Can ultrasound be an assessment tool for sagittal spine mobility and chest expansion in patients with ankylosing spondylitis?

WOS: 000449373500099PubMed ID: 30278577We aimed to examine whether ultrasound (US) is useful for evaluating spinal mobility and chest expansion in ankylosing spondylitis (AS) patients and determine a cutoff value to identify reduced sagittal lumbar mobility. Our cross-sectional study included 50 AS patients and 50 controls. Metric measurements and Bath AS indices were measured in AS patients. The distance between C6-C7, T11-T12, and L4-L5 vertebrae was measured, and the difference and percentage of difference between erect position and maximal cervical and lumbar flexion was calculated (T11-T12(dif), T11-T12%, L4-L5(dif), L4-L5%, T+L-dif, T+L%). Intercostal divergence was measured 1.5cm away on the left from the sternocostal space during maximum inhalation and maximum exhalation, and the difference and percentage of difference between them was calculated (ICdif, IC%). All metric measurements were lower in the AS group except for tragus-to-wall distance. T11-T12(dif), T11-T12%, L4-L5(dif), T+L-dif, and T+L% values were higher in the control group, while other US measurements did not differ between the groups. All US measurements except ICdif and IC% correlated with the Bath AS Metrology Index. Thus, US may be used for assessing spinal mobility in patients with AS. T11-T12(dif) <0.79cm may show decreased lumbar sagittal mobility

Whıch muscles’ strength in upper extremity are related to disease activity, functionality, and disability in female patients with rheumatoid arthritis

“16. TIHUD International Internal Medicine Training Meetings” kongresinde sözel bildiri olarak sunulmuştur (22 - 24 Şubat 2019, Bükreş/ Romanya)Bu çalışmada kas gücü kaybına neden olan romatoid artrit (RA) hastalarında; dominant üst ekstremitede hangi kas gruplarının etkilendiğinin, bu etkilenmelerin hastalık aktivitesi, fonksiyonellik ve engellilik ile ilişkisinin araştırılması amaçlanmıştır. Çalışmaya 30 RA hastası, 30 sağlıklı gönüllü dahil edildi. Hasta grubunda “hastalık aktivite skoru-28 (DAS28)”, “üst ekstremite fonksiyonel indeksi-15 (UEFI-15)” ve “sağlık değerlendirme anketi (HAQ)” skorları hesaplandı. Gönüllülerin dominant üst ekstremitelerinden; başparmak interfalanjiyal (IP) ve metakarpofalanjiyal (MKF), diğer parmakların proksimal interfalanjiyal (PIP) ve MKF eklem fleksörlerinden, el bileği ile dirsek fleksör ve ekstansörleri ile omuzun fleksör, ekstansör, iç rotator (IR), dış rotator (ER), abduktör ve addüktör kaslarının maksimum ve ortalama kas güçleri ölçüldü. Hastaların toplam PIP ve MKF (PIPtoplam, MKFtoplam) değerleri elde edildi. Hasta ve kontrol grubu arasında yaş ve boy açısından anlamlı fark görülmemiştir. Kas güçleri açısından; RA grubunda, başparmak IP ve MKF ile PIPtoplam, MKFtoplam ve el bileği fleksiyonunun maksimum ve ortalama değerleri, kontrol grubundan anlamlı düşük tespit edilirken; omuz ekstansiyonu ortalama ve adduksiyon, abduksiyon maksimum ve ortalama kas güçleri RA grubunda düşük tespit edilmiştir. DAS28 ile parmak fleksörleri, el bilek ekstansörleri ve dış rotatorlar haricindeki omuz kasları negatif ilişkiliyken; UEFI-15 skorları ile bilek ekstansör ve omuz kuşağı kasları pozitif ilişkili bulunmuştur. HAQ skorlarının ortalama el bilek fleksiyonu, dirsek ekstansiyonu ve omuz kuşak kasları ile ilişkili olduğu saptanmıştır. El ve el bileği kasları hastalık aktivitesinden en çok etkilenenler olmalarına rağmen dirsek ve omuz kuşağı kaslarının fonksiyonelliği ve engelliliği daha çok etkilediği görülmüştür. Üst ekstremite kaslarının toplam kuvveti, hastalık aktivitesi; fonksiyonellik ve engellilik ile ilişkili bulunmuştur.The aim of this study is to investigate which muscle groups are affected in dominant upper extremity, and relation of these effects with disease activity, functionality, disability in patients with rheumatoid arthritis (RA) which causes muscle strength loss. 30 RA patients, 30 healthy volunteers were included in this study. In patient group, "disease activity score-28 (DAS28)", "upper extremity functional index-15 (UEFI-15)", "health assessment questionnaire (HAQ)" scores were calculated. From dominant upper extremities of volunteers; maximum and average muscle strengths of thumb interphalangeal (IP), metacarpophalangeal (MCP), proximalinterphalangeal (PIP) and MCP joint flexors of other fingers, wrist and elbow flexors/extensors, flexor, extensor, internal rotator (IR), external rotator (ER), abductor/adductor muscles of shoulder were measured. Total PIP/MCP (PIPtotal, MCPtotal) values of patients were obtained. There was no significant difference between patient and control groups in age/height. In muscle strengths; thumb IP, MCP/PIPtotal, MCPtotal, wrist flexion mean and maximum values were significantly lower in RA group than control group; mean shoulder extension, maximum adduction/abduction, mean muscle strengths were low in RA group. DAS28, finger flexors, wrist extensors, shoulder muscles except ER were negatively related; UEFI-15 scores, wrist extensor, shoulder girdle muscles were positively related. HAQ scores were associated with mean wrist flexion, elbow extension, shoulder girdle muscles. Although hand and wrist muscles are the most affected by disease activity, it has been observed that elbow and shoulder girdle muscles affect functionality and disability more. Total strength of upper extremity muscles has been associated with disease activity, functionality and disability

Top 100 cited articles on ankylosing spondylitis

Ankylosing spondylitis is a global health problem. There are continuous innovations in terms of etiopathogenesis, diagnosis, and treatment. Here, the top 100 most cited articles on ankylosing spondylitis during the last three decades are analyzed

The relationship between gluteus medius latent trigger point and muscle strength in healthy subjects

Introduction: We hypothesized that latent MTrPs might decrease gluteus medius muscle strength in healthy individuals. This study aimed to investigate the relationship between latent MTrPs and gluteus medius muscle strength in a group of healthy adults. Methods: Forty-eight healthy men were included in the study. Trigger point examination for the gluteus medius was performed bilaterally. Subjects with one or more trigger points on the dominant side and those without any trigger point were assigned to two groups. Muscle strength for the gluteus medius was assessed with a manual muscle tester using the “break test” technique on both sides. For statistical analysis, the independent sample t-test was used to compare the intergroup differences. Results: The latent MTrP group demonstrated lower abduction muscle strength in the dominant gluteus medius. Moreover, the latent MTrP group showed higher abduction muscle strength in the non-dominant gluteus medius (p < 0.05). Intergroup comparison revealed that gluteus medius abduction muscle strength on the dominant side was higher in the non-latent MTrP group (p < 0.05). Conclusion: Latent MTrP may cause joint movement limitation, overload by affecting motor activation patterns and reciprocal inhibition mechanisms. Outcomes of the current study revealed that gluteus medius abduction strength values below 9.7 kg could be associated with latent MTrP with high sensitivity and low specificity. It is imperative to note that the latent MTrP of gluteus medius muscle, which has a critical role in the lumbopelvic junction, should not be ignored in clinical practice, and treatment should be applied when detected

Axial Spondyloarthritis and Autosomal Dominant Polycystic Kidney Disease in Two Siblings: A Rare Cooccurrence

Autosomal dominant polycystic kidney disease (ADPKD) is the most frequently occurring hereditary kidney disease, and axial spondyloarthritis (SpA) is one of the most frequently occurring rheumatic diseases. Treatment-related decisions for axial SpA may pose a challenge in case of renal involvement. The authors describe two siblings with cooccurrence of these two diseases. The association of these two diseases is not well known. Practitioners should monitor renal function in SpA patients and take treatment-related decisions regarding renal involvement. Antitumor necrosis factor-alpha (anti-TNF-α) agents may be used in case nonsteroidal anti-inflammatory drugs (NSAIDs) cannot be utilized

Neuropathic pain questionnaire and neuropathic pain questionnaire-short form: Translation, reliability, and validation study of the Turkish version

AIM: To perform reliability and validity studies of the Neuropathic Pain Questionnaire (NPQ) and NPQ-Short Form (SF) in the Turkish language. MATERIAL and METHODS: The Turkish translation and cross-cultural validation were performed. Then, 101 patients (36 males, 65 females; mean age: 50.4 ± 14.49; range: 20-87) with chronic pain were asked to fill out a pack of questionnaires, including the NPQ, NPQ-SF, Douleur Neuropathique 4 (DN4), Leeds Assessment of Neuropathic Symptoms (LANSS), and Numeric Rating Scale (NRS). A subgroup of 41 patients (11 males, 30 females) completed the NPQ and NPQ-SF for the second time after 3 days by telephone. Internal consistency was tested by Cronbach's-α and test-retest reliability was assessed by calculating the intraclass correlation coefficients (ICC). Construct validity was assessed by comparing NPQ, NPQ-SF, and NRS. Concurrent validity was tested by comparing NPQ, NPQ-SF, DN4, and LANSS. RESULTS: Internal consistency by Cronbach's-α was 0.84 and 0.67 for the NPQ and NPQ-SF, respectively, indicating adequate and low internal consistency, respectively. ICC was 0.96 (p < 0.001; 95% confidence interval [CI], 0.95-0.97) for NPQ and 0.97 (p < 0.001; 95% CI, 0.95-0.97) for NPQ-SF, indicating a high test-retest reliability for both questionnaires. CONCLUSION: The Turkish versions of NPQ and NPQ-SF were reliable and valid for patients with chronic pain. To our knowledge, this is the first Turkish adaptation and test of the reliability and validity of the NPQ and NPQ-SF (short-form). These questionnaires could potentially help clinicians who seek to assess neuropathic pain for clinical and investigational purposes

How does cross-education affects muscles of paretic upper extremity in subacute stroke survivors?

Introduction This study aimed to evaluate the benefits of adding electromuscular stimulation (EMS) to the flexors of wrist muscles on the nonparetic limb in conventional stroke training to strengthen homologous agonist and antagonist muscles on the paretic side in patients with subacute stroke. Methods The EMS group patients (n = 15) received conventional therapy for 30 sessions for 6 weeks (60 min/session) with 30 min of electrical stimulation to their nonparetic forearm using wrist flexors, with 5 min of pre- and post-warm-up. The transcutaneous electrical nerve stimulation (TENS) group patients (n = 15) received the same conventional rehabilitation training with 30 min of conventional antalgic TENS at a barely sensible level to their nonparetic forearm. The Fugl-Meyer motor function assessment for upper extremity (FMA-UE), functional independence measure (FIM), Brunnstrom staging of recovery for hand, maximum and mean wrist flexion force (flexion(max) and flexion(mean)), and wrist extension force (extension(max) and extension(mean)) of paretic untrained limb were evaluated before and after the treatment. Results EMS and TENS group patients improved similarly in terms of FMA-UE, FIM, and Brunnstrom staging for hand recovery. However, flexion(max) and flexion(mean) of the paretic limb increased more in the EMS group than in the TENS group. Extension(max) and extension(mean) on the paretic side increased in the EMS group but did not differ in the TENS group. Conclusion Cross-education via EMS may have a beneficial effect as an adjunct to conventional treatment methods. This study is retrospectively registered and is available at (ID: NCT04113369).Coordinatorship of Scientific Research Projects of Bezmialem Universit

Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire: A cross-cultural adaptation and validation to the Turkish language

WOS: 000451729300012PubMed ID: 30054752In chronic inflammatory rheumatic diseases (CIRD), it is important to understand patients' fears towards their disease in order to improve patient-physician dialog, to raise the quality of care offered, and to optimize treatment adherence. In this study, we aimed to translate the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire into Turkish and evaluate its psychometric properties in patients with CIRD. One hundred fifteen patients filled the provided socio-demographic information form, FAIR-Tr questionnaire, Hospital Anxiety and Depression Scale (HADS), and Beck's Hopelessness Scale (BHS). For the analysis of short-term reliability, 50 patients re-filled the FAIR-Tr questionnaire 1week later. Internal consistency was evaluated with Cronbach's coefficient and test-retest reliability was evaluated with intraclass correlation coefficients (ICC). Construct validity analysis was investigated based on the correlation with HADS and BHS. All patients found FAIR-Tr easily understandable and acceptable. FAIR-Tr internal consistency (Cronbach's =0.93) and test-retest reliability (ICC=0.91) were excellent. Psychometric validation was proved upon observing high correlation with HADS (Anxiety, r=0.77; Depression, r=0.70) and moderate correlation with BHS (r=0.65). FAIR-Tr is a questionnaire that has excellent internal consistency and test-retest reliability. The successful correlation with HADS and BHS supported its psychometric validity in terms of evaluating the fear in CIRD cases. We think that FAIR-Tr is a specific scale that can help to evaluate the disease- and treatment-related fears of the Turkish patients with CIRD and may be useful in both routine practice and clinical studies

Cross-cultural adaptation and validation of the Turkish version of the Functional Index for Hand Osteoarthritis (FIHOA)

Background: To perform reliability and validity study of the Functional Index for Hand Osteoarthritis (FIHOA) in the Turkish language. Methods: FIHOA was translated into Turkish following the principles of cross-cultural adaptation. Our translation was firstly tested in 40 patients with hand osteoarthritis. Adapted FIHOA questionnaire was then administrated to 100 hand OA patients successively with Modified Health Assessment Questionnaire (mHAQ), Numerical Rating Scale (NRS), and Short Form-36 (SF-36). Patients filled out the FIHOA questionnaire one more time after five days for test-retest assessment. Patients were divided into two groups as symptomatic or asymptomatic, with a NRS score of 5 or above defining symptomatic OA. Internal consistency was assessed by Cronbach's alpha and intraclass correlation coefficient (ICC) of test-retest reliability. Spearman correlation analysis was used to determine the correlation and validity between data. External construct validity was assessed using the correlation between FIHOA, mHAQ, hand pain NRS, and negative correlation with SF-36 subgroups. Results: According to the total score, Cronbach-alpha was found as 0.90, while ICC was determined as 0.98 for test-retest reliability. When the correlations between the FIHOA questionnaire, mHAQ, and NRS questionnaires were examined, significant correlations were determined, and negative correlations between FIHOA and SF-36 subgroups were observed. Conclusion: Turkish FIHOA is a reliable and valid method for assessing functionality in Turkish patients with hand osteoarthritis