MEFV mutation frequencies in a Turkish cohort with low prevalence of familial Mediterranean fever

Background/aim: Familial Mediterranean fever (FMF) is a genetically recessive autoinflammatory disease caused by mutations in the Mediterranean fever (MEFV) gene. The aim of this study was to investigate the frequencies of the most common MEFV mutations among a sample of healthy individuals from the Havsa population of European Turkey, where FMF is less prevalent compared to Asian Turkey. Materials and methods: The study group consisted of 263 unrelated healthy adults. All of the participants were analyzed for the M694V, V726A, M680I, and E148Q mutations in the MEFV gene. Results: In total, 25 of the 263 individuals carried MEFV mutations (9.5%). The observed allele frequencies were 1.5% for M694V (95% confidence interval [CI] 0.5-2.5), 2.6% for E148Q (95% CI 1.6-3.9), 0.5% for M680I (95% CI 0.0-1.1), and 0.0% for V726A. The frequencies of the M694V, M680I, and E148Q mutations were not significantly different from allele frequencies (approximately 20%) determined for other regions of Turkey where FMF is more prevalent. Conclusion: These data suggest that the positivity of the MEFV gene mutation tests have lower predictive value in a population with low FMF prevalence.

A multicenter report of biologic agents for the treatment of secondary amyloidosis in Turkish rheumatoid arthritis and ankylosing spondylitis patients.

In this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy-based on creatinine level, proteinuria and disease activity-was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2 % of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17 months), two RA patients died and two developed tuberculosis. In AS group, 45.7 % of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38 months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern.

Impact of rheumatoid arthritis in Turkey: a questionnaire study.

OBJECTIVES: Unmet needs of rheumatoid arthritis (RA) patients regarding physician/patient communication, treatment preferences and quality of life issues were investigated in a Turkish survey study. METHODS: The study was conducted with the contribution of 33 rheumatologists, and included 519 RA patients. The study population included patients who had been on biologic therapy for >6 months and were still receiving biologic therapy (BT group), and those who were biologic naive, but found eligible for biologic treatment (NBT group). Of the RA patients, 35.5% initially had a visit to an internal disease specialist, 25.5% to a physical therapy and rehabilitation specialist, and 12.2% to a rheumatology specialist for their RA complaints. The diagnosis of RA was made by a rheumatologist in 48.2% of patients. RESULTS: The majority of RA patients (86.3%) visit their doctor within 15-week intervals. Most of the physician-patient communication focused on disease symptoms (99.0%) and impact of the disease on quality of life (61.8%). The proportion of RA patients who perceived their health status as good/very good/excellent was higher in the BT group than in the NBT group (74.3% vs. 51.5%, p<0.001). However, of those RA patients in the NBT group, only 24.8% have been recommended to start a biologic treatment by their doctors. With respect to dose frequency options, once-monthly injections were preferred (80%) to a bi-weekly injection schedule (8%). CONCLUSIONS: In conclusion, RA patients receiving biologic therapy reported higher rates of improved symptoms and better quality of life and seemed to be more satisfied with their treatment in our study.

Diaphragmatic movements in ankylosing spondylitis patients and their association with clinical factors: an ultrasonographic study.

We compared diaphragmatic motion between ankylosing spondylitis (AS) patients and controls, as assessed by the ultrasonographic method. We included 33 consecutive AS patients (19 males, 14 females) followed up at our center and 14 apparently healthy controls (8 males, 6 females) into our study. AS patients fulfilled the modified New York classification criteria for AS. Patients' demographic and clinical data, functional parameters, and radiographic findings were recorded down. By evaluating the motion of right and left diaphragm during deep expirium and inspirium, the mean diaphragmatic motion was determined by ultrasonography. Diaphragmatic motion in AS patients was less than in controls, but the difference was not significant (68.9 ± 17 mm vs. 77.8 ± 22.4 mm, P = 0.14). Diaphragmatic motion in AS patients who were active according to BASDAI score (>4) was not different from inactive patients (70.4 ± 20.5 vs. 67.5 ± 13.5, P > 0.05). The mean diaphragmatic motion had a positive correlation with occiput-to-wall distance (r = 0.35, P = 0.048); and negative correlations with cervical rotation (r = -0.45, P = 0.01) and modified Schober test (r = -0.34, P = 0.05) in AS patients. We did not detect any association of mean diaphragmatic motion with thoracic expansion on deep expiration. Diaphragmatic motion in AS does not differ significantly from the control group. Factors like disease activation, chest expansion, and the severity of radiographic findings do not affect diaphragmatic motion. There is no compensatory increase in diaphragmatic motion in AS.

Subclinical atherosclerosis in gouty arthritis patients: a comparative study.

We evaluated the incidence of subclinical atherosclerosis and associated factors in our gouty arthritis patients. We included 55 gouty arthritis patients diagnosed at our center within the last 4 years. The control group included 41 patients with rheumatoid arthritis (RA) and 34 patients with asymptomatic hyperuricemia (AHU). Atherosclerotic risk factors were determined in all subjects. Carotid intima-media thickness (IMT) and the presence of plaques were evaluated by B-mode ultrasonography. The carotid IMT in gouty arthritis patients (0.730 ± 0.19) was significantly higher than in AHU subjects (0.616 ± 0.12) (P = 0.004) and tended to be higher than the RA group (0.669 ± 0.17) (P = 0.1). Atheromatous plaques were significantly more frequent in gouty arthritis patients (16 cases, 29.1%) than in RA patients (5 cases, 12.2%) and AHU subjects (3 cases, 8.8%) (P values, 0.05 and 0.023). Gout patients with plaques were older (P = 0.006) and tended to have tophi more frequently (P = 0.06). Logistic regression analysis showed that age (OR: 1.3, 95% CI: 1.02-1.54) and the presence of tophi (OR: 12.5, 95% CI: 1.2-140) were independent risk factors for the presence of plaques. Gouty arthritis bears a higher risk of atherosclerosis than both RA and AHU.

The prevalences of some rheumatic diseases in western Turkey: Havsa study.

To study the prevalence major rheumatic diseases in western Turkey. This survey was conducted in Havsa which have a total population of 18,771. Physicians and interns visited every household, interviewed face to face a questionnaire about the symptoms of rheumatic disorders. The individuals replied positively to any question were examined at the nearest health center. Those have no objective findings related to any rheumatic diseases were excluded. People could not be clinically diagnosed were asked to come to the hospital for further evaluation. A total 17,835 of 18,771 residents participated. We estimated the prevalence of Behçet's Disease (BD) as 0.019%; ankylosing spondylitis: 0.120%; rheumatoid arthritis: 0.321%; knee osteoarthritis (OA): 5.351%; hand OA: 1.110%; hand and knee OA: 1.958%; total OA: 8.420%; primary Raynaud's: 1.192%; psoriasis: 0.424 %; psoriatic arthritis: 0.050%; rheumatic fever: 0.318%; rheumatic heart disease: 0.200%; inflammatory bowel disease: 0.023%; lupus: 0.059%; gout: 0.018%; systemic sclerosis: 0.022%; juvenile rheumatoid arthritis: 0.032%; temporal arteritis: 0.020%, and familial Mediterranean fever (FMF) as 0.006%. Figures were adjusted for age-sex of the general Turkish population. The prevalence's of BD and FMF are considerably lower in Havsa as compared to other regions in Turkey.

Evaluation of the role of spectral-domain optical coherence tomography in the early detection of macular and ganglion cell complex thickness changes in patients with rheumatologic diseases taking hydroxychloroquine.

BACKGROUND: The aim was to investigate the effects of hydroxychloroquine (HCQ) on macular and ganglion cell complex (GCC) thickness measured by spectral-domain optical coherence tomography (SD-OCT). METHODS: A total of 145 patients were included in the study. Patients who had taken HCQ for at least 6 months formed group 1 (n:81), while 34 patients with rheumatologic diseases who did not receive HCQ therapy, and 30 healthy subjects formed groups 2 and 3. The patients in group 1 were divided into two subgroups one with more than 60 months of usage (A), and the other with less than 60 months (B). All patients underwent a complete ophthalmologic examination, as well as visual field (VF) testing, and the measurement of macular and GCC thickness with SD-OCT. RESULTS: The mean duration of taking HCQ was 100.96±46.97 and 26.50±14.45 months and the total dose was 843.37±489.38 g and 208.63±135.01 g in groups 1A and 1B, respectively. Patients in group 1 had significantly worse VF scores than groups 2 and 3, but no difference was found between groups 1A and 1B. The SD-OCT macular thickness was thinner in the inner and outer nasal quadrants according to the ETDRS 9 sector chart in the patients using hydroxychloroquine, while the GCC in the group 1A patients was thinner in the superior, inferior areas and inferior inner nasal, inferior-superior outer temporal quadrants compared to the other groups (p < 0.05). CONCLUSION: Assessment of regional macular and GCC changes by SD-OCT is a valuable tool for early detection of HCQ maculopathy.

The frequency of smoking in fibromyalgia patients and its association with symptoms.

The objective of the study was to determine the frequency of smoking in fibromyalgia (FM) and rheumatoid arthritis (RA) patients and investigate its association with the symptoms of FM. We included age-matched 302 FM (289 F, 13 M), and 115 (105 F, 10 M) RA patients. All patients were questioned about smoking and the severity of their chronic widespread pain (CWP) and symptoms of FM by using a visual analog scale (VAS, 0-10) and FM impact questionnaire. In addition, patients were asked questions about depression and anxiety. The frequency of smoking in FM patients (77 subjects, 25.5%) tended to be higher than in RA patients (19 subjects, 16.5%) (P = 0.05). When the features of smoker FM patients were compared to others, it was observed that the frequencies of subjects with an education duration >9 years (P < 0.001) and subjects with an history of psychiatric therapy (P = 0.01) and alcohol consumption (P = 0.013) were higher. The mean age of FM patients with smoking (P = 0.002) was lower; the duration of FM (P = 0.024) was shorter; and the scores of CWP severity (P = 0.05), unrestorative sleepiness (P = 0.017), paresthesia (P = 0.038) and anxiety-depression (P = 0.007) were higher. An important proportion of FM patients, nearly one-fourth, were re-smokers. Smoker FM patients had higher education level, and the severity of their FM-related symptoms like CWP and their anxiety-depression scores were higher.

Increased platelet activation markers in rheumatoid arthritis: are they related with subclinical atherosclerosis?

Atherosclerotic cardiovascular mortality is increased in rheumatoid arthritis (RA) patients. We evaluated the association of inflammatory response with platelet, endothelial, coagulation activation parameters; and subclinical atherosclerosis in RA patients. We included 27 RA patients (21 female; six male) and 19 healthy subjects (14 female; five male). Disease activity score (DAS28) in RA patients was calculated; and patients were divided into two groups as active and inactive. Flow cytometry was used to determine platelet CD62P expression, platelet microparticles (PMP), platelet-monocyte (PMC) and platelet-neutrophil complexes (PNC). Plasma E-selectin, thrombin-antithrombin (TAT) complex, and serum sCD40L levels were determined by ELISA. The intima-media thickness (IMT) of carotid arteries was determined by B-mode ultrasonography. In RA patients, platelet CD62P expression (p < 0.001), PMC (p = 0.037) and sCD40L (p < 0.001) levels were increased when compared to the control group. PNC (p = 0.07) and TAT levels (p = 0.1) were non-significantly higher, and PMP level (p = 0.075) was nonsignificantly lower in RA patients. Soluble E-selectin level was significantly higher in the active RA group than in the inactive RA group (p = 0.009). There was no correlation between carotid IMT and activity markers, the evaluated parameters (p > 0.05).The increase in markers of active platelets, CD62P and sCD40L, and PMC levels might be associated with the increased cardiovascular mortality in RA. Nevertheless, none of these parameters were associated with carotid IMT: this suggests that one cross-sectional value might not be a good marker for atherosclerosis

Neuro-Behcet's disease in a case with papilledema and intracranial hypertension as the initial presentation.

A 27-year-old female presented to the Clinic of Ophthalmology with the complaints of photophobia, headache, and diplopia. An ophthalmological examination indicated that her best-corrected visual acuity was 20/20 in both eyes with decreased contrast sensitivity. Fundoscopic examination revealed bilateral papilledema. The cerebrospinal fluid opening pressure was above normal at 38.5 cm H2O. Cranial magnetic resonance imagining venography revealed left lateral sinus thrombosis and right lateral sinus retardation of filling. Based on her history, laboratory tests, and neuro-imaging findings, she was diagnosed with vascular neuro-Behcet's disease (NBD). It is important to consider NBD in the differential diagnosis of patients with bilateral papilledema and intracranial hypertension.

Increased circulating platelet-leucocyte complexes in patients with primary Raynaud's phenomenon and Raynaud's phenomenon secondary to systemic sclerosis: a comparative study.

Platelet activation and circulating platelet-leucocyte complexes increase in vascular ischemic events and autoimmune inflammatory diseases. Platelet activation markers and platelet-leucocyte complexes were evaluated in primary Raynaud's phenomenon (RP) and in RP secondary to systemic sclerosis (SSc). Whole-blood flow cytometry was utilized to quantify CD62P, platelet microparticles (PMP), platelet-monocyte complexes (PMC) and platelet-neutrophil complexes (PNC) in primary RP and in SSc patients with secondary RP. SSc patients with secondary RP had significantly higher platelet CD62P expression than primary RP patients and controls (P = 0.017 and 0.004, respectively). Primary and secondary RP patients had higher mean PMC and PNC levels than controls (all P < or = 0.001). PMP level in SSc patients with pulmonary hypertension was significantly higher than in others (P = 0.048). All parameters were similar in SSc patients with and without digital ulcers, aspirin-users and nonusers (P > 0.05). CD62P level decreased significantly after iloprost administration in four patients with digital ulcers (16.1 +/- 17.4 vs 7.4 +/- 3.8%, P = 0.03). Our results suggest there is platelet-leucocyte complex formation in RP, and, despite antithrombotic therapy, platelet activation and platelet-leucocyte interaction are ongoing in SSc. This is important as it might have potential therapeutic implications with respect to using antiplatelet drugs in SSc.

The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms.

We determined the frequency of thyroid autoantibodies in fibromyalgia (FM) patients and the relationship between FM symptoms and these antibodies. Euthyroid 128 FM patients, 64 rheumatoid arthritis (RA) patients, and 64 healthy control subjects were included in the study. The sociodemographic features and the clinical features of FM patients were determined. By using a visual analog scale, patients were questioned about the severity of FM-related symptoms. All patients were administered with Duke-Anxiety Depression (Duke-AD) scale, the physical function items of the fibromyalgia impact questionnaire scale. Thyroid autoimmunity was defined as the presence of detectable antithyroglobulin (TgAb) and/or antithyroid peroxidase (TPOAb) antibodies by the immunometric methods. Patients with a connective tissue disorder, hypo- or hyperthyroidism, and patients who had psychiatric treatment within the last 6 months were not included into the study. The frequencies of thyroid autoimmunity in FM (34.4%) and RA (29.7%) patients were significantly higher than controls (18.8%) (p<0.05). Twenty-six (20.3%) FM patients had positive TgAb and 31 (24.2%) had positive TPOAb. When patients with thyroid autoimmunity were compared to others, it was seen that the mean age, the percentage of postmenopausal patients, the frequency of dryness of the mouth, and the percentage of patients with a previous psychiatric treatment were higher in this group (p<0.05). FM patients had thyroid autoimmunity similar to the frequency in RA and higher than controls. Age and postmenopausal status seemed to be associated with thyroid autoimmunity in FM patients. The presence of thyroid autoimmunity had no relationship with the depression scores of FM patients.

Hemophagocytic syndrome in one patient with adult-onset Still's disease. Presentation with febrile neutropenia.

Macrophage activation syndrome (MAS) is an important complication seen in systemic for juvenile rheumatoid arthritis; until now, it has been reported in only a few cases of adult-onset Still's disease (AOSD). Here, we shall present a 50-year-old female patient who was using steroids and antimalarial drugs for AOSD, and who developed MAS during follow-up. The patient presented with febrile neutropenia, and the neutropenic period lasted for 15 days. The examination of bone marrow aspiration smears demonstrated increased macrophages and findings of hemophagocytosis. Flow cytometric analysis of peripheral blood showed decreased natural killer cells. The patient developed neurologic findings during this period, and during the recovery of neutropenia, she had icterus and liver function test abnormalities. The patient was given granulocyte colony-stimulating factor during neutropenic period, and her neutropenia improved after the administration of high-dose steroids. Our patient was the first AOSD patient who presented with febrile neutropenia during the course of her disease and who was diagnosed to have MAS.

Factors that affect the number of tender points in fibromyalgia and chronic widespread pain patients who did not meet the ACR 1990 criteria for fibromyalgia: are tender points a reflection of neuropathic pain?

OBJECTIVE: This study aims to compare fibromyalgia (FM) and chronic widespread pain (CWP) patients who do not fulfill the criteria for tender points (TP). METHODS: We included 150 patients diagnosed with FM according to ACR 1990 criteria and 42 patients with CWP who did not fulfill TP criteria for FM into the study. The clinical features of the patients were recorded, and the TP count was determined. By means of a visual analog scale (VAS), all patients were questioned about the severity of pain and FM-related symptoms. In addition, the patients were administered the Duke Anxiety Depression (Duke-AD) scale and somatization symptom questionnaire. Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale was used to determine the neuropathic pain score. RESULTS: According to VAS, the severity of pain, sleep disturbance, the number of somatization symptoms, LANSS, and Duke-AD scores were significantly higher in FM patients than in patients with CWP (all P values <0.05). The number of TP correlated with severity of pain (r = 0.32, P < 0.001), the number of somatization symptoms (r = 0.26, P = 0.01), sleep disturbance (r = 0.18, P = 0.01), and LANSS score (r = 0.4, P < 0.001). Multiple logistic regression analysis revealed that independent factors that affected the presence of > or =11 TP were the severity of pain on VAS (OR: 1.03, 95% CI: 1.01-1.06, P = 0.045) and LANSS score (OR: 1.36, 95% CI: 1.12-1.62, P = 0.001). CONCLUSIONS: CWP patients have symptoms similar to FM patients, though less severe. The most important factor that affects the criteria for fulfilling the number TP in CWP patients is the neuropathic pain score, which suggests that FM is primarily a neuropathic pain syndrome.

The renal effects of the addition of low-dose aspirin to COX-2 selective and nonselective antiinflammatory drugs.

OBJECTIVE: We aimed to evaluate the effect on renal functions and blood pressure of the addition of low dose aspirin (LDA) to cyclooxygenase-2 (COX-2) inhibitors or nonselective NSAIDs. METHODS: Two groups each containing 14 patients with one group using celecoxib and the other indomethacin regularly for at least 1 week were included into the study. Both groups were initially administered 100 mg/day (week 1), and later 300 mg/day (week 2) aspirin. Baseline and weekly serum creatinine, uric acid, electrolytes, creatinine clearance (CrCl) and blood pressure were obtained. RESULTS: Contrary to the celecoxib group, in the indomethacin group, both after the first and the second weeks the mean serum creatinine increased and CrCl decreased when compared to baseline values (p values<0.05). In the indomethacin group, when compared to baseline values systolic blood pressure was significantly higher after week 1 and uric acid level after week 2 (p values = 0.01). The frequency of patients with a >or=20% decrease in CrCl at the end of week 2 was higher in the indomethacin group than in the celecoxib group (42.9% vs. 0%, p = 0.016). The difference between the mean creatinine (p = 0.017) and CrCl values (p = 0.007) from baseline until after week 2 was more significant in the indomethacin group than in the celecoxib group. CONCLUSIONS: The addition of LDA to patients using indomethacin led to significant renal dysfunction. Subjects using celecoxib seem to have been protected from the renal side effects of LDA.

Performance of the new American College of Rheumatology classification criteria in Turkish systemic sclerosis patients: a multicenter study.

In our study, we compared the sensitivity and specificity of the new ACR/EULAR 2013 criteria to the ACR 1980 criteria in our systemic sclerosis (SSc) population. Three rheumatology centers from Turkey participated into this study. The medical records of SSc patients diagnosed between 2008 and 2014 were retrospectively reviewed, and their features at disease onset were recorded. Patients admitted to each center within the same time period for conditions other than SSc, in whom ANA was positive and was deemed necessary within the diagnostic workup, were included as controls. One hundred and ninety-seven SSc patients (174 females, 23 males) and 103 controls (96 females, 7 males) were included. Limited cutaneous SSc was present in 68 % of patients, and 30.5 % had diffuse SSc. The sensitivity of ACR/EULAR 2013 and ACR 1980 criteria were, respectively, 94.4 and 85.3 % (p = 0.003). The specificity of ACR/EULAR 2013 and ACR 1980 criteria were, respectively, 98.1 and 100 %. According to the new criteria, 13 patients were misclassified; however, according to the ACR 1980 criteria, 29 patients were misclassified (p = 0.005). The sensitivity of ACR/EULAR 2013 criteria was significantly better than that of the ACR 1980 criteria in limited cutaneous SSc group (94.8 vs. 82.8 %). In patients whose disease duration was <3 years, the new criteria had better sensitivity than the previous criteria (92.7 vs. 78.1 %, p = 0.006). The new ACR/EULAR 2013 criteria for SSc had better sensitivity in Turkish SSc patients, and less patients were misclassified.

Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study.

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.

A patient with ankylosing spondylitis who presented with chronic necrotising aspergillosis: report on one case and review of the literature.

Upper lobe fibrobullous disease is a well-known finding in advanced stages of ankylosing spondylitis (AS). In this report, we present a 57-year-old male patient who was diagnosed with a right apical cavitary lesion after coming to us with the complaint of haemoptysis. The patient underwent upper lobe segmentectomy and an aspergilloma was detected. Histologic findings were in favour of necrotising Aspergillus pneumonia. It was interesting that the patient had not been diagnosed with AS before and presented initially with chronic necrotising Aspergillus pneumonia. In the literature, there are recently published series of pulmonary high-resolution computed tomography (HRCT) in AS which claim that parenchymal abnormalities are quite frequent. Although the clinical significance of these abnormalities is not known with certainty, it has been reported that they might be seen even in early-stage patients. It is suggested that the pulmonary involvement in AS might be affected by mechanical factors related to limitation of motion of the thoracic cage and also by parenchymal inflammation. Here, we review the series of pulmonary HRCT in AS patients.

The correlation between ferritin level and acute phase parameters in rheumatoid arthritis and systemic lupus erythematosus.

OBJECTIVE: In this study, we evaluated the relationship between ferritin levels and disease activation in rheumatoid arthritis (RA) patients. MATERIAL AND METHODS: We included 44 patients with RA, 20 patients with systemic lupus erythematosus (SLE), 25 patients with infection, 22 patients with malignancy, and 20 healthy control subjects. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), whole blood count, and serum iron parameters were determined in all cases. The joint findings in RA patients were recorded, and disease activity score (DAS) was calculated. In SLE patients, antinuclear antibody (ANA) and anti-dsDNA titers and C3 and C4 complement levels were determined. SLE disease activity index (SLEDAI) score was calculated. RESULTS: Serum ferritin levels in the RA, SLE, and control groups were lower than those in the infection and malignancy groups (p<0.05). The ferritin levels in the RA group did not differ significantly from the SLE and control groups. In RA patients, serum ferritin level had a positive correlation with ESR, CRP, RF, platelet count, and DAS score and had a negative correlation with hematocrit (all p values <0.05). In SLE patients, on the other hand, serum ferritin had a positive correlation with ANA, anti-dsDNA, and SLEDAI (all p values <0.05). According to DAS, ferritin level in inactive RA patients was lower than that in active RA patients. When transferrin saturation was considered, iron deficiency anemia was a quite frequent finding in both active and inactive RA patients. CONCLUSION: Interestingly, we observed that ferritin level in RA patients was similar to the control group; however, it was a good parameter of disease activation. This is because a reduction in storage iron and resultant iron deficiency anemia are very common in RA patients.

The Frequency of anti-CCP antibodies in patients with rheumatoid arthritis and psoriatic arthritis and their relationship with clinical features and parameters of angiogenesis: A comparative study.

OBJECTIVE: Macrophage migration inhibitory factor (MIF) and vascular endothelial growth factor (VEGF), as crucial parameters of angiogenesis and inflammation, were evaluated to identify the role of cyclic citrullinated peptide antibodies (anti-CCP) during angiogenesis in rheumatoid arthritis (RA) and psoriatic arthritis (PsA). MATERIAL AND METHODS: A total of 145 patients with RA, 44 patients with PsA, and 73 healthy subjects were included in this study. The clinical features, total blood counts, and acute phase parameters of RA and PsA patients were recorded. Anti-CCP antibody, VEGF, and MIF levels were determined with enzyme-linked immunosorbent assay (ELISA). RESULTS: Anti-CCP positivity was significantly higher in the RA group (69%) than in both PsA (20.6%) and controls (8.2%) (p values<0.001). There was no difference between anti-CCP-positive and -negative RA patients regarding the extra-articular manifestations (p>0.05). VEGF and MIF levels were similar in anti-CCP-positive and -negative RA patients (all p values>0.05). The specificity of anti-CCP antibodies for RA was found to be 87.2%. No relationship was found between anti-CCP antibody positivity and clinical features, disease activity, functional disability as assessed by health assessment questionnaire scores, and extra-articular manifestations. There was no relationship between parameters of angiogenesis and anti-CCP antibody positivity. Both RF and anti-CCP antibodies were observed to be positive in most patients with RA. CONCLUSION: Either RF or anti-CCP antibody was positive in a considerable proportion of our RA patients. Therefore, anti-CCP antibodies are important in the diagnosis of RF-negative patients who present with clinical findings of RA.