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Öğe AB0311 Evaluating of atherosclerosis in rheumatoid arthritis patients with carotid intima media thİckness and lipoprotein phospholipase A2 activity(Bmj Publishing Group, 2014) Bes, Cemal; Gürel, Safiye; Buğdaycı, Güler; Dikbaş, Oğuz; Soy, MehmetÖğe Anaplastic large cell lymphoma in a patient with rheumatoid arthritis(Springer Heidelberg, 2011) Beş, Cemal; Beş, Z. Senem; Vardı, Şeref; Soy, MehmetIt is known that patients with rheumatoid arthritis (RA) have an increased risk for non-Hodgkin's lymphomas in comparison with the general population. Although increased risk of lymphoma is attributed to the disease activity, the drugs used in the therapy of RA may also cause increased risk of malignancy. Herein, we report on an RA patient who developed non-Hodgkin's lymphoma after methotrexate therapy and review the literature about it. A 74-year-old man with RA had been treated with low-dose methotrexate and subsequently developed anaplastic large cell lymphoma of the T-cell phenotype. Anaplastic large cell lymphoma has been reported rarely in rheumatoid arthritis.Öğe Atherosclerosis assessment and rheumatoid arthritis(Springer Heidelberg, 2018) Bes, Cemal; Gürel, Safiye; Buğdaycı, Güler; Dikbaş, Oğuz; Soy, MehmetRheumatoid arthritis is associated with increased morbidity and mortality due to atherosclerotic cardiovascular diseases. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme of phospholipase A2; it plays an important role in inflammation and atherosclerosis. Herein we aimed to investigate whether Lp-PLA2 activity is associated with atherosclerosis in patients with rheumatoid arthritis and compare the Lp-PLA2 activity with carotid intima media thickness (CIMT). 25 patients with rheumatoid arthritis and 40 controls (20 patients with type 2 diabetes mellitus [DM] and 20 healthy controls) were included in the study. Frozen serum samples were used for analyzing Lp-PLA2 activity. Disease activity was calculated with DAS28 (Disease Activity Score 28) in the rheumatoid arthritis group. The mean CIMT was calculated in all participants. Lp-PLA2 activity was significantly higher in the DM group (p = 0.006) and LDL (Low density cholesterol levels) were lower in rheumatoid arthritis and healthy control groups compared with diabetics (p = 0.001 and p = 0.029, respectively). The mean CIMT was significantly higher in patients with type 2 DM (p = 0.047). Lp-PLA2 activity was not increased in the rheumatoid arthritis group when compared with healthy controls and the DM group. This result may be associated with low disease activity scores in patients with rheumatoid arthritis.Öğe Bronchocentric granulomatosis in a patient with rheumatoid arthritis(Springer Heidelberg, 2012) Beş, Cemal; Kılıçgün, Ali; Talay, Fahrettin; Yılmaz, Fahri; Soy, MehmetBronchocentric granulomatosis is an uncommon entity which has no specific clinical, radiological and immunological features. It is usually diagnosed at morphological examination of biopsy or resected lung material. Aetiology of bronchocentric granulomatosis is unclear. A 49-year-old female patient, who was followed up with diagnosis rheumatoid arthritis in our outpatient clinic, presented with right lobe nodular lesion in chest radiography. Right thoracotomy and wedge resection was performed. Pathological examination revealed bronchocentric granulomatosis. Bronchocentric granulomatosis has been rarely reported in rheumatoid arthritis. This case might be a proof that bronchocentric granulomatosis may be one of the respiratory manifestations of rheumatoid arthritis.Öğe Can bone quality be predicted accurately by Singh Index in patients with rheumatoid arthritis?(Springer London Ltd, 2012) Bes, Cemal; Güven, Melih; Akman, Budak; Atay, Evren Fehmi; Ceviz, Emrah; Soy, MehmetThe aim of this study was to evaluate Singh index as a simple and inexpensive means of estimation of bone quality in patients with rheumatoid arthritis. Singh index evaluation was made on digital pelvis radiographs in 50 consecutive patients by three observers. Bone mineral density T scores of the spine and left proximal femur were assessed using dual energy X-ray absorptiometry. Singh index was correlated with densitometry measurements after grouping the patients as normal, osteopenia and osteoporosis. Intra-and interobserver agreements were evaluated by kappa correlations. Sensitivity, specificity, positive and negative predictive values and likelihood ratio's of Singh index were calculated. Both intra-and interobserver agreements were 0.71 (range, 0.69 to 0.72) on average. Singh index proved highly sensitive for the diagnosis of osteopenia at the proximal femur (91%) and spine (90%), whereas the specificity of Singh index for identifying of osteoporosis at the femoral neck (93%) and spine (91%) was higher than sensitivity. Predictive values for osteoporosis at the proximal femur and spine were acceptable and positive likelihood ratios of Singh index for osteopenia and osteoporosis at the proximal femur were 2.4 and 10.1, respectively. Singh index can identify osteoporosis with a high specificity in patients with rheumatoid arthritis. However, the patients who are graded as osteopenia by the Singh index should undergo further evaluation with dual energy X-ray absorptiometry.Öğe A case of propylthiouracil-induced antineutrophilic cytoplasmic antibody-positive vasculitis successfully treated with radioactive iodine(2013) Bes, Cemal; Dikbaş, Oğuz; Keskin, Fatma Ela; Kaptanoğulları, Nazmiye Özlem; Soy, MehmetAntineutrophilic cytoplasmic antibody (ANCA) associated vasculitis is one of the rare complications of propyl-thiouracil treatment. Having a variable clinical spectrum, it may be presented with both skin limited vasculitis and life-threatening systemic vasculitis. In this study, we present a case that developed ANCA-positive vascu-litis with skin and kidney involvement (hematuria and proteinuria) six months after propylthiouracil treatment was initiated for toxic nodular goiter. Proteinuria recovered dramatically subsequent to radioactive iodine treat-ment following ceasing the drug.Öğe The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey(Clinical & Exper Rheumatology, 2012) Malhan, Simten; Pay, Salih; Ataman, Şebnem; Dalkılıç, Ediz; Dinç, Ayhan; Soy, MehmetObjectives To determine the direct and indirect costs due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients in Turkey. Methods An expert panel was convened to estimate the direct and indirect costs of care of patients with RA and AS in Turkey. The panel was composed of 22 experts chosen from all national tertiary care rheumatology units (n=53). To calculate direct costs, the medical management of RA and AS patients was estimated using "cost-of-illness" methodology. To measure indirect costs, the number of days of sick leave, the extent of disability, and the levels of early retirement and early death were also evaluated. Lost productivity costs were calculated using the "human capital approach", based on the minimum wage. Results The total annual direct costs were 2,917.03 Euros per RA patient and 3,565.9 Euros for each AS patient. The direct costs were thus substantial, but the indirect costs were much higher because of extensive morbidity and mortality rates. The total annual indirect costs were 7,058.99 Euros per RA patient and 6,989.81 for each AS patient. Thus, the total cost for each RA patient was 9,976.01 Euros and that for an AS patient 10,555.72 Euros, in Turkey. Conclusion From the societal perspective, both RA and AS have become burden in Turkey. The cost of lost productivity is higher than the medical cost. Another important conclusion is that indirect costs constitute 70% and 66% of total costs in patients with RA and AS, respectively.Öğe Current antiviral practice and course of Hepatitis B virus infection in inflammatory arthritis: a multicentric observational study (A(Aves, 2015) Kalyoncu, Umut; Emmungil, Hakan; Onat, Ahmet Mesut; Yılmaz, Sedat; Kaşifoğlu, Timuçin; Bes, Cemal; Soy, MehmetObjective: The reactivation of hepatitis B virus (HBV) infection is a well-known event in hepatitis B surface antigen (HbsAg)-positive patients receiving immunosuppressive therapy. The objective of this study was to assess the antiviral practice and course of HBV infection in inflammatory arthritis. Material and Methods: Nineteen rheumatology centers participated in this retrospective study. HbsAg-positive patients who were taking disease-modifying antirheumatic drugs and who were being tested for HBV viral load at a minimum of two different time points were included. The case report form (CRF) consisted of demographic data, rheumatic diseases, treatment profiles, transaminase levels, viral hepatitis serological markers, and HBV viral load. The reactivation of HBV was defined as the abrupt rise in HBV replication by an increase in serum HBV DNA levels in a patient with a previously inactive HBV infection. Results: In total, the data of 101 (female 50.5%) patients were included (76 patients with inactive HBV carriers and 25 patients with chronic HBV infection). The mean age of patients was 44 +/- 12 years, and the mean follow-up duration was 31 +/- 22 months. Of the 101 patients, 70 (69.3%) received antiviral treatment. HBV reactivation was detected in 13 of 76 (17.1%) patients with inactive HBV carriers. HBV reactivation was observed less frequently, not although significantly, in those patients receiving antiviral prophylaxis compared with those not receiving prophylaxis [5/41 (12.2%) vs. 8/33 (24.2%), p=0.17]. Forty-two patients (31 patients had inactive HBV carriers) were using anti-tumor necrosis factor agents. HBV reactivation was detected in 6 of the 31 (19.3%) patients. Twenty-five patients had chronic hepatitis, and five (20%) of them had not received antiviral prophylaxis. HBV viral loads were persistently elevated in 7 (28%) of 25 patients (three patients under and four patients not under antiviral treatment). Conclusion: HBV reactivation was observed in approximately 17% of patients under immunosuppressive treatments. HBV reactivation was more frequently observed in those who did not receive antiviral prophylaxis.Öğe The effect of TNF-alpha blockers on psychometric measures in ankylosing spondylitis patients: a preliminary observation(Springer Heidelberg, 2013) Arısoy, Özden; Bes, Cemal; Çifçi, Çiğdem; Sercan, Mustafa; Soy, MehmetThere is a high co-morbidity between chronic inflammatory disorders and depression. Proinflammatory cytokines like TNF-alpha seem to play a central role in the pathogenesis of these disorders, and its neutralization provides a potent treatment for inflammatory disorders. Few studies showed that TNF-alpha blockers also caused an improvement in depressive symptoms associated with these chronic inflammatory disorders. To evaluate the effectiveness of TNF-alpha blockers on symptoms of ankylosing spondylitis (AS), depression, anxiety and quality of life, 9 AS patients resistant to classical therapy were enrolled and followed-up at 2nd and 6th weeks after a TNF-alpha blocker was started. Hamilton Depression and Anxiety Scales (HAM-D, HAM-A), Hospital Depression and Anxiety Questionnaire (HAD), Quality of Life Scale (SF36) and AS severity index (BASDAI) were applied to the patients at weeks 0, 2 and 6. ESR and CRP were evaluated to monitor biological disease activity. There was a significant reduction in HAM-D (p = 0.00), HAM-A (p = 0.00), HAD anxiety scores (p = 0.02) and a significant improvement in SF36 physical function (p = 0.00), physical role limitations (p = 0.00), bodily pain (p = 0.05), general health (p = 0.01), vitality (p = 0.03) and emotional role limitations (p = 0.00) subscales, BASDAI scores (p = 0.00), ESR (p = 0.00) and CRP (p = 0.00). Change in clinical disease activity (BASDAI) was not correlated with change in depression-anxiety scores, while change in biological disease activity (CRP) was correlated with change in depression-anxiety scores. TNF alpha blockers may have a potential antidepressant effect besides its anti-inflammatory effect that seems to be independent of its clinical effect.Öğe The effect of TNF? blockers on psychometric measures in treatment resistant ankylosing sponylitis patients: A pilot study(Elsevier France-Editions Scientifiques Medicales Elsevier, 2011) Arısoy, Özden; Beş, Cemal; Çifci, Çiğdem; Sercan, Mustafa; Soy, MehmetThere is a high co-morbidity between chronic inflammatory disorders and depression1. Proinflammatory cytokines like TNFα seems to play a central role in the pathogenesis of these disorders and its neutralization provides a potent treatment for inflammatory disorders2. Trying et al (2006) showed that a TNF-α blocker -etanercept- caused at least a 50% improvement in depression scores in psoriasis patients.3 These observations together with the theoretical background led to the hypothesis that TNF-α blockers may reverse depressive symptoms associated with chronic inflammatory disorders.Öğe Erythema nodosum associated with granulomatous mastitis: report of two cases(Springer Heidelberg, 2010) Beş, Cemal; Soy, Mehmet; Vardı, Şeref; Şengül, Neriman; Yılmaz, FahriGranulomatous mastitis is a rare breast disease characterized by chronic inflammation. Clinical presentation of granulomatous mastitis usually mimics malignancy or infection. Coincidence of granulomatous mastitis and erythema nodosum is a quite rare feature. In this paper, we aimed to present two young women with granulomatous mastitis accompanied by erythema nodosum and successfully treated with corticosteroids. Granulomatous mastitis should be kept in the mind for differential diagnosis of erythema nodosum.Öğe Impairment of arterial distensibility in premenopausal women with systemic lupus erythematosus(Via Medica, 2008) Yıldız, Mustafa; Yıldız, Banu Şahin; Soy, Mehmet; Tutkan, HavaBackground and aim: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease affecting young women and is associated with increased frequency of atherosclerotic vascular diseases. Pulse wave velocity (PWV) is an index of arterial stiffness and a marker of cardiovascular events. This study aimed to investigate arterial distensibility using carotid-femoral (aortic) PWV measurements in premenopausal women with SLE. Methods: We recruited 24 premenopausal women with SLE (SLE duration: 5.3+/-4.6 years) and 24 age- and sex-matched controls. Aortic PWV was determined by using an automatic device, the Complior Colson (France), which allowed on-line pulse wave recording and automatic calculation of PWV Results: The carotid-femoral PWV (8.98+/-2.05 vs. 8.05+/-0.94 m/s), systolic blood pressure (117.08+/-17.12 vs. 106.87+/-11.96 mmHg), pulse pressure (45.62+/-11.91 vs. 38.33+/-9.04 mmHg), heart rate (81.41+/-9.20 vs. 71.12+/-10.32 beat/min) and serum glucose levels (89.68+/-8.12 vs. 73.80+/-10.72 mg/dl) were significantly higher in premenopausal women with SLE, as compared with control subjects (p=0.04, p=0.02, p=0.02, p=0.001, p <0.001, respectively). We found a significant correlation between PWV and age, body mass index, waist-to-hip ratio, heart rate and blood pressure. Conclusion: Arterial distensibility is decreased in premenopausal women with SLE.Öğe Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis(Springer Wien, 2013) Kurt, Özlem Kar; Kurt, Bahar; Talay, Fahrettin; Tuğ, Tuncer; Soy, Mehmet; Bes, Cemal; Hayran, MutluThe use of anti-TNF drugs for rheumatic diseases has increased in recent years. Several studies have reported an increased risk of reactivation of tuberculosis (TB) with anti-TNF agents. The aim of this study was to present the follow-up results of a single center from Turkey, a country with a high rate of active and latent tuberculosis infection (LTBI), for INH chemoprophylaxis in patients receiving anti-TNF-alpha therapy for rheumatic diseases infection. In this prospective observational study, consenting patients who were to be administered an anti-TNF agent for a rheumatic disease were evaluated for the presence of active infection or LTBI by a chest X-ray and a tuberculin skin test. Patients with LTBI were given chemoprophylaxis 1 month prior to commencement of anti-TNF treatment. All patients were followed-up bimonthly for any signs of pulmonary or extrapulmonary TB. A total of 73 patients, 23 female (31.5 %) and 50 male (68.5 %), with a mean age of 41.0 +/- A 13.1 years (18-78) were enrolled in the study. Overall, 44 patients (60.3 %) had ankylosing spondylitis, 18 (24.7 %) had rheumatoid arthritis, 7 (9.6 %) had juvenile rheumatoid arthritis, and 3 (4.1 %) had psoriatic arthritis. LTBI was identified in 58 patients all of whom received chemoprophylaxis for 9 months. None of the patients in the study developed any signs of tuberculosis reactivation during follow-up. TST is a reliable and cost-effective method for the diagnosis of LTBI in patients prior to anti-TNF therapy. Moreover, chemoprophylaxis with INH seems to be effective for the prevention of TB reactivation in individuals with LTBI.Öğe Items of Yamaguchi criteria might be associated with diseases severity and prognosis in adult-onset still's disease(Wiley-Blackwell, 2015) Kalyoncu, Umut; Solmaz, Dilek; Emmungil, Hakan; Yazıcı, Ayten; Kaşifoğlu, Timuçin; Bes, Cemal; Soy, MehmetÖğe Joint and nail involvement in Turkish patients with psoriatic arthritis(Springer-Verlag GmbH Germany, part of Springer Nature, 2008) Soy, Mehmet; Karaca, Nuran; Ümit, Elif Uğur; Beş, Cemal; Pişkin, SüleymanPsoriatic arthritis is an autoimmune, chronic, systemic inflammatory disorder characterized by the association of arthritis with psoriasis. In this paper, we explore the characteristics of joint and nail involvement in Turkish patients with psoriatic arthritis. Forty patients with psoriasis (M/F, 18/22) and 49 (M/F, 25/24) subjects with psoriatic arthritis were included in the study. Clinical characteristics of the patients were recorded. The distribution of the subjects with arthritis: (according to the clinical and radiological findings): polyarticular, 65%; oligoarticular, 23%; isolated axial involvement, 7.7%; arthritis mutilans, 3.8%; sacroiliitis, 19%. Nail involvement was significantly higher among patients with arthritis; i.e., 91 versus 32%; (P < 0.05). There were no correlation between the skin involvement pattern and the arthritis type (P > 0.05). Nevertheless, no relation was observed between the psoriasis duration and arthritis (P > 0.05). Nail involvement is a frequent feature of the psoriatic arthritis which may be a useful finding for differential diagnosis of psoriatic arthritis from other inflammatory arthropathies.Öğe Lack of an effect of CYP3A4 and MDR1 gene polymorphisms on colchicine pharmacogenetics in the treatment of familial Mediterranean fever(Funpec-Editora, 2013) Doğruer, D.; Tuğ, Esra; Bes, Cemal; Soy, MehmetThe P-gp/MDR1 multidrug transporter mediates detoxification of numerous drugs, including colchicine, and CYP3A4 is key to the biotransformation of colchicine. We investigated the effects of CYP3A4 and P-gp/MDR1 polymorphisms on bioavailability of colchicine in patients with Familial Mediterranean fever (FMF). Forty-eight Turkish patients with FMF treated with colchicine were genotyped for 3435C>T, (-)1A>G, 61A>G, 1199G>A, 1236C>T, 2677G>A, 2677G>T polymorphisms in the P-gp/MDR1 gene and 3435C>T, *1B(-392A>G), *2(15713T>C), *3(23171T>C), *12(21896C>T), *17(15615T>C) polymorphisms in the CYP3A4 gene. Doses of colchicine administered to patients did not differ with respect to P-gp/MDR1 or CYP3A4 gene polymorphism. We also determined the genotype distributions of CYP3A4 and P-gp/MDR1 genes among FMF patients. There was no significant gender difference in the P-gp/MDR1 polymorphism, whereas there were significant gender differences in the frequencies of 15713T>C and 15615T>C polymorphisms in the CYP3A4 gene. No significant relationship was found between colchicine doses that would introduce optimal clinical response and affect the therapeutic dose and CYP3A4 and P-gp/MDR1 gene polymorphisms in these FMF patients.Öğe Massive lower gastrointestinal bleeding associated with solitary rectal ulcer in a patient with Behcet's disease(Pagepress Publ, 2015) Bes, Cemal; Dağlı, Ülkü; Yılmaz, Fahri; Soy, MehmetSolitary rectal ulcer syndrome is a rare benign disorder that has a wide range of clinical presentations and variable endoscopic findings which makes it difficult to diagnose and treat. The clinical and endoscopic picture in this condition can also mimic malign ulceration, malignancy or Crohn's disease. Behcet's disease can affect the gastrointestinal tract. However to the best of our knowledge, no case with solitary rectal ulceration has been reported so far in literature. We herein present a patient diagnosed with Behcet's disease admitted to our clinic with rectal bleeding due to solitary rectal ulceration.Öğe Paraneoplastic arthritis : a multi-centered experience(Bmj Publishing Group, 2013) Kısacık, Bünyamin; Onat, Ahmet Mesut; Kaşifoğlu, Timuçin; Pehlivan, Yavuz; Pamuk, Orhan Nuri; Bes, Cem; Soy, MehmetÖğe Parkinsonism in elderly rheumatoid arthritis patients(2014) Bes, Cemal; Altunrende, Burcu; Yılmaz Türkoğlu, Şule; Yıldız, Nebil; Soy, MehmetObjective. The incidences of extrapyramidal symptoms and Parkinson's disease were reported to be increased in patients with rheumatoid arthritis (RA). In this study we aimed to explore the frequency of the symptoms of Parkinsonism among RA patients older than 60 years. Patients and Methods. 30 (6 males, 24 females) consecutive RA patients, followed at a rheumatology outpatient clinic, who were 60 years of age or older; 23 patients who were diagnosed as PD and 50 sex and age matched healthy controls were included to the study. All participants were examined for the motor and non-motor findings of Parkinsonism including bradykinesia, rigidity, tremor, postural abnormality, upper limb sway abnormality, gait impairment, decrease in facial expression, seborrhea, slowing of speech and impairment in the self care. Results. When the RA, PD cases and healthy control group were compared for bradykinesia, rigidity, tremor, posture, upper limb sway, gait impairment, facial expression, seborrhea, speech and self care; highly significant differences were seen for all parameters. Two out of the 30 RA cases (6,7%) were diagnosed as Parkinson's disease. Conclusion. The signs of Parkinsonism and Parkinson's disease were found more frequent in elderly RA cases as compared to healthy controls.Öğe A rare form of SLE: pseudo-pseudo meigs syndrome and hydrocephalus(Springer Heidelberg, 2013) Bes, Cemal; Dağlı, Ülkü; Memedoğlu, Pınar; Soy, Mehmet
