RESUMO
Osteoarthritis (OA) is a slow, chronic disease characterized by the focal deterioration and abrasion of articular cartilage. Leptin may play an important role in the pathophysiology of OA. Exercise and glucosamine sulfate therapy is one of the most commonly used in patients with knee OA. The goals of the present study are performed to investigate whether 12-week strength training program and glucosamine sulfate have an effect on serum leptin levels in knee OA and the relationship between leptin, clinical parameters, and radiographic severity of knee OA. Thirty-seven women with the diagnosis of knee OA were enrolled in the study. Patients were randomized into two groups. Group I (n = 19) received an exercise program, while group II (n = 18) received glucosamine sulfate (1,500 mg/day) in addition to the exercise therapy. Both groups were treated for 12 weeks. Leptin level was assessed at baseline and after 12 weeks. The concentration of leptin was measured by ELISA. The patients were evaluated regarding pain, disability, functional performance, and muscle strength. Both groups showed significant improvements in leptin levels, pain, disability, muscle strength, and functional performance with no statistically significant difference between the groups after the therapy. At basal time, plasma leptin levels were significantly correlated with body mass index and duration of disease, but no significant correlation was found with patient age, pain, disability, functional performance, muscle strength, and radiographic severity of knee OA. The results of this preliminary study revealed that exercise alone was adequate to prevent structural changes relieving the symptoms of OA. We also found that exercise alone could affect serum plasma levels of the leptin, important mediators of cartilage metabolism. Decreases in serum leptin may be one mechanism by which cartilage metabolism affects physical function and symptoms in OA patients.
Assuntos
Terapia por Exercício , Glucosamina/uso terapêutico , Leptina/sangue , Osteoartrite do Joelho/terapia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Força Muscular , Osteoartrite do Joelho/sangueRESUMO
The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P < 0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P > 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.
Assuntos
Depressão/etiologia , Diatermia/métodos , Micro-Ondas/uso terapêutico , Força Muscular , Qualidade de Vida , Síndrome de Colisão do Ombro/terapia , Articulação do Ombro/fisiopatologia , Dor de Ombro/terapia , Adulto , Idoso , Artrometria Articular , Fenômenos Biomecânicos , Distribuição de Qui-Quadrado , Terapia Combinada , Depressão/diagnóstico , Depressão/psicologia , Avaliação da Deficiência , Método Duplo-Cego , Terapia por Exercício , Feminino , Força da Mão , Humanos , Hipertermia Induzida , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Estudos Prospectivos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Síndrome de Colisão do Ombro/diagnóstico , Síndrome de Colisão do Ombro/fisiopatologia , Síndrome de Colisão do Ombro/psicologia , Dor de Ombro/diagnóstico , Dor de Ombro/fisiopatologia , Dor de Ombro/psicologia , Fatores de Tempo , Resultado do Tratamento , Turquia , Adulto JovemRESUMO
The aim of this trial is to investigate and compare the effects of electrical stimulation (ES) program and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 59 patients with definite CLBP were enrolled in this study. These patients were randomized into three groups. Group 1 (n = 20) was given an ES program and exercises. Group 2 (n = 19) was given an US treatment and exercises. Group 3 (n = 20) was accepted as the control group and was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The patients were evaluated according to pain, disability, walking performance, endurance, mobility, QOL, depression. The trunk muscle strength was measured with a hand-held dynamometer. All of the groups showed stastically significant improvements in pain, disability, muscle strength, endurance, walking performance, mobility, sub-scores of SF 36, and depression when compared with their initial status. The intergroup comparison showed significant difference in physical function, energy and social function sub-groups of SF-36, VAS pain, extensor muscle strength, between three groups. This difference was statistically significant in the groups 1 and 2 compared to the control group. There was also no significant difference between the groups 1 and 2. We observed that US treatment and ES treatment were effective in improving pain, isometric extensor muscle strength, and QOL in patients with CLBP.
Assuntos
Depressão/terapia , Terapia por Estimulação Elétrica/métodos , Transtornos Neurológicos da Marcha/terapia , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Debilidade Muscular/terapia , Terapia por Ultrassom/métodos , Atividades Cotidianas/psicologia , Adulto , Depressão/etiologia , Depressão/psicologia , Avaliação da Deficiência , Terapia por Estimulação Elétrica/estatística & dados numéricos , Tolerância ao Exercício/fisiologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Dor Lombar/complicações , Pessoa de Meia-Idade , Limitação da Mobilidade , Força Muscular/fisiologia , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Medição da Dor/métodos , Satisfação do Paciente , Qualidade de Vida/psicologia , Resultado do Tratamento , Terapia por Ultrassom/estatística & dados numéricosRESUMO
The aim of this trial was to investigate the effects of a 12-week home-based exercise program (HEP) on quality of life (QOL) and fatigue in patients with Ankylosing Spondylitis (AS). Forty-three patients with AS were included in this study. Group 1 was given a HEP; Group 2 served as the control group. The functional capacity (Bath Ankylosing Spondylitis Functional Index), disease activity (Bath Ankylosing Spondylitis Disease Assessment Index), fatigue (Multidimensional Assessment of Fatigue Scale), depression (Beck Depression Inventory scores), and QOL (Short Form 36) of all participants were evaluated. There were significant improvements for all the parameters in two groups after the treatment. The improvements for all the parameters were better in the exercise group than in the control group. Home-based exercise programs are very effective in improving QOL and reducing fatigue. Because of these advantages, HEP should be advised for the management program in AS in addition to medical treatments.
Assuntos
Depressão/reabilitação , Fadiga/reabilitação , Qualidade de Vida , Autocuidado , Espondilite Anquilosante/reabilitação , Adulto , Estudos de Casos e Controles , Exercício Físico , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Espondilite Anquilosante/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
The aim of this clinical trial was to evaluate the effects of electrical stimulation (ES) program on trunk muscle strength, functional performance, quality of life (QOL) in the patients with chronic low back pain (CLBP). A total of 41 patients with definite CLBP were included in this study. These patients were randomized into two groups. Group 1 (n = 21) was given an ES program and exercises. Group 2 (n = 20) was accepted as the control group and given only exercises. Both the programs were performed 3 days a week, for 8 weeks in the out-patient department. The patients were evaluated according to pain, disability, functional performance, endurance, quality of life, depression. The muscle strengths were measured with a hand-held dynamometer. There were significant improvements for all the parameters in two groups after the treatment. Except depression and social function, the improvements for all the parameters were better in the ES group than in the control group. We observed that ES program was very effective in improving QOL, functional performance and isometric strength. In conclusion, we can say that ES therapy provides comfortable life functions by improving muscle strength, functional performance and QOL.
Assuntos
Depressão/reabilitação , Terapia por Exercício/métodos , Dor Lombar/reabilitação , Força Muscular , Qualidade de Vida , Adulto , Doença Crônica , Estimulação Elétrica , Feminino , Humanos , Dor Lombar/fisiopatologia , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Pacientes Ambulatoriais , Medição da Dor , Resultado do TratamentoRESUMO
There are no specific diagnostic tests or a gold standard method for measuring disease activity and outcome in spondyloarthropathies (SpA). Many different methods have been developed to assess the signs and symptoms in SpA. The aim of this study was to evaluate the value of scintigraphy, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankilosing Spondylitis Disease Activity Index (BASDAI) in the evaluation of disease activity in early axial SpA diagnosed with magnetic resonance imaging (MRI). Thirty early MRI-positive axial SpA patients (23 males, 7 females) with a median age of 35 (18-55) years and a median duration of inflammatory low back pain of 24 (8-60) months were included in the study. In the patients with sacroiliitis, the sensitivity, specificity, and positive and negative predictive values of disease activity parameters were determined regarding MRI as the gold standard method. The sensitivities of quantitative scintigraphy, visual scintigraphy, ESR, CRP, and BASDAI were 32, 82, 35, 71, and 60%, respectively. The specificities of quantitative scintigraphy, ESR, CRP, and BASDAI were 100, 100, 50, and 100%, respectively. The positive predictive values of quantitative scintigraphy, visual scintigraphy, ESR, CRP, and BASDAI were 100, 92, 100, 95, and 100%, respectively. The negative predictive values of quantitative scintigraphy, ESR, CRP, and BASDAI were 9, 10, 11, and 15%, respectively. Regarding MRI as the gold standard in the evaluation of disease activity, combined visual and quantitative bone scintigraphy can be valuable in patients with MRI-incompatible implants. Additionally, use of cheaper, simple, and readily reproducible tests such as CRP and BASDAI together could be valuable and practical in detecting disease activity in long-term follow-up of these patients.
Assuntos
Imageamento por Ressonância Magnética , Espondiloartropatias/diagnóstico por imagem , Espondiloartropatias/patologia , Adolescente , Adulto , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Antígeno HLA-B27/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cintilografia , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Espondiloartropatias/sangueRESUMO
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.
RESUMO
The aim of this study was to evaluate the effects of electrical stimulation program on pain, disability, and quadriceps strength in the patients with knee osteoarthritis. Fifty women diagnosed as knee osteoarthritis were randomized into two groups as electrical stimulation and biofeedback-assisted isometric exercises. Both of the programs were performed 5 days a week, for a duration of 4 weeks. Outcome measures for pain were visual analogue scale pain score and Western Ontario McMaster osteoarthritis index (WOMAC) pain score. Disability and stiffness were assessed with WOMAC physical function and stiffness score. One repetition maximum (RM) and 10 RM were used for measuring quadriceps strength. In addition, 50 m walking time and 10 steps stairs climbing up-down time were evaluated. Both groups showed significant improvements in pain, physical function, and stiffness scores after the therapy. There were statistically significant improvements in 50 m walking time and 10 steps stairs climbing up-down time and 1 RM and 10 RM values indicating the improvement in muscle strength. In addition, there were no significant differences between the groups after the therapy. We conclude that electrical stimulation treatment was as effective as exercise in knee osteoarthritis and electrical stimulation treatment can be suggested especially for the patients who have difficulty in or contraindications to perform an exercise program.
Assuntos
Terapia por Estimulação Elétrica , Força Muscular/fisiologia , Osteoartrite do Joelho/terapia , Dor/fisiopatologia , Músculo Quadríceps/fisiologia , Adulto , Idoso , Biorretroalimentação Psicológica , Terapia por Exercício/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologiaRESUMO
The pathogenesis of Behçet's disease (BD) is not fully understood and immunological abnormalities and genetic factors have been investigated. Because serum concentrations of mainly T helper 1 (Th1) type cells have been reported to be increased in BD, we aimed to investigate whether certain cytokine polymorphisms might represent a risk factor for developing BD. We genotyped 80 patients with BD and 105 healthy controls for interleukin (IL)-1 alpha (T/C -889), IL-1 beta (C/T -511, T/C +3962), IL-1R (C/T pst11970), IL-1RA (T/C mspa111100), IL-2 (T/G -330), IL-12 (C/A -1188), interferon (IFN)-gamma (A/T UTR 5644), and TNF-alpha (G/A -238) polymorphisms. Analyses of cytokine polymorphisms were performed with PCR-SSP. The genotype and allele frequencies of the patients and controls were compared and the association between the polymorphisms of the cytokines with the clinical findings was investigated. Genotype distribution showed significant differences between the patients and the controls for the IL-1 alpha -889, IL-1 beta -511, IL-1 beta +3962, IL-1R, IL-12, IFN- gamma, and TNF-alpha cytokines. We didn't observe significant difference in genotypic frequencies of IL-1RA and IL-2 in our study. Comparison of the IL-1 alpha -889, IL 1 beta -511, and IL 1 beta +3962 genotype frequencies showed significant increase in CC genotype between the patients and the controls. The individuals with IL-1R TT polymorphism had a higher risk for BD compared to patients with CT/CC polymorphism. Comparison of IL-12, IFN- gamma, and TNF-alpha, genotype frequencies showed significant increase in CA, AA, and AA genotypes between the patients and controls, respectively. The frequencies of genotypes according to the clinical features of the patients with BD did not show a significant difference (p>0.05). Our study suggests that development of BD might be determined by various cytokine gene polymorphisms. However, further studies on larger numbers of cases are needed before definite conclusions can be drawn.
Assuntos
Síndrome de Behçet/genética , Citocinas/genética , Polimorfismo de Nucleotídeo Único/genética , Adulto , Síndrome de Behçet/imunologia , Estudos de Casos e Controles , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Linfócitos T Auxiliares-Indutores/imunologiaRESUMO
Bladder exstrophy patients with or without augmentation have not been investigated according to metabolic bone problems, bone ages and growth, and development in details yet. We studied alterations in growth, bone ages, biochemistry of bone, bone mineral densities (BMD) of the forearm, neck of femur and lumbar vertebrae, blood gases, glomerular filtration rates (GFR), and electrolytes of 15 bladder exstrophy patients with augmentation and in those who had no augmentation. In six patients, a sigmoid colon was used for bladder augmentation and one patient underwent a ureterosigmoidostomy. Growth charts of all children were analyzed for determination of the percentiles. The parameters were compared with normal children and a comparison between augmented and nonaugmented patients were made. Growth retardation and decreased bone age were detected in all of the children. Ten patients with bladder exstrophy were below the 10th percentile for height. The mean age/bone age ratio of the patients was 1.59. The mean lumbar and femoral Z scores of the patients were -1.00 and -0.49, respectively. Mean BMD for distal radius was 0.239 g/cm2. Seven patients had a marked BMD decrease, their femoral and/or lumbar Z scores were below -1. Four cases had a pH lower than 7.35. In five patients, a HCO3 level less than 19 mmol/l was detected, four of them had an augmentation. Chloride measurements were slightly increased in six patients and alkaline phosphatase levels in five cases. Reduced GFR values were detected in two patients. There were no significant difference in laboratory values, in percentile height, and weights, in BMDs of femur, vertebra, forearm nor were any differences noted in age/bone age ratios in patients with augmentation when compared with those who had no augmentation. We found varying alteration in bone mineral density and HCO3 levels in patients with bladder exstrophy. Patients with bladder exstrophy, with or without augmentation, may develop serious growth retardation. As much as 45% of them, regardless of presence of augmentation, have an osteopenia or osteoporosis. We found a considerable difference in percentiles of heights as well as bone ages in bladder exstrophy patients when compared with normal population. We recommend close follow up of children with bladder exstrophy for linear growth, development of osteopenia, and bone ages.
Assuntos
Determinação da Idade pelo Esqueleto , Extrofia Vesical/fisiopatologia , Densidade Óssea , Desenvolvimento Ósseo , Osso e Ossos/metabolismo , Adolescente , Ácido Carbônico/metabolismo , Criança , Pré-Escolar , Feminino , Taxa de Filtração Glomerular , Humanos , Concentração de Íons de Hidrogênio , MasculinoRESUMO
It is well-known that local and systemic side effects due to intralesional corticosteroid injections are common. We report the case of a 28-year-old woman with cutaneous linear atrophy along the abductor pollicis longus tendon, which appeared after an injection of intralesional corticosteroid in the treatment of de Quervain tendonitis.
Assuntos
Glucocorticoides/efeitos adversos , Dermatopatias/induzido quimicamente , Dermatopatias/diagnóstico , Tendinopatia/tratamento farmacológico , Triancinolona/efeitos adversos , Adulto , Braço , Atrofia , Diagnóstico Diferencial , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intralesionais , Pele/patologia , Triancinolona/administração & dosagemRESUMO
INTRODUCTION: The aim of this study was to determine coping with stress and body image in patients with ankylosing spondylitis (AS) and to investigate the correlation between these two characteristics together and also between them and disease activity/functional capacity. METHOD: Fourty healthy controls and 40 patients with AS who were diagnosed on the basis of Modified New York Criteria were included in the study. The exclusion criteria were another medical disease or comorbid psychiatric disorder. All participants were administered the Coping Orientations to Problems Experienced (COPE) questionnaire in order to evaluate attitudes to coping with stress and the Multidimensional Body-Self Relations Questionnaire (MBSRQ) to evaluate body image. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were used to evaluate AS patients' disease activities and functional capacities. RESULTS: There was no difference between the two groups in terms of COPE scores. The MBSRQ 'health evaluation' subscale scores were lower and the 'fitness orientation' scores higher in the AS group. The COPE active coping subscale had a weak, positive correlation with MBSRQ total score and a weak, negative correlation with BASFI score. MBRSQ total score had a moderate, negative correlation with BASFI score, and a weak, negative correlation with BASDAI score. CONCLUSION: The attitudes to coping with stress in AS patients with no accompanying medical disease or psychiatric disorder may not differ from that in healthy controls. Negative health evaluation and fitness orientation must be characteristics considered in psychotherapeutic interventions applied to these patients. In addition, psychotherapeutic interventions directed toward coping with stress and body image may be especially useful in active stages of the disease and in patients with limited functional capacity.
RESUMO
INTRODUCTION: Osteoarthritis (OA) is a chronic disease characterized by the focal deterioration and abrasion of articular cartilage. The goals of therapy are preserving normal joint function, relieving pain and improving quality of life (QOL). This study is performed to investigate whether glocosamine sulfate and exercise could both delay joint structure degradation evaluated with magnetic resonance imaging (MRI) and improve symptoms in a short time period. MATERIALS AND METHODS: Thirty-nine women with the diagnosis of knee OA were enrolled in the study. Patients were randomized into two groups. Group I (n=20) received an exercise program, while group II (n=19) received glucosamin sulphate (1500 mg/day) in addition to the exercise therapy. Both groups were treated for 12 weeks. The patients were evaluated before and after the treatment regarding pain, disability, functional performance, muscle strength, QOL, depression and MRI findings (cartilage volume, medial and lateral cartilage thickness). RESULTS: Both groups showed significant improvements in pain, disability, functional performance, QOL and depression with no statistically significant difference between the groups after the therapy. While there were significant improvements for all MRI parameters expect right knee cartilage volume and lateral cartilage thickness in two groups, statistically significant differences could not be demonstrated between the groups after the therapy. CONCLUSION: We found no additional effect of glucosamine in delaying the radiological progression and relieving the symptoms of OA. We also demonstrated that exercise alone was adequate to prevent structural changes and cartilage loss of the knee joint as assessed by MRI.
Assuntos
Cartilagem Articular/patologia , Terapia por Exercício , Glucosamina/uso terapêutico , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética , Osteoartrite do Joelho/terapia , Artralgia/patologia , Artralgia/fisiopatologia , Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/fisiopatologia , Terapia Combinada , Depressão/epidemiologia , Feminino , Glucosamina/farmacologia , Humanos , Incidência , Articulação do Joelho/efeitos dos fármacos , Articulação do Joelho/fisiopatologia , Pessoa de Meia-Idade , Força Muscular/efeitos dos fármacos , Força Muscular/fisiologia , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/fisiopatologia , Qualidade de Vida/psicologia , Amplitude de Movimento Articular/efeitos dos fármacos , Amplitude de Movimento Articular/fisiologia , Resultado do TratamentoRESUMO
AIM: The aim of this trial was to evaluate the short-term effectiveness of ultrasound (US) therapy on pain, physical function, ambulation activity, disability and psychological status in patients with knee OA. METHODS: Forty-two inpatients with bilateral knee OA were randomized by an independent researcher not involved in the data assessment, to receive either therapeutic continuous US (group 1) or sham US (group 2). A 1-MHz US head was used, set to an intensity of 1 W/cm(2) for 10 min. All patients received 20 min of hot packs, 10 min of interferential current, and 15 min of quadriceps isometric exercise of both knees. Patients in each group received treatments five times weekly for 3 weeks. Patients were evaluated at baseline and at the end of the treatment sessions. Outcome measures included visual analogue scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 50-m walking speed, Lequesne index, Hospital Anxiety and Depression Scale (HADS). RESULTS: The patients with knee OA had significant improvements in pain, stiffness, functional activity, walking time, disability, depression and anxiety scores with therapeutic US and sham US (P < 0.05). The improvement in pain VAS scores, WOMAC scores, Lequesne index and HADS scores were not significantly different in patients treated with US and sham US (P > 0.05). No side-effects were reported during or after the US treatment periods. CONCLUSION: US therapy is safe but use of US in addition to conventional physical therapy programs seems to have no further significant effect in people with knee OA.
Assuntos
Terapia por Exercício , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/terapia , Terapia por Ultrassom/métodos , Ansiedade , Depressão , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Nível de Saúde , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/reabilitação , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Recuperação de Função Fisiológica , Fatores de Tempo , Ultrassonografia , CaminhadaRESUMO
We proposed to assess serum antioxidant vitamins and magnesium (Mg) levels in patients with fibromyalgia (FM) in comparison to healthy controls. Additionally, the association between the serum antioxidant vitamins, magnesium levels, and clinical parameters in FM patients was also investigated. Forty female patients, aged between 30 and 50 years, were diagnosed with FM according to ACR-1990 criteria, and 40 healthy controls were included in the present study. Socio-demographic characteristics of participants, accompanying symptoms, and number of tender points (TP) of the patients were recorded. The intensity of pain was measured using the visual analogue scale (VAS). The functional status and depression levels were evaluated with Fibromyalgia Impact Questionnaire (FIQ) and Beck Depression Inventory (BDI), respectively. Serum vitamins A, C, and E and Mg levels were measured. There were no significant differences in the levels of vitamins A, C, and E and Mg between control subjects and patients with fibromyalgia (p > 0.05). In addition, no statistically significant correlations were found between mean levels of serum vitamins A, C, and E, and Mg and number of TP, scores of VAS, FIQ, and BDI in patients with FM (p > 0.05). According to the results of this study, it was asserted that other complex mechanism may play an important role in the pathophysiology of FM without plasma antioxidant vitamins and Mg levels.
Assuntos
Antioxidantes/análise , Fibromialgia/sangue , Magnésio/sangue , Vitaminas/sangue , Atividades Cotidianas , Adulto , Feminino , Fibromialgia/complicações , Fibromialgia/fisiopatologia , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Dor/complicações , Dor/fisiopatologia , Medição da Dor , Pré-Menopausa/fisiologia , Índice de Gravidade de DoençaRESUMO
Bone mineral density (BMD) is affected in young adults with multiple sclerosis (MS), which leads to disabling disease. We aimed to show changes that were independent of immobilization by measuring BMD and laboratory markers of bone metabolism in mobile MS patients. We compared a total of 52 premenopausal female patients with relapsing-remitting multiple sclerosis (RRMS) to 41 women of similar age who had no risk factors for osteoporosis. The lumbar and femur BMD were measured using the dual energy X-ray absorptiometry (DXA) method. The urine concentration of serum 25-hydroxycholecalciferol (25-OH vit D(3)), and pyridinoline and deoxypyridinoline were also measured. The concentration of serum osteocalcin was measured to determine the speed of bone metabolism. The mean age of patients (+/- standard deviation [SD]) was 36.1+/-7.4. The average Expanded Disability Status Scale (EDSS) score was 2.2+/-1.8. The concentration of 25-OH vit D(3) and osteocalcin was lower, whereas the concentration of parathyroid hormone (PTH), alkaline phosphatase (ALP), pyridinoline and deoxypyridinoline was higher in the patient group. In the patient group, lumbar 2-4 BMD, T score and Z score and femur neck and trochantor BMD, T score and Z score were significantly lower than in the control group. There was a significant negative relationship between: the disease period and L 2-4 BMD, T score and Z scores; and the femoral neck BMD, T score and Z scores. There was a significant relationship between the total Functional Independence Measure score and the femoral neck, femoral trochanter BMD, T score, and Z score. There was a significant negative relationship between the average EDSS, L 2-4 and all the DXA measurements obtained from the femur. There was a significant relationship between the 25-OH vit D(3) concentration and L 2-4 T score and Z score from the DXA measurements obtained from the femur. There were no significant relationships between osteocalcin, pyridinoline, deoxypyridinoline levels and the BMD measurements. Therefore, the duration of the disease and decrease in functional capacity are the main factors that affect BMD in MS. Apart from the decrease in functional capacity, 25-OH vit D(3) deficiency and secondary PTH increase contribute to the BDM changes observed in MS.
Assuntos
Densidade Óssea/fisiologia , Osso e Ossos/metabolismo , Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Absorciometria de Fóton/métodos , Adulto , Fosfatase Alcalina/sangue , Fosfatase Alcalina/urina , Aminoácidos/sangue , Aminoácidos/urina , Calcifediol/sangue , Calcifediol/urina , Avaliação da Deficiência , Feminino , Humanos , Pessoa de Meia-Idade , Esclerose Múltipla/sangue , Esclerose Múltipla/urina , Osteocalcina/sangue , Osteocalcina/urina , Osteoporose Pós-Menopausa/etiologia , Pré-MenopausaRESUMO
OBJECTIVES: The aims of this study were to electrophysiologically evaluate polyneuropathy in rheumatoid arthritis (RA) patients and to examine the relationships among polyneuropathy and demographic, clinical and laboratory findings. PATIENTS AND METHODS: Sixty consecutive patients (51 women and nine men) with a clinical diagnosis of RA were examined electrophysiologically for the evidence of polyneuropathy. Parameters including age, gender, subcutaneous nodules, erosions, joint deformities, laboratory parameters, duration of RA, as well as dose, duration and type of disease modifying anti-rheumatic drug (DMARD) and steroid usage were recorded. RA activity was assessed using a 28-joint disease activity score (DAS28). The functional status of patients was measured using the health assessment questionnaire (HAQ). The symptoms and signs of polyneuropathy were quantified using the neuropathy symptoms score (NSS) and the neuropathy disability score (NDS), respectively. RESULTS: Ten patients (17%, eight women and two men) had polyneuropathic involvement as defined by nerve conduction studies (NCS). Two patients had mild symmetric sensory neuropathy and eight patients had mild symmetric sensorimotor axonal polyneuropathy. There was no significant difference in age, gender, subcutaneous nodules, erosions, joint deformities, rheumatoid factor, as well as dose, duration and type of DMARD and steroid therapy administered. We found a significant relationship among polyneuropathy and duration of RA, DAS28, HAQ, as well as abnormal NSS and NDS values. The durations of RA and DAS28 were also associated with a four- and three-fold increase in the risk of polyneuropathy, respectively. CONCLUSION: Mild symmetric sensory or sensorimotor axonal polyneuropathies are common in RA patients and it is difficult to distinguish the symptoms of polyneuropathy from those of arthritis. An electrophysiological examination should be routinely carried out especially when patients have had a long disease duration and high scores for DAS28, HAQ, NSS and NDS.
Assuntos
Artrite Reumatoide/complicações , Polineuropatias/complicações , Polineuropatias/diagnóstico , Atividades Cotidianas , Adulto , Artrite Reumatoide/fisiopatologia , Avaliação da Deficiência , Eletrodiagnóstico , Feminino , Nível de Saúde , Humanos , Articulações/fisiopatologia , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Polineuropatias/fisiopatologia , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Cytokine genes play important roles in the pathogenesis of rheumatoid arthritis (RA). In RA, the plasma and synovial fluid levels of transforming growth factor beta1 (TGFbeta1) have been shown to be raised. The aim of this study was to investigate the relationship between the TGFbeta1 T869C polymorphism and RA in a Turkish population. METHODS: One hundred and thirty-one patients with a clinical diagnosis of RA and 133 healthy controls were enrolled in this study. Analyses of TGFbeta1 T869C gene were made by the polymerase chain reaction-restriction fragment length polymorphism technique. RESULTS: There was no significant difference in genotypic frequency of TGFbeta1 T869C polymorphism between the patients with RA (TT:TC:CC=42.7%:41.2%:16%) and controls (TT:TC:CC=36.1%:48.1%:15.8%) (p=0.48). The age at first occurrence of clinical symptoms of RA did not differ significantly in relation to TGFbeta1 T869C genotypes (p=0.07). Furthermore, there was no significant association between TGFbeta1 T869C genotypes and the presence or absence of radiographic erosions in the patient group (p=0.67). But presence of T allele was associated with 1.92-fold increased risk for RF positivity (p=0.02, OR=1.92, 95% CI=1.08-3.40). CONCLUSION: The allele frequencies for TGFbeta1 T869C polymorphism in RA patients were similar to those in the control group. However, the T allele carriers had 1.92-fold increased risk for RF positivity. Further studies on larger numbers of cases and on the other polymorphic regions of this gene are needed before definite conclusions can be drawn about the role of TGFbeta1 in the etiology of RA.
Assuntos
Artrite Reumatoide/genética , Predisposição Genética para Doença , Polimorfismo de Fragmento de Restrição , Fator de Crescimento Transformador beta1/genética , Artrite Reumatoide/metabolismo , Artrite Reumatoide/fisiopatologia , Sedimentação Sanguínea , Proteína C-Reativa/análise , DNA/análise , Feminino , Frequência do Gene , Genótipo , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fator Reumatoide/sangue , Índice de Gravidade de Doença , TurquiaRESUMO
OBJECTIVE: The aim of the present study was to investigate the prevalence of MEFV gene mutations in patients with ankylosing spondylitis (AS) and to assess the clinical significance of the MEFV gene mutations in AS. METHODS: Eighty AS patients and 85 healthy controls were examined for 12 common MEFV mutations via strip-assay technique. Bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis functional index (BASFI), visual analogue scale (VAS) for pain, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Schober test, chest expansion measurements, hip involvement, ocular involvement, articular pain, and presence of syndesmophytes were used to assess the disease severity in patients. RESULTS: Twenty-four of the AS patients (30%) and 17 of the healthy controls (20%) were found to carry a single MEFV mutation. There was no significant difference between the AS patients and controls in terms of MEFV gene mutation frequency (p = 0.13, OR: 1.71, 95% CI: 0.83-3.50). When the patients were divided into two groups as MEFV mutation carriers and noncarriers, there was significant difference between the groups regarding BASFI and BASDAI whereas there was no significant difference in VAS score for pain. No association was found with the clinical findings and MEFV mutation except hip involvement. While there was no significant difference in CRP levels, individuals with MEFV mutation had a higher ESR than the noncarriers. CONCLUSION: MEFV gene mutation carriage rate was not found to be significantly higher in AS patients when compared with healthy controls. However having an MEFV mutation seems to aggravate the disease course in AS.
Assuntos
Proteínas do Citoesqueleto/genética , Predisposição Genética para Doença , Mutação/genética , Espondilite Anquilosante/genética , Adulto , Antígeno HLA-B27/imunologia , Nível de Saúde , Humanos , Razão de Chances , Dor/fisiopatologia , Medição da Dor , Pirina , Índice de Gravidade de Doença , Espondilite Anquilosante/imunologia , Espondilite Anquilosante/fisiopatologiaRESUMO
OBJECTIVE: The aim of this study was to evaluate the impact of two different home-based daily exercise programs on pulmonary functions in the patients with ankylosing spondylitis (AS). METHODS: Fifty-one patients with AS were distributed into three groups. Group 1 (n=19) was given a conventional exercise regimen. Group 2 (n=19) received exercises based on the Global Posture Reeducation (GPR) method. Group 3 (n=13) was accepted as the control group. Patients were assessed according to pain, functional capacity (The Bath Ankylosing Spondylitis Functional Index - BASFI), disease activity (The Bath Ankylosing Spondylitis Disease Activity Index - BASDAI), chest expansion, pulmonary function parameters, and 6-min walk distance (6MWD) test. RESULTS: Although there were significant improvements for BASDAI and BASFI scores in all groups, significant improvements in the VAS pain, chest expansion, pulmonary function parameters and 6MWD test were observed in the exercise groups. The improvements in pain, functional capacity, disease activity, chest expansion, pulmonary function parameters and 6MWD test were better in the exercise groups than in the control group. The GPR method resulted in greater improvements than the conventional exercise program in specific pulmonary function parameters like forced vital capacity, forced expiratory volume in 1s, and peak expiratory flow parameters. CONCLUSION: Both exercises are efficient in improving pulmonary functions. Since the improvements in pulmonary function tests were greater in the patients who performed the exercise according to GPR method, motivated patients should be encouraged to perform this exercise program.