Esma Ceceli

Fibromyalgia Syndrome: Is It Related to Vitamin D Deficiency in Premenopausal Female Patients? ---

There are a number of studies that have evaluated the relationship between fibromyalgia (FM) and vitamin D deficiency with conflicting results. The aim of this study was to assess vitamin D deficiency in patients with FM and to evaluate the relationship with the common symptoms of FM and levels of serum vitamin D. Forty premenopausal female fibromyalgia patients and 40 age- and sex-matched control subjects were included in the study. The demographic characteristics of all subjects, including age, sex, and body mass index, were recorded. The number of tender points was recorded, and the intensity of the widespread pain of the subjects was measured by the visual analog scale. The activities of daily living component of the Fibromyalgia Impact Questionnaire (FIQ-ADL), was used to assess physical functional capacity. Serum vitamin D was measured in both groups, and vitamin D levels <37.5 nmol/L were accepted as vitamin D deficiency. The vitamin D levels and clinical and laboratory characteristics of the patient and control groups were comparatively analyzed. The relationship between vitamin D levels and clinical findings of the FM patients were also determined. The mean age was 41.23 ± 4.8 and 39.48 ± 4.08 years for the patient and control groups, respectively. The pain intensity, number of tender points, and FIQ-ADL scores were higher in FM patients than in control subjects. The mean levels of vitamin D in the patient and control groups were determined to be 31.97 ± 15.50 and 28.97 ± 13.31 nmol/L, respectively (p > .05). The incidence of vitamin D deficiency was similar between the patient and control groups (67.5% vs. 70%). Vitamin D levels significantly correlated with pain intensity (r = -0.653; p = .001) and FIQ-ADL scores in the FM group (r = -0.344; p = .030). In conclusion, the results of this study indicate that deficiency of vitamin D is not more common in premenopausal female patients with FM than in control subjects without FM. However, the association between pain and vitamin D levels in FM patients emphasizes that hypovitaminosis of vitamin D in the FM syndrome may have an augmenting impact on pain intensity and functional status. Future studies are needed to show the effect of vitamin D supplementation in the reduction of pain intensity and disability in patients suffering from this chronic condition.

A Multicenter Pilot Study of Burden Among Caregivers of Geriatric Rehabilitation Patients with Neuromusculoskeletal Diseases

Purpose: In this study, we aimed to describe the sociodemographic characteristics of caregivers of patients in a geriatric unit and to clarify the relationship between caregiver burden and specific clinical variables in the patients and the characteristics of the caregivers. Design: Cross-sectional multicenter study. Methods: One hundred twenty-three patients and 123 caregiver dyads, with mean ages of 72.5 ± 7.7 years and 51 ± 14.7 years, respectively, were included. The functional, psychological, and cognitive statuses of the patients were determined, and the sociodemographic characteristics of the caregivers as well as the type and duration of caregiving were recorded. Caregivers completed the Caregiver Burden Inventory (CBI) to measure the perceived burden of care. Most patients were female and generally lived with their family. Findings: Most of the caregivers were family members (90%), female (73.2%), primary school graduates (52.8%), and first-degree relatives (73.1%). The average CBI score was 33, and the highest CBI subscores were for time, developmental, and physical burdens. Caregiver burden correlated with the patient’s ambulatory, psychological, and cognitive status and with the caregiver’s age, gender, income level, and duration of caregiving. Conclusions: We have highlighted the relationship between caregiver and patient characteristics in a cohort of elderly Turkish patients with neurological and musculoskeletal disorders. In particular, we have highlighted the heavy caregiver burden in a developing country. Clinical Relevance: Our results may guide the nurses to understand the requirements of caregivers and to help them find suitable resources that would meet their needs to cope with their burden.

The inadequate anti-tumour necrosis factor (anti-TNF) therapy in patients with ankylosing spondylitis

Dear editor, Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of axial and peripheral joints associated with serious disability and a significant reduction in quality of life [1]. The prevalences of AS and related spondyloarthritis in most of the Meditterenean countries including ours have been determined as 0.5–1% and seems to be higher than the observed prevalences in other countries [2, 3]. Until recently, delayed diagnosis was common, due to insensitivity of traditional radiographs and treatment strategies were limited to NSAIDs, DMARDs and physical therapy interventions. However, conclusive evidence for the efficacy of these drugs with respect to axial disease is still lacking. The introduction of tumour necrosis factor (TNF) blocking drugs has remarkably changed the treatment options and clinical progression of this condition. Although the guidelines for introducing anti-TNF agents in patients with AS has been defined, there is still a doubtful approach to optimal use of these agents and there exists an unmet need for anti-TNF therapy in AS patients [2, 4, 5]. We have retrospectively determined the demographical and clinical characteristics of AS patients following at our rheumatology outpatient unit and evaluated the current therapies as well as the disease activity status. The demographical variables including age, sex, occupation, disease duration, axial, and peripheral involvement were determined. The current BASDAI, BASFI, BASMI, and pain intensity assessed by VAS were also recorded. For BASDAI, the cut off limit was accepted as four for active disease. A total of 103 AS patients (80 male,23 female) with a mean age of 39.6 ± 12.4 years (18–78) were enrolled to the study. The male/female ratio was 34.7. The mean disease duration was 12.7 ± 9.5 years. Regarding occupational status 65 (63.1%) were employed, 15 (14.5%) were housewifes and 12 (11.6%) were retired, while 11 (10.6%) were unemployed. The ratios of axial, peripheral and both involvements were 97.2, 46.4, and 28.8%, respectively, in our patient group. The mean values of pain by VAS, BASDAI, BASMI, and BASFI were 5.8 ± 2.6, 3.54 ± 2.1, 4.8 ± 3.2, and 3.8 ± 2.2, respectively. The rate of patients with BASDAI [4 was 39.8%. The percentage of patients using NSAID was 89.4%, salazopyrine 71.9%, methotrexate 1.9% and the ratio of antiTNF medication was 8.7%. In this retrospective analysis, we indicated a high disease activity and inadequate therapy for most of our patients with AS, being followed at a big tertiary reference hospital in the capital of a developing country. Almost half of the patients met the recommended criteria for anti-TNF therapy, but only 8% patients were using anti-TNF drugs. Conventional therapies rather than biological therapies were common in our patient group. Most of our patients were working, but had an acitivity limitation. Our results are in accordance with a recent study evaluating patients from different parts of the same country [2]. Almost 10 years after the introduction of anti-TNF agents for the treatment of AS, physicians are still struggling with their appropriate use. Several factors may contribute to these results. The cost of these new agents, economic considerations, safety issues, patient concerns regarding side effects and toxicities, the absence of predictive markers of response and difficulty of careful monitorization in some centers, have prevented their use in demand and unabled to give the appropriate treatment. In conclusion, awareness of the disease activity and the unmet P. Borman (&) F. Ayhan E. Ceceli Ankara Training and Research Hospital, Clinic of PMR, Cebeci, Ankara, Turkey e-mail: pinarb@ato.org.tr

Comparison of 2 methods of neuropathic pain assessment in carpal tunnel syndrome and hand functions

OBJECTIVE To compare the effectiveness of the Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) to the painDETECT questionnaire (PD-Q) in Carpal Tunnel Syndrome (CTS), and determine if there are any differences between hand related functions in the 2 questionnaires. METHODS This prospective clinical trial was conducted from April to July 2014. Ninety patients with a positive Tinel or Phalen sign were recruited. Hands were evaluated by electromyography and grouped according to mild, moderate or severe involvement. Neuropathic pain was analysed by the LANSS and the PD-Q; hand functions were evaluated by the Duruoz Hand Index (DHI), Semmes Weinstein monofilaments and grip strength. RESULTS Electromyographic findings revealed 32.9% of hands had mild, 61.8% had moderate and 5.3% had severe CTS. There was a correlation between the LANSS scores and the Visual Analogue Scale (VAS) pain, while the PD-Q scores were correlated with the VAS pain, DHI and Semmes Weinstein Monofilaments (SWM). Comparison of the hand related parameters of the questionnaires showed there was a statistically significant difference between the 2 groups with respect to the DHI and SWM tests in the PD-Q. However, there was no difference in the LANSS. CONCLUSION Although there was a significant correlation between the LANSS and PD-Q scores, the PD-Q scores revealed better correlation coefficients in VAS pain, DHI scores and SWM tests. In conclusion, the PD-Q seems to be better than the LANSS both in neuropathic pain and in detecting functions related to hand abilities.