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

Evaluation of frequency and the attacks features of patients with colchicine resistance in FMF

Introduction: Colchicine is the mainstay for the treatment of FMF, which is an auto-inflammatory disease mainly with relapsing polyserositis. Despite daily doses of 2 mg ormore each day, approximately 5% to 10% of the patients continue to suffer from its attacks. In this study, we aimed to investigate the depression and attack features in patients withFMF who have colchicine resistance (CR).Patients e Methods: CR was defined for FMF patients with 2 or more attacks within the last6 months period while using 2 mg/day colchicine. Eighteen patients (9 Female/9 Male) wereenrolled into the CR group and 41 patients were enrolled into the control group (12 Male/29Female). Demographic, clinical e laboratory findings, treatment adherence, and the BeckDepression Inventory (BDI) scores were evaluated. Results: The age of onset of FMF was significantly lower in the CR group (12.3 yrs vs. 16.9 yrs, P = 0.03). Disease duration was longer in the CR group (P = 0.01). Abdominal and leg pain dueto exercise were significantly more frequent in the CR group versus controls (83% vs. 51%;P = 0.02 e 88% vs. 60%; P = 0.04, respectively). Patients with BDI scores over 17 points weremore frequent in the CR group compared to controls (50% vs. 34.1%; P < 0.001).Discussion: We found that: (1) the age of disease onset was lower and (2) the disease durationwas longer in CR group. Pleuritic attacks, hematuria e proteinuria were more frequent in CRpatients. We propose that depression is an important factor to consider in the susceptibilityto CR. © 2014 Elsevier Editora Ltda

Ailesel Akdeniz Ateşi

Otoinfl amatuvar hastalıkların en sık olanı Ailesel Akdeniz Ateşidir (AAA). Ani başlayan ateş ve seröz zarların infl amasyonu ile karakterizedir. On altıncı kromozomun kısa kolunda (MEFV geni) otozomal resesif olarak kalıtılmaktadır. AAA esas olarak, Akdeniz kıyısında bulunan Sefardik Yahudiler, Ermeniler, Türkler ve Araplar’da sık tanımlanmıştır. Hastalığın tipik belirtileri 1–3 gün süren şiddetli karın ağrısı ve tekrarlayan ateş atakları ve daha sonra bu atakların kendiliğinden çözülmesidir. Ataklar arasında, hastalar kendilerini tamamen iyi hissederler.Karın ağrısı ve ateş genellikle ani başlangıçlı olup kısa bir süre içinde zirveye ulaşır. AAA hastalarının yüzde doksan beşinde hastalığın en baskın şekli karın ağrısıdır. Ağrı atakları göğse lokalize olabilir. Artrit AAA’ nın diğer önemli klinik bulgusudur. Atak sırasında infl amasyonun sistemik serum belirteçlerinin yükselmesi tabloya eşlik eder. Hastaların çoğunda kolşisin etkilidir. Son yıllarda AAA’nın hem genetiği hem de tedavisi ile ilgili gelişmeler oldu. Bu derlemede, AAA ile ilgili bu gelişmeler aktarılmaya çalışıldı.

Effect of clonazepam on Raynaud's phenomenon and fingertip ulcers in scleroderma

OBJECTIVE: To report the novel finding of a significant improvement in Raynaud's phenomenon symptoms with clonazepam in a patient with systemic sclerosis. CASE SUMMARY: A 45-year-old female with limited scleroderma and chronic renal failure was admitted to our hospital due to hyponatremia (sodium 103 mEq/L). Her hyponatremia was treated by intravenous infusion of NaCl 3%. Clonazepam, which had been prescribed previously for anxiety and insomnia, was discontinued. Three weeks after she was discharged from the hospital, the patient presented with the complaint of increased severity of Raynaud's phenomenon and digital ulcers. She told us that her fingertip ulcers had been healed while she was taking clonazepam and that episodes of Raynaud's phenomenon had increased after discontinuation of the drug. Clonazepam 1 mg twice daily was restarted, and Raynaud's phenomenon and fingertip ulcers resolved within a month. On 2 occasions after that time, we discontinued clonazepam and replaced it with alprazolam, as the patient believed alprazolam was more beneficial in alleviating anxiety. Episodes of Raynaud's phenomenon and new digital ulcers recurred on both of these occasions, and clonazepam was restarted. At the time of writing, no severe episodes of Raynaud's phenomenon or fingertip ulcers have occurred with clonazepam treatment. DISCUSSION: Raynaud's phenomenon and recurrent digital ulcers are a manifestation of vascular disease in patients with systemic sclerosis and lead to pain, impaired function, and tissue loss. Few drugs have previously been shown to affect digital ulcers in the setting of scleroderma. Our patient experienced a significant and sustained improvement in Raynaud's phenomenon and digital ulcers following the initiation of clonazepam. To our knowledge, as of March 2007, this is the first reported use of clonazepam in Raynaud's phenomenon and digital ulcer. While its therapeutic mechanism remains unclear, clonazepam may offer some advantages compared with current agents. CONCLUSIONS: We report a case of Raynaud's phenomenon and digital ulcers responding to clonazepam. Further research is warranted to test the robustness of this preliminary finding

MEFV Gene Mutation Frequency and Correlation of Mutations with Clinical Symptoms in Gout

Abstract Not Availabl