Ece Aydog

Comparison of serum IL-1β, sIL-2R, IL-6, and TNF-α levels with disease activity parameters in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic, inflammatory, rheumatological disease affecting primarily the sacroiliac joint and vertebral column, with an etiology that remains obscure. Cytokines are soluble proteins that have specific roles in inflammatory response, arranging the interaction between cells of the immune system both in natural and specific immune reactions. This study was planned to evaluate the relation between the level of cytokines and the clinical and laboratory findings of patients with AS compared to healthy subjects. In this study, we demonstrated increased serum levels of soluble interleukin-2 receptor (sIL-2R), Interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in patients with AS compared with healthy subjects. Only IL-1β levels were not increased in AS patients. We found a correlation between C-reactive protein and IL-6 levels and between erythrocyte sedimentation rate and sIL-2R, IL-6 and TNF-α levels. Only the sIL-2R level was correlated with Bath AS Metrology Index and Bath AS Functional Index. We suggest that sIL-2R, IL-6, and TNF-α may have a role in the pathogenesis of AS and that their serum levels can be used as disease activity parameters and tools for diagnosis.

Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients

The aim of this study was to investigate dynamic postural balance in patients with rheumatoid arthritis (RA) in relation to the disease characteristics. Seventy-four patients with RA and 42 controls of the same age group were tested using the Biodex Stability System (Biodex Medical Systems, Shirley, NY, USA). Anterior/posterior (AP), medial/lateral (ML), and overall (OA) indices were obtained with bilateral stance at platform stabilities of 2 and 8. Subjects were tested with “eyes open” at all times. At the same time, Disease Activity Score, functional disability [Health Assessment Questionnaire, (HAQ)], and Steinbrocker Functional Class (SFC) were assessed. Both the AP and OA indices in the RA group were significantly higher than in the control group for level 8. For OA index, the results were 2.7±0.9 in RA and 2.2±0.7 in the control group (p=0.006), and for AP index, the results were 2.1±0.7 in RA and 1.7±0.6 in the control group (p=0.002). Eleven patients (15.9%) and three controls (7.1%) could not complete the test at level 2. When the patients and controls who completed the test were compared, a significant difference was found only in the ML index. The results were 4.6±2.4 in RA and 3.8±1.6 in the control group (p=0.047). A positive correlation between HAQ and postural balance for all three stability indices at level 8 was detected. A positive correlation between SFC and postural balance for OA and ML at level 8 was also found. Multiple linear regression analyses revealed age and body mass index (BMI) to be the most important factors influencing postural dynamic balance at both levels in the RA group and in healthy controls. RA has a negative effect on dynamic postural stability. The functional status affects dynamic balance more than disease activity. Age and BMI were the most important factors influencing postural dynamic balance in the RA group and in healthy controls. Level 2 does not appear to be an appropriate level for evaluating postural stability in RA.

The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study

Objective: To evaluate the effect of home versus in-hospital exercise (under supervision) programmes on hip strength, gait speed and cadence in patients with total hip arthroplasty at least one year after operation. Setting: Physical therapy and rehabilitation department. Subjects: Twenty-six patients who had had a total hip arthroplasty operation 12—24 months prior to the study were enrolled. Interventions: The patients were randomized into three groups: group 1 patients were assigned a home exercise programme, group 2 patients exercised under physiotherapist supervision in hospital, and group 3 served as the control group, with no specific intervention. The study duration was six weeks. Main measures: Maximum isometric abduction torque of operated hip muscle, gait speed and cadence were measured before and after the study. Results: Maximum isometric abduction torques of the hip abductor muscles improved in groups 1 and 2, but not in group 3 (30 ± 12 to 38 ± 11 ft.lb in group 1, 18 ± 10 to 30 ± 9.8 ft.lb in group 2). Gait speed improved from 67.8 ± 23 to 74.35 ± 24 m/min in group 1, from 48.53 ± 4 to 56.7 ± 5 m/min in group 2 and from 58.01 ± 12 to 59.8 ± 14 m/min in group 3. Cadence also improved, from 97.7 ± 18 to 111 ± 17 steps/min in group 1, from 90.75 ± 6 to 104.75 ± 7 steps/min in group 2, and from 87 ± 16 to 88.22 ± 16 steps/min in group 3. When the three groups were compared, group 2 showed the best improvement (P = 0.006) only in maximum isometric abduction torque. Conclusion: Our findings suggest that both home and supervised exercise programmes are effective one year after total hip arthroplasty. Home exercise programmes with close follow-up could be recommended.

Reliability of isokinetic ankle inversion- and eversion-strength measurement in neutral foot position, using the Biodex dynamometer

This study was designed to investigate the intratester and intertester reliability of isokinetic ankle inversion and eversion-strength measurement in neutral foot position in healthy adults using the Biodex dynamometer. Twenty-five men and women performed five maximal concentric contractions at 60 and 180°/s angular velocities. Two physicians tested each subject. The first physician applied the test four times, and the second physician three times. Reliability of peak torque was assessed by calculating the intraclass correlation coefficient (ICC). At both angular velocities, inversion strength was greater than eversion, and when the angular velocity was increased, inversion and eversion strength were decreased, as tested by both physicians. The first measurements of inversion and eversion strength of the first physician were significantly lower than the other measurements (p<0.01). The intratester ICCs for ankle inversion in healthy young adults were highly reliable (ICC 0.92–0.96), and for the eversion values ranged from 0.87 to 0.94. Intertester ICCs for ankle inversion and eversion peak torque values demonstrated a value of 0.95. Isokinetic tests of ankle inversion and eversion strength at 60 and 180°/s angular velocities in neutral foot position for healthy adults are highly reliable with the Biodex dynamometer.

Assessment of shoulder involvement and disability in patients with ankylosing spondylitis

The purpose of the study was to evaluate the parameters which have an important role in shoulder involvement and disability in ankylosing spondylitis (AS). Ninety patients with AS were divided into two groups according to the presence of shoulder involvement. Bath AS metrology index (BASMI), ankylosing spondylitis quality of life (ASQoL) and shoulder pain and disability index (SPADI) were used. Ranges of movements of limited shoulders were measured. Mean disease duration, age, BASMI, and ASQoL were higher and hip involvement was more frequent in the shoulder-involved group. Disease duration was found to be the most significant factor in shoulder involvement. A significant relationship was found between all SPADI scores and ASQoL. The SPADI disability score was affected by flexion limitation. Patients with hip involvement and longer disease duration should be evaluated for shoulder involvement. Flexion limitation of shoulder affected shoulder disability and shoulder disability impaired quality of life.

Hand deformity in Parkinson’s disease: case report

Hand and foot deformities were originally described in Parkinson’s disease (PD) in 1864, although their pathogenesis still remains to be clarified. Typical hand deformities are flexion in metacarpopharyngeal joints and hyperextension in interphalangial joints, sometimes accompanied by ulnar deviation. Unlike rheumatoid arthritis (RA), there is no swelling and stiffness in joints. In this report, a case that was previously misdiagnosed as RA due to deformities in the hand and whose PD was detected upon presentation to our clinic is presented, and the differential diagnosis of the disease is discussed.