Kemal Dincer

Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients.

The aim of this study was to determine the emotional and sociodemographic characteristics of patients with ankylosing spondylitis (AS) and to investigate the impact of the disease on their social life and quality of life (QOL). This study included 101 patients with the diagnosis of AS. All patients filled in a questionnaire comprising their sociodemographic and emotional status and their self-rating on the disease and completed the 36-item Short Form Health Survey (SF-36). The impact of the disease on work status, sexuality, and family relations was measured on a Likert scale. The impact of the disease on employment, family and sexual relations, work life as well as SF-36 was investigated. Therefore, the effect of educational level, employment, social security, and sexual relations with spouse, etc. on QOL were assessed. More than half of the patients had no knowledge about the disease and half of them were not under a physician’s control. Thirty-two percent of the previously working patients quit their jobs because of the disease. Quitting a job due to the disease was more frequent in the first 10 years of the disease. The most affected domains of the SF-36 were physical role power, general health, and pain. Patients unemployed due to the disease had lower SF-36 scores compared with employed ones. Unemployed patients without social insurance had lower values on SF-36 subscales (p<0.05). A higher education level had positive influences on disease impact. The level of anxiety was high and was associated with sexual relations (p<0.05). Our results show that the disease affects patients’ work and social life. Work disability affects QOL. Educating the patients about the disease may play an important role in improving his/her life quality and coping with the disease. Thus, the socioeconomic burden of the disease on the person and on society can be diminished.

Bier block with methylprednisolone and lidocaine in CRPS type I: A randomized, double-blinded, placebo-controlled study

Background and objective To investigate the effect of intravenous regional anesthesia (Bier block) with methylprednisolone and lidocaine in complex regional pain syndrome (CRPS) type I in a randomized, double-blinded, and placebo-controlled study. Methods Twenty-two patients with the diagnosis of CRPS of their upper limb were divided randomly into 2 groups. The mean age was 22.3 ±1.6 years. Average pain duration was 3.1 ± 1.4 months. In the placebo group (10 patients), patients received only 100 mL of saline. In the study group (12 patients), 40 mg of methylprednisolone and 10 mL of 2% lidocaine were added to the saline. Treatments were applied once a week. Unless significant adverse effects occurred, 3 sessions of blockade were completed. Pain severity, range of motion (ROM), and volumetric edema measurements were obtained before treatment. Pain severity and satisfaction (resolved, better, no change, or worse) were recorded after each session. The final assessment was performed 1.5 months later. ROM and volumetric measurements were repeated the day after the block and at the final assessment. Results Differences in pretreatment features of the patients were not statistically significant (P > .05). In all assessment periods during the study, improvement in pain severity was statistically significant (P < .05) in both groups. This statistically significant difference disappeared at the final assessment (P > .05). No statistically significant difference was obtained in ROM and volumetric measures in any assessment period before and after the block. Satisfaction scores between the groups were also not different in any assessment period. Conclusions Bier block with methylprednisolone and lidocaine in CRPS type I does not provide long-term benefit in CRPS, and its short-term benefit is not superior to placebo.

Reflex sympathetic dystrophy: a retrospective epidemiological study of 168 patients

This is a retrospective epidemiological study. The objective is to determine the epidemiological characteristics including the patient demographics, etiological factors, duration of symptoms, treatment modalities applied and clinical outcome of the treatment in reflex sympathetic dystrophy (RSD). Medical records of the 168 patients managed in two tertiary hospitals with the diagnosis of RSD that was made according to both IASP criteria and three-phase bone scan were reviewed. The upper limb was affected 1.5 times as commonly as the lower limb. Of the 168 cases, 10.7% were non-traumatic. In 89.3% of the patients, RSD developed after a traumatic inciting event with a predominance of fracture. In 75.6% of the patients, RSD developed due to job-related injuries. The percentage of successful clinical outcome was 72%. The percentage of the patients that did not respond to therapy was 28%. The management period is long and this causes higher therapeutic costs in addition to loss of productive effort. However, response to therapy is good. On the other hand, in approximately one third of the patients, RSD does not improve despite all therapeutic interventions. In addition to compensation costs, this potentially debilitating feature causes RSD to appear as a socioeconomic problem.

Sacroiliitis in familial Mediterranean fever and seronegative spondyloarthropathy: importance of differential diagnosis

Familial Mediterranean fever (FMF) is a multisystemic autosomal recessive disease, occasionally accompanied by sacroiliitis. Transient and non-erosive arthritis of the large joints is the most frequent articular involvement. Amyloidosis is also the most significant complication of FMF, leading to end stage renal disease. Here we present three cases of FMF with sacroiliitis and review the literature for spinal arthritic involvement of FMF. All cases were referred to our clinic with a diagnosis of seronegative spondyloarthropathy and with low back pain sourced by sacroiliitis. They also had homozygous M694V gene mutations and negative HLA B27 antigens. Molecular analysis of the gene mutation is recommended during the evaluation of uncertain cases in order to clarify diagnostic discrimination. We suggest that FMF with sacroiliitis, which is rare in rheumatological practice, should be considered in the differential diagnosis of seronegative spondyloarthropathy or other rheumatologic diseases causing spinal involvement.

Familial mediterranean fever unusually coexisted in an ankylosing spondylitis patient. MEFV mutation has any role

Dear editor, Ankylosing spondylitis (AS) and familial mediterranean fever (FMF) are two clinical conditions aVecting people of almost same age group. In AS, sacroiliitis is the hallmark, but peripheral joints can also be aVected. On the other hand, articular involvement is the second most common manifestation of FMF. In FMF, although peripheral joints are aVected mostly, sacroiliac joints can be involved and it can be accompanied by seronegative spondyloarthropathy (SNSA). The shared feature of AS and FMF is sacroiliitis. The higher rate of coincidence of sacroiliitis with FMF in comparison with the healthy population was found to be statistically signiWcant [1]. This Wnding has led the sacroiliitis to be accepted as one of joint involvements of FMF [1–3]. Although sacroiliitis can occur in course of both conditions, it is not known yet exactly if there is any pathogenic relation between FMF and AS. Almost all of the FMF-related SNSA are HLAB27 negative [1–4]. There were only Wve patients who had both FMF and HLAB27 positive AS in the literature. These patients were considered as being more severe form of FMF-related SNSA because of the presence of HLAB27. It was also proposed that the presence of HLAB27 could predispose the occurring of AS in these FMF-related SNSA patients [1, 4, 5]. In review of literature, we perceived that, in all of these HLAB27 positive patients, AS was diagnosed after a period of time from the onset of FMF or simultaneously in one. In our opinion, this might have led the authors to put forward this consideration. Herein we represent an unusual case of HLAB27 positive AS that was accompanied with FMF 8 years after the diagnosis of AS, having M680I mutation in MEFV gene. A 27-year-old man with low back pain for 10 years that was accompanied with abdominal pain, fever, polyarthralgia recurring periodically for last 2 years was presented. He had been feeling stiVness and pain in his low back and occasionally left hip at morning that was relieving with motion and daily activities slowly within about 2 h. His Wrst episode of abdominal pain, accompanying with polyarthralgia (especially low back, left hip and knee) had occurred 2 years ago and he had been hospitalized with the possible diagnosis of appendicitis but resolved spontaneously in 12 h and had been discharged. After two additional episodes occurred with intervals of approximately 3 months, he was diagnosed with FMF and began to receive colchicine. Regular colchicine treatment reduced not only the frequency but also intensities of complaints during episodes. Physical examination revealed restricted lumbar motions (Schober: 3 cm), Patrick–Fabere and sacroiliac compression tests were positive bilaterally. There was swelling in left ankle, pain in both of the wrists, both of the knees and left shoulder. Laboratory investigations revealed that HLAB27 was positive. Erythrocyte sedimentation rate was 14 mm/h. Whole blood counts were normal. The urine contained no protein. Radiographs of painful peripheral joints were normal. Sacroiliac plain radiography revealed marginal irregularities, increased in density and sclerosis at especially iliac sides of sacroiliac joints. Bone scan showed increased I. Duman (&) · B. Balaban · I. Tugcu · K. Dincer Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, 06018 Etlik-Ankara, Turkey e-mail: iltekinduman@yahoo.com

Reflex sympathetic dystrophy secondary to deep venous thrombosis mimicking post-thrombotic syndrome

The objective of this report is to represent a case of reflex sympathetic dystrophy (RSD) secondary to the upper extremity deep venous thrombosis (DVT). A 21-year-old man admitted with the complaints of pain and swelling in his right upper limb was presented. The patient had been diagnosed DVT in the right subclavian vein. The thrombosis had recovered completely with the standard treatment of DVT and doppler ultrasound had revealed normal findings at follow-up. After few months, he developed limb edema and pain considering post-thrombotic syndrome (PTS). The patient showed no response to the treatments for PTS. He was diagnosed with RSD according to the clinical findings. The bone scan confirmed the diagnosis. He responded well to the physical therapy and therapeutic exercises program. RSD and PTS are the two conditions having some common features and resembling clinical pictures. RSD also should be kept in mind in differential diagnosis of patients who developed limb pain and edema after DVT. There are some different points in the characteristics of the common symptoms obtained in both of the clinical conditions. Bone scan can help to confirm the diagnosis if RSD is suspected. Because the treatments of two conditions are different, making the differential diagnosis is crucial.

Inflammatory sacroiliitis in a man with spinal cord injury.

Abstract Background: Inflammatory sacroiliitis associated with spinal cord injury (SCI) as an unusual cause of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level has not been reported previously to our knowledge. Objective: To represent a case of SCI associated with bilateral sacroiliitis causing ESR and CRP level elevation. Methods: Case report of a man with T9 paraplegia. Findings: ESR and CRP levels were high. Pelvic radiography was nearly normal, except for mildly blurred sacroiliac joints with normal margins. A 3-phase bone scan revealed bilateral sacroiliitis and heterotopic ossification at medial side of the left knee. Past history was significant for a recent urinary tract infection. Indomethacin and etidronate were prescribed. Significant decreases in ESR and CRP level were seen 1 month later. Conclusions: Sacroiliitis might be an unusual cause of elevated ESR and CRP levels in patients with SCI. Sensory and motor deficits may obscure the typical clinical presentation; therefore, imaging studies are essential for the diagnosis.