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

Common problems in the elderly: Urinary incontinence, pain, immobilization

In this review, urinary incontinence, pain and immobilization problems in elderly people have been discussed. Urinary incontinence is a growing medical, social and economic health problem for the elderly people. Urge urinary incontinence and stress urinary incontinence are the most common forms of incontinence and they both affect the quality of life of the elderly. Assessment and treatment of urinary incontinence will significantly influence the elder's quality of life. Many older adults consider pain as a natural part of aging. While elderly people are more likely to experience pain than the general population, in many cases, they are undertreated. Safe pharmacological and non-pharmacological pain treatment options are available for the elderly. Bed rest and immobilization are a common consequence of many diseases and are also a proposed treatment modality for several acute and chronic disorders. It has been approved that inactivity fosters the healing of the affected part of the body; however, the deleterious effects and complications of prolonged bed rest and immobility have been increasingly recognized since the mid-1940s. Although the unfavorable effects and complications of immobilization seem to be variable for individuals, the elderly people are likely to lose significant independent functions easier and faster

Relapsing Polychondritis: Inflamed Joints and Ears

Background: Relapsing polychondritis (RP) is an episodic and progressive inflammatory disease of the cartilaginous structures, including elastic cartilage of the ear and nose, hyaline cartilage of the peripheral joints, fibrocartilage at axial sites, and cartilage of the tracheobronchial tree. The spectrum of its presentations may vary from intermittent mild episodes of chondritis to occasional organ involvement or even life-threatening manifestations. Case Report: We presented a 64 year-old male patient with bilaterally knee arthritis and discoloration of pinna. Conclusion: There is lack of awareness about this disease due to its rarity. With this case presentation, our goal was to draw attention to this disease, which could be delayed for the diagnosis

Vertebral Compression Fracture in a Patient with Hyperthyroidism

Osteoporosis in men is an important public health problem, and its prevalence is increasing as the population ages. Although it is traditionally considered as a women’s health issue, osteoporosis-related mortality and morbidity rates are higher in men. Although the lifetime risk of the hip fracture is lower in men than women, men are twice as likely to die after a hip fracture. All men diagnosed with osteoporosis should be evaluated for secondary causes of bone loss, such as hypogonadism, the use of corticosteroid, smoking, excessive alcohol consumption, low calcium intake, vitamin D deficiency and hypothyroidism. Here, we aimed to present a male patient in whom osteoporotic a vertebral fracture was detected and who was diagnosed with hyperthyroidism

The Bone Mineral Density Values in Fibromiyalgia Syndrome: A Risk Factor For Osteoporosis

Fibromyalgia syndrome(FMS) is a chronic musculoskeletal disease characterized by widespread pain, tender points and clinical findings like, fatigue, sleep disturbances, irritable bowel syndrome. Because of the association with depression and sedantary life style, osteoporosis may be a problem in patients with fibromyalgia. This study was carried out to determine whether fibromyalgia is a risk factor in osteoporosis or not. Thirty-eight women with ages ranging from 25 to 50, meeting the American College of Rheumatology criteria for fibromyalgia and 20 healthy controls were included in the study. Lumbar spine and left femoral bone mineral density (BMD) values were determined with Hologic 2000 DEXA. Beck Depression Scale was used to determine the depression levels. BMD values were significantly lower in FMS group than controls in both lumbar and hip regions (p<0.05). There was also a negative significant correlation between Beck Depression Scale and BMD values in in both lumbar and hip regions (r = -0.537, p=0.001; r = -0.473, p=0.003, respectively). We concluded that fibromyalgia may be a risk factor for osteoporosis and the association with depression may have important implications. Early implementation of appropriate nutritional supplementation (calcium/vitamin D), and exercise and pharmacological therapy may be indicated in patients with FMS. Of Clearly further studies are needed on this subject

Bone Mineral Density in Patients Receiving Anticonvulsant Drugs

The study was carried out to determine possible effects of anticonvulsant drugs on bone mineral density. Twenty two patients with epilepsy who have been receiving anticonvulsant drugs and also 22 healthy controls were included in the study. The average age was 28.9 ± 8.9 years in the patients group and 30.5 ± 6.9 years in the control group. The average drug receiving time was 6.45 ± 4.2 years. At baseline ESR, hemogram, urine deoxypiridinoline (DPD), routine biochemical and hormonal values were determined in both groups. Lumbar spine and left femur bone mineral density (BMD) values were determined with hologic 2000 DEXA. In the statistical analysis, urine DPD levels in the patient group were significantly higher than control group (p0.05). Lumbar spine and left femur BMD values were significantly decreased in patients group (respectively p<0.01, p<0.001). We determined that in the patients using anticonvulsant drugs there was an increase in bone resorption and this effect was more evident in cortical bone than trabecular bone

Effects of Alendronate, Calcitonin and Raloxifene Used in the Treatment of Postmenopausal Osteoporosis On Serum No Levels

The aim of the present study was to evaluate the effects of alendronate, calcitonin and raloxifene used in the treatment of postmenopausal osteoporosis on serum nitric oxide (NO) levels. One hundred women with postmenopausal osteoporosis were enrolled and treated during the 6 months in this study. Patients were equally randomized into four groups: calcitonin, alendronate, raloxifene and control groups. All patients in these three groups and in the control group were supplemented with calcium 500 mg/day elemental calcium. Serum NO levels were determined at baseline and at 6 months. There were not significant changes on serum NO levels after the calcitonin, alendronate, raloxifene and calcium treatment. Also, no significant difference was found among any group comparisons in terms NO levels (p> 0.05). In conclusion, alendronate, calcitonin and raloxifene treatments may not cause to significant changes on serum NO levels

Relationship Between Body Composition and Regional BMD in Premenopausal Women with Rheumatoid Arthritis - Original Investigation

Aim: This study was performed to investigate the relationship between body composition and regional bone mineral density (BMD) in premenopausal women with rheumatoid arthritis (RA). Material and Methods: 23 RA patients and 31 age and sex-matched healthy controls were recruited in this study. Clinical and laboratory assessments of patients were recorded. Health assessment questionnaire (HAQ) was used in the assessment of functional disability. BMD values were measured by dual energy X-ray absorptiometry (DXA). The regional BMD (upper and lower extremities), L1-L4 lumbar spine BMD, femoral neck BMD and total body BMD were analyzed. Also, regional lean mass(upper and lower extremities), total lean mass of body, regional fat mass (upper and lower extremities), body fat mass, percentage of body fat were measured with DXA. Results: BMD values of all body sites were significantly lower in RA patients versus the controls, while body composition determinants were no different between the two groups. BMD of lower extremities, femoral neck and total body were affected by lean mass of lower extremities and total body as independent from body weight in RA patients. Disease duration and HAQ scores were correlated with BMD values among the disease characteristics. Conclusion: Regional and total fat mass does not appear as relationship with BMD values. Lean mass of lower extremities and total body may be significant determinants of BMD on regions of femoral neck, lower limbs and total body in premenopausal women with RA. (From the World of Osteoporosis 2009;15:29-33