The role of nailfold capillaroscopy in interstitial lung diseases - Can it differentiate idiopathic cases from collagen tissue disease associated interstitial lung diseases?

Introduction: Nailfold capillaroscopy (NFC) is a non-invasive diagnostic test that is mostly used for early diagnosis of collagen tissue diseases (CTDs). We aimed to evaluate whether NFC findings could be a clue for discriminating idiopathic interstitial lung diseases (ILD) from CTD associated ILDs (CTD-ILD). Additionally it was aimed to determine whether NFC could be helpful in discriminating usual interstitial pneumonia (UIP) pattern from non-specific interstitial pneumonia (NSIP) pattern. Materials and Methods: We grouped patients into three main groups: 15 CTD-ILD, 18 idiopathic ILD, and 17 patients in the control group. The CTD-ILD group was split into two subgroups: 8 patients with Sjögren’s syndrome (SJS)-associated ILD and 7 with rheumatoid arthritis (RA)-associated ILD. The idiopathic-ILD group consisted of 10 idiopathic NSIP and 8 IPF patients. The control group consisted of 10 SJS and 7 RA patients without lung disease. None of the patients were on acute exacerbation at the time of examination, and none had Reynaud’s phenomenon. Results: Mean capillary density was significantly reduced only in the CTD-ILD group as compared to the control group (p= 0.006). In subgroup analysis, it was determined that RA-ILD, IPF, and SJSILD subgroups had more severe capillaroscopic abnormalities. Mean capillary density in patients with the UIP pattern was reduced compared to patients with the NSIP pattern and those in the control group; p values were 0.008 and < 0.001, respectively. Conclusion: This study is to be the first describing and comparing the nailfold capillaroscopic findings of patients with NSIP and UIP patterns. NFC findings can be helpful in discriminating UIP patterns from NSIP patterns. But to show its role in differentiating idiopathic disease, more studies with more patients are needed. © 2015, Ankara University. All rights reserved

Kronik yaygın ağrılı kadınlarda ağrı ve yorgunluğu etkileyen faktörler

Amaç: Bu çalışma Kronik Yaygın Ağrı’lı (KYA) kadınlarda ağrı şiddeti ve genel yorgunlukla ilişkili faktörleri incelemek amacıyla yapıldı. Gereç ve yöntem: KYA’lı 104 hasta dahil edildi. Yaş ortalaması 40.28±10.82 yıldı. Hem ağrı şiddeti hem de genel yorgunluk görsel analog skalası kullanılarak değerlendirildi. Hastane Anksiyete ve Depresyon Ölçeği anksiyete ve depresyon bulgularını tanımlamak için kullanıldı. Üç farklı anket (boş zaman aktivitesi, iş ve evde fiziksel aktivite) fiziksel aktivite düzeylerini tanımlamak için kullanıldı. Sonuçlar: Anksiyete skoru ağrı eşiğini etkileyen en yaygın faktördü (p=0.003). Diğer taraftan, orta düzeydeki evdeki fiziksel aktivite (p=0.027), işteki fiziksel aktivite (p=0.008) ve anksiyete skoru (p=0.027) genel yorgunluğu etkileyen anlamlı faktörlerdi. Tartışma: Sonuçlarımız anksiyetenin KYA’lı kadınlarda ağrı ve genel yorgunluğu etkileyen en önemli faktör olduğunu göstermiştir. Bu sonuçlar ağrı, yorgunluk ve anksiyete özelliklerinin ayrıca değerlendirilmesinin gerekli olduğu düşüncesini desteklemektedir.Purpose: This study was conducted to investigate factors related to pain intensity and global fatigue in females with Chronic Widespread Pain (CWP). Material and methods: One hundred four patients with CWP were included. The mean age was 40.28±10.82 years. Both Pain intensity and global fatigue were assessed using a Visual Analogue Scale (VAS). The Hospital Anxiety and Depression Scale was used to describe anxiety and depression symptoms. Three different questionnaires (leisure time activity, and physical activity at home, at work) were used to determine physical activity levels. Dorsal regression was used to analyze the data. Results: The anxiety score was the most common factor affecting pain intensity (p=0.003). On the other hand, a moderate level of physical activity at home (p=0.027), physical activity level at work (p=0.008), and the anxiety score (p=0.027) were significant factors affecting global fatigue. Conclusion: Our results show that anxiety is the most important factor affecting both pain and global fatigue in women with CWP. These results also support the idea that the characteristics of pain, fatigue and anxiety should be evaluated separately

Evaluation of biventricular myocardial performance index in patients with Behçet's disease

Objective: The global function of both left ventricular (LV) and right ventricular (RV) functions were compared in patients with Behçet's disease (BD) versus healthy controls. Methods: Biventricular function was evaluated by measurement of the myocardial performance index (MPI) evaluated from tissue Doppler echocardiographic measurements in 24 BD patients and was compared with measurements in 24 age- and sex-matched healthy controls. Results: Significantly higher MPI values were associated with ventricular dysfunction. The study demonstrated impaired RV function in patients with BD compared with healthy controls, whereas normal LV function was observed both in patients with BD and in healthy controls. Conclusion: Early noninvasive evaluation of the properties of BD during the asymptomatic phase of this inflammatory disease may have prognostic value in the management of patients. © 2012 Field House Publishing LLP

PTPN22 gene polymorphism in Takayasu's arteritis

Objective. Takayasu's arteritis (TA) is a chronic, rare granulomatous panarteritis of unknown aetiology involving mainly the aorta and its major branches. In this study, genetic susceptibility to TA has been investigated by screening the functional single nucleotide polymorphism (SNP) of PTPN22 gene encoding the lymphoid-specific protein tyrosine phosphatase. Methods. Totally, 181 patients with TA and 177 healthy controls are genotyped by PCR-RFLP method for the SNP rs2476601 (A/G) of PTPN22 gene. Polymorphic region was amplified by PCR and digested with Xcm I enzyme. Results. Detected frequencies of heterozygous genotype (AG) were 5.1% (9/177) in control group and 3.8% (7/181) in TA group (P = 0.61, odds ratio: 0.75, 95% CI: 0.3, 2.0). No association with angiographic type, vascular involvement or prognosis of TA was observed either. Conclusion. The distribution of PTPN22 polymorphism did not reveal any association with TA in Turkey. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved

Development of Two Types of Skin Cancer in a Patient with Systemic Sclerosis: a Case Report and Overview of the Literature

Systemic sclerosis (SSc) is an uncommon rheumatic disease in which the underlying main histopathologic feature is a thickening of the skin due to excessive accumulation of collagen in the extracellular tissue. Fibrogenesis, chronic inflammation, and ulceration may eventually promote skin neoplasms. Although nonmelanoma skin cancer (NMSC) is the most frequent type, there have been restricted case reports and case series with skin cancers in SSc patients in the literature. Herein, we describe a 78-year-old woman diagnosed with diffuse cutaneous systemic sclerosis thirteen years ago and associated nonspecific interstitial pneumonia that was successfully treated with high cumulative doses of cyclophosphamide. She developed basal cell carcinoma and squamous cell carcinoma of the skin in the follow-up. She is still on rituximab treatment with stable interstitial lung disease as indicated by pulmonary function tests and high-resolution chest computed tomography. To our knowledge and a literature search, this is the first reported patient with SSc with two types of skin cancer. In this review, we also aimed to emphasize the relationship between SSc and skin cancer, and possible risk factors for SSc-related skin cancer

Rare Association of Antiphospholipid Antibody Syndrome, Systemic Lupus Erythematosus and Aortic Dissection: A Striking Presentation with Multi-Organ Failure?

Systemic lupus erythematosus is a chronic autoimmune disease with a wide variety of clinical presentations induced by different immunocomplexes and autoantibodies. Antiphospholipid antibody syndrome (APLAS) is a life-threatening clinical condition characterized by venous and arterial thromboses or pregnancy morbidity in the presence of persistent moderate/high levels of antiphospholipid antibodies. Aortic dissection is rarely associated with APLAS and always requires prompt diagnosis and early treatment. We report a rare case with a striking presentation. The patient developed multi-organ failure due to lethal aortic dissection and the obstruction of abdominal and thoracic branch vessels. LEARNING POINTS: Aortic dissection is a rare lethal clinical condition that always requires prompt diagnosis and early treatment.Signs of multi-organ ischaemia due to obstruction of abdominal and thoracic branch vessels should be kept in mind by clinicians.Venous thrombosis and medial wall necrosis in the aorta may be underlying complex pathophysiological mechanisms in patients with antiphospholipid antibody syndrome