Rheumatoid Arthritis: Unsal E

Unsal E, Arici AM, Kavukçu S, Pirnar T. · Department of Paediatrics, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey. · Pediatr Radiol. · Pubmed #12164351 No free full text.

Abstract: We present two patients with seronegative enthesopathy and arthropathy (SEA) syndrome and Andersson lesions. Peripheral arthritis and enthesitis with or without back pain are very important in the recognition of Andersson lesion. MRI seems to be the best method for early diagnosis.

Unsal E, Makay B. · Department of Pediatrics, Dokuz Eylul University Hospital, Division of Immunology and Rheumatology, 35340 Balcova, Izmir, Turkey. · Indian Pediatr. · Pubmed #19129569 links to  free full text

Abstract: Thirty seven children with juvenile idiopathic arthritis (JIA) who were treated with one or more intra-articular triamcinolone acetonide (TA) injections were evaluated. Ninety five joints were injected with a total number of 125 injections. Complete remission of the joint inflammation lasting at least 6 months was obtained in 62 of 95 injections (65%). Treatment of the joint contractures was successful in 35 of 51 joints (69%). In patients with oligoarthritis, 21 of 26 injected joints (81%) were in full remission at six-months. The 6-month remission was significantly lower in the other subtypes of JIA (P<0.01), 41 of 69 (59%) injected joints, when compared to oligoarticular patients. Intra-articular TA injection is an effective and safe therapy for inflammatory joint disease in JIA, particularly in the oligoarticular form.

Unsal E, Oren O, Salar K, Makay B, Abaci A, Ozhan B, Böber E. · Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey. · Turk J Pediatr. · Pubmed #19102051 No free full text.

Abstract: Few studies have been performed to investigate autoimmune diseases associated with organ non-specific rheumatological disorders in children, such as juvenile idiopathic arthritis (IA). The objective in this study was to determine the frequency of autoimmune diseases of the thyroid gland in children with JIA. Eighty patients with JIA and 81 healthy sex- and age-matched controls were enrolled in the study. Serum free T3, free T4, thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies, and anti-peroxidase antibodies were evaluated. The mean age was 11.5 +/- 5.5 years in the patient group and 10.5 +/- 4.9 years in the control group. Twenty-seven of the cases were classified as oligoarticular, 26 as polyarticular, 17 as enthesitis-related, 6 as systemic, and 4 as psoriatic arthritis. Autoimmune thyroid disease was found in 4 patients in the JIA group (5%). There were no significant differences between the study and control groups regarding the existence of anti-thyroid antibodies (p = 0.17). Girls were more likely to develop autoimmune thyroiditis (3 girls, 1 boy). Autoimmune thyroiditis was more frequent in patients who had a family history of thyroid disease (p = 0.02). There was no statistical correlation between rheumatoid factor (RF) and antinuclear antibody (ANA) positivity and autoimmune thyroiditis (p > 0.05). We conclude that there is no need for routine screening of serum thyroid function tests and thyroid antibody levels in patients with JIA in the absence of clinical symptoms.

Ikiz AO, Unsal E, Kirkim G, Erdag TK, Guneri EA. · Dokuz Eylul University School of Medicine, Department of Ear Nose Throat and Head and Neck Surgery, 35340 Izmir, Turkey. · Int J Pediatr Otorhinolaryngol. · Pubmed #17482280 No free full text.

Abstract: OBJECTIVE: Evaluation of the hearing status and middle ear function of patients with juvenile idiopathic arthritis. METHODS: The study group was comprised of 38 ears of 19 patients (6 males, 13 females) aged between 5 and 23 years. The control group was comprised of 30 ears of 15 healthy subjects (5 males, 10 females) aged between 5 and 22 years. All subjects were examined audiologically using tympanometry, stapedial reflex, acoustic reflex decay, pure-tone audiometry, high frequency audiometry and transient evoked otoacoustic emission tests. RESULTS: There were statistically significant (p<0.05) number of ears (32%) with abnormal tympanograms in the patient population while all tympanograms were normal, type A in the control group. Seven type As, 2 type Ad, and 3 type C tympanograms were seen in the patient population. In pure tone audiometry tests there was no subject having neither a conductive nor sensorineural hearing loss individually in both groups. But as a group, patients with juvenile idiopathic arthritis showed statistically significant elevation of air conduction thresholds at frequencies of 250, 500, 6000, 14,000 and 16,000 Hz for right ears; and at 500, 2000, 12,500 and 16,000 Hz for left ears; and larger air-bone gaps at 500 and 2000 Hz for right ears; and at 500 Hz for left ears (p<0.05). Comparison of bone conduction thresholds and otoacoustic emission tests between both groups did not reveal any statistically significant difference (p>0.05). CONCLUSION: This study suggests a dual effect of disease on both the middle and inner ear of patients with juvenile idiopathic arthritis. Presence of abnormal tympanograms together with worse air conduction thresholds at lower frequencies as well as larger air bone gaps at frequencies of 500 and 2000 Hz suggest subclinical middle ear involvement; while hearing losses at 6000 Hz and very high frequencies of 12,500, 14,000 and 16,000 Hz suggest inner involvement at an early stage.

Senocak O, Unsal E, Akalin E, Ergör G. · Department of Physical Medicine and Rehabilitation, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey. · Turk J Pediatr. · Pubmed #12718368 No free full text.

Abstract: Diagnosis, treatment and follow-up of children with juvenile idiopathic arthritis are based upon the articular examination. The objective of the current study was to assess the interobserver agreement in grading the joint with arthritis and limited range of motion, and to detect the sources of disagreement. Twenty children with juvenile idiopathic arthritis were included. Assessment parameters were a) Physician Global Assessment, b) number of joints with active arthritis, and c) number of joints with limited range of motion. A total number of 1,320 joints were examined by both observers, blinded to each other. Each observer marked the involved joints as active arthritis, as limited range of motion, or as both. Interobserver agreement was determined by using Kappa statistics and Wilcoxon signed rank test. The statistical analysis was performed by SPSS 10.0. There was no statistical difference in the comparison of Physician Global Assessment of the two observers. There was substantial agreement in both arthritis and limited range of motion scores. Chance corrected agreement for the interobserver reliability was also performed for frequently involved joint such as neck, wrist, hip and knee. A substantial agreement was found. The close agreement between the observers could be attributed to standardization of examination techniques and to using objective variables.

Berk AT, Koçak N, Unsal E. · Department of Ophthalmology, School of Medicine, Dokuz Eylül University, Urla Berk Sitesi 143, Urla/Izmir, Turkey. · Ocul Immunol Inflamm. · Pubmed #11935434 No free full text.

Abstract: PURPOSE: To evaluate the clinical features of and determine the risk factors for uveitis in patients with juvenile arthritis. METHODS: The prevalence and clinical characteristics of uveitis were studied retrospectively in 90 children diagnosed with arthritis. Patients with uveitis were compared with those who did not have eye involvement. RESULTS: Uveitis was diagnosed in 11 patients (12.2%). Of these, seven (63.6%) had oligoarticular, two (36.4%) had polyarticular, and one (9.1%) had systemic-onset juvenile rheumatoid arthritis (JRA). One patient (9.1%) was diagnosed with enthesitis-related arthritis (ERA) (9.1%). The prevalence of uveitis was significantly higher in patients with oligoarticular JRA. The mean age at onset of arthritis in the uveitis patients was 4.39 years, which was significantly lower than in the non-uveitis group. There was no gender difference in the risk of developing uveitis. Antinuclear antibodies (ANA) was positive in seven (63.6%) of the 11 uveitis patients, confirming ANA as a significant determinant for uveitis in juvenile arthritis. Rheumatoid factor was not found to be a risk factor. One (9.1%) of the 11 patients developed serious sight-threatening complications during the follow-up period. CONCLUSION: This study confirmed that oligoarticular onset, ANA positivity, and young age are risk factors for developing uveitis in patients with juvenile arthritis. Gender was not found to be a determining factor. Prompt treatment of uveitis effectively decreased the prevalence of visual impairment.

Unsal E, Gülay Z, Günal I. · Department of Pediatrics, Dokuz Eylül University, School of Medicine, Izmir, Turkey. · Arch Orthop Trauma Surg. · Pubmed #11768638 No free full text.

Abstract: Seventeen children who met the criteria for juvenile chronic arthritis (JCA) were reviewed. Throughout the study, the clinical examination, HLA phenotyping, and radiological assessment of the hips were performed by separate authors who were blinded to other data. At the end of the study, the results were also compared with 25 healthy, age- and sex-matched children. Six of the children with JCA also had radiological signs of slipped capital femoral epiphysis (SCFE; five with minimal slip pattern, one with moderate slip), and five of them had DR4 in their genotypes, in contrast to the remaining 11 patients who did not (p < 0.001). On the other hand, only 2 of 25 children in the control group had DR4 (p < 0.01). The difference was not significant when the patients without SCFE were compared with the control group (p = 1.0). The relative risk of cases with DR4 antigen for SCFE was 57.5, while it was below I for the other antigens. These results suggest that although DR4 is not specific for JCA, it is the common HLA antigen for those who have SCFE, and patients with JCA and HLA-DR4 antigen should be examined for evidence of SCFE, which was not reported before to exist with JCA.

Unsal E, Büyükgebiz B, Cevik N. · Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey. · Turk J Pediatr. · Pubmed #11592507 No free full text.

Abstract: Protein-energy malnutrition (PEM) has been estimated to occur in 10 to 50% of children with juvenile chronic arthritis (JCA). Thirty-eight children with JCA were evaluated and their nutritional status determined, and they were compared with 23 healthy sex and age-matched children as controls. A standardized, 9-parameter comprehensive nutritional assessment profile was used. The simple anthropometric measurements, height and weight for age, were abnormal in 30% and 27% of the patients, respectively. A detailed evaluation revealed that 71% had abnormal somatic protein stores, and that they also had significantly low levels of visceral protein stores, when compared to their healthy peers. The results were consistent with the fact that inflammation put the JCA patients at significant risk for developing complicated malnutrition and it might result in PEM without any obvious signs of malnutrition. A nutritional screening test would be very useful in detecting early PEM in children with chronic arthritis.

Ozdogan H, Ruperto N, Kasapçopur O, Bakkaloglu A, Arisoy N, Ozen S, Ugurlu U, Unsal E, Melikoglu M, Anonymous00085. · Cerrahpasa Tip Fakültesi, Iç Hastaliklari ABD, Romatoloji BD, Kasaneler sk. 2/5 Erenköy, 81060 Istanbul, Turkey. · Clin Exp Rheumatol. · Pubmed #11510322 No free full text.

Abstract: We report herein the results of the cross-cultural adaptation and validation into the Turkish language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Turkish CHAQ CHQ were fully validated with 3 forward and 3 backward translations. A total of 145 subjects were enrolled: 85 patients with JIA (35% systemic onset, 41% polyarticular onset, and 24% persistent oligoarticular subtype) and 60 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, and polyarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the systemic onset, and polyarticular onset having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Turkish version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Cakmakci H, Kovanlikaya A, Unsal E. · Department of Radiology, Dokuz Eylül University School of Medicine, Inciralti, Izmir, Turkey. · Pediatr Radiol. · Pubmed #11297085 No free full text.

Abstract: OBJECTIVE: To determine the correlation between clinical status and 3D, fat-saturated contrast-enhanced MRI findings in assessing the response to treatment in patients with knee-joint involvement from juvenile rheumatoid arthritis (JRA). MATERIALS AND METHODS: Synovial hypertrophy, effusion, cartilage and epiphyseal status were scored using spin-echo (SE) T1-weighted, SE T2-weighted and contrast-enhanced, fat-suppressed 3D MRI in 42 knees of 21 patients. MRI findings were evaluated by scoring results and compared with the clinical scoring results. Progression, improvement and equivalence were analysed between 0-3 and 3-6 months, both clinically and by MRI. RESULTS: Fat-suppression imaging generated high contrast between cartilage, synovium, effusion and bone. Correlation coefficients according to progression, improvement and equivalent findings of months 1-3 and months 3-6 comparison of clinical and MRI scores were found to be 0.50 and 0.70, respectively. CONCLUSION: Contrast-enhanced 3D MRI with fat suppression provides good discrimination between synovial hypertrophy and fluid. Fat-suppressed imaging offers better contrast between cartilage and synovium. Long-term MRI follow-up of JRA improves direct follow-up of pathological changes and helps in modifying treatment regimens.

Akay AP, Unsal E, Ozbek A, Baykara B. · No affiliation provided · Rheumatol Int. · Pubmed #16155758 No free full text.

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