Assessment of phonophoresis and iontophoresis in the treatment of carpal tunnel syndrome: a randomized controlled trial.

To define the role of phonophoresis and iontophoresis of corticosteroids in conjunction with wrist splint use in the treatment of carpal tunnel syndrome (CTS) compared to wrist splint use alone, 52 CTS subjects were analyzed based on clinical and electrophysiological criteria. A prospective, randomized controlled trial was carried out to assess symptom severity, motor skills, and hand function according to the Boston Symptom Severity Scale (BSSS), grip strength, and nine-hole peg test (NHPT), respectively, on the initial visit and in the 3rd month after treatment. The patients underwent conservative interventions randomly as follows: (1) 3 weeks of phonophoresis with betamethasone in conjunction with wrist splint use (group I, n: 18) or (2) 3 weeks of iontophoresis with betamethasone in conjunction with wrist splint use (group II, n: 16) or (3) wrist splint use alone (control, group III, n: 18). The mean age of the patients was 43.7 ± 8.4 (range 24-57) years. Groups I, II, and III showed a significant and further improvement in BSSS at the 3rd month evaluations compared with baseline (P < 0.001, P = 0.001, P < 0.001, respectively), but no significant change was observed in grip strength or NHPT (P > 0.05). There was a statistically significant difference between the phonophoresis and control groups after treatment only regarding BSSS, in favor of phonophoresis (P = 0.012). We recommend the use of wrist splints especially with phonophoresis for relief of symptoms in patients with CTS. Our results demonstrated no superiority among the treatment groups. Further, transdermal steroid treatments are not key determinants of efficacy with respect to motor skills and hand dexterity.

Articular damage in late rheumatoid arthritis.

This study aims to examine the long-term articular damage in rheumatoid arthritis (RA) patients according to rheumatoid arthritis articular damage (RAAD) score and to evaluate the parameters correlated with this score. The RAAD score was assessed in 85 RA patients who had the disease for more than 10 years. Patients were divided into three groups according to duration of the disease: group 1, 10-14 years; group 2, 15-19 years; and group 3, more than 20 years. Patients were also divided into three groups according to the time of initiation of treatment with disease-modifying antirheumatic drugs: group A, within the first 2 years, group B, between 2 and 5 years; and group C, after 5 years. We investigated the RAAD score relationship between groups 1, 2, 3; groups A, B, C; sex; drug compliance; age of onset of the disease; and Health Assessment Questionnaire (HAQ). We observed significant differences in RAAD scores according to groups 1, 2, 3 (p<0.01), but not to groups A, B, C; sex; or drug compliance (p>0.05). While the RAAD score correlated well with the HAQ (r=0.560, p<0.001), it did not correlate with the age at onset of the disease (p>0.05). As RA is not a benign disease and articular damage progresses over time, the goal of RA therapy must be to maintain a response before the onset of irreversible damage and loss of function.

Factors affecting drug treatment compliance in patients with rheumatoid arthritis.

We prospectively examined 100 rheumatoid arthritis (RA) patients to calculate drug compliance rates, characteristics of compliant and non-compliant patients, and changes in compliance over time. Three assessments were obtained over a one-year follow-up. Detailed drug history of RA and for concomitant disease was queried. Sedimentation rate, C-reactive protein, and rheumatoid factor values, Ritchie articular index, morning stiffness, and health assessment questionnaire were evaluated. Twenty-six patients (30.2%) were consistently compliant and 10 patients (11.6%) were consistently non-compliant. Older age was associated with a greater likelihood of compliance. Comparison of compliant and non-compliant groups revealed no statistically significant difference in distribution of gender, disease duration, and total number of pills taken for RA and/or total number of pills taken for any reason. In conclusion, compliance to drugs in RA patients is a common problem. Clinical and laboratory activity of RA had less influence on drug compliance. Older age is associated with a greater likelihood of compliance.

Functional disability in children with hemophilic arthropathy.

Hemophilia is a coagulation disorder characterized by acute hemorrhages into the musculoskeletal system, leading eventually to arthropathy and disability. We investigated the functional loss, namely disability, in hemophiliacs. The clinical and radiological characteristics of joint involvement were also evaluated. There were 31 patients between the ages of 3 and 18 years and 65 involved joints. The knees were the most commonly affected joints followed by the elbows and ankles. There was a positive correlation between the radiological and clinical evaluation scores; however, the clinical evaluation score did not correlate with age. The radiological score increased in conjunction with increasing age of the patients. We observed a significant relationship between the disability score and the clinical evaluation and radiological scores. These observations suggest that hemophilia is a life-long condition, with a high potential for functional disability if not promptly and adequately controlled. The main principle in the treatment of hemophilic arthropathy is the restoration of the patient's lifestyle and mobility with a comprehensive multidisciplinary approach.

Genital sympathetic skin responses in fibromyalgia syndrome.

The study was designed to investigate the autonomic dysfunction in fibromyalgia syndrome (FMS) by recording sympathetic skin response (SSR) from palmar, plantar and genital regions. The second aim was to evaluate the relation between sexual problems and autonomic dysfunction in FMS. SSR potential was recorded from palmar, plantar and genital regions in 28 married, female FMS patients and 18 married, healthy females. Fibromyalgia Impact Questionnaire (FIQ) was used to show the clinical severity and functional disability in FMS patients. Glombok Rust Inventory of Sexual Satisfaction (GRISS), a 28-item questionnaire, was used to assess the existence and severity of sexual problems. Beck test was used to evaluate anxiety and depression. The amplitude of SSR recorded from palmar, plantar and genital regions was lower than in the control subjects (P < 0.05). GRISS (total and subscale), Beck test and FIQ scores of FMS patients were higher than in the control subjects (P < 0.05). No correlation was found between the SSR potential and GRISS scores. The results of our study reveal that abnormality in SSR recorded from palmar, plantar and genital regions reflects the abnormality in the autonomic nervous system (ANS) of FMS patients. These patients have more sexual problems than healthy subjects, and we think this finding is related to increased anxiety and depression in these patients.