Nilgün Üstün

Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: A single-blind randomized prospective study.

ObjectiveThe aim of this study was to compare the efficacy and the safety of ultrasound (US)–guided vs. blind steroid injections in patients with carpal tunnel syndrome (CTS). DesignThis prospective randomized single-blind clinical trial included 46 patients with CTS (46 affected median nerves). The subjects were randomized—to either the US-guided or the blind injection group—before they received 40 mg of methylprednisolone. They were evaluated using the Boston Carpal Tunnel Questionnaire symptom/function at baseline and at 6 wks and 12 wks after injection, and the side effects were noted. ResultsThe symptom severity and functional status scores improved significantly in both groups at 6 wks after treatment, and these improvements persisted at 12 wks after treatment (all P < 0.05). The improvement in symptom severity scores in the US-guided group at 12 wks was higher than in the palpation-guided group (P < 0.05). Average time to symptom relief was shorter in the US-guided group (P < 0.05). There was no significant difference between the two groups in terms of side effects (P > 0.05). ConclusionsAlthough both US-guided and blind steroid injections were effective in reducing the symptoms of CTS and improving the function, an earlier onset/better improvement of symptom relief suggests that US-guided steroid injection may be more effective than are blind injections in CTS.

Thymoquinone Attenuates Trauma Induced Spinal Cord Damage in an Animal Model

BACKGROUND Spinal cord injury (SCI) is one of the most devastating conditions leading to neurological impairment and disabilities. The aim of the study was to investigate the potential neuroprotective effect of thymoquinone (TQ) histopathologically in an experimental model of traumatic spinal cord injury (SCI). METHODS Twenty-four male Wistar albino rats were randomly divided into 4 groups: control group; SCI group; SCI-induced and 10 mg/kg/day TQ administered group; SCI-induced and 30 mg/kg/day TQ administered group. TQ was given as intraperitoneal for three days prior to injury and four days following injury. Spinal cord segment between T8 and T10 were taken for histopathologic examination. Hemorrhage, spongiosis and liquefactive necrosis were analyzed semiquantatively for histopathological changes. RESULTS Administration of TQ at a dose of 10 mg/kg did not cause any significant change on the histological features of neuronal degeneration as compared to the SCI group (p=0.269); however, 30 mg/kg TQ significantly decreased the histological features of spinal cord damage below that of the SCI group (p=0.011). CONCLUSION Data from this study suggest that TQ supplementation attenuates trauma induced spinal cord damage. Thus, TQ needs to be taken into consideration, for it may have a neuroprotective effect in trauma induced spinal cord damage.

Effects of habitual knuckle cracking on metacarpal cartilage thickness and grip strength

Joint cracking involves a manipulation of the finger joints resulting in an audible crack. This study aimed to determine whether habitual knuckle cracking (KC) leads to an alteration in grip strength and metacarpal head (MH) cartilage thickness. Thirty-five habitual knuckle crackers (cracking their joints ≥5times/day) (20 M, 15 F, aged 19-27 years) and 35 age-, gender-, and body mass index-matched non-crackers were enrolled in the study. MH cartilage thickness was measured with ultrasound and grip strength was measured with an analog Jamar hand dynamometer. Grip strength was similar between groups (P>0.05). Habitual knuckle crackers had thicker MH cartilage in the dominant and non-dominant hands than those of the controls (P=0.038 and P=0.005, respectively). There was no correlation between MH cartilage thickness and grip strength in both groups (P>0.05). While habitual KC does not affect handgrip strength, it appears to be associated with increased MH cartilage thickness.

Ultrasonographic Assessment of the Distal Femoral Cartilage Thickness in Patients with Homozygous Sickle Cell Disease.

Objective To compare the distal femoral cartilage thickness of patients with sickle cell disease (SCD) with those of healthy subjects using ultrasonography. Methods The study comprised 30 patients with SCD (16 male, 14 female; mean age, 30.1 years) and 30 age- and sex-matched healthy subjects. Demographic features and medications of the patients were recorded. With the knees held in maximum flexion, the femoral cartilage thickness was measured bilaterally with a 7- to 12-MHz linear probe. Using ultrasonography, 3 midpoint measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). Results Patients with SCD had thinner femoral cartilage thickness values at LFC (P = 0.004), at MFC (P = 0.000), and ICA (P = 0.002) when compared with those of the healthy subjects. Patients with SCD also had lower Hb levels (P = 0.000) levels. Weak positive correlations were determined between Hemoglobin (Hb) levels and ultrasonographic measurements in the SCD group at MFC (r = 0.331, P = 0.010), and ICA (r = 0.289 , P = 0.025 ). Low levels of Hb seem to affect the femoral cartilage thickness. Conclusion These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.

Association of Vitamin D with Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

1 Abdullah Erman Yagiz1, Nilgun Ustun1, Hacer Paksoy1, Ihsan Ustun2, Ayhan Mansuroglu3, Hayal Guler1, Ayse Dicle Turhanoglu1 1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Mustafa Kemal University, 2Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, 3Clinic of Physical Medicine and Rehabilitation, Antakya State Hospital, Hatay, Turkey Vitamin D ve Hastalık Aktivitesi / Vitamin D and Disease Activity Association of Vitamin D with Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

The Seropositivity of Parvovirus B19 in Patients with Ankylosing Spondylitis

Objective: Parvovirus B19 is one of the most common causes of viral arthritis, which suggests that it can be a significant factor in the pathogenesis of chronic inflammatory diseases, such as rheumatoid arthritis. The aim of the present study was to investigate the seropositivity of parvovirus B19 in patients with ankylosing spondylitis (AS). Material and Methods: The patient group consisted of 43 patients with ankylosing spondylitis; the control group consisted of 70 subjects who did not have any bone joints complaints. Anti-parvovirus B19 IgM and IgG antibodies were measured by ELISA. Results: Parvovirus B19 IgM antibody positivity in patients with AS was significantly higher than that in the control group (p<0.001). Conclusion: The high frequency of anti-parvovirus B19 IgM positivity in patients with AS suggests that the virus reactivates or persists in these patients due to immuno deficiency.

SAT0173 Assessment of Left Ventricular Dyssynchrony in Patients with Familial Mediterranean Fever

Background Familial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Various clinical and subclinical cardiovascular involvements have been reported in FMF patients. However, there is considerable lack of evidence regarding contraction synchrony in FMF. Objectives We aimed to study the left ventricular contraction synchrony in FMF patients with narrow QRS and normal EF. Methods Seventy patients with FMF and 35 age- and sex- matched control subjects were included the study. Left ventricular dyssynchrony was investigated by color coded tissue Doppler imaging. Results In the FMF group, the mean high-sensitive C-reactive protein (hs-CRP) values were significantly higher, compared with the controls (p<0.01). According to the tissue Doppler measurements, E/Em value exhibited statistically significant increase in FMF patient and mean Em value were found to be significantly low (p<0.01). In the control group, two patients had diastolic dysfunction, whereas in the FMF group there were 23 (%46) patients with diastolic dysfunction. LV systolic dyssynchrony parameters including Ts-SD-12, Ts-12, Ts-SD-6, and Ts-6 were found to be higher in FMF group when compared to controls (p<0.01). In addition to that, number of the patients with ventricular dyssynchrony (a Ts-SD-12>34.4 ms) were higher in the FMF group than the control group (34.2±6.9 vs. 24.7±5.8; p<0.01). Ventricular dyssynchrony was detected in all FMF patients with diastolic dysfunction. In the correlation analysis, systolic dyssynchrony parameters were found to be correlated with hs-CRP, E/Em, and Em (p<0.01). Conclusions We found out that in FMF patients with normal EF and narrow QRS, left ventricular systolic dyssynchrony is an early manifestation of heart involvement and may be coexisted with by diastolic dysfunction. References Kiris A, Karkucak M, Karaman K, Kiris G, Capkin E, Gokmen F, et al. Patients with ankylosing spondylitis have evidence of left ventricular asynchrony. Echocardiography. 2012 Jul;29(6):661-7. Lachmann HJ, Sengul B, Yavuzsen TU, Booth DR, Booth SE, Bybee A, et al. Clinical and subclinical inflammation in patients with familial Mediterranean fever and in heterozygous carriers of MEFV mutations. Rheumatology (Oxford). 2006 Jun;45(6):746-50. Korkmaz C, Ozdogan H, Kasapcopur O, Yazici H. Acute phase response in familial Mediterranean fever. Ann Rheum Dis. 2002 Jan;61(1):79-81. Tavil Y, Ureten K, Ozturk MA, Sen N, Kaya MG, Cemri M, et al. The detailed assessment of left and right ventricular functions by tissue Doppler imaging in patients with familial Mediterranean fever. Clin Rheumatol. 2008 Feb;27(2):189-94. Baysal T, Peru H, Oran B, Sahin TK, Koksal Y, Karaaslan S. Left ventricular diastolic function evaluated with tissue Doppler imaging in children with familial Mediterranean fever. Clin Rheumatol. 2009 Jan;28(1):23-8. Kalkan GY, Bayram NA, Erten S, Keles T, Durmaz T, Akcay M, et al. Evaluation of left ventricle function by strain imaging in patients with familial Mediterranean fever. Echocardiography. Oct;27(9):1056-60. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1345

AB0952 Subclinical Left Ventricular Dysfunction in Patients with Ankylosing Spondylitis without Clinically Evident Cardiovascular Disease: A Two-Dimensional Speckle Tracking Echocardiographic Study

Background Cardiac involvement is common in ankylosing spondylitis (AS), which has not been previously evaluated by using speckle tracking echocardiography (STE). Objectives The objectives of this study were to evaluate the left ventricle (LV) systolic strain by STE in order to provide the subclinical myocardial dysfunction in patients with AS and to examine the relationship between LV systolic strain and disease activity indices. Methods A total of 26 patients with AS without clinically evident cardiovascular disease and 26 age-,sex-,and BMI-matched healthy controls were included in the study. Bath AS disease activity index, Bath AS fuctional index, Bath AS metrology index and Bath AS radiologic index were used as clinical indices. Conventional echocardiography, tissue Doppler imaging, color tissue Doppler derived strain/strain rate echocardiographic imaging were performed by a single cardiologist using a 2.5–3.5 MHz transducer and Vingmed System 7 (Vivid 7 Pro; Horton, Norway). All data were transferred to a workstation for further offline analysis (EchoPAC 6.1; GE Vingmed Ultrasound AS). For left ventricle color tissue Doppler dynamic images were obtained from from LV apical 4-, 3- and 2-C (chamber) views. Results There were no significant differences in baseline demographic characteristics and cardiovascular risk factors between the patients and the controls. There were no significant differences between patients and controls in terms of left ventricle diameters, ejection fraction, posterior wall thickness, interventriculer septum wall thickness, mitral deceleration time and systolic myocardial flow velocity (p>0.05). AS patients were observed to have statistically significantly lower left ventricule peak longitudinal and global strain/strain rate values in the 4C, 3C, and 2C views compared with the controls (p>0.05). In addition, we detected no correlation in left ventricule global strain values and AS clinical indices values (p>0.05). Conclusions Myocardial systolic function assessed by STE, which is a sensitive marker of ventricular dysfunction is impaired in AS. References Teske AJ, De Boeck BW, Melman PG, Sieswerda GT, Doevendans PA, Cramer MJ. Echocardiographic quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue Doppler and speckle tracking. Cardiovasc Ultrasound 2007;5:27. Schiller NB, Shah PM, Crawford M, et al: American Society of Echocardiography committee on standards, subcommittee on quantitation of two-dimensional echocardiograms: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiography 1989;2:358–367. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1961

AB0681 Bisphenol A Levels in Patients with Ankylosing Spondylitis and Its Correlation with Disease Activity

Background Ankylosing spondilitis (AS) is a systemic chronic inflammatory disorder of unidentified etiology. Bisphenol A (BPA) which act as a protective lining on the inside of metal-based food and beverage cans, is a chemical produced in large quantities for use primarily in the production of polycarbonate plastics such as hard plastic bottles and epoxy resins. BPA is an estrogenic endocrine disruptor that exerts an extensive variety of metabolic effects. Objectives The objective of present study was to measure serum BPA levels in patients with AS and to explore a possible link between serum BPA levels and disease activity scores. Methods A total of 50 AS patients (40 male, 10 female, mean age 41.14±11.65 years, mean body mass index 26.78±3.94 kg/m2) and 30 age-sex- and body mass index-matched healthy controls (23 male, 7 female, mean age 41.44±6.98, mean body mass index 27±3.06 kg/m2) were taken to the study. Disease activity of the AS patients was measured by Bath ankylosing spondylitis disease activity index (BASDAI). Results The median disease duration of the AS patients was 10.68±10.43 years. Forty-three patients were taking NSAID and/or DMARD. Seven patients were taking an anti-TNF agent. Serum BPA levels of the patients with AS was significantly higher than that of healthy controls (3.98±2.35 vs. 0.49±0.29; p=0.001). There was significant positive correlation between the serum BPA levels and BASDAI scores (r=0.321, p=0.025). Conclusions These data clearly show that serum BPA levels are significantly higher in patients with AS in comparison to age-sex-BMI-matched healthy controls. Furthermore, levels of BPA in AS patients were positively correlated with disease activity scores. References Ozgocmen S, Akgul O, Altay Z, et al. Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. International journal of rheumatic diseases 2012;15(3):229-38. Vandenberg LN, Maffini MV, Sonnenschein C, Rubin BS, Soto AM. Bisphenol-A and the great divide: a review of controversies in the field of endocrine disruption. Endocrine reviews 2009;30(1):75-95. Rogers JA, Metz L, Yong VW. Review: Endocrine disrupting chemicals and immune responses: a focus on bisphenol-A and its potential mechanisms. Molecular immunology 2013;53(4):421-30. Wells EM, Jackson LW, Koontz MB. Association between bisphenol A and waist-to-height ratio among children: National Health and Nutrition Examination Survey, 2003-2010. Annals of epidemiology 2013. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1383

Pathological fracture: an ill telltale in osteoporosis

A 31-year-old lady was admitted to our internal medicine ward for further evaluation after a previous episode of three concomitant fractures in her right ulna and radius last year. She described the cause as a fall down the stairs. Despite internal fixation, union was not achieved after 10 weeks, and a bowing deformity had simultaneously developed in her right humerus (Fig. 1). The medical history was uneventful except for goiter for the last 5 years that had been followed with a regimen of propylthyrouracil and propranolol. Her physical examination revealed tachycardia, tremor in her hands, wet skin, grade 2 diffuse palpable thyroid gland besides an obtrusive curvilinear forearm deformity. The laboratory analysis yielded Ca: 10.8 mg/dl (8.1–10.4), P: 3.38 mg/dl (2.6–4.5), alkaline phosphatase: 534 U/L (38–155), parathyroid hormone (PTH): 81 qmol/l (0.8–6.4), 25-OH vit-D3: 11.8 gg/ml (7.6–75), deoxypyridinoline: 23.4 nM/ day, free T3: 23.8 qmol/ml (1.45–3.48), free T4: 4.2 gg/dl (0.71–1.85), TSH: 0.06 lIU/ml (0.49–4.67), anti-thyroglobulin antibody: 483.5 U/ml (0–60), anti-microsomal antibody: 4358.8 U/ml (0–60). Bone mineral density was significantly decreased in the lumbar and hip regions ()2.75<T scores<-4.4). She was diagnosed with Graves’ disease along with a suspicion of parathyroid adenoma. She was then followed with the same drugs at higher doses, and further diagnostic interventions were carried out to uncover any parathyroid pathology. The ultrasonography was consistent with a diffuse enlargement of the thyroid gland with normal parathyroids. Thyroid scintigraphy demonstrated diffuse increased activity, while parathyroid scintigraphy with Tc-99m MIBI was normal. Therefore, although her age was atypical, we also considered Paget’s disease in the differential diagnosis. Accordingly, we performed bone scintigraphy which readily demonstrated multiple pathological sites of increased activity in the cranium, bilateral shoulders, right humerus, costae, right femur and tibia. Bone biopsy from the right humerus did not disclose any pathology. Due to the sustained increase in the subsequent PTH levels, we eventually decided to visualize the parathyroid glands and/or any likely ectopic foci secreting PTH with computed tomography (CT), which revealed a hypodense nodule with a diameter of 12 mm at the inferior pole of the left thyroid lobe (Fig. 2). Consequently, subtotal thyroidectomy and parathyroid adenectomy were performed, and the pathological evaluation was consistent with parathyroid adenoma. After discharge from the hospital, monitoring with serial thyroid function tests and bone turnover markers was planned, but she did not comply with her follow-up visits. Concurrent Graves’ disease and primary hyperparathyroidism is rare and accounts for hypercalcaemia in no more than 1% of thyrotoxic patients [1]. The clinical finding of increased calcium in such patients poses great diagnostic challenges to the physician. Hyperthyroidism itself, per se, can cause hypercalcaemia [2, 3], and thus the diagnosis of a parathyroid pathology may readily be overlooked. In our patient the consecutive PTH levels were found to be increased whereas, interestingly, the diagnostic interventions failed to ascertain the underlying disorder. Normally, ultrasonography and Tc-99m MIBI scintigraphy are highly sensitive for pathological parathyroids: 97.4% and 96.1%, respectively, and 100% when combined [4]. However, this adenoma could have only been demonstrated in the upper axial sections of the thorax CT, which also aimed to depict the presence of any extrasecretory foci. We also performed bone biopsy to rule out Paget’s disease which is known to accompany primary hyperparathyroidism or thyroid disease in Rheumatol Int (2004) 24: 187–188 DOI 10.1007/s00296-003-0385-1