Investigation of asymptomatic intestinal inflammation in ankylosing spondylitis by fecal calprotectin.

BACKGROUND AND STUDY AIMS: This study aimed to investigate the prevalence of intestinal inflammation in patients with ankylosing spondylitis (AS) by assessing fecal calprotectin (FC) levels and comparing them with those in patients with rheumatoid arthritis (RA) and non-inflammatory rheumatic diseases. Our secondary aim was to correlate FC levels with antirheumatic treatment, nonsteroidal anti-inflammatory drug (NSAID) usage, and disease activity measures. PATIENTS AND METHODS: This cross-sectional study included 97 patients with AS fulfilling the modified New York criteria, 48 patients with RA fulfilling the American College of Rheumatology criteria, and 49 patients with non-inflammatory rheumatic diseases. All patients were questioned about intestinal complaints, and symptomatic patients were excluded. Disease activity was measured in the AS and RA patient groups. RESULTS: The AS group had a significantly higher FC test positivity rate than the RA group (p = 0.016). Furthermore, the AS group had FC levels that were negatively correlated with disease duration (p = 0.04). FC levels were not correlated with any disease activity index, erythrocyte sedimentation rate, C-reactive protein, uveitis, or peripheral arthritis. Patients with AS who used NSAIDs had significantly higher FC levels than nonusers (p = 0.001). CONCLUSIONS: This study revealed that 11% of patients with AS without intestinal complaints had elevated FC levels. FC levels were not correlated with disease activity in AS. Subclinical intestinal inflammation was higher in the early stages of AS. The AS group had a significantly higher FC test positivity than the RA group. In the AS group, NSAID users had significantly higher FC levels than nonusers; thus, no statistically significant difference was observed between biological agent users and nonusers.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study.

OBJECTIVES: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. MATERIAL AND METHODS: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. RESULTS: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). CONCLUSION: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

Chest Expansion and Modified Schober Measurement Values in a Healthy, Adult Population.

OBJECTIVES: This study aims to demonstrate chest expansion and lumbar mobility using modified Schober measurement values in healthy male and female populations aged 15 and over, and to identify factors affecting these measurements. PATIENTS AND METHODS: The prospective study included 444 volunteers (195 males, 249 females; mean age 47.13 years; range 15 to 88 years) from among patients presenting to the Akdeniz University Faculty of Medicine Hospital Physical Medicine and Rehabilitation Clinic. Participants were divided into seven 10-year age groups: group 1: 15-24 years, group 2: 25-34, group 3: 35-44, group 4: 45-54, group 5: 55-64, group 6: 65-74, and group 7: over 75. Exclusion criteria comprised factors potentially influencing spinal mobility and chest expansion. All volunteers' chest measurements were performed in three planes (circumferential with a tape measure, and anteroposteriorly and transversely with calipers) and lumbar mobility was measured using the modified Schober method. The same physician performed the measurements. RESULTS: Chest expansion measurements using tape and calipers varied considerably in all age groups and in both sexes. While there was no difference between males and females in circumferential chest expansion measurement, there was a significant difference decrease in both sexes from group 3 and onward. The only difference between the sexes in terms of modified Schober measurement was in group 4, in favor of male sex. Age-related change in both sexes was higher at age 55 and above compared to the young age groups. CONCLUSION: We may conclude that chest expansion measurement in the circumferential plane is sufficient when appropriate conditions are established and provides the most accurate result by permitting measurement in all planes.

The serum levels of resistin in ankylosing spondylitis patients: a pilot study.

Resistin is a recently described adipokine which is a member of cysteine-rich secretory protein family. Although it has been primarily defined in human adipocytes, it has been identified that its level was higher in mononuclear leukocytes, macrophages, spleen, and bone marrow cells. Because ankylosing spondylitis is an inflammatory disease, it is suspected that upregulation of proinflammatory cytokines is effective in its immunopathogenesis. The aim of our study is to determine the serum resistin levels in patients with AS and to research the relationship with disease activity markers. A total of 30 patients with AS and 30 healthy controls were included in this study. Serum resistin concentrations, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath AS Disease Activity Index (BASDAI) were evaluated. In results resistin levels in ankylosing spondylitis group were significantly higher than in control group. But, there was no correlation between resistin and ESR, CRP, BASDAI. In conclusion, higher serum resistin levels in patients with AS compared to healthy subjects give clues that resistin could have a role in the pathogenesis of AS.

Comparison of radiological indices (SASSS, M-SASSS, BASRI-s, BASRI-t) in patients with ankylosing spondylitis.

This study was performed to compare radiologic methods of Bath Ankylosing Spondilitis Radiology Index-spine (BASRI-s), Bath Ankylosing Spondilitis Radiology Index-total (BASRI-t), Stoke Ankylosing Spondilitis Spine Score (SASSS) and Modified Stoke Ankylosing Spondilitis Spine Score (M-SASSS) and to test their superiority over each other. Eighty-one patients (60 males, 21 females) with ankylosing spondylitis (AS) were included in the study. Patients were evaluated for their functional status, disease activity, quality of life, and spinal mobility using Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), AS Quality of Life Index (ASQoL) scale, and Bath AS Metrology Index (BASMI), respectively. Radiographs of the patients were evaluated using BASRI-s, BASRI-t, SASSS, and M-SASSS methods. Spearman's correlation test was used for the correlation analysis. Significant correlations were found between the duration of disease with radiological indices (P < 0.05), BASMI with SASSS (P < 0.01), M-SASSS (P < 0.01), BASRI-s (P < 0.01), and BASRI-t (P < 0.01). Furthermore, there were correlations between BASFI with SASSS (P < 0.05), M-SASSS (P < 0.05), BASRI-s (P < 0.05). and BASRI-t (P < 0.05). According to the results of our study, among these four radiological measuring methods, SASSS appears to be the one that is the least reflective of patient status. The reason to that is the fact that while in SASSS method only lumbosacral radiography is evaluated, in other methods one more area is evaluated. However, the disadvantages of BASRI methods relative to others, in BASRI methods, patients are exposed to more radiation.

Internal iliac artery pseudoaneurysm: an unusual cause of sciatica and lumbosacral plexopathy.

This report describes an unusual case of lumbosacral plexopathy resulting from internal iliac artery pseudoaneurysm. A 50-yr-old woman presented with multiple penetrating trauma to the thorax, abdomen, and left buttock. Several weeks after the injury, severe sciatica and motor dysfunction developed in her left leg. Progressively worsening pain was followed by left foot drop. An electrodiagnostic evaluation suggested a lower lumbosacral plexopathy. Magnetic resonance imaging showed a hematoma extending adjacent to the left lumbosacral plexus. Computerized tomographic angiography revealed a left internal iliac artery pseudoaneurysm. The pseudoaneurysm was excised surgically. In the early postoperative period, the patient reported total relief of pain. Her motor function recovered gradually over several weeks; however, some residual weakness of foot dorsiflexion persisted. With this case presentation, we underscore that an arterial pseudoaneurysm should be remembered as an etiologic possibility of lumbosacral plexopathy and sciatica, especially in patients with history of iatrogenic or accidental trauma. An increased awareness of this rare cause of sciatica and lumbosacral plexopathy may enable early intervention alternatives.

Hyperostosis frontalis interna in a patient with giant cell arteritis.

Hyperostosis frontalis interna (HFI) is a disorder characterized by progressive symmetric thickening of the inner table of the frontal bone of the human skull. HFI may be accompanied by headache and some neuropsychiatric diseases such as epilepsy and dementia. Giant cell arteritis (GCA), also called temporal arteritis, is a systemic inflammatory vasculitis of unknown etiology that affects medium- and large-sized arteries. It affects elderly people and may result in a wide variety of systemic, neurologic and ophthalmologic complications. As no association of HFI and GCA was encountered in the literature, we found it interesting to report a case with both of these clinical entities.

Superior vena cava syndrome associated with Behcet's disease and 18 months' follow up: a case report.

Behcet's disease is a multisystemic disorder that the main pathological defect is vasculitis and superior vena cava syndrome (SVCS) caused by vasculopathy is a rare manifestation of the disease. Although successful results of endovascular surgery were observed in some cases, medical therapy may have priority among the treatment alternatives because of the high risk of surgery due to the lesional localization of the vessel. In this report, a Behcet's disease case with SVCS and 18 months' follow-up data with medical therapy is presented.

Spontaneous pneumothorax in Wegener's granulomatosis: a case report.

Wegener's granulomatosis (WG) is a multiorgan system disease of unknown etiology characterized by granulomatous inflammation, tissue necrosis, and variable degrees of vasculitis in small- and medium-sized blood vessels. In patients with WG, the musculoskeletal system can be involved before other typical symptoms of the disease. Also in WG, pneumothorax can develop as a rare complication. In this paper, we report a case with WG who had early articular involvement in the absence of classic features of illness and had pneumothorax which resulted from the rupture of the sub-pleural nodule. The aim of this work is to increase the awareness of early articular involvement in WG and the pneumothorax possibility especially in cases with cavitated nodules closure to pleura. This case emphasizes that early diagnosis and treatment is very important in avoiding further complications.

Musculoskeletal sarcoidosis with a dermatologic clue for diagnosis: a case report.

Sarcoidosis is a multisystem, inflammatory disorder characterized by infiltration of any organ with non-caseating granuloma. Clinical picture depends on which system(s) involved. Pulmonary, lymphatic and musculoskeletal systems are the most commonly affected systems. Skin is one of the frequently involved organs. Its involvement may provide a direct diagnostic clue. Here we have presented a young man with systemic sarcoidosis. The major complaint from him was the musculoskeletal pain. But the route to diagnosis starts from a lesion over the scalp.

Prevalence of low back pain in a developing urban setting.

STUDY DESIGN: A cross-sectional survey was conducted using face-to-face interviews. OBJECTIVES: To estimate the prevalence of low back pain (LBP) in an urban population of Turkey and to determine the factors associated with occurrence of LBP. SUMMARY OF BACKGROUND DATA: Little information exists in the literature regarding the epidemiology of LBP in developing countries. A few data from previous studies suggest that the prevalence of LBP is rather lower in developing countries compared with developed countries. METHODS: A total of 100 clusters of households (3,215 residents aged 16 years or older) in municipality area of Antalya was selected by systematic sampling. Of these, 3,173 study participants agreed to interview. The response rate was 98.7%. RESULTS: The crude lifetime, 12-month, and point prevalences of LBP were 46.6% (95% confidence interval [CI], 44.9-48.3), 35.9% (95% CI, 34.2-37.6), and 20.1% (95% CI, 18.7-21.5), respectively. In logistic regression analysis, age of 36 years or older, female sex, multiparity, being a housewife, being from East Turkey, and smoking showed independent associations with having current LBP. Being religious, heavy smoking, and age 26 to 45 years were associated with having restricted activity related to LBP. CONCLUSIONS: In comparison with other developing countries, point prevalence of LBP is higher in Turkey and approximates to prevalence estimates of LBP in developed countries. Smoking may be associated with both occurrence and severity of LBP. Although piety is not associated with having LBP, religious people are more likely to have restricted activity related to LBP.

The association of syndesmophytes with vertebral bone mineral density in patients with ankylosing spondylitis.

OBJECTIVE: To determine bone mineral density (BMD) using the posteroanterior L2-L4 (PA) and lateral L3 (LAT-L3) projections of dual energy x-ray absorptiometry (DEXA) in patients with ankylosing spondylitis (AS), and to evaluate the relationship between BMD and the presence of syndesmophytes. METHODS: Twenty men with AS were studied. BMD was measured by femoral neck DEXA, PA DEXA, and LAT-L3 DEXA scans. Radiographs of lumbar spine were evaluated to obtain a lumbar spine score (LSS) for the presence of syndesmophytes. Twenty-three age matched healthy men served as controls. RESULTS: While there was no significant difference in BMD from PA DEXA results between AS patients and controls, BMD from the LAT-L3 DEXA was significantly reduced in AS patients (p = 0.009). LSS correlated significantly with BMD from PA DEXA (r = 0.55, p = 0.013), but not with BMD of LAT-L3 DEXA. CONCLUSION: LAT-L3 DEXA was superior to PA DEXA in detecting a decrease of BMD in patients with AS. The presence of syndesmophytes had no distorting effect on BMD measured by LAT-L3 DEXA.

Review of the chronology of clinical manifestations in 60 patients with Behçet's disease.

BACKGROUND: The natural course of Behçet's disease is not fully known. OBJECTIVE: The aim of the present study was to determine the occurrence of the symptoms retrospectively in chronologic order in patients with Behçet's disease, diagnosed according to the criteria of the International Study Group for Behçet's Disease. METHODS: A total of 60 consecutive patients (29 male and 31 female; aged 35.87 +/- 9.84 years) were involved in the study. The symptoms of the disease were retrospectively recorded in the time order of the manifestations per patient. RESULTS: Oral ulcer was the most commonly observed onset manifestation (51 of 60 patients: 85%), followed by genital ulcer (13 of 60 patients: 21.7%) and articular symptoms (10 of 60 patients: 16.7%). The duration between the oral ulcer and the fulfillment of diagnostic criteria was calculated to be 3.77 +/- 4.43 years. The same duration was 2.50 +/- 4.74 and 2.11 +/- 3.44 years for genital ulcer and articular symptoms, respectively. The duration between the time point of fulfillment of diagnostic criteria and the diagnosis (2.83 +/- 2.3 years) was found to be longer in female patients (3.2 +/- 2.5 years). The duration was also longer in patients having only mucocutaneous lesions (3.18 +/- 2.5 years) than in patients having serious organ involvement such as eye disease (1.63 +/- 0.7 years; p < 0.05). CONCLUSION: Our study indicates that oral ulcer is the onset manifestation in the majority of the patients and the disease is often diagnosed with a delay of several years after the appearance of the onset sign.