Sacroiliitis during isotretinoin treatment: Causal association or coincidence?

Isotretinoin, a retinoid derivate used in acne treatment, has a variety of side effects involving the musculoskeletal system; however, sacroiliitis is rarely observed. Our aim was to present nine cases of sacroiliitis in patients being treated with isotretinoin. Sacroiliitis was identified and monitored using magnetic resonance imaging (MRI). Clinical symptoms were resolved with nonsteroidal anti-inflammatory drug therapy after isotretinoin treatment was ceased. Different from the other cases, follow-up MRI was done. Follow-up MRI revealed improvement in some patients. Although the association between isotretinoin therapy and sacroiliitis has been covered in literature, this association is not yet completely understood. We aimed to discuss the relationship between two.

Efficacy of kinesio tape application on pain and muscle strength in patients with myofascial pain syndrome: a placebo-controlled trial.

[Purpose] The purpose of this study was to determine the short- and mid-term effects of Kinesio taping on the trapezius muscle in individuals with myofascial pain syndrome. [Subjects and Methods] Thirty-seven patients with active upper trapezius myofascial trigger points were randomly divided to 2 groups: group 1 received Kinesio taping for the upper trapezius muscle, and group 2 received a sham Kinesio taping application. Neck pain (Visual Analog Scale and pressure algometry) and trapezius muscle strength data were collected at baseline, immediately after Kinesio taping application, and at one month follow-up. [Results] The mean changes in Visual Analog Scale scores were significantly different between groups at T2 and T1, with less pain in group 1. The mean changes in algometry scores were significantly different between groups at T3 compared with T2 in favor of group 1. The mean changes in trapezius muscle strength were significantly different between the groups at T2 compared with T1 in favor of group 1. [Conclusion] Patients with myofascial pain syndrome receiving an application of Kinesio taping exhibited statistically significant improvements in pain and upper trapezius muscle strength.

Effects of lower back pain on postural equilibrium and fall risk during the third trimester of pregnancy.

OBJECTIVE: To evaluate the effects of lower back pain (LBP) on postural equilibrium and fall risk during the third trimester pregnancy period by comparing postural stability between pregnant with LBP and pregnant without LBP control women. METHODS: The study population comprised 68 women of 24-35 years in the third trimester of pregnancy. They were divided into Groups 1 (n = 30) and 2 (n = 38) according to the presence or absence of LBP, respectively. Postural stability were evaluated between groups using Tetrax Interactive Balance System posturography (Tetrax, Sunlight Medical Ltd, Tel Aviv, Israel) with eight sensory conditions. RESULTS: For eight different positions, pregnant patients with LBP showed significantly higher values of general stability index, Fourier transformation index (F1, F2-F4, F5-F6 and F7-F8) and fall index than controls. CONCLUSION: LBP has a negative effect on postural stability. Postural equilibrium decreases and fall risk increases in pregnant patients with LBP.

Pregabalin-induced hyperprolactinemia in a patient with fibromyalgia: A case report.

Several pharmacological and non-pharmacological modalities have been proposed for the treatment of fibromyalgia syndrome (FMS), a common rheumatic disease. Pregabalin is suggested as a first-step medication for FMS in the newest guidelines. Drowsiness, dizziness, and peripheral edema are well-known side effects of pregabalin; however, mastalgia is rarely seen. Presently described is a case of FMS in a patient who developed mastalgia and hyperprolactinemia (HPL) while taking pregabalin.

Intrapartum sacral stress fracture due to pregnancy-related osteoporosis: a case report.

INTRODUCTION: Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes. CASE REPORT: A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient's symptoms subsided in 3 months after physical therapy and rest. CONCLUSION: In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.

Biopsychosocial influence on exercise-induced delayed onset muscle soreness at the shoulder: pain catastrophizing and catechol-o-methyltransferase (COMT) diplotype predict pain ratings.

OBJECTIVE: The experience of pain is believed to be influenced by psychologic and genetic factors. A previous study suggested pain catastrophizing and catechol-O-methyltransferase (COMT) genotype influenced clinical pain ratings for patients seeking operative treatment of shoulder pain. This study investigated whether these same psychologic and genetic factors predicted responses to induced shoulder pain. METHODS: Participants (n=63) completed self-report questionnaires and had COMT genotype determined before performing a standardized fatigue protocol to induce delayed onset muscle soreness. Then, shoulder pain ratings, self-report of upper-extremity disability ratings, and muscle torque production were reassessed 24, 48, and 72 hours later. RESULTS: This cohort consisted of 35 women and 28 men, with a mean age of 20.9 years (SD=1.7). The frequency of COMT diplotypes was 42 with "high COMT enzyme activity" (low pain sensitivity group) and 21 with "low COMT enzyme activity" (average pain sensitivity/high pain sensitivity group). A hierarchical regression model indicated that an interaction between pain catastrophizing and COMT diplotype was the strongest unique predictor of 72-hour pain ratings. The same interaction was not predictive of self-report of disability or muscle torque production at 72 hours. The pain catastrophizingxCOMT diplotype interaction indicated that participants with high pain catastrophizing and low COMT enzyme activity (average pain sensitivity/high pain sensitivity group) were more likely (relative risk=3.5, P=0.025) to have elevated pain intensity ratings (40/100 or higher). DISCUSSION: These findings from an experimental model converge with those from a surgical cohort and provide additional evidence that the presence of elevated pain catastrophizing and COMT diplotype indicative of low COMT enzyme activity have the potential to increase the risk of developing chronic pain syndromes.

Effectiveness of corticosteroid injection in adhesive capsulitis.

OBJECTIVE: To assess whether intraarticular corticosteroids improve the outcome of a comprehensive home exercise programme in patients with adhesive capsulitis. SETTING: The study was undertaken in the Physical Therapy and Rehabilitation Department of a Ministry of Health hospital in Turkey. SUBJECTS: Eighty patients with adhesive capsulitis were enrolled in the study. INTERVENTIONS: The patients were randomly assigned to two groups: Group 1 patients were given intraarticular corticosteroid (1 mL, 40 mg methylprednisolone acetate) followed by a 12-week comprehensive home exercise programme. Group 2 patients were given intraarticular serum physiologic (1 mL solution of 0.9% sodium chloride) followed by a 12-week comprehensive home exercise programme. MAIN MEASURES: The outcome parameters were Shoulder Pain and Disability Index and University of California-Los Angeles end-result scores, night pain and shoulder passive range of motion. RESULTS: Mean actual changes in abduction range of motion, Shoulder Pain and Disability Index-total score and Shoulder Pain and Disability Index-pain score were statistically different between the two groups at the second week, with the better scores determined in group 1. However, there were no significant differences between the groups at the 12th week. Medians of University of California-Los Angeles scores in the second week were significantly different between the two groups (P = 0.02), with better scores in group 1; however, the difference in 12th week scores was insignificant. CONCLUSIONS: Intraarticular corticosteroids have the additive effect of providing rapid pain relief, mainly in the first weeks of the exercise treatment period. In patients with adhesive capsulitis who have pain symptom predominantly, intraarticular corticosteroid therapy could be advised concomitantly with exercise.

The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study.

OBJECTIVE: To evaluate the effect of home versus in-hospital exercise (under supervision) programmes on hip strength, gait speed and cadence in patients with total hip arthroplasty at least one year after operation. SETTING: Physical therapy and rehabilitation department. SUBJECTS: Twenty-six patients who had had a total hip arthroplasty operation 12-24 months prior to the study were enrolled. INTERVENTIONS: The patients were randomized into three groups: group 1 patients were assigned a home exercise programme, group 2 patients exercised under physiotherapist supervision in hospital, and group 3 served as the control group, with no specific intervention. The study duration was six weeks. MAIN MEASURES: Maximum isometric abduction torque of operated hip muscle, gait speed and cadence were measured before and after the study. RESULTS: Maximum isometric abduction torques of the hip abductor muscles improved in groups 1 and 2, but not in group 3 (30 +/- 12 to 38 +/- 11 ft.lb in group 1, 18 +/- 10 to 30 +/- 9.8 ft.lb in group 2). Gait speed improved from 67.8 +/- 23 to 74.35 +/- 24 m/min in group 1, from 48.53 +/- 4 to 56.7 +/- 5 m/min in group 2 and from 58.01 +/- 12 to 59.8 +/- 14 m/min in group 3. Cadence also improved, from 97.7 +/- 18 to 111 +/- 17 steps/min in group 1, from 90.75 +/- 6 to 104.75 +/- 7 steps/min in group 2, and from 87 +/- 16 to 88.22 +/- 16 steps/min in group 3. When the three groups were compared, group 2 showed the best improvement (P = 0.006) only in maximum isometric abduction torque. CONCLUSION: Our findings suggest that both home and supervised exercise programmes are effective one year after total hip arthroplasty. Home exercise programmes with close follow-up could be recommended.

Assessment of shoulder involvement and disability in patients with ankylosing spondylitis.

The purpose of the study was to evaluate the parameters which have an important role in shoulder involvement and disability in ankylosing spondylitis (AS). Ninety patients with AS were divided into two groups according to the presence of shoulder involvement. Bath AS metrology index (BASMI), ankylosing spondylitis quality of life (ASQoL) and shoulder pain and disability index (SPADI) were used. Ranges of movements of limited shoulders were measured. Mean disease duration, age, BASMI, and ASQoL were higher and hip involvement was more frequent in the shoulder-involved group. Disease duration was found to be the most significant factor in shoulder involvement. A significant relationship was found between all SPADI scores and ASQoL. The SPADI disability score was affected by flexion limitation. Patients with hip involvement and longer disease duration should be evaluated for shoulder involvement. Flexion limitation of shoulder affected shoulder disability and shoulder disability impaired quality of life.

Dermatitis herpetiformis and rheumatoid arthritis.

Dermatitis herpetiformis DH is a rare, intensely pruritic, chronic, recurrent, papulovesicular disease. The disease can be clearly distinguished from the other subepidermal blistering eruptions by histologic, immunologic, and gastrointestinal criteria. Most patients have an associated gluten-sensitive enteropathy GSE that is usually asymptomatic. Both enteropathy and the dermatologic findings disappear with a gluten-free diet, therefore, DH is thought to be the specific dermatologic finding of celiac disease CD. An association between CD and autoimmune disease has been documented in several studies. Similar associations have been reported in DH. We report a 46-year-old man with DH diagnosed more than 10 years previously who developed GSE, pernicious anemia, and rheumatoid arthritis in the following years.

Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients.

The aim of this study was to investigate dynamic postural balance in patients with rheumatoid arthritis (RA) in relation to the disease characteristics. Seventy-four patients with RA and 42 controls of the same age group were tested using the Biodex Stability System (Biodex Medical Systems, Shirley, NY, USA). Anterior/posterior (AP), medial/lateral (ML), and overall (OA) indices were obtained with bilateral stance at platform stabilities of 2 and 8. Subjects were tested with "eyes open" at all times. At the same time, Disease Activity Score, functional disability [Health Assessment Questionnaire, (HAQ)], and Steinbrocker Functional Class (SFC) were assessed. Both the AP and OA indices in the RA group were significantly higher than in the control group for level 8. For OA index, the results were 2.7+/-0.9 in RA and 2.2+/-0.7 in the control group (p=0.006), and for AP index, the results were 2.1+/-0.7 in RA and 1.7+/-0.6 in the control group (p=0.002). Eleven patients (15.9%) and three controls (7.1%) could not complete the test at level 2. When the patients and controls who completed the test were compared, a significant difference was found only in the ML index. The results were 4.6+/-2.4 in RA and 3.8+/-1.6 in the control group (p=0.047). A positive correlation between HAQ and postural balance for all three stability indices at level 8 was detected. A positive correlation between SFC and postural balance for OA and ML at level 8 was also found. Multiple linear regression analyses revealed age and body mass index (BMI) to be the most important factors influencing postural dynamic balance at both levels in the RA group and in healthy controls. RA has a negative effect on dynamic postural stability. The functional status affects dynamic balance more than disease activity. Age and BMI were the most important factors influencing postural dynamic balance in the RA group and in healthy controls. Level 2 does not appear to be an appropriate level for evaluating postural stability in RA.

Foot deformities in rheumatoid arthritis and relevance of foot function index.

The aim of this study were to assess what type of foot deformities are found in rheumatoid arthritis (RA) patients, to detect frequency of deformities, and to evaluate deformities affecting Foot Function Index (FFI) and patient functional capacity. Anteroposterior and lateral weight-bearing radiographs of 156 feet of 78 patients who had RA for > or =2 years and of 76 feet of 38 healthy controls were studied. We measured hallux valgus angle, intermetatarsal angle between first and second (M1/2) and intermetatarsal angle between first and fifth (M1/5) on anteroposterior radiographs, and calcaneal pitch on the lateral radiographs. We examined the feet of all RA patients and healthy controls for hallux rigidus, cock-up deformity, clawing toe, and mallet finger, and measured calcaneal valgus angle. FFI, comprised of pain, disability, and activity limitation subscales, was administered to all RA patients. Their Steinbrocker Functional Class (SFC) and Health Assessment Questionnaire (HAQ) scores were determined. We determined frequency of deformities as 96.2% in RA patients and 97.4% in controls by radiological and physical examination (p>0.05). The frequency of each deformity was markedly increased in RA patients, with the exception of calcaneal valgus deformity. There was significant correlation between SFC and HAQ with FFI and subscales (respectively, r=0.46, p=0.001; r=0.67, p=0.001). For FFI and subscales, HAQ was the most important predictor factor, followed by gender and hallux rigidus. Foot deformities are seen very frequently in RA. These deformities may affect patient functional foot, especially hallux rigidus and calcaneal valgus.

Hand deformity in Parkinson's disease: case report.

Hand and foot deformities were originally described in Parkinson's disease (PD) in 1864, although their pathogenesis still remains to be clarified. Typical hand deformities are flexion in metacarpopharyngeal joints and hyperextension in interphalangial joints, sometimes accompanied by ulnar deviation. Unlike rheumatoid arthritis (RA), there is no swelling and stiffness in joints. In this report, a case that was previously misdiagnosed as RA due to deformities in the hand and whose PD was detected upon presentation to our clinic is presented, and the differential diagnosis of the disease is discussed.

The effects of menstrual cycle on the knee joint position sense: preliminary study.

The purpose of this study was to determine the effects of menstrual cycle on proprioception by using the active knee joint position sense test (JPST). The 19 healthy women (ages between 20 years and 27 years) who have normal regular menstrual cycle were included in the study. We applied JPSTs at two different directions throughout the three different phases of the menstrual cycle, i.e. menstrual, follicular, and early luteal in dominant knees. When we started from flexion (90 degrees ), target angles were 70 degrees , 50 degrees , and 30 degrees and we started from extension (0 degrees ), target angles were 20 degrees , 40 degrees and 60 degrees . The absolute reposition errors from the target angles have been evaluated. Results have shown that reposition errors from the target angle at 40 degrees , 50 degrees and 70 degrees of knee angles were higher in the menstrual phase than that of the follicular phase (P<0.05). In addition, higher value of reposition error from the target angle at 40 degrees was found in the menstrual phase compared to luteal phase (P<0.05). In conclusion, we have demonstrated that active JPST was significantly reduced in the menstruation period.

The sole arch indices of adolescent basketball players.

OBJECTIVE: The aim of this study was to find out the difference between sole arch indices of adolescent basketball players and an age matched non-athletic group. METHODS: This study was carried out in the Sports Education, Health and Research Center, Ankara, Turkey, between November 1998 and December 1998. In junior (16-18 years) categories 48 male basketball players and 45 age matched controls were included in the study. Body mass index and podoscopic sole images of subjects were recorded, and the arch index was calculated for each group. RESULTS: The sole arch index has no difference between basketball players and controls. The right foot arch index of the control group was 59.62 +/- 23.26 and 56.74 +/- 17.21 in players (p=0.497). The left foot arch index was 54.54 +/- 23.72 in control groups and 55.13 +/- 17.33 in players (p=0.890). There was a significant negative correlation between sole arch index and training age in basketball players (r=-0.3312 for right sole arch index, p value is less than 0.05; r=-0.3056 for left sole arch index, p less than 0.05). CONCLUSION: These results have shown that basketball might result in specific adaptation on sole arches of adolescent players.

Reliability of isokinetic ankle inversion- and eversion-strength measurement in neutral foot position, using the Biodex dynamometer.

This study was designed to investigate the intratester and intertester reliability of isokinetic ankle inversion and eversion-strength measurement in neutral foot position in healthy adults using the Biodex dynamometer. Twenty-five men and women performed five maximal concentric contractions at 60 and 180 degrees/s angular velocities. Two physicians tested each subject. The first physician applied the test four times, and the second physician three times. Reliability of peak torque was assessed by calculating the intraclass correlation coefficient (ICC). At both angular velocities, inversion strength was greater than eversion, and when the angular velocity was increased, inversion and eversion strength were decreased, as tested by both physicians. The first measurements of inversion and eversion strength of the first physician were significantly lower than the other measurements (p<0.01). The intratester ICCs for ankle inversion in healthy young adults were highly reliable (ICC 0.92-0.96), and for the eversion values ranged from 0.87 to 0.94. Intertester ICCs for ankle inversion and eversion peak torque values demonstrated a value of 0.95. Isokinetic tests of ankle inversion and eversion strength at 60 and 180 degrees/s angular velocities in neutral foot position for healthy adults are highly reliable with the Biodex dynamometer.