Antirheumatic drugs in older adults and polypharmacy issues.

Older individuals experience various noninflammatory and autoimmune inflammatory rheumatic diseases. Given the increased incidence of rheumatic conditions in older adults, it is of great importance for healthcare providers to be aware of the potential benefits and risks of antirheumatic drugs. The present article aims to provide a comprehensive review regarding antirheumatic drug use in older patients, particularly by focusing on safety issues and polypharmacy. Antirheumatic medications include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and disease-modifying antirheumatic drugs (DMARDs), which comprise conventional synthetic DMARDs, targeted synthetic DMARDs and biological DMARDs. Due to the alteration in drug pharmacokinetics and pharmacodynamics in old people, antirheumatic drug efficiency and safety may be different than in the younger population. Polypharmacy and multimorbidity are other potential challenges to be faced during the treatment of older patients with rheumatic diseases. The current review also discusses the strategies to minimize adverse reactions due to antirheumatic drugs.

Incorporating patient preferences into osteoarthritis treatment.

Objectives: This study aims to identify the relationship between treatment modalities and the patients' preferences in osteoarthritis (OA) treatment and identify the related factors. Patients and methods: This multi-center, cross-sectional study included a total of 305 patients with OA (66 males, 239 females; mean age: 66.4±9.7 years; range, 38 to 90 years) between July 2019 and January 2020. Data including demographic and clinical characteristics of the patients were recorded using a structured questionnaire. Results: The mostly common involvement sites were knee joints, lumbar, and cervical regions, respectively. Prior to the study, the treatment modalities which were prescribed to patients were oral drugs (79.7%), topical drugs (73.8%), home-based exercise program (62.6%), and physical therapy (outpatient) (61.3%). Of the recommended remedy, 89.2% were prescribed by physiatrists, 24.6% by orthopedists, 5.6% by family practitioners, 2.6% by neurosurgeons, and 1.6% by algologists. The most beneficial treatments (to whom) were inpatient physical therapy program (47%), oral drugs (41%), home-based exercise programs (24.9%) according to patients' perspective. According to patient preferences, nearly half of the patients preferred outpatient physical therapy program (45.9%), oral drugs (33.1%), inpatient physical therapy (20%), and home-based exercises (18%). The most common reasons for their preferences were previous benefits from treatment (54.4%), long-term effects (38%), easy access to treatment (33.1%) and concerns about side effects (28.9%). The mostly common reasons for their preferences were previous benefits from the treatment (54.4%), long-term positive effects of physical therapy (38%), easy access to the treatment (33.1%) and concerns about side effects of drugs (28.9%). Conclusion: Besides medical regimen, the results of this study showed that the patients preferred outpatient and inpatient physical therapy modalities, and home-based exercises programs. In the light of these findings, initiation of a new prescription (e.g., drugs or physical therapy modalities) in OA patients, previous treatment modalities, and approaches are suggested to be carefully reviewed by the clinician to anticipate and improve the adherence behavior to the new treatment.

Updated approach for the management of osteoporosis in Turkey: a consensus report.

As a result of the current demographics, increased projections of osteoporosis (OP) and prevalence of the disease in Turkey, a panel of multidisciplinary experts developed a thorough review to assist clinicians in identifying OP and associated fracture risk patients, diagnosing the disease with the appropriate available diagnostic methods, classifying the disease, and initiating appropriate treatment. The panel expects to increase the awareness of this prevalent disease, decrease consequences of OP with corresponding cost savings and, ultimately, decrease the overall burden of OP and related fractures in Turkey. BACKGROUND: OP is not officially accepted as a chronic disease in Turkey despite the high prevalence and predicted increase in the following years. However, there are areas where the country is performing well, such as having a country-specific fracture risk assessment model, DXA access, and the uptake of FRAX. Additional efforts are required to decrease the existing treatment gap estimating 75-90% of patients do not receive pharmacological intervention for secondary prevention, and the diagnosis rate is around 25%. METHODS: A selected panel of Turkish experts in fields related to osteoporosis was provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion until a consensus was achieved. Represented in the panel were a number of societies including The Turkish Osteoporosis Society, The Society of Endocrinology and Metabolism of Turkey (SEMT), and The Turkish Society of Physical Medicine and Rehabilitation. RESULTS: Standardized general guidelines to identify OP and related fractures and at-risk population in Turkey, which will enable clinicians to accurately and effectively diagnose the disease, treat the appropriate patients with available pharmacological and non-pharmacological treatments and decrease the burden of the disease. CONCLUSIONS: This manuscript provides a review of the current state of OP and related fractures in Turkey. Moreover, this manuscript reviews current international guidelines and national studies and proposes a number of helpful country-specific classifications that can be used by healthcare providers caring for the at-risk population. Additionally, the panel proposes practical recommendations that should be implemented nationally in order to decrease the burden of OP and related fractures and effectively preventing the burden in future generations.

Erratum: The use of diagnostic imaging in low back or leg pain.

[This corrects the article on p. 314 in vol. 63.].

The use of diagnostic imaging in low back or leg pain.

OBJECTIVES: The aim of this study is to evaluate the imaging method preferences of physicians working in different clinics and departments for the patients suffering from low back and/or leg pain. PATIENTS AND METHODS: In this retrospective study, the radiological imaging types of 900 patients (301 males, 599 females; mean age 46.8±17.1 years; range 2 to 89 years) with low back and/or radicular leg pain who were admitted for the first time to the Physical Medicine and Rehabilitation (PMR), Orthopedics and Traumatology (OT), and Neurosurgery (NS) clinics in our hospital between July 2013 and August 2014 were reviewed. Age, sex, and radiological methods applied were recorded. The correlation between radiological methods and differences in terms of age and sex and how the radiological method preferences differed according to the departments were evaluated. RESULTS: Of the patients, 22%, 35% and 34.7% were evaluated without using any imaging methods in the OT, PMR, and NS outpatient clinics, respectively. A total of 32.7%, 48.7%, and 8.7% of the patients were evaluated using lumbar X-ray in the OT, PMR, and NS outpatient clinics, respectively. A total of 19.3%, 11.7%, and 54.3% of the patients were evaluated using the lumbar magnetic resonance imaging (MRI) in the OT, PMR, and NS outpatient clinics, respectively. There were no statistically significant correlations between the age, sex, and imaging modality used. CONCLUSION: Our study results showed that the most common imaging tool which is used by the physicians in the PMR and OT clinics is lumbar X-ray, while the lumbar MRI is the most common tool in the NS clinics. However, we recommend that not only the medical, but ethical aspects and cost-effectiveness of the imaging modality to be selected should be considered.

A Multicenter Pilot Study of Burden Among Caregivers of Geriatric Rehabilitation Patients With Neuromusculoskeletal Diseases.

PURPOSE: In this study, we aimed to describe the sociodemographic characteristics of caregivers of patients in a geriatric unit and to clarify the relationship between caregiver burden and specific clinical variables in the patients and the characteristics of the caregivers. DESIGN: Cross-sectional multicenter study. METHODS: One hundred twenty-three patients and 123 caregiver dyads, with mean ages of 72.5 ± 7.7 years and 51 ± 14.7 years, respectively, were included. The functional, psychological, and cognitive statuses of the patients were determined, and the sociodemographic characteristics of the caregivers as well as the type and duration of caregiving were recorded. Caregivers completed the Caregiver Burden Inventory (CBI) to measure the perceived burden of care. Most patients were female and generally lived with their family. FINDINGS: Most of the caregivers were family members (90%), female (73.2%), primary school graduates (52.8%), and first-degree relatives (73.1%). The average CBI score was 33, and the highest CBI subscores were for time, developmental, and physical burdens. Caregiver burden correlated with the patient's ambulatory, psychological, and cognitive status and with the caregiver's age, gender, income level, and duration of caregiving. CONCLUSIONS: We have highlighted the relationship between caregiver and patient characteristics in a cohort of elderly Turkish patients with neurological and musculoskeletal disorders. In particular, we have highlighted the heavy caregiver burden in a developing country. CLINICAL RELEVANCE: Our results may guide the nurses to understand the requirements of caregivers and to help them find suitable resources that would meet their needs to cope with their burden.

The relationship between body mass index and footprint parameters in older people.

BACKGROUND: The relationship of body mass index (BMI) with footprint parameters has been studied in paediatric populations, but there are limited data regarding the effects of BMI on parameters in the elderly. OBJECTIVES: To establish the relationship between BMI and static footprint parameters in the elderly population. METHODS: 128 subjects aged 65 and above with no history of lower extremity surgical intervention and no significant lower extremity weakness were included in the current study. BMI and footprint parameters of arch angle, Chippaux-Smirak index (CSI), Staheli index (SI), arch index (AI) and footprint index (FI) were measured for each subject, and statistical analysis was done to investigate the correlation between BMI and the parameters. RESULTS: Weak correlations detected between all calculated indices and angles with BMI, except the left foot arch angle. CSI, SI and AI of the right foot were found to be positively correlated with BMI, while a negative correlation between the arch angle and FI of right foot was shown with BMI. CONCLUSIONS: The results reveal a relationship between BMI and footprint parameters that are indicative of flatfoot in the elderly. This could be due either to confounding of the footprint measure by fat or possibly due to an as yet unknown structural change that requires further evaluation.

Pain and quality of life (QoL) in elderly: the Turkish experience.

PURPOSE: The aims of this study were to evaluate the effects of demographic and clinical determinants on pain and to investigate the possible risk factors that disrupt QoL. MATERIALS AND METHODS: The design of this research was a prospective study performed in tertiary care hospital-based physical medicine and rehabilitation departments. A comprehensive geriatric pain assessment (Geriatric Pain Scale, GPS) and health-related quality of life (HR-QOL) assessment (Nottingham Health Profile, NHP) were performed. RESULTS: Of the 275 patients, 76% were female and 59.6% were older than 70 years of age. Two hundred seventy four patients (99.7%) had various levels of pain. The mean age of the patent group was 72.77 ± 5.7 (min: 65, max: 96) years. The overall GPS was 60.41 ± 22 (min: 0, max: 99.9), and the total NHP score was 49.01 ± 22.4 (min: 0, max: 100). Correlation analyses showed that for the total GPS score, female gender, lower education, and economic status were significant determinants of higher levels of pain. The multiple linear regression analysis showed that the NHP, GPS, Self-Reported Disability Index (SRDI), and Geriatric Depression Scale (GDS) were significant determinants of poorer HR-QOL. CONCLUSIONS: There was a high prevalence of pain and being female, having low income, having low social support, having a higher rate of disability with related multiple comorbidities, and depression as related factors of HR-QOL. Strengthening these negative predictors of HR-QOL might enhance the efficiency of pain therapies in this population.

Polypharmacy in the elderly: a multicenter study.

OBJECTIVE: The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients. DESIGN: Cross-sectional SETTING: Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces. PARTICIPANTS: A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included. MEASUREMENTS: Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement. RESULTS: The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly. CONCLUSIONS: Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.

Effect of socio-economic status on bone density in children: comparison of two schools by quantitative ultrasound measurement.

BACKGROUND: There are conflicting findings regarding the relationship between socio-economic status (SES) and bone mineral density. We aimed to investigate bone status and its possible determinants by comparing students from two schools, located in a high and a low SES district. METHODS: Data were gathered by using anthropometric measurements and a questionnaire for both families and the students from the two schools chosen by the Ministry of Education. Quantitative ultrasound measurements were done with Omnisense 700P. For normally distributed variables t-test and for others Mann-Whitney U test was utilized. We used the chi-squared test for nominal variables. RESULTS: Forty-two girls and 35 boys from a low SES school, and 41 girls and 38 boys from a high SES school were included in the study. Students in the high SES school had significantly higher calcium scores and more physical activity compared to those in the low SES school. Boys in the high SES school had higher z-scores for quantitative ultrasound; however, they had higher Tanner stages when compared to boys from the low SES school. Speed of sound (SOS) and z-scores of the girls were similar between the two schools. CONCLUSIONS: This study supports the notion that certain environmental factors, such as calcium intake and physical activity, might reflect socioeconomic trends in adolescents, similar to adults; however, genetic influences may dominate in terms of bone status.

A multicenter, case control study of risk factors for low tibial speed of sound among residents of urban areas in Turkey.

Risk factors which have been associated with low bone mass are multifactorial and represent regional differences between and within countries. The purpose of this study was to evaluate the possible risk factors of low tibial speed of sound (tSOS), which determines cortical bone status among residents of urban regions in Ankara, Izmir, and Istanbul, in Turkey, and also to compare groups of different socioeconomic status (SES). A total of 1,026 subjects (63% women and 53% of low socioeconomic status) 40-70 years old were included in the study. Risk factors of osteoporosis were determined using the European Vertebral Osteoporosis Study (EVOS) questionnaire, and the bone status was screened by tSOS. Socioeconomic status was found to be among the major risk factors of low tSOS in our population (odds ratio 0.39, 95% confidence interval 0.26-0.58), besides the well-known risk factors such as age and gender. Therefore, we suggest that SES is an important determinant of cortical bone status. Additionally, our results confirmed the correlation between tSOS and the clinical determinants of bone mass.