Tuncay Cakir

The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study

OBJECTIVE To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). MATERIAL AND METHOD The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. RESULTS Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd-3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th-5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). CONCLUSION The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.

FRI0504 Retinotoxicity of hydroxychloroquine; is it possible to demonstrate by spectral domain optical coherence tomography before development? a cross sectional investigation

Background Hydroxychloroquine is an antimalarial drug, which has been used for the treatment of autoimmune disorders as rheumatoid arthritis, connective tissue disease and Sjögren’s syndrome. Potential retinotoxicity of the antimalarial drugs is the main limiting issue of their consumption. Objectives To evaluate the alterations of retinal layers in rheumatic patients, who have been treated with hydroxchloroquine without the signs or symptoms of retinopathy by using spectral domain ocular coherence tomography (SD-OCT). Methods The retinal layers of patients who have been treated with hydroxychloroquine for rheumatoid arthritis, Sjögren’s syndrome and connective tissue diseases and age matched healthy controls were evaluated with SD-OCT. The macular cube protocol, optic disc cube protocol and horizontal and vertical HD five line raster scan protocol were applied. The measured parameters were compared between hydroxychloroquine users and healthy controls and among different diagnostic groups. in addition, correlation of these parameters with drug consumption duration and dose parameters of hydroxychloroquine were performed. Results A total of 402 eyes of 201 subjects [114 hydroxychloroquine users;40 RA, 47 SjS, 27 CTD and 87 age-mathced healthy females] were evaluated. The central and perifoveal layers and superior and inferior quadrants of retinal nerve fiber layer (RNFL) of hydroxychloroquine users were thinner than of non-users. Connective tissue disease group had longer duration and higher cumulative dose of hydroxychloroquine than other diagnostic groups. This group had thinner mean RFNL values than the other groups as well. There were significant and negative correlations between cumulative dose of drug and first quadrant of full foveal thickness and inferior quadrant of RFNL. Parafoveal and perifoveal layers were correlated negatively with dose of drug per kg of body weight. Conclusions We did not encounter a significant finding consistent with hydroxychloroquine-induced retinotoxicity. This may be the result of relatively short duration and low cumulative dose of consumed hydroxychloroquine as well as the possible safety of the drug. Nevertheless, peroidic screening should not be ommitted in order to be sure of being not-involving by retinotoxicity. SD-OCT may be the golden standard technique for the follow up of antimalarial-induced retinotoxicity in future. We need further investigation concerning the evaluation of retinotoxicity by SD-OCT Disclosure of Interest None Declared

THU0539 Mechanical traction for lumbar radicular pain: supine or prone? a randomised controlled trial

Background Mechanical lumbar traction has been used to treat spinal disorders and low back pain for centuries, since Hippocrates(.2,3Although the supine position is generally preferred, the patient may also be positioned prone during traction treatment(.4,5 However, to the best of our knowledge, no studies have compared the effects of lumbar traction in these two different positions for patients with chronic LBP. Objectives To compare the effects of mechanical lumbar traction either in the supine or prone position with conventional physical therapy(PT) in patients with chronic low back pain(LBP) and lumbosacral nerve root involvement in terms of disability, pain, and mobility. Methods Participants(n=125) were randomly assingned to receive 15 sessions of PT with additional mechanical lumbar traction either in the supine position (supine traction group), or in the prone position (prone traction group), or only PT without traction(PT only group). Patients were assessed at baseline and at the end of the PT sessions in terms of disability, pain, and mobility. Disability was assessed using the modified Oswesty Disability Index (ODI); pain was assessed using a visual analogue scale (VAS); and lumbar mobility was assessed using the modified lumbar Schober test (mLST). Results 118 patients completed the trial. All groups improved significantly in the ODI, VAS, and mLST (p<0.05) (table 1). In the between-group analysis, improvements of ODI and VAS were found significantly better in the prone traction group compared with the PT only group (adjusted p=0.031 and.006, respectively). Conclusions Addition of traction in prone position to other modalities resulted in larger immediate improvements in terms of pain and disability, and the results suggest that when using traction, prone traction might be first-choice. Further research is needed to confirm the benefits of lumbar traction in the prone position. References [1] Marketos SG, Skiadas P. Hippocrates. The father of spine surgery. Spine1999;24:1381–7. [2] Krause M, Refshauge KM, Dessen M, et al. Lumbar spine traction: evaluation of effects and recommended application for treatment. Manual therapy2000;5:72–81. [3] Harte AA, Gracey JH, Baxter GD. Current use of lumbar traction in the management of low back pain: results of a survey of physiotherapists in the UK. Archives of physical medicine and rehabilitation2005;86:1164–9. [4] Fritz JM, Lindsay W, Matheson JW, et al. Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine2007;32:E793–800. Disclosure of Interest None declaredAbstract THU0539 – Table 1 Supine traction group(n=39) Prone traction group(n=39) Only PT group(n=40) preintervention postintervention P preintervention postintervention P preintervention postintervention P ODI 50.4±22.5 33.2±15.5 .001 53.8±15.1 35.9±15.9 .001 49.5±15.1 40.9±17.6 .002 VAS 8.0±1.6 4.3±2.2 .001 8.0±1.7 3.7±2.7 .001 7.7±1.5 5.2±2.3 .001 mLST 19.4±1.9 20.7±1.8 .001 18.8±1.8 20.5±1.3 .001 19.7±1.9 20.8±1.7 .001

Acute Calcium Pyrophosphate Arthritis after Parathyroidectomy

Hypocalcemia after parathyroidectomy is a well-known metabolic sequela, but rare conditions such as acute calcium pyrophosphate (CPP) arthritis can be observed. In this study, we presented a case of acute CPP arthritis in both knees after parathyroidectomy. A 48-year-old man presented with pain and swelling in his right knee that started 1 day ago. There was no feature in his background and family history other than parathyroidectomy surgery performed for parathyroid adenomy a week ago. The diagnosis of acute CPP arthritis was made on the basis of blood, imaging and synovial fluid analysis. Evaluation was made after 3 days and acute arthritis in left knee was detected. Similar findings were also observed in the synovial fluid examination. After cold application and colchicine 1 mg/day started, improvement in arthritis and acute phase markers was detected. Acute CPP arthritis after parathyroidectomy is a rare condition and there are various theories in this regard. According to the most widely accepted theory; as a result of the decrease in the calcium level, the solubility of the CPP crystals decreases, and the CPP crystals previously deposited in the articular cartilage are poured into the synovial fluid. As a result; CPP arthritis should also be considered in differential diagnosis in patients with arthritis after parathyroidectomy and synovial fluid analysis should be performed.

Evalution the Effects of Raloxifene and Risedronate on Serum Biochemical Markers

Summary Objective: Osteoporosis a progressive bone disease that is characterized by a decrease in bone mass which can lead to an increased risk of fracture. Osteoporosis is still a global public health problem. In recent years, many new osteoporosis drugs have become available but none of them is totally curative. The aim of the present study was to evaluate and compare the effects of risedronate and raloxifene on bone mineral density (BMD) and bone turnover markers. Materials and Methods: A total of ninety patients with postmenopausal osteoporosis were randomly divided into three groups receiving calcium-vitamin D plus raloxifene, calcium-vitamin D plus risedronate, and only calcium-vitamin D (control group). Serum osteocalcin and collagen type 1 cross-linked C-telopeptide (CTX) were measured before treatment and after 3, 6, 9 and 12 months of treatment. BMD was measured by Dual-Energy X-Ray absorptiometry (DEXA) before treatment and after 12 months of treatment. Results: Serum CTX levels were decreased significantly (p<0.001) in all groups from baseline to post therapy of 3 months and this decrease continued to the end of the study. Serum osteocalcin levels were decreased significantly (p<0.001) in treatment groups compared to control group. L1-L4 and femur total BMD was statistically lower in treatment groups compared to control group after 12 months of the therapy (p<0.001 and p<0.05, respectively). Conclusion: The results of the present study showed us that risedronate and raloxifene were both effective on bone mineral density and the effect of both of them to do not differ not from each other in the treatment of osteoporosis. (Turkish Journal of Osteoporosis 2014;20: 110-6)

AB0799 The Efficacy of Platelet Rich Plasma Injection on Pain Severity and Functional Status in Patients with Knee Osteoarthritis

Background Knee osteoarthritis is one of the most frequent causes of pain and disability (1). The aims of the treatment are to control pain, prevent or improve joint functions, facilitate functional self-dependence and increase quality of life (2). Platelet Rich Plasma (PRP) injection is one of the current treatment options which has been used with increasing frequency. The PRP is obtained from autolog blood that contains intensive platelets and growth factors 3-5 times more than normal plasma and contributes tissue healing. Objectives The aim of this study is to investigate the efficacy of PRP injection on pain severity and function in knee osteoarthritis. Methods 515 patients (1030 knees) with knee osteoarthritis according to ACR criterias were included in the study. The data of the patients who underwent PRP injections 2 times within 3 months was investigated retrospectively. Pain severity and functional status were assessed with VAS and WOMAC questionnaire before and after the treatment. Results Before the treatment, the mean values of VAS in motion and rest were 7,37±2,03 and 4,11±2,47; respectively. After the treatment the mean values of VAS were 5,35±2,26 and 2,25±2,15. WOMAC total scores were 80,93±17,32 and 61,75±18,15 before and after the treatment. Statistically significant differences were found in VAS and WOMAC scores before and after the treatment (p=0.000). Conclusions In this study, the efficacy of PRP injection on pain severity and functional status in knee osteoarthritis was demonstrated however it is clear that high quality randomised plasebo controlled studies are needed. References Hunter DJ, Log GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment Rheum Dis Clin N Am 2008;34:689-712 Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism Turk J Rheumatol 2012;27(1):1-17 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5127

AB0861 Genetic Role of Serotonergic System on Pathogenesis of Primer Fibromyalgia

Background Fibromyalgia is a chronic pain syndrome, characterized by widespread pain and tenderness at spesific anatomical localizations. Objectives The purpose is investigating candidate genes related to the serotonergic system which is thought to be responsible for the pathophysiology of primer fibromyalgia and the validity of serotonin receptor gene polymorphisms for the Turkish society. Methods Ninety-six female patients diagnosed with fibromyalgia according to 1990 and 2010 ACR criteria and 96 healthy controls were included in the study. A detailed medical history of the patients were taken, the symptoms were questioned. Assessment of disease activity and functional status were performed with tender point examination and assessment of the severity of the pain, Fibromyalgia Impact Questionnaire. A total of 192 blood samples were taken from the patient and the control group and isolation of DNA was performed. Primer design for serotonin receptor gene was done, the products derived from polymerase chain reaction were cleaned. The analysis of sequence results after the sequence reaction and statistical evaluation were performed. Results The regions of serotonin receptor 2A gene were analyzed. According to the analysis, E318E mutation occurring at amino acid 318 which has not caused a change in any amino acid, and V143V mutation which has not caused a change at amino acid 143 were detected for the first time. A similar number of heterozygous polymorphic allele of rs35224115 single-nucleotide polymorphism were found in the patient and control groups. Although, Rs6305 was found as polymorphic heterozygous in 7 samples in the patient grup, it was found in 3 samples in the control group. Although, Rs6314 was found in 3 samples as polymorphic heterozygous in the control group, it was found in 16 samples in the patient group. The difference between the two groups in terms of the incidence of heterozygous allele was statistically significant according to chi-square test (p=0.002). Conclusions In our study that we investigate the relationship between fibromyalgia and the exons of serotonin receptor 2A gene which are the protein-coding regions, we found that rs6314 polymorphism associated with the disease. This relationship is a result which can be used and developed for diagnostic and treatment process. We also determined two new possible polymorphism single base change (E318E, V143V), but we did not find any relationship with the fibromyalgia syndrome. We determined that, there was no differce in terms of other known polymorphisms between patients and controls. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4187