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Öğe Ankilozan spondilitte osteoporoz ve kırık sıklığı ile HLA-B27 ve klinik aktivite arasındaki ilişki(2017) Ulu, Mehmet Ali; Çevik, RemziAmaç: Kemik kaybı Ankilozan spondilit(AS) de dahil enflamatuar artritlerin iyi bilinen bir özelliğidir. Ancak AS'de sindesmofitler nedeniyle kemik mineral kaybı posteroanterior(PA) dual-energy x-ray absorbsiyometri(DEXA) ölçümünde maskelenebilmektedir. Bu çalışma ankilozan spondilitli hastalarda kemik kaybını en iyi yansıtan ölçüm yöntemini araştırmak ve osteoporoz ve fraktür sıklığı ile HLA-B27 pozitifliği, klinik ve laboratuar aktivite arasındaki ilişkiyi değerlendirmek amacıyla yapıldı. Gereç ve yöntem: Çalışmamıza 86 AS hastası ve 50 kontrol hastası alındı. Hasta ve kontrol gruplarında PA vertebra, lateral vertebra ve kalça DEXA ölçümleri yapıldı. Hasta dosyalarından HLA-B27 durumu kaydedildi. AS hastaları hastalık evresi, şiddeti, osteoporoz durumu, sindesmofit ve kırık varlığına göre gruplara ayrılıp kemik kaybı durumuna göre alt grup analizleri yapıldı. Hastalık aktivitesi için Bath ankilozan spondilit hastalık aktivite indeksi (BASDAİ), Mobilizasyon kısıtlılığı için Bath ankilozan spondilit metrolojik indeks (BASMİ), fonksiyonel durum için Bath ankilozan spondilit fonksiyonel indeksi (BASFİ), radyolojik durum için Bath ankilozan spondilit radyolojik indeks (BASRİ) skorları kullanıldı. Bulgular: Çalışmaya alınan hastaların 69'u(%80.2) kontrol grubunun ise 35'i(%70.0) erkekti. PA vertebra KMY değerleri bakımından iki grup arasında fark saptanmazken kalça KMY değerleri ile lateral vertebra KMY değerleri hasta grubunda anlamlı olarak düşüktü. Geç dönem hastalarda erken dönem hastalara göre istatistiksel olarak anlamlı olmasa da femur ve lateral vertebra DEXA değelerine göre kemik kaybı daha fazlaydı. PA vertebra değerleri ise erken dönemde daha fazla kemik kaybı gösterdi. AS hastalarında osteoporoz ile ilişkili faktörler; düşük VKİ, yüksek BASMİ ve BASFİ skoru ve yüksek ESH olarak bulundu. Hastaların %28'inde kompresyon kırığı mevcuttu. Kırık varlığı ile ilişkili faktörler; sindesmofit varlığı, femur ve lateral vertebra değerlerine göre osteoporoz varlığı, yaş, tanısal gecikme süresi, yüksek BASMİ ve BASRİ total skorlarıydı. HLA-B27 pozitif olan hastalarda negatif olanlara göre vertebra, femur ve herhangi bir bölge osteoporoz ve düşük kemik kitlesi oranları daha yüksekti, ancak istatistiksel olarak anlamlı düzeyde değildi. Sonuç: AS hastalarında kontrollere göre kemik kaybı artmıştır. PA vertebra KMY ölçümleri ile erken dönem hastalarda kemik kaybı gösterilebilirken, geç dönem hastalarda sindesmofitler nedeniyle kemik kaybı maskelenmektedir. Lateral projeksiyonda yapılan KMY ölçümü AS'nin progresyonu ile paralel olarak artan kemik kaybını ve kırık riskini PA vertebra ve femur ölçümlerine göre daha iyi yansıtmaktadır. Kemik kaybı ve kırık riski HLA-B27 durumuna göre değişmemektedir. Anahtar kelimeler: Ankilozan spondilit, osteoporoz, HLA-B27, kompresyon kırığı, lateral vertebra DEXAÖğe A Case of Spondyloepiphyseal Dysplasia Tarda Coexisting With Osteoporosis and Mimicking Spondyloarthropathy(Galenos Yayincilik, 2013) Batmaz, Ibrahim; Sariyildiz, Mustafa Akif; Dilek, Banu; Ulu, Mehmet Ali; Verim, Sabahattin; Budulgan, Mahmut; Cevik, RemziSpondyloepiphyseal dysplasia tarda (SEDT), which is characterized by short stature with short trunk, may cause barrel chest, kyphoscoliosis, platyspondyly, coxa vara and genu varum/valgum deformities due to delayed formation of epiphyses. The association of SEDT with osteopenia and osteoporosis has been reported. Chronic back and buttock pain, swelling of the joints and morning stiffness are some of the clinical findings of SEDT which can be confused with inflamatory diseases. In this article, we present a 19-year-old male patient with SEDT who was diagnosed as having spondyloarthropathy because of back and buttock pain and morning stiffness associated with osteoporosis.Öğe A Case of Tibialis Anterior Muscle Herniation Diagnosed by Ultrasonography(Galenos Yayincilik, 2013) Ulu, Mehmet Ali; Cakmak, Muharrem; Nas, KemalMuscle hernia is a focal muscular protrusion through a fascial defect and the tibialis anterior muscle is the most commonly affected site in the lower leg. It is usually an asymptomatic bulge which changes in size with the patient's position. In this article, we report a patient who presented with a swelling on his leg and was diagnosed with tibialis anterior muscle herniation by ultrasonographic examination. Turk J Phys Med Rehab 2013;59:73-5.Öğe Comparison of PA spine, lateral spine, and femoral BMD measurements to determine bone loss in ankylosing spondylitis(Springer Heidelberg, 2013) Ulu, Mehmet Ali; Cevik, Remzi; Dilek, BanuTo evaluate bone loss in the early- and late-stage ankylosing spondylitis (AS) patients using posteroanterior (PA) and lateral lumbar and femoral bone mineral density (BMD) measurement methods. Eighty-six AS patients and 50 control subjects were enrolled. PA spine, lateral spine, and femur BMD values of patients and controls were measured. The presence of any syndesmophytes or compression fractures was determined. Patients were divided as early (< 10 years) and late stage (a parts per thousand yen10 years) according to the onset of the inflammatory pain. Mean PA spinal BMD was similar in patients and controls (p = 0.460). Femoral and lateral spine BMD values were significantly lower in patients (p = 0.012 and p = 0.001). When comparing early- and late-stage AS groups, mean PA spinal BMD was found to be lower in the early group (p = 0.005), while femoral and lateral spinal values were lower (although statistically not significant) in the late group. At least one compression fracture was present in 28 % of patients. Although not statistically significant, mean PA spinal BMD was higher in those with fractures. Femoral and lateral spinal BMD values were significantly lower in the fracture group (p = 0.034 and p = 0.004). Lateral spinal BMD values were significantly lower in patients with syndesmophytes (p = 0.004). Bone loss is increased in AS compared with control subjects. The BMD measurement at the lateral lumbar spine reflects bone loss and fracture risk better than PA spine and femoral measurements.Öğe Efficacy of Pulsed and Continuous Therapeutic Ultrasound in Myofascial Pain Syndrome A Randomized Controlled Study(Lippincott Williams & Wilkins, 2015) Ilter, Leman; Dilek, Banu; Batmaz, Ibrahim; Ulu, Mehmet Ali; Sariyildiz, Mustafa A.; Nas, Kemal; Cevik, RemziObjectives This study aimed to compare continuous and pulsed ultrasound therapy with sham ultrasound in terms of pain, severity of muscle spasm, function, depression, and quality of life in patients with myofascial pain syndrome. Design Patients were randomly divided into three groups, including the continuous ultrasound group (3 MHz, 1 W/cm(2), n = 20), the pulsed ultrasound group (3 MHz, 1 W/cm(2), 1:1 ratio, n = 20), and control group (sham, n = 20). The primary outcome measures were severity of pain at rest and during activity (visual analog scale, 0-10 cm). The secondary outcome measures were function (Neck Pain and Disability Scale), depressive mood (Beck Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, after treatment, and at the 6th and 12th wks. Results All three groups had significant improvements in all of the pain scores, the severity of muscle spasms, function assessments, and certain subparameters of the quality of life scale (P < 0.05). The continuous ultrasound group had significantly greater improvements in pain at rest (P < 0.05). However, no statistically significant differences were observed in the other parameters (P > 0.05). Conclusions Continuous ultrasound therapy is more efficient in reducing pain at rest for myofascial pain syndrome patients than is sham or pulsed ultrasound therapy.Öğe The performance of psoriatic arthritis classification criteria in Turkish patients with psoriatic arthritis(Wiley, 2017) Nas, Kemal; Karkucak, Murat; Durmus, Bekir; Ulu, Mehmet Ali; Karatay, Saliha; Capkin, Erhan; Ulusoy, HasanObjectivesTo investigate performance of some of the published psoriatic arthritis (PsA) classification criteria as well as Assessment of Spondyloarthritis International Society (ASAS) criteria for peripheral spondyloarthritis (SpA) in Turkish patients with PsA (in early and late disease subgroups). MethodsPatients were recruited using case report forms and physical examination methods proposed by the Anatolian Group for the Assessment in Rheumatic Diseases (ANGARD). The Moll and Wright (MW), modified Fournie (MF), modified McGonagle (mMG), Vasey and Espinoza (VE), classification of PsA (CASPAR) criteria and ASAS criteria were assessed in patients with PsA who were diagnosed based on expert opinion. ResultsOne hundred and twenty-eight patients with PsA (58 male, 70 female, mean age 41.8years) were included. Thirty patients were in the early PsA and 98 patients were in the late PsA groups. Diagnostic delay was 2.6years. In the 15.6% of patients arthritis developed before the skin findings. The proportion of patients fulfilling the MW, MF, mMG, VE, CASPAR and ASAS criteria were at a ratio of 90.6%, 82.8%, 62.5%, 84.4%, 96.1% and 76.5%, respectively. In early PsA (< 12months disease duration) the proportions were 93.4%, 83.3%, 76.7%, 76.7%, 96.7% and 66.6%, respectively. On the other hand, in late PsA the proportions were 89.8%, 82.6%, 57.1%, 86.7%, 95.9%, 79.5%, respectively. ConclusionsEven though the sensitivity of PsA classification criteria in Turkish patients changes, the CASPAR criteria seems to be more prominent among all criteria for both early and late cases with its high sensitivity.Öğe Prevalence of osteoporosis and vertebral fractures and related factors in patients with ankylosing spondylitis(Chinese Medical Assoc, 2014) Ulu, Mehmet Ali; Batmaz, Ibrahim; Dilek, Banu; Cevik, RemziBackground Osteoporosis and vertebral factures are well recognized features in patients with ankylosing spondylitis (AS). The aim of this study was to investigate the prevalence and risk factors of osteoporosis and vertebral fractures in patients with AS. Methods Fifty-nine AS patients and 40 healthy controls were enrolled. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA) at posterior-anterior (PA) lumbar, lateral lumbar and hip regions. Thoracic and lumbar X-rays were obtained for morphometric measurements. Clinical, biological and radiological statuses were evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiology Index-total (BASRI-t), erythrocyte sedimentation rate (ESR) and the C-reactive protein levels. Results Osteoporosis was present in 32% of patients and 5% of controls according to lateral vertebral BMD measurements. Fracture was present in 31% of patients. The effect of some clinical and laboratory parameters on BMD status and vertebral fractures was analyzed in the patient group. Osteoporosis in lateral lumbar DEXA was associated with higher BASMI, BASFI, BASRI-t scores and ESR level. Low hip BMD was associated with low BMI and high BASF! and BASRI-t scores. Vertebral fractures were associated with advanced age, longer disease duration, longer duration since diagnosis, higher BASMI and BASRI-t scores, higher ESR level, reduced femoral and lateral lumbar BMD. Logistic regression analysis revealed that only BASRI-t score was significantly associated with low lateral spinal BMD and BMI and BASFI score were independently associated with low hip BMD. The presence of compression fractures was independently associated with BASRI-t score and low lateral lumbar BMD. Conclusions Osteoporosis and vertebral fractures in AS seem to be related to the extent of radiological involvement. A low lateral lumbar BMD is an important risk factor for vertebral fractures.Öğe The relationship between bone mineral density and levels of RANKL, osteoprotegerin and cathepsin-K in patients with rheumatoid arthritis(Dicle Üniversitesi Tıp Fakültesi, 2012) Çakırca, Gökhan; Mete, Nuriye; Batmaz, Ibrahim; Sarıyıldız, Mustafa Akif; Ulu, Mehmet Ali; Yazmalar, Levent; Çelepkolu, Tahsin; Çevik, RemziObjectives: The aim of this study was to evaluate the levels of osteoprotegerin (OPG), nuclear factor kappa B receptor activator ligand (RANKL), cathepsin K in patients with rheumatoid arthritis (RA) and the relation between these parameters and bone mineral density (BMD). Materials and methods: Totally 90 cases including 30 postmenopausal and healthy women, 30 with postmenopausal osteoporosis and 30 with postmenopause RA were enrolled in the study. The serum RANKL, OPG and cathepsin K were measured by ELISA method. Results: The levels of serum RANKL and OPG in the patients with postmenopausal RA were found significantly higher compared to the postmenopausal healthy women whereas the rate of serum OPG/RANKL was found significantly lower. In addition, the rate of OPG and OPG/RANKL were significantly lower in patients with postmenopausal RA compared to the postmenopausal osteoporosis, whereas the level of serum RANKL was significantly higher. Positive correlation was detected between bone densities of lumbar spine (LS), femur neck (FN) and the rate of OPG/RANKL in patients with postmenopausal RA. Also negative correlation was detected between LS and FN bone densities and RANKL levels. Conclusions: The system of RANKL/RANK/OPG may have a role in osteoporosis and RA pathogenesis and the rate of OPG/RANKL might be a significant determiner of bone densityÖğe Sistemik sklerozlu hastalarda depresif semptomlar: Klinik değişkenler, fonksiyonel durum ve yaşam kalitesi ile ilişkisi(Dicle Üniversitesi Tıp Fakültesi, 2013) Sarıyıldız, Mustafa Akif; Batmaz, İbrahim; Budulgan, Mahmut; Bozkurt, Mehtap; Yazmalar, Levent; Okçu, Mehmet; Ulu, Mehmet AliAmaç: Bu çalışmanın amacı sistemik sklerozlu (SS) hastalarda depresif semptomların hastalıkla ilişkili değişkenler, fonksiyonel durum ve yaşam kalitesi ile ilişkisini değerlendirmektir. Gereç ve yöntem: Bu çalışmaya SS tanısı alan 40 hasta ve 36 sağlıklı kontrol grubu alındı. Hastaların reynaud fenomeni, SS alt tipi, dijital ülser, gastrointestinal ve akciğer tutulumu ve hastalık aktivitesi gibi klinik karakteristikleri kaydedildi. Tüm hastalara Short Form-36 (SF-36) yaşam kalitesi skalası, sağlık değerlendirme anketi ve Beck Depresyon ölçeği dolduruldu. Yaygın ağrı ve yorgunluk görsel analog skala ile değerlendirildi. Bulgular: Sistemik sklerozlu hastalarda sağlıklı kontrol grup ile kıyaslandığında depresif semptom skorları anlamlı olarak yüksekti. Spearman korelasyon analizinin sonuçlarına göre, depresif semptomlar ile eğitim seviyesi, yaygın ağrı, dispne, hastalık aktivite skoru, gastroözefageal reflü, disfaji, fonksiyonel durum ve SF-36’ nın mental ve fiziksel skoru arasında anlamlı korelasyon tespit edildi. Sonuç: Sistemik sklerozlu hastalarda depresif semptomlar artmıştır. Sistemik sklerozlu hastalarda depresif semptomlar özellikle yaygın ağrı, hastalık aktivitesi, disfaji, fonksiyonel durum ve yaşam kalitesi ile ilişkilidir.Öğe Spondiloartropatiyi taklit eden osteoporozun eşlik ettiği spondiloepifizyal displazi tarda olgusu(2013) Verim, Sabahttin; Dilek, Banu; Budulgan, Mahmut; Sarıyıldız, Mustafa Akif; Çevik, Remzi; Batmaz, Ibrahim; Ulu, Mehmet AliSpondiloepifizyal displazi tarda (SEDT), epifizlerin ortaya çıkmasındakigecikmeye bağlı olarak gövde ve ekstremitelerde kısalık, bel ağrısı,fıçı göğüs deformitesi, kifoskolyoz, platispondili, koksa vara ve genuvarum/valgum deformitelerine neden olabilen nadir görülen birosteokondrodisplazi türüdür. Osteoporoz ve osteopeni birlikteliği derapor edilmiştir. Kronik bel ve bacak ağrısı, eklem şişlikleri ve sabahtutukluğu SEDTnin klinik bulgularından birkaçıdır ve bu nedenle bazenenflamatuvar hastalıklarla karışabilir. Bu makalede bel ve kalça ağrısı,sabah tutukluğu olan ve bu nedenle Spondiloartopati (SpA) tanısı almışaynı zamanda osteoporoz birlikteliği bulunan 19 yaşındaki SEDTli erkekbir hasta sunumu amaçlanmıştır. Türk Fiz T p Rehab Derg 2013;59:260-3.
