Accelerated Nodulosis in a Patient With Rheumatoid Arthritis.

In patients with rheumatoid arthritis (RA), subcutaneous nodules are the most frequently seen extra-articular findings that are seen in areas of extensor pressure. In this article, we present the case of a RA patient with accelerated nodulosis that started with the use of methotrexate and exacerbated with etanercept and leflunomide treatment.

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.

Medial collateral ligament bursitis in a patient with knee osteoarthritis.

BACKGROUND: Medial collateral ligament (MCL) bursitis has been described as a distended and inflamed bursa between the superficial and deep portions of the MCL. It is a rare but important cause of medial knee pain. CASE DESCRIPTION: A 65-year-old woman with knee osteoarthritis (OA) presented with severe pain and swelling in her left knee. She did not have a traumatic injury. After a clinical examination, a slight decrease in the range of motion of the left knee, and a painful swelling and tenderness over the medial side of the knee and proximal tibia were detected. The pain was exacerbated by valgus stress test. The magnetic resonance (MR) imaging showed a distended bursa with internal septations beneath the superficial portion of the MCL. MCL bursitis was considered as diagnosis and an ultrasound-guided corticosteroid injection into the bursa was performed. RESULTS: There was a significant improvement in pain intensity in the follow-up examination. A repeated MR imaging 2 months later showed a marked improvement, and approximation of the deep and superficial portions of the MCL. CONCLUSIONS: MCL bursitis, which is a rare condition, must be considered for the differential diagnosis of increased medial knee pain in patients with knee OA. Corticosteroid injection is an effective and safe treatment modality for the management.

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.

Bone metabolism and mineral density in patients with beta-thalassemia major.

OBJECTIVE: To evaluate bone metabolism in patients with beta-thalassemia major and to determine the factors associated with the development of osteoporosis. METHODS: We studied 25 patients with thalassemia major with a mean age of 18.4 years (range 5-31) and aged and gender matched 24 healthy controls who were attending the outpatient physical medicine and rehabilitation clinic of Akdeniz University Hospital between January 2004 and March 2004 in Turkey. Bone mineral density (BMD) of lumbar spine (L1-L4) and proximal femur were determined using dual x-ray absorptiometry (DXA). Venous blood samples were obtained for determination of blood cell count and markers of bone formation and resorption. RESULTS: The BMD values, both at lumbar and femoral neck levels were significantly lower in patients compared to controls. Serum N-telopeptide level was slightly higher, whereas osteocalcin was slightly lower in patients; however, these values were not statistically significant. Plasma levels of insulin like growth factor-1 (IGF-I) and insulin like growth factor binding protein-3 (IGFBP-3) were significantly lower in patients. Also, serum levels of estradiol and progesterone in females, luteinizing hormone and follicle-stimulating hormone in both gender were significantly lower in patients. Serum levels of free testosterone and total testosterone were lower in patients, but not statistically significant. Patients also had significantly higher serum phosphorus levels, and lower serum calcitonin levels compared to controls. CONCLUSION: The BMD is decreased in thalassemic patients. Growth retardation, growth hormone / IGF-I / IGFBP-3 axis dysfunction, gonadal dysfunction and hypothalomo-pituitary-gonadal axis dysfunction may be responsible for the development of osteoporosis in the patients with beta-thalassemia major.

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.