Hayal Güler

Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder?

The role of free radicals in fibromyalgia is controversial. In this study, 85 female patients with primary fibromyalgia and 80 age-, height-, and weight-matched healthy women were evaluated for oxidant/antioxidant balance. Malondialdehyde is a toxic metabolite of lipid peroxidation used as a marker of free radical damage. Superoxide dismutase is an intracellular antioxidant enzyme and shows antioxidant capacity. Pain was assessed by visual analog scale. Tender points were assessed by palpation. Age, smoking, body mass index (BMI), and duration of disease were also recorded. Malondialdehyde levels were significantly higher and superoxide dismutase levels significantly lower in fibromyalgic patients than controls. Age, BMI, smoking, and duration of disease did not affect these parameters. We found no correlation between pain and number of tender points. In conclusion, oxidant/antioxidant balances were changed in fibromyalgia. Increased free radical levels may be responsible for the development of fibromyalgia. These findings may support the hypothesis of fibromyalgia as an oxidative disorder.

Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis

Pulmonary function is altered in ankylosing spondylitis (AS) owing mainly to the restriction of chest wall involvement (limited chest expansion). The objective of this study was to investigate the relationship between chest expansion, respiratory muscle strength (MIP, MEP) maximum voluntary ventilation (MVV), and BASFI score in patients with AS. Twenty-three male patients with definite AS and 21 age-matched healthy male controls were recruited for the study. Patients with AS were assessed for functional status by BASFI. Measurement of chest expansion and lumbar spinal flexion (modified Schober) method was performed in all subjects. Pulmonary function tests were performed by spirometry. Respiratory muscle strength was evaluated by a mouth-pressure meter (MPM). Body mass index (kg/m2) was recorded in all individuals. Chest expansion and modified Schober measurement were significantly lower in AS patients (p<0.05). Pulmonary function tests revealed restrictive lung disease. The mean BASFI score suggested good functional capacity in the AS group. The respiratory muscle strength and MVV were also lower in AS (p<0.05). The chest expansion was correlated with MIP and MEP values (r=0.491; p=0.02, r=0.436; p=0.05). Chest expansion was also correlated negatively with disease duration (r=−0.502; p=0.03). In addition, there was no correlation between chest expansion and BASFI score (r=−0.076; p=0.773). This study demonstrates that functional status (BASFI) is not influenced by the limitation of chest wall movement. It may be as a result of the maintenance of moderate physical activity during active life in patients with AS.

Effect of coexisting foot deformity on disability in women with knee osteoarthritis.

BACKGROUND Knee osteoarthritis, a common musculoskeletal disorder, can cause considerable pain and disability. This study investigates the effect of certain foot deformities on the functional status of women with knee osteoarthritis. METHODS The common foot deformities pes planus and hallux valgus were evaluated in 115 women with knee osteoarthritis and Kellgren-Lawrence grade 2 and 3 osteoarthritis. Anteroposterior and lateral foot-ankle standard radiographs were obtained bilaterally. A lateral talometatarsal angle greater than 4 degrees was defined as pes planus. A hallux valgus angle greater than 21 degrees was defined as hallux valgus. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to objectively assess functional impairment. Knee pain intensity was measured with a visual analog scale. RESULTS Fifty-nine patients had bilateral pes planus, hallux valgus, or both. The mean visual analog scale value was higher for the deformity group, but the difference was not statistically significant. There was a significant difference in WOMAC scores between the group with foot deformities versus the group without (P = .000). Visual analog scale scores were positively correlated with WOMAC scores (r = 0.499, P = .000). Also, there was a significant correlation between WOMAC scores and lateral talometatarsal angle (r = 0.266, P = .004) and hallux valgus angle (r = 0.362, P = .000) values. CONCLUSIONS There is a significant correlation between indicators of pain and disability (visual analog scale and WOMAC scores). Also, the presence of foot deformities increased disability levels in women with knee osteoarthritis.

The effect of circulating nitric oxide level on axial bone mineral density in postmenopausal Turkish women with rheumatoid arthritis: a preliminary report

The aim is to investigate the differences in the circulating nitric oxide (NO) levels of rheumatoid arthritis (RA) patients, healthy controls and osteoporotic (OP) patients. We also examined whether the circulating NO levels may be correlated with bone mineral density (BMD) in RA patients. Forty-five patients with RA, 30 healthy women and 30 osteoporotic patients were recruited from the outpatient clinic. All the subjects were female and postmenopausal. Serum NO levels were measured (Nitrite/Nitrate, calorimetric method 1746081, Roche diagnostics, Mannheim, Germany) and BMD was measured at the spine and hip using dual energy X-Ray absorbtiometry (DEXA, Norland XR-46). Height and weight were measured and body mass index was calculated. Circulating NO levels were significantly higher in RA patients than other groups. Moreover, the RA group showed significantly higher BMD at lumbar spine and femoral neck regions compared to osteoporotic patients. However, the RA group showed significantly lower BMD at all sites than the controls. There was no correlation between circulating NO levels and BMD in all groups. We suggest that, unlike postmenopausal osteoporosis, inflammation induced osteoporosis is associated with RA is characterised by relatively preserved bone mass at the axial bone regions, and circulating NO levels as a parameter or determinant of inflammation are not correlated with axial BMD in RA patients.

Fibromyalgia, obesity and obesity related measurements

Abstract Objective: To evaluate the relationship between obesity and fibromyalgia (FM). Methods: 241 female patients with FM were seen consecutively in outpatient clinic and they were analyzed. Spearman correlation was used. The relationship between FM and obesity was compared with respect to the BMI (body mass index) value. A p value of 0.05 was accepted as significant. Results: Body mass index was significantly correlated with age in FM patients. BMI was also correlated with waist/hip ratio. A significant positive correlation was found between health assessment questionnaire (HAQ) and VAS score in all patients. HAQ was also correlated positively with tender points (P 25 were considered as obese. Obese patients were older than non-obese patients. The values of waist/hip ratio and skin fold thickness and number of tender points were higher in obese patients. Also, the mean duration of disea...

Association of Vitamin D with Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

1 Abdullah Erman Yagiz1, Nilgun Ustun1, Hacer Paksoy1, Ihsan Ustun2, Ayhan Mansuroglu3, Hayal Guler1, Ayse Dicle Turhanoglu1 1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Mustafa Kemal University, 2Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, 3Clinic of Physical Medicine and Rehabilitation, Antakya State Hospital, Hatay, Turkey Vitamin D ve Hastalık Aktivitesi / Vitamin D and Disease Activity Association of Vitamin D with Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

Trigger finger: ultrasound-guided injection with an in-plane approach under the A1 pulley:

A 65-year-old man was referred to our outpatient clinic with a 3-month history of hand pain and locking of the index finger during active flexion–extension activity. His medical history was unremarkable. Musculoskeletal examination revealed tenderness, nodules, and locking of the metacarpophalangeal (MCP) joint of the right index finger. Laboratory tests were within normal limits. Longitudinal ultrasound imaging showed a thickening of the first annular (A1) pulley (Figure 1A), and axial ultrasound imaging showed synovial sheath effusion (Figure 1B). Real-time ultrasound-guided methylprednisolone acetate with a local anesthetic injection was performed under the A1 pulley (Figure 1C), and follow-up examinations were recommended.