A comparison between hypertonic dextrose prolotherapy and conventional physiotherapy in patients with knee osteoarthritis.

The aim of the present study was to compare the efficacy of hypertonic dextrose prolotherapy (HDP) with conventional physiotherapy (CPT) in improving symptoms in females with knee osteoarthritis (OA). The present study included 60 patients with a diagnosis of knee OA. The patients were randomly assigned to the HDP (n=30) and CPT (n=30) groups. The patients in the HDP group were treated with a dextrose injection into the knee joint (25% dextrose) and around the knee (15% dextrose) in two sessions for 1 month, while those in the CPT group received a hot pack, transcutaneous electrical nerve stimulation and therapeutic ultrasound in five sessions a week for 4 weeks. Prior to commencing the treatment, and at 1 and 3 months post-treatment, all the patients were evaluated using the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the goniometric measurement of active knee range of motion (ROM), a 50-m walking test and isokinetic knee muscle strength measurements. There were no statistically significant differences between the two groups as regards the demographic characteristics at pre-treatment (P>0.05). However, at 1 and 3 months post-treatment, the scores of all the outcome parameters were significantly improved in the HDP group compared with the CPT group (P<0.05 for all). In both groups, a significant improvement was observed in the VAS scores, WOMAC total values and ROM following the treatments, with the greatest improvement observed in the HDP group (P<0.001). The isokinetic quadriceps peak torque measurements were increased in both groups following treatment. All the scores exhibited a statistically significant improvement in the HDP group at both 1 and 3 months post-treatment. On the whole, the results of the present study demonstrate that both HDP and CPT are effective treatment modalities to relieve pain, and increase functionality and strength in patients with knee OA. However, greater improvements in pain and functionality can be achieved with prolotherapy.

Short­term effects of pregabalin plus exercise therapy on pain, emotional status, physical function and nociceptive responses in patients with fibromyalgia.

The aim of the present study was to investigate the effects of pregabalin plus exercise vs. pregabalin treatment alone on the electromyographic nociceptive flexion reflex (NFR) threshold in patients with fibromyalgia (FM). For this purpose, the present study included a total of 40 patients diagnosed with FM according to the American College of Rheumatology 2010 criteria. The patients were divided into two groups as follows: Group 1 received pregabalin treatment only and group 2 received exercise therapy in addition to pregabalin treatment. Assessments were made at baseline and at the 1st month using a visual analog scale (VAS) to measure pain, the Fibromyalgia Impact Questionnaire (FIQ) to measure the severity of FM, Beck's Depression Inventory (BDI) to measure depression and the NFR to measure the compressive forces on peripheral nerves. In both groups, the NFR threshold following treatment was significantly higher than that at the baseline results (P#x003C;0.001). There was no significant difference between the groups as regards the difference from pre- to post-treatment NFR threshold values (P=0.610 and P=0.555, respectively). There was a strong, negative correlation between the pre-treatment NFR threshold and VAS resting, VAS motion and FIQ scores (Rho=-0.62, Rho=-0.69 and Rho=-0.60, respectively). There was a moderate negative correlation between the pre-treatment NFR threshold and BDI scores (Rho=-0.35). On the whole, the present study demonstrates that in the treatment of FM, pregabalin improves the clinical scores and leads to an increase in the NFR threshold. Herewith, it should be noted that short-term exercise therapy does not appear to provide additional benefits.

Optical coherence tomography changes in ankylosing spondylitis patients on long-term adalimumab treatment.

OBJECTIVE: Long-term ocular effects of tumor necrosis factor-alpha inhibitors remain to be elucidated. This study aimed to examine the long-term effects of adalimumab use on neural tissue of the anterior visual pathways using optical coherence tomography in patients with ankylosing spondylitis. METHODS: This was a single-center, open-label, cross-sectional study conducted at the Giresun University Faculty of Medicine, Physical Medicine and Rehabilitation Department, between November 2019 and August 2020. This study included 26 ankylosing spondylitis patients receiving adalimumab for at least 1 year and 21 healthy controls. All subjects underwent a full ophthalmological examination and optical coherence tomography examination with the following measurements: peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, peripapillary choroidal thickness, ganglion cell complex thickness, and the optic head properties. RESULTS: Peripapillary retinal nerve fiber layer thickness and retinal thickness measurements were lower in the adalimumab group. In addition, ganglion cell complex thickness was significantly lower and the cup-to-disc ratio was significantly higher in the adalimumab group (p<0.05). However, the two groups did not differ in terms of peripapillary choroidal thickness and disc area (p>0.05). CONCLUSION: Although tumor necrosis factor-alpha inhibitors have some favorable effects on the ocular involvement of patients with ankylosing spondylitis, they may also have paradoxical detrimental effects as evidenced by structural changes observed by optical coherence tomography. Future studies with better design, probably including a large number of patients with a range of rheumatological diseases and tumor necrosis factor-alpha inhibitors, are warranted.

The effect of oral baclofen and botulinum toxin treatments in hemiplegic spasticity on the nociceptive flexor reflex: A randomized clinical trial.

Objectives: This study aimed to analyze the effect of oral baclofen treatment and botulinum toxin type A (BT-A) injection treatment in hemiplegic patients with spasticity on the electromyographic nociceptive flexor reflex (NFR) threshold. Patients and methods: A total of 29 spastic hemiplegic patients (20 males, 9 females; mean age: 52.9±10.1; range, 27 to 64) with Modified Ashworth Scale (MAS) grades 2-4 were included in the prospective, randomized study between May 2018 and March 2019. The patients were divided into two groups: the BT-A group consisted of 15 patients that underwent a BT-A injection and the baclofen group consisted of 14 patients treated with baclofen. Modified Ashworth Scale, Visual Analog Scale (VAS), Barthel daily life activity index, and NFR threshold values were used in the evaluation of the patients before and after the treatment at the sixth week. The motor evaluation of the patients was performed using Brunnstrom motor staging. Results: In both groups, MAS and VAS values decreased significantly compared to pretreatment (p<0.05). There was a significant decrease in ankle MAS score (p<0.001) and a significant increase in Brunnstrom hand recovery stages in the BT-A group compared to pretreatment (p=0.020). While the NFR threshold statistically significantly increased in the baclofen group compared to pretreatment (p=0.007), there was no significant change in the BT-A group (p=0.669). Conclusion: These results suggest that BT-A injections do not cause a significant change in the NFR threshold in the treatment of spasticity.

Optical coherence tomography changes in ankylosing spondylitis patients on long-term adalimumab treatment

SUMMARY OBJECTIVE: Long-term ocular effects of tumor necrosis factor-alpha inhibitors remain to be elucidated. This study aimed to examine the long-term effects of adalimumab use on neural tissue of the anterior visual pathways using optical coherence tomography in patients with ankylosing spondylitis. METHODS: This was a single-center, open-label, cross-sectional study conducted at the Giresun University Faculty of Medicine, Physical Medicine and Rehabilitation Department, between November 2019 and August 2020. This study included 26 ankylosing spondylitis patients receiving adalimumab for at least 1 year and 21 healthy controls. All subjects underwent a full ophthalmological examination and optical coherence tomography examination with the following measurements: peripapillary retinal nerve fiber layer thickness, peripapillary retinal thickness, peripapillary choroidal thickness, ganglion cell complex thickness, and the optic head properties. RESULTS: Peripapillary retinal nerve fiber layer thickness and retinal thickness measurements were lower in the adalimumab group. In addition, ganglion cell complex thickness was significantly lower and the cup-to-disc ratio was significantly higher in the adalimumab group (p<0.05). However, the two groups did not differ in terms of peripapillary choroidal thickness and disc area (p>0.05). CONCLUSION: Although tumor necrosis factor-alpha inhibitors have some favorable effects on the ocular involvement of patients with ankylosing spondylitis, they may also have paradoxical detrimental effects as evidenced by structural changes observed by optical coherence tomography. Future studies with better design, probably including a large number of patients with a range of rheumatological diseases and tumor necrosis factor-alpha inhibitors, are warranted.

Does Kinesiology Taping Improve Muscle Strength and Function in Knee Osteoarthritis? A Single-Blind, Randomized and Controlled Study.

OBJECTIVES: This study aims to evaluate the efficacy of kinesiology taping (KT) on pain, movement restriction, walking speed, daily living activities, and isokinetic muscle performance in female patients with knee osteoarthritis. PATIENTS AND METHODS: The study included 61 female patients (mean age 53.5±3.5 years; range 50 to 60 years) who were admitted to Physical Medicine and Rehabilitation Outpatient Clinic with complaints of mechanical knee pain. Knee osteoarthritis was diagnosed according to the clinical/ radiological criteria of the American College of Rheumatology and patients with Kellgren-Lawrence grade 2 and 3 were included. Patients were randomly divided into two groups. Both groups received transcutaneous electrical nerve stimulation for 30 minutes, hot pack for 30 minutes, and therapeutic ultrasound for 10 minutes in a day for three weeks (five days in a week). Also, one group was treated with KT (KT group, n=31) while the other group was treated with sham-KT (sham-KT group, n=30) one time a week for three weeks. A home program of around the knee strengthening exercises was recommended for all patients. All patients were evaluated with visual analog scale, Western Ontario and McMaster Osteoarthritis Index (WOMAC) values, goniometric measurement of active knee range of motion, 50-meter walking distance, and isokinetic knee extensor muscle peak torque measurements before treatment, at the end of treatment, and at one month and three months after treatment. RESULTS: There was a significant improvement in after treatment and first month visual analog scale values in the KT group compared to the sham-KT group (p<0.05). In the KT group, the WOMAC pain and WOMAC total scores decreased significantly after treatment compared to the sham-KT group (p<0.05). Visual analog scale values were significantly decreased after treatment in both groups (p<0.05). In both groups; WOMAC pain, stiffness, physical function, and total values decreased significantly after treatment (p<0.05). In both groups, isokinetic quadriceps peak torque measurements were increased after treatment (p<0.05). CONCLUSION: The application of KT to females with knee osteoarthritis appears to be a method that may be effective on pain and functional capacity.