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Öğe Bone mineral density measurements in otosclerosis using dual-energy X-ray absorptiometry(Wiley, 2016) Tönük, Şükrü Burak; Köybaşı, Serap; Biçer, Yusuf Özgür; Alkan Temel, SemaObjectivesThis study aims to evaluate patients with otosclerosis with respect to bone mineral density (BMD) at different regions of interest (ROI), using dual-energy X-ray absorptiometry (DXA). DesignCross-sectional controlled study. SettingTertiary referral hospital. ParticipantsThe patients with a definite diagnosis of otosclerosis confirmed intra-operatively were defined as the study group (n=30). The control group consisted of volunteer, healthy subjects with normal hearing (n=43). Main outcome measuresFollowing an audiometric evaluation, a venous blood sample was obtained and a single BMD measurement using DXA was applied to each participant. ResultsThe mean BMD, T and Z scores were higher in the otosclerosis group than in the control group in all the regions considered, but not significantly; only the L2-L3 lateral BMD and its T and Z scores were significant (P=0.036, P=0.029 and P=0.036, respectively). ConclusionThis study shows that the BMD does not decrease in the presence of otosclerosis despite its genetic and metabolic relevance with osteoporosis. Concerning the L2-L3 lateral BMD measurements, the BMD increased in otosclerosis.Öğe The condition of symmetrical sacroiliitis in axial spondyloarthritis: Comment on the article by Coates et al(Wiley, 2021) Tönük, Şükrü BurakTo the Editor:I read the article by Coates et al (1), recently published in Arthritis Care & Research, with great interest as it relates to the radiographic phenotype of axial spondyloarthritis according to the presence of HLA– B27, regardless of the primary diagno-sis of ankylosing spondylitis (AS) or psoriatic arthritis (PsA). The authors stated that the HLA– B27 gene is related to radiographic progression, syndesmophyte symmetry, and marginal syndes-mophytes, but not to sacroiliac symmetry. I would like to offer some suggestions from a biomechanical aspect, based on their important findings. Chronic biomechanical stress and microdam-age have been postulated as major triggering factors for lesion development, particularly in PsA. As compatible with a biome-chanical standpoint, tissue- specific kinetic factors (applied forces during motion) may play a critical role in the development of psori-atic lesions. Thus, PsA can de defined as an inflammatory disorder of more mobile musculoskeletal structures when AS is considered.Öğe Diz Osteoartritinde Pulse Elektromanyetik alan tedavisi ile Transkutanöz Elektriksel Sinir Stimülasyonu tedavisinin ağrı ve fonksiyonellik üzerine etkilerinin karşılaştırılması: Randomize klinik çalışma(2018) Yaşar, Mustafa Fatih; Tönük, Şükrü BurakAmaç: Diz osteoartrit tanısı almış hastalarda yüzeyel sıcak ve diatermi tedavilerine ek olarak uygulanan transkutanöz elektriksel sinir stimülasyon (TENS) ile yüzeyel sıcak ve diatermi tedavilerine ek olarak uygulanan pulse elektromanyetik alan (PEMF) tedavisinin ağrı ve fonksiyonel durum üzerine etkilerini karşılaştırmaktır. Gereç ve Yöntemler: Çalışmaya 48 semptomatik diz osteoartitli hasta dâhil edildi. Hastalar, kapalı zarf yöntemi ile TENS (n=24) ve PEMF (n=24) grupları olarak ikiye ayrıldı. Birinci gruba 100 Hz frekansta, 30 dakika/seans TENS uygulandı. İkinci gruba ise 50 Hz frekansta, 60 mikrotesla şiddet ile 24 dakika/seans PEMF uygulandı. Her iki gruba da iki hafta boyunca, haftada beş gün, günde bir seans yüzeyel sıcak (sıcak paket, sıcak toleransa göre, 20 dakika/seans) ve diatermi (ultrason 1,5 W/cm2 6 dakika/seans) uygulandı. Değerlendirmeler başlangıçta ve tedavi sonunda yapıldı. Sonuç ölçümleri olarak, vizüel analog skala (VAS) (0-100), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) ve Lequesne Skalası kullanıldı. Bulgular: Her iki grupta da VAS, WOMAC indeks ve Lequesne skala skorunda tedavi sonrasında tedavi öncesine göre anlamlı düzelme izlendi (p<0.05). Tedavi öncesi ve tedavi sonrası ölçüm değerleri farkının gruplar arası karşılaştırılmasında, TENS ve PEMF grupları arasında VAS (p=0,109), WOMAC (p=0,427) ve Lequesne (p=0,264) skorlarına göre istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Çalışmamız konvansiyonel tedaviye ek olarak uygulanan TENS ve PEMF’nin her ikisinin de diz OA semptomlarını iyileştirmede etkili olduğunu göstermiştir. PEMF ve TENS’nin benzer etki düzeyine sahip olduğu saptanmıştır.Öğe The effects of physical therapeutic agents on serum levels of stress hormones in patients with osteoarthritis(Lippincott Williams & Wilkins, 2016) Tönük, Şükrü Burak; Serin, Erdinç; Ayhan, Fikriye Figen; Yorgancıoğlu, Zeynep RezanTo investigate the effects of physical agents on the levels of stress hormones in patients with osteoarthritis (OA).Transcutaneous electrical nerve stimulation, hot packs, and therapeutic ultrasound were applied to the lumbar region and knees of patients with OA. Blood samples were taken for the measurement of the serum levels of glucose, insulin (INS), growth hormone (GH), prolactin (PRL), cortisol (COR), and plasma adrenocorticotropic hormone (ACTH) immediately before and after the 1st session, to investigate the acute effects of those physical agents on the endocrine system. The hormone levels were also measured every 5 sessions in a total of 10 sessions. The treatment response was also evaluated by using the visual analogue scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) throughout the therapy period.After the 1st session, there was a decrease in INS levels and a mild decrease in PRL levels (P=0.001 and P<0.05, respectively). Throughout the 10-session therapy period, the INS levels increased, whereas the ACTH and COR levels decreased (P<0.05 for all). The VAS-spine, RMDQ, VAS-knee, and WOMAC scores decreased (P=0.001 for VAS-spine and P<0.001 for all others). A positive correlation was detected between the changes in serum COR and WOMAC-pain score (P<0.05).Although the combination therapy caused changes in INS level accompanied with steady glucose levels, the application of physical agents did not adversely affect the hormone levels. The decrease in ACTH and COR levels may be attributed to the analgesic effect of agents and may be an indicator of patient comfort through a central action.Öğe Günlük yaşamda boyun fleksiyonu gerektiren aktiviteler ile servikal omurga dizilim bozukluğu arasındaki ilişki(2010) Şahin, Özlem; Kıyan, Aysu; Yaşar, Mustafa Fatih; Taşlıgil, Cemal; Çoğalgil, Şirzat; Tönük, Şükrü BurakAmaç: Günlük yaşamda boynu fleksiyona zorlayan aktivitelerin servikal omurgada dizilim bozukluğuna neden olup olmadığını araştırmaktır. Yöntemler: Çalışmaya kronik boyun ağrısı şikayeti olan 104 olgu alındı. Servikal omurgada düzleşme ya da kifotik deformite olması dizilim bozukluğu olarak kabul edildi. Servikal omurgadaki dizilim bozukluğu, posteriyor tanjant metoduna göre yan servikal omurga grafisinin değerlendirilmesi ile belirlendi. Boynu fleksiyona zorlayan aktiviteler sırt üstü yatarak televizyon seyretme ve sırt üstü yatarak ve oturarak kitap okuma aktiviteleri olarak belirlendi. Bulgular: Dizilim bozukluğu olan grupta 32 olgu (%68,1) sırt üstü yatarak televizyon seyrediyordu, 9 olgu (%19,1) sırt üstü yatarak kitap okuyordu, 20 olgu (%42,6) oturarak kitap okuyordu. Dizilim bozukluğu olmayan grupta, 32 (%71,1) olgu sırt üstü yatarak televizyon seyrediyordu, 8 (%17,8) olgu sırt üstü yatarak kitap okuyordu, 13 (%28,9) olgu oturarak kitap okuyordu. Gruplar arasında sırt üstü yatarak televizyon seyretme, sırt üstü yatarak ve oturarak kitap okuma dağılımına bakıldığında istatistiksel olarak anlamlı farklılık tespit edilmedi (p>0,05). Sonuç: Bu çalışmanın bulgularına göre boynu sıkça fleksiyona zorlayan aktiviteler, servikal omurgada dizilim bozukluğuna neden olmamaktadır. Dizilim bozukluğu, sorguladığımız aktiviteler dışında boynu fleksiyona zorlayan başka aktiviteleri ya da bireylerin omurga stabilitesini sağlayan kas ve bağ yapılarındaki olası güçsüzlüğü akla getirmektedir. Bu konuda kesin yargıya varmak için daha fazla sayıda olgu katılımının olduğu, boynu fleksiyona zorlayan aktivitelerin sorgulandığı ve egzersizin de etkilerinin incelendiği prospektif çalışmalara ihtiyaç vardır.Öğe Investigation of The Effect of Adalimumab on Experimental Brain Injury in Mice(2019) Günal, Mehmet Yalçın; Çankaya, Seyda; Tönük, Şükrü Burak; Özdemir, Ekrem Musa; Şakul, Ayşe Arzu SayınAim: We aimed to investigate the neuroprotective role of adalimumab based on the hypothesis that "TNF-alpha inhibitor adalimumab may affect inflammationrelated neuronal injury due to its anti-inflammatory effect". Methods: To investigate the effects of adalimumab, we induced brain injury in mice using a cold trauma model and evaluated the underlying cell survival/ death mechanisms via cresyl violet and calculated infarct/edema volume with image analyze system. Results: Although our data indicated a tendency to decreased infarct and edema volume, these findings are not significant statistically. Conclusion: To the best of our knowledge, this is the first study evaluating the neuroprotective effect of adalimumab on injured neurons.Öğe Kinetic factors may trigger lesion development in the patients with psoriatic arthritis(Wiley, 2016) Tönük, Şükrü Burak; Ramadan, Barış; Yorgancıoğlu, Zeynep RezanBiomechanical factors are likely to play a more sub-stantial role in the pathogenesis of psoriatic arthritis(PsA) compared to other spondyloarthropathies. Thenail, and particularly the lunula, is a frequently trau-matized tissue that is both functionally and histologi-cally integrated with the musculoskeletal system.1Arelationship between the inflammatory enthesealchanges of the distal interphalangeal joint capsuleand nail lesions in patients with PsA was demon-strated using magnetic resonance imaging (MRI).2Entheseal thickening of the digital extensor tendon ismore common in patients with clinical nail diseasecompared to patients without clinical nail disease inboth psoriasis and PsA.3Just as in the Koebner anddeep Koebner phenomena, these results point to thepotential effects of biomechanical factors in the path-ogenesis of psoriasis. It should be noted that psoriat-ic skin lesions most commonly appear on the sacralarea and extensor surfaces of the knee and elbow,where the skin is strained due to the excessive rangeof flexion motion. Another frequently involved site,the scalp, is also a stretched skin tissue. The cervicalspine, which is more mobile during the activities ofdaily living compared to the lumbar region, is proba-bly more frequently involved in PsA compared toother spondyloarthopathies. Radiographic changes ofthe cervical spine are more commonly observed inboth patients with psoriasis and those with PsA com-pared to healthy controls.4The cervical spine may bethe only axial involvement, especially when PsApatients are female and human leukocyte antigen(HLA)-B27 negative.Öğe Relationship between primary nodal generalized osteoarthritis with tissue antigens HLA-A and HLA-B in the Western Black Sea region of Turkey(Japan Soc Internal Medicine, 2011) Taşlıgil, Cemal; Çoğalgil, Şirzat; Tuğ, Esra; Tönük, Şükrü Burak; Şahin, Özlem; Doğruer, DilekObjective To investigate the relationship between patients diagnosed with nodal generalized osteoarthritis (NGOA) and tissue antigens HLA-A and HLA-B in the Western Black Sea Region of Turkey. Patients and Methods Forty-six patients with NGOA (64.74 +/- 8.46) and 60 controls (62.32 +/- 6.8) were included in the study. Inclusion criteria were: (i) stage 2 and higher OA of the hand and knee based on the Kellgren-Lawrence classification, and (ii) stage 2 and higher lumbar disc degeneration according to Lawrence classification. Family histories were taken from patients. HLA-A and HLA-B were typed by PCR using sequence specific primer. Results The frequencies of HLA-A*02 and HLA-B*38 were 58.7% and 15.2%, respectively, in patients with NGOA, and there was a statistically significant relationship between the disease and HLA-A*02 and HLA-B*38. The relationship between positive family history and HLA-B*44 allele was also statistically significant. In the control group, the frequency of HLA-A*29 was 11.7% and it was statistically significant. Conclusion To our knowledge this is the first study to demonstrate the epidemiologic association between HLA-A*02 and HLA-B*38 with NGOA in our population. We conclude that, HLA-B*44 positivity may be associated with familial NGOA and HLA-A*29 may be a preventive factor against NGOA.Öğe Serum levels of visfatin, resistin and adiponectin in patients with psoriatic arthritis and associations with disease severity(Wiley-Blackwell, 2016) Dikbaş, Oğuz; Tosun, Mehmet; Beş, Cemal; Tönük, Şükrü Burak; Akşehirli, Özge Yılmaz; Soy, MehmetAim: Psoriatic arthritis (PsA) is an inflammatory form of arthritis typically associated with psoriasis and/or psoriatic nail disease. Adipocytokines were once thought to influence development of (only) insulin resistance and diabetes mellitus. However, it is now clear that adipocytokines play important roles in development of the inflammation associated with either autoimmune or auto-inflammatory disorders. In the present study, we measured changes in the serum levels of adiponectin, resistin and visfatin, and the associations of such changes with the extent of disease activity and insulin resistance in PsA patients. Material and methods: A total of 67 subjects (28 with PsA and 39 healthy controls) without hypertension or diabetes mellitus were enrolled. Adiponectin, resistin and visfatin levels, and the extent of insulin resistance (assayed using the homeostasis model [HOMA-IR]), were measured in all subjects. Assessment of PsA disease activity was done with the Disease Activity Index for Psoriatic Arthritis (DAPSA). Results: Psoriatic arthritis patients had considerably higher serum levels of adiponectin, resistin and visfatin than did healthy controls (all P < 0.05). In the logistic regression analysis, the following variables may contribute to complex pathogenesis of PsA: adiponectin (P = 0.001, OR = 3.1, 95% CI = 1.6-6.0), resistin (P = 006, OR = 1.8, 95% CI = 1.2-2.9) and visfatin (P = 0.031, OR = 3.9, 95% CI = 1.1-13.9). In contrast, we have not detected any correlation between DAPSA and adipocytokine serum levels (P > 0.05). Conclusion: There is no correlation between adipocytokines and disease activity. Although serum adiponectin, resistin and visfatin levels are higher in patients with PsA, pathophysiological significance of the result has to be evaluated with more extensive studies.Öğe Subclinical entheseal findings are related with nail involvement and high body mass index in the patients with psoriasis without arthritis(Clinical & Exper Rheumatology, 2014) Ramadan, Barış; Tönük, Şükrü Burak; Parlak, Ali Haydar; Çoğalgil, ŞirzatÖğe Temperament and character profiles of ankylosing spondylitis patients compared to major depression patients and healthy controls(Clinical & Exper Rheumatology, 2014) Tönük, Şükrü Burak; Arısoy, Özden; Öztürk, Erhan Arif; Boztaş, Mehmet Hamid; Sultanoğlu, Tuba ErdemÖğe Temperament and character profiles of ankylosing spondylitis patients compared with major depression patients and healthy controls(LIPPINCOTT WILLIAMS & WILKINS, 2021) Tönük, Şükrü Burak; Arısoy, Özden; Öztürk, Erhan Arif; Boztaş, Mehmet Hamid; Kaygusuz, Çiğdem ÇifciBackground/Objective Depressive disorder is common in patients with ankylosing spondylitis (AS), who exhibit specific brain imaging abnormalities resembling those in major depression (MD). We compared temperament and character profiles between patients with AS and MD. Methods The study involved 36 patients with AS, 40 with MD, and 36 healthy controls (HCs). The participants were age-, sex-, and education-matched. Depression, anxiety, temperament, and character were evaluated using the Temperament and Character Inventory and physician-rated Hamilton Depression and Anxiety Scales. Disease severity was assessed using the Bath Ankylosing Spondylitis Disease Activity, Radiology, Metrology, and Functionality Indexes; erythrocyte sedimentation rate; and C-reactive protein. Results Depression and anxiety scores were highest in MD, lowest in HCs, and intermediate in AS (p < 0.001). Harm avoidance was significantly higher in MD and AS than HCs (p = 0.01). Reward dependency was lower (p = 0.011) and self-transcendence higher in AS only (p = 0.034). Bath Ankylosing Spondylitis Radiology Index was negatively correlated with depression (p = 0.020). Bath Ankylosing Spondylitis Radiology Index and Bath Ankylosing Spondylitis Metrology Index were negatively correlated with harm avoidance (p < 0.05). Disease duration was negatively correlated with self-transcendence (p = 0.027). Harm avoidance was correlated with depression score (p = 0.029). Patients under tumor necrosis factor alpha inhibitor treatment had lower cooperativeness score (p = 0.022). Conclusions Patients with AS had a specific Temperament and Character Inventory pattern. Harm avoidance was common in both AS and MD. In AS, harm avoidance and depression decreased in patients with progression, probably because progressive fusion of the spinal segments causes decrease in pain. Harm avoidance (fear of pain) seemed to be an acting factor for occurrence of depressive symptoms in AS.
