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Öğe Arthropathy, quality of life, depression, and anxiety in Behcet's disease: relationship between arthritis and these factors(Springer London Ltd, 2006) Gur, Ali; Sarac, Aysegul Jale; Burkan, Yahya Kemal; Nas, Kemal; Cevik, RemziWe aimed to determine arthritis frequency, quality of life (QoL), anxiety, and depression levels in Behcet's disease (BD) and thereby the effect of joint involvement on QoL, anxiety, and depression. Sixty-three patients diagnosed with BD according to the International Study Group Diagnostic Criteria and 45 healthy subjects as control were included in the study. All patients were evaluated in terms of clinical findings, the number and site of the joints involved, sacroiliac joint involvement, pain intensity, QoL, anxiety, and depression scale. The instruments used were Beck Depression Inventory (BDI) for depression, State-Trait Anxiety Inventory (STAI-T) for anxiety, and Health Assessment Questionnaire (HAQ) and Nottingham Health Profile (NHP) for health status and QoL. Joint involvement was seen in 41.3% of the patients. The most characteristic form was asymmetric oligoarthritis, which was seen in 65.3% of the patients. The joints most commonly involved were found to be in the wrist (53.8%) and knee (50%). Sacroiliitis was found at a rate of 38.1%. In BD patients without arthritis, rates of men (p=0.004) and genital ulcer (p=0.001) were higher, and rates of erythema nodosum (p=0.001) and human leukocyte antigen B5 positivity (p=0.023) were less than those of BD patients with arthritis. Pain intensity (p=0.000), NHP (p=0.004), and HAQ (p=0.003) scores were significantly higher in BD patients with arthritis than those without arthritis. Pain intensity, NHP, BDI, and STAI-T scores were significantly higher in BD patients without arthritis than in healthy controls, while pain intensity, NHP, HAQ, BDI, and STAI-T scores were significantly higher in BD patients with arthritis than in healthy controls (p=0.000). In conclusion, our study establishes that arthropathy is one of the common manifestations of BD. Arthritis in BD affects considerably patients' pain levels and QoL. A multistep approach is required for these patients. We are of the opinion that this approach may also improve the QoL of these patients and prevent the activation of the disease.Öğe Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: New concepts in treatment(Bentham Science Publ Ltd, 2008) Gur, Ali; Oktayoglu, PelinFibromyalgia (FM) and chronic fatigue syndrome (CFS) are poorly understood disorders that share similar demographic and clinical characteristics. The etiology and pathophysiology of these diseases remain unclear. Because of the similarities between both disorders it was suggested that they share a common pathophysiological mechanisms, namely, central nervous system (CNS) dysfunction. Current hypotheses center on atypical sensory processing in the CNS and dysfunction of skeletal muscle nociception and the hypothalamic-pituitary-adrenal (HPA) axis. Researches suggest that the (CNS) is primarily involved in both disorders in regard to the pain, fatigue and sleep disturbances. Many patients experience difficulty with concentration and memory and many others have mood disturbance, including depression and anxiety. Although fibromyalgia is common and associated with substantial morbidity and disability, there are no US Food and Drug Administration (FDA)-approved treatments except pregabalin. Recent pharmacological treatment studies about fibromyalgia have focused on selective serotonin and norepinephrine (NE) reuptake inhibitors, which enhance serotonin and NE neurotransmission in the descending pain pathways and lack many of the adverse side effects associated with tricyclic medications. CFS is a descriptive term used to define a recognisable pattern of symptoms that cannot be attributed to any alternative condition. The symptoms are currently believed to be the result of disturbed brain function. To date, no pharmacological agent has been reliably shown to be effective treatment for CFS. Management strategies are therefore primarily directed at relief of symptoms and minimising impediments to recovery. This chapter presents data demonstrating CFS, abnormal pain processing and autonomic nervous system (ANS) dysfunction in FM and CFS and concludes by reviewing the new concepts in treatments in CFS and FM.Öğe Comparison of the Efficacy of Phonophoresis and Conventional Ultrasound Therapy in Patients with Primary Knee Osteoarthritis(Erciyes Univ Sch Medicine, 2014) Oktayoglu, Pelin; Gur, Ali; Yardimeden, Ibrahim; Caglayan, Mehmet; Cevik, Figen; Bozkurt, Mehtap; Em, SerdaObjective: To compare the efficacy of phonophoresis (PH) versus ultrasound (US) in patients with primary knee osteoarthritis (OA). Materials and Methods: Forty patients were divided into two groups as PH and US. Acoustic gel containing no pharmacological agent was applied in the US group, whereas a gel containing 1.16% diclofenac diethylamonium was applied in the PH group for 10 sessions. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and Visual Analogue Scale (VAS) were used for the assessment of pain. The WOMAC physical function subscale, Lequesne functional index and Stanford Health Assessment Questionnaire (HAQ) were used for the assessment of physical activities. Patients were assessed for a 3 month follow-up period. Results: In the PH group, painless walking duration improved at all follow-up times except for week 2 (p< 0.05). Painless walking distance and VAS scores also improved at all follow-up times (p< 0.05). In the US group, VAS scores during walking and flexion of the knee, WOMAC pain and physical function scores and total WOMAC scores improved significantly at all follow-up times (p< 0.05). Conclusion: Both therapeutic modalities were found effective. We suggest neither therapy is superior to the other but PH can improve painless walking duration more successfully than US.Öğe Effect of new traction technique of prone position on distraction of lumbar vertebrae and its relation with different application of heating therapy in low back pain(Ios Press, 2007) Cevik, Remzi; Bilici, Aslan; Gur, Ali; Sarac, Ayseguel Jale; Yildiz, Hidir; Nas, Kemal; Ceviz, AdnanObjective: In medicine, traction is used for act of pulling force for producing distraction or separation between two or more parts of body. However, it is limited to the cervical or lumbar spine in physiotherapic application. We aimed to investigate effect of new traction technique on anatomic structures of lumbar vertebrae, and its' relation to different application of heating therapy. Method: Ninety five consecutive patients with persistent low back pain participated in this study. Traction applied on new table in prone position. Heating therapy applied concomitantly with traction (group I, n: 32) and sham traction (group III, n: 31), and before traction (group II, n: 32). Lateral lumbosacral radiographs were obtained before and during traction. Results: Significant distraction in each disc space; decreasing in both lumbosacral angles and increasing in L1-S1 total distance were found with lying on new table without traction in three groups. Significant widening of all disc spaces and L1-S1 total distances were also obtained during traction in group I, while there were significant widening in L1-L2 anterior, L3-L4 anterior and posterior, L5-S1 posterior disc spaces, and L1-S1 anterior and posterior total distances during traction in group II and in posterior disc space of L5-S1 during sham traction in group III as compared to lying on table without traction. Conclusion: This is a preliminary study to investigate efficacy of new traction technique in prone position. Significant increasing in lumbar intervertebral disc spaces and changes in other anatomic structures were obtained on new table. Efficacy of traction application seemed to be increased by synchronized heating therapy. Creation of negative intradiscal pressure is important to suck back herniated disc material with distraction of lumbar vertebrae in prone position. Future clinical studies should be carried out to investigate efficacy of this traction technique in treatment of low back pain.Öğe New therapeutic options in central nervous system involvement of rheumatologic disease(Bentham Science Publ Ltd, 2008) Gur, Ali[Abstract Not Available]Öğe Paraoxonase and arylesterase activities in fibromyalgia(Taylor & Francis Ltd, 2007) Altindag, Ozlem; Gur, Ali; Calgan, Nazife; Soran, Neslihan; Celik, Hakim; Selek, SahabettinPublished by Maney Publishing ( c) W. S. Maney & Son Limited We aimed to evaluate the association of serum paraoxonase and arylesterase activities and oxidative/ antioxidative status in patients with fibromyalgia. Forty-two patients with fibromyalgia and 53 healthy controls were included in the study. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. Oxidative and antioxidative status were evaluated by measuring serum lipid hydroperoxide ( LOOH) levels, total antioxidant status ( TAS) and free sulfhydryl groups ( - SH = total thiol). Lipid parameters were determined by routine laboratory methods. Serum paraoxonase and arylesterase activities, and TAS were lower in patients with fibromyalgia than in controls ( P < 0.001, for all), and the - SH level was also lower in the patient group ( P = 0.03). LOOH levels were higher in the patient group than in controls ( P = 0.01). Our results suggest that patients with fibromyalgia were exposed to oxidative stress, and paraoxonase and arylesterase activities were decreased in these patients. Patients with fibromyalgia might be prone to development of atherosclerosis with reduced paraoxonase and arylesterase activities.Öğe Psychological status is associated with health related quality of life in patients with rheumatoid arthritis(Ios Press, 2011) Nas, Kemal; Sarac, Aysegul Jale; Gur, Ali; Cevik, Remzi; Altay, Zuhal; Erdal, Akin; Ersoy, YukselObjective: 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.Öğe Relationship Between Clinical Findings, Quality of Life and Functional Disability Related to Disease Activity in Patients with Ankylosing Spondylitis(Turkish League Against Rheumatism, 2011) Nas, Kemal; Cevik, Remzi; Bozkurt, Mehtap; Gur, Ali; Sarac, Aysegul JaleObjectives: In this study we evaluated the relationships between clinical findings, quality of life and functional disability related to disease activity in patients with ankylosing spondylitis (AS). Patients and methods: Seventy-three patients diagnosed with AS (62 males, 11 females; mean age 33.3 +/- 9.5 years; range 17 to 60 years) who fulfilled the modified New York criteria were included in this study. The mean age for female patients was 29.2 +/- 7.3 years and for males 34.0 +/- 9.7 years. The demographic data of the patients were recorded. The disease activity was assessed using the Bath ankylosing spondylitis disease activity index (BASDAI). The functional disability was evaluated using the Bath ankylosing spondylitis functional index (BASFI). The clinical status was evaluated with the Bath ankylosing spondylitis metrology index (BASMI) and the quality of life was assessed with the Short Form 36 (SF-36). Results: The patients were divided into two groups: patients having a BASDAI score of less than four (BASDAI < 4) with mildly active disease (n=34) and patients having a BASDAI score of four or higher (BASDAI >= 4) with moderate-severe disease activity (n=39). The BASFI and BASMI scores were higher in patients with high disease activity (p < 0.05), and a significant correlation was found between the BASDAI total score and the BASFI and BASMI scores (p < 0.05). Patients with a BASDAI score of < 4 had a lower finger floor distance, a higher cervical rotation and modified Schober's measurement values compared with patients with a BASDAI score of >= 4. There was a significant correlation between the BASDAI score and SF-36 subscores of physical function, physical role, bodily pain and emotional role (p < 0.05). Conclusion: Clinical findings, functional disability, metrological measurements and quality of life are adversely affected by disease activity in AS. The subgroups of SF-36 subscores related to physical health show a more significant relationship with the disease activity in AS.Öğe The relationship between clinical parameters and depression level in patients with myofascial pain syndrome(Oxford Univ Press, 2008) Altindag, Ozlem; Gur, Ali; Altindag, AbdurrahmanObjective. Several studies and reviews have documented the high degree of comorbidity between depression and chronic pain. It was reported that chronic muscle pain is frequently accompanied by symptoms of depression. The purpose of this study was then to investigate the prevalence of major depression in chronic pain patients (CPP) with myofascial pain syndrome (MPS) and to investigate the relationship between some clinical parameters and level of depression, utilizing a healthy control group without MPS. Design/Setting/Patients. The study group consisted of 77 MPS patients (65 female, 12 male) and 72 healthy volunteers (60 female, 12 male). The diagnosis of MPS was based on clinical characteristics, examination findings, and ruling out other diagnoses. Major depressive disorder was diagnosed by a psychiatrist utilizing DSM-IV criteria. Levels of depression were obtained from the Beck Depression Inventory (BDI). Results. There was no significant difference between MPS patients and controls with respect to age and gender (P > 0.05). The mean age of the patients was 31.1 years (SD 9.8) and the mean age of controls was 29.7 years (SD 7.1). Major depression was more frequently found in CPPs with MPS (P < 0.001). BDI scores were higher in the MPS group than in controls (P < 0.001). There was a significant correlation between the severity of pain and depression level in patients with MPS (r = 0.654, P < 0.001). Conclusion. Major depression is found in MPS CPPs at a rate previously noted in the literature in mixed diagnoses CPPs. In addition, the severity of the depression may be related to perceived pain severity.Öğe Status of immune mediators in Fibromyalgia(Springer, 2008) Gur, Ali; Oktayoglu, PelinFibromyalgia (FM) is a form of nonarticular rheumatism characterized by long-term (> 3 months) and widespread musculoskeletal pain. However, the biophysiology of FM has remained elusive, and the treatment remains mainly empirical. There are numerous hypotheses about the pathophysiology of chronic widespread pain and FM; one includes a possible role of cytokines. Cytokines play a role in diverse clinical processes and phenomena such as fatigue, fever, sleep, pain, stress, and aching. Cytokines related to acute or repetitive tissue injuries may be responsible for long-term activation of spinal cord glia and dorsal horn neurons, thus resulting in central sensitization. Pain, stiffness, and depression in FM could be associated with some signs of inflammatory response system activation. Illumination of the pathophysiologic secrets of FM will result in more effective treatment regimens. We review the role of immune mediators in the pathophysiology of FM.Öğe Treatment of central nervous system involvement associated with primary Sjogren's syndrome(Bentham Science Publ Ltd, 2008) Ozgocmen, Salih; Gur, AliSjogren's syndrome (SS) is a chronic autoimmune disease that mainly affects the exocrine glands and usually presents with sicca symptoms of the main mucosal surfaces. The prevalence and the type of central nervous system (CNS) tissue damage caused by SS are debatable. The wide spectrum of CNS manifestations, different classification criteria used and unclear inclusion or exclusion criteria pose some difficulty reviewing these studies. Careful examination of the SS patients and to be aware of neurological findings which may be associated with suspicious CNS involvement is highly important. Central nervous system may also hypothetically have a role in the pathophysiology of SS. The wide spectrum of CNS involvement includes focal (sensorial and motor deficits, brain stem, cerebellar lesions, seizure, migraine etc.)or non-focal (encephalomyelitis, aseptic meningitis, neuropsychiatric dysfunctions), spinal cord (myelopathy, transverse myelitis, motor neuron disease etc.) findings or multiple sclerosis-like illness and optic neuritis. Evolving imaging techniques such as single photon emission computed tomography (SPECT), magnetic resonance spectroscopy or magnetization transfer imaging are promising for better understanding the nature of CNS involvement in SS. Treatments usually comprise symptomatic approach in milder cases however, pulse cyclophosphamide and steroids or other immunosuppressants (chlorambucil or azathioprine) are required in cases with progressive symptoms leading to neurological impairment. Anti-TNF agents (infliximab and etanercept) and B cell targeted therapies (rituximab and epratuzumab) are used in primary SS however their efficacy on CNS manifestation is still unclear. Randomized, multicenter studies are warranted to confirm the efficacy of treatment regimes which were reported to be effective in anecdotal reports or in small uncontrolled series. This article reviews the clinical approach to current therapy of CNS involvement in patients with primary SS.
