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Parlar K, Ates MB, Egeli BH, Ugurlu S. The clinical role of anakinra in the armamentarium against familial Mediterranean fever. Expert Rev Clin Immunol 2024; 20:441-453. [PMID: 38133629 DOI: 10.1080/1744666x.2023.2299230] [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: 08/30/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Familial Mediterranean Fever (FMF) is the most common autoinflammatory disease that has mainly been treated with colchicine since 1972. A significant portion of patients do not respond to colchicine and require further treatment, mainly IL-1β antagonists such as anakinra, canakinumab and rilonacept as IL-1β has a crucial role in pathogenesis of FMF. This review summarizes the current approach to treating FMF and discovers the pharmacological and clinical utility of IL-1 blocking agents based on accumulated evidence with a focus on anakinra. AREAS COVERED This review focuses on anakinra treatment in FMF. The data obtained from case reports, case series, retrospective studies and a Phase III trial are analyzed. Safety and efficacy profiles of anakinra are discussed. EXPERT OPINION Anakinra is the cheapest anti-IL-1 agent used in the treatment of colchicine-resistant FMF. It is shown to be effective and safe when used in adjunct to colchicine however its short half-life and potential to cause injection site reactions limit its use.
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Affiliation(s)
- Kerem Parlar
- Cerrahpasa University Faculty of Medicine, Istanbul, Turkey
| | | | - Bugra Han Egeli
- Department of Pediatrics, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Kilic B, Guler Y, Azman FN, Bostanci E, Ugurlu S. Efficacy and safety of anti-interleukin-1 treatment in familial Mediterranean fever patients: a systematic review and meta-analysis. Rheumatology (Oxford) 2024; 63:925-935. [PMID: 37769252 DOI: 10.1093/rheumatology/kead514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES FMF is the most common hereditary monogenic fever syndrome marked by recurrent attacks of fever and polyserositis. Colchicine is the current recommended first-line treatment for FMF. However, a small portion of FMF patients are unresponsive or intolerant to colchicine. Anti-IL-1 agents are alternative treatment options for colchicine-resistant or -intolerant FMF patients. This systematic review and meta-analysis aimed to provide qualitative and quantitative evidence for the efficacy and safety of anti-IL-1 agents in adult and paediatric FMF patients. METHODS MEDLINE, EMBASE, CENTRAL and Web of Science were screened from inception to May 2023. We included adult and paediatric FMF patients who received continuous treatment with at least one of the anti-IL-1 drugs: anakinra, canakinumab and rilonacept. The primary efficacy outcome was the proportion of patients who achieved complete remission of attacks and the primary safety outcome was the proportion of patients who experienced at least one adverse event during treatment. A random-effects meta-analysis was performed for the quantitative synthesis. RESULTS Fourty-four reports consisting of 1399 FMF patients were included. Sixty percent (95% CI 49%, 72%) of the adult patients and 81% (95% CI 72%, 89%) of the paediatric patients achieved complete remission. Anti-IL-1 agents significantly decreased levels of inflammatory markers. At least one adverse event was observed in 25% (95% CI 13%, 37%) of the adult patients and 12% (95% CI 3%, 21%) of the paediatric patients. CONCLUSION Anti-IL-1 agents were effective and demonstrated a low adverse event profile in paediatric and adult FMF patients.
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Affiliation(s)
- Berkay Kilic
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yelin Guler
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Feyza N Azman
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ece Bostanci
- 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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Hacıoglu E, Er O, Karup S, Ugurlu S. Case report: Other autoinflammatory mutations in a patient with atypical familial Mediterranean fever symptoms. Int J Rheum Dis 2024; 27:e15136. [PMID: 38570934 DOI: 10.1111/1756-185x.15136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Ervanur Hacıoglu
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozan Er
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sejla Karup
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Cerrahpasa Faculty of Medicine, Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Er O, Ugurlu S. Fertilization, reproductive system, and pregnancy in familial Mediterranean fever: Clinical state of art. Mod Rheumatol 2024; 34:265-271. [PMID: 37405693 DOI: 10.1093/mr/road067] [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: 03/29/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
Systemic autoinflammatory diseases have always been one of the most striking and challenging aspects of the art of medicine. Among this fascinating constellation of diseases, familial Mediterranean fever (FMF) is the most common. FMF involves the reproductive system and may cause fertility problems. With the start of the interleukin (IL)-1 inhibitors era, there is a need to reorganize our knowledge on FMF management, particularly in pregnant patients and those experiencing fertilization problems. The primary aim of this review is to gather recent information on the effects of FMF on fertilization and the reproductive system, as well as to shed light on the management of pregnancy in FMF patients.
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Affiliation(s)
- Ozan Er
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
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Kilic B, Parlar K, Ugurlu S. Comment on: Pregnancy outcomes in patients with familial Mediterranean fever: systematic review and meta-analysis. Rheumatology (Oxford) 2024; 63:e56-e57. [PMID: 37952166 DOI: 10.1093/rheumatology/kead607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
- Berkay Kilic
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Kerem Parlar
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Kilinc OC, Kilinc A, Azman FN, Ardac S, Egeli B, Demirel OF, Ugurlu S. Anxiety and depression among patients with familial Mediterranean fever. Z Rheumatol 2024; 83:236-241. [PMID: 37957401 DOI: 10.1007/s00393-023-01445-z] [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] [Accepted: 10/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is a systemic autoinflammatory disease that requires lifelong treatment and is associated with several comorbidities, including mental health disorders such as anxiety and depression. FMF and mental health necessitate further research; hence, this study aims to observe anxiety and depression and their relationship with several variables in patients with FMF. METHODS As the study population, 360 FMF patients were surveyed between June and October 2022. Surveys included inventories assessing anxiety and depression, i.e., the Beck's Depression Inventory (BDI), the Beck's Anxiety Inventory (BAI), and the State-Trait Anxiety Inventory (STAI). RESULTS Mean scores for STAI-Y1 (state), STAI-Y2 (trait), BAI, and BDI were 42.2 ± 12.0, 45.9 ± 10.6, 24.0 ± 13.9, and 13.1 ± 8.99, respectively. Medication-adherent patients had significantly lower scores on STAI-Y1 (41.5 ± 11.4 vs. 45.2 ± 14.0; p-value: 0.04). M694V homozygous patients exhibited significantly lower scores in the BDI (12.4 ± 9.37 vs. 13.2 ± 8.93; p-value: < 0.001) and BAI (17.0 ± 12.1 vs. 25.1 ± 13.9; p-value: 0.001). The patients with an exon-10 mutation demonstrated significantly lower scores compared to patients with an exon‑2 mutation (17.9 ± 12.3, 29.6 ± 13.3; p-value: < 0.001). CONCLUSION The patients with FMF had mild depression and moderate anxiety scores. A higher level of education and medication adherence were associated with lower levels of anxiety. Likewise, the patients with genotypes associated with severe disease courses had lower levels of anxiety. We suggest that physicians should be more attentive to patients with a milder disease course and ensure that these patients are provided with sufficient treatment and knowledge about their disease.
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Affiliation(s)
- Ozgur C Kilinc
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 53 Kocamustafapasa Street, Fatih, 34098, Istanbul, Turkey
| | - Abdulmenaf Kilinc
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 53 Kocamustafapasa Street, Fatih, 34098, Istanbul, Turkey
| | - Feyza N Azman
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 53 Kocamustafapasa Street, Fatih, 34098, Istanbul, Turkey
| | - Selim Ardac
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 53 Kocamustafapasa Street, Fatih, 34098, Istanbul, Turkey
| | - Bugra Egeli
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, USA
| | - Omer F Demirel
- Department of Psychiatry, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 53 Kocamustafapasa Street, Fatih, 34098, Istanbul, Turkey.
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Toker Dincer Z, Karup S, Yilmaz E, Corbali O, Azman FN, Melikoglu M, Ugurlu S. Anakinra in idiopathic recurrent pericarditis: a comprehensive case series and literature review. Z Rheumatol 2024:10.1007/s00393-023-01471-x. [PMID: 38277021 DOI: 10.1007/s00393-023-01471-x] [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] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Idiopathic recurrent pericarditis (IRP) is defined by recurring episodes of pericardial inflammation without a known cause. This study investigates the safety and efficacy of anakinra, an interleukin‑1 inhibitor, as a successful therapy for IRP in cases resistant to conventional treatment. METHODS A retrospective evaluation of patients treated at our autoinflammatory center between 2011 and 2023 was conducted. Patient files were examined for demographic, clinical, and treatment response data, including nonsteroid anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine. Monogenic autoinflammatory disease screening was performed for Mediterranean Fever (MEFV), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), mevalonate kinase (MVK), nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3), and nucleotide-binding oligomerization domain-containing protein 2 (NOD2). Patients who experienced multiple episodes of pericarditis were diagnosed with recurrent pericarditis. The study evaluated anakinra treatment in IRP patients unresponsive to conventional therapy. RESULTS The study included 21 participants, 9 (42.9%) female and 12 (57.1%) male. The average age of the participants was 43.1 ± 16.5 years. The MEFV mutation analysis revealed that 2 (9.5%) had a mutation in exon 10 and 4 (19.0%) had one in exon 2. Out of the 16 cases, 15 successfully discontinued steroid treatment. Four patients (19.0%) experienced injection site reactions. C‑reactive protein (CRP) levels were measured at an average of 196 ± 67.8 mg/l before and 2.6 ± 3.15 mg/l after anakinra treatment. CONCLUSION In conclusion, the study adds to the growing evidence for the efficacy of interleukin-1 inhibitors, such as anakinra, as a promising treatment modality for IRP in cases resistant to conventional treatment.
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Affiliation(s)
- Zeynep Toker Dincer
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Sejla Karup
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Erkin Yilmaz
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Osman Corbali
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Feyza Nur Azman
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34098, Istanbul, Turkey.
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 53 Kocamustafapasa Street, 34098, Fatih, Turkey.
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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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Bahar F, Ugurlu S. Unprecedented Coexistence of Autoinflammatory Myositis and Chronic Thrombosis with heterozygotic M694V mutation: An atypical presentation of Familial Mediterranean Fever. Mod Rheumatol Case Rep 2023:rxad072. [PMID: 38123484 DOI: 10.1093/mrcr/rxad072] [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: 08/23/2023] [Revised: 10/24/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disorder predominantly characterized by periodic fever, abdominal pain, and joint manifestations. It can exhibit various atypical presentations and affects individuals globally. However, cases of FMF concurrently presenting with chronic thrombosis and myositis have not been previously reported. A 41-year-old male presented with alternating severe bilateral leg pain, stiffness, and localized swellings without fever or abdominal symptoms. His history included recurrent inflammatory joint pain treated with prednisolone. Physical examination revealed leg pain, limited ankle joint movement, and tender swellings in thighs, forearms, and feet. Collateral abdominal veins were also observed. Unresponsive to prednisolone and colchicine, the patient underwent MRI, revealing muscle inflammation in both legs and thighs and chronic thrombosis in the infrarenal inferior vena cava. Genetic testing confirmed the heterozygotic M694V mutation, diagnosing an atypical FMF. Anakinra treatment led to substantial clinical and laboratory improvement. Although FMF diagnosis typically relies on characteristic clinical features and genetic analysis, atypical presentations challenge established criteria. This case uniquely showcases coexisting myositis and chronic thrombosis in FMF. Myalgia is common in FMF, with M694V mutation associated with severe muscular symptoms. The lack of fever and myositis findings differentiate our case from protracted febrile myalgia syndrome. FMF's chronic inflammatory state is known to influence thrombosis risk, and our findings align with this association. Chronic thromboembolism and myositis together signify an unusual clinical presentation of FMF. This case highlights the potential for FMF to present with complex manifestations beyond the conventional symptoms. Myositis and vascular involvement should prompt consideration of FMF diagnosis when combined with patient history, clinical features, and laboratory results. These rare associations underscore the need for further research to enhance understanding of FMF's diverse clinical spectrum.
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Affiliation(s)
- Furkan Bahar
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Ates MB, Karup S, Ugurlu S. Infliximab as successful treatment option in a case of adenosine deaminase 2 deficiency. Reumatismo 2023; 75. [PMID: 38115782 DOI: 10.4081/reumatismo.2023.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/13/2023] [Indexed: 12/21/2023] Open
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is a recessively inherited autoinflammatory disease characterized by systemic inflammation and immunodeficiency. Infliximab proved to be favorable in the treatment of this condition. This case report is concerned with a DADA2 deficient patient treated with infliximab. This is a rare case of DADA2 in a 32-year-old female patient. The patient was admitted with a clinical presentation of erythema, ulcers, and pruritus on both legs and ankles, accompanied by red ulcerative oral lesions, fatigue, malaise, and dizziness. The patient's genetic analysis was positive for DADA2. Treatment based on TNF-α inhibition was highly effective for this patient. We used laboratory testing and punch biopsy as differential diagnostic tools, where antinuclear antibody positivity, high prolactin levels, and high serum C-reactive protein were observed. The punch biopsy revealed both orthohyperkeratosis and parahyperkeratosis of the dermis, diffuse core fragments, plasma in the stratum corneum, and hypergranulous acanthosis. DADA2 treatment is centered on tumor necrosis factor α suppression. Although high-dose systemic glucocorticoids can reduce inflammation in the initial stages of the disease, most patients have a resistant or relapsing response to tapering attempts. The prevalence of undiagnosed cases of autoinflammatory diseases is anticipated to diminish with the growing awareness of them.
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Affiliation(s)
- M B Ates
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, University of Istanbul.
| | - S Karup
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, University of Istanbul.
| | - S Ugurlu
- Division of Rheumatology, Department of Medicine, Cerrahpasa Medical Faculty, University of Istanbul.
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Parlar K, Kilic B, Ugurlu S. Comment on: Increased risk of osteoporosis and femoral neck fractures in patients with familial Mediterranean fever-a large retrospective cohort study. Rheumatology (Oxford) 2023:kead635. [PMID: 38048600 DOI: 10.1093/rheumatology/kead635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Affiliation(s)
- Kerem Parlar
- Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Berkay Kilic
- Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Yılmaz R, Murt A, Gurses I, Ugurlu S. A different presentation of tubulointerstitial nephritis and uveitis syndrome mimicking Sjögren's syndrome. Arch Rheumatol 2023; 38:659-661. [PMID: 38125065 PMCID: PMC10728746 DOI: 10.46497/archrheumatol.2023.10042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/22/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Reyhan Yılmaz
- Department of Internal Medicine, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Ahmet Murt
- Department of Nephrology, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Iclal Gurses
- Department of Pathology, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Serdal Ugurlu
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
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Baspinar SN, Kilic B, Azman FN, Guler Y, Gunay UB, Tanin MK, Can G, Ugurlu S. Cancer incidence in Familial Mediterranean Fever: A retrospective analysis. Semin Arthritis Rheum 2023; 63:152284. [PMID: 37979399 DOI: 10.1016/j.semarthrit.2023.152284] [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: 07/28/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Familial Mediterranean Fever (FMF) is the most common hereditary monogenic fever syndrome that is characterized by recurrent attacks of fever and polyserositis. Anti-inflammatory drugs, with colchicine being the first-line therapy, have been used in the management of FMF. This study aims to evaluate the risk of cancer in Turkish FMF patients. METHODS We retrospectively screened the cancer-related outcomes of our study group which consisted of Turkish FMF patients registered at our division. Cancer estimates of the Turkish population were published by the Turkish Ministry of Health in the Turkey Cancer Statistics Report 2018. Standardized incidence rates (SIR) were calculated to compare the cancer incidence observed in our study group with the expected cancer incidence of the Turkish population. Subgroup analyses were conducted on the subgroups, based on gender and usage of biological agents. RESULTS Our study included 1734 FMF patients, 1054 (60.8 %) of whom were females. The total follow-up was 68,784 person-years. Cancer was observed in 35 (2 %) of these patients. Turkish FMF patients had a significantly lower incidence of cancer, compared with the overall Turkish population [SIR 0.64 (95 % CI 0.46-0.89), p < 0.01]. No significant association was found between cancer and biological agent therapies in FMF patients. CONCLUSIONS Findings from our study indicate that the risk of cancer was decreased by 36 % in Turkish patients with FMF, compared with the outcomes of the overall Turkish population. Life-long exposure to anti-inflammatory drugs, primarily colchicine, may be the underlying reason for this outcome. Further studies are needed for the confirmation and explanation of this association.
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Affiliation(s)
- Sura Nur Baspinar
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Berkay Kilic
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Feyza Nur Azman
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Yelin Guler
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ulgar Boran Gunay
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Gunay Can
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Public Health, Istanbul, Turkey
| | - Serdal Ugurlu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey.
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Kilinc OC, Ugurlu S. Clinical features of dermatomyositis patients with anti-TIF1 antibodies: A case based comprehensive review. Autoimmun Rev 2023; 22:103464. [PMID: 37863375 DOI: 10.1016/j.autrev.2023.103464] [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: 09/20/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Dermatomyositis is chronic autoimmune disease primarily affecting skin and muscles. Antibodies are key players of pathogenesis and are in strong correlation with distinct clinical phenotypes. We present a case and a comprehensive review of the literature on dermatomyositis patients with Anti TIF1 antibodies. METHODS PubMed and Web of Science databases were reviewed. 166 articles were identified; 95 of them were evaluated; 79 of them included to the study. 45 of the included articles were case reports 9 were case series and 25 were research articles. In total 1065 patients were identified but number of patients with available information for different clinical features varied. RESULTS 69.6% of the patients with Anti TIF1-γ were female. Prevalence of malignancy was 42.6% among patients with Anti TIF1-γ. Muscle weakness (83%), Gottron sign (82.2%), heliotrope rash (73.7%), nailfold capillary changes (67.7%), dysphagia (38.4%), and joint involvement (31.1%) were the most common clinical features seen in patients with Anti TIF1-γ. Interstitial lung disease (ILD) was reported among 8.7% of patients with Anti TIF1-γ. Advanced age, male gender, dysphagia, and V-neck rash were significant risk factors for malignancy, whereas juvenile age, ILD, TIF1-β antibodies and joint involvement were associated with a decreased risk for malignancy. Advanced age, malignancy, dysphagia, and muscle involvement were associated with an increased risk for mortality. CONCLUSIONS Patients with advanced age, male gender, dysphagia, and V-neck rash require strict cancer screening. Patients with advanced age, malignancy, dysphagia, and muscle involvement have poor prognosis and should receive aggressive treatment.
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Affiliation(s)
- Ozgur C Kilinc
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Civi Karaaslan T, Tarakci E, Keles O, Aslan Keles Y, Ugurlu S. Comparison of telerehabilitation methods for patients with systemic sclerosis in the COVID-19 Era: A randomized controlled study. J Hand Ther 2023; 36:751-769. [PMID: 37574373 DOI: 10.1016/j.jht.2023.02.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 08/15/2023]
Abstract
STUDY DESIGN This was a single-blinded randomized clinical trial. INTRODUCTION Systemic sclerosis (SSc) is an autoimmune connective tissue disease that progresses with fibrosis. Patients with SSc need to be protected against epidemic diseases and provided for in terms of rehabilitation needs. PURPOSE OF THE STUDY To compare the effects of real-time telerehabilitation (RTT) and asynchronous telerehabilitation (AT) on individuals with SSc. METHODS Forty-two participants with SSc with a mean age of 44.17 ± 11.05 years were included in the study. The patients were randomly divided into three groups, RTT (n = 16), AT (n = 16), and control (n = 16) groups. A structured rehabilitation program was performed in real-time (RTT group) and asynchronously (AT group) for 40 minutes per day, in three sessions per week for 8 weeks. The participants' finger and wrist joint range of motion (ROM), upper extremity functions, grip strength, superficial sense of touch, activities of daily living (ADL), and general health status were assessed at baseline and after treatment. RESULTS After 8 weeks, there were improvements in finger ROM (effect size [ES] = 0.23 to 0.60), wrist ROM (ES = 0.45 to 0.83), upper extremity functions (ES = 0.61 to 1.00), and ADL parameters (ES = 0.74) in the RTT group (p < 0.05). Also, there were improvements in finger ROM (ES = 0.16 to 0.45) and hand functions (ES = 0.54 to 0.55) in the AT group (p < 0.05). The RTT and AT groups had better hand functions and finger ROM than the control group in (p < 0.05). In addition, the RTT group had better wrist ROM than the control group (p = 0.008). RTT was superior to AT only in lateral pinch strength (p = 0.025). DISCUSSION Experimental groups achieved a statistically significant change in ROM, upper extremity functions and ADL over time in concordance with prior investigations. Changes in grip strength, superficial sense of touch, and general health status scores differed from previous investigations and the between-group comparison was not statistically significant. CONCLUSIONS Both RTT and AT may be effective in individuals with SSc, and RTT has additional benefits.
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Affiliation(s)
- Tugba Civi Karaaslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozal Keles
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey
| | - Yasemin Aslan Keles
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Therapy and Rehabilitation, Physiotherapy Program, Vocational School, Biruni University, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, 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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Temiz Karadag D, Yalcinkaya Y, Akdogan A, Avanoglu A, Bes C, Birlik AM, Cefle A, Erdogan M, Hatemi G, Icacan OC, Inanc M, Inanc N, Koca SS, Kucuksahin O, Ozgen M, Sari A, Sahin A, Senel S, Tufan A, Ugurlu S, Yargucu Zihni F, Yolbas S, Hamuryudan V. Treatment of systemic sclerosis-associated digital ulcers: recommendations of the Turkish Society for Rheumatology. Clin Exp Rheumatol 2023:19685. [PMID: 37470234 DOI: 10.55563/clinexprheumatol/ce13vk] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES Digital ulcers (DUs) are associated with a significant burden in systemic sclerosis (SSc) by leading to severe pain, physical disability, and reduced quality of life. This effort aimed to develop recommendations of the Turkish Society for Rheumatology (TRD) on the management of DUs associated with SSc. METHODS In the first meeting held in December 2020 with the participation of a task force consisting of 23 rheumatologists the scope of the recommendations and research questions were determined. A systematic literature review was conducted by 5 fellows and results were presented to the task force during the second meeting. The Oxford system was used to determine the level of evidence. The preliminary recommendations were discussed, modified, and voted by the task force and then by members of TRD via e-mail invitation allowing personalised access to a web-based questionnaire [SurveyMonkey®]. RESULTS A total of 23 recommendations under 7 main headings were formulated covering non-pharmacological measures for the prevention of DUs and pharmacological treatments including vasodilators, anti-aggregants, antibiotics, wound care, pain control, and interventions including sympathectomy, botulinum toxin, and surgery. Risk factors, poor prognostic factors, prevention of DU and adverse effects of medical treatments were reported as 4 overarching principles. CONCLUSIONS These evidence-based recommendations for the management of SSc-associated DUs were developed to provide a useful guide to all physicians who are involved in the care of patients with SSc, as well as to point out unmet needs in this field.
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Affiliation(s)
- Duygu Temiz Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Yasemin Yalcinkaya
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Akdogan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aslihan Avanoglu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Cemal Bes
- Division of Rheumatology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ahmet Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mustafa Erdogan
- Division of Rheumatology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nevsun Inanc
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Suleyman Serdar Koca
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Orhan Kucuksahin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Yildirim Beyazıt University, Ankara, Turkey
| | - Metin Ozgen
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Ali Sahin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Soner Senel
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Figen Yargucu Zihni
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Servet Yolbas
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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18
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Hatemi G, Tukek NB, Esatoglu SN, Ozguler Y, Taflan SS, Uygunoglu U, Melikoglu M, Ugurlu S, Fresko I, Siva A, Kutlubay Z, Yurdakul S, Yazici H, Hamuryudan V. Infliximab for vascular involvement in Behçet's syndrome. Clin Immunol 2023:109682. [PMID: 37385325 DOI: 10.1016/j.clim.2023.109682] [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: 04/27/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Vascular involvement is an important cause of morbidity and mortality in patients with Behçet's syndrome (BS). We aimed to survey the efficacy and safety of infliximab (IFX) in BS patients with vascular involvement followed in a dedicated tertiary center. METHODS Charts of all BS patients who used IFX for vascular involvement between 2004 and 2022 were reviewed. Primary endpoint was remission at Month 6, defined as lack of new clinical symptoms and findings associated with vascular lesion, lack of worsening of the primary vascular lesion and a new vascular lesion on imaging, and CRP < 10 mg/L. Relapse was defined as development of a new vascular lesion or recurrence of the preexisting vascular lesion. RESULTS Among the 127 patients (102 men, mean age at IFX initiation: 35.8 ± 9.0 years) treated with IFX, 110 (87%) had received IFX for remission induction and 87 of these (79%) were already on immunosuppressives when the vascular lesion requiring IFX developed. The remission rate was 73% (93/127) at Month 6 and 63% (80/127) at Month 12. Seventeen patients experienced relapses. Remission rates were better among patients with pulmonary artery involvement and venous thrombosis compared to patients with non-pulmonary artery involvement and venous ulcers. Fourteen patients had adverse events leading to IFX discontinuation and 4 had died due to lung adenocarcinoma, sepsis, and pulmonary hypertension-related right heart failure due to pulmonary artery thrombosis (n = 2). CONCLUSION Infliximab seems to be effective in majority of BS patients with vascular involvement, even in those who are refractory to immunosuppressives and glucocorticoids.
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Affiliation(s)
- Gulen Hatemi
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nur Beyza Tukek
- Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yesim Ozguler
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sitki Safa Taflan
- Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ugur Uygunoglu
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Melike Melikoglu
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Serdal Ugurlu
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Izzet Fresko
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Aksel Siva
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zekayi Kutlubay
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Department of Dermatology, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sebahattin Yurdakul
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Vedat Hamuryudan
- Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
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Aktan Suzgun M, Erener N, Cavus GH, Ozdede A, Guner S, Ugurlu S, Comunoglu N, Kizilkilic O, Saip S. A review of rheumatoid meningitis with case studies. Mod Rheumatol Case Rep 2023; 7:340-346. [PMID: 36718604 DOI: 10.1093/mrcr/rxad010] [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: 11/15/2022] [Revised: 12/17/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease involving synovial joints, and it is known that extra-articular manifestations that may affect the central and peripheral nervous systems may develop during its course. Rheumatoid meningitis is very rare among all neurological involvements. In this study, cases diagnosed as rheumatoid meningitis with clinical, imaging, laboratory, and histopathological features are presented, and the aim of the study is to present current approaches in the diagnosis and treatment of rheumatoid meningitis in the light of case studies and current literature. The data of the patients who were followed up with the diagnosis of rheumatoid meningitis in neurology clinic between 2017 and 2021 were reviewed retrospectively. Three cases diagnosed with rheumatoid meningitis are presented in detail. In the first case, the diagnosis was reached by clinical, imaging, and laboratory findings as well as treatment response, while the diagnosis was made by histopathological verification in the second case. The third case shows that spontaneous remission can be observed in the course of rheumatoid meningitis. Rheumatoid meningitis, which is one of the rarest involvements in the course of RA, may present with headaches, focal neurological deficits, seizures, and altered consciousness. A meningeal biopsy is recommended when the differential diagnosis cannot be ruled out with imaging and laboratory findings. In the differential diagnosis Mucobacterium tuberculosis, syphilis, neuro-sarcoidosis, immunoglobulin G4-related disease, lymphoproliferative diseases, and systemic metastasis should be kept in mind. Aggressive RA management is recommended for treatment.
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Affiliation(s)
- Merve Aktan Suzgun
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nursena Erener
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gokce Hande Cavus
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ozdede
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabriye Guner
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Seyahi E, Ugurlu S, Amikishiyev S, Gul A. Behçet disease, familial Mediterranean fever and MEFV variations: More than just an association. Clin Immunol 2023; 251:109630. [PMID: 37216220 DOI: 10.1016/j.clim.2023.109630] [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: 04/13/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Behçet disease (BD) and familial Mediterranean fever (FMF) are two inflammatory disorders that share many features including historical background, ethnical distribution and inflammatory characteristics. Several studies suggested that BD and FMF might occur in the same individual more commonly than expected. Additionally, the pathogenic MEFV gene variants, especially p.Met694Val, activating the inflammasome complex have been shown to increase the risk for BD in regions where both FMF and BD are prevalent. Whether these variants are associated with certain disease subtypes and whether they may help in the planning of treatment need to be explored. This review provides a recent overview of the plausible association between FMF and BD and the role of MEFV variants in the pathogenesis of BD.
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Affiliation(s)
- Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey
| | - Shirkhan Amikishiyev
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, 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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22
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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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Adrovic A, Karatemiz G, Esatoglu SN, Yildiz M, Sahin S, Barut K, Ugurlu S, Hatemi G, Kasapcopur O, Seyahi E. Juvenile and adult-onset scleroderma: different clinical phenotypes. Semin Arthritis Rheum 2023; 60:152197. [PMID: 37031645 DOI: 10.1016/j.semarthrit.2023.152197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Systemic sclerosis (SSc) represents extremely rare disease with majority of data coming from adults. Studies comparing juvenile- (jSSc) and adult-onset (aSSc) patients are limited. We aimed to compare clinical features, treatment modalities and survival rates of jSSc and aSSc patients. METHODS A retrospective study among pediatric and adult Scl patients has been performed. Demographic characteristics, clinical features, autoantibody profiles, and treatment data were retrieved from the databases. Survival analysis was done using Kaplan-Meier plot and factors associated with mortality were identified with multiple regression analysis. RESULTS A total of 158 adults and 58 juvenile Scl patients were identified. The mean age at the disease onset was 37±14.7 vs. 8.8 ± 4.1 years, mean age at diagnosis 42±15.2 vs. 10.4 ± 3.8 years and mean follow-up duration was 6.3 ± 4.9 years vs. 6.6 ± 4.9 years for aSSc and jSSc patients, respectively. The frequency of interstitial lung disease (ILD) (50.9% vs 30%, p<0.001) and systemic hypertension (17.9% vs 0, p = 0.009) was significantly higher among aSSc. While aSSc patients had presented mostly with limited cutaneous subset (74.1%), diffuse cutaneous subset was the dominant subset among jSSc (76.7%), (p<0.001). The mortality rate was significantly higher among adults (p = 0.005). The ILD (p = 0.03) and cardiac insufficiency (p = 0.05) were independent risk factors of mortality in both aSSc and jSSc patients. CONCLUSION Juvenile and adult-onset Scl represent rarely seen conditions with different clinical phenotypes. Pediatric patients with LS are more commonly seen by pediatric rheumatologists, in contrary to adults. Diffuse disease subset is the dominant form among juvenile patients, whereas limited form is the main disease subset among adults. On the other hand, juvenile-onset patients have a better survival than those with adult-onset.
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Karatemiz G, Esatoglu SN, Gurcan M, Ozguler Y, Yurdakul S, Hamuryudan V, Fresko I, Melikoglu M, Seyahi E, Ugurlu S, Ozdogan H, Yazici H, Hatemi G. Frequency of AA amyloidosis has decreased in Behçet's syndrome: a retrospective study with long-term follow-up and a systematic review. Rheumatology (Oxford) 2022; 62:9-18. [PMID: 35657376 DOI: 10.1093/rheumatology/keac223] [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: 01/26/2022] [Accepted: 03/23/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE A decline in the frequency of AA amyloidosis secondary to RA and infectious diseases has been reported. We aimed to determine the change in the frequency of AA amyloidosis in our Behçet's syndrome (BS) patients and to summarize the clinical characteristics of and outcomes for our patients, and also those identified by a systematic review. METHODS We identified patients with amyloidosis in our BS cohort (as well as their clinical and laboratory features, treatment, and outcome) through a chart review. The primary end points were end-stage renal disease and death. The prevalence of AA amyloidosis was estimated separately for patients registered during 1976-2000 and those registered during 2001-2017, in order to determine whether there was any change in the frequency. We searched PubMed and EMBASE for reports on BS patients with AA amyloidosis. Risk of bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. RESULTS The prevalence of AA amyloidosis was 0.62% (24/3820) in the earlier cohort and declined to 0.054% (3/5590) in the recent cohort. The systematic review revealed 82 cases in 42 publications. The main features of patients were male predominance and a high frequency of vascular involvement. One-third of patients died within 6 months after diagnosis of amyloidosis. CONCLUSION The frequency of AA amyloidosis has decreased in patients with BS, which is similar to the decrease observed for AA amyloidosis due to other inflammatory and infectious causes. However, AA amyloidosis is a rare, but potentially fatal complication of BS.
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Affiliation(s)
- Guzin Karatemiz
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Gurcan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sebahattin Yurdakul
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hasan Yazici
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Aydin O, Egeli BH, Ozdogan H, Ugurlu S. Late-onset familial mediterranean fever: single-center experience and literature review. Intern Emerg Med 2022; 17:1301-1306. [PMID: 35061158 DOI: 10.1007/s11739-021-02912-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/09/2021] [Indexed: 11/05/2022]
Abstract
Familial Mediterranean fever (FMF) is a hereditary, autoinflammatory disease characterized by recurrent fever and serositis attacks. The disease onset occurs before 20 years of age in 90% of patients and rarely after the 4th decade. The aim of this study is to screen our FMF patient pool for patients with disease onset after age of 40 and to compare them to patients with early onset with regard to clinical and genetic features. The charts of 2020 patients registered in our FMF center in the years 2008-2017 were screened with regard to age of disease onset. Patients with disease onset after the age of 40 were considered as late-onset group (Group 1). The control group (Group 2) consisted of patients with a disease onset before the age of 20 who were randomly selected from the patient pool with twice the number of probands. Demographic, clinical and genetic data were recorded. Out of 2020 patients, the attacks of FMF had started after the fourth decade in 41 patients (2.02%), (Group 1). The male to female ratio was 1:1.7 in both groups. The delay of diagnosis was 5.6 ± 5.75 years in group 1, 10.7 ± 12.3 years in group 2. The only significant difference with regard to clinical features between two groups was the frequency of fever, which was present in 26 (63.4%) patients in group 1 and 67 (81.7%) in group 2 (p = 0.026). M694V mutation was more prevalent among early-onset group whereas exon 2 variants were more frequent in patients with late onset. The mean colchicine dose in the last 6 months was 1.38 ± 0.64 mg in group 1, and 1.61 ± 0.47 mg in group 2. FMF may start after 40 years of age in approximately 2% of the patients. Lower frequency of fever, lower daily colchicine dose and lower prevalence of exon 10 mutations point out that FMF patients with a disease onset after 40 years of age experience a milder disease compared to those with an onset before the second decade of life.
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Affiliation(s)
- Okan Aydin
- Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Bugra Han Egeli
- Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey.
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Aydin O, Egeli BH, Ozdogan H, Ugurlu S. Correction to: Late-onset familial mediterranean fever: single-center experience and literature review. Intern Emerg Med 2022; 17:1307. [PMID: 35244865 DOI: 10.1007/s11739-022-02953-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Okan Aydin
- Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Bugra Han Egeli
- Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey.
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Oztas M, Selvi O, Ergezen B, Ozdogan H, Ugurlu S. AB1470 DOES TESTING FOR SAA IS MORE BENEFICIAL THAN CRP FOR THE FOLLOW-UP OF PATIENTS WITH FMF? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn order to follow subclinical inflammation and adjust the therapy for an optimal disease control, clinicians seek for readily accessible, affordable and reproducible markers. C reactive protein (CRP) is widely used for this purpose. Some suggest that the Serum Amyloid A (SAA) is preferable to CRP as a biomarker of inflammation in FMF patients1.ObjectivesTo evaluate and to compare the sensitivity of the serum SAA and CRP levels in FMF patients.MethodsSerum SAA and CRP levels were measured in 45 patients. 153 measurements from 28 patients with M694V homozygous mutation and 74 measurements from 17 patients with M694V heterozygous mutation were obtained during a mean follow-up of 1 year. For the analysis, the folds of normal CRP and SAA values were used for correlation. Serum levels of the given markers were measured with nephelometric kits (normal CRP levels < 5 mg/L and SAA levels < 6,8 mg/L). More than one and half fold increasement of CRP and SAA was defined as an active inflammation. The correlation coefficients and their significance were calculated using the Spearman test.ResultsExcept a patient, all patients in whole cohort were on prophylactic colchicine. Among 28 patients with M694V homozygous mutation, a patient with adalimumab, 12 (42,8%) patients with anti-IL-1 regimens. Of the 17 patients with M694V heterozygous mutation, four (23,5%) were under anti-IL-1 treatment. There was a total of 227 measurements of CRP and SAA from 45 patients. Twenty-five (11%) measurements were obtained during the attack period in and the remaining 202 measurements were collected in attack free period. Figure 1 demonstrates the correlation between CRP and SAA levels (r=0.8, p< 0,001). Both acute phase reactants were increased in 72 (31,7%) measurements, while in 13 (5,7%) CRP level was high but SAA level was normal and in 31 (13,6%) SAA level was high however CRP level was within the normal limits. The vast majority (30:31) of high SAA with normal CRP levels were observed in patients with M694V homozgous mutation. The mean increase in CRP of the entire cohort was 2,06 ± 3,34-fold, whereas mean increase in SAA was 6,23 ± 15,04-fold of the normal levels.Figure 1.The folds of the serum CRP and SAA levels in the entire cohort.ConclusionAccording to our results, serial testing of SAA does not provide any additional advantages over CRP. Readily accessible and affordable bio-marker CRP seems to be sufficient for follow-up of patients with FMF.References[1]DOI: 10.1038/nrrheum.2010.181Disclosure of InterestsNone declared
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Oztas M, Bektaş M, Karacan I, Aliyeva N, Dag A, Aghamuradov S, Cevirgen SB, Sari S, Bolayirli M, Can G, Hatemi G, Seyahi E, Ozdogan H, Gul A, Ugurlu S. AB1082 FREQUENCY AND SEVERITY OF COVID-19 IN PATIENTS WITH VARIOUS RHEUMATIC DISEASES TREATED REGULARLY WITH COLCHICINE OR HYDROXYCHLOROQUINE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSeveral anti-inflammatory drugs which were targeted different mechanisms and investigated for both prevention and treatment for COVID-19.ObjectivesThe current study aimed to investigate whether patients regularly using colchicine or hydroxychloroquine (HCQ) have an advantage of protection from COVID-19 or developing less severe disease.MethodsPatients who were taking colchicine or HCQ regularly for a rheumatic disease including Familial Mediterranean Fever, Behçet’s syndrome, Systemic Lupus Erythematosus, Rheumatoid Arthritis and Sjogren’s syndrome as well as their healthy household contacts as the control group were included into the study. The clinical data regarding COVID-19 were collected using a standard form, and serum samples were analyzed for anti-SARS-COV-2 nucleocapsid IgG. Patients treated with any biologic or immunosuppressive treatments were not included into the study.ResultsA total of 635 regular colchicine users with their 643 household contacts and 317 regular HCQ users with their 333 household contacts were analyzed. Anti-SARS-Cov2 IgG was positive in 43 (6.8%) regular colchicine users and 35 (5.4%) household contacts (OR=1.3; 95% CI:0.8-2; p=0.3) (Table 1). COVID-19 related symptoms were described by 29 (67.4%) of the patients and 17 (48.6%) household contacts (OR=2.2; 95% CI:0.9-5.5; p=0.09), and hospital admission was observed in five (11.6%) and one (2.9%) of these subjects (OR=4.5; 95% CI:0.5-40.2; p=0.1), respectively (Figure 1). Seropositive subjects were observed in 22 (6.9%) regular HCQ users and 24 (7.2%) household contacts (OR=1.1; CI:0.6-1.9; p=0.8) (Table 1). COVID-19-related symptoms occurred in 16 (72.7%) of the 22 patients and 12 (50%) of 24 household contacts (OR=2.7; 95% CI:0.8-9.1; p=0.1). Three patients (13.6%) were admitted to hospital, while one household contact (4.2%) was hospitalized (OR=3.6; 95% CI:0.3- 37.8; p=0.2) (Figure 1). Disease-specific analyses disclosed that there was no significant difference in terms of COVID-19 frequency and severity between a particular disease subset and household contacts (Table 1). Univariate logistic regression analysis showed no effect of age and gender on the SARS-CoV-2 seroprevalence rate among regular colchicine or HCQ users and household contacts (p=0.2 and p=0.7, respectively for colchicine users versus contacts, p=0.7 and p=0.3, respectively for HCQ users versus contacts).Figure 1.Severity of COVID-19 in regular colchicine or HCQ users and these patients’ household contactsTable 1.Disease specific outcomes of the entire cohortVariableFMF (n=373)FMF HHC* (n=386)PBehcet Patients (n=262)Behcet HHC (N=257)PSLE Patients (N=197)SLE HH (n=221)pRA Patients (n=79)RA HH (n=73)PSjögren patients (N=41)Sjögren HH (N=39)pAge, mean ± SD years36.4 ± 13.236.3 ± 16.10.942.9 ± 11.438.1 ± 15.20.00144.2 ± 12.639.4 ± 170.00253.9 ± 10.340.3 ± 16.60.00157.1 ± 11.246.2 ± 16.10.001Gender, n (%) Female249 (66.8)173 (44.8)0.001160 (61.1)118 (45.9)0.001184 (93.4)75 (33.9)0.00173 (61.1)20 (27.4)0.00141 (100)10 (25.1)0.001Positive antibody to SARS-COV-2, n (%)25 (6.7)23 (5.9)0.618 (6.9)12 (4.7)0.314 (7.1)19 (8.6)0.64 (5.1)2 (2.7)0.54 (9.8)3 (7.7)0.9Symptomatic COVID-19 in seropositive cases, n (%)18 (72)10 (43.4)0.0411 (61.1)7 (58.3)0.611 (78.6)9 (47.3)0.073 (75)0 (0)0.42 (50)3 (100)0.4Hospital admission in seropositive cases, n (%)1 (3.8)0 (0)-4 (22.2)1 (8.3)0.32 (14.3)0 (0)0.21 (25)0 (0)-1 (25)1 (33.3)0.3Mean colchicine dose, mg/day ± SD1.5 ± 0.4--1.4 ±0.4-----------Mean duration of colchicine usage, years ± SD11.3 ± 8.3--10.4 ± 7.7-----------Mean HCQ dose, mg/day ± SD------263.6 ± 95.1--255 ± 90.8--273.7 ± 132.5--Mean duration of HCQ usage, years ± SD------10.1 ± 6.6--7.3 ± 5.2--9 ± 6.3--HCQ hydroxychloroquine, FMF familial mediterranean fever, HHC household contacts, RA rheumatoid arthritis, SLE systemic lupus erythematosusConclusionBeing on a regular treatment of colchicine or HCQ was not resulted in the prevention of COVID-19 or amelioration of its manifestations.Disclosure of InterestsNone declared
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Alkan A, Ugurlu S. Canakinumab might be Protective against Severe COVID-19 for Patients with Autoinflammatory Disorders. Mediterr J Rheumatol 2022; 33:237-240. [PMID: 36128203 PMCID: PMC9450204 DOI: 10.31138/mjr.33.2.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arif Alkan
- Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
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Civi Karaaslan T, Tarakci E, Keles O, Aslan Keles Y, Ugurlu S. AB1492 COMPARISON OF TELEREHABILITATION METHODS FOR SYSTEMIC SCLEROSIS PATIENTS IN THE COVID-19 ERA: A RANDOMIZED CONTROLLED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundScleroderma (SSc) is an autoimmune connective tissue disease progressing with fibrosis. SSc patients need to be protected from epidemic diseases as well as rehabilitation needs. For this reason, it is important for them to continue their exercises in an environment where they can be both rehabilitated and protected from infectious diseases.ObjectivesIn this study, it was aimed to reveal the effects of exercises performed by telerehabilitation on individuals with Scleroderma with hand involvement and to compare the effects of real-time telerehabilitation (RTT) and asynchronous telerehabilitation (AT).MethodsForty-two participants with a mean age of 44.17±11.05 years were included in the study. The patients were divided into three groups and followed for 8 weeks. RTT was applied to the 1st group and AT was applied to the 2nd group, and the 3rd group was the control group. Participants’ finger and wrist joint range of motion (ROM) were evaluated with a goniometer, upper extremity functions were evaluated with Scleroderma Hand Mobility Test (HAMIS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and 9Hole Peg Test (9HPT), grip strength was evaluated with a dynamometer, superficial sense of touch was evaluated with the Semmes Weinstein Monofilament test, activities of daily living (ADL) were evaluated with the Michigan Hand Outcomes Questionnaire (MHQ), and general health status was evaluated with the Scleroderma Health Assessment Questionnaire (SHAQ).ResultsThere were improvements in finger and wrist ROM, upper extremity functions and ADL parameters in the RTT group; and there were improvement in finger ROM and hand functions in the AT group (p<0.05). Wrist radial deviation ROM decreased in the control group (p<0.05). Significant differences were noted between the groups in finger ROM and upper extremity functions after treatment (p<0.05).ConclusionOur study shows that exercises performed via RTT and AT are effective in individuals with Scleroderma with hand involvement, and RTT has additional benefits.References[1]Sendur N, Sendur UG. Scleroderma. Turkiye Klinikleri J Dermatol. 2018;15-20.[2]Baron M, Lee P, Keystone EC. The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis. 1982;41(2):147-152.[3]Spinella A, Magnani L, De Pinto M, et al. Management of Systemic Sclerosis Patients in the COVID-19 Era: The Experience of an Expert Specialist Reference Center. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine 2021; 15:1–3.[4]Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020;26(5):309-313.Disclosure of InterestsNone declared
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Ayan G, Hatemi G, Can G, Bektaş M, Ozdede A, Akdogan N, Yalici-Armagan B, Oksum Solak E, Yazici S, Ozsoy Adisen E, Atakan N, Bulbul Baskan E, Borlu M, Engin B, Hamuryudan V, Inanc M, Kiraz S, Onen F, Ugurlu S, Yayli S, Kalyoncu U. AB0938 A new screening tool for Psoriatic Arthritis in Psoriasis Patients: TurPAS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPsoriatic arthritis (PsA) is a heterogenous disease with different disease manifestations. Several tools have been developed for screening of PsA in patients with psoriasis with variable performances. An optimal screening tool for PsA is still an unmet need.ObjectivesWe aimed to develop a new screening tool in Turkish which could detect different domains involved.MethodsA core group was determined including 11 rheumatologists/10 dermatologist and a systematic literature review on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis` was performed. The review revealed tools named PEST, PASE, EARP, STRIPP, SIPAS, SIPAT, TOPAS-II, GEPARD, PASQ, CONTEST, A novel, short, and simple screening questionnaire. Each item of those tools were included in the Delphi set. After the 3 rounds of Delphi, a new set of screening questionss was developed.ResultsOverall 85 items were inquired, including questions on joint, dactylitis, enthesitis, back, skin-nail domains as well as morning stiffness, function, treatment and others for the first round of Delphi. Seventeen experts (9 dermatologists/ 8 rheumatologists from the core group) and fifteen patients (Female/Male= 9/6) answered the Delphi (mean (SD) age of 39.3 (10.9) participated to the first round. The involvemet types were peripheral (73.4%), axial (40%), entheseal (33.4) and dactylitis was present in 14% of the patients. As a result of this first evaluation, 44 out of 85 questions were selected and carried to second round The distribution of these questions was as follows; joint question n=13, skin and nail involvement n=6, dactylitis n=5, morning stiffness n=5, axial n=3, enthesitis n=2, general questions n=5. These questions were sent to the members through rheumatology and dermatology societies. In total, 85 rheumatology specialists and 48 dermatology specialists answered the questions in the second round. At the second tour, the number of questions was reduced from 44 to 22. The distribution of the questions was as follows; Skin and nail involvement n=5, dactylitis n=3, joint question n=2, axial involvement n=2, morning stiffness n=2, axial involvement and morning stiffness n=2, enthesitis n=1, general questions n=5. A consensus meeting was held to discuss 22 questions determined at the end of the second round within the initial core group. Each question was handled one by one, some of the questions were combined, if necessary, adapted to Turkish. The tool was given its final form. The final version of the questionnaire consists of 6 questions. (Table 1).Table 1.The new screening toolDomainTurkish versionEnglish versionJointEl/ayak parmaklarinizda ya da herhangi bir ekleminizde hiç şişlik veya ağri oldu mu?Have you ever had swelling or pain in your fingers/toes or any of your joints?DactylitisResimde gösterildiği gibi el veya ayak parmağinizda sosis şeklinde şişlik oldu mu?Have you had a sausage-shaped swelling on your fingers or toes as shown in the picture?EnthesitisTopuk ağriniz olur mu?Do you have heel pain?Axial involvement and morning stiffnessBelinizde, sirtinizda veya boynunuzda istirahatle artan, özellikle sabaha karşi kötüleşen veya sabahlari hareketinizi kisitlayan ağriniz olur mu?Do you have pain in your lower back, back, or neck that increases with rest, worsens especially in the morning, or restricts your movement in the morning?Drug useEklem şikayetleriniz için zaman zaman ilaç kullanir misiniz?Do you take medication for your joint complaints from time to time?History of rheumatic diseaseSize daha önce iltihapli romatizma tanisi konuldu mu?Have you ever been diagnosed with a rheumatic disease before?ConclusionA new screening tool targeting different domains in Psoriatic disease was developed in Turkish. While cultural differences play an important role in screening, we believe that the first tool developed in Turkish will be helpful in clinical practice and research settings. Further assessments will be done to understand its validity and reliability within a large cohort of psoriatic patients.Disclosure of InterestsNone declared
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Karatemiz G, Esatoglu SN, Gurcan M, Ozguler Y, Yurdakul S, Hamuryudan V, Fresko I, Melikoglu M, Seyahi E, Ugurlu S, Ozdogan H, Yazici H, Hatemi G. AB1305 A SYSTEMATIC REVIEW OF AA AMYLOIDOSIS AMONG PATIENTS WITH BEHÇET’S SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundData on patients with Behçet’s syndrome (BS) complicated with AA amyloidosis is limited to case reports or case series with a small number of patients.ObjectivesIn this study, we aimed to perform a systematic review (SR) of published reports on BS patients with AA amyloidosis.MethodsPubMed and EMBASE were searched with the keywords “Behcet* AND amyloidosis”, without date and language restriction, until May 2020. Two independent reviewers (SNE, GK) performed title/abstract and full text screening and data extraction. A third reviewer (GH) made the final decision in case of disagreement between the two reviewers. Studies that reported patients who were reported by authors as having BS and AA amyloidosis were included. The risk of bias assessment was done using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.ResultsThe systematic literature search yielded 760 articles of which 703 were excluded after title and abstract review. After full-text review, we further excluded 15 duplicate articles and 1 article was added after handsearching the reference lists of the full texts. Finally, we included 43 articles reporting 96 cases. Among these articles, 38 were case reports and 5 were case series reporting between 6 and 14 patients. All patients but 8 were reported from Mediterranean countries. The quality of all articles according to GRADE was very low due to the lack of a control group.The main features of the patients were male predominance (81/96, 84%), a high frequency of major organ involvement (62/80, 77.5%) especially vascular involvement (60%), a low frequency of comorbidities predisposing to AA amyloidosis (11/96, 11.5%), and a very low frequency of gastrointestinal involvement (3/72, 4%). All but 8 patients were diagnosed with BS and AA amyloidosis simultaneously. The most common presentation was nephrotic syndrome (60/81, 74%). Presenting symptoms other than proteinuria were diarrhea (n=2), acute renal failure (n=2), upper gastrointestinal bleeding (n=1), end stage renal disease (ESRD) (n=1), cardiac symptoms due to cor pulmonale (n=1), and hypertension (n=1). Renal biopsy (72%) and rectal biopsy (17%) were the most commonly used procedures to diagnose AA amyloidosis.After diagnosing AA amyloidosis, colchicine was initiated in 58 patients, cyclophosphamide in 16, and biologics in 3 (1 anakinra and 2 tocilizumab). In the 67 patients with available data on follow-up, 43% of the patients were followed-up for ≤1 year and median follow-up duration was 20 months (IQR: 4-48). Among the 64 patients with available data, 30 (47%) had developed ESRD. Among the 72 patients with available data on survival status, 30 patients (42%) had died. Ten patients (33%) had died within 6 months, 15 had died after a median follow-up of 48 months (IQR: 24-150), and follow-up duration was not available in the remaining 5 patients including 3 patients whose diagnoses were made by autopsy. Reasons for death were infection (n=7), ESRD (n=6), intractable diarrhea (n=3), pulmonary embolism (n=1), cor pulmonale (n=1), hemorrhage due to pulmonary artery aneurysm (n=1), liver cirrhosis (n=1), gastric cancer (n=1), subarachnoid hemorrhage (n=1), and not reported (n=8).ConclusionMale gender and major organ involvement, especially vascular involvement, appear to be risk factors for the development of AA amyloidosis in BS patients. While BS patients complicated with AA amyloidosis have been reported rarely, it is a fatal complication of BS. One third of the patients had died within 6 months after AA amyloidosis diagnosis.Disclosure of InterestsGüzin Karatemiz: None declared, Sinem Nihal Esatoglu Speakers bureau: Sinem Nihal Esatoglu has received honorariums for presentations from UCB Pharma, Roche, Pfizer, and Merck Sharp Dohme., Mert Gurcan: None declared, Yesim Ozguler Speakers bureau: Yesim Ozguler has received honorariums for presentations from UCB Pharma, Novartis, and Pfizer., Sebahattin Yurdakul: None declared, Vedat Hamuryudan Speakers bureau: Vedat Hamuryudan has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma., Grant/research support from: Vedat Hamuryudan has received grant/research support from Celgene., Izzet Fresko: None declared, Melike Melikoglu: None declared, Emire Seyahi Speakers bureau: Emire Seyahi has received honorariums for presentations from Novartis, Pfizer, AbbVie, and Gliead., Serdal Ugurlu: None declared, Huri Ozdogan: None declared, Hasan Yazici: None declared, Gulen Hatemi Speakers bureau: Gulen Hatemi has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma, Grant/research support from: Gulen Hatemi has received grant/research support from Celgene.
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Yenigun S, Ayla AY, Baspinar SN, Yuzbasioglu MB, Alkan A, Durucan I, Kirman M, Polat BC, Ergun S, Ozdogan H, Ugurlu S. POS1378 ARTHRITIS IN PATIENTS WITH FAMILY MEDITERRANEAN FEVER. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFamilial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent episodes of fever and serositis. Arthritis is one of the most common attack manifestations. Arthritis in FMF is usually in the form of acute mono- or oligoarthritis of the large joints of the lower extremities. While acute attacks of arthritis usually heal without causing permanent deformity, the severe, long-lasting form of chronic arthritis can last for months or even years and result in permanent deformity.ObjectivesIn this study, we described the characteristics of joint involvement in FMF in a single cohort.MethodsThe medical records of patients with joint involvement from our cohort of 2350 patients who were diagnosed with familial Mediterranean fever were retrospectively scanned through the files and hospital database. The prevalence, demographic information, genetic test results, clinical features, features of joint involvement, treatments and responses, acute phase values in the attack and remission periods, and family history of patients with joint involvement were recorded.Results953 patients (n=953) from a total of 2350 patients had arthralgia or arthritis (40%). In our study, the male/female ratio was found to be 0.49 (male n=316, female n=637). The number of patients who underwent genetic testing was 787 (82%), and 702 (89%) of these patients had mutations in the MEFV gene. The most common pathogenic mutation is the M694V mutation with a rate of 43%. Concomitant diseases and their frequencies are shown in Table 1, the most common accompanying disease was spondylarthritis at a rate of 27%. Arthritis was present in the first attack in 55% (n=531), while arthritis was found in the ongoing attacks in 45%. The duration of the attack was between 24-96 hours in 77% (n=837) of the patients, and the duration was longer than 96 hours in 23% (n=116). The most common finding accompanying the attacks was exercise-related leg pain. Family history was present in 61% (n=580). 73% of the patients (n=696) were involved in the ankle and 51% were involved in the knee (n=492). The incidence of sacroiliitis was 14% (n=142). As for the number of joints, 91% of the patients had mono- and oligoarthritis. Asymmetric involvement was detected in 77% of the patients. Red arthritis was present in %73 of our study group. HLA-B27 was examined in 185 patients, 24 of them were positive (12%). It was found that 43% of the patients had treatment changes due to arthritis. Colchicine dose increases and changes were performed in 32% of these patients. NSAIDs were started in 21%, corticosteroids in 15%, DMARDs in 12%, anti-TNF in 10%, and anti-IL-1 in 8%. The mean dose of colchicine was as 1.56 ± 0.5 mg. Unresponsiveness to colchicine was found in 21% (n=122).Table 1.Concomitant diseases of our FMF cohortConclusionFMF diagnosis should definitely be considered in people with red mono-oligoarthritis in the large joints of the lower extremities. One of the most important features of joint involvement in FMF patients is the short duration of arthritis. The accompanying effort-related leg pain is an important symptom that should suggest FMF. In patients with a diagnosis of FMF and arthritis, the required colchicine dose in the treatment and the rate of colchicine unresponsiveness are higher than in other attack types. The incidence of sacroiliitis and spondyloarthropathy increases in patients with FMF, and joint involvement features are similar. FMF should be considered in the differential diagnosis of patients with inflammatory low back pain.Disclosure of InterestsNone declared
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Baspinar SN, Durucan I, Yuzbasioglu MB, Yenigun S, Ayla AY, Alkan A, Ayalti T, Demirkol F, Sahin B, Alizade S, Ozdogan H, Ugurlu S. AB1323 THE MYSTERY OF FAMILIAL MEDITERRANEAN FEVER: IS THERE ANY FACTOR TRIGGERING THE ATTACKS? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFamilial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by recurrent episodes of fever and serositis. Although it is known that the attack frequency differs among patients carrying different mutant genotypes [1], whether physical and environmental factors play a role in triggering attacks or whether they have an influence on timing of attacks remains to be elucidated.ObjectivesWe aimed to identify different conditions causing flare-ups in FMF course and to investigate if there is a significant difference between patients carrying distinct mutations, regarding the distribution of the factors mentioned.MethodsTwo hundred patients were randomly selected among individuals who were routinely followed-up with FMF diagnosis in our centre. Individuals carrying only a variant of unknown significance or polymorphism such as R202Q, according to Infevers database, were excluded in order to gather a cohort consisting of patients with definite FMF. An inquiry was made based upon triggering factors determined by the patients themselves. The patients were classified into subgroups by their sex and mutation genotype. Since M694V variant is responsible for pronounced FMF course [2], we sorted the patients according to their status for M694V mutant allele. Group A included patients carrying M694V homozygously. Group B included patients carrying at least one M694V mutant allele whereas Group C consisted of patients who were non-M694V carriers. Chi-square test was performed to assess distribution of the trigger factors in terms of establishing its significance.ResultsDetailed distribution of trigger factors is shown in Table 1. 144 out of 200 patients described a culprit condition. Patients usually stated more than one factor, however some patients reported only one. The most-reported trigger factors by the cohort are summarized as following: 76 emotional stress (38%), 60 menstruation (30%), 40 cold exposure (20%), 34 fatigue (17%), 13 seasonal changes (6.5%). The distribution of trigger factors between Group A, B, and C were non-significant (p=0.88).Table 1.The distribution of triggering factors in subgroups.GroupTotal(%)Reported trigger factor (%)Mens- truation(%)Emotionalstress(%)Cold exposure(%)Fatigue(%)Seasonalchanges(%)Others(%)Female12397 (78.8)60 (48.8)47 (38.2)24 (19.5)19 (15.4)7 (5.7)6 (4.9)Male7747 (61)-29 (37.7)16 (20.8)15 (19.5)6 (7.8)7 (9.1)Group A6144 (72.1)14 (23)24 (39.3)13 (21.3)12 (19.7)4 (6.6)6 (9.8)Group B165120 (72.7)49 (29.7)66 (40)34 (20.6)29 (17.6)13 (7.9)11 (6.6)Group C3524 (68.6)11 (31.4)10 (28.6)6 (17.1)5 (14.3)01 (2.8)Group A: M694V homozygous patients, Group B: patients with at least one M694V allele, Group C: non-M694V carriersConclusionWe concluded that trigger factors did not vary between distinct mutant genotypes. Although emotional stress is the most reported trigger factor by the participants, one should bear in mind that emotional stress influences most chronic diseases negatively. We also observed that menstruation overtly triggers an FMF attack. Additionally, cold exposure should be considered as a notable trigger factor. It is still unclear what triggers an FMF attack in 28% of the patients, remains a mystery.References[1]Grossman C, Kassel Y, Livneh A, Ben-Zvi I. Familial Mediterranean fever (FMF) phenotype in patients homozygous to the MEFV M694V mutation. Eur J Med Genet. 2019 Jun;62(6):103532. doi: 10.1016/j.ejmg.2018.08.013.[2]Egeli BH, Ugurlu S. Familial Mediterranean Fever: Clinical State Of The Art. QJM. 2020 Oct 20:hcaa291. doi: 10.1093/qjmed/hcaa291.Disclosure of InterestsNone declared
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Yuzbasioglu MB, Ayla AY, Besiroglu I, Baspinar SN, Yenigun S, Durucan I, Alkan A, Gazioglu ME, Hiyamli MF, Sarac I, Ozdogan H, Ugurlu S. AB1325 DIAGNOSTIC DELAY IN FAMILIAL MEDITERRANEAN FEVER: IS IT STILL A PROBLEM? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundFamilial Mediterranean fever (FMF) is a rare hereditary autoinflammatory disease with disease onset in childhood in most cases. Although autoinflammatory disease awareness is increasing among physicians, delayed diagnosis is still prevalent as a cause of greater morbidity[1].ObjectivesWe aimed to study the characteristics of FMF patients diagnosed between 2000-2010 and 2011-2021 and to see if there was a difference in diagnostic delay.MethodsWe retrospectively evaluated the medical records of the FMF patients followed up in our rheumatology clinic that were diagnosed between 2000-2021 and split them into two groups according to the year they received their diagnosis. There were 1151 patients diagnosed between 2000-2010 (Group 1) and 821 patients diagnosed between 2011-2021 (Group 2). The data studied included gender, age of onset, diagnostic delay, attack characteristics, MEFV mutation, and family history.ResultsThe median current age of patients in Group 1 is 37 years (IQR:30-46) and the median current age of the patients in Group 2 is 36 years (IQR:29-44). The female to male ratio was 1.57 in Group 1 and 1.75 in Group 2, with no significant difference between the groups. Group 2 had later disease onset (p<0.001) and later diagnosis (p<0.001) than Group 1 as shown in the Table 1. The proportion of patients with at least one M694V mutation was higher in Group 2 (p<0.001). The attack durations did not vary between the groups. There was no significant difference in the prevalence of abdominal pain, fever, arthritis, and arthralgia between Group 1 and Group 2. Chest pain (p=0.005), myalgia (p<0.001), and erysipelas-like erythema (p=0.041) were more common in Group 2 than Group 1. Patients with positive family history were more frequent in Group 2 than Group 1 (p=0.046).Table 1.Group 1 (2000-2010, n=1151)Group 2 (2011-2021, n=821)pFemale/Male, n704/447522/2990.275Age at onset, median (IQR) years13 (7-21)18 (12-26)<0.001Delay in diagnosis, median (IQR) years4 (1-11)5,5(2-15)<0.001Attack duration, median (IQR) years3(2-4)3(2-4)0.325Presence of at least one M694V mutation (%)526(46%)390(60%)<0.001Presence of abdominal pain in the initial attack (%)936(81%)669(81%)0.926Presence of fever in the initial attack (%)855(74%)592(72%)0.281Presence of chest pain in the initial attack (%)218(19%)199(24%)0.005Presence of arthritis in the initial attack (%)330(29%)215(26%)0.224Presence of arthralgia in the initial attack (%)213(19%)170(21%)0.223Presence of myalgia in the initial attack (%)45(4%)65(8%)<0.001Presence of erysipelas like erythema in the initial attack (%)31(3%)36(4%)0.041Presence of positive family history (%)652(57%)502(61%)0.046ConclusionThere was some increase in the diagnostic delay in 2011-2021 compared to 2000-2010. This may be partly due to the later onset of symptoms in patients diagnosed in 2011-2021, which could have led the physicians to consider other differential diagnoses. Nevertheless, diagnostic delay in FMF still seems a prevalent problem that should be addressed to prevent excess morbidity and mortality.References[1]Erdogan M, Ugurlu S, Ozdogan H, Seyahi E. Familial Mediterranean fever: misdiagnosis and diagnostic delay in Turkey. Clin Exp Rheumatol. 2019;37 Suppl 121(6):119-124.Disclosure of InterestsNone declared
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Ozdede A, Güner S, Ozcifci G, Yurttas B, Toker Dincer Z, Atli Z, Uygunoglu U, Durmaz E, Ucar D, Ugurlu S, Saip S, Tabak ÖF, Hamuryudan V, Seyahi E. POS1255 SAFETY OF THE PFIZER/BIONTECH AND SINOVAC/CORONAVAC VACCINES AMONG PATIENTS WITH BEHCET’S SYNDROME AND FAMILIAL MEDITERRANEAN FEVER. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSince first emerged in December 2019, the COVID-19 pandemic has resulted in a death toll surpassing 5.5 million worldwide and had severe consequences on the global economy, environment, public health and social life [1, 2]. Multiple potential vaccines against COVID-19 have been developed swiftly and as shown in several phase 3 clinical trials, they demonstrated considerable efficacy without an unusual safety signal in healthy individuals.ObjectivesIn this study, we aimed to evaluate vaccine reactivity and disease flare following vaccination with either Sinovac/CoronaVac or Pfizer/BioNTech among BS and FMF patients compared with patients with various diagnosis of RD and healthy controls.MethodsOnly those patients and healthy controls who rece,ved at least one single shot of either CoronoVac or BioNTech against COVID-19 were included in the study. We tried to contact all of these patients and controls consecutively by telephone and attempted to make interviews with the eligible ones.ResultsWe studied the efficacy, side effects and disease flares after COVID-19 vaccination in 256 patients with Behcet’s syndrome (BS), 247 with familial Mediterranean fever (FMF), 601 with rheumatic diseases (RD) and 612 healthy controls (HC). Study participants were vaccinated either with CoronaVac (BS:109, FMF: 90, RD: 343, and HC: 334) or BioNTech (BS: 147, FMF:157, RD: 258 and HC: 278). BioNTech ensured a significantly better efficacy than CoronaVac against COVID-19 in all patient groups (BS: 1.4% vs 10.1%; FMF: 3.2% vs 12.2%, RD:2.7% vs 6.4%). Those with at least one adverse event (AE) were significantly more frequent among those vaccinated with BioNTech than those with CoronaVac (BS: 86.4% vs 45%; FMF: 83.4% vs 53.3%; RD: 83.3% vs 45.5% and HC: 86.3% vs 52.1%). The majority of AEs were mild to moderate and transient and this was true for either vaccine. There were also AEs that required medical attention in all study groups following CoronaVac (BS:5.5%, FMF:3.3%, RD:2.9% and HC:3.3%) or BioNTech (BS:5.4%, FMF:1.9%, RD:4.7% and HC:4.7%). The main causes for medical assistance were disease flare, and cardiovascular events. Disease flares after vaccination were significantly more frequent among BS (41/256; 16.0%) and FMF (43/247; 17.4%) patients compared to patients with RD (36/601; 6.0%). This was true for both CoronaVac (BS: 11.0%, FMF: 24.4% and RD: 5.2%, p<0.001) and BioNTech (BS: 19.7%, FMF: 13.4% and RD: 7.0%, p=0.001)(Table 1).Table 1.Flares among patients with Behçet’s syndrome, familial Mediterranean fever, rheumatic diseases after vaccination with CoronaVac and BioNTechCoronaVacBehçet’s syndrome,n=109Familial Mediterranean Fever,n=90Rheumatic diseases, n=343Flares, n (%)Flares, n (%)Flares, n (%)12 (11.0)22 (24.4)18 (5.2)BioNTechBehçet’s syndrome, n=147Familial Mediterranean Fever, n=157Rheumatic diseases, n=258Flares, n (%)Flares, n (%)Flares, n (%)29 (19.7)21 (13.4)18 (7.0)RA, Rheumatoid Arthritis; BS, Behçet’s syndrome; FMF, Familial Mediterranean FeverConclusionOur study demonstrates that BS and FMF patients vaccinated with either CoronaVac or BioNTech demonstrated almost similar AE profile and frequency compared to RD patients and HC. AEs that required physician consultation or hospitalization occurred in all study groups after either CoronaVac or BioNTech. Caution should be required when monitoring these patients after vaccination. Increased frequency of flares in BS and FMF compared to that seen in RD might reflect defects in innate immunity and deserves further investigation.References[1]https://covid19.who.int Accessed date 22.01.2022[2]Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, Agha M, Agha R. The so-cio- economic implications of the coronavirus pandemic (COVID-19): A review. Int J Surg. 2020 Jun; 78:185-193. doi: 10.1016/j.ijsu.2020.04.018. PMID: 32305533; PMCID: PMC7162753.Disclosure of InterestsAyse Ozdede: None declared, Sabriye Güner: None declared, Guzin Ozcifci: None declared, Berna Yurttas: None declared, Zeynep Toker Dincer: None declared, Zeynep Atli: None declared, Ugur Uygunoglu: None declared, Eser Durmaz: None declared, Didar Ucar: None declared, Serdal Ugurlu Speakers bureau: Novartis,Pfizer,Celltrion and Lilly, Sebahattin Saip: None declared, Ömer Fehmi Tabak Speakers bureau: Abbvie, Gilead, MSD and GSK, Consultant of: Abbvie, Gilead, MSD and GSK, Vedat Hamuryudan: None declared, Emire Seyahi Speakers bureau: Pfizer, Abbvie, Novartis and Gilead,
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Oztas M, Ugurlu S. AB1502 AWARENESS OF BIOLOGICAL AGENTS RELATED SIDE EFFECTS AMONG INTERNAL MEDICINE RESIDENTS IN A UNIVERSITY HOSPITAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBiological agents have become a core component of therapeutic strategies in the last two decades. The number of patients treated with biological agents has been increasing with the expansion of these agents’ indications among rheumatic disorders.ObjectivesUnfortunately, biological agents have varied side effect profiles, and rheumatic patients with possible side effects are commonly consulted with internal medicine physicians in emergency departments. We surveyed to assess the awareness of biological agents related side effects among internal medicine residents in our university hospital.MethodsWe conducted a web-based multiple-choice test with 10 questions in total. Monoclonal antibodies (anti-TNF, anti-CD20), anti-cytokines, and JAK inhibitors related side effects and management of these adverse events were assessed. Figure 1 depicted the topics and the correct answer rate of the related questions.Figure 1.The topics and the correct answer rate of the related questionsResultsA total of 57 responses were collected and analyzed. The mean number of the correct answers was 6,4± 1,5. Fourteen (24,6%) out of the 57 participants scored below 5, whereas 58% of the participants scored ≥6 points. The majority of the participants have correctly answered the anti-TNF, rituximab and tocilizumab-related questions, however, less than half of the participants have accurately answered the anakinra and JAK inhibitors-related questions (Figure 1). Awareness of the JAK inhibitors related zoster reactivation and increased risk of serious cardiovascular events were 35% and 42%, respectively. The approach to the delayed and mild infusion reactions was adequate, however, 33% of the participants accurately approached the severe infusion reaction.ConclusionOur survey suggests that the awareness of biologic agents related side effects among the internal medicine residents is satisfactory. Poorer results were observed especially in JAK inhibitors related side effects and severe infusion reaction management which indicate the educational needs of the residents for these topics.Disclosure of InterestsNone declared
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Hatemi G, Tukek B, Esatoglu SN, Ozguler Y, Taflan SS, Melikoglu M, Ugurlu S, Fresko I, Kutlubay Z, Yurdakul S, Yazici H, Hamuryudan V. POS0814 OUTCOME OF VASCULAR INVOLVEMENT OF BEHÇET’S SYNDROME TREATED WITH INFLIXIMAB: A RETROSPECTIVE COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundVascular involvement is the most common cause of mortality and an important cause of disability in patients with Behçet’s syndrome (BS). Cyclophosphamide has been the treatment choice for severe vascular involvement, but high frequency of adverse events such as infertility and infections cause concern. TNF inhibitors can be an alternative for BS patients with vascular involvement.ObjectivesTo survey the efficacy and safety of infliximab (IFX) in BS patients with arterial and venous vascular involvement.MethodsWe reviewed the charts of BS patients who used IFX for vascular involvement. We extracted data on demographic and clinical features, type of vascular involvement, laboratory tests, imaging modalities, concomitant immunosuppressives, duration of IFX use, and outcome. The primary endpoint was remission, defined as the presence of all of the following 3 parameters: 1) lack of new clinical symptoms/findings associated with the vascular lesion 2) normalization of CRP level defined as <10 mg/dl) 3) lack of worsening of the primary vascular lesion or a new lesion vascular at another site on imaging. Remission was assessed at month 6 and month 12. Secondary endpoints were relapse, overall disease activity assessed with BDCAF at baseline and at the final visit, development of new organ involvement other than vascular involvement during IFX treatment, severe adverse events leading to discontinuation of IFX therapy, hospitalization or death, and death.ResultsAmong the 371 patients who used IFX between 2004 and June 2021, 127 patients (102 men, 25 women, mean age 40 ± 8.7 years) had used it for vascular involvement. The types of vascular involvement that required IFX were venous thrombosis in 61 patients (48%), pulmonary artery involvement in 37 (29%), non-pulmonary artery involvement in 16 (13%), and venous ulcer in 13 (10%). Remission rate was 72% (92/127) at month 6 and 61% (71/117) at month 12. 17/99 (17%) patients experienced 22 relapses during a mean follow-up of 28.4±21 months of IFX therapy. Among the 22 relapses, 12 were the progression of the pre-existing vascular lesion and 10 were new vascular lesions. Overall disease activity improved with a decrease in mean BDCAF score from 1.76 ± 1.27 to 0.6 ± 0.8 at the final visit (p<0.001). Remission and relapse rates according to type of vascular involvement and causes of IFX discontinuation are presented in the Table 1. Adverse events leading to IFX discontinuation were infusion reactions in 5, tuberculosis, disseminated zona, lung adenocarcinoma, fibromyxoid sarcoma, heart failure, SLE, palmoplantar pustulosis, auricular chondritis, and aortic stent graft infection in 1 patient each.Table 1.The frequency of concomitant immunosuppressive use, duration of infliximab use and outcomes of BS patients with vascular involvement treated with IFXVenous thrombosis (n=61)Pulmonary artery involvement (n=37)Non-pulmonary arterial involvement (n=16)Venous ulcers (n=13)Overall (n=127)Number of patients who used concomitant immunosuppressives48 (79)24 (65)14 (87)7 (54)93 (73)Duration of IFX use (mean ± SD months)24 ± 19.725 ± 19.335 ± 29.626 ± 2425 ± 21Remission rate at month 650 (82)31 (84)10 (63)1 (8)92 (72)Remission rate at month 12a40 (70)21 (64)8 (53)2 (17)71 (60)Relapse rate4 (7)4 (11)9 (60)017 (13)Number of patients who discontinued IFX31 (51)23 (62)5 (31)9 (69)68 (54)Due to remission1560122Due to inefficacy313411Due to relapse10102Due to adverse event741113Due to noncompliance340310Due to new organ development10001Due to other reasonsb18009Death22004a Since 10 patients did not reach the 12th month yet, the percentages were calculated on 117 patients.b Other reasons were preparation for surgical operation (n=2), not wanting to come to the infusion frequently during the pandemic (n=2), pregnancy (n=1), willing to get pregnant (n=1), lack of health insurance (n=1), due to prison sentence (n=1), and death (n=1).ConclusionInfliximab may be beneficial in BS patients with vascular involvement, even in those who are refractory to immunosuppressives and corticosteroids.Disclosure of InterestsGulen Hatemi Speakers bureau: Gulen Hatemi has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma, Grant/research support from: Gulen Hatemi has received grant/research support from Celgene, Beyza Tukek: None declared, Sinem Nihal Esatoglu Speakers bureau: Sinem Nihal Esatoglu has received honorariums for presentations from UCB Pharma, Roche, Pfizer, and Merck Sharp Dohme., Yesim Ozguler Speakers bureau: Yesim Ozguler has received honorariums for presentations from UCB Pharma, Novartis, and Pfizer., Sitki Safa Taflan: None declared, Melike Melikoglu: None declared, Serdal Ugurlu: None declared, Izzet Fresko: None declared, Zekayi Kutlubay: None declared, Sebahattin Yurdakul: None declared, Hasan Yazici: None declared, Vedat Hamuryudan Speakers bureau: Vedat Hamuryudan has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma, Grant/research support from: Vedat Hamuryudan has received grant/research support from Celgene.
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Baspinar SN, Alkan A, Yuzbasioglu MB, Yenigun S, Ayla AY, Durucan I, Candan M, Karabicek A, Belli C, Bayraktar T, Ozdogan H, Ugurlu S. AB1322 APPENDICITIS STILL A MISDIAGNOSIS FOR FMF PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundFamilial Mediterranean Fever(FMF) is an autoinflammatory disease characterized by recurrent polyserositis attacks. Attacks typically consist of fever and/or abdominal pain and/or chest pain and/or arthritis. The disease is caused by mutations in the MEFV gene. Abdominal pain during the attacks is frequently misdiagnosed as acute abdomen and these patients go undersurgical intervention is not uncommon [1].ObjectivesSevere abdominal pain during FMF attacks is frequently misdiagnosed as acute abdomen and patients receive surgical intervention. In this study, we aim to compare the clinical and genetic characteristics of FMF patients with appendectomies to those without appendectomies.MethodsWe reviewed 176 patients with FMF who went under appendectomy. We randomly matched these patients with 176 FMF patients without appendectomy for comparison. We compared clinical manifestations, MEFV mutations, and treatment modalities.ResultsIn this study, 176 patients with FMF went under appendectomy. Only 2 of these appendectomies were performed after FMF diagnosis. In the appendectomy group fever(84% vs 68%), abdominal pain(91% vs 79%), pathogenic exon 10 mutations(65% vs 59%), lower leg pain(0.5% vs 0%) and orchitis(0.5% vs 0%) were more common but only the abdominal pain and fever was statistically significant. In the control group chest pain(18% vs 19%), arthralgia(46% vs 53%), arthritis(29% vs 37%), anti IL-1 usage(3% vs 5%), amyloidosis (0% vs 3%) and erysipelas(1% vs 3%) were more common but none of them were statistically significant. Myalgia(3%) was the same in both groups[Table 1]. Median diagnostic delay was 8(IQR 2-15) years in the appendectomy group and 3.5(IQR1-10) years in the control group.Table 1.Characteristics of the patientsNo Of Patients(%)AppendicitisNo Of Patients(%)P valueControl GroupPatients176(100)176(100)Fever148(84)120(68)0.0007Abdominal Pain160(91)139(79)0.0029Chest Pain32(18)33(19)1Arthralgia81(46)94(53)0.20Arthritis51(29)65(37)0.12Myalgia5(3)5(3)1Erysipelas2(1)5(3)0.45Lower Leg Pain1(0.5)0(0)-Orchitis1(0.5)0(0)-Anti IL-1 usage6(3)9(5)0.6Amyloidosis0(0)6(3)-Diagnostic Delay8.5(IQR2-15) years3.5(IQR1-10) years0.0002Pathogenic Exon 10 Mutations114(65)103(59)0.27Appendectomy Before FMF diagnosis174(99)0(0)ConclusionEven after the discovery of colchicine and identification of the MEFV gene diagnosis of FMF remains a challenge. Previous studies reported a median diagnostic delay of 8.2-11 years. In these studies, 28%-32% of the patients went under abdominal surgical intervention before the diagnosis of the FMF[2,3]. The most common symptoms of FMF(fever and abdominal pain) are also the most common symptoms of acute abdomen. Thus distinguishing between FMF and acute abdomen in undiagnosed FMF patients represents an understated problem. These patients have a longer diagnostic delay[8(IQR 2-15) vs 3.5(IQR1-10) years], worse control of attacks, poorer quality of life. In our study, most of the appendectomies were unnecessary in the FMF patients. Thus we recommend investigating the patient for FMF if the evidence of the acute abdomen does not expand beyond the symptoms.References[1]Ozdogan H, Ugurlu S. Familial Mediterranean Fever. Presse Med. 2019 Feb;48(1 Pt 2):e61-e76.[2]Erdogan M, Ugurlu S, Ozdogan H, Seyahi E. Familial Mediterranean fever: misdiagnosis and diagnostic delay in Turkey. Clin Exp Rheumatol. 2019 Nov-Dec;37 Suppl 121(6):119-124.[3]Hageman IMG, Visser H, Veenstra J, Baas F, Siegert CEH. Familial Mediterranean Fever (FMF): a single centre retrospective study in Amsterdam.Disclosure of InterestsNone declared
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Durucan I, Guner S, Kilickiran Avci B, Unverengil G, Melikoglu M, Ugurlu S. Post-COVID-19 vaccination inflammatory syndrome: A case report. Mod Rheumatol Case Rep 2022; 7:280-282. [PMID: 35556127 PMCID: PMC9129185 DOI: 10.1093/mrcr/rxac041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 01/07/2023]
Abstract
A previously healthy 24-year-old male patient was referred to our clinic with bilateral lower extremity pain and dark urine, which were developed 2 weeks after receiving the second dose of the BNT162b2 vaccine against severe acute respiratory coronavirus 2. Laboratory tests indicated rhabdomyolysis. Lower extremity magnetic resonance imaging was compatible with myositis. Myositis-related antibodies were negative. Biopsy taken from gastrocnemius muscle revealed muscle necrosis and striking expression of major histocompatibility complex class I antigen. He was successfully treated, and his complaints were resolved. One week later at follow-up, he reported new-onset exertional dyspnoea with palpitations. ST-segment depressions were spotted on electrocardiography. Troponin T was found elevated as 0.595 ng/ml (normal <0.014 ng/ml). Echocardiography showed a hypokinetic left ventricle with an ejection fraction of 40% and pericardial effusion of 2 mm. An appropriate treatment plan was formulated for the diagnosis of myocarditis, eventually, the patient recovered within 10 days. The BNT162b2 messenger ribonucleic acid (mRNA) vaccine was felt to cause the aforementioned condition since no other aetiology could be identified. Although it is known that BNT162b2 may induce myocarditis, myositis concomitant myocarditis appears to be a very rare adverse effect of this vaccine.
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Affiliation(s)
- Ibrahim Durucan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Sabriye Guner
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Burcak Kilickiran Avci
- Department of Cardiology, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Gokcen Unverengil
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Corresponding Author: Serdal Ugurlu, Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 34098 Turkey. E-mail: , Mobile: 00905424356265, Tel: 00902124143000/21243
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Oztas M, Bektas M, Karacan I, Aliyeva N, Dag A, Aghamuradov S, Cevirgen SB, Sari S, Bolayirli M, Can G, Hatemi G, Seyahi E, Ozdogan H, Gul A, Ugurlu S. Frequency and severity of COVID-19 in patients with various rheumatic diseases treated regularly with colchicine or hydroxychloroquine. J Med Virol 2022; 94:3431-3437. [PMID: 35315100 PMCID: PMC9088463 DOI: 10.1002/jmv.27731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/02/2022] [Accepted: 03/18/2022] [Indexed: 11/11/2022]
Abstract
This study aimed to investigate whether patients regularly using colchicine or hydroxychloroquine (HCQ) have an advantage of protection from coronavirus disease 2019 (COVID-19) or developing less severe disease. Patients who were taking colchicine or HCQ regularly for a rheumatic disease including Familial Mediterranean Fever, Behçet's syndrome, Systemic Lupus Erythematosus, Rheumatoid Arthritis, and Sjogren's syndrome, as well as their healthy household contacts as the control group, were included in the study. The clinical data regarding COVID-19 were collected using a standard form, and serum samples were analyzed for anti-severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) nucleocapsid immunoglobulin G (IgG). A total of 635 regular colchicine users with their 643 household contacts and 317 regular HCQ users with their 333 household contacts were analyzed. Anti-SARS-COV-2 IgG was positive in 43 (6.8%) regular colchicine users and 35 (5.4%) household contacts (odds ratio [OR] = 1.3; 95% confidence interval [CI]:0.8-2; p = 0.3). COVID-19-related symptoms were described by 29 (67.4%) of the patients and 17 (48.6%) household contacts (OR = 2.2; 95% CI :0.9-5.5; p = 0.09), and hospital admission was observed in five (11.6%) and one (2.9%) of these subjects (OR = 4.5; 95% CI: 0.5-40.2; p = 0.1), respectively. Seropositive subjects were observed in 22 (6.9%) regular HCQ users and 24 (7.2%) household contacts (OR = 1.1; 95% CI: 0.6-1.9; p = 0.8). COVID-19-related symptoms occurred in 16 (72.7%) of the 22 patients and 12 (50%) of 24 household contacts (OR = 2.7; 95% CI: 0.8-9.1; p = 0.1). Three patients (13.6%) were admitted to hospital, while one household contact (4.2%) was hospitalized (OR = 3.6; 95% CI: 0.3-37.8; p = 0.2). Being on a regular treatment of colchicine or HCQ did not result in the prevention of COVID-19 or amelioration of its manifestations.
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Affiliation(s)
- Mert Oztas
- Department of Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Bektas
- Department of Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Ilker Karacan
- Department of Molecular Biology and Genetics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Numune Aliyeva
- Department of Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Ayten Dag
- Department of Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sarvan Aghamuradov
- Department of Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Selim Berke Cevirgen
- Department of Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Selma Sari
- Department of Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Murat Bolayirli
- Department of Medical Biochemistry, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gunay Can
- Department of Public Health, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulen Hatemi
- Department of Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Emire Seyahi
- Department of Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Huri Ozdogan
- Department of Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Gul
- Department of Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Serdal Ugurlu
- Department of Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Cerme E, Oztas M, Balkan II, Cetin EA, Ugurlu S. Haemophagocytic lymphohistiocytosis in a patient with familial Mediterranean fever and miliary tuberculosis: a case report. Mod Rheumatol Case Rep 2022; 6:140-144. [PMID: 34549298 DOI: 10.1093/mrcr/rxab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/08/2021] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a lethal complication of several infections, especially viral origin. Mycobacterium tuberculosis infection can also lead to HLH, yet it is an uncommon trigger. Considering the role of increased cytokines in HLH, autoinflammatory conditions, such as familial Mediterranean fever (FMF), might contribute to its development. Nevertheless, the possible relationship between FMF and HLH has been suggested only in some case reports. We present a case of FMF who admitted to the hospital with consitutional symptoms and chest pain regarding to recurrent pericarditis. On a blood test, pancytopenia and elevated acute phase reactants were seen. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography demonstrated positive FDG uptake sites on both the right and left surrenal glands, the visceral layer of pericard, and reactive lymphadenomegalies at multiple mediastinal regions. Bone marrow biopsy revealed haemophagocytosis. Methylprednisolone treatment was initiated. Despite immunosuppressive treatment, clinical and biochemical parameters deteriorated; thus, a thorax computed tomography was executed. Findings were consistent with miliary tuberculosis infection. M. tuberculosis was detected in blood culture and bronchoalveolar lavage culture material. Also, bone marrow and surrenal biopsy material revealed necrotising caseating granuloma.
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Affiliation(s)
- Emir Cerme
- Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Oztas
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esin Aktas Cetin
- Institute of Experimental Medicine (DETAE), Department of Immunology, Istanbul University, Istanbul, Turkey
| | - Serdal Ugurlu
- Department of Internal Medicine, Division of Rheumatology, 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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Tukek NB, Esatoglu SN, Hatemi G, Calıskan EB, Ozyazgan Y, Ucar D, Ozguler Y, Seyahi E, Melikoglu M, Uygunoglu U, Siva A, Kutlubay Z, Hatemi İ, Celik AF, Ugurlu S, Fresko I, Yurdakul S, Yazici H, Hamuryudan V. Emergence of New Manifestations During Infliximab Treatment in Behçet Syndrome. Rheumatology (Oxford) 2021; 61:3746-3753. [PMID: 34958357 DOI: 10.1093/rheumatology/keab944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/12/2021] [Revised: 12/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Infliximab (IFX) is being increasingly used for the treatment of severe manifestations of Behçet syndrome (BS). However, emergence of new manifestations has also been occasionally reported during IFX treatment. We aimed to assess the frequency of new manifestations in our BS patients treated with IFX. METHODS A chart review was conducted to identify all BS patients treated with IFX in our clinic between 2004 and 2020. Demographic data, indications for IFX initiation, concomitant treatments, and outcomes were recorded. A new manifestation was defined as the emergence of a new organ involvement or mucocutaneous manifestation developing for the first time during IFX treatment or within 12 weeks after the last infusion of IFX. RESULTS Among our 282 patients who used IFX, 19 (7%) patients had developed a total of 23 new manifestations during a mean follow up of 20.0 ± 15.3 months. Patients with vascular involvement were more likely to develop a new manifestation (12/19, 63%). Initial manifestations that required IFX were in remission at the time of new manifestation in 14/19 patients. IFX treatment was intensified (n = 6) and/or glucocorticoids, immunosuppressives, or colchicine were added to IFX (n = 21). IFX was switched to another agent for the remaining manifestations (n = 8). These treatment modifications led to remission in 17/19 patients. CONCLUSION New manifestations developed during IFX treatment in 7% of our patients with BS. They could be managed by intensifying IFX treatment or adding other agents in majority of these manifestations.
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Affiliation(s)
- Nur Beyza Tukek
- Department of Internal Medicine, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Elif Buse Calıskan
- Department of Internal Medicine, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Yılmaz Ozyazgan
- Department of Ophthalmology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Didar Ucar
- Department of Ophthalmology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Zekayi Kutlubay
- Department of Dermatology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - İbrahim Hatemi
- Department of Gastroenterology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Aykut Ferhat Celik
- Department of Gastroenterology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Sebahattin Yurdakul
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Hasan Yazici
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
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Ozcifci G, Aydin T, Atli Z, Balkan II, Tabak F, Oztas M, Ozguler Y, Ugurlu S, Hatemi G, Melikoglu M, Fresko I, Hamuryudan V, Seyahi E. The incidence, clinical characteristics, and outcome of COVID-19 in a prospectively followed cohort of patients with Behçet's syndrome. Rheumatol Int 2021; 42:101-113. [PMID: 34825278 PMCID: PMC8614218 DOI: 10.1007/s00296-021-05056-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/13/2021] [Indexed: 12/28/2022]
Abstract
Initial case series of small number of patients at the beginning of the pandemic reported a rather guarded prognosis for Behçet’s syndrome (BS) patients infected with SARS-CoV-2. In this prospective study, we describe the incidence, clinical characteristics, disease course, management, and outcome in a large cohort of BS patients with laboratory-confirmed infection of SARS-CoV-2. We defined a cohort of 1047 registered BS patients who were aged between 16 and 60 years and seen routinely before the pandemic at the multidisciplinary outpatient clinic. We followed prospectively this cohort from beginning of April 2020 until the end of April 2021. During 13 months of follow-up, of the 1047 (599 M/448 F) patients, 592 (56.5%) were tested for SARS-CoV-2 PCR at least once and 215 (20.5%; 95% CI 0.18–0.23) were tested positive. We observed 2 peaks which took place in December 2020 and April 2021. Of the 215 PCR positive patients, complete information was available in 214. Of these 214, 14 (6.5%) were asymptomatic for COVID-19. In the remaining, the most common symptoms were anosmia, fatigue, fever, arthralgia, and headache. A total of 40 (18.7%) had lung involvement, 25 (11.7%) were hospitalized, 1 was admitted to the intensive care unit while none died. Favipiravir was the most prescribed drug (74.3%), followed by colchicine (40.2%), and hydroxychloroquine (20.1%) in the treatment of COVID-19. After COVID-19, 5 patients (2.3%) were given supplemental O2 and 31 (14.5%) antiaggregant or anticoagulants. During COVID-19, of the 214 PCR positive patients, 116 (54.2%) decreased the dose of their immunosuppressives or stopped taking completely; 36 (16.8%) experienced a BS flare which was mostly oral ulcers (10.3%). None of the patients reported a thrombotic event. A total of 93 (43.5%) patients reported BS flares after a median 45 days of COVID-19 infection and this was found to be significantly associated with immunosuppressive drug discontinuation. Multiple regression analysis adjusted for age and gender indicated that smoking and using interferon-alpha decreased the likelihood of getting COVID-19. The incidence and severity of COVID-19 did not differ between those who were using colchicine or not. The cumulative incidence of COVID-19 in this prospectively followed cohort of BS patients was almost two folds of that estimated for the general population living in Istanbul, Turkey, however, the clinical outcome of COVID-19 was not severe and there was no mortality. The protective effect of smoking and interferon deserves further investigation. On the other hand, colchicine did not have any positive or negative effect against COVID-19. Significant number of patients flared after COVID-19, however, this was significantly associated with immunosuppressive discontinuation during the infection. Contrary to our previous observations, COVID-19 did not seem to exacerbate thrombotic events during or after the infection.
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Affiliation(s)
- Guzin Ozcifci
- Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tahacan Aydin
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Atli
- Department of Accounting and Taxation, Sinop University, Sinop, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Oztas
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, 81310, Turkey.
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Karabul E, Borekci S, Ugurlu S, Musellim B. The frequency of obstructive sleep apnea in patients with primary Sjogren's syndrome. Sleep Breath 2021; 26:1583-1591. [PMID: 34773202 PMCID: PMC8589227 DOI: 10.1007/s11325-021-02491-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/28/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There is a lack of information about the frequency of obstructive sleep apnea (OSA) in primary Sjogren's syndrome (pSS). Using all-night polysomnography (PSG), this study aimed to investigate the frequency of OSA in pSS and the factors affecting the frequency of OSA in this condition. METHODS: Consecutive patients with pSS who presented to the Collagen Tissue Diseases follow-up polyclinic of the Department of Chest Diseases between 1 April 2019 and 31 December, 2020, were included in the study. Demographic characteristics, chronic diseases, smoking history in pack-years, anthropometric data, Epworth Sleepiness Scale score, pulmonary function test parameters, current thorax computed tomography findings, and PSG data were recorded. The control group was created by the retrospective screening of patients admitted to the sleep polyclinic and who underwent PSG but did not have pSS. RESULTS OSA was detected in 37 (84%) of 44 patients with pSS who underwent PSG. Of 37 patients with OSA, 25 (68%) had moderate or severe OSA. Snoring and witnessed apneas, REM%, snoring index, and maximum apnea and maximum hypopnea duration were statistically significantly lower in the pSS group compared with the control group (p < 0.001, p = 0.003, p = 0.025, p = 0.001, p = 0.028, and p = 0.035, respectively). CONCLUSION The frequency of OSA in patients with pSS was 84%, with a decrease in REM%. Although a correlation between symptoms suggesting OSA and the presence of radiological lung involvement, spirometry, and DLCO values with OSA could not be demonstrated, physicians are recommended to be attentive for the presence of OSA in all patients with pSS and to investigate OSA using PSG.
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Affiliation(s)
- Emine Karabul
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
| | - Sermin Borekci
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey.
| | - Serdal Ugurlu
- Department of Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Benan Musellim
- Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, 34098, Turkey
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Egeli BH, Ergun S, Cetin A, Gursoy YK, Ugurlu S. Rituximab as a glucocorticoid-sparing agent in idiopathic inflammatory myopathies: a retrospective single-center cohort study. Clin Rheumatol 2021; 41:123-127. [PMID: 34387760 DOI: 10.1007/s10067-021-05871-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/23/2021] [Revised: 07/17/2021] [Accepted: 07/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIM) are essentially treated aiming to improve muscle function and extra muscular disease manifestations. Rituximab is potentially a glucocorticoid-sparing agent which was reviewed in multiple studies with small sample sizes due to the rarity of the disease. Higher statistical power can enhance the trustworthiness of alternative treatment modalities yielding the main objective of this study. METHODS This retrospective study was conducted at a tertiary rheumatology center. Patients were diagnosed with an idiopathic inflammatory myopathy (dermatomyositis (DM), polymyositis (PM)) and were treated with rituximab to be included in this study. Parameters of disease activity including acute phase reactants, muscle enzyme levels, and disease-specific autoantibodies were analyzed. The primary study endpoint was the improvement of the patient symptoms. The secondary endpoint was the decrease in the creatinine kinase level. RESULTS The study includes 26 patients (19 DM, 7 PM). The age of diagnosis was 42.04 ± 15.22 years; the follow-up duration was 64.84 ± 71.91 months. The mean corticosteroid dose decreased from 32.895 ± 24.399 to 8.44 ± 11.29 (p < 0.001). Other treatment methods were methotrexate (n = 18), intravenous immunoglobulin (IVIG) (n = 7), and cyclophosphamide (n = 2). Two patients were lost to follow-up. CONCLUSION Rituximab is shown to be effective in treating myositis along with corticosteroids as well as a corticosteroid-sparing agent in retrospective studies and open-label clinical trials; however, lack of statistical power should be underlined. Long-term decrease in steroid use and decrease in disease activity markers hint the effective use of rituximab as a glucocorticoid-sparing agent as well as its safety with minimal side effects. Key Points • Long-term decrease in steroid use and decrease in disease activity markers hint the effective use of rituximab as a glucocorticoid-sparing agent as well as its safety with minimal side effects.
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Affiliation(s)
- Bugra Han Egeli
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Department of Pediatrics, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Sercan Ergun
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Arya Cetin
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yahya Kerem Gursoy
- 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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Akgun E, Halac M, Ugurlu S, Sonmezoglu K. An unusual sacral joint localization of granulomatosis with polyangiitis detected by 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2021; 41:261-263. [PMID: 34373216 DOI: 10.1016/j.remnie.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Elife Akgun
- Yuksek Ihtisas Hospital, Department of Nuclear Medicine, Kirikkale, Turkey.
| | - Metin Halac
- Neolife Medical Center, Department of Nuclear Medicine, Istanbul, Turkey
| | - Serdal Ugurlu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Division of Rheumatology, Department of Internal Medicine, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey
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Civi Karaaslan T, Ugurlu S, Tarakci E. AB0860-HPR IS THERE A RELATIONSHIP BETWEEN PHYSICAL ACTIVITY, SLEEP QUALITY, ANXIETY AND DEPRESSION IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Maintenance of regular physical activity is associated with better physical and mental health (1). In addition, sleep disturbances and mood disorders are common in chronic inflammatory diseases (2).Objectives:The aim of this study was to determine the relationship between physical activity, sleep quality, anxiety and depression in patients with FMF.Methods:A total of 56 patients (30 female, 26 male) with Familial Mediterranean Fever (FMF) were enrolled in the study. They were diagnosed with FMF based on the Livneh diagnostic criteria (3). International Physical Activity Questionnaire - Short Form (IPAQ) was used to evaluate health-related physical activity. Patient-reported sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression in FMF patients. Patients who were 20-55 years old was included in the study.Results:The mean age was 32.23±9.87 years. The mean disease duration of the patients was 12.24±7.61 years. The education level of 51.8% (n=29) of the participants was undergraduate and above. The rate of those who did not work was 32.1% (n=18) and 48.2% (n=27) of the participants were married. The mean of scores of IPAQ was 2333.99±2640.29, the mean of PSQI was 6.14±3.66, the mean of HADS-Anxiety was 7.89±5.03 and HADS-Depression was 7.01±4.44. The patients were classified according to physical activity categories as low (25.0%, n=14), moderate (41,1% n=23) and high (33.9%, n=19). Physical activity categories were not found associated with PSQI (p=0.437), HADS-Anxiety (p=0.363) and HADS-Depression (p=0.861). The relationships of scores of IPAQ, PSQI and HADS were demonstrated Table 1.Conclusion:This study confirmed that patients with FMF suffer from sleep disturbances, anxiety and depression. In addition, sleep disturbances, anxiety and depression were not associated with physical activity category.References:[1]Sokka, Tuulikki, et al. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 2008, 59.1: 42-50.[2]Kucuksahin, Orhan, et al. Incidence of sleep disturbances in patients with familial Mediterranean fever and the relation of sleep quality with disease activity. International journal of rheumatic diseases, 2018, 21.10: 1849-1856.[3]Bashardoust, Bahman. Familial Mediterranean fever; diagnosis, treatment, and complications. Journal of nephropharmacology, 2015, 4.1: 5.Table 1.The correlations of IPAQ, PSQI and HADS scores.HADS-DepressionHADS-AnxietyPSQIIPAQr-0.091-0.142-0.002p0.5050.2950.990PSQIr0.6890.615p0.0010.001HADS-Anxietyr0.681p0.001-Pearson CorrelationDisclosure of Interests:None declared
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Ugurlu S, Civi Karaaslan T, Toker Dincer Z, Tarakci E. AB0715 THE PREVALENCE OF FIBROMIYALGIA IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER AND THE RELATIONSHIP BETWEEN FATIGUE AND QUALITY OF LIFE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Familial Mediterranean Fever (FMF) can cause various muscle diseases. Because it is a chronic auto inflammatory disease, painful trigger points may be encountered in the examination due to a decrease in the pain threshold (1-3).Objectives:The aim of this study was to determine the prevalence of Fibromiyalgia in patients with FMF, at the same time to identify the relationship between fatigue and quality of life.Methods:Sixtyseven patients (38 female, 29 male) with FMF were enrolled in the study. They were diagnosed with FMF based on the Livneh diagnostic criteria (4). Fibromyalgia involvement of the patients was evaluated according to the Fibromyalgia Impact Questionnaire (FIQ). Patients with diagnose with other chronic disease were excluded. Fatigue Severity Scale (FSS) was used to evaluate fatigue. Quality of life was evaluated with Short Form-36 (SF-36).Results:Respectively, the mean age, disease duration and body mass index were 34.46±12.69 years, 12.66±7.86 years and 24.96±5.42 kg/m2. In addition, 65% of the patients had no rheumatic disease in their family history. The mean of scores of FIQ was 38.66±25.14, the mean of FSS was 38.07±17.56, the mean of SF-36-PCS was 45.55±10.54 and SF36-MCS was 30.93±17.39. Patients were categorized as mild (n=28), moderate (n=24) and severe (n=15) affected according to their FİQ score. The relationships of scores of FIQ, FSS and SF-36 were demonstrated Table 1.Conclusion:Fibromyalgia symptoms can be seen in FMF. According to our results, it has been shown that patients with moderate and severe symptoms have increased fatigue levels and decreased quality of life. In the light of these results, we can say that also the fibromyalgia symptom of patients with FMF should be considered in the treatment.References:[1]Sari, Ismail; Birlik, Merih; Kasifoglu, Timucin. Familial Mediterranean fever: an updated review. European journal of rheumatology, 2014, 1.1: 21.[2]Alayli G, Durmus D, Ozkaya O, Sen HE, Genc G, Kuru O. Frequency of juvenile fibromyalgia syndrome in children with familial Mediterranean fever: effects on depression and quality of life. Clin Exp Rheumatol 2011; 29: S127-32.[3]Langevitz P, Buskila D, Finkelstein R, Zaks N, Neuman L, Sukenik S, et al. Fibromyalgia in familial Mediterranean fever. J Rheumatol 1994; 21: 1335-7.[4]Bashardoust, Bahman. Familial Mediterranean fever; diagnosis, treatment, and complications. Journal of nephropharmacology, 2015, 4.1: 5.Table 1.The correlations of FIQ, FSS and SF-36 scores.FSSSF-36 PCSSF-36 MCSFIQ-mildmean±sd23.78±14.8853.34±7.0140.98±13.73r0.595**-0.014-0.551**p0.0010.9440.002FIQ-moderatemean±sd45.75±10.8341.09±8.8938.13±9.19r0.053-0.379-0.145p0.8060.0680.498FIQ-severemean±sd52.46±10.1138.13±9.1920.32±15.68r0.622*-0.548*-0.268p0.0130.0350.333-Pearson CorrelationDisclosure of Interests:None declared
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