Predicting the Speed of Response to Omalizumab in Chronic Spontaneous Urticaria.

INTRODUCTION: Two distinct chronic spontaneous urticaria (CSU) endotypes, IgE-mediated autoallergic and IgG-mediated autoimmune, were defined based on the response patterns to omalizumab. However, the coexistence of IgE and IgG autoantibodies in a subset of patients might complicate the prediction of the treatment outcomes. This study aimed to evaluate the effectiveness and safety of omalizumab in CSU patients, focusing on the factors predicting the response patterns. METHODS: This was a retrospective cross-sectional single-center study investigating CSU patients treated with omalizumab for at least 6 months between September 2015 and February 2023. Patients were evaluated regarding demographics, clinical findings, baseline laboratory parameters, treatment outcomes, and side effects. Early and late responders were defined depending on the time for response, within or after 3 months, respectively. RESULTS: Among 82 patients, 75 (91.5%) responded to omalizumab during the first 6 months, classified as early (n = 51) and late responders (n = 24). The IgG anti-thyroid peroxidase (anti-TPO)/total IgE ratio was an independent predictor for determining the speed of response (p < 0.05). Of 29 patients who discontinued omalizumab, 19 (65.5%) experienced relapse with a good response to retreatment (n = 18/19, 94.7%). Early responders relapsed more frequently than late responders (77.3% vs. 28.6%) (p < 0.05). Only mild side effects were observed in a minority of patients (n = 8/82, 9.8%). CONCLUSION: Omalizumab is an effective and safe treatment in CSU. The IgG anti-TPO/total IgE ratio seems a valuable tool to predict the early and late responders, the former having a higher possibility of relapse upon drug withdrawal.

Association between mean platelet volume and disease severity in patients with psoriasis and psoriatic arthritis.

INTRODUCTION: Mean platelet volume (MPV) is an important marker that shows the activation and function of the platelets, which is effective in the inflammatory diseases. AIM: To show the relationship between MPV and the development of psoriatic arthritis (PA) in patients with psoriasis vulgaris (PV) and the correlation between MPV and psoriasis severity score (PASI). MATERIAL AND METHODS: Our study included 116 patients with psoriatic arthritis (68 female, 48 male) and 41 patients in the psoriasis group (19 female, 22 male) and 90 subjects in the control group (55 female, 35 male). The demographic data of the patients, duration of disease, PASI, the nature of the disease were evaluated retrospectively. RESULTS: Mean platelet volume levels of both the PV group (8.79 ±0.86 fl) and the PA group (9.18 ±1.26 fl) were significantly higher compared to the control group (8.42 ±0.74 fl). There was a weak statistically positive correlation between the PASI and the MPV according to the correlation analysis (r = 0.165; p = 0.046). CONCLUSIONS: Our results show that MPV may be helpful as an indicator of the clinical course of PV and PA. In this regard, that study should be supported by prospective studies to find strong correlations.

Evaluation of Macular Ganglion Cell-inner Plexiform Layer and Choroid in Psoriasis Patients Using Enhanced Depth Imaging Spectral Domain Optical Coherence Tomography.

PURPOSE: To evaluate changes in the thickness of the central macula, macular ganglion cell-inner plexiform layer (mGCIPL), and subfoveal choroid in patients with psoriasis using spectral domain optical coherence tomography (SD-OCT). METHODS: The measurements of macular, mGCIPL thicknesses and subfoveal choroidal thickness (SFCT) obtained by SD-OCT of psoriasis patients (n = 46). These measurements were compared with those of 50 healthy controls. RESULTS: The macular, mGCIPL, and choroidal thicknesses did not differ between the controls and psoriatic subjects (p>0.05). When the patients were divided into two distinct groups, only the SFCT was significantly thicker in the severe psoriasis group compared with the mild psoriasis group (p = 0.003). CONCLUSIONS: These findings suggest that choroidal alterations are seen without macular changes in patients with psoriasis. Severe psoriasis appears to be related to increases in SFCT as a consequence of possible inflammatory cascades that are part of the disease's pathogenesis.

Is there any increased risk of hypertension, diabetes and cardiac diseases in psoriatic patients with TNF-α G238A and G308A polymorphism?

INTRODUCTION: Psoriasis is regarded as a complex autoimmune disease with strong genetic background. Psoriatic patients suffer from many comorbidities including hypertension, diabetes and cardiovascular diseases. Cytokines such as tumor necrosis factor α (TNF-α) may be a key player that triggers psoriasis and diabetes, hypertension and cardiac disease at the same time. AIM: To evaluate genetic variations in the TNF-α region and its association with psoriasis and related comorbidities. MATERIAL AND METHODS: The study covered 129 psoriasis patients with three main subgroups with coronary artery disease (n = 41), hypertension (n = 35), and diabetes (n = 21). DNA samples were genotyped for TNF-α G308A and G238A polymorphisms by real-time polymerase chain reaction melting-curve analysis and results were compared statistically. RESULTS: Psoriatic patients with both TNF-α-298 and TNF-α-308 polymorphisms showed no statistically significant increase in the risk of hypertension (OR = 0.425, χ² = 1.76, p = 0.18 and OR = 1.87, χ² = 1.33, p = 0.25), coronary artery disease (OR = 1.97, χ² = 1.91, p = 0.17 and OR = 2.63, χ² = 1.35, p = 0.25), or diabetes (OR = 1.35, χ² = 0.24, p = 0.62 and OR = 1.53, χ² = 0.24, p = 0.62). CONCLUSIONS: The current preliminary results suggested that there was no correlation between TNF-α promoter polymorphism and diabetes, hypertension and cardiac disease among psoriatic patients in the Turkish population.

The ischemia modified albumin and mean platelet volume levels in patients with Behçet's disease.

INTRODUCTION: Behçet's disease (BD) is a chronic inflammatory disorder with endothelial dysfunction. Ischemia-modified albumin (IMA) is a marker used in the detection of diseases associated with oxidative stress, vascular endothelial cell dysfunction and ischemia. Mean platelet volume (MPV) signifies the platelet function and activity. AIM: To show whether MPV and IMA are useful in revealing the oxidative stress and the risk of thrombosis in patients with BD. MATERIAL AND METHODS: Twenty-six patients with BD and 28 healthy volunteers as a control group over 18 years of age were included in the study. Serum IMA and MPV levels were analyzed in both groups. RESULTS: The mean MPV values were identified as 0.86 ±0.15 and 0.82 ±0.08 (in the BD and control groups, respectively; p = 0.188) and the mean IMA values were 9.39 ±0.73 and 9.17 ±1.09 (in the BD and control groups, respectively; p = 0.275). There were no statistically significant differences between the groups. The IMA values of BD patients who were in the active phase were significant as compared to inactive BD patients and control groups (p = 0.041). The IMA and MPV values of the thrombotic patients, non-thrombotic patients and control groups were not significant. CONCLUSIONS: Ischemia-modified albumin may be a helpful marker of possible complications during an active period of BD.

The correlation between the psoriasis area severity index and ischemia-modified albumin, mean platelet volume levels in patients with psoriasis.

INTRODUCTION: Ischemia-modified albumin (IMA), a novel ischemia marker, and mean platelet volume (MPV), a determinant of platelet activation, have been reported as elevated markers in cardiovascular risk factors such as atherosclerosis, metabolic syndrome, diabetes mellitus (DM), hypertension, and dyslipidemia. As psoriasis is a chronic inflammatory disease having comorbidities, IMA and MPV can help determine the risk factors for psoriasis. AIM: To investigate the correlation between the psoriasis area severity index (PASI), IMA and MPV levels in patients with psoriasis. MATERIAL AND METHODS: This cross-sectional, case-control study was performed between January 2014 and December 2014 at the University hospital in Çanakkale, Turkey. Forty-five patients with psoriasis and 44 healthy volunteers over 18 years of age were included in the study. In the psoriasis patient group, clinical features and PASI scores were recorded. Serum IMA and MPV concentrations were evaluated in both groups. RESULTS: The mean IMA values were 0.85 ±0.15 and 0.79 ±0.09 (in the psoriasis patients and control groups, respectively), and there was a statistically significant difference (p = 0.048). Ischemia-modified albumin levels were not correlated with PASI scores (r = 0.024; p = 0.889) but were correlated with disease duration (r = 0.323; p = 0.048). There was no statistically significant difference between the MPV values of the two groups (8.98 ±1.14 and 9.19 ±1.28 in the psoriasis patients and control groups, respectively) (p = 0.435). CONCLUSIONS: Ischemia-modified albumin may be used as a marker for detecting oxidative stress in patients with psoriasis, especially those with a long disease duration.

Prevalence of skin disorders in primary and secondary school age children in Canakkale, Turkey: a community-based survey.

INTRODUCTION: Skin lesions may be of dermatological importance, affect appearance, and cause problems communicating with peers and may be especially more significant in childhood. AIM: Information on the prevalence of pediatric dermatoses in Western Turkey. This study was aimed to define the existing data. MATERIAL AND METHODS: A cross-sectional study was conducted in Canakkale, Turkey, in September-December 2013. It involved 1,957 students from five randomly selected primary and secondary schools. Each student was interviewed for age, gender, and family history, and a dermatologic examination was performed by a dermatologist. Data were coded and analyzed. RESULTS: Of the students, 79.9% revealed at least one dermatosis. The most common disease was benign neoplasms (76%), followed by pigmentary disorders (26.8%), and xerosis (5.8%). In primary schools, the acquired melanocytic nevus, hypopigmented macule, and xerosis; in secondary school the acne was statistically significantly more common. Acne and xerosis was more common in girls, and pityriasis alba was statistically more common in boys. Students who had at least one dermatosis were positively correlated with monthly income. CONCLUSIONS: In Turkish school age children, the prevalence of dermatosis is 79.9%. It may be due to not using preventive means for adequate protection from the sun and other environmental factors. Infectious dermatosis and atopic dermatitis are rare and it may depend on the adequacy of public health work.

Contribution of the STAT4 rs7574865 gene polymorphism to the susceptibility to autoimmune thyroiditis in healthy Turk population and psoriatic subgroups.

INTRODUCTION: STAT4 is an important transcription factor that activates gene transcription as a response to cytokines. Recently, the influence of STAT4 gene on autoimmune disease has been widely studied in many different immune-related diseases. Autoimmune, metabolic and cardiovascular disorders are more common in psoriatic patients. STAT4 may be a unique gene that switches on in autoimmune-related thyroid disease in psoriatic patients. THE AIM OF THE STUDY: To explore the association of a STAT4 rs7574865 polymorphism to autoimmune thyroid diseases in the general Turkish population and psoriatic subgroups. MATERIAL AND METHODS: A total of 132 psoriatic patients and 118 non-psoriatic volunteers were genotyped for STAT4 rs7574865 using real time PCR. Twenty-four of the psoriatic patients and 15 of the non-psoriatic volunteers have autoimmune-related thyroid diseases. RESULTS: The prevalence of the T allele [OR = 4.37; 95% CI: 1.05-19; p = 0.03] of the STAT4 rs7574865 was higher in individuals with autoimmune-related thyroid diseases among the all non-psoriatic volunteers. The volunteers with autoimmune-related thyroid diseases has an increased allele positivity and carriers having at least one of the risk allele was significantly higher than in counterparts with a GG wild genotype [ORGT/TT vs. GG: 1.73; 95% CI: 0.09-32; p = 0.03]. Yet, there was no evidence of an association between rs7574865 and autoimmune-related thyroid disease in psoriatic patients. CONCLUSIONS: The STAT4 rs7574865 polymorphism increases autoimmune-related thyroid disease susceptibility among the general population but not in psoriatic patients.

Triggering drug use in patients with psoriasis: an investigative report from Turkey.

INTRODUCTION: The patients clinically diagnosed with psoriasis were investigated for drug use that may trigger psoriasis. AIM: To minimize the triggering drug use and help the medical treatment of psoriasis patients. MATERIAL AND METHODS: The study involved 289 psoriatic patients who attended our clinic in 2010-2012 and were asked to bring their drug lists of the last year, which they obtained from the pharmacy's record system. They were advised not to use the drugs that may trigger psoriasis. Data analyses were performed using SPSS program version 19.0. RESULTS: A total of 289 patients were included in the study. Two hundred and twenty-one patients were using non-steroidal anti-inflammatory drugs; 133 patients were using anti-reflux drugs; 35 patients were using antidiabetic drugs; 31 patients were using calcium-channel blockers and 24 patients were using ß-blockers. In our study group, there was no significantly difference between median PASI scores of the patients using a triggering drug and those of who are not using a triggering drug. However, there was a positive low correlation between PASI rates and numbers of drugs used (r = 0.180, p = 0.013). CONCLUSIONS: Many other factors may trigger psoriasis, therefore the effect of stopping or minimizing the drug use on disease remission is not known. Because of the high triggering drug use rate, it is important to enlighten psoriasis patients about triggering drugs.

Primary cutaneous lymphomas: single center experience of dermatology and hematology clinics.

PURPOSE: To present the clinical characteristics, treatments performed, response to treatment, and follow up of 40 patients diagnosed with primary cutaneous lymphoma. METHODS: In this retrospective study included were 23 males and 17 females from our center with confirmed diagnosis of primary cutaneous lymphoma over an 8-year period. Data were retrieved from the patient medical records. RESULTS: The median patient age at diagnosis was 59.5 years (range 33-86). Skin biopsies showed that 31 patients (77.5%) had mycosis fungoides (MF), 2 (5%) had anaplastic large cell lymphoma, 3 (7.5%) had diffuse large B cell lymphoma, 3 (7.5%) had poikilodermic mycosis fungoides, and 1 (2.5%) had non-classified non-Hodgkin lymphoma (NHL). In patients with T cell lymphoma clinical stage IA prevailed (42.5%). The 3 patients with B cell lymphoma had stage IE and 2 of them had B symptoms. Sezary cells were detectable in the peripheral blood of 3 patients. Twenty-three patients (57.5%) used only topical corticosteroids, 2 (5%) were treated with PUVA (psoralen ultraviolet A), 1 (2.5%) was treated with PUVA and chemotherapy, 8 (20%) received combination chemotherapy, 1 patient (2.5%) received PUVA+ interferon+topical nitrogen mustard, and 1 (2.5%) received chemotherapy+topical nitrogen mustard+interferon. Among 16 patients with the valuable response to treatment 5 (33%) showed complete remission (CR) and 9 (60%) partial remission (PR). The median follow up time for all patients was 1.5 months (range 1-135). While mean overall survival (OS) time was 123 months (95% CI 100.6-145.3), the estimated median OS was not reached. CONCLUSION: Early diagnosis of MF is rather favorable in terms of high and long-term response rates to topical treatments.

Association of endothelial nitric oxide synthase Glu298Asp gene polymorphism in psoriasis cases with hypertension.

BACKGROUND AND OBJECTIVES: Psoriasis is a common autoimmune-mediated chronic, inflammatory skin disease. Although, the molecular mechanism is not completely understood, psoriasis is caused by genetic and non-genetic parameters. The current study aimed (1) to define genotype and allele frequency of endothelial nitric oxide synthase (eNOS Glu298Asp) gene polymorphism in hypertensive and/or non-hypertensive psoriatic patients (2) to investigate the possible relationship between the eNOS Glu298Asp polymorphism and the risk of hypertension among psoriatic patients in the Turkish population. DESIGN AND SETTINGS: This cross-sectional, case-control study was performed between March 2010 and November 2012 at the University hospital in Çanakkale, Turkey Patients and Methods: Gene profiles of 75 psoriatic patients (21 hypertensive and 54 normotensive pa.tients) and 55 healthy (normotensive and non-psoriatic) volunteers were compared. Peripheral blood-EDTA samples were used for total genomic DNA isolation and genotyping. Target eNOS gene was genotyped for patients and control groups by real-time PCR melting-curve analysis system (LightCycler 2.0,Roche, Germany, and results were compared statistically. RESULTS: An increased T allele frequency in eNOS Glu298Asp single-nucleotide polymorphism (SNP) was determined in psoriatic patients when compared with normotensive non-psoriatic healthy volunteers (OR 2.3, CI 1.14-3.99), (P=.017). The T allele frequency was also found to be increased in hypertensive psoriatic patients when compared with healthy volunteers (4.83-fold increased, 95% CI 1.62-14.43 ([P=.003]) and normotensive psoriatic patients (3.03-fold increased, 95% CI 1.03-8.94 [P=.041]), respectively. CONCLUSION: The current preliminary results suggested that there was a correlation between eNOS Glu298Asp polymorphism and hypertension among psoriatic patients in the Turkish population. The T allele frequency of eNOS Glu298Asp SNP was different in hypertensive psoriatic patients, and the difference was statistically significant when compared with the normotensive psoriatic patients and healthy controls. These results need to be confirmed by large-scale studies.

Severe candida laryngitis in a patient with rheumatoid arthritis treated with adalimumab.

Rheumatoid arthritis is a chronic erosive rheumatic disease that can present with polyarticular involvement. Anti-TNF-alpha drugs are used in cases that are resistant to traditional disease-modifying antirheumatic drugs (DMARDs). Anti-TNF-alpha drugs are groundbreaking drugs, the efficacy of which has been proven in the treatment of rheumatoid arthritis. However, the data concerning safety remain limited and contradictory. The risk of tuberculosis reactivation, various infections, as well as lymphoproliferative disease and/or secondary malignancy is a matter of discussion. In this report, we report a 52-year-old male patient using adalimumab for active rheumatoid arthritis who presented to our polyclinic with generalized mouth and throat sores, hoarseness, and swallowing difficulty. Candida laryngitis was detected in the laryngoscopy and culture samples. Adalimumab was discontinued, and the infection was controlled with anti-fungal treatment.