Musculoskeletal symptoms and related factors in postacute COVID-19 patients.

AIM: There is a lack of an overview of the factors associated with postacute COVID-19 musculoskeletal symptoms. The aims of this study were as follows: 1- to evaluate the most frequent admission symptoms and the frequency of musculoskeletal symptoms in postacute COVID-19 patients; and 2- to determine the related factors with the postacute COVID-19 musculoskeletal symptoms. METHODS: A total of 280 postacute COVID-19 patients (183 females, 97 males) were enrolled and divided into two groups: 1- patients whose musculoskeletal symptoms initiated with or were aggravated by COVID-19 (n = 240); and 2- patients whose musculoskeletal symptoms did not change with COVID-19 (n = 40). The variables were demographic and treatment data, symptoms on admission, postacute COVID-19 symptoms, laboratory results (complete blood count, erythrocyte sedimentation rate, C-reactive protein, ferritin and d-dimer), chest computed tomography findings and symptoms during acute COVID-19. RESULTS: Most of the patients have fatigue (71.8%), spine pain (70.7%) and myalgia (60.7%). The most common pain region was the back (30.4%). The frequency of dyspnoea was 30%, cough 18.5% and chest pain 10.7%. Having any chronic disease (P = .031), the duration of hospital stay (P = .016), frequency of back pain during acute COVID-19 (P = .018), tomography findings and d-dimer (P = .035) levels were significantly higher, and lymphocyte (P = .024) levels were significantly lower in the patients whose symptoms began with or were aggravated by COVID-19. CONCLUSION: Back pain was the most frequent symptom on admission. The most common postacute COVID-19 musculoskeletal symptoms were fatigue, spine pain and myalgia. Lower lymphocyte and higher d-dimer levels, the presence of COVID-19 findings in tomography and back pain during acute COVID-19 infection, higher duration of hospital stay and having chronic diseases were related to post-COVID-19 musculoskeletal symptoms.

Ultrasonographic evaluation of femoral cartilage thickness in patients with familial Mediterranean fever.

OBJECTIVES: This study aims to determine femoral cartilage thickness using ultrasonography in familial Mediterranean fever (FMF). PATIENTS AND METHODS: A total of 45 patients (16 males, 29 females; mean age: 38.5±9.1 years; range, 24 to 49 years) with the diagnosis of FMF and 31 healthy individuals (6 males, 25 females; mean age: 37.0±8.7 years; range, 25 to 47 years) between January 2016 and July 2016 were included in this study. Clinical data and demographic characteristics of the patients were recorded. All FMF cases in the study were in remission with colchicine treatment. The thickness of femoral cartilage in both knees were evaluated using ultrasonography. Three measurements (mid-point) were taken from both knees (at the medial/lateral femoral condyles and intercondylar area). RESULTS: Ultrasonographical measurements revealed that cartilage measurements of FMF patients were significantly thinner at both the medial/lateral femoral condyles and intercondylar area on the right knee and at the medial/lateral femoral condyles on the left knee (p<0.001). The cartilage measurements in FMF patients were significantly thinner at the intercondylar area on left knee, compared to those in controls (p=0.023). CONCLUSION: Our study showed decreased femoral cartilage thickness in FMF patients. These findings indicate that even if these patients do not have an attack, they may have subacute and chronic arthritis in their joints, and their femoral cartilage thickness can be affected.

Relationship Between Q-Angle and Articular Cartilage in Female Patients With Symptomatic Knee Osteoarthritis: Ultrasonographic and Radiologic Evaluation.

OBJECTIVES: This study aims to examine the association between Q-angle and clinical, radiological, and ultrasonographic findings in patients with knee osteoarthritis (OA). PATIENTS AND METHODS: Sixty-eight female patients (mean age 59.8±6.8 years; range 39 to 78 years) diagnosed with knee OA were included in this study and classified into two groups according to Q-angle of symptomatic knees: low Q-angle group (LQ) (n=40) and high Q-angle group (HQ) (n=28) (LQ-angle <15° and HQ-angle ≥15°, respectively). Patients were clinically assessed for pain and functional status by using a visual analog scale and the Western Ontario and McMaster Universities Arthritis Index. X-rays of knees were scored using the Kellgren-Lawrence OA grading system. Symptomatic knees were also evaluated using ultrasonography for distal femoral cartilage thickness/grading. RESULTS: No significant difference was observed in clinical and imaging findings between the groups (p>0.05). HQ-angle measurements were positively correlated with cartilage grading by ultrasonography (r=0.435, p=0.033) and Kellgren-Lawrence grading system (r=0.435, p=0.021), and negatively correlated with cartilage thickness measurements of the medial femoral condyle (r=-0.399, p=0.036). CONCLUSION: We found that HQ-angle was associated with cartilage thickness measurements of the medial femoral condyle and cartilage grading by ultrasonography and the Kellgren-Lawrence grading system in patients with knee OA.

Relationship between atherosclerosis and knee osteoarthritis as graded by radiography and ultrasonography in females.

[Purpose] The aim of this study was to assess the relationship between atherosclerosis and knee osteoarthritis grade in women as assessed by both ultrasonography and radiography. [Subjects and Methods] Seventy women diagnosed with knee osteoarthritis were classified into two groups according to cartilage grading/radiographic grading. Patients with Kellgren-Lawrence grades 1 and 2 were included in group 1, while those with Kellgren-Lawrence grades 3 and 4 were included in group 2. Patients with cartilage grades 1-3 were included in group 1, while those with cartilage grades 4-6 were included in group 2. Patients were clinically assessed using a visual analog scale and the Western Ontario and McMaster Universities Arthritis Index. Radiographic osteoarthritis grade was scored using the Kellgren and Lawrence grading system. Using ultrasonography, symptomatic knees were graded and evaluated for distal femoral cartilage thickness. Carotid intima-media thickness and serum lipid levels were measured to assess atherosclerosis. [Results] Carotid intima-media thickness measurements were higher in group 2 than in group 1 as determined by the Kellgren-Lawrence and cartilage grading systems. Carotid intima-media thickness measurements were positively correlated with both the ultrasonographic cartilage grade and Kellgren-Lawrence. [Conclusion] The results of this study suggest that osteoarthritis as assessed by ultrasonography was successful and comparable to assessment with radiography. We showed a correlation between atherosclerosis and ultrasonographic knee osteoarthritis grade.

Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis.

OBJECTIVE: In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal osteoporosis patients. METHODS: A total of 979 patients with postmenopausal osteoporosis (mean age: 63.2 ± 7.2 years) were included in this national, multicenter, prospective non-interventional observational cohort registry study. Patients were randomized into training (n = 492, 50.3%, mean age: 63.4 ± 7.2 years) and control (n = 487, 49.7%, mean age: 63.0 ± 7.1 years) groups. Patients in each intervention group were given weekly (44.9% and 44.6% for training and control subjects, respectively) or monthly (55.1% and 55.4%, respectively) bisphosphonate regimens. After the initial visit, patients were followed up at three-month intervals throughout 12 months of treatment for evaluation of persistence, compliance and adverse events. RESULTS: On average, 79.4% of the patients were persistent with the treatment with a mean of 350.4 days of duration during the 12-month follow-up period. The mean compliance in the compliant and fully compliant group remained at an average of 86.6%. No significant difference was detected between the training and control groups in terms of compliance and persistence. Significantly longer persistence (360.0 ± 89.0 vs. 345.0 ± 108.0 days; p = 0.035), higher percentage of persistent patients (83.4% vs. 74.2%; p = 0.012) and higher compliance rates (88.8% vs. 83.3%; p = 0.002) were noted in monthly regimen patients in comparison to those given weekly regimen. CONCLUSION: Our findings revealed remarkably high rates for persistence and compliance with bisphosphonate treatment in postmenopausal osteoporosis, with no impact of training on compliance and persistence rates. Longer persistence and better compliance rates were achieved with the monthly bisphosphonate regimen when compared to the weekly regimen.

Continuous passive motion in adhesive capsulitis patients with diabetes mellitus: A randomized controlled trial.

BACKGROUND: The aim of this study was to clarify the effects of continuous passive motion (CPM) treatment on adhesive capsulitis (AC) in diabetes mellitus (DM) patients. METHODS: Forty-one DM patients with AC were randomized to two treatment groups. The first group (n= 20) (CPM group) received CPM treatments; the second group (n= 21) had conventional physical therapy (CPT group), including active stretching, range of motion (ROM) and pendulum exercises. All patients received electrotherapy. After a four-week-long physical therapy program, the patients were instructed to continue with an eight-week home exercise program. The patients rated the pain they felt at night, both while at rest and in motion, in the past week using the visual analogue scale (VAS). Functional outcome evaluations were performed using the Constant Shoulder Score (CSS) and Shoulder Pain and Disability Index (SPADI). All patients were evaluated at baseline, and during the fourth and twelfth weeks of the study. RESULTS: There were significant improvements in both groups' active and passive ROM for the shoulder, VAS measures, SPADI pain and disability scores and CSS, and excluding the active and passive internal and external rotation of shoulder increased with both treatment methods (CPM or CPT) over time (p< 0.001), however these differences were found to be prominent in patients receiving CPM therapy. CONCLUSIONS: Both the CPM and CPT therapies seemed to be beneficial for the treatment of AC in DM patients, however CPM revealed more distinctive improvements in the function and pain levels of the AC patients.

Butterfly vertebra anomaly: A case report.

Butterfly vertebra is an uncommon congenital spinal anomaly. Only a small number of cases with butterfly vertebra have thus far been reported in the literature.We herewith describe a 32-year-old male admitted to our clinic with low back pain. He has been suffering from low back pain since early adolescence. Radiologic investigations confirmed presence of butterfly vertebra at Lumbar(L)2 level and L3-4, L4-5 posterior disc protrusion and slight osteoarthritic changes in lumbar spine which proved to be a coincidental finding along with nonspecific low back pain. Routine examination of the motor and sensory system was found to be normal. Hematologic evaluation was made to rule out pathologic causes of anterior wedging of the vertebra like infections and metastases in the spine. Butterfly vertebra anomaly is considered to be incidental and usually asymptomatic. Awareness of this anomaly is important for correct diagnosis, while its imaging features may be confused with traumatic compression fracture, or with a pathologic fracture. Also, this spinal anomaly may be associated with many syndromes. This taken into account, all the necessary investigations should be carried out for purposes of achieving a correct diagnosis.

[Efficiency of TENS treatment in hemiplegic shoulder pain: a placebo controlled study]. / Hemiplejik omuz agrisinda TENS tedavisinin etkileri: plasebo kontrollü bir çalisma.

OBJECTIVE: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy on shoulder pain and upper extremity functions in hemiplegic patients. MATERIAL-METHODS: Total of 19 hemiplegic patients with shoulder pain were as consecutive randomly assigned into two groups. TENS was applied in group 1 (n = 10) for 20 minutes and group 2 (n = 9) received placebo stimulation. Conventional rehabilitation program were applied total 15 sessions during a period of 3 week in both groups.The visual analog scale (VAS) to evaluate shoulder pain, Barthel Index (BI) for daily-life activities (DLA) were used. The shoulder passive range of motions (PROMs) and Brunnstrom stage of motor recovery were measured. RESULTS: Clinical parameters were similar at baseline. In both groups, significant improvements were observed in VAS and BI (group 1: p<0.001; group 2: p<0.05). In VAS (p<0.001), and BI (p<0.05) were showed significant improvements in favor of group 1, when compared with the groups. In PROMs of abduction and external rotation of shoulder significant improvements were observed in only group 1 (p<0.001, p<0.001 respectively). There was not any significant improvement on Brunnstrom stage of motor recovery in both groups (p>0.05). CONCLUSION: In conclusion that TENS therapy together with conventional rehabilitation could be used as a good alternative therapy in patients with hemiplegic shoulder pain.

Neuropathic arthropathy caused by syringomyelia in different joints and lesion of brachial plexus at right upper extremity: a case report.

Syringomyelia is characterized by slow progression; the joints involved most frequently are the shoulders and elbows. Neuropathic arthropathy of the hand is quite rare. Herewith, we present a case of neuropathic arthropathy (NA) of the joints in the upper limb secondary to Syringomyelia. Atypical features of the case included NA of the shoulder, elbow and metacarpophalengeal joint in the same upper limb. These atypical features superimposed shoulder subluxation and brachial plexopathy which diagnosed by electrophysiologic studies. To the best of our knowledge, our study is the first of its kind that reports a patient who had all the above mentioned symptoms in the same upper limb.

Effect of low level laser therapy in rheumatoid arthritis patients with carpal tunnel syndrome.

OBJECTIVE: the aim of the present study was to evaluate the efficacy of low level laser therapy (LLLT) in patients with rheumatoid arthritis (RA) with carpal tunnel syndrome (CTS). MATERIAL AND METHODS: a total of 19 patients with the diagnosis of CTS in 19 hands were included and randomly assigned to two treatment groups; LLLT (Group 1) (10 hands) with dosage 1.5 J/ per point and placebo laser therapy group (Group 2) (9 hands). A Galium-Aluminum-Arsenide diode laser device was used as a source of low power laser with a power output of 50 mW and wavelength of 780 nm. All treatments were applied once a day on week days for a total period of 10 days. Clinical assessments were performed at baseline, at the end of the treatment and at month 3. Tinel and Phalen signs were tested in all patients. Patients were evaluated for such clinical parameters as functional status scale (FSS), visual analogue scale (VAS), symptom severity scale (SSS) and grip-strength. However, electrophysiological examination was performed on all hands. Results were given with descriptive statistics and confidence intervals between group means at 3 months adjusted for outcome at baseline and for the difference between unadjusted group proportions. RESULTS: clinical and electrophysiological parameters were similar at baseline in both groups. Improvements were significantly more pronounced in the LLLT group than placebo group. A comparison between groups showed significant improvements in pain score and functional status scale score. Group mean differences at 3 months adjusted at baseline were found to be statistically significant for pain score and functional status scale score. The 95% significant confidence intervals were [-15 - (-5)] and [-5 - (-2)] respectively. There were no statistically significant differences in other clinical and electrophysiological parameters between groups at 3 months. CONCLUSIONS: our study results indicate that LLLT and placebo laser therapy seems to be effective for pain and hand function in CTS. We, therefore, suggest that LLLT may be used as a good alternative treatment method in CTS patients with RA.

Ankylosing spondylitis in a patient with Turner syndrome: a case report.

Turner's syndrome (TS) is a chromosomal disorder where phenotypic females have either a missing chromosome (45 X0) or a structural aberration of one of the chromosomes. It is possible for TS to accompany such autoimmune diseases as thyroid diseases, inflammatory intestinal diseases, diabetes mellitus, psoriatic arthritis and juvenile rheumatoid arthritis. Herein, we present an unusual case with Ankylosing spondylitis (AS) and autoimmune thyroiditis associated with TS. We suggest that the possibility that TS patients may also develop such other diseases as AS apart from the already known accompanying autoimmune diseases should not be ruled out when monitoring TS patients.