Ahmet Ozgul

Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients.

The aim of this study was to determine the emotional and sociodemographic characteristics of patients with ankylosing spondylitis (AS) and to investigate the impact of the disease on their social life and quality of life (QOL). This study included 101 patients with the diagnosis of AS. All patients filled in a questionnaire comprising their sociodemographic and emotional status and their self-rating on the disease and completed the 36-item Short Form Health Survey (SF-36). The impact of the disease on work status, sexuality, and family relations was measured on a Likert scale. The impact of the disease on employment, family and sexual relations, work life as well as SF-36 was investigated. Therefore, the effect of educational level, employment, social security, and sexual relations with spouse, etc. on QOL were assessed. More than half of the patients had no knowledge about the disease and half of them were not under a physician’s control. Thirty-two percent of the previously working patients quit their jobs because of the disease. Quitting a job due to the disease was more frequent in the first 10 years of the disease. The most affected domains of the SF-36 were physical role power, general health, and pain. Patients unemployed due to the disease had lower SF-36 scores compared with employed ones. Unemployed patients without social insurance had lower values on SF-36 subscales (p<0.05). A higher education level had positive influences on disease impact. The level of anxiety was high and was associated with sexual relations (p<0.05). Our results show that the disease affects patients’ work and social life. Work disability affects QOL. Educating the patients about the disease may play an important role in improving his/her life quality and coping with the disease. Thus, the socioeconomic burden of the disease on the person and on society can be diminished.

Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain.

Study Design. A prospective clinical investigation. Objective. To determine the clinical significance of congenital lumbosacral malformations in young male patients with subacute or chronic low back pain and to investigate a possible worsening of the clinical picture with the concurrence of transitional vertebra (TV) or spina bifida occulta (SBO). Summary of Background Data. Although the causative roles of congenital malformations in low back pain and lumbar disc herniation have been investigated, there is no study that compares the incidence of congenital malformations in prolonged low back pain between radicular and nonradicular groups; nor is there a study that compares the pain intensity between the groups with and without congenital malformations. Methods. Lumbosacral plain radiographs of 881 young male patients with low back pain lasting for >4 weeks were evaluated. For all patients, we recorded the clinical signs and their pain intensities based on a 10-cm visual analog scale (VAS). Results. Congenital lumbosacral malformations were determined in 88 of 881 patients. Of these, 48 were TV, 38 were SBO, and 2 were a combined lesion of TV and SBO. The difference in positive clinical sign and VAS was statistically significant (P < 0.05) between the groups with and without congenital lumbosacral malformations. In contrast to SBO, there was a statistically significant difference of TV incidence between the sign positive and the sign negative groups (P < 0.05). The difference in VAS values was statistically significant for both TV and SBO (P < 0.001). Conclusions. The results of this study show that SBO and TV increase the severity of the clinical picture whether or not they have a causal relationship. Additionally, transitional vertebrae seem to increase nerve-root symptoms whereas spina bifida occulta does not.

Bier block with methylprednisolone and lidocaine in CRPS type I: A randomized, double-blinded, placebo-controlled study

Background and objective To investigate the effect of intravenous regional anesthesia (Bier block) with methylprednisolone and lidocaine in complex regional pain syndrome (CRPS) type I in a randomized, double-blinded, and placebo-controlled study. Methods Twenty-two patients with the diagnosis of CRPS of their upper limb were divided randomly into 2 groups. The mean age was 22.3 ±1.6 years. Average pain duration was 3.1 ± 1.4 months. In the placebo group (10 patients), patients received only 100 mL of saline. In the study group (12 patients), 40 mg of methylprednisolone and 10 mL of 2% lidocaine were added to the saline. Treatments were applied once a week. Unless significant adverse effects occurred, 3 sessions of blockade were completed. Pain severity, range of motion (ROM), and volumetric edema measurements were obtained before treatment. Pain severity and satisfaction (resolved, better, no change, or worse) were recorded after each session. The final assessment was performed 1.5 months later. ROM and volumetric measurements were repeated the day after the block and at the final assessment. Results Differences in pretreatment features of the patients were not statistically significant (P > .05). In all assessment periods during the study, improvement in pain severity was statistically significant (P < .05) in both groups. This statistically significant difference disappeared at the final assessment (P > .05). No statistically significant difference was obtained in ROM and volumetric measures in any assessment period before and after the block. Satisfaction scores between the groups were also not different in any assessment period. Conclusions Bier block with methylprednisolone and lidocaine in CRPS type I does not provide long-term benefit in CRPS, and its short-term benefit is not superior to placebo.

Sexual problems in male ankylosing spondylitis patients: relationship with functionality, disease activity, quality of life, and emotional status

This study has focused on sexual problems of male ankylosing spondylitis (AS) patients. Initially, patients’ perceptions about the effects of disease on sexual intercourse were assessed. Secondly, we investigated the factors that relate to the disease and affect sexual intercourse negatively. Thirdly, we compared data from the patients whose sexual intercourse were affected negatively with of those whose sexual intercourse were unaffected. This is a cross-sectional and double-centered study. A total of 53 married or sexually active male patients, who were certainly diagnosed with AS according to modified New York criteria, were assessed. Twenty seven patients (50.94%) expressed that their sexual life was affected negatively by the AS in general (affected patients), and 26 patients (49.06%) expressed no negative effect (unaffected patients). Both affected and unaffected patients were compared with each other with regard to educational level, joint involvement, functionality, disease activity, quality of life, and depression status. Mean BASFI, BASDAI scores were worse in the affected group, and the difference was statistically significant (p = 0.012, p = 0.039, respectively). There were statistically significant differences between the groups with regard to lumbar column and hip involvement (p = 0.035, p = 0.021; respectively). The physical functioning, role limitations due to physical problems, vitality/energy/fatigue, general mental health, and general health perception subscale scores of SF-36 were worse in the affected group, and the differences were statistically significant (p = 0.027, p = 0.023, p = 0,013, p = 0.005, p = 0.045, respectively). Affected patients’ Beck Depression Inventory scores were worse than those of unaffected patients, and the difference between the groups was statistically significant (p = 0.039). Sexual problems are common in AS patients and might usually be associated with joint involvement, decreased functionality, increased disease activity, decreased health quality, and depression. Therefore, while examining AS patients and managing their treatments, special attention must be given to all domains of life instead of only physical problems.

Sacroiliitis in familial Mediterranean fever and seronegative spondyloarthropathy: importance of differential diagnosis

Familial Mediterranean fever (FMF) is a multisystemic autosomal recessive disease, occasionally accompanied by sacroiliitis. Transient and non-erosive arthritis of the large joints is the most frequent articular involvement. Amyloidosis is also the most significant complication of FMF, leading to end stage renal disease. Here we present three cases of FMF with sacroiliitis and review the literature for spinal arthritic involvement of FMF. All cases were referred to our clinic with a diagnosis of seronegative spondyloarthropathy and with low back pain sourced by sacroiliitis. They also had homozygous M694V gene mutations and negative HLA B27 antigens. Molecular analysis of the gene mutation is recommended during the evaluation of uncertain cases in order to clarify diagnostic discrimination. We suggest that FMF with sacroiliitis, which is rare in rheumatological practice, should be considered in the differential diagnosis of seronegative spondyloarthropathy or other rheumatologic diseases causing spinal involvement.

Factitious disorders encountered in patients with the diagnosis of reflex sympathetic dystrophy

Reflex sympathetic dystrophy (RSD) may be a misdiagnosis or at least not descriptive enough in patients with atypical hand posture and atypical edema. Seven patients with the previous diagnosis of RSD were investigated further because of inconsistent clinical picture with the underlying pathology and bizarre course of the disease. Four patients had clenched fist and three had factitious edema. These seven patients underwent psychological examination, and MMPI was applied to all. In two of these no psychological disorder was obtained according to DSM-IV. One patient could not adapt to MMPI. In two anxiety disorders, in one depression, and in one patient conversion disorder was diagnosed. We suggest that these patients are not motivated enough to improve their conditions and expectations of such patients may show some differences depending on the environment.

Effects of steroid with repetitive procaine HCl injection in the management of carpal tunnel syndrome: An ultrasonographic study

BACKGROUND AND AIM With the use of musculoskeletal ultrasonography (MSUS), morphological changes in the median nerve have been recently reported in patients with carpal tunnel syndrome (CTS). On the other hand, the literature still lacks the information whether those changes are further altered with steroid and local anesthetic injection which is a widely used treatment in this group of patients. Therefore, the aim of our study was to explore in-vivo the effects of steroid with repetitive procaine HCl injection on the median nerve of patients with CTS. MATERIALS AND METHOD This prospective clinical trial followed-up patients for 2 months. 22 patients (37 median nerves) with clinical and electrophysiological evidence of CTS were included in the study. All patients received both 40 mg of triamcinolone acetonide once and 4 ml of 1% procaine HCl twice a week for 2 weeks with the same technique. Clinical, functional, electrophysiological and ultrasonographic evaluations were performed at the study onset, and 2 months after the last injection. RESULTS Electrophysiological, ultrasonographic findings (median nerve anterior-posterior diameter, transverse diameter and cross sectional area in the proximal carpal tunnel and volar bulging,) VAS scores, Boston carpal tunnel symptom and function assessment scale improved significantly (P<0.05). CONCLUSION Steroid injection with repetitive procaine HCl injection effectively reduced the symptoms of CTS, improved the Boston carpal tunnel symptom and function assessment scale and also electrophysiological and ultrasonographic findings. Long term effects remain to be studied. Indisputably, the use of MSUS seems to be promising in this regard.

Clinical presentations of chlamydial and non-chlamydial reactive arthritis

The aim of this study was to investigate the triggering micro-organisms and the clinical as well as laboratory differences between Chlamydial and non-chlamydial reactive arthritis (ReA) in a prospective study on 98 patients with acute/subacute arthritis. An inciting organism was found in 42 patients. Eighteen of these were chlamydial. Fifty-seven percent of all ReA patients were carriers for HLA-B27, which increased to 67% in the chlamydial group. Chlamydial ReA patients had more urethritis (P<0.05) with a longer period between arthritis and inciting infection, significantly lower CRP levels, and involved joint counts (P<0.05). Additionally, sacroiliitis was more frequent besides extra-articular manifestations in chlamydial ReA group. This study shows that chlamydial ReA differs in some points from non-chlamydial ReA, which in turn may affect the evaluation of an arthritic patient. ReA due to chlamydia more frequently encompasses a monoarticular or oligoarticular clinical picture with predominant distal extremity involvement. Non-chlamydial ReA presents higher joint counts and may involve upper extremity joints.

Effects of Sociodemographic Characteristics, Illness Process, and Social Support on the Levels of Perceived Quality of Life in Veterans

Quality of life is a broad, complex, multidimensional concept incorporating psychological, sociopsychological, economic, philosophical, social, cultural, and spiritual dimensions. As accompanying or even constituting the concept of quality life, social support (empathic, informational, instrumental, and reassurance support) has not been studied. This study sought to determine the effects of sociodemographic characteristics, illness process, and type of social support on the quality of life levels of veterans hospitalized in a rehabilitation center. Seventy-nine veterans were involved in the study. None of the sociodemographic characteristics of the veterans correlated with the quality of life of the veterans except housing conditions. The perceived quality of life scores of the veterans who needed psychological help were lower than those of their counterparts (p < 0.01). The quality of life scores of the veterans were not different from those of the average Turkish population, but veterans who had not received any type of social support had lower quality of life scores (3.74 vs. 4.70). Veterans who had empathic, informational, and reassurance social support had higher quality of life scores than did those who did not have these types of social support. Having tangible social support did not change the quality of life scores. Our findings indicate that social support has a greater impact on the perceived quality of life than sociodemographic and medical factors among the veterans.

Effects of Steroid Iontophoresis and Electrotherapy on Bicipital Tendonitis

Objective: The aim of this study was to compare the effects of steroid iontophoresis [SI] and electrotherapy [ET] on bicipital tendonitis. Methods: Forty-seven patients with bicipital tendonitis, diagnosed by ultrasonography, were all treated with hot packs [15 minutes], ultrasound [1.5 w/cm2, five minutes], and a standard exercise program. They were also divided randomly into two experimental groups. One group received SI [0.5 percent hydrocortisone acetate given with the negative electrode, 3–4 mA galvanic current, 15 minutes]. The second group was treated with ET [interferential current, 0–100 Hz, 15 minutes]. All patients were evaluated at pre-treatment, post-treatment, and one month later with the following assessment tools: pain [pain at rest, with normal activities, and with strenuous activities] with a numeric scale [0 to 10], range of motion [ROM] with goniometry and with the ROM items of Constants Shoulder Scale, patient satisfaction with a numeric scale [0 to 10], and disability by using the function section of the Pennsylvania Shoulder Scale. Results: All of the assessment parameters revealed statistically significant improvement at post-treatment and one month later [P < 0.05] in the SI group. The ET group experienced less dramatic improvement in the immediate post-treatment [P < 0.05] assessment and the durability of benefit was less than with SI. Conclusions: Application of SI to the conventional physical therapy for patients with biceps tendonitis seems to provide a better and more prolonged clinical and functional improvement.