Yasemin Tombak

Rheumatoid arthritis (RA) is a symmetrical joint inflammation, whereas Crohn's disease (CD) is characterized by granulomatous inflammation. Combining seropositive RA with axial spondyloarthritis (SpA) and human leukocyte antigen (HLA)-B27 positive CD is a rare occurrence. We report the case of a 64-year-old male patient with RA and axial SpA experienced diarrhea recently. He had previously experienced joint pain, swelling, and inflammatory type neck, back, and bilateral hip pain. The patient had discontinued treatment and failed to attend follow-up appointments. He had swollen joints, abdominal distension, tenderness, and inflammatory bowel disease. Colonoscopy revealed numerous linear ulcers in the terminal ileum and aphthous ulcers in the ileocecal valve and sigmoid colon. Histopathological examination indicated active ileitis signs consistent with CD. The patient responded well to subcutaneous anti-tumor necrosis factor (TNF) alpha therapy. This case emphasizes that skeletal involvement in CD can develop before bowel complaints, and patients with axial SpA experiencing bowel symptoms should be closely monitored for potential signs of inflammatory bowel disease.

Introduction: Neuromuscular diseases (NMDs) have a substantial burden on patients, their caregivers, and healthcare systems. The level of knowledge of Physical Medicine and Rehabilitation (PMR) specialists about NMD is of great importance for these patient groups. This study aimed to measure the level of knowledge and expectation of PMR specialists about NMD. Methods: We conducted a national, population-based, cross-sectional survey of PMR specialists caring for persons with NMD. An experience-based survey had three themes: clinician facing NMD, clinician’s NMD knowledge, and clinician’s expectations. Results: Of the 198 PMR specialists included in the study. Among the NMD subgroup diseases, Duchenne Muscular dystrophy was the most well-known disease (n=179, 90.4%), followed by Myasthenia Gravis (n=174, 87.9%) and Amyotrophic Lateral Sclerosis (ALS) (n=162, 81.8%). The subgroup with the least awareness was diabetic polyneuropathy (n=61, 30.8%). While most of the participants (n=192, 97%) thought that rehabilitation programs could be effective in NMD, almost half of them (n=83, 41.9%) thought that stretching and strengthening exercises were harmful. Conclusion: Despite the high potential and thousands of patients who might benefit, NMD rehabilitation awareness is inadequate among PMR specialists. Improving PMR specialists' knowledge of NMD may contribute to patient outcomes. We recommend future studies investigating patient outcomes based on increased PMR knowledge following educational interventions.

Background: This study aimed to diagnose calcium pyrophosphate deposition (CPPD) disease with nonspecific hand and finger pain using ultrasonography (US) and, to examine the effect of CPPD crystals on nerve conduction studies. Methodology: This cross-sectional study involved 155 painful hands of 103 patients, aged 26–71 who had hand (finger) and/or wrist pain symptoms for over a year and no prior diagnosis. The study recorded electrophysiological data, radiological evaluations (Kellgren-Lawrence grading), and ultrasonographic examinations for all joints on both hands. Results: Pain in the 1st carpometacarpal joint was the most commonly reported in 123 hands (79.4%). US revealed calcification in the radiocarpal joint in 43 hands (27.7%), and in the triangular fibrocartilage (TFC) in 37 hands (23.9%). Right wrist calcification negatively affected right ulnar nerve sensory nerve conduction velocity (SNCV) ( p = 0.036). TFC calcification negatively affected both ulnar nerve sensory nerve action potentials (SNAP) amplitude (right: p = 0.005; left: p = 0.007) and ulnar nerve SNCV (right: p = 0.001; left: p = 0.001). Conclusion: Ultrasound effectively identifies CPPD. To our knowledge, this study is the first study to evaluate the effects of CPPD crystals on nerve conduction studies. It found CPPD-related TFC calcification negatively affects the ulnar nerve SNAP amplitude and SNCV. This is the first report of a negative significant association between wrist calcification and ulnar nerve SNCV.

Background/aim: Shoulder pain is common and often evaluated with physical examination tests, yet their diagnostic accuracy remains controversial. The aim of this cross-sectional study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) rates of clinical test results in patients with shoulder pain, based on ultrasonography (US) and magnetic resonance imaging (MRI) findings as reference diagnostic methods. Materials and methods: The study included 78 patients who had complaints of shoulder pain. All patients underwent physical examinations and specific clinical tests (such as Neer and Jobe tests) to reveal shoulder pathologies, and US and MRI evaluations were performed. Results: The sensitivity of clinical examination tests for subacromial impingement syndrome, biceps tendinitis and rupture, and infraspinatus tendinitis was higher than US. The specificity of tests for biceps rupture, rotator cuff rupture, infraspinatus and subscapularis tendinitis was higher compared with US. Subacromial impingement tests also showed higher sensitivity compared to MRI. The specificity of tests for acromioclavicular arthritis, biceps rupture, rotator cuff rupture, infraspinatus tendinitis was higher than MRI. Comparison of diagnostic performance with US was significant for subacromial impingement syndrome, acromioclavicular arthritis, biceps tendinitis and rupture, rotator cuff rupture and subscapularis tendinitis (p values; 0.003, 0.003, 0.000, 0.026, 0.000, 0.000, respectively). In contrast, comparison with MRI was significant only for subacromial impingement syndrome (p = 0.026). Conclusion: Clinical tests have an important place in practice when examining shoulder lesions with their high specificity and sensitivity. Although US reveals many shoulder lesions that cannot be detected by clinical tests or support our examination, MRI maintains its importance in shoulder imaging.

Background: The study compared biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs) efficacy and safety in elderly rheumatoid arthritis (RA) patients over a period of 1 year. Results: This retrospective study included 52 RA patients. At baseline elderly patients had longer disease duration, more comorbidities and extraarticular involvement, and previously used conventional synthetic (cs) DMARDs (p < 0.05). A statistically significant change from baseline was observed in the 6th and 12th months regarding Disease Activity Score (DAS-28) and the Health Assessment Questionnaire (HAQ) scores were observed in both groups following treatment with bDMARDs/tsDMARD (p < 0.000). These changes in DAS-28 and HAQ scores were similar in both groups and showed no statistical difference between groups (p = 0.974 and p = 0.578 respectively). Also, no differences were observed between the groups with respect to the percentage of good, moderate or non-responders according to European Alliance of Associations for Rheumatology response criteria. Similarly, no differences were found between groups regarding severe adverse events, drug discontinuation or switch rates. Conclusion: The efficacy and adverse effects of bDMARDs/tsDMARD were similar in elderly and younger RA patients. Both bDMARDs and tsDMARD are efficacious and safe for use in elderly RA patients.

POSITIVE IMPACT OF RILUZOLE USE AND SWALLOWING REHABILITATION FOR DYSPHAGIA IN AMYOTROPHIC LATERAL SCLEROSIS: A CASE-BASED PERSPECTIVE

Bilateral Shoulder Osteoarthritis After COVID-19 in a Patient with Hereditary Spastic Paraplegia: A Case Report - Turkish Journal of Osteoporosis

Aim: Breast cancer patients who get certain chemotherapeutic agents are more likely to experience early menopause and to suffer osteoporotic fractures at a younger age. This study investigated the impact of breast cancer history on bone mineral density (BMD) levels in postmenopausal osteoporosis (OP) treatment. Materials and Methods: This is a retrospective case-control study analyzed 65 female cases diagnosed with OP, including 32 patients with stable breast cancer who had undergone chemotherapy and/or radiotherapy but not within the last 5 years, and 33 matched controls. Demographic characteristics, total lumbar and femoral neck BMD levels and biochemical parameters were recorded for both groups. Results: Before treatment, femoral neck T-score and serum Ca levels were lower in the patient group than in the control group (p=0.038, p=0.007, respectively). There was no difference between groups for the first year (p>0.05), but when the change within a group was examined, only the patient group showed a significant increase in femoral neck T-score and serum Ca levels (p=0.027, p=0.001, respectively). Patients who received radiotherapy had lower femoral neck BMD levels before and after treatment than those who did not receive radiotherapy (p=0.021, p=0.024, respectively), and the post-treatment recovery was not different (p>0.05). Conclusion: This study demonstrated the success of osteoporosis treatment in patients with a previous diagnosis of breast cancer. Patients with breast cancer must be screened for osteoporosis and treated accordingly.

Objective: Knowing which of the special clinical tests used in subacromial impingement syndrome is more successful in making the diagnosis is important for patient evaluation, determining if further examination is necessary, and arranging treatment. Utilizing sonographic impingement as a reference diagnostic technique, the study sought to evaluate how well clinical test results performed in diagnosing patients with subacromial impingement syndrome. Material and method: The study involved 42 patients with shoulder pain and at least one positive subacromial impingement test, including Neer, Hawkins, or Yocum tests. Dynamic sonographic compression of the tendon in the coracoacromial area was examined by abducting the shoulder. Dynamic sonographic compression findings were compared with clinical examination tests. Results: In 40.5% of the patients, the ultrasonographic impingement test was positive. Hawkins test was positive in 81% of patients, Neer test was positive in 69% of patients, and Yocum test was positive in 78.6% of patients. A significant relationship was found between the ultrasonographically evaluated subacromial impingement test and the Neer test, but no significant relationship was found with other special tests (Hawkins and Yocum test) (p = 0.02, p = 0.4, p = 0.12, respectively). Conclusion: We have demonstrated a significant relationship between the ultrasonographic finding of dynamic subacromial impingement and the Neer test, which is a non-invasive and device-independent physical examination test.

Summary Objective Rotator cuff calcific tendinitis (RCCT) is a benign but incapacitating condition and in some patients it is the cause of chronic debilitating pain and functional disability. We aimed to reveal the short-term effects of low-level laser therapy (LLLT) on clinical and sonographic parameters in patients with symptomatic RCCT. Method This prospective randomized controlled study analyzed 76 painful shoulders of 68 patients aged 18–75 years, with over 3 months of shoulder pain and where RCCT was confirmed sonographically. Patients in the LLLT group (received 5 LLLT sessions per week and home exercises for 5 days/week for 3 weeks) and the control group (received home exercises, 5 days/week for 3 weeks) were assessed clinically and sonographically just before and after treatment, recording pain intensity, range of motion (ROM), shoulder functional status, location (supraspinatus/infraspinatus, subscapularis), number and degree of calcification. Degree of calcification was determined with ultrasound and classified by the Bianchi-Martinoli classification. The LLLT was applied to the calcified areas marked under ultrasound guidance. Results Both groups showed statistically significant improvements in ROM, pain intensity, shoulder pain and disability index (SPADI) pain/disability/total, and degree of calcification after treatment. No significant change was achieved for calcification in the control group. Considering the change values, improvements in abduction, extension, pain intensity, SPADI pain/disability/total, calcification number, and calcification degree parameters were found to be statistically significantly better in the LLLT group than in the control group. Conclusion Adding LLLT to the home program in treatment of symptomatic RCCT outperformed the home program alone, reducing the number and severity of calcifications, improving pain and disability.