The effects of forward head posture on expiratory muscle strength in chronic neck pain patients: A cross-sectional study.

OBJECTIVES: This study aims to investigate the relationship between forward head posture (FHP) and respiratory dysfunctions in patients with chronic neck pain. PATIENTS AND METHODS: Between June 2014 and November 2016 , a total of 99 patients (11 males, 88 females; mean age 54.1±9 years; range, 38 to 75 years) with chronic neck pain were evaluated for head posture by cervical lateral radiograph measuring the anterior head translation distance (FHPmm) and C7 vertebrae position (C7°). We examined the chest expansion by subtracting chest circumference from the level of xiphoid during maximal inspiration and expiration. Pain severity and neck disability were assessed using the Visual Analog Scale (VAS) and modified Neck Disability Index (MNDI), respectively. The respiratory functions were evaluated using spirometry tests, lung volumes, and maximal inspiratory and expiratory pressures (Pimax and Pemax, respectively). RESULTS: There was a negative correlation between the FHPmm with Pemax% (rho: -0.314; p=0.005). A negative correlation was also observed between C7° and Pemax, Pemax%, forced expiratory volume in one sec (FEV1)/forced vital capacity (FVC)%, forced expiratory flow (FEF)25-75%, and FEF75% (rho:-0.245, -0.349, -0.218, -0.214, and -0.259 respectively; p=0.028, 0.002, 0.035, 0.040, and 0.012, respectively). There was a positive correlation between neck disability and VAS scores (rho: 0.424; p<0.001), while there was a negative correlation between neck disability and chest expansion, maximum voluntary ventilation (rho: -0.201 and -0.217, respectively; p=0.049 and 0.046, respectively). CONCLUSION: Based on our study results, FHP is associated with expiratory muscle weakness in chronic neck pain patients. To evaluate respiratory dysfunction, chest expansion tests may be useful, although these tests are not specific to muscle weakness. Interventions about FHP and neck pain should focus on the effects of respiratory muscle training.

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.

Hypothalamic-pituitary-adrenal hormonal responses to exercise stress test in patients with rheumatoid arthritis compared to healthy controls.

OBJECTIVE: There is controversy about hormonal dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis that is supposed to contribute to the development or persistence of rheumatoid arthritis (RA). We investigated whether there is an altered and blunted response of the HPA axis when stimulated by exercise stress in patients with RA. METHODS: Twenty women with RA and 15 matched healthy controls were included in the study. All subjects took an ergospirometric exercise test on the treadmill to determine anaerobic threshold (AT). On another day, blood was collected for basal plasma levels of growth hormone (GH), insulin-like growth factor-I, cortisol, and adrenocorticotrophic hormone (ACTH); and subjects exercised on treadmill at an intensity above their AT. Blood was collected again to measure hormone levels just after the exercise stopped and 60 minutes later. RESULTS: Two subjects left the study, so 19 patients and 14 controls were evaluated. Peak oxygen consumption (VO(2)), VO(2) at AT, exercise test duration, and basal hormone levels were similar in groups. In both groups, GH slightly increased just after the exercise (0 min), and decreased at 60 min compared to baseline, but the change was not different between groups. Cortisol levels decreased significantly at 0 and 60 min in both groups, ACTH levels did not change in time, and there was no difference between groups. CONCLUSION: There was no perturbation in HPA axis stimulated by exercise stress test in patients with RA and all the variables measured were similar to those of the control group.

Does the combination of inhaled steroids with long acting beta2 agonists decrease the risk for osteoporosis? A 1-year prospective follow-up study.

Combination of inhaled corticosteroids (ICS) with long acting beta2 agonists has been used increasingly in the treatment of moderate-severe asthma, however there is indefinitive data about their effect on bone loss. The aim of this study was to compare the effects of treatment with single ICS and combination of ICS with long acting beta2 agonists (combination therapy) on BMD and biomarkers of bone metabolism in adult patients with asthma over 1 year period. Forty-three patients with asthma were enrolled. Patients were separated into two groups according to their use of asthma drugs: single ICS or combination therapy (ICS plus long-acting inhaled beta2-agonist). Change in bone mineral density (BMD) and biochemical markers of bone metabolism were measured at baseline and at the end of 1 year. Mean ages and basal BMD of patients did not differ between the two groups (P > 0.05). The decrease in BMD was higher in the single ICS group than the combination therapy group, however there was no significant difference between them (P > 0.05). One year change (%) in BMD and biochemical markers of bone metabolism were not different between two groups (P > 0.05). In conclusion, use of ICS-in the range of doses used- does not seem to have an effect on the change of BMD. However, our data indicate a nonsignificant trend towards reducing bone loss with the use of combination therapy. Future studies are needed to provide definitive evidence for this trend to allow us suggesting combination therapy for minimizing bone loss.

The peak oxygen uptake of healthy Turkish children with reference to age and sex: a pilot study.

Maximal oxygen uptake (VO2max) has an important place in the assessment of cardiopulmonary fitness. Currently there is insufficient normative data for Turkish children. With this preliminary study, we aimed to set up a normative data for our lab which may also serve as a basis for future large population based studies in Turkey. We assessed the peak oxygen consumption of 80 healthy Turkish children aged 5-13 years and examined the cardiopulmonary responses to exercise test in relation to their age, sex and body size. Dynamic lung functions were positively and significantly correlated with age. A similar correlation was observed for the peak VO2. A significant positive correlation between peak VO2 and body size was demonstrated only in boys for height. There were no differences in all of the test parameters with reference to sex except in the age group of 13 years. Boys who were 13 years old had higher mean values of maximal voluntary ventilation (MVV), oxygen uptake at anaerobic threshold, peak VO2, and exercise test duration than those of girls of the same age (p < 0.05). VO2 plateau was detected only in 25%, and when two groups with and without VO2 plateau were compared, there were no differences regarding the age, sex, weight, height and exercise test results. Assessment of VO2 by graded exercise stress testing by treadmill is accepted as a safe and effective method of evaluating the physical fitness of children. Current study presents normal data for a limited subpopulation of healthy Turkish children.