The impact of the presence of fibromyalgia on fatigue in patients with psoriatic arthritis: comparison with controls

Abstract Background: Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls. Methods: Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria. Results: Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001). Conclusion: It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.(AU)

Association of work instability with fatigue and emotional status in patients with ankylosing spondylitis: comparison with healthy controls.

INTRODUCTION/OBJECTIVE: Ankylosing spondylitis (AS) is usually seen in among younger person of working age and carries a significant economic burden. It was aimed to explore the relation of work instability with fatigue, depression, and anxiety in working AS patients comparing with healthy controls. METHOD: This case-control study was conducted on working 61 AS patients and 40 sex-age-matched working healthy controls. The data were collected using Visual analogue scale-pain, Bath AS Disease Activity Index, Bath AS Functional Index, Bath AS Metrology Index in patients; and Beck Depression Inventory, Beck Anxiety Inventory, Multidimensional Assessment of Fatigue, AS Work Instability Scale in all participants. Data were analyzed by SPSS, using chi-squared test, Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation analysis, and multivariate linear regression analysis. RESULTS: Depression, fatigue, and work instability scores were significantly higher in patients than controls (p < 0.05). Clinical parameters (except spinal mobility) showed a significant worsening across the levels of work instability in patients (p < 0.05) and work instability scores were positively correlated with all clinical parameters except spinal mobility (p < 0.001). There was a weak correlation between work instability and spinal mobility (p < 0.05). Fatigue (p < 0.001), pain, and functional capacity scores (p < 0.05) were found to be influential variables on work instability scores. CONCLUSION: The results of this study demonstrated that fatigue and depressive symptoms had negative effect on work instability beside pain, disease activity, and functionality in patients with AS. The recognition and improvement of fatigue and depression may lead to reduced risk of job loss in these patients.

The impact of the presence of fibromyalgia on fatigue in patients with psoriatic arthritis: comparison with controls.

BACKGROUND: Coexisting fibromyalgia (FM) to psoriatic arthritis (PsA) has been identified and it has been associated with more severe symptoms, impaired function, and greater disability. It was aimed to explore the effect of the presence of FM on fatigue in patients with PsA comparing with controls. METHODS: Fifty patients with PsA and 34 sex-age matched controls were enrolled. In patients; pain was assessed by Visual Analogue Scale, disease activity by DAS-28, enthesitis by The Leeds Enthesitis Index. Fatigue level of all participants was evaluated by Multidimensional Assessment of Fatigue. In all participants, FM was determined according to 2010 American College of Rheumatology criteria. RESULTS: Seventeen patients with PsA (34%) and 4 controls (11.8%) were diagnosed with FM and all of them were women. There was significant difference between the patients and controls in terms of presence of FM (p < 0.05). Patients' fatigue scores were significantly higher than controls' (p = 0.001). There were significant differences between the PsA patients with and without FM with regard to gender, enthesitis, DAS-28 and pain scores (p < 0.05); fatigue scores (p < 0.001). The significant effect of the presence of FM on fatigue was found by univariate analysis of variance in patients (p < 0.001). CONCLUSION: It was observed that FM presence and fatigue were more common in PsA patients than controls and comorbid FM had significant effect on fatigue in these patients. Physicians should be aware of the possibility of concomitant FM in patients with PsA.

Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls.

OBJECTIVES: This study aims to compare fall history and fear of falling (FOF) in patients with rheumatoid arthritis (RA) and healthy controls and to evaluate associated factors for fall risk and FOF in patients with RA. MATERIALS AND METHODS: Between March 2016 and July 2016, a total of 120 patients with RA and 60 age- and sex-matched healthy volunteers were included in the study. The presence of FOF (Yes/No), fall history, and the number of falls within the past 12 month were questioned. All participants were assessed with the Falls Efficacy Scale-International (FES-I), 10 Meter Walk Test (10MWT), One-Leg Stand Test (OLST), Berg Balance Scale (BBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Pain Severity and Patient Global Assessment (PGA) by Visual Analog Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), and disease activity by Disease Activity Score in 28 joints (DAS28) were evaluated in patients with RA. RESULTS: There was no statistically difference between the RA patients and healthy controls in terms of presence of fall history, while the presence of FOF and FES-I scores were significantly higher in the RA patients (p<0.05). In the patient group, the FES-I score was positively correlated with pain VAS, PGA, DAS-28, HAQ, BAI, BDI, and 10MWT and negatively BBS and OLST (p<0.05). The number of falls, HAQ, BBS, and BDI scores were found to be significant independent risk factors affecting variations in the FES-I scores (p<0.001). CONCLUSION: Fear of falling seems to be an important problem in patients with RA, and patients without fall history may also have FOF. The most important factors associated with FOF were impaired balance, increased disability and depression, and number of falls in RA patients. Strategies for preventing falls, maintaining balance, improving emotional status and against FOF are of utmost importance in patients with RA.

Reliability and Validity of Turkish Version of Short Form of the Social Role Participation Questionnaire in Patients With Ankylosing Spondylitis.

OBJECTIVES: This study aims to evaluate the reliability and validity of the Turkish version of the Short Form of the Social Role Participation Questionnaire (s-SRPQ) in Turkish patients with ankylosing spondylitis. PATIENTS AND METHODS: The Turkish version of s-SRPQ questionnaire was obtained after a translation and back translation process. The study sample included 100 ankylosing spondylitis patients (59 males, 41 females; mean age 42.0±11.0 years; range 19 to 69 years). To assess the test-retest reliability of the Turkish s-SRPQ, the questionnaire was reapplied 15 days after the first interview (interclass correlation coefficient [ICC]). Cronbach's alpha (a) was used to evaluate the internal consistency. The s-SRPQ was compared with Short Form-36 (SF-36) survey, Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Satisfaction With Life Scale (SWLS) for convergent validiy. RESULTS: For s-SRPQ/experienced physical difficulties; the individual item ICC ranged from 0.78 to 1.00 and Cronbach's alpha value ranged from 0.88 to 1.00. For s-SRPQ/satisfaction with role performance; the individual item ICC ranged from 0.93 to 0.98 and Cronbach's alpha value ranged from 0.96 to 0.99. The Turkish version of s-SRPQ/experienced physical difficulties scores correlated with the SWLS and SF-36 sub-parameters negatively; and Ankylosing Spondylitis Disease Activity Index, and BASFI, and ASQoL positively. The SRPQ/satisfaction with role performance scores correlated with the SWLS and SF-36 sub-parameters positively; and BASDAI, and BASFI, and ASQoL negatively. CONCLUSION: Turkish version of s-SRPQ has good comprehensibility, internal consistency, and validity and is an adequate and useful instrument for the assessment of participation in Turkish patients with ankylosing spondylitis.

Quantitative assessment of muscle stiffness with acoustic radiation force impulse elastography after botulinum toxin A injection in children with cerebral palsy.

PURPOSE: Our objective in this study was to assess the changes in medial gastrocnemius muscle (GCM) stiffness after botulinum toxin A (BTA) injection in children with cerebral palsy (CP) by using acoustic radiation force impulse (ARFI) elastography and to research the usability of this technique in clinical practice. MATERIALS AND METHODS: Twenty-four spastic lower extremities of 12 children with CP were assessed. BTA injection treatment was applied to the medial GCM. Muscle stiffness was measured with the ARFI technique before the procedure and a month after the procedure. The patients were assessed with the modified Ashworth scale (MAS) in the physiotherapy department at about the same time. Shear wave velocity (SWV) values and MAS scores before and after the treatment were compared. RESULTS: Mean SWV values were measured as 3.20 ± 0.14 m/s before BTA and as 2.45 ± 0.21 m/s after BTA, and the difference between them was found to be statistically significant (p < 0.001). Mean MAS score (2.33 ± 0.70) after BTA decreased significantly when compared to the score before BTA (2.96 ± 0.62) (p = 0.001). SWV values positively correlated with MAS scores (ρ = 0.578, p = 0.003). The interobserver agreement expressed as interclass correlation coefficient (ICC) was 0.65 (95% CI 0.33-0.84, p < 0.001). CONCLUSION: ARFI elastography for identifying structural changes that occur in the spastic muscle after BTA injection in children with CP can yield more valuable information with combined use of MAS.

Are Illness Perceptions Associated With Disease Activity or Psychological Well-Being in Rheumatoid Arthritis? A Study With the Evidence of Confirmatory Factor Analysis.

OBJECTIVES: This study aims to assess the factor structure of the Turkish Revised Illness Perception Questionnaire (IPQ-R) in patients with rheumatoid arthritis (RA) and the relationship of illness perceptions with disease activity and psychological well-being. PATIENTS AND METHODS: One hundred and fifty RA patients (8 males, 142 females; mean age 51.1±12.7 years; range 21 to 81 years) were included in the study. Confirmatory factor analysis was used to test the factor structure of the IPQ-R. Pain was assessed by visual analog scale, disease activity by Disease Activity Score 28, depression by Beck Depression Inventory, global life satisfaction by the Satisfaction with Life Scale, and illness perception by the IPQ-R. RESULTS: Three items (items 12, 18, 19) were deleted because of poor factor loadings. The modified 35-item model showed good reliability and discriminant validity. Beck Depression Inventory scores were correlated with identity, consequences, and emotional representations subscales positively (p<0.001); and with illness coherence subscale negatively (p<0.05). There were positive correlations between Satisfaction with Life Scale scores, and treatment control and illness coherence subscales (p<0.05). Satisfaction with Life Scale scores were negatively correlated with identity, emotional representation, and timeline acute/chronic subscales (p<0.05), and consequences subscale (p<0.001). Disease Activity Score 28 was not correlated with IPQ-R domains (p>0.05). CONCLUSION: The Turkish IPQ-R appears to be a useful clinical assessment tool to evaluate RA-related illness perceptions. RA healthcare should include psychological intervention to strengthen patients' beliefs about their RA regardless of disease activity.

Early Diagnosis of Lymphedema after Breast Cancer Treatment: Bio-Impedance Spectroscopy.

OBJECTIVE: Breast cancer-related lymphedema is an important health problem. The aim of this study is to ensure early diagnosis of patients at risk of developing lymphedema and revealing the predisposing factors. MATERIALS AND METHODS: Measurements in the pre-operative period and in postoperative months 3, 6, 9 and 12 and years 2 and 3 were performed prospectively with bio-impedance spectroscopy for patients treated for breast cancer between November, 2013 and November, 2016. Demographic and clinical-pathological data of the patients were investigated to assess the factors that affect the development of lymphedema. RESULTS: 245 measurements were obtained from the 67 patients who participated in the study. 18 (26.8%) patients were diagnosed with lymphedema and 16 (89%) of these patients were clinically diagnosed with stage 0 and 2 (1%) patients with stage 1 lymphedema. The median age was 50.7 (32-77) years. Performing axillary dissection and positivity in more than 3 nodes were found to be statistically significant with a percentage of 63.3% (n=15) and 64.7% (n=11) p=0.049 and p<0.001, respectively. CONCLUSION: Periodic measurements with bio impedance spectroscopy can be an effective method to diagnose early stage lymphedema after breast cancer, and enable selecting the group of patients who would benefit from early treatment.

Reliability and Validity of the Turkish Adaptation of VITACORA-19 in Patients with Psoriatic Arthritis.

OBJECTIVES: This study aims to evaluate the reliability and validity of the Turkish language version of VITACORA-19 (psoriatic arthritis quality of life questionnaire) in patients with psoriatic arthritis. PATIENTS AND METHODS: The Turkish version of VITACORA-19 questionnaire was obtained after a translation and back translation process. The study sample included 61 PsA patients (22 males, 39 females; mean age 46.5±12.2 years; range 19 to 71 years). To assess the test-retest reliability of the Turkish VITACORA-19, the questionnaire was reapplied 10 to 15 days after the first interview (interclass correlation coefficient). Cronbach's alpha (a) was used to evaluate the internal consistency. VITACORA-19 was compared with visual analog scale for physician and patient global assessments, the Health Assessment Questionnaire, and Nottingham Health Profile for construct validity. The internal structure of VITACORA-19 was examined by factor analysis. RESULTS: The individual item intraclass correlation coefficient ranged from 0.77 to 0.98 and Cronbach's alpha ranged from 0.77 to 0.98. The Cronbach's alpha value for whole scale was determined as 0.96. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.90, and Bartlett's test of sphericity had a p<0.001. Turkish VITACORA-19 total scores were correlated negatively with Health Assessment Questionnaire, visual analog scale for pain, and Nottingham Health Profile subgroups, and positively with physician and patient global assessments (p<0.01). CONCLUSION: Turkish version of VITACORA-19 questionnaire is a reliable and valid measure for health-related quality of life in Turkish patients with psoriatic arthritis.

Psychiatric symptoms in ankylosing spondylitis: their relationship with disease activity, functional capacity, pain and fatigue.

OBJECTIVES: The aim of this study is to evaluate psychiatric symptoms in patients with ankylosing spondylitis (AS) and to investigate the relationship of the disease activity, functional capacity, pain, and fatigue with psychiatric symptoms. METHODS: Eighty AS patients and 80 healthy controls were included in the study. Spinal pain by visual analog scale (pain VAS-rest), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), and fatigue by Multidimensional Assessment of Fatigue (MAF) were assessed in patients. Psychiatric symptoms were measured using the Symptom Checklist-90-R (SCL-90 R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and Rosenberg Self-Esteem Scale (RSES). RESULTS: SCL-90-R total and all subscale scores (except interpersonal sensitivity and psychoticism) and BDI scores were significantly higher in the AS group compared to control group. PSQI total and all subscale scores were significantly higher in the AS group. State anxiety scale score was significantly higher and RSES score was significantly lower in the AS group. Psychiatric symptoms (except Rosenberg Self-Esteem score) were significantly correlated with BASDAI, BASFI, pain VAS rest, and MAF scores. CONCLUSION: Psychiatric symptoms are often seen in patients with AS. Disease activity, functional capacity, pain and fatigue were correlated with psychiatric symptoms but self-esteem was not. Therefore, psychiatric symptoms should be taken into consideration in the management of AS.

Functional capacity, strength, and quality of life in children and youth with familial Mediterranean fever.

PURPOSE: To examine functional capacity and muscle strength in children and youth with familial Mediterranean fever (FMF) as compared with controls, and to assess whether these factors influence quality of life (QOL) in FMF. METHODS: A total of 100 subjects with FMF and 55 control subjects (8-18 years old) without known health issues were enrolled in the study. The 6-Minute Walk Test (6MWT) was used to evaluate functional capacity. Quadriceps strength was measured with a hand-held dynamometer. Quality of life was evaluated with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0). RESULTS: Significant differences were found between subjects with FMF and controls in the 6MWT and strength test. PedsQL scores of subjects with FMF were significantly lower than the scores of the controls. The 6MWT and quadriceps strength were weakly correlated with the PedsQL. CONCLUSION: Subjects with FMF displayed lower functional capacity and QOL than peers who are healthy. Decreased functional capacity was correlated with decreased QOL in those with FMF.

Does microwave diathermy have an effect on clinical parameters in chronic low back pain? A randomized-controlled trial.

OBJECTIVE: The aim of this trial was to investigate the effect of therapeutic microwave diathermy (MD) on pain, disability, trunk muscle strength, walking performance, mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). METHODS: A total of 39 patients were included in this study. The patients were randomized into two groups. Group 1 (n=19) received MD treatment and exercises. Group 2 (n=20) was given only exercises. The pain (visual analog scale), disability (Oswestry Disability Questionnaire and pain disability index), walking performance (6 minute walking test, 6MWT), depression and QOL (Short Form 36) of all participants were evaluated. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). RESULTS: The patients with CLBP in each group had significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression AT and F when compared with their initial status. There was no statistically significant difference between the groups regarding the change scores between AT-BT test and F-BT test. CONCLUSION: Since a 2,450-MHz MD showed no beneficial effects on clinical parameters, exercise program could be preferable for the treatment of patients with CLBP alone.

Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index in Turkish patients with ankylosing spondylitis: relationship with disease activity and quality of life.

AIM: The aim of this study was to investigate the relationship between Spondyloarthritis Research Consortium of Canada (SPARCC) enthesitis index and disease activity and health-related quality of life in patients with ankylosing spondylitis (AS). METHODS: Eighty-six AS patients not receiving antitumour necrosis factor (TNF) therapy were included in the study. Spinal pain by visual analogue scale (pain VAS rest and activity), disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional capacity by Bath Ankylosing Spondylitis Functional Index (BASFI), enthesitis severity by SPARCC index, quality of life by Short Form-36 (SF-36), and Bath Ankylosing Spondylitis Metrology Index (BASMI) were assessed in patients. In the laboratory evaluations, the erythrocyte sedimentation rates and serum C-reactive protein levels of the patients were determined. RESULTS: All participants were aged between 18 and 65 years, with a mean age of 36.9 ± 11.13 years. The most frequent region of enthesitis was Achilles tendon insertion into calcaneum (55.8%). Pain VAS rest and activity, BASFI and all parameters of SF-36 were significantly different in AS patients with and without enthesitis. SPARCC index was significantly correlated with pain VAS activity (P < 0.05), pain VAS rest, BASDAI, BASFI and all parameters of SF-36 (P < 0.001). There were no correlations between SPARCC index and BASMI, disease duration and laboratory parameters (P > 0.05). CONCLUSION: The clinical assessment of enthesitis in AS is an important outcome measure, and enthesitis indexes such as SPARCC enthesitis index can be valuable tools in the evaluation of disease activity in AS patients not receiving anti-TNF therapy.

Femoral cartilage thickness measurements in healthy individuals: learning, practicing and publishing with TURK-MUSCULUS.

BACKGROUND AND OBJECTIVES: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. METHODS: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). RESULTS: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. CONCLUSION: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

Ultrasound neurography in the evaluation of sciatic nerve injuries.

[Purpose] The aim of this clinical study was to investigate the benefits and the basic principles of ultrasonographic examination in the evaluation of sciatic nerve injuries. [Subjects and Methods] Patients with sciatic nerve injury were evaluated using a real-time utrasonographic examination. The capabilty of ultrasonography in terms of determination of the type and the localization of injury, the position of the proximal and distal nerve segments, the presence or absence of a neuroma, and perilesional scar tissue were evaluated in all cases. [Results] Ten cases with sciatic nerve injury were evaluated with real time sonography. Perilesional scar tissue formation was found in 4 (40%) cases. Two (20%) cases had stump neuroma diagnosed by sonographic examination. The capability of ultrasonographic examination was satisfactory for all evaluation parameters. [Conclusion] Ultrasonographic examination of sciatic nerve lesions may be used for the description of the degree of injury, determination of complete or incomplete nerve sectioning, the presence of hematoma and foreign body, the continuity of nerve, determination of nerve stumps, formation of perilesional scar tissue, and the presence of neuroma.

Prevalence of juvenile fibromyalgia syndrome in an urban population of Turkish adolescents: impact on depressive symptoms, quality of life and school performance.

BACKGROUND: Juvenile Fibromyalgia Syndrome (JFMS) is a chronic health condition characterized by widespread musculoskeletal pain and multiple tender points (TP). The objective of this study was to determine the prevalence of JFMS in the urban population of Samsun and to determine the impact of JFMS on depression symptoms, school performance and quality of life (QOL). METHODS: A cross-sectional study was conducted in 1109 children (mean age (14.8 ± 2.0) years old). A questionnaire was applied to the children and a medical examination including TP was performed. Yunus and Masi's criteria were used for diagnosis of JFMS. The children with JFMS were compared with an age and sex matched non-JFMS group. Depression was assessed with Children's Depression Inventory (CDI) and QOL was evaluated with Pediatric Quality of Life Inventory 4.0 (PedsQL4.0). RESULTS: Sixty-one (5.5%) (13 boys and 48 girls) of 1109 children met the diagnostic criteria of JFMS. While PedsQL scores of children with JFMS were lower than the non-JFMS group for physical, emotional, social, school functioning and total score (P = 0.001), CDI total score was higher in the JFMS group than in the non-JFMS group (P = 0.001). The JFMS group reported more school absences (P = 0.001) and the average school grade was lower in the JFMS group than in the non-JFMS group (P = 0.03). CONCLUSION: The prevalence of JFMS is high in school age children. Since JFMS is a common problem of childhood, early diagnosis and identification of the disorder and more comprehensive and successful treatment approaches with appropriate psychological assistance may prevent more complex and severe problems in adulthood.

Michigan Hand Outcomes Questionnaire in rheumatoid arthritis patients: relationship with disease activity, quality of life, and handgrip strength.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the clinical relevance of Michigan Hand Outcomes Questionnaire (MHQ) in patients with rheumatoid arthritis (RA) and to evaluate the relationship between MHQ and disease activity, quality of life (QL), and handgrip strength separately. MATERIAL AND METHOD: Eighty RA were included in the study. Disease activity is evaluated with Disease Activity Score 28 (DAS28), pain is evaluated with Visual Analog Scale (VAS). The Disabilities of Arm, Shoulder and Hand (DASH), MHQ, Short-Form 36 (SF-36), and Health Assessment Questionnaire (HAQ), Arthritis Impact Measurement Scales-hand and finger function scale-2 (AIMS-2) were completed by all patients. Hand muscle strength (HMS) was measured with a hand-held dynamometer. RESULTS: The MHQ moderately correlated with DAS28. When the patients were grouped according to three disease activity measurements, DASH scores were significantly higher with higher disease activity and MHQ scores were significantly lower with higher disease activity. A high correlation was found between MHQ total and HAQ, AIMS-2. The SF-36 scores were correlated with MHQ scores. CONCLUSIONS: The MHQ scores correlate with disease activity indices, functional disability, QL and DASH. The clinical relevance of MHQ, like DASH, is high and both questionnaires can be used effectively.

Association between osteoporosis and polymorphisms of the IL-10 and TGF-beta genes in Turkish postmenopausal women.

Osteoporosis is a multifactorial disease in which genetic determinants are modulated by hormonal, environmental and nutritional factors. The balance between bone resorption and bone formation seems to be regulated by a variety of growth factors and cytokines. An important clinical risk factor in the pathogenesis of osteoporosis is the presence of genetic polymorphisms in susceptibility genes. In this study, we investigated the association between osteoporosis and interleukin 10 (IL-10) -597 C > A and transforming growth factor ß1 (TGF-ß1) T869C (also named Leu10 > Pro) polymorphisms in Turkish postmenopausal women. Genomic DNA obtained from 255 individuals (152 osteoporotic and 103 healthy controls). The DNA sample was isolated from peripheral bloods by salting-out method and analyzed by the techniques of PCR-RFLP. Genotype and allele frequencies were calculated and data were analyzed using the χ(2) test. We found a statistically significant difference between the groups with respect to IL-10 genotype distribution (p = 0.001) and allele frequencies (p < 0.0002). However, we did not found any difference between the groups with regarding TGF-ß1 genotype distribution and allele frequencies (p > 0.05). In the combined genotype analysis, IL-10/TGF-ß1 CCCC combine genotype was also estimated risk factor for osteoporosis in Turkish postmenopausal women (p = 0.026). To our knowledge, this is the first report to examine IL-10 gene -597 C > A polymorphism and osteoporosis in Turkish population.

Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial.

The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.

Functional disability of children with spina bifida: its impact on parents' psychological status and family functioning.

OBJECTIVE: To evaluate the impact of functional disability of Turkish children with spina bifida (SB) on parents' psychological status and family functioning. METHODS: Fifty-four children with SB and parents were included. The Functional Measure for Children (WeeFIM), Beck Depression Inventory (BDI), and Family Assessment Device (FAD) were used. RESULTS: Mothers' BDI scores were significantly higher than fathers' (p < 0.001). No significant effects of the knowledge of having children with SB before birth and the number of children in families on BDI scores and FAD sub-scores were found (p > 0.05). According to multiple regression analysis; significant correlations with fathers' BDI were problem-solving (p = 0.012) and general functioning (p = 0.037) and with mothers' BDI was roles (p = 0.018). Only childrens age was found to be an influential variable on WeeFIM scores (p < 0.001). CONCLUSION: Spina bifida healthcare should include psychological support to parents of these children and this support should be independent from disability level of children.