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To evaluate of hepatitis serology and reactivation frequency in patients with rheumatic disease receiving biologic agents. Our study included patients with inflammatory rheumatic diseases from 23 centers, who were followed up with biological therapy. Demographic and clinical characteristics of the patients, duration of drug use and hepatitis serology and the state of viral reactivation were analyzed. A total of 4060 patients, 2095 being males, were included in our study. Of the patients, 2463 had Ankylosing Spondylitis (AS), 1154 had Rheumatoid Arthritis (RA), 325 had Psoriatic Arthritis (PsA), and 118 had other inflammatory rheumatic diseases. When the viral serology of the patients was evaluated, 79 patients (2%) who were identified as HBs Ag positive, 486 (12%) patients who were HBs Ag negative and anti-HBc IgG positive and 20 patients (0.5%) who were anti-HCV positive. When evaluated on a disease-by-disease basis, the rate of HBsAg was found to be 2.5% in RA, 2% in AS and 0.9% in PsA. Viral reactivation was detected in 13 patients while receiving biologic agents. HBs Ag was positive in nine patients with reactivation and negative in four patients. Anti-HBc IgG, however, was positive. Six of these patients had AS, four had RA, and three had PsA. The development of hepatitis reactivation in 11.4% of HBs Ag positive patients and 0.82% of anti-HBc IgG positive patients due to the use of biologic agents is an important problem for this group of patients. Antiviral prophylaxis is recommended to be started especially in patients who are HBs Ag positive and who are using biologic agents due to viral reactivation. Therefore, it is important to carry out hepatitis screenings before biologic agent treatment and to carefully evaluate the vaccination and prophylaxis requirements. [ABSTRACT FROM AUTHOR]

To determine plasma homocysteine levels in ankylosing spondylitis (AS) and their correlation with disease activity measurements. To examine the effects of different treatment modalities on homocysteine levels. One hundred eight patients diagnosed with AS according to New York criteria and 65 healthy individuals matched in terms of age and gender were enrolled in the study. Patients were given detailed physical examinations. The Bath AS Disease Activity Index (BASDAI) was used for disease activity, the Bath AS Metrology Index (BASMI) for spinal mobility, the Bath AS Functional Index (BASFI) to determine functional status and the Bath AS Radiological Index (BASRI) for radiological analysis. Sedimentation rate (ESR) and C reactive protein (CRP) levels, acute phase reactants, were measured. Plasma homocysteine levels, serum interleukin (IL) -6 and serum tumor necrosis factor- α (TNF- α) levels were investigated using the enzyme-linked immunosorbent assay (ELISA) method. Plasma homocysteine levels in AS patients were statistically significantly lower compared with those in the healthy control group ( P = 0.0001). There was no significant difference among sub-groups established on the basis of medical treatments and disease activity (BASDAI ≤4 and >4). No statistically significant correlation was determined between homocysteine level and disease activity parameters, radiological score and functional indices. A significant negative correlation was, however, established between age and homocysteine level in the AS group ( P < 0.05, r = −0.426). Plasma homocysteine was lower in AS patients compared with the control group. This is not correlated with disease activation and medical treatment employed. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA [MIM 180300]) is a complex, polygenic inflammatory autoimmune disease, resulting from interactions between genetic and environmental factors. Some of the RA-associated HLA-DRB1 alleles have shared epitope, but their distribution varies among different racial/ethnic groups. This study was aimed at investigating the distribution of HLA-DRB1 alleles in patients with RA in eastern Black Sea region of Turkey. DNA samples of 320 patients with RA and 360 healthy controls were studied for the determination of HLA-DRB1 allele distribution using PCR-SSP method. The allele frequencies of HLA-DRB1*01, *04, and *09 were higher in patients with RA compared with the controls ( P < 0.005, P < 0.0001, and P < 0.01, respectively). On the other hand, in patients with RA, HLA-DRB1*13 allele was lower than the controls ( P < 0.001). Of the HLA-DRB1*04 subgroups, *0401 (40.83% vs. 18.75%, P < 0.001) was the most frequent allele in patients with RA, while DRB1*0402 (30.00% vs. 12.50%, P < 0.005) allele in the controls. HLA-DRB1 allele frequencies in the patients with RA and the controls showed Hardy-Weinberg rule compliance. Results of this study indicate that HLA-DRB1*01, *04, and *09 alleles were associated with RA, and HLA-DRB1*13 was protective allele against RA. Among the subgroups of HLA-DRB1*04, *0401 was detected to be RA associated, while *0402 was being protective. These results have some differences compared with previous reports originating from other regions of Turkey. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate any relationship between peripheral neuropathy and anti-TNF-α therapy used in ankylosing spondylitis (AS). Thirty-nine patients monitored in our clinic with a diagnosis of AS and without neuropathic symptoms were enrolled in the study. Patients were divided into two groups. The first consisted of 21 patients using biological agents for more than one year. The control group was made up of 18 patients of similar age and demographic characteristics receiving non-biological therapy. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores were calculated, and sedimentation rate and C-reactive protein (CRP) levels measured. Motor and sensory nerve conduction analysis for the median, tibial, and sural nerves was performed. The nerve conduction results of the biological therapy group were then compared with those of the non-biological therapy group. Thirty-nine patients with a mean age of 37.05 ± 8.1 were enrolled. Patients were divided into two groups, depending on drugs used. The first group (using anti-TNF-α) consisted of 21 patients with a mean age of 42.2 ± 8.8, and the second (the non-biological group) of 18 patients with a mean age of 35.8 ± 7.5. There was no statistically significant difference between the groups in terms of age, sex, drug use, or duration of disease ( p = 0.052, p = 0.55, p = 0.33, and p = 0.72, respectively). Sedimentation rate, CRP, and BASDAI scores were statistically significantly higher in the second group ( p = 0.04, p = 0.03, and p = 0.009, respectively). No statistically significant difference was determined in any parameters at nerve conduction analysis between the two groups ( p > 0.05). There was a positive correlation between sedimentation rate and median sensory conduction velocity ( p = 0.02, r = 0.48) and tibial conduction velocity ( p = 0.07, r = 0.43). A negative correlation was determined between duration of disease and median distal motor latency ( p = 0.22, r = −0.37) and between length of drug use and median sensory conduction velocity ( p = 0.02, r = −0.38). There was no significant correlation between other clinical and demographic data and nerve conduction parameters. No effect on nerve conduction of biological agents in AS patients without neurological symptoms was determined. Clinicians should be alert for signs and symptoms, suggesting neuropathy in patients given anti-TNF-α. [ABSTRACT FROM AUTHOR]

A 50-year-old man presented with a complaint of low-back pain and widespread joint pain for the previous 20 years. Conventional radiography revealed wide areas of calcification in the intervertebral discs and degenerative changes in the peripheral joints. A diagnosis of ochronosis was made by the observation of bluish-brown pigmentation in the nose and ears, dark urine colors following alkalization, and high levels of homogentisic acid in the urine. Ochronosis should be considered in the differential diagnosis of patients with chronic low-back pain regarding features of widespread calcification in the intervertebral discs at radiography and bluish-brown pigmentation in the nose and ears. [ABSTRACT FROM AUTHOR]

Hypertrophic osteoarthropathy is characterized by digital clubbing and periosteal reaction of long bones. Most cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia, and gastrointestinal polyps. We report a 19-year-old man presenting wıth arthritis, broadening of the fingers and clubbing of the fingers and toes for the previous 3 years. The ankles and knees were swollen. X-rays showed periosteal apposition. The search for a secondary cause remained negative. In cases of arthralgia/arthritis together with clubbed fingers, consideration must be given to hypertrophic osteoarthropathy. The primary or idiopathic form is rare and has a good prognosis. [ABSTRACT FROM AUTHOR]

Sjogren’s syndrome and ankylosing spondylitis can occur either alone or in conjunction with other disorders. In this article we report a female patient afflicted with ankylosing spondylitis and Sjogren’s syndrome. [ABSTRACT FROM AUTHOR]

Subclinical atherosclerosis has been demonstrated in patients with early rheumatoid arthritis (ERA) without any signs of cardiovascular disease (CVD). The aim of this study was to investigate the relationship between serum YKL-40 level and arterial stiffness in patients with ERA. Forty two patients with ERA and 35 healthy controls with no history or current sign of CVD were included in the study. ERA patients with active disease, defined as DAS28 ≥3.2, and symptoms onset <12 months were recruited. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (CF-PWV), and the intima-media thickness carotid (IMT-C) was measured by carotid ultrasonography. Serum YKL-40 levels were measured by an enzyme-linked immunoassay method. The mean age was 43.1 ± 5.8 years in ERA patients and 41.0 ± 5.9 years in control group. The CF-PWV and IMT-C of the ERA patients were determined significantly higher than the control group ( P = .001, P < .001, respectively). YKL-40 levels were significantly elevated in ERA patients than controls ( P = .008). The serum levels of YKL-40 in the ERA patients showed a strong correlation with CF-PWV ( r = .711, P < .001) and IMT-C ( r = .733, P < .001). Multiple linear regression analysis revealed that CF-PWV could be explained by serum YKL-40 levels (adjusted R² = .493, P < .001). We have shown that patients with ERA had increased CF-PWV and serum YKL-40 levels. In addition, there was an association between CF-PWV values and serum YKL-40 levels in patients with ERA. As a result, we believe that serum YKL-40 level and CF-PWV might reflect early atherosclerosis in patients with ERA. [ABSTRACT FROM AUTHOR]