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Objective: Patients with sarcoidosis may present with cutaneous lesions or other systemic involvement, particularly pulmonary. In this study, we investigated our hypothesis that the clinical course of sarcoidosis patients who present with skin involvement be different. Methods: Fifty-two sarcoidosis patients who applied to our rheumatology outpatient clinic were included in the study. Data on demographics, smoking status, angiotensin converting enzyme (ACE) level at the time of diagnosis, other organ involvement and lung involvement stages were collected. We then compared the clinical and demographic characteristics of patients with and without skin involvement and patients with skin involvement at first presentation, and others separately. Results: While the initial involvement was lung involvement in 28 (53.5%) patients, 19 (36.5%) patients applied to the clinic with skin involvement as a presenting feature. In 23 (44.2%) patients, skin involvement was present at any time during the disease. In our study, the most common skin involvement was erythema nodosum observed in 9 patients (17.3%). Demographic and clinical findings of patients presenting with skin findings did not differ significantly from other patients. High ACE levels were more common in patients without skin involvement than in patients with skin involvement. Conclusion: Even if the clinical course does not differ in sarcoidosis patients presenting with cutaneous involvement, it is important to recognize the cutaneous manifestations of sarcoidosis. We would like to emphasize that detailed physical examination is important, as easily overlooked, small and asymptomatic lesions are the most appropriate site for histopathological diagnosis of sarcoidosis. [ABSTRACT FROM AUTHOR]

To describe the safety and efficacy of intralesional rituximab (anti-CD 20 monoclonal antibody) therapy in a patient with conjunctival extranodal marginal zone lymphoma. A single case report from a tertiary referral center. A 43 years old female patient with low-grade conjunctival extranodal marginal zone lymphoma who was completely and safely treated with intralesional rituximab therapy was presented. After four injections per week, intralesional rituximab injections were given monthly, and the treatment was completed in 6 months. Near-total regression was achieved at the end of the tenth cycle. No recurrence was observed during the 20-month follow-up period. The intralesional rituximab is a cost-effective and well-tolerated treatment for low-grade conjunctival lymphoma. The intralesional rituximab therapy may be prefer in the patients with low grade conjunctival lymphoma instead of radiotherapy. There will be needed further researches in this area. [ABSTRACT FROM AUTHOR]

Enthesopathy is pathology of bony insertions of tendons, ligaments or joint capsules. It is a frequent finding in rheumatic diseases, like ankylosing spondylitis (AS) and Behçet's disease. Musculoskeletal complaints are common in patients with familial Mediterranean fever (FMF), and these could be a clinical manifestation of enthesopathy. Hence, we investigated the possible association between FMF and enthesopathy. Fifty-six patients with FMF and 11 patients with FMF-associated spondyloarthropathy (FMFS) were enrolled. Forty-seven healthy individuals and 36 patients with AS formed the healthy and diseased control groups. Musculoskeletal complaints were meticulously questioned, and all patients underwent a detailed physical and ultrasonographic (US) examination of the lower limbs. US scorings of enthesopathy was performed according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Demographic data, disease characteristics, MEFV genotypes and HLA B27 results were retrieved from the medical records. Patient-reported pain and physical examination findings consistent with enthesopathy were frequent in all groups with the highest prevalence in the FMFS group. Heel was the most common region affected in all patient groups. FMF patients harboring M694 V variant had higher GUESS scores compared to patients with other variants (2.78 ± 2.43 vs. 1.37 ± 1.67, p = 0.026). There was no statistically significant difference in the mean ± SD GUESS scores between healthy subjects and those FMF patients with genetic variants other than M694 V (1.38 ± 1.42 vs. 1.37 ± 1.67, p > 0.05). Enthesopathy may not be a feature of general FMF population; rather, it might be specifically associated with the presence of M694 V variant. Our results further support the previous evidence regarding M694 V mutation and spondyloarthropathy association. [ABSTRACT FROM AUTHOR]

Background/aim: High-dose steroid has been shown to reduce the mortality rate in Corona virus disease 2019 (COVID-19) patients who need oxygen support. Here, we evaluated the effectiveness of pulse-steroid in case of unresponsiveness to treatment with high dose steroid. Materials and methods: The study is a retrospective controlled trial. We divided the patients in 3 groups: standard-care therapy alone, high-dose steroid treatment (6 mg/day dexamethasone equivalent), and pulse-steroid treatment (250 mg/day methyl-prednisolone). One hundred and fifty patients were enrolled in each group. All patients were hospitalized and needed oxygen support. We matched the patients according to disease severity at the onset of hypoxia, weight of co-morbidities, age, and sex. We then compared 3 groups in terms of mortality, length of hospitalization, need for intensive care unit (ICU) admission and mechanical ventilation (MV), length of stay in ICU, and duration of MV. Results: The pulse-steroid group had shorter ICU stay. The median ICU stay was 9.0 (CI 95% 6.0–12.0) days in standard-care group, 8.0 (CI 95% 5.0–13.0) days in high-dose steroid group and 4.5(CI %95 3.0–8.0) days in pulse-steroid group. Moreover, although patients in pulse-steroid group were initially unresponsive to high dose steroid therapy, they achieved similar results compared to the high-dose steroid group in other outcomes except for length of hospital stay. Conclusion: Pulse-steroid treatment would be an option for COVID-19 patients who do not respond to the initial high-dose steroid treatment. [ABSTRACT FROM AUTHOR]

Objective: Familial Mediterranean fever (FMF) is an auto-inflammatory disease that is also characterized with some of the common musculoskeletal features of spondyloarthritis (SpA). Enthesitis is the hallmark of SpA. Recently, it was postulated that exertional leg pain is a possible sign of lower extremity enthesitis associated with FMF severity. In this study, we have evaluated the association between the enthesitis, enthesitis score and disease severity in FMF patients. Methods: We enrolled 238 FMF patients that fulfilled the modified Tel-Hashomer criteria. We assessed the presence of enthesitis at the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) defined sites with standard palpation method. Then, FMF patients dichotomised two groups as enthesitis group and controls. Herein, we evaluated the enthesis extensity with MASES. FMF disease severity was determined via the international severity scoring system for FMF (ISSF). Firstly, we have compared demographic properties, disease-related features and ISSF scores of the groups. Then, we have correlated ISSF with MASES in enthesitis group. Results: We showed that 54 (22.6%) of 238 patients had enthesitis. The demographic features were similar between the groups. The enthesitis group had higher ISSF scores (p < 0.001); higher frequency of fever (p = 0.004), exertional leg pain (p < 0.001), myalgia (p < 0.001) and arthritis (p = 0.01); and more intense, widespread, frequent and longer attacks compared with controls. Moreover, there was a weak correlation between ISSF and MASES in the patients with enthesitis. Conclusion: Enthesitis may be a sign of more severe FMF phenotype and frequently associated with other musculoskeletal manifestations resemble SpA. Key points •More than one-fifth of the patients with FMF would suffer from enthesitis. •The FMF patients with enthesitis had higher ISSF scores; higher frequency of fever, exertional leg pain, myalgia and arthritis; and more intense, widespread, frequent and longer attacks as compared with controls. •Enthesitis may be a sign of more severe FMF phenotype and frequently associated with other SpA-like musculoskeletal feature. [ABSTRACT FROM AUTHOR]

Background. Systemic amyloidosis is a potentially fatal condition, unless diagnosed and treated before development of irreversible organ damage. Demonstration of amyloid deposits within tissue biopsies is only definitive diagnostic method, which makes appropriate selection of biopsy site essential. Herein, we evaluated efficacy of minimally invasive minor salivary gland biopsy (MSGB) for the diagnosis of amyloidosis. Methods. We analyzed 37 biopsies taken from 35 patients. Suggestive findings for amyloidosis were significant proteinuria, renal impairment, refractory diarrhea, neuropathy, and restrictive cardiomyopathy. Minor salivary gland was the initial biopsy site in all subjects. When MSGB was negative but there was a high suspicion for amyloidosis, a kidney, duodenum, or rectal biopsy was performed for further investigation. Results. Mean age of patients was 45.4 and 21 were female. In 11 patients amyloidosis was diagnosed with MSGB. In overall 18 patients were diagnosed with amyloidosis. Sixteen of them were identified as being of AA type and two were AL type amyloidosis. The sensitivity of minimally invasive MSGB is 61.1% for diagnosing amyloidosis in this study. Conclusion. MSGB is a safe and simple method for the diagnosis of amyloidosis which can be performed in an outpatient setting. We suggest extensive use of this minimally invasive method. [ABSTRACT FROM AUTHOR]

Background. Systemic amyloidosis is a potentially fatal condition, unless diagnosed and treated before development of irreversible organ damage. Demonstration of amyloid deposits within tissue biopsies is only definitive diagnostic method, which makes appropriate selection of biopsy site essential. Herein, we evaluated efficacy of minimally invasive minor salivary gland biopsy (MSGB) for the diagnosis of amyloidosis. Methods. We analyzed 37 biopsies taken from 35 patients. Suggestive findings for amyloidosis were significant proteinuria, renal impairment, refractory diarrhea, neuropathy, and restrictive cardiomyopathy. Minor salivary gland was the initial biopsy site in all subjects. When MSGB was negative but there was a high suspicion for amyloidosis, a kidney, duodenum, or rectal biopsy was performed for further investigation. Results. Mean age of patients was 45.4 and 21 were female. In 11 patients amyloidosis was diagnosed with MSGB. In overall 18 patients were diagnosed with amyloidosis. Sixteen of them were identified as being of AA type and two were AL type amyloidosis. The sensitivity of minimally invasive MSGB is 61.1% for diagnosing amyloidosis in this study. Conclusion. MSGB is a safe and simple method for the diagnosis of amyloidosis which can be performed in an outpatient setting. We suggest extensive use of this minimally invasive method. [ABSTRACT FROM AUTHOR]

Amaç: Sarkoidoz nonkazeifiye granülomlarla karakterize, nedeni bilinmeyen, en sık akciğer tutulumu yapan, multisistemik bir hastalıktır. Deri lezyonları sarkoidoz olan hastaların %15-20'sinde izlenirken yaklaşık 1/3'inde ilk hastalık belirtisi olarak ortaya çıkar, sistemik tutulum olmaksızın yalnızca deri sarkoidozu olarak da ortaya çıkabilir.Bu yazıda topikal takroli-mus tedavisine iyi yamt veren, makopapuler görünümlü kuta-nöz periokuler sarkoidozlu bir olgu sunulmuştur. Olgu: Kırkyedi yaşında erkek hasta her iki göz çevresindeki lez-yonları için dermatoloji bölümüne başvurusunda yapılan cilt biyopsisi "non-nekrotizan granülomatöz inflamasyon" uyumlu bulgular saptanması üzerine Romatoloji polikliniğine yönlendirilmiş. Patolojik olarak EZN boyamada basil lehine bulgu, Pas boyaması ile fungal mikroorganizma lehine bulgu ve yabancı cisim varlığı izlenmedi. Yapılan fizik muayenede bilateral göz çevresinde makopapuler görünümlü lezyonlar mevcuttu. Solunum sistem muayenesi olağandı, hepatomegali saptanmadı. La-boratuvar bulgularında hemogram, karaciğer ve böbrek fonksi-yon testleri, serum kalsiyum seviyesi, eritrosit sedimentasyon hızı, CRP normal sınırlarda saptandı. Serum ACE düzeyi 36.2 U/L ( 8-52 U/L) saptandı. Çekilen PA akciğer grafisi ve toraks BT(de aktif sarkoidoz tutulumuna ait bulgu saptanmadı. Batın US'de hepatomegali saptanmadı. Göz hekimi tarafından değerlendirilen hastada sarkoidoz göz tutulumu bulgusu saptanmadı. Cilt tutulumu açısından dermatoloji hekimi tarafından değerlendirilen hastada iç organ tutulumu saptanmadığı için lokal takroliıuus tedavisi başlandı. Tedavinin ikinci ayında cilt lez-yonları geriledi. Laboratuvar bulguları normal sınırlarda idi. Dermatoloji hekimi ile görüşülerek bir ay daha takrolimus tedavisinin devamına ve sonrasında kontrolü önerildi. Sonuç: Sarkoidozda kutanöz lezyonlar histopatolojik incelemede nonkazeifiye granülomların görüldüğü özgül lezyonlar (rna-kopapüler, plak, nodül, lupus perniyo) ve reaktif olarak gelişen histopatolojik olarak granülomların izlenmediği özgül olmayan deri lezyonları (eritema nodozum) olmak üzere ikiye ayrılır. Kutanöz sarkoidozda tedavi genelde topikal, intralezyoner veya sistemik steroidler, topikal takrolimus ayrıca tetrasiklin türevleri, antimalaryal ilaçlar (klorokin ve hidroksiklorokin), metot-reksat, TNF-α inhibitörleri, izotretinoin ve pentoksifilin de başarılı sonuçlar vermektedir. [ABSTRACT FROM AUTHOR]

Relapsing polychondritis (RP) is a rare multisystemic disease. It affects cartilage and proteoglycan-rich structures. Ocular findings are the most frequent systemic involvement of the disease. The most common ocular manifestations are episcleritis and scleritis. During the course of the disease, uveitis may also be seen. However, as far as we know, nongranulomatous anterior uveitis with hypopyon is an uncommon ocular finding. In this article, we report a 27-year-old male patient who presented with hypopyon anterior uveitis as a revealing manifestation of RP. [ABSTRACT FROM AUTHOR]

The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden

In this study, we present a case of bilateral optic neuropathy and macular ischemia in the right eye associated with neurosarcoidosis. A 26-year-old woman presented to our clinic with complaints of bilateral blurred vision. Bilateral granulomatous anterior uveitis, vitritis, optic neuropathy, and macular ischemia were detected in the right eye in slit-lamp examination. She also reported complaints of fever, weakness, sweating, arthralgia, and headache for 2 months. She was referred to the pulmonary diseases unit of our hospital due to hilar lymphadenopathy seen in her chest x-ray, and biopsies were taken for diagnostic purposes. Histological analysis of the mediastinal lymph node biopsies revealed chronic, non-caseating, granulomatous inflammation. Furthermore, the patient was referred to a neurologist due to concomitant complaint of intense headaches. She was diagnosed with neurosarcoidosis supported by findings on cranial magnetic resonance imaging and lumbar puncture. She received a 3-day course of high-dose (1 g/day) intravenous steroid treatment (methylprednisolone) followed by a tapering dose of oral prednisone. The patient began receiving oral methotrexate 15 mg/week as a steroid-sparing agent. Significant improvement in neurological and ophthalmological symptoms occurred in the first week of treatment. In this case report, we emphasized that neurosarcoidosis should be included in the differential diagnosis of patients with both bilateral optic neuropathy and macular ischemia. Furthermore, early diagnosis and timely treatment of neurosarcoidosis are important for favorable visual outcomes. [ABSTRACT FROM AUTHOR]

Amaç: Bu çalışmanın amacı Ailevi Akdeniz ateşi (FMF) tanılı hastalarda ilaç uyumu ve ilişkili faktörlerin değerlendirilmesidir. Yöntem: 2021-2022 Haziran tarihleri arasında polikliniğimize başvuran 117 FMF hastası çalışmaya dahil edilmiştir. Hastalık aktivitesi son 3 ay içinde atak geçirme öyküsü ile, hastalık şiddeti ISSF skoruyla (hafif-orta-ağır şiddette hastalık) ve ilaç uyumu ise MASIF ölçeği (<60 puan "kötü ilaç uyumu", ≥60 puan "iyi ilaç uyumu") ile değerlendirilmiştir. Bulgular: Hastaların %64,4'ü (n=80) kadın, yaş ortalaması 34,4±9,1 yıl ve ortalama FMF tanı yaşları 23,7±10,4 yıl idi. Hastalarda en sık görülen şikayetler karın ağrısı (%85,2), ateş (%61,2) ve göğüs ağrısı (%53) idi. En sık görülen mutasyon M694V heterozigot mutasyonuydu (%38,4). ISSF skoruna göre hastaların %60,7 (n=71) hafif, %27,4 (n=32) orta ve %12,0 (n=14) ağır şiddette saptandı. Yirmi üç hastada (%19,6) kolşisin tedavisine direnç mevcuttu. Hastaların MASIF ölçeğinden aldıkları ortalama puan 65,9±10,7 idi. İyi düzeyde ilaç uyumu olan hasta oranı %71,8 (n=84) idi. İlaç uyumunun iyi/kötü olması ile demografik özellikler arasında anlamlı farklılık yoktu (Tablo 1). İlaç uyumu iyi olanların %53,0'ı (n=44) son üç ay içinde atak geçirmiş iken, bu oran ilaç uyumu kötü olanlarda %81,8 (n=27) idi (p=0,006). Son üç ay içinde atak geçirme durumuna göre MASIF ölçeği toplam ve alt boyutlarından alınan puan ortalamaları Tablo 2'de verilmiştir. İlaç uyumu iyi ve kötü olan hastaların ISSF sınıfları arasında anlamlı bir farklılık mevcuttu. İlaç uyumu iyi olan hastaların %16,7'si (n=14) hastalık şiddeti açısından ağır iken, ilaç uyumu kötü olanlarda ağır şiddette hasta yoktu (p=0,021). Amiloidoz varlığı açısından iyi/kötü ilaç uyumu olan gruplarlar arasında anlamlı bir farklılık yoktu (p=0,321). Sonuç: Ailevi Akdeniz ateşi hastalarının ilaç uyumunun iyi seviyede olduğu söylenebilir. İlaç uyumu ile hastalık aktivitesi ve şiddeti arasında anlamlı bir ilişki mevcuttur. İlaç uyumunun artırılması için ilaç ile ilgili bilgilerden çok uyumu artırıcı faktörler ve ilaç uyumu önündeki bireysel engellere odaklanılması faydalı olacaktır. [ABSTRACT FROM AUTHOR]

Patients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 ± 2.3 vs 4.3 ± 5.9 years) ( p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features. [ABSTRACT FROM AUTHOR]

Although gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 ± 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists. [ABSTRACT FROM AUTHOR]

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of reentrant paroxysmal supraventricular tachycardia that occurs in the presence of dual AV nodal physiology. Wolff-Parkinson- White (WPW) syndrome is another type of supraventricular tachycardia characterized by short PR intervals, delta waves and wide QRS complexes on the surface electrocardiogram (ECG), reflecting atrioventricular pre-excitation. Uncommonly, AV nodal reentry and accessory pathways can coexist. In this case report, we present a patient who had frequent episodes of palpitation and syncope and recently presented to the emergency department (ED) with the complaint of dizziness. We performed successful radiofrequency (RF) catheter ablation of mitral annulus posterolateral accessory pathway and AVNRT which was the cause of the second tachycardia induced during the same session. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20-year-old male patient who was admitted in a hospital with the complaint of palpitation. He was medically treated with the calcium channel blocker and beta-blocker which was proved unsuccessful. He was examined under the imaging system whose report of electrocardiogram (ECG) showed the presence of premature ventricular contractions (PVCs) with a right bundle branch block morphology and inferior axis.

Amaç: Hastalık algısı hastaların somut ve soyut kaynaklardan aldıkları bilgilerle hastalıklarına ilişkin geliştirdikleri düşüncelerdir. Hastalık algısının hastalıkla baş etme, tedaviye uyum ve tedavi etkinliği ile ilişkili olduğu gösterilmiştir. Bu çalışmanın amacı, Ailevi Akdeniz ateşi (FMF) hastalarının hastalık algısının ilaç uyumu ile ilişkisinin değerlendirilmesidir. Yöntem: 2021-2022 Haziran tarihleri arasında polikliniğimize başvuran 117 erişkin FMF hastası çalışmaya dahil edilmiştir. Hastalık algısı kısa hastalık algısı ölçeği (KHAÖ) ile değerlendirilmiştir. KHAÖ, her bir maddesi 0-10 arasında puanlanan ve hastalık algısına ilişkin bir bileşeni sorgulayan 8 madde ve hastalık nedenlerinin sorgulandığı açık uçlu bir sorudan oluşmaktadır. Hastalık algı skoru arttıkça bireyin hastalıktan etkilenme düzeyi ve hastalığı endişe verici olarak algılama düzeyi artmaktadır. İlaç uyumu MASIF ölçeği (<60 puan "kötü ilaç uyumu", =60 puan "iyi ilaç uyumu") ile değerlendirilmiştir. Bulgular: Hastaların %64,4'ü (n=80)'ü kadın, yaş ortalaması 34,4±9,1 yıl ve FMF tanı yaşı ortalaması 23,7±10,4 yıldı. Hastaların ortalama KHAÖ skoru 43,7±10,5 idi. Hastaların cinsiyet, medeni durum, eğitim durumu, kronik hastalık varlığı ve çalışma durumuna göre KHAÖ puan ortalamaları arasında anlamlı bir farklılık yoktu (Tablo 1). İyi düzeyde ilaç uyumu olan hasta oranı %71,8 (n=84) idi. İlaç uyumu kötü olan hastaların hastalık algı puanı anlamlı olarak yüksekti. Hastaların ilaç uyumu ve hastalık algısı ölçeği alt boyutlarından aldıkları puan ortalamaları Tablo 2'de verilmiştir. İlaç uyum durumuna göre, hastalıktan etkilenme, hastalık üzerine kontrol, tedaviye inanç ve hastalığı anlama alt boyut skorları anlamlı farklılık göstermektedir (Tablo 2). Sonuç: FMF hastalarında hastalık algısının orta düzeyde olduğu söylenebilir. İlaç uyumu kötü olan hastalarda hastalık algısı puanları anlamlı olarak yüksektir. İlaç uyumunun artırılması için, uyum üzerinde olumsuz etkisi olan hastalık algısı alt boyutlarında hastaların daha iyi bilgilendirilmesi faydalı olacaktır. [ABSTRACT FROM AUTHOR]

LupusPRO is a disease-targeted patient-reported outcome measure that was developed and validated from and among US patients with systemic lupus erythematosus (SLE). We herein report the results of the cross-cultural adaptation and validation study of the Turkish translated version of the LupusPRO. Turkish LupusPRO and the Medical Outcomes Study Short Form (SF-36) (Turkish) were administered to the Turkish lupus patients. Disease activity was ascertained using the physician global assessment (PGA), Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI), and flare (defined by LFA-Lupus Foundation of America). Disease damage was assessed with Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SDI). Also, second Turkish LupusPRO tests were given to the patients to be completed within 2-3 days and sent back to us. Internal consistency reliability, test-retest reliability, and convergent and criterion validity (against disease activity or health status) were tested. All reported p values are two-tailed. The conceptual framework of the LupusPRO was evaluated using confirmatory factor analysis appropriate for categorical data. One hundred two SLE subjects (94 % women) were enrolled. The median (IQR) age and mean disease duration (±SD) were 38.5 (18) years and 60.3 (±56.3) months, respectively. The mean ± SD, SLEDAI, and SDI scores were 3.1 ± 3.7 and 0.52 ± 0.75, respectively. There were 25 patients who had flares at the time of study. Forty-two patients with no change in their health status completed and sent back the second LupusPRO test and were included in the test-retest analysis. Test-retest reliability of LupusPRO domains ranged from 0.87 to 0.97, while internal consistency reliability of the domains ranged from 0.63 to 0.94. Convergent validity with corresponding domains of SF-36 was present. Health-related quality-of-life domains performed well against disease activity measures (PGA, total SLEDAI, LFA flare, and SF-6D-overall health status), establishing its criterion validity. Item-to-factor loadings representing the hypothesized item-to-scale relationships were satisfactory. The model fit for the hypothesized item-to-scale relationships was also satisfactory. The Turkish version of the LupusPRO is valid and appears to perform comparably to the English and Spanish language versions. It can be used as a patient-reported outcome parameter in clinical trials, as well as longitudinal studies for testing responsiveness to change. [ABSTRACT FROM AUTHOR]

Objective: Real-time sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on tissue elasticity and stiffness. We determined the efficacy of SE for assessing Achilles tendon abnormalities in patients with ankylosing spondylitis (AS). Materials and methods: Forty-one consecutive AS patients and 32 asymptomatic healthy subjects were enrolled. Achillodynia was scored on a 0- to 100-mm visual analog scale. A high-resolution ultrasound machine equipped with an elastography-compatible linear probe was used to perform bilateral B-mode ultrasound, Doppler ultrasound, and SE examinations of Achilles tendons. Tendons were divided into proximal, middle, and distal segments. B-mode examinations included tendon thicknesses, echotextures, and enthesopathic findings. SE using color-coded images was performed in the same areas. Normal consistent tendon structures were coded as blue or green, and moderately (yellow) or severely (red) softened areas were considered pathological. Results: The distal third of the Achilles tendons was the most commonly affected part in the AS patients compared with healthy subjects ( p = 0.001), whose middle third was more commonly affected. Achillodynia intensity tended to be higher in patients with pathological B-mode or SE examination findings ( p = 0.09 and p = 0.07 respectively). Softening detected by SE in the distal third was associated with enthesopathy findings such as calcaneal bone erosions (Fisher's X, p = 0.07) and tendinous enlargement (Fisher's X, p = 0.001). B-mode and SE findings had moderate to good correlation in the assessment of Achilles tendon abnormalities. Conclusions: Sonoelastography may be useful for the evaluation of tendon abnormalities in patients with AS; in addition; it may be useful for the evaluation of other inflammatory rheumatic conditions. [ABSTRACT FROM AUTHOR]

Aim The association of uric acid (UA) level with major cardiovascular risk factors has been well-known. However, whether UA is a risk factor for coronary artery disease (CAD) still remains controversial. We aimed to examine the short term effect of plasma UA level on cardiovascular events (CVEs) in patients with stable CAD. Methods The study included 147 consecutive patients with CAD. The patients were evaluated in two groups. Group 1: 101(68.7%) patients with UA level higher than 6.5 mg/dL for females and 7 mg/dL for males (n= 38 and 63, respectively); Group 2: 46 (31.3%) patients with UA level lower than those values (n= 15 and 31, respectively). The patients were followed for 15.3 ± 5.5 months. Death, acute coronary syndrome, stroke and other cardiovascular hospitalizations were defined as CVE. The relationship between CVEs and plasma UA level was examined using the Cox-regression analysis. Results The mean age was 63 ± 11 years [94 (63.9%) males, 53 (36.1%) females]. Forty-five (30.6%) had diabetes mellitus and 106 (72.1%) had hypertension. The mean UA level was 6.0 ± 1.5 mg/dL. In the follow-up, 23 (15.6%) had any defined CVEs. Only two patients died. No statistical significance was found in terms of the association between plasma UA level and CVEs (p = 0.61). Conclusion In patients with stable CAD no relation between plasma UA level and CVEs in the short-term was found. However, this subject still needs further studies with longer follow-up period. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a multi-system chronic inflammatory disease with a broad spectrum of clinical and serological manifestations. Although clinical evidence of proximal skeletal muscle involvement is not rare in patients with SLE, there is no knowledge about the effects of SLE on the macroscopic structural parameters of the muscles. Therefore, in this study, we aimed to explore the muscle strength and structure of SLE patients using isokinetic testing and ultrasonographic imaging. Thirty-one SLE patients (5 men, 26 women) with a mean age of 38.61 ± 10.68 years and mean disease duration of 3.71 ± 3.23 years without any previous history of myositis and 31 age- and sex-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients were recorded. Ultrasonographic evaluations were performed with a 7- to 12-MHz linear probe from vastus lateralis and gastrocnemius muscles of the nondominant extremity. Measurements included muscle thickness, pennation angle, and fascicule length. Isokinetic nondominant knee muscle strength tests were performed at 60 and 180°/s. We found that muscle thickness, pennation angle, and fascicle length of vastus lateralis muscles were increased in patients with SLE in comparison to control subjects ( p < 0.001, p = 0.007, and p = 0.217, respectively). On the other hand, the measurements pertaining to the gastrocnemius muscles were found to be similar between the two groups. We observed that all isokinetic knee muscle strength values were decreased in SLE patients, and knee strength values were found to be negatively correlated with age and positively correlated with height (all p < 0.01). We found that the structural and strength changes were seen in the proximal muscles of SLE patients. Pathophysiology and clinical relevance of these changes need to be further investigated. [ABSTRACT FROM AUTHOR]

Purpose: In this study we aimed to investigate myocardial function and atrial electromechanical properties by conventional and tissue doppler echocardiography in patients with primary Sjögren syndrome. Methods: Forty patients with Sjögren syndrome (SS) and 25 age- and sex-matched healthy volunteers were enrolled in the study. Using transthoracic echocardiography, myocardial performance index and atrial electromechanical properties were measured. Results: Basal characteristics were similar between two groups. Myocardial performance index values were disturbed in patients with Sjögren syndrome (0.41 vs. 0.32, p<0.01). there was significant intraatrial (16.4±6.4, 5.0±4.5, p<0.01) and interatrial (30.6±10.1, 15.4±5.9, p<0.01) electromechanical delay in this patient group. Conclusion: Myocardial function is disturbed and there is significant atrial electromechanical delay in patients with primary SS. This study is the first to show altered myocardial function and atrial electromechanical properties in primary SS. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory disease with a broad spectrum of clinical and serological manifestations. Although articular involvement is known in SLE, articular cartilage has not been studied before. Therefore, in this study, we have evaluated the femoral cartilage by using ultrasonography. Twenty-nine SLE patients (5 M, 24 F) with a mean age of 37.93 ± 10.66 years and mean disease duration of 3.69 ± 3.24 years and 29 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients were recorded. The thickness of the femoral articular cartilage was measured by using a 7- to 12-MHz linear probe. Three mid-point measurements were taken from each knee; from right lateral condyle, right intercondylar area (RIA), right medial condyle (RMC), left medial condyle, left intercondylar area (LIA) and left lateral condyle (LLC). Although SLE patients had thicker femoral cartilage values than those of the control group at all measurement sites, the differences were not statistically significant (all p > 0.05). Twenty-two patients (75.9 %) were using corticosteroids, and when those patients were compared with their healthy controls, the difference reached statistical significance at RIA ( p = 0.022), LIA ( p = 0.059) and LLC ( p = 0.029). We found that SLE patients seem to have thicker femoral cartilage values and that this increase could be related with corticosteroid treatment. In addition to studies that have shown the favorable effects of corticosteroids on chondrogenesis, further studies are needed to clarify the scenario in SLE patients. [ABSTRACT FROM AUTHOR]

Madelung's disease is a rare acquired disorder of fat metabolism characterized by multiple symmetric lipomas with typical distribution mainly around the upper trunk, neck, and shoulders. The condition is strongly associated with chronic alcohol use and has various systemic manifestations like polyneuropathy, muscle weakness, and small bone fractures. Herein, we report a 56- year-old male patient with Madelung's disease and multiple fractures and discuss possible underlying factors leading to multiple fractures. [ABSTRACT FROM AUTHOR]

The article presents the author's view on essential risk factors for contrast-induced nephropathy in patients with segment elevation myocardial infarction.