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1.  Bone mass in axial spondyloarthritis: A literature review 
World Journal of Orthopedics  2015;6(2):298-310.
AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis (SpA) particularly those studies using dual X-ray absorptiometry (DXA) methods.
METHODS: This literature review examines the reported bone mass in patients with ax-SpA, particularly those using the DXA methods. The MEDLINE, Web of Science and Scopus databases were searched for relevant articles published between September 1992 and November 2013. Some of used search terms were ankylosing spondylitis (AS), SpA, spondyloarthropathy, bone loss, bone mass, osteopenia, bone mineral density, osteoporosis (OP), densitometry. Studies in which bone loss was investigated by using DXA in patients with SpA were eligible. Each article was reviewed and the key elements were noted.
RESULTS: There were 286 hits on MEDLINE, 200 on Web of Science and 476 on Scopus. After applying inclusion and exclusion criteria, we identified 55 articles in our systematic search. The sample size of the studies varied from 14 to 332 patients with SpA. The reported age range varied from 25 to 56 years in the reviewed studies. The symptom duration of patients with axSpA varied from 1.6 to 49 years. There were more males than females in these studies. Most of the recruited females were premenopausal women. Reported HLA-B27 positivity changed between 19% to 95%. The prevalence of OP and osteopenia in patients with SpA varied from 3%-47% to 5%-88%, respectively, in the included studies. In particular, the prevalence of OP and osteopenia ranged from 2.0%-47.0% and 5.0%-78.3%, respectively, in patients with AS. There are conflicting results regarding the relationship among disease activity, acute phase response and bone mass. Some studies suggest good correlation of bone mass with disease activity and acute phase reactants.
CONCLUSION: Bone loss may be determined in patients with axSpA at the lumbar spine or proximal femur even in the early phase of the disease and may be associated with inflammation (bone marrow edema) at the vertebral colon.
PMCID: PMC4363813  PMID: 25793171
Bone mineral density; Dual X-ray absorptiometry; Osteoporosis; Spondyloarthritis; Ankylosing spondylitis
2.  Hand bone mass in rheumatoid arthritis: A review of the literature 
World Journal of Orthopedics  2015;6(1):106-116.
Rheumatoid arthritis (RA) is a common chronic inflammatory disease and periarticular osteoporosis or osteopenia of the inflamed hand joints is an early feature of RA. Quantitative measurement of hand bone loss may be an outcome measure for the detection of joint destruction and disease progression in early RA. This systematic review examines the published literature reporting hand bone mass in patients with RA, particularly those using the dual X-ray absorptiometry (DXA) methods. The majority of the studies reported that hand bone loss is associated with disease activity, functional status and radiological progression in early RA. Quantitative measurement of hand bone mineral density by DXA may be a useful and practical outcome measure in RA and may be predictive for radiographic progression or functional status in patients with early RA.
PMCID: PMC4303779  PMID: 25621215
Rheumatoid arthritis; Hand bone density; Dual X-ray absorptiometry; Periarticular; Osteoporosis
3.  Ultrasound and Doppler US in Evaluation of Superficial Soft-tissue Lesions 
Improved developments in digital ultrasound technology and the use of high-frequency broadband transducers make ultrasound (US) imaging the first screening tool in investigating superficial tissue lesions. US is a safe (no ionizing radiation), portable, easily repeatable, and cheap form of imaging compared to other imaging modalities. US is an excellent imaging modality to determine the nature of a mass lesion (cystic or solid) and its anatomic relation to adjoining structures. Masses can be characterized in terms of their size, number, component, and vascularity with US and Doppler US especially with power Doppler US. US, however, is operator dependent and has a number of artifacts that can result in misinterpretation.
In this review, we emphasize the role of ultrasound, particularly power Doppler, in superficial soft-tissue lesions.
PMCID: PMC3988607  PMID: 24744969
Doppler; lesion; soft tissue; ultrasound
4.  Commentary 
PMCID: PMC3724318  PMID: 23914116
5.  Oxidative Stress and Raloxifene 
PMCID: PMC3693630  PMID: 23843825
Raloxifene; Bone Metabolism
6.  Agreement of Turkish Physiatrists with the Assessment in Spondyloarthritis International Society and the European League Against Rheumatism Recommendations for the Management of Ankylosing Spondylitis and Rheumatoid Arthritis 
New developments in the field of targeted therapies or biologic agents led more effective management of ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Recommendations for the management of rheumatic diseases propose to reduce inappropriate use of medications, minimize variations among countries, and enable cost-effective use of health care resources.
The aim this study was to evaluate conceptual agreement of ASsessment in SpondyloArthritis International Society (ASAS) and the EUropean League Against Rheumatism (EULAR) recommendations for the management of AS and EULAR recommendations for RA and to assess the rate of application among Turkish physiatrists in daily clinical practice.
An online survey link has been sent to 1756 Turkish physiatrists with e-mails asking to rate agreement on 11-item ASAS/EULAR AS recommendations and 15-item EULAR RA recommendations with synthetic and biological disease-modifying anti-rheumatic drugs. Also barriers and difficulties for using biologic agents were assessed.
Three hundred nine physiatrists (17.5%) completed the survey. The conceptual agreement with both recommendations was very high (Level of agreement; mean 8.35±0.82 and 8.90± 0.67 for RA and AS recommendations, respectively), and the self-declared application of overall recommendations in the clinical practice was also high for both RA and AS (72.42% and 75.71%, respectively).
Turkish physiatrists are in good conceptual agreement with the evidence-based recommendations for the management of AS and RA. These efforts may serve to disseminate the knowledge and increase the current awareness among physicians who serve to these patients and also implementation of these recommendations is expected to increase as well.
PMCID: PMC3314866  PMID: 22481985
Rheumatoid arthritis; ankylosing spondylitis; recommendations; agreement; physiatrist.
7.  Classification criteria for spondyloarthropathies 
World Journal of Orthopedics  2011;2(12):107-115.
Spondyloarthropathies (SpA) are a group of inflammatory arthritis which consist of ankylosing spondylitis (AS), reactive arthritis, arthritis/spondylitis associated with psoriasis (PsA), and arthritis/spondylitis associated with inflammatory bowel diseases. It is now more important than ever to diagnose and treat SpA early. New therapeutic agents including blockers of tumor necrosis factor have yielded tremendous responses not only in advanced disease but also in the early stages of the disease. Sacroiliitis on conventional radiography is the result of structural changes which may appear late in the disease process. However, magnetic resonance imaging (MRI) can visualize active inflammation at sacroiliac joints and spine in recent onset disease. The modified New York criteria, the European Spondyloarthropathy Study Group criteria and the Amor criteria do not include advanced imaging techniques like MRI which is very sensitive to the early Inflammatory changes. Assessment of SpondyloArthritis international Society has defined MRI methods for the assessment of sacroiliac joints and spine, criteria for inflammatory back pain and developed new criteria for classification of axial and peripheral spondyloarthritis. These new criteria are intended to be used for patients with SpA at the very early stage of their disease. Also, classification of psoriatic arthritis study group developed criteria for the classification of PsA. The widespread use of these criteria in clinical trials will provide evidence for a better definition of early disease and recognize many patients who may further develop classical AS or PsA. These efforts will guide therapeutic trials of potent drugs like biological agents in the early stage of these diseases.
PMCID: PMC3302034  PMID: 22474629
Classification criteria; Spondyloarthritis; Psoriatic arthritis; Ankylosing spondylitis
8.  Thoracic disc herniation causing transient paraplegia coincident with epidural anesthesia: a case report 
Cases Journal  2009;2:6228.
Neurological deficits following epidural or spinal anesthesia are extremely rare. Transient paraplegia following epidural anesthesia in a patient with thoracic disc herniation has been presented. A 44-year-old woman developed paraplegia during the operation for vascular surgery of her legs under epidural anesthesia. Epidural hematoma or spinal cord ischemia was ruled out by magnetic resonance imaging of the thoracic and lumbar spine in which protruded disc at T11-12 level compressing the spinal cord has been verified. Patient responded well to steroid treatment and rehabilitation interventions. Physicians should be aware of preceding disc protrusions, which may have detrimental effects on spinal cord perfusion, as a cause of persistent or transient paraplegia before epidural anesthesia procedure. MRI is a valuable imaging option to rule out epidural anesthesia complications and coexisting pathologies like disc herniations.
PMCID: PMC2769273  PMID: 19918563

Results 1-8 (8)