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Oxidative status in rheumatoid arthritis

The insufficiency of antioxidant defense systems and the acceleration of the oxidative reactions can be results of the pro-oxidant/antioxidant imbalance in rheumatoid arthritis (RA). The aim of our study was to investigate the changes in oxidant status by measuring two different parameters; one was the level of malondialdehyde (MDA) as an index of lipid peroxidation and the other was total oxidative status; we could then compare our results with the antioxidant status, superoxide dismutase (SOD) enyzme activities. All were assessed in 22 patients with active RA and 18 age- and gender-matched control subjects. While serum MDA levels were significantly increased in patients with RA compared to the control group (p<0.03), the total oxidative status levels were decreased in patients with RA compared to the control group (p<0.008), and serum SOD activities did not show any statistical difference between the two groups. In conclusion, the increased MDA levels in our study may be important as a marker but are not sufficient to conclude that there was an increase in oxidative stress in RA patients because supporting results were not obtained from SOD and oxidative status measurements. These results give further support to the concept of oxygen free radicals playing a role in the pathogenesis of chronic inflammatory disorders, but we also consider that there is a more complex relationship than has been assumed. We think that further studies are needed to clarify these conflicting results.

Isokinetic and isometric strength in osteoarthrosis of the knee. A comparative study with healthy women.

Dynamic stability of the knee joint depends on the appropriate strength ratio of quadriceps and hamstring muscles. The purpose of this investigation was to determine the maximum peak torque (MPT) and MPT ratios of hamstrings to quadriceps (H/Q) muscles in patients with knee osteoarthritis (OA). Two groups of patients were included in the study. The first group consisted of 30 patients (Group A) with the clinical and radiologic findings of knee OA. The second group consisted of 30 patients (Group B) exhibiting knee joint pain without roentgenologic findings of knee OA. The findings of two patient groups were compared with each other and also with 30 healthy subjects (Group C). Isokinetic (at 60 degrees/s and at 180 degrees/s) and isometric (at 30 degrees and at 60 degrees of knee flexion) tests were performed by the rate-limiting isokinetic dynamometer system. Isokinetic and isometric MPT loss of knee flexors and extensors was found in both patient groups with respect to controls, but MPT ratios of H/Q muscles did not show a statistically significant difference compared with the control group. This may be related to the equal strength loss of knee flexors and knee extensors in patients with knee OA. It is concluded that strengthening exercises of hamstring muscles is as important as quadriceps strengthening in rehabilitation of knee OA.

Oxidation of Uric Acid in Rheumatoid Arthritis: Is Allantoin a Marker of Oxidative Stress?

Free radicals are implicated in many diseases including atherosclerosis, cancer and also in rheumatoid arthritis. Reaction of uric acid with free radicals, such as hydroxyl radical and hypochlorous acid (HOCl) results in allantoin production. In this study, we measured the serum allantoin levels, oxidation products of uric acid, as a marker of free radical generation in rheumatoid arthritis. Fasting blood samples were obtained from 21 rheumatoid patients and 15 healthy controls. In this study, the serum allantoin and uric acid levels were measured by a gas chromatography–mass spectrometry method and the ratios were calculated. The mean allantoin and uric acid levels and ratios in the patient group were 22.1±11.3, 280.5±65.0 and 8.0±3.7 μM, while in the control group they were 13.6±6.3, 278.3±53.6 and 4.9±2.1 μM, respectively. The effects of gender, age, menopausal status, duration of disease and medications on serum allantoin and uric acid levels of the patient and control groups were studied. Our results suggest that uric acid acts as a free radical scavenger and thus is converted to allantoin. Increased allantoin levels suggest the possible involvement of free radicals in rheumatoid arthritis.

Assessment of homocysteine, neopterin and nitric oxide levels in Behcet's disease

Abstract Background: Behçets disease is a multysystemic immunoinflammatory disease with a wide variety of clinical manifestations, whereas recurrent aphthous stomatitis is a local oral disease. The aim of this study was to examine the distribution of homocysteine levels in patients with active Behçets disease, possible association of homocysteine with nitric oxide and neopterin levels, and to characterize the differences between patients with Behçets disease and those with recurrent aphthous stomatitis in terms of these parameters compared with healthy controls. Methods: A total of 23 patients with active Behçets disease, 25 patients with recurrent aphthous stomatitis as positive controls, and 21 healthy subjects were included in this study. Serum homocysteine and neopterin levels were measured flourimetrically by HPLC. Serum nitric oxide production was assayed by measuring total nitrite levels with Griess reagent. Results: Significantly higher homocysteine (12.9±3.3 μmol/L) and lower nitric oxide (41.5±10.9 μmol/L) and neopterin (6.4±1.0 nmol/L) levels were observed in patients with Behçets disease compared with healthy controls (10.7±2.0 μmol/L, 49.7±16.2 μmol/L, 8.7±2.2 nmol/L, respectively) (p<0.03 for neopterin, p<0.04 for homocysteine and nitric oxide). However, homocysteine, nitric oxide, biopterin and neopterin levels and the neopterin/biopterin ratio for recurrent aphthous stomatitis patients were not significantly different compared to healthy controls. A significant positive correlation was observed between serum homocysteine and serum neopterin/biopterin ratio in patients with Behçets disease (r=0.975, p<0.005). Conclusions: In contrast to recurrent aphthous stomatitis, there is a higher prevalence of hyperhomocysteinemia in Behcets disease. Homocysteine may have deleterious effects on the pathology of Behcets disease by decreasing nitric oxide levels and interfering with the immune system. Clin Chem Lab Med 2007;45:73–7.

Hip fracture risk and different gene polymorphisms in the turkish population

BACKGROUND We aimed to discuss the risk assessments for both patients with hip fractures due to fall-related, low energy traumas and non-fractured control patients by examining bone mineral density and genetic data, two features associated with femoral strength and hip fracture risk. METHODS Twenty-one osteoporotic patients with proximal femur fractures and non-fractured, osteoporotic, age- and gender-matched controls were included in the study. Bone mineral density measurements were performed with a Lunar DXA. The COL1A1, ESR, VDR, IL-6, and OPG genes were amplified, and labeling of specific gene sequences was performed in a multiplex polymerase chain reaction using the osteo/check PCR kit from the whole blood of all subjects. RESULTS The bone mineral density (trochanteric and total bone mineral density values) of the fracture group was significantly decreased relative to the control group. We were not able to conduct statistical tests for the polymorphisms of the COL1A1, ESR, and VDR genes because our results were expressed in terms of frequency. Although they were not significant, we did examine differences in the IL-6 and OPG genes polymorphisms between the two groups. We concluded that increasing the number of cases will allow us to evaluate racial differences in femoral hip fracture risk by genotypes.

Evaluation of allantoin levels as a new marker of oxidative stress in Behçet's disease.

The increased production of reactive oxygen species (ROS) from activated neutrophils in Behçets disease (BD) and recurrent aphthous stomatitis (RAS) may result in increased oxidative stress. Uric acid can react rapidly with neutrophil‐derived ROS to form allantoin. The purpose of the study was to evaluate the serum levels of allantoin as a new marker of oxidative stress in BD compared with malondialdehyde (MDA) levels as a well‐known marker. Blood samples were obtained from 23 BD patients, 22 RAS patients as positive controls, and 21 healthy controls. When compared to the healthy controls, we found higher allantoin and MDA levels in the BD patients and higher MDA levels in the RAS patients. Serum ascorbic acid levels in the BD patients were significantly lower than in the controls. Increased allantoin and MDA levels suggest the possible involvement of free radicals in BD. As allantoin is only a product of uric acid oxidation by reactive oxygen and nitrogen species, it may also be used as a marker of oxidative stress in BD.

Hand orthosis as a writing aid in writer's cramp

Writers cramp is a focal, task‐specific dystonia of the hand and wrist. It primarily affects people who do a significant amount of writing, and causes difficulties in writing. We present five cases with writers cramp who showed improvement in their writing ability with an applied hand orthosis.

Sympathetic skin response and R-R interval variation in rheumatoid arthritis. Two simple tests for the assessment of autonomic function.

Autonomic nervous system involvement with peripheral neuropathy is a well known complication of rheumatoid arthritis (RA). In the assessment of autonomic function of patients with rheumatoid arthritis, we performed sympathetic skin response (SSR) and R-R interval variation (RRIV) tests in 30 patients and in 30 normal controls. Of 30 patients, 5 had complaints of clinical dysautonomic symptoms. SSRs were abnormal in 6 of 30 patients, whereas 8 showed abnormal RRIVs during deep breathing. Nine of 30 patients also showed electrophysiologic evidence of peripheral neuropathy. All 5 of the patients with clinical dysautonomic symptoms showed abnormal SSR and RRIV test results. No patient with normal results on both tests had clinical dysautonomia. This study showed that there are frequent abnormalities in SSR and RRIV tests in patients with rheumatoid arthritis whether there is a clinical symptom of autonomic dysfunction or not.

The association of proximal femur geometry with hip fracture risk

We aimed to discuss the risk assessments of patients with hip fractures due to the fall‐related moderate or minimal trauma and compare them with non‐fractured control patients by bone mineral density (BMD) and proximal femur geometric measurements to assess whether geometric measurements of femoral dimensions were associated with femoral strength and hip fracture risk. Forty‐two osteoporotic patients with proximal femur fracture and 40 osteoporotic non‐fractured age and gender‐matched controls were included in the study. Lunar DXA was used for BMD measurements and proximal femur geometric measurements were performed manually on direct X‐rays as hip axial length (HAL), femoral length (FL), and femoral neck width (FW). The trochanteric and total BMD values of the fracture group were significantly lower than the control group. There was a significant increase in FW/FL ratio in the fracture group that would be of specific importance for guidance: if FL values did not increase as did FW, it would point out a risk for fracture. The trochanteric BMD values were correlated with all increased measurements in the control group. There are genetically determined adaptive differences among individuals concerning bone morphology and bone mineral distribution. These different adaptations result in different bone strengths and fracture formation risk. Clin. Anat. 21:575–580, 2008.

Relationship between bone mineral density of the proximal femur and strength of hip muscles in postmenopausal women.

The relationship between muscle strength and bone density is well known, but only a limited number of studies relating muscle strength to bone mineral density of a site-specific limb have been performed. The main purposes of this study were as follows: (1) to assess the relationship between the strength of hip muscles and bone mineral density of the proximal femur in 100 postmenopausal women; (2) to compare strength values of three subgroups, which were formed on the basis of the femoral neck Z-scores. By using an isokinetic dynamometer (Cybex 350), muscle strength tests were performed for hip muscles and bone mineral density measurements were obtained by dual energy x-ray absorptiometry. Statistical analysis demonstrated a moderately positive correlation between bone mineral density of the femoral neck and hip muscle strength (with abductors: r = 0.267, P = 0.008; with adductors: r = 0.276, P = 0.007). A moderate correlation was also found between bone mineral density of Wards triangle and hip adductors (r = 0.327; P = 0.001). When muscle strength mean values of subgroups were compared with each other, there was no statistically significant differences. These data may suggest that the isokinetic strength of hip muscles may not contribute to the bone mineral density of the proximal femur.