Gul Devrimsel

Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome.

[Purpose] The aim of the present study was to investigate and compare the effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. [Subjects and Methods] Sixty outpatients (30 per group) with complex regional pain syndrome participated. They received 15 treatment 5 days per week for 3 weeks. The outcome measures were the visual analogue scale for pain, edema, range of motion of the wrist (flexion and extension), fingertip-to-distal palmar crease distance, hand grip strength, and pinch strength. All parameters were measured at baseline (week 0) and at the trial end (week 3). [Results] There were significant improvements in all parameters after therapy in both groups. The whirlpool bath group showed significantly better improvements in the visual analogue score, hand edema, hand grip strength, wrist range of motion (both flexion and extension), fingertip-to-distal palmar crease distance, and the three-point and fingertip pinch strengths than the neuromuscular electrical stimulation group; however, the lateral pinch strengths were similar. [Conclusion] Both whirlpool bath and neuromuscular electrical stimulation are effective in the treatment of complex regional pain syndrome, but the efficacy of the whirlpool bath treatment was better.

Comparison among pain, depression, and quality of life in cases with failed back surgery syndrome and non-specific chronic back pain

[Purpose] The aim of this study is to compare patients with failed back surgery syndrome (FBSS) with those with non-specific chronic back pain (NSCBP) in terms of pain, depression, and quality of life levels to explain the effects of surgery experience on low-back pain. [Subjects and Methods] A total of 50 patients with FBSS and 51 patients with NSCBP who consecutively applied to the outpatient clinic from September 2012 to April 2013 were included in the study. Patients completed questionnaires on demographics, body mass index, education level, work history, and pain duration (in months). Lumbar pain at rest, during movement, and at night were measured with a visual analogue scale (VAS). The Short Form 36 scale was used for evaluating quality of life, and the Beck Depression Inventory (BDI) was used for assessing depression. [Results] VAS scores reporting pain at rest and at night and BDI scores were significantly higher in the FBSS group than in the NSCBP group. Role limitations due to physical functioning, which is one of the measures of quality of life, were significantly higher in the FBSS group than in the NSCBP group. [Conclusion] These assessments show that surgery experience in patients with ongoing low-back pain makes their pain and depression worse.

Coexistence of Systemic Lupus Erythematosus and Familial Mediterranean Fever

Sir, Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune disease characterized with fatigue, fever and weight loss, malar rash, arthritis, polyserositis, proteinuria, erythema nodosum, and vasculitic lesions. Familial Mediterranean Fever (FMF) is an autosomal recessive, chronic, autoimmune inflammatory disease characterized by periodic fever, abdominal pain, polyserositis, and arthritis. Here, we present a rare case with concurrent SLE and FMF. A 46-year-old female patient admitted with complaints of recurrent fever, abdominal pain, skin rash, oral aphthous ulcers, fatigue, diffuse joint pain, and morning stiffness. Malar rash, oral ulcers, polyarthritis and diffuse joint pain were observed during physical examination. Her medical and family histories were unremarkable. The abdominal ultrasound was normal. The urine analysis was nonspecific, and the proteinuria levels in the 24-hour urine sample were normal. The blood test results were as follows: serum C-reactive protein 2.3mg/dl; erythrocyte sedimentation rate 47mm/hour; and uric acid; 3.8mg/dl. Kidney and liver function tests were normal. The antinuclear antibodies were positive, while the anti-dsDNA antibody and rheumatoid factor were negative. The patient was diagnosed with SLE based on the American College of Rheumatology diagnostic criteria, and began treatment with hydroxychloroquine and prednisolone. The patient’s symptoms decreased after treatment, although her recurrent fever and abdominal pain attacks continued. Additional tests were performed with consideration of a coexistence of another autoimmune disease, and a heterozygous M694V mutation was found in the MEFV gene. 0.5mg Colchicine three times daily treatment was added to the regimen. The patient had significant improvements in fever and attacks of abdominal pain in the follow-up. SLE and FMF are autoimmune diseases that are often characterized by chronic peritonitis, arthritis and polyserositis. SLE patients often have gastrointestinal symptoms, and 8–40% of SLE patients have reported having abdominal pain. The abdominal pain may be caused by medications that are used to treat SLE-induced pancreatitis, vasculitis, serositis, and acute peritonitis. FMF and SLE have similar clinical signs and symptoms. When FMF occurs with an inflammatory disease such as SLE, the fever attacks and/or serositis are often considered to be signs of SLE, and therefore, the diagnosis of FMF may be overlooked. Fever attacks are seen in both SLE and FMF, but the duration of the attacks are shorter in FMF than in SLE. Arthritis is one of the most important clinical features of FMF, and is seen in 50–70% of FMF patients. In FMF, arthritis is generally seen as acute monoarthritis in the lower extremity, while in SLE, it is usually seen as polyarthritis and arthralgia. The arthritis symptom in our cases was identified as polyarthritis. The MEFV gene mutation associated with FMF has also been found in patients with SLE. The SLE disease activity index score has been correlated with the probability of carrying the mutation. In a Turkish study with 2716 FMF patients, 4 cases (0.1%) of SLE were identified. In conclusion, other autoimmune diseases should be considered in cases when chronic inflammatory disease does not respond to treatment.

Three Case Reports of Rhupus Syndrome: An Overlap Syndrome of Rheumatoid Arthritis and Systemic Lupus Erythematosus

We present the clinical and serological characteristics of three patients with rhupus. The 3 patients with rhupus presented ACR criteria for SLE as well as for RA, ANA positive with a titer of 1/100 in all patients, and positive anti-DNA in 2 of the 3 patients, with the predominance of symmetrical polyarthritis. We found anti-CCP positivity and rheumatoid factor positivity and high titers in all patients, positive anti- anti-SSA in one patient, and positive anti- anti-Sm in one patient. Renal and liver function tests were normal in all patients. The 3 patients achieved clinical remission with DMARD treatment.

Ultrasonographic evaluation of the femoral cartilage thickness in patients with hypothyroidism.

[Purpose] The aim of this study was to investigate the effects of hypothyroidism on femoral cartilage thickness by using ultrasound, which has been found to be useful in the early diagnosis of knee osteoarthritis. [Subjects and Methods] Forty patients diagnosed with hypothyroidism and 30 age-, gender-, smoking status, physical activity-, and body mass index-matched healthy subjects were enrolled. The thickness of the femoral articular cartilage was measured using a 7- to 12-MHz linear probe. Three mid-point measurements were taken from each knee at the lateral condyle, intercondylar area, and medial condyle. [Results] Age, gender, body mass index, smoking status, and physical activity were similar between the groups, but patients with hypothyroidism had thinner femoral cartilage than the healthy controls at all measurement sites. Nonetheless, the differences were not statistically significant (except in the case of the left medial condyle). [Conclusion] Ultrasonographic measurement of femoral cartilage thickness may be useful in the early diagnosis of knee osteoarthritis in patients with hypothyroidism.

Atypical Skin Rash in a Patient with Adult-Onset Still's Disease: A Case Report

Adult-onset Stills disease (AOSD) is an uncommon idiopathic disorder with various clinical manifestations. The absence of specific serological and pathological findings often makes the disease difficult to diagnose. The presence of skin lesions is important to the correct diagnosis of the disease. Various atypical skin lesions have been reported in association with Adult-onset Stills disease. We present a 52-year-old male who had atypical cutaneous manifestations of Adult-onset Stills disease. The rash manifested as persistent, pruritic, dark reddish, confluent, erythematous maculopapules and plaques on his chest, abdomen, upper back and proximal extremities. He suffered high, spiking fevers and had marked elevations of ferritin, C-reactive protein, and the erythrocyte sedimentation rate, which are characteristic of Adult-onset Stills disease. The fever and systemic symptoms improved after the administration of intravenous pulse methylprednisolone therapy. The skin lesions improved after prednisolone and methotrexate combination therapy. Therefore, to make the correct diagnosis, it is important to understand that patients with Adult-onset Stills disease may present with various types of skin lesions.