Leptin induces ADAMTS-4, ADAMTS-5, and ADAMTS-9 genes expression by mitogen-activated protein kinases and NF-ĸB signaling pathways in human chondrocytes.

Elucidation of the causes of inflammation has vital importance in the development of new approaches for the treatment of arthritic diseases. The degradation of aggrecan by upregulated disintegrin and metalloproteinase with trombospondin motifs (ADAMTSs) is the key event in the development of both rheumatoid arthritis (RA) and osteoarthritis (OA). Increased levels of leptin in both RA and OA have been demonstrated, thus linking leptin to arthritic diseases, but the mechanism has not been clarified. This study investigated the putative role of signaling pathways (p38, JNK, MEK1, NF-ĸB, and PI3) involved in leptin-induced cartilage destruction. Normal human articular chondrocytes were cultured with recombinant human leptin at 100, 250, 500, and 1000 ng/mL doses for 6, 12, 24, and 48 h, after which ADAMTS-4, -5, and -9 genes expression were determined by real time-polymerase chain reaction (RT-PCR) and Western Blot methods. The signaling pathways involved in leptin-induced ADAMTSs upregulation were also investigated by using inhibitors of signaling pathways. It was demonstrated that ADAMTSs expression level was peaked at 1000 ng/mL doses for 48 hours, and MAPKs (p38, JNK, and MEK) and NF-ĸB signaling pathways involving in leptin triggered ADAMTSs upregulation. Obesity as a risk for RA and OA may contribute to the inflammation of both RA and OA diseases by secreting adipokines like leptin. We hypothesize that leptin is involved in the development of RA and OA accompanied with obesity by increasing ADAMTS-4, -5, and -9 genes expression via MAPKs and NF-ĸB signaling pathways.

Heart rate recovery index in patients with psoriasis.

OBJECTIVES: In clinical practice, autonomic functions are indirectly investigated with heart rate recovery (HRR) index measurements. Our aim was to evaluate the HRR index in patients with psoriasis, which is a systemic inflammatory disease. STUDY DESIGN: The study population included 39 psoriasis patients (18 female, mean age 48±15 years) and 40 control group (18 female, mean age 44±9 years) healthy individuals. The severity of psoriasis was calculated using the psoriasis area and severity index (PASI). None of the study patients had a PASI score >50. All of the participants underwent treadmill exercise testing using the Bruce protocol. RESULTS: According to basic clinical and demographic characteristics, both groups were similar with regard to age, body mass index, and fasting glucose and cholesterol levels. No significant differences were observed in the systolic or diastolic blood pressures or resting heart rates between the two groups. All patients and control-group participants had sinus rhythm and normal 12-lead ECG results at rest. All subjects completed the exercise tests to exhaustion without rhythm abnormalities, ischemic changes, or other complications. The maximal heart rate and metabolic equivalents achieved during the exercise stress test (EST) were similar in the psoriasis and control group (163±16 vs. 170±16, p=0.07; 9.8±0.9 vs. 10.1±1.0, p=0.24, respectively). The 1st, 3rd, and 5th minute HRR indices of patients with psoriasis were similar to those of the control group (HRR1: 30±12, 32±18, p=0.71; HRR3: 57±13, 64±17, p=0.10; HRR5: 64±15, 68±16, p=0.46, respectively). CONCLUSION: The HRR index, which is calculated by an EST and associated with autonomic nervous system function, is not effected in mild to moderate psoriasis patients.

Bilateral volleyball-related deformity of the little fingers: mallet finger and clinodactyly mimic.

A 14-year-old male high school volleyball player was seen to evaluate right- and left-hand little-finger distal interphalangeal joint deformity and pain. His symptoms began during his second season of competitive play. The distal interphalangeal (DIP) joints of the little fingers flexed 20-30°, and a 10-15° valgus deformity was seen at the same joints. Pain was relieved with rest but returned immediately after playing volleyball, so plain radiographs were obtained. The flexion and valgus deformity was obvious on plain radiographs and through a clinical examination. Thus, a bilateral little-finger distal phalanx base epiphysis injury was seen. This injury is characterized by a biplanar Salter Harris physeal injury; type 5 on anteroposterior radiographs and type 2 on lateral plain radiographs. The deformity occurred as a result of competitive volleyball play. To our knowledge, this is the first reported case of a bilateral biplanar physial injury of the base of distal phalanges of the little fingers. Flexion and valgus deformities of DIP joints are a result of repeated micro traumas around the physis. Key pointsAs a result of repeated micro traumas to the physial region, flexion and valgus deformities of the distal interphalangeal (DIP) joints should be occurred.Sports injuries to the hand often require treatment in orthopedic departments to avoid permanent deformities.Short- or long-term functional results can be gained by simple splinting procedures and abstention from play.

An investigation of serum irisin levels and inflammatory markers in fibromyalgia syndrome.

OBJECTIVE: In the present study, we aimed to compare serum irisin levels in patients with fibromyalgia syndrome (FMS) and healthy control subjects and also investigate the relationship between irisin, disease activity and inflammation markers in patients. METHODS: A total of 84 women, including 48 patients who were diagnosed with FMS and 36 healthy controls, were included in this study. The demographic characteristics of the patients and control group were recorded. VAS for pain and the Fibromyalgia Impact Questionnaire for the assessment of the physical function of the patients, SF36 was used for quality of life, and accompanying Beck Depression Inventory to assess depression was used. Blood samples were taken for analysis that irisin, and inflammatory markers of the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP) and neutrophil/lymphocyte ratio (NLO). Serum irisin levels were determined using the Enzyme-Linked Immunosorbent Assay (ELISA) method. RESULTS: Serum irisin level of the patients with FMS had no significant differences compared with the healthy control group. When we compared the values of ESR, CRP, hsCRP, NLO with FMS patients and healthy controls, there was no significant difference found between them (p>0.05). There was no significant correlation between inflammatory markers and level of serum irisin (p>0.05). In patients, there was no significant correlation between inflammatory markers and level of serum irisin (p>0.05). CONCLUSION: Irisin, which is a myokine, was determined to have no significant role in the pathogenesis of FMS. Irisin had no association with disease activity and inflammatory markers. Also, the inflammation hypothesis was not supported, which suggested in FMS.

Adaptation of the Shoulder Disability Questionnaire to the Turkish population, its reliability and validity.

The objective of this study was to adapt the Shoulder Disability Questionnaire (SDQ) for use in Turkey, and to test its reliability and validity. Eighty patients with shoulder pain were included in the study. Pain severity at rest, with motion and during sleeping was assessed by using a numeric pain scale. The shoulder's active and passive range of motion were measured by a goniometer and recorded. The Constant-Murley scale was used for functional assessment. The Turkish version of the SDQ, which was adapted by using guidelines, was completed by the patients. To assess reproducibility, the SDQ was completed by 32 patients who did not improve 1 week later. The reliability of the adapted version was good, with high internal consistency (Cronbach's alpha=0.76) and test-retest reliability (Pearson's correlation coefficient=0.88). The Turkish version of the SDQ was found to have a moderate correlation with pain at rest, with motion and during sleeping. The Turkish version of the SDQ was found to be reliable and valid. The moderate correlation of the questionnaire with clinical parameters including pain shows its validity, but the questionnaire should be tested extensively for detecting changes within time, for use in the follow-up and clinical practice.

The relationship between serum leptin level and disease activity and inflammatory markers in fibromyalgia patients.

OBJECTIVE: The aim of this study was to investigate whether there is a correlation between serum leptin level, disease activity and inflammation markers in patients with fibromyalgia syndrome (FMS). METHODS: A total of 48 patients with FMS diagnosed according to the 1990 American College of Rheumatology criteria were included in the study, as well as 36 healthy women as controls. The Visual Analogue Scale was used to gauge pain severity, the Fibromyalgia Impact Questionnaire was used to assess physical function, the 36-Item Short Form Health Survey was used to examine quality of life, and depression was measured with the Beck Depression Inventory. Blood samples were examined for erythrocyte sedimentation rate (ESR), C-reactive protein level (CRP), high-sensitivity CRP level (hsCRP), the neutrophil-to-lymphocyte ratio (NLR), and the serum leptin level was determined using the enzyme-linked immunosorbent assay method. RESULTS: The serum leptin level in patients with FMS was significantly higher than in the healthy group. However, no significant relationship was found between leptin level and clinical and inflammatory parameters. In addition, there were no significant differences between the patients and the control group in measurements of ESR, CRP, hsCRP, or NLR. CONCLUSION: A higher serum leptin level in patients with FMS suggested that leptin may play role in the pathogenesis of FMS, yet there was no relationship between leptin and clinical and inflammatory parameters, suggesting that leptin is not an indicator of disease activity in FMS. Additional research should be performed with larger patient groups.

Cohesive taping and short-leg casting in acute low-type ankle sprains in physically active patients.

BACKGROUND: Cohesive taping is commonly used for the prevention or treatment of ankle sprain injuries. Short-leg cast immobilization or splinting is another treatment option in such cases. To determine the clinical efficacy and antiedema effects of cohesive taping and short-leg cast immobilization in acute low-type ankle sprains of physically active patients, we performed a preliminary clinical study to assess objective evidence for edema and functional patient American Orthopaedic Foot and Ankle Society (AOFAS) scores with these alternative treatments. METHODS: Fifty-nine physically active patients were included: 32 in the taping group and 27 in the short-leg cast group within a year. If a sprain was moderate (grade II) or mild (grade I), we used functional taping or short-leg cast immobilization for 10 days. We evaluated the edema and the functional scores of the injured ankle using the AOFAS Clinical Rating System on days 1, 10, and 100. RESULTS: In each group, edema significantly decreased and AOFAS scores increased indicating that both treatment methods were effective. With the numbers available, no statistically significant difference could be detected. CONCLUSIONS: Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option.

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis.

PURPOSE: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. METHODS: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV-EDV)/PSV]. RESULTS: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. CONCLUSION: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Dual diagnosis: rheumatoid arthritis and multiple sclerosis.

Juvenile rheumatoid arthritis (JRA) is the most common rheumatologic disease in children. Moreover, multiple sclerosis (MS) is the most frequent demyelinating disease and has been associated with various chronic inflammatory diseases. However, its association with JRA has not been frequently described. Autoimmunity in both JRA and MS has been documented in the scientific literature, although there has been no definitive finding that patients with JRA are prone to the development of MS. An increasing frequency of MS resulting from an increased use of antitumor necrosis factor agents in the treatment of rheumatoid arthritis and other chronic inflammatory diseases has been reported recently. In this study, we report on the development of MS in a patient with JRA who did not have a history of antitumor necrosis factor use.

Does MBL2 codon 54 polymorphism play a role in the pathogenesis of psoriasis?

BACKGROUND: Psoriasis is a T cell-mediated immune disease in which various cytokines, primarily tumor necrosis factor-α (TNF-α), are complexly involved. Mannose-binding lectin (MBL) gene polymorphisms decrease MBL serum levels, thereby increasing the synthesis of proinflammatory cytokines such as TNF-α. OBJECTIVES: This trial was designed to evaluate the role of the MBL2 codon 54 polymorphism in the pathogenesis of psoriasis. METHODS: Fifty patients diagnosed with psoriasis vulgaris and 53 healthy subjects were included in the trial. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was applied to determine the MBL2 codon 54 polymorphism. Genotypes were determined according to the bands formed in agarose electrophoresis gels. For the statistical analysis, the level of significance was set at P < 0.05. RESULTS: A total of 33 (66.0%) of the 50 psoriasis patients were detected to have A/A genotype and 17 (34.0%) had B/B genotype. Of the control subjects, 44 (83.0%) had A/A genotype and nine (17.0%) had B/B genotype. There was a statistically significant difference between the groups (P = 0.047). The analysis of allele frequencies revealed A allele prevalences to be 79 (79.0%) and 95 (89.6%), and B allele prevalences to be 21 (21.0%) and 11 (10.4%), in the patient and control groups, respectively. A statistically significant difference between allele frequencies was detected (P = 0.031). CONCLUSIONS: This study suggests that the MBL2 codon 54 polymorphism may have an association with psoriasis in the Turkish population.

The prevalence of fibromyalgia among patients with hepatitis B virus infection.

Fibromyalgia (FM) is a syndrome characterized by widespread and chronic musculoskeletal pain, fatigue, morning stiffness, and sleep disturbance. However, the etiopathogenesis of FM remains unclear. Various etiological factors have been suggested to trigger FM. These include systemic rheumatismal disease, physical trauma, psychological disorders, and chronic infections. We determined the prevalence of FM in patients with chronic active hepatitis B virus (HBV) and inactive hepatitis B carriers, compared with matched healthy controls. Seventy-seven HBV patients (39 HBV carriers and 38 with chronic active hepatitis), were evaluated for FM syndrome. Seventy-seven HBsAg-negative healthy subjects were enrolled as a control group. We found that FM was very prevalent in patients with HBV infections (22% of the total). We found no difference in FM prevalence when patients with chronic active hepatitis B infections (21% FM prevalence) and those who were inactive hepatitis B carriers (23% FM prevalence) were compared. FM was not associated with the levels of HBV-DNA, ALT, or AST. Recognition and management of FM in HBsAg-positive patients will aid in improvement of quality-of-life. We fully accept that our preliminary results require confirmation in studies including larger numbers of patients. More work is needed to allow us to understand the role played by, and the relevance of, infections (including HBV) in FM syndrome pathogenesis.

Incremental effects of restless legs syndrome on nocturnal blood pressure in hypertensive patients and normotensive individuals.

BACKGROUND: Few studies have evaluated the role of restless legs syndrome (RLS) in the development of nondipping 24 h blood pressure (BP) patterning/sleep-time hypertension, which has been shown to be an independent predictor of cardiovascular risk. These were indirect studies that had reported the relation between BP and RLS attacks during polysomnographic investigations in the lab. The aim of the present study was to assess the relationship between RLS, which was diagnosed clinically, and night-time BP patterns in a relatively large young cohort who had not been treated before. PATIENTS AND METHODS: After applying the exclusion criteria, this cross-sectional study included 230 consecutive patients with never-treated hypertension who presented to our institution for initial evaluation of hypertension. RLS was assessed using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The questions on RLS were completed by 214 patients and ambulatory BP monitoring was carried out for all patients. RESULTS: In the study group, 133 patients were diagnosed as hypertensive (53.4% nondippings) and 81 patients as normotensives (54.3% nondippings). RLS was present in 61 patients (28.5%) in the total sample. The prevalence of RLS, overall, was significantly higher in nondippings compared with dippings (34.7 vs. 21.2%, respectively; P=0.028). Logistic regression analysis showed that the RLS is an independent determinant for both hypertension (odds ratio=0.43, 95% confidence interval=0.21-0.83; P=0.013) and the nondipping BP patterns (odds ratio=1.96, 95% confidence interval=1.05-3.67; P=0.035). CONCLUSION: We have shown that clinically diagnosed RLS was associated with the nondipping pattern, which has been shown to be an independent predictor of cardiovascular risk.