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Evaluation of Macular Ganglion Cell-inner Plexiform Layer and Choroid in Psoriasis Patients Using Enhanced Depth Imaging Spectral Domain Optical Coherence Tomography

ABSTRACT Purpose: To evaluate changes in the thickness of the central macula, macular ganglion cell-inner plexiform layer (mGCIPL), and subfoveal choroid in patients with psoriasis using spectral domain optical coherence tomography (SD-OCT). Methods: The measurements of macular, mGCIPL thicknesses and subfoveal choroidal thickness (SFCT) obtained by SD-OCT of psoriasis patients (n = 46). These measurements were compared with those of 50 healthy controls. Results: The macular, mGCIPL, and choroidal thicknesses did not differ between the controls and psoriatic subjects (p>0.05). When the patients were divided into two distinct groups, only the SFCT was significantly thicker in the severe psoriasis group compared with the mild psoriasis group (p = 0.003). Conclusions: These findings suggest that choroidal alterations are seen without macular changes in patients with psoriasis. Severe psoriasis appears to be related to increases in SFCT as a consequence of possible inflammatory cascades that are part of the disease’s pathogenesis.

Predictive value of striae gravidarum severity for intraperitoneal adhesions or uterine scar healing in patients with previous caesarean delivery

Abstract Objective: Previous abdominal operations might cause severe intraperitoneal adhesions (IPA), which can complicate caesarean section (CS) procedures. When selecting the mode and timing of delivery, obstetricians are also curious about uterine scar healing if the previous operation was a CS. Uterine scar thickness is an indicator of uterine scar healing. We aimed to evaluate the possible predictive value of striae gravidarum (SG) on IPA formation and uterine scar thickness (UST). Methods: Fifty-five women with a previous CS history were evaluated for SG Davey Score. They were investigated for IPAs and lower segment uterine scar thickness during the current CS operation. Results: Out of the patients with no SG (n = 11), mild SG (n = 10) and severe SG (n = 34), 1 (9.1%), 3 (30%) and 17 (50%) had IPA, respectively (p = 0.044). The mean uterine scar thicknesses in the no SG, mild SG and severe SG groups were 3.82 ± 4.04, 5.20 ± 4.13 and 5.18 ± 3.52, respectively (p = 0.561). Conclusions: To the best of our knowledge, this was the first study to investigate the relationship between SG and IPA and uterine scar thickness. The SG status of a patient with a previous delivery and abdominal operation history might help predict IPA status before planning a new operation.

Contribution of the STAT4 rs7574865 gene polymorphism to the susceptibility to autoimmune thyroiditis in healthy Turk population and psoriatic subgroups

Introduction STAT4 is an important transcription factor that activates gene transcription as a response to cytokines. Recently, the influence of STAT4 gene on autoimmune disease has been widely studied in many different immune-related diseases. Autoimmune, metabolic and cardiovascular disorders are more common in psoriatic patients. STAT4 may be a unique gene that switches on in autoimmune-related thyroid disease in psoriatic patients. The aim of the study: To explore the association of a STAT4 rs7574865 polymorphism to autoimmune thyroid diseases in the general Turkish population and psoriatic subgroups. Material and methods A total of 132 psoriatic patients and 118 non-psoriatic volunteers were genotyped for STAT4 rs7574865 using real time PCR. Twenty-four of the psoriatic patients and 15 of the non-psoriatic volunteers have autoimmune-related thyroid diseases. Results The prevalence of the T allele [OR = 4.37; 95% CI: 1.05-19; p = 0.03] of the STAT4 rs7574865 was higher in individuals with autoimmune-related thyroid diseases among the all non-psoriatic volunteers. The volunteers with autoimmune-related thyroid diseases has an increased allele positivity and carriers having at least one of the risk allele was significantly higher than in counterparts with a GG wild genotype [ORGT/TT vs. GG: 1.73; 95% CI: 0.09-32; p = 0.03]. Yet, there was no evidence of an association between rs7574865 and autoimmune-related thyroid disease in psoriatic patients. Conclusions The STAT4 rs7574865 polymorphism increases autoimmune-related thyroid disease susceptibility among the general population but not in psoriatic patients.

Association between mean platelet volume and disease severity in patients with psoriasis and psoriatic arthritis

Introduction Mean platelet volume (MPV) is an important marker that shows the activation and function of the platelets, which is effective in the inflammatory diseases. Aim To show the relationship between MPV and the development of psoriatic arthritis (PA) in patients with psoriasis vulgaris (PV) and the correlation between MPV and psoriasis severity score (PASI). Material and methods Our study included 116 patients with psoriatic arthritis (68 female, 48 male) and 41 patients in the psoriasis group (19 female, 22 male) and 90 subjects in the control group (55 female, 35 male). The demographic data of the patients, duration of disease, PASI, the nature of the disease were evaluated retrospectively. Results Mean platelet volume levels of both the PV group (8.79 ±0.86 fl) and the PA group (9.18 ±1.26 fl) were significantly higher compared to the control group (8.42 ±0.74 fl). There was a weak statistically positive correlation between the PASI and the MPV according to the correlation analysis (r = 0.165; p = 0.046). Conclusions Our results show that MPV may be helpful as an indicator of the clinical course of PV and PA. In this regard, that study should be supported by prospective studies to find strong correlations.

Successful infliximab therapy in a patient with comorbid spondyloarthritis, primary biliary cirrhosis and generalized morphea

The patient in this report was diagnosed simultaneously with primary biliary cirrhosis (PBC), spondyloarthritis, and generalized morphea and was started on infliximab therapy. In addition to an improvement in clinical symptoms with this therapy, an improvement was also observed in laboratory parameters such as cholestatic enzymes, C-reactive protein, and erythrocyte sedimentation rate. Infliximab was well tolerated in this 56-year-old patient. However, further studies must be performed in order to clarify the therapeutic role of TNF-α blockers in, PBC and generalized morphea.

The correlation between the psoriasis area severity index and ischemia-modified albumin, mean platelet volume levels in patients with psoriasis

Introduction Ischemia-modified albumin (IMA), a novel ischemia marker, and mean platelet volume (MPV), a determinant of platelet activation, have been reported as elevated markers in cardiovascular risk factors such as atherosclerosis, metabolic syndrome, diabetes mellitus (DM), hypertension, and dyslipidemia. As psoriasis is a chronic inflammatory disease having comorbidities, IMA and MPV can help determine the risk factors for psoriasis. Aim To investigate the correlation between the psoriasis area severity index (PASI), IMA and MPV levels in patients with psoriasis. Material and methods This cross-sectional, case-control study was performed between January 2014 and December 2014 at the University hospital in Çanakkale, Turkey. Forty-five patients with psoriasis and 44 healthy volunteers over 18 years of age were included in the study. In the psoriasis patient group, clinical features and PASI scores were recorded. Serum IMA and MPV concentrations were evaluated in both groups. Results The mean IMA values were 0.85 ±0.15 and 0.79 ±0.09 (in the psoriasis patients and control groups, respectively), and there was a statistically significant difference (p = 0.048). Ischemia-modified albumin levels were not correlated with PASI scores (r = 0.024; p = 0.889) but were correlated with disease duration (r = 0.323; p = 0.048). There was no statistically significant difference between the MPV values of the two groups (8.98 ±1.14 and 9.19 ±1.28 in the psoriasis patients and control groups, respectively) (p = 0.435). Conclusions Ischemia-modified albumin may be used as a marker for detecting oxidative stress in patients with psoriasis, especially those with a long disease duration.

Is there any increased risk of hypertension, diabetes and cardiac diseases in psoriatic patients with TNF-α G238A and G308A polymorphism?

Introduction Psoriasis is regarded as a complex autoimmune disease with strong genetic background. Psoriatic patients suffer from many comorbidities including hypertension, diabetes and cardiovascular diseases. Cytokines such as tumor necrosis factor α (TNF-α) may be a key player that triggers psoriasis and diabetes, hypertension and cardiac disease at the same time. Aim To evaluate genetic variations in the TNF-α region and its association with psoriasis and related comorbidities. Material and methods The study covered 129 psoriasis patients with three main subgroups with coronary artery disease (n = 41), hypertension (n = 35), and diabetes (n = 21). DNA samples were genotyped for TNF-α G308A and G238A polymorphisms by real-time polymerase chain reaction melting-curve analysis and results were compared statistically. Results Psoriatic patients with both TNF-α-298 and TNF-α-308 polymorphisms showed no statistically significant increase in the risk of hypertension (OR = 0.425, χ² = 1.76, p = 0.18 and OR = 1.87, χ² = 1.33, p = 0.25), coronary artery disease (OR = 1.97, χ² = 1.91, p = 0.17 and OR = 2.63, χ² = 1.35, p = 0.25), or diabetes (OR = 1.35, χ² = 0.24, p = 0.62 and OR = 1.53, χ² = 0.24, p = 0.62). Conclusions The current preliminary results suggested that there was no correlation between TNF-α promoter polymorphism and diabetes, hypertension and cardiac disease among psoriatic patients in the Turkish population.

Authors reply to Letter to the Editor—In response to: “Ersan I, Kilic S, Arikan S, et al. Evaluation of macular ganglion cell-inner plexiform layer and choroid in psoriasis patients using enhanced depth imaging spectral domain optical coherence tomography”

We appreciate the interest of Uzun et al. in our article, “Evaluation of macular ganglion cell-inner plexiform layer and choroid in psoriasis patients using enhanced depth imaging spectral domain optical coherence tomography”. TNF-α has been found to be related to psoriasis development. To the best of our knowledge, antiTNF-α therapy’s effect on choroidal thickness has not been well documented. Ishikawa et al. report that infliximab significantly reduced choroidal thickness in patients with Behçet disease associated with uveitis. As we specified in our exclusion criteria, due to the potential effects of anti-TNF-α therapy on choroidal thickness, we excluded patients undergoing anti-TNF-α therapy. Psoriatic patients using topical medications, such as calcipotriol and corticosteroids, were included. The choroid is the tissue with the highest blood supply per area. A previous study suggested that the choroidal vessels are poorly autoregulated. As Uzun and Pehlivan stated, the studies evaluating choroidal thickness need strict inclusion and exclusion criteria concerning ocular and systemic participant conditions. Axial length, intraocular pressure, age, sex, and other factors significantly affect choroidal thickness, which we are well aware of. It is still unknown what factors affect choroidal thickness; determining this is a high-priority task. However, we did not ask the participants in our study about menstruation, smoking habits, and alcohol or caffeinated/non-caffeinated beverage consumption – we knew that the patients had already fasted overnight for blood sampling before the ocular examination. Further studies taking these confounding factors into account for large patient groups are needed to explore choroidal thickness in psoriasis patients. Finally, all participants were free of systemic diseases other than psoriasis (such as obesity and hypertension) as mentioned in our Methods section. We hope we have clarified each of the points related to the authors’ comments and thank them again for their contributions.

Pustulotic arthro-osteitis (Sonozaki Syndrome): A rare case report

Pustulotic arthro-osteitis is a rare disease involving the skin and musculoskeletal system that was first described by Sonozaki. Onset is frequently seen at age 30-40. The prevalences between the sexes are similar. Palmoplantar pustulosis and sternoclavicular joint involvement are the most typical findings. It may be difficult to distinguish seronegative spondyloarthropathies and SAPHO syndrome due to sacroiliac joint, vertebral column and peripheral joint involvement. Arthritis being non-erosive and short-lived in character and the absence of deformity or contracture in the joints are significant clinical characteristics. Anti-inflammatory and immunesuppressive drugs are used in the treatment of the disease, the course of which involves remission and flare-ups. We describe the case of a 43-year-old male patient diagnosed with pustulotic arthro-osteitis.

Possible association between germline methylenetetrahydrofolate reductase gene polymorphisms and psoriasis risk in a Turkish population

Psoriasis is a common chronic inflammatory skin disease caused by genetic and epigenetic factors. There are conflicting results in the literature about the association between psoriasis and the methylenetetrahydrofolate reductase gene (MTHFR), ranging from strong linkage to no association.