Safinaz Ataoğlu

The platelet indices in patients with rheumatoid arthritis: Mean platelet volume reflects disease activity

The present study was designed to investigate the interaction between platelet indices, inflammatory markers and disease activity in rheumatoid arthritis (RA) subjects. The effects of anti-TNF-α therapy and conventional treatment on platelet indices were also compared. We studied 97 patients with RA (19 men, 78 women: mean age 51 years) and 33 age and sex-matched healthy subjects as a control group. All RA patients were administered conventional therapy. After 3 months of therapy, 35 subjects who had high disease activity score (DAS28 > 5.1) were grouped as non-responders and were administered infliximab as a TNF-α blocker at the standard intravenous dose. Responders to the conventional therapy and non-responders were also compared. At baseline white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet count and mean platelet volume (MPV) were significantly higher in patients with RA. Mean platelet volume was positively correlated with DAS28 score (r = 0.27; p = 0.007). These markers of inflammation and platelet indices were substantially decreased after therapy. The reductions were similar in responders to conventional therapy and non-responders (TNF alpha group). In conclusion, we found that MPV was correlated with inflammatory markers and disease activity in patients with RA. Both anti-TNF-alpha and conventional therapy decreases markers of inflammation and platelet indices. MPV can reflect both disease activity and response to treatment.

The platelet functions in patients with ankylosing spondylitis: anti-TNF-α therapy decreases the mean platelet volume and platelet mass.

The present study was designed to investigate the interaction between platelet indices (mean platelet volume (MPV), platelet count (PLC) and platelet mass (PLM)), inflammatory markers and disease activity in ankylosing spondylitis (AS) subjects. The effects of anti-TNF-α therapy and conventional treatment on platelet indices were also compared. We studied 68 patients with AS (group I, 46 men, age: 36.4 ± 6.9 years) and as control group 34 age and sex-matched healty subjects. All patients received conventional therapy (CT) at the beginning (Group I). The patients were reevaluated after 3 months according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. Group II consisted of 35 subjects who responded to the CT and continued to take the same therapy for 3 months additionally. Group III consisted of 33 subjects who had a high disease activity score (BASDAI > 4) after 3 months and were accepted refractory to the CT therapy. In Group III the treatment was switched to infliximab and continued for 3 months at the standard intravenous dose. Significantly higher baseline MPV, PLC and PLM was reported as compared to controls decreased by therapy (9.12 ± 1.20 vs. 8.35 ± 0.94 fl, p < 0.001, 340 ± 69 vs. 251 ± 56 (×103/ µL) p < 0.0001, 3096 ± 736 vs. 2110 ± 384; p < 0.0001, respectively). In the same way, they were substantially lowered by both treatments in group II and group III. PLC and PLM were positively correlated with WBC and ESR (r : 0.44; p < 0.0001, r : 0.41; p = 0.001, r : 0.52; p < 0.0001, r : 0.41; p = 0.001), respectively) in AS patients. Additionally, MPV and PLM were positively correlated with BASDAI score (r : 0.41; p < 0.001, r = 0.29; p < 0.001 respectively). We have found that increased platelet activity reduced by therapy in AS patients. Additionally, it was correlated with inflammatory markers and disease activity. According to these results, it can be suggested that both anti-TNF-α and conventional therapy might contribute to a decrease in the risk of cardiovascular morbidity and mortality in AS patients.

Anemia as a risk factor for low bone mineral density in postmenopausal Turkish women

BACKGROUND We investigated the association of bone mineral density (BMD) by detected dual-energy X-ray absorptiometric (DXA) method and hemoglobin (Hb) levels in a large sample. METHODS The current study enrolled 371 postmenopausal women (82 anemic patients), who were screened for osteopenia or osteoporosis by DXA. Patients with osteopenia or osteoporosis (T score<-1.0 SD) were grouped as having low bone mass (LBM). RESULTS Anemic patients were older and had significantly higher duration of menopause. When compared with subjects with normal Hb, anemic patients had significant lower femur t score, femur BMD, femur Z score, spinal t score, spinal BMD and spinal Z score (p<0.001). Additionally, the ratio of subjects with LBM in the femur and spine were significantly high in anemic patients (p<0.002, p<0.002, respectively). There were significant correlations between Hb values and femur t score, femur BMD, spine t score, and spine BMD values of the study population in bivariate correlation analysis (r=0.150, p=0.004, r=0.148, p=0.004, r=0.160, p=0.002, r=0.164, p=0.001, respectively). Furthermore, presence of anemia was found to be an independent predictor of LBM for spine [OR: 2.483 (95% CI: 1.309-4.712), p<0.005] in logistic regression analysis. Additionally, number of anemic patients was significantly high in low femur and spine BMD groups (56 vs. 26; p=0.01, 66 vs. 16; p=0.002, respectively). CONCLUSION We have found that the presence of anemia was as an independent predictor of LBM for spine after adjusting for body mass index and other confounders in postmenopausal Turkish women.

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis

Abstract Purpose: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. Methods: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV–EDV)/PSV]. Results: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. Conclusion: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Avulsion Fracture of the Anterior Inferior Iliac Spine in a Soccer Player

A 14-year-old male soccer player presented with left groin pain that had started suddenly after kicking the ball during a soccer game the day before. His pain was aggravated during the swing phase of walking and active flexion of the hip. Inspection revealed no swelling or erythema in the inguinal area. Moderate tenderness was noted upon palpation of the right inguinal region. Passive range of motion of the right hip was normal except for limited hip extension. Weakness in hip flexion was attributed to pain. An anteroposterior radiograph of the pelvis showed a displaced avulsion fracture of the anterior inferior iliac spine (AIIS; Figure 1). This finding was confirmed by a pelvic computed tomography scan that revealed a crescent-shaped bone fragment displaced inferiorly about 1.5 cm from the right AIIS (Figure 2). Avulsion fractures of the pelvic apophyses are very uncommon and almost always occur in adolescents before their growth plates close [1]. The most typical locations are the anterior superior iliac spine, AIIS, and ischial tuberosity [2]. These fractures may be overlooked and can be easily confused with an insertional tendinitis or musculotendinous tear. Patient history, as in this case, demonstrates the typical mechanism of injury involving a sudden and forceful muscular contraction during sport activities. The avulsion of the AIIS occurs after forceful contraction of the rectus femoris muscle. The most commonly reported mechanisms are kicking and running [2,3]. Treatment of avulsion fractures of the pelvic apophyses includes surgical and nonsurgical interventions. Surgical treatment, primary open reduction, and internal fixation may be warranted when the fragment is displaced greater than 2 cm or the ischial tuberosity is involved [3]. This young athlete was treated conservatively with 3 weeks of non–weightbearing activity, 3 weeks of partial weight-bearing activity, and then a gradual return to full

Dual diagnosis: rheumatoid arthritis and multiple sclerosis.

Juvenile rheumatoid arthritis (JRA) is the most common rheumatologic disease in children. Moreover, multiple sclerosis (MS) is the most frequent demyelinating disease and has been associated with various chronic inflammatory diseases. However, its association with JRA has not been frequently described. Autoimmunity in both JRA and MS has been documented in the scientific literature, although there has been no definitive finding that patients with JRA are prone to the development of MS. An increasing frequency of MS resulting from an increased use of antitumor necrosis factor agents in the treatment of rheumatoid arthritis and other chronic inflammatory diseases has been reported recently. In this study, we report on the development of MS in a patient with JRA who did not have a history of antitumor necrosis factor use.

Lumbar Fractures More Common in Multiple Myeloma

To the Editor: We have read with interest the article entitled “Inpatient Rehabilitation in Persons With Multiple Myeloma–Associated Fractures: An Analysis of 8 Consecutive Inpatient Admissions” by Cheng and O’Dell [1]. We would like to share our experience. A 57-year-old male patient was admitted to our outpatient clinic with abdominal pain and severe low back pain. His back pain progressed during a 2-month period without any antecedent trauma. Initially he was diagnosed with gastritis and then lumbar spondylosis. Upon admission to our clinic, spinal motion in this patient was painful in all directions, and there was prominent muscle spasm at the thoracolumbar region. Lower limb neurologic function was normal. Spine x-rays and then lumbar magnetic resonance imaging revealed a lumbar compression fracture with collapse (Figure 1). In addition, an elevated erythrocyte sedimentation rate and level of C-reactive protein, along with hypoalbuminemia, hypercalcemia, hyperuricemia, and severe anemia, were found. He was finally diagnosed with multiple myeloma. Although the femur was the most common site of fracture in Cheng and O’Dell’s cohort, the spine is the most common site of