Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosis.

Objectives: The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods: This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results: Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200). Conclusion: The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.

The frequency and factors affecting anxiety and depression in patients with rheumatoid arthritis.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease. Anxiety and depression are important problems in patients with RA. The aim of this study was to determine the frequency and the factors affecting depression and anxiety in patients with RA. Material and methods: One hundred and eighty-two patients with RA, aged 18-85 years, were included in this study. The diagnosis of RA was established according to ACR/EULAR RA classification criteria from 2010. Psychosis, pregnancy, breastfeeding and malignancy were exclusion criteria. The demographic data as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), Health Assessment Questionnaire (HAQ) score and the Hospital Anxiety and Depression Scale (HADS) were the parameters used in the analysis. Results: Depression symptoms were present in 50.3%, anxiety in 25.3% of the studied patients. In patients with depression and/or anxiety HAQ and DAS28 scores were higher than other studied RA patients. Depression was determined at significantly higher rates in females, housewives and those with a low education level. Anxiety was determined significantly more often in blue-collar workers. Conclusions: In the present study, depression and anxiety were observed at high rates in patients with RA. These results confirm the real problem in RA patients in comparison to the general population. This points to the relationship between inflammation and depression and anxiety. Psychiatric evaluations and mental status assessment should not be forgotten together with physical examinations of RA patients.

The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study.

Objectives: This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods: Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results: The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion: In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak

Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.

Accelerated Nodulosis in a Patient With Rheumatoid Arthritis.

In patients with rheumatoid arthritis (RA), subcutaneous nodules are the most frequently seen extra-articular findings that are seen in areas of extensor pressure. In this article, we present the case of a RA patient with accelerated nodulosis that started with the use of methotrexate and exacerbated with etanercept and leflunomide treatment.

Coexistence of ankylosing spondylitis and discoid lupus: A case report.

Coexistence of ankylosing spondylitis with connective tissue diseases is very rare. Here, in this study, we describe a coexistence of ankylosing spondylitis and discoid lupus erythematosus in a 35-year-old man. He presented with a 5-year history of low back pain and concurrent development of a discoid rash. Inflammatory low back pain, HLA-B27 positivity and bilateral active sacroiliitis confirmed the diagnosis of ankylosing spondylitis. Discoid lupus erythematosus was diagnosed based on a skin biopsy. There are reports of discoid lupus associated with medications, particularly with tumour necrosis factor-alpha (TNF-α) blocking drugs. However, the patient presented here had coexistence of ankylosing spondylitis and discoid lupus before starting such treatments.

Medial collateral ligament bursitis in a patient with knee osteoarthritis.

BACKGROUND: Medial collateral ligament (MCL) bursitis has been described as a distended and inflamed bursa between the superficial and deep portions of the MCL. It is a rare but important cause of medial knee pain. CASE DESCRIPTION: A 65-year-old woman with knee osteoarthritis (OA) presented with severe pain and swelling in her left knee. She did not have a traumatic injury. After a clinical examination, a slight decrease in the range of motion of the left knee, and a painful swelling and tenderness over the medial side of the knee and proximal tibia were detected. The pain was exacerbated by valgus stress test. The magnetic resonance (MR) imaging showed a distended bursa with internal septations beneath the superficial portion of the MCL. MCL bursitis was considered as diagnosis and an ultrasound-guided corticosteroid injection into the bursa was performed. RESULTS: There was a significant improvement in pain intensity in the follow-up examination. A repeated MR imaging 2 months later showed a marked improvement, and approximation of the deep and superficial portions of the MCL. CONCLUSIONS: MCL bursitis, which is a rare condition, must be considered for the differential diagnosis of increased medial knee pain in patients with knee OA. Corticosteroid injection is an effective and safe treatment modality for the management.

The relationship between body composition and knee osteoarthritis in postmenopausal women.

OBJECTIVES: The aim of this study was to examine the relationship between the body composition measures and knee osteoarthritis (OA) in postmenopausal women to determine whether the fat mass or the lean mass was closely associated with knee OA. PATIENTS AND METHODS: This retrospective, cross-sectional study included a total of 212 postmenopausal women (mean age 59.9±6.2 years; range, 46 to 76 years). Descriptive characteristics were recorded and height was measured using a stadiometer. Body weight, fat mass, and lean mass were estimated using bioelectrical impedance analysis. X-rays of the knees were obtained. Knee OA was radiographically diagnosed according to the Kellgren-Lawrence criteria. Based on the radiographic knee OA diagnosis the women were divided into two groups. Logistic regression analyses were used to examine the associations between the body composition measures and knee OA. RESULTS: Knee OA was present in 117 women. Body Mass Index, body weight, fat mass, and lean mass were all significantly associated with knee OA after adjusting for confounding factors such as age, height, and physical activity (p<0.001). When assessed together with lean mass in a multivariate regression model, fat mass was closely and significantly found to be related to knee OA, compared to lean mass (p<0.001, OR: 1.17). Furthermore the fat mass/lean mass ratio was positively associated with knee OA (p<0.001). CONCLUSION: In postmenopausal women body weight was significantly and positively associated with knee OA and among the components that constitute body weight, fat mass was closely and significantly associated with knee OA compared to lean mass. This result suggests that the relationship between obesity and knee OA is mainly based on the fat mass, and supports the importance of systemic metabolic effects of adiposity in this relationship.

Determinants of physical functioning in women with knee osteoarthritis.

BACKGROUND: Knee osteoarthritis (OA) is an important health problem with its high prevalence and association with pain and functional disability in physical tasks and activities especially in women. AIMS: To explore the impacts of widely seen demographic, pathological, psychological, and impairment factors on physical functioning in women with knee OA using the performance-based and self-reported measures. METHODS: One hundred and ten women with knee OA participated in this study. Performance-based measures included the 10-m walk test, timed up and go (TUG) test, and a stair test. Self-reported physical functioning was measured using the Western Ontario and McMasters Universities OA Index. Knee muscle strength, pain intensity, flexion range of motion (ROM), body mass index (BMI), radiographic severity, and anxious and depressive symptoms were measured. Age, disease duration, and comorbidities were recorded. Correlation and linear regression analyses were used to assess the associations. RESULTS: In the linear regression models, knee muscle weakness, limited knee flexion ROM, pain intensity, and older age contributed to 65% of variance in physical performance measures mostly explained by knee muscle weakness. Knee pain intensity, BMI, anxiety, and knee muscle weakness contributed to 60% of variance in WOMAC physical function score mostly explained by pain. Radiologic severity, depression, comorbidities, and disease duration did not have a significant association (P < 0.05). Performance-based measures had significant but moderate correlations with WOMAC physical function score (r range 0.51-0.57, P < 0.05). CONCLUSION: In women with knee OA, knee muscle strength was the main determinant of performance-based physical functioning together with knee flexion ROM, knee pain, and age. Knee pain was the main determinant of self-reported physical functioning. BMI, anxiety, and knee muscle strength had some contributions as well. Performance-based and self-reported measures had moderate relations and evaluate different aspects of physical functioning. In the management of women with knee OA strengthening of weak knee muscles, improving limited flexion ROM, pain management, weight loss, and improving anxiety should be considered as a priority and performance-based and self-reported measures should be used together for a comprehensive evaluation of physical functioning.

Bone mineral density in patients with mucopolysaccharidosis type III.

Mucopolysaccharidosis type III (MPS III) is a neurodegenerative disorder. In MPS III patients, heparan sulfate accumulates in many tissues especially the central nervous system. There are limited data regarding bone involvement in MPS III compared to other MPS types. The aim of this study was to evaluate bone mineral density (BMD) and the prevalence of low bone mass, and to explore the association between BMD, vitamin D levels, bone fracture, and patient characteristics in MPS III. A clinical assessment and interview was held to obtain data about family history, height, weight, body mass index (BMI), nutrition, walking capacity, bone fracture, epilepsy, and medical therapy of 15 patients with MPS III. Height, weight, and BMI z scores were calculated. Laboratory tests including 25-hydroxyvitamin D (25-OH-D) were measured. BMD measurements for the lumbar spine were obtained using dual-energy X-ray absorptiometry (DXA). BMD z scores were adjusted for height-for-age z score (HAZ) to provide correction for height deficits. Lumbar spine BMD z score was low (<-1) in five patients for chronological age and normalized in two of five patients after adjustment for HAZ. Three patients continued to have low BMD; these were older than the other patients and one had a history of long bone fracture. Two of these patients were observed to have lost walking capacity at 10 and 14 years, and the other was walking with support. Six patients had deficient, and three patients had insufficient levels of 25-OH-D. Two osteoporotic patients had significantly lower levels of 25-OH-D. We found that older patients with immobility are at high risk of osteoporosis and bone fracture, and vitamin D deficiencies/insufficiencies are widely seen. We recommend monitoring BMD by DXA and checking vitamin D metabolism to assess low bone mass and fracture risk in older MPS III patients with immobility.

The relationship between body composition and bone mineral density in postmenopausal Turkish women.

In a retrospective cross-sectional study among 202 postmenopausal women aged 46-75 years, we aimed to investigate the relationship between body composition and bone mineral density (BMD) to determine whether fat mass or lean mass is a better determinant of BMD in Turkish postmenopausal women. Lumbar spine (L1-L4) and proximal femur BMD were measured by dual energy X-ray absorbsiometry. Body composition analysis was performed by bioelectric impedance method and fat mass, lean mass, and percent fat were measured. Both fat mass and lean mass were positively correlated with BMD at the lumbar spine and proximal femur, weight and body mass index. Lean mass was also positively correlated with height and negatively correlated with age and years since menopause (P < 0.01). The correlations of fat mass and lean mass with BMD at the lumbar spine and proximal femur remained significant after adjustment for age, years since menopause and height. When the lean mass was adjusted together with age, years since menopause and height, the significant relationship between the fat mass and BMD continued, however the significant correlation between the lean mass and BMD disappeared at all sites after adjustment for fat mass. In multiple regression analyses, fat mass was the significant determinant of all BMD sites. Our data suggest that fat mass is the significant determinant of BMD at the lumbar spine and proximal femur, and lean mass does not have an impact on BMD when fat mass was taken into account in Turkish postmenopausal women.

[Aerobic endurance training for cancer patients]. / Aerobes Ausdauertraining für Krebspatienten.

With the increase in the number of patients who survive cancer, there is a growing need to attend to the physical and emotional effects of cancer and oncological treatment. Reduced physical performance, fatigue, nausea, weight gain, psychological distress, changes in body image, dependency, and reduced quality of life are some of the short- and long-term sequelae of cancer. We describe data from the literature about firstly the effects of aerobic exercise as an additive treatment for cancer patients, and about the feasibility of aerobic exercise secondly during oncological treatment, and thirdly in patients suffering from terminal cancer. The data from the literature support that exercise as an additive treatment may help to attenuate the physical limitations caused by cancer and oncological treatment and there by contribute to rehabilitation and quality of life of cancer patients. Feasibility of aerobic exercise has been demonstrated also for patients suffering from advanced cancer. Aerobic exercise has been shown to provide benefits to cancer patients. It enables these patients to recover their physical function and to return to an active lifestyle. Aerobic exercise seems to be an effective possibility to reduce sequelae of cancer and to increase quality of life.

Aerobic exercise as additive palliative treatment for a patient with advanced hepatocellular cancer.

Aerobic exercise is known to improve biopsychosocial outcomes in cancer patients. Currently, exercise is not regarded as a quality-of-life intervention for patients with advanced cancer. The aim of this case study was to determine the feasibility and effects of an aerobic exercise programme for a patient with advanced hepatocellular cancer. After written informed consent, a 55-year-old male patient with advanced hepatocellular carcinoma participated in an aerobic exercise programme of precise intensity, duration and frequency, consisting of ergometer cycling 2 times a week, carried out for a period of 6 weeks. Exercise testing and a 6-min walk were performed, and the patient's quality of life was assessed. The feasibility, safety and beneficial effects of the programme were proven for this patient. At the end of the exercise programme, peak work capacity had increased by 20.3%. The patient has experienced an improvement in physical performance, which was underlined by the 6-min walk. Quality of life has been improved (physical functioning, vitality, mental health, role functioning/emotional, social functioning). Knowledge about the benefits of aerobic exercise for patients suffering from advanced cancer is not yet widespread. Nevertheless, aerobic exercise initiated and executed with appropriate care may serve as a useful additional means of palliative treatment in some patients with advanced cancer.