Betül Bakan

Sonographic Evaluation of Subclinical Entheseal Involvement in Patients With Behçet Disease

OBJECTIVE The aim of the current study was to determine the prevalence of subclinical entheseal involvement in patients with Behçet disease via ultrasound using a newly developed method, the Madrid sonography enthesitis index. SUBJECTS AND METHODS The study was conducted with 36 patients with Behçet disease and 46 healthy sex- and age-matched control subjects. All patients with Behçet disease who had no clinical evidence of arthritis or enthesitis underwent an ultrasound examination. All sonographic findings were identified according to the Madrid sonography enthesitis index. Madrid sonography enthesitis index values of patients and control subjects were compared by Student t test and Mann-Whitney U test. Validity was analyzed by receiver operating characteristic curve. RESULTS Total enthesitis score was 12.16 ± 6.16 among patients with Behçet disease and 2.06 ± 2.18 among healthy control subjects (p < 0.001). The receiver operating characteristic curve established an ultrasound score greater than 4.5 in the Behçet disease group as the best cut-off point differentiating case subjects from control subjects. This cutoff was exceeded by 88.8% of the patients with Behçet disease. When the Madrid sonography enthesitis index score in each affected enthesis was evaluated, patients with Behçet disease had significantly higher scores than did control subjects when all entheseal sites were compared (all p values < 0.05). CONCLUSION This is the first study to our knowledge to show significant subclinical enthesopathy of the triceps tendon enthesis in patients with Behçet disease who had no arthritic involvement. These data suggest that the Madrid sonography enthesitis index scoring system for sonographic detection of enthesopathy should be incorporated into the clinical protocol for evaluating patients with Behçet disease in routine clinical practice.

Frequency of peripheral arterial disease and venous insufficiency in toenail onychomycosis

Onychomycosis in toenails is a common fungal infection and vascular abnormalities of lower extremities have been thought as one of the predisposing conditions. The aim of this study was to evaluate predisposition effect of venous insufficiency and peripheral arterial disease on toenail onychomycosis. Thirty‐three patients with bilateral onychomycosis in toenails and 37 control subjects, who had healthy nails, were enrolled in the study. Veins and arteries of lower extremities were examined with Doppler ultrasound in terms of venous insufficiency or peripheral arterial disease. Patients with onychomycosis presented more frequent venous insufficiency than the control group (42.4% and 10.8%, respectively; P = 0.003). Although all patients had bilateral onychomycosis, reflux was bilateral in six out of 14 patients with onychomycosis (42.8%). No significant difference in frequency of peripheral arterial disease was found in patients, compared to healthy controls. Our study demonstrated a significant relationship between onychomycosis and venous insufficiency, but not with peripheral arterial disease. Also, we point out discordance with bilateral onychomycosis and unilateral venous insufficiency.

Increased Enthesopathy in Patients With Familial Mediterranean Fever Evaluation With a New Sonographic Enthesitis Index

The aim of this study was to determine the frequency of enthesopathy in familial Mediterranean fever by using a newly developed sonographic method, the Madrid Sonographic Enthesitis Index (MASEI).

Avaliação de entesopatia em pacientes com fibromialgia por meio do novo índice ultrassonográfico de entesite

OBJECTIVE: The aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI). METHODS: This study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Students t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points. CONCLUSIONS: Misdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.

Mitchell’s Osteotomy With Mini-Plate and Screw Fixation for Hallux Valgus

Background: The aim of this study was to evaluate the use of mini-plate and screw fixation to stabilize the first metatarsal osteotomy in patients undergoing Mitchell bunionectomy, with the outcomes of interest being radiological alignment and the time to bony union. Methods: We used mini-plates and screws in 43 feet of 25 patients to avoid cast immobilization and prevent osteotomy displacement. The mean age at operation was 45.4 ± 13.4 years (range, 17.0-65.0 years). The mean follow-up was 16.9 ± 3.6 months (range, 12.0-30.0 months). The hallux valgus angles, intermetatarsal angles, and American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were evaluated preoperatively and at postoperative month 12. Results: The mean preoperative value for the hallux valgus angle was 35.9 ± 4.4 degrees (range, 26.0-45.0 degrees) and for the intermetatarsal angle was 12.1 ± 1.4 degrees (range, 10.0-15.0 degrees). The mean postoperative value for the hallux valgus angle was 16.0 ± 2.12 degrees (range, 12.0-20.0 degrees) and for the intermetatarsal angle was 7.7 ± 1.2 degrees (range, 5.0-10.0 degrees). The mean AOFAS score was 50.5 ± 12.8 points (range, 30.1-76.0 points) preoperatively and 75.9 ± 11.3 points (range, 43.3-92.3 points) at postoperative month 12. Improvement of range of motion of the metatarsophalangeal joint, pain relief, and satisfactory alignment of the first ray were achieved in 41 feet (95.3%). Conclusions: We recommend this fixation for Mitchell’s bunionectomy because it provided stable fixation without the need for casting. Level of Evidence: Level IV, retrospective case series.

Psoriatic Arthritis and Sonographic Entheseal Index

To the Editor: We read with great interest the recent article, “Identification of the Clinical Features Distinguishing Psoriatic Arthritis and Fibromyalgia” by Marchesoni, et al 1. However, we have some doubts about their results. They reported that Achilles tendon entheses were not significantly more involved in patients with psoriatic arthritis (PsA), because of the infrequent involvement of this tendon in these patients. This is an intriguing finding. The Achilles tendons are among the most frequent sites of enthesopathic involvement in PsA, and are reported in … Address correspondence to Dr. Ozkan, Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Radiology, 46050 Kahramanmaras, Turkey. E-mail: drfozkan{at}yahoo.com

Assessment of enthesopathy in patients with fibromyalgia by using new sonographic enthesitis index

OBJECTIVE The aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI). METHODS This study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Students t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P < 0.05 were considered significant. RESULTS Total enthesitis score was 7.39 ± 4.99 (mean ± SD) among FM patients and 3.7 ± 3.22 among healthy controls (P < 0.001). The receiver operating characteristic curve established an ultrasound score of > 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points. CONCLUSIONS Misdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.

Maraş dövme dondurma ustalarında üst ekstremite birikimli travma rahatsızlıkları

Objective: Upper Extremity Cumulative Trauma Disorders (UE-CTD) are among the major health problems affecting the workers. The aim of this study was to investigate UE-CTD in the makers of Maras pounded ice cream (MMPIC) Methods: This study was conducted among 50 volunteers who work as a MMPIC and 50 control in our downtown area. During face-to-face conversion, the participants filled out a survey inquiring about age, duration of work (in years) in job, daily working time, occupation with another job, health history, and medication usage. The subjects were questioned regarding the musculoskeletal complaints within the last six months and upper body physical examination was performed in all participants. Results: The study group was composed of males. The mean age of study group and control group were 31.78±6.58 and 30.74±5.99 years (p=0.411), respectively. The mean duration of work in pounded ice cream business and the mean duration of work in control were 11.64± 6.26 years and 10.68±5.48 years (p=0.417), respectively. The mean daily working time in the study group and in control group were 10.64±1.82 hours and 11.12±1.62 hours (p= 0.168), respectively. Musculoskeletal complaints of the upper extremity were found in 52% of the study group, and 28% of the control group. Musculoskeletal disease of upper extremity was found in 28% of the study group and in 12% of the control group. Upper extremity musculoskeletal system complaints and illness were difference statistically between the two groups (p= 0.014; p= 0.046, respectively). Conclusion: UE-CTD was seen in the makers of pounded ice cream and its prevalence was similar to the other laborers work in the areas needing repetitive arm and hand motion.