Gamze Kilic

Efficacy and Safety of Biologic Treatments in Familial Mediterranean Fever

Objective:Colchicine is the mainstay treatment for Familial Mediterranean Fever (FMF). However 5% to 10% of the patients with FMF are unresponsive or intolerant to colchicine. Biologics are efficient in many rheumatic diseases, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, cryopyrin-associated periodic syndromes. We performed a systematic review to analyze patients with FMF, including juvenile patients who received treatment with biologics. Methods:A MEDLINE search, including articles published in English language between 1990 and May 2012, was performed. Patients who had Mediterranean fever variants but could not be classified as FMF according to Tel-Hashomer criteria were excluded. Results:There is no controlled trial on the efficacy and safety of biologics in FMF. Fifty-nine (32 female and 27 male) patients with FMF who had been treated with biologics (infliximab, etanercept, adalimumab, anakinra, and canakinumab) were reported in 24 single reports and 7 case series. There were 16 children and 43 adults (7- to 68-year olds). Five patients were reported to have colchicine intolerance or had adverse events related to colchicine use, and the rest 54 were unresponsive to colchicine treatment. Conclusions:The current data are limited to case reports, and it is difficult to obtain a quantitative evaluation of response to biologic treatments. However, on the basis of reported cases, biologic agents seem to be an alternative treatment for patients with FMF who are unresponsive or intolerant to colchicine therapy and seem to be safe. Controlled studies are needed to better evaluate the safety and efficacy of biologics in the treatment of patients with FMF.

Determination of electromagnetic shielding performance of hybrid yarn knitted fabrics with anechoic chamber method

The electromagnetic shielding effectiveness (SE) of various weft-knitted fabrics made of hybrid yarns is investigated by considering the anisotropy of the structures, which has not been analyzed in previous studies. The anechoic chamber with aperture method at different polarizations of electromagnetic waves within the frequency range of 30 MHz and 9.93 GHz is used to determine the SE of knitted fabrics manufactured on a circular weft knitting machine from siro-spun and siro core-spun yarns without and with a metal core. The results show that SE depends on the orientation of the fibers within the structure regarding the direction of the electrical field in addition to parameters such as metal content, loop length and frequency; these results can be used to outline the basic points in determining a knit structure with desired SE.

Comparison of ASDAS and BASDAI as a measure of disease activity in axial psoriatic arthritis

The aim of this study was to compare the discriminative ability of Ankylosing Spondylitis Disease Activity Score (ASDAS) with Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) and other clinical disease activity parameters in patients with axial psoriatic arthritis (axPsA). Patients with axPsA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and Anatolian Group for the Assessment in Rheumatic Disease (ANGARD) cohort and were assessed for BASDAI, ASDAS, BASFI (Bath Ankylosing Spondylitis Functional Index), Ankylosing Spondylitis Quality of Life (ASQoL), and visual analog scale (VAS) pain. The discriminant ability of ASDAS-C-reactive protein (−CRP) and ASDAS-erythrocyte sedimentation rate (−ESR) was assessed using standardized mean differences between patients with high and low disease activity. Fifty-four patients with axPsA were included in the study. Both ASDAS scores showed good discriminative ability between high and low disease activity states. Both ASDAS versions and BASDAI had relatively high area under the curve (AUC) according to ASAS partial remission, patient and physician global assessments in receiver operating characteristic (ROC) curve analysis. There was no significant difference between AUC scores for the models that compared ASDAS-CRP and ASDAS-ESR with BASDAI for each individual definition of disease activity states. ASDAS versions and BASDAI showed good similar discriminative ability between high and low disease activity as reflected by the AUC analysis in axPsA. The cutoff values for inactive disease and high disease activity were relatively similar to predefined cutoff values for AS. Further, prospective validation is now required to identify the appropriate assessment tools and cutoff values in axPsA.

Relationship Between Psychiatric Status, Self-Reported Outcome Measures, and Clinical Parameters in Axial Spondyloarthritis

AbstractThis article aims to compare the risks of depression and anxiety in patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA) and investigate the relationship among self-reported outcome measures, clinical parameters, and physical variables of patients with axSpA.Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort. The patients met Assessment of Spondyloarthritis International Society classification criteria for axial SpA and were assessed in a cross-sectional study design for visual analog scale (VAS) pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life questionnaire (ASQoL), and Ankylosing Spondylitis Disease Activity Score–C-reactive protein (ASDAS-CRP). Psychological status was evaluated using the hospital anxiety and depression scale (HADS). Multivariate logistic regression analysis was applied to determine the associations between psychological variables and clinical parameters after adjusting for confounding variables.Of the 316 patients (142 nr-axSpA, 174 AS), 139 (44%) had high risk for depression (HADS-D score ≥7) and 71 (22.5%) for anxiety (HADS-A score ≥10). HADS-D and HADS-A scores were similar between patients with AS and nr-axSpA. Patients with high risk for depression and anxiety had higher scores in BASDAI, BASFI, and ASDAS-CRP, and also poorer scores in VAS pain and ASQoL. Multivariate logistic regression analysis showed that the ASDAS-CRP, ASQoL, BASDAI, as well as educational level were factors associated with the risk of depression whereas the ASQoL and educational level were factors associated with the risk of anxiety.Patients with nr-axSpA and AS have similar burden of psychological distress. The quality of life (ASQoL) and educational level were factors associated with the risk of both depression and anxiety whereas disease activity (BASDAI and ASDAS-CRP) was the independent risk factor associated with depression but not anxiety in axSpA. These findings suggest that psychological status should be examined while assessing patients with axSpA including AS and nr-axSpA.

Discriminant validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with non-radiographic axial spondyloarthritis and ankylosing spondylitis: a cohort study

The aim of this study was to assess discriminant validity of Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein (-CRP) and ASDAS-erythrocyte sedimentation rate (-ESR) and to compare with The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) as clinical tools for the measurement of disease activity in patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Also, the cut-off values for ASDAS-CRP in nr-axSpA and AS is revisited. Patients with axSpA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and were assessed for disease activity, quality of life and functional measures. The discriminatory ability of ASDAS-CRP and ASDAS-ESR was assessed using standardized mean differences and receiver operating characteristic (ROC) curves analysis. Optimal cut-off values for disease activity scores were calculated. Two hundred and eighty-seven patients with axSpA (nr-axSpA:132, AS:155) were included in this study. Two ASDAS versions and BASDAI had good correlations with patient’s and physician’s global assessment in both groups. Discriminatory ability of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in patients with nr-axSpA and AS when the patients were assigned into low and high disease activity according to the ASAS partial remission, patient’s and physician’s global assessment scores (based on the comparison of ROC curves). ASDAS cut-off values are quite similar between groups indicating that ASDAS-CRP works similarly well in nr-axSpA and AS. The performance of ASDAS to discriminate low and high disease activity and cut-off values are quite similar in patients with AS and non-radiographic axial SpA.

Ultrasonographic assessment of diurnal variation in the femoral condylar cartilage thickness in healthy young adults.

Objective In vivo measurement of articular cartilage thickness is a significant marker of structural joint damage in many inflammatory or noninflammatory diseases including rheumatoid arthritis or osteoarthritis. The aim of this study was to assess the diurnal variation of femoral condylar cartilage thickness (FCT) in young adults by using ultrasonography. Design The thickness of femoral articular cartilage was measured in healthy volunteers at 8:00–9:00 a.m. and 4:00–5:00 p.m. on the same day using standard sonographic methods. Three midpoint measurements were taken from each knee at the lateral femoral condyle, femoral intercondylar area, and medial femoral condyle. Results The FCT significantly decreased in all the areas assessed. The maximal decrease (in millimeters) in the mean (standard deviation) FCT was in the right lateral femoral condyle (0.21 [0.24]) and left medial femoral condyle (0.21 [0.21]) followed by the right medial femoral condyle (0.19 [0.23]), left lateral femoral condyle (0.19 [0.19]), left femoral intercondylar area (0.13 [0.30]), and right femoral intercondylar area (0.11 [0.33]). The mean diurnal change in FCT from a.m. to p.m. reached up to 10.6%. Conclusions This study suggests that the FCT significantly decreased in all of the measured areas from a.m. to p.m. Future studies, particularly those assessing the effect of any pharmacologic or nonpharmacologic applications on cartilage thickness in the weight-bearing joints, should be designed bearing in mind that cartilage thickness has diurnal variations. Assessment of diurnal variation in cartilage thickness in elderly osteoarthritic or nonosteoarthritic populations warrants further research.

Increased risk for bone loss in women with systemic sclerosis: a comparative study with rheumatoid arthritis

To assess bone mass in women with systemic sclerosis (SSc) in comparison to age and sex‐matched patients with rheumatoid arthritis (RA), and to evaluate factors influencing bone mineral density (BMD).

Decreased femoral cartilage thickness in patients with systemic sclerosis.

Background:Systemic sclerosis (SSc), or scleroderma, is a severe connective tissue disease. Although musculoskeletal involvement is frequent and causes significant functional disability in patients with SSc, articular cartilage thickness has not been previously investigated. The aim of this study was to compare the femoral cartilage thickness (FCT) in patients with SSc with that of controls who were matched for age, body mass index and osteoarthritis prevalence. Methods:The thickness of femoral articular cartilage was measured by ultrasonography in patients and controls. Three midpoint measurements were taken from each knee: lateral femoral condyle (LFC), femoral intercondylar area and medial femoral condyle (MFC). Results:Forty female patients with SSc and 85 female controls were included. In patients with SSc, 18 (45.0%) had diffuse SSc, 18 (45.0%) had limited SSc, 1 (2.5%) had overlap (polymyositis) and 3 (7.5%) had SSc sine scleroderma. The mean FCT measurements of patients with SSc at MFC of the right and left knees (1.86 and 1.84 mm, respectively) and LFC of the left knee (1.93 mm) were statistically lower than in the controls (right and left MFC, 2.23 and 2.25 mm, respectively, P < 0.0001, and left LFC 2.15 mm, P = 0.026). Conclusions:Patients with SSc had thinner femoral cartilage compared with controls. The underlying possible mechanisms of thin FCT may be multifactorial, and there may be many influencing factors like immune activation, vasculopathy, oxidative stress and synovial fibrosis or markers of cartilage degradation. The possible factors influencing the change in cartilage thickness or metabolism in patients with SSc require further research.

Gender specific differences in patients with psoriatic arthritis

Abstract Objectives: To assess gender related differences in a cohort of patients with psoriatic arthritis (PsA). Methods: Consecutively recruited patients were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms. Results: Women (n = 115) with PsA had higher symptom duration and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), Erythrocyte sedimentation rate (ESR) and poorer physical activity and fatigue than men (n = 72) with PsA. Psoriasis area and severity index (PASI) were higher in male patients. However quality of life (SF36 physical and mental component scores), articular pattern, extra-articular features (including uveitis, iritis) and family history for psoriasis, spondyloarthritis (SpA) (PsA and ankylosing spondylitis [AS]) were quite similar between men and women. Conclusions: Some of the clinical and laboratory variables tend to be different between men and women with PsA. The extent of quality of life and articular pattern seem to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations.

A patient with ankylosing spondylitis who developed infliximab-induced lupus and treated with etanercept

We read the paper by Diaz et al. [1] which reported patients with rheumatoid arthritis (RA) who developed druginduced lupus erythematosus (DILE) who were treated with rituximab. Although treatment recommendations for DILE are not currently available, patients with RA may have different drug options like rituximab which is also approved for the treatment of RA. However, in patients with ankylosing spondylitis (AS), options for the treatment of DILE are highly restricted since biologics other than anti-TNF agents (i.e., rituximab) have no proven efficacy [2, 3]. The challenge is the treatment of patients with AS who developed DILE while on the treatment of anti-TNF drugs; patients may inevitably exacerbate when TNF blockers stopped for the reversal of DILE symptoms and to continue non-steroid anti-inflammatory drugs (NSAIDs) alone may not be sufficient for the management. Anti-TNF drugs are effective therapies for AS in terms of signs, symptoms, and functioning [4]. Since the emergence and widespread usage of TNF inhibitors for the treatment of rheumatic diseases including AS, there have been case reports of DILE and ‘lupus-like’ syndromes associated with the use of TNF inhibitors [5]. Although there is no approved classification or diagnostic criteria for DILE, following criteria are widely used: (1) Treatment with a suspected drug of at least 1 month duration, (2) Symptoms like arthralgia, myalgia, fever or organ involvement like serositis or rashes, (3) Anti-nuclear antibodies (ANA) or anti-histone positivity in the absence of other antibody specificities (4) Improvement of symptoms within days/weeks of the drug discontinuation [6]. Herein, we report our experience in a patient with AS who developed DILE while under treatment with infliximab (INF) but did not recur after switching to etanercept (ETN).