Selda Sarikaya

The Effect(s) of a Six-Week Home-Based Exercise Program on the Respiratory Muscle and Functional Status in Ankylosing Spondylitis

Background:Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Involvement of costovertebral and costotransverse joints results in rigidity of the chest wall and inability to expand the chest fully on inspiration. Also significant reduction in exercise capacity in the AS patients was reported. Objectives:To determine the effects of a 6-week home-based exercise program on the respiratory muscle and energy cost in AS. Methods:Twenty-two AS patients were included. Chest expansion, tragus-wall distance, modified Schober test, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking distance, physiologic cost index and functional status Bath Ankylosing Spondylitis Functional Index of patients were measured at baseline and repeated at the end of an open 6-week home-based exercise program. Breathing exercises and upper extremity exercises were taught to all the patients. The patients were then asked to practice these exercises at home individually for 6 weeks. Results:Chest expansion, maximal inspiratory pressure, and maximal expiratory pressure values and Bath Ankylosing Spondylitis Functional Index scores of patients significantly increased after 6 weeks (P < 0.001). Six-minute walking distance and physiologic cost index values did not change at the end of the 6 weeks (P > 0.05). Conclusions:A home-based exercise program can have an effect on some measures respiratory muscle and functional status. Greater emphasis should be placed on maintaining cardiorespiratory fitness as well as spinal mobility to encourage patients with AS.

Is osteoporosis generalized or localized to central skeleton in ankylosing spondylitis

Background:Osteoporosis at the lumbar spine and at the femur is a well-established complication in ankylosing spondylitis (AS), but the exact mechanism and the distribution of osteoporosis are not known absolutely. Objective:To determine whether the osteoporosis is generalized or localized to central skeleton and to examine the relation between bone mineral density (BMD) and disease activity and radiologic progression in patients with AS. Methods:In this study, 26 patients with AS and 33 healthy controls matched for age and sex were recruited to the study. Hip and forearm BMD were measured by dual energy X-ray absorptiometry (DEXA). Laboratory and clinical disease activity parameters were documented, and anteroposterior sacroiliac radiographs were taken to determine the radiologic progression. Results:The urine deoxypyridinoline levels of the patients with AS were statistically significantly higher (P = 0.02) and the serum osteocalcin levels were significantly lower with respect to controls (P = 0.03). The femoral neck and femur BMD values and T scores were significantly lower in patients with AS compared with the controls (P = 0.019, 0.003, 0.01, and 0.01, respectively). The differences in BMD values and T scores of the distal 1/3 radius between 2 groups were not statistically significant. The relation between BMD and disease activity, and radiologic progression in patients with AS could not detected. Conclusion:Sparing of distal regions such as the as radius suggests that osteoporosis might be due to localized effects of inflammatory activity or immobility rather than a systemic effect. Both increased resorption and decreased formation might be involved in the pathogenesis of osteoporosis. Radius BMD may not be appropriate to evaluate bone loss in patients with AS.

Evaluation of Bone Mineral Density and Bone Turnover Markers in Patients with non-Cirrhotic Chronic Hepatitis B

Objective: To evaluate the bone mineral density (BMD) and the biochemical markers of bone turnover in non-cirrhotic chronic hepatitis B patients. Material and Methods: We compared 18-65 years old non-cirrhotic chronic hepatitis B patients and healthy controls for BMD and biochemical markers of bone turnover. BMD was measured at the lumbar spine and the left hip using DXA. Results: There were 31 hepatitis B patients (19 males, 12 females) and 72 healthy controls (56 males, 16 females) in the study. Their mean age was 37.4 ± 10.0 years in the study group and 38.5 ± 7.1 years in the controls. There were no differences between the two groups for the mean BMD levels and T scores. However, left hip BMD and T scores were significantly lower in male patients with chronic hepatitis B infection when compared to males in the control group. Serum calcium, phosphate, osteocalcine, intact parathyroid hormone, deoxypyridinoline and 25-hydroxycholecalciferol levels did not differ between the groups. Conclusion: In our study, left hip BMD and T scores were found to be significantly lower in the male patients with chronic hepatitis B infection when compared to males in the control group, however a significant difference was not detected when all cases were compared with the control group. Therefore, we suppose that further studies on a larger population are needed in this issue.