Relationship between DXA measured systemic bone mineral density and subchondral bone cysts in postmenopausal female patients with knee osteoarthritis: a cross-sectional study : Osteoarthritis cysts and bone mineral density.

BACKGROUND: Individuals with high systemic bone mineral density (BMD) may have an increased risk of incident knee osteoarthritis (OA). Besides that, radiographic osteophytes are strongly associated with BMD. Because of these reasons, the aim of the study was to investigate the possible association between radiological subchondral bone cyst (SBC) grade and systemic BMD and vitamin D status in the postmenopausal female patients with knee OA in a crosss-sectional study. METHODS: This study included of 48 osteoporosis treatment-free postmenopausal patients diagnosed with symptomatic medial compartment knee OA. BMD analysis was performed using dual-energy X-ray absorptiometry (DXA) and serum vitamin D levels were measured after recording patients' findings. Each knee was scanned using computed tomography (CT), and categorical SBC scores were graded for the medial and lateral tibiofemoral (TF) and patellofemoral (PF) compartments and further calculated as compartmental total, total TF and grand total of both TF compartments. SBC scores were analysed with correlation analysis. RESULTS: The patient population was characterized by radiographic joint space narrowing, obesity and low vitamin D status. Median medial total and grand total TF SBC scores were significantly different between the patient groups according to the Kellgren-Lawrence (KL) radiographic grading (p = 0.006 and p = 0.007, respectively). There were no correlations between femoral BMD values and SBC scores. However, positive correlations were detected significantly between L1 - 4 DXA values and TF SBC scores, but not with PF SBC scores (p = 0.005 for the correlation between L1 - 4 BMD and medial compartments total TF SBC score, p = 0.021 for the correlation between L1 - 4 BMD and grand total TF SBC score). No significant correlations were found with Vitamin D levels. CONCLUSIONS: Development of TF OA high-grade SBCs may be linked to systemic bone mass as represented by trabecular bone-rich lumbar vertebrae. The relationship might point to the importance of bone stiffness as an acting factor in knee OA possibly with mechanical energy transfer to the joint.

Biomechanical Factors in Psoriatic Disease: Defective Repair Exertion as a Potential Cause. Hypothesis Presentation and Literature Review.

Joining main clinical manifestations of psoriatic skin disorder are inflammatory arthritis and nail lesions. Repetitive microdamage has been postulated as a main triggering factor in lesions of psoriatic arthritis. This concept of psoriatic disease might also be admissible for triggering nail lesions because the nail is a frequently traumatized structure. Here, we aimed to describe the conjectural injury mechanisms of nail complex with regard to acting biomechanical factors. Tissue repair response to physical microdamage may be altered in psoriatic disease. It is plausible to consider that a defective repair process in the dysregulated prepsoriatic tissue may lead to innate immune activation and further development of autoinflammatory lesions, although excessive inflammation is known to impair wound healing. Recently published data have revealed the importance of mechanosensitive Wingless-type (Wnt) signaling in the pathophysiology of psoriasis and ankylosing spondylitis. The Wnt signaling system is involved in morphogenesis, repair, and regeneration as a biologic process main regulator. Wnt5a seems to be a dominating mediator in both psoriatic plaques and during the spondylitis process that might also be a linking molecule of psoriatic response to mechanical stress. Future studies should focus on complex responsive interactions of tissue repair regulators regarded in psoriatic disease.

Ultrasonographic evaluation of hand and foot tendons in Behçet's disease.

BACKGROUND: There have been few studies in the literature evaluating the effect of Behçet's disease (BD) on tendons. Thus, we planned to search for the involvement of hand and foot tendons in BD by using ultrasonography and to determine the relation of tendon involvement with clinical measurements. METHODS: The study consisted of 33 randomly selected BD patients and 36 voluntary healthy controls matched by age and body mass index. Sonographic evaluations were performed from hands (flexor digitorum süperficialis (2-5), flexor digitorum profundus (2-5), flexor carpi radialis) and Achilles tendons of the nondominant extremities using an 8-10 MHz linear array probe. Grip strength and crepitation were also measured on the nondominant side. RESULTS: Mean hand and foot tendon thickness values of BD patients were significantly higher than in control group (p=0.00). Disease duration, age, and presence of crepitation were not correlated with tendon thickness in the BD group (all p values>0.05). Grip strength values were lower in the BD group than in control group but the difference was not statistically significant (p=0.344). Grip strength values were not correlated with hand tendon thicknesses in BD groups (all p values>0.05). CONCLUSION: Because tendons tears and thicknesses are associated with inflammation, awareness of tendon pathologies is very important in rheumatic diseases. It would be of value to investigate this relationship in future studies in order to determine if this increment in tendon thickness is an indicator of disease activity and affects prognosis. The physician should be on alert about tendon involvement even if the patient has no complaints.

The effects of physical therapeutic agents on serum levels of stress hormones in patients with osteoarthritis.

To investigate the effects of physical agents on the levels of stress hormones in patients with osteoarthritis (OA).Transcutaneous electrical nerve stimulation, hot packs, and therapeutic ultrasound were applied to the lumbar region and knees of patients with OA. Blood samples were taken for the measurement of the serum levels of glucose, insulin (INS), growth hormone (GH), prolactin (PRL), cortisol (COR), and plasma adrenocorticotropic hormone (ACTH) immediately before and after the 1st session, to investigate the acute effects of those physical agents on the endocrine system. The hormone levels were also measured every 5 sessions in a total of 10 sessions. The treatment response was also evaluated by using the visual analogue scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) throughout the therapy period.After the 1st session, there was a decrease in INS levels and a mild decrease in PRL levels (P = 0.001 and P < 0.05, respectively). Throughout the 10-session therapy period, the INS levels increased, whereas the ACTH and COR levels decreased (P < 0.05 for all). The VAS-spine, RMDQ, VAS-knee, and WOMAC scores decreased (P = 0.001 for VAS-spine and P < 0.001 for all others). A positive correlation was detected between the changes in serum COR and WOMAC-pain score (P < 0.05).Although the combination therapy caused changes in INS level accompanied with steady glucose levels, the application of physical agents did not adversely affect the hormone levels. The decrease in ACTH and COR levels may be attributed to the analgesic effect of agents and may be an indicator of patient comfort through a central action.