Ajda Bal

Comparison of serum IL-1β, sIL-2R, IL-6, and TNF-α levels with disease activity parameters in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic, inflammatory, rheumatological disease affecting primarily the sacroiliac joint and vertebral column, with an etiology that remains obscure. Cytokines are soluble proteins that have specific roles in inflammatory response, arranging the interaction between cells of the immune system both in natural and specific immune reactions. This study was planned to evaluate the relation between the level of cytokines and the clinical and laboratory findings of patients with AS compared to healthy subjects. In this study, we demonstrated increased serum levels of soluble interleukin-2 receptor (sIL-2R), Interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in patients with AS compared with healthy subjects. Only IL-1β levels were not increased in AS patients. We found a correlation between C-reactive protein and IL-6 levels and between erythrocyte sedimentation rate and sIL-2R, IL-6 and TNF-α levels. Only the sIL-2R level was correlated with Bath AS Metrology Index and Bath AS Functional Index. We suggest that sIL-2R, IL-6, and TNF-α may have a role in the pathogenesis of AS and that their serum levels can be used as disease activity parameters and tools for diagnosis.

Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients

The aim of this study was to investigate dynamic postural balance in patients with rheumatoid arthritis (RA) in relation to the disease characteristics. Seventy-four patients with RA and 42 controls of the same age group were tested using the Biodex Stability System (Biodex Medical Systems, Shirley, NY, USA). Anterior/posterior (AP), medial/lateral (ML), and overall (OA) indices were obtained with bilateral stance at platform stabilities of 2 and 8. Subjects were tested with “eyes open” at all times. At the same time, Disease Activity Score, functional disability [Health Assessment Questionnaire, (HAQ)], and Steinbrocker Functional Class (SFC) were assessed. Both the AP and OA indices in the RA group were significantly higher than in the control group for level 8. For OA index, the results were 2.7±0.9 in RA and 2.2±0.7 in the control group (p=0.006), and for AP index, the results were 2.1±0.7 in RA and 1.7±0.6 in the control group (p=0.002). Eleven patients (15.9%) and three controls (7.1%) could not complete the test at level 2. When the patients and controls who completed the test were compared, a significant difference was found only in the ML index. The results were 4.6±2.4 in RA and 3.8±1.6 in the control group (p=0.047). A positive correlation between HAQ and postural balance for all three stability indices at level 8 was detected. A positive correlation between SFC and postural balance for OA and ML at level 8 was also found. Multiple linear regression analyses revealed age and body mass index (BMI) to be the most important factors influencing postural dynamic balance at both levels in the RA group and in healthy controls. RA has a negative effect on dynamic postural stability. The functional status affects dynamic balance more than disease activity. Age and BMI were the most important factors influencing postural dynamic balance in the RA group and in healthy controls. Level 2 does not appear to be an appropriate level for evaluating postural stability in RA.

Low-level laser therapy in subacromial impingement syndrome.

BACKGROUND DATA AND OBJECTIVE Although previous studies have evaluated the effect of different kinds of physical therapy in subacromial impingement syndrome (SIS), there have been few investigations assessing the effectiveness of low-level laser therapy (LLLT) in shoulder disorders. The goal of this prospective randomized study was to assess whether gallium-arsenide (Ga-As) laser therapy improves the outcome of a comprehensive home exercise program in patients with SIS. MATERIALS AND METHODS Forty-four newly-diagnosed SIS patients were enrolled in this study. Group 1 patients (n = 22) received Ga-As laser therapy combined with a 12-wk comprehensive home exercise program, and group 2 patients (n = 22) received the same 12-wk comprehensive home exercise program alone. Night pain, shoulder pain and disability index (SPADI), and University of California-Los Angeles end-result (UCLA) scores were used as outcome measures. RESULTS Both groups showed a significant reduction in night pain and SPADI scores at the second and 12th weeks with respect to baseline values, with the exception of the SPADI total score at the second week in group 1. UCLA results improved significantly in both groups at the 12th in comparison to the second week. There were no significant differences between groups in mean actual changes in night pain and SPADI scores at the second week from baseline. When values at the 12th week were compared to baseline, mean actual changes in night pain differed significantly between the groups, with a larger change in group 1, but there was no difference between groups in mean actual change in SPADI scores. Second- and 12th-week UCLA scores did not differ between the two groups. CONCLUSION Our study was unable to demonstrate any distinct advantage of low-level laser therapy over exercise alone. Comprehensive home exercise programs should be the primary therapeutic option in the rehabilitation process in SIS.

Health-related quality of life in first-ever stroke patients.

Background and Objectives: Health-related quality of life (HRQOL) is important to measure as it is an indication of outcome after stroke. Our objectives were to assess HRQOL in patients 3 months after stroke and to identify factors that predict HRQOL in stroke survivors. Patients and Methods: This cross-sectional study included 67 first-ever stroke patients hospitalized in the Ministry of Health Ankara Diskapi Yildirim Beyazit Education and Research Hospital Physical Therapy and Rehabilitation Clinic. HRQOL was measured by means of the Stroke Impact Scale-16 (SIS-16). Patients were characterized by age, sex, duration of education, comorbidities, stroke type, affected side, concordance (pa-retic arm=dominant hand), cognitive function (Mini-Mental State Examination [MMSE]), and functional status (Functional Independence Measure [FIM]). We used a linear regression model to examine the influence of de-mographic and clinical characteristics on the different SIS-16 domains. Results: The mean (SD) for age of the 67 patients was 62.03 (13.22) years (range, 33 to 81 years). The MMSE and FIM scores were significantly correlated with the SIS-16 score (P< .001). Linear regression analysis showed that age and functional status were the major independent determinants affecting HRQOL (P=.002 and P< .001,respectively). Conclusion: In this study, we found that age and functional status had a powerful influence on HRQOL. Comprehensive therapy programs aimed to improve HRQOL should focus on improving functional disability,particularly in older stroke patients. There is a need for long-term follow-up studies in stroke patients throughout all recovery stages to evaluate HRQOL in more detail.

Stanger bath therapy for ankylosing spondylitis: illusion or reality?

We compared the short-term effects of Stanger bath therapy and conventional exercises on spinal mobility, functional capacity, disease activity, and quality of life with conventional exercise alone in ankylosing spondylitis (AS) patients. A total of 58 patients with a diagnosis of AS according to the modified New York criteria were included in this randomized prospective study. The patients were divided into two groups. Patients in group I (n = 30) received Stanger bath therapy and an exercise program. Group II (n = 28) patients were given the same exercise program but did not receive Stanger bath therapy. Patients were evaluated before (T0) and at the end of the treatments (T1). Evaluation parameters were the Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), and AS Quality of Life (ASQoL). In both patient groups, a significant improvement was determined in all clinical outcomes between T0 and T1 except for BASMI in group II. Comparison of the groups showed significantly superior results in group I parameters of BASMI, BASFI, BASDAI, and ASQoL. Stanger bath therapy showed beneficial effects in spinal mobility, functional capacity, disease activity, and quality of life in AS patients immediately after the treatment period. We recommend Stanger bath therapy for AS patients in the short-term, but further research is imperative to assess whether improvement is sustained over a long-term follow-up.

Assessment of shoulder involvement and disability in patients with ankylosing spondylitis

The purpose of the study was to evaluate the parameters which have an important role in shoulder involvement and disability in ankylosing spondylitis (AS). Ninety patients with AS were divided into two groups according to the presence of shoulder involvement. Bath AS metrology index (BASMI), ankylosing spondylitis quality of life (ASQoL) and shoulder pain and disability index (SPADI) were used. Ranges of movements of limited shoulders were measured. Mean disease duration, age, BASMI, and ASQoL were higher and hip involvement was more frequent in the shoulder-involved group. Disease duration was found to be the most significant factor in shoulder involvement. A significant relationship was found between all SPADI scores and ASQoL. The SPADI disability score was affected by flexion limitation. Patients with hip involvement and longer disease duration should be evaluated for shoulder involvement. Flexion limitation of shoulder affected shoulder disability and shoulder disability impaired quality of life.

Hemiplegic Shoulder Pain: Associated Factors and Rehabilitation Outcomes of Hemiplegic Patients With and Without Shoulder Pain

Abstract Objectives: To analyze the incidence of and the factors associated with shoulder pain in people with hemiplegia and to understand the effect of rehabilitation programs on the parameters of motor function and activity limitations in patients with and without hemiplegic shoulder pain. Methods: Patients in the initial 6-month period after stroke who were hospitalized in the physical medicine and rehabilitation clinic were included in the study. Patients were considered early rehabilitation entrants if they were admitted in the first 0 to 30 days after a stroke and late rehabilitation entrants if they were admitted 30 to 120 days after a stroke. Demographic and clinical features, complications, and medical histories of the patients were recorded. Upper extremity Fugl-Meyer Motor Assessment (FMA), Frenchay Arm Test (FAT), and Functional Independence Measure (FIM) were applied to the patients on admission, at discharge, and after 1 month of follow-up. Results: Twenty-one (38%) patients did not have shoulder pain, and 34 (62%) patients had decreased shoulder pain. Immobilization, duration of disease, and late rehabilitation were shown to be effective treatments for shoulder pain. The major risk factors were disease duration and poor initial motor function. In both groups, the FMA, FAT, and FIM scores showed significant changes. This improvement did not differ between the 2 groups. Conclusion: Duration of disease and low motor functional capacities have the most important impact on shoulder pain. In patients with and without shoulder pain, a systematic rehabilitation program is beneficial with respect to motor function and daily living activities.

Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti‐TNF‐α therapy on sleep problems: A polisomnographic study

This study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti‐tumor necrosis factor α (anti‐TNF‐α) therapy on sleep disorders.

Methotrexate treatment in myasthenia gravis.

To the Editor: Myasthenia gravis (MG) is an autoimmune neuromuscular disease characterized by weakness and fatigability of skeletal muscles. It is associated with various autoimmune diseases including thyroid diseases, diabetes mellitus type 1, and rheumatoid arthritis (RA). The frequency of autoimmune diseases in patients with MG is still uncertain. The most significant sign of this disease is muscle weakness due to circulating antibodies. These antibodies are produced by plasma cells that block acetylcholine receptors at the postsynaptic neuromuscular junction. Furthermore, T lymphocytes play an important role in MG by stimulating B-cell antibody production and binding to the acetylcholine receptor. Treatment of MG mainly consists of acetylcholinesterase inhibitors. In addition, a variety of immunosuppressive agents have been studied in patients with MG. Deleterious effects on metabolic function and other adverse effects of these immunosuppressive agents limit treatment regimens for this disorder. Among these drugs, low doses of methotrexate (MTX) seem to have a beneficial effect in slowing progression of MG without any significant side effect. In one study, authors assessed the effect of MTX treatment in MG and found a reduction in total prednisone doses in 9 months for the MTX group over the placebo group. MTX is now first-line therapy for the treatment of RA because of its anti-inflammatory and immunomodulatory actions that are effective and safe. The antiinflammatory effects of MTX are probably believed to be mediated by adenosine acting at adenosine receptors (A2A and possibly A3) on inflammatory cells. The adenosine A2A receptor (A2AR) is the major cellular adenosine receptor commonly associated with immunosuppression. Moreover, the activation of the adenosine A2A receptor attenuates experimental autoimmune MG severity. In this case series, our aim is to present 3 patients with concomitant MG and RA, which are both autoimmune diseases, and emphasize that MTX treatment is beneficial for MG because of similar pathophysiology with RA.

A difficult case of polymyalgia rheumatica.

To the Editor: We read with great interest the article by Mazzantini, et al 1 that assessed the occurrence of adverse events in patients with polymyalgia rheumatica (PMR) treated with low-dose glucocorticoids (GC). They found that longterm, low-dose GC treatment of PMR is associated with serious adverse events. PMR is an inflammatory rheumatic disease of elderly people that is characterized by aching and stiffness in shoulder and pelvic girdle. The incidence of PMR increases with age, peaking in the 70 to 80-year age group2. The response … Address correspondence to Dr. Karaahmet; E-mail: drozguroz{at}gmail.com