Rheumatoid Arthritis: Akkoc N

Akkoc N. · Division of Rheumatology and Immunology, Department of Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey. · Curr Rheumatol Rep. · Pubmed #18817640 No free full text.

Abstract: The high-range estimate of 1.3% by the National Arthritis Data Workgroup for the prevalence of the entire spectrum of spondyloarthropathies (SpAs) suggests that SpAs may be more prevalent than rheumatoid arthritis (RA) in the United States. Recent surveys from many European countries using the same sample population have also found SpA to be at least as common as RA in most of the studied populations, including Finnish, Swedish, Lithuanian, French, Italian, and Turkish. Among Asian populations, China has the highest prevalence of SpA, with reported estimates generally higher than that of RA. In Thailand and Vietnam, the two diseases are probably equally common, whereas RA seems to be more prevalent than SpA in the rest of Asia, the Pacific Region, and Latin America, as indicated by studies following the COPCORD (Community-Oriented Program for the Control of Rheumatic Diseases) protocol. Both rheumatic disorders are rare in Africa, but SpA is less common than RA.

Akkoc N, van der Linden S, Khan MA. · Department of Internal Medicine, Division of Rheumatology and Immunology, Dokuz Eylul University School of Medicine, Balcova, 35340 Izmir, Turkey. · Best Pract Res Clin Rheumatol. · Pubmed #16777581 No free full text.

Abstract: The main objectives of medical therapy in ankylosing spondylitis (AS) are to relieve pain, stiffness and fatigue and to prevent structural damage. The Assessment in Ankylosing Spondylitis Working Group has proposed different domains with specific instruments to assess the efficacy of therapeutic agents classified as symptom-modifying and disease-controlling antirheumatic drugs. Non-steroidal antiinflammatory drugs (NSAIDs) are still the first-line treatment in the management of AS, and they are effective in controlling symptoms such as pain and stiffness and maintaining mobility in many patients. A recent randomized trial suggested that the progression of radiological damage occurs less on continuous use of celecoxib compared with on-demand use. If such findings were confirmed by other studies, the therapeutic value of NSAIDs in AS may extend beyond symptom control. However, for each individual patient, the expected advantages of treatment with NSAIDs should be weighted against any possible gastrointestinal and cardiovascular disadvantages. Disease-modifying antirheumatic drugs (DMARDs) are widely used for second-line therapy in AS, but the evidence for their efficacy is poor. The term 'DMARD' has been borrowed from rheumatoid arthritis, and none of the DMARDs have been shown to prevent or significantly decrease the rate of progression of structural damage which is required to be qualified as a disease-controlling antirheumatic drug for AS. Sulphasalazine is the most extensively studied DMARD and studies suggest some degree of clinical benefit confined to peripheral joint involvement, but no evidence of benefit in axial disease. Methotrexate, which is the gold standard DMARD in rheumatoid arthritis, does not seem to have a substantial therapeutic effect in AS on axial or peripheral joint involvement. Leflunomide appears to exert little beneficial effect, if any, even on peripheral joint involvement. There is also good evidence that local therapy with corticosteroids is effective and may be used in selected patients. Oral corticosteroids may be somewhat effective in relieving the symptoms of AS, but this has not been formally studied. Small studies have reported favourable results with intravenous methylprednisolone pulse therapy, but the effect is temporary. Pamidronate and thalidomide have been used in some preliminary trials but need further studies to assess their potential role in treating AS patients resistant or intolerant to other forms of treatment. Treatment with tumour necrosis factor blockers is not discussed in this review.

Saruhan-Direskeneli G, Inanc M, Fresko I, Akkoc N, Dalkilic E, Erken E, Karaaslan Y, Kinikli G, Oksel F, Pay S, Yucel E, Yentür SP, Duymaz-Tozkir J, Yilmaz V, Inanc N, Yazici H, Konice M, Direskeneli H. · Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. · Rheumatology (Oxford). · Pubmed #18032542 No free full text.

Abstract: OBJECTIVES: To investigate the role of shared epitope (SE) alleles in the short-term clinical response to leflunomide for the treatment of active RA. METHODS: In an open-label, multi-centre study of 16-weeks duration, 93 patients (82% female) fulfilling ARA 1987 RA criteria were treated with leflunomide (100 mg loading dose for 3 days, then 20 mg/day as the maintenance dose). The primary efficacy criterion was the response status according to the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score-28 (DAS28) activity measure. SE determinations have been undertaken by polymerase chain reaction and sequence-specific oligonucleotide genotyping methods. RESULTS: The mean (s.d.) Disease Activity Score-28 (DAS28) was 5.1 (1.3) before the treatment, which was significantly decreased after 16 weeks [3.0 (1.1), P < 0.001]. According to the EULAR response criteria, 55 patients (59.1%) were classified as good responders. SE was positive in 51 (54.8%) of the patients, with 13 (13.9%) having SE homozygosity or carrying any two SE alleles. Among SE-positive patients, 68.6% (35/51) were good responders, compared with 47.6% (20/42) in SE negatives (P = 0.04). No difference was present according to SE hetero- or homozygosity (68.4 vs 69.2%). RF was also present significantly more frequently in the SE-positive group compared with negatives (78.4 vs 57.1%, P = 0.03). However, no significant difference was observed in the prevalence of RF positivity in patients with a good clinical response (72.7 vs 63.2%, P = 0.32). CONCLUSIONS: The results suggest that HLA-DRB1 SE presence may favourably affect the outcome of leflunomide monotherapy in an unselected group of RA patients with an active disease and naive to leflunomide.

Sari I, Birlik M, Binicier O, Akar S, Yilmaz E, Onen F, Akkoc N. · Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine, Turkey. · J Korean Med Sci. · Pubmed #19270830 links to  free full text

Abstract: Adult-onset Still's disease (AOSD) is an inflammatory disease that presents with a variety of clinical symptoms. Pulmonary involvement is well-known in AOSD and is seen in up to 53% of AOSD cases, with the most common pulmonary diseases being pleural effusion and transient pulmonary infiltrates. We present the first case of chronic AOSD complicated with diffuse alveolar hemorrhage during the acute flare of the disease.

Sari I, Akar S, Pakoz B, Sisman AR, Gurler O, Birlik M, Onen F, Akkoc N. · Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Dokuz Eylul Universitesi Tip Fakultesi, Romatoloji Bilim Dali, Balcova, 35340, Izmir, Turkey. · Rheumatol Int. · Pubmed #19048257 No free full text.

Abstract: The aim of this study was to examine the prevalence of hyperuricemia and its associated factors in an urban area of Izmir, located in western Turkey. Our study group was selected by computerized sampling from the participants of a larger population-based study searching for the prevalence of rheumatoid arthritis in Balcova and Narlidere districts of Izmir. A total of 132 subjects (69 women and 63 men) were included in this study. Serum uric acid, glucose, creatinine and lipid levels were studied. Body composition along with body fat percentage was determined anthropometrically. A total of 16 subjects had hyperuricemia (4 women and 12 men). The overall prevalence of hyperuricemia was 12.1% and the mean uric acid level was 4.9 +/- 1.3 mg/dl. Males had significantly higher uric acid levels than females (P < 0.05; 5.5 +/- 1.3 vs. 4.3 +/- 1.1 mg/dl, respectively). The prevalence of hypertension, diabetes, obesity and metabolic syndrome was 24.4, 5.3, 28 and 26.5%, respectively. There was no gouty subject. Sum of skinfold thickness (SFT) measurements and creatinine levels were the independent predictors of hyperuricemia (beta = 0.45, 0.47, respectively). Uric acid measurement is important not only for inflammatory rheumatic disorders but also for predicting metabolic syndrome and related coronary artery disease. There is sex difference in uric acid levels in favor of women most probably explained by gonadal hormones. Hyperuricemia is significantly predicted by anthropometric measure of SFT which is a simple clinical screening method along with creatinine levels.

Akar S, Can G, Binicier O, Aksu K, Akinci B, Solmaz D, Birlik M, Keser G, Akkoc N, Onen F. · Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Dokuz Eylul Universitesi Tip Fakultesi, Ic Hastaliklari AD, Immunoloji-Romatoloji BD, Inciralti, 35340 Izmir, Turkey. · Clin Rheumatol. · Pubmed #18097710 No free full text.

Abstract: The aims of the study were to assess the health-related quality of life (QOL) in patients with Takayasu's arteritis (TA) by two different generic QOL instruments and to compare the results with those patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and healthy controls (HC). A cross-sectional study was performed in 51 patients with TA (41 women; mean age 38.4 +/- 13.5), 43 RA (36 women; 55.2 +/- 9.6), 31 AS (12 women; 41.2 +/- 13.1), and 75 HC (53 women; 38.8 +/- 10.9). Quality of life was assessed by using Short-Form 36 (SF-36) and Nottingham Health Profile (NHP). Separate dimensions of SF-36 and NHP and physical and mental summary scores of SF-36 as well were compared between patients and control groups. Physical and mental health summary scores and all SF-36 subscales, except for social functioning, were significantly lower in patients with TA than healthy controls. No significant differences between TA, RA, and AS patients were found in all SF-36 subscales and summary scores. NHP scores for energy level, pain, emotional reactions, and physical mobility were significantly higher in TA patients than controls. All NHP subscales, except for pain, were comparable in patients with TA, RA, and AS. Pain score was worse in RA patients. The NHP scores for sleep and social isolation were not different between patients and controls. Many aspects of QOL in patients with TA are significantly impaired in comparison with local healthy controls and similar to those in patients with RA and AS.

Onen F, Akar S, Birlik M, Sari I, Khan MA, Gurler O, Ergor A, Manisali M, Akkoc N. · Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey. · J Rheumatol. · Pubmed #18085733 No free full text.

Abstract: OBJECTIVE: To determine the prevalence of ankylosing spondylitis (AS) and related spondyloarthritides (SpA) in an adult urban population of Izmir, Turkey. METHODS: A survey was conducted of 2887 subjects aged 20 years or over, selected by cluster sampling. Those who responded positively to the screening questions were contacted by 2 rheumatologists and evaluated in detail to establish presence of AS (modified New York criteria) or related SpA (ESSG criteria). RESULTS: In the initial screening, 2835 subjects participated; 422 were considered screening-positive and a telephone interview was done with 328 (78%). Based on their clinical history, 145 subjects were invited to the hospital and 120 (83%) agreed to do so. After detailed evaluation, 31 subjects were classified as having SpA (including 14 with AS). The age- and sex-adjusted prevalence was estimated to be 0.49% for AS (95% CI 0.26-0.85), and 1.05% for SpA (95% CI 0.70-1.50). The prevalence of AS was 0.54% in men (95% CI 0.19-1.20) and 0.44% in women (95% CI 0.19-0.88), and that of SpA was 0.88% in men (95% CI 0.42-1.59) and 1.22% in women (95% CI 0.73-1.89). CONCLUSION: This epidemiological study suggests a high prevalence (0.49%) of AS in an adult urban population from western Turkey, which equals that of rheumatoid arthritis in the same population. The overall prevalence of SpA, including AS, was 1.05%. A minimal male predominance was noted among AS patients, which disappeared among the whole group of patients with SpA.

Sari I, Akar S, Birlik M, Sis B, Onen F, Akkoc N. · Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey. · J Rheumatol. · Pubmed #16821276 No free full text.

Abstract: We describe a patient with rheumatoid arthritis who developed psoriasis during treatment with etanercept; psoriatic lesions resolved completely after the drug was discontinued, but returned on rechallenge. No such adverse skin reaction occurred after switching therapy to infliximab. Through a Medline search we identified 11 reports involving 32 patients who developed psoriasis/psoriasiform eruptions during therapy with tumor necrosis factor-alpha (TNF-alpha) inhibitors. All TNF-alpha blocking agents have been reported to lead to or exacerbate psoriasis. In some cases skin changes were severe enough to discontinue the medication.

Akkoc N, Akar S. · DEUTF, Romatatoloji-Immunoloji Bilim Dali Balcova, 35340, Izmir, Turkey. · Clin Rheumatol. · Pubmed #16397748 No free full text.

This publication has no abstract.

Sari I, Okan T, Akar S, Cece H, Altay C, Secil M, Birlik M, Onen F, Akkoc N. · Department of Internal Medicine, Division of Rheumatology, Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey. · Rheumatology (Oxford). · Pubmed #16204374 links to  free full text

Abstract: OBJECTIVE: In recent years, accelerated atherosclerosis and increased risk of cardiovascular events have been described in patients with rheumatic disease, particularly for rheumatoid arthritis and systemic lupus erythematosus. However, the link between inflammation, atherosclerosis and ankylosing spondylitis is controversial. We evaluated the degree of atherosclerosis and endothelial function of ankylosing spondylitis patients ultrasonographically. METHODS: Fifty-four patients with ankylosing spondylitis (37 +/- 11 yr, 29 males, 25 females) and 31 healthy controls (35 +/- 9 yr, 16 males, 15 females) were consecutively enrolled in the study. Serum lipids, creatinine, glucose, and acute-phase proteins were assessed. The Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were also evaluated. Flow-mediated dilatation and endothelium-independent dilatation of the brachial artery and intima-media thickness of the common carotid artery were measured sonographically. RESULTS: Left, right and averaged intima-media thickness of the common carotid artery did not show a statistically significant difference between the ankylosing spondylitis and control groups. However, flow-mediated dilatation was significantly lower in the ankylosing spondylitis patients (14.1 +/- 6.7 vs 17.6 +/- 8%; P = 0.03). Likewise, nitroglycerin-induced dilatation was lower in the patient group, but the difference was not significant (16.4 +/- 6.8 vs 19.8 +/- 10%; P = 0.07). No correlation was detected between flow-mediated dilatation and age, sex, serum lipids, CRP, ESR, smoking habits and disease activity scores. Intima-media thickness of the common carotid artery was positively correlated with age and BASMI score (r = 0.55, P = 0.00; r = 0.22, P = 0.04, respectively). CONCLUSION: This study demonstrates impairment of endothelial function in ankylosing spondylitis.

Akar S, Birlik M, Gurler O, Sari I, Onen F, Manisali M, Tirpan K, Demir T, Meral M, Akkoc N. · Dokuz Eylul University School of Medicine, Division of Rheumatology, Dokuz Eylul University, Izmir, Turkey. · Clin Exp Rheumatol. · Pubmed #15301237 No free full text.

Abstract: OBJECTIVE: To estimate the prevalence of rheumatoid arthritis (RA) in an urban area in Izmir, Turkey. METHODS: The study was conducted in the Balcova and Narlidere districts of Izmir and a total of 2,887 people aged 20 years or older were contacted with a 98.2% acceptance rate. Nine medical doctors administered an RA questionnaire by face-to-face interview. Subjects reporting a history of swelling in at least 2 joints lasting more than 4 continuous weeks or a history of a diagnosis of rheumatoid arthritis, inflammatory joint rheumatism or joint rheumatism were considered as screening positive and they were invited to come in for an examination. RA cases were defined by the 1987 American College of Rheumatology (ACR) criteria modifiedfor use in population studies. RESULTS: A total of 301 subjects (243 women, 58 men), or 10.6% of those who received the questionnaire were screening positive. 240 (79.7%) of these agreed to undergo a clinical examination either in the clinic or at home. Among these, 14 (12 female, 2 male) patients fulfilled the ACR criteria for RA. The prevalence of RA was 0.49% (95% CI 0.27-0.83) in the total population interviewed, 0.77% (95% CI 0.40-1.35) in women and 0.15% (95%CI 0.02-0.60) in men. The age- and sex-adjusted prevalence for the general population was estimated as 0.36%. Five of the 14 RA (36%) cases had not been diagnosed previously CONCLUSION: These data are consistent with the results of other Mediterranean countries. A significant proportion of RA cases remain undiagnosed in the community.

Birlik M, Akar S, Onen F, Ozcan MA, Bacakoglu A, Ozkal S, Manisali M, Akkoc N. · Division of Immunology-Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey. · Rheumatol Int. · Pubmed #14658004 No free full text.

Abstract: Polyarticular joint manifestations as the predominant symptom of non-Hodgkin's lymphoma (NHL) are quite rare. In the absence of peripheral lymph node and visceral involvement, lymphomas presenting as polyarthritis create a problem for the patients as another rheumatic disease. We present a case that had been diagnosed with rheumatoid arthritis because of symmetrical articular symptoms. The patient later developed severe pain and marked swelling in her right fourth finger, and a diagnosis of septic arthritis and osteomyelitis complicating rheumatoid arthritis was assumed. The final diagnosis of NHL with synovial involvement could be made only after histopathologic examination of a biopsy specimen obtained from the amputated finger. This is the first case report demonstrating direct synovial involvement of a small joint in a patient with NHL presenting with polyarthritis. Articular and periarticular involvement of multiple joints shown by MRI in this patient suggests that direct synovial involvement may be responsible for the polyarticular symptoms in such patients.

Onen F, Tuncer D, Akar S, Birlik M, Akkoc N. · Division of Immunology-Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey. · Rheumatol Int. · Pubmed #12682785 No free full text.

Abstract: OBJECTIVE: Turkey is one of the countries where Behçet's disease is most prevalent. Although its pathogenesis is not defined clearly, infectious agents are thought to play a role in the etiology. In one study of a group of uveitis patients, including those with Behçet's disease, increased seropositivity to B. burgdorferi was reported by enzyme-linked immunosorbent assay (ELISA). The seroprevalence of B. burgdorferi has been found to be as high as 36% in some rural areas of Turkey, although Lyme disease caused by B. burgdorferi is quite rare. In this study, we investigated the seroreactivity to B. burgdorferi antigens in patients with Behçet's disease and compared it with that of healthy and disease controls. MATERIALS AND METHODS: This study was conducted in Izmir in western Turkey. B. burgdorferi immunoglobulin (Ig)M and IgG antibodies were tested by ELISA in the sera of patients with Behçet's disease ( n=30), rheumatoid arthritis patients as disease controls ( n=31), and healthy controls ( n=31). Positive results were confirmed by Western blotting. RESULTS: The difference in B. burgdorferi seropositivity between the groups was not significant by any method. Seroreactivity to B. burgdorferi antigens by ELISA was detected in 26.7% of the patients with Behçet's disease, 35.5% of those with rheumatoid arthritis, and 19.4% of the healthy controls. Immunoblots were positive in 13.3% of the Behçet's disease patients, 22.6% of the rheumatoid arthritis patients, and 12.9% of healthy controls. CONCLUSION: These results suggest no association between Behçet's disease and B. burgdorferi infection.

Akkoc N, Sari I, Birlik M, Pay S, Binicier O, Akar S, Onen F. · No affiliation provided · Rheumatology (Oxford). · Pubmed #18658204 No free full text.

This publication has no abstract.

Akkoc N, Akar S. · No affiliation provided · Clin Rheumatol. · Pubmed #17021666 No free full text.

This publication has no abstract.

Akar S, Söylev M, Onen F, Ada E, Birlik M, Akkoc N. · No affiliation provided · Clin Exp Rheumatol. · Pubmed #11407097 No free full text.

This publication has no abstract.