Budd-Chiari syndrome in Behçet's disease: a retrospective multicenter study.

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.

Disease characteristics of psoriatic arthritis patients may differ according to age at psoriasis onset: cross-sectional data from the Psoriatic Arthritis-International Database.

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.

PsART-ID inception cohort: clinical characteristics, treatment choices and outcomes of patients with psoriatic arthritis.

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.

Assessment of Microcirculation in HIV-Positive Patients with a Noninvasive Method: Nailfold Videocapillaroscopy.

Chronic inflammation that contributes to the deterioration of the mechanical form of both the vascular wall and the function of endothelial has been shown to cause vascular dysfunction in patients with human immunodeficiency virus (HIV). Nailfold videocapillaroscopy (NVC) is a noninvasive and simple technique used to analyze dermal microvasculature. The aims of our study were to detect the morphological and functional properties of microcirculation in HIV-positive patients utilizing NVC and to compare the results with those obtained from healthy individuals and investigate whether these changes had supported any correlation with HIV. In this prospective study, 51 male HIV-positive patients were the subjects and 59 male healthy individuals made up the control group. Capillaroscopic findings, obtained from both groups by NVC, were evaluated. Tortuosity, a capillaroscopic finding, was significantly higher in the group with HIV (p < .001). In logistic regression analysis, tortuosity [odds ratio (OR), 4.658; p = .001], bizarre capillary (OR, 1.733; p = .319), and capillary ectasia (OR, 0.867; p = .493) were considered significant. The changes of capillaroscopic findings were found to be correlated with HIV. We suggest videocapillaroscopy in the evaluation of microvascular changes in HIV patients, as a dependable contributing method.

Bone mineral density and serum osteocalcin levels in patients with gout.

Objective: The objective of the study is to evaluate the relation of gout with osteoporosis and serum osteocalcin (OC) levels. Material and methods: Seventy-five patients diagnosed with gout and 55 controls were included in the study. Comorbid conditions and drugs associated with osteoporosis were excluded. The T and Z scores from lumbar spine (L2-L4) and femur (neck, ward, trochanter, total) were determined by dual-energy X-ray absorptiometry (DXA). OC levels were measured by enzyme-linked immunosorbent assay. Results: Osteoporosis according to T scores of lumbar vertebrae L2-L4 was found to be significantly higher in patients with gout compared to the control group (p = 0.02). Lumbar spine T-score was -1.6 in gout group and -1.0 in controls. OC level was 7.9 ng/mL in the gout group and 18.9 ng/mL in the control group. There was a significant difference (p < 0.001). In addition, mean OC level was 12.4 ± 6.9 ng/mL in the patients diagnosed with osteoporosis and 17.2 ± 10.6 ng/mL in the patients that were classified as normal and a significant difference was established between the two groups (p = 0.03). A significant negative correlation was found between OC level and body mass index, age, and age at first attack. Similarly, femoral T-score established a negative correlation with parathyroid hormone, age, age at first attack, and allopurinol dose. Conclusion: Serum OC level can be a useful marker in the assessment of bone turnover and clinicians should keep osteoporosis in mind in gout patients.

Association of synaptosomal-associated protein 25 (SNAP-25) gene polymorphism with temperament and character traits in women with fibromyalgia syndrome

Abstract Background: Synaptosomal-associated protein 25 (SNAP-25) may be contribute to the pathogenesis of fibromyalgia Syndrome (FMS) by affecting the release of neurotransmitters. Objectives: We aimed to investigate the relationship between the SNAP-25 gen (DdeI = rs1051312 and MnlI = rs3746544) polymorphism and the temperament and character traits. Methods: A total of 85 female patients diagnosed with FMS and 70 age-matched healthy female subjects were enrolled into the study. The Temperament and Character Inventory (TCI) were performed on all the patients. SNAP-25 gene polymorphism was determined in the patients group and controls group. Results: No significant difference between groups was found regarding the distribution of SNAP-25 MnlI polymorphism (p > 0.05), but it was seen that the frequency of TC genotype for DdeI gene was higher in the patients group (p < 0.05). Increased hazard avoidance was found in the patients group (p < 0.05). When TCI scores were assessed in terms of SNAP-25 gene polymorphism, no statistically significant relationship was detected between the TT, TG, GG genotypes for MnlI gen and TCI scores (p > 0.05). However, increased hazard avoidance was detected in patients with TC genotype for DdeI gene compared to patients without such genotype. Discussion: SNAP-25 might be an etiological factor in FMS pathogenesis and might affect personality traits of FMS patients by mediating neurotransmitter release.

Axial psoriatic arthritis: the impact of underdiagnosed disease on outcomes in real life.

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.

Frequency of Erectile Dysfunction in Males with Central Serous Chorioretinopathy.

OBJECTIVES: To evaluate the frequency of sexual dysfunction and associated factors in patients with central serous chorioretinopathy (CSCR). MATERIAL AND METHODS: Fifty-eight CSCR patients who met the inclusion criteria and 99 age- and sex-matched healthy controls were prospectively investigated for sexual dysfunction and associated factors. All participants were investigated using the Beck Depression Inventory (BDI), Beck Anxiety Scale (BAS), and the15-question Index of Erectile Function-15 (IIEF-15) and by extensive examination of CSCR, associated factors, and confounding factors. RESULTS: The mean ages of the patient and control groups were 46.95±11.27 and 45.3±10.93 years, respectively (p=0.370). The erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall sexual satisfaction scores of the patient group were significantly lower than those of the control group (p<0.001). Severe erectile dysfunction (ED) was diagnosed in 3 (5.2%), moderate ED in 10 (17.2%), mild-to-moderate ED in 7 (12.1%), and mild ED in 15 (25.9%) patients in the patient group, whereas no severe or moderate ED was diagnosed in the control group. The erectile function score was found to be negatively correlated with age and BMI. No sexual parameters were found to be correlated with choroidal thickness (CT) in either the patient or control group. CONCLUSION: CSCR patients experience a higher incidence of sexual dysfunction compared to healthy individuals without CSCR. The exclusion of confounding factors suggests that factors involved in CSCR pathogenesis may also play a role in ED.

A variant allele of the Mediterranean-fever gene increases the severity of gout.

BACKGROUND: Gout is a clinical syndrome that occurs as an inflammatory response to increased concentration of uric acid and monosodium urate crystals. Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease with autosomal recessive inheritance. The Mediterranean fever (MEFV) gene is responsible for FMF and encodes pyrin that suppresses the inflammatory response. Most of the FMF-related mutations have been identified in exon 2 (e.g., E148Q and R202Q) and exon 10 (M680I, M694V, M694I and V726A) of the MEFV gene, and each missense mutation is known to increase production of interleukin-1, a proinflammatory cytokine. Our aim was to investigate effects of MEFV variant alleles on the manifestations of gout. METHODS: Seventy-one patients diagnosed with gout (age: 61.73 ± 11.73 years, F/M: 14/57) and 50 healthy subjects (age: 61.48 ± 11.97, F/M: 10/40) as controls were included in this study. RESULTS: MEFV variant alleles were found in 24 (33.8%) of the gout patients and in 13 (26%) of the control subjects; the difference was not statistically significant. In the gout patients with a MEFV variant allele, the interval between the first two attacks was shorter (P = 0.014), and the platelet count was higher (P = 0.026), compared to the patients without a variant allele. In addition, the patients with a MEFV variant allele showed the higher incidence of tophus (8.5% vs. 1.4%) (P = 0.005) and the higher number of attacks per year (P = 0.001). CONCLUSION: We propose that a variant allele of the MEFV gene may be responsible for the severity of gout.

Incidence of sleep disturbances in patients with familial Mediterranean fever and the relation of sleep quality with disease activity.

AIM: To evaluate the sleep quality and the relation of sleep quality with depression, anxiety, fatigue and disease activity in adult patients with familial Mediterranean fever (FMF). METHOD: One hundred and seventy-four FMF patients and 84 age-sex matched healthy individuals were included in this study. The Pittsburgh Sleep Quality Index (PSQI), Multidimensional Assessment of Fatigue (MAF) and the Hospital Anxiety and Depression Index (HADS) were used to assess sleep quality, fatigue, depression and anxiety, respectively. RESULT: FMF patients had significantly higher depression, anxiety, fatigue and PSQI scores than healthy controls. As the severity of the disease increased, scores of total PSQI and its domains increased. Patients with total PSQI score higher than 5 had statistically significantly higher erythrocyte sedimentation rates (ESR), serum C-reactive protein and serum amyloid levels during attacks, more attack numbers in last 3 months and worse fatigue, depression scores. Total PSQI score was positively correlated with inflammatory markers during attacks, attack numbers in the last 3 months and fatigue score. Logistic regression models identified disease duration, ESR during attacks, fatigue, attack numbers in the last 3 months as predictors of poor sleep quality. CONCLUSION: Poor sleep quality is common in adult FMF patients. Anxiety, depression and fatigue are more frequent in FMF patients than healthy individuals. Poor sleep quality is associated with inflammatory marker levels during attacks, fatigue and attack numbers in the last 3 months.

Nationwide Experience With Off-Label Use of Interleukin-1 Targeting Treatment in Familial Mediterranean Fever Patients.

OBJECTIVE: Approximately 30-45% of patients with familial Mediterranean fever (FMF) have been reported to have attacks despite colchicine treatment. Currently, data on the treatment of colchicine-unresponsive or colchicine-intolerant FMF patients are limited; the most promising alternatives seem to be anti-interleukin-1 (anti-IL-1) agents. Here we report our experience with the off-label use of anti-IL-1 agents in a large group of FMF patients. METHODS: In all, 21 centers from different geographical regions of Turkey were included in the current study. The medical records of all FMF patients who had used anti-IL-1 treatment for at least 6 months were reviewed. RESULTS: In total, 172 FMF patients (83 [48%] female, mean age 36.2 years [range 18-68]) were included in the analysis; mean age at symptom onset was 12.6 years (range 1-48), and the mean colchicine dose was 1.7 mg/day (range 0.5-4.0). Of these patients, 151 were treated with anakinra and 21 with canakinumab. Anti-IL-1 treatment was used because of colchicine-resistant disease in 84% and amyloidosis in 12% of subjects. During the mean 19.6 months of treatment (range 6-98), the yearly attack frequency was significantly reduced (from 16.8 to 2.4; P < 0.001), and 42.1% of colchicine-resistant FMF patients were attack free. Serum levels of C-reactive protein, erythrocyte sedimentation rate, and 24-hour urinary protein excretion (5,458.7 mg/24 hours before and 3,557.3 mg/24 hours after) were significantly reduced. CONCLUSION: Anti-IL-1 treatment is an effective alternative for controlling attacks and decreasing proteinuria in colchicine-resistant FMF patients.

Neutrophil/lymphocyte ratio and mean platelet volume in central serous chorioretinopathy.

PURPOSE: This study aimed to evaluate mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) values and their relationship with clinical findings in patients with central serous chorioretinopathy (CSCR). METHODS: Overall, 87 patients fulfilling inclusion criteria and 320 age- and sex-matched healthy individuals as controls were included in the study. The CSCR patients (n=87) were classified into 2 groups as acute CSCR (group 1, n=43) and chronic CSCR (group 2, n=44). RESULTS: It was found that NLR (P<0.05) and C-reactive protein (CRP) (P<0.05) values were higher in acute CSCR group than the other groups. MPV value was found to be higher in chronic CSCR group than the other groups (P<0.001). CONCLUSION: It seems that neutrophils play a major role in acute CSCR while platelets are involved in progression to chronic CSCR. Larger, prospective studies are needed on this topic.

Pain, depression levels, fatigue, sleep quality, and quality of life in elderly patients with rheumatoid arthritis.

BACKGROUND/AIM: The aim of this study was to evaluate and determine the relationships (if any) among pain, depression levels, fatigue, sleep quality, and quality of life in patients with rheumatoid arthritis (RA) aged 65 years and over, and to compare the results with those of RA patients under 65 years of age. MATERIALS AND METHODS: The study included 52 patients with RA aged 65 years and over (Group 1) and 84 patients with RA under 65 years of age (Group 2). Pain, depression levels, fatigue, sleep quality, quality of life, and disease activity of all of the participants were evaluated using a visual analog scale (VAS), the Beck Depression Inventory (BDI), the Checklist Individual Strength (CIS), the Pittsburgh Sleep Quality Index (PSQI), the Short Form-36 (SF-36), and the Disease Activity Score-28, respectively. RESULTS: When the two groups were compared, higher scores for the VAS, BDI, total CIS, and PSQI were found in Group 1 compared to Group 2 (P = 0.003, P = 0.003, P = 0.007, and P = 0.001, respectively). The SF-36 subscales of the physical component summary and mental component summary were not statistically significantly different between the two groups (P > 0.05). CONCLUSION: This study evaluated the situation in elderly patients with RA and showed that pain, depression level, fatigue, and sleep quality worsen with age.

Effects of Vitamin D Therapy on Quality of Life in Patients with Fibromyalgia.

OBJECTIVE: The role of vitamin D in the etiopathogenesis of fibromyalgia and non-specific musculoskeletal pain is controversial. In our study, we aimed to investigate the effect of vitamin D therapy on quality of life in patients with fibromyalgia. MATERIALS AND METHODS: Seventy patients diagnosed with fibromyalgia and 65 age- and sex-matched controls were included in the study. Patients were grouped as deficient (<20 ng/mL), inadequate (20-30 ng/mL), and sufficient (>30 ng/mL) according to the levels of vitamin D. Vitamin D replacement was performed for patients with deficiencies and inadequacies. Before and after vitamin D therapy, patients filled in the assessment tools, fibromyalgia impact questionnaire (FIQ), Arizona sexual experience scale (ASEX), Beck depression inventory (BDI), visual analog scale (VAS), and short form-36 (SF-36). RESULTS: Vitamin D deficiencies and inadequacies were observed in 60% of the patients (n=42). Among patients with low and normal levels of vitamin D, no statistically significant difference was observed in their values. In scales examined after vitamin D replacement therapy, statistically significant differences were observed in the FIQ, BDI, VAS, and SF-36 compared with pre-treatment. CONCLUSION: Vitamin D deficiency seems to be linked to the pathogenesis of fibromyalgia. Vitamin D supplementation may improve the quality of life in patients with fibromyalgia.

Frequency of fibromyalgia syndrome in patients with central serous chorioretinopathy.

PURPOSE:: To investigate frequency of fibromyalgia syndrome (FMS) among patients with central serous chorioretinopathy (CSCR). METHODS:: The study included 83 patients with CSCR and 201 age- and sex-matched healthy controls; the mean age was 47.5 ± 11.3 years in the CSCR group (18 women; 21.7%) and 47.2 ± 11.2 years in the control group (44 women; 21.9%). All participants were assessed for FMS based on 2010 American College of Rheumatology diagnostic criteria and for depression and anxiety with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). RESULTS:: FMS was diagnosed in 35 patients (42.2%) from the CSCR group and in 21 individuals (10.4%) from the control group (p<0.001). It was found in 77.77% of the women (14/18) and 32.3% of the men (21/65) in the CSCR group and in 22.7% of the women (10/44) and 7.0% of the men (11/157) in the control group. Familial stress, BDI and BAI scores were higher in the patients with FMS than in those without. When independent risk factors were evaluated by logistic regression analysis, it was found that only the presence of familial stress was a significant risk factor for FMS. CONCLUSIONS:: Patients with CSCR should be assessed for the presence of FMS, and this should be taken into consideration when developing a treatment plan. Further studies with a larger sample size are needed to clarify the relationship between FMS and CSCR.

Criteria sets for primary Sjogren's syndrome are not adequate for those presenting with extraglandular organ involvements as their dominant clinical features.

Patients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 ± 2.3 vs 4.3 ± 5.9 years) (p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features.

Frequency of fibromyalgia syndrome in patients with central serous chorioretinopathy / Frequência de síndrome de fibromialgia em pacientes com coriorretinopatia serosa central

ABSTRACT Purpose: To ınvestigate frequency of fibromyalgia syndrome (FMS) among patients with central serous chorioretinopathy (CSCR). Methods: The study included 83 patients with CSCR and 201 age- and sex-matched healthy controls; the mean age was 47.5 ± 11.3 years in the CSCR group (18 women; 21.7%) and 47.2 ± 11.2 years in the control group (44 women; 21.9%). All participants were assessed for FMS based on 2010 American College of Rheumatology diagnostic criteria and for depression and anxiety with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Results: FMS was diagnosed in 35 patients (42.2%) from the CSCR group and in 21 individuals (10.4%) from the control group (p<0.001). It was found in 77.77% of the women (14/18) and 32.3% of the men (21/65) in the CSCR group and in 22.7% of the women (10/44) and 7.0% of the men (11/157) in the control group. Familial stress, BDI and BAI scores were higher in the patients with FMS than in those without. When independent risk factors were evaluated by logistic regression analysis, it was found that only the presence of familial stress was a significant risk factor for FMS. Conclusions: Patients with CSCR should be assessed for the presence of FMS, and this should be taken into consideration when developing a treatment plan. Further studies with a larger sample size are needed to clarify the relationship between FMS and CSCR.

RESUMO Objetivo: Investigar a frequência da fibromialgia (FMS) entre os pacientes com coriorretinopatia serosa central (CSCR). Métodos: O estudo incluiu 83 pacientes com CSCR e 201 controles saudáveis pareados por idade e sexo. Todos os participantes foram avaliados com base nos critérios de diagnóstico de FMS do American College of Rheumatology de 2010 (ACR), Beck Anxiety Inventory (BAI) e Beck Depression Inventory (BDI). Resultados: A idade média foi 47,53 ± 11,33 anos no grupo CSCR (18 mulheres; 21,7%) e 47,19 ± 11,19 anos (44 mulheres; 21,9%) no grupo controle. FMS foi diagnosticada em 35 pacientes (42,2%) do grupo CSCR e em 21 indivíduos (10,4%) do grupo controle (p<0,001). FMS foi encontrado em 77,77% das mulheres (14/18) e 32,3% dos homens (21/65) no grupo CSCR e em 22,7% das mulheres controles (10/44) e 7,0% dos homens controles (11/157). Estresse familiar, BDI e BAI foram maiores nos pacientes com FMS em comparação com aqueles sem FMS. Quando os fatores de risco independentes foram avaliados por análise de regressão logística, verificou-se que apenas a presença de estresse familiar foi um fator de risco significativo para FMS. Conclusões: Os pacientes com CSCR devem ser avaliados para presença de FMS e a FMS deve ser levada em consideração durante o desenvolvimento de um plano de tratamento. São necessários mais estudos com maior tamanho da amostra para esclarecer relações entre FMS e CSCR.

Chronic Non-Productive Cough in Patients With Primary Sjögren's Syndrome.

OBJECTIVES: This study aims to evaluate the frequency of chronic cough due to dryness in the trachea and the relationship between depression and chronic cough in patients with primary Sjögren's syndrome (pSS). PATIENTS AND METHODS: Eighty non-smoking patients (7 males, 73 females; mean age 47.6±9.2 years; range 18 to 70 years) with newly diagnosed pSS were included. All patients were evaluated clinically, radiologically, and physiologically. Patients with cough were assessed using the Leicester Cough Questionnaire and visual analog scale. Beck Depression Inventory was used to determine the risk of depression in patients with cough. Patients with asthma, rhinosinusitis, gastrooesophageal reflux, and drug use which cause cough and pulmonary involvement in pSS were excluded. RESULTS: Non-productive cough was detected in 30 patients (37.5%). Fourteen patients (17.5%) were admitted to the hospital with cough at least once before the diagnosis of pSS. The median time between onset of symptoms and firm diagnosis was 24 months (25-75 interquartile ranges: 3-60 months). A significant difference was observed in the Beck Depression Inventory scores between patients with and without cough. There was a significant negative relationship between Leicester Cough Questionnaire and Beck Depression Inventory scores. CONCLUSION: Patients with pSS often have symptoms for a long duration that mimic those of more commonly encountered non-specific pulmonary conditions. Xerotrachea should be considered in the differential diagnosis of chronic cough, especially in patients with normal pulmonary function tests and pulmonary imaging.

Leptin and leptin receptors in salivary glands of primary Sjögren's syndrome.

BACKGROUND: The role of leptin in primary Sjögren's syndrome (SS) pathogenesis is unknown. The aim of this study was to investigate the expression of leptin and leptin receptor (LEPR) in minor salivary glands in patients with SS. MATERIALS AND METHODS: The expression of leptin and LEPR in minor salivary gland specimens obtained from patients with primary SS (n=50) and control subjects (n=50) were examined using immunohistochemical staining. RESULTS: Acinar cells, epithelial cells and adipocytes in salivary glands can express leptin and LEPR. It was observed that there was intense staining in the focal lymphocytic infiltration areas in SS patients. The intensity of leptin and LEPR staining under microscopy (400×) were graded semiquantitatively as negative, mild, moderate or strongly positive, and scored as 1, 2 or 3, respectively. The expression levels of leptin and LEPR in patients with primary SS were not higher than in controls. There was no significant difference in degrees of leptin and LEPR staining, staining intensity, and immunoreactive scores between groups. The expression of leptin and LEPR were not correlated with autoantibodies such as RF, ANA, anti-Ro, and/or anti-La positivity. CONCLUSIONS: These findings indicate that leptin and its receptors do not play an important role in primary SS pathophysiology.

The management of gout in different clinical specialties in Turkey: a patient-based survey.

Although gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 ± 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists.