Rheumatoid Arthritis: Evcik D

Kavuncu V, Evcik D. · Kocatepe University, School of Medicine, Department of Physical Medicine and Rehabilitation, Afyon-Turkey. · MedGenMed. · Pubmed #15266230 links to  free full text

Abstract: Rheumatoid arthritis (RA) is a chronic and painful clinical condition that leads to progressive joint damage, disability, deterioration in quality of life, and shortened life expectancy. Even mild inflammation may result in irreversible damage and permanent disability. The clinical course according to symptoms may be either intermittent or progressive in patients with RA. In most patients, the clinical course is progressive, and structural damage develops in the first 2 years. The aim of RA management is to achieve pain relief and prevent joint damage and functional loss. Physiotherapy and rehabilitation applications significantly augment medical therapy by improving the management of RA and reducing handicaps in daily living for patients with RA. In this review, the application of physiotherapy modalities is examined, including the use of cold/heat applications, electrical stimulation, and hydrotherapy. Rehabilitation treatment techniques for patients with RA such as joint protection strategies, massage, exercise, and patient education are also presented.

Bodur H, Ataman S, Akbulut L, Evcik D, Kavuncu V, Kaya T, Günaydin R, Kuran B, Kotevoğlu N, Bal A, Aydoğ E, Altay Z, Uğurlu H, Kocabaş H, Olmez N, Yazgan P, Gürsoy S, Madenci E, Ozel S, Delialioğlu SU. · Physical Medicine and Rehabilitation (PMR) Department, Ankara Numune Training and Research Hospital, Mürsel Uluç Ankara, Turkey. · Clin Rheumatol. · Pubmed #18357499 No free full text.

Abstract: 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) > or =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 > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =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.

Alpaslan M, Onrat E, Evcik D. · Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey. · Clin Rheumatol. · Pubmed #12740669 No free full text.

Abstract: Cardiac involvement in rheumatoid arthritis (RA) has been reported previously. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been reported before. Thus, the aim of this study was to evaluate ventricular function by measurement of myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). Thirty-two patients with long-standing RA and 32 control subjects (mean ages 52 +/- 11 and 50 +/- 10 years, respectively) participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle (LV). LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, MPI and TFPV. Right ventricular (RV) function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. Systolic function was normal in all subjects. Among the echocardiographic indices of LV diastolic function the peak E velocity, E velocity/A velocity ratio, isovolumetric relaxation time, MPI and TFPV in the RA group were significantly different from those of the controls ( P < 0.05). However, we did not observe a significant difference in RV echocardiographic indices between the two groups. Our results show that there is LV diastolic dysfunction in patients with long-standing RA. The lack of a history of cardiotoxic antirheumatic drug use among our patients suggests that this abnormality is due to RA itself.

Alpaslan M, Evcik D, Onrat E. · Department of Cardiology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey. · J Am Soc Echocardiogr. · Pubmed #11696842 No free full text.

Abstract: This report describes a 51-year-old man with rheumatoid arthritis, coronary artery disease, left ventricular failure, and saccular aneurysm of the left coronary cusp of the aortic valve. Rheumatoid arthritis can involve the heart in several ways; however, aortic valve aneurysm in rheumatoid arthritis has not been reported before. Absence of vegetation, lack of a history of infective endocarditis, and the preservation of aortic valve function suggested that this saccular aneurysm was not a result of infective endocarditis. An intimal flap, which strongly suggests aortic dissection, was not observed. To our knowledge, this may be a novel cardiac manifestation of rheumatoid arthritis, and this is the first published report.