), PSAQoL, MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and BASDAI(Bath Ankylosing Spondylitis Disease Activity Index) values., Results: The results showed that 25(OH)-D3 levels was not correlated with these values. (p>0.05 for r = -0.171, r = -0.167, r=-0.069, r=-0.236, r=-0.062, r= -0.058 and r = -0.106 respectively). It was determined that the PSAQoL score had a positive and statistically significant correlation with the DGD, swollen JC, CRP, HGD, tender JC, VAS-pain, HAQ-S, MASES and BASDAI values in PsA patients. (p>0.05 for r=0.291, r=0.324, r=0.346, r=0.312; and p=0.001 for r=0.472, r=0.380, r=0.565, r=0.696, r=0.359, r=0.633, respectively) Statistical analyses demonstrated that PsA patients with vertebral deformities had higher numbers of tender joints, more prolonged periods of morning stiffness, higher DAS28-ESR (Disease Activity Score) scores, and higher levels of vitamin D (p<0.05, p<0.05, p=0.05 and p<0.05, respectively). The multiple logistic regression analysis indicated that the only factor which had an effect on the development of vertebral deformities was the use of steroids., Conclusions: This result has demonstrated that psoriatic arthritis has a considerable effect on patient quality of life. Most significant factors that affecting quality of life were physical pain and disability while vertebral deformities and 25-(OH)D3 had no significant effect.

Background and Purpose: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Although its etiology is unknown, certain conditions are commonly associated with CTS, such as obesity, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, and sarcoidosis. We aimed to determine the association between metabolic syndrome and CTS, and we compared the severity of CTS between patients with diabetes (and no concomitant metabolic syndrome) and patients with metabolic syndrome., Methods: Two hundred patients with a clinically and electrophysiological confirmed diagnosis of CTS were included in the study. Their demographic characteristics and severity of CTS were analyzed according to the presence or the absence of metabolic syndrome. Differences in the electrophysiological findings were evaluated between the following four groups: 1) metabolic syndrome alone (n=52), 2) diabetes alone (n=20), 3) combined metabolic syndrome and diabetes (n=44), and 4) no metabolic syndrome or diabetes (n=84)., Results: CTS was more severe in the patients with metabolic syndrome than those without this syndrome. The electrophysiological findings were worse in patients with metabolic syndrome alone than in those with diabetes alone and those without diabetes and metabolic syndrome., Conclusions: CTS appears to be more severe in patients with metabolic syndrome than patients with diabetes. Diabetes is one of the well-known risk factors for CTS, but other components of metabolic syndrome may have a greater effect on the severity of CTS.

Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors., Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing., Results: Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups., Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life., (Copyright © 2015 Elsevier Editora Ltda. All rights reserved.)

Objective: To determine predictors of falls in stroke patients in the first 6 months after a baseline evaluation before their discharge from inpatient rehabilitation., Design: Prospective cohort study., Setting: Rehabilitation hospital, then home., Participants: Consecutive stroke patients (N=66) were followed at home after discharge from the rehabilitation hospital., Interventions: Not applicable., Main Outcome Measures: Fall occurrence within 6 months after a baseline evaluation. All patients were assessed for baseline data during their inpatient rehabilitation (1.5±1.2 wk before discharge). Data regarding cerebrovascular accident (CVA) date, number of attacks, and brain imaging results were obtained; motor function and balance impairment were examined by the Fugl-Meyer Assessment Scale. The FIM and Functional Ambulation Category were also used. Presence of urinary incontinence, drug use, fall history, postural hypotension, neglect, cognitive status, poor vision, and hearing were evaluated. Six months after the baseline evaluation, any fall occurrence was ascertained via telephone calls to the caregivers of each patient. Multivariate logistic regression analysis was used to identify risk factors., Results: The mean age ± SD was 64±10 years. The median time elapsed since CVA at the time of admission was 4 months. Twenty-four (36%) patients fell within the 6-month period. The fall rate was significantly higher in patients with left (47%) versus right (21%) hemispheric stroke. Left hemispheric lesion (vs right) showed a 4 times greater risk of fall within 6 months (odds ratio=4.093; 95% confidence interval, 1.082-15.482). There were no other significant differences between fallers and nonfallers with respect to the other evaluated factors., Conclusions: Our results suggest that the fall risk within 6 months after a baseline evaluation is greater in patients with left hemispheric lesions versus those with right hemispheric lesions., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Rheumatoid arthritis (RA) is a systemic disease that causes disability. Disability and quality of life indexes are used in the assessment and treatment of patients with RA. Disability of Arm, Shoulder and Hand Questionnaire (DASH) is a patient-based outcome measurement developed to evaluate the upper extremities. The aim of this study was to investigate the clinical relevance of DASH in RA patients and the relationship between disease activity and health-related quality of life measurements. One hundred and sixty-six RA patients were included in the study. Disease activity was measured with Disease Activity Score 28 (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI). The DASH questionnaire, Short-Form 36 (SF-36), and Health Assessment Questionnaire (HAQ) were completed by all patients. The DASH score moderately correlated with DAS28 (r=0.672), SDAI (r=0.586) and CDAI (r=0.565). When the patients were grouped according to the activity obtained using the three disease activity measurements, DASH score was statistically significantly higher with higher disease activity (P<0.001). A high correlation (r=0.883) was found between DASH and HAQ (r=0.883). The SF-36 scores were correlated with DASH (r=-0.785 with physical component, r=-0.619 with mental component). DASH scores correlate with disease activity indices, functional disability and QoL and can be used in the assessment of upper extremities in patients with RA.

The objective of the present study was to compare two radiographic scoring methods (the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-spine)) in terms of reliability, construct validity, and feasibility in Turkish ankylosing spondylitis (AS) patients. The study involved seventy-four patients. The patients were evaluated with 100-mm visual analog scale (VAS) for pain, global assessment of patient, and global assessment of doctor. The laboratory evaluations of patients comprised erythrocyte sedimentation rate and serum C-reactive protein. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and Bath AS Radiology Index (BASRI) were calculated. Bilateral cervical, lumbar spine, and anteroposterior pelvis radiographs of all patients were obtained and evaluated by two radiologists. Each radiograph was scored by two scoring methods, mSASSS and BASRI-spine, and these methods were tested according to the aspects of the Outcome Measures in Rheumatology Clinical Trials filter: reliability, construct validity, and feasibility. The BASRI-spine reached intra- and interobserver intraclass correlation coefficient (ICC) of 0.726 and 0.689, respectively. The mSASSS scores more reliable, with ICC of 0.831 and 0.840, respectively. The BASMI and BASFI correlated significantly with the two scoring systems, respectively (mSASSS r: 0.557, r: 0.319; BASRI-spine r: 0.605, r: 0.285). For the two methods, the magnitude of the correlation with disease duration was similar (mSASSS p < 0.01 and BASRI p < 0.01), but no significant correlation was observed when compared to the BASDAI. It is known that the BASRI-spine is a feasible method that reliably detects damage in patients with AS. However, the present authors believe that, in AS patients, mSASSS should be the radiological scoring method to choose because of less radiation exposure, along with excellent intra- and interobserver reliability.

In this study, the relation between osteoporosis and vitamin D and the disease activity in patients with ankylosing spondylitis (AS) was investigated. A hundred patients with AS and 58 healthy individuals were included in the study. In addition to the routine blood and urine tests, serum 25-(OH)D3, parathormone (PTH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total calcium, ionized calcium, and phosphorous levels of all participants were also measured. Bone mineral density (BMD) measurements were performed at the anterior-posterior and lateral lumbar and femur regions. Anterior-posterior and lateral thoracic and lumbosacral radiography was performed on all participants. The disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status by Bath Ankylosing Spondylitis Functional Index (BASFI), and mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI). In the patient group, BMD values obtained from the lateral lumbar and femur regions and serum vitamin D levels were lower than the control group. A negative relation was determined between the lateral lumbar BMD values and ESR, CRP, and BASDAI scores of patients with AS. The ESR, CRP levels, and BASMI scores of the AS patients with osteoporosis were significantly higher, when compared to patients without osteoporosis. The negative correlation between serum 25-(OH)D3 level and ESR, CRP levels did not reach a statistically significant level in patients with AS; the positive correlation between PTH levels and ESR, and the negative correlation between CRP and BASDAI also did not reach a statistically significant level. Vitamin D deficiency in AS may indirectly lead to osteoporosis by causing an increase in the inflammatory activity. The present authors believe that it would be beneficial to monitorize vitamin D levels together with BMD measurements in order to determine the patients under osteoporosis risk.

In this study serum homocystein (Hcy) level was measured and its relationship with disease activity criteria and treatment protocols was investigated in ankylosing spondylitis (AS) patients. Ninety-two AS patients and 58 healthy individuals were recruited. Erythrocyte sedimentation rate and serum C-reactive protein were determined. Bath AS disease activity index and Bath AS functional index were calculated. Serum Hcy levels >15 micromol/l were considered as hyperhomocysteinemia. The mean serum homocysteine levels were 14.40 and 12.60 micromol/l in patients with AS and the control group, respectively, and the difference between two groups was significant. While there was no significant difference between the sulfasalazine (SSZ) group with 14.25 micromol/l mean Hcy level and the methotrexate (MTX)/SSZ group with 16.05 micromol/l, there was a statistically significant difference between the Hcy levels of these two groups and Hcy level of 12.15 micromol/l of the non-steroidal anti-inflammatory drugs group, and 12.60 micromol/l Hcy level of the control group. Mean serum Hcy level was 13.65 micromol/l in patients with active AS and 14.60 micromol/l in patients with inactive AS, and there was no significant difference between the groups. In our study serum Hcy level was found to be significantly higher in patients with AS than in healthy control subjects. Especially for the AS patients receiving MTX and SSZ treatment without folic acid supplementation, addition of folic acid to their therapy may decrease the risk of cardiovascular disease which in turn decreases the mortality in these patients, but further prospective studies are needed for supporting these results.

The effect of the serum lipid levels on vertebral fractures and bone mineral density is not clear. A total of 107 postmenopausal women aged 45-79 examined by lumbar spine, hip and radius bone mineral density (BMD) measurements, lateral dorsal and lumbar spine radiographies, routine blood tests and serum lipids [total cholesterol (TC), triglyceride (TG), HDL-C, LDL-C, VLDL-C]. Demographic and lifestyle characteristics were collected. Eighty-nine radiographies with good technical properties were scored by the Kleerekoper method. Patients with vertebrae fractures had lower levels of TC, TG, LDL-C than the patients without vertebrae fractures. Total cholesterol level was the most prominent factor affecting the vertebral fracture existence. An increase of 1 mg/dl total cholesterol decreases the risk of vertebrae fracture by 2.2%. The existence of osteoporosis due to T score was not influencing the lipid values. TC and LDL-C were weakly associated with BMD at the forearm UD region after the adjustment for the possible confounders. This study shows that the serum lipids have impact on vertebrae fracture existence rather than BMD alterations.

In this study, patients with ankylosing spondylitis (AS) were assessed both by patient and physician using two enthesitis indices and the relationship between these indices and disease activity parameters was investigated. The study involved 100 AS patients. The patients were evaluated with 10-cm visual analog scale (VAS) for spinal pain (VAS-S), peripheral joint pain (VAS-P), global assessment of patient, and global assessment of doctor. In the laboratory evaluations, the erythrocyte sedimentation rates (ESR) and serum C-reactive protein levels of the patients were determined. Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index, and Bath AS radiology index were calculated. The severity of enthesitis was evaluated according to Mander enthesitis index (MEI) and Maastricht ankylosing spondylitis enthesitis score applied by both the patient (MASES-P) him/herself and the physician (MASES-D). There was a correlation between BASDAI and BASFI as well as MEI, MASES-D, and MASES-P indices (r = 0.447, r = 0.342, r = 0.663, r = 0.530, r = 0.464, and r = 0.435, respectively). No correlation between the laboratory parameters and enthesitis indices were detected. In multiple linear regression analysis, BASFI, VAS-S, and female gender (41.3%) were the best predictors of MEI-D, whereas BASFI, VAS-S, female gender, and ESR (32.5%) were the best predictors for MASES-D and BASFI (18.9%) was the best predictor of MASES-P. The assessment of simple and easily applicable MASES score by a patient may be expected to help the physician in clinical practice. When the disease activity of the patients with AS are evaluated, both BASDAI, the clinical importance of which has been confirmed in numerous studies and which is recommended by ASAS, and BASFI, which is valued by patients, should be considered.

Aim: Vitamin D deficiency is one of the most important risk factors in the development of osteoporosis. Recently, vitamin D deficiency is more frequently encountered than expected in Mediterranean countries, which are sunny most of the time. Our country is one of these sunny countries and here, we investigated the effect of outfitting style on bone mineral density (BMD) and plasma vitamin D levels in women aged between 30-40 years., Method: Eighty women, aged between 30 and 40 years, were included in the study. They were divided into two groups, depending on their dress selection. Group-1 consisted of 40 cases with an open clothing style, while the 40 women in group-2, preferred the covered clothing style. Women were questioned in terms of the risk factors for osteoporosis. Levels of plasma 25(OH)2 vitamin D3 and parathormone (PTH) were tested along with routine blood analyses. BMD of Lumbar 1-4, femur neck, trochanter, and Ward's triangle were measured., Results: In group-2, number of pregnancies and body mass index (BMI) was statistically significantly higher (p < 0.05). When the laboratory parameters were compared, in group-2, only levels of plasma 25 (OH)2 vitamin D3 was significantly lower than group-1 (p < 0.05). There was no significant difference among groups in terms of BMD. In group-2, there was a positive correlation between BMI and BMD at L1-4, hip, femur neck, and trochanter regions (p < 0.01, 0.01, 0.05, and 0.05, respectively)., Conclusion: Traditional clothing style leads to vitamin D deficiency in women. In order to meet vitamin D need, the face, arm and leg regions of the body should be exposed to one minimal erythemal dose (MED; i.e., slight redness of the skin) of sunlight, at least two or three times a week. We believe that these cases should be more closely monitored for bone loss, especially during postmenopausal period, which is considered as a risky term in terms of osteoporosis development.

Non-prescribed antacid drugs that contain magnesium and aluminum are widely used in the treatment of gastritis and peptic ulcer. One of the side effects of these antacid drugs is that they bind phosphate in the gut and result in its malabsorption. In this paper, a 42-year-old female patient who used magnesium hydroxide (Magnesie calcinee powder 100 g) to benefit from its laxative feature, and developed osteomalacia after losing 90 kg in 2 years will be presented by going through the related literature. She had widespread joint pain and could hardly walk without the help. Ca, P and vitamin D were at lower limit of normal, ALP, Mg and PTH were increased in her laboratory tests. There were stress fractures at the femur neck and at the upper part of the tibia in plane radiographies. The patient was hospitalized with the diagnosis of osteomalacia and she was treated successfully.

The aim of this study was to investigate the association of vertebral deformities developed as a result of osteoporosis in female patients with rheumatoid arthritis (RA) with bone mineral density (BMD) and disease activity parameters. In the study, 100 female patients with the diagnosis of RA and 56 healthy subjects were recruited. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF) tests were performed and the number of swollen and tender joints, level of pain and health assessment questionnaire (HAQ) were recorded in order to evaluate disease activity. Anteroposterior and lateral thoracic and lumbosacral roentgenograms of all patients were taken for radiological examination and deformities of vertebrae were assessed. BMD measurements of patients were performed on vertebrae L1-4 of lumbar region and on total hip, femur neck, trochanter and Ward's triangle of the right side. Vertebral deformity was established in 30% of RA patient group and 7.1% of control group and this was statistically significant. In the statistical analysis, no statistically significant difference was found between BMD measurements of RA and control groups. Patients with RA were divided into two subgroups with regard to using corticosteroids (CS) or not. Vertebral deformity was 32.4% in the subgroup using CS and 24.1% in the subgroup not using CS, and the difference was not statistically significant. There was a correlation between number of deformed joint and age and vertebral deformity incidence. RA is a risk factor on its own for the development of osteoporosis and vertebral deformity and this risk increases by age, excess number of deformed joints and severe course of disease. We think that precautions should be taken immediately to suppress the disease activity as well as to protect the quality and density of bone and to prevent the development of vertebral deformity and fracture while planning the treatment of patients with RA.

The aim of this study is to investigate the correlation between joint erosion and osteoporosis in patients with rheumatoid arthritis (RA). Fifty-one patients with RA were included for the study. Hand radiograms of all patients were evaluated by the Larsen modified Sharp and carpometacarpal ratio methods. Bone mineral density (BMD) measurements were performed at the femur, lumbar, and forearm regions. Disease activity was assessed clinically by the health assessment questionnaire (HAQ), visual analog scale, erythrocyte sedimentation rate, C-reactive protein (CRP), and the rheumatoid factor (RF). There was no statistically significant difference in terms of the BMD values at L1-4 between the patients with RA and the control group. The BMD measurements at the right forearm and the right hip were statistically significantly lower in the patient group. For radiological scoring, hand radiograms were evaluated by three different methods. There was a significant correlation between the duration of disease and the radiological evaluation methods. HAQ scores, Larsen and Sharp methods 1/3 distal and mid-distal (MID), and BMD measurements of the forearm were correlated. Moreover, 1/3 distal, MID, and ultra-distal BMD showed significant correlations with CRP levels. Radiogram continues to have an important role in determining and following-up the joint erosion seen in patients with RA. However, we believe that as establishing periarticular osteoporosis in the early term by performing BMD measurements on the forearm is correlated with disease activity, it may be useful in the early diagnosis of RA and its objective results will be efficient in predicting the progression of disease.