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Purpose: This study investigated the effectiveness of major salivary gland ultrasonography (MSGUS) using a new grading system and shear wave elastography (SWE) in evaluating the major salivary glands of patients with Sjögren syndrome (SjS).Methods: This prospectively-designed cross-sectional study included 49 SjS patients and 49 healthy controls. Major salivary glands were examined with gray-scale ultrasonography and SWE. A new grading system for salivary glands was developed using MSGUS findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MSGUS and shear wave velocity (SWV) values were investigated. The MSGUS grading system and SWV values were evaluated together by logistic regression analysis. A cutoff value of SWE for salivary glands was determined.Results: The sensitivity, specificity, PPV, and NPV of MSGUS were 69.4%, 73.5%, 72.3%, and 70.6% for the submandibular gland and 69.4%, 65.3%, 66.7%, and 68.1% for the parotid gland, respectively. The mean SWV values of the parotid and submandibular glands were significantly higher in SjS patients than in controls (P

Background/aim Chronic spontaneous urticaria (CSU) is a chronic disease with an unknown etiology. In human leukocyte antigen (HLA) system, the association of class I and class II antigens with autoimmune diseases has been identified and HLA antigens that have a tendency to or can prevent chronic urticaria have been studied. The aim of this study is to investigate the association between chronic spontaneous urticaria and HLA class I and class II antigens. Materials and methods A total of 80 subjects, 40 patients with CSU and 40 healthy individuals were enrolled in the study. DNA sample isolation from blood was primarily done by the real-time polymerase chain reaction (RT-PCR) technique for the first time. Using HLA SSP Typing Kit (ROSE Cat. No: 800118) PCR technique, HLA-A, B, C, DRB and DQB alleles from DNA samples were analyzed. Results The mean age was 36.80 ± 9.48 years and the duration of the disease was 4.26 ± 5.18 years. Among the HLA class I and class II antigens, HLA-A was detected significantly more often in the control group (P = 0.039). HLA-DRB1 was more often detected in the CSU group but no statistical difference (P > 0.05). Conclusion It can be considered that HLA-DRB1 may have a tendency to CSU, while HLA-A might prevent the disease.

OBJECTIVE: Systemic lupus erythematosus (SLE) rarely has a late onset. Late-onset SLE (LSLE) has a milder course and less organ involvement. The purpose of the present study was to compare the clinical and laboratory (lab) findings of SLE regarding age at onset. MATERIALS AND METHODS: Seventy-two patients with SLE were included in the study. The age at onset was considered adult-onset SLE (ASLE) if it was

Background and aim. Chronic spontaneous urticaria (CSU) is a disease of unknown etiology and autoimmunity has been thought to be an etiological factor. Immunoglobulin E (IgE)-anti-thyroid peroxidase antibodies (anti-TPO) may play a role in the pathogenesis of certain cases of urticaria. The aim of this study is to investigate IgE-anti-TPO in patients with chronic spontaneous urticaria and in patients with Hashimoto’s thyroiditis. Methods. A total of 175 -subjects were included in this study. 59 patients had chronic spontaneous urticaria without history of Hashimoto’s thyroiditis, while 58 patients had Hashimoto’s thyroiditis without history of urticaria. The control group consisted of 58 participants without history of Hashimoto’s thyroiditis and urticaria. Serum IgE-anti-TPO levels were analyzed by site-directed IgE capture Enzyme-Linked Immunosorbent Assay technique. We used this technique by modifying it. Results. IgE-anti-TPO antibodies were detected in all three groups and in all subjects. There was no significant difference between the three groups in terms of IgE-anti-TPO levels. Although total IgE and IgE-anti-TPO levels were higher in the IgG-anti-TPO positive chronic spontaneous urticaria, there was no significant difference. Conclusions. IgE-anti-TPO antibodies do not play a pathogenic role in the majority of patients with chronic spontaneous urticaria.

Introduction Suppression of free immunoglobulin E (IgE) levels and an increase in total IgE levels are observed during omalizumab treatment. However, whether omalizumab has any effect on other immunoglobulins is unknown. Aim To investigate the effect of omalizumab treatment on serum IgE and other immunoglobulins, and demonstrate any association with response to treatment in patients with chronic spontaneous urticaria (CSU). Material and methods The study included 41 patients diagnosed with CSU. Baseline and post-12-week-treatment total IgE, IgA, IgM, and IgG levels and blood eosinophil, neutrophil, lymphocyte and platelet levels were compared. Patients were grouped based on weekly urticaria activity score (UAS-7) responses and these parameters were compared. Results There was a significant increase in baseline and post-12-week-treatment total IgE levels, while there was no significant difference in other immunoglobulin levels. A significant reduction was found in neutrophil counts after the treatment, whereas there was no significant difference in eosinophil, lymphocyte and platelet levels. There was no difference in these parameters between groups with complete response and without complete response. Conclusions Omalizumab treatment can also be used in patients with immunoglobulin deficiency. Due to the observed reduction in neutrophil counts after the treatment, patients must be closely followed for whole blood parameters.

Introduction Before starting tumour necrosis factor (TNF)-α blocking agents, standard tests should be used for the diagnosis of tuberculosis infection. The specificity of traditional tuberculin skin test (TST) is low in immunosuppressed patients due to prior Bacille Calmette Guerin (BCG) vaccination, non-tuberculous mycobacteria infections, false positive and negative results. In this study, we aimed to compare TST and Interferon-Gamma Release Assay (IGRA) tests for detecting latent tuberculosis infection in patients with rheumatic disease planned to receive TNF-α blocking agents. Materials and Methods One hundred and nine patients (45 male, 64 female) with the diagnosis of rheumatoid arthritis (RA) (n= 70) and ankylosing spondylitis (AS) (n= 39) were included in the study. Age, sex, number of BCG scar, results of TST (using the Mantoux method), QuantiFERON-TB Gold test and T-SPOT.TB test were recorded for all patients. Correlation between the tests was assessed by Pearson correlation coefficient. Result The mean age of RA and AS patients were 50 ± 13 (19-78 years). The prevalence of latent tuberculosis was 43.1% for TST, 39.4% for QuantiFERON-TB Gold test and 13.8% for T-SPOT.TB test, compared with the evaluation using the composite criteria such as close contact with active tuberculosis infection and/or suspicious fibrotic/calcific lesions on chest X-Ray without active tuberculosis infection. There was a moderate correlation between BCG scar number and TST (p< 0.001, r= 0.495), T-SPOT.TB test and QuantiFERON-TB Gold test (p= 0.007, r= 0.406), T-SPOT.TB test and composite criteria (p= 0.024, r= 0.343). The specificity of QuantiFERON-TB Gold test was 85.7%, and sensitivity was 73.9% for all patients with rheumatic disease. It was 73.5% and 66.7% for T-SPOT.TB test, respectively. The specificity of TST was 60.3% and sensitivity was 47.8% for TST. Conclusions IGRA tests are not affected prior vaccination and useful for detecting latent tuberculosis infection in patients treated with corticosteroid due to lack of correlation between test negativity and corticosteroid therapy. Also, they are useful tests for diagnosis of latent tuberculosis infection as an alternative to TST due to their specificity and sensitivity.

Background Systemic sclerosis (SSc) has increased risk of morbidity and mortality due to pulmonary fibrosis, pulmonary arterial hypertension, renal crisis, infections and malignancies. Chemical exposure, smoking and cytotoxic drugs increase the malignancy risk in rheumatic diseases including SSc. We aim to evaluate characteristics, identify risk factors and mortality in SSc patients with malignancies. Methods One hundred and fifty-three patients with SSc (24 male, 129 female, with mean age of 56.4 ± 12.9 years) according to 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for SSc were enrolled in this study. Clinical, demographic, laboratory and radiological characteristics of the patients were evaluated by using SPSS 17.0. Chi-square test was used to compare qualitative data and descriptive statistics are shown as n (%). Results Seven cases of cancer (three male, four female, with mean age of 51.2 ± 7.0 years) were identified. The tumor types included lung cancer, gastrointestinal tract cancer (gastric adenocarcinoma and gastric neuroendocrine tumor), myelodysplastic syndrome and malignant melanoma (eye and skin). Five (3.4%) died due to infection, cardiopulmonary involvement and renal crisis. Six of them had a diffuse cutaneous SSc clinical subtype, and the ratio for anti-Scl-70 was 71.4%. There was no significant relationship between age, sex, anti-Scl-70, pulmonary and cardiac involvement between cancer and non-cancer patients. Conclusions The malignancies may occur before, together or after the diagnosis of SSc. Both of these disorders have increased morbidity and mortality compared with the general population. Rational treatment, monitoring and reducing the risk factors may prevent the development of malignancy. Also, the clinical features, risk factors and prevalence ratios are similar to that reported by large cohorts.

Introduction. Omalizumab is recommended as a third-line treatment in the treatment of chronic spontaneous urticaria. During omalizumab use, which has high efficacy and safety, the side effects observed are usually moderate and temporary. Here we discuss the triggering of atrial fibrillation following omalizumab injection.Case report. A 72-year-old female patient was treated with omalizumab 300 mg / day due to chronic spontaneous urticaria resistant to conventional treatments. Atrial fibrillation developed 6 hours after the second injection of omalizumab in the patient who had atrial fibrillation and who had been monitored with antiarrhythmic treatment and sinus rhythm for 1 year. The treatment was discontinued because omalizumab was thought to trigger atrial fibrillation, as no other reason to explain the triggering of atrial fibrillation could be found.Results and conclusion. There is no data in the literature on the use of omalizumab in patients with atrial fibrillation. Different side effects of biological treatments can be observed. In particular, omalizumab should be used with caution in elderly patients and patients with arrhythmia.

Background. Some patients may have psychosomatic complaints due to their previous experiences during the drug hypersensitivity reaction. Worry about being hurt due to an administered drug is termed nocebo effect, which is the opposite of the placebo effect. In our study, we investigated the effect of distraction on symptoms during drug provocation test.Methods. Our study included 112 patients who underwent DPTs for alternative purposes in our clinic. Previous hypersensitivity reactions of all the patients had objective signs. Patients were divided into two groups for the DPT. Sixty-three patients were kept busy during the test, performing tasks such as filling questionnaires, arranging files in alphabetical and numerical order, and doing archiving (Group 1). Forty-nine patients did not perform any tasks during the test (Group 2). Reactions that occurred during the test were recorded. Results. During the DPT, 5 patients in Group 1 (5/63, 7.9%) and 17 patients in Group 2 (17/49, 34.7%), i.e. a total of 22 patients (22/112, 19.6%), had a reaction. There was a statistically significant difference between Group 1 and Group 2 according to the frequency of the reaction development.Conclusions. Patient psychosomatic complaints during DPTs are proportional to their association with previous allergic reactions. In order to prevent such reactions, it may be beneficial to keep the patients busy with an activity in order to distract them during the test.

Pustulotic arthro-osteitis (PAO) is a rare chronic inflammatory disease, which has now been classified as a seronegative spondyloarthritis. The sternoclavicular and sternocostal joints, pelvis, vertebra, hip, and long bones are affected. Skin findings of the disease are accepted as a variant of pustular psoriasis, but some authors have suggested that palmoplantar pustulosis (PPP) is a different entity. The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome should be considered in the differential diagnosis. PAO differs from SAPHO by the absence of hyperostosis and the difference in skin manifestations. Here, we aimed to present a 34-year-old female patient with a diagnosis of PAO with typical skin findings and joint involvement.

Amac: Anti-TNF tedaviler gunumuzde romatizmal hastaliklarin tedavisinde etkin olarak kullanilmaktadir. Kullaniminin artmasi ve uzun surekli takiplerde tedavi ile iliskili bazi yan etkiler de ortaya cikmaktadir. Bu yan etkilerden birisi de otoimmunite gelisimidir. Bu calismanin amaci romatizmal hastaliklari nedeniyle anti-TNF tedavi alan hastalarda otoimmunite gelisim sikligini belirlemektir. Gerec ve Yontem: Calismaya romatoid artrit ve ankilozan spondilit hastaliklari nedeniyle anti-TNF tedavi almakta olan 67 hasta dahil edildi. Otuz iki hasta romatoid artrit, 35 hasta ankilozan spondilit idi. Otuz bes hasta infliximab, 16 hasta adalimumab, 16 hasta etanercept almaktaydi. Hastalik gruplarina ve anti-TNF tiplerine gore hastalar gruplara ayrildi. ANA ve anti-dsDNA immunfloresan metodla, ACA ise ELISA yontemi ile calisildi. Bulgular: ANA pozitifliginde anti-TNF tedavi oncesi %10.4 iken, tedavi sonrasinda %40.3 olarak anlamli bir artis tespit edildi. Yalnizca bir hastada anti-dsDNA pozitifligi saptandi. ACA ise hastalarin hicbirinde pozitif degildi. Diger iki anti-TNF'ye kiyasla ANA pozitiflesmesi infliximab kullanan hastalarda belirgindi. ANA pozitifligi saptanan hastalarin hicbirinde lupusa ait klinik mevcut degildi. ANA pozitiflesmesi ile anti-TNF tedavi ile birlikte kullanilan metotrexat ve kortikosteroid kullanimi arasinda, romatizmal hastalik tipi arasinda bir iliski saptanmadi. Sonuc: Anti-TNF tedaviler, otoantikor gelisimini belirgin olarak arttirmaktadir. Ancak anti-TNF tedavilerin tetikledigi lupus gelisimi nadirdir.

Background Sulfasalazine (SSZ), which has an arylamine sulfonamide structure, is an anti-inflammatory drug used in the treatment of many rheumatic diseases. Various adverse effects have been reported related to SSZ. In the present study, we aimed to define the frequency of SSZ-related hypersensitivity reaction in patients with rheumatoid arthritis and ankylosing spondylitis. Methods A total of 136 patients were included in this study. During follow-ups, reaction type, reaction duration, and drug doses were recorded in patients who developed hypersensitivity reactions. Drugs were discontinued in patients who developed reactions, and they were treated with antihistaminics and/or corticosteroids, according to requirements. Drug provocation tests with the drugs and aminosalicylic acid were performed in patients with negative skin prick test individually. Results A total of 136 patients, with ages ranging from 19 to 71 years (mean, 41.97 [SD, 12.04] years), were included in the study. Hypersensitivity reactions according to the drug provocation test were found against SSZ in 12 patients (8.8%). The SSZ-related hypersensitivity reaction types were urticaria in 7 patients, urticaria and angioedema in 4 patients, and pruritus in 1 patient. Conclusions Sulfasalazine is widely used by rheumatologists in the treatment of rheumatic diseases. Whereas the frequency of sulfonamide-related hypersensitivity reactions was reported as 3.0% in the population, we detected hypersensitivity reactions to be 8.8% with SSZ usage in rheumatic diseases.

Amaç:Antinükleer antikor, sistemik romatizmal hastalıkların tanı ve tedavisinde yıllardır kullanılmaktadır. İndirekt immünfloresan (IIF) yöntem antinükleer antikor (ANA) varlığını tespit etmede altın standart yöntemdir. Bu çalışmanın amacı sistemik romatizmal hastalıklarda ANA boyanma tipleri, titrasyon ve antikor tiplerinin ilişkisini araştırmaktır. Gereç ve yöntem:Çalışmaya Eylül-Aralık 2015 tarihleri arasında kliniğimize başvuran, ANA sonucu pozitif olup subgrup analizi yapılmış olan, yeni sistemik romatizmal hastalık tanısı konulmuş toplam 215 hasta dahil edildi. ANA, IIF yöntemiyle, ANA subgrupları immünblot yöntemi ile ticari kitler kullanılarak çalışıldı. ANA boyanma tipleri, titrasyon ve antikor tipleri, sistemik romatizmal hastalık tipleri ile karşılaştırıldı. Bulgular:Çalışmamızda en sık ANA boyanma tipi granüler (%34.3) ve homojen (%33.5) özellikte olup, antikor analizinde en sık R0-52 (%28.8), SS-A (%24.1) ve ds-DNA (%19.06) pozitifliği saptandı. ANA titrasyonu, sıklık sırasına göre 1/100, 1/320, 1/1000 ve üstü şeklinde idi. Sonuç:Spesifik antikor pozitifliklerinin en sık sistemik lupus eritematozus ve sistemik skleroderma’da görülmesine rağmen, değişen oranlarda tüm sistemik romatizmal hastalıklarda saptanması, tanı ve izlemde ANA’nın klinikle birlikte değerlendirilmesi gerektiğinin önemini göstermektedir., Purpose:Antinuclear antibodies have been used for years for diagnosis and follow-up of systemic rheumatic diseases. Indirect immunofluorescence assay (IIF) is the gold standard to reveal the presence of ANA (ANA). This study intends to investigate by the IF-ANA method the relation of ANA staining patterns, titration and antibodies types with systemic rheumatic diseases. Materials and methods:The study included 215 patients, who were being followed up in our clinic with the diagnosis of systemic rheumatic disease between September 2015 and December 2015, who had an ANApositive test and underwent subgroup analysis. ANA was tested using IIF method and ANA profile was tested by using a commercial kit with immunoblotting. ANA staining patterns, titration results, and results of antibodies types were compared with types of systemic rheumatic disease. Results:In the study, the most frequent ANA staining pattern was granular (34.4%) and homogeneous (33.5%) while the most frequent result in the subgroup analysis was R0-52 (28.8%), SS-A (24.1%), and ds-DNA (19.06%) positive. The most frequent ANA titration was 1/100, 1/320, 1/1000 and above, respectively. Conclusion:Although specific antibody positivity is higher in SLE and SSc, the existence of specific antibodies in different percentages in all the rheumatic diseases indicates the importance of using ANA with the clinic findings in the diagnosis and follow-up of systemic rheumatic disease.

Background/aim: This study aimed to assess the relationship between skin fibrosis as determined by sonoelastography and the degree of pulmonary involvement as determined by high-resolution computed tomography (HRCT) in patients with diffuse cutaneous systemic sclerosis (dcSSc).Materials and methods: This prospective study included 40 patients with dcSSc. All patients with HRCT scans underwent conventional ultrasonography and sonoelastography to determine skin thickness and degree of fibrosis. The degree of fibrosis was classified according to color-scale sonoelastography. The degree of pulmonary involvement was classified according to HRCT grading groups. The relationship between skin fibrosis and pulmonary involvement was investigated.Results: There was a statistically significant difference between HRCT grading groups according to the sonoelastographic color scale (P < 0.001). Sonoelastographic color-scale groups showed a statistically significant difference in duration of disease (P = 0.013). No significant difference was found between the sonoelastographic color-scale groups in age, sex, or skin thickness.Conclusion: Sonoelastography is a useful and reliable tool for assessing skin involvement in dcSSc. We found a good correlation between the degree of skin fibrosis as determined by sonoelastography and the degree of pulmonary involvement.

Background: The aim of this study was to investigate atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy and compare them with patients with diabetic foot without charcot neuro-arthropathy. Methods: This retrospective study consists of 78 patients with diabetic foot who had lower extremity angiography with antegrade approach. All patients were classified into two groups; neuro ischemic wounds with charcot neuro-arthropathy (30/78) and without charcot neuro-arthropathy (48/78).Atherosclerotic load at the side of diabetic foot was determined by using the Bollinger angiogram scoring method. Comparison of atherosclerotic load between the two groups was performed. Results: The mean of total and infrapopliteal level angiogram scoring of all patients was 33.3 (standard deviation, sd:±17.2) and 29.3 (sd:±15.6), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds with charcot neuro-arthropathy group was 18.1 (sd:±11.6) and 15.7 (sd:±10.4), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds without charcot neuro-arthropathy group was 42.8 (sd:±12.7) and 37.7 (sd:±12.0), respectively. There was a statistically significant difference between the two groups of mean total and infrapopliteal angiogram scoring (p

The aim of this study is to investigate the potential association of neutrophil–lymphocyte ratio (NLR) between primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula stenosis and type (Conventional and Drug-Eluting) of balloons used in PTA. This retrospective study consists of 78 patients with significant arteriovenous fistulas stenosis who were treated with PTA by using Drug-Eluting Balloon (DEB) (n = 29) or Conventional Balloon (CB) (n = 49). NLR was calculated from preinterventional blood samples. All patients were classified into two groups. Group A; primary patency

A 69-year-old female patient was admitted to our clinic with photosensitivity, symmetric erosive polyarthritis, and cutaneous vasculitis of lower extremities. Rhupus syndrome was diagnosed, and Chiari's network in the right atrium and interatrial septum patent foramen ovale was achieved on transthoracic and transesophageal echocardiography. If it is thought that increased prevalence of antiphospholipid antibodies in patients with rhupus, this congenital remnant is important for the thrombosis risk, cardiac event, and stroke. The association of both diseases may lead to more serious events and cause worse prognosis. Here, our aim is to present a 69-year-old female patient with rhupus syndrome presenting with cutaneous vasculitis and Chiari's network in the right atrium.

Systemic amyloid A (AA) amyloidosis is a serious complication of familial Mediterranean fever (FMF), with a prevalence of 11.4% (1). It is associated with gender, ethnicity, mutations such as M694V...

Pulmonary hemorrhage is the most devastating pulmonary complication of systemic lupus erythematosus. It has rarely been reported to occur as the initial presentation in lupus patients. We report a 50-year-old male who presented with pulmonary hemorrhage and nephritis as the ini - tial manifestation of systemic lupus erythematosus. He presented with dyspnea, hemoptysis and pretibial edema. He responded to early intravenous pulse methylprednisolone therapy and cy - clophosphamide therapy, but his pulmonary hemorrhage relapsed 20 days later. He was given in - travenous methylprednisolone, intravenous cyclophosphamide and 5 sessions of plasmapheresis, resulting in temporal stabilization of his condition. Pulmonary hemorrhage in this connective tis - sue disease is an uncommon but serious complication with high mortality rates in spite of intensive treatment.

Primary ciliary dyskinesia (PCD) is a rare disease, predominantly inherited as an autosomal recessive, with ciliary dysfunction leading to impaired mucociliary clearance, chronic airway infection and inflammation. Situs inversus totalis occurs in ~50 % of PCD patients and it is known as Kartagener syndome. Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent attacks of fever and peritonitis, pleuritis, arthritis, or erysipelas-like skin disease. FMF is caused by mutations in the MEFV gene which is located on chromosome 16p13.3. p.M680I, p.M694 V, p.M694I, p.V726A on exon 10 and p.E148Q on exon 2 are the most common mutations among FMF patients and these constitute 85 % of all. Homozygosity of R202Q polymorphism is strongly associated with FMF. We would like to present a case of Kartagener syndrome accompanied by FMF with R202Q polymorphism. Our case is the first in the literature indicating the accidental coexistence of FMF and Kartagener syndrome.

Background: The correlation between neutrophil-lymphocyte ratio (NLR) and acute pulmonary embolism (APE) related mortality, platelet-lymphocyte ratio (PLR) and clinical severity classification of APE were demostrated. Clot load also burden one of the prognostic criteria of pulmonary embolism. Method: The pulmonary arterial computed tomographic obstruction index ratio (PACTOIR) was calculated in 62 patients diagnosed with APE, retrospectively. Patients were divided into two groups according to their PACTOIR values. NLR and PLR were calculated from the blood samples collected on the day of diagnosis. Results: Mean PACTOIR, mean NLR and mean PLR of all patients with APE were calculated as 23.58%, 4.4 and 186.5, respectively. A positive correlation was observed between PACTOIR and NLR and PLR. A statistically significant difference was found between the NLR and PLR levels of low and high PACTOIR groups. Conclusion: A statistically significant correlation was found between PACTOIR and NLR and PLR in patients with APE. According to the findings of our study, NLR and PLR ratios may give an idea about the thrombus load in patients with clinically suspected APE.