Journal of the European Academy of Dermatology and VenereologyVolume 16, Issue 1 p. 89-91 Calcitriol treatment of glucocorticoid-induced osteoporosis in subjects with pemphigus vulgaris A Sivri, A Sivri Departments ofPhysical Medicine and Rehabilitation, and Corresponding author, tel. +90(312)3094142; fax +90(312)3195769; E-mail: aysen@tr.netSearch for more papers by this authorA Karaduman, A Karaduman Dermatology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.Search for more papers by this authorY Gökçe-Kutsal, Y Gökçe-Kutsal Departments ofPhysical Medicine and Rehabilitation, andSearch for more papers by this authorN Atakan, N Atakan Dermatology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.Search for more papers by this author A Sivri, A Sivri Departments ofPhysical Medicine and Rehabilitation, and Corresponding author, tel. +90(312)3094142; fax +90(312)3195769; E-mail: aysen@tr.netSearch for more papers by this authorA Karaduman, A Karaduman Dermatology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.Search for more papers by this authorY Gökçe-Kutsal, Y Gökçe-Kutsal Departments ofPhysical Medicine and Rehabilitation, andSearch for more papers by this authorN Atakan, N Atakan Dermatology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.Search for more papers by this author First published: 14 March 2002 https://doi.org/10.1046/j.1468-3083.2002.382_8.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume16, Issue1January 2002Pages 89-91 RelatedInformation

Objectives: To evaluate the presence of dyspnea and its association with the pulmonary function test or any other clinical parameters in patients with fibromyalgia syndrome [FMS].Methods: Thirty-five females satisfying the American College of Rheumatology criteria for FMS and 20 healthy controls were included in this study. A history of dyspnea was obtained and classified into five grades according to the World Health Organization's [WHO] dyspnea classification. Spirometric pulmonary functions were measured in each subject including forced vital capacity, forced expiratory volume in one second, peak and forced expiratory and inspiratory flow, and maximum voluntary ventilation.Results: Patients with FMS and controls did not differ in age and body mass index. Dyspnea was the fifth most common associated symptom and found in 57.1% of the patients. Spirometric values were normal among patients and controls, and the differences in pulmonary functions between patients and controls were not statistically significant [P > 0.05]. There was a statistically significant positive correlation between pain score measured by visual analog scale and the WHO dyspnea grade [R = 0.532, P < 0.001]. The WHO dyspnea grade was also found to be correlated positively with chest pain [R = 0.464, P < 0.005].Conclusions: Dyspnea is a common symptom in patients with FMS and is not explained by pulmonary causes, but may partly be due to chest wall discomfort and pain intensity. Understanding the cause of this symptom in FMS may help in the management of these patients who are suffering from dyspnea.

Objective: Inhaled corticosteroids have become a key element in the maintenance treatment of bronchial asthma. Recent studies have shown that administration of inhaled corticosteroids is associated with evidence of derangement in bone turnover. Therefore, we studied the bone mineral density (BMD) of asthmatic women receiving long‐term inhaled corticosteroids and compared them with healthy individuals matched for age, sex, menopausal status and body mass index.Methodology: Thirty‐two female patients with bronchial asthma, who had been using inhaled corticosteroids (beclomethasone dipropionate 750–1500 μg/day) regularly for at least 3 months, were included in the study. Bone mineral density measurements were done with dual X‐ray absorptiometry in the lumbar area of the spine and the hip. Detailed laboratory examation was also done for the patients and 26 controls.Results: There was a significant decrease in BMD of the patient group at the lumbar region and femur as compared with normal controls. In the patients there was a significant negative correlation between the duration of therapy, daily and cumulative doses, and BMD at the lumbar region but not BMD at the femur.Conclusions: These results indicate that long‐term use of inhaled corticosteroids is associated with significant bone loss in asthmatic women and is especially related to the duration of therapy. Therefore, it is necessary to appropriately screen and give prophylactic treatment to those who are likely to develop osteoporosis from inhaled corticosteroid treatment.

Objectives: Chronic plantar fasciitis is a clinical condition characterized by pain and tenderness localized to the plantar surface of the heel. Patients with plantar fasciitis have very few findings on physical examination. The aim of this study was to document the frequency of abnormalities seen in scintigraphic images from patients with chronic heel pain and a control population, and to correlate scintigraphic findings with clinical parameters.Methods: Twenty-two patients [ 17 female and five male] with chronic heel pain were included in this cross-sectional study. The control group consisted of 17 [nine female, eight male] Subjects with no history of heel pain who were referred for a bone scan for other nonpedal conditions. Daily standing times of each subject were recorded and body mass index of the study subjects were measured. Heel pain of the patients at rest and on weight bearing were evaluated using a 10 point visual analog scale. All patients were scanned after intravenous injection of Tc-99 m methylene diphosphonate.Results: Bone scans of 16 of the 22 patients with heel pain showed increased uptake at the medial calcaneal tubercle. However, scan findings of the control group were normal. There were no differences between patients and controls as to age, body mass index, and daily standing time.Conclusions: It is concluded that plantar fasciitis is a common cause of heel pain and the bone scan is a simple and convenient method for diagnosing plantar fasciitis.

Background Objectives Arthropathy is a consequence of growth hormone excess in acromegalic patients due to articular cartilage and nearby soft tissue involvement. Rheumatoid arthritis (RA) is, on the other hand, another entity, which may sometimes look alike due to the similar clinical findings. We present this case where these both diseases exist at the same time. Methods A 63-year old male complaining of joint pain and ankle swelling was evaluated. The arthralgia he described, was mainly in his knees, elbows and shoulders, and exaggerated especially at night. Recently accompanying swelling and erythema in his left ankle and in the left second metacarpophalangeal (MCP) joint did exist. He has been diagnosed as acromegalia for 15 years whereas his symptoms related with the joints came out within the last 6 years. He is somatotropinectomized and has also received radiotherapy for his primary disease. His neck, bilateral wrist, elbow and shoulder joints were involved, thus were painful and limited during normal range of motions. MCP joints being worse than the interphalangeal joints were likewise involved. His left ankle and MCP joints were swollen and red additionally. Laboratory and radiological evaluations comprising complete blood count, liver and kidney function tests, serological tests, direct x-rays of the joints were carried out. His erythrocyte sedimentation rate (ESR) was 93 mm/h, RF: 685 IU/ml. The diagnosis of rheumatoid arthritis other than the concurrent acromegalic arthropathy was confirmed with the radiological and clinical findings according to the ARA criteria. He was then treated with steroids. Results We considered this case challenging and notifying since an acromegalic patient can easily be misdiagnosed as having RA especially when high ESR and morning stiffness accompanies the case. We think the uncommon coexistence i.e. not mentioned up to date in the literature, may enlighten the still unknown pathogenesis of RA with the probability of growth factors mastering the whole event. Conclusion

The therapeutic indications for interferons (IFNs) have increased in recent years to include many different diseases of viral and malignant origin. Autoimmune phenomena may occur with IFN therapy, but arthritis is uncommon. In this case report, we describe a patient who developed monoarthritis in the knee after IFN-α therapy for chronic hepatitis B infection. A synovial fluid assay by polymerase chain reaction was negative for hepatitis B virus DNA and serum transaminase levels were normal as the arthritis developed. The patient was thought to have arthritis due to IFN-α treatment. A connection between IFN-α therapy and an induced autoimmune disorder is discussed.

BACKGROUND:Quantitative ultrasound (QUS) of bone is a relatively new technique that appears to assess 'bone quality' in addition to bone mineral density. The purpose of this study was to evaluate the diagnostic potential of QUS of calcaneum and to correlate it with dual energy X-ray absorptiometry (DEXA) in chronic haemodialysis patients.METHODS:Broad-band ultrasound attenuation (BUA; dB/MHz) and speed of sound (SOS; m/s) of calcaneum and DEXA (g/cm(2)) measurements of the lumbar spine and hip were made in 39 patients. The indices obtained by either method were compared with age-and sex-matched controls. Calcaneal measurements were correlated to DEXA and relevant clinical and biochemical data of patients.RESULTS:BUA and SOS values were markedly reduced in dialysis patients compared to controls (59.1+/-13.8 vs 73.0+/-16.2 dB/MHz, P:<0.001 and 1533+/-28 vs 1560+/-29 m/s, P:=0.014 respectively). There was a moderate, but significant association between calcaneal parameters and DEXA (r=0.32-0.53, P:<0.05). Both BUA and SOS scores were inversely correlated with age (r=-0.69, P:<0.001) and duration of menopause (r=-0.74, P:<0.01). Additionally, BUA values showed a moderate negative association with serum intact parathyroid values (r=-0.38, P:=0.018).CONCLUSION:Chronic haemodialysis patients have reduced calcaneal BUA and SOS scores. QUS of the calcaneum is an easy-to-apply and radiation-free technique. It could be a useful substitute for assessment of bone density in such patients. However, further studies in large patient groups and comparisons with plasma markers of bone turnover and bone biopsy findings are needed to assess its potential place in the management of renal osteodystrophy.

Beta-thalassaemias have a wide variety of musculoskeletal system manifestations. In this cross-sectional study, we aimed to investigate the frequency and features of musculoskeletal system problems in children with beta-thalassaemia. A total of 20 beta thalassaemic patients with an average age of 13.8 years were enrolled in the study. In all patients studied, detailed history regarding musculoskeletal involvement was taken and locomotor examinations were performed. All patients underwent radiographic examination with standing anteroposterior and lateral X-rays of the spine. Two physicians blinded for the diagnosis used Cobb technique for determining the degree of scoliosis. In 12 of 20 patients (60%) locomotor system involvement was found. Most frequent complaints were arthralgia and low back pain in 30% and 25% of patients respectively. Scoliosis was detected radiologically in 40% of patients with a lateral curve of at least 5° Cobb.

In Rheumatoid Arthritis (RA), one clinical hallmark of the vasculitis is the appearance of neurological findings. However, it is often difficult to diagnose these slight or early neuropathies and the study of the peripheral neuromuscular system is often made difficult by symptoms resulting from pain in the joints, and limitations of movement. It is nevertheless often possible, by means of electroneuromyography to show objectively the existence and distribution of even subclinical neuropathies. In order to evaluate the neurophysiological functions of RA patients by means of the peripheral nerve conduction and somatosensory evoked potential studies, 33 RA patients and 20 healthy controls were included in this study. Two (6%) patients were found to have carpal tunnel syndrome, while 6 (18%) patients had mononeuritis multiplex. Delayed N12, N13, N1 and P1 latencies were detected in 6 (18%) of 33 RA patients suggesting central nervous system involvement with intact peripheral nervous system. Our results confirm earlier observations that symptoms of neuropathy are fairly common in cases of RA without there being any clear correlation with any clinical variable. Therefore, the inclusion of an electroneuro-physiologic examination of the RA patients is recommended in routine diagnostic procedure.

Fibromyalgia and irritable bowel syndrome are both common conditions which account for most of the referrals to physical medicine and rehabilitation-rheumatology and gastroenterology clinics, and they frequently coexist. In this study, we utilized a previously validated questionnaire to assess the prevalence of symptoms of bowel dysfunction and irritable bowel syndrome, and to survey the range of bowel pattern in 75 patients with fibromyalgia as compared to 50 normal controls. Symptoms associated with irritable bowel syndrome (p < 0.05) were reported in 41.8% of the fibromyalgia patients and 16% of the normal controls, In conclusion, we found that patients with fibromyalgia have a high prevalence of gastrointestinal complaints confirming the results indicating that fibromyalgia and irritable bowel syndrome frequently coexist, This may suggest a common pathogenic mechanism for both conditions.

Vertebral osteoporosis is a well-recognized feature of ankylosing spondylitis (AS) and also the vertebral compression fractures due to osteoporosis are a common but frequently unrecognized complication of AS. Both may contribute to the pathogenesis of spinal deformity and back pain. The aim of this study was to measure vertebral and femoral neck bone mass in patients with AS by dual photon absorptiometry, to determine the prevalence of compression fractures and to examine the relationship between bone density and disease severity. We found that the bone mass was diminished in the lumbar spine in moderate AS versus mild forms but the patients with advanced disease had the highest BMD values. Examination of spinal radiographs revealed compression and biconcave fractures in 9 (40.9%) cases. Neither the duration of the disease and the degree of sacroiliitis, nor the disease activity assessed by laboratory and clinical parameters was found to significantly affect the results.

Arthritis & RheumatismVolume 38, Issue 11 p. 1713-1713 LetterFree to Read Igm deficiency in systemic lupus erythematosus patients Ayşen Sivri MD, Ayşen Sivri MD University of Hacettepe Ankara, TurkeySearch for more papers by this authorZafer Hasçlik MD, Zafer Hasçlik MD University of Hacettepe Ankara, TurkeySearch for more papers by this author Ayşen Sivri MD, Ayşen Sivri MD University of Hacettepe Ankara, TurkeySearch for more papers by this authorZafer Hasçlik MD, Zafer Hasçlik MD University of Hacettepe Ankara, TurkeySearch for more papers by this author First published: November 1995 https://doi.org/10.1002/art.1780381127Citations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume38, Issue11November 1995Pages 1713-1713 RelatedInformation

In lupus the neurological abnormalities usually mimic many primary neurological diseases and often represent the only manifestation of SLE for several years before the onset of other features of the disease. The aim of this study was to investigate lupus patients to obtain electrophysiological data of possible neurological abnormalities even in the absence of neuropathy symptoms. Thirty-eight SLE patients, twenty healthy volunteers and 10 steroid-using control subjects were included. Eighteen were asymptomatic but 20 of them had neuropathy symptoms. Median, ulnar and peroneal nerve motor, median, ulnar and sural nerve sensory conduction velocities, median and tibial somatosensory evoked potentials (SEP) were recorded. 23.6% of all lupus patients had peripheral nerve conduction slowing and 39.5% had SEP abnormalities; almost half of them being asymptomatic. 44.7% of the total had carpal tunnel syndrome; again almost half of them (47%) were asymptomatic. There was no significant correlation between the electrophysiologic parameters and the clinical and laboratory parameters of the disease. In lupus patients, SEP abnormalities were more pronounced than peripheral findings, reflecting the CNS involvement more common than the peripheral neuropathy. Therefore, we suggest performing the electrophysiological studies in lupus patients, even in the asymptomatic ones, early in the course in order to detect the nervous system involvement.

The dermatomal somatosensory evoked potentials (DSEP) of 15 patients with cervical spondylosis and unilateral radiculopathy were compared to those of 10 healthy volunteers. The diagnosis of root compression was verified by computerized tomography (CT). DSEP investigations revealed abnormalities in 80% of the patients in our study, and CT showed disk prolapse in 66.7%. The results of DSEP and CT were comparable in 73.3% of the cases. Even though DSEP correlates well with root compression demonstrable by CT, we found electrodiagnostic abnormalities in patients who had no disk prolapse but probably degenerative spondylopathic changes. We conclude from this that DSEP is a valuable electrodiagnostic method of detecting abnormalities in root function especially when motor signs are absent

In order to assess the prevalence of the carpal tunnel syndrome (CTS) suggestive of beta 2 microglobulin amyloid deposit in patients undergoing hemodialysis with cuprophan and acetate membrane, we studied 30 patients who had been receiving hemodialysis for varying lengths of time. Besides a standard physical and rheumatological examination, nerve conduction velocity studies were done in median and ulnar motorsensory nerves. 12 patients had normal findings, 12 had CTS (9 pure CTS, 3 with neuropathy), and 9 had peripheral neuropathy. Nerve dysfunction was independent of the disease underlying renal failure, the side of the dialysis access shunt and factors such as age and sex. We suggest that hemodialysis patients need frequent EMG analysis to identify CTS early and to avoid irreversible nerve damage.