Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study.

[Purpose] The purpose of this study is to compare effectiveness of extracorporeal shock wave therapy (ESWT), ultrasound (US) and sham ESWT in the treatment of myofascial pain syndrome (MPS). [Subjects and Methods] Sixty MPS patients aged 18-60 years were included in the study. The patients were randomized equally into 3 groups. Group 1 received ESWT for 4 session with 3 day-intervals. Group 2 received 4 sessions of sham ESWT. US was applied to Group 3 for 10 sessions. All patients were recommended an exercise program. The patients were evaluated before-post and 6 weeks after treatment. Measurements were made using pressure pain threshold (PPT), pain score (PS) and visual analogue scale (VAS). Patients were evaluated by using SF-36 and HADS (hospital anxiety and depression scale). [Results] A significant posttreatment difference was found in VAS, PPT and SF-36 subparameters in group 1. In group 2, a significant difference was not found in any parameter. In group 3, a significant difference was detected in parameters of VAS and PPT. A significant difference was found between groups 1 and 2 as for subtitles of PPT, VAS, SF-36. [Conclusion] These results suggest that ESWT is as effective as US. ESWT and US are significantly more effective than sham ESWT.

Lipocalin 2 as a clinical significance in rheumatoid arthritis.

AIM OF THE STUDY: In this study, serum lipokalin 2 (LCN-2) levels and its clinical and radiological significance in patients with rheumatoid arthritis was evaluated. MATERIAL AND METHODS: The study enrolled 37 patients with RA and 34 healthy controls. Serum LCN-2 level was measured using ELISA method. Patients with DAS 28 scores ≤ 3.2, and > 3.2 were allocated into lower and high/moderate disease activity groups, respectively. Additionally patients were divided into 2 groups as early RA (disease duration ≤ 2 years) and established RA (duration of the disease ≥ 2 years). Functional disability was evaluated using Health Assessment Questionnaire (HAQ). Radiographs were scored using the modified Larsen score. RESULTS: Serum LCN-2 (p = 0.029) levels were significantly higher in patients with RA than in the controls. Serum LCN-2 level did not correlate with laboratory and clinical parameters of disease activity like erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), DAS 28, Health Assessment Questionnaire Score (HAQ) and Nottingham Health Profile (NHP). Similarly, any correlation could not be found between structural joint damage and serum LCN2 levels. CONCLUSIONS: These results indicate that serum LCN-2 levels may be used as an indicator for structural damage like erosions in the early stage of the disease but do not able to be used to monitor disease activity.

Prevalence of atopic disorders in rheumatic diseases.

OBJECTIVES: The aim of this study was to assess the point prevalences of hay fever, asthma, and atopic dermatitis in OA, RA, and AS, and to compare with healthy controls. METHODS: A total of 935 patients and healthy controls were included. Demographic and clinical features were recorded, and a questionnaire assessing the existence of atopic disorders like asthma, hay fever, and atopic dermatitis in all groups was applied. "Either atopy" implied that an individual was either diagnosed with or had symptoms of one or more of these disorders, such as asthma, hay fever, or atopic dermatitis. RESULTS: When compared to the controls, only patients with AS had an increased risk for hay fever (OR 1.52, 95 % CI 1.00-2.41). Patients with RA had increased risks for hay fever, atopic dermatitis, and either atopy compared to the patients with OA (2.14, 95 % CI 1.18-3.89; 1.77, 95 % CI 1.00-3.18; and 3.45, 95 % CI 1.10-10.87, respectively). Steroid use had no effect on the prevalence of atopic disorders in patients with RA. CONCLUSIONS: Patients with OA, RA, and AS seem to have similar risks for asthma, atopic dermatitis, and either atopy to healthy controls. However, the prevalence of hay fever may increase in AS. Patients with RA have a higher risk of atopy than patients with OA.

Effects of cypermethrin on Allium cepa.

In this study, toxic effects of the cypermethrin in Allium cepa L. cells were investigated. For this aim, we investigated the changes in pigment contents, antioxidant enzymes, mitotic index and chromosomal abnormalities as indicators of toxicity. The seeds were treated with different doses (1.5, 3.0, 6.0 ppm) of cypermethrin for 72 h. The result showed that there was a significant alteration in the tested parameters depending on treatment dose in the seeds exposed to cypermethrin when compared to the control group. Cypermethrin exposure significantly reduced the carotenoid, chlorophyll a and b pigments in all treatment groups. The activity of superoxide dismutase showed a concentration-time dependent increase and the maximum increase was observed on day 15 of treatment at 6.0 ppm cypermethrin exposure. The activity of catalase increased gradually with increasing cypermethrin concentration, but a soft decrease in CAT activity was decreased after 15 days of 1.5 ppm and 3.0 ppm cypermethrin treatment. In the roots treated with 1.5, 3.0, and 6.0 ppm cypermethrin, the level of malondialdehyde was about 1.8, 2.4, and 3.4 times higher than the control group, respectively. It was also found that cypermethrin has a mitodepressive action on mitosis, and the MI was decreased depending on the dose of cyprmethrin. All of the concentrations of cypermethrin induced chromosomal abnormalities and the most common abnormality observed in the present study was chromosome bridges.

Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis.

Our aim in this study was to compare the depression and anxiety risk in patients with AS and healthy controls and also to determine the relationship between disease activity, quality of life and psychological well-being. Two hundred and forty-three patients with ankylosing spondylitis (AS) and 118 age-, sex- and education-matched healthy controls were enroled into the study. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Functional Index, and Metrology Index, Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), Hospital Anxiety and Depression Scale (HADS) including depression subscale (HADS-D) and anxiety subscale (HADS-A), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, duration of morning stiffness, pain-visual analogue scale (VAS), patient and physician's global assessment of disease activity (100 mm VAS) were used to assess clinical and psychological status. Patients had similar HADS-D but higher HADS-A than healthy controls. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI and also poorer scores in VAS pain, patient global assessment, physician global assessment, HAQ-S and ASQoL. There was a negative correlation of HADS-D and HADS-A scores with educational level of the patients. Higher scores in HADS-D and HADS-A indicated poorer functional outcome and quality of life. Multivariate logistic regression analysis revealed that the HADS-D (OR=6.84), HAQ-S (OR=1.76), VAS pain score (OR=1.03) and ESR (OR=1.02) were independent risk factors for higher anxiety scores whereas HADS-A (OR=1.36) and ASQoL (OR=1.24) were independent risk factors for higher depression scores. The psychological status had close interaction with disease activity and quality of life in patients with AS.

Comparison of low power laser and kinesio taping for the treatment of carpal tunnel syndrome: A prospective randomized study.

BACKGROUND: Although carpal tunnel syndrome (CTS) is a common neuromuscular disorder, studies on its conservative treatment are inadequate and contradictory. OBJECTIVES: This study aimed to investigate and compare the effectiveness of low power laser therapy (LPLT) and Kinesio taping (KT) for the treatment of CTS. METHODS: Sixty patients with CTS were included in this study. One group received 15 sessions of KT, and the second group underwent 15 sessions of LPLT within three weeks. All patients were assessed with hand grip strength (HGS), Visual Analogue Scale (VAS)-pain, Douleur Neuropathique-4 (DN4) score, Boston Questionnaire (BQ), and electroneuromyography before and after treatment. RESULTS: Before treatment, all clinical and neurophysiological parameters were similar between the groups. After treatment, both groups significantly improved in terms of HGS, VAS-pain, DN4, and BQ. However, the LPLT group had significantly better HGS, VAS-pain, DN4, and BQ than the KT group. In addition, while median nerve motor distal latency and median nerve sensory conduction velocity improved significantly with treatment in both groups, the LPLT group's improvement was significantly better than that of the KT group. CONCLUSIONS: In patients with CTS, both LPLT and KT were effective treatments. However, the LPLT group had significantly better improvements than the KT group.

The Evaluation of Radiologic Angular Measurements in Patients with Foot Pain.

BACKGROUND: The aim of this study was to investigate the relationship between foot deformities by comparing foot radiographs of patients with complaints of foot pain with those of healthy individuals. METHODS: The study included 30 patients with pes cavus, 30 patients with pes planus, 30 patients with calcaneal spur, and 30 controls aged 30 to 60 years. All participants underwent measurement of right and left foot length; metatarsophalangeal width; and calcaneal pitch (CA), talohorizontal (TA), talometatarsal (TM), and lateral talocalcaneal (LTC) angles from lateral radiographs. RESULTS: There were no statistically significant differences between all participants regarding sex, age, weight, and body mass index (P > .05). Among patients with clinically diagnosed pes cavus, the diagnostic rate of CA was 100% in both feet, and 83.3% in the right foot and 96.7% in the left foot according to the TM angle. The diagnostic rates of angular measurements in patients with pes planus were as follows: 20% in the right foot and 30% in the left foot depending on the CA angle, 100% in both feet depending on the TM angle, and 66.7% in the right foot and 46.7% in the left foot depending on the LTC angle. A very strong positive correlation was found between the CA and LTC angles in patients with calcaneal spur and pes planus (P < .001); also, statistically significant positive correlation was found between the CA and TA angles (P < .05). The angular measurements in patients with calcaneal spur were found to be consistent with pes planus with a high rate. CONCLUSIONS: Angular changes caused by deterioration of foot biomechanics lead to various deformities. Pes planus ranks first among these. Therefore, we believe that radiographic angular measurements in patients presenting with foot pain in addition to clinical evaluation would be useful in considering associated deformities and planning treatments.

Bone loss in ankylosing spondylitis: does syndesmophyte formation have an influence on bone density changes?

OBJECTIVE: The aim of this study was to assess bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) in a group of patients with ankylosing spondylitis (AS) and the factors which have an impact on bone mass. Also, a subgroup of patients not treated with anti-osteoporotic or disease-modifying anti-rheumatic drugs was followed for 24 months to assess potential influencing factors on BMD changes. SUBJECTS AND METHODS: Fifty-five patients (42 males, 13 females) with AS were enrolled in the study. Clinical examinations were performed. BMD was measured using DXA at lumbar spine (L2-L4) and proximal femur (femur neck BMD and total femur BMD). Lumbar spine radiographs were scored using the Stoke Ankylosing Spondylitis Spine Score (SASSS). Twenty-one of 55 patients who completed 24 months of follow-up without using the aforementioned medications were reassessed. RESULTS: Active patients (Bath Ankylosing Spondylitis Disease Activity Index >4, n = 22) had significantly lower femur neck and total BMD compared to inactive patients (n = 33), whereas spinal BMD was not different. Follow-up data revealed a 3.4% increase in spinal BMD but 0.9% and 0.25% decreases in femur neck BMD and total femur BMD, respectively. Percent changes in BMD measurements and SASSS scores were not significantly different between active (n = 10) and inactive (n = 11) patients. CONCLUSION: Significant increase in spinal BMD in parallel with increased SASSS revealed that spinal involvement prominent with new bone formation, sclerosis and syndesmophytes may influence spinal BMD measurements using DXA methods in AS. Proximal femur measurements seem to be less affected from disease-related new bone formation.

Direct current therapy with/without lidocaine iontophoresis in myofascial pain syndrome.

OBJECTIVES: This study aimed to assess the effectiveness of lidocaine iontophoresis for inactivation of trigger points (TrPs) in the treatment of myofascial pain syndrome (MPS). METHODS: Fifty-eight trigger points (cervical and/or periscapular regions) in 18 female and 2 male patients with MPS were randomly assigned to two groups. These groups were treated with: lidocaine iontophoresis using direct current (3 mA, 10 min) (n: 10, 28 TrPs) or only direct current (n: 10, 30 TrPs). Lidocaine iontophoresis or direct current, followed by stretching and strengthening exercises of each of the involved muscles and postural exercises were given in both groups once daily for ten days. Clinical assessment including cervical range of motion (ROM), TrP pain pressure threshold (PPT) measurement, and manual pain scores (PS), Visual analogue scale-pain (VAS-pain), fatigue and work disability scores were evaluated at baseline, at the end of a 10 session course of treatment and at the end of fourth week. Additionally, Hamilton depression and anxiety rating scales and Nottingham Health Profile (NHP) were used to evaluate and assess depression and anxiety and quality of life, respectively. The subjects were also asked to describe their side effects. RESULTS: PPT, pain scores, VAS-pain were significantly improved in both groups at the end of treatment and during evaluation at fourth week. The improvement of these parameters was not significantly different between groups at the end of treatment. Quality of life (NHP scores) (p<0.016) and depression and anxiety scores (p<0.05) significantly improved with treatment in both groups. CONCLUSION: Direct current therapy with/without lidocaine iontophoresis were determined to be effective treatment modalities in TrP management. These treatment modalities are non-invasive, cost effective and provide long term improvement. Thus, these modalities could be safely used in the management of MPS with minimal side effects, particularly if patients may not accept injection or other treatments (Tab. 3, Ref. 44). Full Text (Free, PDF) www.bmj.sk.

Matrix metalloproteinase-3 levels in relation to disease activity and radiological progression in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory and systemic disease of unknown etiology that primarily affects synovial joints and involves progressive destruction around the joints. Inflammation starting in the joint synovium causes the destruction of cartilage, bone and other adjacent tissues with pannus formation. OBJECTIVES: The aim of this study was to evaluate serum matrix metalloproteinase-3 (MMP-3) levels and their clinical and radiological significance in patients with rheumatoid arthritis. MATERIAL AND METHODS: The study included 59 patients with RA and 30 healthy controls. Serum MMP-3 levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Patients with a Disease Activity Score 28 (DAS28) ≤3.2 were categorized as having lower disease activity, while a DAS28 score >3.2 indicated patients with moderate/high disease activity. Additionally, the patients were divided into 2 groups in terms of disease duration: early RA (disease duration ≤2 years) and established RA (disease duration ≥2 years). Functional disability was evaluated using the Health Assessment Questionnaire (HAQ) and Nottingham Health Profile (NHP). Radiographs were scored using modified Larsen scoring. RESULTS: Serum MMP-3 levels in patients with RA were significantly higher than in controls (p = 0.001). Serum MMP-3 levels were correlated with laboratory and clinical parameters of disease activity, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), DAS28, and HAQ score; the exceptions were rheumatoid factor (RF) and cyclic citrullinated peptides (CCP). The serum MMP-3 levels of RA patients with moderate/high disease activity were found to be significantly higher than those of the patients with low disease activity (p < 0.001). However, MMP-3 levels were found to be similar in both established and early RA patients (p = 0.927). Additionally, the modified Larsen scores, which indicate structural damage, correlated significantly with serum MMP-3 levels (p = 0.001). CONCLUSIONS: These results indicate that serum MMP-3 levels may be used as an indicator for structural damage such as erosions in the early stages of the disease, and to monitor disease activity.

Association of the Commitments and Responsibilities of the Caregiver Within the Family to the Disease Activity in Patients With Rheumatoid Arthritis: A Report From Turkey.

OBJECTIVES: This study aims to investigate the commitments and responsibilities of the family caregiver of rheumatoid arthritis patients and determine the association of these to the disease activity. PATIENTS AND METHODS: The study included a total of 240 subjects, consisting of 60 rheumatoid arthritis patients (8 males, 52 females; mean age 50.4±11.1 years; range 25 to 76 years) with their respective 60 primary caregivers (42 males, 18 females; mean age 43.1±15.3 years; range 12 to 77 years) and 60 OA patients (7 males, 53 females; mean age 62.8±9.0 years; range 45 to 85 years) with their respective 60 primary caregivers (38 males, 22 females; mean age 47.6±13.2 years; range 27 to 87 years). Disease severity and pain of patients were assessed through visual analog scale. Sedimentation and C-reactive protein values were recorded during routine visits. Patients were stratified by disease activity that was determined by disease activity score-28. Caregivers of patients evaluated disease severity and pain by visual analog scale, and completed Caregiver Reaction Assessment (CRA) and Caregiver Strain Index questionnaires. For a more objective assessment, tasks related to care, household, and assistance and allocated time periods for each group of tasks were queried. RESULTS: When CRA and Caregiver Strain Index were compared in terms of disease activity, patients significantly differed in impact on schedule subscale of CRA (p<0.05). Similarly, disease activity was significantly associated with impact on finance subscale of CRA (p<0.05). Impact on health subscale of CRA was also correlated with disease activity; i.e., the higher the disease activity score-28, the more negative impact on health of the caregiver. CONCLUSION: Patient care is an important part of rheumatoid arthritis management. Chronic diseases form commitment on patient's caregiver. That the care of the patient may be associated with many factors related to both the patient and the caregiver should not be underestimated. We suggest that caregiver's strain may be correlated with disease activity.

Cerebral Blood Flow Volume Using Color Duplex Sonography in Patients With Fibromyalgia Syndrome.

OBJECTIVES: This study aims to evaluate cerebral blood flow using color duplex Doppler ultrasonography in patients with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: The study included 30 female patients with FMS (mean age 42.3 years; range 22 to 59 years) and 30 female healthy controls (mean age 39.6 years; range 22 to 56 years). Color duplex Doppler ultrasonography imaging was performed with an EPIQ 5 unit equipped with a multi-frequency linear probe (3-12 MHz) in the supine position. Severity of pain, fatigue, and the patient's and physician's global assessments of disease were evaluated on a visual analog scale. The Symptom Severity Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Evaluation Scale, and Fibromyalgia Impact Questionnaire were also implemented to assess disease severity. RESULTS: Cerebral blood flow volume and bilateral internal carotid artery (ICA) and vertebral artery (VA) volumes were not significantly higher in FMS patients compared to controls. Bilateral ICA and VA diameters were similar between FMS patients and controls. Bilateral mean peak systolic velocities and end diastolic velocities in the common carotid arteries, ICAs and VAs were similar in both groups. A significant correlation between symptom severity parameter and the cerebral blood flow volume was noted in FMS patients. CONCLUSION: Cerebral blood flow volume, ICA flow, and VA flow do not appear to increase, and are correlated with only Symptom Severity Scale among other clinical parameters reflecting disease severity in patients with FMS.

Serum heat-shock protein-65 antibody levels are elevated but not associated with disease activity in patients with rheumatoid arthritis and ankylosing spondylitis.

OBJECTIVES: Heat-shock proteins (HSPs) have gained increased interest for their role in autoimmune disorders. These proteins are targeted by the immune system in various autoimmune diseases. The aim of this study was to assess the serum heat-shock protein-65 antibody (anti-HSP65) levels and their clinical significance in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). PATIENTS AND METHODS: A total of 30 patients with RA, 30 patients with AS, and 30 healthy controls were enrolled in this study. All patients were assessed using routine clinical and laboratory evaluations. Serum anti-HSP65 levels were determined by ELISA. RESULTS: Serum anti-HSP65 levels of both RA and AS patients were significantly higher than those of controls (p=0.014 and p=0.001, respectively). No association was found between serum anti-HSP65 levels and disease activity in either RA or AS patients. There was a significant correlation between anti-HSP65 and anti-cyclic citrullinated peptide levels in patients with RA (p=0.024). CONCLUSION: In this study, serum anti-HSP65 levels were increased, but not associated with disease activity in both RA and AS patients. These results suggest that HSP antigens may play a role in the pathogenesis. However, further follow-up studies are needed. Identification of target antigens such as HSP65 is vital to developing new immunotherapeutic agents.

Osteoporosis risk factors and association with somatotypes in males.

BACKGROUND: Osteoporosis is a systemic and metabolic skeletal disease characterized by reduced bone mass, changes in microarchitecture, and consequential increased fracture risk. Previous reports described a relationship between bone content with fat mass and lean body mass. In this study, we assessed osteoporosis risk factors and the association with somatotypes in males aged 45-65 years. METHODS: Standard axial spine and proximal femur bone mineral density (BMD) were measured using dual x-ray (DXA) absorptiometry in 70 healthy men. Heath-Carter procedure was followed to assess individual's somatotype. RESULTS: All body types were grouped as endomorphy, mesomorphy, and ectomorphy. Moderate to weak correlations were found between lumbar BMD with endomorphy and mesomorphy. Negative correlation was found between lumbar BMD and ectomorphy. Total femur BMD correlated positively with endomorphy and mesomorphy and negatively correlated with ectomorphy. Body mass index correlated weakly with lumbar, femur neck, and total femur BMD. Multiple regression analysis revealed that endomorphy was significantly related to BMD measurements at lumbar spine (standardized coefficient, SC = 0.51, p = 0.001), femur neck (SC = 0.52, p = 0.001), and total femur BMD (SC = 0.41, p = 0.01). Lumbar BMD and age, hand grip strength, smoking, tea and coffee consumption, calorie expenditure, calcium intake, PTH, albumin, total protein, sex hormone-binding globulin, and testosterone were not significantly correlated. CONCLUSIONS: Endomorphy seems related to high BMD values at the lumbar spine and the proximal femur in middle-aged men. Somatotype together with daily calorie expenditure may be taken into account when assessing risk factors for male osteoporosis.

Clinical presentation of cutaneous manifestations in complex regional pain syndrome (type 1).

OBJECTIVE: Complex regional pain syndrome type I (CRPS I) is a primary polymorphic condition of persistent pain and swelling that frequently occurs secondary to trauma associated with vasomotor disorders. The aim of this study was to evaluate the cutaneous findings in patients with CRPS I. METHODS: Eighteen patients with CRPS I were included in the study. Written informed consent was obtained from all participants. RESULTS: Of the 18 patients with CRPS I, 9 (50%) had hyperhidrosis, while hypohidrosis was present in 2 patients (11.1%). Eight patients (44.4%) had hypertrichosis, and 1 patient (5.6%) had hypotrichosis. Five of the patients (27.8%) had nail changes. CONCLUSIONS: These cutaneous changes are not rare in CRPS I and generate difficulties for the patient; therefore, they should be prevented during the early stages of CRPS I with use of an effective treatment.

A comparison of the effectiveness of amitriptilin and pregabalin treatment in fibromyalgia patients.

OBJECTIVE: The present study is a comparison of the effectiveness of amitriptyline and pregabalin on the symptoms of fibromyalgia patients. METHODS: A total of 71 female patients aged ≥18 years were included in this study. The patients were divided into 2 groups. Pregabalin (n=36) or amitriptyline (n=35) treatment was initiated at daily oral dose of 450 mg and 25 mg, respectively for the indicated number of patients. The patients were evaluated at the start of treatment and at the end of 12 weeks. The Fibromyalgia Impact Questionnaire, Fatigue Severity Scale, Modified Fatigue Impact Scale, Hospital Anxiety Depression Scale, Nottingham Health Profile, Mini Mental State Test, and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were administered to all study participants. Pain at all tender points was measured using a pressure algometer. RESULTS: Significant improvement was observed in both groups after 12 weeks of treatment (p<0.05). Percent change in LANSS was greater in the pregabalin group compared with the amitriptyline group. Tender point pressure pain thresholds and total myalgic score improved significantly in both groups (p<0.05); however higher percentage change in these parameters was achieved in the amitriptyline group when compared with the pregabalin group (p<0.05). CONCLUSION: Both drugs improved pain, fatigue, sleep disorder, disability, psychological evaluation, and cognitive function; however, amitriptyline was more effective at reducing experimentally measured pain than neuropathic pain. According to these results, preference for pregabalin may be recommended in fibromyalgia patients whose primary complaint is neuropathic pain.

R-R interval variation and sympathetic skin response in fibromyalgia.

BACKGROUND: This study proposed to assess the autonomic nervous system (ANS) functions in fibromyalgia (FM) by using two electrophysiological tests, sympathetic skin response (SSR) and the heart rate variability named R-R interval variation (RRIV). METHODS: Sympathetic skin response and RRIV were studied in 29 female patients with FM and 22 healthy age-matched female controls. R-R interval variation at rest (R%), during deep breathing (D%), the difference between D% and R% (D-R) and the ratio of D-R% (D/R) were determined. Pain threshold was measured using a mechanical algometer. RESULTS: R-R interval variation at rest (R%) and D/R did not show significant difference between patients and controls, whereas D% and D-R were significantly lower in patients compared to controls. SSR latencies of patients' hands and feet had no significant difference compared to controls' hand and feet SSR latencies. SSR latencies of patients' hands correlated significantly with control point score, total myalgic score, Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale. Sympathetic skin response latencies of patients' feet correlated only with HARS. CONCLUSIONS: Analysis of heart rate variability may be useful and complementary to clinical examination in patients with symptoms of dysfunction in cardiovascular reflex pathways.

Familial Mediterranean fever responds well to infliximab: single case experience.

The most common arthritic involvement in familial Mediterranean fever (FMF) is acute recurrent monoarthritis; however, sometimes spondyloarthropathy-like findings or typical ankylosing spondylitis may also ensue. Reported here is our favorable experience with infliximab in an FMF patient who had been resistant to colchicine and disease-modifying antirheumatic drugs (sulfasalazine and methotrexate) treatments. A 72-week follow-up of the patient yielded complete remission of the febrile abdominal episodes, and spondylitis responded well. The patient's bilateral aseptic necrosis of the femoral head deteriorated and caused hip pain, discomfort, and disability. Overall, we believe that tumor necrosis factor (TNF) alpha has an important role in the disease pathogenesis and also that anti-TNF may represent a promising robust treatment alternative in FMF.

Relationship Between Leptin and Neopterin Levels and Disease Activation Parameters in Patients With Rheumatoid Arthritis.

OBJECTIVES: This study aims to determine serum leptin and neopterin levels in patients with rheumatoid arthritis (RA) and investigate the relationship between clinical and laboratory parameters of disease activity and radiographic progression. PATIENTS AND METHODS: The study included 33 RA patients (9 males, 24 females; mean age 52.5±12.3 years; range 29 to 75 years) and age- and sex-matched 24 healthy controls (11 males, 13 females, mean age 42.5±14.8; range 18 to 75). RA patients were divided into three groups based on Disease Activity Scores in 28 joints (DAS28) as low disease activity, moderate disease activity, and high disease activity groups. Of the patients, 13 (39.4%) had low disease activity (DAS28=2.6-3.2), 12 (36.4%) had moderate disease activity (DAS28=3.2-5.1), and eight (24.2%) had high disease activity (DAS28≥5.1). RESULTS: Mean serum leptin and neopterin levels in the RA group were 23.98±18.88 ng/mL and 1.88±1.84 nmol/L, respectively. Mean serum leptin and neopterin levels in the control group were 19.40±13:42 ng/mL and 1.13±0.55 nmol/L, respectively. There was no statistically significant difference in the levels of serum leptin (p=0.674) and neopterin (p=0.078) between RA patients and control group. Serum leptin (p=0.574) and neopterin (p=0.921) levels in RA patients and control group showed no correlation with body mass index levels. Besides, there was no correlation between age and plasma leptin and neopterin levels and rheumatoid factor positivity, anti-cyclic citrullinated peptide antibodies, disease duration, erythrocyte sedimentation rate, and C-reactive protein levels in RA group. In RA patients, there was no correlation between serum leptin and neopterin levels and clinical and laboratory parameters indicating the disease activity. In RA patients, there was also no correlation between radiographic joint damage and serum leptin and neopterin levels. A positive correlation was shown in RA patients between disease duration and modified Larsen score (p=0.01). CONCLUSION: In our study, no correlation was detected between serum leptin and neopterin levels and disease activity parameters in RA patients. Therefore, leptin and neopterin levels may not be considered as beneficial inflammation parameters to be used in the diagnosis of RA and disease activation tracking.

Is 4-Hydroxynonenal a Predictive Parameter for the Development of Joint Erosion in Patients With Rheumatoid Arthritis?

OBJECTIVES: This study aims to evaluate serum 4-hydroxynonenal (4-HNE) levels and its clinical and radiological significance in patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: The study included 40 patients (8 males, 32 females; mean age 51.4±11.2 years; range 24 to 72 years) with RA and 30 healthy controls (8 males, 32 females; mean age 53.0±11.7 years; range 24 to 72 years. Serum 4-HNE levels were measured using sandwich enzyme-linked immunosorbent assay method. Patients with disease activity score 28 ≤3.2 and >3.2 were allocated into low and high/moderate disease activity groups, respectively. Additionally, patients were divided into two groups as early RA (disease duration ≤2 years) and established RA (disease duration ≥2 years). Functional disability was evaluated using health assessment questionnaire. Radiographs were scored using the modified Larsen scoring. RESULTS: Serum 4-HNE levels in patients with RA were significantly higher than controls (p=0.001). Serum 4-HNE levels did not correlate with laboratory or clinical parameters of disease activity including erythrocyte sedimentation rate, C-reactive protein, disease activity score 28, and health assessment questionnaire. Serum 4-HNE levels were higher in patients with established RA than patients with early RA (r=0.487, p=0.001). Besides, modified Larsen score which indicates structural damage correlated significantly with serum 4-HNE levels (p=0.001). CONCLUSION: These results indicate that serum 4-HNE levels may be used as an indicator for structural damage such as erosions in the early stage of RA; however, they are not efficient to monitor disease activity.