Merih Birlik

Irritable bowel syndrome in persons who acquired trichinellosis.

BACKGROUND AND AIM:The postinfectious irritable bowel syndrome (PI-IBS) frequently follows bacterial infections. Since people suffering from PI-IBS and Trichinella spiralis–infected mice develop similar findings, this animal model has been successfully used for PI-IBS studies; however, IBS has never been studied in humans after trichinellosis. The aim of this study was to evaluate the IBS symptoms in people who had acquired trichinellosis.PATIENTS AND METHODS:A large outbreak of trichinellosis caused by Trichinella britovi occurred in Izmir, Turkey, in 2003–2004. The diagnosis of trichinellosis was confirmed by serology and muscle biopsy. After clinical and laboratory evaluations, 72 patients (38 women, 34 men, mean age 33.2 ± 10.4 yr) with trichinellosis without preexisting IBS were enrolled in the study. Noninfected people (N = 27) were used as control group. A questionnaire was developed to assess symptoms of IBS and alarm symptoms. The first interview was done face-to-face. After 2, 4, and 6 months of the first interview, the questionnaire was readministered to the patients without any information on the occurrence of a previous trichinellosis syndrome, while it was applied after a year only to the patients who had suffered IBS symptoms according to at least one of the previous interviews.RESULTS:According to Rome II criteria, PI-IBS developed in 10 of 72 (13.9%) people with confirmed trichinellosis, who had no preexisting IBS. The rate of PI-IBS was 13.9% and 13.9% at the 4th and 6th months, respectively. The symptoms of PI-IBS persisted in five of them up to 1 yr. People without trichinellosis did not develop any IBS symptoms.CONCLUSIONS:This is the first report of the development of PI-IBS after T. britovi. Consequently, IBS can be considered as a secondary syndrome induced by trichinellosis.

Body composition, insulin, and leptin levels in patients with ankylosing spondylitis

The aim of this study was to compare the effect of chronic inflammation on insulin resistance, serum leptin levels, and body composition (BC) in patients with ankylosing spondylitis (AS) and healthy controls. Twenty-eight AS patients and 17 healthy controls were included in this study. Subjects with hypertension, diabetes, hyperlipidemia, and obesity were excluded. Acute phase reactants and serum levels of glucose, insulin, lipids, and leptin were studied. BC was determined anthropometrically and by foot-to-foot body fat analyzer (BIA, bioelectrical impedance analysis). Quantitative insulin-sensitivity check index, homeostasis model assessment for insulin resistance, and McAuley indices were calculated. Spinal mobility was assessed by the Bath Ankylosing Spondylitis Metrology Index (BASMI). Patients were also evaluated with the Bath Ankylosing Spondylitis Functional Index and the Bath Ankylosing Spondylitis Disease Activity Index. Age, sex distribution, smoking status, serum lipids, insulin concentrations, and insulin resistance indices were comparable between AS patients and controls (p > 0.05). However, acute phase reactants were significantly higher and leptin levels were significantly lower in the AS patients than in controls (p < 0.05). Fat percent assessed by both BIA and anthropometrical methods was lower in the male and female AS patients than in controls, and this reduced fat level reached statistical significance for men (p < 0.05). There were significant correlations between percent body fat, body mass index, leptin, age, and BASMI (p < 0.05; r = 0.6, 0.75, 0.35, −0.41, respectively). On the other hand, body fat percent, waist-to-hip ratio, C-reactive protein, and BASMI were significantly correlated with serum leptin levels (p < 0.05; r = 0.75, −0.42, −0.52, −0.47, respectively). Chronic inflammatory condition in AS may be responsible for the reduced body fat content and lower circulating leptin concentrations. Insulin levels and insulin resistance indices seem similar in patients and controls in the absence of classic vascular risk factors.

Prevalence of primary Sjogren's syndrome in Turkey: a population-based epidemiological study.

Objectives:  The aim of this study was to determine the prevalence of primary Sjogren’s syndrome (pSS) in a general Turkish population according to the latest proposed American–European Consensus Group (AECG) criteria and European‐1 (EU‐1) criteria.

Increased Prevalence of M694V in Patients With Ankylosing Spondylitis Additional Evidence for a Link With Familial Mediterranean Fever

OBJECTIVE To assess whether there is a statistically significant difference in the frequency of common MEFV allele variants in patients with ankylosing spondylitis (AS) as compared with control patients with rheumatoid arthritis (RA) and with healthy control subjects. METHODS Sixty-two patients with AS, 50 healthy control subjects, and 46 patients with RA were assessed for the presence of MEFV variants. Exon 10 was analyzed by direct sequencing. E148Q was analyzed by restriction endonuclease enzyme digestion (REED) or by direct sequencing when REED analysis failed. RESULTS The allele frequency of all MEFV variants in the AS group was significantly higher than that in the pooled control group of healthy subjects plus RA patients (15.3% versus 6.8%; P = 0.021). M694V was the only variant that was significantly more common in the AS group than in the combined or individual control groups (P = 0.026 for AS patients versus healthy controls, P = 0.046 for AS patients versus RA patient controls, and P = 0.008 for AS patients versus healthy and RA patient control groups). The carriage rate of M694V was also significantly higher in the AS patient group than in the combined control group (odds ratio 7.0, P = 0.014). Neither M694V nor any other MEFV variant showed a correlation with most of the disease-related measures examined. CONCLUSION We found an increased frequency of MEFV variants in AS patients as compared with healthy controls and with RA patient controls. This was primarily due to the presence of M694V. The roles of other exon 10 variants, as well as the relationship between the variant status and the severity and clinical course of the disease, need to be explored in further studies that include sufficiently large sample sizes.

Quality of life in patients with Takayasu's arteritis is impaired and comparable with rheumatoid arthritis and ankylosing spondylitis patients

The aims of the study were to assess the health-related quality of life (QOL) in patients with Takayasus arteritis (TA) by two different generic QOL instruments and to compare the results with those patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and healthy controls (HC). A cross-sectional study was performed in 51 patients with TA (41 women; mean age 38.4 ± 13.5), 43 RA (36 women; 55.2 ± 9.6), 31 AS (12 women; 41.2 ± 13.1), and 75 HC (53 women; 38.8 ± 10.9). Quality of life was assessed by using Short-Form 36 (SF-36) and Nottingham Health Profile (NHP). Separate dimensions of SF-36 and NHP and physical and mental summary scores of SF-36 as well were compared between patients and control groups. Physical and mental health summary scores and all SF-36 subscales, except for social functioning, were significantly lower in patients with TA than healthy controls. No significant differences between TA, RA, and AS patients were found in all SF-36 subscales and summary scores. NHP scores for energy level, pain, emotional reactions, and physical mobility were significantly higher in TA patients than controls. All NHP subscales, except for pain, were comparable in patients with TA, RA, and AS. Pain score was worse in RA patients. The NHP scores for sleep and social isolation were not different between patients and controls. Many aspects of QOL in patients with TA are significantly impaired in comparison with local healthy controls and similar to those in patients with RA and AS.

Efficacy of interleukin-1 targeting treatments in patients with familial mediterranean Fever.

Herein, we reported our experience in colchicine-resistant familial Mediterranean fever (FMF) patients who are treated with anti-interleukin-1 (IL-1) drugs. A retrospective review of medical records of anti-IL-1 recipients was performed. The main clinical characteristics of these patients and the evolution after anti-IL-1 were recorded. There were 20 patients (11 male [M] and 9 female [F]). Despite regular colchicine treatment, median number of attacks per month and per year was 1 (1–4) and 12 (4–50), respectively. Twelve patients were receiving anakinra, and eight patients were treated with canakinumab. The number of monthly and yearly attacks after IL-1 treatment was significantly decreased after the biologic agent (p < 0.05). One patient did not respond to the treatment, and one patient developed serious infection during anti-IL-1. We also observed a significant decrease in proteinuria in the amyloidosis complicated FMF patients. Anti-IL-1 targeting drugs seem safe and effective therapies in colchicine-resistant FMF.

Coexistence of familial Mediterranean fever with sacroiliitis and Behçet's disease: A rare occurrence

Familial Mediterranean fever (FMF) and Behçets disease are relatively rare but may still coexist in the same patient. Sacroiliitis is another feature whose significance is controversial in either of the diseases. We report a case of longstanding FMF with sacroiliitis who later developed typical characteristics of Behçets disease. Although occurrence by chance cannot be ruled out, this unusual patient may enhance the claims that FMF and Behçets disease have common aetiopathogenetic mechanisms. It would be appropriate to include this coexistence in the list of differential diagnoses of the two diseases.

Acute trichinellosis in children compared with adults.

Objectives: Trichinellosis is a cosmopolitan parasite infection caused by Trichinella nematodes that is acquired from consumption of raw meat from several animal species. Knowledge of the clinical pattern and laboratory features of the disease in childhood is limited. The purpose is to study the clinical pattern of trichinellosis caused by Trichinella britovi in children and to compare it in household adults. Methods: We evaluated all children up to 17 years of age and their adult householders exposed to the consumption of infected meat during an outbreak of trichinellosis. A questionnaire was developed to record clinical data. The blood sample was collected for blood count, muscle enzymes, serum electrolytes, albumin and serology. All exposed children were treated with mebendazole, and severe symptomatic patients received prednisolone. Clinical and laboratory presentations and outcome were recorded. To evaluate the clinical picture of trichinellosis in childhood, clinical and laboratory findings were compared between children and household adults with a confirmed diagnosis who consumed the same amount of infected meat. Results: In 47 (62%) of 76 children with suspected trichinellosis, the diagnosis was serologically confirmed. The main clinical and laboratory findings in children were fever, abdominal pain, myalgia, facial and/or eyelid edema, rash, eosinophilia and increased muscular enzymes. The incubation period was similar in children and adults, but myalgia (66% versus 96%, P < 0.01), facial and/or eyelid edema (57% versus 86%, P < 0.05), eosinophilia (52% versus 96%, P < 0.01) and increased serum creatine kinase (38% versus 79%, P < 0.01) were less common in children than in adults. Seroconversion occurred in fewer children than adults, but the difference was not statistically significant. Conclusions: T. britovi infection shows a benign course and a milder clinical picture in children than in adults who consumed the same amount of infected meat.

Prevalence of spondyloarthritis in Turkish patients with inflammatory bowel disease

Rheumatic manifestations are the most common extraintestinal findings of inflammatory bowel disease (IBD), although there are wide variations among different studies. The only previous Turkish study reported a rather high prevalence of spondyloarthritis (SpA) in patients with IBD. We aimed to determine the frequency of SpA and ankylosing spondylitis (AS) in patients with IBD attending a gastroenterology clinic from a referral centre. The study was conducted in 122 patients with established diagnosis of IBD [28 with Crohn’s disease (CD) and 94 with ulcerative colitis (UC)]. A detailed medical history was obtained and a complete physical examination was performed in all the patients. Standard pelvic X-rays for examination of the sacroiliac joints were performed only when clinically indicated. The X-rays were read blindly by an experienced rheumatologist and reported according to the established grading system. The modified New York criteria were used to classify AS, and the European Spondyloarthropathy Study Group criteria for SpA. The prevalence of AS and SpA in patients with IBD was 8.2 and 28.7%, respectively. SpA was found to be significantly more common in the patients with CD compared to patients with UC, but the frequency of AS was not different between these two groups. There was no correlation between localisation or extent of the intestinal inflammation and presence of AS and SpA. A higher frequency of women was observed in patients diagnosed as SpA. Almost half of the patients with SpA (45.7%) had not been diagnosed before the study, although they had a history of IBP and/or peripheral arthritis. This study suggests that the prevalences of SpA and AS in Turkish patients with IBD are similar to those in many other populations. There may be a significant female predominance of SpA among patients with IBD.

Articular, B-cell, non-Hodgkin’s lymphoma mimicking rheumatoid arthritis: synovial involvement in a small hand joint

Polyarticular joint manifestations as the predominant symptom of non-Hodgkin’s lymphoma (NHL) are quite rare. In the absence of peripheral lymph node and visceral involvement, lymphomas presenting as polyarthritis create a problem for the patients as another rheumatic disease. We present a case that had been diagnosed with rheumatoid arthritis because of symmetrical articular symptoms. The patient later developed severe pain and marked swelling in her right fourth finger, and a diagnosis of septic arthritis and osteomyelitis complicating rheumatoid arthritis was assumed. The final diagnosis of NHL with synovial involvement could be made only after histopathologic examination of a biopsy specimen obtained from the amputated finger. This is the first case report demonstrating direct synovial involvement of a small joint in a patient with NHL presenting with polyarthritis. Articular and periarticular involvement of multiple joints shown by MRI in this patient suggests that direct synovial involvement may be responsible for the polyarticular symptoms in such patients.