Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study.

OBJECTIVES: This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. MATERIAL AND METHODS: The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. RESULTS: In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). CONCLUSION: The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

Does quantitative tibial ultrasound predict low bone mineral density defined by dual energy X-ray absorptiometry?

PURPOSE: Efforts for the early detection of bone loss and subsequent fracture risk by quantitative ultrasound (QUS), which is a non-invasive, radiation free, and cheaper method, seem rational to reduce the management costs. We aimed in this study to assess the probable correlation of speed of sound (SOS) values obtained by QUS with bone mineral density (BMD) as measured by the gold standard method, dual energy X-ray absorptiometry (DEXA), and to investigate the diagnostic value of QUS to define low BMD. MATERIALS AND METHODS: One hundred twenty-two postmenopausal women having prior standard DEXA measurements were included in the study. Spine and proximal femur (neck, trochanter and Ward's triangle) BMD were assessed in a standard protocol by DEXA. The middle point of the right tibia was chosen for SOS measurement by tibial QUS. RESULTS: The SOS values were observed to be significantly higher in the normal BMD (t score > -1) group at all measurement sites except for the lumbar region, when compared with the low BMD group (t score < -1). SOS was negatively correlated with age (r= -0.66) and month since menopause (r= -0.57). The sensitivity, specificity, and positive and negative predictive values for QUS t score to diagnose low BMD did not seem to be satisfactory at either of the measurement sites. CONCLUSION: Tibial SOS was correlated weakly with BMD values of femur and lumbar spine as measured by DEXA and its diagnostic value did not seem to be high for discriminating between normal and low BMD, at these sites.

How do marginal osteophytes, joint space narrowing and range of motion affect each other in patients with knee osteoarthritis.

To assess the number, location, direction and size of osteophytes and the change of the joint space width (JSW) in radiographs of the tibiofemoral (TF) joint in middle-aged people with longstanding knee pain with radiographic osteoarthritis (OA), and to correlate between the range of motion (ROM). In the format of a retrospective study, the OA of both knee in 84 people, 8 men and 76 women (aged 42-77 years), with chronic knee pain at inclusion were examined. The JSW of the TF joint and the number, location, direction and size of osteophyte were evaluated using a PA view in weightbearing. The location and direction of osteophytes showed some variation at each site, particularly at the lateral tibial plateau and medial femoral trochlea. Significant correlations were found between ROM of the right and left knee and the size, location and direction of the most osteophytes. In both knees, the JSW medially was lower when compared with the lateral compartment. The mean JSW in the lateral tibiofemoral compartment of the right knee was associated with active and passive flexion degree of the patients. The mean JSW in the medial and lateral tibiofemoral compartment of the left knee correlated with BMI, and changes in the Kellgren and Lawrence grade of the patients. There was found statistically significant correlation between mechanical medial proximal tibial angle and the osteophyte size of the right and left knee. We think that definitions which incorporate both osteophytes and joint space narrowing offer the association with worsening of active and passive ROM.

Serum antibodies to oral anaerobic bacteria in patients with rheumatoid arthritis.

BACKGROUND: This study was conducted to determine the component that causes the disease in rheumatoid arthritis (RA), which shows great resemblance to periodontitis in a pathologic context. MATERIALS AND METHODS: Within this study, the pathogen-specific IgG levels formed against Porphyromonas gingivalis FDC 381, Prevotella melaninogenica ATCC 25845, Actinobacillus actinomycetemcomitans Y4, Bacteroides forsythus ATCC 43047, and Prevotella intermedia 25611 oral bacteria were researched from the blood serum samples of 30 RA patients and 20 healthy controls with the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The IgG levels of P gingivalis, P intermedia, P melaninogenica, and B forsythus were found to be significantly higher in RA patients when compared with those of the controls. Of the other bacteria antibodies, A actinomycetemcomitans was not found at greater levels in RA serum samples in comparison with the healthy samples. CONCLUSION: The antibodies formed against P gingivalis, P intermedia, P melaninogenica, and B forsythus could be important to the etiopathogenesis of RA.

The relationship between bone mineral density and immobilization duration in hemiplegic limbs.

OBJECTIVE: Prolonged immobilization in stroke is known to result in hypercalciuria, hypercalcemia, accelerated bone resorption, and osteoporosis. Furthermore, bone mineral loss accelerated with increasing duration of hemiplegia. Although stroke is a common disease that causes sudden immobilization, relatively few investigations of bone metabolism in stroke have been reported. The aim of this study was to investigate the changes in bone mineral density of the forearms and legs related to duration of hemiplegia-induced immobilization after stroke. METHODS: Forty-one hemiplegic patients with stroke were evaluated. The patients' age, gender and duration of hemiplegia-induced immobilization were recorded. The measurements of bone mineral density (BMD) in all patients were evaluated with DEXA using the Norland apparatus. The BMD values (g/cm2) were determined by measurements made in the lumbar vertebrae, both forearm and legs (femoral neck and trochanter). RESULTS: We found that bone mineral density was decreased in the affected extremities relative to the intact contralateral side on measurements by dual energy x-ray absorptiometry in bones such as forearm, femoral neck and trochanter. There was a significant difference between bone mineral density of paretic and nonparetic forearms and legs. Bone mineral density of the upper limbs was lower than that of the lower limbs. There was a negative correlation between duration of hemiplegia and BMD values. CONCLUSIONS: Bone mineral loss may be related to the duration of hemiplegia-induced immobilization. Bone mineral loss is accelerated when the duration of hemiplegia is prolonged.

Pedobarography and its relation to radiologic erosion scores in rheumatoid arthritis.

OBJECTIVE: The aim of this study was to assess probable plantar pressure alterations in rheumatoid arthritis (RA) patients by comparison with normal subjects and to investigate the probable relation between pressure distribution under the foot and radiologic foot erosion score. METHODS: Two hundred feet of 50 chronic RA patients and 50 healthy controls were evaluated. Static and dynamic pedobarographic evaluations were used to define the plantar pressure distribution. Also, the modified Larsen scoring system was used to detect the staging of erosions on feet radiograms of the RA patients. RESULTS: Static pedobarography revealed higher pressure and contact areas in the forefoot. All dynamic pedobarographic parameters except for plantar contact area were significantly different between the RA patients and control subjects. Patients with high erosion scores had higher static forefoot and dynamic phalanx peak pressure values. CONCLUSION: Pedobarographic investigation can be useful to evaluate pressure distribution disorders in RA feet and may provide suitable guidelines for the design of various plantar supports.

[Static and dynamic plantar pressure measurements in adolescents]. / Ergenlik dönemindeki çocuklarda statik ve dinamik ayak basinç degerleri.

OBJECTIVES: This study was designed to determine normal values of pedobarography during standing and walking in adolescents in our country and to investigate correlations between demographic data and pedobarographic values. METHODS: Fifty volunteers (25 girls, 25 boys; mean age 14 years; range 13 to 15 years) who were found to have healthy feet according to the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating system for the ankle and foot were enrolled into the study. Plantar pressures were measured during standing and walking tasks with the use of the Mini-Emed pedobarographic device. RESULTS: Static measurements showed significantly higher pedobarographic values for right medial forefoot and toes in girls, and for left midfoot in boys (p<0.05). Overall, no significant differences existed between static pressure values for the right and left feet. The mean right medial foot pressure was higher than that of the contralateral foot in girls. There were no significant differences between the right and left feet in boys. Dynamic measurements showed a significantly larger contact area of the right foot in boys, and a significantly higher maximum plantar pressure of the left medial forefoot in girls (p<0.05). The strength of the correlation of body weight and body mass index was high with maximum plantar pressures (r=0.87 and r=0.83), and moderate with contact area of the foot (r=0.63 and r=0.59) in static measurements. Body weight (r=0.64) and body mass index (r=0.54) were moderately correlated with contact area of the foot in dynamic measurements. CONCLUSION: Appreciation of normal plantar pressure values in adolescents is important in monitoring the development stages of foot, in the assessment of foot disorders, and in making proper footwear modifications in compliance with age.

Pressure-induced pain on the tibia: an indicator of low bone mineral density?

Previous literature investigating bone pain in osteoporosis has prominently focused on painful conditions following osteoporotic fractures. "Is osteoporosis really a silent disease without bone pain and tenderness unless a fracture occurs?" Our aim in this study was to answer the question by assessing the questionable tenderness on tibia bones of fracture-free patients with low bone density and to compare the findings with a normal population. One-hundred-thirty-three consecutive postmenopausal female patients with the mean age of 56 years admitted to our clinic for bone mass measurement were included in the study. Bone mineral density (BMD) values of lumbar spine (L2-L4) and right proximal femur (neck, trochanter, Ward's triangle) were measured by dual-energy X-ray absorptiometry (DXA). Patients with T scores lower than -1 formed the osteopenic-osteoporotic group of patients (low BMD group) whereas those with T scores higher than -1 constituted the normal BMD group according to the osteoporosis definition regarding T score for DXA. Mechanical pressure was applied by a hand algometer on the middle points of three equally divided sections on the anterior part of tibia, and the pressure levels starting the pain sensation (POPL) were recorded. Although the patients in the normal BMD group reported consistently high POPL at all regions of tibia for all BMD measurement sites, this difference reached to a statistical significance level only for the femur neck region. Only mean POPL for the whole tibia had independent association with only femur neck BMD by multiple linear regression analysis. These results are encouraging for assessing the significance of pressure-induced tibial pain as an indicator of low BMD in the future.

Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation.

BACKGROUND AND OBJECTIVES: The efficacy of low level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. Our aim was to clarify the effect of LLLT in MPS by using algometry and thermography. STUDY DESIGN/MATERIALS AND METHODS: Sixty-two patients with MPS having an active trigger point in the neck or upper back region were randomly divided into two equal groups according to therapy applied (group 1: LLLT + stretching exercises, group 2: stretching exercises alone). The outcome measures were pain measured with visual analogue scale (VAS), algometry on the trigger point, algometric difference, thermographic difference, and thermal asymmetry. Comparison was made within and between the groups pre- and post-therapeutically and 3 weeks after therapy. RESULTS: Mean pain values decreased more significantly in group 1 from baseline to 3 weeks follow up (7.54-3.06) while these values were 7.03-5.19 in group 2 (P < 0.05). Group comparisons revealed significant favorable differences in group 1 patients in terms of all other parameters at the first and the second evaluation post therapeutically (P < 0.05). CONCLUSIONS: LLLT seemed to be beneficial for pain in MPS by using algometry and thermography.