Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis?

AIM: To evaluate the relationship between mean platelet volume (MPV) and red cell distribution width (RDW), and disease activity in rheumatoid arthritis (RA). PATIENTS & METHODS: Hundred RA and 100 controls were included. RESULTS: MPV and RDW were higher in RA (p < 0.0001). The cut-off levels of RDW and MPV were 14.8 and 10.4. Patients with RDW >14.8 had higher Disease Activity Score 28 (DAS28; p = 0.002) and pain score (p = 0.0007). RDW was positively correlated with DAS28 and pain. But, DAS28 and pain were not different between patients with MPV >10.4 and <10.4. CONCLUSION: MPV and RDW were significantly higher in RA. RDW and MPV were similar to erythrocyte sedimentation rate and C-reactive protein to indicate inflammatory activity. RDW was correlated with pain and DAS28, but MPV was not associated with them.

Sleep quality in patients with chronic low back pain: a cross-sectional study assesing its relations with pain, functional status and quality of life.

OBJECTIVE: The aim of this study was to investigate sleep quality in patients with chronic low back pain (CLBP) and its relationship with pain, functional status, and health-related quality of life (HRQOL). METHODS: Two hundred patients with CLBP aged 20-78 years (mean: 50.2 years) and 200 sex- and age-matched pain-free healthy controls (HCs) aged 21-73 years (mean: 49.7 years) were included in this study. After lumbar region examination, in patients, pain was evaluated with the Short Form-McGill Pain Questionnaire (SF-MPQ), functional capacity with the Functional Rating Index (FRI), and health-related quality of life with the Short Form-36 (SF-36). The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality of both groups.The sleep quality was compared between the patients and HCs. In patients with CLBP, its relations with pain, functional status and HRQOL were also investigated. RESULTS: The patients had significantly higher total scores (8.1 ± 4.3, 4.6 ± 3.4, P< 0.001, respectively) and subscale scores (P< 0.001) for PSQI compared to HCs. The groups were only similar in use of sleeping medication (P> 0.05) Among the patients, sleep quality was worse in women, in the patients with complaints more than 11 years, in the patients with low back and two leg pain (P< 0.05). Mean scores of the FRI, SF-MPQ, and visual analog scale in the patients were 8.5 ± 3.0, 16.7 ± 8.0, 6.9 ± 1.2, respectively. The PSQI total scores of patients were positively related with both SF-MPQ and FRI scores (P< 0.001). Also, there were negative relationships between the physical component summary score of the SF-36 and all subscale scores of the PSQI, without sleep duration of PSQI (P< 0.001). CONCLUSION: The sleep quality of patients with CLBP was worse compared to HCs, and there were positive relations between the sleep quality with pain and functional status. Also, the poor sleep quality had negative effect on the physical component of quality of life.

The geriatric hand: correlation of hand-muscle function and activity restriction in elderly.

On the basis of the importance of hand manipulation in activities of daily living (ADL), deterioration of hand function because of various factors reduces quality and independence of life of the geriatric population. The aim of this study was to identify age-induced changes in manual function and to quantify the correlations between hand-muscle function and activity restriction in the geriatric age group, through grip and pinch measurements and a set of questionnaires. Twenty-four geriatric (aged 65-79 years) volunteers participated in the study. Bilateral grip and pinch strengths have been recorded. To document impairment of manual functions, self-estimated hand function, Duruöz and Dreiser hand indices, Geriatrics-Arthritis Impact Measurement Scale (GERI-AIMS) manual dexterity questionnaires have been completed. Activity restriction and quality of life of these patients were inquired with short form (SF)-36 and Instrumental Activities of Daily Living (IADL) scores. Grip and pinch strengths correlated best with Duruöz and Dreiser indices. Similarly, SF-36 and IADL had higher correlation coefficients for Duruöz and Dreiser indices. A very good correlation between IADL and SF-36 was calculated too. Male and female participants revealed statistically significant differences for grip and pinch strengths as well as self-estimated hand function and SF-36. Another result was that none of our parameters, including grip strength and SF-36 had differed significantly between the 65-70 and 70-79 years age subgroups. However, grip strength displayed statistically significant lower values when compared with young adult mean values of a previous study. Our data in this study support the hypothesis that hand-muscle function correlates with functional dependency in the elderly. Manual function can be determined by grip strength in addition to multiple available functional tools. In this study, Dreiser and Duruöz hand function indices were the best to correlate with ADL and quality of life.

Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire.

OBJECTIVES: The aim of this study was to develop a Turkish version of the Boston Questionnaire and assess its reliability and validity. METHODS: Sixty-seven patients with idiopathic carpal tunnel syndrome were included in the study. The Turkish version of Boston Questionnaire was obtained after translation process, and was then administered to subjects twice within seven days. Reliability was assessed by internal consistency (Cronbach's alpha and item-total correlation), and reproducibility. Validity was examined by correlating the Boston Questionnaire scores to general health status (Short Form-36), pain severity (Visual Analogue Scale) and pinch and grip strength measures. RESULTS: Reliability of the Turkish version was very good, with high internal consistency (Cronbach's alpha 0.82 for symptom severity scale, and 0.88 for functional status scale), and reproducibility (Pearson correlation coefficient 0.60 for symptom severity scale, and 0.77 for functional status scale). The Boston Questionnaire scores were correlated with Visual Analogue Scale, physical functioning, physical role, bodily pain and emotional role subscales of Short Form-36, pinch and grip strength scores to obtain coefficients for external construct validity. CONCLUSION: Adaptation of the Boston Questionnaire for use in Turkey was successful. Our results seem to support previous finding of the English version, indicating that it is valid and reliable.

Soft tissue composition, axial bone mineral density, and grip strength in postmenopausal Turkish women with early rheumatoid arthritis: Is lean body mass a predictor of bone mineral density in rheumatoid arthritis?

OBJECTIVE: To study bone mineral density and body composition in patients with early rheumatoid arthritis to determine the relationship of lean mass, fat mass and hand grip strength to bone mineral density. METHODS: Fifty-one female patients who fulfilled the American College of Rheumatology (ACR) for RA were recruited. Fifty-one (51) female RA patients, age matched female control subjects and 53 osteoporotic patients (WHO criteria) were included in the study. All subjects were at postmenopausal period. Early RA is defined as the disease duration <10 years. Whole body composition and BMD were estimated by DEXA (Norland XR-46). Hand grip strength was measured by JAMAR hand dynamometer. Body mass index (BMI) and anthropometric measures (skinfold thickness and waist-hip ratio) were also assessed. RESULTS: The mean age of patients and controls was 55.4 +/- 9.5, 56.9 +/- 7.4, and 55.2 +/- 7.6, respectively. There was no statistically significant difference in age, BMI, and years since menopause between RA patients, OP patients, and controls (p < 0.05). Bone mineral density of lumbar and femoral neck regions, total bone mineral density, and bone mineral content in RA patients were significantly lower than in controls but not in osteoporotic patients. Lean body mass was also significantly lower in RA patients than controls but not in osteoporotic patients. However, hand grip strength was significantly lower in RA patients than in osteoporotic patients and controls (p < 0.05). Total lean mass was correlated with body mass index, waist-hip ratio, femoral neck BMD, and total bone mineral content, total BMD in RA patients (p < 0.05). Grip strength was correlated with duration of disease (RA) and age negatively, and also correlated with total BMD in RA patients. CONCLUSION: These results indicate that lean mass was associated with BMD. To preserve BMD, maintaining or increasing lean mass would appear to be an appropriate strategy for avoiding hip fracture and its complications.

The effect of circulating nitric oxide level on axial bone mineral density in postmenopausal Turkish women with rheumatoid arthritis: A preliminary report.

The aim is to investigate the differences in the circulating nitric oxide (NO) levels of rheumatoid arthritis (RA) patients, healthy controls and osteoporotic (OP) patients. We also examined whether the circulating NO levels may be correlated with bone mineral density (BMD) in RA patients. Forty-five patients with RA, 30 healthy women and 30 osteoporotic patients were recruited from the outpatient clinic. All the subjects were female and postmenopausal. Serum NO levels were measured (Nitrite/Nitrate, calorimetric method 1746081, Roche diagnostics, Mannheim, Germany) and BMD was measured at the spine and hip using dual energy X-Ray absorbtiometry (DEXA, Norland XR-46). Height and weight were measured and body mass index was calculated. Circulating NO levels were significantly higher in RA patients than other groups. Moreover, the RA group showed significantly higher BMD at lumbar spine and femoral neck regions compared to osteoporotic patients. However, the RA group showed significantly lower BMD at all sites than the controls. There was no correlation between circulating NO levels and BMD in all groups. We suggest that, unlike postmenopausal osteoporosis, inflammation induced osteoporosis is associated with RA is characterised by relatively preserved bone mass at the axial bone regions, and circulating NO levels as a parameter or determinant of inflammation are not correlated with axial BMD in RA patients.

Bone and stone in ankylosing spondylitis: osteoporosis and urolithiasis.

Ankylosing spondylitis (AS) has well-defined renal complications, but urolithiasis has not been studied in detail. We aimed to evaluate the relation between AS and urolithiasis presence and the effect of this coexistence on the bone mineral status of patients. By dual-energy x-ray absorptiometry measurements at the femoral neck and lumbar vertebrae, we assessed the influence of urolithiasis, disease activity, and duration on bone mineral density (BMD) at different sites. Fifty-three AS patients and 25 control subjects were enrolled in the study. Mean age was 39.49+/-13.01 years for the AS group and 43.80+/-10.69 years for the control group, with no statistically significant difference. Patients were accepted as having active disease if two of the following were present: (1) symptomatic peripheral arthritis, (2) erythrocyte sedimentation rate greater than 30 mm/h, (3) C-reactive protein greater than 5 mg/L, and (4) dorsal-lumbar morning stiffness more than 60 min. The ratios of urinary stone presence were 11.32 and 12% for AS and control groups, respectively. We observed that a statistically significant difference in femur neck BMD between AS patients with or without urolithiasis was apparent. The lumbar BMD values were also lower in the urolithiasis subgroup but could not reach the statistical significance. There were no significant BMD alterations in the control group due to stone presence. Comparison of active-inactive disease groups revealed significantly low T scores in either the femur neck or L2-4 regions of patients with higher activity indices, but this difference was more prominent in the femur neck. In the early AS group (23 patients), 18 patients (78.26%) had L2-4 T scores lower than -1 SD, and in the advanced AS population, 19 of 30 patients (63.33%) had either osteopenia or osteoporosis (OP). We conclude that severe disease and concomitant urolithiasis might increase bone loss and fracture risk especially at the femur neck.

Effect of stanford pouch and ileal conduit urinary diversions on bone mineral density and metabolism.

After urinary-intestinal diversions metabolic complications may occur in long term follow up. We aimed to evaluate bone metabolism changes in urinary diverted patients. Nineteen patients with urinary diversions (11 Stanford pouch and 8 ileal conduit) performed with diagnosis of locally invasive bladder cancer and 19 age-sex matched healthy subjects were enrolled in the study. Bone mineral density (BMD), arterial blood pH, bicarbonate and base excess as well as bone mineralisation parameters at urine and serum were evaluated for all groups. For statistical evaluation, nonparametric comparisons between groups were used. Comparison of ileal conduit and control groups displayed higher alkaline phosphatase and parathormone levels in the patient group though the difference was not significant. The mean BMD values of ileal conduit group were osteopenic, revealing a significant difference with the control group. Statistically significant differences between alkaline phosphatase, parathormone levels of Stanford pouch and control groups were apparent whereas BMD values were not significantly different. When the two patient groups were compared with each other, no difference in BMD or bone metabolism parameter values could be observed. Patients with urinary diversions are under risk of bone demineralisation and must be followed by BMDs, arterial blood analysis and bone mineral metabolism parameters.

Relationship between high-resolution computed tomography findings and the Stoke index in patients with rheumatoid arthritis.

The aim of this study was to evaluate the relationship between high-resolution computed tomography (HRCT) findings and the Stoke index (SI) in patients with rheumatoid arthritis (RA). Forty RA patients (31 women, 9 men) were evaluated. All patients fulfilled the criteria proposed by the American College of Rheumatology. Clinical evaluation, haematological data, chest radiography, pulmonary function tests (PFTs) and HRCT were obtained in all patients. The SI was used to assess disease activity. In 17 (42.5%) patients, there were no signs of pulmonary involvement on HRCT; 23 (57.5%) of 40 patients had abnormal HRCT findings. Of 23 patients with HRCT abnormalities, six (two male, four female) had respiratory symptoms, four (one male, three female) had abnormalities on chest radiography and five (all female) had abnormalities on PFTs. There was no relationship between pulmonary changes observed on HRCT, clinical and laboratory disease activity parameters, chest X-ray and PFTs. There was no difference in the mean SI between patients included in the HRCT (+) and those included in the HRCT (-) groups. No significant correlations between the HRCT and the SI were seen. The main findings of this study are that HRCT can give useful information on RA-associated lung changes and that there was no relationship between the SI and the HRCT findings of patients with RA.

Obesity related measurements and joint space width in patients with knee osteoarthritis.

BACKGROUND: The aim of this study is to analyze the relationship between body mass index and obesity related measurements and tibiofemoral joint space which have been the principal method of radiographic evaluation in progression and therapeutic trials of knee osteoarthritis. METHODS: Fifty-five female patients with the diagnosis of osteoarthritis in knees according to the criteria of American College of Rheumatology in knees were included in the study. The mean age of patients was 57,42+/-8,60(SD) years with a range of 42-77. Medial and lateral compartment joint space widths were measured on antero-posterior knee radiography. Body mass index, triceps, biceps, subscapular and suprailiac skinfold thickness, waist and hip circumference were measured. Body composition was determined by dual energy X-ray absorpsiometry (DEXA) (Norland XR 46) and total lean mass (g), total fat mass (g), trunk lean mass, trunk fat mass, abdomen lean mass, abdomen fat mass measurements were recorded. RESULTS: Patients with body mass index>30 were accepted as obese patients. According to these criteria 33 of the 55 patients were obese. Tibial medial compartment and tibial lateral compartment measurements of obese patients were significantly lower than nonobese patients (p=0,000, p=0,003 respectively). Body mass index was correlated with total lean mass, total fat mass, trunk fat mass, abdominal fat mass, leg fat mass. Tibial medial compartment and tibial lateral compartment space measurements were negatively correlated with body mass index. CONCLUSION: Our results revealed significant difference in both medial and lateral joint spaces of obese and nonobese patients with knee osteoarthritis. Medial and lateral joint spaces of obese patients were narrower than nonobese osteoarthritis patients. The more body mass index had the patients the narrower joint space they had displayed. However body composition analysis and obesity related measurements did not show additional correlation with tibial compartment measurement.

Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis.

Pulmonary function is altered in ankylosing spondylitis (AS) owing mainly to the restriction of chest wall involvement (limited chest expansion). The objective of this study was to investigate the relationship between chest expansion, respiratory muscle strength (MIP, MEP) maximum voluntary ventilation (MVV), and BASFI score in patients with AS. Twenty-three male patients with definite AS and 21 age-matched healthy male controls were recruited for the study. Patients with AS were assessed for functional status by BASFI. Measurement of chest expansion and lumbar spinal flexion (modified Schober) method was performed in all subjects. Pulmonary function tests were performed by spirometry. Respiratory muscle strength was evaluated by a mouth-pressure meter (MPM). Body mass index (kg/m(2)) was recorded in all individuals. Chest expansion and modified Schober measurement were significantly lower in AS patients (p<0.05). Pulmonary function tests revealed restrictive lung disease. The mean BASFI score suggested good functional capacity in the AS group. The respiratory muscle strength and MVV were also lower in AS (p<0.05). The chest expansion was correlated with MIP and MEP values (r=0.491; p=0.02, r=0.436; p=0.05). Chest expansion was also correlated negatively with disease duration (r=-0.502; p=0.03). In addition, there was no correlation between chest expansion and BASFI score (r=-0.076; p=0.773). This study demonstrates that functional status (BASFI) is not influenced by the limitation of chest wall movement. It may be as a result of the maintenance of moderate physical activity during active life in patients with AS.

Bone mineral density and urolithiasis interaction in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a systemic inflammatory disease with extraarticular manifestations involving many organs. Both urinary stone formation and bone mineral density (BMD) can be affected by calcium (Ca) metabolism changes in RA. We aimed, in our study, to investigate the incidence of urolithiasis in adult RA patients and to identify the BMD characteristics of stone-forming RA patients. Seventy-nine RA patients and 35 control subjects participated in our study. None had a known renal disease, except for urolithiasis. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP) were recorded. Twenty-four-hour urinalysis, as well as plain X-ray, ultrasound imaging, and BMD measurements with dual-energy X-ray absorptiometry (DEXA) were performed. T scores more than 1 SD below the mean value were accepted as low BMD. There was no statistically significant difference between urinary stone incidence in RA patients and controls. There was a significant difference between BMD values in RA patients with and without urinary stone disease. The low T scores of stone-forming RA patients may be explained by the additive effect of two coexisting diseases, both shown to be related to low bone mass. From another point of view, both BMD loss and urolithiasis can be consequences of altered Ca metabolism in RA. So we suggest that RA patients with urolithiasis should be evaluated for BMD, and that RA patients with low BMD be evaluated for urolithiasis.

Muscle imbalance in hallux valgus: an electromyographic study.

OBJECTIVE: Hallux valgus is a very common foot deformity in modern societies. Muscle imbalance in abductor and adductor muscles was cited as a major factor in the production of hallux valgus. Our aim in this study was to evaluate the role of certain muscles in this deformity. DESIGN: Twenty hallux valgus patients and 20 healthy volunteers participated in the study. After thorough physical, neurologic, and radiographic investigations, we performed an electromyographic study to observe the relationship of hallux valgus deformity with the muscles coordinating first metatarsophalangeal joint movements. Voluntary extension, flexion, abduction, and adduction at the hallux with maximum resistance were performed. Firing rates and amplitudes of motor unit potentials of four muscles: musculus abductor hallucis, musculus adductor hallucis, musculus extensor hallucis longus, and musculus flexor hallucis brevis were recorded. Statistical analysis, including Spearman's correlation analysis and Mann-Whitney U tests were performed with SPSS 8.0 for Windows. RESULTS: We observed that in the hallux valgus group, abduction activity of musculus abductor hallucis was markedly decreased when compared with adduction of musculus adductor hallucis. Motor unit potential amplitude of abductor activity recorded from musculus abductor hallucis was slightly more than half of the activity in flexion. CONCLUSION: Muscle imbalance in abductor and adductor muscles is apparent in hallux valgus deformity, and this imbalance may be the reason or the result of joint deformity.

Seronegative spondyloarthropathy of familial Mediterranean fever.

Familial Mediterranean fever (FMF) is characterized by an autosomal inheritance pattern, Mediterranean ancestry, and history of recurrent fever. We present a 30-year-old Turkish man with FMF and accompanying seronegative spondyloarthropathy. His diagnose depended on the clinical course of his disease: recurrent fever accompanied by abdominal pain attacks together with a positive family history and his ethnic origin and sacroiliitis. We review the common manifestations of FMF and remind physicians that sacroiliac joint involvement must be kept in mind in presence of articular symptoms in a FMF patient.

Grip strength: effect of hand dominance.

AIM OF THE STUDY: Reliable and valid evaluation of hand strength is important for determining the effectivity of treatment strategies and it is accepted that grip and pinch strength provide an objective index for the functional integrity of upper extremity. This study was designed to evaluate the grip and pinch strength differences between sides for the right and left handed population. METHODS: The study included 128 right and 21 left hand dominant volunteers. Grip strength of the participants were measured by using a Jamar dynamometer. Pulp pinch strength measurements were performed by manual pinchmeter. RESULTS: When the study group was totally evaluated, a statistically significant difference was found between the grip and pinch strengths of dominant and nondominant hands in favour of the dominant hand. For further information we grouped 149 participants as right and left handed and investigated the number of subjects with stronger nondominant hand for each group. The percentage of stronger nondominant hand grip was 10.93% and 33.33% for right and left handed groups respectively. The results were less significant for pinch strength with 28.12% and 28.57% for right and left handed subjects respectively. CONCLUSION: We concluded that the dominant hand is significantly stronger in right handed subjects but no such significant difference between sides could be documented for left handed people.

Pain pressure threshold values in ankylosing spondylitis.

Rheumatic patients experience persistent and disabling pain. We aimed to investigate the pain pressure threshold (PPT) values in ankylosing spondylitis (AS) patients compared to rheumatoid arthritis (RA) patients and healthy subjects. The relationship between lumbar and thoracal Schober, chin-to-chest distance, occiput-to-wall distance, finger-to-floor distance, chest expansion, and pain scores were also evaluated in an AS group. Our study group consisted of 17 AS patients, 20 RA patients, and 21 healthy volunteers. Eighteen tender points accepted by the American College of Rheumatism (ACR) for fibromyalgia syndrome evaluation in 1990 and three control points were evaluated with Fischer's tissue compliance meter, which can also be used as an algometer. Fourteen paravertebral points were evaluated, and mean values of paravertebral myalgic scores were recorded in the AS group. Our data indicate that AS patients do not have lower PPT with respect to healthy individuals, whereas RA patients have significantly lower PPT. A significant correlation was obtained between finger-to-floor distance and paravertebral myalgic score for AS. We conclude that AS does not have a widespread pain nature as RA.