Long-term effects of neridronate and its discontinuation in patients with primary hyperparathyroidism

In patients with primary hyperparathyroidism (PHPT) not suitable for surgical correction, a skeletal protection with bisphosphonates is considered a reasonable option, but the long-term effects after treatment discontinuation are not well known. Sixty postmenopausal women with PHPT were given 400-600 IU vitamin D(3) daily and 100 mg neridronate IV every 2 months for 2 years with 2 additional years of follow-up without antiresorptive therapies. Bone mineral density (BMD) progressively rose by 6.7 ± 7.6% (SD) and by 2.9 ± 4.5% at the spine and femoral neck, respectively. During follow-up, mean BMD progressively fell, but after 2 years it was still 3.9 ± 5.5% higher than baseline values at the spine. Bone alkaline phosphatase and serum C-telopeptide of type I collagen decreased significantly within 6 months (28 and 49% versus baseline, respectively) and rose to baseline values within 6-12 months during follow-up. Serum PTH significantly rose from baseline during treatment, but it remained significantly higher than baseline during follow-up. The PTH changes were significantly correlated with serum 25-hydroxyvitamin D (25OHD) levels. In conclusion, in this study we observed that in patients with mild PHPT treatment with bisphosphonates is associated with the expected changes in bone-turnover markers and that the significant increases of both hip and spine BMD are partially maintained for at least 2 years after treatment discontinuation at the vertebral site. The marked increases in serum PTH levels, particularly in subjects with low 25OHD levels, persist after treatment discontinuation and this raises the suspicion that this might reflect a worsening of PHPT.

Determination of spondylolisthesis in low back pain by clinical evaluation

AIM

Current guides recommend to evaluate the patients with low back pain complaints with initial clinical assessment and history, and to utilize radiological or other imaging technics, in case of possible diagnosis. The aim of this study was to compare the findings of radiological and clinical assessment, and validate the reliability of spondylolisthesis diagnosed with clinical assessment. This study is conducted on 100 patients with, and 30 patients without (control group) radiological diagnosis of spondylolisthesis, who had applied to Department of Physical Therapy and Rehabilitation, Haydarpasa Numune Hospital with low back pain complaints in one and a half year. Clinic assessment was consisted of 20 parameters including examinations of motor system such as, sign of slipping observed on palpation and inspection, extension of trunk and increase in lumbar lordosis. Antero-posterior, lateral, oblique and lateral flexion/extension radiographies were used for radiological assessment. Slipping degree and lumbar lordosis angle were measured.

RESULTS

Women/men patients ratio was 91/9 in spondylolisthesis group and 22/8 in control group. Age of 69% of patients were 50 and over. In both groups, sciatalgia was observed in more than half of the patients, and no significant difference was detected in localization (p > 0.05). In clinical assessment, weak and drooping abdominal wall, paravertebral muscle hypertrophy, increase in lumbar lordosis, sign of slipping observed on palpation and inspection, hamstring muscle spasm, pain during lateral trunk flexion-extension tasks and during double leg raising task were found to be positively correlated with radiological assesment (p < 0.05).

CONCLUSION

In our study, a systematic clinical assessment was proved to be useful in determination of possible spondylolisthesis cases. Radiological assessments are required in order to make the diagnosis clear and to determine the grade and prognosis of spondylolisthesis. Advanced imaging techniques like MRI and CT have to be used when neurological symptoms are present, and when surgical intervention is indicated.

The role of melatonin in rheumatic diseases

Melatonin is a neurohormone that has attracted a great deal of attention, being frequently investigated in recent years. Due to its wide-spectrum of properties, melatonin has been suggested to be effective with respect to the etiology and treatment of several diseases. Its action on the immune system and antioxidant features has brought interest to this hormone's role in chronic inflammatory diseases. Furthermore, the detection of a correlation between the circadian release of melatonin and the rhythmic symptoms and signs of rheumatoid patients has led scientists to address its involvement in rheumatic diseases. Studies with suitable methodologies and broad perspectives are required in order to determine the functions of this neurohormone, whose effects are dependent on its physiological and pharmacological doses.

The interrelation of glutathione reductase, catalase, glutathione peroxidase, superoxide dismutase, and glucose-6-phosphate in the pathogenesis of rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, a systemic autoimmune disease characterized by chronic inflammation of the synovial joints, ultimately leading to joint destruction and permanent disability, affecting 1% of the world population. Oxidative stress in rheumatoid inflammation, due to the fact that antioxidant systems are impaired in RA and caused by fee radicals, might have an essential role in etiology of RA. This review includes the interrelation of antioxidants against free radicals in RA patients. There is much evidence that antioxidant team that covers glutathione reductase, catalase, glutathione peroxidase, superoxide dismutase, and glucose-6-phopshate destroy reactive oxygen species and other free radicals through enzymatic as well as nonenzymatic means. The change in relative levels of antioxidants vis-à-vis free radical formation and level could be used as indicators for effective and earlier diagnosis of RA.

Efficacy of a flexible orthotic device in patients with osteoporosis on pain and activity of daily living

OBJECTIVE

To study the efficacy of a flexible orthotic device in patients with osteoporosis.

DESIGN

Open observational study.

PATIENTS

Fifty patients with osteoporosis.

METHODS

An open observational study was performed on 50 patients with osteoporosis in order to investigate the efficacy of a new osteoporosis orthotic device, which is an elastic back support with paravertebral air chamber pads. The outcome parameters were pain, activities of daily living, individual compliance and comfort. The observation period was approximately 2.5 months, and the orthotic device was worn continuously during daytime.

RESULTS

There was a highly significant reduction in pain under exertion from mean 6.1 (SD 1.7) to 4.5 (SD 1.4) (p < 0.00001), pain when driving (from 5.2 (SD 2.4) to 3.8 (SD 1.9) (p < 0.00001)), and pain at rest from 4.1 (SD 2.4) to 3.1 (SD 1.9) (p < 0.0001). About 50% of the patients judged their ability to perform everyday activities as "much better"or "better". If physiotherapy was interrupted upon onset of orthosis treatment, the results were significantly worse than in patients with continued physiotherapy.

CONCLUSION

This orthotic device could be a useful addition to the medical care of patients with osteoporosis and a complement to drug treatment and physiotherapy with regular exercises, which should be continued.