Hypothyroidism and autoimmune thyroid disorders in rheumatoid arthritis: relationship with disease activity.

Background and aims: Thyroid function abnormalities and thyroid autoantibodies have previously been described in rheumatoid arthirits (RA) with limited data. In some studies, a relationship was found between thyroid autoantibodies and RA disease activity. However, there are not strong studies in the literature indicating the relationship between thyroid diseases and RA. The aim of this study was to determine the frequency of hypothyroidism and to investigate the relationship between thyroid hormone levels, autoantibodies and disease activity in patients with rheumatoid arthritis (RA). Methods : 1017 patients with the diagnosis of RA were recruited. This observational study was conducted between January 2014 and July 2015. Demographic variables were recorded. Anti-nuclear antibodies (ANA), anti-cyclic citrulli-nated peptide antibody (anti-CCP), Rheumatoid Factor (RF), C reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), anti-microsomal antibody (anti-TPO )and anti-thyroglobulin antibody (anti-TG) were determined. Visual analog score and Disease Activiy Score 28 (DAS-28) ESR and DAS-28 CRP were recorded. The relationship between thyroid hormone levels and thyroid antibodies and disease activity parameters were determined. Results: 98 (%9,7) patients had hypothyroidism and 61 (%6) patients had hyperthyroidism. 210 (20,7%) patients with RA was positive for TPOAb and 165(16,3%) for anti-TG. Positive correlation was detected between anti-TPO positivity and anti-CCP levels (p:0.005, r:0,274). In anti-TG antibody positive patients, there was a significant positive correlation of thyroid hormone levels with CRP and DAS 28-CRP (p:0.01, r:0,120; p:0.01, r:0,169). Conclusion: Thyroid autoantibodies were found to be positive in 16-21% of patients with RA. Though hypothyroidism is not very frequent in RA patients, autoimmune thyroid disease is quite common, which may be related to disease activity.

Prolotherapy Versus Phonophoresis and Corticosteroid Injections for the Treatment of Plantar Fasciitis: A Randomized, Double-Blind Clinical Trial.

The aim of this study was to compare the effectiveness of prolotherapy with phonophoresis and steroid injection in patients with plantar fasciitis (PF). One hundred forty-six patients with PF were randomly divided into prolotherapy, phonophoresis, and injection groups. The treatment method to be applied to them was determined by drawing lots of equal numbers of papers with "Prolotherapy," "Corticosteroid," and "Phonophoress" written on it among those who accepted to be treated. Patients were evaluated using heel sensitivity index (HSI), visual analog scale (VAS), foot function index (FFI), and Short Form (SF)-36 at baseline, first and third months after the therapy. Plantar fascia thickness (PFT) was measured by ultrasonography (USG) at baseline, first and third months after the therapy. Statistically significant improvements were found in all parameters at 1 and 3 months after treatment in all groups (p < .05). There was no significant difference between VAS and FFI scores between the 3 groups (p > .05). Improvement in the HSI (p = .021) and SF-36 general health (GH) subscales at the third month after treatment in the prolotherapy group was significantly better at the first and third months compared to the other groups (p = .033 and p < .01). No complications were observed in any of the patients. Our study results suggest that prolotherapy, phonophoresis, and steroid injection are beneficial as safe treatment modalities in the early period of PF treatment. The improvement of HSI and SF-36 GH subscale lasts longer with prolotherapy, but ultrasonographic findings do not change in the third month of these treatment applications.