Yavuz Pehlivan

Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients

OBJECTIVE This observational prospective cohort study aimed to evaluate the effects of non-surgical periodontal treatment on clinical periodontal measurements and systemic inflammatory mediator levels in low or moderate to highly active rheumatoid arthritis (RA) patients with chronic periodontitis. SUBJECTS AND METHODS Rheumatoid arthritis activity was assessed with disease activity score test (DAS28). Thirty patients with RA with moderate to high disease activity (DAS28 ≥ 3.2) and chronic periodontitis (MHDA group) and thirty patients with RA with low disease activity (DAS28 < 3.2) and chronic periodontitis (LDA group) were enrolled in the study. The patients were monitored at the beginning and 3 months after undergoing periodontal therapy. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α) levels in serum, DAS28 and periodontal parameters were evaluated. RESULTS Erythrocyte sedimentation rate, CRP, TNF-α levels in serum, DAS28 and periodontal parameters exhibited similar and significant reduction 3 months after the non-surgical periodontal treatment. CONCLUSION Non-surgical periodontal treatment may prove beneficial in reducing RA severity as measured by ESR, CRP, TNF-α levels in serum and DAS28 in low or moderate to highly active RA patients with chronic periodontitis.

Enhanced Depth Imaging Optical Coherence Tomography Findings in Behçet Disease

Abstract Purpose: Investigation of subfoveal choroidal thickness in Behçet disease (BD) with enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: The study included 35 patients with posterior uveitis (PU) associated with BD, 35 patients with BD without ocular involvement, and 30 healthy controls. Results: There were no significant differences between the groups in terms of age, gender, axial length, or spherical equivalent refractive error. The mean subfoveal choroidal thickness was thinner in eyes with PU than in eyes without PU and healthy controls (p = 0.026). Conclusion: EDI-OCT is a beneficial test for evaluating choroid morphology in BD. Thinning of the subfoveal choroidal tissue has been observed in patients with BD-associated PU.

Amyloidosis and its related factors in Turkish patients with familial Mediterranean fever: a multicentre study

OBJECTIVE The primary aim of this study was to investigate the prevalence of amyloidosis and its related factors in a large number of FMF patients. METHODS Fifteen centres from the different geographical regions of Turkey were included in the study. Detailed demographic and medical data based on a structured questionnaire and medical records were collected. The diagnosis of amyloidosis was based on histological proof of congophilic fibrillar deposits in tissue biopsy specimens. RESULTS There were 2246 FMF patients. The male/female ratio was 0.87 (1049/1197). The mean age of the patients was 34.5 years (S.D. 11.9). Peritonitis was the most frequent clinical finding and it was present in 94.6% of patients. Genetic testing was available in 1719 patients (76.5%). The most frequently observed genotype was homozygous M694V mutation, which was present in 413 (24%) patients. Amyloidosis was present in 193 patients (8.6%). Male sex, arthritis, delay in diagnosis, M694V genotype, patients with end-stage renal disease (ESRD) and family history of amyloidosis and ESRD were significantly more prevalent in patients with amyloidosis compared with the amyloidosis-negative subjects. Patients with homozygous M694V mutations had a 6-fold higher risk of amyloidosis compared with the other genotypes (95% CI 4.29, 8.7, P < 0.001). CONCLUSION In this nationwide study we found that 8.6% of our FMF patients had amyloidosis and homozygosity for M694V was the most common mutation in these patients. The latter finding confirms the association of homozygous M694V mutation with amyloidosis in Turkish FMF patients.

Serum leptin, resistin and TNF-α levels in patients with systemic sclerosis: the role of adipokines in scleroderma

Systemic sclerosis (SSc) is a chronic fibrotic collagen tissue disease. Leptins role in regulating immune and inflammatory response has become increasingly evident. Resistin has pro‐inflammatory properties and also is associated with inflammatory markers in some rheumatologic diseases. The purpose of this study was to determine serum leptin, resistin and tumor necrosis factor alpha (TNF‐α) in SSc patients and evaluate their association with other frequently used laboratory and clinic findings.

Effect of chronic periodontitis on oxidative status in patients with rheumatoid arthritis.

BACKGROUND Rheumatoid arthritis (RA) and chronic periodontitis (CP) are the most common chronic inflammatory diseases and have remarkable similar pathologies. The aim of this study is to investigate the impact of periodontal status on oxidative stress in patients with RA by evaluating serum oxidative parameters and prolidase levels. METHODS For this cross-sectional comparative study, the following four groups were composed of 20 individuals each (80 individuals total): 1) RA with CP (RA-CP group); 2) RA but periodontally healthy (RA-C group); 3) systemically healthy with CP (CP group); and 4) systemically and periodontally healthy (C group). Demographic, periodontal, rheumatological, and serum oxidative parameters as determined by serum total antioxidant status, total oxidant status, oxidative stress index (OSI), lipid hydroperoxide levels, paraoxonase, arylesterase, and ceruloplasmin activity, prolidase level, and total sulfhydryl groups were evaluated. RESULTS The OSI values of the RA-CP group were statistically significantly higher than those of the C group (P <0.05). The prolidase levels of the RA-C, RA-CP groups and the CP group were statistically higher than those of the C group (P = 0.001, P = 0.007, and P = 0.001, respectively). CONCLUSIONS Although CP and RA each increase oxidative stress, in a small sample size these effects are only significant when both CP and RA are combined relative to neither exposure. In addition, increased prolidase levels in patients with RA and CP may be related to increased oxidative tissue damage.

Initial diagnosis of lumbar disc herniation is associated with a delay in diagnosis of ankylosing spondylitis.

Objective. There is often a considerable delay in diagnosis of ankylosing spondylitis (AS). In this multicenter study, we analyzed the delay and possible associated factors, including an initial diagnosis of lumbar disc herniation (LDH), which we frequently encounter in daily clinical practice. Methods. The study included 393 consecutive patients [258 men (65.6%), mean age 39.3 ± 10.8 yrs] with AS according to the modified New York criteria. Face-to-face interviews were done using a structured questionnaire, addressing all the potentially relevant factors. Results. The mean diagnostic delay was 8.1 ± 8.6 years in the whole study population. The shortest delay was observed when rheumatologists were the first physicians consulted (2.9 ± 5.3 yrs). An initial diagnosis of LDH was reported by 33% of the patients. The diagnostic delays in patients with an initial diagnosis of LDH and those without were 9.1 ± 8.5 years and 6.2 ± 7.4 years, respectively (p = 0.002). In a regression model, predictive factors for delay in diagnosis were age at onset of spondyloarthritic symptoms, back pain, education level, prior diagnosis of LDH, and surgical history for LDH. Conclusion. These results indicate the need to increase awareness of the concept of axial spondyloarthritis among specialists who might be the first physicians consulted by patients with AS for their back pain. There is also a need to develop strategies for early referral of such patients to rheumatologists.

Incidence of Cyclophosphamide-induced Urotoxicity and Protective Effect of Mesna in Rheumatic Diseases

Objective. To assess bladder toxicity of cyclophosphamide (CYC) and uroprotective effect of mesna in rheumatic diseases. Methods. Data of 1018 patients (725 women/293 men) treated with CYC were evaluated in this retrospective study. All of the following information was obtained: the cumulative CYC dose, route of CYC administration, duration of therapy, concomitant mesna usage, and hemorrhagic cystitis. Cox proportional hazard model was used for statistics. Results. We identified 17 patients (1.67%) with hemorrhagic cystitis and 2 patients (0.19%) with bladder cancer in 4224 patient-years. The median time for diagnosis to hemorrhagic cystitis was 10 months (4–48) and bladder cancer was 8 years (6–10.9). There were 583 patients (57.2%) who received mesna with intravenous CYC therapy. We observed similar incidence rate for hemorrhagic cystitis in both patient groups concomitantly treated with or without mesna [9/583 (1.5%) vs 8/425 (1.8%) respectively, p = 0.08]. Cumulative CYC dose (HR for 10-g increments 1.24, p < 0.001) was associated with hemorrhagic cystitis. Conclusion. Cumulative dose was the only risk factor for hemorrhagic cystitis in patients treated with CYC. No proof was obtained for the uroprotective effect of mesna in our cohort.

Evaluation of oxidant and antioxidant status and relation with prolidase in systemic sclerosis.

SummaryPurposeSystemic sclerosis (SSc) is a disease characterized by fibrosis of the skin and organs; it is associated with diffuse fibroproliferative microangiopathy and autoimmune background. The studies have shown that the production of excessive free radicals and increased collagen synthesis by the fibroblasts play an important role in the pathophysiology of SSc. Prolidase is an important marker in collagen turnover. We aimed to compare total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and prolidase levels of SSc patients and healthy controls. We also investigated the relationship between prolidase and oxidative stress.MethodsA total of 38 SSc patients and 33 healthy volunteers were included in the study. Serum TAS, TOS, and prolidase activity were evaluated in the groups.ResultsIt was found that the TOS and OSI levels of patients were higher than those in the control group (P = 0.012 and 0.015, respectively), whereas TAS was not significantly different between groups (P = 0.451). Prolidase activity was lower in patients than in controls (P = 0.008). There was a weak correlation between prolidase and OSI in patients. It was found that TAS was lower by marginal significance in the patients with lung and gastrointestinal tract (GT) involvement than the patients without those (P = 0.067 and 0.059, respectively).ConclusionsOur data suggest that oxidative stress is increased in SSc. TAS is decreased in patients with lung and GT involvement. These results support that antioxidant treatment may be useful in SSc, especially in patients with lung and GT involvement. Antioxidant treatment may prevent organ involvement in SSc. TAS may be a marker that predicts the risk of involvement of a specific organ. In addition, prolidase may be a marker of SSc.ZusammenfassungZiel der StudieDie systemische Sklerose (SSc) ist eine Erkrankung, die durch Fibrose der Haut und der Organe gekennzeichnet ist; sie ist vergesellschaftet mit einer diffusen fibroproliferativen Mikroangiopathie und einem autoimmunen Hintergrund. Es konnte in verschiedenen Studien gezeigt werden, dass die überschießende Produktion von freien Radikalen und die gesteigerte Kollagensynthese durch Fibroblasten eine wichtige Rolle in der Pathophysiologie der SSc spielen. Prolidase ist ein wichtiger Marker des Turnovers von Kollagen. Ziel unserer Studie war es, den gesamten oxidativen Status (TOS), den gesamten antioxidativen Status (TAS), den oxidativen Stress Index (OSI) und die Serum-Konzentrationen der Prolidase bei Patienten mit SSc und bei gesunden Kontrollen zu erheben. Außerdem untersuchten wir, ob ein Zusammenhang zwischen Prolidase und oxidativem Stress besteht.Methodik38 Patienten mit SSc und 33 gesunde Freiwillige wurden in die Studie aufgenommen. Serum TAS, TOS und Prolidase-Aktivität wurden in beiden Gruppen erhoben.ErgebnisseDie TOS und OSI waren bei den Patienten höher als bei der Kontrolle (P = 0,012 beziehungsweise 0,015). Die TAS unterschied sich allerdings nicht signifikant zwischen beiden Gruppen (P = 0,451). Die Aktivität der Prolidase war bei den Patienten niedriger als bei den Gesunden (P = 0,008). Bei den Patienten bestand eine schwache Korrelation zwischen Prolidase und dem OSI. Bei den Patienten mit Beteiligung der Lunge und des Gastrointestinaltraktes (GI-Trakt) waren die TAS grenzwertig signifikant niedriger (P = 0,067 beziehungsweise 0,059) als bei den Patienten ohne Befall dieser Organe.SchlußfolgerungenUnsere Ergebnisse lassen vermuten, dass der oxidative Stress bei SSc erhöht ist. TAS ist bei Beteiligung der Lungen und des GI-traktes erniedrigt. Eine antioxidative Behandlung könnte daher bei SSc – vor allem wenn Lungen und GI-Trakt befallen sind, von Nutzen sein. Diese Behandlung könnte der Organbeteiligung vorbeugen. TAS könnte ein Marker sein, der das Risiko des Befalls eines bestimmten Organs vorhersagt. Außerdem könnte die Prolidase ein Marker der SSc sein.

Characteristics Predicting Tuberculosis Risk under Tumor Necrosis Factor-α Inhibitors: Report from a Large Multicenter Cohort with High Background Prevalence

Objective. Screening strategies for latent tuberculosis (TB) before starting tumor necrosis factor (TNF)-α inhibitors have decreased the prevalence of TB among patients who are treated with these agents. However, despite vigilant screening, TB continues to be an important problem, especially in parts of the world with a high background TB prevalence. The aim of this study was to determine the factors related to TB among a large multicenter cohort of patients who were treated with anti-TNF. Methods. Fifteen rheumatology centers participated in this study. Among the 10,434 patients who were treated with anti-TNF between September 2002 and September 2012, 73 (0.69%) had developed TB. We described the demographic features and disease characteristics of these 73 patients and compared them to 7695 patients who were treated with anti-TNF, did not develop TB, and had complete data available. Results. Among the 73 patients diagnosed with TB (39 men, 34 women, mean age 43.6 ± 13 yrs), the most frequent diagnoses were ankylosing spondylitis (n = 38) and rheumatoid arthritis (n = 25). More than half of the patients had extrapulmonary TB (39/73, 53%). Six patients died (8.2%). In the logistic regression model, types of anti-TNF drugs [infliximab (IFX), OR 3.4, 95% CI 1.88–6.10, p = 0.001] and insufficient and irregular isoniazid use (< 9 mos; OR 3.15, 95% CI 1.43–6.9, p = 0.004) were independent predictors of TB development. Conclusion. Our results suggest that TB is an important complication of anti-TNF therapies in Turkey. TB chemoprophylaxis less than 9 months and the use of IFX therapy were independent risk factors for TB development.

Diagnostic dilemma of paraneoplastic arthritis: case series.

Paraneoplastic arthritis (PA) may mimic rheumatic diseases. While presenting the demographic and laboratory features of the patients diagnosed with PA, this study also aims to provide possible appropriate tools to differentiate the PA cases from early rheumatoid arthritis (ERA).