Ali Gür

Relationship between psychological status and disease activity and quality of life in ankylosing spondylitis

Our aim in this study was to compare the depression and anxiety risk in patients with AS and healthy controls and also to determine the relationship between disease activity, quality of life and psychological well-being. Two hundred and forty-three patients with ankylosing spondylitis (AS) and 118 age-, sex- and education-matched healthy controls were enroled into the study. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Functional Index, and Metrology Index, Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), Hospital Anxiety and Depression Scale (HADS) including depression subscale (HADS-D) and anxiety subscale (HADS-A), Ankylosing Spondylitis Quality of Life (ASQoL) Scale, duration of morning stiffness, pain-visual analogue scale (VAS), patient and physician’s global assessment of disease activity (100xa0mm VAS) were used to assess clinical and psychological status. Patients had similar HADS-D but higher HADS-A than healthy controls. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI and also poorer scores in VAS pain, patient global assessment, physician global assessment, HAQ-S and ASQoL. There was a negative correlation of HADS-D and HADS-A scores with educational level of the patients. Higher scores in HADS-D and HADS-A indicated poorer functional outcome and quality of life. Multivariate logistic regression analysis revealed that the HADS-D (ORxa0=xa06.84), HAQ-S (ORxa0=xa01.76), VAS pain score (ORxa0=xa01.03) and ESR (ORxa0=xa01.02) were independent risk factors for higher anxiety scores whereas HADS-A (ORxa0=xa01.36) and ASQoL (ORxa0=xa01.24) were independent risk factors for higher depression scores. The psychological status had close interaction with disease activity and quality of life in patients with AS.

Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis

Aim:u2002 Physiotherapy is an integral part of the management of ankylosing spondylitis (AS) and there is a need for recommendations which focus on the rehabilitation of patients with AS. We aimed to develop recommendations for the physical therapy and rehabilitation of patients with AS based on the evidence and expertise.

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

Objectives:u2002 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).

Characteristics of traumatic spinal cord injuries in south-eastern Anatolia, Turkey: a comparative approach to 10 years' experience.

The purpose of this study was to determine the demographic and epidemiological characteristics of traumatic spinal cord-injured patients.The hospital records of 539 patients (416 men, 123 women) with spinal cord injuries (SCIs) admitted to four hospitals that were major referral centers for trauma in the south-eastern region of Turkey from 1990 to 1999 were reviewed retrospectively. The patients with SCI were investigated for two periods; the first period covered patients admitted between 1990 and 1994 during which time an influx of people from rural to urban areas occurred and firearm injuries were common. In the second period (1995–1999) the influx of people declined and firearm injuries were reduced.The most common causes of injuries were road traffic accidents (200, 37.12%), followed by falls (172, 31.90%) and bullet wounds (115, 21.34%). In the first period, incomplete paraplegia was encountered more often than in the second period (P<0.001).In conclusion, in our series, while the leading cause of SCI for the two time periods was road traffic accidents, firearm injuries for the first period and falls for the second period were second-most frequent causes of SCI. In addition, the present study suggests that demographic and epidemiological factors may affect the characteristics of SCI in a region-based population even in a 10-year period of time.

Reliability and efficacy of the new massage technique on the treatment in the patients with carpal tunnel syndrome

We aimed to bring a more understandable and applicable technique to the literature instead of “massage therapy” in CTS. We compared our new technique with the splint wear, of which the efficacy in CTS has been proven with many studies. Eighty-four patients between 31 and 65xa0years of age were included in the study. The patients were divided into two equal groups. In the first group, splint and “Madenci” hand massage technique were applied, and in the second group only splint was applied. A splint was provided for all patients with tendon and nerve gliding exercises, and also when needed analgesic drugs were given. When the pretreatment and posttreatment parameters were compared via repetitive measurement analysis, it was found that PGA and MDPGA were significantly decreased in both groups (Pxa0=xa00.001), whereas grip strength was significantly increased (Pxa0=xa00.001). While no statistically significant difference was found between the groups regarding pretreatment values (Pxa0>xa00.05), the posttreatment PGA, MDPGA, and grip strength scores were significantly improved in Group I compared to Group II (Pxa0<xa00.05). To the best our knowledge, the present study is the first and largest study in the literature conducted on the massage technique that will contribute to the treatment of CTS. As this new massage technique is easy for self-application, cheap, and practical, every patient with CTS can apply the massage to him/herself easily.

Prevalence of atopic disorders in rheumatic diseases

ObjectivesThe aim of this study was to assess the point prevalences of hay fever, asthma, and atopic dermatitis in OA, RA, and AS, and to compare with healthy controls.MethodsA total of 935 patients and healthy controls were included. Demographic and clinical features were recorded, and a questionnaire assessing the existence of atopic disorders like asthma, hay fever, and atopic dermatitis in all groups was applied. “Either atopy” implied that an individual was either diagnosed with or had symptoms of one or more of these disorders, such as asthma, hay fever, or atopic dermatitis.ResultsWhen compared to the controls, only patients with AS had an increased risk for hay fever (OR 1.52, 95xa0% CI 1.00–2.41). Patients with RA had increased risks for hay fever, atopic dermatitis, and either atopy compared to the patients with OA (2.14, 95xa0% CI 1.18–3.89; 1.77, 95xa0% CI 1.00–3.18; and 3.45, 95xa0% CI 1.10–10.87, respectively). Steroid use had no effect on the prevalence of atopic disorders in patients with RA.ConclusionsPatients with OA, RA, and AS seem to have similar risks for asthma, atopic dermatitis, and either atopy to healthy controls. However, the prevalence of hay fever may increase in AS. Patients with RA have a higher risk of atopy than patients with OA.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

Serum Vitamin D Level and its Relation with Clinical Parameters in Fibromyalgia as a Neuropathic Pain

The aim of this article is to examine the role of vitamin D on severity of pain in patients with fibromyalgia. Eighty premenopausal female fibromyalgia patients and 90 healthy controls were included in the study. The demographic characteristics of all subjects, including age, and body mass index, were recorded. The number of tender points was recorded, and the intensity of pain of the subjects was measured by Visual Analogue Scale (VAS). Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate disease severity. The mean age was 44.86 ± 2.4 and 41.48 ± 4.1 years for the patient and control groups, respectively (p=0.08). The mean levels of vitamin D in patient and control groups were determined as 19.9 ± 4.5 and 32.97 ± 13.31 ng/ML, respectively (p<0.001). Apart from BMD in lumbar spine and femur which were significantly lower in the patients compared with healthy women. Vitamin D levels were negatively correlated with VAS (r=-0.653; p=0.001) and FIQ total scores in the fibromyalgia group (r=-0.344; p=0.030). Furthermore, the mean value of LANSS was 16.5 ± 0.4 in patient group. nIn conclusion, the study confirmed high prevalence of hypovitaminosis D and osteoporosis in patients with FMS than in controls. Furthermore, vitamin D was closely related with pain and disease severity.

Sleep Disturbances in Patients with Spinal Cord Injury

Sleep problems in rehabilitation patients have not yet understood. Age, physiological, or environmental condition may affect sleep habits. Sleep problems occur frequently in the general population, and are even more common in individuals with spinal cord injury (SCI). SCI patients have restless sleep, complain of spasms, difficulty in initiating and maintaining sleep, snoring, often awaking in the early hours of the morning and are unable to fall asleep again, and during the day time they are tired and sleepy. Patients with SCI often say they sleep less or don?t feel rested when they wake up. Studies have been reported that sleep disturbances have potential negative impact and sleep disorders can hinder the rehabilitation process and affect global outcomes in patients with spinal cord injury. It is important to assess the presence of sleep problems in SCI patients, and to provide effective treatments when indicated for their compliance of rehabilitation program and increasing quality of life.

Comparison of the Efficacy of Ultrasound and Extracorporeal Shock Wave Therapies in Patients with Myofascial Pain Syndrome: A Randomized Controlled Study

Abstract Objective: Evaluation and comparison of the efficacy of ultrasound [US] and extracorporeal shock wave therapy [ESWT] in the treatment of myofascial pain syndrome. Methods: Sixty-six patients with active myofascial trigger points in the trapezius muscle were randomized into treatment groups with US and three sessions of ESWT. Efficacy of the therapies were evaluated prior to therapy at 3 weeks and at 3 months of therapy using the Patient Global Assessment and Physician’s Global Assessment scales, Neck Pain and Disability Scale, Nottingham Health Profile, and Hamilton Anxiety Scale. Results: No severe complications were encountered with US and ESWT, and patients tolerated the therapies well overall. Statistically significant improvement was determined in the number of trigger points, pain, quality of life, and anxiety scores in post-therapy evaluations [pu2009<u20090.01]. Efficacy of therapies in inter-group comparison was evaluated in terms of improvement in the same scores, and the ESWT group had greater improvement when the anxiety scores were excluded [pu2009<u20090.05]. Conclusion: Our results indicated that both US and ESWT were effective and safe treatment modalities in myofascial pain syndrome. Three sessions of low dosage ESWT was more effective compared to US therapy that could be used as an effective and safe modality in the treatment protocols of myofascial pain syndrome.