Disease activity, handgrip strengths, and hand dexterity in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the hand joints and leading to impairment in hand functions. Evaluation of functional impairment is necessary for assessing patient's quality of life, disease activity, and treatment outcome. To date, many scientific studies assessed the disease activity of patients with RA, but little attention has been carried out to assess these patients' hand functions and dexterity. The purposes of this study were to determine the clinical relevance of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), hand dexterity with the Purdue Pegboard Test (PPT), and handgrip strength and pinch strengths of RA patients and to look into their relation between each other. A prospective trial was performed in women with RA who were followed at the physical medicine and rehabilitation department of our university hospital. Eighty-two women between the ages of 18 and 70, with a diagnosis of RA according to the 2010 American College of Rheumatology/the European League Against Rheumatism (ACR/EULAR) criterion, were recruited to the study. The Disease Activity Scores were determined by using Disease Activity Score-28 (DAS-28). Handgrip strength was measured with a Jamar dynamometer, and lateral, palmar, and tip pinch strengths were measured by a pinchmeter. Hand functions were evaluated with the PPT, and functional outcomes were assessed with the QuickDASH questionnaire. The mean age of the study group was 49.27 ± 10.69 years. The average values of DAS-28 and the QuickDASH values were found to be 4.22 ± 1.28 and 38.33 ± 19.78, consecutively. High correlation was observed between DAS-28 and the QuickDASH values (p < 0.001). The mean grip strengths in both hands were significantly correlated with the QuickDASH values (p < 0.001), and also, DAS-28 values were very significantly correlated with the mean grip strength in the dominant hand (p < 0.001) and in the nondominant hand (p < 0.01). The mean lateral pinch strengths in both hands were correlated statistically significantly with DAS-28 and the QuickDASH scores (p < 0.001). The mean tip pinch strengths in both hands were correlated with DAS-28 scores, but correlation with the QuickDASH scores was seen just in the dominant hand (p < 0.05). There was no correlation between palmar pinch strengths in both hands with the DAS-28 and QuickDASH scores (p > 0.05). DAS-28 was correlated with PPT performance on the dominant hand (p < 0.05), but there was no correlation with the nondominant hand, both hands, and assembly (p > 0.05). The QuickDASH values were not correlated with all PPT performances (p > 0.05). Handgrip strengths of both hands were positively correlated with the PPT performances (p < 0.05). In conclusion, we determined that handgrip strengths were significantly related to disability and disease activity in the RA patients in our study. The QuickDASH is practical to use in clinical practice, and positively correlates with the disease activity. Dexterity measurements with PPT in the RA patient group were found practical and effective in our study. As a result, we can suggest using QuickDASH questionnaire for functional outcomes, handgrip strength measurements for assessment of hand disability and functional impairments, and also dexterity measurements even in patients with low disease activity.

Incidence of hip fracture and prevalence of osteoporosis in Turkey: the FRACTURK study.

UNLABELLED: The incidence of hip fractures in Turkey increased markedly from that reported in 1988/1989 so that FRAX® models for Turkey should be revised. INTRODUCTION: The MEDOS study in 1988/1989 reported that men and women from Turkey had exceptionally low rates of hip fracture. The aim of the FRACTURK study was to estimate current and future hip fracture risks and the prevalence of osteoporosis in Turkey. METHODS: Hip fracture cases in 2009 were identified from interviews of a population-based sample of 26,424 residents aged 50 years or more in 12 different regions of Turkey and in two hospital surveys. Bone mineral density was evaluated by DXA in an age-stratified sample of 1,965 men and women. RESULTS: Hip fracture incidence in the community-based survey was similar to that in the hospital survey. The age-specific incidence in men and women was substantially higher than that reported for 1988/1989. At the age of 50 years, the remaining lifetime probability of a hip fracture was 3.5% in men and 14.6% in women. In 2009, there were approximately 24,000 hip fractures estimated in Turkey, 73% of which were found in women. Assuming no change in the age- and sex-specific incidence, the number of hip fractures was expected to increase to nearly 64,000 in 2035. The prevalence of osteoporosis at the femoral neck was 7.5% and 33.3% in men and women, respectively, aged 50 years or more. CONCLUSION: Although Turkey is still among the countries with low hip fracture rates in Europe, the incidence has increased markedly in the last 20 years. This finding can be used to recalibrate fracture risk assessment models for Turkey.

Correlation of back pain, compression fracture and quadriceps muscle strength with bone mineral density in renal insufficiency patients.

AIM: The purpose of this study was to evaluate bone mineral density (BMD), bone parameters, complete blood count, erythrocyte sedimentation rate, electrolyte values, back pain, compression fracture and quadriceps muscle strength in mild and moderate renal insufficiency patients. METHODS: Thirty-six female, 3 male, patients with the diagnosis of osteoporosis in addition to mild or moderate chronic renal insufficiency who were followed in Istanbul University, Cerrahpasa Faculty of Medicine, Physical Therapy and Rehabilitation Department, Osteoporosis and Nephrology Outpatient Clinics between March 2003 and March 2004, were included in the study. In the control group there were 17 female, 5 male patients with osteoporosis but without renal insufficiency. The inclusion criteria were to have osteoporosis, be aged between 40-70 with a creatinine clearance between 30-70 mL/min in the case group, >70 mL/min in the control group. The patients whose creatinine clearance was <30 mL/min, and whose BMD was normal or osteopenic even though creatinine clearance was >30 mL/min were excluded from the study. RESULTS: There was no significant difference with respect to back pain, compression fracture and quadriceps muscle strength between the 2 groups. The mean value of neck BMD, T and Z score were significantly lower in the case group (P<0.05). CONCLUSIONS: As a conclusion, PTH related bone disease had an important effect on BMD, although, the risk factors for osteoporosis were equally important. In various researches, the relationship between BMD values and history of fracture in renal osteodystrophy patients could not be shown. In our study, the history of prior fracture or fracture in the family were important risk factors for osteoporosis. Renal osteodystrophy patients had low BMD values in mild and moderate stages of the disease. Prior fracture as well as osteoporotic fractures in the family should be part of a comprehensive evaluation of the patient.