Cortisol and hypothalamic–pituitary–gonadal axis hormones in follicular-phase women with fibromyalgia and chronic fatigue syndrome and effect of depressive symptoms on these hormones

We investigated abnormalities of the hypothalamic–pituitary–gonadal axis and cortisol concentrations in women with fibromyalgia and chronic fatigue syndrome (CFS) who were in the follicular phase of their menstrual cycle, and whether their scores for depressive symptoms were related to levels of these hormones. A total of 176 subjects participated – 46 healthy volunteers, 68 patients with fibromyalgia, and 62 patients with CFS. We examined concentrations of follicle-stimulating hormone, luteinizing hormone (LH), estradiol, progesterone, prolactin, and cortisol. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). Cortisol levels were significantly lower in patients with fibromyalgia or CFS than in healthy controls (P < 0.05); there were no significant differences in other hormone levels between the three groups. Fibromyalgia patients with high BDI scores had significantly lower cortisol levels than controls (P < 0.05), and so did CFS patients, regardless of their BDI scores (P < 0.05). Among patients without depressive symptoms, cortisol levels were lower in CFS than in fibromyalgia (P < 0.05). Our study suggests that in spite of low morning cortisol concentrations, the only abnormalities in hypothalamic–pituitary–gonadal axis hormones among follicular-phase women with fibromyalgia or CFS are those of LH levels in fibromyalgia patients with a low BDI score. Depression may lower cortisol and LH levels, or, alternatively, low morning cortisol may be a biological factor that contributes to depressive symptoms in fibromyalgia. These parameters therefore must be taken into account in future investigations

Evaluation of cognitive impairment in rheumatoid arthritis: predictive value of joint destruction and disease activity

AMAÇ: Romatoid Artrit (RA), oryantasyon, dikkat ve bellek zayıflığı gibi azalmış bilişsel işlevlere neden olur. Sunulan bu çalışmanın amacı RA’da bilişsel işlevlerin bir belirleyicisi olarak eklem yıkımını ve hastalığın diğer parametrelerini değerlendirmektir. GEREÇ VE YÖNTEM: Bu kesitsel çalışma, 45 hasta ve 40 sağlıklı kontrol içemektedir. RA’lı hastalarda radyolojik progresyon skoru (≥0.5, modifiye Sharp / van der Heijde skorları- MTS’ler), 28 eklemin hastalık aktivite skoru (DAS-28) ve 44 eklemin hastalık aktivite skoru (DAS-44) değerlendirildi. Mini Mental Test (MMSE) ve Hastane Anksiyete Depresyon Ölçeği (HADÖ) değerlendirildi. Sonuçlar, bilişsel işlevleri belirlemek için hasta ve kontrol grubu arasında karşılaştırıldı. BULGULAR: MMSE skorları açısından gruplar arasında istatistiksel olarak anlamlı fark vardı (p=0.003). RA ve kontrol grupları arasında anksiyete ve depresyon düzeyleri açısından anlamlı farklılık yoktu. MMSE skoru; hastalık süresi (p=0.011, r=-0.371), Sharp skoru (p=0.018, r=-0.350) ve DAS-28(p=0.044, r=-0.296) skoru ile ilişkilendirildi. Depresyon skoru da DAS ile ilişkiliydi (p=0.004, r=0.425). Romatoid faktör düzeyleri, antisiklik sitrullinat peptid düzeyleri ve bilişsel işlev testleri arasında herhangi bir ilişki bulunamadı. SONUÇ: Sonuçlar, uzun süredir RA olan hastalarda inflamatuar mediatörlere maruz kalmanın, eklemleri etkilediği sürece merkezi sinir sisteminde de bozulmaya neden olabileceğini göstermektedir. Bilişsel bozulma, hastalık şiddeti ve eklem yıkımı ile ilişkili idi. Dolayısıyla, radyografik eklem hasarı, RA’daki bu kronik süreç boyunca nöronal hasarın ve bilişsel bozulmanın boyutunu yansıtan pozitif bir ön belirteç olabilir.OBJECTIVE: Rheumatoid Arthritis (RA) cause poor cognitive functions including reduced memory, orientation and attention. The aim of the present study is to evaluate joint destruction and other parameters of disease as a predictor of cognitive functions in RA. MATERIAL AND METHODS: This cross-sectional study included forty five patients and forty healthy controls. Radiological progression score (≥0.5 the modified Sharp/ van der Heijde scores- MTSs), disease activity score of 28 joints (DAS-28) and disease activity score of 44 joints (DAS-44) were evaluated in patients with RA. Mini Mental State Examination (MMSE) and Hospital Anxiety Depression Scale (HADS) were evaluated and the results were compared between patients and control groups to determinate cognitive functions. RESULTS: There was a statistically significant difference between groups in terms of MMSE scores (p=0.003). There were no significant differences in terms of anxiety and depression levels between RA and control groups. MMSE score was correlated with disease duration (p=0.011, r=- 0.371), Sharp score (p=0.018, r=-0.350) and DAS-28 score (p=0.044, r=-0.296). Depression score was also correlated with DAS (p=0.004, r=0.425). No relationship was found between Rheumatoid factor levels, anti-cyclic citrullinated peptide levels and the cognitive function tests. CONCLUSIONS: The results indicate that exposure to inflammatory mediators in patients with long standing RA may lead to deterioration on central nervous system as long as affecting joints. Cognitive deterioration was correlated with disease severity and joint destruction. Thus, the radiographic joint destruction can be a positive predictor of reflecting the extent of neuronal damage and cognitive deterioration during this chronic process in RA

Increased mRNA expression of ADAMTS1 and ADAMTS4 in peripheral blood mononuclear cells of psoriasis patients developed psoriatic arthritis

Background and purpose: Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO) affecting both skin and joint. ADAMTS (A disintegrin-like and metalloproteinase domain with thrombospondin-1 repeats) is a large family of proteoglycanase enzymes and the expression levels of ADAMTS proteases are upregulated in arthritis. In this study, we aimed to determine mRNA expression levels of ADAMTS1, ADAMTS4 and ADAMTS5 and identifying the key signaling pathways involved in the regulation of these proteases in peripheral blood mononuclear cells (PBMCs) of patients with PsO who later developed PsA. Materials and methods: 25 PsA patients, 25 PsO patients and 25 healthy individuals were included in this study. PBMCs were isolated from venous blood and mRNA expression levels of ADAMTS1, ADAMTS4 and ADAMTS5 were measured through Real-time quantitative PCR (RTqPCR). Results: mRNA expression levels of ADAMTS1 and ADAMTS4 were found to be increased in PsA patients compared with control and PsO patients. In response to TNF-a stimulation, the expression of ADAMTS1 in PsA patients was determined to be reduced in a Erk1/2 activity dependent manner, whereas p38 and JNK activities were shown to induce the expression of ADAMTS4 in PsA patients. The reduced ADAMTS1 expression in PsA patients induced by IL-1b stimulation was revealed to be dependent on NFkB activity. Conclusions: mRNA expressions of ADAMTS1 and ADAMTS4 regulated by MAPKs and NFkB were increased in PBMCs of PsA patients. This study supports the hypothesis that ADAMTS1 and ADAMTS4 mRNA level might be diagnostic markers for identifying psoriatic patients who are more likely to develop PsA and a future drug target for PsA treatment

Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

Spinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI). The patient was re-operated and the patient's neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery

The Relationship Between Serum Pentraxine 3 Levels and Hematological Markers in Patients With Rheumatoid Arthritis

Conclusion: We found no correlation between PTX3 and disease activity score 28 or NLR, although PTX3 levels were higher in RA patients than the controls. As a result, we were unable to establish a relationship between PTX3 and disease activity, directly or indirectly. To our knowledge, our study was the first to investigate the relationship between PTX3 and NLR

Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain.

Background and Objectives: The aim of this study was to determine whether low power laser therapy (GalliumArsenide) is useful or not for the therapy of chronic low back pain (LBP). Study Design/Materials and Methods: This study included 75 patients (laser þ exercise-25, laser alone-25, and exercise alone-25) with LBP. Visual analogue scale (VAS), Schober test, flexion and lateral flexion measures, Roland Disability Questionnaire (RDQ) and Modified Oswestry Disability Questionnaire (MODQ) were used in the clinical and functional evaluations pre and post therapeutically. A physician, who was not aware of the therapy undertaken, evaluated the patients. Results: Significant improvements were noted in all groups with respect to all outcome parameters, except lateral flexion (P &lt; 0.05). Conclusions: Low power laser therapy seemed to be an effective method in reducing pain and functional disability in the therapy of chronic LBP

The Evaluation of Serum Tumor Necrosis Factor-Like Weak Inducer of Apoptosis, Interleukin-6, Fetuin-A, Homeostatic Model Assessment-Insulin Resistance, and Insulin Levels in Rheumatoid Arthritis Patients in Clinical Remission

Conclusion: We found that RA patients had lower sTWEAK levels and higher fetuin-A levels than the control group subjects. Furthermore, these two molecules were associated with each other. This study demonstrated that in RA patients, even if the disease is controlled with treatment, some molecules associated with an increased metabolic and cardiovascular risk continue to function. Follow-up studies on larger populations are warranted to confirm these findings

Hypothalamic-pituitary-gonadal axis hormones and cortisol in both menstrual phases of women with chronic fatigue syndrome and effect of depressive mood on these hormones

BACKGROUND: Chronic fatigue syndrome (CFS) is a disease which defined as medically unexplained, disabling fatigue of 6 months or more duration and often accompanied by several of a long list of physical complaints. We aimed to investigate abnormalities of hypothalamic-pituitary-gonadal (HPG) axis hormones and cortisol concentrations in premenopausal women with CFS and find out effects of depression rate on these hormones. METHODS: We examined follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone and cortisol concentrations in 43 premenopausal women (mean age: 32.86 ± 7.11) with CFS and compared matched 35 healthy controls (mean age: 31.14 ± 6.19). Patients were divided according to menstrual cycle phases (follicular and luteal) and compared with matched phase controls. Depression rate was assessed by Beck Depression Inventory (BDI), and patients with high BDI scores were compared to patients with low BDI scores. RESULTS: There were no significant differences in FSH, LH, estradiol and progesterone levels in both of menstrual phases of patients versus controls. Cortisol levels were significantly lower in patients compared to controls. There were no significant differences in all hormone levels in patients with high depression scores versus patients with low depression scores. CONCLUSION: In spite of high depression rate, low cortisol concentration and normal HPG axis hormones of both menstrual phases are detected in premenopausal women with CFS. There is no differentiation between patients with high and low depression rate in all hormone levels. Depression condition of CFS may be different from classical depression and evaluation of HPG and HPA axis should be performed for understanding of pathophysiology of CFS and planning of treatment