Aslan Tekatas

Increased frequency of restless leg syndrome in patients with ankylosing spondylitis

To assess the prevalence of restless leg syndrome (RLS) in patients with ankylosing spondylitis (AS) and to investigate factors potentially associated with RLS.

Evaluation of the Effects of Sildenafil Citrate (Viagra) on Vertebral Artery Blood Flow in Patients with Vertebro-Basilar Insufficiency

Objective To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). Materials and Methods The study included 21 patients with VBI (aged 31-76; mean 61.0 ± 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Results Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm2 to 10.80 cm2 at 45 minutes and 10.81 cm2 at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Conclusion Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs.

Extraspinal Incidental Findings on Routine MRI of Lumbar Spine: Prevalence and Reporting Rates in 1278 Patients

Objective The aim of the present study was to determine the prevalence and reporting rate of incidental findings (IF) in adult outpatients undergoing lumbar magnetic resonance imaging (MRI). Materials and Methods Re-evaluation of a total of 1278 lumbar MRI images (collected from patients with a mean age of 50.5 years, range 16-91 years) captured between August 2010-August 2011 was done by a neuroradiologist and a musculoskeletal radiologist. IFs were classified according to organ or system (liver, gallbladder, kidney, bladder, uterus, ovary, lymph node, intestine and aorta). The rate of reporting of a range of IF was examined. The outcome of each patients treatment was evaluated based on review of hospital records and by telephone interviews. Results A total of 253 IFs were found in 241 patients (18.8% of 1278). Among these, clinically significant IFs (n = 34) included: 2 renal masses (0.15%), 2 aortic aneurysms (0.15%), 2 cases of hydronephrosis (0.15%), 11 adrenal masses (0.86%), 7 lymphadenopathies (0.55%), 6 cases of endometrial or cervical thickening (0.47%), 1 liver hemangioma (0.08%), 1 pelvic fluid (0.08%) and 2 ovarian dermoid cysts (0.15%). Overall, 28% (71/253) of IFs were included in the clinical reports, while clinically significant findings were reported in 41% (14/34) of cases. Conclusion Extraspinal IFs are commonly detected during a routine lumbar MRI, and many of these findings are not clinically significant. However, IFs including clinically important findings are occasionally omitted from formal radiological reports.

Neuroprotective effects of octreotide on diabetic neuropathy in rats

The purpose of the present study is to investigate the possible healing effects of octreotide (OCT) on motor performance, electrophysiological and histopathological findings of diabetic neuropathy in a rat model of diabetes mellitus (DM). To induce diabetes, rats were administered a single dose (60mg/kg) of streptozotocin (STZ). Diabetic rats were treated either with saline (1ml/kg/day, n=7) or OCT (0.1mg/kg/day, n=7) for four weeks. Seven rats served as control group and received no treatment. At the end of the study, electromyography (EMG), gross motor function (inclined plate test), general histology and the perineural thickness of sciatic nerve were evaluated. At the end of study, weight loss was significantly lower in OCT treated rats than that of saline treated ones (p<0.001). Electrophysiologically, compound muscle action potential (CMAP) amplitudes of the saline treated DM group were significantly reduced than those of controls (p<0.0001). Also, distal latency and CMAP durations were significantly prolonged in saline treated DM group (p<0.05) compared to control. However, treatment of diabetic rats with OCT significantly counteracted these alterations in EMG. Furthermore, OCT significantly improved the motor performance scores in diabetic rats (p<0.05). Histomorphometric assessment of the sciatic nerve demonstrated a significant reduction in perineural thickness in OCT treated group compared to saline group. In conclusion, OCT possesses beneficial effects against STZ-induced diabetic neuropathy, which promisingly support the use of OCT as a neuroprotective agent in patients with diabetic neuropathy.

A comparison of risk factors and prognosis between intra and extracranial acute atherosclerotic stroke in the Turkish population: a prospective study.

Background: The aim of this study was to compare the differences in risk factors and prognosis between acute stroke caused by definitive intracranial atherosclerosis (ICAS) or extracranial atherosclerosis (ECAS) in the Turkısh population. Methods: This study was prospectively designed in a single centre and conducted with patients who were hospitalised due to acute ischaemic stroke. Inclusion criteria were the diagnosis of atherosclerotic ischaemic stroke, defined as more than 50% stenosis or occlusion in the arterial structure supplying the ischaemic area, having excluded other possible causes. Results: Information on 58 ICAS and 57 ECAS stroke patients was collected in a 13-month period. The ECAS patients had male gender predominance (p = 0.003). Ageing, stroke history and hyperlipidaemia were related with stroke severity in ECAS, and gender was associated with severity in ICAS. Hypertension and being female were related with poor prognosis in ICAS (p = 0.081 vs. 0.087). Congestive heart failure (p = 0.002) was associated with poor prognosis and alcohol with a favourable outcome (p = 0.087) in ECAS. Stroke severity was related with poor prognosis in both groups (p < 0.001). Conclusions: The prevalence of risk factors differs between ICAS and ECAS, and their influence differs for stroke severity and prognosis.

Pruritus: Do Aδ fibers play a role?

Neuropathological and molecular basis of pruritus has not been clarified and the presence of certain specific neural circuits have been proposed. Our aim in this study was to evaluate the role of Aδ fibers in the neural circuits of pruritus by cutaneous silent period (CSP). Thirty‐six patients with chronic idiopathic generalized pruritus and 32 healthy controls were enrolled in the study. CSP and nerve conduction studies of upper and lower extremities were performed in both groups. Latencies of CSP in the upper and lower extremities were observed to be prolonged in the patient group compared with the controls while durations were shortened (all P < 0.001). However, these values were not correlated with sex, age, duration or severity of the disease (all P > 0.05). Our data suggest that pruritus may be developed by a nerve conduction abnormality in the afferent fibers of Aδ, or cortical hypersensitivity, abnormality of the cortical inhibitory mechanisms or lack of inhibition in the intermediate spinal inhibitory neurons generating CSP. This topic needs to be evaluated thoroughly in larger series with more detailed studies.

Lumbar Opening Pressure and Radiologic Scoring in Idiopathic Intracranial Hypertension: Is There Any Correlation?

Summary Background To investigate correlation between lumbar opening pressure (LOP) and radiological scores based on cranial MRI and contrast-enhanced MR venography in patients with idiopathic intracranial hypertension (IIH). Material/Methods Patients with IIH who underwent brain MRI and contrast-enhanced MR venography before measurement of LOP between 2010–2014 were evaluated retrospectively. Three experienced radiologists (blinded to LOP values) evaluated a total of 51 patients. They reached a consensus on the presence or absence of 6 radiological findings identified in the literature as characteristic for IIH: empty sella, perioptic dilation, optical tortuosity, flattening of the posterior globe, swelling of the optic disc, and bilateral transverse sinus stenosis. The radiological score was obtained by giving 1 point for the presence of each finding, with the highest possible score of 6 points. The correlation between the calculated radiological scores and LOP was evaluated. Results There was no significant correlation between LOP and radiological scores (r=0.095; p=0.525, Spearman’s rank coefficient). Similarly, no significant correlation was detected between LOP and each of the radiological findings (partial empty sella [p=0.137], perioptic dilation [p=0.265], optical tortuosity [p=0.948], flattening of the posterior globe [p=0.491], swelling of the optic disc [p=0.881], and bilateral dural sinus stenosis [p=0.837], Mann-Whitney U test). Conclusions There was no significant correlation between LOP and reliable radiological features of IIH.

Investigation of Nerve Conduction Studies of Carpal Tunnel Syndrome Cases with Different Risk Factors: An Electrodiagnostic Study.

Purpose: The aim of this study was to determine whether there are electrodiagnostic differences between carpal tunnel syndrome (CTS) patients with diabetes mellitus, CTS + hypothyroidism (HT), CTS + fibromyalgia syndrome, CTS + rheumatoid arthritis (RA), and idiopathic CTS cases, by comparing nerve conduction studies. Methods: This research examined electrophysiologic studies of 47 untreated HT + CTS, 47 diabetes mellitus + CTS, 49 RA + CTS, 52 fibromyalgia syndrome + CTS, 50 idiopathic CTS cases, and a healthy control group of 50 individuals (a total of 293 patients and 433 hands with CTS). Results: There were no significant differences between the groups in terms of sex and age. There was no significant difference between the CTS groups—in terms of numbers—with mild, moderate, and severe CTS. When the CTS groups were compared with the control group, in all CTS groups on both left and right hands, there was a significant prolongation in median motor latency and median sensory latency (in the 3rd finger); also a significant decrease in median sensory velocity in the 3rd finger. In diabetes mellitus, HT, and RA groups, the median motor amplitudes in both hands were significantly decreased compared with the idiopathic group. There was a moderate significant negative correlation between disease duration and median motor amplitudes (of both right and left sides) in RA (right; P = 0.028, r = 0.761, left; P = 0.041, r = 0.694) and HT groups (right; P = 0.035, r = 0.637, left; P = 0.049, r = 0.697). Conclusions: Electrodiagnostic results showed both demyelinating injury and axonal damage in diabetes mellitus, HT, and RA patients with CTS, in these patients during treatment for CTS. Early treatment planning should include the risk factor diseases.

FRI0123 The Relationship between Ankylosing Spondylitis and Restless Leg Syndrome

Objectives To assess the prevalence of restless leg syndrome (RLS) in patients with ankylosing spondylitis (AS) and to investigate factors potentially associated with RLS. Methods 130 patients diagnosed with AS (95M, 35F, mean age: 38.4) according to modified New York criteria and age-and-sex matched 91 healthy control subjects (66M, 25F, mean age: 37.6) were included in this study. The diagnosis of RLS was made according to the criteria of the International RLS Study Group. The factors associated with RLS were evaluated. Electrophysiological procedures were performed in a group of patients with RLS. Results The frequency of RLS was significantly higher in AS patients (30.8%) than in healthy subjects (13.2%) (p=0.002). When AS patients with RLS was compared with AS patients without RLS, it was seen that peripheral arthritis (60% vs 26.7%, p<0.001), uveitis (25% vs 8.8%, p=0.016), iron deficiency anemia (62.5% vs 24.4%, p<0.001) and smoking (60% vs 30%, p=0.001) were significantly higher in the former group. AS patients with RLS tended to be have a younger mean age than others (p=0.088). We also evaluated cutaneous silent period in a subgroup AS patients with and without RLS. The mean level of upper extremity (87.6+10.6 vs 76.8+10, p=0.004) and lower extremity latency (123.9+22.6 vs 105.9+18.7, p=0.017) were significantly higher in AS patients with RLS than in AS patients without RLS. The mean duration of upper extremity (31.3+10.5 vs 39.9+8.5, p=0.013) and lower extremity (29+9.5 vs 43.9+9.6, p<0.001) were significantly shorter in AS patients with RLS than in AS patients without RLS. In multivariate regresssion analysis, it was seen that independent parameters associated with RLS in AS patients were the presence of iron deficiency anemia (OR: 4.3, 95%CI: 1.6-11.4, p=0.001) and smoking (OR: 5.2, 95%CI: 1.8-15.2, p=0.004). Conclusions Our findings indicate that RLS is commonly associated with AS. Possible causes include iron deficiency anemia, smoking and small fiber neuropathy. It is possible that many of AS patients with uncertain neurosensory symptoms and electrophysiologic abnormalities have previously unrecognized small fiber neuropathy. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4018

AB0495 Cutaneous Silent Period in Patients with Systemic Lupus Erythematosus without Neuropathic Symptoms

Background Small fiber neuropathy (SFN) is a peripheral nerve disorder affecting specifically small myelinated A Delta fibers and unmyelinated C fibers. SFN is one of the common causes of neuropathic pain syndrome, however it can not be shown in conventional nerve conduction studies, making it difficult to diagnose. It was suggested that Cutaneous Silent Period (CSP) can be used as an objective method for evaluating small nerve fibers. Objectives Evaluating small nerve fibers in patients with systemic lupus erythematosus (SLE) using CSP and assesssing the relationship between clinical signs, autoantibodies and neuropathic pain score. Methods 51 SLE (48 female, 3 male, mean age:39.9±9.4), and 46 healthy control subjects (42 females, 4 males, mean age: 40±9.2) were included the study. Patients having risk factors for peripheral neuropathy were excluded. Electrophysiologic recordings were performed both on patients and the control group using nerve conduction studies and CSP. Values (latency and duration) gahered by using CSP from lower and upper extremities were recorded. Clinical features were extracted from medical charts. Results The mean level of upper and lower extremity latencies were significantly higher in patients with SLE than in healthy control subjects (p<0.001). In addition, the mean duration of upper and lower extremity were significantly shorter in SLE patients than in controls (p<0.001). The mean upper latency is significantly higher in active SLE patients (SLEDAI score ≥6) when compared to inactive patients (85.4±14.9 vs. 78.6±8.4, p=0.023). The mean level of upper latency of active SLE patients tended to be higher (117.3±22 vs. 108.3±13.9, p=0.08). In SLE patients with nephritis, the mean level of lower extremity latency was significantly higher than in SLE patients without nephritis (119.4±20.2 vs. 107.6±14.3, p=0.028). Other EMG measures (NCS) were similar in patients with and without nephritis (all p values >0.05). When patients with anti-dsDNA positive were compared to the anti-dsDNA negative, it was observed that there was a tendency a lower duration of upper extremity in former group (31.2±8.2 vs. 35.2±7.5, p=0.08). Other measures were similar in patients with and without anti-dsDNA (all p values >0.05). The mean level of latency and duration were similar in SLE patients with and without hypocomplementemia, arthritis, photosensitivity, serositis, CNS involvement and other ENA antibodies. Age, treatment with antimalarials, steroids, immunsuppressives (azathioprine, cyclophosphamid), hemogram parameters had no effect on the NCS or CSP results. Also, LANNS score was not associated with any clinical parameters and NCS or CSP measure.In SLE patients, SLEDAI scores correlated with upper (r=0.36, p=0.009) and lower extremity latency (r=-0.38, p=0.008). The level of lower extremity latency also correlated with ESR (r=0.34, p=0.01) and disease duration (r=0.30, p=0.03). Conclusions We detected marked small nerve fiber damage in both lower and upper extremities in SLE patients using CSP. However, patients must be observed in the long term, because a correlation with neuropathic pain score was not found. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4019