Education and Visual Information Improves Effectiveness of Ultrasound-Guided Local Injections on Shoulder Pain and Associated Anxiety Level: A Randomized Controlled Study.

OBJECTIVE: Local injections are widely used in patients with a painful shoulder. The aim of this study was to evaluate the possible impact of patients' visual information on the effectiveness of ultrasound (US)-guided local injections on anxiety levels and shoulder pain. DESIGN: A total of 151 patients, scheduled for local injection owing to shoulder pain, were randomly assigned into two groups in a consecutive order. Patients in group I (n = 72) were provided information related to US findings and allowed to watch the procedures from the monitor, whereas patients in group II (n = 79) received the injection only without any collaboration. Data were collected from both groups immediately before and after injections through visual analog scale and questionnaire (the State-Trait Anxiety Inventory [STAI] forms 1 and 2). RESULTS: US-guided local injections provided significant improvement of anxiety and pain in both groups, irrespective of providing visual information. Group I and group II comparisons with respect to the visual analog scale, STAI 1, and STAI 2 yielded significant difference only for postinjection STAI 2 in group I (P = 0.006). Intragroup comparisons revealed significant differences between preinjection and postinjection values (group I: visual analog scale, P = 0.001; STAI form 1, P = 0.001; STAI form 2, P = 0.002; group II: visual analog scale, P = 0.001; STAI form 1, P = 0.002; STAI form 2, P = 0.042). There was no significant difference between the groups in terms of postinjection satisfaction levels from the procedures (P = 0.824). CONCLUSIONS: Performing US-guided shoulder injections with patient visual information provides positive contributions to coping with pain and anxiety. In particular, the patient collaboration-based US-guided injections have positive consequences on patients' long-standing "trait-anxiety" levels.

Treatment of ankylosing spondylitis with TNF inhibitors does not have adverse effect on results of liver function tests: a longitudinal study.

AIM: To retrospectively investigate and compare the effects of tumor necrosis factor alpha inhibitors (TNFi) on hepatic enzymes in ankylosing spondylitis (AS) patients. METHODS: A retrospective analysis of the records of 94 AS (66 male, 28 female) patients using TNFi was performed. Patients' clinical data, Bath Ankylosing Spondylitis Disease Activity (BASDAI) scores, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were all examined. Liver function test (LFTs) results of patients before the treatment and 3, 6 and 12 months after treatment with TNFi were investigated. Aspartate transaminase (AST) and alanine transaminase (ALT) levels were investigated as indicators of LFTs. RESULTS: The TNFi drugs used were infliximab (n = 28), adalimumab (n = 32) and etanercept (n = 34). Pre-treatment values of ESR, CRP and BASDAI scores were 28.3 ± 20.1 mm/h, 1.5 ± 1.2 ng/dL and 5.2 ± 0.8, respectively. Following TNFi use there was a statistically significant decrease in disease activity score (P = 0.001). There was a significant increase in LFT at the third month evaluation compared to the initial values, while the average value was within normal range (baseline AST 19.6 ± 10.8 U/L, ALT 19.1 ± 6.4 U/L, third month AST 31.3 ± 21.6 U/L, ALT 28.1 ± 18.1 U/L, P = 0.001). Drug group comparison analysis revealed a significant difference in the adalimumab group value at the end of the first year, but no other significant difference in the data for the other months (P > 0.05). No significant correlation was determined between initial disease activity scores and LFT. CONCLUSION: TNFi use-associated rises in hepatic enzymes were determined compared to pre-treatment but the mean values remained within normal limits. Considering the cases in the literature, in daily practice patients must be carefully monitored for liver function before treatment and at follow-up.

Anti-TNF-α therapy may not improve arterial stiffness in patients with AS: a 24-week follow-up.

OBJECTIVE: The availability of new-generation drugs has provided significant success reflected by disease activity markers and clinical status in AS, but controversial reports necessitate further assessment of associated increased risk of cardiovascular burden that might persist. Hence this prospective clinical study evaluated the effectiveness of a 24-week anti-TNF-α therapy on vascular stiffness [pulse wave velocity (PWV)] in AS. METHODS: A total of 28 active AS patients (21 males, 7 females) were enrolled before the start of biologic therapy. Demographic and clinical characteristics were recorded. Arterial stiffness was assessed using PWV. Patients were evaluated before and 24 weeks after anti-TNF-α therapy. RESULTS: The mean disease duration was 8.4 (4.9) years. After 24 weeks of anti-TNF-α therapy, despite significant improvements in patients' symptoms and clinical activity parameters, including BASDAI score [4.9 (0.9) vs 1.9 (0.5), P = 0.0001], ESR [35.5 (23.1) vs 13.8 (9.2) mm/h, P = 0.0001) and CRP level [2.1 (1.6) vs 0.4 (0.3) ng/dl, P = 0.0001], no significant change was seen in arterial stiffness parameters [7.9 (1.3) vs 7.7 (1.3) m/s, P = 0.412]. Significant correlation was determined between arterial stiffness and age, systolic blood pressure and high-density lipoprotein cholesterol levels. CONCLUSION: Despite significant improvement in markers of disease activity, anti-TNF-α therapy does not seem to improve arterial stiffness, a significant AS-associated cardiovascular burden. Thus, when treating AS, significant end-points other than DASs should also be considered, and any hidden threat like arterial stiffness should be addressed further.

HLA-DRB1 allele distribution and its relation to rheumatoid arthritis in eastern Black Sea Turkish population.

Rheumatoid arthritis (RA [MIM 180300]) is a complex, polygenic inflammatory autoimmune disease, resulting from interactions between genetic and environmental factors. Some of the RA-associated HLA-DRB1 alleles have shared epitope, but their distribution varies among different racial/ethnic groups. This study was aimed at investigating the distribution of HLA-DRB1 alleles in patients with RA in eastern Black Sea region of Turkey. DNA samples of 320 patients with RA and 360 healthy controls were studied for the determination of HLA-DRB1 allele distribution using PCR-SSP method. The allele frequencies of HLA-DRB1*01, *04, and *09 were higher in patients with RA compared with the controls (P < 0.005, P < 0.0001, and P < 0.01, respectively). On the other hand, in patients with RA, HLA-DRB1*13 allele was lower than the controls (P < 0.001). Of the HLA-DRB1*04 subgroups, *0401 (40.83% vs. 18.75%, P < 0.001) was the most frequent allele in patients with RA, while DRB1*0402 (30.00% vs. 12.50%, P < 0.005) allele in the controls. HLA-DRB1 allele frequencies in the patients with RA and the controls showed Hardy-Weinberg rule compliance. Results of this study indicate that HLA-DRB1*01, *04, and *09 alleles were associated with RA, and HLA-DRB1*13 was protective allele against RA. Among the subgroups of HLA-DRB1*04, *0401 was detected to be RA associated, while *0402 was being protective. These results have some differences compared with previous reports originating from other regions of Turkey.

Osteitis condensans ilii in differential diagnosis of patients with chronic low back pain: a review of the literature.

Osteitis condensans ilii (OCI) is a benign pathology causing chronic back and hip pain. Although the definitive cause is uncertain, mechanical stress is a significant factor in the development of the disease. Bilateral involvement of the sacroiliac joint is typical. We describe a case of unilateral OCI with unilateral sclerosis observed at radiography in a 34-year-old patient presenting with chronic back and hip pain, together with a review of the literature.