Erosive arthritis in a patient with primary sjogren's syndrome: a case report

Primer Sjögren sendromu, sıklıkla ağız ve göz kuruluğu ile seyreden bir kronik otoimmun ekzokrinopatidir. Ağız içi bezleri ve göz yası bezleri dışında, nadir de olsa diğer ekzokrin bezler de etkilenebilir. En sık kas-iskelet sistem tutulusu ile karsımıza çıkmaktadır. Artralji, sabah tutukluğu ve romatoid artrite benzer kronik inflamatuvar poliartrit, eklem bulgularını oluşturmaktadır. Romatoid artrit'ten farklı olarak, Sjögren sendromunda sabah tutukluğu ve hareket kısıtlığı daha hafif olup, el ve el bilek deformasyonları görülmektedir. Romatoid artrit'ten ayıran en önemli özellik ise, direk grafi ve/veya magnetik rezonans görüntülerde, eklemlerde eroziv değişikliklerin olmamasıdır. Bu bildiride, primer Sjögren sendromu tanısı almış hastada, eroziv artrit rapor edilmiştir.Primary Sjogren's syndrome (SS) is an autoimmune exocrinopathy characterized by dry eyes and dry mouth. Exocrine glands other than salivary and lacrimal glands may be affected less frequently. The most common mode of presentation is musculoskeletal system involvement. Articular signs and symptoms include arthralgias, morning stiffness, and chronic polyarthritis that resemble those seen in rheumatoid arthritis (RA). Compared with RA, the arthritis tends to be more relapsing and remitting, and stiffness is less marked. The distinction fromRAis that, there is not any erosive changes neither on direct radiography nor magnetic resonance imaging (MRI).We report a patient of primary SS presented with erosive arthritis

Magnetic resonance ımaging of the sacroiliac joints in ankylosing spondilitis before and after therapy with anti-tumor necrosis factor alpha

AMAÇ: Çalışmanın amacı, dirençli AS'li hastalarda, anti-TNF-alfa ilaçların etkinliğini ve güvenirliğini yanısıra, manyetik rezonans (MR) görüntüleme ile tedavi öncesi ve sonrası sakroiliak eklem değişiklerini tespit etmektir. GEREÇ ve YÖNTEM: Modifiye New York tanı kriterlerine göre AS tanısı almış, 27 hasta çalışmaya dahil edildi. Sakroiilitis bulguları, anti-TNF-alfa tedavi öncesi ve sonrası, Gd-MR ile tespit edildi. Sekiz hastaya, 4 haftada bir İnfliximab 4 mg/kg i.v. infüzıon verildi. Diğer 19 hastaya ise Etanercept 2x25 mg/hafta s.c. verildi. Değerlendirilen klinik ve laboratuvar parametreler; BASDAı, BASFı, ağrı (VAS skoru), Schöber testi, göğüs ekspansiyonu, C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH). BULGULAR: Hastaların çoğu, anti-TNF-alfa tedavilerine iyi yanıt verdi. 24. haftanın sonunda, takip edilen tüm parametrelerde iyileşme gözlendi. MR görüntüleme çalışmalarında, anti-TNF-alfa tedavi sonrası sadece 3 hastanın sakroiliak eklem inflamasyonunda gerileme gözlendi. SONUÇ: Aktif AS'li hastalarda, 24. hafta sonunda anti-TNF-alfa ilaçları güvenilir ve etkin bulundu. BASDAı, BASFı, ağrı skorlarında belirgin düşüş gözlendi. Fakat, sakroiliak eklemin akut inflamatuvar bulgularında, MR görüntüleme ile herhangi bir gerileme tespit edilmedi.OBJECTIVE: The goal of this study is to assess the changes in the sacroiliac joints (Sİ) by magnetic resonance imaging (MRI) in a 24-week follow-up period and to determine the efficacy and safety of anti-TNF-α therapies for refractory AS. MATERIALS and METHODS: Twenty-seven patients who met the modified New York criteria for AS were enrolled in this study. Activity of sacroiliitis was determined by Gd-MRI scan before and after anti-TNF-α treatment. Eight patients received infliximab at a dose of 4mg/kg by intravenous infusion over 2 hours at every 4 week. Other 19 patients were treated with 25mg subcutaneous etanercept twice weekly. Total observational period was 24 weeks. The clinical and laboratory variables included: Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), pain on a visual analog scale, Schober's index, chest expansion, C-reactive protein(CRP), erythrocyte sedimentation rate (ESR). RESULTS: Most patients responded well to treatment of anti-TNF-α antagonists. At 24 weeks, there was an improvement in all of the following measures. Imaging studies showed decreased inflammation of the SI joints after 24 weeks of treatment with anti-TNF-α therapies in only 3 patients. CONCLUSION: The anti-TNF-α therapy was safe and effective in treating patients with active AS during 24-week study period. The BASDAI, BASFI, VAS of pain were decreased well. But we could not determine any regression of acute inflammatory changes of the SI joints as depicted by MR

Ailesel Akdeniz ateşi olan hatalarda TNF-ALFA promoter geni polimorfizmi

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.[Abstarct Not Available

Safra kesesi kanserinde Helikobakter 16SrDNA ve üreaz gen analizi

Background/aim: The presence of Helicobacter species has been shown in bile and the resected gallbladder of patients with chronic cholecystitis. Therefore, an association between Helicobacter and gallbladder carcinoma might be proposed. The aim of this study was to analyze the presence of Helicobacter DNA in gallbladder carcinoma. Materials and methods: Thirty-one patients diagnosed as gallbladder carcinoma in the E;Uuml;TF Pathology Laboratory between 1995-2000 were included in the study. Sections were taken from their paraffin-embedded gallbladder tissue. Polymerase chain reaction (PCR) for Helicobacter 16SrDNA and urease gene was performed. Normal gallbladder tissues of 10 liver transplantation donors were used as controls. Results: Helicobacter urease gene was found positive only in one patient with gallbladder adenocarcinoma. Helicobacter 16SrDNA and urease gene were both negative in all the gallbladder tissues of the other cases with gallbladder carcinoma and of the control group. Conclusion: Thus, our data did not support the proposed association between Helicobacter species and gallbladder carcinoma.Giriş ve amaç: Kronik kolesistit hastalarının, safra ve rezeke safra keselerinde, Helikobakter türlerinin varlığı gösterilmiştir. Bu veriler, Helikobakter türlerinin safra kesesi kanseri ile ilişkisini akla getirmektedir. Bu çalışmada, safra kesesi kanserinde Helikobakter DNA analizi amaçlanmı ştır. Gereç ve yöntem: 1995-2000 yılları arasında EÜTF Patoloji laboratuvarı nda, rezeke safra keselerinde kanser saptanan 31 olgu çalışmaya alınmıştır. Bu hastaların parafin bloklarından alınan kesitlerde, polimeraz zincir reaksiyonu (PCR) ile Helikobakter 16SrDNA ve üreaz gen analizi yapılmıştır. Kontrol grubu olarak karaciğer transplantasyon donörü 10 olgunun normal safra kesesi dokuları kullanılmıştır. Bulgular: Safra kesesi adenokarsinomu olan tek bir olgunun tümöre komşu, tümörsüz safra kesesi dokusunda üreaz geni pozitif bulunmuştur. Safra kesesi kanserli diğer olguların, tümörlü ve tümörsüz dokularında ve kontrol grubunun normal safra kesesi dokularında Helikobakter 16SrDNA ve üreaz geni saptanmamıştır. Sonuç: Bu bulgular, safra kesesi kanseri ile Helikobakter türleri arasında öngörülen ilişkiyi desteklememektedir

The Efficacy and Safety of Rituximab in a Patient with Rheumatoid Spondylitis

Rheumatoid arthritis (RA) is considered as a connective tissue disease while ankylosing spondylitis (AS) is a prototype of spondyloarthritis. These diseases are seen concomitantly only very rarely. Also, rituximab has proven efficacy in the treatment of RA while its role in the treatment of AS is unclear. In this presentation, the concomitant presence of RA and AS in a 43-year-old male patient as well as the efficacy and safety of rituximab is discussed. Rituximab was given due to lack of response to treatment with anti-TNF-alpha. Evaluations made at the 6th and 12th months of treatment showed complete response for RA and partial response for AS

Sarcoidosis Presenting as Löfgren’s Syndrome with Myopathy

A 34-year-old female patient, who had proximal muscle weakness for 8 months, presented with erythema nodosum lesions on the pretibial region in addition to pain, swelling, and movement restriction in both ankles for the last one month. Thoracic CT demonstrated hilar and mediastinal lymphadenopathy. She underwent mediastinoscopic lymph node biopsy; biopsy result was consistent with noncaseating granuloma. Serum angiotensin converting enzyme level and muscle enzymes have been elevated. Muscular MRI and EMG findings were consistent with myositis. Muscle biopsy was done, and myopathy was found. The patient was diagnosed with sarcoidosis, Löfgren's syndrome, and sarcoid myopathy. The patient displayed remarkable clinical and radiological regression after 6-month corticosteroid and MTX therapy

Concomitant Autoimmune Diseases in Patients With Sarcoidosis in Turkey

Objectives: This study aims to determine the frequency and characteristics of autoimmune diseases associated with sarcoidosis patients. Patients and methods: the study included 131 sarcoidosis patients (36 males, 95 females; mean age 46.1 years; range, 20 to 82 years). Demographic, clinical, laboratory and radiological data of patients were evaluated retrospectively. the characteristics of autoimmune diseases associated with sarcoidosis (sarcoidosis-overlap group) patients and isolated sarcoidosis (isolated sarcoidosis group) were analyzed and compared. Results: Concomitant autoimmune diseases were detected in 15 (11.5%) (5 males, 10 females; mean age 50.8 years; range, 26 to 58 years) of the 131 patients with sarcoidosis and their mean disease duration was three months (range, 1 to 30 months). When compared with isolated sarcoidosis patients, more hand finger joint involvement, rheumatoid factor (RF) positivity, higher erythrocyte sedimentation rate (ESR) and less nonsteroidal anti-inflammatory drugs (NSAIDs) usage were found in the sarcoidosis-overlap group (p=0.035, p=0.049, p=0.015, p=0.018, respectively). There were no statistically significant differences between the two groups when evaluated for demographic, clinical parameters and disease-modifying antirheumatic drugs usage. Conclusion: Concomitant autoimmune diseases in patients with sarcoidosis may be rarely seen. These patients are characterized with more hand finger joint involvement, RF positivity, higher ESR and less NSAIDs usage. Multicenter, prospective studies involving large numbers of patients are needed to understand whether the association of sarcoidosis-autoimmune diseases is based only on coincidence or on a common etiopathogenesis

Coexistence of Ankylosing Spondylitis and Klinefelter's Syndrome

Ankylosing spondylitis is a chronic inflammatory disease characterized by inflammatory lower back pain and morning stiffness and accompanied by spine and sacroiliac joint involvement. Klinefelter's syndrome is a genetic condition that only affects males. Affected males have an extra X chromosome. This paper reports a 30-years-old male on followup with the diagnosis of Klinefelters syndrome. The patient admitted with complaints of inflammatory lower back, and neck pain and morning stiffness and was diagnosed with ankylosing spondylitis. Nonsteroidal anti-inflammatory drug and salazopyrine treatment resulted in significant regression in his complaints