Relationship of hematologic markers with IL-17 and IL-1 beta in patients with rheumatoid arthritis.

OBJECTIVES: In this study, we aimed to investigate the relationship of NLR (Neutrophil lymphocyte ratio), MPV (mean platelet volume), PDW (distribution width) rates in rheumatoid arthritis (RA) patients with IL-17 and IL-1 beta which are within the cytokines playing an important role in etiopathogenesis and activity of the disease. PATIENTS AND METHODS: Fifty-seven RA patients diagnosed according to RA classification criteria of ACR/EULAR 2010 and 37 controls were included into the study. WBC (white blood cell), NEU (neutrophil), PLT (platelet), LYM (lymphocyte) values in complete blood count received from routine blood examination of patients were recorded, and NLR, PLR (platelet lymphocyte ratio) rates were recorded. IL-17 and IL-1 beta were studies in serum samples. Disease activity of RA patients was evaluated with Disease Activity Score (DAS28). Age, gender, disease age, BMI (body mass index), medications used, co-morbid diseases, smoking of the patients were recorded. RESULTS: Fifty-seven RA patients (46 (80.7%) females, 11 (19.3%) males), and 34 patients (24 (70.6% females and 10 (29.4) males) as a control group were involved. Demographic characteristics were similar between two groups, and statistically significant difference was not detected between patient and control groups in terms of gender, age, and BMI (p> 0.05). We found higher NLR, MPV, PDW, IL-17 values in RA patients compared to control group (p< 0.05). There was a positive correlation of NLR with DAS28, CRP. While erythrocyte sedimentation rate (ESR) had negative correlation with MPV and PDW, it had positive correlation with PLT. We found positive correlation of C-reactive protein (CRP) with NLR and PLT. We could not find correlation of IL-1 beta and IL-17 with hematologic markers. CONCLUSION: In this study, we investigated the relationship of IL-17 and IL-1 beta which play an important role in pathogenesis of RA patients with the parameters analyzed in routine complete blood count, providing information about disease activity such as DAS 28, CRP, and ESR. We illuminated on an issue which has not discussed before by looking from a different angle. More extensive, follow-up studies are needed to emphasize the importance of these parameters and to reveal the relationship between cytokines during the follow-up of the disease activity.

Seasonal disease activity and serum vitamin D levels in rheumatoid arthritis, ankylosing spondylitis and osteoarthritis.

BACKGROUND: Vitamin D is a steroid hormone that plays essential roles in calcium and phosphorus metabolism, bone formation and mineralization homeostasis, also has a role in the maintenance of immune-homeostasis. OBJECTIVE: We aimed to investigate seasonal serum vitamin D levels and seasonal disease activity in patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Osteoarthritis. METHODS: Seventy-one Rheumatoid Arthritis patients, 72 Ankylosing Spondylitis patients, 74 knee Osteoarthritis patients and 70 healthy controls were recruited for the study. Bi-seasonal measurements of serum 25(OH)D vitamin were checked in either in July or August or September for summertime and either in December or January or February for wintertime. Disease activity were evaluated by Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index, and Western Ontario and McMaster Universities Osteoarthritis Index in groups of Rheumatoid Arthritis, Ankylosing Spondylitis, and Osteoarthritis respectively. RESULTS: We did not find any correlation between serum 25(OH)D levels and Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index, and Western Ontario and McMaster Universities Osteoarthritis Index scores in winter and summer. The difference of Disease Activity Score-28 and Western Ontario and McMaster Universities Osteoarthritis Index scores between winter and summer seasons were not significant in Rheumatoid Arthritis and Osteoarthritis patients (p>0.05). The mean Bath Ankylosing Spondylitis Disease Activity Index score was significantly higher in winter than in summer (p<0.05). Consequently we did not find any correlation between variations of seasonal serum 25(OH)D and the disease activity in the patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Osteoarthritis. CONCLUSION: These results suggest that vitamin D does not have an important role in the seasonal disease activity of these diseases and that seasonal changes in disease activity may play an important role in evaluating Ankylosing Spondylitis patients rather than Rheumatoid Arthritis and Osteoarthritis patients and should be taken into account when examining these patients. These conclusions need to be validated in multicenter studies with high number of patients.

The relationship between shoulder impingement syndrome and sleep quality.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine potential relationship between subjective sleep quality and degree of pain in patients with shoulder impingement syndrome (SIS). MATERIALS AND METHODS: Fourty patients with shoulder impingement syndrome were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Shoulder Disability Questionnaire (SDQ). Forty three of age and sex matched healthy subjects were included in the control group. RESULTS: There was a significant difference between the patient and control groups in terms of all PSQI global scores and subdivisions (p < 0.01). The pain scores assessed by SDQ were positively correlated with the scores for subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbance (r = 0.49/p < 0.01, r = 0.44/p < 0.01, r = 0.36/p < 0.05, r = 0.40/p < 0.05, and r = 0.37/p < 0.05 respectively). The comparison of total SDQ pain and global PSQI scores also revealed a significant correlation (r = 0.54/p < 0.01). CONCLUSIONS: Subjective sleep disturbance connected to shoulder pain was found obviously in patients with SIS. For this reason, patients with shoulder pain due to SIS may benefit from the pain killers and cognitive-behavioral interventions that specifically target sleep disturbances. Further studies which contain polysomnographic assessments, as well as determine psychologic status are still needed to put forth sleep quality in patients with SIS.  

Increased oxidative stress in patients with familial Mediterranean fever during attack period.

OBJECTIVES: We aimed to investigate the status of oxidant and antioxidants during attack period (AP) and attack free periods (AFP) in Familial Mediterranean fever (FMF) patients. METHODS: Measured the levels of malondialdehyde (MDA), protein carbonyl (PC), glutathione (GSH) and antioxidant vitamins (A,C and E) as well as the activities of catalase (CAT) and glutathione peroxidase (GSH-Px) in serum and whole blood of FMF patients in FMF-AP and FMF-AFP. RESULTS: Levels of MDA and PC were found significantly higher (p <0.05) both in serum and whole blood of FMF-AP group compared with other groups. The CAT and GSH-Px activities in FMF-AP group were found markedly lower (p <0.05) comparing to HC group. However, there were no statistically significant differences between the groups in terms of antioxidant vitamin levels. CONCLUSIONS: Our study demonstrated increased oxidative stress in patients with FMF during AP. Investigations are needed to establish the effect of antioxidant supplementation on FMF attack frequency and severity. We also suggest that these increased MDA and PC levels and decreased antioxidants may be used as supportive markers to differentiate AP from AFP. These conclusions need to be validated in further multicenter studies with high number of FMF patients.

Can the patient-reported outcome instruments determine disease activity in rheumatoid arthritis?

OBJECTIVES: The aim of this study was to investigate the indicative value of the patient-reported outcome instruments (PROs) on disease activity in rheumatoid arthritis (RA). METHODS: Three hundred sixty eight patients with RA were included in this cross-sectional study. Disease activity was evaluated using both the Disease Activity Score 28 (DAS 28) and the Clinical Disease Activity Index (CDAI). Patients who had DAS 28 score < 3.60 points and CDAI score <10.00 points were allocated into the "low disease activity" group and those who had DAS 28 score > or = 3.60 points and CDAI score > or = 10.00 points into the "moderate or high disease activity" group. The Health Assessment Questionnaire (HAQ), Nottingham Health Profile (NHP), Rheumatoid Arthritis Quality of Life (RAQoL), and Short Form 36 (SF 36) were used as PROs. Logistic regression analysis was used to find variables, which had an indicative value for disease activity. RESULTS: HAQ, pain and emotional reaction subscales of NHP, and bodily pain, general health and social functioning subscales of SF 36 had independent indicative values, when DAS 28 was used as dependent variable. On the other hand, HAQ, pain and emotional reaction subscales of NHP, and general health and emotional role limitation subscales of SF 36 had indicative values when CDAI was used as dependent variable. DAS 28 and CDAI both showed HAQ as the parameter with the highest odds ratio (OR). But RAQoL had shown no independent indicative value for projecting disease activity. CONCLUSION: It was concluded that HAQ could determine disease activity in RA better than other PROs included in this study (Tab. 4, Ref. 36).

Effect of number of pregnancies on bone mineral density.

This study investigated the effect of the number of pregnancies on bone mineral density (BMD) in 320 post-menopausal women aged between 49 and 64 years. Cases were selected from people with similar lifestyles and stratified into five groups according to the number of pregnancies. Each group was divided into two subgroups according to the duration of the menopause (3-5 years versus 6-10 years). Lumbar (L2-L4) and femoral neck BMD were measured by dual-energy X-ray absorptiometry and T-score values were used in the statistical evaluation. No significant difference was found between the number of pregnancies and BMD within each group based on the same menopause duration, but a significant correlation was found in most groups based on menopause duration: T-scores decreased as menopause duration increased. Changes in BMD are likely to be related to menopause duration, rather than the number of pregnancies.

The pneumatic compression test and modified pneumatic compression test in the diagnosis of carpal tunnel syndrome.

There are no precise criteria for the diagnosis of carpal tunnel syndrome (CTS): the history is useful but the value of the various provocative tests is questionable. The purpose of this study was to examine the diagnostic value of a new provocative test, the 'modified pneumatic compression test' in CTS. The study group consisted of 37 patients with 50 symptomatic CTS hands. A control group of 50 healthy volunteers was recruited. The diagnosis was based on a combination of the history, the clinical findings on examination and electrophysiological criteria. Sensitivity for the pneumatic compression and the modified pneumatic compression tests were 68% and 84%, respectively. Specificities for these tests were 97% and 95%, respectively. The modified pneumatic compression test demonstrated high sensitivity and specificity for CTS. This test facilitated the diagnosis and was easy to use. It may reduce referrals for neurophysiology testing, and so reduce costs.

Prevalence of rheumatoid arthritis in Antalya, Turkey.

The aim of this study was to evaluate the prevalence of rheumatoid arthritis (RA) in Antalya, Turkey. A cross-sectional study was performed face-to-face using a structured interview. Subjects were asked whether they had arthritis at present or previously. Subjects suspected of having RA were invited to the hospital for physical examination and laboratory investigations. Diagnosis of RA was confirmed if the patient fulfilled 1987 American College of Rheumatology (ACR) criteria for RA. A total of 3173 subjects were interviewed. The diagnosis of RA was established in 12 subjects. The prevalence of RA was determined as 0.38% [95% confidence interval (CI): 0.16-0.59]. The mean age was 49.92+/-11.56 years in subjects with RA and greater than that of other subjects (p<0.001). Of 12 subjects with RA, 9 had previously been diagnosed with the disease. Rheumatoid factor was detected in the sera of eight subjects. RA is less frequent in Turkey than in Northern Europe. Different genetic and environmental factors may have a role in this result.

Comparison of cyclic and continuous calcitonin regimens in the treatment of postmenopausal osteoporosis.

We aimed to compare and evaluate the efficacies of a continuous regimen of intranasal salmon calcitonin (SCT) and two cyclic regimens (different cyclic regimens from previous studies) based on alternating 15 days or on 10 days consecutively per month for 1 year in the treatment of postmenopausal osteoporosis. We performed an open-label, prospective, randomized clinical trial. A total of 120 postmenopausal osteoporotic participants between 50 and 65 years old were randomly assigned to one of three treatment groups. Patients in group 1 (n = 40) received continuously SCT nasal spray at a dose of 200 IU/day, plus continuously 500 mg/day elementary calcium and 0.25 microg/day 1-alpha hydroxyvitamin D3, for 1 year. Patients in group 2 (n = 40) received cyclically SCT nasal spray at a dose of 200 IU/day on alternating 15 days per month, plus continuously 500 mg/day elementary calcium and 0.25 microg/day 1-alpha hydroxyvitamin D3, for 1 year. Patients in group 3 (n = 40) received cyclically SCT nasal spray on 10 days consecutively per month (20 days/month rest), plus continuously 500 mg/day elementary calcium and 0.25 microg/day 1-alpha hydroxyvitamin D3, for 1 year. Data was evaluated by repeated analysis of variance (ANOVA). In addition, statistical differences between groups were assessed by the two-tailed Student's t test. After 1 year of the study, seven patients from group 1, eight patients from group 2 and five patients from group 3 withdrew from the study. No patient discontinued the study because of adverse drug effects. There was a statistically-significant improvement in pain intensity VAS scores at the end of the year to baseline scores in all three groups (p < 0.001). There was no significant difference in pain intensity VAS scores between groups at the end of the year (p > 0.05). Lumbar and femur neck BMD scores improved significantly at the end of treatment in all three groups (p < 0.05). There was no statistically-significant difference in BMD scores between groups at final (p > 0.05). Urinary DPD/Cre levels decreased significantly in all three groups by the end of the year (p < 0.05). There was no statistically-significant difference in urinary DPD/Cre final levels between groups (p > 0.05). According to the results of the present study, consecutive 10 days therapy with SCT, which is the first in the literature to our knowledge, is as effective as the other two regimens in the treatment of osteoporosis. Both cyclic regimens in our study (alternating 15 days and 10 consecutive days each month for 1 year) do appear to offer some advantages, especially economically and clinically, as compared to continuous treatment.

The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey.

The aim of this cross-sectional study was to estimate the prevalence and risk factors of symptomatic knee and distal interphalangeal (DIP) joint osteoarthritis (OA) in the elderly (> or =50 years of age) urban population of Antalya, Turkey. According to the 1997 national census, Antalya's population was 508,840. By random cluster sampling, 655 individuals aged 50 years or more were interviewed face-to-face and subjected to structured interviews regarding knee pain, worsening pain on exertion, and the gelling phenomenon. They were also asked about performing namaz (a fundamental act of worship in Islam performed five times a day), smoking, type of residence, type of toilet, work style, and duration of walking per day. They were also questioned about swelling in DIP joints. In the case of suspicion of knee OA, the individuals were invited to the hospital for further evaluation by physical examination and direct roentgenogram. The diagnosis of knee OA was based on clinical or clinical and radiographic findings. The prevalence of symptomatic knee OA was determined as 14.8% in the population aged 50 years or over. Advanced age, female sex, namaz, and type of residence were found to be associated with knee OA. The rate of symptomatic knee OA was significantly lower in smokers and those walking more than 2 h per day. Female sex was also strongly associated with OA DIP joints. OA of DIP joints was found significantly associated with symptomatic knee OA. The latter is a major health problem in the elderly population, especially in about one fourth of women aged 50 years or over. These data suggest that advanced age, female sex, and type of residence are risk factors.

The association of milk consumption with the occurrence of symptomatic knee osteoarthritis.

OBJECTIVE: To evaluate the association of nutritional factors with symptomatic knee OA. METHODS: This cross-sectional study was performed face-to-face using a structured interview. Individuals who had a diagnosis of symptomatic knee OA and were aged 50 years or over were included in this study. The frequency of consumption of dairy products, meat/poultry, fish, cereals, vegetables, tea and coffee were also determined. The diagnosis of knee OA was made clinically or clinically and radiologically according to the ACR criteria for knee OA. RESULTS: A total of 655 subjects was interviewed. The frequency of symptomatic knee OA was significantly lower in daily milk consumers (p < 0.05). Tea consumption was also inversely associated with symptomatic knee OA (p < 0.05), although other nutritional elements showed no significant relationship with OA. CONCLUSION: Milk consumption may have beneficial effects on symptomatic knee OA.

Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study.

STUDY DESIGN: An epidemiological study conducted all over the country. OBJECTIVE: The present retrospective study was conducted to survey the new traumatic spinal cord injury (SCI) cases during 1992 in Turkey. SETTING: Intensive care units, emergency services and departments of orthopaedic surgery, neurosurgery and rehabilitation of state hospitals, rehabilitation centers, military and university hospitals. METHODS: Postal questionnaires were used for data collection and the records from medical institutes nation-wide were reviewed for the analysis of the epidemiological factors. RESULTS: Five hundred and eighty-one new traumatic SCI cases were reported in 1992. The annual incidence was found to be 12.7 per million population. Male to female ratio was 2.5:1 and the average age at injury was 35.5+/-15.1 (35.4+/-14.8 for males and 35.9+/-16.0 for females). The most common cause of injury was motor vehicle accidents (48.8%) followed by falls (36.5%), stab wounds (3.3%), gunshot injuries (1.9%) and injuries from diving (1.2%). One hundred and eighty-seven patients (32.18%) were tetraplegic and 394 patients (67.8%) were paraplegic. The most common level of injury was C5 among tetraplegics and T12 among paraplegics. The most prevalent associated injury was head trauma followed by extremity fractures. Severe head trauma resulting in death may obscure the real incidence of SCI and may cause underreporting of cases in epidemiological studies. CONCLUSION: Considering that motor vehicle accidents and falls were found to be the leading causes of traumatic SCI, it was concluded that the prevention measures should be focused mainly on these in order to reduce the frequency of SCI in Turkey.

Sleep quality and pain threshold in patients with fibromyalgia.

The purpose of the study was to examine the association between the subjective sleep quality and pain threshold in fibromyalgia. Sixteen patients with fibromyalgia were included in the study. The pain threshold was determined using a manual algometer. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The pain threshold was negatively correlated with the scores for subjective sleep quality, habitual sleep efficiency, and sleep disturbance and the PSQI global score. We conclude that there is a negative correlation between pain and sleep disturbance: increased pain sensitivity is associated with greater sleep disturbance.

Progressive pseudorheumatoid chondrodysplasia: a hereditary disorder simulating rheumatoid arthritis.

Progressive pseudorheumatoid chondrodysplasia is a rare hereditary disorder. This autosomal recessive condition is characterised by progressive arthropathy and platyspondyly. The symptoms are similar to those of rheumatoid arthritis but synovitis is absent. In this study a patient with inherited progressive pseudorheumatoid chondrodysplasia is presented.

Hypnotizability, pain threshold, and dissociative experiences.

BACKGROUND: There may be an association between pain threshold, hypnotizability, and dissociative experiences. The purpose of the present study was to examine this association. METHODS: Forty-one healthy subjects were included in the study. Pain thresholds were determined using a manual algometer. The Dissociative Experiences Scale was administered to all subjects. Hypnotizability of the subjects was assessed by the eye roll sign of the Hypnotic Induction Profile. There were 14, 15, and 12 subjects in the Grade 1, 2, and 3 groups, respectively. RESULTS: Highly hypnotizable subjects had lower pain thresholds and were more likely to report dissociative experiences than the less hypnotizable subjects. CONCLUSIONS: There is an association between pain threshold, hypnotizability, and dissociative experiences. It may be suggested that dissociative and somatic symptoms may be integrally linked and related to hypnotic suggestibility.

Distraction of lumbar vertebrae in gravitational traction.

STUDY DESIGN: Experimental study of 30 patients diagnosed with low back pain resulting from lumbar disc herniation, disc degeneration, and segmental instability. Patients underwent gravitational traction, and widening of the intervertebral space and posterior facets was measured on radiographs. This same procedure was performed with a group of 30 healthy individuals. OBJECTIVES: To determine the effect of gravitational traction on the widening of the intervertebral space and the other vertebral structures in patients with low back pain and in healthy individuals. SUMMARY OF BACKGROUND DATA: Gravitational traction is performed by suspending the patient in a hanging, upright position for an extended period of time. In spite of disagreement among authors about the effect of lumbar traction, recent innovations have enabled the distraction of vertebrae. METHODS: A specially designed apparatus was used to apply gravitational traction. Pre- and post-traction radiographs were obtained to study the changes in the L2-L3, L3-L4, L4-L5, and L5-S1 intervertebral spaces; Ferguson's angle; L1-S1 total distance; and blood pressure. RESULTS: Distraction was more than approximately 3 mm in each intervertebral space in both groups. CONCLUSION: Gravitational traction had a very apparent effect on intervertebral space and was found to be an effective method to distract lumbar vertebrae. Discomfort experienced by the patient during suspension may be overcome by making biomedical changes to the suspension corset.