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Parlar K, Tahir Turanli E, Nuhoglu Kantarci E, Hacioglu A, Kirectepe Aydin A, Ayla AY, Voyvoda U, Ozdogan H, Ugurlu S. A case with febrile attacks and vasculopathy associated with ADA2 and MEFV pathogenic variants. Mod Rheumatol Case Rep 2023; 8:121-124. [PMID: 37542433 DOI: 10.1093/mrcr/rxad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/06/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
Deficiency of adenosine deaminase 2 (DADA2), caused by recessive mutations in the adenosine deaminase 2 (ADA2) gene, results in cutaneous or systemic vasculitis with variable clinical manifestations. There is only one other case in literature carrying both ADA2 and MEFV gene pathogenic variants. Here we report the second case that carries both ADA2 and MEFV pathogenic variants, presenting with characteristic phenotypes of both familial Mediterranean fever (FMF) and DADA2. A male patient, currently 29 years old, was initially diagnosed with FMF and developed livedo reticularis and nodular dermal lesions compatible with cutaneous polyarteritis nodosa (PAN) a year after diagnosis. His family history revealed a brother 2 years older than himself who was diagnosed with PAN and died at age 22 because of gut perforation secondary to acute mesenteric ischaemia. ADA2 gene mutation analysis on chromosome 22q11.1 was positive, and the patient responded to colchicine and infliximab.
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Affiliation(s)
- Kerem Parlar
- Yeditepe University School of Medicine, Istanbul, Turkey
| | - Eda Tahir Turanli
- Faculty of Engineering and Natural Sciences, Molecular Biology and Genetics, Acıbadem University, Istanbul, Turkey
- Graduate School of Natural and Applied Science, Molecular Biology and Genetics, Acibadem University, Istanbul, Turkey
| | - Eda Nuhoglu Kantarci
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aysa Hacioglu
- Department of Endocrinology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Asli Kirectepe Aydin
- Medical Faculty, Department of Biomedical Science, Nisantasi University, Istanbul, Turkey
| | - Ali Yagiz Ayla
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Umut Voyvoda
- Graduate School of Natural and Applied Science, Department of Molecular and Translational Biomedicine, Acibadem University, Istanbul, Turkey
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Oztas M, Altun I, Ayla AY, Cerme E, Demirdag C, Asa S, Sonmezoglu K, Ugurlu S. Rituximab in the management of retroperitoneal fibrosis: A single tertiary rheumatology care center experience. Int J Rheum Dis 2023; 26:1714-1721. [PMID: 37358327 DOI: 10.1111/1756-185x.14798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/27/2022] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
AIM To investigate the clinical and radiological outcomes and glucocorticoid-sparing effect of rituximab therapy in 13 patients with retroperitoneal fibrosis (RPF). METHODS We analyzed the data of both glucocorticoid-naive and glucocorticoid-resistant RPF patients who were treated with rituximab. Demographic features, positron emission tomography computed tomography (PET-CT) findings, and clinical and histopathologic outcomes were collected retrospectively. RESULTS We evaluated the data of 13 RPF patients (8M/5F). The median follow-up duration was 28 months (interquartile range [IQR] 24.5-55.5 months) and median age at the time of diagnosis was 50.8 years (IQR 46.5-54.5 years). PET-CT scans showed that following the rituximab therapy, the craniocaudal diameter of the RPF mass reduced from 74 mm (IQR 50.5-130 mm) to 52 mm (IQR 35-77 mm; p = .06), and periaortic thickness of the RPF mass reduced from 14 mm (5.5-21.9 mm) to 7 mm (4.5-11 mm; p = .12). The maximum standardized uptake value (based on body weight) of the RPF mass decreased from 5.8 (4.3-9.7) to 3.1 (2.8-5.3) after the therapy (p = .03). The number of patients with hydronephrosis reduced from 11 to 6 following rituximab therapy (p = .04). Before rituximab, nine patients received a median dose of 10 mg (IQR 0-27.5 mg) prednisolone per day. After the rituximab treatment, we discontinued prednisolone treatment for four out of nine patients and reduced the daily dose for the remaining patients. At the time of the final evaluation of the patients, the median prescribed prednisolone dose was 5 mg/day (IQR 2.5-7.5 mg/day; p = .01). CONCLUSION Our study shows that rituximab may be a favorable treatment option for glucocorticoid-refractory RPF patients with high disease activity on PET-CT scans.
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Affiliation(s)
- Mert Oztas
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Izzet Altun
- Department of Medicine, St. Agnes Medical Center, Baltimore, Maryland, USA
| | - Ali Yagiz Ayla
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Emir Cerme
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cetin Demirdag
- Department of Urology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sertac Asa
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ak T, Mustafayeva L, Celik Y, Ayla AY, Ugurlu S. When to start secukinumab treatment in patients with axial spondyloarthropathy: Before or after anti-TNFα treatment? Reumatol Clin (Engl Ed) 2023; 19:175-179. [PMID: 37061278 DOI: 10.1016/j.reumae.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/24/2022] [Indexed: 04/17/2023]
Abstract
INTRODUCTION AND OBJECTIVES This study aimed to evaluate the efficacy of secukinumab (SEC) in axial spondyloarthropathy (axSpA) in anti-TNFα naïve and anti-TNFα experienced patients. It also focused on the duration of SEC treatment and its side effects. PATIENTS AND METHODS The patients with axSpA treated with SEC and followed up in our outpatient clinic from May 2018 through October 2021 were included in this study. All patients in the study also fulfilled the ASAS classification criteria for axSpA. Patients were separated into two groups according to whether they received prior anti-TNFα therapy. While anti-TNFα naïve patients comprised group 1, anti-TNFα experienced patients were included in group 2. Pre- and post-treatment BASDAI scores were reported and compared. RESULTS Eighty-four axSpA patients (42 men; duration of the disease: 86.86±65.35 months in group 1 and 160.65±97.4 months in group 2) were treated with SEC. 45.5% of anti-TNFα naïve patients and 56.5% of anti-TNFα experienced patients were still on SEC therapy in October 2021. Duration of SEC treatment was 12.5±7.9 months in group 1 and 17.19±12 months in group 2 (p=0.098). The differences between pre-and post-treatment BASDAI scores were statistically significant in both groups (p<0.001). While patients in group 1 did not develop any adverse effects, three patients in group 2 experienced alopecia, uveitis, and recurrent pneumonia after SEC treatment. CONCLUSION Our study's efficacy and safety data on the use of SEC were reassuring in both anti-TNFα naïve and anti-TNFα experienced patients. However, further studies are still needed to determine the appropriate timing to begin SEC treatment.
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Affiliation(s)
- Tumay Ak
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Istanbul, Turkey
| | - Leyla Mustafayeva
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Yeliz Celik
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Ali Yagiz Ayla
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Serdal Ugurlu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
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Ak T, Temiz SNY, Taner M, Ayla AY, Aygun AA, Engin B, Can G, Ugurlu S. Effectiveness of anti-interleukin-23 therapy in psoriatic arthritis: A pilot prospective real-world study. Int J Rheum Dis 2023; 26:878-884. [PMID: 36929151 DOI: 10.1111/1756-185x.14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
AIM This study aimed to show the effectiveness of interleukin (IL)-23 inhibitors in psoriatic arthritis (PsA) at weeks 12 and 24 in a real-world setting. MATERIALS AND METHODS Forty-three patients with active PsA were enrolled in this study. These patients were treated with either guselkumab (n = 20) or risankizumab (n = 23). Treatment responses at the 12th and 24th weeks were evaluated with the parameters of the number of joints with active arthritis, Psoriasis Area Severity Index (PASI) response rate, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, Disease Activity Index for Psoriatic Arthritis (DAPSA) score, and C-reactive protein (CRP) value. The study's primary endpoint was BASDAI ≤ 4 and DAPSA ≤ 14 at week 24, and the secondary endpoint was the absence of joints with clinically active arthritis signs at week 24. RESULTS IL-23 inhibition significantly improved all treatment response parameters at the 12th and 24th weeks (P < 0.001). While 90% of patients reached the primary endpoint with anti-IL23 therapy, 74% achieved the secondary endpoint. Both biologic-naïve and biologic-experienced patients responded significantly to anti-IL-23 therapy. Also, no adverse events related to anti-IL-23 agents were observed. CONCLUSIONS The response parameters indicating the severity of PsA (the number of joints with active arthritis, BASDAI score, DAPSA score, and CRP value) and a parameter indicating the severity of skin involvement, that is, PASI score, significantly improved with anti-IL-23 therapy at weeks 12 and 24. Moreover, significant improvement was achieved at week 24 compared to week 12 in all response parameters.
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Affiliation(s)
- Tumay Ak
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sera Nur Yucesoy Temiz
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Meliksah Taner
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ali Yagiz Ayla
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Atıl Aygun
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burhan Engin
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ugurlu S, Akcin R, Ayla AY, Kocazeybek B, Oztas M, Can G, Mustafayeva L, Saltoglu N, Yilmaz B, Ozdogan H. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:SI194-SI196. [PMID: 35258567 PMCID: PMC9383560 DOI: 10.1093/rheumatology/keac123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/10/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Serdal Ugurlu
- Correspondence to: Serdal Ugurlu, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Fatih, Istanbul 34098, Turkey. E-mail:
| | | | - Ali Yagiz Ayla
- Division of Rheumatology, Department of Internal Medicine
| | | | - Mert Oztas
- Division of Rheumatology, Department of Internal Medicine
| | | | | | - Nese Saltoglu
- Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Betul Yilmaz
- Division of Rheumatology, Department of Internal Medicine
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine
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