Lale Cerrahoglu

Lumbar stiffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitis.

Abstract Involvement of the costovertebral (CV) and costotransverse (CT) as well as the sacroiliac (SI) joints is known to occur in patients with ankylosing spondylitis (AS). The functional significance of these changes is not clear. We have performed clinical and radiological evaluations and assessed the effect of joint involvement on pulmonary function. We detected radiologic evidence of involvement of the CV joint in 80% of patients and of the CT joint in 60 %. We found a direct relation between the severity of CV, CT and SI joint affliction, and the severity of CV and SI joints were related to time of evolution of the disease. Pulmonary function tests revealed neither restrictive nor obstructive defects. No relation was found between pulmonary function and CV and CT joint affliction. Patients with stiffer spines had a tendency to have pulmonary function tests within the lower limit of the normal range. In patients with AS diaphragmatic breathing might compensate the chest respiration to some extent.

Relationship between enthesitis, clinical parameters and quality of life in spondyloarthritis.

OBJECTIVE To investigate the involvement of enthesis and its correlation with clinical and quality of life parameters in patients with spondyloarthritis (SpA). METHODS One hundred and eighteen patients who comply with the SpA classification criteria of the European Spondylarthropathy Study Group (ESSG) were included into the study. Clinical parameters such as morning stiffness, rest pain, activity pain, tender joints and swollen joints were evaluated. Enthesitis were assessed by Mander Enthesis Index (MEI). The quality of life was assessed by Short Form-36 (SF-36). RESULTS The incidence of enthesitis in patient with SpA was found at a rate of 84.9%. There was a significant correlation between MEI and morning stiffness, disease duration, tender joints and six subgroups of SF-36. The highest correlation was found between MEI and number of tender joint (p<0.001). CONCLUSION Enthesitis is commonly seen among patients with SpA. Enthesitis also affects the life quality of patients negatively.

Serum hyaluronic acid levels in patients with ankylosing spondylitis

Our aim in this study was to investigate serum hyaluronic acid (HA) levels and the relationship between clinical parameters in ankylosing spondylitis (AS). Approximately 30 patients with AS and 30 healthy individuals were recruited in this study consecutively. Cross-sectional study was planned, and demographic, clinical, functional, radiological, and laboratory data of patients were evaluated. Disease activity, functional status, and quality of life were assessed, respectively, with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Short-Form 36 (SF-36). Mander Enthesis Index (MEI) was used for evaluation of enthesis involvement. We examined serum concentrations of HA (ng/ml) in patients with AS and controls. The mean ages of patients and control group were 38.3 (SD = 10.8) and 42.7 (SD = 10.6) years, respectively. The mean of serum HA levels in AS patients was 40.4 (SD = 34.8) ng/ml and in controls was 24.9 (SD = 20.2). There was significant difference of HA levels between two groups (p = 0.04). Furthermore, there was a significant correlation between HA level and distance of hand–floor (r = 0.444, p = 0.014), modified lumbar Schober’s (r = −0.413, p = 0.023), distance of chin to chest (r = 0.436, p = 0.016), right sacroiliit grade (r = 0.601, p < 0.001), left sacroiliit grade (r = 0.610, p < 0.001), C reactive protein level (r = 0.404, p = 0.027), albumin (r = −0.464, p = 0.010), C3 (p = 0.449, p = 0.013), and IgA levels (r = 0.369, p = 0.045). However, there was no significant correlation between HA levels with MEI, BASFI, BASDAI, and SF-36 (p ≥ 0.05). Serum HA level was significantly higher in AS patients than controls. However, there was no significant correlation between serum HA level and disease-specific measures as BASFI and BASDAI; it had significant relation with spinal mobility limitation, sacroiliitis, and laboratory parameters related with acute inflammation. The serum HA level may be a potential biomarker of axial inflammation and disease severity in AS.

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial

ABSTRACT We determined and compared the effectiveness of low‐level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm2; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm2); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle‐hindfoot scale, Roles–Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes. &NA; Level of Clinical Evidence: 2

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy

BACKGROUND We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications. METHODS Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program. RESULTS In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P < .001); static pedobarographic values showed significant reduction in right forefoot-medial pressure (P = .010); and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial (P = .007), right forefoot lateral (P = .018), left midfoot (P < .001), and right hindfoot (P = .021) after exercise. No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups (P > .05). CONCLUSIONS A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Ankle pain in hereditary multiple exostoses: a case report.

pain for 1 month. She had moderate pain at rest and pain increased especially by walking or standing which is restricting daily activities. There was no history of trauma. She had no surgical exostoses resection history. Her exostoses first had developed by the age of 10 years but she had diagnosed with HME by the age of 20 years. Also, her father operated several times for exostoses and her son has the diagnosis of HME. She has short stature with normal systemic examination. On the musculoskeletal examination, there was swelling at the posterior left ankle slightly, tenderness, pain and ankle dorsiflexion was restricted. There was no neurovascular deficit in the extremities. She had palpable bony exostoses on the bilateral proximal tibias, shoulders, and forearms. Her wrists were painful with palpation. Laboratory findings were within normal limit. [Hemoglobin was 10.3 g/dL, white blood cells 6.35 × 10/μL, platelets 330 × 10/μL, aspartate aminotransferase (AST) 18 U/L, alanine aminotransferase (ALT) 13 U/L, creatine 0.84 mg/dL, and blood urea nitrogen 11 mg/dL. Erythrocyte sedimentation rate (ESR) was 19 mm/h, and C-reactive protein (CRP) level was 3.19 mg/L]. Conventional radiography of the shoulder, wrist, and tibia showed exostoses and shortening of the ulna (Fig. 1). Ankle joint effusion and synovitis were found by ultrasonography. Magnetic resonance imagining (MRI; Fig. 2) has planned to rule out the malignant transformation and showed exostoses in the distal part of the tibia and fibula in relation to joint, talo-calcaneal coalition, and tendinosis at the hallucis longus tendon. She was hospitalized and treated for foot and ankle complaints with physical treatment program including cold pack, pulsed ultrasound therapy, electrotherapy, and exercise for 18 days. Patient‘s complaints decreased significantly after treatment. Pain (VAS) score decreased from 80 mm to 10 mm with free range of motion with no pain. Dear editor,