Isotretinoin, a retinoid derivate used in acne treatment, has a variety of side effects involving the musculoskeletal system; however, sacroiliitis is rarely observed. Our aim was to present nine cases of sacroiliitis in patients being treated with isotretinoin. Sacroiliitis was identified and monitored using magnetic resonance imaging (MRI). Clinical symptoms were resolved with nonsteroidal anti-inflammatory drug therapy after isotretinoin treatment was ceased. Different from the other cases, follow-up MRI was done. Follow-up MRI revealed improvement in some patients. Although the association between isotretinoin therapy and sacroiliitis has been covered in literature, this association is not yet completely understood. We aimed to discuss the relationship between two.

Several pharmacological and non-pharmacological modalities have been proposed for the treatment of fibromyalgia syndrome (FMS), a common rheumatic disease. Pregabalin is suggested as a first-step medication for FMS in the newest guidelines. Drowsiness, dizziness, and peripheral edema are well-known side effects of pregabalin; however, mastalgia is rarely seen. Presently described is a case of FMS in a patient who developed mastalgia and hyperprolactinemia (HPL) while taking pregabalin.

Stress fractures are caused by the repetitive force, often by overuse such as repeatedly long term exercises. They are usually seen in elderly postmenopausal women and frequently affects pelvic ring bones. Although, pelvic insufficiency fractures could be asymptomatic, they may also present as groin and low back pain. Pelvis stress fractures which are hard to diagnose and often unnoticed should be kept in the mind especially in elder patients with low back and hip pain in the differential diagnosis.

[Purpose] The purpose of this study was to determine the short- and midterm effects of Kinesio taping on the trapezius muscle in individuals with myofascial pain syndrome. [Subjects and Methods] Thirty-seven patients with active upper trapezius myofascial trigger points were randomly divided to 2 groups: group 1 received Kinesio taping for the upper trapezius muscle, and group 2 received a sham Kinesio taping application. Neck pain ( Visual Analog Scale and pressure algometry) and trapezius muscle strength data were collected at baseline, immediately after Kinesio taping application, and at one month followup. [Results] The mean changes in Visual Analog Scale scores were significantly different between groups at T2 and T1, with less pain in group 1. The mean changes in algometry scores were significantly different between groups at T3 compared with T2 in favor of group 1. The mean changes in trapezius muscle strength were significantly different between the groups at T2 compared with T1 in favor of group 1. [Conclusion] Patients with myofascial pain syndrome receiving an application of Kinesio taping exhibited statistically significant improvements in pain and upper trapezius muscle strength.

Objective: The aim of this study was to investigate the coexistence of myofascial trigger points (MTrPs) and cervical disc herniations (CDH) in patients with neck and upper back pain.Materials and Methods: In this retrospective study, patients having only MTrPs were defined as group-1, patients having only CDH were defined as group-2, patients having both MTrPs and CDH were defined as Group-3. Two hundred twenty three patients (151 females/72 males; mean age 38.2 +/- 10.1 years) were enrolled in this study. There were 30 patients in group 1, 46 patients in group 2, 147 patients in group 3.Results: Thirty eight patients had radiculopathy, 27 of them had MTrP(s). There was no significant difference in terms of CDH level (p=0.275) and degree of herniation (p=0.188) between groups 2 and 3. There was no significant difference in terms of MTrP localisation (p=0.684) between groups 1 and 3. There was no significant difference in terms of MTrP localisations according to CDH level and nerve root compression level in groups 3.Conclusion: MTrP and CDH coexistence is frequent. Management of the pain in the upper back region should be based on whether if the pain originates from MTrP, CDH or both.

Aims: Fibromyalgia Syndrome (FMS) is described as a central afferent processing disorder that might be associated with multiple physical and somatic symptoms. Sleep disturbances might be associated with the experience of somatic symptoms in FMS. The aim of this cross-sectional study is to evaluate the insomnia frequency, the relationship between insomnia and widespread Pain, somatic symptoms; functional status in FMS. Materials and methods: Subjects diagnosed as FMS according to American College of Rheumatology (ACR) 2010 criteria were included. Patients were asked for Fibromyalgia Impact Questionnaire (FIQ), Fibrofatigue Scale (FFS) and Insomnia Severity Index (ISI). Correlations between the ISI scores and the FIQ, the FFS total and each item of the FFS, the Widespread Pain Index (WPI) scores and the sum of the Symptom Severity Scores (SS) were analysed. Data of the patients were compared in terms of those parameters according to insomnia levels determined by the. Results: Ninety-one patients with FMS participated into the study. 76% of the patients had insomnia according to The scores were found to be correlated With the WPI, the SS, total score of ACR 2010 criteria, the FIQ score, FFS total score, and some items of the FFS score, but not correlated with age, gender, symptom duration and education level. When patients were sub-grouped according to IS!, a significant statistical difference was found regarding FIQ, FFS, ACR 2010 total, WPI score and the SS score with respect from severe to moderate insomnia. Conclusion: In this study, insomnia is one of the major symptoms of FMS and Correlated with other somatic symptoms. Sleep quality should be evaluated in every FMS patient.

Objective: To evaluate the effects of lower back pain (LBP) on postural equilibrium and fall risk during the third trimester pregnancy period by comparing postural stability between pregnant with LBP and pregnant without LBP control women.Methods: The study population comprised 68 women of 24-35 years in the third trimester of pregnancy. They were divided into Groups 1 (n=30) and 2 (n=38) according to the presence or absence of LBP, respectively. Postural stability were evaluated between groups using Tetrax Interactive Balance System posturography (Tetrax, Sunlight Medical Ltd, Tel Aviv, Israel) with eight sensory conditions.Results: For eight different positions, pregnant patients with LBP showed significantly higher values of general stability index, Fourier transformation index (F1, F2-F4, F5-F6 and F7-F8) and fall index than controls.Conclusion: LBP has a negative effect on postural stability. Postural equilibrium decreases and fall risk increases in pregnant patients with LBP.

Osteoporosis is common metabolic bone disease in older people. Bisphosphonates is usually used in the management of osteoporosis. However, a small number of patients have been recognized to develop ocular inflammation due to administration of bisphosphonates. We report the case of risedronate-induced conjunctivitis in a 68-year-old woman. This was successfully treated with stopping risedronate. Applying Naranjo's adverse drug reaction probability scale, a causality assessment was made which categorized this reaction as probable with a score of 7. This case report reviews the literature on the ocular effects of risedronate and discusses a possible mechanism for the association. Although ocular adverse effects of bisphosphonates are rare, it may effect eyesight. Physical Medicine and Rehabilitation clinicians should be aware of ocular side-effects in older patients because a delay in diagnosis may result in serious adverse outcomes.

Endometriosis is a common disease characterized by the presence of endometrial tissue outside the uterus, such as over, colon, nasal mucosa. Furthermore, it can affect sciatic nerve as a rare presentation causing cyclic sciatica, chronic pelvic pain, paresis, and paresthesia. Early diagnosis and treatment is very important to minimize the nerve damage caused by endometrial focus on sciatic nerve. Diagnosis of sciatica due to endometriosis can be made by magnetic resonance neurography (MRN), thereby identifying abnormalities of the sciatic nerve in patients with unexplained sciatica. MRN is a sensitive tool for evaluating both the lumbosacral plexus and sciatic nerve. We described a 38-year-old female patient with cyclic sciatica for 4 years. She had an endometrial focus compressing sciatic nerve at left sciatic foramen level that was diagnosed by MRN. In this case report, we aimed to underline the importance of appropriate diagnostic tools in the patients with extraspinal sciatica.

Objectives: To report a previously undescribed sudden onset of bilateral complex regional pain syndrome [CRPS] associated with cervical disc herniation [CDH].Findings: A patient with sudden onset of intensive pain in both hands was diagnosed as bilateral CRPS. The etiologic factor was found to be CDH, spinal cord, and C6 nerve root compression. The diagnosis was confirmed by three-phase scintigraphy. The patient was treated with pregabalin.Conclusions: This case allows clinicians to suggest CDH in the etiology of CPRS, even if the patient does not have any symptoms and complaints resulting from CDH. The mechanism is not clear, but suggests nerve damage.

INTRODUCTION:Low back pain (LBP) and hip pain frequently occur during pregnancy and postpartum period. Although pelvic and mechanic lesions of the soft tissues are most responsible for the etiology, sacral fracture is also one of the rare causes.CASE REPORT:A 32-year-old primigravid patient presented with LBP and right hip pain which started 3 days after vaginal delivery. Although direct radiographic examination was normal, magnetic resonance imaging of the sacrum revealed sacral stress fracture. Lumbar spine and femoral bone mineral density showed osteoporosis as a risk factor. There were no other risk factors such as trauma, excessive weight gain, and strenuous physical activity. It is considered that the patient had sacral fatigue and insufficiency fracture in intrapartum period. The patient's symptoms subsided in 3 months after physical therapy and rest.CONCLUSION:In conclusion, sacral fractures during pregnancy and postpartum period, especially resulting from childbirth, are very rare. To date, there are two cases in the literature. In cases who even do not have risk factors related to vaginal delivery such as high birth weight infant and the use of forceps, exc., sacral fracture should be considered in the differential diagnosis of LBP and hip pain started soon after child birth. Pregnancy-related osteoporosis may lead to fracture during vaginal delivery.

1Department of Physical Medicine and Rehabilitation, Medical Faculty of Ankara University, Division of Rheumatology, Ankara, Turkey; 2Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey; 3Department of Therapy and Rehabilitation, Ankara University, Haymana Vocational School, Ankara, Turkey; 4Department of Physical Medicine and Rehabilitation, Medical Faculty of Yeditepe University, İstanbul, Turkey; 5Department of Physical Medicine and Rehabilitation, Medical Faculty of Ankara University, Ankara, Turkey; 6Department of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Ankara, Turkey; 7Department of Physical Medicine and Rehabilitation, Medical Faculty of İnönü University, Malatya, Turkey; 8Department of Physical Medicine and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey; 9Department of Physical Medicine and Rehabilitation, Medical Faculty of Akdeniz University, Division of Rheumatology, Antalya, Turkey; 10Department of Physical Medicine and Rehabilitation, Medical Faculty of Celal Bayar University, Division of Rheumatology, Manisa, Turkey; 11Department of Physical Medicine and Rehabilitation, Medical Faculty of Gazi University, Division of Rheumatology, Ankara, Turkey; 12Department of Physical Medicine and Rehabilitation, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey; 13Department of Physical Medicine and Rehabilitation, Van Training and Research Hospital, Division of Rheumatology, Van, Turkey; 14Department of Physical Medicine and Rehabilitation, Medical Faculty of Cumhuriyet University, Division of Rheumatology, Sivas, Turkey; 15Department of Physical Medicine and Rehabilitation, İzmir Atatürk Training and Research Hospital, İzmir, Turkey; 16İstanbul Physical Medicine and Rehabilitation Training and Research Hospital, İstanbul, Turkey; 17Department of Physical Medicine and Rehabilitation, Medical Faculty of Bezmialem Vakıf University, İstanbul, Turkey; 18Department of Physical Medicine and Rehabilitation, Medical Faculty of Süleyman Demirel University, Isparta, Turkey; 19Department of Physical Medicine and Rehabilitation, Medical Faculty of Erciyes University, Division of Rheumatology, Kayseri, Turkey;

1Department of Physical Medicine and Rehabilitation, Ankara Numune Education and Research Hospital, Ankara, Turkey; 2Department of Physical Medicine and Rehabilitation, Medical Faculty of Erciyes University, Rheumatology Division, Kayseri, Turkey; 3Department of Physical Medicine and Rehabilitation, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey; 4Department of Physical Medicine and Rehabilitation, Medical Faculty of Ankara University, Rheumatology Division, Ankara, Turkey; 5Department of Physical Medicine and Rehabilitation, Medical Faculty of Uludag University, Bursa, Turkey; 6Department of Physical Medicine and Rehabilitation, Medical Faculty of Inonu University, Malatya, Turkey; 7Department of Physical Medicine and Rehabilitation, Medical Faculty of Yeditepe University, Istanbul, Turkey; 8Department of Physical Medicine and Rehabilitation, Medical Faculty of Trakya University, Edirne, Turkey; 9Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, Ankara, Turkey; 10Istanbul Physical Medicine and Rehabilitation Education and Research Hospital, Istanbul, Turkey; 11Department of Physical Medicine and Rehabilitation, Medical Faculty of Akdeniz University, Rheumatology Division, Antalya, Turkey; 12Department of Physical Medicine and Rehabilitation, Medical Faculty of Fatih University, Ankara, Turkey; 13Department of Physical Medicine and Rehabilitation, Medical Faculty of Celal Bayar University, Rheumatology Division, Manisa, Turkey; 14Department of Physical Medicine and Rehabilitation, Van State Hospital, Rheumatology Division, Van, Turkey; 15Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Izmir, Turkey; 16Department of Physical Medicine and Rehabilitation, Medical Faculty of Firat University, Rheumatology Division, Elazig, Turkey; 17Department of Physical Medicine and Rehabilitation, Medical Faculty of Ondokuz Mayis University, Samsun, Turkey; 18Department of Physical Medicine and Rehabilitation, Medical Faculty of Ankara University, Ankara, Turkey; 19Department of Physical Medicine and Rehabilitation, Izmir Ataturk Education and Research Hospital, Izmir, Turkey; 20Department of Physical Medicine and Rehabilitation, Medical Faculty of Bezmialem Vakif University, Istanbul, Turkey

Objectives: To develop Turkish League Against Rheumatism (TLAR) National Recommendations for the management of ankylosing spondylitis (AS). Materials and methods: A scientific committee of 25 experts consisting of six rheumatologists and 19 physical medicine and rehabilitation specialists was formed by TLAR. Recommendations were based on the 2006 ASsessment in Ankylosing Spondylitis International Working Group (ASAS)/European League Against Rheumatism (EULAR) recommendations and a systematic review of associated publications between January 2005 and September 2010. A Delphi process was used to develop the recommendations. Twelve major recommendations were constructed for the management of AS. Voting using a numerical rating scale assessed the strength of each recommendation. Results: The 12 recommendations include patient assessment, patient follow-up along with pharmacological and nonpharmacological methods. Some minor additions and changes have been made to the ASAS/EULAR recommendations. All of the recommendations had sufficient strength. Conclusion: National recommendations for the management of AS were developed based on scientific evidence and consensus expert opinion. These recommendations will be updated regularly in accordance with recent developments.

Objectives: Taking new developments in the management of rheumatoid arthritis (RA) and the economic conditions of our country into account, the Turkish League Against Rheumatism (TLAR) aimed to develop national treatment recommendations for the management of RA; thus, they consulted with national experts for their opinions.Materials and methods: Eight rheumatologists and 15 physiatrists experienced in the field contributed to the development of the TLAR recommendations for the management of RA. The expert committee planned to develope "Recommendations for the Management of RA in Turkey" based on EULAR 2010 recommendations for the management of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) in light of expert opinions. Following the meeting, a systematic literature review was performed by searching the Medline and Cochrane, Embase, and Turkish Medical Index databases between 2009 and 2010 for pharmacological treatment recommendations and between 2007 and 2010 for non-pharmacological treatment recommendations. This was done in addition to the studies included in the EULAR 2010 recommendations. All articles were examined, their contents were summarized, their levels of evidence were determined, and the Delphi process was initiated.Results: Sixteen general recommendations were listed along with five main principles and one non-pharmacological treatment method. A consensus was reached for all recommendations, and their strength levels were voted upon.Conclusion: Recommendations were formed for the management of RA in Turkey. These national recommendations are intended to guide physical medicine and rehabilitation specialists (physiatrists), rheumatologists, and family physicians and should be regularly updated.

Introduction: The most common cause of mortality and morbidity among osteoporotic individuals is bone fracture which in many cases is a direct result of falls. Individual factors contributing to the risk of fall are poor postural balance and lack of muscle strength. Our aims were to assess postural dynamic balance in osteoporotic women and to describe the effective factors on the balance performance. Methods: Twenty osteoporotic women with kyphosis, 50 osteoporotic women without kyphosis, and 30 healthy women were included in the study. Anterior/Posterior (AP), Medial/Lateral (ML) and Overall (OA) stability indices were obtained using Biodex Stability System (Biodex Medical System, Shirley, NY). Subjects were tested both with eyes open and eyes closed. Quadriceps-hamstring muscles’ strength were measured with isokinetic system at angular speeds of 60-180-300°/sec. Results: OA, AP, ML stability indices in the group with osteoporosis were found to be statistically significantly higher in the open-eyed balance test. When a correlation analysis was performed on all osteoporotic patients, a negative correlation was detected between balance stability indices and knee flexion-extension strength at 60°/sec and knee flexion strength at 300°/sec. Multivariable regression analysis revealed knee extension strength at 60°/sec to be the most effective factor contributing to balance in osteoporotic patients. Conclusion: Postural balance in osteoporotic women presenting is significantly worse than in the healthy women and the factor exerting the greatest influence on balance is quadriceps muscle strength. Therefore, particular importance must be given to balance and quadriceps strengthening exercises in order to prevent falls in osteoporotic patients. (Turkish Journal of Osteoporosis 2011;17:37-43)

A proposed model suggests that the experience of pain is influenced by psychological and genetic factors. Our previous study reported that pain catastrophizing and catechol-O-methyltransferase (COMT) genotype influenced clinical pain ratings for patients seeking operative treatment of shoulder pain. The current study investigated whether these same psychological and genetic factors predicted responses to induced shoulder pain. Our a priori hypothesis was that subjects with high pain catastrophizing and COMT genotype indicative of low COMT enzyme activity would have the highest induced shoulder pain ratings. Subjects (n = 63) completed the Pain Catastrophizing Scale (PCS) and had COMT genotype determined by PCR-based strategies. Subjects then completed a standardized fatigue protocol to induce delayed onset muscle soreness and underwent post-fatigue assessments at 24, 48, and 72 hours. The post-fatigue assessments included pain intensity (visual analog scale), evoked pressure pain (visual analog scale), muscle force production (maximum voluntary isometric contraction), and upper-extremity disability (Disability of Arm, Shoulder, and Hand Questionnaire). Hierarchical regression investigated the contributions of pain catastrophizing and previously described COMT diplotypes for shoulder pain intensity at 72 hours. A statistically significant interaction between pain catastrophizing and COMT diplotype was detected, and this interaction was the strongest unique predictor of 72 hour pain intensity ratings. This same interaction was statistically significant for prediction of evoked pressure pain at 72 hours, but not for muscle force production or upper-extremity disability. In conclusion, these findings converge with those from the surgical cohort and provide additional evidence that pain catastrophizing and COMT diplotype have the potential to increase the risk of developing chronic pain syndromes. This study was supported by a grant from the University of Florida.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 ± 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) ≥1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 ± 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was ≥4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI ≥4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

Objective: The experience of pain is believed to be influenced by psychologic and genetic factors. A Previous Study Suggested pain catastrophizing and catechol-O-methyltransferase (COMT) genotype influenced clinical pain ratings for patients seeking operative-treatment of shoulder pain. This Study investigated whether these same psychologic and genetic factors predicted responses to induced shoulder pain.Methods: Participants (n = 63) completed self-report questionnaires and had COMT genotype determined before performing a standardized fatigue protocol to induce delayed onset muscle soreness. Then, shoulder. pain ratings, self-report of upper-extremity disability ratings, and muscle torque production were reassessed 24, 48, and 72 hours later.Results: This cohort consisted of 35 women and 28 men, with a mean age of 20.9 years (SD = 1.7). The frequency of COMT diplotypes was 42 with "high COMT enzyme activity" (low pain sensitivity group) and 21 with "low COMT enzyme activity" (average pain sensitivity/high pain sensitivity group). A hierarchical regression model indicated that an interaction between pain catastrophizing and COMT diplotype was the strongest unique predictor of 72-hour pain ratings. The same interaction was not predictive of self-report of disability or muscle torque production at 72 hours. The pain catastrophizing x COMT diplotype interaction indicated that participants with high pain catastrophizing and low COMT enzyme activity (average pain sensitivity/high pain sensitivity group) were more likely (relative risk = 3.5, P = 0.025) to have elevated pain intensity ratings (40/100 or higher).Discussion: These findings from an experimental model converge with those from a surgical cohort and provide additional evidence that the presence of elevated pain catastrophizing and COMT diplotype indicative of low COMT enzyme activity have the potential to increase the risk of developing chronic pain syndromes.