Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosis.

Objectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200). Conclusion: The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.

Neuropathic Pain and Its Relationship with Clinical Findings in Patients with Fibromyalgia.

Introduction: Fibromyalgia syndrome (FMS) is a clinical condition characterised by chronic generalised body pain, fatigue and presence of tender points. In this study, we hypothesized that FMS could be a type of neuropathic pain and investigated the relationship between neuropathic pain and sleep disturbance and depression. We also investigated the association between these clinical conditions and disease severity. Methods: Seventy-six patients who had FMS diagnosis according to 2010 ACR criteria were included in the study. Patients were evaluated by Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), Douleur Neuropathique 4 Questions (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). Results: Patients had neuropathic pain in 92.1% of patients with LANSS and 82.9% of patients with DN4. According to the Pittsburg Sleep Quality Scale, 90.8% of patients had poor sleep quality. According to HAM-D, 82.9% of the patients had depression. The mean FIQ values of the patients were calculated as 63.16±10.73. There was a positive correlation between DN4 values and FIQ, PSQI, HAM-D and LANSS. There was a positive correlation between LANSS values and FIQ and PSQI values. Conclusion: In this study we found the frequency of neuropathic pain high in FMS. We also found a positive association between neuropathic pain scales and depression, sleep disturbance, and fibromyalgia impact score. Pain, functionality and psychosocial characteristics should be assessed extensively to understand fibromyalgia completely. Abnormal pain process and secondary clinical conditions should be considered together.

The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study.

Objectives: This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods: Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results: The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion: In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

Use of lower extremity orthoses in patients with cerebral palsy and related factors.

BACKGROUND: The purpose of this study was to investigate the frequency of using lower extremity orthosis prescribed for patients with cerebral palsy (CP) and to determine the factors associated with orthosis use. STUDY DESIGN: The study had a retrospective and descriptive design. METHODS: One hundred and twenty-nine patients with CP who were prescribed orthoses were included in this study. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. The study had a retrospective and descriptive design and included 129 patients with CP (53 females and 76 males) who were prescribed orthosis. The sociodemographic data and orthosis use status of patients were questioned with telephone calls. Motor functions were evaluated with Gross Motor Function Classification System (GMFCS). Spasticity was evaluated with the modified Ashworth scale, and range of motion was evaluated by goniometry. RESULTS: A total of 53 patients who were included in the study were female, and 76 were male. The most commonly used orthosis was Ankle-Foot Orthosis. The number of patients who used orthosis every day was 45 (34.8%). The most common reason for not using orthosis was difficulty in wearing it. The mean age was significantly lower in the group that used orthosis regularly (P < 0.05). Spasticity and range of motion limitations were low in the group that used orthosis regularly at significant levels (P < 0.05). A significant relation was detected in logistic regression analysis between age and orthosis use (P < 0.05). CONCLUSION: Regular orthosis use is at quite low levels in patients with CP. The decision for prescribing orthosis should be made with a rehabilitation team, with the patient included before orthosis is prescribed. Problems related to orthosis use should be addressed at regular intervals after prescribing orthosis.

Efficacy of high intensity laser therapy in knee osteoarthritis: a double-blind controlled randomized study.

OBJECTIVE: The aim of this study is to investigate the effectiveness of high intensity laser therapy on pain, functionality, flexion range of motion (FROM), and ultrasonographic cartilage measurement in patients with knee osteoarthritis. METHODS: This study was designed as a double-blind randomized placebo-controlled study. Forty patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were included in the study. After obtaining written informed consent, patients were randomized into high intensity laser therapy (HILT) + exercise therapy (ET), and placebo laser (PL) + ET groups. Each patient was treated five sessions per week for 2 weeks. The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. The femoral cartilage thickness measurement was made ultrasonographically, and FROM was measured with goniometry. RESULTS: Statistically significant improvements were detected in VAS, WOMAC scores, femoral cartilage thickness, and FROM at the end of the treatment (in week 2) compared to the pre-treatment period in both groups (p < 0.05). There were significant decreases in the VAS and WOMAC scores of both groups in the 6th week compared to the pre-treatment period, and the results of the FROM and femur cartilage thickness measurements were increased at statistically significant levels (p < 0.05). The VAS and WOMAC scores were significantly lower in the 6th week in HILT + ET group compared to the PL + ET group (p < 0.05). Similarly, statistically significant increases were detected in the FROM and femur cartilage thickness measurements in HILT + ET group (p < 0.05). CONCLUSION: HILT + ET combination was more effective in KOA than the PL + ET combination. Key Points • HILT is an effective modality on pain, functional status and FROM in patients with KOA. • HILT is a modality that increases femoral cartilage thickness in patients with KOA.

Alexithymia and attention deficit and their relationship with disease severity in fibromyalgia syndrome.

OBJECTIVES: The aim of this study was to investigate the frequency of alexithymia and attention deficit and to evaluate their relationship with the severity of disease in patients with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: A total of 101 patients (6 males, 95 females; mean age 45.0 years; range, 33 to 56 years) who were admitted to Gaziantep University, Medical Faculty, Physical Medicine and Rehabilitation Department between January 2013 and December 2013 and were diagnosed with FMS and 40 healthy volunteers (4 males, 36 females; mean age 41.5 years; range, 31 to 51 years) were enrolled in this study. The Fibromyalgia Impact Questionnaire (FIQ), Hamilton Depression Scale (HAM-D), Toronto Alexithymia Scale-26 (TAS-26), and Jasper-Goldberg Attention Deficit Test (ADT) were applied. RESULTS: The rate of alexithymia and possible alexithymia was 56.4% and 20.8% in the patients with FMS and 2.5% and 5% in the control group, respectively. The mean TAS-26 score was 60.1±11.7 in the patients with FMS. According to the HAM-D, depressive symptoms were seen in 72.0% and 2.5% of the patients with FMS and healthy controls, respectively. CONCLUSION: Our study results confirm the presence of psychiatric comorbidities in patients with FMS and clearly suggest that depression, alexithymia, and attention deficit are high and mutually correlated in FMS patients. Therefore, all patients should be meticulously evaluated for these conditions at the treatment stage.

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.

The effects of reflexology on pain and sleep deprivation in patients with rheumatoid arthritis: A randomized controlled trial.

OBJECTIVE: This study was intended to examine the effect of foot reflexology on RA patients' pain and sleep quality. METHODS: This is a randomized controlled trial and was held at the "Rheumatology Follow-up Polyclinic" in Turkey between January-July 2015. A total of 60 patients were included in the research. A sociodemographic data form, the Pittsburgh Sleep Quality Index (PSQI) and the Visual Analogue Scale (VAS) were used. Foot Reflexology was administered to the experimental group. RESULTS: The research found that the pain scores of the experimental group were statistically more significant than those of the control group (p < .01). The experimental group's average pain was reduced by the six weeks of foot reflexology. The total PSQI score of the experimental group was lowered. CONCLUSIONS: Foot reflexology is a non-pharmacological nursing intervention that may reduce the pain and sleep deprivation symptoms of RA patients.

[Coexistence of polymyalgia rheumatica with ankylosing spondylitis: A case report]. / Ankilozan spondilit polimiyaljia romatika birlikteligi: Olgu sunumu.

Ankylosing spondylitis is a chronic inflammatory disease that affects the spine and peripheral joints. Polymyalgia rheumatica is an inflammatory disease characterized by aching and prolonged morning stiffness mainly in the shoulder and pelvic girdles. Many other diseases may mimic polymyalgia rheumatica, and thus differential diagnosis is predominantly required. A wide variety of diseases, including spondyloarthropathies, may present polymyalgia-like symptoms, and two diseases rarely coexist. We present a case of a 54-year-old man who had been followed-up for ankylosing spondylitis and presented with pain in the shoulder and pelvic girdles, restricted movement, and morning stiffness for 2 months. Physical examination revealed that the pain was located mostly in the shoulder and pelvic girdles. In addition, increased erythrocyte sedimentation rate revealed the coexistence of the two diseases. Corticosteroid treatment dramatically improved the patient's symptoms and supported the diagnosis. This case demonstrated that ankylosing spondylitis may present polymyalgia-like symptoms, and the two diseases may rarely coexist in the elderly. The coexistence of these two diseases has been rarely reported in literature. Accurate diagnosis of the two diseases is essential for improving the patient's symptoms and quality of life.

Comparison of education and balneotherapy efficacy in patients with fibromyalgia syndrome: A randomized, controlled clinical study.

OBJECTIVES: Fibromyalgia is a disease characterized by chronic, widespread pain. Pharmacological and non-pharmacological treatment methods are used. The aim of the present study was to determine the effect of balneotherapy on treatment of fibromyalgia syndrome, compared with education alone. METHODS: A total of 66 patients diagnosed with fibromyalgia syndrome were randomly separated into balneotherapy and control groups. Patients in both groups were informed about fibromyalgia syndrome. In addition, the balneotherapy group received 21 sessions of spa treatment with 34.8 °C thermomineral water, attending the spa 5 days a week. Patients were evaluated by visual analogue scale, tender point count, fibromyalgia impact questioning, and modified fatigue impact scale at initiation of treatment on the 15th day, 1st month, 3rd month, and 6th month. Evaluations were performed by the same doctor. RESULTS: Statistically significant improvement was detected in all parameters, compared to starting evaluation, in both groups. Most improved results among all parameters were observed in the balneotherapy group on the first 3-month follow-up. In addition, all parameters beyond tender point count and modified fatigue impact were improved on 6-month follow-up. CONCLUSION: It was concluded that addition of balneotherapy to patient education has both short- and long-term beneficial effects on female patients with fibromyalgia.

Might there be a link between intron 3 VNTR polymorphism in the XRCC4 DNA repair gene and the etiopathogenesis of rheumatoid arthritis?

DNA repair genes are involved in several diseases such as cancers and autoimmune diseases. Previous studies indicated that a DNA repair system was involved in the development of rheumatoid arthritis (RA). In this study, we aimed to examine whether four polymorphisms in the DNA repair genes (xeroderma pigmentosum complementation group D [XPD], X-ray repair cross-complementing group 1 [XRCC1], and X-ray repair cross-complementing group 4 [XRCC4]) were associated with RA. Sixty-five patients with RA and 70 healthy controls (HCs) were examined for XPD (A-751G), XRCC1 (A399G), and XRCC4 (intron 3 VNTR and G-1394T) polymorphisms. All polymorphisms were genotyped by PCR and/or PCR-RFLP. The association between the polymorphisms and RA was analyzed using the chi-square test and de Finetti program. The intron 3 VNTR polymorphism in the XRCC4 gene showed an association with RA patients. The DI genotype was found lower in RA patients (χ(2)=8.227; p=0.0021), while the II genotype was higher in RA patients (χ(2)=5.285; p=0.010). There were deviations from the Hardy-Weinberg Equilibrium (HWE) in both intron 3 VNTR and G-1394T polymorphisms in the XRCC4 gene and in the polymorphism in the XRCC1 gene, and the observed genotype counts deviated from those expected according to the HWE (p=0.027, 0.004, and 0.002, respectively); however, there was no deviation in the other gene polymorphisms. There is no statistical difference between the RA patients and HCs for XPD (A-751G), XRCC1 (A399G), and XRCC4 (G-1394T) gene polymorphisms (p>0.05). Although XPD (A-751G), XRCC1 (A399G), and XRCC4 (G-1394T) gene polymorphisms have been extensively investigated in different clinical pictures, this is the first study to evaluate the role of these polymorphisms in the genetic etiopathogenesis of RA in Turkish patients. In conclusion, we suggested that the intron 3 VNTR polymorphism in the XRCC4 gene may be associated with the etiopathogenesis of RA as a marker of immune aging.

Plasma nitrite levels, total antioxidant status, total oxidant status, and oxidative stress index in patients with tension-type headache and fibromyalgia.

OBJECTIVES: Tension-type headache (TTH) and fibromyalgia syndrome (FM) are worldwide seen chronic pain syndromes of unknown etiology. Despite the growing body of data on pathophysiology and generation mechanisms of pain; our knowledge on pain mechanisms in both FM and TTH is yet to be limited. PATIENTS AND METHODS: We investigated the plasma nitrite levels, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) in 35 TTH, 33 FM patients and 31 healthy controls. RESULTS: The mean plasma nitrite levels and TAS levels were significantly low and OSI was found to be significantly high in TTH and FM groups compared to the control group (p=0.001, p=0.001, p=0.001 and p=0.001, respectively). The mean serum TOS levels were also significantly higher in FM group according to the control group (p=0.034), but there was not a significant difference between TTH and control groups (p=0.066). CONCLUSION: These results indicated that; FM and TTH patients revealed higher oxidative stress index and lower total nitrite levels than healthy controls. We conclude that oxidative stress may have a role in the pathophysiological mechanisms of TTH and FM, although, whether it is the cause or the consequence, is not clear.

Late onset spondyloarthropathy mimicking polymyalgia rheumatica.

We report a 55-year-old woman with late onset spondyloarthropathy who had widespread body pain and pitting oedema of both ankles. She had been followed up for polymyalgia rheumatica for nearly 10 years. On laboratory examination, ESR: 62 mm/h and CRP: 16.1 mg/dl. HLA was positive. There was tenderness on both of her ankles. We diagnosed late onset spondyloarthropathy according to clinic and radiographic findings. The patient was treated with sulphasalazine 200 mg/day and indomethacin 100 mg/day. As a conclusion, LoSPA may mimic a variety of rheumatic conditions such as PMR and reflex sympathetic dystrophy syndrome. Careful examination should be warranted in such conditions.

Severe neck and back pain in adolescence: remember osteoblastoma.

Osteoblastoma is a rare benign tumor of the bone. A 15-year-old boy presented with severe neck and back pain and was followed up for myofascial pain syndrome for 12 months. There was no neurologic deficit or scoliosis. The X-ray of the patient was normal. MRI revealed local destructive tumorous lesion of the T3-T5 vertebrae. The tumor was resected by a spinal surgeon and histologic examination revealed osteoblastoma. The patient's complaints have been completely resolved and there was no recurrence during the follow-up.

The relation between genitourinary prolapse and joint hypermobility in Turkish women.

OBJECTIVE: In this cross-sectional study, we compared frequency of hypermobility syndrome in pelvic organ prolapse (POP) patients and normal healthy Turkish women. METHODS: Sixty-five women who had diagnosed as POP and ward to surgery and 52 healthy women with similar age group were included into this study. RESULTS: It was found that subjects with POP had a significantly higher prevalence of joint hypermobility (53.8%) when compared with normal individuals (9.6%). No significant correlation was demonstrated between Beighton scores and incontinence, exercises pattern and hormone replacement therapy. CONCLUSION: We concluded that joint laxity is associated with POP but not with urinary incontinence in Turkish women.

Coexistence of the monostatic Paget's disease, sensorimotor neuropathy and elderly onset rheumatoid arthritis.

Paget's disease is a chronic focal disease of the skeleton that affects up to 2-3% of the population over the age of 60. Polymyalgia rheumatica (PMR) is an inflammatory condition of unknown etiology characterized by aching and stiffness in the shoulder, pelvic girdle and the neck. There are two incompletely overlapping subsets of RA that have been recognized: one exhibits the classical RA clinical picture, while the other has a PMR-like onset in later ages of life. We reported a rare case of monostatic Paget's disease, sensorimotor neuropathy and elderly onset rheumatoid arthritis in an elderly women.

Which genotype of MAO gene that the patients have are likely to be most susceptible to the symptoms of fibromyalgia?

The objective of this study was to analyze the genotype distributions and allele frequencies for the MAO-A and MAO-B polymorphism of the MAO gene among the patients with fibromyalgia syndrome (FS). One hundred and seven fibromyalgia patients and 90 unrelated healthy subjects were included into the study. Genomic DNA of 107 FS patients and 90 healthy control subjects were analyzed by polymerase chain reaction. Polymorphism of the MAO gene was: 1-1, 1-3, 3-3, 3-4. The "allele 3" had a 2.7 to 4.8-fold increased transcription activity than the "allele 1". The frequencies of the genotypes of the patients with FS and healthy controls were compared. Although no significant difference was found in genotypes of patients and controls (P = 0.0559), it is likely that "allele 3" could be a more riskful factor for FS than "allele 1" (P = 0.033). Fibromyalgia impact questionnaire was administered to FS group as well as control group. One of our findings is that, the patients whose genotype 3-3 may be mostly affected by the symptoms of FS. In conclusion, it seems plausible to say that MAOA-dependent metabolism of the biological amines may be partly related to high-activated MAO-A, allele 3, in the occurrence of FS among Turkish population.

Anatomical variations with joint space measurements on CT.

This study has been performed to demonstrate the type and frequency of the anatomical variations of the sacroiliac joint according to age, gender, Body Mass Index and childbirth, and the influence of the anatomical variants to the uniformity and width of the joint space. It was conducted on 400 consecutive patients without sacroiliac complaint who underwent pelvic CT scanning for various reasons. Patients' ages were 15 or above. Anatomical variants that we observed were accessory sacroiliac joint (70 patients, 17.5%), iliosacral complex (38 patients, 9.5%), bipartite iliac bony plate (22 patients, 5.5%), semicircular defects on iliac/ sacral side (19 patients, 4.8%), crescent like iliac bony plate (14 patients, 3.5%) and ossification centers (4 patients, 1.0%). The mean joint space width of the 400 patients was 1.72+/-0.57 mm (from 0.77 mm to 4.39 mm). In adults below 40 years of age, the measured width was 2.49+/-0.66 mm. In older patients, 1.47+/-0.21 mm. Joints which presented anatomical variants (206 articulations) had a non-uniform joint space in 164 (79.6%), whereas uniform joint space were seen in 42 (20.4%) articulations. The joint width were less than 2 mm in 193 (93.7%) articulations and in 13 (6.3%) articulations were greater or equal to 2 mm. This study has demonstrated that anatomical variations and joint space are independently related to age, gender, Body Mass Index and childbirth in patients. We believe that all this information is helpful to interpret and examine the sacroiliac computed tomography images.

No evidence for an association between the Glu298Asp polymorphism of the endothelial nitric oxide synthase gene and fibromyalgia syndrome.

The objective of this study was to analyze the genotype distributions and allele frequencies for the Glu298Asp (G894T) polymorphism of the eNOS gene and the serum nitric oxide level among the patients with fibromyalgia syndrome (FS). Ninety-six fibromyalgia patients and 79 unrelated healthy volunteer controls were included in the study. All patients and controls were females. Genomic DNA from 96 patients meeting the American College of Rheumatology 1990 criteria for FS and 79 healthy controls was analyzed by polymerase chain reaction. A polymerase chain reaction-restriction fragment-length polymorphism analysis of eNOS gene polymorphism was performed, and the results of the patients with FS and healthy controls were compared. Ozone-based chemiluminescence assay with Sievers NO Analyzer was used to measure the serum nitric oxide levels. Neither the frequencies of the Glu298Asp genotypes nor the serum nitric oxide levels showed a significant difference between the groups. These results suggested that FS of the Turkish population seemed to develop without any alterations in eNOS Glu298Asp genotype frequency and the serum nitric oxide level.