Comparison of serum IL-1 beta, sIL-2R, IL-6, and TNF-alpha levels with disease activity parameters in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic, inflammatory, rheumatological disease affecting primarily the sacroiliac joint and vertebral column, with an etiology that remains obscure. Cytokines are soluble proteins that have specific roles in inflammatory response, arranging the interaction between cells of the immune system both in natural and specific immune reactions. This study was planned to evaluate the relation between the level of cytokines and the clinical and laboratory findings of patients with AS compared to healthy subjects. In this study, we demonstrated increased serum levels of soluble interleukin-2 receptor (sIL-2R), Interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in patients with AS compared with healthy subjects. Only IL-1 beta levels were not increased in AS patients. We found a correlation between C-reactive protein and IL-6 levels and between erythrocyte sedimentation rate and sIL-2R, IL-6 and TNF-alpha levels. Only the sIL-2R level was correlated with Bath AS Metrology Index and Bath AS Functional Index. We suggest that sIL-2R, IL-6, and TNF-alpha may have a role in the pathogenesis of AS and that their serum levels can be used as disease activity parameters and tools for diagnosis.

The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis.

BACKGROUND: We studied clinical signs and symptoms of temporomandibular disorders and radiological changes in the temporomandibular joint from patients with rheumatoid arthritis (RA) compared to patients with myofascial pain dysfunction of the temporomandibular system and control patients to evaluate clinical and radiological relationships. METHODS: A cross-sectional, controlled, clinical and radiological study was planned and 99 subjects (69 patients and 30 controls) were included in the study. RESULTS: Twenty-three patients with RA (69.7 per cent) had painful temporomandibular joint. Fifty-five per cent had myofascial pain dysfunction according to the research diagnostic criteria for temporomandibular disorders (TMD). Nearly all of our patients with RA (93.9 per cent) had symptoms, and almost all of them had positive findings of TMD in high resolution computed tomography. Condylar head resorption, joint space narrowing and degeneration were statistically more prominent features in patients with rheumatoid arthritis compared with controls (p < 0.05). The pain score on active palpation correlated with the number of the mandibular subchondral cysts on high resolution computed tomography (r = 0.6, p < 0.05). CONCLUSION: Although the myofascial pain of the temporomandibular system is an important cause of pain in rheumatoid arthritis, prospective controlled studies are needed to develop effective therapeutic strategies for these patients.

The musculoskeletal complications seen in type II diabetics: predominance of hand involvement.

The musculoskeletal complications of diabetes mellitus (DM), which are the most common endocrine arthropathy, have been generally ignored and poorly treated compared with other complications such as neuropathy, retinopathy and nephropathy. Like other quality of life issues, the musculoskeletal disability of DM has not been investigated effectively. The incidence of diabetic foot has decreased thanks to excellent foot care, but the hand is still an important target for diabetic complications. The aim of this study was to investigate early diabetic musculoskeletal complications on the basis of a collaborative multidisciplinary study design. For this purpose 78 patients (mean age 57.8 +/- 11.9 years, 55 women and 23 men) who had type II DM for 15 years maximally and 37 non-diabetic controls (mean age: 55.7 +/- 11.5, 27 women and 10 men) were randomly selected for inclusion in the study. All patients were evaluated by the Rheumatology, Orthopedic Rehabilitation and Hand Rehabilitation Divisions. Dupuytren's disease was present in 17 (21.8%) of 78 diabetic subjects as the most frequent and statistically significant complication of the musculoskeletal system. In correlation and logistic regression analysis, only retinopathy was significantly associated with duration of diabetes and diabetic foot. Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed.

Oxidant/antioxidant status of the erythrocytes from patients with rheumatoid arthritis.

It has been suggested that enzymatic and/or non-enzymatic antioxidant systems are impaired in rheumatoid arthritis (RA) and hence patients are exposed to oxidant stress. This study aimed to establish whether this is really the case. Fasting blood samples were obtained from 24 patients with rheumatoid arthritis and 20 controls. The activities of erythrocyte superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and xanthine oxidase (XO) enzymes and malondialdehyde (MDA), oxidant resistant (OR) and non-enzymatic superoxide radical scavenger activity (NSSA) values were measured in both groups. Patients with RA had higher SOD and XO activities and MDA levels than did the controls. However, NSSA and OR levels were found to be decreased, and CAT and GSH-Px activities unchanged in the study group. Results suggest that excessive free radical production through the xanthine-xanthine oxidase system is the primary factor in rheumatoid arthritis, rather than an impaired antioxidant system. The therapeutic use of XO enzyme inhibitors and some antioxidants can be beneficial in this regard.

Platelet aggregation in traumatic spinal cord injury.

STUDY DESIGN: Collagen-induced platelet aggregation and platelet count of ten paraplegic patients (four females, six males, aged 16 - 42 years) with traumatic spinal cord injury (SCI) (posttraumatic 12 - 48 weeks) and of ten age-matched healthy volunteers (control group; five females, five males, aged 18 - 37 years) were investigated. OBJECTIVES: Investigation of platelet aggregation in the whole blood of the patients with SCI. SETTING: Ankara/Turkey. METHODS: Platelet aggregation was evaluated by impedance technique using Chrono Log Model 560 WB aggregometer in whole blood. Platelet count was determined by Medonic Cell Analyser 610. RESULTS: Maximal intensity of collagen-induced platelet aggregation of the patients was 18.50+/-8.28 ohm (mean+/-SD) and of the controls was 7.60+/-4.25 ohm. Maximal rate of collagen-induced aggregation of platelets from the patients was 3.98+/-1.59 ohm/min, maximal rate of aggregation of platelets from the controls was 1.57+/-1.01 ohm/min. Platelet counts of the patients and controls were 290 500+/-50 357/mm3 and 273 000+/-48 343/mm3 respectively. It was determined that both maximal rate (P<0.001) and maximal intensity (P<0.01) of collagen-induced platelet aggregation of the patients were significantly higher than those of the controls. There was no significant difference between the two groups in respect to platelet counts. CONCLUSION: Collagen-induced platelet aggregation of patients with traumatic SCI 12 - 48 weeks after the trauma was significantly higher than that of the controls. Our results indicate that increased tendency of platelet aggregation, which is probably induced by free radicals, may have a great impact on the late thromboembolic complications reported in patients with traumatic SCI.

The effects of a pulmonary rehabilitation program on pulmonary function tests and exercise tolerance in patients with Parkinson's disease.

The effects of exercise training, as a part of a pulmonary rehabilitation program, on pulmonary function tests and exercise tolerance have not been clarified in patients with Parkinson's disease (PD). This study compares the results of pulmonary function test parameters and exercise tolerance in individuals with and without PD. It also compares the results of pulmonary function test parameters, exercise tolerance and subjective ratings of perceived exertion (RPE) between entry to and the end of exercise training program in patients with PD. Nine patients with PD and 9 age-matched healthy controls participated in the study. Pulmonary function tests and a six-minute walk test were performed in subjects with and without PD, and the Borg RPE scale was applied to patients with PD at the beginning of the study. After the exercise training program, all parameters were recorded again in patients with PD. Statistically significant differences were observed between the groups in some of the pulmonary function test parameters and in exercise tolerance. After the training program, we observed improvement in some of the pulmonary function test parameters, exercise tolerance, and RPE in patients with PD.