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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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Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/fisiopatologia , Adulto , Antirreumáticos/uso terapêutico , Estudos de Coortes , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Articulações dos Dedos/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Deformidades Articulares Adquiridas/fisiopatologia , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Doenças da Unha/tratamento farmacológico , Doenças da Unha/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Sulfassalazina/uso terapêutico , Inibidores do Fator de Necrose Tumoral/uso terapêuticoRESUMO
OBJECTIVES: To explore the impact of early versus late-onset psoriasis (PsO) on the disease characteristics of psoriatic arthritis (PsA) in a large-multicentre cohort. METHODS: The data from a multicentre psoriatic arthritis database was analysed. Patients were grouped according to age at psoriasis onset (early onset; <40 years of age, late-onset; >40 years of age) and disease characteristics of the groups were compared by adjusting for BMI and PsA duration, where necessary. RESULTS: At the time of analyses, 1634 patients were recruited [62.8% females; early onset 1108 (67.8%); late-onset, 526 (32.2%)]. The late-onset group was more over-weight [66.8% vs. 86.8%, p<0.001; adjusted for age - aOR 1.55 (1.11-2.20; 95% CI)]. The early onset group had more scalp psoriasis at onset (56.7% vs. 43.0%, p<0.001), whereas extremity lesions were more common in the late-onset group (63.8% vs. 74.2%, p<0.001). Axial disease in males and psoriatic disease family history in females were significantly higher in the early onset group [38.0% vs. 25.4%; p=0.005; adjusted for PsA duration - aOR 1.76 (1.19-2.62; 95% CI) / 39.5% vs. 30.1%; p=0.003; OR 1.51 (1.15-1.99; 95% CI), respectively]. Psoriatic disease activity parameters, patient-physician reported outcomes and HAQ-DI scores were similar in both groups. CONCLUSIONS: Clinical features of PsA may be affected by the age at onset of PsO. Different genetic backgrounds in early and late-onset PsO may be driving the differences in psoriasis and PsA phenotypes.
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Artrite Psoriásica , Psoríase , Adulto , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Psoríase/diagnóstico , Psoríase/epidemiologiaRESUMO
PURPOSE: The aim of this study was to examine the effects of long-term use of hydroxychloroquine (HQ) on the pachymetric, aberrometric, and densitometric values of the cornea and corneal endothelium in lupus patients. METHOD: Twenty-two eyes (study group) of 22 patients using HQ for treatment of lupus and 25 eyes (control group) of 25 healthy individuals were included in this prospective study. A specular microscopy was used to measure corneal endothelial cell density (ECD), percentage of hexagonal cells (HEX%), coefficient of variation of the cell size (CV). Then, a Pentacam® HR corneal tomography system was used to measure central corneal thickness (CCT), corneal aberrometry values in 6-mm pupil diameters and corneal densitometry values in 6-mm corneal zones (0-2 mm and 2-6 mm). RESULTS: While ECD was significantly lower in the study group than in the control group (p = 0.034), CCT was significantly higher in the study group (p = 0.032). The higher-order aberrations values and the anterior corneal densitometry values in the 0-2 mm and 2-6 mm corneal zones in the study group were found to be significantly higher than the control group (p = 0.021, p = 0.007 and p = 0.013). CONCLUSION: Prolonged use of HQ may cause some changes in the cornea. In the follow-up of these cases, detailed examination of the cornea as well as the macula may be important for the protection of corneal health.
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Córnea/efeitos dos fármacos , Doenças da Córnea/prevenção & controle , Endotélio Corneano/efeitos dos fármacos , Hidroxicloroquina/efeitos adversos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Aberrometria , Adolescente , Adulto , Córnea/diagnóstico por imagem , Doenças da Córnea/induzido quimicamente , Paquimetria Corneana , Estudos Transversais , Densitometria , Endotélio Corneano/diagnóstico por imagem , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica , Adulto JovemRESUMO
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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Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Necessidades e Demandas de Serviços de Saúde , Sistema de Registros , Atividades Cotidianas , Adulto , Distribuição por Idade , Artrite Psoriásica/complicações , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/fisiopatologia , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Indução de Remissão , Índice de Gravidade de Doença , Distribuição por Sexo , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Turquia/epidemiologiaRESUMO
BACKGROUND: Blood neutrophil-to-lymphocyte (N/L) ratio is an indicator of the overall inflammatory status of the body, and an alteration in N/L ratio may be found in patients with familial Mediterranean fever (FMF). The aim of this study was to investigate the interrelationship between N/L ratio and FMF. METHODS: One hundred and fifteen patients and controls were enrolled in the study. The cases in the study were categorized as FMF with attack, FMF with attack-free period, and controls. The neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated from these parameters. All patients were diagnosed according to Tel Hashomer criteria. RESULTS: A total of 79 FMF patients were included in the study and all subjects were receiving colchicine treatment at the time. The serum N/L ratios of active patients were significantly higher than those of attack-free FMF patients and controls (P < 0.001). The optimum N/L ratio cut-off point for active FMF was 2.63 with sensitivity, specificity, positive predictive value, and negative predictive value of 0.62 (0.41-0.80), 0.85 (0.72-0.93), 0.67 (0.44-0.85), and 0.82 (0.69-0.91), respectively. The overall accuracy of the N/L ratio in determination of FMF patients during attack was 71%. CONCLUSION: Our results demonstrate that N/L ratio is higher in patients with active FMF compared with FMF patients in remission and controls, and a cut-off value of 2.63 can be used to identify patients with active FMF.
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Febre Familiar do Mediterrâneo/patologia , Linfócitos/patologia , Neutrófilos/patologia , Proteína C-Reativa/metabolismo , Contagem de Células , Colchicina/uso terapêutico , Citocinas/sangue , Febre Familiar do Mediterrâneo/sangue , Febre Familiar do Mediterrâneo/tratamento farmacológico , Feminino , Humanos , Masculino , Curva ROC , Receptores de Estrogênio/metabolismo , Estudos Retrospectivos , Moduladores de Tubulina/uso terapêuticoRESUMO
Evidence suggests that peripheral nerve injury occurs during the early stages of disease with mild glycemic dysregulation. Two proteins, neuron-specific enolase (NSE) and neurofilament light chain (NFL), have been examined previously as possible markers of neuronal damage in the pathophysiology of neuropathies. Herein, we aimed to determine the potential value of circulatory NSE and NFL mRNA levels in prediabetic patients and in those with peripheral neuropathy. This prospective clinical study included 45 prediabetic patients and 30 age- and sex-matched controls. All prediabetic patients were assessed with respect to diabetes-related microvascular complications, such as peripheral neuropathy, retinopathy and nephropathy. mRNA levels of NSE and NFL were determined in the blood by real-time polymerase chain reaction. NSE mRNA levels were similar between prediabetic and control groups (p > 0.05), whereas NFL mRNA levels were significantly higher in prediabetics than in controls (p < 0.001). NSE mRNA levels did not significantly differ between prediabetic patients with and without peripheral neuropathy (p > 0.05), while NFL mRNA levels were significantly higher in prediabetics with peripheral neuropathy than in those without (p = 0.038). According to correlation analysis, NFL mRNA levels were positively correlated with the Douleur Neuropathique 4 questionnaire score in prediabetic patients (r = 0.302, p = 0.044). This is the first study to suggest blood NFL mRNA as a surrogate marker for early prediction of prediabetic peripheral neuropathy, while NSE mRNA levels may be of no diagnostic value in prediabetic patients.
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Proteínas de Neurofilamentos/biossíntese , Doenças do Sistema Nervoso Periférico/genética , Estado Pré-Diabético/genética , RNA Mensageiro/biossíntese , Adulto , Idoso , Feminino , Regulação da Expressão Gênica , Humanos , Filamentos Intermediários , Masculino , Pessoa de Meia-Idade , Proteínas de Neurofilamentos/genética , Doenças do Sistema Nervoso Periférico/patologia , Fosfopiruvato Hidratase/biossíntese , Estado Pré-Diabético/patologia , Estudos Prospectivos , RNA Mensageiro/genéticaRESUMO
INTRODUCTION: A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients. METHODS: Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). RESULTS: Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3 ± 3.9 versus 24.1 ± 2.3, p = 0.001; 19.5 ± 4.3 versus 13.8 ± 2.1, p = 0.001; and 11.4 ± 2.8 versus 8.8 ± 1.5, p = 0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels. CONCLUSION: This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias' in non-dipper pre-hypertensive patients.
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Sistema de Condução Cardíaco/fisiopatologia , Pré-Hipertensão/fisiopatologia , Adulto , Arritmias Cardíacas/fisiopatologia , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/inervação , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pré-Hipertensão/diagnóstico por imagemRESUMO
INTRODUCTION: There is an increasing interest in the association between erectile dysfunction (ED) and cardiovascular risk factor. Epicardial adipose tissue (EAT) is associated with insulin resistance, increased cardiometabolic risk, and coronary artery disease. Our aim was to investigate relationships between epicardial fat thickness (EFT) as a cardiometabolic risk factor and erectile dysfunction. METHOD: We selected 30 erectile dysfunction patients without comorbidities and 30 healthy individuals. IIEF-5 score was applied to all patients, and IIEF-5 score below 22 was considered as erectile dysfunction. EFT was measured by echocardiography. RESULTS: Body mass index (BMI) was higher in ED patients than those without ED (28.19 ± 4.45 kg/m(2) versus 23.84 ± 2.36 kg/m(2), P = 0.001, resp.). Waist circumstance (WC) was higher in ED patients than those without ED (106.60 ± 5.90 versus 87.86 ± 14.51, P = 0.001, resp.). EFT was higher in ED patients compared to non-ED patients (0.49 ± 0.09 cm versus 0.45 ± 0.03 cm, P = 0.016, resp.). There was positive correlation among BMI, WC, and EFT. There was negative correlation between EFT and IIEF-5 score (r : - 0.632, P = 0.001). CONCLUSION: EAT, BMI, and WC as cardiometabolic risk factors were higher in erectile dysfunction patients.
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Doenças Cardiovasculares/etiologia , Disfunção Erétil/complicações , Adulto , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico por imagem , Estudos de Casos e Controles , Disfunção Erétil/sangue , Humanos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Risco , UltrassonografiaRESUMO
OBJECTIVE: To estimate the kidney volume of the healthy Turkish population using ultrasound and to evaluate the relationship between kidney volume and body indexes. MATERIALS AND METHODS: Kidney ultrasound evaluation was performed on 152 patients (mean age: 42 ± 13.7 years). Kidney length, width and thickness were measured using ultrasound. Mean total and parenchymal volume were also calculated. Patients' age, sex, weight, height and body mass index (BMI) (kg/m²) were recorded. RESULTS: According to ultrasound, kidney lengths were 10.3 ± 7.8 cm for the right and 10.4 ± 9 cm for the left. Volumes were 158 ± 39 cm3 for the right and 168 ± 40 cm3 for the left. Volumes in women were 151.8 ± 39 cm3 for the right and 159.8 ± 37 cm3 for the left, and 164.3 ± 38 cm3 for the right and 175.8 ± 41 cm3 for the left in men. Kidney measurements correlated with body height and weight. A strong correlation with total kidney volume and kidney measurements was determined for body weight for both kidneys (p<0.001). A significant correlation with kidney volume and width was determined for both kidneys (p<0.001). A positive correlation was also found between parenchymal and total kidney volume for both kidneys (p<0.001). CONCLUSION: The most significant factors associated with kidney volume for both kidneys in the Turkish population are kidney width and body weight. Measuring kidney volume with ultrasound is a feasible modality and is widely available for daily clinical practice.
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Pesos e Medidas Corporais , Rim/anatomia & histologia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valores de Referência , Fatores Sexuais , Turquia , Ultrassonografia DopplerRESUMO
OBJECTIVE: To retrospectively evaluate the effect of anti-tumor necrosis factor-alpha (TNF-α) drugs on hepatic and renal functions in patients with ankylosing spondylitis (AS). METHODS: A total of 148 patients (89 male, 59 female) who were followed up for a minimum duration of 1 year on newly started anti TNF-α therapy were included. Patients were divided into 5 groups based on the TNF-α treatment received. Initially, pre-treatment BASDAI (Bath Ankylosing Spondylitis Disease Activity) scores and laboratory results were compared between the groups before the treatment. Also, ESR (erythrocyte sedimentation rate), C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine values were compared before treatment and at 3, 6, and 12 months after treatment. Also presence of hematuria and proteinuria was examined. RESULTS: Of the overall group, 68 (45%), 33 (22%), 23 (15%), 18 (12%), and 6 (4%) received golimumab, certolizumab, etanercept, adalimumab, and infliximab. Baseline demographic characteristics, disease activity scores, and laboratory parameters were comparable between the groups (P > .05). There was a significant decline in BASDAI scores from baseline at 12 months (pre-treatment 5.24 ± 0.5, 3.01 ± 0.48 post-treatment at 12 months, P < .001). Although there was an increase in AST and ALT from baseline to 3, 6, and 12 months of treatment, the values remained within normal range (P > .05). Also, there were no significant changes in mean creatinine levels (P > .05). There were no correlations between disease activity parameters (ESR, CRP, and BASDAI) and hepatic and renal functions (P > .05). CONCLUSION: No hepatotoxicity or nephrotoxicity were found in association with the use of anti-TNF-α agents over a 1 year period. However, hepatotoxicity and nephrotoxicity are among known adverse effects of these agents. Based on the existing literature data, routine monitoring of patients in terms of potential hepatic and renal toxicity before and after treatment remains a valid recommendation in clinical practice.
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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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Síndrome de Behçet , Síndrome de Budd-Chiari , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/epidemiologia , Síndrome de Budd-Chiari/complicações , Síndrome de Budd-Chiari/epidemiologia , Estudos de Coortes , Humanos , Imunossupressores/uso terapêutico , Estudos Retrospectivos , Veia Cava InferiorRESUMO
Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate heart rate recovery in patients with familial Mediterranean fever (FMF). The study population included 38 patients with FMF (14 men; mean age, 36.2 ± 12.1 years, and mean disease duration = 11.3 ± 6.5 years) and 35 healthy control subjects (12 men; mean age = 34.1 ± 9.9 years). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients and control participants. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate 1st-minute (HRR(1)), 2nd-minute (HRR(2)), 3rd-minute (HRR(3)), and 5th-minute (HRR(5)) after the cessation of exercise stress testing. There are significant differences in HRR(1) and HRR(2) indices between patients with FMF and control group (26.4 ± 7.4 vs. 35.0 ± 8.0; P = 0.001 and 47.3 ± 11.8 vs. 54.8 ± 10.3; P = 0.002, respectively). Similarly, HRR(3) and HRR(5) indices of the recovery period were lower in patients with FMF, when compared with indices in the control group (56.0 ± 14.0 vs. 63.7 ± 11.2; P = 0.01 and 64.1 ± 14.7 vs. 71.5 ± 12.7; P = 0.02, respectively). There were also remarkably positive correlations between the disease duration and HRR(1) (r = 0.31, P = 0.02), and HRR(2) (r = 0.26, P = 0.04). The heart rate recovery index impaired in patients with FMF compared to control subjects. When the prognostic significance of the heart rate recovery index is considered, a useful, simple, and noninvasive test may be clinically helpful in the recognition of high-risk patients with FMF.
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Sistema Nervoso Autônomo/fisiopatologia , Febre Familiar do Mediterrâneo/fisiopatologia , Frequência Cardíaca/fisiologia , Adulto , Ecocardiografia , Eletrocardiografia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In this article, we describe a case of neuro-Behçet's disease presenting with unilateral ptosis and facial paresis due to an intracranial mass lesion. A 25-year-old male patient with a history of Behçet's disease presented with headache, vertigo, double vision, ptosis in his right eyelid and slurred speech. Cranial magnetic resonance imaging scan revealed a right-sided capsulothalamic lesion, which was extending to the right cerebral pedicle, pons and superior cerebellar pedicle. This lesion was interpreted as neuro-Behçet's disease involvement of central nervous system. Cerebral mass- like lesion is a rare form of neuro-Behçet's disease. Review of the literature revealed a limited number of cases. Ptosis related with Behçet's disease is also a very rare presentation. This case shows that this symptom might be a part of the clinical presentation of neuro-Behçet's disease.
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Psoriatic arthritis (PsA) may affect different joints, including the spine. The prevalence of spinal involvement is variable depending on the definition and a subset of patients have been identified in cohorts that do not have clinical features of axial disease and yet have imaging findings. Still, there is not a consensus on how and when to screen axial disease. In this study, we aimed to investigate factors associated with being underdiagnosed for axial psoriatic arthritis (axPsA) and its impacts on outcomes. Disease features and outcomes of axPsA according to the physician (n = 415) were compared with patients with imaging findings only (sacroiliitis fulfilling the modified New York criteria, n = 112), using data from a real-life PsA registry. Patients with imaging findings only were more frequently women (83/220 (37.7%) vs 29/122 (23.8%); p = 0.008). This group also had higher peripheral disease activity (imaging only vs clinical AxPsA: mean (SD) tender joint count 5.3 (6.1) vs 3.3 (4.7), swollen joint count 1.9 (2.9) vs 1.2 (2.4); p < 0.001 for both comparisons) and was less often treated using TNF inhibitors (16.1 vs 38.2%; p < 0.001) than patients who were classified as axPsA. Patient-reported outcomes were similar in both groups. PsA patients, especially women with more severe peripheral disease, have a higher risk of being underdiagnosed for axPsA. The severity of peripheral symptoms may be a risk factor to mask the spinal features of PsA.
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Artrite Psoriásica/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Adulto , Artrite Psoriásica/complicações , Artrografia , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Prevalência , Radiografia , Sistema de Registros , Reprodutibilidade dos Testes , Reumatologia/normas , Fatores de Risco , Sacroileíte/complicações , Índice de Gravidade de Doença , Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Turquia/epidemiologiaRESUMO
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by several immunological abnormalities. We wish to communicate the case of a patient with SLE and lupus nephritis (LN) who developed pseudothrombocytopenia. Pseudothrombocytopenia can occur in patients with SLE and LN and should be considered when diagnosing patients with thrombocytopenia without bleeding.
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OBJECTIVE: Behçet's disease (BD) is a chronic, relapsing type of vasculitis of unknown etiology and is characterized by oral and urogenital ulcers and ocular inflammation with cutaneous, musculoskeletal, vascular, and nervous system manifestations. Few cases involving the nasal mucosa have been reported in the literature, and the true prevalence of BD remains unknown. Neurological involvement associated with BD might play a more important role in causing olfactory dysfunction than mucosal involvement, but sufficient clinical data are not available on the effect of BD on olfaction in adults. We therefore evaluated the olfactory function of patients diagnosed with BD. MATERIAL AND METHODS: Patients were chosen from among a consecutive patient group population who visited the internal medicine rheumatology polyclinic and otolaryngology departments of Ondokuz Mayis University Hospital. A total of 50 patients (both males and females) aged 18 to 60 years with a diagnosis of BD and 46 healthy controls (matched to the study group in terms of age and gender) were included. BD was diagnosed based on the criteria defined by the International Study Group for BD. A complete clinical history was taken for and a physical examination was performed in all participants. Patients with other rheumatic diseases; obstructive nasal pathologies leading to conductive-type olfactory dysfunction (e.g., septum deviation or nasal polyp); advanced systemic disease (e.g., hypertension or malignancy); a history of antithyroid, antihistamine, antidepressant, or steroid medication use within the past month; or who were current smokers, had an active upper respiratory infection, or had a history of otolaryngologic operations were excluded. The results of the "Sniffin' Sticks" (SS) olfactory test were compared between the two groups. RESULTS: The mean age of the 50 BD patients was 35.3±10 years; that of the 46 health controls was 36.9±11 years. There was no significant group difference in age or gender distribution (p>0.05). Odor identification and overall scores were significantly lower in the BD group than in the control group. There were no significant differences in odor discrimination scores between the BD and control groups (p>0.05). CONCLUSION: To our knowledge, this is the first study to evaluate olfactory function in patients diagnosed with BD using the SS test. Odor identification was more impaired in BD patients than in healthy controls, but there was no group difference in odor discrimination. BD patients should also be assessed for the involvement of olfactory function and may require treatment due to a malfunction of the olfactory system that affects the quality of life.
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OBJECTIVE: To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. METHODS: Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. RESULTS: Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. CONCLUSION: The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.
Assuntos
Artrite Reumatoide/diagnóstico , Polimialgia Reumática/diagnóstico , Dor de Ombro/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimialgia Reumática/classificação , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
We present a case of a neurosarcoidosis patient with skin lesions. A 50-year-old woman was admitted with a 1-year history of violaceous, smooth and shiny plaques on her face and right arm. These lesions were biopsied and the histological examination indicated sarcoidosis. The patient had a history of headache and syncope that lasted for about 1â h. Brain CT showed masses measuring 37×20â mm in both frontal lobes. Thoracic and abdominal CT showed many pathologically enlarged lymph nodes. The patient was diagnosed with cutaneous, lung and neuronal sarcoidosis, and treated with 20â mg/day methylprednisolone, 15â mg/week methotrexate, 10â mg/week folic acid, 400â mg/day hydroxychloroquine and 800â mg/day carbamazepine. One month later, the patient's neurological symptoms had improved and her skin lesions had decreased. At 6-month follow-up, the size of the cranial masses had markedly regressed.
Assuntos
Encefalopatias/complicações , Doenças do Sistema Nervoso Central/complicações , Sarcoidose/complicações , Dermatopatias/complicações , Braço , Encefalopatias/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Doenças do Sistema Nervoso Central/tratamento farmacológico , Comorbidade , Dermatoses Faciais/complicações , Dermatoses Faciais/tratamento farmacológico , Feminino , Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Radiografia , Sarcoidose/tratamento farmacológico , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Síncope/etiologiaRESUMO
Sjögren's syndrome, an autoimmune disease characterized by lymphocytic infiltration of the lacrimal and salivary glands, leads to dryness of the mouth and eyes. Herein, we present a case of Sjögren's syndrome that developed after silicone breast implantation. A cause-effect relationship between breast implantation and Sjögren's syndrome has not been established. However, the possibility of such an association should be considered when a patient with silicone implants is admitted to the hospital for treatment of Sjögren's syndrome.
RESUMO
We present a rare case of a comorbidity of sacroiliitis and brucellosis infection. A 28-year-old woman received irregular medication due to ongoing backache and hip pain for 5â years. The patient presented to our hospital for evaluation of visual loss and was diagnosed with uveitis. Sacroiliac MRI was performed to investigate the inflammatory backache and hip pain, and the aetiology of the uveitis, revealing the presence of sacroiliitis. The patient's blood test results were as follows: positive brucellosis Rose Bengal test and positive tube agglutination test with a titre of 1/640. The patient was treated with doxycycline and rifampicin for 8â weeks for the brucellosis infection, and with acemetacin for the ankylosing spondylitis. The patient's back and hip pain decreased significantly 8â weeks later; however, the uveitis was not controlled by the treatment. Therefore, anti-tumour necrosis factor (infliximab) treatment was started.