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Okyar B, Akben S, Torun B, Çetin GY. A rare syndrome mimicking scleroderma: Werner syndrome. Mod Rheumatol Case Rep 2023; 7:315-319. [PMID: 36208300 DOI: 10.1093/mrcr/rxac077] [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: 08/09/2022] [Revised: 09/04/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Werner syndrome (WS), also known as adult progeria, is a premature ageing syndrome that can manifest itself with grey hair, hair loss, diabetes mellitus, hyperlipidaemia, hypertension, skin disorders, ocular cataracts, myocardial infarction, osteoporosis, and stroke, especially after puberty. Physical examination findings similar to systemic sclerosis may be seen. Therefore, it may mimic this disease as misleading. A 43-year-old female patient was admitted to our clinic with a pre-diagnosis of systemic sclerosis complaint of skin hardening up to the ankle. In the first physical examination, there were wrinkles and thinning of the lip, suggesting systemic sclerosis in the facial appearance. On her capillaroscopy, there was tortuosity and an old focus of microhemorrhage. She had a history of diabetes mellitus and chronic osteomyelitis. When all symptoms, clinical findings, and antibody results were combined, it was thought that the patient might have WS. WS was diagnosed with homozygous c.2221 C>P p.R741*(rs763089663) positive in genetic analysis. It is known that WS creates a predisposition to malignancies, and most patients die secondary to malignancies. Therefore, early diagnosis becomes essential. Early diagnosis is of vital importance both to prevent complications and to delay treatment. In particular, systemic sclerosis-like findings of this syndrome may cause delays in diagnosis. For this reason, small clues suggesting WS in the clinic should be well known and well defined.
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Affiliation(s)
- Burak Okyar
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş,Turkey
| | - Seçkin Akben
- Department of Internal Medicine, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Bekir Torun
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş,Turkey
| | - Gözde Yıldırım Çetin
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş,Turkey
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Okyar B, Torun B, Öktem ES, Bahar AY, Yıldız F, Çetin GY. Mimic or coincidentally? TAFRO syndrome and systemic lupus erythematosus: A case-based review. Mod Rheumatol Case Rep 2023; 7:271-275. [PMID: 35538613 DOI: 10.1093/mrcr/rxac045] [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: 03/25/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 01/07/2023]
Abstract
Castleman's disease (CD) is a rare, systemic disease with histopathological features of angiofollicular lymph node hyperplasia. In the literature, there are case-level reports that mimic or coexist with systemic lupus erythematosus (SLE) clinically and in the laboratory. Is this condition two separate diseases or is it an imitation of each other? A 73-year-old female patient was admitted to our clinic with arthritis, lymphadenopathy, fever, weight loss, and malar rash. He had a history of idiopathic thrombocytopenic purpura and thrombosis in the right leg tibialis posterior and dorsalis pedis arteries. Excisional lymphadenopathy biopsy indicated a diagnosis of hyaline-vascular-type CD. She had anti-nuclear antibody >1/80 homogeneous pattern, anti-double stranded DNA (anti-dsDNA), Anti-Smith (Sm) antibody positivity, hypocomplementemia (C3 and C4), pleural effusion, and pericardial effusion. For this reason, the classification criteria of the European League Against Rheumatism/American College of Rheumatology were studied. Clinical findings, idiopathic thrombocytopenic purpura history, antibody positivity, malar rash, and arthritis led us to the diagnosis of SLE. She was treated with 1 mg/kg/day prednisolone and hydroxychloroquine 200 mg 2 × 1. Azathioprine 2.5 mg/kg daily was added to the patient whose complaints did not improve. In the follow-ups, she completely recovered clinically and laboratory. SLE and CD are systemic diseases that overlap in many ways. The literature review shows that these two diseases may mimic each other or may coexist. This situation may be a reflection of a pathophysiological process that has not yet been clarified. This confusing process also affects the treatment decision. This confusing process also affects the treatment decision.
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Affiliation(s)
- Burak Okyar
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Onikişubat/Kahramanmaraş, Turkey
| | - Bekir Torun
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Onikişubat/Kahramanmaraş, Turkey
| | - Esen Saba Öktem
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Onikişubat/Kahramanmaraş, Turkey
| | - Abdulkadir Yasir Bahar
- Department of Pathology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Onikişubat/Kahramanmaraş, Turkey
| | - Fatih Yıldız
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Onikişubat/Kahramanmaraş, Turkey
| | - Gözde Yıldırım Çetin
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Onikişubat/Kahramanmaraş, Turkey
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Akyol L, Toz B, Bayındır Ö, Zengin O, Cansu D, Yiğit M, Çetin GY, Omma A, Erden A, Küçükşahin O, Altuner MŞ, Çorba B, Ünal AU, Küçük H, Küçük A, Balkarli A, Gönüllü E, Tufan AN, Bakırcı S, Öner SY, Balcı MA, Kobak Ş, Yazıcı A, Özgen M, Şahin A, Koca SS, Erer B, Gül A, Aksu K, Keser G, Onat AM, Kısacık B, Kaşifoğlu T, Çefle A, Kalyoncu U, Sayarlıoğlu M. Budd-Chiari syndrome in Behçet's disease: a retrospective multicenter study. Clin Rheumatol 2021; 41:177-186. [PMID: 34368908 DOI: 10.1007/s10067-021-05878-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/18/2021] [Revised: 07/17/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the clinical features, laboratory findings, and prognosis of Behçet's disease (BD) patients with and without Budd-Chiari syndrome (BCS). METHODS This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017. RESULTS Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p < 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14-47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%). CONCLUSION To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.
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Affiliation(s)
- Lütfi Akyol
- Department of Internal Medicine, Division of Rheumatology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
| | - Bahtiyar Toz
- Department of Medicine, Icahn School of Medicine At Mount Sinai, Queens Hospital Center, New York, NY, USA
| | - Özün Bayındır
- Department of Internal Medicine, Division of Rheumatology, Katip Çelebi University School of Medicine, İzmir, Turkey
| | - Orhan Zengin
- Department of Internal Medicine, Division of Rheumatology, Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - DöndüÜsküdar Cansu
- Department of Internal Medicine, Division of Rheumatology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Murat Yiğit
- Department of Internal Medicine, Division of Rheumatology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Gözde Yıldırım Çetin
- Department of Internal Medicine, Division of Rheumatology, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Ahmet Omma
- Department of Internal Medicine, Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Abdulsamet Erden
- Department of Internal Medicine, Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Orhan Küçükşahin
- Department of Internal Medicine, Division of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Şakir Altuner
- Department of Internal Medicine, Division of Rheumatology, Malatya Training and Research Hospital, Malatya, Turkey
| | - BurçinŞeyda Çorba
- Department of Statistics, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ali Uğur Ünal
- Department of Internal Medicine, Division of Rheumatology, Medıcal Park Hospital, Ordu, Turkey
| | - Hamit Küçük
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Adem Küçük
- Department of Internal Medicine, Division of Rheumatology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Ayşe Balkarli
- Department of Internal Medicine, Division of Rheumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Emel Gönüllü
- Department of Internal Medicine, Division of Rheumatology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ayşe Nur Tufan
- Department of Internal Medicine, Division of Rheumatology, Health Sciences University, İstanbul Haseki Training and Research Hospital, İstanbul, Turkey
| | - Sibel Bakırcı
- Department of Internal Medicine, Division of Rheumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Sibel Yılmaz Öner
- Department of Internal Medicine, Division of Rheumatology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Ali Balcı
- Department of Internal Medicine, Division of Rheumatology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Şenol Kobak
- Department of Internal Medicine, Division of Rheumatology, Liv Hospital, Istanbul, Turkey
| | - Ayten Yazıcı
- Department,of Internal Medicine, Division of Rheumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Metin Özgen
- Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ali Şahin
- Department of Internal Medicine, Division of Rheumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Süleyman Serdar Koca
- Department of Internal Medicine, Division of Rheumatology, Fırat University School of Medicine, Elazığ, Turkey
| | - Burak Erer
- Department of Internal Medicine, Division of Rheumatology, Memorial Şişli Hospital, İstanbul, Turkey
| | - Ahmet Gül
- Department of Internal Medicine, Division of Rheumatology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Kenan Aksu
- Department of Internal Medicine, Division of Rheumatology, Ege University School of Medicine, İzmir, Turkey
| | - Gökhan Keser
- Department of Internal Medicine, Division of Rheumatology, Ege University School of Medicine, İzmir, Turkey
| | - Ahmet Mesut Onat
- Department of Internal Medicine, Division of Rheumatology, Medıcal Park Hospital, Gaziantep, Turkey
| | - Bünyamin Kısacık
- Department of Internal Medicine, Division of Rheumatology, Medıcal Park Hospital, Gaziantep, Turkey
| | - Timuçin Kaşifoğlu
- Department of Internal Medicine, Division of Rheumatology, Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ayşe Çefle
- Department,of Internal Medicine, Division of Rheumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Sayarlıoğlu
- Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Ayan G, Aydin SZ, Kimyon G, Ozisler C, Tinazzi I, Dogru A, Omma A, Kilic L, Yılmaz S, Kucuksahin O, Gönüllü E, Yıldız F, Can M, Balkarlı A, Solmaz D, Dalkılıc E, Bayindir O, Yıldırım Çetin G, Ergulu Esmen S, Ersozlu ED, Duruoz MT, Akyol L, Kucuk A, Bes C, Cınar M, Erden A, Mercan R, Bakirci S, Kasifoglu T, Yazısız V, Kalyoncu U. PsART-ID inception cohort: clinical characteristics, treatment choices and outcomes of patients with psoriatic arthritis. Rheumatology (Oxford) 2021; 60:1755-1762. [PMID: 33097960 DOI: 10.1093/rheumatology/keaa663] [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: 07/01/2020] [Revised: 09/04/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts. METHODS PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5-10 years (n = 328), ≥10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts. RESULTS The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ≥10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months. CONCLUSION The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.
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Affiliation(s)
- Gizem Ayan
- Faculty of Medicine, Rheumatology, University of Ottawa, Ottawa, ON, Canada.,Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
| | - Sibel Zehra Aydin
- Faculty of Medicine, Rheumatology, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gezmis Kimyon
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Mustafa Kemal University, Hatay, Turkey
| | - Cem Ozisler
- Department of Internal Medicine, Division of Rheumatology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Ilaria Tinazzi
- Sacro Cuore Don Calabria Hospital, Unit of Rheumatology, Negrar-Verona, VR, Italy
| | - Atalay Dogru
- Department of Internal Medicine, Division of Rheumatology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Ahmet Omma
- Department of Internal Medicine, Division of Rheumatology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Levent Kilic
- Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
| | - Sema Yılmaz
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Orhan Kucuksahin
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Emel Gönüllü
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Sakarya University, Sakarya, Turkey
| | - Fatih Yıldız
- Department of Internal Medicine, Division of Rheumatology, Van Training and Research Hospital, University of Health Sciences, Turkey
| | - Meryem Can
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Ayşe Balkarlı
- Department of Internal Medicine, Division of Rheumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Dilek Solmaz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University, Izmir, Turkey
| | - Ediz Dalkılıc
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Uludag University, Bursa, Turkey
| | - Ozun Bayindir
- Department of Internal Medicine, Division of Rheumatology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Gözde Yıldırım Çetin
- Department of Internal Medicine, Division of Rheumatology, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Serpil Ergulu Esmen
- Department of Internal Medicine, Division of Rheumatology, Konya Education and Research Hospital, Konya, Turkey
| | - Emine Duygu Ersozlu
- Department of Internal Medicine, Division of Rheumatology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Tuncay Duruoz
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University, Istanbul, Turkey
| | - Lütfi Akyol
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayis University, Samsun, Turkey
| | - Adem Kucuk
- Meram Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Necmettin Erbakan Univeristy, Konya, Turkey
| | - Cemal Bes
- Department of Internal Medicine, Division of Rheumatology, and Research Hospital, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Muhammet Cınar
- Department of Internal Medicine, Division of Rheumatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Abdulsamet Erden
- Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
| | - Rıdvan Mercan
- Department of Internal Medicine, Division of Rheumatology Tekirdag, Faculty of Medicine, Namık Kemal University, Turkey
| | - Sibel Bakirci
- Department of Internal Medicine, Division of Rheumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Timucin Kasifoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Osmangazi University, Eskisehir, Turkey
| | - Veli Yazısız
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology Ankara, Faculty of Medicine, Hacettepe University, Turkey
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Aydın SZ, Kimyon G, Özişler C, Tarhan EF, Günal EK, Küçük A, Omma A, Solmaz D, Ersözlü ED, Yıldız F, Tufan MA, Çınar M, Mercan R, Yavuz Ş, Alhussain FA, Erden A, Can M, Çetin GY, Kılıç L, Bakırcı S, Al Osaimi N, Kalyoncu U. Psoriasis Symptom Inventory (PSI) as a patient-reported outcome in mild psoriasis: Real life data from a large psoriatic arthritis registry. Eur J Rheumatol 2020; 7:64-67. [PMID: 31922480 DOI: 10.5152/eurjrheum.2019.19126] [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: 08/01/2019] [Accepted: 10/16/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Our aim is to test the validity of the Psoriasis Symptom Inventory (PSI), a patient-reported outcome, to assess the psoriasis severity within the scope of rheumatology. METHODS Within the PsA international database (PSART-ID), 571 patients had PSI, while 322 of these also showed body surface area (BSA). Correlations between PSI, BSA, and other patient- and physician-reported outcomes were investigated. RESULTS There was a good correlation between PSI and BSA (r=0.546, p<0.001), which was even higher for mild psoriasis (BSA<3 (n=164): r=0.608, p<0.001). PSI significantly correlated with fatigue, pain, and patient and physician global parameters (p<0.001). CONCLUSION PSI has a good correlation with other patient- and physician-reported outcomes, and our findings support its use in rheumatology practice.
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Affiliation(s)
- Sibel Zehra Aydın
- Division of Rheumatology, Department of Internal Medicine, University of Ottawa School of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Gezmiş Kimyon
- Division of Rheumatology, Department of Internal Medicine, Hatay Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Cem Özişler
- Division of Rheumatology, Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emine Figen Tarhan
- Division of Rheumatology, Department of Internal Medicine, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Esen Kasapoğlu Günal
- Division of Rheumatology, Department of Internal Medicine, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Adem Küçük
- Division of Rheumatology, Department of Internal Medicine, Meram University School of Medicine, Konya, Turkey
| | - Ahmet Omma
- Division of Rheumatology, Department of Internal Medicine, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey
| | | | - Fatih Yıldız
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Müge Aydın Tufan
- Division of Rheumatology, Department of Internal Medicine, Başkent University, Ankara, Turkey
| | - Muhammet Çınar
- Division of Rheumatology, Department of Internal Medicine, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Rıdvan Mercan
- Division of Rheumatology, Department of Internal Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Şule Yavuz
- Division of Rheumatology, Department of Internal Medicine, Marmara University, İstanbul, Turkey
| | - Fatıma Arslan Alhussain
- Division of Rheumatology, Department of Internal Medicine, İstanbul Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Abdulsamet Erden
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Meryem Can
- Division of Rheumatology, Department of Internal Medicine, Marmara University, İstanbul, Turkey
| | - Gözde Yıldırım Çetin
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Levent Kılıç
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Sibel Bakırcı
- Division of Rheumatology, Department of Internal Medicine, University of Ottawa School of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Noura Al Osaimi
- Division of Rheumatology, Department of Internal Medicine, University of Ottawa School of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
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Bilge ŞY, Solmaz D, Şenel S, Emmungil H, Kılıç L, Öner SY, Yıldız F, Yılmaz S, Bozkırlı DE, Tufan MA, Yılmaz S, Yazısız V, Pehlivan Y, Beş C, Çetin GY, Erten Ş, Gönüllü E, Şahin F, Akar S, Aksu K, Kalyoncu U, Direskeneli H, Erken E, Kısacık B, Sayarlıoğlu M, Çınar M, Kaşifoğlu T, Sarı İ. Exon 2: Is it the good police in familial mediterranean fever? Eur J Rheumatol 2019; 6:34-37. [PMID: 30489254 PMCID: PMC6459332 DOI: 10.5152/eurjrheum.2018.18115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/08/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Familial Mediterranean fever (FMF) is the most common autoinflammatory disease. Most of the identified disease-causing mutations are located on exon 10. As the number of studies about the effect of the exonal location of the mutation and its phenotypic expression is limited, we aimed to investigate whether the exonic location of the Mediterranean fever (MEFV) mutation has an effect on the clinical manifestation in patients with FMF. Methods Study population was derived from the main FMF registry that included 2246 patients from 15 different rheumatology clinics. We categorized the mutations according to their exon locations and retrieved the clinical and demographic information from the database. Results Patients having the MEFV mutations on exon 2 or 10 (n:1526) were divided into three subgroups according to the location of the MEFV mutations: Group 1 (exon 2 mutations), Group 2 (exon 10 mutations), and Group 3 (both exon 2 and exon 10 mutations). Group 2 patients were of a significantly younger age at onset, and erysipel-like erythema, arthritis, amyloidosis, and a family history of FMF were more common in this group. Conclusion Patients with FMF and exon 10 mutations show more severe clinical symptoms and outcome. Exon 2 mutations tend to have a better outcome.
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Affiliation(s)
- Şule Yaşar Bilge
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Soner Şenel
- Division of Rheumatology, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hakan Emmungil
- Division of Rheumatology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Levent Kılıç
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sibel Yılmaz Öner
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Fatih Yıldız
- Division of Rheumatology, Department of Internal Medicine, Çukurova University School of Medicine, Adana, Turkey
| | - Sedat Yılmaz
- Division of Rheumatology, Department of Internal Medicine, Gülhane Military School of Medicine, Ankara, Turkey
| | - Duygu Ersözlü Bozkırlı
- Division of Rheumatology, Department of Internal Medicine, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Müge Aydın Tufan
- Division of Rheumatology, Department of Internal Medicine, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Sema Yılmaz
- Division of Rheumatology, Department of Internal Medicine, Selçuk University School of Medicine, Konya, Turkey
| | - Veli Yazısız
- Division of Rheumatology, Department of Internal Medicine, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Yavuz Pehlivan
- Division of Rheumatology, Department of Internal Medicine, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Cemal Beş
- Division of Rheumatology, Department of Internal Medicine, Abant İzzet Baysal University School of Medicine, Bolu, Turkey
| | - Gözde Yıldırım Çetin
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Şükran Erten
- Division of Rheumatology, Department of Internal Medicine, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emel Gönüllü
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Fezan Şahin
- Department of Biostatistics, Eskisehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Kenan Aksu
- Division of Rheumatology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Eren Erken
- Division of Rheumatology, Department of Internal Medicine, Çukurova University School of Medicine, Adana, Turkey
| | | | - Mehmet Sayarlıoğlu
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Muhammed Çınar
- Division of Rheumatology, Department of Internal Medicine, Gülhane Military School of Medicine, Ankara, Turkey
| | - Timuçin Kaşifoğlu
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - İsmail Sarı
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Kızıldağ B, Yurttutan N, Sarıca MA, Atilla N, Baykara M, Şereflican B, Yıldırım Çetin G. Insights into chest computed tomography findings in Behcet's disease. Tuberk Toraks 2019; 66:325-333. [PMID: 30683028 DOI: 10.5578/tt.27936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction To evaluate the spectrum and frequency of abnormal chest multidedector computed tomography (MDCT) findings in Behcet's disease(BD). Materials and Methods Chest MDCT scans of 44 patients referred to radiology department for chest symptoms those had prior or newly established diagnosis of BD between 2009-2016 were retrospectively reviewed. Abnormal findings within pulmonary artery (PA), lungs, other large vessels, heart, mediastinum, pleura and pericardium were noted. Result Sixteen patients had one ore more computed tomography (CT) findings related to BD. PA involvement was most common (27.2%) presentation revealing thrombosis in 8 and aneurysms in 4 of 12 patients. Mean PA diameter was 29 ± 3.7 mm. Patients with PA involvement had significantly higher PA diameters than those without (p< 0.001). Hypertrophied bronchial artery seen as serpiginous vessels around hilum was a common finding (66.6%). Lung parenchyma findings was rarely isolated and usually associated with PA involvement with subpleural alveolar opacities, focal atelectasis and ill-defined nodular opacities. Cardiac filling defects were accompanying lesions in most of patients with PA aneurysms (75%). Conclusions BD is associated with a wide spectrum of simultaneous involvement of discrete anatomical sites. PA enlargement and hypertrophied bronchial artery is a clue for patients with PA involvement. Heart chambers should be checked for filling defects particularly in patients with PA aneurysms.
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Affiliation(s)
- Betül Kızıldağ
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Nursel Yurttutan
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Mehmet Akif Sarıca
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Nurhan Atilla
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Murat Baykara
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Betül Şereflican
- Department of Dermatology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Gözde Yıldırım Çetin
- Department of Rheumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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8
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Kalyoncu U, Bayindir Ö, Ferhat Öksüz M, Doğru A, Kimyon G, Tarhan EF, Erden A, Yavuz Ş, Can M, Çetin GY, Kılıç L, Küçükşahin O, Omma A, Ozisler C, Solmaz D, Bozkirli EDE, Akyol L, Pehlevan SM, Gunal EK, Arslan F, Yılmazer B, Atakan N, Aydın SZ. The Psoriatic Arthritis Registry of Turkey: results of a multicentre registry on 1081 patients. Rheumatology (Oxford) 2016; 56:279-286. [PMID: 27794533 DOI: 10.1093/rheumatology/kew375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 01/19/2016] [Revised: 09/09/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim was to assess the characteristics of PsA, find out how well the disease is controlled in real life, demonstrate the treatments and identify the unmet needs. METHODS The PsA registry of Turkey is a multicentre Web-based registry established in 2014 and including 32 rheumatology centres. Detailed data regarding demographics for skin and joint disease, disease activity assessments and treatment choices were collected. RESULTS One thousand and eighty-one patients (64.7% women) with a mean (sd) PsA duration of 5.8 (6.7) years were enrolled. The most frequent type of PsA was polyarticular [437 (40.5%)], followed by oligoarticular [407 (37.7%)] and axial disease [372 (34.4%)]. The mean (sd) swollen and tender joint counts were 1.7 (3) and 3.6 (4.8), respectively. Of these patients, 38.6% were on conventional synthetic DMARD monotherapy, 7.1% were on anti-TNF monotherapy, and 22.5% were using anti-TNF plus conventional synthetic DMARD combinations. According to DAS28, 86 (12.4%) patients had high and 105 (15.2%) had moderate disease activity. Low disease activity was achieved in 317 (45.7%) patients, and 185 (26.7%) were in remission. Minimal disease activity data could be calculated in 247 patients, 105 of whom (42.5%) had minimal disease activity. The major differences among sexes were that women were older and had less frequent axial disease, more fatigue, higher HAQ scores and less remission. CONCLUSION The PsA registry of Turkey had similarities with previously published registries, supporting its external validity. The finding that women had more fatigue and worse functioning as well as the high percentage of active disease state highlight the unmet need in treatment of PsA.
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Affiliation(s)
- Umut Kalyoncu
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara
| | - Özün Bayindir
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ege University, Izmir
| | - Mustafa Ferhat Öksüz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Uludag University, Bursa
| | - Atalay Doğru
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Suleyman Demirel University, Isparta
| | - Gezmiş Kimyon
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Gaziantep University, Ankara
| | - Emine Figen Tarhan
- Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University School of Medicine, Izmir
| | - Abdulsamet Erden
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara
| | - Şule Yavuz
- Istanbul Florence Nightingale Hospital, Department of Rheumatology, Istanbul Bilim University
| | - Meryem Can
- Department of Rheumatology, Fatih Sultan Mehmet Education and Research Hospital, İstanbul
| | - Gözde Yıldırım Çetin
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Sutcu Imam University, Kahramanmaras
| | - Levent Kılıç
- Department of Rheumatology, Yildirim Beyazit University, Yenimahalle Education and Research Hospital, Ankara
| | - Orhan Küçükşahin
- Faculty of Medicine, Atatürk Education and Research Hospital Department of Rheumatology, Yıldırım Beyazit University
| | - Ahmet Omma
- Department of Rheumatology, Ankara Numune Training and Research Hospital
| | - Cem Ozisler
- Department of Rheumatology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara
| | - Dilek Solmaz
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Namik Kemal University, Tekirdag
| | | | - Lütfi Akyol
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ondokuz Mayıs University, Samsun
| | | | | | - Fatos Arslan
- Istanbul Medeniyet University, Goztepe Training and Research Hospital
| | - Barış Yılmazer
- Department of Rheumatology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul
| | - Nilgun Atakan
- Faculty of Medicine, Department of Dermatology, Hacettepe University, Ankara, Turkey
| | - Sibel Zehra Aydın
- Division of Rheumatology, University of Ottawa, Ottawa, Ontario, Canada
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9
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Pamuk ÖN, Kalyoncu U, Aksu K, Omma A, Pehlivan Y, Çağatay Y, Küçükşahin O, Dönmez S, Çetin GY, Mercan R, Bayındır Ö, Çefle A, Yıldız F, Balkarlı A, Kılıç L, Çakır N, Kısacık B, Öksüz MF, Çobankara V, Onat AM, Sayarlıoğlu M, Öztürk MA, Pamuk GE, Akkoç N. A multicenter report of biologic agents for the treatment of secondary amyloidosis in Turkish rheumatoid arthritis and ankylosing spondylitis patients. Rheumatol Int 2016; 36:945-53. [DOI: 10.1007/s00296-016-3500-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/16/2016] [Indexed: 12/21/2022]
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10
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Doğu B, Atilla N, Çetin GY, Yılmaz N, Öksüz H. A case of acute respiratory failure in a rheumatoid arthritis patient after the administration of abatacept. Eur J Rheumatol 2016; 3:134-135. [PMID: 27733944 DOI: 10.5152/eurjrheum.2015.0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/02/2015] [Accepted: 08/03/2015] [Indexed: 12/15/2022] Open
Abstract
Drug-induced pulmonary disease is an important consideration in the differential diagnosis of patients with rheumatoid arthritis (RA) who present with respiratory symptoms. We report a patient with RA who developed acute respiratory failure two weeks after the administration of abatacept. The clinical findings were consistent with drug-induced acute respiratory failure, most likely acute eosinophilic pneumonia. Pulse steroid was administered at 1000 mg/kg/day in the emergency department. Chest X-ray and arterial blood gas values revealed significant improvement on the second day of hospitalization. However, in the second week, the patient's fever rose up to 40°C, procalcitonin level increased to 15 ng/mL (<0.5 ng/mL is normal), and the patient died because of sepsis in the fourth week. This is the second report of respiratory failure, after the abatacept administration in the literature. We have reported an acute respiratory failure that occurred after use of the biological agent abatacept. With the increasing use of novel immunomodulatory agents, it is important for clinicians and pathologists to add the possibility of a drug reaction to the traditional differentials of acute respiratory failures occurring in these settings.
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Affiliation(s)
- Birsen Doğu
- Department of Anesthesia and Reanimation, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Nurhan Atilla
- Department of Chest Diseases, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Gözde Yıldırım Çetin
- Department of Rheumatology, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Nezir Yılmaz
- Department of Anesthesia and Reanimation, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Hafize Öksüz
- Department of Anesthesia and Reanimation, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
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11
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Acar GR, Akkoyun M, Nacar AB, Dirnak I, Yıldırım Çetin G, Nur Yıldırım M, Zencir C, Karaman K, Cetin M, Sayarlıoğlu M. Evaluation of Tp-e interval and Tp-e/QT ratio in patients with rheumatoid arthritis. Turk Kardiyol Dern Ars 2015; 42:29-34. [PMID: 24481092 DOI: 10.5543/tkda.2014.52959] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias. The aim of this study was to evaluate ventricular repolarization by using the Tp-e interval and Tp-e/QT ratio in patients with rheumatoid arthritis (RA), and to assess the relation with inflammation. STUDY DESIGN Ninety-six patients (72 females, 24 males; mean age 43.8±11.8 years) with RA and 50 controls (35 females, 15 males; mean age 44.2±11.1 years) were included. From the 12-lead electrocardiogram, Tp-e interval and Tp-e/QT ratio were measured. Blood samples were taken for erythrocyte sedimentation rate (ESR) and plasma levels of C-reactive protein (CRP). These parameters were compared between groups. The relationship between ventricular repolarization and inflammation was assessed by Pearson correlation coefficients. RESULTS Tp-e interval and Tp-e/QT ratio were increased in RA patients compared to the controls (72.6±8.2 vs 66.4±8.5 ms, 0.20±0.02 vs 0.18±0.02; p<0.001 and p<0.001, respectively). The Tp-e interval was significantly correlated with CRP, ESR, and disease activity score (DAS-28) (r=0.56, p<0.001, r=0.57, p<0.001, and r=0.29, p=0.02, respectively). The Tp-e/QT ratio was also correlated with CRP, ESR, and DAS-28 score (r=0.43, p<0.001, r=0.53, p<0.001, and r=0.25, p=0.03, respectively). CONCLUSION In RA patients, the increased frequency of ventricular arrhythmias may be explained by increased indexes of ventricular repolarization and their relationship with inflammation.
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Affiliation(s)
- Gu Rkan Acar
- Department of Cardiology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey.
| | - Murat Akkoyun
- Department of Cardiology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Alper Bugra Nacar
- Department of Cardiology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Imran Dirnak
- Department of Cardiology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Gözde Yıldırım Çetin
- Department of Rheumatology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | | | - Cemil Zencir
- Department of Cardiology, Necip Fazıl State Hospital, Kahramanmaraş, Turkey
| | - Kayıhan Karaman
- Department of Cardiology, Necip Fazıl State Hospital, Kahramanmaraş, Turkey
| | - Mustafa Cetin
- Department of Cardiology, Necip Fazıl State Hospital, Kahramanmaraş, Turkey
| | - Mehmet Sayarlıoğlu
- Department of Rheumatology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
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12
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Çetin GY, Sayarlıoğlu H, Erhan Ç, Kahraman H, Cıralık H, Sayarlıoğlu M. A case of neutrophilic dermatosis who develop palpable purpura during the use of montelukast. Eur J Rheumatol 2014; 1:170-171. [PMID: 27708908 DOI: 10.5152/eurjrheumatol.2014.140032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/15/2014] [Accepted: 05/18/2014] [Indexed: 11/22/2022] Open
Abstract
In this case report, we present a female patient with neutrophilic dermatosis (ND) occurring as palpable purpura after using montelukast. Neutrophilic dermatoses (NDs) are characterized by skin lesions in which mature neutrophils are predominantly located in the epidermis and dermis in the absence of any infective pathology. Classification of the NDs is based upon the recognition of clinical and pathologic features, as well as the identification of associated diseases, like Sweet's syndrome, pyoderma gangrenosum, generalized pustular psoriasis, and Behçet's disease. Cutaneous findings in NDs are variable and can include vesiculopustules, plaques, nodules, or ulcerations. Drug-induced NDs are not uncommon, but ND with palpable purpura is uncommon. The current patient appeared with a rare presentation as palpable purpura without vasculitis regarding ND. It is important that this is the first case report.
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Affiliation(s)
- Gözde Yıldırım Çetin
- Department of Rheumatology, Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Hayriye Sayarlıoğlu
- Department of Nephrology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Çiğdem Erhan
- Department of Internal Medicine, Sütçü İmam University Facultry of Medicine, Kahramanmaraş, Turkey
| | - Hasan Kahraman
- Department of Chest Diseases, Sütçü İmam University Facultry of Medicine, Kahramanmaraş, Turkey
| | - Harun Cıralık
- Department of Pathology, Sütçü İmam University Facultry of Medicine, Kahramanmaraş, Turkey
| | - Mehmet Sayarlıoğlu
- Department of Rheumatology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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13
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Öztürk MA, Kaya A, Şenel S, Dönmez S, Balkarlı A, Çobankara V, Erhan Ç, Sayarlıoğlu M, Ugan Y, Tunç ŞE, Pehlivan Y, Kısacık B, Tufan A, Onat AM, Tezcan E, Yıldırım Çetin G, Pamuk ON. Demographic and clinical features of gout patients in Turkey: a multicenter study. Rheumatol Int 2012; 33:847-52. [PMID: 22588430 DOI: 10.1007/s00296-012-2442-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 04/24/2012] [Indexed: 12/22/2022]
Abstract
Gout results from multifactor interactions between gender, age, genetic and environmental factors. Environmental factors underlying gout and precipitating factors triggering acute attacks might vary in different populations with different lifestyles. In this study, we aimed to collect data regarding the demographic and clinical features, comorbid factors, and precipitating factors associated with the initiation of acute attacks in gout patients in Turkey. A total of 312 patients were included in this study (mean age, 58.8 ± 13.8 years; female/male ratio, 55/257). The demographic features, alcohol intake, clinical and laboratory features, and comorbid conditions including obesity, diabetes mellitus, hyperlipidemia, hypertension, and coronary heart disease were noted in a standard questionnaire. Precipitating factors initiating acute attacks (if any) were also noted. The patients were divided into 4 groups according to the region of location as central Anatolian region, southeast Anatolian region, Aegean region, and Trakya region. Our results were compared according to the gender and the location of the patients. The mean age at the start of the symptoms was 10 years higher in women (60.4 ± 14.8 and 50.6 ± 13.5 years in women and men, respectively, p < 0.001).Obesity was present in 40.1 %, diabetes mellitus in 17.9 %, hyperlipidemia in 30.1 %, hypertension in 53.5 %, coronary artery disease in 17 %, and nephrolithiasis in 21.8 % of patients. Precipitating factors triggering gout flares were as follows: diet (high consumption of meat or fish) in 46.5 %, alcohol consumption in 15.7 %, diuretics in 8.3 %, diet or diuretics in 5.1 %, diet or alcohol in 4.5 %, diet or alcohol or diuretics in 1.6 %, others in 4.2 %, and none in 14.1 %. The presence of diabetes and diuretic use was more common among women. Use of diuretics is a more common trigger for gout flares among women. On the other hand, various comorbid conditions, such as obesity and hypertension, and triggers for gout flares may differ between patients living in different geographic regions. In summary, we reported the first data regarding clinical and demographic characteristics of gout in Turkey. The majority of our patients could describe at least one "trigger" that initiated gout flare. Both comorbid conditions and triggers of attack might differ between men and women, and in different geographic areas. Better knowledge of the modifiable risk factors can be useful for the management strategy to optimize long-term patient outcomes in local clinics.
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Affiliation(s)
- Mehmet Akif Öztürk
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Beşevler, Ankara, Turkey.
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