Comparison of F18-FDG PET/CT findings with current clinical disease status in patients with Takayasu's arteritis.

OBJECTIVES: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG PET/CT) scanning has been proposed as a new tool to assess disease activity in Takayasu Arteritis (TA). We investigated whether F-18 FDG PET/CT findings were consistent with current clinical disease status in patients with TA. METHODS: In this cross-sectional study, 22 patients with TA were enrolled. Clinical disease activity was assessed by the combination of National Institutes of Health (NIH) criteria, Disease Extent Index-Takayasu (DEI-Tak) score, physician global assessment and F-18 FDG PET/CT scans. RESULTS: At the time F-18 FDG PET/CT scans were taken, the majority of the patients (17/22) were using immunosuppressive (IS) drugs, and only four patients had clinically active disease. F-18 FDG PET/CT scans confirmed the presence of active vasculitic lesions in those four patients. In 16 out of 18 patients who were accepted to be in clinical remission, F-18 FDG PET/CT scans were also normal. There were only two patients with discordant results, i.e. active F-18 FDG PET/CT findings despite the lack of clinical activity. Interestingly, clinical exacerbation occurred four weeks later in one of them. Overall sensitivity and specificity of F-18 FDG PET/CT findings for clinical activity were 100% and 88.9%, respectively. CONCLUSIONS: We found that F-18 FDG PET/CT findings were generally consistent with clinical disease status in TA. Although use of IS drugs certainly impairs diagnostic accuracy of F-18 FDG PET/CT in TA, this imaging method may still have a potential for confirming remission or detecting disease activity in patients with TA receiving treatment.

Nail changes in connective tissue diseases: do nail changes provide clues for the diagnosis?

OBJECTIVE: To evaluate the frequency and the specificity of nail changes associated with connective tissue diseases (CTD). METHODS: In a case-control study, 190 patients including those with systemic lupus erythematosus (SLE; 56), rheumatoid arthritis (RA, 47), primary Sjögren's syndrome (pSS; 35), systemic sclerosis (SSc; 39), and dermatomyositis/polymyositis (DM/PM; 13) were enrolled in the study. Patients with SLE and other CTDs were compared with two different control groups. Twenty nails were examined. Nail features were noted and classified. Nail samples were collected for mycological cultures. RESULTS: In patients with SLE, erythema of proximal nailfold (P<0.01), splinter haemorrhages in fingernails (P<0.01), capillary loops in proximal nailfold (P<0.05), periungual erythema (P<0.05), and thin nail plates (P<0.05) were more common than those in controls. Only splinter haemorrhages were associated with the disease activity. In patients with SSc and DM/PM, splinter haemorrhages (P<0.05) and capillary loops in proximal nailfold (P<0.01) in fingernails were common as well. Increase in longitudinal curvature (P<0.001), transverse curvature (P<0.01), and white dull colour in fingernails were other frequent findings in patients with SSc. Increase in transverse curvature was associated with the disease activity in SSc. In patients with RA, splinter haemorrhages (P<0.05), red lunula (P<0.05), and white dull colour (P<0.05) in fingernails were frequent. The sensitivity values of all these changes were very low. However, their specificity values were found to be relatively high. CONCLUSION: Proximal nailfold is the most important site of affection in CTDs. These nail changes can be used in combination with highly sensitive diagnostic modalities to establish an accurate diagnosis.

QT dispersion in rheumatoid arthritis patients with and without Sjögren's syndrome.

The aim of this study was to assess the effect of secondary Sjögren's syndrome (SjS) on QT dispersion and corrected QT dispersion in patients with rheumatoid arthritis (RA). We performed electrocardiography and Doppler echocardiography on 58 patients with RA whom we divided into two groups according to the presence of secondary SjS, and on 29 healthy controls. All patients revealed significantly longer QT dispersion and corrected QT dispersion values ( P< 0.05). Diastolic function variables were significantly different in all patients compared to controls. QT dispersion and corrected QT dispersion values were significantly longer in RA patients with secondary SjS than in those without. We concluded that secondary SjS could be a cardiovascular risk factor contributing to the well documented cardiovascular disease in RA patients.

Sudden hoarseness due to unilateral cord vocal paralysis in a patient with Behçet's disease.

Behçet's disease is a systemic necrotising vasculitis affecting arteries and veins of all sizes in any location [1]. Here we report a patient with Behçet's disease who presented with sudden hoarseness due to unilateral vocal cord paralysis from recurrent laryngeal nerve damage.

An unusual presentation of Behçet's disease: intestinal perforation.

Behçet's disease (BD), when first described in 1937, consisted of three symptoms: recurrent oral and genital ulcerations and iridocyclitis. Today, it is known that BD is a multisystemic chronic vasculitic disorder which may involve both arteries and veins of all sizes, as well as the central nervous and gastrointestinal systems. The rate of gastrointestinal involvement of BD varies in different populations, being more common in Japan (50%-60%) and less common in the Mediterranean basin, including Turkey (0%-5%). We present a 34-year-old Turkish woman with BD who had ileal and colonic ulcerations complicated by perforation and gastrointestinal bleeding. Special emphasis was placed on the differential diagnosis between Crohn's disease (CD) and BD with gastrointestinal involvement.

Effect of trimethoprim-sulfamethaxazole in Blastocystis hominis infection.

OBJECTIVE: Blastocystis hominis (B. hominis) is a common intestinal parasite that has long been considered nonpathogenic. Recently there have been many reports supporting a role for the organism as a potential pathogen. We performed a study to examine the pathogenicity of B. hominis and the effect of trimethoprim-sulfamethaxazole (TMP-SMX) on this organism. METHODS: Stool samples of patients, who came to the Department of Parasitology, Faculty of Medicine, Celal Bayar University, were examined by direct wet-mount, trichrome staining, formalin-ethyl acetate concentration, and Kinyoun acid fast techniques for intestinal parasites, and bacteriological stool cultures were performed. Fifty-three symptomatic patients (38 children and 15 adults) with two consequent stool samples positive for abundant B. hominis (five or more organisms per x400 field) and negative for other parasitic and bacterial pathogens were treated with TMP-SMX for 7 days, children 6 mg/kg TMP, 30 mg/kg SMX, and adults 320 mg TMP, 1600 mg SMX, daily. On the seventh day, at the end of treatment, stool samples of all patients were examined by same methods, and clinical symptoms were again evaluated. RESULTS: B. hominis was eradicated in 36 of 38 (94.7%) children, and 14 of 15 (93.3%) adults. Clinical symptoms disappeared in 39 (73.6%), decreased in 10 (18.9%), and no change was observed in one (1.9%) patient, whereas symptoms persisted in all three (5.7%) patients in whom B. hominis could not be eradicated. Mean number of stools per day was significantly decreased from 4.3 to 1.2 in the 33 children (p < 0.001), and decreased from 3.5 to 1.0 in the four adults (p = 0.06) with diarrhea. CONCLUSIONS: These results suggested that B. hominis may be pathogenic, especially when it is present in large numbers, and TMP-SMX is highly effective against this organism. Although there are some anecdotal reports, to our knowledge this is the first study examining the effect of TMP-SMX on B. hominis in humans.