Yasemin Kabasakal

The prevalence of Sjogren's syndrome in adult women

Objectives: The aim of this study was to determine the prevalence of primary Sjögrens syndrome (pSS) according to European criteria (1993) and to the US–European Consensus Group (US‐EU) criteria (2002) in adult women in Bornova, Izmir, Turkey. Materials and method: The study was designed as a two‐phase cross‐sectional survey consisting of a baseline questionnaire and collection of blood samples and clinical examination. In the initial phase, positivity for autoantibodies Ro(SS‐A), La(SS‐B), rheumatoid factor (RF), and anti‐nuclear antibodies (ANA) was determined, and in the clinical phase, clinical examination, salivary and ocular tests were performed. Minor salivary gland biopsy was performed for those who had at least three of these five criteria positive. Results: In our sample the prevalence of SS was 1.56% [95% confidence interval (CI) 0.92–2.66] according to the European criteria and 0.72% (95% CI 0.33–1.57) according to the US‐EU criteria. Conclusion: To prevent the loss in diagnosis of pSS, the addition of ANA, RF, and tear break‐up time (BUT) tests to US‐EU criteria would be appropriate.

Ankylosing spondylitis-related secondary amyloidosis responded well to etanercept: a report of three patients

Secondary (AA) amyloidosis is one of the most significant complications of ankylosing spondylitis (AS) that frequently leads to proteinuria and renal dysfunction. Anti-tumor necrosis factor alpha (anti-TNF) agents are promising in inducing clinical remission by suppressing systemic inflammation in AA amyloidosis. We report three cases with AS-related AA amyloidosis that responded well to etanercept therapy. Despite treatment with disease modifying anti-rheumatic drugs, all three patients had active AS, marked proteinuria, impaired renal function, and low serum albumin level. During 1-year treatment with etanercept, all patients experienced gradual improvement in all of these parameters.

Detection of Microembolic Signals in Patients with Neuropsychiatric Lupus erythematosus

The pathogenesis of central nervous system involvement in systemic lupus erythematosus (SLE) is not completely understood. In this study, we investigated the association of microembolic signals (MES) with a variety of neuropsychiatric SLE manifestations and compared our results with those from SLE patients without neuropsychiatric lupus and normal controls. Fifty-three patients with SLE (45 females and 8 males), all fulfilling the revised classification criteria for SLE, and 50 control subjects (44 females and 6 males) were enrolled in this study. All SLE patients were assessed by neuropsychological examination, including various neuropsychiatric tests. Twenty-five patients with SLE were found to have at least one of the neuropsychiatric syndromes defined by The American College of Rheumatology. The mean MES count in patients with neuropsychiatric lupus was significantly higher than those without (5.4 ± 1.1 vs. 0.3 ± 0.8/h; p < 0.005). We found a positive correlation between higher mean MES counts and the presence of neuropsychiatric syndromes in SLE. The mean MES count in the whole group of SLE patients was also significantly higher than that in healthy controls. The mean MES count of SLE patients with antiphospholipid (aPL) antibody positivity was significantly higher than those without aPL antibodies (3.6 ± 1.6 vs. 0.8 ± 0.1/h; p < 0.005). In conclusion, the association of MES with neuropsychiatric lupus may support the possible contribution of MES to the complex pathophysiology of this syndrome. More importantly, detection of MES on transcranial Doppler monitoring might suggest a high risk of involvement of the central nervous system in SLE, and could be used as a diagnostic tool.

Pulmonary hypertension in rheumatoid arthritis.

Using Doppler echocardiography (DE), we measured pulmonary arterial systolic pressure (PASP) in rheumatoid arthritis (RA) patients without coexisting cardiopulmonary diseases. Accepting the normal upper limit of PASP as 30 mmHg, we found elevated PASP in 11 out of 40 (27.5%) RA patients, values being mostly 30–40 mmHg, indicating mild pulmonary hypertension (PHT). Although estimation of PASP by DE is not as reliable as cardiac catheterisation, it is possible that mild elevations in PASP may contribute to the high incidence of cardiovascular events not explained by traditional cardiac risk factors in patients with RA. Long‐term follow‐up will be obviously necessary to ascertain the impact of mild PHT on the prognosis and mortality rate of RA patients.

Effects of hydroxychloroquine on salivary flow rates and oral complaints of Sjögren patients: a prospective sample study

OBJECTIVE The objective of this study was to evaluate whether hydroxychloroquine (HCQ) therapy effects subjective and/or objective complaints and salivary flow rates of patients with primary Sjögrens syndrome (PSS). STUDY DESIGN Thirty women recently diagnosed with PSS, scheduled for HCQ treatment (400 mg daily), participated and were clinically examined before initiation of 30 weeks of HCQ treatment. During baseline evaluation, both the objective and/or subjective oral findings were recorded. Unstimulated (uSFR) and stimulated salivary flow rates (sSFR) were determined. After initiation of HCQ treatment, study parameters were assessed at 6, 12, 18, 24, and 30 weeks. Each patient served as her own control; measurements of the baseline and control times were analyzed by ANOVA. RESULTS uSFR values increased significantly with HCQ treatment, but sSFR values, objective and/or subjective complaints did not change considerably. CONCLUSION A positive impact of 30 weeks of HCQ treatment only on uSFRs of SS patients was revealed.

Headache in primary Sjögren’s syndrome: a prevalence study

Objectives –  To determine the prevalence of headache in patients with primary Sjögren’s syndrome (pSS) and to examine the relationship between headache types and clinical, serologic features of the disease.

The frequency of sicca symptoms and Sjögren's syndrome in patients with systemic sclerosis.

The objectives are to detect the frequency of sicca symptoms and Sjögrens syndrome (SS) in patients with systemic sclerosis (SSc) based on the diagnostic criteria of the American–European Consensus Group (AECG) and to evaluate demographic, clinical and serologic characteristics.

Spinal abnormalities similar to ankylosing spondylitis in a 58-year-old woman with ochronosis

SummaryOchronotic arthropathy (spondylosis or peripheral arthropathy) is a late complication of alkaptonuria. There is a tendency for HLA-B27 positive patients with alkaptonuria to develop ochronotic spondylosis. A 58-year-old white woman, presented with ochronotic spondylosis. She was HLA-B27 positive. Her family history was positive for alkaptonuria. Ochronotic patients with HLA-B27 positivity develop spinal changes similar to ankylosing spondilitis (AS).

Tumor necrosis factor-alpha gene promoter polymorphism in patients with familial Mediterranean fever.

The proinflammatory cytokine tumor necrosis factor-alpha (TNF-α) plays an important role on the course of disease in familial Mediterranean fever (FMF). TNF-α gene promoter polymorphism may be a marker of susceptibility and severity of FMF. The aim of this study is to evaluate both TNF-α/238 and TNF-α/308 genotypes and allelic distribution in patients with FMF. Forty-one FMF patients and 43 healthy volunteers were included in the study. Genomic DNA was extracted from EDTA-preserved whole blood of whole series of patients and controls. Polymorphism of TNF-α promoter at positions −238 and −308 were detected by using amplification refractory mutation system polymerase chain reaction. TNF-α/238 and TNF-α/308 genotype distributions and allele frequencies of FMF patients and healthy volunteers were found to be similar. Moreover, there was no association between TNF-α/238 and TNF-α/308 genotypes and the frequency of acute attacks in FMF. TNF-α/238 and TNF-α/308 promoter polymorphisms do not seem to be major genetic risk factors for susceptibility to FMF and severity of the disease.

Impact of Buccotherm® on xerostomia: a single blind study.

OBJECTIVE The purpose of this single blind study was to investigate effects of Buccotherm® spray on subjective symptoms of xerostomia patients. METHODS Twenty patients with dry mouth complaint were instructed to use placebo six times a day for 2 weeks. After a wash period, mineral water spray was provided. Patients were asked to reply questions regarding dry mouth using visual analog scale (VAS). Baseline and subsequent subjective findings on 1 hour after the application of the materials at the end of 1st, 7th, and 14th days were recorded. RESULTS At the end of 14-day treatment, no statistically significant differences were observed between the efficacy of placebo and commercial mineral water dental spray (p > 0.05). The VAS scores revealed that difficulty in mastication (p = 0.006), difficulty in swallowing (p = 0.00), need to sip liquids while eating (p = 0.000), difficulty in speech (p = 0.003), and waking up at night to sip water (p = 0.005) were statistically lower for placebo than commercial mineral water spray. CONCLUSION The commercial mineral water dental spray was not more efficient than placebo in the management of dry mouth-related symptoms. CLINICAL RELEVANCE This study emphasizes the fundamental role of saliva in oral health and evaluates the clinical utility of a commercial dental spray.