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    Biomechanical Factors in Psoriatic Disease: Defective Repair Exertion as a Potential Cause. Hypothesis Presentation and Literature Review
    (Wiley, 2019) Tonuk, Sukru Burak; Yorgancioglu, Zeynep Rezan
    Joining main clinical manifestations of psoriatic skin disorder are inflammatory arthritis and nail lesions. Repetitive microdamage has been postulated as a main triggering factor in lesions of psoriatic arthritis. This concept of psoriatic disease might also be admissible for triggering nail lesions because the nail is a frequently traumatized structure. Here, we aimed to describe the conjectural injury mechanisms of nail complex with regard to acting biomechanical factors. Tissue repair response to physical microdamage may be altered in psoriatic disease. It is plausible to consider that a defective repair process in the dysregulated prepsoriatic tissue may lead to innate immune activation and further development of autoinflammatory lesions, although excessive inflammation is known to impair wound healing. Recently published data have revealed the importance of mechanosensitive Wingless-type (Wnt) signaling in the pathophysiology of psoriasis and ankylosing spondylitis. The Wnt signaling system is involved in morphogenesis, repair, and regeneration as a biologic process main regulator. Wnt5a seems to be a dominating mediator in both psoriatic plaques and during the spondylitis process that might also be a linking molecule of psoriatic response to mechanical stress. Future studies should focus on complex responsive interactions of tissue repair regulators regarded in psoriatic disease.
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    Comparison of the Efficacy of Corticosteroid and Local Anesthetic Injections Combined with Physiotherapy in Patients with Concomitant Pes Anserine Bursitis and Knee Osteoarthritis: A Prospective Randomized Study
    (2022) Yaşar, Mustafa Fatih; Kurul, Ramazan; Yakşi, Elif; Aydilek, Merve; Ates, Zeynep; Tonuk, Sukru Burak
    Objectives: It was aimed to investigate the effects of local corticosteroid and local anesthetic injection in patients with concomitant pes anserine bursitis and knee osteoarthritis.\rMethods: In this prospective randomized controlled study, 102 patients with knee osteoarthritis with pes anserine bursitis were divided into three groups: group I (physiotherapy + lidocaine), group II (physiotherapy + betamethasone dipropionate), and group III (physiotherapy: control). Evaluations were performed three times at the start of treatment, \rat day 15, and at week eight, using the Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and the Timed up and go (TUG).\rResults: There was no difference in age, BMI, gender and baseline values in all three groups. There was a significant difference between the groups in pre and post treatment VAS and WOMAC scores (p<0.05). However, there was no difference between the groups in the post-test follow-up values (p>0.05). While betamethasone significantly decreased \rVAS and WOMAC scores, only WOMAC scores were decreased in the lidocaine group. There was no significant difference between the WOMAC scores of the lidocaine and betamethasone groups (p>0.05).\rConclusion: Corticosteroids and lidocaine are avaiable choices to relieve pain, our results show, corticosteroids are more effective. Consequently, steroids may be considered as a better option in patients with concomitant pes anserine bursitis and knee osteoarthritis.
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    Relationship between DXA measured systemic bone mineral density and subchondral bone cysts in postmenopausal female patients with knee osteoarthritis: a cross-sectional study
    (Bmc, 2024) Tonuk, Sukru Burak; Yorgancioglu, Zeynep Rezan; Ramadan, Selma Uysal; Kocaoglu, Seher
    BackgroundIndividuals with high systemic bone mineral density (BMD) may have an increased risk of incident knee osteoarthritis (OA). Besides that, radiographic osteophytes are strongly associated with BMD. Because of these reasons, the aim of the study was to investigate the possible association between radiological subchondral bone cyst (SBC) grade and systemic BMD and vitamin D status in the postmenopausal female patients with knee OA in a crosss-sectional study.MethodsThis study included of 48 osteoporosis treatment-free postmenopausal patients diagnosed with symptomatic medial compartment knee OA. BMD analysis was performed using dual-energy X-ray absorptiometry (DXA) and serum vitamin D levels were measured after recording patients' findings. Each knee was scanned using computed tomography (CT), and categorical SBC scores were graded for the medial and lateral tibiofemoral (TF) and patellofemoral (PF) compartments and further calculated as compartmental total, total TF and grand total of both TF compartments. SBC scores were analysed with correlation analysis.ResultsThe patient population was characterized by radiographic joint space narrowing, obesity and low vitamin D status. Median medial total and grand total TF SBC scores were significantly different between the patient groups according to the Kellgren-Lawrence (KL) radiographic grading (p = 0.006 and p = 0.007, respectively). There were no correlations between femoral BMD values and SBC scores. However, positive correlations were detected significantly between L1 - 4 DXA values and TF SBC scores, but not with PF SBC scores (p = 0.005 for the correlation between L1 - 4 BMD and medial compartments total TF SBC score, p = 0.021 for the correlation between L1 - 4 BMD and grand total TF SBC score). No significant correlations were found with Vitamin D levels.ConclusionsDevelopment of TF OA high-grade SBCs may be linked to systemic bone mass as represented by trabecular bone-rich lumbar vertebrae. The relationship might point to the importance of bone stiffness as an acting factor in knee OA possibly with mechanical energy transfer to the joint.