Turkish Journal of Geriatrics-Turk Geriatri Dergisi, 2013
Girifl: Bu çal›flma, hemiplejik omuz a¤r›l› hastalarda lokal kortikosteroid enjeksiyonu ve fizik ... more Girifl: Bu çal›flma, hemiplejik omuz a¤r›l› hastalarda lokal kortikosteroid enjeksiyonu ve fizik tedavi modaliteleri kombinasyonunun tek bafl›na fizik tedavi modaliteleri etkinli¤ine üstün olup olmad›¤›n› araflt›rmak amac›yla yap›ld›. Gereç ve Yöntem: Bu çal›flmaya serebrovasküler bir olay sonras› hemipleji geçiren ve hemiplejiye ba¤l› omuz a¤r›s› geliflen 30 hasta al›nd›. Hastalar rastgele iki gruba ayr›ld›. Birinci gruba (enjeksiyon grubu) konvansiyonel fizik tedavi modaliteleri (hotpack, ultrason, TENS), 15 seans egzersiz tedavisi ve çal›flman›n bafllang›c›nda omuza lokal steroid enjeksiyonu yap›lan 15 kifli al›nd›. ‹kinci gruba (kontrol grubu) sadece konvansiyonel fizik tedavi modaliteleri ve egzersiz tedavisi uyguland›. Hastalar tedavi öncesi, tedavi program›n›n birinci haftas› ve tedavinin bitiminden sonraki 4. haftada olmak üzere toplam üç kez de¤erlendirildi. De¤erlendirmelerde vizüel analog skala, eklem hareket aç›kl›¤› ölçümleri, fonksiyonel ba¤›ms›zl›k ölçe¤i, Brunnstrom ...
International Journal of Medicine and Pharmacy, 2015
Objectives: Proinflammatory mediators play an important role in the pathophysiology and developme... more Objectives: Proinflammatory mediators play an important role in the pathophysiology and development of complex regional pain syndrome type 1. Elevated cytokine production is suggested to increase nitric oxide production by activating the inducible nitric oxide synthase pathway. In this study, we aimed to determine the circulating nitric oxide concentrations in complex regional pain syndrome type 1 patients, and to compare them with those of healthy controls. Methods: Serum circulating nitric oxide concentrations were measured in twenty-five patients (15 female and 10 male) with complex regional pain syndrome type 1 who fulfillied the criteria of the modified International Association for the Study of Pain (IASP) and compared those of twentyfive (15 female and 10 male) age, gender matched healthy subjects. Nitric oxide concentration is estimated indirectly based on Greiss method by measuring the combined oxidation products of nitric oxide (total nitrites and nitrates). Results: There was no significant difference in the demographic data among two groups (p>0.05). The mean serum nitric oxide concentration (39.50±13.26 µmol) was significantly higher in the complex regional pain syndrome type 1 patients group compared to those of controls (27.15±11.90 µmol) (p<0.001). Conclusions: We suggest that nitric oxide levels play an important role on inflammatory reactions in CPRS 1 patients.
Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2013
Sum mary Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small vess... more Sum mary Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small vessels. MPA is associated with renal dysfunction in most cases and occasionally with pulmonary hemorrhage. However, inflammatory polyarthritis is a rare manifestation. Here, we report the case of a 26-year-old man with MPA who developed rheumatoid arthritis. The patient presented with fever, general fatigue, weight loss, hemoptysis, polyarthritis, and macular rash. Clinical examination showed pulmonary capillaritis. Pathological findings revealed vasculitis of small vessels, including cutaneous leukocytoclastic vasculitis by the skin biopsy. MPA was diagnosed based on clinical symptoms, elevated perinuclear antineutrophil cytoplasmic (p-ANCA) antibody testing and the histopathological findings of lung biopsy specimens. The patient also had rheumatoid arthritis with positive anti-CCP antibody. He had no renal involvement and a negative antiglomerular basal membrane. We aimed to draw attention to the differential diagnosis of joint involvement with a case presenting MPA and RA coincidence.
Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2012
Sum mary Dermatomyositis (DM) is a connective tissue disease characterized by specific inflammato... more Sum mary Dermatomyositis (DM) is a connective tissue disease characterized by specific inflammatory lesions in muscle biopsy. An increased risk of underlying malignancy has been found in patients with DM. The common cancers associated with DM include ovarian cancer, lung cancer, pancreatic cancer, melanoma, colon cancer, non-Hodgkin's lymphoma, stomach cancer and breast cancer. The association between DM and breast cancer has not been fully evaluated. We present the case of a 58-year-old female patient with DM diagnosed to be suffering from breast cancer. A literature review revealed that the association of dermatomyositis with breast cancer is rare and consistent with poor prognosis.
This study was carried out to determine the serum levels of melatonin (MLT) in patients with anky... more This study was carried out to determine the serum levels of melatonin (MLT) in patients with ankylosing spondilitis (AS) and to evaluate its correlation with disease activity. We assessed clinical characteristics and labaratory parameters. Serum samples from 36 patients (25 males, 11 females) with active AS and 25 healthy subjects (18 males, 7 females) were collected. MLT levels were measured by enzyme-linked immunosorbent assay, and disease activity of AS was assessed according to the Bath AS disease activity index (BASDAI), the erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Then, the results were compared with those from 25 healty controls. The serum levels of MLT were significantly increased in AS patients as compared to healthy controls (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). MLT levels were correlated with BASDAI (r = 0.871, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and CRP levels (r = 0.691, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), but not with ESR, in patients with AS. Our results suggest a possible role for this immunoregulatory hormone in the disease activity in AS patients.
The fibromyalgia syndrome (FMS) is a chronic, widespread pain disorder of unknown etiology. It ha... more The fibromyalgia syndrome (FMS) is a chronic, widespread pain disorder of unknown etiology. It has been suggest that familial component, environmental factors, endocrine and neurotransmitter alterations, and psychological factors may contribute to the development of FMS. The role of melatonin in FMS is unclear. Some studies describe a lower nocturnal peak and a decreased secretion of melatonin in women with FMS when compared with healthy matched controls. The aim of the present study was to determine the possible role of melatonin in FMS patients. We examined the characteristics and levels of melatonin in 25 consecutive premenopausal women with FMS. Serum blood samples were collected from 25 patients and 20 the age and gender matched healthy controls. Melatonin levels were measured by enzyme-linked immunosorbent assay. Then, the results were compared with those from healthy subjects. Serum melatonin levels of FMS patients were not statistically different from those of controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). No association was observed between melatonin levels of patients with FMS and disease duration, sleep disturbances, fatigue, and pain scores. Our results demonstrate that melatonin levels were similar in patients with FMS and healthy controls. Further studies are needed to determine the possible role of melatonin.
Background: Prophylaxis of tuberculosis in patients treated with anti-tumor necrosis factor (Anti... more Background: Prophylaxis of tuberculosis in patients treated with anti-tumor necrosis factor (Anti-TNF) prevents the latent tuberculosis infections (LTBI). But incidence rate of tuberculosis with anti-TNF therapy in tuberculosis-endemic area is higher than in other areas despite strict prophylaxis. We analyzed incidences and characteristics of patients with reactivation of LTBI and new tuberculosis infection. Method: We identified 549 patients treated with anti-TNF in tertiary care center from June 2003 through June 2010. The number of patients with ankylosing spondylitis, rheumatoid arthritis, psoariatic arthritis, spondyloarthropathy and behcet's disease were 317, 215, 11, 3 and 3 respectively. Their medical records including history of tuberculosis infection were reviewed. Result: Among 549 patients, 526 patients took tuberculosis screening test and 266 patients had LTBI prophylaxis. Nevertheless, we observed 11 cases of tuberculosis (2.0%) and the incidence rate of tuberculosis was 968 per 100,000 person-years. Patients infected by tuberculosis were 6 non-LTBI, 4 LTBI received prophylaxis and 1 without screening test. The mean duration of anti-TNF therapy was 21.73 months and patients of extrapulmonary tuberculosis were 9. Among 11 tuberculosis patients, 3 non-LTBI patients and 2 LTBI patients who received prophylaxis were infected by tuberculosis after anti-TNF therapy of 12 months and their mean duration of anti-TNF therapy was 40.8 months. In addition, three non-LTBI patients treated with anti-TNF therapy for less than 12 months were infected by new tuberculosis or reactivated LTBI with false-negative screening test. Conclusion: The incidence of tuberculosis in patients treated with anti-TNF was higher than other previous reports. This result show that the reactivation of LTBI and development of new tuberculosis infection as a long period of anti-TNF therapy for the endemic area. Screening and prophylaxis of LTBI are important but we also have to be concerned about new tuberculosis infection during anti-TNF therapy.
Background: Arthritis in familial Mediterranean fever (FMF) is typically monoarticular, of sudden... more Background: Arthritis in familial Mediterranean fever (FMF) is typically monoarticular, of sudden onset, self-limiting, rarely destructive, and a frequent manifestation of FMF. The mechanisms governing the initiation and resolution of this highly inflammatory disease entity are not fully understood. Therefore, to decipher the complexity of articular autoinflammation, we defined inflammatory cells and some mediators of inflammation and apoptosis in the synovial membrane of a patient with FMF. Methods: A synovial tissue sample obtained from an inflamed hip joint of a boy homozygous for mutation M694I in pyrin/marenostrin was studied by immunohistochemistry using commercially available antibodies specific for tryptase, CD68, CD3, CD20 and CD138. With the same technique, we also analyzed the expression and distribution of myeloperoxidase, lysozyme, galectin-1, galectin-3, p65 (RelA)/NF-B, iNOS, COX-2 and activated caspase-3. Results: Abundant neutrophils, macrophages and mast cells, but also B cells were observed, which were more numerous than T lymphocytes or plasma cells. Neutrophils had no granules containing myeloperoxidase or lysozyme in their cytoplasm. Galectin-1 was found in many mononuclear cells sparse throughout the synovial tissue, whereas the expression of galectin-3 was less prominent and scattered. Neither of the galectins was detected in neutrophils. p65 (RelA)/NF-B and iNOS were both up-regulated in most of the inflammatory cells, whereas COX-2 expression was low, and cleaved caspase-3, used as proxy to demonstrate intrinsic apoptosis, was undetectable. Conclusions: The exquisitely inflammatory, yet non-destructive character of FMF arthritis may correlate with the presence of nonpathogenic neutrophils lacking effector molecules and the preferential expression of iNOS and anti-inflammatory galectin-1 in regulatory cells of the innate immune system, most likely in macrophages. Intrinsic apoptosis seemed irrelevant for controlling synovial autoinflammation, but regulation through pyroptosis, mast cells and the adaptive immune system are possible alternatives.
Familial Mediterranean fever (FMF) is an autosomal, recessively inherited multisystem disease tha... more Familial Mediterranean fever (FMF) is an autosomal, recessively inherited multisystem disease that affects various groups of people originating from the Mediterranean Sea region, most specifically those of Jewish, Turkish, Armenian, and Arabic ethnicity. Recurrent attacks of fever and sterile polyserositis of the peritoneum, synovial membranes, and pleura are the main clinical features, although the clinical features of FMF have been expanded in recent years to also include severe myalgia, scrotal swelling, cardiac involvement, and protracted febrile myalgia syndrome (PFMS). PFMS is seen in only a small percentage of FMF patients and is characterized by severe debilitating myalgia of the upper and lower extremities and high fever, occasionally accompanied by abdominal pain, diarrhea, arthritis/arthralgia, and transient vasculitic purpura mimicking Henoch-Schönlein purpura (HSP). Here, we report on a patient with FMF who also presents with PFMS, which is an uncommon and severe manifestation of the disease.
Objective: Complex regional pain syndrome (CRPS) type I is one of the most important problems wit... more Objective: Complex regional pain syndrome (CRPS) type I is one of the most important problems with regard to physical medicine and rehabilitation. CRPS may cause not only higher therapeutic costs but also greater work time loss. The mechanism and pathogenesis of CRPS still remains unknown. Some findings indicating oxidative stress have been reported. This study was carried out to determine the role of oxidative stress in patients with CRPS. Materials and methods: Twenty patients (13 women and seven men) with CRPS and 20 age-and sex-matched healthy controls were enrolled in this study. Complex regional pain syndrome was diagnosed according to the modified International Association for the Study of Pain (IASP) criteria. We evaluated demographic, clinical and laboratory characteristics of the patients. Antioxidant enzymatic activities consisting of serum superoxide dismutase (SOD), glutathion peroxidase (GPX) and glutathione S-transferase (GST) activities were measured using appropriate methods and compared with healthy controls. Results: The mean age of the patients was 39.5 years and the mean duration of symptoms was 5.5 months. Complex regional pain syndrome devoleped after a traumatic event in 90% of patients. In 10% of patients there were no traumatic events. SOD, GPX and GST levels were significantly higher in patients with CRPS than healthy controls (P = 0.012, P = 0.036 and P = 0.016, respectively). Conclusion: Our findings suggest a possible role of oxidative stress in the pathogenesis of CRPS.
Introduction: The lack of expertise in the diagnosis of rheumatoid arthritis (RA) by general prac... more Introduction: The lack of expertise in the diagnosis of rheumatoid arthritis (RA) by general practitioners (GPs) has led to misdiagnosis of patients with this disease. It was found that osteoarthritis (OA) is one of the most frequent causes of false-positive classification of OA as RA.
Turkish Journal of Geriatrics-Turk Geriatri Dergisi, 2013
Girifl: Bu çal›flma, hemiplejik omuz a¤r›l› hastalarda lokal kortikosteroid enjeksiyonu ve fizik ... more Girifl: Bu çal›flma, hemiplejik omuz a¤r›l› hastalarda lokal kortikosteroid enjeksiyonu ve fizik tedavi modaliteleri kombinasyonunun tek bafl›na fizik tedavi modaliteleri etkinli¤ine üstün olup olmad›¤›n› araflt›rmak amac›yla yap›ld›. Gereç ve Yöntem: Bu çal›flmaya serebrovasküler bir olay sonras› hemipleji geçiren ve hemiplejiye ba¤l› omuz a¤r›s› geliflen 30 hasta al›nd›. Hastalar rastgele iki gruba ayr›ld›. Birinci gruba (enjeksiyon grubu) konvansiyonel fizik tedavi modaliteleri (hotpack, ultrason, TENS), 15 seans egzersiz tedavisi ve çal›flman›n bafllang›c›nda omuza lokal steroid enjeksiyonu yap›lan 15 kifli al›nd›. ‹kinci gruba (kontrol grubu) sadece konvansiyonel fizik tedavi modaliteleri ve egzersiz tedavisi uyguland›. Hastalar tedavi öncesi, tedavi program›n›n birinci haftas› ve tedavinin bitiminden sonraki 4. haftada olmak üzere toplam üç kez de¤erlendirildi. De¤erlendirmelerde vizüel analog skala, eklem hareket aç›kl›¤› ölçümleri, fonksiyonel ba¤›ms›zl›k ölçe¤i, Brunnstrom ...
International Journal of Medicine and Pharmacy, 2015
Objectives: Proinflammatory mediators play an important role in the pathophysiology and developme... more Objectives: Proinflammatory mediators play an important role in the pathophysiology and development of complex regional pain syndrome type 1. Elevated cytokine production is suggested to increase nitric oxide production by activating the inducible nitric oxide synthase pathway. In this study, we aimed to determine the circulating nitric oxide concentrations in complex regional pain syndrome type 1 patients, and to compare them with those of healthy controls. Methods: Serum circulating nitric oxide concentrations were measured in twenty-five patients (15 female and 10 male) with complex regional pain syndrome type 1 who fulfillied the criteria of the modified International Association for the Study of Pain (IASP) and compared those of twentyfive (15 female and 10 male) age, gender matched healthy subjects. Nitric oxide concentration is estimated indirectly based on Greiss method by measuring the combined oxidation products of nitric oxide (total nitrites and nitrates). Results: There was no significant difference in the demographic data among two groups (p>0.05). The mean serum nitric oxide concentration (39.50±13.26 µmol) was significantly higher in the complex regional pain syndrome type 1 patients group compared to those of controls (27.15±11.90 µmol) (p<0.001). Conclusions: We suggest that nitric oxide levels play an important role on inflammatory reactions in CPRS 1 patients.
Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2013
Sum mary Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small vess... more Sum mary Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small vessels. MPA is associated with renal dysfunction in most cases and occasionally with pulmonary hemorrhage. However, inflammatory polyarthritis is a rare manifestation. Here, we report the case of a 26-year-old man with MPA who developed rheumatoid arthritis. The patient presented with fever, general fatigue, weight loss, hemoptysis, polyarthritis, and macular rash. Clinical examination showed pulmonary capillaritis. Pathological findings revealed vasculitis of small vessels, including cutaneous leukocytoclastic vasculitis by the skin biopsy. MPA was diagnosed based on clinical symptoms, elevated perinuclear antineutrophil cytoplasmic (p-ANCA) antibody testing and the histopathological findings of lung biopsy specimens. The patient also had rheumatoid arthritis with positive anti-CCP antibody. He had no renal involvement and a negative antiglomerular basal membrane. We aimed to draw attention to the differential diagnosis of joint involvement with a case presenting MPA and RA coincidence.
Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2012
Sum mary Dermatomyositis (DM) is a connective tissue disease characterized by specific inflammato... more Sum mary Dermatomyositis (DM) is a connective tissue disease characterized by specific inflammatory lesions in muscle biopsy. An increased risk of underlying malignancy has been found in patients with DM. The common cancers associated with DM include ovarian cancer, lung cancer, pancreatic cancer, melanoma, colon cancer, non-Hodgkin's lymphoma, stomach cancer and breast cancer. The association between DM and breast cancer has not been fully evaluated. We present the case of a 58-year-old female patient with DM diagnosed to be suffering from breast cancer. A literature review revealed that the association of dermatomyositis with breast cancer is rare and consistent with poor prognosis.
This study was carried out to determine the serum levels of melatonin (MLT) in patients with anky... more This study was carried out to determine the serum levels of melatonin (MLT) in patients with ankylosing spondilitis (AS) and to evaluate its correlation with disease activity. We assessed clinical characteristics and labaratory parameters. Serum samples from 36 patients (25 males, 11 females) with active AS and 25 healthy subjects (18 males, 7 females) were collected. MLT levels were measured by enzyme-linked immunosorbent assay, and disease activity of AS was assessed according to the Bath AS disease activity index (BASDAI), the erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Then, the results were compared with those from 25 healty controls. The serum levels of MLT were significantly increased in AS patients as compared to healthy controls (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). MLT levels were correlated with BASDAI (r = 0.871, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and CRP levels (r = 0.691, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), but not with ESR, in patients with AS. Our results suggest a possible role for this immunoregulatory hormone in the disease activity in AS patients.
The fibromyalgia syndrome (FMS) is a chronic, widespread pain disorder of unknown etiology. It ha... more The fibromyalgia syndrome (FMS) is a chronic, widespread pain disorder of unknown etiology. It has been suggest that familial component, environmental factors, endocrine and neurotransmitter alterations, and psychological factors may contribute to the development of FMS. The role of melatonin in FMS is unclear. Some studies describe a lower nocturnal peak and a decreased secretion of melatonin in women with FMS when compared with healthy matched controls. The aim of the present study was to determine the possible role of melatonin in FMS patients. We examined the characteristics and levels of melatonin in 25 consecutive premenopausal women with FMS. Serum blood samples were collected from 25 patients and 20 the age and gender matched healthy controls. Melatonin levels were measured by enzyme-linked immunosorbent assay. Then, the results were compared with those from healthy subjects. Serum melatonin levels of FMS patients were not statistically different from those of controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). No association was observed between melatonin levels of patients with FMS and disease duration, sleep disturbances, fatigue, and pain scores. Our results demonstrate that melatonin levels were similar in patients with FMS and healthy controls. Further studies are needed to determine the possible role of melatonin.
Background: Prophylaxis of tuberculosis in patients treated with anti-tumor necrosis factor (Anti... more Background: Prophylaxis of tuberculosis in patients treated with anti-tumor necrosis factor (Anti-TNF) prevents the latent tuberculosis infections (LTBI). But incidence rate of tuberculosis with anti-TNF therapy in tuberculosis-endemic area is higher than in other areas despite strict prophylaxis. We analyzed incidences and characteristics of patients with reactivation of LTBI and new tuberculosis infection. Method: We identified 549 patients treated with anti-TNF in tertiary care center from June 2003 through June 2010. The number of patients with ankylosing spondylitis, rheumatoid arthritis, psoariatic arthritis, spondyloarthropathy and behcet's disease were 317, 215, 11, 3 and 3 respectively. Their medical records including history of tuberculosis infection were reviewed. Result: Among 549 patients, 526 patients took tuberculosis screening test and 266 patients had LTBI prophylaxis. Nevertheless, we observed 11 cases of tuberculosis (2.0%) and the incidence rate of tuberculosis was 968 per 100,000 person-years. Patients infected by tuberculosis were 6 non-LTBI, 4 LTBI received prophylaxis and 1 without screening test. The mean duration of anti-TNF therapy was 21.73 months and patients of extrapulmonary tuberculosis were 9. Among 11 tuberculosis patients, 3 non-LTBI patients and 2 LTBI patients who received prophylaxis were infected by tuberculosis after anti-TNF therapy of 12 months and their mean duration of anti-TNF therapy was 40.8 months. In addition, three non-LTBI patients treated with anti-TNF therapy for less than 12 months were infected by new tuberculosis or reactivated LTBI with false-negative screening test. Conclusion: The incidence of tuberculosis in patients treated with anti-TNF was higher than other previous reports. This result show that the reactivation of LTBI and development of new tuberculosis infection as a long period of anti-TNF therapy for the endemic area. Screening and prophylaxis of LTBI are important but we also have to be concerned about new tuberculosis infection during anti-TNF therapy.
Background: Arthritis in familial Mediterranean fever (FMF) is typically monoarticular, of sudden... more Background: Arthritis in familial Mediterranean fever (FMF) is typically monoarticular, of sudden onset, self-limiting, rarely destructive, and a frequent manifestation of FMF. The mechanisms governing the initiation and resolution of this highly inflammatory disease entity are not fully understood. Therefore, to decipher the complexity of articular autoinflammation, we defined inflammatory cells and some mediators of inflammation and apoptosis in the synovial membrane of a patient with FMF. Methods: A synovial tissue sample obtained from an inflamed hip joint of a boy homozygous for mutation M694I in pyrin/marenostrin was studied by immunohistochemistry using commercially available antibodies specific for tryptase, CD68, CD3, CD20 and CD138. With the same technique, we also analyzed the expression and distribution of myeloperoxidase, lysozyme, galectin-1, galectin-3, p65 (RelA)/NF-B, iNOS, COX-2 and activated caspase-3. Results: Abundant neutrophils, macrophages and mast cells, but also B cells were observed, which were more numerous than T lymphocytes or plasma cells. Neutrophils had no granules containing myeloperoxidase or lysozyme in their cytoplasm. Galectin-1 was found in many mononuclear cells sparse throughout the synovial tissue, whereas the expression of galectin-3 was less prominent and scattered. Neither of the galectins was detected in neutrophils. p65 (RelA)/NF-B and iNOS were both up-regulated in most of the inflammatory cells, whereas COX-2 expression was low, and cleaved caspase-3, used as proxy to demonstrate intrinsic apoptosis, was undetectable. Conclusions: The exquisitely inflammatory, yet non-destructive character of FMF arthritis may correlate with the presence of nonpathogenic neutrophils lacking effector molecules and the preferential expression of iNOS and anti-inflammatory galectin-1 in regulatory cells of the innate immune system, most likely in macrophages. Intrinsic apoptosis seemed irrelevant for controlling synovial autoinflammation, but regulation through pyroptosis, mast cells and the adaptive immune system are possible alternatives.
Familial Mediterranean fever (FMF) is an autosomal, recessively inherited multisystem disease tha... more Familial Mediterranean fever (FMF) is an autosomal, recessively inherited multisystem disease that affects various groups of people originating from the Mediterranean Sea region, most specifically those of Jewish, Turkish, Armenian, and Arabic ethnicity. Recurrent attacks of fever and sterile polyserositis of the peritoneum, synovial membranes, and pleura are the main clinical features, although the clinical features of FMF have been expanded in recent years to also include severe myalgia, scrotal swelling, cardiac involvement, and protracted febrile myalgia syndrome (PFMS). PFMS is seen in only a small percentage of FMF patients and is characterized by severe debilitating myalgia of the upper and lower extremities and high fever, occasionally accompanied by abdominal pain, diarrhea, arthritis/arthralgia, and transient vasculitic purpura mimicking Henoch-Schönlein purpura (HSP). Here, we report on a patient with FMF who also presents with PFMS, which is an uncommon and severe manifestation of the disease.
Objective: Complex regional pain syndrome (CRPS) type I is one of the most important problems wit... more Objective: Complex regional pain syndrome (CRPS) type I is one of the most important problems with regard to physical medicine and rehabilitation. CRPS may cause not only higher therapeutic costs but also greater work time loss. The mechanism and pathogenesis of CRPS still remains unknown. Some findings indicating oxidative stress have been reported. This study was carried out to determine the role of oxidative stress in patients with CRPS. Materials and methods: Twenty patients (13 women and seven men) with CRPS and 20 age-and sex-matched healthy controls were enrolled in this study. Complex regional pain syndrome was diagnosed according to the modified International Association for the Study of Pain (IASP) criteria. We evaluated demographic, clinical and laboratory characteristics of the patients. Antioxidant enzymatic activities consisting of serum superoxide dismutase (SOD), glutathion peroxidase (GPX) and glutathione S-transferase (GST) activities were measured using appropriate methods and compared with healthy controls. Results: The mean age of the patients was 39.5 years and the mean duration of symptoms was 5.5 months. Complex regional pain syndrome devoleped after a traumatic event in 90% of patients. In 10% of patients there were no traumatic events. SOD, GPX and GST levels were significantly higher in patients with CRPS than healthy controls (P = 0.012, P = 0.036 and P = 0.016, respectively). Conclusion: Our findings suggest a possible role of oxidative stress in the pathogenesis of CRPS.
Introduction: The lack of expertise in the diagnosis of rheumatoid arthritis (RA) by general prac... more Introduction: The lack of expertise in the diagnosis of rheumatoid arthritis (RA) by general practitioners (GPs) has led to misdiagnosis of patients with this disease. It was found that osteoarthritis (OA) is one of the most frequent causes of false-positive classification of OA as RA.
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