Background:
Heart-type fatty acid-binding protein (H-FABP) is a major cytoplasmic low molecular weight protein and released into the circulation when the myocardium is injured. Previous studies have ...demonstrated that H-FABP is closely associated with acute coronary syndrome, hypertrophic and dilated cardiomyopathy, heart failure, stroke, obstructive sleep apnea syndrome, and pulmonary embolism. The aim of this study was to investigate serum H-FABP value in patients with acromegaly.
Methods and results:
We measured serum H-FABP levels in 30 consecutive patients with acromegaly, and 55 age-matched control subjects by using a sandwich enzymelinked immunosorbent assay. Serum H-FABP levels were significantly higher in patients with acromegaly than in control subjects (17.40±10.70, and 8.30±7.20, respectively) (
p
<0.001). A significant positive correlation was found by Spearman’s correlation test between serum H-FABP levels and left ventricular end-systolic diameter (r=0.483,
p
=0.004).
Conclusion:
Patients with acromegaly have increased levels of H-FABP. Serum H-FABP levels might be a marker of myocardial performance in patients with acromegaly.
Presence of extra-articular manifestations (EAM) in rheumatoid arthritis (RA) is associated with more severe disease and increased mortality. Prevalence of EAM may vary in different geographic areas ...and in different ethnic populations. In this study we investigated the frequency of EAM in 526 RA patients from a single university hospital in Turkey.
The hospital records of patients who had been diagnosed as RA in Hacettepe University Department of Rheumatology between the years 1988 and 2003 were retrospectively evaluated. There were 73 males and 453 females, and mean age of the patients was 48.0 +/- 12.3 years. The mean follow-up period was 4.8 +/- 4.1 years. Three hundred and fifty-nine patients were rheumatoid factor (RF) positive (68.3%).
The overall frequency of EAM was 38.4% (202 patients). The most common EAM was rheumatoid nodules (18.1%). Sicca symptoms, pulmonary findings, Raynaud's phenomenon, livedo reticularis, carpal tunnel syndrome, vasculitis, amyloidosis, and Felty syndrome were present in 11.4%, 4.8%, 3%, 4.8%, 2.8%, 1.3%, 1.1%, and 0.3% of the patients, respectively. Overall EAM and rheumatoid nodules were significantly more common in RF positive patients than RF negative patients. The frequency of rheumatoid nodules was significantly higher in males than in females.
The prevalence of EAM in Turkey is higher than East Asia and Africa, and lower than UK and North America. Excluding secondary Sjögren's syndrome, our results are similar to other Mediterranean populations like Italy.
BackgroundIn contrast to many European countries, patients can easily admit to secondary and tertiary centers without referral by the primary care in Turkey. Therefore we also compared the management ...options for gout preferred in different clinical specialties.ObjectivesIn this study we investigated how gout is treated in Turkey.Methods319 consecutive patients were included in this multicenter study (mean age 58.60±12.8 years, 44 females, 272 males). All patients filled a standard questionnaire.Results53 patients were first admitted to primary care (16.6%), 101 patients to orthopedics (31.7%), 29 patients to physical therapy and rehabilitation (9.1%), 70 patients to internal medicine (21.9%), 49 patients to rheumatology departments (15.4%), and 17 patients to other clinical specialties (5.3%).Among those 313 patients admitting to health care with acute gout attack, 40 patients were referred the patient to another center without any treatment (12.8%). Referral rate remarkably higher in the primare care (%28.8).NSAIDs were the most common drugs prescribed for acute attack (60.06%), followed by colchicine (58.15). Allopurinol was given in 12.8%, and steroids in 7.99% of patients during acute attack.Regarding long term treatment, 92 patients had never been treated with allopurinol (28.8%). 29.1% (37/127) patients having less than 2 attacks per year and 28.6% (55/192) of patients having two or more attacks per year had never been treated with allopurinol (p>0.05). Only 89 patients (27.9%) were treated with allopurinol by their first physicians, and 138 patients (43.3%) were treated with allopurinol later in a different specialty. Prescription of allopurinol was more common among the rheumatologists.Diet and life style modifications were recommended in 118 of the patients (37%) by their first physicians. 171 patients (53.6%) were later recommended diet and life style modifications during their follow up in a different clinical specialty (total 289 patients, 90.6%). Diet and life style modifications were recommended more commonly in rheumatology (41 patients, 83.7%).183 (57.4%) were treated with colchicine by their first physicians, and 114 patients (35.7%) were treated with colchicine by a physician of different specialty (total 297 patients, 93.1%). Significantly more patients were treated with colchicine than with allopurinol during long term management (p<0.001).ConclusionsTreatment of gout appears suboptimal in primary care, and more than 25% of patients were referred without any treatment. Long term management also appears suboptimal in both primary care and among some specialists such as orthopedics. Only a minority of patients were recommended allopurinol and/or life style modifications by the doctors first diagnosed gout. Although long term treatment appears better among rheumatologist, still a considerable number of patients were not recommended uric acid lowering approaches in the rheumatology clinics.Disclosure of InterestNone declared
Validation of a translated, culturally adapted questionnaire.
To translate and culturally adapt the Turkish version of the Oswestry Disability Index (ODI) (2.0), and to validate its use for assessing ...disability in Turkish patients with low back pain.
The ODI is a reliable evaluation instrument for disability, but no validated Turkish version is available.
A total of 95 outpatients with low back pain were assessed by the ODI. Sixty-five of these patients were observed on a second occasion. Translation/retranslation of the ENG version of the ODI was done blindly and independently by four different individuals, and adapted by a team. Individuals were given the ODI and other scales (Visual Analog Scale, Schober Test, and the Roland-Morris Disability Questionnaire) on their first visit and a week later.
Scores of the two ODIs were 27.10 (SD 16.22) on day 1 and 22.88 (SD 13.94) on day 7, with an intraclass correlation coefficient of r = 0.938 (P < 0.001). Cronbach's alpha was 0.918 (day 1) and 0.895 (day 7) in the validation. Concurrent validity, measured by comparing ODI responses with the results of Visual Analog Scale and Schober test, was r = 0.367 (P < 0.01), r = -0.068 (P = 0.591) for day 1, and r = 0.392 (P < 0.01), r = -0.041 (P = 0.745) for day 7, respectively. Construct validity, tested by determining the correlation between the Turkish ODI and the Turkish adaptation of the Roland-Morris Disability Questionnaire, yielded r = 0.815 (P < 0.001) on day 1 and r = 0.708 (P < 0.001) on day 7.
The Turkish version of ODI has good comprehensibility, internal consistency, and validity and is an adequate and useful instrument for the assessment of disability in patients with low back pain.
Familial Mediterranean fever (FMF) is the most common auto-inflammatory syndrome with exaggerated acute phase and inflammatory response. After revealing the MEFV gene mutation with the finally ...disturbed end product pyrin, some of the mechanisms were explained. However it is still unknown what triggers or ends these periodical attacks. Moreover, the treatment of up to 30% of the patients, that are resistant to colchicine is still a problem. In this study we investigated the role of serotonin in colchicine-resistant FMF patients.
Twenty-four FMF patients (male/female: 15/9) and 32 age- and sex-matched healthy controls (male/female: 17/15) were included into the study. Patients were subdivided into two groups. Thirteen had FMF attacks despite regular colchicine (colchicine-resistant group), other 11 had disease under control with colchicine for at least 6-months. Sampling was done both during the attack and ten days after its cessation. Plasma and platelet serotonin levels and acute phase reactants were studied in patients and controls.
Colchicine-resistant patients had plasma serotonin (5-HT) levels of 7.85 +/- 1.0 nmol/l during acute attacks which significantly reduced to the levels of 6.3 +/- 0.6 nmol/l (p < 0.001), after 10 days of acute attacks and these levels were significantly lower than those of attack-free patients' and controls' (10.7 +/- 0.2 nmol/l and 10.1 +/- 0.3 nmol/l, respectively). Platelet 5-HT level was 6.4 +/- 0.3 nmol/10(9) platelets during acute attack, and this level was increased to 9.8 +/- 0.5 nmol/10(9) platelets on the 2(nd) sampling, 10 days after the cessation of the acute attack (p < 0.001). They were both significantly higher than those of attack-free FMF patients (5.9 +/- 0.1 nmol/10(9) platelets) and healthy controls (5.7 +/- 0.3 nmol/10(9) platelets). There was a negative correlation between plasma and platelet 5-HT levels (r=-0.77, p < 0.001).
Changes in plasma and platelet 5-HT levels may be related to the disturbances in 5-HT transport mechanisms or may also be attributed to the potential role of serotonin in the inflammatory cascade. Last but not least, serotonin may have a role in the pathogenesis of FMF.
Increments in circulating thrombomodulin levels reflect endothelial cell injury. Thrombomodulin can also be synthesized by several inflammatory cells including monocytes, neutrophils, and ...thrombomodulin itself can modulate the inflammatory response. In this study, we assessed circulating thrombomodulin concentrations in patients with familial Mediterranean fever (FMF). Twenty-five patients with FMF (F/M: 14/11) (mean age: 31.1 +/- 9.7 years) and 25 healthy controls (F/M: 13/12) (mean age: 34.6 +/- 7.0 years) were involved in the study. Thrombomodulin levels were measured by commercially available enzyme-linked immunosorbant assay (ELISA) (Immunoassay of thrombomodulin Diagnostica Stago, Asnieres-Sur-Seine, France). Twenty of the patients were in attack-free period and the remaining five had been during acute FMF attacks. Thrombomodulin levels were higher in the study group (20.9 +/- 12.1 ng/ml) than healthy controls (14.1 +/- 8.4 ng/ml) (p < 0.05). Circulating thrombomodulin levels were also higher in attack-free FMF patients (22.4 +/- 12.9 ng/ml) than controls. This study disclosed for the first time significantly higher increments in the circulating levels of thrombomodulin in FMF. This observation could be a consequence of injured endothelium and/or activated inflammatory cells.
To investigate the prevalence and levels of anti-cyclic citrullinated peptide antibodies (anti-CCP) in patients with familial Mediterranean fever (FMF) with and without arthritis.
Eighty-three ...patients with FMF and 43 healthy controls were included in the study. Thirty seven FMF patients had a history of arthritis, and 46 patients did not. Serum antibodies directed to the anti-CCP were assessed with a commercial enzyme-linked immunosorbent assay (ELISA) kit. Values <20U were considered negative, between 20 and 39U low, 40-99U moderate, and >100U high positive.
Positivity rate of anti-CCP in the whole FMF group (14.5%) was three-fold higher than the control group (4.7%). However, the difference failed to achieve a statistically significant level (p=0.09). Anti-CCP levels were 21±30.1 in patients with arthritis and 13.1±10.3 in the non arthritic group (p<0.05). Anti-CCP positivity rates were 10/37 (27%) in patients with arthritis and 2/46 (4.3%) in patients without arthritis (p<0.005). Five FMF patients with arthritis (13.5%) had moderate-high anti-CCP levels (>40U/ml). Anti-CCP levels were between 20-39U/ ml in 2FMF patients without arthritis and in 2 healthy controls. Anti-CCP positivity rate is higher in FMF patients with arthritis (27%) than healthy controls (4.7%) (p<0.005).
Anti-CCP prevalence is higher in FMF patients with arthritis than without arthritis, and that a significant proportion of FMF patients with arthritis (13.5%) had moderate-high titers of anti-CCP. Therefore, anti-CCP antibodies may not be a reliable indicator to differentiate between FMF arthritis and rheumatoid arthritis.
This study aimed to assess the frequency of all palpable lymph nodes during active disease and remission in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Hospital ...records of 100 SLE patients, 100 RA patients, 100 spondyloarthropathy patients, and 150 osteoarthritis patients, treated in our rheumatology department, were evaluated retrospectively. Overall frequencies of enlarged lymph nodes in patients with active RA and SLE were 82% and 69%, respectively. Enlarged lymph nodes associated with RA were mostly located in the axillary region, and in SLE the nodes were smaller and lymphadenopathy was more generalized compared with RA. Palpable lymph nodes disappeared in the majority of patients during remission. Lymphadenopathy was significantly less frequent in patients treated with steroids before admission. Lymph node enlargement is an important physical finding associated with RA and SLE disease activity. Atypical locations and unusually large lymph nodes should raise clinical suspicion of another underlying disease.
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