Relationship between cytosine-adenine repeat polymorphism of ADAMTS9 gene and clinical and radiologic severity of knee osteoarthritis.

OBJECTIVE: The aim of this study is to determine the role of cytosine-adenine (CA) micro-satellite repeat sequence of ADAMTS9 gene on the development and progression of osteoarthritis (OA). METHODS: A total of 110 participants, including those with primary knee OA and healthy controls were enrolled in the study. Patients were stratified into two groups using the Kellgren-Lawrence staging (K-L staging) as group 1 for controls and mild OA and group 2 for moderate and severe OA. Genetic analyses were performed to determine the CA repeat length in ADAMTS9 gene. RESULTS: Twenty CA repeats were found to be statistically significant for differentiating groups 1 and 2 (P = 0.020). Age was the most significant risk factor involved, followed by ≥ 20 CA repeats and body mass index (P < 0.05). CA repeat length of ≥ 20 showed a 6.1-fold increase in probability for having OA at stage 3 or 4 compared to those of CA repeat length of < 20 (P = 0.004). In conclusion, the CA repeat length of ≥ 20 has a six-fold increase in probability for having severe OA. CONCLUSION: ADAMTS9 gene CA repeat polymorphism may be used to determine the prognosis for OA radiologic progression. Being the first in the literature reporting the CA repeat in the promotor region of ADAMTS9 gene in patients with OA, our study could be highlighted further in future research with larger sample size.

Median and Ulnar Neuropathy Assessment in Parkinson's Disease regarding Symptom Severity and Asymmetry.

Background. While increasing evidence suggests comorbidity of peripheral neuropathy (PNP) and Parkinson's disease (PD), the pathogenesis of PNP in PD is still a debate. The aim of this article is to search the core PD symptoms such as rigidity and tremor as contributing factors to mononeuropathy development while emphasizing each individual patient's asymmetric symptom severity. Methods. We studied 62 wrists and 62 elbows of 31 patients (mean age 66.48 ± 10.67) and 64 wrists and 64 elbows of 32 age-gender matched healthy controls (mean age 62.03 ± 10.40, p = 0.145). The Hoehn and Yahr disability scale and Unified Parkinson's Disease Rated Scale were used to determine the severity of the disease. Results. According to electrodiagnostic criteria, we confirmed median neuropathy in 16.12% (bilateral in two-thirds of the patients) and ulnar neuropathy in 3.22% of the PD group. While mean age (p = 0.003), age at PD onset (p = 0.019), and H&Y scores (p = 0.016) were significant, tremor and rigidity scores were not. The comparison of the mean indices of electrophysiologic parameters indicated subclinical median and ulnar nerve demyelination both at the wrist and at the elbow in the patient groups where a longer disease duration and mild tremor and rigidity scores are prominent, remarkably. Conclusion. A disease related peripheral neurodegeneration beyond symptom severity occurs in PD.

Can mastalgia be another somatic symptom in fibromyalgia syndrome?

OBJECTIVE: The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome. METHODS: Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically. RESULTS: Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome. CONCLUSIONS: We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.

Can mastalgia be another somatic symptom in fibromyalgia syndrome?

OBJECTIVE: The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome. METHODS: Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically. RESULTS: Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome. CONCLUSIONS: We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.

Fear of needles in children with type 1 diabetes mellitus on multiple daily injections and continuous subcutaneous insulin infusion.

OBJECTIVE: To assess the prevalence of fear of needles and its effect on glycemic control in children with type 1 diabetes mellitus (T1DM) on multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). METHODS: Patients aged 6 to 17 years with T1DM on MDI or CSII (n = 150) were enrolled. All caregivers and patients aged ≥11 years completed a "Diabetes Fear of Injecting and Self-testing Questionnaire" (D-FISQ). Needle phobia was defined as a score ≥6 for fear of self-testing (FST), fear of injections (FI), and fear of infusion-site changes (FISC). RESULTS: Positive FST scores were noted in 10.0% and positive FI or FISC scores in 32.7% (caregivers' responses). Patients aged 6 to 10 years on CSII had greater fear (FISC) than those on MDI (FI) (P = .010). FST was inversely related to the number of daily blood sugar checks (P = .003). Patients with positive scores for FI/FISC or FST had significantly higher glycated hemoglobin (HbA1c) levels than those without. An inverse association was noted between positive FI/FISC scores and age of the patient (P = .029). Based on patient responses, FST severity was directly related to the age of the patient (P = .013). CONCLUSION: Needle phobia is common in children with T1DM. Although FI/FISC are more common in younger children, especially in those on CSII, FST is more often encountered in older patients. Patients with a more intense fear of needles have higher HbA1c levels and less frequent blood sugar monitoring. Identifying these patients may help improve glycemic control.

Hand and heart, hand in hand: is radiological hand osteoarthritis associated with atherosclerosis?

AIM: Increasing evidence suggests that atherosclerosis contributes to the initiation or progression of osteoarthritis (OA). It has been suggested that atherosclerosis may cause vascular insufficiency which may lead to or progress OA. In this study, the association between the severity of radiologic hand OA and atherosclerosis was analyzed in women. METHODS: Sixty-one women, ≥ 50 years of age, free of hand symptoms were enrolled in the study. Postero-anterior views of both hands were obtained using digital radiography. A total of 14 joints were assessed for radiographic OA according to Kellgren/Lawrence (K/L) score. An OA-affected joint was defined as K/L score of ≥ 2. Hand OA was defined as ≥ 3 joints of both hands affected with OA and severity of hand OA was defined as total K/L scores of all 14 joints of both hands. Gensini scoring was used to evaluate the patients for atherosclerosis severity. RESULTS: The patient characteristics such as presence of diabetes, smoking, hypertension, dyslipidemia and medications used were similar for patients with and without hand OA (P > 0.05) and did not correlate with Gensini or hand OA scores. The mean Gensini scores of patients with hand OA was 21.5 ± 17.1 and without hand OA was 11.8 ± 9.2 (P = 0.017). The degree of osteoarthritic joint involvement and Gensini scores showed a positive correlation (r = 0.332, P = 0.009). CONCLUSION: Hand OA may be a benign clinical finding that may suggest a possible serious underlying atherosclerosis. Patients with significant hand OA should be screened for atherosclerosis to prevent serious coronary artery disease and related comorbidities.

Clinical and demographic findings of patients with rheumatoid arthritis and ankylosing spondylitis treated in a tertiary care center in Turkey.

BACKGROUND/AIM: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are 2 common rheumatic diseases that are frequent causes of disability. In this descriptive study, demographic, clinical, and laboratory findings of patients with RA and AS being followed in a tertiary care center in Turkey were reported. MATERIALS AND METHODS: The patient data of 45 RA and 45 AS cases were collected retrospectively from electronic medical records. Demographic findings, clinical and laboratory assessments of disease activity, drugs used for the treatment, and effect on quality of life of patients with RA and AS were analyzed. RESULTS: In RA patients, 27% had mild, 44% had moderate, and 29% had severe disease and 25% of the patients had satisfactory functional state. In AS patients, the mean Bath Ankylosing Spondylitis Disease Activity Index score was 4.6 ± 2.3 and 64% had active disease. Sixteen percent of the patients with AS reported satisfactory functional state. In RA cases, the highest percentage of patients were treated with biological agents. In AS cases, 24% of patients were treated with NSAIDs and 22% received biological agents. CONCLUSION: In our tertiary care center, the majority of patients with RA and AS had active disease with unsatisfactory functional states.