OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The diagnosis is based
on the history, clinical signs and symptoms of the patient,
but electrodiagnostic studies are done to confirm the di- agnosis and to manage the treatment. This study aimed
to assess sensitivities of clinical symptoms, provocative
tests and electrodiagnostic studies (EDS) in patients with
idiopathic mild CTS.
MATERIAL AND METHODS:The study included 90 han- ds of 75 patients with idiopathic mild CTS and 30 hands
of 15 healthy volunteers. The patients were questioned
for symptoms in the innervation area of the median ner- ve such as pain, paresthesia, weakness in the hand and
numbness and pain worsening at night, relief from the
symptoms by shaking hands. Tinel and Phalen tests were
done. The EDS included; motor, mixed and sensorial (di- gits 1-2-3-4 and palm) nerve conduction studies (NCS)
for median nerve; motor, mixed and sensorial (fifth digit)
NCS for ulnar nerve, sensorial NCS (first digit) for radial
nerve, median and ulnar F waves. The values for distal la- tency and nerve conduction velocity (NCV) were calcula- ted for all studied nerves. Sensitivities of median sensory
distal latency and NCV to digits 1,2,3,4 and palm-wrist
segments and sensitivities of the following comparative
tests were detected; median-radial sensory distal latency
difference (SDLD) to the first digit, median-ulnar SDLD to
the fourth digit, median-ulnar SDLD to the digits 2-5, 3-5,
4-5 and median-ulnar F latency difference.
RESULTS: The most common symptoms in patients with idiopathic mild CTS were paresthesia (95.6%) and noc- turnal numbness (88.8%). The sensitivity of Phalen’s and
Tinel’s tests were 67.8% and 56.7%, respectively. Among
the EDS, first digit and palm-wrist sensorial NCV were the
most sensitive tests (98.9%). Of the comparative tests,
median-ulnar SDLD to digits 4-5 was the most sensitive
one (93.3%). Median-ulnar F latency difference had the
lowest sensitivity (38.9%).
CONCLUSIONS: The most sensitive EDS were first digit and palm-wrist sensorial NCV. Median-ulnar SDLD to di- gits 4-5 was more sensitive than the other tests. With use
of these tests, the diagnostic sensitivity of EDS may be
increased in patients with mild CTS.
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Objective: The aim of this study was to identify the frequency of intensive care unitacquired paresis (ICU-AP) and predisposing factors for muscle weakness in our ICU patients.
Materials and Methods: A prospective observational study was conducted in a 25-bed ICU of
a tertiary hospital. Patients who were cooperated with muscle strength examination, stayed in
ICU more than three days and had no preexisting neuromuscular disorder were included in the
study. The diagnosis of hospitalization, need for mechanical ventilation, comorbidities, length of ICU
stay, mobilization level, discharge status, and Sequential Organ Failure Assessment (SOFA) were
recorded. Manual muscle strength test was assessed according to Medical Research Council scale.
Handgrip and finger pinch strength values were recorded.
Results: Forty-two patients completed muscle strength examination. ICU-AP was determined in
16 (38.09%) patients. Length of ICU stay, mechanical ventilation rate, SOFA score and frequency of
decubitus ulcers were higher in patients with ICU-AP (p<0.05). There was a significant relationship
only between mechanical ventilation and ICU-AP
Conclusion: ICU-AP is a common problem in critically ill patients and influences outcomes of
patients. Patients without mechanical ventilation may develop ICU-AP and mechanical ventilation
can be determined as one of the risk factors for muscle weakness.
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Aim: In this study, our aims were to identify vitamin D levels in rheumatoid arthritis (RA) individuals as compared to controls and the impact of vitamin D levels on both objective and subjective assessments in RA patients. Methods: The current study was a prospective case-control study conducted on 108 RA patients and 50 age-gender matched healthy controls. We first compared the levels of vitamin D among the RA patients and controls. Demographic and clinical data, parameters of disease activity, inflammatory markers, rheumatoid factor and anti-cyclic citrullinated peptide seropositivity and radiological damage scores were recorded in RA patients. These patients were also demanded to complete RA Quality of Life Questionnaire (RAQoL), fatigue severity scale (FSS) and Health Assessment Questionnaire (HAQ). Results: D vitamin levels in RA patients were significantly lower than healthy controls (p=0.001). Vitamin D deficiency was determined in 73% of the RA patients and 52% of the controls. Vitamin D deficiency was not associated with disease activity (p=0.862). There was no significant relationship among vitamin D levels and all subjective and objective assessments (p>0.05 for all ). Conclusion: Vitamin D deficiency was common in RA participants than normal population. However, it was not shown that there was a significant relationship between vitamin D levels and objective and subjective assessments of disease, including disease activity, inflammatory markers, rheumatoid factor and anti-cyclic citrullinated peptide seropositivity, radiological damage scores, RAQoL, FSS and HAQ.
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Objectives: This study aims to translate the Evaluation of Ankylosing Spondylitis Quality of Life (EASi-QoL) into the Turkish language and test its
validity and reliability.
Patients and methods: A total of 100 AS patients (74 males; 26 females; mean age 38.2±9.9 years; range 21 to 63 years) were included. The mean
disease duration was 115.9±91.6 months. EASi-QoL was translated from English into Turkish, and synthesis, back translation, revision, and pretest
stages were performed. All patients were asked to complete the Turkish version of EASi-QoL. The internal consistency of EASi-QoL was determined
with Cronbach’s alpha coefficient, and test-retest reliability was assessed by calculating the intra-class correlation coefficient. Confirmatory
and explanatory factor analyses were performed to assess structural validity. Construct validity was also investigated by comparing the results
of EASi-QoL with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath
Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Disease Activity Score, Maastricht Ankylosing Spondylitis Enthesitis Score
(MASES), and AS-specific QoL scale.
Results: Cronbach’s alpha coefficient was 0.910 in the physical function category, 0.893 in the disease activity category, 0.935 in the emotional wellbeing
category, and 0.930 in the social contribution category (α>0.7). Factor loadings of all items in EASi-QoL were higher than 0.7, indicating the
high reliability of the questionnaire. There was also a strong positive correlation between all subcategories of EASi-QoL (physical function, disease
activity, emotional well-being and social participation) and AS-specific QoL scale, BASDAI, Bath BASFI, patient’s global assessment and pain severity.
MASES and BASMI showed a moderate correlation with emotional well-being and social participation categories of EASi-QoL.
Conclusion: Turkish version of EASi-QoL is a reliable and valid scale that can be used in clinical practice to evaluate QoL in detail in patients with AS.
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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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Objectives: This study aims to investigate the relationship between smoking and structural damage, autoimmune antibodies, and disability in rheumatoid arthritis (RA) patients. Patients and methods: This cross-sectional study included 165 RA patients (36 males, 129 females; mean age 52.4±12.8 years; range 21 to 82 years). Disease duration, age at disease onset, smoking habits, rheumatoid factor (RF), and anti-cyclic citrullinated peptide levels were recorded. Morning stiffness, pain with visual analog scale, Health Assessment Questionnaire Scores And Disease Activity Score 28 were calculated. Patients’ standard hand radiographs were evaluated. Results: Patients were divided into three groups according to their smoking habits. Ninety-nine patients (60%) were never smokers, 45 patients (27.3%) were long-term smokers and 21 patients (12.7%) were new smokers. Three groups were compared for disease activity. Disease activity score 28 scores were 3.2±1.2, 3.2±1.3, and 3.2±1.4, respectively (p>0.05). The erosion score (2.6±5.8, 7.1±10.9, and 11.1±19.2, respectively) and joint space narrowing score (9.9±7.3, 18.6±14.9, and 17.3±12.3, respectively) according to modified Sharp method were significantly lower in never smokers group than other groups (p<0.05). RF titrations were 55.2±58.9, 60.5±63.1, and 84.9±71.5, respectively, and levels of long-term smokers group were significantly higher than the other groups (p<0.05). Joint space narrowing score was 16.2±11.9 and 6.4±10.4 in RF (+) and RF (-) patients, respectively (p<0.05). There was no significant relationship between anti-cyclic citrullinated peptide levels and others parameters. Conclusion: Although smoking is known as a poor prognostic factor in RA, there was no correlation between disease activity and smoking in our study. However, less radiographic damage was found in never smokers. Smoking does not appear to correlate with RA disease activity but it may be effective in the long-term joint damage.
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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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Fatma GÜL YURDAKUL, Yeşim Garip ÇİMEN, Ayşegül KILIÇARSLAN, Aslı ÇALIŞKAN UÇKUN,
HATİCE BODUR
Fatma GÜL YURDAKUL, Yeşim Garip ÇİMEN, Ayşegül KILIÇARSLAN, Aslı ÇALIŞKAN UÇKUN,
HATİCE BODUR
Objectives: The aim of our study is to evaluate the depression rate in patients with rheumatoid arthritis
(RA) and its association with pain, disease activity, functional status, and various health related quality
of life (HRQoL) domains in terms of functional status, vitality, social and emotional functioning.
Materials and Methods: A total of 90 RA patients and 50 sex and age matched controls were included
in the study. Demographic characteristics, erythrocyte sedimentation rates, C‐reactive protein, tender
and swollen joint count, patient and physician global assessment of disease activity were recorded.
Disease Activity Score‐28 (DAS28) was used for measuring disease activity. The severity of pain was
determined by using 10 cm Visual Analog Scale‐Pain (VAS‐pain). HRQoL was evaluated by using Short
Form 36 (SF 36).
HAQ (Health Assessment Questionnaire) was used for evaluation of the functional status. Depression
was evaluated by using Beck Depression Scale (BDS).
Results: Mean age was 54.51±12.54 in RA (75 women, 15 men) group and 51.94±9.69 in the control group
(41 women, 9 men). Mean VAS‐pain was 55.85±26.24; HAQ was 1.27±0.81 and DAS28 was 5.04 ±2.44 in
RA patients. The mean BDS was 19.67±13.11 in RA group and 6.64±6.73 in the control group. RA patients
scored significantly higher in BDS when compared with the controls (p<0.001). BDS was linearly related
with DAS28 and VAS‐pain at a high level and negatively correlated with physical function, physical role,
bodily pain, general health, vitality, mental health, social functioning and emotional role subgroups of
SF36 (p<0.001). There was no statistically significant relation between BDS and HAQ (p=0.431)
Conclusion: Depression is common in the patients with RA and associated with disease activity and
pain. It negatively affects HRQoL in terms of vitality, and physical, social and emotional functioning.
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Objective: The aim of this study was to investigate the influence of demographic features
such as age, gender, body mass index (BMI), educational and employment status, place of residence
and comorbidities of patients with primary hip osteoarthritis and radiographic severity on
the functional improvements of the patients after total hip arthroplasty. Material and Methods:
Fifty patients (41 females/9 males) with primary hip osteoarthritis were included. The radiographs
were graded according to Kellgren-Lawrence system (KL). The operations were performed by the
same orthopedist with the same surgical technique. Functional level was determined with hip disability
and Osteoarthritis Outcome Score-Physical function Short-form (HOOS-PS) before and six
months after the operation. Results: The functional levels of all the patients improved at the sixth
month. Age, BMI, presence of a comorbidity, working in a job or not, place of residence (rural or
city) and obesity did not influence the functional improvement rates. The males, the patients with
KL grade 4 osteoarthritis and the primary school graduates showed significantly much more improvements.
Conclusion: The clinical relevance of this study is that age, gender, BMI, co-morbidities,
education degree, place of residence and being an employee or not does not need to be
considered by physicians when recommending total hip replacement surgery after failure of conservative
treatment in patients with primary hip osteoarthritis. Male patients, patients with radiographically
end stage osteoarthritis and educated patients may improve much more in comparison
with their counterparts.
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