Rheumatoid Arthritis: Ozgocmen S

Ozgocmen S, Gur A. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, Elazig, Turkey. · Curr Pharm Des. · Pubmed #18537651 No free full text.

Abstract: Sjögren'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.

Ozgocmen S, Ozdemir H, Kiris A, Bozgeyik Z, Ardicoglu O. · Division of Rheumatology, Firat University, Faculty of Medicine, Elazig Turkey. · South Med J. · Pubmed #18364651 No free full text.

Abstract: OBJECTIVE: This study proposed to assess the relationship between power Doppler ultrasound examination and spectral Doppler analysis of hand joints with clinical and laboratory parameters in rheumatoid arthritis. METHODS: Patients receiving disease-modifying antirheumatic drugs or biologics (infliximab) underwent joint examination and were assessed by a Health Assessment Questionnaire, Duruoz's Hand Index, and Hand Function Test. All were categorized for disease activity using the American College of Rheumatology and disease activity score 28-joint (DAS28) criteria. Ten metacarpophalangeal joints and 4 wrist joints (ulnar-carpal and radiocarpal joints) in each patient were examined by power Doppler and spectral Doppler. Flow signal in the synovium was semiquantitatively graded. A cumulative flow signal score (CFS) and mean resistive index (RI) was calculated in each patient. RESULTS: Patients with active disease had significantly higher CFS compared with patients with inactive disease, but the mean RI was similar. Health Assessment Questionnaire, Duruoz's Hand Index, Larsen, and DAS28 scores correlated significantly with CFS, but the erythrocyte sedimentation rate and C-reactive protein scores did not. Mean RI did not correlate with clinical or laboratory parameters. A majority of patients who were in clinical remission according to American College of Rheumatology or DAS28 criteria had ongoing synovial inflammation on power Doppler ultrasound (58% and 62%, respectively). CONCLUSION: Power Doppler examination of rheumatoid hand joints is a practical method to estimate synovial inflammation. A modification of current remission criteria by combining imaging techniques with clinical and laboratory examination may be conceivable. These results underscore the necessity of more sophisticated research, assessing the agreement between long-term Doppler changes and clinical parameters.

Kiris A, Ozgocmen S, Kocakoc E, Ardicoglu O. · Department of Radiology, Firat University, Faculty of Medicine, Elazig, Turkey. · J Clin Ultrasound. · Pubmed #16353227 No free full text.

Abstract: PURPOSE: To examine synovial vascularity and flow patterns in hand and wrist joints--metacarpophalangeal (MCP) joints and ulnar stiloid (USTL) regions--of patients with rheumatoid arthritis (RA) using power Doppler sonography (PDUS) and spectral Doppler analysis and to assess the accuracy of PDUS in detecting overall disease activity in RA patients. METHODS: Two hundred forty MCP joints and 48 USTL regions in 24 RA patients were examined. Patients were categorized into 2 groups--active and inactive--according to the American College of Rheumatology remission criteria. Resistance indexes (RIs) were measured. RESULTS: Flow signals were detected in 50 MCP joints (in 13 patients) and 24 USTL regions (in 16 patients) and spectral analysis was performed in 46 MCP joints (12 patients) and 23 USTL regions (16 patients). The sensitivity and specificity of PDUS in detecting disease activity in RA were 92% and 40%, respectively. There was a negative correlation between flow signal number and RI, with higher scores of flow signals corresponding to lower RIs. CONCLUSION: PDUS appears to be a reliable method for assessing inflammatory activity in rheumatoid synovium.

Kaya A, Ozgocmen S, Kiris A, Ciftci I. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Firat University, Firat Tip Merkezi, Fiziksel Tip ve Reh. ABD, Romatoloji BD, 23119, Elazig, Turkey. · Clin Rheumatol. · Pubmed #15877179 No free full text.

Abstract: The aim of this case report is to describe unusual cases of progressive pseudorheumatoid dysplasia (PPD) affecting the axial skeleton and peripheral joints and to stress the importance of examining the entire skeleton for definite diagnosis and the importance of rehabilitation interventions. PPD is a rare familial disease characterized by generalized bone-cartilage dysplasia, progressive arthropathy, and platyspondyly. PPD presents as spondyloepiphyseal dysplasia (SED) tarda with progressive arthropathy and progressive pseudorheumatoid arthritis of childhood and is described as a specific autosomal recessive subtype of SED. Two sisters, 18 and 16 years old, with low back pain and polyarthritis are presented. Radiographic and magnetic resonance imaging of the cases revealed typical features characteristic for PPD-like platyspondyly, multiple intravertebral herniations, changes in metaphyses and epiphysis, and mega os trigonum. Consequently, PPD is a rare disease of childhood and should be kept in mind in the differential diagnosis of juvenile idiopathic arthritis to prevent delayed diagnosis and to begin rehabilitation interventions early. It is essential to carefully examine the entire body, particularly the axial skeleton, and to perform radiological evaluation of the spine. These illustrative cases serve to remind physicians to examine the entire skeleton and not to concentrate only on "branches" but also on the "trunk."

Ozgocmen S, Kiris A, Kocakoc E, Ardicoglu O, Kamanli A. · Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, 23119 Elazig, Turkey. · Joint Bone Spine. · Pubmed #15474389 No free full text.

Abstract: OBJECTIVE: To evaluate intra-articular vascularization and flow patterns of the metacarpophalangeal (MCP) joints in rheumatoid arthritis (RA) patients by using power Doppler technique. The relationship between the flow patterns and the regional bone mineral density (BMD) measurements of MCP joints using dual-energy X-ray absorptiometry (DXA) was also assessed. METHODS: Fifteen patients (mean age 48.5 +/- 13.8) with a disease duration of 6.8 +/- 4.9 years were included into the study. Thirty MCP joints of three healthy subjects were also assessed as controls. Clinical activity of MCP joint inflammation was classified according to a modified index for synovitis activity based on joint swelling, warmness and pain. Ultrasonography was performed using LOGIQ 7 unit by means of a 6-13 MHz linear array transducer. Gray-scale US and power Doppler sonography (PDS) examination was performed. Using spectral Doppler the quality of flow was determined and the indices of pulsatility (PI) and resistance (RI) were measured in longitudinal plane. The erosive scores of the MCP joints were determined on the plain hand radiographs using Sharp/van der Heijde method. Hand BMD, MCP BMD and the ratio of MCP BMD to whole hand BMD (rBMD) were measured using a Lunar DPX densitometer. RESULTS: Total 150 MCP joints of 15 patients and 30 MCP joints of three healthy controls were examined in both hands. Flow was determined in 31 joints (10 moderately active, 21 active) in eight patients whereas seven patients had no quantifiable flow in MCP joints. MCP joints of healthy controls had no quantifiable flow. Mean PI of these joints were 2.17 +/- 2.37 in moderately active and 2.12 +/- 1.93 in active MCP joints. RI was 0.76 +/- 0.12 in moderately active and 0.75 +/- 0.15 in active MCP joints. There was no significant difference in RI and PI of these active and moderately active MCP joints. There was a significant correlation between erosive scores and PI, RI of total MCP joints (r = 0.40 and r = 0.41, P < 0.05). PI and RI also negatively correlated with rBMD (r = -0.46, P < 0.01 and r = -0.36, P < 0.05, respectively). PIc was 4.07 +/- 3.26 and RIc was 0.88 +/- 0.16 in the neighboring soft tissues which were significantly higher than PI and RI of MCP joints (P < 0.001). CONCLUSION: Power Doppler ultrasonography (PDUS) is a useful method demonstrating synovial vascularization and flow patterns and offers new alternatives for monitoring disease activity and measurement of therapeutic response. Flow patterns had intimate correlation with intra-articular bone and cartilage destruction.

Incel NA, Erdem HR, Ozgocmen S, Catal SA, Yorgancioglu ZR. · Ankara State Education and Research Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey. · Rheumatol Int. · Pubmed #12172953 No free full text.

Abstract: Rheumatic patients experience persistent and disabling pain. We aimed to investigate the pain pressure threshold (PPT) values in ankylosing spondylitis (AS) patients compared to rheumatoid arthritis (RA) patients and healthy subjects. The relationship between lumbar and thoracal Schober, chin-to-chest distance, occiput-to-wall distance, finger-to-floor distance, chest expansion, and pain scores were also evaluated in an AS group. Our study group consisted of 17 AS patients, 20 RA patients, and 21 healthy volunteers. Eighteen tender points accepted by the American College of Rheumatism (ACR) for fibromyalgia syndrome evaluation in 1990 and three control points were evaluated with Fischer's tissue compliance meter, which can also be used as an algometer. Fourteen paravertebral points were evaluated, and mean values of paravertebral myalgic scores were recorded in the AS group. Our data indicate that AS patients do not have lower PPT with respect to healthy individuals, whereas RA patients have significantly lower PPT. A significant correlation was obtained between finger-to-floor distance and paravertebral myalgic score for AS. We conclude that AS does not have a widespread pain nature as RA.

Ardicoglu O, Ozgocmen S, Kamanli A, Pekkutucu I. · Department of Physical Medicine and Rehabilitation, Firat University, School of Medicine, Elazig, Turkey. · J Clin Densitom. · Pubmed #11740068 No free full text.

Abstract: This study proposed to assess the relationship between hand bone mineral density (BMD) and radiographic scoring methods, important measures to assess the course of rheumatoid arthritis. Hand, spine, and femur BMD of 49 patients with rheumatoid arthritis and 34 age- and sex-matched healthy control subjects were measured using dual X-ray absorptiometry and the results were compared. Standard hand films of patients were scored according to five different scoring methods--Larsen method, modified Larsen method, Sharp/van der Heijde modified method, carpo:metacarpal ratio, and simple erosion narrowing score (SENS)--and were correlated with hand BMD. There was a moderate relationship between hand BMD measurements and radiologic scores. SENS was the method that correlated significantly with the highest correlation coefficient. Hand BMD correlated significantly with disease duration and c-reactive protein levels. Hand BMD in patients with rheumatoid arthritis was significantly lower than in control subjects, whereas there was no significant difference in axial BMD measurements. The advantages and disadvantages of hand BMD and radiographic scoring methods were determined. Our results indicate that hand BMD measurements may be as useful is assessing the course of rheumatoid arthritis as radiologic scoring methods. However to prove this, a well-designed reference population for hand BMD and longitudinal studies are required.

Duyur B, Erdem HR, Ozgocmen S. · Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, Ankara, Turkey. · Spinal Cord. · Pubmed #11641802 links to  free full text

Abstract: OBJECTIVE: To report a case of Brucellosis causing severe joint and vertebra destruction in a patient with rheumatoid arthritis (RA). SETTING: Ankara, Turkey. CASE REPORT: A 47-year-old man with a known diagnosis of (RA) for 5 years developed paravertebral and epidural abscesses and vertebral fractures and nerve root compression due to brucellosis. The patient underwent surgery for L3-L4 vertebra stabilisation and medical treatment for knee arthritis. CONCLUSION: It is important to be aware of the possibility of brucellosis in endemic areas, even among patients with a known diagnosis of RA presenting with clinical pictures that may be confused with a flare-up of the RA itself. Steroids and NSAIDs may have the potential to mask disease manifestations.

Ozgocmen S, Karaoglan B, Kocakoc E, Ardicoglu O, Yorgancioglu ZR. · Department of Physical Medicine and Rehabilitation, Ankara State Hospital, Turkey. · Yonsei Med J. · Pubmed #10565260 links to  free full text

Abstract: This study proposed an assessment of the correlation of hand bone mineral density measured by dual energy x-ray absorbtiometry (DXA) with the carpo:metacarpal (C:MC) ratio and metacarpal cortical index (CI) in patients with rheumatoid arthritis (RA). The correlation of total hand BMD, CI and C:MC ratio with BMD at other sites, the Health Assessment Questionnaire (HAQ) and Larsen scores were also examined. The hand and axial BMD of 30 female patients were also compared with 29 age-matched healthy female controls. Total hand BMD values of patients were significantly lower than the control group. There was no significant difference between groups in axial measurements. CI correlated moderately with the second metacap (II.MC) midshaft and total hand BMD. The C:MC ratio correlated with II.MC midshaft and total hand BMD. Total hand BMD correlated moderately with the AP spine (L2-L4) and femoral neck BMD. Larsen scores showed weak negative correlation with II.MC midshaft BMD and CI. Grip strength correlated weakly only with total hand BMD. The results indicated that CI may reflect cortical bone mass of the hand accurately and did not predict bone density of the spine or hip in patients with RA. The C:MC ratio is a useful method for evaluating progression of wrist involvement and may be related to the loss of hand bone mineral density associated with disease process.