Correlation between clinical disease activity and sacroiliac magnetic resonance imaging detection in axial spondyloarthropathy.

Objectives: The study aimed to evaluate the correlation between the clinical disease activity of axial spondyloarthropathy (axSpA) and magnetic resonance imaging findings of the sacroiliac joint. Patients and methods: Thirty-two patients (21 males, 11 females; mean age: 39.3±9.2 years; range, 18 to 55 years) who were diagnosed with axSpA according to the Assessment in Spondyloarthritis International Society classification criteria between November 2015 and August 2017 were included in this cross-sectional study. Visual Analog Scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-erythrocyte sedimentation rate (ESR), and ASDAS-C-reactive protein (CRP) were used as the indicators of clinical activity. Magnetic resonance imaging of the sacroiliac joint was performed and the Spondyloarthritis Research Consortium of Canada (SPARCC) score was evaluated by a radiologist who was blinded to the clinical and laboratory parameters of the patients. Results: The mean duration of symptom onset was 9.3±7.7 years, and the mean duration of diagnosis was 3.6±2.8 years. Human leukocyte antigen (HLA)-B27 was positive in 16 (50%) patients. There was no correlation between the SPARCC score and VAS, BASDAI, MASES, BASFI, ASDAS-CRP, ASDAS-ESR, ESR, and CRP values (p>0.05). In the HLA-B27 subgroup analyses, a statistically significant correlation was found between HLA-B27-negative patients and SPARCC score (r=0.639, p=0.008). Conclusion: No relationship was found between other clinical disease parameters and sacroiliac joint imaging findings, except for the relationship between the SPARCC and BASDAI in HLA-B27- negative patients with axSpA.

Low levels of serum vitamin D3 are associated with fibromyalgia syndrome in pre-menopausal women: A pilot study.

OBJECTIVES: This study aims to investigate the prevalence of fibromyalgia syndrome (FMS) among patients with low and adequate vitamin D levels in premenopausal women. PATIENTS AND METHODS: Between October 2012 and April 2013, a total of 80 premenopausal patients (mean age 38.1±7.1 years; range, 18 to 50 years) with non-specific musculoskeletal symptoms were included in the study. The determination of 25-hydroxyvitamin D3 (25(OH)D3) deficiency was based on a reference value of 25 ng/mL. Patients with deficient serum 25(OH)D3 levels (<25 ng/mL, n=40) comprised the patient group, while those with adequate serum 25(OH)D3 levels (≥25 ng/mL, n=40) comprised the control group. Data including demographic characteristics, laboratory parameters (i.e., calcium, phosphorus, alkaline phosphatase [ALP], and parathyroid hormone [PTH]), and clinical findings (i.e., proximal muscle weakness [PMW] and periarticular sensitivity [PAS]) were recorded and compared between the groups. Pain severity was evaluated using the visual analog scale (VAS), psychological status was evaluated using the Beck Depression Inventory (BDI), and quality of life (QoL) was evaluated using the Short Form 36 (SF-36). The diagnosis of FMS was made based on the 2010 criteria of the American College of Rheumatology. RESULTS: Although there were no statistically significant differences in the demographic characteristics between the groups, ALP and PTH levels were higher in the patient group (p<0.05). The VAS, frequency of FMS, PMW, and PAS were also significantly higher in the patient group (p<0.05). Depression and the mental and physical component scores of the SF-36 did not significantly differ between the two groups (p<0.05). CONCLUSION: Our study results suggest that patients with low 25(OH)D3 levels may more frequently experience FMS and pain than healthy individuals.

Influence Disease Activity on Voice and Laryngeal Findings of Rheumatoid Arthritis Patients.

OBJECTIVES: To reveal and to compare the voice pathologies and the detectable laryngeal findings in different phases of rheumatoid arthritis (RA). STUDY DESIGN: Prospective clinical study. METHODS: Sixty-seven consecutive patients with RA, followed up at our Physical Therapy and Rehabilitation Clinic, were included in the study. Disease activity indices of patients were calculated with Disease Activity Score-28 Index. With Voice Handicap Index (VHI), patients answered 30 questions of functional, physical, and emotional aspects. Videolaryngostroboscopy was performed by the same physician for all patients with a 70° rigid telescope (Karl Storz, Tuttlingen, Germany), and then acoustic voice analysis (PRAAT program) was performed. Reflux Finding Score was used in evaluating the laryngopharyngeal reflux. RESULTS: Posterior comissure hypertrophy (25.3%) and hyperemia/edema in arytenoid mucosa (22.3%) were detected as the most frequent findings. Other common findings were thick endolaryngeal mucus, vocal cord varices. Twenty-two patients had reflux findings (32.8%). Fundamental frequency, shimmer, maximum phonation time and VHI value were not significantly different between active and remission phases of the disease (P > 0.05). In remission phase, the jitter value and the noise to harmonic ratio value were significantly higher (P < 0.05) than active phase of the disease (P < 0.05). Abnormal laryngeal findings are higher in active phase (28% in remission phase, 54% in active phase). The mean VHI score of patients in remission phase was lower than that in active phase. CONCLUSION: RA should be included in the differential diagnosis of patients with voice disorders. Nonspecific pathologies are more prevalent in the picture. There are more objective findings and subjective complaints of patients in active phase of the disease than in the remission phase.

Comparison of the efficacy of dry needling and trigger point injections with exercise in temporomandibular myofascial pain treatment.

OBJECTIVES: We aimed to compare the efficacy of dry needling, trigger point injection, and protection methods through physical exercise on clinical symptoms and the pain threshold in patients with temporomandibular myofascial pain. PATIENTS AND METHODS: Between March 2013 and September 2013, in a random consecutive manner, a total of 63 consecutive patients (10 males, 53 females; median age 39.4±14.9 years; range, 18 to 65 years) were randomly divided into three groups: Group 1 (only exercise and protection training), Group 2 (dry needling + exercise + protection training), and Group 3 (trigger point injection + exercise + protection training). Dry needling or trigger point injection was performed for three times to the patients in Group 2 and Group 3 on a weekly basis. All patients were followed on Day 10 and at one month. RESULTS: A statistically significant improvement in the assessment and response variables was found for all groups, particularly for pain and functional limitation status (p<0.001). All groups were similar in terms of the improvement degree (p<0.001). Although not statistically significant, the highest improvement in the facial pain was seen in Group 3 on Day 10 (p=0.235); however, on Day 30, no significant difference was observed. CONCLUSION: Our study results showed that improvement in the subjective and objective symptoms in all treatment groups. Particularly, only exercise therapy was found to be beneficial as invasive methods. We suggest that all these methods should be applied together to achieve long-term efficacy.

The effect of a 12 week prehabilitation program on pain and function for patients undergoing total knee arthroplasty: A prospective controlled study.

BACKGROUND: The concept of preparing the body before a stressful event, such as surgery, has been termed "prehabilitation" (preoperative physiotherapy and exercise programs). Prehabilitation programs for people awaiting total knee arthroplasty (TKA) have positive effects on patients health status and may also lead to better postoperative outcomes. AIM: The purpose of this study was to examine effect of a prehabilitation program on knee pain, functional ability among patients with knee osteoarthritis after TKA surgery. STUDY DESIGN: A Prospective Controlled Study. PATIENTS AND METHODS: Subjects enrolled in this prospective controlled study who referred to our Orthopedics and Traumatology outpatient clinic between 2014 April-2015 May, had severe OA with pain not responsive to conservative treatment and scheduled for unilateral TKA. Subjects were assigned to a control or prehabilitation group. Patients of prehabilitation group were recruited from the orthopaedic waiting lists for primary unilateral TKA. Partipicants in the prehabilitation group were prescribed a training program that consisted of education and home-based exercise 12 weeks before the operation. After the TKA, all subjects partipicated in the same postoperative rehabilitation protocol. Evaluations were made before the surgery, with follow-up assessments at 3 and 6 months after surgery. Knee pain was assessed by the use of a 10-cm Visual Analog Scale (VAS) and function assesed by Knee injury and Osteoarthritis Outcome Score (KOOS) scale. RESULTS: A statistically significant improvement was observed in the values of VAS and all subsclaes of KOOS in both groups at third and sixth month compared to baseline. The intergroup comparison of the improvement (pre-post scores at sixth month) did not show any statistically significant diffeferences in VAS and KOOS scores. CONCLUSION: Our results show that prehabilitation before TKA is not superior to surgical treatment alone but about 20% of the patients changed their operation decision. So it is important to be able to postpone this process especially in the early period.

The effect of pregabalin treatment on balance and gait in patients with chronic low back pain: a retrospective observational study.

Background: Low back pain is the most common musculoskeletal problem, and is a major cause of loss of workforce. Chronic low back pain associated with radiculopathy often includes nociceptive and neuropathic components. While non-steroidal anti-inflammatory drugs are the first choice for the nociceptive component, pregabalin is preferred as the neuropathic component. Materials and methods: A retrospective analysis was conducted of 48 patients (26 women, 22 men) who had chronic low back pain associated with radiculopathy. A follow-up chart was used to collect data from February 2017 to November 2017. The patients characteristics (age, gender, initial daily dose of pregabalin), neuropathic pain (DN4 scale; Douleur Neuropathique, 4 questions), and balance and gait (Tinetti Balance and Gait Test) were assessed. Results: The DN4 scores in the fourth (p < .001) and 12th (p < .001) weeks were significantly lower in patients. The Tinetti total test scores (23.2 ± 3.9) in the first (p > .001) week were significantly lower. There was no significant difference between the Tinetti test scores (balance, gait, and total scores) at baseline and in the 12th week (p > .001). Conclusion: Pregabalin is effective on neuropathic pain and may have adverse effects on balance at initial doses and dose increments. Tolerance develops to these effects at maintenance doses.