Kemal Nas

Levels of serum pentraxin 3, IL-6, fetuin A and insulin in patients with rheumatoid arthritis

OBJECTIVEnThe aim of this study was to investigate the relationship between disease severity and biochemical parameters such as pentraxin-3, fetuin-A, IL-6, insulin and HOMA-IR levels in patients with rheumatoid arthritis.nnnMETHODSnThis study included 60 patients with RA and 20 healthy controls. Serum pentraxin-3, fetuin-A, IL-6 and insulin concentrations were measured. Also, HOMA-IR values were calculated. Disease activity was assessed with Disease Activity Score (DAS28). To evaluate quality of life, the Health Assessment Questionnaire disability index was applied.nnnRESULTSnThe serum values for ESR, CRP, pentraxin-3 and fetuin-A in patients with RA were found to be higher than control subjects (p values=0.001, 0.001, 0.000, 0.000, 0.01, 0.02, respectively). A positive correlation was evident between the DAS 28 score and IL6 levels (r=0.263, p=0.045). We found no correlation between the DAS28 score and HOMA-IR, the levels of pentraxin 3, fetuin A, insulin (p<0.05). Fetuin A levels were positively correlated with cumulative steroid dose (r=0.382, p=0.035). A statistically significant correlation was evident between presence of cardiovascular disease and HOMA-IR values in RA patients (r=0.437, p=0.032).nnnCONCLUSIONnElevated levels of pentraxin-3, fetuin-A, CRP, ESR might play a role in the pathogenesis of RA. Levels of fetuin-A, insulin HOMA-IR, pentraxin-3, CRP and ESR were not associated with clinical severity of the RA.

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 (nu2009=u2009115) 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 (nu2009=u200972) 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.

Psychological health of caregivers and association with functional status of stroke patients

Abstract Objective: Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients. Methods: This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey. Results: The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores. Conclusion: Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.

Comorbidities in patients with psoriatic arthritis: a comparison with rheumatoid arthritis and psoriasis

Psoriatic arthritis (PsA) is a chronic, inflammatory disease. The purpose of this study was to examine the association between PsA and comorbid conditions. This is the first study to investigate comorbid diseases in PsA in Turkey.

Comparison of fetuin-A and transforming growth factor beta 1 levels in patients with spondyloarthropathies and rheumatoid arthritis.

We investigated the serum transforming growth factor beta 1 (TGFβ1) and fetuin‐A levels, and determined the relationships between these biomarkers and disease activity, mobility and radiologic progression in patients with spondyloarthropathy (SpA) and rheumatoid arthritis (RA).

Nailfold videocapillaroscopy results in patients with rheumatoid arthritis

We aimed to analyse the nailfold capillaryscopy findings morphologically and examine their relationship with disease activity and demographic characteristics in patients with rheumatoid arthritis. In accordance with the 2010 ACR/EULAR classification criteria, 201 patients diagnosed with Romatoiad artrit (RA) and 50 healthy controls were included. We analysed capillaroscopic abnormalities such asmegacapillaries, haemorrhages, ramifications and avascular areas in patients affected with rheumatoid arthritis. The findings in our study are as follows: in 45.77% of the RA patients, there were nonspecific capillaryscopy findings. When compared to control group, the incidence of tortuosity, dilated capillary and bushy capillary was higher in RA patients (p values, respectively, 0.110, 0.330, 0.440 and 0.516). In RA patients with Raynaud’s phenomenon, the incidence of nonspecific capillaryscopy findings was higher. While there is a weak relationship between tortuosity and the duration of disease, no significant relation was detected between capillaryscopy findings and parameters such as RF, anti-CCP positivity and disease activity score (DAS28). When compared to controls, we have detected that RA patients have more nonspecific capillaryscopic findings. We could not find a relationship between nonspecific capillaryscopic findings and RA’a clinical findings and laboratory parameters. There is a need for a long-term wider-scale follow-up study to investigate whether there is a capillaryscopic pattern that can be correlated with RA’s clinical findings.

Central nervous system involvement in rheumatoid arthritis: possible role of chronic inflammation and tnf blocker therapy

Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, which causes activation of proinflammatory pathways that bring about joint and systemic inflammation. Although peripheral nervous system anomalies are observed widely in RA, very few case reports on changes in the central nervous system (CNS) have been published. In recent years, the pathophysiology of CNS involvement that can occur in RA has attracted a great deal of attention. Emphasis has focused on the possibility that CNS involvement occurs due to blood–brain barrier (BBB) damage associated with chronic inflammation. The present study was performed to investigate the possible effects of BBB dysfunction and tumor necrosis factor (TNF) blocker therapy on BBB function, which may cause CNS damage in patients with RA. 58 RA patients [47 (81.0%) females, 11 (19.0%) males] and 34 healthy controls [24 (70.6%) females, 10 (29.4%) males] were included in the study. All RA patients were on synthetic DMARD therapy at the beginning. Thirty patients continued DMARD therapy, and 28 patients with high disease activity were started on TNF blocker therapy. All demographic characteristics of the patients were recorded. Disease activity was evaluated using the Disease Activity Score 28-joint count C reactive protein. The Mini-Mental State Examination was used to evaluate cognitive function, and the Fazekas scale was used to assess cranial lesions visualized by magnetic resonance imaging (MRI). Patients’ peripheral blood S100β, glial fibrillary acidic protein (GFAP), claudin, interleukin (IL)-17, and IL-1β levels were measured at the beginning of the study and after 6xa0months. Demographic characteristics (including sex, age, and body mass index) were similar in the RA and control groups. S100β and GFAP levels were significantly higher in the patient group than in the control group. In the group that was started on TNF blocker therapy, S100β and GFAP levels were significantly decreased 6xa0months after commencement of treatment. No difference was observed between the RA and control groups in terms of hyperintense lesions seen on cranial MRI. The S100β levels increased with lesions in the deep white matter seen on cranial MRI in patients with RA. In conclusion, next to decreasing disease activity and joint erosions by suppressing inflammation, anti-TNF therapy in RA can also suppress potential CNS involvement linked to BBB (blood–brain barrier) dysfunction. Further studies with broader participation and longer patient follow-up are needed to reinforce this hypothesis.

Noncontiguous multiple-level brucellar spondylodiscitis with an epidural abscess

A 57-year-old man presented with a 6-month history of low back pain with decreased range of motion, fever, chills, and sweating, especially at night. The lumbar and thoracic spine was tender, and his neck was stiff, with fi xed fl exion. His white blood cell count and erythrocyte sedimentation rate were 5,500/mm3 and 25mm/h, respectively. The brucella capture test result was positive (1:320). Magnetic resonance imaging showed diffuse spondylodiscitis with an epidural abscess. The midsagittal image revealed increased signal intensity involving the T2–T3, T8–9, T11–12, and L4–5 disks and vertebral bodies (Figure A, arrows). Pathologic signal changes were detected, compatible with a 14 × 8-mm paraspinal abscess anterior to the corpus of the L5 vertebrae, with low signal intensity on T1weighted images, high signal intensity on T2-weighted images, and post-contrast peripheral enhancement (Figure B, arrow). Based on the clinical, laboratory, and radiological fi ndings, multifocal brucellar musculoskeletal involvement was diagnosed. In the second week of treatment with 200-mg/ day doxycycline, 600-mg/day rifampicin, and 1,600/320-mg/ day trimethoprim/sulfamethoxazole, his clinical condition improved. The therapy was stopped after 3 months. No relapse was observed at the end of the sixth month. The frequency of spondylodiscitis in brucellosis is 2-53%. Involvement at multiple levels accounts for only 3.2-9% of patients with osteoarticular complications. Nonspecifi c clinical and radiological fi ndings in this rare condition might lead to diagnostic diffi culties. Early recognition of complicated cases is critical for preventing complications. Brucella spondylodiscitis should be considered in patients in endemic areas with chronic spinal pain.

Improvement of large-joint ultrasonographic synovitis is delayed in patients with newly diagnosed rheumatoid arthritis: results of a 12-month clinical and ultrasonographic follow-up study of a local cohort.

We analyzed the longitudinal changes in gray-scale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS) parameters and correlated them with clinical, functional, and radiologic outcomes in patients with newly diagnosed rheumatoid arthritis (RA). GSUS and PDUS examinations, 44-joint disease activity score (DAS44) calculations, measurements of erythrocyte sedimentation rate, and C-reactive protein levels were performed in 68 RA patients at baseline and after 1, 3, 6, 9, and 12xa0months. Metacarpophalangeal joints, wrist, elbow, knee, ankle, metatarsophalangeal joints, and wrist and ankle tendons were examined by GSUS and PDUS. The laboratory and clinical findings began to decrease significantly at 1xa0month (Pu2009<u20090.05). Improvement of the ultrasonography (US) variables began at 3xa0months. After 6xa0months, all of the joint synovitis scores, except those of the knee, elbow, and ankle joints, showed a statistically significant reduction compared to baseline scores (Pu2009<u20090.001). DAS44 scores were lower in the very early RA group at 12xa0months compared to those whose symptom duration was greater than 3xa0months of RA (respectively, 1.53u2009±u20090.34; 1.80u2009±u20090.38; zu2009=u2009−2501, Pu2009=u20090.012). The total modified Sharp scores at 12xa0months correlated with total PDUS synovitis scores at 12xa0months (ru2009=u20090.354, Pu2009=u20090.003). Regression of US synovitis at large joints such as the knee, elbow, and ankle tended to be delayed compared to that at small joints. PD synovitis that is persistent despite disease-modifying anti-rheumatic drug therapy may cause radiographic bone erosions.

Clinical and ultrasonographic enthesopathy in inflammatory rheumatic diseases

AimWe aimed at investigating the ultrasonographic (US) and clinical prevalence of enthesopathy in patients with rheumatoid arthritis (RA), and axial spondyloarthropathy (SpA), as well as the correlation between this condition and disease activity, along with the quality of life.MethodsIncluded in the study were 30xa0axial SpA, 21xa0patients with RA, and 25xa0healthy cases. Bath Anklylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Quality of Life (ASQoL), Disease activity index xa028 (DAS28), and Health Assessment Questionnaire (HAQ) were used for clinical evaluation, and enthesal pain was evaluated by VAS, whereas enthesitis US evaluation was performed by using the MAdrid Sonographic Enthesitis Index (MASEI). Axa0total of 152 knees, ankles, and elbow regions of all patients and controls were examined by US.ResultsTotal scores of physical examination of enthesitis were 1.97xa0± 2.68 in axial SpA, 2.43xa0± 1.80 in RA, and 0.23xa0± 0.12 in the control groups. No statistically significant difference was identified in the enthesitis examination between axial SpA and RA groups (pxa0= 0.123). According to the MASEI, no significant difference was observed in quadriceps tendon enthesitis or in distal patellar ligament enthesitis between axial SpA and RA groups (MASEIxa03,xa04,xa05: pxa0= 0.993, pxa0= 0.124, pxa0= 0.652). Aside from those points, axial SpA patients had statistically higher enthesitis scores at all MASEI enthesitis points (pxa0< 0.05). In the axial SpA group, axa0significant and positive correlation was identified between BASDAI scores and total scores of enthesitis physical examination and MASEI total scores (rxa0= 0.739, pxa0= 0.0001, rxa0= 0.516, pxa0= 0.002). Axa0moderately significant correlation was identified between ASQoL total scores and MASEI total scores (rxa0= 0.466, pxa0= 0.006), but not between the HAQ total scores and MASEI total scores (rxa0= 0.213, pxa0= 0.065).ConclusionsCompared to RA, US and clinical examination of enthesitis in patients with axial SpA should focus on the calcaneal enthesitis region. In axial SpA, ultrasonographic enthesitis is associated with impaired quality of life.ZusammenfassungZielsetzungErmittelt werden sollten die sonographische (US) wie die klinische Prävalenz der Enthesopathie bei Patienten mit rheumatoider Arthritis (RA) und Patienten mit axialer Spondyloarthropathie (SpA) sowie die Korrelationen mit der Krankheitsaktivität und der Lebensqualität.MethodenIn die Studie aufgenommen waren 30 Patienten mit axialer SpA, 21 mit RA und 25 gesunde Kontrollpersonen. Zur klinischen Evaluation dienten „Bath Anklylosing Spondylitis Disease Activity Index“ (BASDAI), „Ankylosing Spondylitis Quality of Life“ (ASQoL), „Disease activity index 28“ (DAS28) und „Health Assessment Questionnaire“ (HAQ), Schmerzen im Bereich von Sehnen wurde mittels einer VAS (visuelle Analogskala) dokumentiert, die sonographische Evaluation dagegen erfolgte unter Verwendung des MASEI (MAdrid Sonographic Enthesitis Index). Insgesamt 152 Knie‑, Sprunggelenk- und Ellenbogenregionen aller Patienten und Kontrollen wurden sonographiert.ErgebnisseDie Summenscores der körperlichen Untersuchung betrugen bei axialer SpA 1,97xa0± 2,68 in axial SpA, bei RA 2,43xa0± 1,80 und bei den Kontrollpersonen 0,23xa0± 0,12. Kein statistisch signifikanter Unterschied ließ sich bei der Untersuchung auf Enthesitis zwischen den beiden Patientengruppen ausmachen (pxa0= 0,123). Gemäß dem MASEI wurde zwischen diesen Gruppen ebenfalls kein signifikanter Unterschied beobachtet hinsichtlich einer Enthesitis der Quadrizeps- oder der distalen Patellarsehne (MASEIxa03,xa04,xa05: pxa0= 0,993, pxa0= 0,124, pxa0= 0,652). Neben diesen Aspekten hatten die SpA-Patienten statistisch signifikant höhere Scores an allen MASEI-Enthesitispunkten (pxa0< 0,05). In der Patientengruppe mit axialer SpA zeigte sich eine signifikante, positive Korrelation zwischen BASDAI-Scores und Summenscores der körperlichen Untersuchung auf Enthesitiden und den MASEI-Summenscores (rxa0= 0,739, pxa0= 0,0001, rxa0= 0,516, pxa0= 0,002). Eine mäßig signifikante Korrelation bestand zwischen den ASQoL- und den MASEI-Summenscores (rxa0= 0,466, pxa0= 0,006), keine statistisch signifikante Korrelation dagegen zwischen den HAQ- und den MASEI-Summenscores (rxa0= 0,213, pxa0= 0,065).SchlussfolgerungenAnders als bei RA sollten bei axialer SpA die sonographische und die klinische Untersuchung auf Enthesitis auf mögliche entsprechende Befunde in der kalkanearen Region fokussiert sein. Bei Patienten mit axialer SpA ist eine sonographisch dargestellte Enthesitis mit einer beeinträchtigten Lebensqualität verbunden.