Fatma Alibaz Öner

Evaluation of the effect of L-thyroxin therapy on endothelial functions in patients with subclinical hypothyroidism

Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (FT4), free T3 (FT3) levels and increased serum thyroid-stimulating hormone (TSH) levels. Endothelial dysfunction, which is an early step of atherosclerosis, has been reported in patients with subclinical hypothyroidism. The aim of this study is to evaluate endothelial functions and the effect of l-thyroxin (L-T4) therapy on endothelial functions in SH. Twenty-seven patients with SH and 22 healthy controls were evaluated in terms of endothelial functions, using brachial artery Doppler ultrasonography. After restorating euthyroidism, measurements were repeated. Baseline and nitroglycerin induced diameter (NID) of brachial artery were similar in patients with SH and the control group. Compared to the control group, the patients with SH showed significantly reduced flow-mediated diameter (FMD). Baseline and NID values were significantly higher after LT4 therapy in SH group. FMD also significantly increased after LT4 therapy. Hypothyroidism accelerates atherogenesis through modification of athero-sclerotic risk factors and direct effects on the blood vessels. In this study, we observed marked improvement in endothelial functions after L-T4 therapy in SH patients. We suggest that thyroid hormone replacement therapy may help to prevent atherosclerosis in this group of patients.

Diagnostic dilemma of paraneoplastic arthritis: case series.

Paraneoplastic arthritis (PA) may mimic rheumatic diseases. While presenting the demographic and laboratory features of the patients diagnosed with PA, this study also aims to provide possible appropriate tools to differentiate the PA cases from early rheumatoid arthritis (ERA).

Vascular endothelial function assessed by a noninvasive ultrasound method and serum asymmetric dimethylarginine concentrations in mild-to-moderate plaque-type psoriatic patients

OBJECTIVES Our aim was to evaluate vascular endothelial function assessed by serum asymmetric dimethylarginine (ADMA) concentrations and noninvasive ultrasonographic parameters such as flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) in mild-to-moderate plaque-type psoriatic patients, as rated by the Psoriasis Area and Severity Index. DESIGN AND METHODS Plaque-type psoriatic patients (n = 29) diagnosed with clinical and/or histopathological findings and control subjects (n = 25) without skin and systemic metabolic diseases were included in the study. RESULTS There was no statistically significant difference between patients and control subjects in respect to FMD (p = 0.441), NID (p = 0.557), or serum ADMA concentrations (p = 0.225). Also, among the acute-phase reactants, serum C-reactive protein and plasma fibrinogen levels were moderately higher in patients when compared to control subjects (p = 0.008 and p = 0.011, respectively). CONCLUSIONS Mild-to-moderate plaque-type psoriatic patients with low-to-medium grade systemic inflammation did not have evidence of vascular endothelial function.

Evaluation of the eff ect of L-thyroxin therapy on cardiac functions by using novel tissue Doppler-derived indices in patients with subclinical hypothyroidism

Objectives Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (fT4), free T3 (fT3) levels and increased serum thyroid stimulating hormone (TSH) levels. The aim of this study was to assess the validity of tissue Doppler imaging (TDI) in evaluating cardiac eff ects of SH and to demonstrate the improving eff ects of L-thyroxin(L-T4) on TDI parameters. Methods Twenty-seven patients with SH and 22 healthy controls were evaluated by standard echocardiography and TDI. TDI-derived systolic velocities [isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa)] and diastolic indices (peak early (Ea) and late diastolic (Aa) velocities, Ea/Aa, E/Ea ratios and Tei index) were measured. After restoring euthyroidism, all measurements were repeated. Results At baseline, left ventricular (LV) systolic velocities (IVV and IVA) and diastolic indices were signifi cantly impaired in the SH group. After L-T4 therapy, left ventricular systolic and diastolic functions were improved. Right ventricular (RV) systolic velocities were similar between the study group and the healthy controls but diastolic functions were impaired in the SH group, at baseline. Tei index of the RV was improved after L-T4 therapy. RV IVA remained unchanged after hormone replacement therapy. Conclusions SH is associated with biventricular systolic and diastolic dysfunction. IVA which is an accurate estimate of subclinical systolic dysfunction, was signifi cantly impaired in the left ventricle and had improved after L-T4 therapy. We found that IVA is able to detect early eff ects of subclinical hypothyroidism on LV systolic functions and L-T4 therapy can improve ventricular functions.

A Nationwide Experience With The Off‐label Use of Interleukin‐1 Targeting Treatment in Familial Mediterranean Fever Patients

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.

The assessment of work productivity and activity impairment in Behçet’s disease

BACKGROUND/AIM The aim of this study was to assess the relationships between the course of Behçets disease (BD), disease-specific fears, and work productivity and activity impairment. MATERIALS AND METHODS In this cross-sectional study, 110 consecutive BD patients were included. The Work Productivity and Activity Impairment questionnaire was used. RESULTS In the group of employed patients, 30.41% had missed work during the previous week. The mean percentages of daily activity impairment were higher in patients with musculoskeletal involvement (39.81 ± 33.61%) compared to those without (23.48 ± 32.45%) (P = 0.008). A greater decrease in working hours was observed in patients with eye involvement (45.52 ± 15.29 h) compared to those without (54.15 ± 15.29 h) (P = 0.007). More of the male patients (67.8%) were afraid of losing their jobs compared to females (30%) (P = 0.000). CONCLUSION The highest levels of lost productivity and the most severe effects on daily life are consequences of eye and musculoskeletal involvement in the study population. More effective therapeutic approaches are required to improve the working lives of patients with BD. Moreover, male patients had a higher fear of losing their jobs, suggesting a match between the expected clinical course and the predictions of BD patients.

Impaired cardiac and vascular motion in patients with Takayasu’s arteritis: A velocity vector imaging-based study

Objective Takayasus arteritis (TAK) is a chronic inflammatory vasculitis of the aorta and its major branches. In the present study, we aimed to evaluate the motion of the vascular wall and myocardial contractility by using a novel strain imaging method, velocity vector imaging (VVI), in patients with TAK. We also aimed to compare them with another inflammatory autoimmune disorder, systemic lupus erythematosus (SLE). Methods We studied 33 patients with TAK, 18 patients with SLE, and 20 age- and sex-matched controls. All participants were subjected to carotid artery Doppler ultrasonography and transthoracic echocardiographic evaluation. VVI analysis was also performed to assess subclinical left ventricular (LV) systolic dysfunction and to determine tissue motion of the common carotid arteries (CCAs). Results Aortic strain and distensibility were significantly impaired in patients with TAK, while the aortic stiffness and carotid artery stiffness indexes were increased. Aortic distensibility was the only parameter that was decreased among SLE patients. The values of CCA peak longitudinal strain, strain rate, and total longitudinal displacement (TLD) were also impaired in patients with TAK. Peak radial velocity was decreased while time-to-peak radial velocity was increased. In the SLE group, peak longitudinal strain, strain rate, TLD, and peak radial velocity were impaired. LV longitudinal peak systolic strain and strain rate were reduced in patients with TAK. Similarly, we revealed impaired subclinical LV systolic function in patients with SLE. Conclusion VVI is a novel strain imaging technique with additional value to determine early impairment in vascular and myocardial wall motion in patients with TAK.

AB0152 The rs11792633-t allele of il-33 gene is associated with systemic sclerosis

Background Systemic sclerosis (SSc) is a chronic inflammatory disease characterized by widespread fibrosis of the skin and several visceral organs. Its pathogenesis is not fully known. However, T lymphocytes actives fibroblasts directly via CD154/CD40 ligand or indirectly via pro-fibrotic cytokines including interleukin (IL)-4, IL-6 and transforming growth factor (TGF)-β. Therefore, extracellular matrix components such as collagen and fibronectin are produced by active fibroblasts. The pro-fibrotic potential of IL-33 has been demonstrated by in both in vitro and in vivo settings; moreover, increased level of IL-33 has also been reported in patients with SSc. Objectives The aim of the present study was to detect the potential association of IL-33 gene polymorphisms on the susceptibility of SSc. Methods 300 SSc patients and 280 healthy controls (HC) from 6 different regions of Turkey were enrolled in this multicentric preliminary candidate gene study. DNA samples were harvested using an appropriate commercial DNA isolation kit. Four single nucleotide polymorphisms (SNPs) of IL-33 gene (rs7044343, rs1157505, rs11792633 and rs1929992) were genotyped using the appropriate commercial primer/probe sets on real-timePCR. Statistical analysis was performed by Chi-square test, and odds ratio (OR) and 95% confidence interval (CI) were determined for alleles. The Tukey-Kramer’s method for multiple testing was used and P values less than 0.0125 were considered as significant. Results There was no significant difference in terms of the genotypic distributions of evaluated four IL-33 polymorphisms between the SSc and HC groups (p>0.05 for all). Moreover, allelic distributions and MAF of rs7044343, rs1157505, and rs1929992 polymorphism were not significantly different (p>0.05 for all). However, the frequency of rs11792633-T allele was significantly higher in the SSc group compared to the HC group (0.0001, OR: 1.5, % 95 CI: 1.2-1.8). Conclusions This preliminary candidate gene study demonstrates thatrs11792633-T allele of IL-33 gene is associated with the susceptibility to the SSc in Turkish population. It may be suggested that IL-33 gene may be a candidate gene to research in SSc. References Schmitz J, et al. Immunity. 2005;23:479-90. Rankin AL, et al. J Immunol. 2010;184(3):1526-35. Manetti M, et al. Ann Rheum Dis. 2011;70(10):1876-8. Yanaba K, et al. Clin Rheumatol. 2011;30(6):825-30. Terras S, et al. Ann Rheum Dis. 2013;72(1):144-5. Acknowledgements none Disclosure of Interest None Declared