Yasemin Turan

Antioxidant status in patients with osteoporosis: A controlled study

OBJECTIVE We aimed to investigate serum antioxidant enzymes and nitric oxide (NO) levels in postmenopausal women with osteoporosis (OP) and in healthy controls; and to determine the relationship between these enzymes, NO and clinical parameters in this present study. METHODS Forty-five postmenopausal women fulfilling OP diagnostic criteria of World Health Organization (WHO) and 42 postmenopausal healthy women without OP were enrolled. Patients in the study population were selected among individuals that were not pre-diagnosed or pre-treated for OP. Patients with metabolic bone diseases, fracture history, which were smokers, alcohol users and taking antioxidant drug treatment, were excluded from the study. Dual Energy X-ray Absorptiometry (DXA) results, body mass indices and demographic data were recorded. Erythrocyte catalases (CAT), glutathione reductase (GR) enzyme activities and erythrocyte glutathione (GSH) levels, plasma malondialdehyde (MDA) levels were measured by spectrophotometer whereas plasma nitrite+nitrate (NOx) levels were measured by ELISA microplate-reader. RESULTS Patients had significantly lower GR (P<0.01) enzyme activity and higher levels of MDA (P<0.01) and NO (P<0.01) than non osteoporotic healthy controls. There was no significant difference between both groups in erythrocyte GSH levels and CAT activities. Total femoral BMD measurements significantly correlated with MDA levels (P=0.001). There was no significant relationship between other antioxidants and lumbar or femoral BMD. CONCLUSION Oxidative stress may play an important role in postmenopausal bone loss and therefore it might be considered when pathogenesis of postmenopausal OP has been investigated.

Serum antioxidants and nitric oxide levels in fibromyalgia: a controlled study.

We proposed to assess antioxidant status and nitric oxide in fibromyalgia (FM) patients in comparison to healthy controls. Additionally, the association between the serum antioxidant levels and clinical findings in FM patients was also investigated. Thirty-seven FM patients and 37 healthy controls were enrolled in this study. Severity of fatigue and pain were determined by Visual Analogue Scale. Functional capacity in daily living activities was evaluated by fibromyalgia impact questionnaire. Serum NO, catalase and glutathione were measured. Serum glutathione and catalase levels were significantly lower in FM patients than controls. However, no significant difference was seen in serum NO levels between the two groups. A significant correlation was evident between serum NO level and pain. Additionally, the correlation between glutathione level and morning stiffness was found to be significant. These findings support other studies, we assume that these two antioxidants might have impact on the pathogenesis of FM disease.

The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia

We examined the association between serum trace elements and clinical findings such as number of sensitive tender points, severity of fatigue and functional status in patients with fibromyalgia (FM). Thirty-two patients diagnosed as having FM according to the ACR 1990 criteria and 32 normal healthy controls (NHC) were included in this study. The demographic data, disease duration, number of tender points and accompanying symptoms (fatigue, sleep disorders, headache, paresthesia, irritable bowel syndrome, sicca symptoms, Raynaud’s phenomena) of the patients were noted. Visual analog scale (10 cm) was implemented to estimate daily severity of pain and fatigue. Fibromyalgia impact questionnaire was used for functional assessment. Serum selenium (μg/dL) and serum zinc (μg/dL) levels were measured by atomic absorption spectrometer. Serum magnesium (mmol/L) level was measured by the original kits of Abbott Aeroset auto-analyzer. The mean age of patients in FM group and NHC were calculated as 42.9 (SD = 7.7) years and 41.3 (SD = 9.7) years, respectively. Serum levels of zinc (P = 0.001) and magnesium (P = 0.002) were significantly decreased by FM groups, whereas there was no considerable difference with selenium levels of both groups (P > 0.05). Association between serum zinc level and number of tender points (P = 0.008) and that between fatigue and magnesium level (P = 0.003) was found as meaningful. According to the results of this study, it was asserted that serum magnesium and zinc levels may play an important role in the pathophysiology of FM.

Camptocormia and dropped head syndrome as a clinic picture of myotonic myopathy.

Dropped head syndrome is primarily based on weakness localized at neck extensors. It may result from motor neuron disease, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy and also from various neuromuscular diseases including inflammatory, dystrophic and metabolic myopathies. Camptocormia (CC) on the other hand is an unusual condition characterized by progressive weakness of the extensor vertebral muscles and results in involuntary trunk flexion. CC may emerge as a clinical feature of many different conditions such as several myopathies and Parkinsons disease. The association of dropped head syndrome with CC has been rarely published in the literature. However, this is the only case presenting with concomitant dropped head syndrome and CC as a clinical picture of myotonic dystrophy (MD). In this report we aimed to represent a female patient, who was diagnosed as having myotonic dystrophy, with concurrent dropped head syndrome and CC.

Serum hyaluronan levels in patients with knee osteoarthritis

We examined the association between clinical parameters of disease activity and serum hyaluronic acid (HA) level in patients with knee osteoarthritis (OA). Fifty-eight patients with knee OA and 40 healthy individuals were included in this study. Demographic data were noted. The radiological evaluation was done according to Kellgren/Lawrence Grading System. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used in evaluating the clinical disability caused by OA. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level were determined in laboratory evaluations. Serum HA levels (in nanogram per milliliter) of both groups were measured by enzyme-linked immunosorbent assay. The mean ages of patients in OA group and control group were 57.58 (9.55) and 43.3(10.2) years, respectively. There was a significant difference between HA levels of both groups (p = 0.02). Also, there was a significant correlation between HA level and disease duration (p = 0.04), ESR (p = 0.001), and CRP level (p < 0.001). However, there was no significant correlation between HA levels with WOMAC and radiological grade (p > 0.05). There is no satisfactory amount of data regarding HA level in OA. In our study, we demonstrated that HA was in high levels in the serum of patients with OA. We suggest that serum HA levels may be used as a marker to determine the disease activity.

Relationship between enthesitis, clinical parameters and quality of life in spondyloarthritis.

OBJECTIVE To investigate the involvement of enthesis and its correlation with clinical and quality of life parameters in patients with spondyloarthritis (SpA). METHODS One hundred and eighteen patients who comply with the SpA classification criteria of the European Spondylarthropathy Study Group (ESSG) were included into the study. Clinical parameters such as morning stiffness, rest pain, activity pain, tender joints and swollen joints were evaluated. Enthesitis were assessed by Mander Enthesis Index (MEI). The quality of life was assessed by Short Form-36 (SF-36). RESULTS The incidence of enthesitis in patient with SpA was found at a rate of 84.9%. There was a significant correlation between MEI and morning stiffness, disease duration, tender joints and six subgroups of SF-36. The highest correlation was found between MEI and number of tender joint (p<0.001). CONCLUSION Enthesitis is commonly seen among patients with SpA. Enthesitis also affects the life quality of patients negatively.

Correlation of Fatigue with Clinical Parameters and Quality of Life in Rheumatoid Arthritis

Objective: We aimed to investigate fatigue and its relationship with disease activity, radiological findings and quality of life in patients with rheumatoid arthritis (RA). Materials and Methods: 41 patients who were diagnosed as RA according to criteria of ACR and 38 healthy controls were enrolled to this study. Patients were asked to record the severity of rest pain (Visual Analog Scale) and duration of morning stiffness. Fatigue was evaluated by the Multidimensional Assessment of Fatigue (MAF) test. Disease activity and quality of life were assessed respectively with DAS-28 and Short Form-36 (SF-36). Radiologic involvement was evaluated according to modified Larsen’s grading system. Results: The mean age of patient and control groups were 50.9±13.4 years and 50±10.1 years, respectively. Two groups were similar with respect age (p=0.744). The median MAF total score was higher in patients with RA (38.5, min-max: 4-50) than in control subjects (22.5, min-max: 0-42) (p<0.001). There were significant correlations between MAF and DAS-28 scores (r=0.478, p=0.004), rest pain (r=0.491, p=0.001), ACR functional scale (r=0.563, p<0.001) and four dimensions of SF36; physical role (r=-0.504, p=0.014), bodily pain (r=-0.416, p=0.048), vitality (r=-0.522, p=0.011), emotional role (r=-0.523, p=0.011). Conclusion: Fatigue symptom may be quite disabling for patients with rheumatoid arthritis. It is affected by disease activity and pain but not by disease duration and radiologic score. Therefore, it is concluded that fatigue is essentially related with disease activity rather than the chronic inflammatory process in RA. (Turk J Rheumatol 2010; 25: 63-7)

Toxic Neuropathy Due to N-Hexane: Report of Three Cases

Chronic exposure to n-hexane is one of the well known causes of peripheral neuropathy. This type of neuropathy is commonly seen among individuals employed in shoe and bag factories with inadequate ventilation. We describe three patients with acute and sub-acute neuropathy following n-hexane exposure via inhalation of glue. All of the patients had history of working in the same place. The results of laboratory examinations were in normal ranges except the electroneuromyographic (ENMG) findings which were showing the neuropathy. All patients were hospitalized and rehabilitation programs were carried out. Symptomatic relief was achieved following this treatment, however the pathologic ENMG findings still persisted.

Validation of Duruöz Hand Index for Diabetic Hand Dysfunction

Objectives Duruöz Hand Index (DHI) is a functional disability scale that can be used successfully to assess the functional disability with different hand arthropathies. The hands are frequently involved in diabetic patients. We aimed to examine the use of DHI for its accuracy and ease in assessing these patients. Methods Forty patients with diabetes mellitus were recruited in this study. Hand pain was assessed with the visual analog scale. Duruöz Hand Index and Hand Functional Index were applied to assess the disability of hand. We evaluated the grip strength and 3 types of pinch strength (tip pinch, lateral or key pinch, and chuck or 3-finger pinch) for the dominant (D) and nondominant (ND) hands of each patient by 2 different kinds of Jamar dynamometers (JA Preston Corp, Jackson, MI). Results The Jamar dynamometer scores were as follows (mean [SD]): grip strength-D (21.56 [5.86]), grip strength-ND (16.42 [4.26]), tip strength-D (5.14 [1.50]), tip strength-ND (5.13 [1.42]), lateral strength-D (5.15 [1.52]), lateral strength-ND (5.07 [1.19]), chuck strength-D (5.40 [1.40]), chuck strength-ND (5.33 [1.28]). There was a high correlation between DHI and Hand Functional Index (P < 0.001, ρ = 0.586) showing that DHI has good convergent validity. The DHI had significant correlation with nonfunctional parameters such as visual analog scale-pain (P < 0.001), restricted hand motion (P = 0.020), chuck strength-D (P = 0.006), pins test-D (P < 0.001), pins test-ND (P = 0.013), and assembly test (P = 0.025). Conclusions The DHI is a practical scale that is efficient in accurate assessment of hand dysfunction in diabetic patients.

Spondyloepiphyseal dysplasia tarda: four cases from two families

Spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA) is an autosomal recessively inherited skeletal dysplasia. We present four patients (three patients—a brother and a sister and their third cousin—in a family and one patient in another family) with SEDT-PA. All patients had short stature and stubby hands and feet. Their radiographs revealed typical changes for SEDT-PA including platyspondyly, severe osteopenia and dysplastic bone changes. Physical therapy and exercises were performed to all patients in order to decrease in pain and increase or at least maintain joint motion and mobility. Symptomatic relief was achieved in all patients for about a couple of months. The major clinical importance of this rather rare disorder is its similarity to juvenile idiopathic arthritis which has rather different treatment protocol.