Is choroidal thickness related with disease activity and joint damage in patient with rheumatoid arthritis.

OBJECTIVE: Aim of the study was to evaluate the choroidal thickness (CT) in patients with RA and detect the relation with disease activity and joint damage in patients with rheumatoid arthritisBACKGROUND: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with various extra-articular organ manifestations including ocular manifestationsMATERIALS AND METHODS: We included 59 eyes of 59 patients with RA and 59 eyes of 59 controls without RA in the study. Subfoveal and perifoveal CT were measured using enhanced depth imaging optic coherence tomography. Disease activity score 28 (DAS 28) and Larsen score were calculated for each patient with RA and compared with measurements of CT. RESULTS: CT was statistically thinner in patients with RA than controls, at subfoveal CT (p = 0.008), at 500 µm temporal to the fovea (p = 0.004), at 1000 µm temporal to the fovea (p = 0.010), at 1500 µm temporal to the fovea (p = 0.005), at 500 µm nasal to the fovea (p = 0.035). Additionally there was no correlation measurements of CT with disease activity and joint damage. CONCLUSIONS: Subfoveal and perifoveal CT was significantly thinner in patients with RA than in healthy controls but there was no correlation detected between CT measurements and DAS 28 or Larsen scores (Tab. 5, Ref. 33).

Neuropathic arthropathy progressing with multiple joint involvement in the upper extremity due to syringomyelia and type I Arnold-Chiari malformation.

Neuropathic arthropathy (NA), known as Charcot neuroarthropathy, is a chronic, degenerative arthropathy and is associated with decreased sensory innervation. Numerous causes of this arthropathy have been described. Neuropathic joint, although first described by Charcot in tabes dorsalis in 1868, has subsequently been observed in a variety of conditions including syringomyelia, diabetes mellitus and peripheral nerve disorders. Syringomyelia is characterized by slow progression. The shoulders and elbows are the most frequently involved joints in syringomyelia. Involvement of the hand is a quite rarely seen in the cases of NA caused by syringomyelia. In this article, we reported a case of NA secondary to syringomyelia. The characteristics of this presented case is the presence of Arnold-Chiari malformation accompanying with syringomyelia and involvement of the shoulder, elbow and hand (multiple joint involvement).

Muscle imbalance in hallux valgus: an electromyographic study.

OBJECTIVE: Hallux valgus is a very common foot deformity in modern societies. Muscle imbalance in abductor and adductor muscles was cited as a major factor in the production of hallux valgus. Our aim in this study was to evaluate the role of certain muscles in this deformity. DESIGN: Twenty hallux valgus patients and 20 healthy volunteers participated in the study. After thorough physical, neurologic, and radiographic investigations, we performed an electromyographic study to observe the relationship of hallux valgus deformity with the muscles coordinating first metatarsophalangeal joint movements. Voluntary extension, flexion, abduction, and adduction at the hallux with maximum resistance were performed. Firing rates and amplitudes of motor unit potentials of four muscles: musculus abductor hallucis, musculus adductor hallucis, musculus extensor hallucis longus, and musculus flexor hallucis brevis were recorded. Statistical analysis, including Spearman's correlation analysis and Mann-Whitney U tests were performed with SPSS 8.0 for Windows. RESULTS: We observed that in the hallux valgus group, abduction activity of musculus abductor hallucis was markedly decreased when compared with adduction of musculus adductor hallucis. Motor unit potential amplitude of abductor activity recorded from musculus abductor hallucis was slightly more than half of the activity in flexion. CONCLUSION: Muscle imbalance in abductor and adductor muscles is apparent in hallux valgus deformity, and this imbalance may be the reason or the result of joint deformity.

Relation between hallux valgus deformity and lumbar and lower extremity biomechanics.

Hallux valgus (HV) is a static subluxation of the first metatarsophalangeal joint with lateral deviation of the great toe and medial deviation of the first metatarsal. Our aim was to evaluate the interference of HV deformity with changes in lumbar lordosis and some foot deformities. Twenty HV patients and 20 healthy subjects were selected for the study. Hallux valgus angle, metatarsus primus varus (MPV), metatarsus omnis varus (MOV), first intermetatarsal (1.IMT), second metatarsal (2. MT) and hallux interphalangeal (HIP) angles were estimated from the anteroposterior foot X-rays. Lumbosacral (LSA) and sacrohorizontal angles (SHA) were measured from lateral lumbar x-rays and pes planus was detected from lateral and anteroposterior ankle and foot radiographs. There was a significant difference between HV angle mean values of two groups. MPV, MOV, 1.IMT, 2. MT and HIP angles did not show significant difference between groups. HV angle was found to be correlated with MPV. HIP angle was found to be correlated with LSA and SHA, indicating a relation with lordosis. HV and pes planus were correlated with each other. HV also showed weak correlation with hyperlordosis. Transmission of variations in body mechanics through pelvis and lower extremity plays an important role for certain foot deformities. Some factors affecting HV development are correctable; early diagnosis and treatment of MPV and pes planus, suggesting healthy rather than fashionable footwear and preventing obesity may lower HV incidence.

Paravertebral abscess formation and knee arthritis due to brucellosis in a patient with rheumatoid arthritis.

OBJECTIVE: To report a case of Brucellosis causing severe joint and vertebra destruction in a patient with rheumatoid arthritis (RA). SETTING: Ankara, Turkey. CASE REPORT: A 47-year-old man with a known diagnosis of (RA) for 5 years developed paravertebral and epidural abscesses and vertebral fractures and nerve root compression due to brucellosis. The patient underwent surgery for L3-L4 vertebra stabilisation and medical treatment for knee arthritis. CONCLUSION: It is important to be aware of the possibility of brucellosis in endemic areas, even among patients with a known diagnosis of RA presenting with clinical pictures that may be confused with a flare-up of the RA itself. Steroids and NSAIDs may have the potential to mask disease manifestations.

Long-term clinical and electrophysiological results of local steroid injection in patients with carpal tunnel syndrome.

The aim of this study was to evaluate the effects of local steroid injection on both the clinical symptoms and motor and sensory conduction of the median nerve in carpal tunnel syndrome (CTS). Using a standard evaluation and treatment protocol, we prospectively studied steroid injection in 32 hands in 24 patients (mean age: 50.7 +/- 10 years; 23 women and 1 man). To determine the normal median nerve values, 42 normal controls (mean age: 39.1 +/- 10.5 years; 21 women and 21 men) were also studied. At follow-up, clinical symptom scores and signs of CTS, as well as electrophysiological variables of the median nerve, showed a significant trend towards improvement with respect to baseline values (p < 0.01). By the end of the one-year follow-up period, the symptoms had remitted completely or partially in 27 hands (84.4%). In addition to the relief of the symptoms, motor nerve conduction abnormalities had improved in 62.6% of hands, and anti-dromic sensory nerve conduction abnormalities in 62.5%. In cases where a sensory nerve action potential (SNAP) could be obtained, the efficacy of this treatment was found to be relatively higher than in cases in which SNAP was absent (p < 0.01).

Brucella disc infection mimicking lumbar disc herniation: a case report.

Brucellosis is a zoonotic disease and still a major health problem in many geographical areas. In this paper a forty year-old woman with spinal brucellosis associated with epidural abscess formation and mimicking lumbar disc herniation is presented. Compression of spinal nerve root(s) by epidural masses due to brucella disc infection is a rare condition and should be kept in mind in differential diagnosis of lumbar disc herniation. The crucial role of magnetic resonance imaging in differential diagnosis is also emphasised.