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The use of anti-tumor necrosis factor alpha (anti-TNF-α) agents has increased during the past decade in rheumatology practice. Opportunistic infections have been reported with anti-TNF-α agents in clinical trials and post-marketing usage. Aspergillus infection is a rare opportunistic infection that is associated with immunosuppression, and there are reported cases of pulmonary aspergillosis in various rheumatic diseases treated with anti-TNF-α agents. Here, we present the first case of pulmonary aspergillosis associated with infliximab treatment in a patient with Still’s disease.

Objective: Immunosuppressive therapies, especially tumor necrosis factor-a inhibitors, are frequently used in treatment of rheumatoid arthritis (RA) and ankylosing spondylitis (AS). These therapies can induce viral reactivation in concurrent hepatitis B virus (HBV)- or hepatitis C virus (HCV)positive patients. On the other hand, the prevalence of HBV and HCV infections is not exactly known in RA and AS patients. The aim of this study was to investigate the prevalence of HBV and HCV infections in RA and AS patients. Material and Methods: A group of 1517 RA and 886 AS consecutive patients followed by six different rheumatology outpatient clinics of Turkey were recruited in this study. The prevalence of HBV surface antigen (HBsAg) and HCV antibody (anti-HCV) were retrospectively investigated. Results: The mean age was 49.0 +/- 13.2 years in RA and 37.3 +/- 10.5 years in AS patients. HBsAg prevalence was 35 (2.3\%) in RA and 27 (3\%) in AS patients. Anti-HCV prevalence was 17 (1.1\%) and 10 (1.1\%), respectively. In the RA group, both HBsAg and anti-HCV positive patients were older than negative ones (p < 0.05), and the highest prevalence was found in those 60-69 years (p < 0.05). Conclusion: In previous national data, the prevalence of HBsAg has been reported as 3.99\% and shown to increase with age. In this study we have found a lower HBV infection prevalence in both RA and AS patients according to Turkish national data. This result may explain by being younger age of our patients. In another conclusion, lower prevalence could be related to, joint complaints may less consulted to Rheumatologist in HBV positive.

A patient with primary Sjögren's syndrome complicated with primary biliary cirrhosis and lymphocytic interstitial pneumonia is presented. She was 38 years old and was admitted to our hospital for generalized pruritus, xerostomia, xerophthalmia, fatigue, and reticulonodular changes on her chest X-ray. With the findings of ground-glass attenuation and centrilobular nodules in high resolution computerized tomography, the diagnosis of lymphocytic interstitial pneumonia was made. Oral methylprednisolone 1 mg/kg/day and ursodeoxycholic acid 15 mg/kg/day were started. At the 6th month follow-up, she had no complaints, and pulmonary function tests and high resolution computerized tomography were normal. This is the first case of Sjögren's syndrome, primary biliary cirrhosis and lymphocytic interstitial pneumonia in the English literature.

Objectives: The prevalence of sexual dysfunction in Behcet patients, patients' practices toward sexual problems, pre-disease sexual life and distribution of postdisease sexual problems were evaluated. Patients and Methods: Sexually active 96 patients were included to the study. The data were collected with the “Sexual Problems in Behcet Patients Data Collection Form” and “Arizona Sexual Experience Scale (ASES)”. The scale's score interval is 5-30; 11-above scores indicate sexual dysfunction. Results: Of the patients, 51 (53.1%) were 40-yearold and above, 49 (51%) were women; the most frequent symptoms were oral aphtosis (58.3%), genital ulcers (31.2%), and erythema nodosum (28.1%). Mean ASES score was 14.2p5.8 66 patients (68.7%) had sexual dysfunction. The most prevalent problems were decreased frequency of intercourse (n=32, 86.5%), painful sexual relation (n=18, 48.6%) and unwillingness (n=9, 24.3%). Most of the patients (n=15, 40.5%) who expressed sexual problems were not using any practice for the solution. None of the patients received any information about sexual problem and the most preferenced source of information would be the doctors (n=83, 86.4%) in case having this opportunity. Female gender and the belief about the impact of Behcet's disease on sexual life determined ASES score (43%). Conclusion: Sexual dysfunction in Behcet's disease was seen in a significant proportion. Amac: Bu calismada Behcet hastalarinda cinsel disfonksiyon gorulme orani, cinsel sorunlara yonelik hasta uygulamalari, hastalik oncesi cinsel yasanti ve hastalik sonrasi cinsel sorunlarin dagilimi degerlendirilmistir. Hastalar ve Yontemler: Calisma kapsamina cinsel acidan aktif olan 96 hasta alinmistir. Veriler “Behcet Hastalarinda Cinsel Sorunlar Veri Toplama Formu” ve “Arizona Cinsel Yasantilar Olcegi” (ACYO) ile toplanmistir. Olcegin puan araligi 5-30 olup, 11 ve uzeri puan cinsel disfonksiyonu gostermektedir. Bulgular: Hastalarin 51'inin (%53.1) 40 yas ve uzerinde, 49'unun (%51) kadin, sik gorulen semptomlarinin oral aftlar (%58.3), genital ulserler (%31.2) ve eritema nodozum (%28.1) oldugu bulunmustur. Arizona Cinsel Yasantilar Olcegi puan ortalamalarinin 14.2p5.8 oldugu 66 hastada (%68.7) cinsel disfonksiyon bulundugu saptanmistir. Hastalarda en cok gorulen cinsel sorunlarin cinsel iliski sikliginda azalma (n=32, %86.5), agrili cinsel iliski (n=18, %48.6) ve cinsel isteksizlik (n=9, %24.3) oldugu bulunmustur. Cinsel sorunu oldugunu ifade eden hastalarin cogunlugunun (n=15, %40.5) sorunun cozumu icin hicbir uygulamada bulunmadigi belirlenmistir. Hastalarin hicbirinin cinsel sorunu ile ilgili saglik calisanlarindan bilgi almadigi ve bilgi alma olanagi olmasi durumda en cok doktorlarin (n=83, %86.4) tercih edilecegi saptanmistir. Calismamizda kadin cinsiyetin ve Behcet hastaligi nedeniyle cinsel yasamin etkilendigi dusuncesinin, ACYO puanini onemli oranda (%43) belirledigi bulunmustur. Sonuc: Bulgular dogrultusunda Behcet hastaliginda cinsel disfonksiyonun onemli oranda goruldugu belirlenmistir.

In the present study, it was aimed to investigate factors of motivation concerning referral of the patient with rheumatoid arthritis (RA) to rheumatology department. Ninety-five consecutive patients with RA presented to Rheumatology Department of Hatay State Hospital between August, 2012 and October, 2012 were included to the study. The patients attended to one or more control visit within prior 6 months were considered as “patients regularly attending control visits”. Those attended to a control visit during study period but not within prior 6 months were considered as “patients not regularly attending control visits”. In the light of information obtained from patients, two distinct forms were designed including reasons for attending regularly or not regularly to control visits. The form designed for “patients regularly attending control visits” included 42 items, whereas the form designed for “patients not regularly attending control visits” included 56 items. Ninety-five patients (63 women) with RA were included to the study. Mean ages were 46.4±13.0 and 40.6±12.6 years. Of these patients, 81 (85.3%) were “patients regularly attending control visits”, whereas 14 (14.7%) were “patients not regularly attending control visits”. It was seen that, the educational levels was primary school or below in 47 (58%) of the 81 “patients attending regularly to control visits” vs. all 14 “patients attending not regularly to control visits” (p=0.002).While 37 (45.6%) of the “patients attending regularly to control visits” were on steroid therapy, 12 (85.7%) of the “patients attending not regularly to control visits” were on steroid therapy. The difference was statistically significant (p=0.006).The main factors motivating patient with RA are found to be related to clinicians and healthcare providers; thoughts, beliefs and expectations of the patients; conditions of hospital; working condition of the patients; economic arguments; and social interactions. Regular follow-up of the patients with rheumatoid arthritis can be affected by several factor originating from patient or clinician. It seems that socio-cultural level of the patients directly affect regular follow-up of these patients.