Hilal Kocabas

The serum levels of resistin in ankylosing spondylitis patients: a pilot study

Resistin is a recently described adipokine which is a member of cysteine-rich secretory protein family. Although it has been primarily defined in human adipocytes, it has been identified that its level was higher in mononuclear leukocytes, macrophages, spleen, and bone marrow cells. Because ankylosing spondylitis is an inflammatory disease, it is suspected that upregulation of proinflammatory cytokines is effective in its immunopathogenesis. The aim of our study is to determine the serum resistin levels in patients with AS and to research the relationship with disease activity markers. A total of 30 patients with AS and 30 healthy controls were included in this study. Serum resistin concentrations, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath AS Disease Activity Index (BASDAI) were evaluated. In results resistin levels in ankylosing spondylitis group were significantly higher than in control group. But, there was no correlation between resistin and ESR, CRP, BASDAI. In conclusion, higher serum resistin levels in patients with AS compared to healthy subjects give clues that resistin could have a role in the pathogenesis of AS.

Validation of the Turkish version of the Quebec back pain disability scale for patients with low back pain.

Study Design. A reliability and validity study of a translated, culturally adapted questionnaire. Objective. The aims of the present study were to translate the Quebec Back Pain Disability Scale (QDS) into Turkish, to perform its cross-cultural adaptation for Turkish patients with LBP, and to investigate its validity and test-retest reliability. Summary of Background Data. As a widely used scale in the evaluation of patients with low back pain (LBP), the QDS awaits formal translation and validation into Turkish to achieve an equivalent questionnaire and to allow comparability of data. Methods. The translation and cross-cultural adaptation of the original questionnaire were performed in accordance with published guidelines. Translation and retranslation of the English version of the QDS was performed blindly and independently by 4 different individuals, and adapted by a team. Hundred patients with LBP were included in our study. The physical examinations were evaluated and the Schober test was assessed for a mobility measurement of the spine. The patients were asked to complete a questionnaire booklet containing the Turkish versions of the modified Oswestry Disability Index (ODI) and QDS, and Visual Analog Scale (VAS) measure of pain. All assessments were repeated 24 hours later for all of the patients. Reliability was evaluated using internal consistency and the intraclass correlation coefficient (ICC). Concurrent validity was measured by comparing the Turkish version of the QDS results to VAS and the Schober test scores. Also, for construct validity, the results of the scale were compared with the Turkish version of modified ODI. Results. The QDS showed excellent test-retest reliability as evidenced by the high ICC for 2 test occasions (ICC = 0.9221, P < 0.000). Also, internal consistency was found to be adequate at both assessments with Cronbach’s alpha (0.9405 and 0.9537 at day 0 and 1, respectively). There was a positive correlation between QDS and VAS both for day 0 (r = 0.368; P < 0.000) and for day 1 (r = 0.441; P < 0.000). There was no correlation determined in the comparison of the QDS sum scores with Schober testing for day 0; however, significant negative correlations in these parameters were observed for day 1 (r = −0.249 P = 0.014). Also significantly positive correlations were deter- mined between the Turkish version of the QDS and the Turkish version of the modified ODI for both day 0 and day 1 (r = 0.666, P < 0.000, r = 0.681; P < 0.000, respectively). Conclusion. The results of our study show that QDS as a functional status questionnaire has been translated into Turkish without losing the psychometric properties of the original version. The Turkish version of the QDS has good comprehensibility, internal consistency, and validity and is an adequate and useful instrument for the evaluation of disability in patients with LBP.

A co-occurrence of sarcoidosis and ankylosing spondylitis: a case report

Sarcoidosis is an inflammatory multi-system disease, which may cause articular involvement. By causing sacroiliitis, it may mimic spondyloarthropathies. A case with a co-occurrence of sarcoidosis and late-onset of typical ankylosing spondylitis was presented and a possible association between these two entities was discussed.

Sacroiliac joint involvement in psoriasis

Psoriasis is a skin disorder that is associated with arthritis. Sacroiliac joint involvement is considered to be less frequent than the other types of psoriatic arthritis. Additionally, the psoriatic sacroiliitis is considered to be asymmetric in general. We aimed to define the frequency and type of sacroiliac involvement in patients with psoriasis. Patients with psoriasis were included the study. Characteristics of skin, nail and articular involvement were noted. Psoriasis area and severity index was calculated. Antero-posterior pelvic X-rays were obtained and graded by two rheumatologists and a radiologist independently. One hundred and thirty-three patients were included. Thirty-seven of patients (27%) have articular involvement symptomatically. The sacroiliac joint involvement was observed in 34 (26%) of patients. More than one-half of sacroiliac involvement was bilateral while less than one-half was in symptomatic patients regarding sacroiliitis. Fifty-seven percentages of all patients have psoriatic nail involvement. Sacroiliac joint involvement did not show any significant association with psoriatic nail involvement or the severity of skin disease. We found higher frequency of sacroiliac joint involvement and bilateral sacroiliitis in patients with psoriasis. This is in contrast to present information about the association of psoriasis and sacroiliitis. These findings need confirmation by further studies and with more sophisticated techniques such as magnetic resonance imaging.

Hyperostosis frontalis interna in a patient with giant cell arteritis

Hyperostosis frontalis interna (HFI) is a disorder characterized by progressive symmetric thickening of the inner table of the frontal bone of the human skull. HFI may be accompanied by headache and some neuropsychiatric diseases such as epilepsy and dementia. Giant cell arteritis (GCA), also called temporal arteritis, is a systemic inflammatory vasculitis of unknown etiology that affects medium- and large-sized arteries. It affects elderly people and may result in a wide variety of systemic, neurologic and ophthalmologic complications. As no association of HFI and GCA was encountered in the literature, we found it interesting to report a case with both of these clinical entities.

Internal iliac artery pseudoaneurysm: an unusual cause of sciatica and lumbosacral plexopathy.

This report describes an unusual case of lumbosacral plexopathy resulting from internal iliac artery pseudoaneurysm. A 50-yr-old woman presented with multiple penetrating trauma to the thorax, abdomen, and left buttock. Several weeks after the injury, severe sciatica and motor dysfunction developed in her left leg. Progressively worsening pain was followed by left foot drop. An electrodiagnostic evaluation suggested a lower lumbosacral plexopathy. Magnetic resonance imaging showed a hematoma extending adjacent to the left lumbosacral plexus. Computerized tomographic angiography revealed a left internal iliac artery pseudoaneurysm. The pseudoaneurysm was excised surgically. In the early postoperative period, the patient reported total relief of pain. Her motor function recovered gradually over several weeks; however, some residual weakness of foot dorsiflexion persisted. With this case presentation, we underscore that an arterial pseudoaneurysm should be remembered as an etiologic possibility of lumbosacral plexopathy and sciatica, especially in patients with history of iatrogenic or accidental trauma. An increased awareness of this rare cause of sciatica and lumbosacral plexopathy may enable early intervention alternatives.

Legg–Perthes disease-like joint involvement and diagnosis delay in Scheie syndrome: a case report

Mucopolysaccharidosis (MPS) type I is an inherited disease caused by the absence or malfunctioning of lysosomal enzymes. Three subtypes, based on severity of symptoms, were described, and Scheie syndrome (also called MPS I S) is the mildest form. Although there may be some typical extra-articular manifestations, musculoskeletal involvement may be the only presenting sign in the absence of other symptoms in the patients with less severe forms. The patients with MPS I S, especially in attenuated phenotypes, may be sometimes difficult to recognize for physicians not familiar with the disease. With this case presentation, it is aimed to draw attention to this disease, which could be delayed for the correct diagnosis. An increased awareness of the disease may contribute to more accurate diagnosis, and patients may benefit from early intervention.

Isokinetic evaluation of muscle strength in patients with thyroid dysfunction

Skeletal muscle weakness is a frequent symptom of thyroid dysfunction. Both hypothyroidism and hyperthyroidism may cause signs and symptoms of neuromuscular dysfunction. It has been reported in previous studies that muscle strength recovers after treatment of thyroid dysfunction. The aim of the current study was to evaluate knee extensors and flexors strength in patients with thyroid dysfunction before and after medical treatment and compare the data with those of a matched control group. For this purpose 11 hyperthyroid, 9 hypothyroid patients and 27 healthy controls were recruited. All were tested isokinetically on the dominant side. The results suggest that return of thyroid hormone concentrations to their reference ranges, significantly increases muscular strength in hyperthyroid patients. However there was no significant recovery in the hypothyroid group. Nevertheless in both groups post-treatment muscle strength was significantly lower than in the control group. The findings suggest that patients with thyroid dysfunction, especially with hypothyroidism, should train for muscle strengthening after establishing euthyroidism to obtain optimum life conditions.

Diagnosis of complex regional pain syndrome type I of the upper extremity: Role of dual energy X-ray absorptiometry and three-phase bone scintigraphy

Objective: The aim of the present study was to evaluate and compare the role of dual energy X-ray absorptiometry and three-phase bone scintigraphy in the diagnosis of complex regional pain syndrome type I of upper extremity. Methods: Five male and nineteen female patients diagnosed with complex regional pain syndrome type I (CRPSI) were included in this study. Three-phase bone scintigraphy (TPBS), bone mineral density (BMD) and bone mineral content (BMC) of wrist, metacarpophalangeal joint (MCP) and proximal interphalangeal (PIP) area in the affected and unaffected hands of patients were measured simultaneously using dual energy X-ray absorptiometry (DEXA). The time passed between the precipitating event and clinical onset of CRPSI was also recorded. Results: TPBS findings were in agreement with CRPSI diagnosis in 96% of the patients (23 of 24 patients). Periarticular BMD and BMC values in wrist, MCP, and PIP joints were statistically lower in affected hands than in unaffected hands for all three regions. Moreover, we found no correlation between BMD or BMC values with the sex, age, dominant hand, and the duration between the clinical onset of CRPSI and its precipitating event. Conclusion: The present study suggests that beside TPBS, a valuable tool in the early diagnosis of CRPSI, DEXA can also be used in the determination of early demineralization of bones in CRPSI patients. DEXA is an accurate, noninvasive, rapid, and safe device for quantitative assessment of unilateral bone loss caused by upper limb CRPSI.