Sansin Tuzun

Bone mineral density in women with sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Almost any organs of the body, but mostly the lungs, are involved. Bone mineral density (BMD) can be affected directly or indirectly in chronic granulomatous systemic diseases such as sarcoidosis. The aim of our study was to evaluate BMD in premenopausal and postmenopausal sarcoidosis patients with or without prednisone treatment and to compare their BMD values with those of a control group having the same menopausal status. Thirty-five premenopausal women (18 untreated, 8 treated, and 9 controls) and 21 postmenopausal women (5 untreated, 5 treated, and 11 controls) were included in the study. All of the patients had a histologically proven diagnosis and were being followed-up at the Sarcoidosis Outpatient Clinic of our unit. BMD of the lumbar (L) spine and femoral neck was measured by dual-energy absorptiometry (DEXA). The subgroups of premenopausals and postmenopausals were compared separately. Comparison among the groups was performed by using analysis of variance. Age, duration of the disease, and body mass index were comparable in treated, untreated, and control subgroups of the pre- and postmenopausal groups, and the subgroups of postmenopausals had comparable durations since menopause. For premenopausals, BMD values at L1–4 were not significantly different among the subgroups (0.920 ± 0.08 g/cm2, 0.801 ± 0.09 g/cm2, and 0.910 ± 0.05 g/cm2, for untreated, treated, and controls, respectively). However, the BMD value at the femoral neck in treated patients (0.921 ± 0.1 g/cm2) was significantly lower than the values in untreated patients (1.080 ± 0.2 g/cm2; P ≪ 0.01) and in controls (1.028 ± 0.17 g/cm2; P ≪ 0.05). For postmenopausals, the BMD value at L1–4 in controls (1.019 ± 0.07 g/cm2) was significantly higher than the values in untreated patients (0.783 ± 0.01 g/cm2) and in treated patients (0.751 ± 0.08 g/cm2; P ≪ 0.001 for both). The BMD value at the femoral neck in controls (0.890 ± 0.1 g/cm2) was higher than the values in untreated patients (0.745 ± 0.08 g/cm2) and treated patients (0.747 ± 0.1 g/cm2), but the difference was not statistically significant (P = 0.06). We concluded that sarcoidosis patients, especially postmenopausal patients with corticosteroid treatment, may have an increased risk of bone mineral loss. Large-scale studies are warranted in order to delineate the exact roles of the disease itself, menopausal status, and corticosteroid treatment in this bone mineral loss.

Effects of flurbiprofen and tiaprofenic Acid on oxidative stress markers in osteoarthritis: A prospective, randomized, open-label, active- and placebo-controlled trial

BACKGROUND The relationship between oxidative stress and osteoarthritis (OA) has been widely investigated. Serum malondialdehyde (MDA), nitric oxide (NO), and Cu/Zn superoxide dismutase (SOD) levels are useful markers of oxidative stress. Because of the importance of oxidative stress markers in the pathogenesis of OA, treatment might involve modification of these markers to control oxidative stress. OBJECTIVE The aim of this study was to compare the effects of 2 conventionalNSAIDs on markers of oxidative stress in patients with OA of the knee. METHODS This 3-week, prospective, randomized, open-label, active- and placebo-controlled study was conducted at the Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey. Adult patients with clinically and radiographically diagnosed moderate OA of the knee who were previously untreated were enrolled. Patients were randomly assigned to 1 of 3 treatment groups: flurbiprofen 100 mg PO (tablets) BID, tiaprofenic acid 300 mg PO (tablets) BID, or placebo tablets BID. Patients were evaluated using clinical assessment and laboratory testing before treatment (week 0; baseline) and at the end of week 3. The primary end points were the differences in serum MDA, NO, and SOD levels versus placebo. Clinical parameters-pain at rest and on motion-were evaluated using a 10-cm visual analog scale (0 = no pain to 10 = worst pain imaginable). The duration (in minutes) of morning stiffness was recorded by patients, using patient diaries. The differences between treatment groups were assessed using multivariate analysis. RESULTS Thirty-nine patients (20 women, 19 men; mean [SD] age, 59.0 [11.3]years) were included in the study. Mean serum MDA and NO levels were significantly decreased at 3 weeks compared with baseline in the 2 active-treatment groups (all, P < 0.001); these values remained statistically similar to baseline in the placebo group. Serum SOD levels were increased significantly from baseline in the 2 active-treatment groups (both, P < 0.001), but not in the placebo group. No significant differences in serum MDA and NO levels were found between the group receiving flurbiprofen and that receiving tiaprofenic acid. Serum SOD levels were significantly higher in the flurbiprofen group compared with the tiaprofenic acid and placebo groups (both, P < 0.01). The mean (SD) score for pain at rest was significantly lower at 3 weeks compared with baseline with flurbiprofen and tiaprofenic acid (both, P < 0.001), but not with placebo. The mean score for pain on motion was significantly reduced from baseline values only with tiaprofenic acid (P < 0.001). The duration of morning stiffness was significantly shorter at 3 weeks compared with baseline in all 3 study groups (all, P < 0.001). The mean scores for pain on motion and duration of morning stiffness were significantly reduced with tiaprofenic acid compared with placebo (both, P < 0.05). The study had some limitations (ie, small sample size, no blinding, the short duration of the study, and the weak correlation between serum and synovial fluid levels of NO). CONCLUSIONS In this comparison of the effects of 3 weeks of treatment withflurbiprofen 100 mg BID and tiaprofenic acid 300 mg BID in patients with knee OA, both treatments effectively reduced serum MDA and NO levels compared with placebo. Only tiaprofenic acid significantly improved pain at rest and on motion and duration of morning stiffness compared with placebo.

The effect of flurbiprofen and tiaprofenic acid on serum cytokine levels of patients with osteoarthrosis

39 patients with active knee osteoarthrosis, chosen according to ACR criteria, were assigned to receive flurbiprofen (n 12, 2 2 100 mg), tiaprofenic acid (n 14, 2 2 300 mg) and placebo (n 13) in a 3-week, placebo-controlled study. All patients completed the study, and both medications were found to be effective: improvement occurred in the clinical signs. These drugs reduced the TNF- f levels. Flurbiprofen especially affected the IL-6 levels. Our findings indicate that NSAIDs may be effective in the etiopathogenesis of osteoarthrosis.

Effect of Whole-Body Vibration on Balance Using Posturography and Balance Tests in Postmenopausal Women.

ObjectiveThe authors examined the impacts of whole-body vibration (WBV) applications on balance control in postmenopausal women using clinical balance tests and computerized static posturography. DesignPatients were randomly divided into two groups and treated with WBV and/or home-based balance coordination exercises (BCEs). Patients in the WBV-BCE group were asked to stand on the platform in standing, squat, and deep squat positions. During each position, 30-sec vibration (30–35 Hz) and 60-sec rest periods were applied twice (20 sessions in total). The BCE program was performed by subjects twice per day. All subjects were evaluated before and after treatment using the Timed Up and Go test and the Berg Balance Scale (BBS). The fall index and the Fourier index were assessed via computerized static posturography. ResultsSixty patients were recruited for the study, but only 42 patients (21 in each group) completed it. Fall index and the total values of the Fourier index 2–4 and Fourier index 5–6 frequencies indicated a significant improvement in the WBV-BCE group (P < 0.05). Both groups showed significant improvements in the Berg Balance Scale and Timed Up and Go test (P < 0.05). ConclusionsThe ease of applying WBV furthermore supports its inclusion in daily treatment protocols for age-related decline in balance performance in women and improved balance and mobility measures associated with increased fall risk.

Anterior inferior iliac spine avulsion fracture.

A 13-yr-old boy was admitted with right groin pain that began after kicking a ball in a soccer game 1 wk before. He reported persistent pain in his groin, which was aggravated by movement of the hip; he also demonstrated tenderness upon palpation in the right inguinal area. Active flexion and passive hyperextension of the right hip were painful. An anterior-posterior radiograph of his pelvis demonstrated a minimally displaced ipsilateral avulsion fracture of the right anterior inferior iliac spine (AIIS) (Fig. 1). He was treated with bed rest for 3 days and simple analgesia for a week. Passive-assisted range-of-motion exercises were initiated as soon as pain allowed. He had limited active hip motion for 4 wks and then was permitted only light activity for another 4 wks. He returned to full activity at 12 wks after his injury. Children and adolescents account for almost half of sports-related injuries for all age groups, and 3%Y5% of all sports injuries occur in the groin area. The diagnosis of groin pain in athletes is difficult because the anatomy of the region is complex and two or more injuries often coexist. The most common avulsion fracture sites in the pelvis are the rectus femoris attachment on the AIIS, the sartorius attachment on the anterior superior iliac spine, and the hamstring attachment on the ischial tuberosity. Avulsion fractures of the AIIS are most commonly associated with sprinting activity or kicking sports, which entail a sudden pull of the rectus femoris muscle during forceful extension of the hip. These usually occur in adolescents when the ratio of muscular strength to physeal strength is greatest. Nonoperative treatment is usually recommended for avulsions from the AIIS. Avulsion fractures of the AIIS are often mistaken for muscle or tendon injuries. These must also be differentiated from os acetabuli (an accessory ossicle at the superior rim of the acetabulum), traumatic myositis ossificans of the rectus femoris, and bone tumors. Early diagnosis and proper management of AIIS fractures are imperative to prevent them from becoming chronic and potentially career limiting. Physicians must cautiously perform detailed physical examinations and correlate the clinical condition and radiologic findings to avoid misdiagnosis. AIIS avulsion injuries should be considered in the differential diagnosis of groin pain occurring while taking part in vigorous sports.