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

Comparison of the therapeutic efficacy of TENS versus intra-articular hyaluronic acid injection in patients with knee osteoarthritis: A prospective randomized study

Knee osteoarthritis (OA) is perceived as a major public health problem, and today, various treatment modalities are used to manage this condition. The purpose of this study was to assess and compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and intra-articular hylan G-F 20 (Synvisc (R); Genzyme Corporation, Ridgefield, NJ) in patients with symptomatic knee OA. A total of 60 patients with primary knee OA were randomized into 2 treatment groups. TENS was applied for 3 weeks in the first group, and in the second group, hylan G-F 20 was injected intra-articularly once a week for 3 weeks. Patients were then followed for 6 months. Disease severity was measured with the Lequesne Index. Efficacy in terms of pain, functional status, and quality of life was assessed through analysis of changes in Western Ontario and McMaster Universities Osteoarthritis Index WOMAC) and Short Form 36 Health Survey (SF-36) scores. Adverse events were monitored throughout the study. WOMAC pain scores were improved at the first control visit in the TENS group and in the viscosupplementation group; this improvement was statistically significant. WOMAC stiffness scores showed a statistically significant decrease in the TENS group at the first control visit. Stiffness did not decrease during the first month in the second group; however, these patients exhibited improvement during the sixth month after injection. Physical function scores and SF-36 total scores did not change in either group after treatment. Pain relief was observed at the first month and continued throughout the 6-month follow-up period in both groups. Stiffness decreased by the sixth month in both groups. Improvement in WOMAC physical function scores was greater in the intra-articular hylan group than in the TENS group at the end of follow-up; however, quality of life was not improved in either group. These therapies used in combination may alleviate symptoms in patients with OA

Importance of tinel and phalen test in the carpal tunnel syndrome

Çalışmamızın amacı karpal tünel sendromu'nun (KTS) klinik teşhisinde sıklıkla kullanılan Tinel ve Phalen testinin duyarlılık ve özgüllüğünü değerlendirmekti. KTS lokal sıkışma sendroniları arasında en sık görülenidir. Teşhiste klinik muayene ve şikayetler temel alınırken, elektrodiagnostik çalışmalar bu teşhisin doğrulanmasında faydalı olabilmektedir. Phalen ve Tinel testi teşhiste faydalı göstergelerdir. Çalışmamıza KTS'nun klinik semptomlarıyla başvuran (örneğin., aralıklı elbileği ve kol ağrısı, me¬dian sinir alanına yayılan uyuşma, gece şikayeti olanlar ve benzerleri), bunu takiben standart sinir ileti kriterleriyle elektrofizyolojik olarak KTS olduğu tespit edilen 126 hasta eli dahil edildi. Çalışmamızda klinik olarak KTS olduğu düşünülen 126 üst ekstremiteye EMG yapıldı. Phalen ve Tinel testi yönünden değerlendirildi. Sonuç olarak; Tinel testi KTS'lu hastaların değerlendirilmesinde faydalı olmasına karşılık Phalen testi daha yüksek duyarlılık ve özgüllüğe sahiptir.The aim ofthis^tudy is evaluating sensitivity and speci¬ficity of Tinel and Phalen tests which is often used in the clinical diagnosis of Carpal Tunnel Syndrome (CTS). CTS is seen the most common among focal entrapment syndromes. While CTS is diagnosed on the basis of pa¬tients history and clinical examination and electrodiagnostic studies may be useful in confirming the diagnostic impression. Phalen and Tinel test are useful indicators of diagnosis. In this study 126 patient hands included, reffered with clinical symptoms of CTS (ie., intermittent wrist and arm pain, paresthesias in the median distribution, noc¬turnal symptoms etc), who were subsequently proven to have electrophysiologic CTS by standard nerve con¬duction criteria. All patient hands which clinically suspected of CTS were performed Phalen and Tinel test. We conclude that the Tinel test is useful in the evaluation of patients with CTS whereas Phalen test has greater sensitivity and specificty

Bone Loss in Ankylosing Spondylitis: A Controlled Study - Original Investigation

Osteoporosis is common in ankylosing spondylitis (AS), which is a chronic inflammatory rheumatic disease.The aim of this study was to assess the bone loss and the effects of disease activity on bone mineral density in patients with AS. Thirty-three (29 men ,4 women ) patients with AS were included in the study. All of the patients were evaluated as their age, sex, height, weight, history, physical examination, laboratory and AP-lateral thoracic and lumbar vertebrae radiographic findings. Control group was consisted of 35 (31 men 4 women) age and sex-matched healthy person. Mean age and disease duration of the patient group were 43.2 ± 9.9 and 13.18 ± 10.6 years, respectively. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DXA) at lumbar spine and proximal femur regions. BMD did not show statistically significant difference at lumbar region between two groups. However BMD values were 10% lower at femur neck in patient group than controls. The rate of osteopenia and osteoporosis was 42.8 % at the femur neck region in the patient group and 22.8 % in the control group. BMD values at femur neck correlated with age and disease duration. There was no correlation between BMD and BASDAI and BASMI, BASFI, BASGI scores. In conclusion, bone loss is common in AS. Ligament calcification and syndesmophytes may lead to higher BMD values at lumbar region in AS .Thus proximal femur BMD is valuable in the patients with long disease duration. Disease activity has no negative effect on bone density in our study. (Osteoporoz Dünyasından 2006;12:81-3

Bone Mineral Density in Women with Rheumatoid Arthritis and Related Factors: Controlled Study - Original Investigation

Aim: The aim of this study was to analyse bone mineral density (BMD) in the patients with rheumatoid arthritis (RA) and to compare the results with those of control group’s; to investigate the bone loss related factors. Material and Method: Sixty women with RA and 50 healthy subjects were included in the study. Control group consisted of age, sex and body mass matched healthy subjects. Bone density was measured at lumbar spine and proximal hip by DEXA (Lunar Dpx pro, Wisconsin, Madison). Demographic characteristics, DAS 28 and Health Assessment Questionnaire (HAQ) scores were enrolled. Z score £-1 was accepted as reduced BMD. Statistical analysis was performed with SPSS package program. Chi square test, t test and ANOVA were used for comparison. Results: Mean age was 51 years and disease duration was 77 months in the patient group. BMD at lumbar spine and hip in the RA patients was lower than those controls, but bone loss only lumbar spine was statistically significant higher in patient group (p<0,05). In the patient group the rate of reduced BMD at lomber spine and total femur were %31.6 and %21.6; the rate of osteoporosis at lomber spine and total femur were %13,3 and %5, respectively. Bone density showed significant correlation with functional capacity, age and weight in the patient group (p<0,05). Conclusion: In this study bone density at lumbar spine in women with RA was significantly lower than the control’s. Bone loss showed relation with age, weight and physical capacity. (From the World of Osteoporosis 2008;14:29-34

Bone Turnover in Postmenopausal Women with Bone Loss - Original Investigation

Osteoporosis is characterized by decrease in bone strength due to decreased bone mass and disruption of bone microstructure and eventually increase in fracture risk. Increased bone turnover in postmenopausal period results in bone loss and osteoporosis. Aim of our study was to investigate the rate of bone turnover in postmenopausal women. Postmenopausal women were included in this study. Dual energy X ray absorbtiometry( Dexa) was used for the measurement of BMD of the lumbar spine and proximal femur. Serum osteocalcin and type 1 collagen cross-linked C-telopeptide (Ctx) levels were measured in blood. 32 postmenopausal women with bone loss were included in our study. The mean age was 61,5 ± 9,6 years, mean menopause duration 14,7± 9,5 years. The mean value of L2- L4 BMD was 0,910 ±0,143 gr/cm2 , femur neck BMD 0,734± 0,134 gr/cm2. Mean blood osteocalcin level was 23,34± 10,9 ng/ml(normal range <20), Ctx level was 0,70± 0,27 (normal range <0.75) ng/ml. There was statistically significant negative relationship between the menopause duration and serum Ctx levels (R =0,382, p<0,05). Mean serum Ctx level was 0,83 ±0,11 ng/ml in the patients whose menopause duration was less than 5 years and was 0,7 ±0,3 ng/ml in the patients whose menopause duration was more than 5 years. There was no relationship between serum osteocalcin and Ctx levels with age, body mass index(BMI), menopause duration, L2- L4 and femur neck BMD values. There was statistically significant relation between BMI(body mass index) and L2 - L4 and femur neck BMD values( p < 0.05). There was no relationship between regular walking activity with BMD, serum osteocalcin and Ctx levels. In this study increased bone turnover rate in early postmenopausal period has been shown. It was known that bone loss increases due to the estrogen deficiency in postmenopausal period. Therefore, bone turnover markers of postmenopausal women should be measured in addition to bone mineral density who had bone loss to determine women with increased bone loss in order to prevent and to treat osteoporosis. (Osteoporoz Dünyasından 2005; 4: 155-158

Quality of Life in the Patients With Osteoporosis: Is There A Difference Between Sexes?

There have been several studies which show the impact of postmenopausal osteoporosis on the patients’ quality of life (QOL). The aim of this study was to investigate the differences in the various domains of QOL between the women and men with osteoporosis. The patients consisted of 30 women and 28 men who hadosteoporosis. Bone mineral density (BMD) was measured by using Dual-Energy X-Ray Absorptiometry (DEXA). Mean age for women and men with osteoporosis was 61.80 (9.13) years and 62.86(11.48) years respectively. QOL was measured by using the Short Form 36 (SF-36). The SF-36 physical function scores were significantly lower in patients with osteoporosis. The impairment in the physical function , physical role and pain domains in women with osteoporosis was significantly greater than those in men. General health score was lowered in men who had fractures. In conclusion, QOL shows different characteristics in men and women with osteoporosis

The effects of orthotic intervention on nerve conduction and functional outcome in Carpal Tunnel Syndrome: A prospective follow-up study

Aim: To evaluate the effects of using night orthosis for 6 weeks in patients with mild to moderate carpal tunnel syndrome (CTS), including a follow up after 3 months using electrophysiological and functional outcome measurements

Description of the registry of patients with ankylosing spondylitis in Turkey: TRASD-IP

GUNDUZ, Osman H/0000-0002-3214-803X; Ayhan, Fikriye Figen/0000-0001-6906-991X; Duruoz, Mehmet Tuncay/0000-0003-3584-2788; Ataman, Sebnem/0000-0003-3570-3825; NAS, Kemal/0000-0002-5845-0851WOS: 000299007300027PubMed: 20711591A web-based application patient follow-up program was developed to create a registry of patients with ankylosing spondylitis (AS) by the Turkiye Romatizma Arastirma Savas Dernegi (TRASD) AS Study Group. This study describes the methodological background and patient characteristics. The patient follow-up program is a web-based questionnaire, which contains sections on socio-demographic data, anamnesis, personal and family history, systemic and musculoskeletal examination, laboratory and imaging data and treatment. Between October 1, 2007 and February 28, 2009, 1,381 patients from 41 centers were included in the registry (1,038 males [75.2%]; mean age 39.5 +/- A 10.7 years). Mean disease duration was 12.1 +/- A 8.5 years, and mean time from initial symptom to diagnosis was 5 +/- A 6.8 years (median 2 years). HLA-B27 positivity was detected in 73.7% of 262 patients tested. Manifestations of extraarticular involvement were anterior uveitis (13.2%), psoriasis and other skin and mucous membrane lesions (6%) and inflammatory bowel disease (3.8%). The prevalence of peripheral arthritis was 11.2%. In 51.7% of patients, the Bath AS Disease Activity Index was a parts per thousand yen4. But since our patients consisted of the ones with more severe disease who referred to the tertiary centers and needed a regular follow-up, they may not represent the general AS population. Disease-modifying anti-rheumatic drugs were being used by 41.9% of patients, with 16.4% using anti-TNF agents. TRASD-IP (Izlem Programi: Follow-up program) is the first AS registry in Turkey. Such databases are very useful and provide a basis for data collection from large numbers of subjects. TRASD-IP gives information on the clinical and demographic profiles of patients, and the efficacy and safety of anti-TNF drugs, examines the impact on quality of life, and provides real-life data that may be used in cost-effectiveness analyses.Wyeth/Pfizer CompanyWyethThe authors express their gratitude to all members of TRASD AS Study group for their cooperation and to Wyeth/Pfizer Company for the sponsorship. The authors declare that they have no conflict of interest

Quality of life and related variables in patients with ankylosing spondylitis

Ataman, Sebnem/0000-0003-3570-3825; Duruoz, Mehmet Tuncay/0000-0003-3584-2788; Karkucak, Murat/0000-0002-4348-8398;WOS: 000289481100010PubMed: 20978859To evaluate quality of life (QoL) and related variables in patients with ankylosing spondylitis (AS), a chronic inflammatory disease of the spine. Nine-hundred and sixty-two patients with AS from the Turkish League Against Rheumatism AS Registry, who fulfilled the modified New York criteria, were enrolled. The patients were evaluated using the Assessment of SpondyloArthritis International Society core outcome domains including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), fatigue (BASDAI-question 1), pain (last week/spine/due to AS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and two QoL questionnaires (the disease-specific ASQoL and generic the Short Form-36 [SF-36]). The mean ASQoL score was 7.1 +/- A 5.7. SF-36 subscales of general health, physical role and bodily pain had the poorest scores. ASQoL was strongly correlated with disease duration, BASDAI, fatigue, BASFI, BASMI, BASRI, MASES, pain and SF-36 subscales (P < 0.001). SF-36 subscales were also strongly correlated with BASDAI and BASFI. Advanced educational status and regular exercise habits positively affected QoL, while smoking negatively affected QoL. In patients with AS, the most significant variables associated with QoL were BASDAI, BASFI, fatigue and pain. ASQoL was noted to be a short, rapid and simple patient-reported outcome (PRO) instrument and strongly correlated with SF-36 subscales.Wyeth/Pfizer CompanyWyethThe authors express their gratitude to all members of the TRASD AS Study group for their cooperation and to Wyeth/Pfizer Company for the registery sponsorship