Ali Salli

Axis I and Axis II psychiatric disorders in patients with fibromyalgia

OBJECTIVE To determine the current prevalence of Axis I and Axis II psychiatric disorders in patients with fibromyalgia. METHOD The study sample includes 103 patients with fibromyalgia and 83 control subjects. Axis I and Axis II disorders were determined by structured clinical interviews. RESULTS The rate of any Axis I psychiatric disorder (47.6% vs. 15.7%), major depression (14.6% vs. 4.8%), specific phobia (13.6% vs. 4.8%), any Axis II disorder (31.1% vs. 13.3%), obsessive-compulsive (23.3% vs. 3.6%) and avoidant (10.7% vs. 2.4%) personality disorders were significantly more common in the patient group compared to the control group. CONCLUSION Our results suggest that a considerable proportion of patients with fibromyalgia also present with Axis I and Axis II psychopathologies.

Evaluation of Sexual Dysfunction in Women with Rheumatoid Arthritis: A Controlled Study

OBJECTIVE To evaluate sexual function in women with rheumatoid arthritis (RA) and compare them with healthy controls. MATERIALS AND METHODS Ninety-five patients with RA and 108 healthy controls were included in the study. Depression levels and sexual functions of all participants were evaluated by the Beck Depression Inventory (BDI) and Index of Female Sexual Function (IFSF), respectively. Morning stiffness in women with RA, pain (Visual Analog Scale--VAS), disability rate (Health Assessment Questionnaire--HAQ), and disease activity score (DAS-28) were defined. RESULTS Total IFSF and mean of IFSF subgroup scores and significance of sexual life score were lower in patients with RA than controls, whereas mean BDI score was higher. The mean of the total IFSF scores was significantly lower in patients with RA with BDI≥17 than that of patients with BDI<17. The mean of the total IFSF score decreased as disease severity increased. There was a strong negative correlation between total IFSF and DAS-28 scores, a moderate negative correlation between total IFSF score and HAQ, BDI, VAS score, age, and morning stiffness, and weak negative correlation between total IFSF and body mass index. CONCLUSION RA is observed to have negative effects on sexual functions of women. Presence of depressive symptoms with RA and increased disease severity increase the degree of sexual dysfunction. Women patients with RA should also be asked about their sexual lives while being evaluated.

The effect of two exercise programs on various functional outcome measures in patients with osteoarthritis of the knee: A randomized controlled clinical trial

We aimed to investigate the effects of isometric and combined concentric-eccentric (C-E) isokinetic types of exercise applied to the knee muscles in patients with knee osteoarthritis (OA) in an attempt to identify which type of exercise would be most effective in terms of pain relief, functional status, quality of life, and muscular strength. This was a controlled trial in which 71 patients were randomized into three groups. The first group was assigned to C-E, the second group to isometric isokinetic exercises, while the third, control group, was only given paracetamol. A visual analog scale for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short From-36 (SF-36) for functional status and quality of life, and the isokinetic test for muscular strength were evaluated. Significant improvements were recorded in all groups for pre and post-treatment pain, the WOMAC and the SF-36 (P < 0.001). Among the exercise groups, improvement was significantly better in the C-E, isokinetic exercise group as compared with the isometric exercise group (P < 0.001). Isokinetic exercises are recommended as a treatment modality. However, the long-term effects of these exercises on pain and osteoarthritis progression need to be investigated.

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis: A randomized clinical trial

Background: Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. Objective: To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Study design: Randomized clinical trial. Methods: Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. Results: After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Conclusions: Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis. Clinical relevance Silicone insole may be considered as a first-line treatment option in patients with plantar fasciitis.

Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomized controlled trial with 1-year follow-up.

OBJECTIVE To determine the short- and long-term effectiveness of the muscle energy technique (MET) compared with corticosteroid injections (CSIs) for chronic lateral epicondylitis (LE). DESIGN Randomized controlled trial with 1 year of follow-up. SETTING Outpatient clinic of a universitys department of physical medicine and rehabilitation. PARTICIPANTS Patients with chronic LE (N=82; 45 women, 37 men). INTERVENTIONS Eight sessions of MET, or a single CSI was applied. MAIN OUTCOME MEASURES Grip strength, pain intensity, and functional status were assessed using the pain-free grip strength (PFGS), a visual analog scale (VAS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, respectively. Measurements were performed before beginning treatment and at 6, 26, and 52 weeks afterward. RESULTS When the baseline PFGS, VAS, and DASH scores were compared with the scores at the 52-week follow-up, statistically significant improvements were observed in both groups over time. The patients who received a CSI showed significantly better effects at 6 weeks according to the PFGS and VAS scores, but declined thereafter. At the 26- and 52-week follow-ups, the patients who received the MET were statistically significantly better in terms of grip strength and pain scores. At 52 weeks, the mean PFGS score in the MET group was significantly higher (75.08±26.19 vs 62.24±21.83; P=.007) and the mean VAS score was significantly lower (3.28±2.86 vs 4.95±2.36; P=.001) than those of the CSI group. Although improvements in the DASH scores were more pronounced in the MET group, the differences in DASH scores between the groups were not statistically significant. CONCLUSIONS This study showed that while both MET and CSI improved measures of strength, pain, and function compared with baseline, subjects receiving MET had better scores at 52 weeks for PFGS and the VAS for pain. We conclude that MET appears to be an effective intervention in the treatment of LE.

Is pain the only symptom in patients with benign joint hypermobility syndrome

The aims of this study were to evaluate pain, depression level, fatigue, sleep, and quality of life (QoL) among patients with benign joint hypermobility syndrome (BJHS) and to compare their results with those of healthy controls. The study involved 115 patients and 114 healthy volunteers. Pain level was rated using visual analogue scale (VAS) for all patients. Depression level, fatigue, sleep quality, and QoL of all the participants were evaluated by the Beck Depression Inventory (BDI), the Checklist Individual Strength (CIS), the Pittsburgh Sleep Quality Index (PSQI), and the Short Form-36 (SF-36), respectively. VAS value was 6.29 ± 0.94 in the patient group. Comparison of two groups showed that there were statistically significant differences between the patient group and the control group with respect to BDI, total CIS, PSQI scores, SF-36 subscales (physical function, role physical, bodily pain, general health, role emotional, and mental health), and mental component summary (p < 0.001). While pain is the predominant symptom among BJHS patients, depression, fatigue, impaired sleep, and QoL also commonly occur. Thus, all of these components should be taken into account when assessing patients with BJHS.

Medical diagnosis of rheumatoid arthritis disease from right and left hand Ulnar artery Doppler signals using adaptive network based fuzzy inference system (ANFIS) and MUSIC method

Rheumatoid arthritis (RA) is a multi-systemic autoimmune disease that leads to substantial morbidity and mortality. In this paper, as spectral analysis methods of Multiple Signal Classification (MUSIC) method is used in order to extract the significant features from the right and left hand Ulnar artery Doppler signals for the diagnosis of RA disease. The MUSIC method has been used as subspace method. To extract features from Doppler signals obtained from the right and left hand Ulnar arterial the MUSIC method model degrees of 5, 10, 15, 20, and 25 were used. Then, an adaptive network based fuzzy inference system (ANFIS) was applied to features extracted from the right and left hand Ulnar artery Doppler signals for classifying RA disease. The methods are not new, but the study has a novelty in that the application area of these methods is new. In the hybrid model, the combination of MUSIC and ANFIS yielded classification accuracies of 95% (for a model degree of 20) using the right hand Ulnar artery and classification accuracies of 91.25% (for a model degree of 10) using left hand Ulnar artery Doppler signals in the diagnosis of RA disease. The proposed approach has potential to help with the early diagnosis of RA disease for the specialists who study this subject.

The Effects of Fibromyalgia Syndrome on Female Sexuality: A Controlled Study

INTRODUCTION Fibromyalgia may have negative effects on sexual function in women. AIMS To evaluate the sexuality of women with fibromyalgia and healthy control subjects, and to investigate the relation between sexuality and clinical parameters of fibromyalgia. MAIN OUTCOME MEASURES Female Sexual Function Index (FSFI), Tender Points Count (TPC), Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire (FIQ), and Visual Analog Scale (VAS). METHODS Clinical evaluation and surveys were done with 126 women with fibromyalgia and 132 healthy women. RESULTS Patients with fibromyalgia had higher BDI scores and lower frequency of sexual intercourse than control subjects. The mean FSFI scores (total and all domains) were significantly lower in patients with fibromyalgia than control subjects. Mean FSFI scores (total and most domains) were significantly lower in patients with fibromyalgia who had BDI score≥17 than those who had BDI score<17. In women with fibromyalgia, a significant negative correlation was noted between total FSFI score, and both FIQ and BDI scores. CONCLUSIONS Fibromyalgia has negative effects on female sexual function that are aggravated by depression.

A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency

The objective of this study is the evaluation of the effect of vitamin D replacement treatment on musculoskeletal symptoms and quality of life in patients with chronic widespread musculoskeletal pain (CWP) including fibromyalgia (FM) and vitamin D deficiency.