Levent Ediz

Seasonal disease activity and serum vitamin D levels in rheumatoid arthritis, ankylosing spondylitis and osteoarthritis

BACKGROUND Vitamin D is a steroid hormone that plays essential roles in calcium and phosphorus metabolism, bone formation and mineralization homeostasis, also has a role in the maintenance of immune-homeostasis. OBJECTIVE We aimed to investigate seasonal serum vitamin D levels and seasonal disease activity in patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Osteoarthritis. METHODS Seventy-one Rheumatoid Arthritis patients, 72 Ankylosing Spondylitis patients, 74 knee Osteoarthritis patients and 70 healthy controls were recruited for the study. Bi-seasonal measurements of serum 25(OH)D vitamin were checked in either in July or August or September for summertime and either in December or January or February for wintertime. Disease activity were evaluated by Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index, and Western Ontario and McMaster Universities Osteoarthritis Index in groups of Rheumatoid Arthritis, Ankylosing Spondylitis, and Osteoarthritis respectively. RESULTS We did not find any correlation between serum 25(OH)D levels and Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index, and Western Ontario and McMaster Universities Osteoarthritis Index scores in winter and summer. The difference of Disease Activity Score-28 and Western Ontario and McMaster Universities Osteoarthritis Index scores between winter and summer seasons were not significant in Rheumatoid Arthritis and Osteoarthritis patients (p>0.05). The mean Bath Ankylosing Spondylitis Disease Activity Index score was significantly higher in winter than in summer (p<0.05). Consequently we did not find any correlation between variations of seasonal serum 25(OH)D and the disease activity in the patients with Rheumatoid Arthritis, Ankylosing Spondylitis, and Osteoarthritis. CONCLUSION These results suggest that vitamin D does not have an important role in the seasonal disease activity of these diseases and that seasonal changes in disease activity may play an important role in evaluating Ankylosing Spondylitis patients rather than Rheumatoid Arthritis and Osteoarthritis patients and should be taken into account when examining these patients. These conclusions need to be validated in multicenter studies with high number of patients.

Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study

PurposeThis is a descriptive analysis, of victims of Turkey’s October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma.MethodsWe retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome.ResultsThe patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively.ConclusionsThe results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

The validity and reliability of the Turkish version of the Revised Fibromyalgia Impact Questionnaire

The Revised Fibromyalgia Impact Questionnaire (FIQR) attempts to address the limitations of the Fibromyalgia Impact Questionnaire (FIQ). As there is no Turkish version of the FIQR available, we aimed to investigate the validity and reliability of a Turkish translation of the FIQR in Turkish female fibromyalgia (FM) patients. After translating the FIQR into Turkish, it was administered to 87 female patients with FM. All of the patients filled out the questionnaire together with a Turkish version of the FIQ, hospital anxiety and depression scales (HADS), short form-36 (SF-36). The tender-point count (TPC) was also calculated from tender points identified by thumb palpation. One week later, FM patients filled out the Turkish FIQR at their second visit. The test–retest reliability of the Turkish FIQR questions ranged from 0.714 to 0.898. The test and retest reliability of total FIQR score was 0.835. Cronbachs alpha was 0.89 for FIQR visit 1 (the first assessment) and 0.91 for FIQR visit 2 (the second assessment), indicating acceptable levels of internal consistency for both assessments. The total scores of the FIQR and FIQ were significantly correlated (r = 0.87, P < 0.01). Significant correlations for construct validity were also obtained between the FIQR total and domain scores and the FIQ, the HADS and the subscales of the SF-36 (FIQR total versus SF-36 physical component score and mental component score were r = −0.63, P < 0.01 and r = −0.51, P < 0.01, respectively). The Turkish FIQR is a reliable and valid instrument for measuring health status in FM, showing sufficient reliability and construct validity. It may be utilized for both clinical practice and research use in the Turkish-speaking population in place of FIQ, since its Turkish version has problems in the wording, omissions, concepts, and scoring from the original FIQ.

Clinical and Magnetic Resonance Imaging Findings of the Temporomandibular Joint in Patients With Rheumatoid Arthritis

Background The aim of this study is to evaluate temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis by magnetic resonance imaging (MRI), jaw clenching force, mouth opening, and Fonseca’s questionnaire, and to establish the relationship between these findings and clinical, radiologic, and laboratory activity parameters that are unique to rheumatoid arthritis. Methods Included in the study were 30 RA patients and 30 healthy volunteers. Jaw clenching force of the entire cases was measured with Istanbul Bite Force Recorder (kg) and the mouth opening was measured with a ruler (cm). Additionally, hand grip forces of patients with rheumatoid arthritis were measured with hand dynamometer (kg). Hand and feet graphs and TMJ MRIs of patients were obtained. MRI findings were classified as normal, mild, medium, and severe. DAS28 and sharp scores of patients were estimated. Sedimentation rate (ESR), C-Reactive protein (CRP) and rheumatoid factor (RF) were checked in the patient group and Fonseca’s questionnaires were filled in. Results A significant difference was not observed between age, gender, and level of education of the groups. Jaw clenching force and mouth opening were established as significantly low in RA group compared to the control group (P < 0.001). A significant correlation was found between jaw clenching force, hand grip force, mouth opening, questionnaire, and MRI findings with the disease duration sharp score, DAS28, and hand grip force of the RA group (P < 0.05). However, a significant correlation was not established with ESR, CRP, and RF (P < 0.001). Conclusions Jaw clenching force, mouth opening, and Fonseca’s questionnaire can be used as parameters pointing to TMJ involvement in patients with RA. Yet, further studies in which TMJ involvement is followed up since the onset of the disease are of necessity.

A randomized controlled trial of electrostimulation effects on effussion, swelling and pain recovery after anterior cruciate ligament reconstruction: a pilot study:

Objective: To evaluate rehabilitation results of electrostimulation especially on joint effusion, swelling and pain recovery after anterior cruciate ligament reconstruction. Design: A randomized controlled trial; the assessor was not blinded to the group allocation. Setting: Orthopaedics-traumatology and physical medicine-rehabilitation departments. Subjects: Twenty-nine consecutive patients underwent anterior cruciate ligament reconstruction. Interventions: Both groups began the voluntary exercise protocol one day post-surgery. The intervention group (n = 15) also received 30 sessions electrostimulation treatment protocol started four days after the operation. Main measures: Numerical bulge-dancing patella signs for effusion assessment; differences in circumferences of the mid-centre of the patella between operated and non-operated knees for swelling assessment. Aself-report of average daily resting pain assessed by visual analogue scale; Intenational Knee Documentation Committee scoring system and Tegner Activity Scale for subjective response assessment. Results: Twenty-six subjects including 13 patients from the intervention group completed the study. Significantly less effusion and swelling were determined in the intervention group after seven days (1.8 ± 1.3 versus 2.4 ± 1.7 for effusion and 1.7 ± 1.2 versus 3.4 ± 1.5 for swelling) to 12 weeks (0.2 ± 0.7 versus 0.6 ± 0.8 for effusion and 0.2 ± 0.8 versus 0.8 ± 0.9 for swelling) postoperative (P < 0.05). Patients treated with electrostimulation had significantly lower pain scores from seven days up to 12 weeks after the operation (P < 0.05). Conclusion: Electrostimulation along with exercise therapy appears superior to exercise alone regarding knee effusion, swelling and pain recovery after anterior cruciate ligament reconstruction. Still, there is need for further clinical studies using a radiologic method to demonstrate this effect of electrostimulation.

Complex regional pain syndrome: A vitamin K dependent entity?

Complex regional pain syndrome (CRPS) is the complication of some injuries, such as a fracture, which affects the distal end of the injured extremity characterized by pain, allodynia, hyperalgesia, edema, abnormal vasomotor and sudomotor activity, movement disorders, joint stiffness, regional osteoporosis, and dystrophic changes in soft tissue. Exact pathogenic mechanism of CRPS is still unclear. Suggested pathogenic mechanisms of CRPS are evaluated in four major groups consist of classic inflammation, hypoxic changes and chronic ischemia, neurogenic inflammation and sympathetic dysregulation. All of these suggested pathogenic mechanisms produced by inflammatory cytokines mediated by nuclear factor kappaB. Vitamin K is a family of structurally similar, fat-soluble, 2-methyl-1,4-naphthoquinones. Vitamin K exerts a powerful influence on bone formation, especially in osteoporosis. Fat in bone stores some vitamin K. Gamma-carboxylation of the glutamic acid in osteocalcin is vitamin K dependent. Osteocalcin plays a role in calcium uptake and bone mineralization. Osteocalcin, the most abundant non-collagenous protein in bone, is produced by osteoblasts during bone matrix formation. Because osteocalcin is not carboxylated in case of vitamin K deficiency at the distal site of fracture or injury, it cannot bind to hydroxyapatite causing osteoporosis. Fracture starts a local inflammatory process in the fracture site and adjacent tissues as seen in CRPS. Vitamin K was shown to suppress the inflammatory cytokines and NF-kappaB and prevent oxidative, hypoxic, ischemic injury (which have key role in both initiation and progression of CRPS) to oligodendrocytes and neurons. We hypothesized that vitamin K has a key role and modulatory effect in CRPS pathogenesis. Vitamin K deficiency at the distal site of fracture occurs because of diminished and slowed circulation, local immobilization after extremity fracture or injury and use of vitamin K store at the distal site of the injured extremity and in the circulation for fracture healing and bone remodelling. In case of vitamin K deficiency at the distal site of fracture, classic inflammation starts with fracture at the distal tissues could not be restricted and classic inflammation, hypoxic changes, chronic ischemia, neurogenic inflammation, sympathetic dysregulation, which are the pathogenic mechanisms of CRPS, and patchy osteoporosis which occur due to high level of under-carboxylated osteocalcin could not be prevented. Briefly vitamin K level decreases in the distal site of the injured extremity consequently resulting in patchy osteoporosis due to high level of under-carboxylated osteocalcin and unrestricted inflammation which are the cause for both initiation and progression of CRPS.

A randomized controlled trial on the efficacy of intermittent and continuous traction for patients with knee osteoarthritis

Objective: To investigate the efficacy of intermittent and continuous traction in the treatment of knee osteoarthritis. Design: A randomized, controlled, observer-blind seven-week trial. Setting: Hospital-based outpatient practice. Subjects: Ninety-eight patients with stage 3 knee osteoarthritis according to Kellgren–Lawrence radiological rating scale. Interventions: All 98 patients were randomly assigned to three treatment groups, for three weeks (weekends excluded). The control group (n=30, mean age: 59.30±8.16) received hot pack and short wave diathermy; the intermittent group (n=30, mean age: 58.20±7.78) received hot pack, short wave diathermy and intermittent traction; and the continuous group (n=30, mean age: 57.97±9.53) received hot pack, short wave diathermy and continuous traction. Outcome measurements: The values of the Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale, and knee passive range of motion were measured at baseline, three-week and seven-week follow-up. Results: Compared with baseline at weeks 3 and 7, all the outcome measures, except range of motion, were significantly reduced in all groups (all P≤0.001). In terms of the change data from baseline to week 3, both traction groups were significantly superior to the control in the WOMAC physical function scores. Considering the change data from baseline to week 7, both traction groups were significantly superior to the control in the pain scores, physical function and total scores, while only the continuous group was significantly better than the control in the stiffness scores (control: 1.17 ± 1.64; continuous: 2.38 ± 1.44) (P=0.014). Compared with baseline at weeks 3 and 7, range of motion values significantly increased in both traction groups (P<0.05) but not in the control (P>0.05). However, there were no significant differences among the three groups considering the change data from baseline to week 7 in range of motion values (P=0.300). Conclusions: Joint traction was found to be beneficial for the improvement of pain and physical function loss related to knee osteoarthritis.

Symptom Modifying Effect Of Colchicine In Patients With Knee Osteoarthritis

DOI: 10.4328/JCAM. 563 Received: 29.12.2010 Accepted: 05.01.2011 Printed: 01.01.2012 J Clin Anal Med 2012;3(1):63-7 Corresponding Author: Levent Ediz, Yuzuncu Yil University, Medical Faculty, Department of Physical Medicine and Rehabilitation, 65100 Van, Turkey. T..:+90 432 2150182; F.:+90 432 2168352. E-Mail: leventediz@yyu.edu.tr Özet Amaç: Bu çalışmanın amacı 6 aylık dönemde diz osteoartritli hastalarda kolşisinin semptom modifiye edici etkisinin olup olmadığını araştırmak idi. Gereç ve Yöntem: 40-75 yaşları arasında, 52 kadın, 22 erkek toplam 74 primer diz osteoartritli olgu çalışmaya alındı. Olgular randomize olarak 6 ay boyunca tek başına 3000 mg/gün parasetamol ya da 3000 mg/gün parasetamol ve 1.5 gr/gün kolşisin almak üzere iki gruba ayrıldı. 6 ay sonunda takibi yapılamayan 5 kadın ve 4 erkek hasta çalışma dışı tutuldu. Hiçbir hasta ilaç yan etkilerinden dolayı çalışmayı terk etmedi. Bulgular: İki grubun kendi içlerinde tedavi öncesine (tö) göre, vizit 1 (v1-tedavinin başlangıcından sonraki 1,5. Ay), vizit 2 (v2tedavinin başlangıcından sonraki 3. Ay), vizit 3 (v3-tedavinin başlangıcından sonraki 4,5. Ay) ve vizit 4 (v4-tedavinin başlangıcından sonraki 6. Ay) arasında Western Ontario and McMaster University (WOMAC) Osteoartrit skorları ve Visual Analog Scale (VAS) skorlarında paired t test ile yapılan karşılaştırmada; her iki grupta tö değerleri ile v1, v2, v3, v4 değerleri arasında istatistiksel anlamlı bir düşüş (p<0.001) vardı. Buda hem parasetamol hemde kolşisin+parasetamol’ün diz osteoartritinde istatistiksel olarak anlamlı derecede tedavi etkinliğinin olduğunu göstermektedir. Her iki grup arasında yapılan bağımsız gruplar için student t test kolşisin lehine WOMAC ağrı, sabah tutukluğu ve fonksiyonel indeksleri ile VAS skorlarında istatistiksel olarak anlamlı derecede fark gösterdi (p<0.05). Bu fark v2 ve v3 te daha belirgin idi (p<0.001). Hem Kolşisin hemde Parasetamol çok iyi tolere edildi. Hiçbir gruptaki hiçbir hasta ciddi laboratuar anormallik göstermedi. Hiçbir hasta ilaç yan etkilerinden dolayı çalışmayı terk etmedi. Kolşisin grubundaki Heberden nodülleri olan bir kadın hastada Heberden nodüllerinin kaybolduğu gözlendi. Sonuç: 3000 mg/gün parasetamol dozu ve 3000 mg/gün parasetamol’e 1,5 gr/ gün kolşisin eklenmesi diz osteoartritli hastalarda çok iyi tolere edilmekte ve yeterli semptom kontrolü sağlamaktadır. Ancak parasetamole kolşisin eklenmesi istatistiksel olarak anlamlı derecede daha iyi semptom kontrolü sağlamaktadır. Bu da osteoartritte kolşisinin muhtemel semptom veya hastalık modifiye edici etkisini gösterebilir. Bunu ortaya koymak için osteoartritte uzun dönem radyolojik ve laboratuar çalışmalara ihtiyaç vardır.

Restless Legs Syndrome in Behçet's Disease

The prevalence of restless legs syndrome (RLS) and its association with the clinical features of Behçets disease (BD) has not previously been elucidated. The inflammatory character, central nervous system involvement and neuropathies of BD led to this investigation of RLS risk in BD patients. A total of 116 BD patients and 104 healthy control subjects were included; seven BD patients were excluded because of concurrent diseases, pregnancy or alcohol misuse that might cause RLS symptoms, and the remaining 109 BD patients were included in the analysis. The prevalence of RLS was significantly higher in patients with BD (32/109; 29.4%) than in controls (5/104; 4.8%). No significant differences were found between BD patients with and without RLS with regard to the clinical features of BD. RLS severity positively correlated with age in BD patients. In conclusion, BD-related RLS should be considered in symptomatic RLS secondary to rheumatological disorders and BD patients should be examined for RLS. Further studies are needed to clarify the pathogenetic mechanisms underlying BD-related RLS.

Effect of number of pregnancies on bone mineral density.

This study investigated the effect of the number of pregnancies on bone mineral density (BMD) in 320 post-menopausal women aged between 49 and 64 years. Cases were selected from people with similar lifestyles and stratified into five groups according to the number of pregnancies. Each group was divided into two subgroups according to the duration of the menopause (3 − 5 years versus 6 − 10 years). Lumbar (L2 – L4) and femoral neck BMD were measured by dual-energy X-ray absorptiometry and T-score values were used in the statistical evaluation. No significant difference was found between the number of pregnancies and BMD within each group based on the same menopause duration, but a significant correlation was found in most groups based on menopause duration: T-scores decreased as menopause duration increased. Changes in BMD are likely to be related to menopause duration, rather than the number of pregnancies.