Ilker Ilhanli

A comparative evaluation of health related quality of life and depression in patients with fibromyalgia syndrome and rheumatoid arthritis

The aim of this study was to compare health related quality of life (HRQoL) and assess functional and psychological status in rheumatoid arthritis (RA), fibromyalgia syndrome (FS) patients and controls (each 30 subjects). Demographic characteristics, pain and sleep disturbance by Visual Analog Scale, depression by Beck Depression Inventory (BDI), disease impact by fibromyalgia impact questionnaire, DAS-28, and HRQoL by SF-36 were gathered. The FS group scored significantly worser than the RA group with respect to physical role, social functioning and bodily pain subscales of SF-36. The scores of all SF-36 subscales were significantly lower in FS and RA patients than controls except mental health score. All of the subscales of SF-36 were negatively correlated with BDI scores in FS patients. In RA group, the DAS-28 scores were inversely correlated with all of SF-36 subscales. In conclusion, presence of comorbid depression must be taken into account when determining HRQoL in FS and RA. Essentials improving the HRQoL are management of depression in FS and control of disease activity in RA.

Are there work-related musculoskeletal problems among teachers in Samsun, Turkey?

INTRODUCTION The aim of this study was to evaluate the prevalence of work-related musculoskeletal pain (WRMSP) and depression and the quality of life (QOL) among teachers in Samsun, Turkey. MATERIALS AND METHODS Among 605~participants 99.30% (n=602) completed the survey. A face-to-face questionnaire was given to the participiants in order to evaluate the QOL (Short Form 36, SF-36), the presence of depression (Beck Depression Inventory, BDI) and the presence of pain (Visual Analogue Scale). RESULTS Among the participants (n=602), 290 were women (48%) and 312 were men (52%). Three hundred sixty three (60.3%) of the participants reported that they had work-related pain. Most of the participants had WRMSP in low back (74.9%), shoulder (55.9%), neck (47.9%), back (42.7%), knee (30.9%) regions. There was a significant difference for BDI and the subscales of SF-36 test, except the emotional role limitation, mental health and energy between the participiants with WRMSP (Group 1) and the participiants without WRMSP (Group 2). BDI scores were significantly higher in the Group 1. The subscale scores of SF-36 were significantly lower in the Group 1. There was a negative correlation between SF-36 and BDI scores; indicating that teachers who have more depressive symptoms have also a lower QOL. CONCLUSIONS Pain in neck, shoulder, back and low back regions are frequently seen in teachers. Depression is common and its presence reduces the QOL of teachers. Modifications of ergonomics in working conditions may reduce the frequency of these complications. The habit of carrying heavy loads, awkward back postures, longterm repetitive physical activities, psychosocial stressors and longterm standing must be reduced.

Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears.

Background: Despite the insufficient evidence, due to potential contribution to the improvement, platelet-rich plasma (PRP) is emerging as a promising method. Objectives: The aim of this study was to assess the effectiveness of PRP injection in partial supraspinatus tears by comparing with physical therapy (PT). Patients and Methods: Seventy patients with chronic partial supraspinatus tears in magnetic resonance imaging were randomized into two groups; PRP (n = 35) and PT (n = 35). Before the treatment, at the end of the treatment and at the 12th month after the end of the treatment, range of motion (ROM), visual analog scale (VAS) for pain, Disabilities of Arm, Shoulder and Hand questionnaire (DASH), Neer’s, Hawkins’ and drop arm tests and Beck Depression Inventory were investigated. Results: Statistical analysis was made for 62 subjects (PRP group, n = 30; PT group, n = 32). There were no differences between the groups according to demographic data. At the 12th month after the end of the treatment, significant improvement in ROM was detected in both groups, pain was reduced significantly in both groups and improvement of the DASH score was observed in both groups. At all the evaluation steps, increases in ROM degrees were significantly higher in the PT group than the PRP group. For VAS in activity and in rest, after the treatment, improvement was higher in the PT group than the PRP group. However, improvement of the DASH score of the PRP group was significantly better than the PT group. Conclusions: When we compared with PT, PRP seemed to be a well-tolerated application which showed promising results in patients with chronic partial supraspinatus tears.

Bilateral sacroiliitis and left hip arthritis secondary to isotretinoin treatment

cne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin [1]. Isotretinoin is a synthetic vitamin A derivative using in severe cystic acne treatment. Pain and arthralgia are observed in 20% of patients treated with isotretinoin [2]; however sacroiliitis is rare and hip arthritis is even more rare. There was no article in the literature about a patient with sacroiliitis and hip arthritis together. A 30-year-old male patient who was suffering from severe pain on his left hip and leg for two days admitted to our clinic. His pain was very intense in the evening and the Visual analog scale (VAS) pain score was 8. He experienced morning stiffness for two days and about an hour on his left lower extremity. The patient had no history of inflammatory low back pain, skin lesion, bowel problem or infection. No pathology was found in rheumatologic examination. Family history was normal, however the patient was taking isotretinoin 20 mg/day for acne vulgaris about two months. The patient resorted to the brain surgery department before our clinic, the lumbar magnetic resonance imaging (MRI) was taken and no pathology was detected. The inspection of left leg and other body parts were normal but there was a pronounced skin dryness around the mouth periphery and face. There was mild sensitivity with palpation on left hip but the movements were limited and so painful. Flexion, abduction, and external rotation (FABER), flexion, adduction, and internal rotation (FADIR), sacroiliac compression, Mennel and Gaenslen tests were bilateral positive but more painful on left side. Lumbar range of motion was normal and there was no neurological deficit. Erythrocyte sedimentation rate (ESR) (33 mm/hr) and C-reactive protein (CRP) (3.84 mg/L) values were higher in the laboratory tests. Complete blood count, routine biochemical tests and HLA-B27 were negative. Bilateral bone narrow edema on iliac sides of sacroiliac joints and increased joint fluid on left hip was found on MRI (Figures 1a and 2a). As a result of all tests, the patient was diagnosed as bilateral sacroiliitis and left hip arthritis due to isotretinoin. The isotretinoin was ceased and nimesulide 2×100 mg, methylprednisolone 1×16 mg and lansoprazole 1×30 mg was started. A dramatic clinical response was obtained. A significant decrease was observed in the laboratory parameters on the seventh day (CRP: 0.06 mg/L, ESR: 5 mm/hr) and the VAS score was 3. Methylprednisolone was reduced and ceased. A repeat MRI performed five months later showed no evidence of left hip arthritis and sacroiliitis (Figures 1b and 2b) and the examination was completely normal.

Case series on remembering pachydermoperiostosis

A rare clinical entity pachydermoperiostosis is an autosomal dominant clinical disorder. It involves the distal extremities. The periosteal new bone formation is the characteristic of pachydermoperiostosis. Generally, patients present with clubbing of fingers, progressive enlargement of distal extremities, thickening of the skin and hyperhidrosis. Symptoms usually occur during adolescence. Often patients’ symptoms get worse over the next decade and then calm down. Accidentally, the progressive expansion of the hands and feet can be considered acromegaly.1

The cultural adaptation of Aberdeen Low Back Pain Scale in Turkish patients and the evaluation of response to physical therapy: A Turkish version study

BACKGROUND Unvalidated Turkish adaptations of existing low back pain disability scales are often used. OBJECTIVE To evaluate the validity and the reliability of the Turkish version of Aberdeen Low Back Pain Scale (ALBP). METHODS The cross-cultural adaptation was performed in accordance with recently published guidelines. The Turkish version was administered to 120 patients. Test-retest and internal consistency were evaluated for reliability. Construct validity and criterion validity were measured. Responsiveness of the questionnaire towards changes by the treatment were assessed. All questionnaires were administered at admission, 1 day later, at the end of treatment, and a month after the end of treatment. Patients were assessed with Ostwestry (OLBP), physical and mental component of SF-36 (PCSSF-36, MCSSF-36), Beck Depression Inventory (BDI), Schober test and visual analog scale for pain (VAS). RESULTS Retest scores were significant and high (Internal Correlation Coefficent: 0.963). For internal consistency, Cronbachs alpha was 0.889. For construct validity, Spearmans Correlation Coefficent was 0.882. For criterion validity of ALBP, correlations were found significant and acceptable for OLBP, PCSSF-36, MCSSF-36, BDI, and VASactivity (p < 0.05). According to responsiveness; ALBP, OLBP, PCSSF-36, VAS and Schober test showed significant improvement after the treatment (p < 0.05). CONCLUSIONS The Turkish version of the ALBP is reliable, valid and responsive.

Persistent Monoarthritis on the Patient of Parkinson’s Disease with Cognitive Impairment and Frequent Falls

Parkinson’s disease is often associated with cognitive impairment and frequent falls [1]. Postural control is severely reduced in PD and postural instability is thought to be one of the main symptoms of the disease [2-4]. Walking speed is reduced in PD patients and this is accompanied by a decrease in arm swing. In addition, there is an increase in cadence, double support, and left-right gait asymmetry and there is a decrease in bilateral coordination [1]. Gait disorders and postural instability increase the risk of falls in PD, which causes severe head trauma, fractures and mortality [1]. In addition, levodopa-induced dyskinesia, symptomatic orthostatic hypotension, sudden loss of postural reflexes, coexisting neurological or other medical disorders, and environmental factors are the other risk factors for falls in PD [5,6]. In the majority of the studies, the falls are related to the cognitive impairment. However, these studies evaluated advanced PD patients with gait disturbances and freezing problems. Cognitive disorders are observed from the early stages of the PD and may include several cognitive domains. Executive dysfunction and attention deficit are two of the most notable dysfunctions, and these are directly related to the risk of falls [7].