The autonomic dysfunction in patients with ankylosing spondylitis: a clinical and electrophysiological study.

The aim of this study was to determine autonomic nervous system (ANS) functions by using clinical and electrophysiological tests in patients with ankylosing spondylitis (AS). Twenty AS and 20 healthy control subjects were recruited. Demographic data, symptoms related with ANS, and neurological findings were recorded. Clinical measurements including the heart rate variation with deep breathing (HRV), heart rate response to standing (HRS), systolic blood pressure response to standing, and diastolic blood pressure response to isometric exercise were obtained to assess parasympathetic and sympathetic functions of the subjects. The electrophysiological assessments of ANS were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) measurements for the sympathetic and parasympathetic functions, respectively. Patients with AS were subdivided into two groups depending on the activity of disease. The difference between the groups and relationship between ANS variables and clinical entities were determined. Fifteen male and five female AS patients with a mean age of 38+/-8.05 years and 14 male and six female healthy control subjects with a mean age of 40+/-9.8 years were included in the study. All the subjects were totally symptom free for ANS involvement and had normal neurological examination findings. The levels of HRV, HRS, and the mean RRIV values were significantly lower in AS patients than in control subjects. The clinical ANS parameters of the patients having more active disease were lower than in subjects with mild disease in regard to HRV values and SSR amplitudes and higher in regard to SSR latencies. The HRV values were found to be correlated with the mean scores of Bath ankylosing spondylitis disease activity index (BASDAI) and C-reactive protein (CRP) levels, and the mean latencies of SSR were correlated with BASDAI scores and CRP levels. In conclusion, our study indicates a subclinical mainly parasympathetic dysfunction of ANS in patients with AS which can be related with disease activity.

The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial.

The aims of this study were to evaluate the effects of low-level laser therapy (LLLT) and to compare these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group-brace plus exercise, 2) ultrasound group-US plus exercise, and 3) laser group-LLLT plus exercise. Patients in the brace group used a lateral counterforce brace for three weeks, US plus hot pack in the ultrasound group, and laser plus hot pack in the LLLT group. In addition, all patients were given progressive stretching and strengthening exercise programs. Grip strength and pain severity were evaluated with visual analog scale (VAS) at baseline, at the second week of treatment, and at the sixth week of treatment. VAS improved significantly in all groups after the treatment and in the ultrasound and laser groups at the sixth week (p<0.05). Grip strength of the affected hand increased only in the laser group after treatment, but was not changed at the sixth week. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain, and that laser therapy is more effective than the brace and US treatment in improving grip strength.

Repeatability and variation of quantitative gait data in subgroups of patients with stroke.

We aimed to determine the repeatability and variation of quantitative gait data in patients with stroke and to compare the subgroups in terms of gait variability. Time-distance and kinematic characteristics of gait were evaluated in 90 inpatients (30 women) with hemiparesis (mean+/-S.D. age 57.7+/-12.5 years and time since stroke 5.99+/-6.46 months). Subgroups were based on "gender", "side of paresis", "lesion type", "motor recovery level", "sensory status", "time since stroke" and "walking velocity". Repeatability was adequate to excellent in all stroke subgroups (ICC range 0.48-0.98). Walking velocity was the most repeatable gait parameter after stroke. Variation in step length was significantly higher in women than in men (CV 16% versus 9%, p<0.05). Slow walkers (walking velocity <0.34 m/s) had a higher variation than fast walkers in step length (CV 12.5% versus 7.5%, p<0.01), single support time (CV 11.9% versus 6.3%, p<0.05), peak hip extensions in stance (CV 11.5% versus 3.7%, p<0.01) and knee flexion in swing (CV 11.8% versus 6.5%, p<0.05). In our stroke patients, their age, time since injury, lesion characteristics, impaired proprioception or level of motor recovery had no effect on gait variability. For better interpretation of quantitative gait data, clinicians should consider that variation in step length, single support time, peak hip extension in stance and knee flexion in swing differs according to walking velocity after stroke.

Evaluation of pulmonary function and bicycle ergometry tests in patients with Behçet's disease.

Behçet's disease (BD) has well-defined pulmonary complications, but cardiopulmonary exercise testing and the strength of the respiratory muscles have not been studied in detail. We aimed to investigate the pulmonary functions tests, inspiratory and expiratory muscle strength and endurance, cardiopulmonary exercise test response, and the relationship of these parameters in patients with BD. Forty BD patients and 20 healthy control subjects were recruited for this study. Mean age was 32.95 +/- 7.66 years for the BD group and 33.85 +/- 6.63 years for the control group with no statistically significant difference. The ratios of slight obstructive ventilatory impairment were 32.5% for the BD group. When the values of pulmonary function tests were compared, no statistically significant difference was found in FEV(1)/FVC (Forced expiratory volume during the first second/forced vital capacity), or maximal midexpiratory flow rate (all in percent) values between patient and control groups. Maximal inspiratory and expiratory pressures, peak expiratory flow rate (in percent) and maximal voluntary ventilation (in percent) values were significantly lower than those of the control group. Body's consumption of peak oxygen (VO(2peak)), oxygen consumption (milliliters per kilogram per minute), anaerobic threshold (AT), maximum exercise ventilation (VE(max)), work load values, and exercise test time in the bicycle exercise test were significantly higher in control groups than in patients with BD. The values of heart rate reserve, breathing reserve, and VE/VCO(2) at the AT of BD patients were within normal limits We conclude that respiratory and aerobic exercise may be recommended to improve respiratory muscle strength and endurance as well as the aerobic capacity and maximal ventilatory capacity in patients with BD.

Pulmonary involvement in lifelong non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms.

Pulmonary involvement seen in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has been detected increasingly by using highly sensitive diagnostic techniques such as high-resolution computed tomography (HRCT). However, HRCT findings in healthy controls and the effects of smoking and drugs have not been well studied. The aim of this controlled study was to evaluate the relationships between disease-specific clinical, laboratory, HRCT and pulmonary function test (PFT) findings in 20 RA patients using methotrexate (MTX) and 20 AS patients using sulphasalazine who were non-smokers and exhibited asymptomatic respiratory signs. For this purpose, a total of 60 persons (40 patients and 20 healthy controls) were included in this study. A restrictive pattern on PFT was detected in four patients (20%) with AS, one patient with RA and one control (p<0.05). Fourteen patients (70%) with RA and ten patients (50%) with AS had positive HRCT findings. Only one patient (5%) in the control group had abnormal HRCT findings (p<0.05). Interstitial lung disease (ILD) was the most frequently seen HRCT finding in both the RA (35%) and AS (20%) groups. The chest expansion measurement, the score of the visual analogue scale (VAS) for pain and C-reactive protein (CRP) levels were statistically significantly better in patients with AS having normal HRCT than in those with abnormal findings (p<0.05). There was no correlation detected between HRCT and duration of disease, disease activity markers, functional indexes and PFT in patients with RA and AS. HRCT is a sensitive tool in detecting ILD in patients with RA and AS with no signs and symptoms of pulmonary involvement and may be an integral part of such work-up. However, future prospective studies are needed to better determine if HRCT is in fact a predictor of subsequent MTX toxicity.

Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings.

OBJECTIVE: Although there has been much research about imaging methods for shoulder impingement syndrome, the clinical information and upper limb level of disability have been generally ignored. The purpose of this study was to detect the relationships between clinical, functional, and radiologic variables in patients with shoulder impingement syndrome. DESIGN: A cross-sectional, clinical, and radiologic study was planned and 59 shoulders of 58 consecutive patients waiting for physical therapy because of a clinically suspected shoulder impingement syndrome were included into this study. Comprehensive clinical examination, radiography, shoulder ultrasonography, and magnetic resonance imaging were performed in the same month. RESULTS: Despite the high sensitivities of ultrasonography for diagnosing rotator cuff tears (98.1%) and biceps pathologies (100%), magnetic resonance imaging was superior to ultrasonography in many important shoulder structures such as a glenoid labral tear and subacromial bursal effusion/hypertrophy (P < 0.01). These structures were the determinants of the shoulder's disability measured by disabilities of the arm, shoulder, and hand questionnaire. CONCLUSION: Ultrasonography and magnetic resonance imaging had comparable high accuracy for identifying the biceps pathologies and rotator cuff tears. The basic clinical tests had modest accuracy in both disorders. The choice of which imaging test to perform should be based on the patient's clinical information (regarding lesion of glenoid labrum, joint capsule, muscle, and bone), cost, and imaging experience of the radiology department.

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.