Erhan Capkin

A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain.

AimTo compare the effectiveness of landmark-guided local injections and ultrasonography (USG) guided injections for shoulder pain. MethodsA total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled, and randomly assigned to receive triamcinolone (40 mg) either by landmark-guided (LMG, n=30) or USG guided (n=30) injection. The patients were evaluated on admission and 6 weeks after the injection. Clinical assessment included demographic and clinical data, a visual analoge scale (VAS) for pain (0 to 10 cm), the Constant scale (0 to 100) for function, passive and active shoulder range of motion (ROM) with goniometric evaluation, and postinjection adverse effects. ResultsInitial demographic, clinical and USG findings in the groups exhibited no significant differences. Six weeks after injection, the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group (mean VAS score decrease: 4.0±1.7 for USG vs. 2.2±0.9 for LMG, P<0.05; mean Constant score change: 32.2 for USG vs. 12.2 for LMG, P<0.05). Significant improvements were observed in active and passive ROM values in both groups, USG group values being better. Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM, of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection (P<0.05). ConclusionsOur results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG-guidance may improve therapeutic effectiveness and reduce adverse effects.

Investigation of effects of different treatment modalities on structural and functional vessel wall properties in patients with ankylosing spondylitis

AIM Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that is associated with increased cardiovascular burden. The aim of this study was to investigate vascular structural and functional changes in patients with AS, with special emphasis on the effects of different treatment modalities, through evaluation of level of vascular stiffness (pulse wave velocity [PVW]) and carotid intima media thickness (IMT-C). METHODS A total of 67 AS patients, and age, sex, body mass index (BMI) smoking status, lipid profiles and blood pressure-matched healthy control subjects (n=34) were studied. Of these, 34 patients were on anti-TNF alpha and 33 on non steroid anti inflammatory drugs (NSAIDs). The IMT-C and PWV values of the right common carotid artery were measured by high-resolution ultrasound. RESULTS The AS patients (n=67) had significantly higher PWV values than the controls [9.0 ± 1.49 m/sec vs. 8.27 ± 0.90 m/sec, P=0.004; 95% confidence interval (CI), -1.22 to -0.24]. Multiple stepwise linear regression analysis revealed that PWV could only be explained by systolic blood pressure (P<0.05) and IMT (P<0.05) in AS. Even though IMT-C in anti-TNF alpha treated group was higher compared to the NSAID treated group, it was not statistically significant (P=0.5). CONCLUSION PWV was found to be higher in AS patients than in the control group, and there was no significant difference between the average PWV values of AS patients treated with anti -TNF alpha or NSAIDs.

Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis

Aim:  Physiotherapy is an integral part of the management of ankylosing spondylitis (AS) and there is a need for recommendations which focus on the rehabilitation of patients with AS. We aimed to develop recommendations for the physical therapy and rehabilitation of patients with AS based on the evidence and expertise.

Case report of a patient with osteopoikilosis

Osteopoikilosis (OPK) is a benign osteosclerotic dysplasia of unknown origin, which is an inherited autosomal disorder. Males and females are equally affected. It is usually asymptomatic and may only be recognized on radiological examination. In this study we report a 33-year-old woman with fibromyalgia who suffers from back and leg pain and was diagnosed OPK by radiologically and review literature.

Musculoskeletal Sonography in Physical and Rehabilitation Medicine: Results of the First Worldwide Survey Study

OBJECTIVES To explore the current status of musculoskeletal ultrasound (MSUS) in the realm of physical medicine and rehabilitation (PMR), and to determine the effects of a 1-day MSUS course on the awareness of physiatrists. DESIGN Survey. SETTING International Society of Physical and Rehabilitation Medicine Congress, 2009, Istanbul. PARTICIPANTS Physiatrists attending the congress (n=276) and the MSUS course (n=30). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The survey contained 17 multiple-choice and open-ended questions concerning personal background, perceptions regarding MSUS, and current use of MSUS. Additionally, a group of physicians who attended the 1-day MSUS course before the congress were evaluated twice (before and after the course) to assess the change in their awareness. RESULTS Data from 306 physiatrists (with a mean experience of 10.5+/-8.1 y in the field of PMR) were evaluated. Among the participants, 57.8% were using MSUS in their diagnostic algorithms, 90.4% were thinking that physiatrists should perform sonography themselves, and 75.1% declared that they would perform sonography if they had a device. The ratio of subjects who rated MSUS to be essential for their clinical practice increased from 35.7% to 58.6% after the MSUS course (P>.05). CONCLUSIONS Physiatrists strongly believe that they should perform MSUS themselves, lack of education and lack of device seem to be important issues to be addressed, and even a 1-day course significantly changes awareness of MSUS.

Evaluation of Choroidal Thickness in Ankylosing Spondylitis Using Optical Coherence Tomography

Abstract Purpose: To investigate posterior segment (PS) findings in the eye in patients with ankylosing spondylitis (AS). Methods: Eighty-four patients with AS and 63 healthy controls were enrolled. PS evaluations were performed using optical coherence tomography (OCT). Foveal thickness, peripapillary retinal nerve fiber layer thickness, macular volume, ganglion cell complex, and choroidal thickness (CT) values were compared between the groups. Results: Mean CT was higher in patients with AS (326.5 ± 71.5 µm) than in the healthy controls (286.2 ± 59.5 µm) (p = 0.001). There was no significant difference between patients with AS and the healthy control group in terms of other OCT parameters. There was also no significant correlation between CT, AS activity index, and disease duration. Conclusions: This is the first study to evaluate effects of AS on CT. CT was high in patients with AS compared to healthy controls.

Comparison of ASDAS and BASDAI as a measure of disease activity in axial psoriatic arthritis

The aim of this study was to compare the discriminative ability of Ankylosing Spondylitis Disease Activity Score (ASDAS) with Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) and other clinical disease activity parameters in patients with axial psoriatic arthritis (axPsA). Patients with axPsA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and Anatolian Group for the Assessment in Rheumatic Disease (ANGARD) cohort and were assessed for BASDAI, ASDAS, BASFI (Bath Ankylosing Spondylitis Functional Index), Ankylosing Spondylitis Quality of Life (ASQoL), and visual analog scale (VAS) pain. The discriminant ability of ASDAS-C-reactive protein (−CRP) and ASDAS-erythrocyte sedimentation rate (−ESR) was assessed using standardized mean differences between patients with high and low disease activity. Fifty-four patients with axPsA were included in the study. Both ASDAS scores showed good discriminative ability between high and low disease activity states. Both ASDAS versions and BASDAI had relatively high area under the curve (AUC) according to ASAS partial remission, patient and physician global assessments in receiver operating characteristic (ROC) curve analysis. There was no significant difference between AUC scores for the models that compared ASDAS-CRP and ASDAS-ESR with BASDAI for each individual definition of disease activity states. ASDAS versions and BASDAI showed good similar discriminative ability between high and low disease activity as reflected by the AUC analysis in axPsA. The cutoff values for inactive disease and high disease activity were relatively similar to predefined cutoff values for AS. Further, prospective validation is now required to identify the appropriate assessment tools and cutoff values in axPsA.

Prevalence of rheumatoid arthritis in the eastern Black Sea region of Turkey.

Aim:  The aim of this study was to estimate the prevalence of rheumatoid arthritis (RA) in the eastern Black Sea region of Turkey.

Education and Visual Information Improves Effectiveness of Ultrasound-Guided Local Injections on Shoulder Pain and Associated Anxiety Level: A Randomized Controlled Study.

ObjectiveLocal injections are widely used in patients with a painful shoulder. The aim of this study was to evaluate the possible impact of patients’ visual information on the effectiveness of ultrasound (US)-guided local injections on anxiety levels and shoulder pain. DesignA total of 151 patients, scheduled for local injection owing to shoulder pain, were randomly assigned into two groups in a consecutive order. Patients in group I (n = 72) were provided information related to US findings and allowed to watch the procedures from the monitor, whereas patients in group II (n = 79) received the injection only without any collaboration. Data were collected from both groups immediately before and after injections through visual analog scale and questionnaire (the State-Trait Anxiety Inventory [STAI] forms 1 and 2). ResultsUS-guided local injections provided significant improvement of anxiety and pain in both groups, irrespective of providing visual information. Group I and group II comparisons with respect to the visual analog scale, STAI 1, and STAI 2 yielded significant difference only for postinjection STAI 2 in group I (P = 0.006). Intragroup comparisons revealed significant differences between preinjection and postinjection values (group I: visual analog scale, P = 0.001; STAI form 1, P = 0.001; STAI form 2, P = 0.002; group II: visual analog scale, P = 0.001; STAI form 1, P = 0.002; STAI form 2, P = 0.042). There was no significant difference between the groups in terms of postinjection satisfaction levels from the procedures (P = 0.824). ConclusionsPerforming US-guided shoulder injections with patient visual information provides positive contributions to coping with pain and anxiety. In particular, the patient collaboration–based US-guided injections have positive consequences on patients’ long-standing “trait-anxiety” levels.

Osteitis condensans ilii in differential diagnosis of patients with chronic low back pain: a review of the literature

Osteitis condensans ilii (OCI) is a benign pathology causing chronic back and hip pain. Although the definitive cause is uncertain, mechanical stress is a significant factor in the development of the disease. Bilateral involvement of the sacroiliac joint is typical. We describe a case of unilateral OCI with unilateral sclerosis observed at radiography in a 34-year-old patient presenting with chronic back and hip pain, together with a review of the literature.