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Objective: Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of life in patients with RA and also to assess which quality of life (QoL) instrument - disease specific and generic - is more prone to this effect. Methods: A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire. Results: Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. There was significant association between anxiety and depression with worsening in both disease specific and generic health related quality of life. However, RAQoL showed more association with depression and anxiety levels. Conclusion: Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is much more influenced by depression and anxiety. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this, open-label, non-comparative study, was to evaluate the efficacy on quality of life and the efficacy of gabapentin monotherapy in patients with chronic radiculopathy. Methods: Thirty-five patients with radicular pain and diagnosed as L_{4}, L_{5} or S_1 radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for eight-week trial period. Quality of life, functional disability and psychological mood of the patients were assessed using the Nottingham Healthy Profile (NHP), Oswestry Low Back Pain Disability Questionnaire (ODQ) and Beck Depression Inventory (BDI). Results: Of the patients (n = 35), 25 were females and 10 were males (mean age: 41.8 ± 10.4, range: 24–60 years); mean radiculopathy duration was 16.4 ± 14.2 months (range: 3–48 months). The pain intensity at rest, quality of life, functional disability and depression scores were determined significantly improved after treatment and 4 months compared to baseline scores (p < 0.001). 1.5 points compared to baseline for at pain rest and 15 points improvement on the ODQ were obtained. Conclusion: Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy. [ABSTRACT FROM AUTHOR]

Although the range of treatments for osteoarthritis has increased recently, osteoarthritis is still a frequently observed disease lacking effective treatment. Osteoarthritis is expected to be the fourth cause of disability by 2020, and is much more common among the elderly. To understand the progression of osteoarthritis better, knowledge of the role of free radicals prior to, and during, the prevalence of osteoarthritis is required. Nitric oxide (NO) is a diatomic free radical produced by the ubiquitous enzyme, nitric oxide synthase. Increased NO production was documented in osteoarthritis in humans. Research on NO in a variety of inflammatory tissues led to the conclusion that modulation of NO synthesis and action could represent a new approach to the treatment of osteoarthritis. [ABSTRACT FROM AUTHOR]

The objective of the study was to compare the effects of alendronate, risedronate and calcitonin on biochemical markers of bone turnover and bone mineral density (BMD) in postmenopausal osteoporosis. The patients (n=200) were equally divided to one of four treatment groups: alendronate 10 mg/daily, risedronate 5 mg/daily, calcitonin 200 IU/daily and control group for 12 months. All groups also received 1000 mg of calcium/daily. The control group received only 1000 mg calcium/daily. Serum osteocalcin (OC), bone specific alkaline phosphatase (BSAP) and urinary deoxypyridinoline (uDPD) levels were determined. There are increases in BMD at two regions, at the end of 12 months in four groups. The mean increases in BMD at 12 months, at the lumbar spine and hip respectively, were: alendronate (p<0.05, p<0.001), risedronate (p<0.001, p<0.01), calcitonin (p<0.05, p<0.01) and control group (p>0.05 for both site). In comparison with control group, the mean changes in BMD at the spine and hip were greater in the other groups (p<0.05 for both region). uDPD levels were gradually reduced at the end of study in all groups (p<0.01 for three groups), while no significant change was found in calcium group. The treatment with alendronate produced significantly greater increases in total hip BMD than did risedronate and calcitonin and tretment with risedronate produced significantly greater increases in lumbar spine BMD than did alendronate and calcitonin over 12 months. This study demonstrated the efficacy of alendronate, risedronate and calcitonin in preventing the bone loss related to postmenopausal osteoporosis. [ABSTRACT FROM AUTHOR]

This study was performed to investigate the relationship between functional disability and depression in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Twenty-three patients with RA, twenty-seven patients with AS and thirty-five healthy individuals were included. Morning stiffness duration, patient's pain evaluation, Stanford health assessment questionnaire (HAQ), Beck depression inventory (BDI), serum C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were evaluated in the RA group. Also, morning stiffness duration, pain levels, Bath ankylosing spondylitis functional index (BASFI), BDI, CRP and ESR levels were measured in the AS group. Significant positive correlations between BDI scores and age, disease duration, pain and HAQ scores were found in the RA group (p < 0.01, p < 0.05, p < 0.05, p < 0.001, respectively). Also, there were similar correlations between BDI scores and disease duration, pain and BASFI scores in the AS group (p < 0.05, p < 0.05, p < 0.001, respectively). In conclusion, depression is associated with chronic inflammatory disorders such as RA and AS. In addition, the degree of functional disability may play an important role on depression of these patients. [ABSTRACT FROM AUTHOR]

Objective: Brucellosis is a zoonotic disease and still a major public health problem in many geographic areas including Mediterranean basin and Middle East. Brucellosis causes multisystemic involvement and although rare central nervous system involvement causes serious manifestations. Neurobrucellosis occurs less than 5% of patients and presents with meningitis, encephalitis, myelitis, myelopathy, stroke, paraplegia, radiculoneuritis, intracerebral abscess, epidural abscess, demyelination and cranial nerve involvement or any combination of these manifestations. Spastic paraparesis and the sensorineural involvement are rarely reported in the literature. Methods: Herein we present a 28 years-old man with spastic paraparesis and sensorineural hearing loss due to neurobrucellosis. Results: The patient was treated with antibiotics combination for 6 months and underwent rehabilitation program. Conclusions: Neurobrucellosis should be ruled out in patients with unexplained neurological symptoms and/or sensorineural hearing loss particularly in those living in endemic areas. [ABSTRACT FROM AUTHOR]

Introduction: The role of vascular endothelial growth factor (VEGF) in osteoporosis has not yet been clearly established. Vascular endothelial growth factor is an important part of bone formation. In the literature, although the effects of VEGF on bone metabolism were investigated by different studies, there are very rare studies analysing the association between osteoporosis and VEGF. In the present study, our objective was to investigate serum VEGF concentrations in patients with postmenopausal osteoporosis (PMO) and the correlation of serum VEGF levels and bone mineral density (BMD)., Material and Methods: This study was performed on 35 PMO patients, and 30 age-matched healthy controls. Serum VEGF concentrations were measured using a quantitative sandwich enzyme immunoassay technique according to the manufacturer's instructions. Bone mineral density values were determined by dual energy X-ray absorptiometry (DEXA)., Results: Serum VEGF concentrations were statistically significantly lower in PMO patients than in controls (150 ±65 pg/ml, 260 ±135 pg/ml respectively; p = 0.005). A positive correlation was found between serum VEGF concentrations and BMD values (r = 0.63, p = 0.001)., Conclusions: Vascular endothelial growth factor concentrations were decreased in PMO patients and VEGF may play an important role in bone health.

Objective: To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design., Methods: A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey., Results: Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25-6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51-6.98, adjusted for current age; and OR 2.26, 95% CI 1.07-4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life., Conclusion: JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.

Aim: Current guides recommend to evaluate the patients with low back pain complaints with initial clinical assessment and history, and to utilize radiological or other imaging technics, in case of possible diagnosis. The aim of this study was to compare the findings of radiological and clinical assessment, and validate the reliability of spondylolisthesis diagnosed with clinical assessment. This study is conducted on 100 patients with, and 30 patients without (control group) radiological diagnosis of spondylolisthesis, who had applied to Department of Physical Therapy and Rehabilitation, Haydarpasa Numune Hospital with low back pain complaints in one and a half year. Clinic assessment was consisted of 20 parameters including examinations of motor system such as, sign of slipping observed on palpation and inspection, extension of trunk and increase in lumbar lordosis. Antero-posterior, lateral, oblique and lateral flexion/extension radiographies were used for radiological assessment. Slipping degree and lumbar lordosis angle were measured., Results: Women/men patients ratio was 91/9 in spondylolisthesis group and 22/8 in control group. Age of 69% of patients were 50 and over. In both groups, sciatalgia was observed in more than half of the patients, and no significant difference was detected in localization (p > 0.05). In clinical assessment, weak and drooping abdominal wall, paravertebral muscle hypertrophy, increase in lumbar lordosis, sign of slipping observed on palpation and inspection, hamstring muscle spasm, pain during lateral trunk flexion-extension tasks and during double leg raising task were found to be positively correlated with radiological assesment (p < 0.05)., Conclusion: In our study, a systematic clinical assessment was proved to be useful in determination of possible spondylolisthesis cases. Radiological assessments are required in order to make the diagnosis clear and to determine the grade and prognosis of spondylolisthesis. Advanced imaging techniques like MRI and CT have to be used when neurological symptoms are present, and when surgical intervention is indicated.

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, a systemic autoimmune disease characterized by chronic inflammation of the synovial joints, ultimately leading to joint destruction and permanent disability, affecting 1% of the world population. Oxidative stress in rheumatoid inflammation, due to the fact that antioxidant systems are impaired in RA and caused by fee radicals, might have an essential role in etiology of RA. This review includes the interrelation of antioxidants against free radicals in RA patients. There is much evidence that antioxidant team that covers glutathione reductase, catalase, glutathione peroxidase, superoxide dismutase, and glucose-6-phopshate destroy reactive oxygen species and other free radicals through enzymatic as well as nonenzymatic means. The change in relative levels of antioxidants vis-à-vis free radical formation and level could be used as indicators for effective and earlier diagnosis of RA.

This study was performed to determine the effects of short-term dynamic exercise on serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in the patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Patients with RA or AS and healthy controls were recruited. Dynamic treadmill exercise therapy was accomplished for 20 min/session with all of the participants. There were five sessions per week for 2 weeks. Morning stiffness duration, body pain, Stanford health assessment questionnaire, Ritchie articular index, Bath ankylosing spondylitis disease activity index (BASDAI), and Bath ankylosing spondylitis functional index (BASFI) were evaluated in the RA and AS patients. Laboratory assessments included: erythrocyte sedimentation rate, serum C-reactive protein, IGF-1, and IGFBP-3. Clinical and laboratory assessments were recorded at baseline and during exercise treatment on days 7 and 15. Twenty patients with RA, 15 with AS, and 14 healthy controls were included in this study. The pain evaluation, Ritchie, BASDAI, and BASFI scores were significantly improved by the exercise treatment in both patient groups. The important increases were found in circulating IGF-1 in RA (p < 0.001) and AS (p = 0.001) at the end of 2 weeks. In control individuals, serum IGF-1 levels showed a significant decline in the first week (p < 0.05). No significant changes were observed on serum IGFBP-3 levels. Our data suggest that serum IGF-1 levels are increased by the dynamic exercise program in RA and AS patients. The increased IGF-1 may play an important role in the beneficial effects of dynamic exercise therapy in these patients.

We conducted this study to assess serum soluble E-selectin (sE-selectin) levels and erythrocyte membrane Na(+)K(+) ATPase activity in patients with rheumatoid arthritis (RA) and correlate the levels with disease activity. Levels of sE-selectin were measured in the serum of 20 patients with RA and 20 control subjects by an enzyme-linked immunosorbant assay. Na(+)K(+) ATPase activity was determined by a colorimetric method in RA patients and healthy controls. There were no statistically significant differences between the two groups with respect to demographic data such as age and sex (p > 0.05). The serum levels of sE-selectin, ESR and C-reactive protein (CRP) in RA patients were significantly higher than in healthy controls (p < 0.001). Erythrocyte membrane Na(+)K(+) ATPase activity was significantly lower in the RA group than in the control group (p < 0.001). Correlation analysis revealed significant positive correlations between soluble E-selectin and ESR (r = 0.457; p < 0.05) and CRP (r = 0.682; p < 0.01) levels. There were statistically significant negative correlations between erythrocyte membrane Na(+)K(+) ATPase activity and ESR (r = -0.450; p < 0.05) and CRP (r = -0.446; p < 0.05) levels. Additionally, a significant negative correlations between sE-selectin and Na(+)K(+) ATPase activity was observed (r = -0.80; p < 0.001). These results show that decreases in erythrocyte membrane Na(+)K(+) ATPase activity and increases in sE-selectin are observed in RA, and that increased levels of sE-selectin may also reflect disease status or activity., (Copyright 2004 John Wiley & Sons, Ltd.)

Serum levels of acute phase reactants (APR) were measured in patients with rheumatoid arthritis (RA) and the correlations of these parameters with the disease activity score (DAS28) were investigated. The study included 47 patients with RA and 50 healthy controls. Laboratory tests included erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), haptoglobin (Hp), ferritin, and plasma fibrinogen. Disease activity was assessed using the DAS28 score. The means (+/- SD) of ESR, CRP, Hp, ferritin, and fibrinogen levels were respectively 36.0 +/- 23.5 mm/hr, 2.4 +/- 1.9 mg/dl, 121.3 +/- 34.2 mg/dl, 67.7 +/- 36.2 ng/ml, and 371.2 +/- 96.0 mg/dl in the patients with RA, vs 16.4 +/- 11.3 mm/hr, 0.4 +/- 0.3 mg/dl, 104.0 +/- 35.3 mg/dl, 50.9 +/- 23 ng/ml, and 332.2 +/- 58.5 mg/dl in the controls. All of the APR levels were significantly higher in patients vs controls (p < 0.001 for ESR and CRP; p < 0.05 for Hp, ferritin, and fibrinogen). There were significant correlations between serum APR levels and disease activity based on DAS28 score in RA patients (for CRP, r = 0.650, p <0.01; for Hp, r = 0.331, p < 0.05; for ferritin, r = 0.299, p < 0.05; for fibrinogen, r = 0.373, p < 0.01). This study indicates that serum CRP, among the various ARP tests, is the most useful biochemical marker for evaluating the disease activity of patients with RA.