Ali Şahin

Two new inflammatory markers associated with Disease Activity Score‐28 in patients with rheumatoid arthritis: neutrophil‐lymphocyte ratio and platelet‐lymphocyte ratio

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease with unknown etiology and systemic involvement. Neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) are two new inflammatory markers used in the assessment of systemic inflammation. The aim here is to study NLR and PLR in patients with RA to investigate their relation with Disease Activity Score of 28 joints (DAS‐28).

Comparison of plasma vitamin D levels in patients with Sjögren's syndrome and healthy subjects

Sjögrens syndrome (SS) is a systemic autoimmune disease characterized by chronic inflammation of the salivary and lacrimal glands. There is increasing evidence indicating that vitamin D is important in the initiation and propogation of a range of autoimmune diseases which may include SS. The aim of the present study was to evaluate plasma vitamin D (vit D) levels in patients with SS and to compare this with a control group.

Evaluation of Ovarian Reserve with Anti-Müllerian Hormone in Familial Mediterranean Fever

Objective. To investigate ovarian reserves in attack-free familial Mediterranean fever (AF-FMF) patients at the reproductive age by anti-Müllerian hormone (AMH), antral follicle count (AFC), ovarian volume, and hormonal parameters. Methods. Thirty-three AF-FMF patients aging 18–45 years and 34 healthy women were enrolled and FSH, LH, E2, PRL, and AMH levels were measured in the morning blood samples at 2nd–4th days of menstruation by ELISA. Concomitant pelvic ultrasonography was performed to calculate AFC and ovarian volumes. Results. In FMF patient group, median AMH levels were statistically significantly lower in the M69V mutation positive group than in the negative ones (P = 0.018). There was no statistically significant difference in median AMH levels between E148Q mutation positive patients and the negative ones (P = 0.920). There was also no statistically significant difference in median AMH levels between M680I mutation positive patients and the negative ones (P = 0.868). No statistically significant difference was observed in median AMH levels between patients who had at least one mutation and those with no mutations (P = 0.868). We realized that there was no difference in comparisons between ovarian volumes, number of follicles, and AMH levels ovarian reserves when compared with FMF patients and healthy individuals. Conclusions. Ovarian reserves of FMF pateints were similar to those of healthy subjects according to AMH. However, AMH levels were lower in FMF patients with M694V mutation.

Rheumatoid Arthritis and Familial Mediterranean Fever or Sacroiliitis Accompanied by FMF

The coexistence of rheumatoid arthritis (RA) and familial Mediterranean fever (FMF) has been rarely seen in case reports in the literature. Herein, we wanted to present a patient who had been followed up and treated as RA, but on investigation we concluded that he really had FMF and its joint complaints associated with sacroiliitis. Recovery was achieved by etanercept administered as if he was an RA patient.

Serum cystatin C is not an appropriate marker for kidney involvement in patients with primary Sjögren's syndrome

We aimed to investigate serum cystatin C (cysC) levels in primary Sjögrens syndrome (pSS) patients, and evaluate its correlation with renal involment.

Primary Sjögren’s Syndrome Adversely Affects the Female Sexual Function Assessed by the Female Sexual Function Index: A Case-Control Study

Objectives This study aims to evaluate the sexual function of females with primary Sjögrens syndrome (pSS) in comparison to healthy females by using the Female Sexual Function Index (FSFI). Patients and methods This case-control study included 31 female patients (mean age 46.0±10.2 years; range 30 to 68 years) with pSS and 27 healthy females (mean age 44.2±8.5 years; range 30 to 55 years) as control group. The sexual function of the participants was assessed by 19-item FSFI. Results Mean duration of pSS in the patient group was 35.9 months (range 3 to 264 months). Significantly higher number of pSS patients reported positive history for vaginal infection compared to controls (n=26, 83.9% vs. n=7, 25.9%, respectively; p<0.001) without any difference in endocervical culture result. Cervical smear assessment revealed more inflammation and atrophy in patient group compared to control group (p=0.001). Mean FSFI total score was significantly lower in patient group than control group (18.9±9.9 vs. 25.1±5.1, respectively; p=0.004). Similarly, five out of six domains of FSFI -arousal, lubrication, orgasm, satisfaction, and pain- were significantly lower in patient group. FSFI total and subscale scores, except for pain, were found to be negatively correlated with duration of pSS. Conclusion The pSS causes sexual dysfunction in female patients. Furthermore, as disease duration increases, female sexual function decreases. Clinical management of female patients with pSS should cover the assessment of their sexual functionality and taking the necessary precautions to maintain satisfactory quality of life and treatment outcome.

Lack of the Association of the PTPN22 C1858T Gene Polymorphism With Susceptibility to Familial Mediterranean Fever

Objectives This study aims to investigate whether the protein tyrosine phosphatase non-receptor type 22 (PTPN22) C1858T gene polymorphism plays a role in the pathogenesis of familial Mediterranean fever (FMF) through T-lymphocyte activation. Patients and methods We conducted a case-control study with 180 FMF patients (68 males, 112 females; mean age 38.2±1.6 years; range 16 to 81 years) and 184 healthy controls (86 males, 98 females; mean age 32.9±9.2 years; range 18 to 58 years). The PTPN22 C1858T polymorphism (rs2476601) was genotyped by polymerase chain reaction restriction fragment length polymorphism. In patients with FMF, clinical features, disease severity score, the frequencies of amyloidosis, positive family history, and Mediterranean fever gene mutations were determined. Results The frequencies of heterozygous genotype (CT) were 4.5% in FMF patients and 2.8% in healthy controls, respectively. The frequencies of polymorphic homozygous genotypes (TT) were 0.5% in both FMF patients and healthy controls. There were no statistically significant differences in the frequencies of CT and TT genotypes between FMF patients and healthy controls (odds ratio: 1.65, 95% confidence interval: 0.53-5.14, p>0.05 for CT genotype). The frequencies of clinical features, sex, amyloidosis, positive family history, Mediterranean fever gene mutations, and disease severity score were not significantly different between the patients. Conclusion The distribution of PTPN22 C1858T polymorphism did not reveal any association with FMF in a Turkish population.

AB0127 The Frequency of Nuerological Involvement in Sjögren's Syndrome: A Single Center Experience

Background Sjögrens syndrome is an autoimmune rheumatic disease that affects many glandular and extra-glandular tissues (1). Autoantibodies (mainly anti-Ro-SS-A and anti-La-SS-B) contribute to playing roles in its clinical pictures (2). Central and peripheral nervous system involvement may be seen as different sign, symptoms and varying its frequencies (2). Objectives The aim of this study is to investigate the frequency of neurological and other involvement patterns of the Sjögrens syndrome (SjS). Methods Between June 2015 and December 2015, fifty-eight-SjS patients that following-up at Cumhuriyet University Medical Faculty Rheumatology-Internal Medicine Department were evaluated in the study. The clinical complaints, glandular and extra-glandular findings, age, sex, other epidemiological data, ANA, RF, anti-Ro/La, C3, C4, IgG, IgA, IgM levels were recorded. Results The mean age of the patients was 47.8±1.3 years, and the mean age at diagnosis was 46.8±1.2 years. Of the SjS patients, fifty-four (93.1%) were female and four (6.9%) were male. The frequencies of the clinical symptoms were as follows arthralgia in 81%, arthritis in 48.3%, skin dryness in 50%, rashes (including palpable purpuric lesions) in 17.2%, biopsy proven vasculitic lesions in 5.2%. The frequencies of the neurological symptoms were as follows headaches in 32.8%, localized numbness in 5.2%, seizure in 1.7%, paresthesia in 3.4%, diffuse nonfocal symptoms in 1.7% (Figure 1). The total frequency of neurological involvement was 24.1% in SjS patients. Peripheral nervous system involvement in 8.6%. The findings of the magnetic resonans imaging of the patient with neurological involvement were as non-spesific gliotic lesions in 21.4%, periventricular lesions in 28.6%, paranchymal vasculitic lesions in 35.7%, multiple sclerosis-like plaques in 14.3%. There was found that anti-Ro positivity in 58.6%, anti-La in 19.2%, RF in 51.7%, ANA in 48.3%, low complement levels in 15.5%. However, anti-Ro positivity was lower in patient with neurological involvement than in patient without neurological involvement (p=0.025). Conclusions The neurological involvement should be kept in mind when the patient has been diagnosed as SjS. It can be seen than it is expected. In addition, further studies need to be done to evaluate the role of anti-Ro autoantibody in SjS patients with neurological involvement. References Mavragani CP, Moutsopoulos HM. Sjogren syndrome. CMAJ 2014 Oct 21;186(15):E579–86. doi: 10.1503/cmaj.122037. Epub 2014 Feb 24. Soliotis FC, Mavragani CP, Moutsopoulos HM. Central nervous system involvement in Sjogrens syndrome. Ann Rheum Dis 2004 Jun;63(6):616–20. Acknowledgement We would like to thank to Ziynet Çınar, M.D. for her statistical analysis Disclosure of Interest None declared

AB0031 Evaluation of Serum Fetuin-A and Apelin Levels in Familial Mediterranean Fever (FMF) Patients and Healthy Subjects

Background Apelin is an adipokine that its level is increased by some proinflammatory cytokine such as TNF-alpha in metabolic, autoimmune and inflammatory conditions (1). Fetuin-A is protein secreted by liver, kidney, bone, brain, lungs and cardiovascular system (2). The levels of fetuin-a are decreased in some rheumatic diseases (ie. Rheumatoid arthritis, osteoarthritis). It has been suggested that fetuin-a can be a novel inflammatory biomarker in familial Mediterranean fever (FMF) (3). Objectives To evaluate of the serum Apelin, Fetuin-A levels in patients with FMF during attack-free period (AFP) and to compare with healthy subjects. Methods Thirty-FMF patients with AFP and thirty healthy subjects were included this study. The erythrocyte sedimentation rate (ESR), CRP, fibrinogen, hemogram, Mediterranean fever (MEFV) gene profiles, BMI, insulin, HOMA-IR, lipid profiles, serum apelin, fetuin-a levels were investigated. Results Of the FMF patients and control, 20 (66.7%) was female and 10 (33.3%) was male. The distribution of MEFV gene mutation frequencies in the FMF patients was no mutation in 4 (13.3%) patients, M694V heterozygous in 7 (23.3%), M694V homozygous in 3 (10%), E148Q heterozygous in 5 (16.7%), M680I heterozygous in 2 (6.7%), M680I homozygous in 1 (3.3%), V726A in 2 (6.7%) and compound heterozygous mutation in 6 (20%). The median levels of apelin were 307.82±52.76 ng/mL in healthy subjects and 113,07±15,9 ng/mL in FMF (p=0.002) (Figure 1). The median levels of fetuin-a were 843,82±137.66 ng/mL in control group and 1352.2±127.61 ng/mL in FMF group (p=0.009) (Figure 1). Conclusions The lower serum apelin and higher fetuin-a levels in FMF patients with AFP than in healthy subjects were observed. It may be suggested that subclinical vascular inflammation is continued during attack-free period in patients with FMF. References Andrade-Oliveira V, Camara NO, Moraes-Vieira PM. Adipokines as drug targets in diabetes and underlying disturbances. J Diabetes Res 2015;2015:681612. doi: 10.1155/2015/681612. Epub 2015 Apr 8. Xiao J, Wang XR, Hu KZ, et al. Serum fetuin-A levels are inversely associated with clinical severity in patients with primary knee osteoarthritis. Biomarkers 2013 Feb;18(1):51–4. doi: 10.3109/1354750X.2012.730551. Epub 2012 Oct 16. Oncu K, Yazgan Y, Tanoglu A, et al. Can serum fetuin-A be regarded as an inflammatory marker among patients with familial Mediterranean fever? Dig Dis Sci 2013 Nov;58(11):3212–7. doi: 10.1007/s10620-013-2814-7. Epub 2013 Aug 8. Acknowledgement We would like to thank to Ahmet Altun, M.D. for his statistical analysis. Disclosure of Interest None declared

AB0126 Comparison of Serum Apelin, Fetuin-A Levels and Carotid Intima-Media Thickness in Patients with Sjögren's Syndrome and Healthy Subjects

Background Apelin is a glycoprotein, adipocytokine that plays an important role in decreasing the vascular inflammation on cardiovascular and metabolic disorders (1). Fetuin-A is also another glycoprotein that can be an acute phase protein negatively correlates with inflammation (2). Carotid intima-media thickness (C-IMT) may indicate vascular inflammation in primary Sjögrens syndrome (3). However, we do not know the relationship between serum apelin, fetuin-a levels and C-IMT in patients with Sjögrens syndrome. Objectives To compare of the serum Apelin, Fetuin-A levels and C-IMT in patients with Sjögrens syndrome (SjS) and healthy controls. Methods Sixty-SjS patients and sixty healthy subjects were enrolled to this study. Serum apelin, fetuin-a levels were measured by ELISA. Concomitant C-IMT evaluations of the participants were performed. The BMI, insulin, HOMA-IR, lipid profiles were studied. Other laboratory parameters, autoantibody profiles, minor salivary gland biopsy scores (Chisholm) were obtained from patients record files. The study was approved by the local ethics committee. Results The median levels of apelin were 178.02±55.23 ng/mL in healthy subjects and 98.66±37.25 ng/mL in SjS (p<0.05) (Figure 1). The median levels of fetuin-a were 1370.3±81.74 ng/mL in control group and 1613±64.49 ng/mL in SjS group (p=0.021) (Figure 1). The C-IMT was negatively correlated with apelin levels in SjS patients (r= - 0.209, p=0.02). There was no significant correlation between fetuin-a levels and C-IMT in SjS (p=0.08). However, there were significant correletions between C-IMT and hemoglobin-A1c (r=0.353, p=0.005), C3 (r=0.36, p=0.004), C4 (r=0.351, p=0.005). Conclusions We found lower serum apelin and higher fetuin-a levels in SjS patients than in healthy subjects. Apelin and fetuin-a may be a new possible surrogate biomarker of inflammation in Sjögrens syndrome. References Gualillo O, Gonzalez-Juanatey JR, Lago F. The emerging role of adipokines as mediators of cardiovascular function: physiologic and clinical perspectives. Trends Cardiovasc Med 2007 Nov;17(8):275–83. Harman H, Tekeoğlu İ, Gürol G, et al. Comparison of fetuin-A and transforming growth factor beta 1 levels in patients with spondyloarthropathies and rheumatoid arthritis. Int J Rheum Dis. 2016 Jan 22. doi: 10.1111/1756-185X.12791. [Epub ahead of print]. Gravani F, Papadaki I, Antypa E, et al. Subclinical atherosclerosis and impaired bone health in patients with primary Sjogrens syndrome: prevalence, clinical and laboratory associations. Arthritis Res Ther 2015 Apr 11;17:99. doi: 10.1186/s13075-015-0613-6. Acknowledgement We would like to thank to “Cumhuriyet University Scientific Researches Project Unit (CUBAP)” for funding this project. Disclosure of Interest None declared