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Retrospective evaluation of 22 patients with Takayasu’s arteritis

Takayasu’s arteritis (TA) is a rare, idiopathic, inflammatory, granulomatous vasculitis that affects the aorta and its primary branches. Clinical features and the pattern of arterial involvement show differences in different regions of the world according to ethnic influences. Our aim in this retrospective study was to evaluate the demographic, clinic, laboratory, and angiographic findings of 22 patients with TA followed by our clinic and also compare our results with series from the literature. The hospital files of the 22 patients followed by our clinic between 1998 and 2009 were retrospectively evaluated. We also compared our results with the series from the literature that we were able to reach by US National Library of Medicine, National Institute of Health. Gender distribution, age at diagnosis, and type of aortic involvement were similar with the study from Turkey. Different clinical manifestations of Takayasu’s arteritis have been described in different ethnic groups. We also want to underline the coincidence of TA and other rheumatic diseases such as sarcoidosis, SLE, RA, and psoriatic arthritis, different from other published series.

Serum Thrombopoietin Levels and Its Relationship With Thrombocytopenia in Patients With Cirrhosis

Background: Patients with cirrhosis usually have thrombocytopenia in discrete levels. The mechanism of thrombocytopenia is thought as splenic sequestration and destruction of platelets, impaired bone marrow generation and diminished hepatic thrombopoietin synthesis. Objectives: The aim of this study was to evaluate serum thrombopoietin levels and its relationship with thrombocytopenia at patients with cirrhosis. Patients and Methods: Ninety–two cirrhotic patients and 45 healthy controls without history or findings of pathologies that can effect thrombopoietin levels were enrolled by simple random sampling to patient and control groups of this case control study performed at Eskisehir-Turkey. Thrombopoietin was measured in serum samples with a solid phase enzyme-linked immune absorbent assay. Additionally, spleen size and volume index were determined. Results: Platelet counts were lower in patients with cirrhosis (97000 ± 8000/mm3) than in healthy subjects (240000 ± 51000/mm3, P < 0.001). Significant difference was determined for platelet counts among child A, B and C stages (Child A vs. Child B P < 0.05 Child A vs. Child C P < 0.001–Child B vs. Child C P < 0.05). Serum TPO concentration was higher (69 ± 12 pg/mL) in cirrhotic group than healthy controls (49 ± 9 pg/ml) (P < 0.05). No significant difference in TPO levels were found among the Child A, B and C stages (64 ± 11 pg/mL, 75 ± 13 pg/mL and 68 ± 10 pg/mL, respectively). Spleen size and SVI was significantly higher in the cirrhotic patients than healthy controls (148 ± 14 mm vs. 98 ± 11 mm, P < 0.001-9167 ± 287 cm2 vs. 4118 ± 123 cm2). Significant difference was determined for spleen size and spleen index among child A, B and C stages (Child A vs. Child B P < 0.05 Child A vs. Child C P < 0.001–Child B vs. Child C P < 0.05). TPO levels were significantly different between cirrhotic patients with platelet levels below 50.000/mm3 (n = 16, plt-count: 41000 ± 8300/mm3, TPO levels: 73 ± 7 pg/mL) and above 50.000/mm3 (n = 76, plt-count: 105000 ± 9500/mm3, TPO levels: 65 ± 10 pg/mL) (P < 0.01). In correlation analysis, there was a strong negative correlation between platelet count-spleen size (P < 0.001, r = -0.74) and platelet count–serum TPO levels (P < 0.001, r = -0.71). Conclusions: Our results suggest that liver cirrhosis does not cause impaired thrombopoietin production even in the late stage of disease. Thrombopoietin has no contribution for the occurrence of thrombocytopenia in cirrhosis; splenic sequestration seems to be the main factor.

Disease-modifying antirheumatic drugs increase serum adiponectin levels in patients with rheumatoid arthritis.

Background:Adiponectin is an adipocyte-derived adipokine with immunosuppressive and anti-inflammatory properties. It also decreases expression of adhesion molecules. In terms of its relationship with acute-phase reactants, there are conflicting results in patients with rheumatoid arthritis (RA). Objectives:The objectives of this study were to evaluate the levels of adiponectin in RA patients before and after the treatment with disease-modifying antirheumatic drugs (DMARDs) and to evaluate whether there is a correlation between adiponectin levels and disease activity and acute-phase-response reactants (APRRs). Methods:Serum adiponectin levels, APRRs, total and high-density lipoprotein cholesterol (HDL-C), body mass index, and body fat mass were measured in 27 patients with RA before and after the treatment with DMARDs plus prednisolone. An inclusion criterion for RA patients was to be DMARD naive for at least 6 months or to have been newly diagnosed with RA. Twenty patients with osteoarthritis were included in this study as a disease control. Results:No significant difference was found between RA and osteoarthritis group in terms of baseline adiponectin level. Mean adiponectin level and mean HDL-C level increased significantly compared with mean baseline level after the treatment with DMARDs plus prednisolone (10 [SD, 4.9] vs. 13.9 [SD, 8.7] &mgr;g/mL; P < 0.001; 56.8 [SD, 19] vs. 65 [SD, 18] mg/dL, P < 0.004, respectively). APRRs and the 28-joint-count disease activity score decreased significantly at the end of the 3 months of therapy. The adiponectin levels tended to be negatively correlated with acute-phase reactants and disease activity, although no changes were significant. There was a positive correlation between HDL-C and adiponectin levels at 3 month (r = 0.53, P < 0.001). No correlation was found between erythrocyte sedimentation rate and adiponectin levels both at baseline and at 3 months. Conclusion:Adiponectin levels can be modified by effective treatment of rheumatoid arthritis. This suggests that active inflammation may decrease serum adiponectin levels. In consideration of the antiatherogenic and anti-inflammatory features of adiponectin, increased adiponectin levels in patients with RA may result in a more favorable cardiovascular profile.

Combined thrombophilic factors increase the risk of recurrent thrombotic events in Behcet’s disease

This retrospective study aims to seek a relationship between the number of thrombotic events and presence of thrombophilic factors in Behcet’s disease (BD). Any patient with a vascular problem evaluated for at least one thrombophilic factor was deemed eligible for the present study. Upon an evaluation of their medical records, 96 (23.9%) of the 402 patients diagnosed with BD were determined to have a history of thrombosis. Of these 96 patients, 72 (75%) had only one thrombotic attack, while the remaining 24 (25%) had two or more thrombotic attacks. Thrombophilic parameters were evaluated in only 36 of the 72 patients (50%) who had one thrombotic event (Group I) and in 18 of the 24 patients (75%) who had more than one thrombotic event (Group II). The patients with recurrent thrombotic events had a significantly higher incidence of combined thrombophilias than those patients with only one thrombotic event (8/18, 44%; 4/36, 11%; p < 0.01). The number of the patients free from thrombophilic risk factors was significantly higher in Group I than in Group II (21/36, 58%; 4/18, 22%; p < 0.02). Group II had an increased frequency of combined thrombophilic risk factors (OR 6.4; 95% CI 1.5–25.8) when compared to Group I. No significant differences were found between Groups I and II with respect to clinical features of BD. In conclusion, combined thrombophilias in patients with BD may have a role in the development of recurrent thrombotic events.

The long-term effects of anti-TNF-α agents on patients with chronic viral hepatitis C and B infections

To evaluate the long‐term effects of anti‐tumor necrosis factor‐alpha (TNF‐α) therapy on patients with chronic hepatitis B and C infections.

The development of primary cutaneous adenoid cystic carcinoma in a patient with ankylosing spondylitis treated with etanercept.

The tumor necrosis factor-alpha (TNF-alpha) inhibitors are widely used in the treatment of some autoimmune disorders with promising results. However, their safety has been questioned with multiple postmarketing reports of increased risk for malignancies. The case of a patient with ankylosing spondylitis who developed cutaneous adenoid cystic carcinoma after three years of treatment with anti-TNF-alpha therapy is discussed.

Osteolysis syndrome mimicking juvenile idiopathic arthritis

Osteolysis syndromes include a group of heterogeneous disorders that can be mistakenly diagnosed as juvenile idiopathic arthritis (JIA) in early course of the disease. We report a case of 16-year-old girl who presented with severe joint deformities, subcutaneous nodules and linear skin indurations. She had been diagnosed as having JIA before and given immunosuppressive therapy. X-ray of the joints showed severe osteopenia and osteolysis of interphalangeal joints of the hands and feet. The patient was diagnosed as having Torg/nodulosis, arthropathy, osteolysis syndrome (NAO). Here, we briefly discuss osteolysis syndromes and the differential diagnosis between osteolysis syndromes and JIA.

Autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome) associated with cutaneous vasculitis

Autoerythrocyte sensitization syndrome (ASS) (Gardner-Diamond syndrome) is characterized by painful ecchymotic lesions affecting mostly women with emotional stress. Although it is widely accepted as a non-inflammatory disease, ASS can be accompanied by some autoimmune diseases. In this case report, we present a case with ASS associated with cutaneous vasculitis. We also briefly discuss the possible inflammatory features of ASS.

Do clinical findings of Behçet’s disease vary by gender?: A single-center experience from 329 patients

OBJECTIVE Behçets disease (BD) is a systemic vasculitis with a significantly varying clinical course following relapses and remissions, which may involve a number of organs such as the skin, joints, lungs, and blood vessels as well as systems such as the central nervous system and gastrointestinal system. Its prognosis is known to be worse in males. There are several studies in the literature on the clinical features and gender distribution of BD. The aim of the present study was to determine the clinical characteristics of BD and the presence of a relation with gender and to investigate the correlation of our results with the current literature. MATERIAL AND METHODS We retrospectively reviewed 329 patient files. The demographic features of the patients, their symptoms and findings of BD, the results of pathergy tests, the presence of any individuals in the family with BD, and HLA-B51 antigen positivity were recorded. RESULTS The most frequent findings were oral aphtous ulcers (100%), genital ulcers (84%), papulopustular lesions (69.9%), and joint involvement (57.4%). Vascular involvement and ocular involvement were significantly higher in males, whereas joint involvement and headache were more common in females (p<0.001, p=0.014, p<0.001, and p<0.001, respectively). Contrary to the literature, we found that the disease had an earlier onset in individuals with a positive familial history of an oral aphthous ulcer or BD (p=0.03 and p=0.02, respectively) and that joint involvement was more common in patients with erythema nodosum (p=0.02). CONCLUSION The clinical features of BD may vary between the genders. Variations exist in the results depending on the population size, the department where the study was conducted, the patient inclusion criteria, and the region where the patients live.

Urolithiasis as an extraarticular manifestation of ankylosing spondylitis

Ankylosing spondylitis (AS) affects sacroiliac and axial joints as well as extraarticular organs, such as the eye, lung, bowel, and heart. Although examples of renal involvement in AS, such as IgA nephropathy, amyloidosis, and glomerulonephritis, have been reported, it has not been emphasized that urolithiasis is frequently formed in the clinical course of AS. Growing evidence indicates that urolithiasis may be observed in AS patients and is more frequent than other extraarticular features. In this review, we will discuss frequency and predictors of AS-related urolithiasis and summarize the possible underlying genetic and biochemical mechanisms. We believe an increased awareness of urolithiasis as a complication of AS will encourage future studies that will shed light on disease mechanisms and preventative therapies.