Burcu Yanik

Neuropathic arthropathy caused by Arnold–Chiari malformation with syringomyelia

We report a case of neuropathic arthropathy caused by Arnold–Chiari malformation with syringomyelia, with details of the clinical and radiologic aspects. The patient had pain and stiffness in his left upper limb. MRI of the left shoulder revealed neuropathic arthropathy. Upon examination, his left elbow also had the characteristic findings for neuropathic arthropathy. Examination of the spinal cord by MRI confirmed Arnold–Chiari malformation associated with syringomyelia. Neuropathic arthropathy requires evaluation of the spinal cord to assess for occult causal lesions.

Influence of obesity on bone mineral density in postmenopausal asthma patients undergoing treatment with inhaled corticosteroids

OBJECTIVES: The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. METHODS: A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. RESULTS: Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 ± 0.29 and 0.88 ± 0.14 g/cm2, respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1%) and control (43.3%) groups. Bone fracture was identified in four patients with asthma (8.6%) and in six patients from the control group (10%). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. CONCLUSIONS: There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.

Associated Factors with Pain and Disability in Patients With Knee Osteoarthritis

Özet Amaç: Diz osteoartriti (OA) olan hastalarda ağrı ve fonksiyonel düzeyle ilişkili etkenleri belirlemektir. Yöntem ve Gereçler: Diz OA tanısı alan 161 hasta çalışmaya alındı. Hastaların yaş ortalaması 62.4± 8.7 yıl olup ortalama semptom süresi 43.76± 26.6 aydı. Hastaların yaş, cinsiyet, vücut kütle indeksi, eğitim düzeyi, sigara ve düzenli egzersiz alışkanlığı ve semptom süreleri kaydedildi. Ön-arka ve lateral diz grafilerinde Kellgren-Lawrence skorları hesaplandı. Hastaların fonksiyonel düzeyi Western Ontario ve McMaster Üniversitesi Osteoartrit İndeksi (WOMAC) ile, ağrı şiddeti Görsel Ağrı Skalası (GAS) ile değerlendirildi. Bulgular: Vücut kütle indeksi ile WOMAC ağrı skoru (r=0.592, p=0.0001), WOMAC eklem sertliği skoru (r=0.634, p=0.0001) ve WOMAC günlük yaşam aktiviteleri skoru (r=0.749, p=0.0001) arasında ilişki saptandı. Eğitim düzeyi ile WOMAC ağrı skoru (r=-0.394, p=0.001), WOMAC eklem sertliği skoru (r=-0.345, p=0.004), ve WOMAC günlük yaşam aktiviteleri skoru (r=-0.352, p=0.003) arasında ters ilişki saptandı. Kellgren-Lawrence skoru (ön-arka ve yan grafi) ile GAS skoru ve her üç WOMAC skoru arasında ilişki saptanmadı (p>0.05). Kellgren-Lawrence ön-arka ve yan grafi skorları yaş ve semptom süresiyle ilişkili bulundu (sırasıyla r=0.263, p=0.001 ve r=0.339, p=0.016). GAS skoru ile herhangi bir parametre arasında ilişki saptanmadı. WOMAC alt grup skorları ve GAS skoru cinsiyete göre karşılaştırıldığında WOMAC ağrı skorunun bayanlarda daha yüksek olduğu saptandı (p= 0.024). Geri kalan faktörlerle WOMAC alt grup skorları arasında korelasyon saptanmadı. Sonuç: Vücut kütle indeksi, diz OA olan hastalarda fonksiyonel düzey ve ağrı şiddetiyle ilişkili en önemli faktördür. Hastalar, semptom ve hastalık şiddetini azaltmak açısından kilo vermeye teşvik edilmelidirler. (Turk J Rheumatol 2010; 25: 77-81) Anah tar sözcükler: Diz, osteoartrit, ağrı, özürlülük

The effect of alendronate, risedronate, and raloxifene on renal functions, based on the Cockcroft and Gault method, in postmenopausal women.

Background. Oral alendronate, risedronate, and raloxifene are effective treatment options in the management of postmenopausal osteoporosis. There is little previously reported about the renal safety profiles of these three agents in osteoporosis. We aimed to assess the risk of renal toxicity associated with oral alendronate, risedronate, and raloxifene in the treatment of osteoporosis, prospectively. Methods. One hundred and twenty-seven patients with osteoporosis and osteopenia according to lumbar or femoral-neck bone mineral density t score were enrolled in the study. The patients were randomized to alendronate 70 mg once weekly (n  =  47), risedronate 35 mg once weekly (n = 44), or raloxifene 60 mg per day (n = 36) for one year. Preliminary screening included medical history, physical examination, lumbar and femoral bone mineral densitometry measurement, and blood biochemical tests, including renal function tests. The biochemical markers were then assessed at the end of 12 months. Results. There was no significant difference between basal and final renal function parameters of each group. Also these parameters did not differ between the three groups after 12 months of treatment period. Conclusions. These results demonstrate that alendronate, risedronate, and raloxifene are all safe drugs for renal functions in the treatment of osteoporosis.

The interval scaling properties of the London Handicap Scale: an example from the adaptation of the scale for use in Turkey

Objectives: To adapt the London Handicap Scale into the Turkish language, and to investigate the scaling properties of this version in a sample of people who have experienced a stroke. Design: After the translation process, the internal construct validity was tested by Rasch analysis and the reliability by internal consistency and intraclass correlation coefficient. The interval scaling properties were assessed by contrasting the raw and weighted London Handicap Scale scores with the Rasch latent estimates. Setting: An outpatient rehabilitation unit of a university hospital. Subjects: One hundred and eighty-eight community-dwelling post-stroke patients (mean age 63 (SD 12) years, 54% male) were assessed by the Turkish version of the London Handicap Scale. Results: After adjustment for local dependency, the data showed good fit to Rasch model expectations with a mean item fit −0.240 (SD 1.868), person fit −0.403 (SD 0.893) and chi-square interaction 8.55 (df 10, P = 0.575). The reliability was good with a Cronbach’s α and intraclass correlation coefficient of 0.845. Analysis of the scaling properties showed that either the raw London Handicap Scale score or its weighted score were non-linear with respect to the Rasch latent estimate. Conclusions: The London Handicap Scale is a valid and reliable scale for use in stroke in Turkey. Its unweighted raw scores and weighted scores are equivalent and ordinal, but a linear transformation is possible through Rasch analysis.

Metastatic vertebral tumor misdiagnosed in magnetic resonance imaging as benign degenerative bone marrow changes: a case report

Many disorders including congenital, degenerative, inflammatory, and neoplastic lesions are associated with low back pain. It is essential to differentiate between malignant disease and the more common causes of back pain. We report a man with low back and right groin pain as a result of metastatic breast carcinoma which was misdiagnosed in magnetic resonance imaging as benign degenerative changes.