Berivan Bitik

The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

Elevated neutrophil count is associated with poor prognosis and increased mortality in many conditions. Neutrophil to lymphocyte ratio (NLR) has emerged as a marker of inflammation in neoplastic and cardiovascular disorders. Herein, we investigated utility of this simple tool in rheumatoid arthritis (RA) and ankylosing spondylitis (AS).

Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis.

ObjectiveReal-time sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on tissue elasticity and stiffness. We determined the efficacy of SE for assessing Achilles tendon abnormalities in patients with ankylosing spondylitis (AS).Materials and methodsForty-one consecutive AS patients and 32 asymptomatic healthy subjects were enrolled. Achillodynia was scored on a 0- to 100-mm visual analog scale. A high-resolution ultrasound machine equipped with an elastography-compatible linear probe was used to perform bilateral B-mode ultrasound, Doppler ultrasound, and SE examinations of Achilles tendons. Tendons were divided into proximal, middle, and distal segments. B-mode examinations included tendon thicknesses, echotextures, and enthesopathic findings. SE using color-coded images was performed in the same areas. Normal consistent tendon structures were coded as blue or green, and moderately (yellow) or severely (red) softened areas were considered pathological.ResultsThe distal third of the Achilles tendons was the most commonly affected part in the AS patients compared with healthy subjects (p = 0.001), whose middle third was more commonly affected. Achillodynia intensity tended to be higher in patients with pathological B-mode or SE examination findings (p = 0.09 and p = 0.07 respectively). Softening detected by SE in the distal third was associated with enthesopathy findings such as calcaneal bone erosions (Fisher’s X2, p = 0.07) and tendinous enlargement (Fisher’s X2, p = 0.001). B-mode and SE findings had moderate to good correlation in the assessment of Achilles tendon abnormalities.ConclusionsSonoelastography may be useful for the evaluation of tendon abnormalities in patients with AS; in addition; it may be useful for the evaluation of other inflammatory rheumatic conditions.

Rapid resolution of protracted febrile myalgia syndrome with anakinra: Report of two cases

Protracted febrile myalgia syndrome (PFMS) is a very rare but severe manifestation of familial Mediterranean fever (FMF) which is characterized by severe debilitating pain in large muscle groups that may last for several weeks. Colchicine is ineffective and treatment is largely supportive. Demonstration of crucial role of interleukin-1 (IL-1) in the pathogenesis of FMF has increased the use of IL-1 blockers in colchicine resistant or intolerant patients. Herein, we reported successful use of an IL-1 inhibitor, anakinra, in treatment of two patients with PFMS.

Minimally invasive minor salivary gland biopsy for the diagnosis of amyloidosis in a rheumatology clinic.

Background. Systemic amyloidosis is a potentially fatal condition, unless diagnosed and treated before development of irreversible organ damage. Demonstration of amyloid deposits within tissue biopsies is only definitive diagnostic method, which makes appropriate selection of biopsy site essential. Herein, we evaluated efficacy of minimally invasive minor salivary gland biopsy (MSGB) for the diagnosis of amyloidosis. Methods. We analyzed 37 biopsies taken from 35 patients. Suggestive findings for amyloidosis were significant proteinuria, renal impairment, refractory diarrhea, neuropathy, and restrictive cardiomyopathy. Minor salivary gland was the initial biopsy site in all subjects. When MSGB was negative but there was a high suspicion for amyloidosis, a kidney, duodenum, or rectal biopsy was performed for further investigation. Results. Mean age of patients was 45.4 and 21 were female. In 11 patients amyloidosis was diagnosed with MSGB. In overall 18 patients were diagnosed with amyloidosis. Sixteen of them were identified as being of AA type and two were AL type amyloidosis. The sensitivity of minimally invasive MSGB is 61.1% for diagnosing amyloidosis in this study. Conclusion. MSGB is a safe and simple method for the diagnosis of amyloidosis which can be performed in an outpatient setting. We suggest extensive use of this minimally invasive method.

An Unusual Case of Madelung's Disease with Multiple Atypical Fractures

Madelungs disease is a rare acquired disorder of fat metabolism characterized by multiple symmetric lipomas with typical distribution mainly around the upper trunk, neck, and shoulders. The condition is strongly associated with chronic alcohol use and has various systemic manifestations like polyneuropathy, muscle weakness, and small bone fractures. Herein, we report a 56-year-old male patient with Madelungs disease and multiple fractures and discuss possible underlying factors leading to multiple fractures.

Serum ferritin as an activity marker for granulamotosis with polyangiitis

Abstract Background: Serum ferritin correlates well with the activities of systemic lupus erythematosus (SLE) and dermatomyositis, but it has not been previously studied in patients with vasculitis. Methods: Medical records of granulomatosis with polyangiitis (GPA, Wegener’s granulomatosis) patients with at least six months of regular follow-up were evaluated. The activity of GPA was assessed with Birmingham Vasculitis Activity Score for Wegener’s Granulomatosis (BVAS/WG). Serum ferritin and other acute phase markers were measured at initial presentation. Results: Serum ferritin levels were found to be the highest in GPA patients with alveolar hemorrhage, median (IQR) 1041 (1281) μg/L. Patients with renal disease also had high levels of ferritin and it was correlated with concurrent glomerular filtration rate (r = −0.65, p < .001). Serum ferritin is also correlated well with the BVAS/WG scores (r = 0.79, p < .001). Conclusions: Measurement of serum ferritin might help in assessing disease activity of GPA.

Primary Sjögren's syndrome is associated with significant cognitive dysfunction.

Cognitive dysfunction is a neurologic manifestation in primary Sjögren syndrome (PSS). On the other hand, several antibodies are related to cognitive dysfunction. The aim of this study is to assess the cognitive dysfunction of PSS patients via detailed neurologic tests. Moreover, its associations with antibodies were also evaluated.

Magnetic resonance imaging features of Familial Mediterranean Fever associated spondyloarthritis

Methods Twenty-nine patients followed up in our clinic with FMF-SPA who fulfilled ASAS classification criteria for axial spondyloarthritis. To figure out only characteristics of FMF-SPA, we excluded those patients with psoriasis, Crohn disease/ulcerative colitis or positive HLA-B27 tests. Patient demographics, clinical features and MEFV mutation analyzes were recorded. All patients underwent sacroiliac and spinal contrast enhanced MR examination. T1, T2 weighted images (WI), STIR sequence and post-contrast fat saturated T1 WI were used to define MRI features.

Underlying causes of persistently elevated acute phase reactants in patiens with Familial Mediterranean Fever

Background Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are most commonly employed acute phase reactants in follow up of patients with Familial Mediterranean Fever (FMF). As a rule CRP increases during FMF attacks but it returns to normal values in attack free periods. Persistently elevated acute phase reactants in attack free periods can be occasionally observed in patients with FMF and is suggested to be a risk for the development of amyloidosis. Some authors suggested the use of IL-1 antagonists in such patients to prevent from amyloidosis. However there is no data regarding causes of elevated acute phase reactants in patients with FMF.

Serum Vitamin B12, Homocysteine and Methylmalonic Acid Levels in Patients With Parenchymal Neuro-Behçet’s Syndrome

Objectives This study aims to investigate the role of serum levels of vitamin B12 (VitB12), homocysteine (Hcy), and methylmalonic acid (MMA) in the development of parenchymal neuro-Behçets syndrome (NBS) and to compare them with healthy controls and Behçets syndrome (BS) patients without NBS. Patients and methods Serum VitB12, Hcy, and MMA were measured using enzyme-linked immunosorbent assay in 64 patients (36 males, 28 females; mean age 36±8.3 years; range 20 to 56 years) who met the criteria of the International Study Group for Behçets Disease and 30 matched healthy controls (17 males, 13 females; mean age 35.76±9.6 years; range 20 to 50 years). The study participants were grouped as BS patients with NBS, BS patients without NBS, and healthy controls. Results There was no significant difference between the groups regarding serum VitB12, Hcy, and MMA levels (p>0.05). Serum VitB12 levels were below the lower limit and serum Hcy levels were above the upper limit in all participants. MMA levels were normal in all participants. There was no correlation between the serum levels of VitB12, Hcy, and MMA and disease activity (p>0.05). Conclusion The results of this study suggest that there is no significant association between VitB12 deficiency and parenchymal NBS. Further studies are needed to investigate the underlying mechanisms of the variable effects of VitB12 deficiency on different clinical manifestations of BS.