Pachydermodactyly (PDD) is a benign, acquired digitalfibromatosis characterized by asymptomatic and progressiveswelling of periarticular soft tissue, and is usually seen inyoung men. The etiology of PDD is not fully understood, butis thought to be due to the result of recurrent mechanicalstimulation. PDD is usually diagnosed by clinical evaluation.There are thick collagen bundles and collection of dermalmucin in the histopathology. Treatment is not indicated dueto benign prognosis. Rheumatologic diseases, particularlyrheumatoid arthritis, affecting the joints of the hands shouldbe considered in the differential diagnosis due to the similarityof the joint involvement.
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Çiğdem ÇİLİNGİROĞLU, Meral BİLGİLİSOY FİLİZ,
İLHAN SEZER
Çiğdem ÇİLİNGİROĞLU, Meral BİLGİLİSOY FİLİZ,
İLHAN SEZER
Melorheostosis is a rare nongenetic developmental anomaly first described in 1922 byLeri and Joanny. Its etiology is unknown. Patients present at any age, and both sexes are affectedequally. Onset is usually insidious, with pain, stiffness and limitation of motion at the affected areas.The characteristic radiographic appearance consists of irregular hyperostotic changes of the cortex,generally on one side of the bone, resembling melted wax dripping down one side of a candle. Thereis usually a demarcation line between the affected and normal bone. Dense, sclerotic linear areasare seen mainly in the cortex but also extending into the cancellous bone. Melorheostosis affectsmainly the long bones of the upper and lower limbs, but also the short bones of the hand and footand, rarely, the axial skeleton may be affected. Bone scintigraphy is positive and shows moderatelyincreased uptake of tracer in all three phases. Computed tomography and magnetic resonance imagingcan further characterize the lesion, but rarely contribute to the diagnosis. Treatment of thischronic condition consists of conservative therapies or surgical soft-tissue procedures and even, invery severe cases, amputation. In this case report, a 53 years old male patient with pain and morningstifness in his left hand for 6 months who has been diagnosed as melorheostosis by radiographicappearence is presented.
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ŞEBNEM ATAMAN , İsmihan SUNAR, Gürkan YILMAZ,
HATİCE BODUR ,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK , Yeşim Garip ÇİMEN, M. Tuncay DURUÖZ,
ATİLLA HALİL ELHAN ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU ,
MELTEM ALKAN MELİKOĞLU , Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , Fatma GÜL YURDAKUL
Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected.Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.
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HATİCE BODUR , Fatma GÜL YURDAKUL,
ŞEBNEM ATAMAN , Yeşim GARİP,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK ,
MEHMET TUNCAY DURUÖZ ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU , Ece KAPTANOĞLU,
MELTEM ALKAN MELİKOĞLU , Erhan ÖZDEMİREL, Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , İsmihan SUNAR,
TUFAN GÜRKAN YILMAZ
Objectives: This study aims to update 2011 Turkish League Against Rheumatism SpondyloArthritis Recommendations, and to compose a national expert opinion on management of axial spondyloarthritis under guidance of current guidelines, and implantation and dissemination of these international guidelines into our clinical practice. Materials and methods: A scientific committee of 28 experts consisting of 14 rheumatologists and 14 physical medicine and rehabilitation specialists (one of them also has an immunology PhD) was formed. The recommendations, systematic reviews, and meta-analyses including pharmacologic and non-pharmacologic treatment were scrutinized paying special attention with convenient key words. The draft of Turkish League Against Rheumatism opinion whose roof consisted of international treatment recommendations, particularly the Assessment of SpondyloArthritis International Society/European League Against Rheumatism recommendations was composed. Assessment of level of agreement with opinions by task force members was established through the Delphi technique. Voting using a numerical rating scale assessed the strength of each recommendation. Results: Panel compromised on five basic principles and 13 recommendations including pharmacological and nonpharmacological methods. All of the recommendations had adequate strength. Conclusion: Turkish League Against Rheumatism expert opinion for the management of axial spondyloArthritis was developed based on scientific evidence. These recommendations will be updated regularly in accordance with current developments.
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KEMAL NAS , Erkan KILIÇ,
REMZİ ÇEVİK ,
HATİCE BODUR ,
ŞEBNEM ATAMAN , Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
ERHAN ÇAPKIN , Abdullah Zübeyir DAĞLI,
MEHMET TUNCAY DURUÖZ ,
GÜLCAN GÜRER ,
FERİDE NUR GÖĞÜŞ , Yeşim GARİP,
CAHİT KAÇAR ,
AYHAN KAMANLI , Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ, Erhan Ali ÖZDEMİREL, Sumru ÖZEL,
İLHAN SEZER , İsmihan SUNAR, Gürkan YILMAZ
Objectives: This study aims to establish the first national treatment recommendations by the Turkish League Against Rheumatism (TLAR) for psoriatic arthritis (PsA) based on the current evidence. Materials and methods: A systematic literature review was performed regarding the management of PsA. The TLAR expert committee consisted of 13 rheumatologists and 12 physical medicine and rehabilitation specialists experienced in the treatment and care of patients with PsA from 22 centers. The TLAR recommendations were built on those of European League Against Rheumatism (EULAR) 2015. Levels of evidence and agreement were determined. Results: Recommendations included five overarching principles and 13 recommendations covering therapies for PsA, particularly focusing on musculoskeletal involvement. Level of agreement was greater than eight for each item. Conclusion: This is the first paper that summarizes the recommendations of TLAR as regards the treatment of PsA. We believe that this paper provides Turkish physicians dealing with PsA patients a practical guide in their routine clinical practice.
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This study aims to demonstrate chest expansion and lumbar mobility using modified Schober measurement values in healthy male and female populations aged 15 and over, and to identify factors affecting these measurements.Patients and methods: The prospective study included 444 volunteers (195 males, 249 females; mean age 47.13 years; range 15 to 88 years) from among patients presenting to the Akdeniz University Faculty of Medicine Hospital Physical Medicine and Rehabilitation Clinic. Participants were divided into seven 10-year age groups: group 1: 15-24 years, group 2: 25-34, group 3: 35-44, group 4: 45-54, group 5: 55-64, group 6: 65-74, and group 7: over 75. Exclusion criteria comprised factors potentially influencing spinal mobility and chest expansion. All volunteers' chest measurements were performed in three planes (circumferential with a tape measure, and anteroposteriorly and transversely with calipers) and lumbar mobility was measured using the modified Schober method. The same physician performed the measurements.Results: Chest expansion measurements using tape and calipers varied considerably in all age groups and in both sexes. While there was no difference between males and females in circumferential chest expansion measurement, there was a significant difference decrease in both sexes from group 3 and onward. The only difference between the sexes in terms of modified Schober measurement was in group 4, in favor of male sex. Age-related change in both sexes was higher at age 55 and above compared to the young age groups.Conclusion: We may conclude that chest expansion measurement in the circumferential plane is sufficient when appropriate conditions are established and provides the most accurate result by permitting measurement in all planes
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Objective: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by fibrosis. The prognosis of the disease is bad when clinically symptomatic cardiac dysfunction is occurred, therefore early detection of cardiac dysfunction is important in patients with SSc. The aim of this study was to investigate the frequency of fQRS in superficial electrocardiography in cardiacally asymptomatic patients with SSc and its relation to the systolic pulmonary artery pressure (sPAP). Methods: This study included 31 cardiacally asymptomatic patients with SSc (23 females, 40.4±9.2 years) and 41 healthy volunteers as the control (31 females, 38.2±11.8 years). The ECGs with 12 derivations and transthoracic echocardiographies of the patients were evaluated. The presence of fQRS in the superficial ECG, and its relation to systolic pulmonary artery pressure (sPAP) were investigated. Results: The mean sPAP value in the SSc group was observed to be higher than that of the control group (26 mm Hg and 20 mm Hg, respec- tively, p<0.001). The presence of fQRS in the SSc group was more frequent than the control group (55% and 10%, respectively, p<0.001). In SSc patients presence of fQRS become relevant with ≥24 mm Hg sPAP by 88% sensitivity and 79% specificity. Conclusion: In our study, the presence of fQRS in SSc patients, were more frequent than in the normal population. Since pulmonary hyperten- sion is the primary cause of mortality in patients with SSc, the correlation of fQRS with sPAP should also be considered.
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Hasan Fatih ÇAY,
İLHAN SEZER , Muhammet Kazım EROL, Deniz ÇOBAN TURGUT, Mehmet BULUT, Tuncay ÇAKIR, Naciye Füsun TOROMAN
Objectives: This study aims to evaluate the alterations of retinal layers in rheumatic patients treated with hydroxychloroquine but without the signs or symptoms of retinopathy by using spectral domain ocular coherence tomography (SD-OCT). Patients and methods: The retinal layers of a total of 402 eyes including 114 patients treated with hydroxychloroquine (for rheumatoid arthritis (n=40), Sjögren s syndrome (n=47) and connective tissue diseases (n=27) and age-matched 87 healthy controls were evaluated with SD-OCT. The macular cube protocol, optic disc cube protocol and horizontal and vertical HD 5-line raster scan protocol were applied. The measured parameters were compared between hydroxychloroquine users and healthy control group. The results of these parameters were also compared with other disease groups using hydroxychloroquine. The correlation of these parameters with the duration of drug consumption and dose was assessed. Results: All layers of outer fovea, superior and inferior quadrants of retinal nerve fiber layers of hydroxychloroquine users were thinner than non- users. Connective tissue disease group had longer duration and higher cumulative dose of hydroxychloroquine than other diagnostic groups. This group had thinner mean retinal nerve fiber layers values than the other groups as well. There were significant and negative correlations between cumulative dose of drug and parafoveal region thickness of outer fovea and inferior quadrant of retinal nerve fiber layers. Thickness of parafoveal and perifoveal layers was negatively correlated with the dose of drug per kg of body weight. Conclusion: Our study results show that SD-OCT may be the golden standard technique for the follow-up of antimalarial-induced retinotoxicity in future.
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Bu araştırmada ülkemizdeki romatizmal hastaların alkol kullanım alışkanlıkları değerlendirildi.Hastalar ve yöntemler: Romatoid artrit (RA), ankilozan spondilit (AS) hastalarından ve sağlıklı kontrollerden oluşan toplam 332 denek [185 erkek, 147 kadın; yaş ortalamaları sırası ile 41.2 (%95 GA 39.5-43.0) ve 45.2 (%95 GA 43.4-47.1) yıl], alkol kullanım alışkanlığı olup olmadığına yönelik olarak sorgulandı. Alkol kullanım alışkanlığı olanlardan Michigan Alkolizm Tarama Testi'nin (MATT) Türkçe versiyonunu yanıtlamaları istendi.Bulgular: Deneklerin toplam %37.3'ü alkol kullanıyordu. Erkeklerin yaklaşık %50'si, kadınların ise %20'si alkol tüketim alışkanlığına sahipti. En düşük alkol kullanım oranı RA grubunda (%23.0), en yüksek oran ise sağlıklı kontrol grubunda (%45.6) idi. Ortalama MATT skoru, RA ve AS grupları için sırasıyla 3.02 (%95 GA: 2.36-3.69) ve 3.13 (%95 GA: 1.76-4.5) olarak bulundu ve her iki değer de kontrol grubuna ait değerden istatistiksel olarak anlamlı oranda küçüktü [4.94 (95% GA: 4.14-5.73) p<0.001]. Michigan Alkolizm Tarama Test skorunun kategorize edilmesi ile yapılan analiz sonucunda alkol bağımlılığı olan deneklerin büyük oranda sağlıklı kontrol grubunda olduğu görüldü.Sonuç: Bizim sonuçlarımıza göre, önemli bir halk sağlığı sorunu olan alkol tüketiminin romatizmal hastalar arasında önemli bir sorun yaratacak boyutta olmadığı ortaya çıkmıştır. Romatizmal hastaların alkol tüketim alışkanlıkları üzerinde rol oynayan potansiyel faktörlerin daha geniş kapsamlı çalışmalarla araştırılması gerekmektedir
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Amaç: Bu çalışmanın amacı diz osteoatririti ile osteoporoz arasındaki birlikteliği araştırmaktır. Gereç ve Yöntem: Çalışmaya diz osteoartriti olan 74 kadın hasta dahil edilmiştir (ortalama yaş: 61.9 ±9.1, ortalama vücut kitle indeksi 27.09±4.24). Diz osteoartritini değerlendirmek için yük verilmiş pozisyonda çekilen diz ön arka grafileri Kellgren-Lawrance kriterlerine göre derecelendirildi. Kemik mineral yoğunluğu (BMD) femur ve lomber omurgadan Dual energy X ray absorbsiyometri yöntemiyle ölçüldü. Radyolojik olarak diz osteoartriti olan ve olmayan hastaların kemik mineral yoğunlukları karşılaştırıldı. Bulgular: BMD ile diz osteoartriti arasında korelasyon tespit edilemezken, yaş ve femur BMD değerleri arasında anlamlı negatif korelasyon mevcuttu. Vücut kitle indeksi ile diz osteoartriti arasında pozitif korelasyon, BMD ile negatif korelasyon mevcuttu. Sonuç: Çalışma sonunda; daha önce yapılan çalışmalardan farklı olarak diz osteoartriti ile osteoporoz arasında anlamlı bir korelasyon tespit edilememiştir.
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