Reyhan Çeliker

Psychological disturbance in fibromyalgia: Relation to pain severity

SummaryFibromyalgia is a form of nonarticular rheumatism characterized by musculoskeletal aching and tenderness on palpation. The role of psychological factors in fibromyalgia has been controversial. The aim of this study was to evaluate the relationship of fibromyalgia to the intensity of anxiety and depression and to determine the correlation between psychological disturbances with disease duration and pain severity.Thirty-nine patients with fibromyalgia and 36 healthy controls were included in this study. Beck depression inventory, State and trait anxiety inventory and Beck hopelessness scale were used to evaluate psychological disturbances. Visual analog scale was used to determine pain intensity.We found a significant difference in the psychological status between patients with fibromyalgia and control subjects as measured by Beck depression inventory and trait anxiety inventory; 35.9% of the patients scored higher than the cut-off score on the Beck depression rating scale. Pain severity was found to be correlated with trait anxiety inventory scores. These results suggest that somatic expression of depression is an important difference between fibromyalgia and control groups. The difference between state and trait anxiety inventory reflects that current anxiety is not secondary to pain but trait anxiety is possibly causally related to pain.

Temporomandibular joint involvement in rheumatoid arthritis. Relationship with disease activity.

Involvement of temporomandibular joint (TMJ) in rheumatoid arthritis (RA) patients is described, but the incidence varies greatly. In this study our aim was to determine the frequency and character of TMJ involvement in RA patients asymptomatic for this joint, to investigate the relationship with disease activity, and to evaluate the early diagnostic value of imaging techniques. Twenty patients were included in this study, ten were evaluated with computed tomography (CT) and ten with magnetic resonance imaging (MRI). Among the 20 patients 45% had TMJ involvement detected by imaging techniques. The most frequent pathological signs were osteophyte formation, erosion of the mandibular condyle and decreased joint space (40%). Age, duration of disease, number of swollen joints. CRP and RF levels were found to be correlated with TMJ involvement. It is concluded that TMJ involvement may be detected even in asymptomatic patients with RA and there is a positive correlation between the severity of disease and involvement of TMJ.

Thoracic sequels after thoracotomies in children with congenital cardiac disease

The standard surgical approach for closed heart procedures in small infants and children is to use a posterolateral thoracotomy incision, which results in the division of the latissimus dorsi and serratus anterior muscles. The aim of our study was to determine the frequency and type of musculoskeletal deformities in children undergoing surgery with this approach for congenital cardiac disease. We included 49 children, 28 boys and 21 girls, in the study. Their mean age was 10.2 +/- 4.8 years, the mean age at the time of surgery was 3.8 +/- 4.0 years, and they were evaluated at an average of 6 years after the thoracotomy. Of the patients, 94% had various musculoskeletal deformities. Scoliosis was observed in 15 patients (31%) but only in two patients did the curves exceed 25 degrees. Of these patients, three-fifths had aortic coarctation. Elevation of the shoulder was seen in 61%, winged scapula in 77%; while 14% had asymmetry of the thoracic wall due to the atrophy of the serratus anterior muscle. Deformity of the thoracic cage was observed in 18%; and 63% had asymmetry of the nipples. Thus, we found that musculoskeletal deformities are frequent after thoracotomies in children with congenital cardiac disease. Patients who have undergone such procedures for cardiac or noncardiac surgery should be followed until their skeletal maturation is complete. Techniques sparing the serratus anterior and latissimus dorsi muscles should be preferred. These adverse effects of thoracotomy may be another reason for using interventional procedures in these cases.

Bone Mineral Density in Children with Juvenile Chronic Arthritis

The aim of this study was to evaluate bone mineral density changes in patients with juvenile chronic arthritis (JCA) and to determine the most likely causes of osteoporosis in these patients. Eighteen (11 male, 7 female) patients suffering from JCA and 14 healthy controls (10 male, four female) were included in this study. The mean age of the patients and control groups were 11.0±3.2 and 10.9±2.9 years respectively. Disease activity was determined by clinical and laboratory evaluation and ‘Articular Disease Severity Score’ (ADSS). Bone mineral density (BMD) of the femoral neck and lumbar spine was measured by dual photon absorptiometry.BMD of the patients at the lumbar spine was significantly lower than the control group (p<0.05). This difference was more marked in patients treated with steroids. Femoral neck BMD was also lower in the patient group but this difference was not statistically significant. There was a negative correlation between ADSS and BMD at the spine. In conclusion, trabecular bone loss is characteristic for osteoporosis in JCA. Our results indicate that steroid treatment and disease severity are important factors in the development of osteoporosis in JCA.

The role of quantitative ultrasound in predicting osteoporosis defined by dual X-ray absorptiometry

Abstract The aim of this study was to establish whether quantitative ultrasound (QUS) parameters could identify patients classified as osteoporotic and osteopenic on the basis of dual energy X-ray absorptiometry (DEXA). One hundred and twenty-three patients (39 male, 84 female) with osteoporosis and suspected of having osteoporosis were included in this study. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured and bone mineral densities (BMD) of the lumbar spine and left hip was measured by DEXA. Subjects were classified into three groups (normal, osteopenic and osteoporotic) on the basis of BMD T-scores measured by DEXA. QUS parameters of the osteoporotic group were significantly lower than those of osteopenic and normal groups; there was no difference in QUS parameters between the normal and osteopenic groups. Correlations of both right and left SOS and BUA with the spine and femoral neck BMD were moderate (r=0.343–0.539, P < 0.001). There was also reasonable correlation between DEXA and QUS T-scores (r=0.364–0.510, P < 0.001). QUS had a sensitivity of 21% and a specificity of 95% for diagnosing osteoporosis. We concluded that, although DEXA and QUS parameters were significantly correlated, QUS parameters can not predict osteopenia as defined by DEXA, and sensitivities and specificities of QUS parameters were not sufficiently high for QUS to be used as an alternative to DEXA.

Osteoporosis in rheumatoid arthritis: Effect of disease activity

SummaryIn addition to juxtaarticular osteoporosis, which appears to reflect predominantly local disease mechanisms, more generalized bone loss can occur in rheumatoid arthritis(RA). The aim of this study was to compare bone mineral density (BMD) of the lumbar spine and proximal femur in RA patients versus controls and evaluate the influence of disease related determinants. Twenty-seven patients with RA and twenty healthy subjects were included in this study. BMD was significantly reduced in RA patients compared with the control group. BMD was correlated with duration of disease, health assessment questionnaire scores, hand grip strength and erythrocyte sedimentation rate. These results support the hypothesis that BMD may be affected by RA related determinants.

Muscle performance in fibromyalgia syndrome.

Abstract The objective of the study was to examine the muscle performance, isokinetic muscle strength, muscle endurance ratio, and submaximal aerobic performance in fibromyalgia syndrome (FMS) patients, to evaluate the relation between muscle performance, pain severity, clinical findings, and physical activity level, and to compare the results with healthy control subjects. Twenty-four FMS patients and 15 control subjects participated in this study. Data were obtained about the symptoms, location and onset of pain, treatment, and associated symptoms. Patients and controls underwent an examination of isokinetic muscle strength of right quadriceps on a Cybex dynamometer, and submaximal aerobic performance tests (PWC-170) were done for all subjects. Maximal voluntary muscle strength of the quadriceps was significantly lower in patients compared with the control group. Endurance ratios showing the work capacity were not statistically different between two groups. Submaximal aerobic performance scores were higher in the control group. There was not a relation between the decreased muscle performance and clinical findings, including pain severity, number of tender points, and duration of the symptoms of FMS patients. We found a reduced quadriceps muscle strength and submaximal aerobic performance in patients with FMS, indicating that patients have impaired muscle function.

Factors playing a role in the development of decreased bone mineral density in juvenile chronic arthritis

ObjectiveThe aims of this study were to evaluate bone mineral density (BMD) in patients with juvenile chronic arthritis (JCA), compare them with healthy controls, and assess the effects of disease activity and corticosteroid treatment on BMD.MethodsTwenty-eight patients diagnosed with JCA and 45 healthy controls were included in this study. Disease activity was determined by clinical and laboratory evaluation, Articular Disease Severity Score (ADSS), and the Juvenile Arthritis Functional Assessment Report (JAFAR). Bone mineral density of the lumbar spine was measured by dual energy X-ray absorptiometry (DEXA).ResultsPatients with JCA showed significant decreases in BMD compared with healthy controls. The JCA patients treated with corticosteroids showed significantly lower BMDs than the healthy control group. Age of the patients and age of onset were found to correlate with BMD.ConclusionOur study showed that glucocorticoids were involved in the development of osteoporosis in JCA, with many other factors affecting bone mineralization. We could not demonstrate any relationship between BMD and disease activity, but the study data suggest that early onset disease is also an important factor in the development of osteoporosis in JCA.

Fibromyalgia versus Rheumatoid Arthritis: A Comparison of Psychological Disturbance and Life Satisfaction

Objectives: The aim of this study was to compare the intensity of anxiety, depression, and hopelessness in fibromyalgia syndrome [FMS] and rheumatoid arthritis [RA] patients and to determine the differences of life satisfaction in these patient groups. Methods: Twenty patients with RA, 20 patients with FMS, and 20 healthy control subjects were included in this study. All the subjects were female. The Beck Depression Inventory [BDI], Spielberger State and Trait Anxiety Inventory [STAI], and Beck Hopelessness Scale [BHS] were used to evaluate psychological disturbance, and the life satisfaction index [LSI] was used to measure psychological well-being. Results: The mean BDI scores were higher in both the FMS and RA groups, trait anxiety scores in FMS and state anxiety scores in RA were significantly higher compared with the control group. The mean BHS score was higher in the RA group. The LSI results were similar in FMS and RA but significantly lower than the control group. The BDI was found to be correlated with functional status which was measured by health assessment questionnaire in the RA group. There was a negative correlation between LSI and STAI in both the FMS and RA groups but LSI was correlated with BDI only in the RA group. Conclusion: In conclusion, life satisfaction was similar in RA and FMS patients although RA patients were more disabled because of the arthritic disease. Both depression and anxiety were predictors of low life satisfaction in RA, but in FMS only anxiety had a negative role on life satisfaction.

Predictors of bone mineral density in healthy males.

Abstract.Osteoporosis (OP) is a growing health problem not only in women but also in men. It is well known that men lose bone during aging and are at risk for OP, but the risk factors for OP in men remain controversial. To assess determinants of bone mineral density (BMD) in the spine and femoral neck, 37 healthy men aged 43–73 years were measured using dual photon absorptiometry. Predictors of lumbar spine and femoral neck BMD were determined using multiple linear regression analysis. Backward elimination procedure was used to identify variables significantly related to BMD. The independent variables entered the regression model included age; body mass index (BMI); smoking history; alcohol intake; urinary calcium and hydroxyproline; and serum concentrations of osteocalcin, parathyroid hormone, testosterone, growth hormone, and cortisol. Backward regression analysis indicated that testosterone, cortisol, and BMI were significant predictors of BMD in the lumbar spine while testosterone, hydroxyproline, and osteocalcin were significant predictors of BMD in the femoral neck. Testosterone, cortisol, and BMI accounted for 44% of the total variance in lumbar spine BMD, and testosterone, hydroxyproline, and osteocalcin accounted for 20% of the total variance in femoral neck BMD. These observations suggest that testosterone, cortisol and BMI are determinants of lumbar spine BMD, while testosterone, urinary hydroxyproline, and osteocalcin are determinants of femoral BMD in healthy men.