Does balneotherapy provide additive effects to physical therapy in patients with subacute supraspinatus tendinopathy? A randomized, controlled, single-blind study.

This study assessed the additional contribution of balneotherapy on physical therapy in subacute supraspinatus tendinopathy. Ninety patients with subacute supraspinatus tendinopathy were included. They were randomized into two equal groups. In group 1 (n = 45), transcutaneous electrical nerve stimulation (TENS), hot pack, ultrasound treatments, and Codman's and range of motion (ROM) exercises were performed. In group 2 (n = 45), balneotherapy was added to the treatment program. In both groups, shoulder active ROM and handgrip strength were measured. Pain was evaluated using a Visual Analogue Scale (VAS) (rest, sleep, movement); functional assessment and quality of life were measured respectively with the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH), and the Short Form-36 health survey (SF 36) form. All measurements were repeated before and after 15 treatment sessions. There were statistically significant differences between the before and after assessment parameters in group 1 (all p < 0.05), but not for SF-36 General Health Perceptions, SF-36 Mental Health sub-parameters, and handgrip strengths. However, there were statistically significant differences between all the evaluation before and after the treatment in group 2 (all p < 0.05). When the two groups were compared in terms of alpha gains, statistically significant differences were observed in favor of group 2 in all measurements (all p < 0.05) except for SF-36 Emotional Role Difficulty and SF-36 Mental Health sub-parameters. This study shows that the addition of balneotherapy to physical therapy for subacute supraspinatus tendinopathy can make additional contributions to shoulder ROM, pain, handgrip strength, functional status, and quality of life.

The effect of balneotherapy on body mass index, adipokine levels, sleep disturbances, and quality of life of women with morbid obesity.

To investigate the effect of balneotherapy on body mass index, adipokine levels, sleep disturbances, and quality of life in women with morbid obesity. Fifty-four women with morbid obesity were included in the study. The body mass indexes (BMI) and waist/hip ratios (WHR) of the women were calculated. Subcutaneous fat thickness was measured using a *skinfold meter, and the percentage of adipose tissue was calculated. The *Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the Nottingham Health Profile (NHP) was used to assess quality of life. In addition to routine biochemical tests, leptin, adipokine, visfatin from blood, and cortisol from saliva samples were studied. Participants were given 15 sessions of balneotherapy for 20 min each. After treatment, the laboratory and clinical parameters of the participants were *reevaluated. There was no statistically significant difference of BMI, WHR, and percentage of adipose tissue between before and after treatment measurements (p Ëƒ 0.05).There was a statistically significant improvement in PSQI and NSP scores (p Ë‚ 0.001). The levels of blood glucose, leptin, and visfatin were significantly decreased, and adiponectin was significantly increased after treatment (p = 0.047, p Ë‚ 0.001, p Ë‚ 0.001, and p Ë‚ 0.001, respectively).There was no statistically significant changes in salivary cortisol levels (p = 0.848). Patients with diabetes showed a statistically significant decrease in glucose levels after treatment (p = 0.017).There was a statistically significant decrease in low-density lipoprotein cholesterol levels in patients with dyslipidemia compared with pre-treatment (p = 0.018). Balneotherapy improves sleep and quality of life of women with morbid obesity. After balneotherapy, glucose, leptin, adiponectin, and visfatin levels may change positively.

Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome.

[Purpose] To evaluate the short-term effects of kinesio tape on joint position sense, isokinetic measurements, kinesiophobia, symptoms, and functional limitations in patients with patellofemoral pain syndrome. [Subjects and Methods] A total of 90 patients (112 knees) with patellofemoral pain syndrome were randomized into a kinesio tape group (n=45) or placebo kinesio tape group (n=45). Baseline isokinetic quadriceps muscle tests and measurements of joint position sense were performed in both groups. Pain was measured with a Visual Analog Scale, kinesiophobia with the Tampa kinesiophobia scale, and symptoms and functional limitations with the Kujala pain scale. Measurements were repeated 2 days after kinesio tape application. [Results] No differences were found between baseline isokinetic muscle measurements and those taken 2 days after application. However, significant improvements were observed in the kinesio tape group, with regard to joint position sense, pain, kinesiophobia, symptoms, and functional limitations after treatment. Examination of the differences between pre- and post-treatment values in both groups revealed that the kinesio tape group demonstrated greater improvements compared to the placebo kinesio tape group. [Conclusion] Although short-term kinesio tape application did not increase hamstring muscle strength, it may have improved joint position sense, pain, kinesiophobia, symptoms, and daily limitations.

Clinical trial: transcutaneous interferential electrical stimulation in individuals with irritable bowel syndrome - a prospective double-blind randomized study.

BACKGROUND: The exact etiology of irritable bowel syndrome (IBS) remains unclear. Curative treatment is not available and current treatment modalities are mainly directed against the predominant symptoms. There are a few studies reporting the beneficial effects of transcutaneous electrical stimulation in patients with chronic constipation, gastroparesis, and functional dyspepsia. AIM: To investigate whether transcutaneous electrical stimulation is an effective procedure in IBS patients. METHODS: IBS patients were randomly placed in vacuum interferential current (IFC) and placebo groups. Both treatments consisted of 12 sessions administered over 4 weeks. Symptoms due to IBS were documented via questionnaires, including the IBS Global Assessment of Improvement Scale, numeric rating scales, visual analogue scale, and IBS Quality of Life Scale at the beginning of, end of, and 1 month after the treatment. RESULTS: Patients in the therapy (29 cases) and placebo (29 cases) groups were homogeneous with respect to demographic data and gastrointestinal system symptoms. When compared to the beginning scores, severity of abdominal discomfort, bloating, and abdominal distension and rumbling improved significantly in either interference or placebo groups at both the end of treatment and 1 month after treatment. In the IFC group, severity of symptoms continued to decrease significantly at 1 month after treatment when compared to scores at just the end of treatment, whereas in the placebo group severity of these symptoms did not change significantly on numeric severity scales. Also, the visual analogue scale of the first month after treatment continued to decrease significantly when compared to the level at the end of treatment in the IFC group. Total quality score increased significantly in the IFC group. CONCLUSIONS: Vacuum IFC therapy can significantly improve symptoms and quality of life in patients with IBS. It may represent a novel treatment modality for drug-refractory IBS patients.

Superior cluneal nerve entrapment neuropathy due to lower crossed syndrome: A case with low back pain.

The superior cluneal nerve (SCN) is a sensory nerve known to be originated from the dorsal rami of the lower thoracic and lumbar nerve roots. One of the overlooked causes of low back pain (LBP) is the SCN Entrapment Neuropathy (SCNEN). SCNEN may also be associated with SCN stretching due to lumbar movement and the poor body posture through an increase in the paravertebral muscle tonus. A 59-year-old female patient presented with chronic LBP localized on the right iliac crest and radiating to the right buttock, groin, and leg. She had increased lumbar lordosis and anterior pelvic tilt. She had a tender point over the right iliac crest, and the pain was radiating to the buttock and posterolateral thigh (Tinel sign +). She was diagnosed with lower crossed syndrome and SCNEN, and a therapeutic nerve block was performed. Clinicians should consider SCNEN as a possible diagnosis of LBP.

Comparison of Radial Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection Effectiveness in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Study.

OBJECTIVE: The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome. DESIGN: A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale-pain, a Visual Analog Scale-numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment. RESULTS: Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale-pain, Visual Analog Scale-numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale-pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups. CONCLUSIONS: Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection.

A rare benign disorder mimicking metastasis on radiographic examination: a case report of osteopoikilosis.

Osteopoikilosis (OPK) is a rare, autosomal dominant bone disorder, characterized by multiple, discrete round or ovoid radio densities scattered throughout the axial and appendicular skeleton. OPK is usually asymptomatic but rarely there may be slight articular pain and joint effusions. OPK is generally diagnosed incidentally on radiographic examinations and may mimic different bone pathologies, including bone metastases. Radionuclide bone scan has a critical role in distinguishing OPK from osteoblastic bone metastases. In this case report, we present a young man with right hip pain due to OPK, whose plain radiogram and computerized tomography findings thought cancer metastasis.

The Effects of Balneotherapy on Oxidant/Antioxidant Status in Patients With Fibromyalgia: An Observational Study.

OBJECTIVES: This study aims to evaluate whether there was a difference between oxidative stress index (OSI), total antioxidant status (TAS), and total oxidant status (TOS) values between patients with fibromyalgia syndrome (FMS) and healthy controls, and to show the effect of balneotherapy on clinical conditions such as pain, depression, and quality of life in patients with FMS and oxidative stress. PATIENTS AND METHODS: Thirty-five females (mean age 39.9±5.8 years; range, 18 to 50 years) with fibromyalgia and 35 healthy females (mean age 37.9±6.6 years; range, 18 to 50 years) were included in the study. The TAS, TOS, and OSI of patients with FMS and healthy controls were measured. Disease severity was evaluated using the Fibromyalgia Impact Questionnaire, pain levels were evaluated using a visual analog scale (VAS), mood was evaluated using the Beck Depression Inventory (BDI), and quality of life was evaluated using the Short Form 36 (SF-36). Patients with FMS were given 15 sessions of balneotherapy. After treatment, the laboratory and clinical parameters of the patients were reevaluated. RESULTS: Although the TAS levels of patients with FMS were not significantly different from those of the control group (p=0.114), the TOS and OSI levels were higher than those of the control group (p<0.001). The VAS, BDI, and SF-36 parameter scores of patients with FMS were significantly higher than those of the control group (p<0.001). A statistically significant decrease (p<0.001) in TOS and OSI levels of patients with FMS was detected after balneotherapy; however, the TAS levels of patients with FMS did not change significantly (p=0.538). All clinical parameters showed significant improvement with balneotherapy (p<0.001). CONCLUSION: An oxidative disorder was detected in patients with FMS compared with the control group. Balneotherapy showed antioxidant activity and decreased oxidative stress while also improving clinical parameters and quality of life.

Short-Term Effects of Steroid Injection, Kinesio Taping, or Both on Pain, Grip Strength, and Functionality of Patients With Lateral Epicondylitis: A Single-Blinded Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to compare the efficacy of steroid injection and kinesio taping (KT) in the treatment of lateral epicondylitis. DESIGN: A total number of 84 patients were randomized into three groups. Group 1 was given steroid injection, group 2 received KT, and group 3 received both. Pain was measured using a visual analog scale, functional status was measured using a quick form of the Disabilities of Arm, Shoulder and Hand questionnaire, pain-free grip strength was measured using a dynamometer, and the pressure pain threshold was measured using an algometer. All evaluations were performed before treatment and at the third and twelfth weeks after the treatment. RESULTS: Twenty-eight patients were included in each group. A statistically significant difference was found between the pretreatment and posttreatment evaluations of all groups in the third and twelfth weeks after treatment. When group 1 and group 2 were compared, there was a significant difference only in pain-free grip strength measured in the twelfth week. The results of treatment in group 3 patients were significantly better in almost all evaluation parameters compared with the other groups. CONCLUSION: In the treatment of lateral epicondylitis, KT alone was found to be as effective as steroid injection alone. However, co-administration of steroid injection and KT is more effective compared with each treatment alone.

Validity and interrater/intrarater reliability of the Turkish version of the postural assessment scale for stroke patients (PASS-Turk).

Background: There is no Turkish version of the Postural Assessment Scale for Stroke patients (PASS). Objectives: To translate and make the cross-cultural adaptation of the PASS into the Turkish language and evaluate the reliability and validity of the Turkish version (PASS-Turk). Methods: Sixty patients with stroke who had survived the three-week acute period were included in the study. The first researcher applied the scale to the participants twice with 5-day intervals. The second researcher applied the scale once at the same time with the first researcher. The reliability of PASS-Turk and its subsections was evaluated using Cronbach's alpha coefficient. In addition, item-total correlation and test-retest reliability were calculated. The interobserver agreement was assessed using the intraclass correlation coefficient. The construct validity of PASS-Turk was assessed using Pearson's product-moment correlation and principal component analyses. The Berg Balance Scale (BBS) and motor subscale of the Functional Independence Measure (FIM) were used for validity. Results: The Cronbach's alpha coefficients of the PASS-Turk scale were 0.903 for the subsection of "maintaining posture," 0.940 for the subsection of "changing a posture," and 0.953 for the total PASS-Turk scale. The first and second researcher evaluations were perfectly consistent with each other in terms of PASS-Turk total scores (ICC = 0.999, 95% CI: 0.998-0.999, and p < .001). A strong positive correlation was found between PASS-Turk and BBS and the motor subscale of FIM. Conclusion: PASS-Turk is a valid and reliable scale for the evaluation of posture and balance of patients with stroke.

Effects of Ai Chi on balance, quality of life, functional mobility, and motor impairment in patients with Parkinson's disease.

PURPOSE: In this study, we aimed to investigate effects of Ai Chi on balance, functional mobility, health-related quality of life, and motor impairment in patients with Parkinson's disease. METHOD: This study was conducted as an open-label randomized controlled trial (ISRCTN26292510) with repeated measures. Forty patients with Parkinson's disease stages 2 to 3 according to the Hoehn and Yahr Scale were randomly allocated to either an Ai Chi exercise group or a land-based exercise control group for 5 weeks. Balance was measured using the Biodex-3,1 and the Berg Balance Scale. Functional mobility was evaluated using the Timed Up and Go Test. Additionally, health-related quality of life and motor activity were assessed with the Parkinson's Disease Questionnaire-39 and the Unified Parkinson's Disease Rating Scale-III. RESULTS: Although patients in both groups showed significant improvement in all outcome variables, improvement of dynamic balance was significantly greater in the Ai Chi group (p < 0.001), Berg Balance Scale (p < 0.001), Timed Up and Go Test (p = 0.002), Parkinson's Disease Questionnaire-39 (p < 0.001), Unified Parkinson's Disease Rating Scale-III (p < 0.001). CONCLUSION: Our results suggest that an Ai Chi exercise program improves balance, mobility, motor ability, and quality of life. In addition, Ai Chi exercise was more effective as an intervention than land-based exercise in patients with mild to moderate Parkinson's disease. Implications for rehabilitation Ai Chi exercises (aquatic exercises) may help improve balance, functional mobility, health-related quality of life, and motor ability in patients with mild to moderate Parkinson's disease more efficiently than similar land-based exercises. Ai Chi exercises should be considered as a rehabilitation option for treatment of patients with mild or moderate Parkinson's disease.

The Association of Skinfold Anthropometric Measures, Body Composition and Disease Severity in Obese and Non-obese Fibromyalgia Patients: A Cross-sectional Study.

OBJECTIVES: This study aims to determine the effects of obesity and obesity related anthropometric and body composition determiners on the severity of fibromyalgia syndrome (FS) and to compare obese, overweight and normoweight FS patients according to general health and psychological status. PATIENTS AND METHODS: The study included 42 obese (mean age 48.8±11.6; range 24 to 65 years), 27 overweight (mean age 47.3±3.4; range 24 to 61 years) and 32 normoweight (mean age 47.1±7.8 years; range 31 to 60 years) female FS patients. Widespread pain scores and symptom severity scores were noted. Pain pressure thresholds of tender points and control points were measured and total myalgic score (TMS) was calculated. The anthropometric assessments and skinfold measurements of all participants were recorded. Quality of life was evaluated by Health Assessment Questionnaire while psychological status was evaluated using Beck Depression Inventory. RESULTS: Control points, TMS values and hand grip strength values of obese FS patients were significantly lower, while disease duration, symptom severity, widespread pain scores, visual analog scale and Health Assessment Questionnaire scores were significantly higher than normoweight and overweight FS patients. Fat free mass, fat mass, body fat percentage and waist/hip ratio values were significantly higher in obese FS patients than overweight and normoweight FS patients (p<0.001 for all values). Stepwise linear regression analysis showed that increased body mass index, decreased fat free mass (R2=0.11) and increased disease duration (R2=0.13) were associated with lower TMS. CONCLUSION: We found that obesity had significant negative effects on pain, disease severity and quality of life in patients with FS.

The effects of sulfasalazine treatment on enthesal abnormalities of inflammatory rheumatic diseases.

The aim of this study was to evaluate the effects of a 1-year course of sulfasalazine monotherapy on enthesal abnormalities of inflammatory rheumatic diseases (IRDs) using ultrasonography. Thirty-six patients with IRD including 20 patients with rheumatoid arthritis (RA) and 16 patients with ankylosing spondylitis (AS) (22 women, 14 men, mean ages 43.3 +/- 8.8 years), and 18 healthy controls (10 women, 8 men, mean ages 42.5 +/- 9.9 years) matched by age and body mass index were enrolled in this study. For the evaluation of enthesal structures, all patients and controls underwent ultrasonographic (USG) examinations of five enthesal sites of both lower limbs using high-resolution and Doppler USG. An ultrasonographic score of lower limb enthesitis was calculated using Glasgow ultrasound enthesitis scoring system (GUESS). Clinical and laboratory activities of IRD patients were also evaluated. Patient group was made to undergo 2 g/day sulfasalazine monotherapy for 1 year. All evaluations were made at the beginning of the treatment and repeated after 1 year follow-up. Results showed that the frequency of enthesal abnormalities of the IRD group was significantly higher than controls. On USG examination, 301/1,296 (23.2%) enthesal structures were abnormal in IRD patients, and 19/648 (2.93%) structures were abnormal in controls. Mean GUESS score of the IRD group (6.40 +/- 2.41) was also significantly higher than controls (1.79 +/- 1.60) (p < 0.001). Although there was a significant improvement in clinical and laboratory activity parameters of the IRD patients, significant decrease was not observed in enthesal abnormalities (295/1,296 enthesal structures-22.7%) and mean GUESS score (6.20 +/- 2.38) after 1 year sulfasalazine trial. Additionally, there was no significant improvement in enthesal abnormalities and mean GUESS scores of AS and RA subgroups separately. Sulfasalazine treatment was not found effective on enthesal abnormalities of IRD patients. Further studies with larger groups including other IRDs are required to validate our results.

Femoral neuropathy in a patient with rheumatoid arthritis.

Femoral mononeuropathy (FMN) as an extraarticular finding of rheumatoid arthritis (RA) is a phenomenon which has not been reported previously. We report a 53-year-old female patient with RA, presenting FMN findings during the course of the disease. On examination, right quadriceps and iliopsoas muscles showed grade 3 weakness on the Medical Research Council (MRC) scale. Sensory examination revealed sensory loss in the right medial leg and thigh. Patellar tendon reflex was absent in the right side. A diagnosis of a partial right femoral neuropathy was confirmed using nerve conduction study and electromyography. The probable mechanism of FMN was thought to be vasculitis.

Are Transitional Vertebra and Spina Bifida Occulta Related with Lumbar Disc Herniation and Clinical Parameters in Young Patients with Chronic Low Back Pain?

OBJECTIVE: Lumbosacral transitional vertebra (LSTV) and spina bifida occulta (SBO) are widespread within the lumbosacral spine. Their connection to lumbar disc herniation (LDH) and/or lower back pain has been debated in the current literature; however, there is no consensus. The purpose of this study is to evaluate the relationship between the frequency of LSTV and SBO with that of LDH among young patients with chronic lower back pain. STUDY DESIGN: Cross-sectional. MATERIALS AND METHODS: A total of 1094 patients with lower back pain, aged between 20 and 40 years, with lower back pain history persisting for longer than 12 weeks were studied. All the patients in the study were evaluated with standard pelvic radiographs and lumbar vertebra magnetic resonance imaging. The severity of pain was measured using the visual analog scale, and the effect of lower back pain on daily life activities was measured using the Oswestry disability index. The patients were separated into two groups: Group 1 consisted of patients without LDH, and Group 2 consisted of patients with LDH. Additionally, these two groups were separated into three subgroups: Non-LSTV-SBO, LSTV, and SBO. RESULTS: It was determined that LSTV frequency was significantly higher (p=0.004) in the lumbar disc herniation group 2. In addition, the existence of LSTV increased the risk of lower back pain (p<0.001, p<0.001) and disability (p<0.001, p<0.001) in young patients with and without LDH or not. However, the presence of SBO did not increase lower back pain (p=0.251, p=0.200) and disability (p=0.134, p=0.161) in both groups. CONCLUSION: A relationship was detected between the frequency of LDH and LSTV in young patients with chronic lower back pain between the ages of 20 and 40 years. Also, the presence of LSTV was found to increase the risk of lower back pain and disability.

Which Non-Pharmacological Treatment is More Effective on Clinical Parameters in Patients With Fibromyalgia: Balneotherapy or Aerobic Exercise?

OBJECTIVES: This study aims to determine the effects of non-pharmacological therapies, namely balneotherapy, exercise, and the combined use of balneotherapy and exercise, on total myalgic score (TMS), sleep quality, health status, and signs of depression in patients with fibromyalgia syndrome, and to compare the efficacies of these treatment programs with respect to the above parameters. PATIENTS AND METHODS: A total of 120 female subjects (mean age 37.21±12.45 years; range 18 to 63 years) diagnosed with fibromyalgia were enrolled. The patients were randomized into three groups with 40 patients in each (group 1: balneotherapy group, group 2: balneotherapy + exercise group, and group 3: exercise group). The patients underwent the treatment program for five days a week for a total of three weeks. Clinical parameters, Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS, and Beck Depression Scale were evaluated at pre-treatment and post- treatment periods, and at the third-month control visit. RESULTS: There were no differences between the groups with respect to Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS and Beck Depression Scale scores on pre-treatment evaluation, while the combined use of balneotherapy + aerobic exercise was more effective on TMS (p<0.001), health status (p=0.009), and level of depression (p<0.001) in post-treatment evaluation. A better state of well-being with respect to sleep quality was achieved by balneotherapy and balneotherapy + exercise groups. The third-month comparisons, on the other hand, demonstrated that the balneotherapy + exercise group had a greater state of well-being with respect to TMS (p<0.001) and general health status (p<0.001). Balneotherapy + exercise and exercise therapy benefited signs of depression to a better degree (p<0.001). Balneotherapy and combined balneotherapy + exercise therapy produced more effective results in terms of sleep quality (p<0.001). TMS regressed to near baseline levels (p=0.397), while Fibromyalgia Impact Questionnaire levels rose to near baseline levels at the third-month control in the exercise therapy group (p=0.070). CONCLUSION: The combined application of balneotherapy + exercise therapy, which are two of the recommended non-pharmacological treatments, may have superior and more sustained effects than administering either therapy alone.

Complex regional pain syndrome type-I after rubella vaccine.

Complex regional pain syndrome type I (CRPS-I) is a complex disorder characterised by pain, autonomic dysfunction, and decreased range of motion. The syndrome was believed as a well-recognized disorder in adults but, less commonly recognized in children. CRPS-I after vaccination has been rarely reported. We reported an 11-year-old young girl with CRPS-I due to rubella vaccine.

Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects.

The objective of this study was to determine tendon involvements and enthesal abnormalities in patients with rheumatoid arthritis (RA) using high-resolution ultrasonographic images and to compare the findings with those seen in patients with ankylosing spondylitis (AS) and healthy controls. A total of 24 patients with RA, 18 with AS, and 20 healthy controls matched by age and body mass index (BMI) were included in the study. All of the patients and controls underwent clinical and ultrasonographic examinations of both lower limbs at five enthesal sites (superior and inferior pole of the patella, tibial tuberosity, Achilles tendon, and plantar aponeurosis) and both upper limbs at two tendon sites (tendons of m. biceps brachii and supraspinatus at the shoulder). High-resolution ultrasonographic examinations were performed to detect bursitis, structure thickness, bony erosion, and enthesophyte. An ultrasonographic score of lower limb enthesitis was calculated using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) in all patients. Tendon involvements and enthesal abnormalities were found significantly more often in the RA group than in controls (p<0.05 to <0.001), but were not found to be different from the AS group (p>0.05). On clinical examination 67 of 336 (19.9%) tendon and enthesal sites were abnormal and on ultrasonographic examination 130 of 336 (38.2%) sites were abnormal in RA patients. The most frequently affected enthesal sites in the lower limbs were suprapatellar, infrapatellar, and Achilles tendon in both the RA and AS groups. The tibial tuberosity was less affected in both groups, and involvement of the plantar aponeurosis was not different from the controls. A statistically significant correlation was found between the Ritchie articular index and GUESS (r=0.578, p=0.008). Tendon involvements and enthesal abnormalities in RA patients were found more often than had been estimated. Further studies are required to validate our results.

Relationship between high-resolution computed tomography findings and the Stoke index in patients with rheumatoid arthritis.

The aim of this study was to evaluate the relationship between high-resolution computed tomography (HRCT) findings and the Stoke index (SI) in patients with rheumatoid arthritis (RA). Forty RA patients (31 women, 9 men) were evaluated. All patients fulfilled the criteria proposed by the American College of Rheumatology. Clinical evaluation, haematological data, chest radiography, pulmonary function tests (PFTs) and HRCT were obtained in all patients. The SI was used to assess disease activity. In 17 (42.5%) patients, there were no signs of pulmonary involvement on HRCT; 23 (57.5%) of 40 patients had abnormal HRCT findings. Of 23 patients with HRCT abnormalities, six (two male, four female) had respiratory symptoms, four (one male, three female) had abnormalities on chest radiography and five (all female) had abnormalities on PFTs. There was no relationship between pulmonary changes observed on HRCT, clinical and laboratory disease activity parameters, chest X-ray and PFTs. There was no difference in the mean SI between patients included in the HRCT (+) and those included in the HRCT (-) groups. No significant correlations between the HRCT and the SI were seen. The main findings of this study are that HRCT can give useful information on RA-associated lung changes and that there was no relationship between the SI and the HRCT findings of patients with RA.

Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection.

OBJECTIVE: To evaluate the long-term efficacy of steroid injection for plantar fasciitis using clinical parameters and high-resolution ultrasonography. MATERIAL AND METHODS: Thirty patients (27 female and three male) with plantar fasciitis and 30 healthy controls matched by age, gender and body mass index (BMI), were enrolled in this study. Seventeen of the patients had bilateral and 13 had unilateral (six right, seven left) plantar fasciitis. Palpation-guided steroid injection was applied to the 47 heels of 30 plantar fasciitis patients. Ultrasound examination and pain intensity with visual analog scale (VAS) were assessed three times in each plantar fasciitis patients; before injection and at 1 and 6 months after steroid injection. Ultrasonography was performed to the controls at initial assessment. RESULTS: The plantar fascia was remarkably thicker in the plantar fasciitis group than in controls (P < 0.001). The thickness of the plantar fascia and mean VAS values in the plantar fasciitis group decreased significantly 1 month after steroid injection (P < 0.001, P < 0.001, respectively) and a further decrease was noted 6 months postinjection (P < 0.001, P < 0.001, respectively). Strong correlation was found between the changes of plantar fascia thickness and VAS values 1 month after (P < 0.001, r: 0.61) and 6 months after (P < 0.001, r: 0.49) steroid injection. The incidence of hypoechoic fascia was 73% in the plantar fasciitis group before steroid injection. It decreased significantly at 1 and 6 months postinjection (33% and 7%, respectively, P < 0.001). Gross fascia disruption or other side effects were not observed after steroid injection. CONCLUSION: Steroid injection could be used in plantar fasciitis treatment for its positive long-term effects.