Akin Erdal

The effectiveness of gabapentin in patients with chronic radiculopathy

AbstractThis study was carried out to determine the efficacy of gabapentin in patients with radiculopathy. Fifty patients (32 women, 18 men) with lumbosciatalgia secondary to L5 or S1 radiculopathy were evaluated. MRI showed L4-5 and/or L5-S1 bulging and/or protrusion without significant spinal stenosis. Baseline assessments for each patient included a standard neurological examination and radiological investigation. The patients were randomly assigned into two groups: group 1 was treated with oral gabapentin from a total of 900 mg per day up a total of 3600 mg per day divided in 3 doses; group 2 received placebo for the 8-week trial period. In group 1 we observed statistically significant improvement in pain at rest (p < 0.001), motor function (p < 0.01), limitation of spinal flexion (p < 0.001), straight leg raising test (p < 0.001) and sensory function (p < 0.001). Stretch reflexes instead did not significantly change. In group 2 we observed significant improvement in all clinical parameters, muscle st...

Pattern of Disease Onset, Diagnostic Delay, and Clinical Features in Juvenile Onset and Adult Onset Ankylosing Spondylitis

Objective. To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design. Methods. A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey. Results. Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25–6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51–6.98, adjusted for current age; and OR 2.26, 95% CI 1.07–4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life. Conclusion. JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.

Relationship between some acute phase reactants and the bath ankylosing spondylitis disease activity index in patients with ankylosing spondylitis

Objectives The aims of this study were to investigate a possible relationship between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and some acute phase reactant (APR) levels in patients with ankylosing spondylitis (AS). Methods Twenty outpatients who fulfilled the modified New York criteria for AS were included in the study. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haptoglobin (Hp), and &bgr;2 microglobulin (&bgr;2MG). Disease activity was assessed according to the BASDAI, which includes a 10-point visual analogue scale to measure pain, fatigue, morning stiffness, swelling, and areas of local tenderness. Results When APR values were analyzed for the BASDAI, a positive correlation between CRP and BASDAI was observed (r = 0.556, P < 0.05). There was no clear, statistically significant correlation between BASDAI and the other APRs (ESR, r = 0.328, P > 0.05; Hp, r = 0.035, P > 0.05; and &bgr;2MG, r = −0.190, P > 0.05). Conclusions Our data suggest that CRP is a better marker of disease activity than ESR, Hp, and &bgr;2MG.

Discrimination ability of ASDAS estimating disease activity status in patients with ankylosing spondylitis.

Objectives:  To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS).

Gabapentin monotherapy in patients with chronic radiculopathy: The efficacy and impact on life quality

OBJECTIVE The purpose of this, open-label, non-comparative study, was to evaluate the efficacy on quality of life and the efficacy of gabapentin monotherapy in patients with chronic radiculopathy. METHODS Thirty-five patients with radicular pain and diagnosed as L4, L5 or S1 radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for eight-week trial period. Quality of life, functional disability and psychological mood of the patients were assessed using the Nottingham Healthy Profile (NHP), Oswestry Low Back Pain Disability Questionnaire (ODQ) and Beck Depression Inventory (BDI). RESULTS Of the patients (n = 35), 25 were females and 10 were males (mean age: 41.8 +/- 10.4, range: 24-60 years); mean radiculopathy duration was 16.4 +/- 14.2 months (range: 3-48 months). The pain intensity at rest, quality of life, functional disability and depression scores were determined significantly improved after treatment and 4 months compared to baseline scores (p < 0.001). 1.5 points compared to baseline for at pain rest and 15 points improvement on the ODQ were obtained. CONCLUSION Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy.

Psychological status is associated with health related quality of life in patients with rheumatoid arthritis

Objective: Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of l ife in patients with RA and also to assess which quality of life (QoL) instrument - disease specific and generic - is more prone to t his effect. Methods: A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire. Results: Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. Th ere was significant association between anxiety and depression wit h worsening in both disease specific and generic health relat ed quality of life. However, RAQoL showed more association with depression and anxiety levels. Conclusion: Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is mu ch more influenced by depression and anxiety.

Protracted febrile myalgia syndrome in familial Mediterranean fever

Familial Mediterranean fever (FMF) is an autosomal, recessively inherited multisystem disease that affects various groups of people originating from the Mediterranean Sea region, most specifically those of Jewish, Turkish, Armenian, and Arabic ethnicity. Recurrent attacks of fever and sterile polyserositis of the peritoneum, synovial membranes, and pleura are the main clinical features, although the clinical features of FMF have been expanded in recent years to also include severe myalgia, scrotal swelling, cardiac involvement, and protracted febrile myalgia syndrome (PFMS). PFMS is seen in only a small percentage of FMF patients and is characterized by severe debilitating myalgia of the upper and lower extremities and high fever, occasionally accompanied by abdominal pain, diarrhea, arthritis/arthralgia, and transient vasculitic purpura mimicking Henoch-Schönlein purpura (HSP). Here, we report on a patient with FMF who also presents with PFMS, which is an uncommon and severe manifestation of the disease.

Comparison of the effects of alendronate, risedronate and calcitonin treatment in postmenopausal osteoporosis

The objective of the study was to compare the effects of alendronate, risedronate and calcitonin on biochemical markers of bone turnover and bone mineral density (BMD) in postmenopausal osteoporosis. The patients (n = 200) were equally divided to one of four treatment groups: alendronate 10 mg/daily, risedronate 5 mg/daily, calcitonin 200 IU/daily and control group for 12 months. All groups also received 1000 mg of calcium/daily. The control group received only 1000 mg calcium/daily. Serum osteocalcin (OC), bone specific alkaline phosphatase (BSAP) and urinary deoxypyridinoline (uDPD) levels were determined. There are increases in BMD at two regions, at the end of 12 months in four groups. The mean increases in BMD at 12 months, at the lumbar spine and hip respectively, were: alendronate ( p 0.05 for both site). In comparison with control group, the mean changes in BMD at the spine and hip were greater in the other groups ( p< 0.05 for both region). uDPD levels were gradually reduced at the end of study in all groups ( p< 0.01 for three groups), while no significant change was found in calcium group. The treatment with alendronate produced significantly greater increases in total hip BMD than did risedronate and calcitonin and tretment with risedronate produced significantly greater increases in lumbar spine BMD than did alendronate and calcitonin over 12 months. This study demonstrated the efficacy of alendronate, risedronate and calcitonin in preventing the bone loss related to postmenopausal osteoporosis.

Decreased percentage of CD4 and CD8 lymphocytes in the synovial fluid of patients with rheumatoid arthritis

AbstractThe purpose of this study was to determine peripheral blood (PB) and synovial fluid (SF) CD4 and CD8 cells in 18 patients with active rheumatoid arthritis (RA). Flow cytometry techniques were used to analyze and compare distribution of lymphocyte subpopulations in PB and SF samples. The lymphocytes of PB from 20 normal subjects served as the control group. The mean percentages of CD4 and CD8 in SF were significantly lower than in PB of the patients and controls (p 0.05). The mean CD4/CD8 ratio was significantly lower in SF of patients than in PB of both patient and control groups (p 0.05). No correlations were found between the mean CD4/CD8 ratio and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) or Ritchie Articular Index (RAI). T...

Bone mineral density in patients with depression

Objective: Depression is a common disorder affecting 5-9% of women and 1-2% of men. Osteoporosis is a condition characterized by bone fragility and increased risk of bone fracture There might be some behavioral and neuroendocrine system changes in depression which are risk factors for decreased bone mineral density. This study was performed to determine whether women with current or past major depression have demonstrable decreases in bone density. Methods: We measured bone mineral density at the hip and spine in 20 premenopausal women with past or current major depression and 20 premenopausal healthy women matched for age and body-mass index and using dual-energy x-ray absorptiometry. Results: The mean BMD values at lumbar region were 0.93± 0.09 gr/cm 2 for the patient group and 0.98 ± 0.04 gr/cm 2 for the control group. And the mean BMD values at left hip region were 0.85± 0.14 gr/cm 2 for the patient group and 0.92 ± 0.07 gr/cm 2 for the control group. The mean BMD values at lumbar region and at left hip region in patient group were both statistically lower than controls ( p< 0.05). Conclusions: We concluded that patients with past or current major depression may have low bone mineral density so this may be a risk factor for osteoporosis.