The Frequency of A1298C and C677T Polymorphisms of the Methylentetrahydrofolate Gene in Turkish Patients with Rheumatoid Arthritis: Relationship with Methotrexate Toxicity

The C677T and A1298C polymorphisms of methylenetatrahydrofolate reductase (MTHFR) gene are reported to have a relationship to methotrexate (MTX) metabolism, with conflicting results. The aim of this study was to determine the frequency of MTHFR C677 T and A1298C gene polymorphisms in a group of Turkish RA patients and evaluate its association with MTX toxicity

Türkiye Romatizma Araştırma ve Savaş Derneği ankilozan spondilit ulusal tedavi önerileri

Objectives: To develop Turkish League Against Rheumatism (TLAR) National Recommendations for the management of ankylosing spondylitis (AS). Materials and methods: A scientific committee of 25 experts consisting of six rheumatologists and 19 physical medicine and rehabilitation specialists was formed by TLAR. Recommendations were based on the 2006 ASsessment in Ankylosing Spondylitis International Working Group(ASAS)/European League Against Rheumatism (EULAR) recommendations and a systematic review of associated publications between January 2005 and September 2010. A Delphi process was used to develop the recommendations. Twelve major recommendations were constructed for the management of AS. Voting using a numerical rating scale assessed the strength of each recommendation. Results: The 12 recommendations include patient assessment, patient follow-up along with pharmacological and non-pharmacological methods. Some minor additions and changes have been made to the ASAS/EULAR recommendations. All of the recommendations had sufficient strength. Conclusion: National recommendations for the management of AS were developed based on scientific evidence and consensus expert opinion. These recommendations will be updated regularly in accordance with recent developments.Türkiye Romatizma Araştırma ve Savaş Derneği᾽nin (TRASD) Ankilozan Spondilit (AS) için ulusal tedavi önerilerinin oluşturulmasıdır. Gereç ve yöntemler: TRASD tarafından altı Romatoloji ve 19 Fiziksel Tıp ve Rehabilitasyon uzmanı olmak üzere toplam 25 kişiden oluşan bir bilimsel kurul oluşturuldu. Önerilerde 2006 yılında yayınlanan Ankilozan Spondilit Değerlendirme Uluslararası Çalışma Grubu (ASAS)/Romatizmaya karşı Avrupa Ligi (EULAR) önerileri ve Ocak 2005 - Eylül 2010 arasında yayınlanmış olan ilişkili yayınlar konusundaki sistematik bir inceleme temel alındı. Öneriler oluşturulurken Delphi süreci kullanıldı. Ankilozan spondilit tedavisi ile ilgili 12 ana öneri oluşturuldu. Oylama yapılarak önerilerin güçlülük düzeyi bir nümerik derecelendirme skalası ile belirlendi. Bulgular: On iki öneri hasta değerlendirilmesini, hasta takibini ve farmakolojik ve non-farmakolojik yöntemleri içermektedir. ASAS/EULAR önerilerine bazı ilaveler ve önerilerde bazı küçük değişiklikler yapılmıştır. Tüm öneriler yeterli kuvvete sahipti. Sonuç: Bilimsel kanıtlar ve uzmanların görüş birliği ile AS tedavisine yönelik ulusal öneriler oluşturulmuştur. Bu öneriler, yeni gelişmeler doğrultusunda düzenli olarak güncellenmelidi

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Objective: The aim of this study was to compare the therapeutic effects of kinesio taping (KT) and localsubacromial injection in patients with subacromial impingement, syndrome (SIS) with regard to pain,range of motion (ROM) and disability.Methods: Sixty-one patients (48 females and 13 males; mean age: 43.04± 6.31, years) with SIS wereenrolled into the study. The patients were randomized into two treatment groups receiving either a singlecorticosteroid and local anesthetic (LA) injection, or kinesio taping performed three times by intervals of 3day. Visual analog scale (VAS) was used to assess pain intensity, range of motion (ROM) degrees of, shoulderwere recorded and Shoulder Pain and Disability Index (SPADI) was, performed to evaluate functionaldisability, before treatment, at theŞrst and fourth, weeks after therapies. A exercise program was prescribed for both groups including pendulum, active range of motion (ROM) and strengthening exercises.Results: Pain, functional outcome measures were determined to have improved signiŞcantly in bothgroups at the end of therapies atŞrst and fourth weeks (p < 0.05), but these improvements were moresigniŞcant in the injection group than in kinesio taping group (p < 0.05). The improvements in pain atrest, shoulder abduction degrees, and SPADI scores atŞrst and fourth weeks were statistically higher ininjection group than in kinesio taping group.Conclusion: Although the improvement in pain intensity at rest, ROM and disability were better withlocal injection, KT may be an alternative noninvasive method to local subacromial injection for patientssuffering from subacromial impingement syndrome.Level of Evidence: Level I, Therapeutic study.&copy; 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Objective: The aim of this study was to compare the therapeutic effects of kinesio taping (KT) and localsubacromial injection in patients with subacromial impingement, syndrome (SIS) with regard to pain,range of motion (ROM) and disability.Methods: Sixty-one patients (48 females and 13 males; mean age: 43.04± 6.31, years) with SIS wereenrolled into the study. The patients were randomized into two treatment groups receiving either a singlecorticosteroid and local anesthetic (LA) injection, or kinesio taping performed three times by intervals of 3day. Visual analog scale (VAS) was used to assess pain intensity, range of motion (ROM) degrees of, shoulderwere recorded and Shoulder Pain and Disability Index (SPADI) was, performed to evaluate functionaldisability, before treatment, at theŞrst and fourth, weeks after therapies. A exercise program was prescribed for both groups including pendulum, active range of motion (ROM) and strengthening exercises.Results: Pain, functional outcome measures were determined to have improved signiŞcantly in bothgroups at the end of therapies atŞrst and fourth weeks (p < 0.05), but these improvements were moresigniŞcant in the injection group than in kinesio taping group (p < 0.05). The improvements in pain atrest, shoulder abduction degrees, and SPADI scores atŞrst and fourth weeks were statistically higher ininjection group than in kinesio taping group.Conclusion: Although the improvement in pain intensity at rest, ROM and disability were better withlocal injection, KT may be an alternative noninvasive method to local subacromial injection for patientssuffering from subacromial impingement syndrome.Level of Evidence: Level I, Therapeutic study.&copy; 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Upper Extremity Function In Elderly Patients With Breast Cancer-Related Lymphedema: A Descriptive Study

Introduction: Lymphedema is a common complication following breast cancer treatment with physical and pyschosocial consequences. The detrimental effects of lymphedema may become more disabiling in conjuction with the aging process. The aim of the study was to evaluate upper extremity function in elderly with breast cancer-related lymphedema and investigate the associations between upper limb function and demographic/clinical characteristics. Materials and Method: Eight-four women with a mean age of 65.1 +/- 5.0 years were enrolled in this study. Demograpic characteristics including age, body mass index, dominant hand, marital status, education level, and occupation were recorded. Cancer and lymphedema-related clinical features were reviewed. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to assess upper extremity function. Results: The mean of patients' body mass index was 31.9 +/- 6.1 kg/cm(2). The median duration of lymphedema was 8 months. Approximately 60% of patients had stage 2 lymphedema. The median value of interlimb volume difference was 558.5 ml. DASH score correlated only with body mass index, volume difference, and lymphedema stage. On regression analysis, the best predictors of upper extremity function in patients with lymphedema were found to be as body mass index and volume difference. Conclusion: The presence of breast cancer-related lymphedema negatively affects upper extremity function in elderly patients. The findings indicate that patients with higher body mass index and interlimb volume difference have more severe disability. Therefore, multimodal therapeutic interventions for reducing volume of the affected arm as well as body mass index could improve upper extremity function in older patients with lymphedema.WoSScopu

The Efficacy of Nasal Calcitonin on The Treatment of Osteoporosis in Male Patients with Ankylosing Spondylitis: A Preliminary Study - Original Investigation

Aim: Osteoporosis is a prominent feature of advanced ankylosing spondylitis and causes decrease in bone mineral density (BMD), disturbance of bone formation and resorption and incerase in incidence of vertebral fractures. It is believed that patients with AS have an increased susceptibility to vertebral fractures due to secondary diffuse osteoporosis. The aim of this study was to evaluate the effectiveness of nasal calcitonin in male AS patients with osteoporosis. Patients and Methods: Thirty-two patients with AS were enrolled to our study. Nasal calcitonin 200 IU daily was given for one year to eleven patients with AS who had osteoporosis according to the The World Health Organization (WHO) criteria. The primary outcome measure was determined as the percentage of change in BMD o f lateral lumbar spine. Results: Although not statistically significant, at the end of calcitonin therapy for twelve months, increase in the mean lumbar spine BMD values of osteoporotic patients was observed. No new vertebral fracture was observed in one year. Calcitonin was well tolerated and no adverse event was reported. Conclusion: As our study group was small to confirm these preliminary findings, larger studies examining the effects of different antiresorptive agents are required for determination of the appropriate treatment of osteoporosis in this chronic condition. (From the World of Osteoporosis 2007;13:67-9

Polimorfismo do gene timidilato sintase e nível plasmático total de homocisteína em um grupo de pacientes turcos com artrite reumatoide: relação com a atividade da doença e toxicidade ao metotrexato

Resumo Introdução: Relata-se que o polimorfismo do gene timidilato sintase (TS) e a homocisteína têm relação com o metabolismo do metotrexato (MTX), com achados conflitantes. O objetivo deste estudo foi determinar os níveis de homocisteína e a frequência de polimorfismos de repetição tripla (TS3R) e dupla (TS2R) do gene TS em um grupo de pacientes turcos com AR e avaliar sua associação com a toxicidade ao MTX e a atividade da doença. Métodos: Foram incluídos no estudo 64 pacientes com AR e 31 indivíduos no grupo controle, com média de 48,7 ± 12,5 e 46,2 ± 13,4 anos. Foram obtidas as características demográficas e foi registrado o número de pacientes que relataram efeitos adversos ao MTX no grupo AR. Foram analisados os níveis de homocisteína e os polimorfismos TS2R/TS3R. Foi determinada a distribuição de genótipos de acordo com a toxicidade ao MTX e a atividade da doença. Resultados: Os dados demográficos foram semelhantes entre os pacientes e controles. Todos faziam suplementação de ácido fólico a uma dose média de 5 mg/semana. Dos 64 pacientes, 36 apresentaram efeitos adversos ao tratamento com MTX. Encontrou-se uma frequência de polimorfismos TS2R e TS3R semelhante nos grupos AR e controle. Encontrou-se que os polimorfismos TS2R e TS3R eram semelhantes em pacientes com e sem eventos adversos relacionados com o MTX. O nível médio de homocisteína também foi similar em pacientes com e sem polimorfismo do gene TS, mas era mais elevado (12,45 μmol/L vs. 10,7 μmol/L) em pacientes com do que sem efeitos adversos relacionados com o MTX. O nível médio de homocisteína se correlacionou com o VHS no grupo AR. Conclusões: Os níveis de homocisteína podem afetar a atividade da doença e a toxicidade ao MTX, mas os polimorfismos 2 R e 3 R no gene TS não se correlacionaram com a toxicidade ao MTX em pacientes com AR que recebem suplementação de ácido fólico. São necessários mais estudos para esclarecer os polimorfismos em outras enzimas que podem ser responsáveis pela toxicidade ao MTX em pacientes com AR

Identifying the characteristics of geriatric patients who referred to outpatient clinics of physical medicine and rehabilitation: A multicenter descriptive study

Amaç: Bu çalışmada amaç, Fiziksel Tıp ve Rehabilitasyon (FTR) polik liniklerine başvuran geriatrik hastaların demografik ve klinik özelliklerini belirlemek, bu klinik ve demografik özelliklerin, yaş, cinsiyet ve öğrenim düzeylerine göre farklılıklarını ortaya çıkarmaktı. Gereç ve Yöntem: Çok merkezli çalışma kapsamına 20 FTR polikliniğine başvuran 65 yaş üzeri toplam 820 hasta alındı. Demografik verilerin yanın da; yakınmaları, hastalıkları, ağrı düzeyleri, kullandıkları ilaçlar, alışkanlıkları ve tıbbi durumları kaydedildi. Yaş, cinsiyet ve öğrenim düzeyinin yakın malar, hastalıklar ve alışkanlıklar üzerindeki etkisi araştırıldı. Bulgular: Hastaların yaş ortalaması 71,7±5,5 yıl idi. %16,7’si tek başına yaşıyordu, %61,7’si ev hanımı idi. %86'sının bir veya daha fazla komorbid hastalığı mevcuttu; en sık hipertansiyon (HT) daha sonra mide ve kalp hastalıkları görülmekte idi. En sık yakınma nedenleri sıklığı sırasıyla eklem ağrısı, halsizlik-yorgunluk, yaygın vücut ağrısıydı. Günde yutulan ilaç sayısı ortalama 4,02±0,9 (ortanca 4), VAS'a göre ağrı ortalaması 5,1±1,3 (ortan ca 5) olarak belirlendi. %16,5’nin düşme öyküsü mevcuttu. %30,1’i yürüyüş yapıyor ve sadece %15,4’ü ev içinde egzersiz yapıyordu. Omurga deformitesi, omurga ağrısı, idrar kaçırma, görme sorunu, yutma güçlüğü, duymada azalma, denge ve diş sorunu 75 yaşın üzerindekilerde istatistiksel açıdan anlamlı olarak daha fazla görülmekteydi. Sonuç: FTR polikliniklerinde hastaların çoğunluğunu yaşlı popülasyon oluş turmaktadır. İleri yaş grubunda komorbid hastalıkların varlığı, kullanılan ilaç sayısının fazla olması, osteoporoz ve düşme sıklığının artması, FTR heki minin hem medikal tedavi planlama aşamasında ve hem de rehabilitasyon programı hazırlarken dikkatli davranmasını gerektirmektedir. İleri yaş grubunun günlük yaşamlarında bağımsız ve daha aktif olabilmesi için sadece kas-iskelet yakınmaları değil, bütün organ sistemleri değerlendiril erek kapsamlı ve çok yönlü bir geriatrik rehabilitasyon programı düzenlen melidir. Türk Fiz Tıp Rehab Derg 2011;57:143-9.Aim: The aim of this study was to define the demographic and clinical characteristics of geriatric patients who referred to physical medicine and rehabilitation (PMR) outpatient clinics and to detect the differences between these characteristics in regard to age, sex and education level. Materials and Methods: 820 patients over 65 years old who attended 20 outpatient clinics were included in the study. In addition to demographic data, the complaints, comorbid diseases, pain levels, drugs being used, exercise and medical status of the patients were recorded. The effects of age, sex and education level on complaints, comorbid diseases and exercise habits were investigated. Results: The mean age of the patients was 71.7±5.5 years. 16.7% were living alone, 61.7% were housewives. 86% of the patients had one or more comorbid diseases - hypertension, gastric problems and heart disease were mostly encountered. The most common complaints were joint pain, fatigue and widespread body pain. The average number of pills taken per day was 4.02±0.9 (median 4), and the VAS pain score was 5.1±1.3 (median 5.0). History of falling was present in 16.5% of patients. 30.1% were routinely walking and 15.4% were performing exercise at home. In patients over 75 years, vertebral pain and deformity, urinary incontinence, eye problem, difficulty in swallowing, decrease in hearing, as well as balance and teeth problems were significantly more frequent than in younger subjects. Conclusion: Aged population constitutes most of the PMR outpatient clinic patients. Considering comorbid diseases, high number of daily taken drugs and falls, PMR specialist should be cautious in prescribing drugs and planning rehabilitation programme. For independence in activities of daily living in this age group, besides the musculoskeletal system, all other systems should be evaluated and a comprehensive geriatric rehabilitation programme should be constructed. Turk J Phys Med Rehab 2011;57:143-9