Relationship of hematologic markers with IL-17 and IL-1 beta in patients with rheumatoid arthritis.

OBJECTIVES: In this study, we aimed to investigate the relationship of NLR (Neutrophil lymphocyte ratio), MPV (mean platelet volume), PDW (distribution width) rates in rheumatoid arthritis (RA) patients with IL-17 and IL-1 beta which are within the cytokines playing an important role in etiopathogenesis and activity of the disease. PATIENTS AND METHODS: Fifty-seven RA patients diagnosed according to RA classification criteria of ACR/EULAR 2010 and 37 controls were included into the study. WBC (white blood cell), NEU (neutrophil), PLT (platelet), LYM (lymphocyte) values in complete blood count received from routine blood examination of patients were recorded, and NLR, PLR (platelet lymphocyte ratio) rates were recorded. IL-17 and IL-1 beta were studies in serum samples. Disease activity of RA patients was evaluated with Disease Activity Score (DAS28). Age, gender, disease age, BMI (body mass index), medications used, co-morbid diseases, smoking of the patients were recorded. RESULTS: Fifty-seven RA patients (46 (80.7%) females, 11 (19.3%) males), and 34 patients (24 (70.6% females and 10 (29.4) males) as a control group were involved. Demographic characteristics were similar between two groups, and statistically significant difference was not detected between patient and control groups in terms of gender, age, and BMI (p> 0.05). We found higher NLR, MPV, PDW, IL-17 values in RA patients compared to control group (p< 0.05). There was a positive correlation of NLR with DAS28, CRP. While erythrocyte sedimentation rate (ESR) had negative correlation with MPV and PDW, it had positive correlation with PLT. We found positive correlation of C-reactive protein (CRP) with NLR and PLT. We could not find correlation of IL-1 beta and IL-17 with hematologic markers. CONCLUSION: In this study, we investigated the relationship of IL-17 and IL-1 beta which play an important role in pathogenesis of RA patients with the parameters analyzed in routine complete blood count, providing information about disease activity such as DAS 28, CRP, and ESR. We illuminated on an issue which has not discussed before by looking from a different angle. More extensive, follow-up studies are needed to emphasize the importance of these parameters and to reveal the relationship between cytokines during the follow-up of the disease activity.

Can the patient-reported outcome instruments determine disease activity in rheumatoid arthritis?

OBJECTIVES: The aim of this study was to investigate the indicative value of the patient-reported outcome instruments (PROs) on disease activity in rheumatoid arthritis (RA). METHODS: Three hundred sixty eight patients with RA were included in this cross-sectional study. Disease activity was evaluated using both the Disease Activity Score 28 (DAS 28) and the Clinical Disease Activity Index (CDAI). Patients who had DAS 28 score < 3.60 points and CDAI score <10.00 points were allocated into the "low disease activity" group and those who had DAS 28 score > or = 3.60 points and CDAI score > or = 10.00 points into the "moderate or high disease activity" group. The Health Assessment Questionnaire (HAQ), Nottingham Health Profile (NHP), Rheumatoid Arthritis Quality of Life (RAQoL), and Short Form 36 (SF 36) were used as PROs. Logistic regression analysis was used to find variables, which had an indicative value for disease activity. RESULTS: HAQ, pain and emotional reaction subscales of NHP, and bodily pain, general health and social functioning subscales of SF 36 had independent indicative values, when DAS 28 was used as dependent variable. On the other hand, HAQ, pain and emotional reaction subscales of NHP, and general health and emotional role limitation subscales of SF 36 had indicative values when CDAI was used as dependent variable. DAS 28 and CDAI both showed HAQ as the parameter with the highest odds ratio (OR). But RAQoL had shown no independent indicative value for projecting disease activity. CONCLUSION: It was concluded that HAQ could determine disease activity in RA better than other PROs included in this study (Tab. 4, Ref. 36).

Comparison of local steroid injection into carpal tunnel via proximal and distal approach in patients with carpal tunnel syndrome.

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy presented to physicians. There are several non-surgical treatments methods, such as; splinting of wrist, physical therapy modalities, non-steroidal anti-inflammatory drugs ((NSAIDs), injection of corticosteroids, etc. In this study, we aimed to compare the effects of proximal and distal approach to the carpal tunnel regarding the steroid injection application in patients with idiopathic CTS for confirmed nerve conduction studies (NCS). MATERIAL AND METHODS: A total of 19 bilateral CTS patients were enrolled in this study and randomly assigned into 1 of the 2 groups according to the local steroid injection (triamsinolone asetonide 20 mg), either via proximal (10 patients, 20 wrist, 1 M, 9 F)) or distal (palmar) approach (9 patients, 18 wrist, 3M, 6 F) into the carpal tunnel. Clinical and NCS examination were done before and at 3 weeks and 3 months after the injection. Also, severity of night pain, muscle strength, disability by Boston carpal tunnel assessment score (BCTS), HAQ were assessed at baseline and at 3 weeks and 3 months after the injection. All patients were used hand-wrist splint during 3 weeks after injection. RESULTS: There were significant reductions in pain and disability scores between the baseline and follow-up periods. There was not a significant difference between the both groups. There were significant improvement in patients' global assessment in patients from the distal injection group. NCSs showed that electrophysiological improvement was slow. CONCLUSION: This study showed that steroid injection from distal approach (palmar) into the carpal tunnel on patients with CTS is very comfortable, easy, effective and alternative (Tab. 3, Fig. 5, Ref. 11).

Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation.

OBJECTIVE: This study measures and compares the outcome of conservative physical therapy with traction, by using magnetic resonance imaging and clinical parameters in patients presenting with low back pain caused by lumbar disc herniation. METHODS: A total of 26 patients with LDH (14F, 12M with mean aged 37 +/- 11) were enrolled in this study and 15 sessions (per day on 3 weeks) of physical therapy were applied. That included hot pack, ultrasound, electrotherapy and lumbar traction. Physical examination of the lumbar spine, severity of pain, sleeping order, patient and physician global assessment with visual analogue scale, functional disability by HAQ, Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline and at 4-6 weeks after treatment. Magnetic resonance imaging examinations were carried out before and 4-6 weeks after the treatment RESULTS: All patients completed the therapy session. There were significant reductions in pain, sleeping disturbances, patient and physician global assessment and disability scores, and significant increases in lumbar movements between baseline and follow-up periods. There were significant reductions of size of the herniated mass in five patients, and significant increase in 3 patients on magnetic resonance imaging after treatment, but no differences in other patients. CONCLUSIONS: This study showed that conventional physical therapies with lumbar traction were effective in the treatment of patient with subacute LDH. These results suggest that clinical improvement is not correlated with the finding of MRI. Patients with LDH should be monitored clinically (Fig. 3, Ref. 18).

Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome.

BACKGROUND: Myofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. Several methods have been recommended for the inactivation of trigger points (TrP). OBJECTIVES: This prospective, single-blind study was proposed to compare TrP injection with botulinum toxin type A (BTX-A) to dry needling and lidocaine injection in MPS. METHODS: Eighty-seven trigger points (cervical and/or periscapular regions) in 23 female and six male patients with MPS were treated and randomly assigned to three groups: lidocaine injection (n=10, 32 TrP), dry needling (n=10, 33 TrP), and BTX-A injection (n=9, 22 TrP). OUTCOME MEASURES: Clinical assessment including cervical range of motion, TrP pain pressure threshold (PPT), pain scores (PS), and visual analog scales for pain, fatigue, and work disability were evaluated at entry and the end of the 4th week. Additionally, depression and anxiety were evaluated with the Hamilton depression and anxiety rating scales, and quality of life was assessed using the Nottingham health profile (NHP). The subjects were also asked to describe side effects. INJECTION PROCEDURE: One milliliter of 0.5% lidocaine was administered to each TrP in the lidocaine injection group, 10-20 IU of BTX-A to each TrP in the BTX-A group, and dry needling to each TrP in the last group, followed by stretching of the muscle groups involved. The patients were instructed to continue their home exercise programs. RESULTS: Pain pressure thresholds and PS significantly improved in all three groups. In the lidocaine group, PPT values were significantly higher than in the dry needle group, and PS were significantly lower than in both the BTX-A and dry needle groups. In all, visual analog scores significantly decreased in the lidocaine injection and BTX-A groups and did not significantly change in the dry needle group. Disturbance during the injection procedure was lowest in the lidocaine injection group. Quality of life scores assessed by NHP significantly improved in the lidocaine and BTX-A groups but not in the dry needle group. Depression and anxiety scores significantly improved only in the BTX-A-injected group. CONCLUSIONS: Injection is more practical and rapid, since it causes less disturbance than dry needling and is more cost effective than BTX-A injection, and seems the treatment of choice in MPS. On the other hand, BTX-A could be selectively used in MPS patients resistant to conventional treatments.

Auditory P300 event related potentials and serotonin reuptake inhibitor treatment in patients with fibromyalgia.

BACKGROUND: The P300 components of auditory event related potentials (ERPs) are objective measures related to information and cognitive processing. OBJECTIVES: To assess P300 ERPs in female patients with fibromyalgia (FM) in comparison with healthy age matched controls. To investigate the relationship between P300 potentials and pain threshold levels of patients, and subsequent effect of sertraline treatment on P300 potentials. METHODS: P300 auditory ERPs were studied in 13 untreated female patients with FM and 10 healthy controls matched for age, sex, and education. Pain pressure thresholds and total myalgic scores (TMS) were assessed with an algometer. Patients were evaluated for clinical measures and P300 potentials (recorded from the vertex) at the first visit, and then in the fourth and eighth weeks of sertraline treatment. RESULTS: Patients with FM had significantly lower P300 amplitudes, but not significantly different P300 latencies, than controls at entry. P300 latencies in patients correlated negatively with TMS (r(s)=-0.79, p<0.01) and P300 amplitudes correlated significantly with TMS (r(s)=0.53, p<0.05). Anxiety and depression scores did not correlate significantly with P300 latencies or amplitudes at the study entry. P300 auditory ERPs had increased amplitudes that had reached nearly the same levels as those of the controls at the eighth week without any significant change in their latencies. CONCLUSION: The results show reduced P300 amplitudes in patients with FM. Further studies assessing the relationship between P300 ERPs and neuropsychiatric tests are required for better clarification of the clinical relevance of P300 potentials in FM.

Radiological abnormalities of the lumbosacral spine in young male individuals.

The purpose of this study was to determine the overall incidence and distribution of lumbosacral congenital abnormalities in healthy and active young male individuals. The study population consisted of 503 healthy young male candidates for sports training. Lumbosacral transitional vertebral (LSTV) abnormalities were found in 37 (7.4%) of subjects and were unilateral in 14 (2.8%) subjects (lumbarization/sacralization). Lumbar rotoscoliosis (LRS) was present in 14 (2.8%) subjects and facet asymmetry in one subject. LSTV and LRS together were present in 3 subjects. Spina Bifida Occulta (SBO) was present in 107 of 503 candidates (21.4%). The distribution of SBO throughout vertebra levels was as follows: 86 only in S1, 11 in S1+S2, 9 in L5, 1 in L5+S1. SBO and LSTV were present together in 8 subjects. SBO and LRS were present together in three subjects. 356 (70.4%) subjects had normal lumbosacral radiographs. Our study results support the notion that SBO is a common lumbosacral abnormality especially in young male healthy individuals.

Relationship between bone mineral density and radiologic scores of hands in rheumatoid arthritis.

This study proposed to assess the relationship between hand bone mineral density (BMD) and radiographic scoring methods, important measures to assess the course of rheumatoid arthritis. Hand, spine, and femur BMD of 49 patients with rheumatoid arthritis and 34 age- and sex-matched healthy control subjects were measured using dual X-ray absorptiometry and the results were compared. Standard hand films of patients were scored according to five different scoring methods--Larsen method, modified Larsen method, Sharp/van der Heijde modified method, carpo:metacarpal ratio, and simple erosion narrowing score (SENS)--and were correlated with hand BMD. There was a moderate relationship between hand BMD measurements and radiologic scores. SENS was the method that correlated significantly with the highest correlation coefficient. Hand BMD correlated significantly with disease duration and c-reactive protein levels. Hand BMD in patients with rheumatoid arthritis was significantly lower than in control subjects, whereas there was no significant difference in axial BMD measurements. The advantages and disadvantages of hand BMD and radiographic scoring methods were determined. Our results indicate that hand BMD measurements may be as useful is assessing the course of rheumatoid arthritis as radiologic scoring methods. However to prove this, a well-designed reference population for hand BMD and longitudinal studies are required.

Effects of long-term inhaled steroid use on bone mineral density in asthma patients.

UNLABELLED: Asthma is a chronic inflammatory disease of the airways. Inhaled corticosteroids are the most effective and most frequently used antiinflammatory drugs in the treatment of asthma. It is well known that long-term systemic steroid therapy causes osteoporosis, whereas it is thought that inhaled forms do not cause this side effect. Despite the recent disagreeing reports, it has been suggested that the use of inhaled steroids are associated with findings of biochemical bone changes. Therefore, we measured the bone mineral densities (BMD) of 18 patients (15 female, 3 male) with bronchial asthma receiving long-term inhaled steroids by X-ray absorptiometry technique and compared the results with those of 14 healthy control subjects (12 female, 2 male) who had been matched according to age, sex, menopausal state, and body mass index (BMI). RESULTS: There were no detectable significant difference between the BMD levels of left hip (trochanter major, neck of femur, Ward's triangle) and lumbar area of the spine (L2-L4) (p > 0.05).

Trace element and magnesium levels and superoxide dismutase activity in rheumatoid arthritis.

It has been suggested that reactive oxygen metabolites and trace elements play some role in the etiology and pathogenesis of rheumatoid arthritis (RA). Superoxide dismutase (SOD) is believed to exert an important protective role against oxygen toxicity. The aim of the study was to investigate the probable changes in the levels of trace elements and SOD activity in RA. Plasma and erythrocyte copper, zinc, and magnesium levels and erythrocyte SOD activity were measured in groups of controls and RA cases. Significantly increased erythrocyte SOD activity was found in RA patients in comparison with controls (p < 0.0001). A rise in erythrocyte Zn level (p < 0.0001) and plasma Cu level (p < 0.0001) and a decrease in erythrocyte Cu level (p < 0.05) and plasma Zn level (p < 0.05) were obtained in RA patients when compared to controls. Plasma and erythrocyte Mg levels of the RA patients showed slight and statistically insignificant reductions when compared to controls (p > 0.05). In RA patients, there were positive correlations between erythrocyte SOD activity and Mg level (r = 0.4345, p < 0.01) and between erythrocyte Zn level and plasma Cu level (r = 0.4132, p < 0.01). There were negative correlations between erythrocyte SOD activity and plasma Zn level (r = -0.3605, p < 0.05) and between plasma Zn level and erythrocyte Cu level (r = -0.4578, p < 0.01) in RA patients.