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.

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.

Carbonic anhydrase II autoantibody and oxidative stress in rheumatoid arthritis.

OBJECTIVES: To investigate the relationship between carbonic anhydrase (CA) II autoantibody and lipid peroxidation, certain antioxidant parameters, and cytokines in rheumatoid arthritis (RA) patients. DESIGN AND METHODS: Serum levels of CA II autoantibody, cytokines (TNFα, IL-6, IFN-γ, IL-1ß) and bone markers (crosslaps, osteocalcine) and erythrocyte levels of antioxidant enzyme activities (SOD, CAT, GPx), GSH and MDA, and CA activities were measured in RA patients and healthy controls. RESULTS: The CA II autoantibody titers were significantly higher (P<0.05), and erythrocyte SOD activities were significantly lower (P<0.05) in RA patients. A significant negative correlation between CA II autoantibody titers and SOD activities in RA group was established (r=-0.430, p=0.006). The elevated cytokine levels could not be correlated with CA II autoantibody levels in RA. CONCLUSION: These results suggest that increased erythrocyte oxidative stress observed in RA may be effective in the mechanism of CA II autoantibody formation.

Prevalence of rheumatoid arthritis in the eastern Black Sea region of Turkey.

AIM: The aim of this study was to estimate the prevalence of rheumatoid arthritis (RA) in the eastern Black Sea region of Turkey. METHOD: The study was carried out between March 2003 and March 2005 by the Karadeniz Technical University Medical Faculty Department of Physical Medicine and Rehabilitation in the urban area in the eastern Black Sea region of Turkey, which has a population of 459021 (according to the 2000 national census). A total of 6103 subjects, 20 years old or over, were selected by the sampling method; 3023 (49.5%) women and 3080 (50.5%) men were included in the study. The diagnosis of RA was performed based on fulfilling the American College of Rheumatology (ACR) criteria. RESULTS: Fifty-nine patients were diagnosed with RA according to the ACR criteria, of which 11 were male and 48 female. The prevalence of RA was 1% (95% CI: 0.75-1.25) in the general population, 1.6% (95% CI: 1.15-2.05) in women and 0.35% (95% CI: 0.14-0.56) in men. The female/male ratio was 4.3 : 1.0, showing that RA prevalence was statistically significantly higher in women (P <0.005). CONCLUSION: Our study demonstrates that RA is a common disease in Turkish society.

A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain.

AIM: To compare the effectiveness of landmark-guided local injections and ultrasonography (USG) guided injections for shoulder pain. METHODS: A total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled, and randomly assigned to receive triamcinolone (40 mg) either by landmark-guided (LMG, n=30) or USG guided (n=30) injection. The patients were evaluated on admission and 6 weeks after the injection. Clinical assessment included demographic and clinical data, a visual analoge scale (VAS) for pain (0 to 10 cm), the Constant scale (0 to 100) for function, passive and active shoulder range of motion (ROM) with goniometric evaluation, and postinjection adverse effects. RESULTS: Initial demographic, clinical and USG findings in the groups exhibited no significant differences. Six weeks after injection, the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group (mean VAS score decrease: 4.0+/-1.7 for USG vs. 2.2+/-0.9 for LMG, P<0.05; mean Constant score change: 32.2 for USG vs. 12.2 for LMG, P<0.05). Significant improvements were observed in active and passive ROM values in both groups, USG group values being better. Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM, of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection (P<0.05). CONCLUSIONS: Our results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG-guidance may improve therapeutic effectiveness and reduce adverse effects.

The association of anti-CCP antibodies with disease activity in rheumatoid arthritis.

Antibodies to citrullinated proteins have been described in patients with rheumatoid arthritis (RA) and these appear to be the most specific markers of the disease. Our objective was to determine the frequency of antibodies to cyclic citrullinated peptides (CCPs) in patients with RA and the association of anti-CCP antibodies with disease activity, radiological erosions and HLA DR genotype. Forty patients with RA and 38 patients with fibromyalgia were included in this study. Serum samples were collected from both patient groups with RA and fibromyalgia. Anti-CCP was measured by the corresponding enzyme-linked immunosorbent assay. Additionally, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), disease activity score (DAS), visual analog scala (VAS), HLA genotype and radiographic information were determined in patients with RA. The rate of sensitivity and specificity of anti-CCP reactivity for the diagnosis RA were measured (sensitivity 50%, specificity 100%). There is no significant difference between anti-CCP (+) and anti-CCP (-) RA patients for DAS28, VAS, ESR, CRP, disease duration, HLA genotype, and radiological assessment of hand. However, there was a significant difference between anti-CCP (+) and anti-CCP (-) RA patients for RF and the radiological assessment of left and right wrists (respectively, P < 0.05, P = 0.04, P = 0.01). There was no significant correlation between anti-CCP antibody and ESR, CRP, VAS, DAS 28 or radiological assessment. A small but significant correlation was found between RF and anti-CCP antibody (P = 0.02, r = 0.35).

[The prevalence of cigarette smoking in the Eastern Black Sea Region]. / Dogu Karadeniz Bölgesi'nde sigara içme prevalansi.

The number of studies conducted on the subject of cigarette smoking habits in Turkish society in general is limited. This study presents data regarding the prevalence of cigarette smoking in the Eastern Black Sea Region of Turkey. This cross-sectional study was carried out between March 2003 and March 2005 in the provinces of Trabzon, Giresun, Rize, Artvin and Gümüshane in the Eastern Black Sea Region. The research was conducted in the provincial capitals and districts. According to the 2000 general census, a total of 459.021 people live in these areas, and 6103 individuals were enrolled in the study, selected to be representative of gender, age groups and settlement locations. Data regarding cigarette smoking were obtained using questions employed by the World Health Organization and the British Health Protection Agency. Daily smoking prevalence (at least one cigarette smoked per day) of 18.3% was determined in women and 50.7% in men, while weekly smoking prevalence (less than one cigarette a day but at least one a week) was determined as 1.3% in men and women. It was also determined that 8.4% of women and 18% of men had quit smoking; 69.7% of women and 27.9% of men stated that they had never smoked in their lives. The difference between men and women in terms of smoking prevalence was statistically significant (p< 0.0005). The highest prevalence was in the 20-29 age group in women (23.3%) and in the 30-39 age-group in men (59.9%). In addition, significantly high levels were determined in high school graduates (46.3%, p< 0.0005), unmarried subjects (41%, p< 0.0005) and in the retired (53.7%, p< 0.0005). Cigarette smoking levels continue to represent a major public health problem in the Eastern Black Sea Region.

Bone mineral metabolism and its relationship to leptin levels in survivors of childhood leukemia and lymphoma.

Leptin has important effects on bone metabolism. Possible relationships between leptin and bone mineral density were evaluated in the survivors of the childhood leukemia and lymphoma. Twenty patients were included the study. Anthropometric parameters, growth hormone response to provocative test, serum calcium, phosphorus, alkaline phosphates, osteocalcin, leptin levels, urinary calcium and deoxyypyridinoline levels, and bone mineral density were obtained. Anthropometric parameters of patients were not significantly different from those of a control group. Growth hormone provocative test was abnormal in 3 patients who received cranial radiotherapy. The osteocalcin levels and bone mineral density of patients were significantly lower than in the control group (p=.001, p=.02). Nine patients were in the osteopenic and 7 were in the osteoporotic range. The leptin levels of patients were significantly lower (p=.01) than in the control group. Bone mineral density (BMD) was significantly correlated with leptin level, age, body mass index, and Tanner stage in simple correlation analysis. However, in multivariate analysis only age was significant (p<.000, r: .752). Markers of bone metabolism, BMD, and leptin levels were not related with the growth hormone status of patients and did not present a correlation with the cumulative doses of drugs. There are a few studies evaluating the relationship between BMD and leptin levels in childhood cancer. Although this study did not find any correlation between the leptin level and BMD, detailed studies of larger numbers of patients are necessary to evaluate causes of decreased leptin level and the possible role of leptin on osteopenia observed in survivors of childhood cancer.

Coexisting ankylosing spondylitis and Sjogren's syndrome: a case report.

Sjogren's syndrome and ankylosing spondylitis can occur either alone or in conjunction with other disorders. In this article we report a female patient afflicted with ankylosing spondylitis and Sjogren's syndrome.

Sleep quality and immune functions in rheumatoid arthritis patients with and without major depression.

The purpose of this study was to determine the discriminative factors between rheumatoid arthritis (RA) patients with and without major depression (MD). We assessed subjective sleep quality, pain, and cell-mediated immune functions in RA patients with (n = 20) and without (n = 20) MD by using Pittsburgh Sleep Quality Index (PSQI), visual analogue scale (VAS), and fluorescein isothiocyanat (FITC) labeled CD3, CD4, CD8, CDI9, CD45, CD56, and HLADR T monoclonal antibodies by flow cytometry. We found that the RA patients with MD had significantly higher pain level, poorer sleep equality, higher HDRS points, and higher HLADR T cell level than those without MD; and that these variables are discriminant factors between patient groups. These findings suggest that the RA patients with MD may be differentiated from those without MD by using VAS, PSQI, and HLADR levels; that these variables correctly classify the depressed and non depressed groups up to an accuracy level of 96.8%.

Classical and atypical neuroleptics, and bone mineral density, in patients with schizophrenia.

There are some reports that classical neuroleptics may lead to osteoporosis or reduced bone mineral density (BMD). However, there is no adequate information about the effects of atypical neuroleptics on BMD. The aim of this study was to measure BMD in schizophrenic patients taking classical and atypical neuroleptics, compared to healthy controls. Seventy-five patients with schizophrenia (40 taking classical neuroleptics [CN], 35 taking atypical neuroleptics [AN]) and 20 healthy controls (HC) were included in the study. Spine (L1-L4) BMD was measured by dual-energy X-ray absorptiometry. ANOVA showed that BMD was higher in HC than AN and CN. In addition, there was a negative correlation between the duration of neuroleptic treatment and BMD and the duration of the illness. These findings suggest that atypical neuroleptics may be safer than the classical neuroleptics in terms of reduced BMD.