Rheumatoid arthritis and corticosteroids

Kortikosteroidler insan adrenal korteksinden salgılanan hormonlardır. Romatoid artrit tedavisinde uzun yıllardır kullanılan bu ilaçların antiinflamatuar ve immun modulatuar etkileri vardır. Romatoid Artritte oluŞan sinoviti güvenilir, etkin ve hızlı bir Şekilde baskılarken, son zamanlarda Romatoid Artritte radyolojik progresyonu önlediği yönünde yayınlar vardır. Romatoid Artritte uzun süreli kullanım endikasyonu olan kortikosteroidlerin olası yan etkilerinin farkında olunmalı ve gerekli önlemler alınmalıdır.Corticosteroids are hormons which are secreted from human adrenal cortex. They are used commonly in treatment of rheumatoid arthritis because of their antiinflamatory and immunmodulatory effect. There are reports about corticosteroids that they quickly and effectively suppress synovitis and prevent radiological progression as erosive changes. The side effects of corticosteroids should be known and prevention must be taken if it is necessary

Impaired Dynamic Thiol%252Fdisulfide Homeostasis and Pro-inflammatory Parameters in Hand Osteoarthritis

Background%253A Reactive oxygen species have a role in pathogenesis of osteoarthritis. The main objective of this study was to determine other oxidant%252Fantioxidant substances and inflammatory markers in hand osteoarthritis patients. Methods%253A Thirty healthy controls and 50 patients with hand osteoarthritis (HOA) were included in the study. All patients were questioned about age, sex, history of the symptoms, presence of sensitive and swollen joints, smoking habits, other systemic diseases and medications. Serum thiol-disulfide homeostasis tests (TDHT), catalase (CAT), ceruloplasmin (Cp), arylesterase (ARES), paraoxonase (PON), stimulated paraoxonase (SPON), total antioxidant status (TAS), total oxidant status (TOS), malondialdehyde (MDA), myeloperoxidase (MPO), routine biochemistry tests and inflammatory markers%253A Interleukin-1b (IL-1b), interleukin-6 (IL-6), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured. Results%253A MPO, TDHT, MDA, MPO and inflammatory markers (IL-6, CRP and ESR) were significantly different in HOA patients from those in control group (p%253D0.005%253B p%253D0.001%253B p%253D0.014%253B p%253D0.005%253B p%253D0.012%253B p%253D0.003 and plt%253B0.001, respectively). Conclusion%253A Our results support that oxidative stress increases in HOA and with the severity of the disease, suggesting that oxidative stress might be involved in pathogenesis of HOA

One year results of raloxifene and calcitonin treatments in postmenopausal osteoporosis

Amaç: Yaslı osteoporozlu kisilerde özellikle de postmenopozal kadınlarda kemik kırık riski daha yüksektir. Raloksifen postmenopozal osteoporozun önlenmesinde ve tedavisinde kullanılan selektif östrojen reseptör modülatörüdür. Kalsitonin kemik rezorpsiyonunu inhibe eder ve osteoporozlu bireylerde kullanım için önerilir. Bu çalısma postmenopozal osteoporozda raloksifen ve kalsitonin tedavilerinin etkilerini arastırmak ve kemik mineral yogunlugu (KMY) degerlerini kıyaslamak için planlandı. Yöntem: Bu amaçla çalısmaya 44 postmenopozal osteoporozlu (raloksifen grubu: 22, kalsitonin grubu: 22) hasta alındı. Hastalar rastgele olarak iki gruba ayrıldı. Hastalarda lomber omurganın ve sol femur proksimalinin KMY'u dual energy X-ray absorptiometry kullanılarak tedavi öncesi ve tedavinin birinci yılı sonunda olmak üzere iki kez ölçüldü. Birinci gruba günde 60 mg raloksifen verilirken, ikinci gruba kalsitonin 200 IU/ gün nazal olarak verildi. Yöntem: Bu tedaviler sonrası lomber omurgada raloksifenle (p=0.011) ve kalsitoninle (p=0.008) istatistiksel olarak belirgin bir düzelme saptanırken, femurKMYölçümlerinde her iki grupta birinci yılın sonunda anlamlı bir iyilesme saptanmadı (p>0.05). Gruplar arası kıyaslamalarda ise KMY iyilesmesi açısından bir farklılık bulunmadı (p>0.05). Sonuç: Postmenopozal osteoporozlu hastalarda raloksifen ve kalsitonin tedavileri bir yılın sonunda trabeküler kemikte belirgin olarak iyilesmesaglarken kortikal kemikte degisiklik gözlenmedi.Objective: The risk of bone fractures is higher in osteoporotic elderly people, particularly in postmenopausal women. Raloxifene is the only selective estrogen receptor modulator that has been approved for the prevention and treatment of postmenopausal osteoporosis. Calcitonin inhibits bone resorption and is recommended for use in women with osteoporosis. This study was performed to investigate the effects of raloxifene and calcitonin treatments in postmenopausal osteoporosis by comparison of the respective bone mineral density (BMD) values. Materials and methods: Forty four women with postmenopausal osteoporosis (raloxifene: 22 , calcitonin :22) were enrolled in this study. Patients were divided into two groups randomly. BMD was measured twice in the lumbar spine and left proximal femur before treatment and at the end of one year by using dual energy X-ray absorptiometry. Raloxifene was administered at a dose of 60 mg/day to the first group; calcitonin was given 200IU per day as a nasal spray. Results: Although statistically significant improvement was found in the lumbar spine with raloxifene (p=0.011) and calcitonin (p=0.008) treatments, no improvement was determined in femur BMD (p>0.05) level at end of the first year. Statistical difference was not observed between two groups (p>0.05). Conclusion: While significant improvement was produced in trabecular bone with raloxifen and calcitonin treatments at the end of one year, no change was observed in cortical bone by the two treatments

Agreement of Turkish Physiatrists with the Assessment in Spondyloarthritis International Society and the European League Against Rheumatism Recommendations for the Management of Ankylosing Spondylitis and Rheumatoid Arthritis

Background: New developments in the field of targeted therapies or biologic agents led more effective management of ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Recommendations for the management of rheumatic diseases propose to reduce inappropriate use of medications, minimize variations among countries, and enable cost-effective use of health care resources. Objective: The aim this study was to evaluate conceptual agreement of ASsessment in SpondyloArthritis International Society (ASAS) and the EUropean League Against Rheumatism (EULAR) recommendations for the management of AS and EULAR recommendations for RA and to assess the rate of application among Turkish physiatrists in daily clinical practice. Methods: An online survey link has been sent to 1756 Turkish physiatrists with e-mails asking to rate agreement on 11-item ASAS/EULAR AS recommendations and 15-item EULAR RA recommendations with synthetic and biological disease-modifying anti-rheumatic drugs. Also barriers and difficulties for using biologic agents were assessed. Results: Three hundred nine physiatrists (17.5%) completed the survey. The conceptual agreement with both recommendations was very high (Level of agreement; mean 8.35±0.82 and 8.90± 0.67 for RA and AS recommendations, respectively), and the self-declared application of overall recommendations in the clinical practice was also high for both RA and AS (72.42% and 75.71%, respectively). Conclusion: Turkish physiatrists are in good conceptual agreement with the evidence-based recommendations for the management of AS and RA. These efforts may serve to disseminate the knowledge and increase the current awareness among physicians who serve to these patients and also implementation of these recommendations is expected to increase as well.PubMedScopu

To review the transient osteoporosis of the hip due to a case report - Case Report

Transient osteoporosis of hip is a rare disease of unknown etiology. It is usually seen in middle-aged men and women in the third trimester of pregnancy and is associated with hip pain. It typically runs a benign course with eventual resolution of symptoms. In this paper, a male patient with a complaint of left hip pain which was diagnosed as transient osteoporosis of the hip was presented by reviewing current literatures. (Osteoporoz Dünyasından 2006; 12 (1): 15-17

Comparison of Different Treatment Protocols in Osteoporosis

The aim of this study was to compare the effectiveness of different medical treatment protocols in osteoporosis. For this purpose 153 postmenopausal women who were diagnosed as osteoporosis were randomly divided into 4 groups and given different medical treatments for 1 year period. Before and after the treatment bone mineral density was measured . Bone mineral density increased in all 4 groups after treatment. But increament in the groups was not statistically different from each other. As a result we concluded that patients choice, side effects and cost must be regarded for drug preference

The Effect of Proprioception Exercises on the Risk of Fall in Knee Osteoarthritis

Objective: The aim of this study was to investigate the effect of proprioception exercises on the risk of fall in primary knee osteoarthritis patients. Materials and Methods: Patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were evaluated among the patients who applied to the outpatient clinic. Among them fifty patients (38 female and 12 male) who were graded as phase 2 or 3 according to Kellgren-Lawrence criteria were included in this study. Proprioception exercises were performed to patients for 10 days in company with physiotherapists. Thereafter patients were given a 6 months of home exercise program. The risk of fall in patients with knee osteoarthritis was assessed by Tetra-axiometric posturographic device (Tetrax, Sunlight Medical Ltd, Israel) that measures in 8 different positions. Functional status was assessed by Lequesne index and pain intensity by visual analogue scale (VAS). The assessments were made in the beginning, on the 15th day and in 1st, 3rd and 6th month. Results: The mean age of the patients was 58.78±7.83 year. A statistically significant improvement in the risk of falls, VAS score and Lequesne index was determined in the first assessment on 15th day after proprioceptive exercises (p<0.001). In the assessment in 6th month, it was observed that this improvement increasingly continued. Conclusion: At the present time, the falls are of great importance due to their medical and economic consequences. At the same time it is known that knee osteoarthritis increases the risk of falls. According to the results of our study, we think that proprioceptive training in the treatment of patients with knee osteoarthritis may provide important contributions both in reducing the risk of falls and in improving functional status

Two Years of Alendronate and Calcitonin Treatments for Osteoporosis in Postmenopausal Women - Original Investigation

This study was to compare and research the effects of alendronate and calcitonin treatments with 2 years duration in women with postmenopausal osteoporosis. One hundred and ten women with postmenopausal osteoporosis (calcitonin group: 55 subjects, alendronate group:55 subjects) were enrolled in this study. Patients were divided into two groups randomly. While alendronate at one dose of 70 mgr weekly was administered to one group, calcitonin at one dose of 200IU daily was gived to another group. Bone mineral density (BMD) was measured at the proximal femur and lumbar spine three times as before treatment, first and second year. Significant improvement was found at the end of treatment in groups itself by lumbar spine and femur BMD. A significant more improvement was determined at the alendronate group than calcitonin group (p=0.001) in the lumbar spine. Statistically a difference was not found in other comparisons among these groups. In the conclusion, alendronate and calcitonin in the treatment of post menopausal osteoporosis by 2 years produced increasing in BMD of the lumbar spine and femur. However, alendronate treatment was found more effective than calcitonin treatment in the lumbar spine. (Osteoporoz Dünyasından 2006; 12 (1): 5-8