Esra Erkol İnal

Effects of smartphone overuse on hand function, pinch strength, and the median nerve.

In this study we investigated the flexor pollicis longus (FPL) tendon and median nerve in smartphone users by ultrasonography to assess the effects of smartphone addiction on the clinical and functional status of the hands. Methods: One hundred two students were divided into 3 groups: non‐users, and high or low smartphone users. Smartphone Addiction Scale (SAS) scores and grip and pinch strengths were recorded. Pain in thumb movement and rest and hand function were evaluated on the visual analog scale (VAS) and the Duruöz Hand Index (DHI), respectively. The cross‐sectional areas (CSAs) of the median nerve and the FPL tendon were calculated bilaterally using ultrasonography. Results: Significantly higher median nerve CSAs were observed in the dominant hands of the high smartphone users than in the non‐dominant hands (P < 0.001). SAS scores correlated with VAS pain for movement and rest, DHI scores, and pinch strength (P < 0.05; r = 0.345, 0.272, 0.245, and 0.281, respectively). Conclusions: Smartphone overuse enlarges the median nerve, causes pain in the thumb, and decreases pinch strength and hand functions. Muscle Nerve, 2015 Muscle Nerve 52: 183–188, 2015

The relationship between enthesitis indices and disease activity parameters in patients with ankylosing spondylitis

In this study, patients with ankylosing spondylitis (AS) were assessed both by patient and physician using two enthesitis indices and the relationship between these indices and disease activity parameters was investigated. The study involved 100 AS patients. The patients were evaluated with 10-cm visual analog scale (VAS) for spinal pain (VAS-S), peripheral joint pain (VAS-P), global assessment of patient, and global assessment of doctor. In the laboratory evaluations, the erythrocyte sedimentation rates (ESR) and serum C-reactive protein levels of the patients were determined. Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrology index, and Bath AS radiology index were calculated. The severity of enthesitis was evaluated according to Mander enthesitis index (MEI) and Maastricht ankylosing spondylitis enthesitis score applied by both the patient (MASES-P) him/herself and the physician (MASES-D). There was a correlation between BASDAI and BASFI as well as MEI, MASES-D, and MASES-P indices (r = 0.447, r = 0.342, r = 0.663, r = 0.530, r = 0.464, and r = 0.435, respectively). No correlation between the laboratory parameters and enthesitis indices were detected. In multiple linear regression analysis, BASFI, VAS-S, and female gender (41.3%) were the best predictors of MEI-D, whereas BASFI, VAS-S, female gender, and ESR (32.5%) were the best predictors for MASES-D and BASFI (18.9%) was the best predictor of MASES-P. The assessment of simple and easily applicable MASES score by a patient may be expected to help the physician in clinical practice. When the disease activity of the patients with AS are evaluated, both BASDAI, the clinical importance of which has been confirmed in numerous studies and which is recommended by ASAS, and BASFI, which is valued by patients, should be considered.

Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis

The objective of the present study was to compare two radiographic scoring methods (the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-spine)) in terms of reliability, construct validity, and feasibility in Turkish ankylosing spondylitis (AS) patients. The study involved seventy-four patients. The patients were evaluated with 100-mm visual analog scale (VAS) for pain, global assessment of patient, and global assessment of doctor. The laboratory evaluations of patients comprised erythrocyte sedimentation rate and serum C-reactive protein. Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and Bath AS Radiology Index (BASRI) were calculated. Bilateral cervical, lumbar spine, and anteroposterior pelvis radiographs of all patients were obtained and evaluated by two radiologists. Each radiograph was scored by two scoring methods, mSASSS and BASRI-spine, and these methods were tested according to the aspects of the Outcome Measures in Rheumatology Clinical Trials filter: reliability, construct validity, and feasibility. The BASRI-spine reached intra- and interobserver intraclass correlation coefficient (ICC) of 0.726 and 0.689, respectively. The mSASSS scores more reliable, with ICC of 0.831 and 0.840, respectively. The BASMI and BASFI correlated significantly with the two scoring systems, respectively (mSASSS r: 0.557, r: 0.319; BASRI-spine r: 0.605, r: 0.285). For the two methods, the magnitude of the correlation with disease duration was similar (mSASSS p < 0.01 and BASRI p < 0.01), but no significant correlation was observed when compared to the BASDAI. It is known that the BASRI-spine is a feasible method that reliably detects damage in patients with AS. However, the present authors believe that, in AS patients, mSASSS should be the radiological scoring method to choose because of less radiation exposure, along with excellent intra- and interobserver reliability.

The evaluation of prevalence of fibromyalgia in patients with chronic urticaria

Background The pathophysiology of chronic idiopathic urticaria (CIU) is not fully understood; however, it has been hypothesized that a subset of people with CIU may have an autoimmune disease and that peripheral cutaneous nerve fibers may be involved in CIU. Similarly, it has been postulated that fibromyalgia syndrome (FMS) is an autoimmune disorder and may be associated with alterations of peripheral cutaneous nerve fibers. Accordingly, the present study aimed to determine whether the frequency of FMS is higher in patients with CIU. Material/Methods A total of 72 patients with CIU and 67 sex- and age-matched healthy controls were included. Urticaria activity score (UAS), fibromyalgia impact questionnaire (FIQ), tender point number, and visual analogue scale (VAS) were assessed. Results The frequency of FMS was similar between the groups (9.7% vs. 4.5%, p=0.32). However, symptom duration of FMS was significantly longer, and tender point number and FIQ were significantly higher in patients with CIU than in controls. In addition, patients with CIU had significantly higher VAS scores. UAS was significantly correlated with presence of FMS, symptom duration of FMS, tender point number, and FIQ and VAS scores. Logistic regression analysis revealed that UAS was an independent predictor of presence of FMS (β=0.34, p=0.003). Conclusions Frequency of FMS was slightly, but not significantly, higher in patients with CIU than in controls. However, symptom duration of FMS, tender point number, and FIQ and VAS scores were significantly higher in patients with CIU, and UAS reflecting severity of the disease was significantly and independently associated with presence of FMS.

Ankylosing Spondylitis patients with Type D personality have worse clinical status

Objectives. Type D personality was identified as an important factor that can explain the differences in clinical outcomes in various diseases. The aim of this study is to clarify the relationships between Type D personality and clinical status of patients with Ankylosing Spondylitis (AS). Methods. The scores of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), the Bath Ankylosing Spondylitis Functional Index (BASFI), the 36-Item Short-Form Health Survey (SF-36), and 14-item Type D Scale (DS-14) were noted. Results. We found significantly higher levels of the BASDAI, the BASFI, and the SF-36 mental subscale scores in patients with Type D personalities compared to those who were Non-Type D (p < 0.05). The total DS-14 scores were found to be correlated with the scores of physical and mental subscales of SF-36, the BASDAI, the BASFI, ASDAS-CRP, and ESR (p < 0.05). In logistic regression analysis, the occurrence of Type D personality was found to be an independent predictor for disease activity of AS due to BASDAI and ASDAS-ESR (p = 0.016, OR, 95% CI = 2.98,1.23–7.22; p = 0.022, OR, 95% CI = 2.78,1.16–6.63 respectively). Conclusions. Patients may over-rate self-reported measurements such as the BASDAI, BASFI, and SF-36 related to their interpersonal characteristics. Therefore, including the Type D personality, which is a stable construct in evaluating AS patients with brief and valid DS-14, may be noteworthy.

Risk factors for complex regional pain syndrome in patients with surgically treated traumatic injuries attending hand therapy

Study Design: Prospective cohort study. Introduction: Identification of risk factors for CRPS development in patients with surgically treated traumatic injuries attending hand therapy allows to watch at‐risk patients more closely for early diagnosis and to take precautionary measures as required. Purpose of the Study: The aim of this study was to evaluate the risk factors for the development of complex regional pain syndrome (CRPS) after surgical treatment of traumatic hand injuries. Methods: In this prospective cohort, 291 patients with traumatic hand injuries were evaluated 3 days after surgery and monitored for 3 months for the development of CRPS. The factors assessed for the development of CRPS were age, sex, manual work, postoperative pain within 3 days measured on a Pain Numerical Rating Scale (0–10), and injury type (crush injury, blunt trauma, and cut laceration injury). Results: CRPS was diagnosed in 68 patients (26.2 %) with a duration of 40.10 ± 17.01 days between the surgery and CRPS diagnosis. The mean postoperative pain score was greater in patients with CRPS than in those without CRPS (P < .001). Patients with pain scores ≥ 5 had a high risk of developing CRPS compared with patients with pain scores <5 (odds ratio: 3.61, confidence interval = 1.94–6.70). Patients with crush injuries were more likely to develop CRPS (odds ratio: 4.74, confidence interval = 2.29–9.80). Conclusions: The patients with a pain score of ≥5 in the first 3 days after surgery and the patients with crush injury were at high risk for CRPS development after surgical treatment of traumatic hand injuries. Level of Evidence: II b.

Relationship between atherosclerosis and knee osteoarthritis as graded by radiography and ultrasonography in females

[Purpose] The aim of this study was to assess the relationship between atherosclerosis and knee osteoarthritis grade in women as assessed by both ultrasonography and radiography. [Subjects and Methods] Seventy women diagnosed with knee osteoarthritis were classified into two groups according to cartilage grading/radiographic grading. Patients with Kellgren-Lawrence grades 1 and 2 were included in group 1, while those with Kellgren-Lawrence grades 3 and 4 were included in group 2. Patients with cartilage grades 1–3 were included in group 1, while those with cartilage grades 4–6 were included in group 2. Patients were clinically assessed using a visual analog scale and the Western Ontario and McMaster Universities Arthritis Index. Radiographic osteoarthritis grade was scored using the Kellgren and Lawrence grading system. Using ultrasonography, symptomatic knees were graded and evaluated for distal femoral cartilage thickness. Carotid intima-media thickness and serum lipid levels were measured to assess atherosclerosis. [Results] Carotid intima-media thickness measurements were higher in group 2 than in group 1 as determined by the Kellgren-Lawrence and cartilage grading systems. Carotid intima-media thickness measurements were positively correlated with both the ultrasonographic cartilage grade and Kellgren-Lawrence. [Conclusion] The results of this study suggest that osteoarthritis as assessed by ultrasonography was successful and comparable to assessment with radiography. We showed a correlation between atherosclerosis and ultrasonographic knee osteoarthritis grade.

Evaluation of central and peripheral corneal thicknesses in patients with rheumatoid arthritis

PURPOSE To evaluate central corneal thickness (CCT) and peripheral corneal thickness (PCT) in patients with rheumatoid arthritis (RA) and to assess the relationships among the corneal parameters, dry eye disease, and clinical variables of RA. METHODS A total of 58 RA patients and 58 control subjects participated in this study. A detailed ophthalmological examination was performed on each subject. Dry eye evaluation was performed using Schirmers test, tear break-up time (TBUT), corneal fluorescein staining, and Ocular Surface Disease Index (OSDI). Corneal thickness at the apex point, the center of the pupil, the thinnest point, and PCT (3 mm from the apex to the superior, inferior, nasal, and temporal locations) were evaluated using Scheimpflug imaging (Pentacam®). Additionally, the relative peripheral index (RPI) was calculated by dividing the PCT by the CCT. The disease severity and quality of life were evaluated with DAS28 and HAQ, respectively. The laboratory evaluation comprised ESR and CRP. RESULTS The mean corneal thicknesses at the apex point, the center of the pupil, the thinnest point, and the superior, inferior, nasal, and temporal points were significantly thinner in RA patients than controls. Schirmers test scores and TBUT were significantly lower, and corneal staining and OSDI scores were significantly higher in RA patients. There were no significant correlations between the corneal parameters and the clinical variables of RA or dry eye tests. CONCLUSION The CCT and PCT were thinner in RA patients compared to those in control subjects. However, there were no significant correlations between the corneal parameters and the clinical variables of RA or dry eye tests.

Romatizmal Hastalıklarda Tamamlayıcı ve Alternatif Tıp Yöntemlerine Başvuru

Objective: Although there areeffective treatmentsforrheumatic diseases, patientsmay appeal for complementary and alternative medicine (CAM) methods. The aim ofthis studyis to determine CAM method referencefrequency, causes, andwhether patients with a diagnosis of Rheumatoid arthritis (RA) or Ankylosing spondylitis (AS) had benefit or not.Material and Methods: 391patients who were admitted to Physical Medicine and Rehabilitation clinics and diagnosed withRA andAS were included. All patients filled ‘The frequency and reasons for applying CAM methods in patients with rheumatic diseases’ questionnaire.Results: A total of211RA and180AS patients were included. 120 patients experienced a CAM method at least one time (69RA,51AS). 100 of them used CAM method because of pain. The patients were mostly