Quality of life and self-reported disability in patients with knee osteoarthritis.

OBJECTIVES: Osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem throughout the world. The aims of this study are to assess quality of life (QoL) in patients with knee OA using the generic instrument Short Form-36 (SF-36) and to determine its relationships with conventional clinical measures and self-reported disability. METHODS: Patients with knee OA (n = 112) with median age of 60 (45-76) years and 40 sex- and age-matched healthy controls were included in the study. Age, sex, body mass index (BMI), symptom duration, and Kellgren-Lawrence scores were recorded. QoL, disability, and pain were assessed using the SF-36, the Western Ontario and McMaster (WOMAC) index, the Lequesne index, and a visual analog scale (VAS) in patients. Also, QoL was assessed using the SF-36 in controls. RESULTS: Patients with knee OA had lower scores in all subgroups of SF-36 compared with controls. In patients, the SF-36 physical function (PF) and pain areas significantly correlated with effusion, VAS pain, and Lequesne and WOMAC subgroup scores (p < 0.05). The pain area of QoL did not show correlation with comorbidity with knee OA. We found that SF-36 and WOMAC pain scores were more severe in female patients. CONCLUSIONS: Patients with knee OA had significantly poorer QoL compared with healthy controls. SF-36 is related to the clinical status and functional ability of patients with OA and can be used as a sensitive health status measure for clinical evaluation. Also WOMAC can be used as a sensitive measure for disability of patients with knee OA.

Fatigue and correlation with disease-specific variables, spinal mobility measures, and health-related quality of life in ankylosing spondylitis.

OBJECTIVES: This study aimed to evaluate fatigue in Turkish patients with ankylosing spondylitis (AS) and its relationship with disease-specific variables, spinal mobility measures, and health-related quality of life (HR-QoL). METHODS: One hundred and ten patients diagnosed as AS according to the Modified New York Criteria and 40 healthy individuals were included in this study. The Multidimensional Assessment of Fatigue (MAF) was used in patient and control groups to assess fatigue. The first item of Bath AS Disease Activity Index (BASDAI) was also used to assess fatigue in the patient group. Evaluation included BASDAI, functional status [BAS Functional Index (BASFI)], and visual analog scale (VAS) of axial and joint pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. The generic instrument Short Form 36 (SF 36) was used to assess HR-QoL in the patient group. RESULTS: Patients with AS had higher total MAF scores and in all MAF subgroup scales than controls. All patient MAF scores were significantly correlated with morning stiffness, number of swollen joints, history of peripheral arthritis, BASDAI, BASFI, BASDAI-fatigue, VAS axial, VAS peripheral, and SF 36 subgroups (p < 0.05). No correlation was observed between all MAF scores and age, body mass index (BMI), disease duration, meteorological measures, and medications in patients. CONCLUSIONS: Patients with AS defined significantly more fatigue when compared with healthy persons. MAF was related to clinical and functional status and HR-QoL of patients with AS. We assume that MAF can be used as a sensitive fatigue measure in patients with AS.

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.

Assessment of lumbar vertebrae morphology by magnetic resonance imaging in osteoporosis.

OBJECTIVE: To investigate the lumbar spinal morphology in patients with and without osteoporosis by comparing the endplate changes, intervertebral disc changes, and vertebral heights. DESIGN: This is a retrospective study. Medical records of the 3,530 patients admitted to the Physical Medicine and Rehabilitation outpatient clinics with low back pain between August 2010 and August 2011 were retrospectively reviewed. A total of 64 patients of whom 57 were females (89.1 %) and seven were males (10.9 %) were included in the study. Participants were divided into an osteoporosis group, an osteopenia group, and a nonosteoporotic control group, according to bone mineral densities. RESULTS: In this study, mid heights of L3, L4, and L5 vertebrae were found to be higher in the normal group than in both the osteopenic and osteoporotic groups. Mid part heights of L1-2, L2-3, and L5-S1 intervertebral discs were significantly lower in the normal group when compared to the osteopenic and osteoporotic groups. End-plate marrow abnormality was detected in L1 lower end plate in 75 % of normal subjects, 40.6 % of osteopenics, and 25 % of osteoporotics. Statistically significant difference in the presence of Schmorl nodes in L5 vertebra lower end plates was present between groups; 58.3 % of normals, 34.4 % of osteopenics and 15 % of osteoporotics had Schmorl nodes in L5 vertebra lower end plates. There was a significant difference regarding disc degeneration and intradiscal gas presence in L5-S1 intervertebral discs between groups; 66.7 % of normals, 28.1 % of osteopenics, and 25 % of osteoporotics had severe disc degeneration and intradiscal gas was present in L5-S1 intervertebral discs. CONCLUSIONS: Significant changes in morphology of the lumbar spine and intervertebral discs were found. It was revealed that the effects of osteoporosis are not limited to the bone but also present in the intervertebral discs. Mid heights of intervertebral discs were higher in the osteoporotic and osteopenic groups when compared to normal subjects along with the lowered mid heights of lumbar vertebrae. It was also observed that stronger vertebral bones were associated with more disc and vertebral degeneration.

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.

Assessment of the frequency of tarsal tunnel syndrome in rheumatoid arthritis.

OBJECTIVES: In this study, we aimed to determine the frequency of tarsal tunnel syndrome (TTS) in rheumatoid arthritis (RA) patients. PATIENTS AND METHODS: Thirty RA patients (1 male, 29 females; mean age: 41.9±10.1 years; range, 26 to 65 years) who met the American College Rheumatology (ACR) classification criteria and 20 healthy volunteers (1 male, 19 females; mean age: 39.3±10.8 years; range, 26 to 60 years) without any complaints between August 2006 and October 2007 were included in the study. Demographic characteristics of the study group were assessed and neurological examinations were performed. The Tinel's sign was checked to provoke the TTS symptoms. Disease severity was measured using Visual Analog Scale (VAS), Disease Activity Score-28 (DAS28), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The health-related quality of life and disability status were determined using the Health Assessment Questionnaire (HAQ), Short Form 36 (SF-36), Foot Function Index (FFI), and VAS (0-100 mm). The positional relationship of the foot pain was questioned with VAS. The 100-m walking distance of the patient and control groups were calculated. RESULTS: Bilateral TTS was detected in 10 of the patients (33.3%) with rheumatoid arthritis. No relationship with the TTS disease duration, seropositivity, rheumatoid nodule, joint deformities, corticosteroid use, and DAS28 score were found. In correlation with TTS, foot and ankle joint were the first involved joints at the beginning of RA disease (p<0.005). The Tinel's sign was found to be 45% positive in patients with TTS. The 100-m walking time was significantly longer in RA patients compared to the control group (p<0.0001). CONCLUSION: Tarsal tunnel syndrome is commonly seen in RA and its incidence increases in patients with primary foot involvement. Therefore, caution should be taken against the entrapment neuropathies in these patients, and they should be supported by electrophysiological practices, when the diagnosis is necessary.

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.

HLA-b27 subtypes in patients with spondylarthropathies, IgE levels against some allergens and their relationship to the disease parameters.

In suitable genetic backgrounds, some exogenous and/or endogenous antigens may cause SpA. In this study, we investigated HLA B27 subtypes and its relationship to some allergens and clinical findings in a group of SpA patients. Forty-eight patients (19F, 29M) with SpA (27 with ankylosing spondylitis, 5 with reactive arthritis, 15 undifferentiated and 1 with psoriatic arthritis) were included to the study. HLA-B alleles have been assessed using the LiPA (Line Probe Assay) reverse hybridization principle method. The allergens studied were following: egg white, yolk, wheat flour, hot pepper, tomatoes, olive, onion, chicken, black tea, sheep cheese, penicillin panel (m1, m25, m28, m30), fungus panel (m1, m2, m3, m6), and housemix panel (e1, e2, d1, d2, m2, m3). 59.3% of the patients were positive for HLA-B27. Of these patients, 53.6% had B*2702 allele which was the most common, followed by B*2708 (21.1%) and B*2701 (10.5%). HLA-B27 was positive in 70% of the ankylosing spondylitis patients and 52% had B*2702 subgroup and B35 was the most common subgroup among the patients who were HLA-B27 negative. Allergic reactions against these 13 allergens were more severe in patients HLA-B27 positive. The most frequent allergic reactions were against the onion and housemix panel, followed by red pepper, tomatoes, sheep cheese and olive. HLA-B*2702 and HLA-B*2701 subgroups had more severe allergic reactions that correlated with a disease severity (p < 0.001). These results indicate that B*2702 and B*2708 is more frequent in our region in contrast to B*2705 which is more commonly found all around the world and that our region represents a heterogeneous distribution. IgE levels against some allergen were found higher in patients with SpA (Fig. 2, Tab. 5, Ref. 37).

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.

Clinical evaluation and power Doppler sonography in rheumatoid arthritis: evidence for ongoing synovial inflammation in clinical remission.

OBJECTIVE: This study proposed to assess the relationship between power Doppler ultrasound examination and spectral Doppler analysis of hand joints with clinical and laboratory parameters in rheumatoid arthritis. METHODS: Patients receiving disease-modifying antirheumatic drugs or biologics (infliximab) underwent joint examination and were assessed by a Health Assessment Questionnaire, Duruoz's Hand Index, and Hand Function Test. All were categorized for disease activity using the American College of Rheumatology and disease activity score 28-joint (DAS28) criteria. Ten metacarpophalangeal joints and 4 wrist joints (ulnar-carpal and radiocarpal joints) in each patient were examined by power Doppler and spectral Doppler. Flow signal in the synovium was semiquantitatively graded. A cumulative flow signal score (CFS) and mean resistive index (RI) was calculated in each patient. RESULTS: Patients with active disease had significantly higher CFS compared with patients with inactive disease, but the mean RI was similar. Health Assessment Questionnaire, Duruoz's Hand Index, Larsen, and DAS28 scores correlated significantly with CFS, but the erythrocyte sedimentation rate and C-reactive protein scores did not. Mean RI did not correlate with clinical or laboratory parameters. A majority of patients who were in clinical remission according to American College of Rheumatology or DAS28 criteria had ongoing synovial inflammation on power Doppler ultrasound (58% and 62%, respectively). CONCLUSION: Power Doppler examination of rheumatoid hand joints is a practical method to estimate synovial inflammation. A modification of current remission criteria by combining imaging techniques with clinical and laboratory examination may be conceivable. These results underscore the necessity of more sophisticated research, assessing the agreement between long-term Doppler changes and clinical parameters.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study.

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.

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.

Dynamic Thiol/Disulphide Homeostasis in Patients With Fibromyalgia.

OBJECTIVES: This study aims to investigate dynamic thiol/disulphide homeostasis in patients with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: Fifty female patients with FMS (mean age 40.5±7.2 years; range 21 to 55 years) and 40 healthy female controls (mean age 39±9.4 years, range 22 to 55 years) were included in the study. Pain visual analog scale, tender points, Fibromyalgia Impact Questionnaire, and Beck Depression Inventory were evaluated. Age, body mass index (BMI), and symptom durations were also recorded. Native thiol, disulphide and total thiol levels were measured with a novel automated method. RESULTS: Serum disulphide levels were 14.7±3.4 µmol/L and 22.2±3.6 µmol/L in the FMS and control groups, respectively (p<0.001). Native thiol levels were 452.1±33.8 µmol/L and 433.5±37.6 µmol/L in the FMS and control groups, (p=0.015), while total thiol levels were 481.7±35.6 µmol/L and 477.5±38.9 µmol/L in the FMS and control groups, respectively (p=0.593). In the FMS group, disulphide/native thiol percent ratios and disulphide/ total thiol percent ratios were statistically significantly lower and native/total thiol percent ratios were statistically significantly higher than those of the control group. There were no correlations between serum thiol/disulphide profiles and pain scores & clinical variables in patients with FMS. CONCLUSION: Because of the decreased disulphide and increased native thiol levels, the thiol/disulphide balance has shifted to the reductive side. This metabolic disturbance may have a role in the pathogenesis of FMS.

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.

Quality of life and correlation with musculoskeletal problems, hand disability and depression in patients with hemodialysis.

OBJECTIVES: The aims of this study were to assess the health-related quality of life (HRQOL) in patients with hemodialysis using the Kidney Disease Quality of Life (KDQOL™) and to determine its relationships with conventional clinical measures, musculoskeletal problems, hand disability and depression. MATERIALS AND METHODS: This study was conducted in our tertiary hospital's dialysis unit. Fifty patients under hemodialysis treatment were included in the study. HRQOL, disability, pain and depression were assessed using KDQOL-36, Duruoz hand index (DHI), visual analog scale (VAS) and Beck Depression Inventory (BDI). RESULTS: It was seen that all of the patients included had one or more musculoskeletal problems, the most common of which were muscle cramps, myalgias and arthralgias. Depression was the second most common accompanying disease. It was also seen that older patients had much poorer physical functioning scores, DHI scores and BDI scores than younger patients. DHI score was found to be significantly lower in men than in women. Educational level, presence of arthrosis, myalgia, bone pain, arthralgia, CTS, VAS-hand and VAS-upper extremities scales, DHI and BDI scores significantly affected both physical and mental areas of KDQOL-36, whereas age, shoulder periarthritis, mobilization scores and presence of hypertension only had effects on physical areas. CONCLUSION: Physical functioning depends mainly on the age, severity of comorbid conditions, depression, locomotor findings and hand disability of hemodialysis patients. The KDQOL-36 is related to the clinical status and functional ability of hemodialysis patients and it can be used as a sensitive health status measure for clinical evaluation.

Relationship between grip strength and hand bone mineral density in healthy adults.

The aim of this study was to assess site-specific relationship of hand bone mineral density (BMD) with hand size, pinch and grip strength in healthy people aged 19-50 years. A total of 143 healthy volunteers participated in the study (mean age: 34 years). One hundred-six were premenopausal women (mean age: 34 years) and 37 were men (mean age: 34 years). Grip and pinch strength was measured by a Jamar dynamometer (Jamar, Irvington, NY). Second, third and fourth middle phalanx BMD were measured on a MetriScan densitometer (Hayward, CA) and mean value of these three phalanxes were used in the analysis. There was not a significant correlation between hand BMD and grip, pinch strength or hand size in premenopausal women. A significant correlation between hand BMD and grip strength was found in men (right hand; r=0.44, p=0.007, left hand; r=0.33, p=0.05). Hand size was not correlated with hand BMD both in men and in women. The short-term precision for RA was estimated as 0.44%. This is the first report of a site-specific relationship of BMD measured by radiographic absorptiometry with hand size, pinch and grip strength in healthy men and premenopausal women. Our results revealed that there is a moderate correlation between hand-grip strength and hand BMD in men. Hand size does not predict hand BMD both in men and women. Radiographic absorptiometry is a practical and reproducible method to detect bone mineral density of hands and may be a valuable screening tool for osteoporosis.

In vivo effect of celecoxib and tenoxicam on oxidant/ anti-oxidant status of patients with knee osteoarthritis.

The aim of this study was to compare the in vivo effects on free radical metabolism of 2 non-steroidal anti-inflammatory drugs (NSAIDs): tenoxicam, an oxicam preferentially cyclooxygenase-1 (COX-1) inhibitor, and celecoxib, a sulfonamide selective COX-2 inhibitor. The serum levels of oxidative stress-related enzymes (ie, xanthine oxidase (XO), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)), of a lipid peroxidation marker (malondialdehyde (MDA)), and of nitric oxide (NO) in patients with knee osteoarthritis were studied at baseline and after a 4-wk course of treatment with celecoxib (n = 11) and tenoxicam (n = 12). Celecoxib-treated patients had significant decrease in nitrite levels (p = 0.043), whereas SOD, XO, GSH-Px enzyme activities, and MDA levels did not change significantly compared to baseline. Tenoxicam-treated patients had significant decrease in nitrite levels (p = 0.036) and XO activity (p = 0.01), but their SOD, GSH-Px enzyme activities, and MDA levels were unchanged from baseline. There was significant correlation between the patients' (n = 23) Western Ontario and McMaster Universities (WOMAC) LK3.0 Osteoarthritis Index, WOMAC-pain scores, and MDA levels (r = 0.50, p = 0.014) and the patients' WOMAC-stiffness scores and XO enzyme activity (r = 0.46, p = 0.027) at baseline. Significant improvement was found in pain-VAS, patients' global assessment, and WOMAC pain, stiffness, and physical function scores in celecoxib and tenoxicam-treated groups. In summary, our study revealed that tenoxicam may have antioxidant effects, and that celecoxib and tenoxicam may reduce nitrite levels, indicating an alteration of NO pathways.

Spinning-induced rhabdomyolysis: A case report and review of literature.

Rhabdomyolysis is a condition of skeletal muscle breakdown in which muscle injury causes a release of myoglobin and the muscle enzymes creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and transaminases. Exertional rhabdomyolysis, which is precipitated by exercise or exertion, ranges from mild muscle injury with negligible symptoms or systemic effects to fulminant cases. Herein, we report a 26-year-old female patient who was admitted to our Physical Medicine and Rehabilitation outpatient clinics with severe bilateral thigh pain persisting for 5 days after participating in a spinning class and diagnosed with exertional rhabdomyolysis. Timely diagnosis and treatment prevented the potentially life-threatening consequences. We assume that it is essential to raise the awareness of this phenomenon not only by physicians but also by the community, since regular exercise and being physically active are increasingly encouraged in modern life.

Effect of fish oil supplementation on plasma oxidant/antioxidant status in rats.

The aim of this study was to investigate effect of dietary omega-3 fatty acid supplementation on the indices of in vivo lipid peroxidation and oxidant/antioxidant status of plasma in rats. The plasma thiobarbituric acid reactive substances (TBARS) and nitric oxide (NO) levels, and activities of xanthine oxidase (XO), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) were studied in male Wistar Albino rats after ingestion of 0.4 g/kg fish oil (rich in omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid) for 30 days and compared to untreated control rats. The rats in the treated group had significantly higher SOD activity (P < 0.001), NO levels (P < 0.01) and decreased TBARS levels (P < 0.05) with respect to controls whereas GSH-Px and XO activities were not significantly different between the groups. None of the measured parameters had significant correlation with each other in both groups. We conclude that dietary supplementation of omega-3 fatty acids may enhance resistance to free radical attack and reduce lipid peroxidation. These results support the notion that omega-3 fatty acids may be effective dietary supplements in the management of various diseases in which oxidant/antioxidant defence mechanisms are decelerated.