Merih Saridogan

Polypharmacy in the elderly: a multicenter study.

OBJECTIVE The aim of this study was to evaluate the polypharmacy issue and its correlations with socioeconomic variables in Turkish elderly patients. DESIGN Cross-sectional SETTING Outpatient clinics of the medical schools, departments of physical medicine and rehabilitation from 12 provinces. PARTICIPANTS A total of 1430 elderly in different geographical regions of Turkey during January 2007 to January 2008 were included. MEASUREMENTS Patients were interviewed using a questionnaire that included demographic characteristics, current medical diagnosis, and pharmaceuticals that are used by elderly. Demographical parameters were gender, age, marital status, number of children, level of education, province, and status of retirement. RESULTS The mean number of drugs was found to be higher in the females. There was a significant difference among age groups, marital status groups, and the number of children categories. The distribution of the number of drugs among education levels did not differ significantly, whereas the distribution of the number of drugs between the status of retirement and presence of chronic disease differed significantly. CONCLUSIONS Polypharmacy is correlated with various factors including age, sex, marital status, number of children, status of retirement, and presence of chronic medical conditions but not educational status in our study group.

Cervical vertebral fracture in a patient with juvenile idiopathic arthritis and osteopoikilosis

Dear Editor, Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. Severe JIA results in joint damage, growth retardation, psychosocial morbidity, reduced quality of life and educational or employment disadvantage. Low bone mineral density (BMD) and fragility fractures are well-recognized serious longterm complications of JIA and are associated with considerable morbidity. Osteopoikilosis (OPK; also called osteopathia condensans disseminata or spotted bone) is a rare sclerosing bone dysplasia. OPK results in small, well-defined, ovoid foci of increased radio density clustered in the periarticular osseous regions and it is generally diagnosed incidentally on plain radiographies which were performed for other locomotor system symptoms. OPK should be considered in the differential diagnosis of osteoblastic metastases, tuberous sclerosis and mastocytosis. Scintigraphy and histologic examination can be useful for the diagnosis of OPK. We present a 26-year-old woman with OPK and tetraplegia due to a C5 vertebral fracture misdiagnosed as an exacerbation of JIA. The patient was admitted complaining of the inability to walk and use both hands, bilateral arm and leg weakness, and bilateral knee and hip pain present for 2–3 months. She was diagnosed with JIA at age 6 years and was followed up for 20 years. She had taken prednisolone 5 mg, leflunomide, indomethacin, calcium–vitamin D, and antitumor necrosis factor (anti-TNF) therapy for the last 15 years. Previously, she had been able to move freely and to care for herself, but progressive weakness and limited movement in both legs and arms developed over the previous 3 months. Her medical history included a right tibia fracture 3 years earlier and neck trauma after falling 1 year ago. The patient was seen in the Department of Rheumatology, İstanbul University Cerrahpasa, Turkey, for her inability to walk for 3 months, and this was thought to be related to joint deformities. She was referred to the Orthopedics Department for hip–knee prostheses and directed to the Department of Physical Medicine and Rehabilitation for muscle strengthening exercises before surgery. The patient was examined in a wheelchair. Movements of the wrist, elbow and shoulder joints were limited and painful. She had flexion contractures of the proximal (PIP) (45°) and distal (DIP) (15°) interphalangeal joints. The FADIR (flexion, abduction and internal rotation) and FABERE (flexion, abduction, external rotation and extension) tests were positive at 30° of flexion due to contractures of the hip. She had stage 3 spasticity on the Ashworth scale. Although it was difficult to assess because of the spasticity, the muscle strength in the patient’s extremities was evaluated as 2/5 on the right and 1/5 on the left. Her superficial sensation decreased bilaterally, beginning from the C4 level. Deep tendon reflexes were increased and she had positive Babinski’s sign and clonus. She had intact anal sensation, but impaired voluntary anal contraction. Laboratory examination revealed an erythrocyte sedimentation rate (ESR) of 54 mm/h, C-reactive protein (CRP) of 51 mg/L, and hemoglobin (Hb) of 9.1 g/dL; the other values were unremarkable. Pelvic X-ray showed bilateral severe osteoarthritic changes in the coxofemoral joints and multiple diffuse radiodensities (the largest measured 3.5 9 1.5 cm) compatible with OPK (Fig. 1). A bone biopsy of the left iliac crest revealed bone tissue compatible with OPK. Whole-body bone scintigraphy showed increased activity in the wrists, elbows, knees and coxofemoral joints bilaterally, compatible with JIA. Cervical X-rays showed a loss of height of the C5 vertebra and C4–5 spondylolisthesis (Fig. 2). Cervical magnetic resonance imaging (MRI) showed collapse and marked destruction of the C5 vertebral body and severe spinal cord compression. Dual-energy X-ray absorptiometry (DXA) of L1–4 gave a total Z score of 2.8.

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease.

AB0762 Fficacy and Safety of Nemartro(Nem®-Stratum Nutrition) Brand Eggshell Membrane in Patients with Knee Osteoarthritis Accompanying with Joint Pain and Stiffness. A Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Crossover Study

Background Traditional treatments for pain and stiffness in osteoarthritis attempt to address only the symptoms associated with the diseases. Objectives To investigate the efficacy and safety of natural eggshell membrane Natural Eggshell Membrane (NEM) in patients with knee osteoarthritis having joint pain and stiffness. Methods This study is a Efficacy and Safety of NEM®ARTRO(NEM®-Stratum Nutrition) Brand Eggshell Membrane in Patients With Knee Osteoarthritis Accompanying With Joint Pain and Stiffness. A Multi-center, Randomized, Double-blind, Placebo-controlled, Crossover Study. This study was planned to include 200 female or male patients, however a total of 166 patients were screened and all the 166 patients were enrolled to the study. Median age of the medication group was 53 and in the placebo group was 57. The study was conducted as a multicenter, randomized, double blind, placebo controlled and crossover study. Patients aged ≥40 years having osteoarthritis complaints for 1–5 years and grade 2 or 3 knee osteoarthritis were included as 166 patients in total (32 male and 134 female). They were randomly assigned to receive either Natural Eggshell Membrane (NEM®) (drug group) or placebo (placebo group) for 30 days. After the evaluations on day 30, the placebo group was also initiated to Natural Eggshell Membrane (NEM®). Thus, at the end of 90 days, two groups (the 60-day and 90-day Natural Eggshell Membrane (NEM®) treatment groups) were evaluated. For pain and stiffness in patients, VAS and WOMAC scales and for quality of life SF-36 scale was used. The degree of pain and stiffness was evaluated at baseline and days 7, 30, and 90. Quality of life scales were evaluated in the baseline and in the end of treatment. Results There was no difference between the drug (n=83) and placebo (n=83) groups regarding demographics, baseline clinical findings, and pain (VAS, WOMAC) and stiffness (WOMAC) scores. At the end of 7- and 30-day treatment, the pain and stiffness scores were significantly lower in the drug group than in the placebo group. A total of 8 adverse events in the medication group and 15 adverse events in placebo group were observed. It was seen that none of the conditions in medication group are serious. WOMAC pain score has decreased 30% in the first month and 40% in the third month for medication group. VAS score was decreased 22% in the first month and 42% in the third month for medication group. WOMAC stiffness score has decreased 34% in the first month and same in the third month for medication group. SF-36 score was 39 for the first month and 46 for the third month for medication group. Conclusions In the treatment of patients with knee osteoarthritis, Natural Eggshell Membrane (NEM®) reduces pain and stiffness in early period and provides a significant progress in quality of life and maintains its efficacy in long-term. Acknowledgement This study is sponsored by Generica. Disclosure of Interest N. Eskiyurt Grant/research support from: Investigator payment from Generica for the study, M. Saridogan Grant/research support from: Investigator payment from Generica for the study, K. Senel Grant/research support from: Investigator payment from Generica for the study, R. Gunaydin Grant/research support from: Investigator payment from Generica for the study, A. Erdal Grant/research support from: Investigator payment from Generica for the study, U. Akarirmak: None declared, O. Sendur Grant/research support from: Investigator payment from Generica for the study, K. Barut: None declared, G. Akyuz Grant/research support from: Investigator payment from Generica for the study, T. Ozsoy: None declared, T. Tuncer: None declared, O. Karatas Grant/research support from: Investigator payment from Generica for the study, J. Irdesel Grant/research support from: Investigator payment from Generica for the study, A. Ketenci: None declared, C. Aydagan Consultant for: Food Supplement Consultant of Generica