Gülcan Gürer

The frequency of hypermobility and its relationship with clinical findings of fibromyalgia patients

The etiology and pathogenic mechanisms of fibromyalgia (FM) are unknown. A number of studies have suggested that there was a link between hypermobility and FM. In this study, we aimed to expose the frequency of hypermobility in FM patients and its relation with clinical findings. For this reason, 236 women (118 FM women as study group and 118 healthy women as control group) were enrolled in the study. Joint hypermobility was evaluated in the participants by using Beighton scoring system. The rate of joint hypermobility among FM patients (Beighton score of at least 4 or more) was found to be higher than the control group (46.6 vs 28.8%). This result was also statistically meaningful (p<0.05). In addition, the mean Beighton score of FM group was observed to be higher than the control (3.68 vs 2.55, p<0.001). Although not reaching statistical difference (p>0.05), more severe clinical findings were observed in FM patients with hypermobility when compared with ones without.

Relationship of Q angle and joint hypermobility and Q angle values in different positions

Patellar malalignment is the most important reason for anterior knee pain. Patellar alignment is commonly determined by the measurement of the quadriceps (Q) angle. In this study, our primary aim was to investigate the Q angle difference between healthy individuals with and without joint hypermobility. The other objectives were to compare the Q angle values, which were measured in supine and upright positions, to determine hypermobility frequency among healthy males in a certain population, and to investigate the correlation between the existent skeletal deformities and Beighton score levels. Two hundred fifty-three healthy male college students were examined for hypermobility and skeletal deformities. According to the Beighton scoring system, three groups (n=20) were formed, and Q angle measurements were performed on the 60 individuals in both supine and upright positions. In the comparison of the groups, the mean Q angle values in healthy hypermobile individuals were found to be significantly higher than that of the nonhypermobile ones (p<0.05). No statistical difference was found between Q angle values in supine and upright positions (p>0.05). The frequency of joint hypermobility (Beighton score 4 or more) was found to be 29.25% in this population. No correlation was determined between existent skeletal deformities and Beighton score values (p>0.05). In conclusion, the Q angle evaluation among healthy hypermobile individuals may have a prognostic value for probable knee pathologies that may appear in the future.

Serum lipid profile in fibromyalgia women

The etiology and pathogenic mechanisms of fibromyalgia (FM) syndrome are unknown. A number of studies have shown that there is an association between some of the musculoskeletal system diseases and hyperlipidemia. The aims of this study were (1) to compare the serum lipid profile among FM and healthy women and (2) to investigate the relationship between serum lipid levels and FM findings. One hundred sixty-four women (82 women with FM as study group and 82 healthy women as control group) were enrolled in the study. The mean serum total cholesterol and low-density lipoprotein cholesterol (LDL-c) were found significantly higher in the FM group than that in the control group (p<0.05). However, There was no statistically significant difference in the mean serum triglyceride, high-density lipoprotein cholesterol (HDL-c), and very low-density lipoprotein cholesterol (VLDL-c) values between the two groups (p>0.05). In the FM group, we could not find a significant correlation between the serum lipid profile values and the FM parameters (p>0.05).

The anxiety between individuals with and without joint hypermobility

Background and Objectives: This study was performed to compare the anxiety disorders between individuals with and without joint hypermobility. Methods: A total of 94 Turkish volunteers, 40 subjects (38 females, 2 males) with joint hypermobility and 54 controls (47 females, 7 males) without joint hypermobility, were in- cluded in this study. We evaluated the joint hypermobility by using the Beighton scoring system in the participants and a Beighton score of at least 4 was considered as joint hy- permobility. In addition, all cases were evaluated with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and Hamilton Anxiety Rating Scale by a psychiatrist in order to define their psychyatric disorders and anxiety levels, respectively. Results: Age, gender and educational levels of the participants were similar between these two groups. Mean of anxiety score was higher statistically in the study group (13.5 ± 5.3) than that of the control group (11.1 ± 4.9) (p < 0.05). No statistically a significant difference in the ratio of psychyatric disorders according to SCID-I were observed be- tween cases with and without hypermobility. Conclusions: Anxiety scores have been found significantly higher in the group with hy- permobility than that of the group without hypermobility. We strongly recommend the as- sessment of medical conditions, including joint hypermobility syndrome, in anxiety patients.

Frequency of joint hypermobility in Turkish patients with knee osteoarthritis: a cross sectional multicenter study

Osteoarthritis (OA) of the knee is one of the major causes of joint dysfunction and physically disabling conditions in the older population. The risk factors for the development of knee OA are very diverse. We aimed to determine the frequency of joint hypermobility in patients with knee OA.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

Benign rheumatoid nodules in childhood.

Correspondence: Assistant Professor Gulcan Gurer, Department of Physical Therapy and Rehabilitation, Adnan Menderes Uni versity Medi cine School Hospital, 09100 Aydin, Turkey. Email: gulcangurer70@hotmail.com Received 21 September 2004; revised 27 December 2004; accepted 30 January 2005. Benign rheumatoid nodules in children are uncommon and are considered to be a variant of granuloma annulare. 1 Lesions resembling rheumatoid nodules may appear among children from time to time without any relation to rheumatoid disease. The laboratory tests are usually normal. The children with rheumatoid nodule have no greater risk of rheumatic disease. 2

The relation between joint erosion and forearm bone mineral density in female patients with Rheumatoid Arthritis

Gülnur Taşçı Bozbaş Yazışma Adresi: Physical Medicine and Rehabilitation Department, Adnan Menderes University Medical School, Aydın. e-mail: gulnurtb@yahoo.com Abstract Purpose: Rheumatoid arthritis (RA) is a disease that characterized by joint damage including periarticular osteoporosis and focal bone erosion. Despite the fact that periarticular osteoporosis and erosions are known as radiographic hallmarks of RA, there is a lack of data on the relationship between forearm bone loss and radiographic damage. For this reason, we aimed in this study to determine whether there is a relationship between focal erosions and OP in RA patients. Materials and methods: We evaluated 49 female patients with RA. Anteroposterior hand and foot radiographs and bone mineral density measurement of forearm, hip and lumbar spine with dual x-ray absorptiometry of all patients were taken at simultaneously. Radiographs were analyzed using the Larsen method. Disease activity was evaluated by DAS-28 and functional ability was measured with Health Assessment Questionnaire and Duruöz Hand Index. Results:Patients had the mean age 53.9±11.8 and an average disease duration of 7.9±5.9 years. The erosion score was correlated with bone mineral density of forearm, but not with lumbar spine and hip. The disease activity and functional ability were not correlated with Larsen score. Both osteoporosis in all evaluated area and correlations were not affected by the menopause status and disease duration. Conclusion: Our results demonstrated that bone mineral density of forearm indicate the erosion severity in female patients with RA.

Turkish League Against Rheumatism Consensus Report: Recommendations For Management of Axial Spondyloarthritis

Objectives This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloArthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Patients and methods A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.

Turkish League Against Rheumatism (TLAR) Recommendations for the Pharmacological Management of Rheumatoid Arthritis: 2018 Update Under Guidance of Current Recommendations

Objectives This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected. Results Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.