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Öğe Are Biologic Agents Effective on the Treatment of Secondary Amyloidosis: A Multicenter Report on Turkish Rheumatoid Arthritis and Ankylosing Spondylitis Patients(Wiley, 2014) Pamuk, Omer Nuri; Kalyoncu, Umut; Aksu, Kenan; Donmez, Salim; Pehlivan, Yavuz; Cagatay, Yonca; Omma, Ahmet[Abstract Not Available]Öğe THE ASSOCIATION BETWEEN ANGIOGENESIS AND TH17 PATHWAY IN SCLERODERMA PATIENTS(Oxford Univ Press, 2011) Aydogdu, Erkan; Donmez, Salim; Pamuk, Gulsum Emel; Pamuk, Omer Nuri; Cakir, Necati[Abstract Not Available]Öğe Association of TRPM Channel Gene Polymorphisms with Systemic Sclerosis(Int Inst Anticancer Research, 2015) Oztuzcu, Serdar; Onat, Ahmet M.; Pehlivan, Yavuz; Alibaz-Oner, Fatma; Donmez, Salim; Cetin, Gozde Y.; Yolbas, ServetBackground/Aim: Systemic sclerosis (SSc) is an inflammatory disease characterized by vascular abnormalities and fibrosis. The aim of the present study was to investigate the possible role of transient receptor potential melastatin (TRPM) channel genes in the susceptibility and phenotype expression of SSc. Materials and Methods: A total of 339 patients with SSc and 302 healthy controls were studied. Genomic DNA was extracted from leukocytes of the peripheral blood, and 25 single nucleotide polymorphisms in the TRPM channel genes were analyzed by the BioMark HD dynamic array system. Results: There were marked increases in the CC genotype (94.7% vs 81.8%, p<0.0001) and C allele frequencies (97.0% vs. 90.1%, p<0.0001) in the TRPM3 rs1328142, and TT genotype (19.0% vs. 7.8%, p=0.0002) in TRPM5 rs34551253 (Ala456Thr) polymorphism in SSc patients when compared to controls. TRPM3 gene rs1328142 polymorphism was also markedly associated with disease phenotype. However, no associations with the other 23 polymorphisms studied were found. Conclusion: This is the first study to examine the involvement of TRPM channel gene variations on the risk of SSc incidence. Our results suggest roles of TRPM3 and TRPM5 gene variants in the susceptibility to or clinical expression of SSc in the Turkish population.Öğe A case of granulomatosis with polyangiitis and pyoderma gangrenosum successfully treated with infliximab and rituximab(Wiley, 2014) Donmez, Salim; Pamuk, Omer N.; Gedik, Mustafa; Ak, Recep; Bulut, GulayHere, we present a young male patient who was admitted with alveolar hemorrhage, arthritis and cutaneous lesions, who later developed bilateral orbital involvement and pyoderma gangrenosum (PG). He also had pathergy test positivity. The patient was refractory to conventional immunosuppressive therapy. Therefore, multiple devastating PG lesions and disease activity in granulomatosis with polyangiitis (GPA) were controlled with infliximab. Later, rituximab was used with success to prevent recurrence of symptoms. The relationship of PG with various autoimmune diseases is known; however, PG in GPA has been only rarely reported. Biologic agents might prove to be effective in GPA and PG patients who are refractory to standard immunosuppressive therapy.Öğe A Case with Symmetrical Intracranial Calcifications and Systemic Lupus Erythematosus Presenting with Optic Neuropathy(Turkish Neurological Soc, 2012) Guler, Sibel; Donmez, Salim; Utku, Ufuk; Yavuz, Selcuk53 years old female patient presented with sudden loss of sight of her right eye. The patient's neurological examination revealed a decrease in visual acuity (2/20) in her right eye. Her optical disc was hyperemic with edema. The patient's brain CT scans showed symmetrical calcifications in cerebellar peduncles, cerebral hemispheres, putamens and thalamus bilateraly. Laboratory examinations showed positive ANA, positive anti-DNA antibodies and lymphopenia leading to the diagnosis of systemic lupus erythematosus (SLE). We report this case with SLE because of the rare comorbity of optic neuropathy with bilateral calcifacitions.Öğe Chronic Tophaceous Gout(J Rheumatol Publ Co, 2014) Donmez, Salim; Pamuk, Omer Nuri[Abstract Not Available]Öğe Clinical Features and Types of Articular Involvement in Patients with Psoriatic Arthritis(Clinical & Exper Rheumatology, 2014) Donmez, Salim; Pamuk, Omer Nuri; Akker, Mustafa; Ak, Recep[Abstract Not Available]Öğe Clinical features and types of articular involvement in patients with psoriatic arthritis(Springer London Ltd, 2015) Donmez, Salim; Pamuk, Omer Nuri; Akker, Mustafa; Ak, RecepPsoriatic arthritis (PsA) is a psoriasis-associated inflammatory arthritis which causes joint destruction. There are some epidemiologic data about PsA; however, there are no sufficient data from Turkey. Herein, we evaluated the frequency of PsA in the Thrace region of Turkey according to hospital-based data. In addition, we evaluated clinical features and types of joint involvement in PsA patients. We included 172 PsA patients fulfilling CASPAR criteria admitted to the Division of Rheumatology, Trakya University Medical Faculty, between 2003 and 2012. Data from Turkish Statistical Institution was used to calculate the incidence and prevalence of PsA. Patients' demographic features, durations of psoriasis and PsA, number of tender and swollen joints, treatment modalities, laboratory data, and X-ray film findings were recorded from hospital files. The annual incidence of PsA was 2.8/100,000. The mean annual incidence was 3.47/100,000 in females and 2.15/100,000 in males. The overall prevalence of PsA in our region was 27.9/100,000 (95 % confidence interval (CI) 23.7-32.1) in individuals > 16 years. The prevalence of PsA was higher in females than in males (34.7/100,000 vs. 21.5/100,000). Polyarthritis was present in 67 (38.9 %), oligoarthritis in 47 (27.3 %), spondyloarthritis in 39 (22.6 %), and distal interphalangeal (DIP) arthritis in 19 (11.0 %) patients. The duration of psoriasis was significantly longer in polyarticular PsA patients than in DIP and oligoarticular groups (p values = 0.016 and 0.018, respectively). The number of swollen joints correlated with age (r = 0.21, p = 0.006), duration of psoriasis (r = 0.20, p = 0.01), number of tender joints (r = 0.92, p a parts per thousand currency signaEuro parts per thousand 0.001), ESR (r = 0.24, p = 0.001), and CRP (r = 0.17, p = 0.026). The frequency of PsA in Thrace region is similar to that in low-frequency regions. The most frequent type of involvement was polyarticular, and it correlated with the duration of psoriasis and erosive disease.Öğe Comparison of Adherence to Disease Modifying Antirheumatic Drugs in Psoriatic Arthritis and Other Rheumatic Disease(Wiley, 2016) Balci, Mehmet Ali; Oksuz, Mustafa Ferhat; Donmez, Salim; Ozen, Tugce; Dalkilic, Ediz; Tufan, Ayse Nur; Pehlivan, Yavuz[Abstract Not Available]Öğe Decreased interleukin-20 level in patients with systemic sclerosis: are they related with angiogenesis?(Springer London Ltd, 2013) Aydogdu, Erkan; Pamuk, Omer Nuri; Donmez, Salim; Pamuk, Gulsum EmelIn this study, we aimed to evaluate the relation between angiogenesis indicators and T helper 17 cytokine group in patients with systemic sclerosis (SSc) which is a disease characterized by impaired angiogenesis and autoimmune response. In our study, patients with SSc are compared with patients with primary Raynaud's phenomenon (RP) and healthy controls. Forty SSc patients, 18 primary RP cases, and 20 healthy controls were included in our study. The demographic and clinical features of patients with SSc were recorded. The serum levels of vascular endothelial growth factor (VEGF), vascular endothelial (VE)-cadherin, interleukin (IL)-20, IL-22, and IL-23 were assessed. In the SSc group, IL-20 level was significantly lower than in both primary RP group and controls (p values < 0.001). VE-cadherin level in SSc was significantly higher than in primary RP (p = 0.016). The IL-22 and IL-23 and VEGF levels of SSc, primary RP, and control groups were similar (p values > 0.05). In SSc patients, IL-23 correlated negatively with VEGF (r = -0.36, p = 0.025) and positively with VE-cadherin (r = 0.55, p < 0.001). IL-20 levels in SSc patients correlated with disease duration (r = 0.32, p = 0.044). SSc patients with limited involvement had significantly higher VE-cadherin levels than SSc patients with diffuse involvement (p = 0.044). We observed that IL-20 which is an IL-10 group angiogenesis indicator was observed to be suppressed in SSc, suggesting abnormal angiogenesis.Öğe Demographic and clinical features of gout patients in Turkey: a multicenter study(Springer Heidelberg, 2013) Ozturk, Mehmet Akif; Kaya, Arif; Senel, Soner; Donmez, Salim; Balkarli, Ayse; Cobankara, Veli; Erhan, CigdemGout results from multifactor interactions between gender, age, genetic and environmental factors. Environmental factors underlying gout and precipitating factors triggering acute attacks might vary in different populations with different lifestyles. In this study, we aimed to collect data regarding the demographic and clinical features, comorbid factors, and precipitating factors associated with the initiation of acute attacks in gout patients in Turkey. A total of 312 patients were included in this study (mean age, 58.8 +/- A 13.8 years; female/male ratio, 55/257). The demographic features, alcohol intake, clinical and laboratory features, and comorbid conditions including obesity, diabetes mellitus, hyperlipidemia, hypertension, and coronary heart disease were noted in a standard questionnaire. Precipitating factors initiating acute attacks (if any) were also noted. The patients were divided into 4 groups according to the region of location as central Anatolian region, southeast Anatolian region, Aegean region, and Trakya region. Our results were compared according to the gender and the location of the patients. The mean age at the start of the symptoms was 10 years higher in women (60.4 +/- A 14.8 and 50.6 +/- A 13.5 years in women and men, respectively, p < 0.001).Obesity was present in 40.1 %, diabetes mellitus in 17.9 %, hyperlipidemia in 30.1 %, hypertension in 53.5 %, coronary artery disease in 17 %, and nephrolithiasis in 21.8 % of patients. Precipitating factors triggering gout flares were as follows: diet (high consumption of meat or fish) in 46.5 %, alcohol consumption in 15.7 %, diuretics in 8.3 %, diet or diuretics in 5.1 %, diet or alcohol in 4.5 %, diet or alcohol or diuretics in 1.6 %, others in 4.2 %, and none in 14.1 %. The presence of diabetes and diuretic use was more common among women. Use of diuretics is a more common trigger for gout flares among women. On the other hand, various comorbid conditions, such as obesity and hypertension, and triggers for gout flares may differ between patients living in different geographic regions. In summary, we reported the first data regarding clinical and demographic characteristics of gout in Turkey. The majority of our patients could describe at least one trigger that initiated gout flare. Both comorbid conditions and triggers of attack might differ between men and women, and in different geographic areas. Better knowledge of the modifiable risk factors can be useful for the management strategy to optimize long-term patient outcomes in local clinics.Öğe Development of systemic sclerosis in a patient with common variable immunodeficiency(Academic Press Inc Elsevier Science, 2015) Balci, Mehmet Ali; Pamuk, Gulsum Emel; Donmez, Salim; Pamuk, Omer Nuri[Abstract Not Available]Öğe Diagnostic dilemma of paraneoplastic arthritis: case series(Wiley-Blackwell, 2014) Kisacik, Bunyamin; Onat, Ahmet M.; Kasifoglu, Timucin; Pehlivan, Yavuz; Pamuk, Omer N.; Dalkilic, Ediz; Donmez, SalimObjectives: Paraneoplastic arthritis (PA) may mimic rheumatic diseases. While presenting the demographic and laboratory features of the patients diagnosed with PA, this study also aims to provide possible appropriate tools to differentiate the PA cases from early rheumatoid arthritis (ERA). Methods: Sixty-five patients with PA (male/female: 43/22) from 15 different rheumatology clinics and 50 consecutive patients with ERA (male/female: 13/37) fulfilling the 2010 American College of Rheumatology (ACR) criteria for the diagnosis if the RA from Gaziantep Rheumatology Early Arthritis Trial (GREAT) as controls who were diagnosed at least 12 months before, were enrolled into study. Results: Mean ages of the patients with PA and ERA were 50.2 +/- 15.3, and 42.7 +/- 12.3, respectively, and the mean ages of the patients with PA were significantly higher than the ERA. Unlike the ERA patients, in our case series PA was predominantly observed among males. Oligoarthritis was significantly higher in solid tumors in contrast to ERA (P = 0.001). Polyarthritis and symmetric arthritis were significantly higher in the ERA group in contrast to all malignancies (P = 0.001). Rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) positivity were significantly higher in the ERA group (each P = 0.001). Lactic dehydrogenase levels of hematologic malignancies were significantly higher than other groups (each, P = 0.001). Conclusions: ERA patients had more symmetric joint involvement than PA; laboratory markers could be also an alternative where there is high RF and anti-CCP positivity with antibody levels among the ERA patients. Finally, the demographic features can be used as differentiatingÖğe Diaphragmatic movements in ankylosing spondylitis patients and their association with clinical factors: an ultrasonographic study(Springer Heidelberg, 2012) Unlu, Ercument; Pamuk, Omer Nuri; Erer, Burak; Donmez, Salim; Cakir, NecatiWe compared diaphragmatic motion between ankylosing spondylitis (AS) patients and controls, as assessed by the ultrasonographic method. We included 33 consecutive AS patients (19 males, 14 females) followed up at our center and 14 apparently healthy controls (8 males, 6 females) into our study. AS patients fulfilled the modified New York classification criteria for AS. Patients' demographic and clinical data, functional parameters, and radiographic findings were recorded down. By evaluating the motion of right and left diaphragm during deep expirium and inspirium, the mean diaphragmatic motion was determined by ultrasonography. Diaphragmatic motion in AS patients was less than in controls, but the difference was not significant (68.9 +/- A 17 mm vs. 77.8 +/- A 22.4 mm, P = 0.14). Diaphragmatic motion in AS patients who were active according to BASDAI score (> 4) was not different from inactive patients (70.4 +/- A 20.5 vs. 67.5 +/- A 13.5, P > 0.05). The mean diaphragmatic motion had a positive correlation with occiput-to-wall distance (r = 0.35, P = 0.048); and negative correlations with cervical rotation (r = -0.45, P = 0.01) and modified Schober test (r = -0.34, P = 0.05) in AS patients. We did not detect any association of mean diaphragmatic motion with thoracic expansion on deep expiration. Diaphragmatic motion in AS does not differ significantly from the control group. Factors like disease activation, chest expansion, and the severity of radiographic findings do not affect diaphragmatic motion. There is no compensatory increase in diaphragmatic motion in AS.Öğe Do impaired memory, cognitive dysfunction and distress play a role in methotrexate-related neutropenia in rheumatoid arthritis patients? A comparative study(Springer Heidelberg, 2013) Pamuk, Omer Nuri; Kisacik, Bunyamin; Pamuk, Gulsum Emel; Onat, Ahmet Mesut; Sayarlioglu, Mehmet; Donmez, Salim; Pehlivan, YavuzWe evaluated the roles of sociocultural status, distress and cognitive functions in rheumatoid arthritis (RA) patients who developed methotrexate (MTX)-related neutropenia. The data of 37 RA patients with MTX-related neutropenia who were being followed up at 3 centers were evaluated. The control group included 74 RA patients. The clinical features, biochemical tests and treatment modalities of the patients were obtained from hospital files. The mini-mental state examination (MMSE) test and the Hospital Anxiety and Depression Scale (HADS) were administered for all RA patients with neutropenia as well as the control group. The frequencies of male patients, illiterate patients, patients living alone, patients with serious visual impairment, those with low income, and patients with high creatinine were significantly higher among RA patients with MTX-related neutropenia than in controls (p values < 0.05). The RA patients with MTX-related neutropenia had significantly lower MMSE scores, and significantly higher HADS-A and HADS-D scores than controls (p values < 0.05). In addition, the proportion of patients with probable dementia was significantly higher in RA patients with MTX-related neutropenia than in controls (p < 0.001). Twenty-six of the 37 patients (70.3 %) developed neutropenia with daily dosing. Patients who used MTX daily were more likely to be living alone than those using weekly dosing (p = 0.011). Multivariate analysis showed that having probable dementia on the MMSE test (OR 52.6), low income level (OR 56.8) and age (OR 1.12) were independent risk factors for the development of MTX-related neutropenia. The presence of probable dementia on MMSE, low socioeconomical status and older age are associated with serious toxicity in RA patients using MTX. Measures should be taken to prevent wrong MTX dosing by the patients. Compliance and patient education is of major importance, in particular, in the patients presented in this study.Öğe The epidemiology of antineutrophil cytoplasmic antibody-associated vasculitis in northwestern Turkey(Springer London Ltd, 2016) Pamuk, Omer Nuri; Donmez, Salim; Calayir, Gokce Busra; Pamuk, Gulsum EmelEpidemiological data about antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is very limited. Until now, there has been no study about the epidemiology of AAV in Turkey. In this study, we evaluated the frequency of AAV in the northeastern part of Turkey. The general clinical features of patients diagnosed with AAV at our center within the last 10 years (2004-2014) were retrospectively recorded down. The incidence rates and the prevalence per 1,000,000 population aged a parts per thousand yen16 years were calculated. In addition, we evaluated the clinical features and survival rates of AAV patients. There were 30 patients with granulomatous polyangiitis (GPA), 15 with microscopic polyangiitis (MPA), and 5 with eosinophilic polyangiitis (EGPA). The overall prevalence of AAV in our region was 69.3/1,000,000 in individuals a parts per thousand yen16 years. Males had a similar prevalence (73.2/1,000,000) with females (65.4/1,000,000). The mean annual incidence rate was 8.1/million for all AAV. The annual incidence of AAV in females was 6.9/million; in males, it was 9.2/million. The annual incidence for GPA was calculated as 4.8/1,000,000, the incidence for MPA was 2.4/1,000,000, and the incidence for CSS was 0.8/1,000,000. Ten-year survival of patients with AAV was 65.3 %. The only independent poor prognostic factor in Cox's multivariate analysis was advanced age at the time of diagnosis (OR 7.5, 95 % CI 10.6-526, p = 0.043). The frequency of all AAV in northwestern Turkey was similar to that in southern Europe; however, it was lower than the frequency in Northern Europe.Öğe The epidemiology of dermatomyositis in northwestern Thrace region in Turkey: epidemiology of dermatomyositis in Turkey(Springer Heidelberg, 2017) Balci, Mehmet Ali; Donmez, Salim; Saritas, Fatih; Bas, Volkan; Pamuk, Omer NuriDermatomyositis (DM) is a rare disease that may affect the skeletal muscles and the skin. Literature data on its incidence and prevalence are limited. There are no data on its incidence or prevalence in Turkey. Patients diagnosed with DM at the Trakya University Medical Faculty, Department of Rheumatology from November 2004 to November 2014 were reviewed retrospectively. Patients' clinical and demographic features, laboratory data, treatment modalities, follow-up durations, disease courses, outcomes, and complications were evaluated. Our study included 23 patients with DM; 14 were females and 9 were males (female/male: 1.55). Over the course of the study, the annual incidence of DM was 3.7 per million (95% CI 0-18.8) person years, and the overall prevalence was 32.2 per million (95% CI 18.1-46.3). Incidence in women was higher (4.6/1,000,000 person years) compared to men (2.9/1,000,000 person years). The frequencies of most common findings were as follows: heliotrope rash (82.6%), Gottron papules (87%), proximal myopathy (78.3%), and facial erythema (60.9%). In our hospital-based study, the frequency of DM was lower than those reported in North America; however, they were similar to European countries.Öğe The Epidemiology Of Systemic LUPUS Erythematosus and Clinical Features Of Patients At A Single Center In Northwestern Turkey(Wiley-Blackwell, 2013) Pamuk, Omer Nuri; Donmez, Salim; Calayir, Gokce Busra; Mengus, Cigdem[Abstract Not Available]Öğe The epidemiology of Takayasu arteritis: a hospital-based study from northwestern part of Turkey(Springer Heidelberg, 2016) Saritas, Fatih; Donmez, Salim; Direskeneli, Haner; Pamuk, Omer NuriTakayasu arteritis (TA) is a chronic, inflammatory large vessel vasculitis that affects aorta and its main branches. We aimed to evaluate the incidence and prevalence of TA in the northwestern part of Turkey. We retrospectively evaluated 23 TA patients followed by our clinic. Clinical features, treatments and responses were recorded. Our hospital is the single tertiary referral center for rheumatic diseases for a mixed rural and urban population of 620,447 people for > 16 years (306,036 males, 314,411 females). Nineteen of the 23 patients were females (82.6 %) and four were males (17.4 %). The annual incidence rate for TA was 0.34/100,000. The overall prevalence of TA in our region was 3.3/100,000 (95 % CI 1.9-4.8) in individuals > 16 years. The most common findings at the time of presentation were blood pressure difference (73 %) and headache (60.4 %). The most common angiographic type was type 1 (12 patients, 52.2 %). Median follow-up period was 48 months (range 10-132). Three (13 %) of the patients had stent replacements to different vascular sites. One patient had an operation for aortic aneurysm, and aortic valve replacement surgery has been made. One patient had renal artery bypass operation. Eleven patients (47.8 %) had recurrency at follow-up period and two patients (8.7 %) died. In northwestern part of Turkey, the annual incidence and prevalence of TA were higher than western population, but similar to East Asian data.Öğe Evaluation of skin lesions of lupus with Turkish revised cutaneous lupus erythematosus disease area and severity index(Deri Zuhrevi Hastaliklar Dernegi, 2014) Urun, Yildiz Gursel; Donmez, Salim; Arican, Ozer; Pamuk, Omer NunriBackground and Design: The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) is used to evaluate the cutaneous manifestations in patients with lupus erythematosus (LE). In recent years, the Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI) which provides more objective assessment has been developed, but the number of studies utilizing RCLASI are limited. The aim of this study was to increase the clinical use of the RCLASI by translating this scale into Turkish and to evaluate the effects of factors, which affect CLASI, on RCLASI. Materials and Methods: The scale was translated into Turkish by using proper international translation steps. Ninety-three LE patients who were admitted to Trakya University Faculty of Medicine were included in this study. Socio-demographic and clinical characteristics of the patients were recorded. Cutaneous manifestations were calculated using RCLASI. Two scores were obtained: activity and damage scores. The relationship of the scores with patient age, gender, duration of illness, facial involvement, subtypes of LE, and antinuclear antibody, Anti-Ro/SS-A antibody and Anti-La/SS-B antibody positivities were evaluated. Results: The mean activity and damage scores were 2.59 +/- 2.88 and 0.81 +/- 1.88, respectively. When activity and damage scores were compared between the age groups, there was no statistically significant difference. The damage scores were significantly higher in male patients than in female patients. The activity scores were statistically significantly higher in patients with disease duration of more than three years and facial involvement. There was no statistically significant difference between the subtypes of LE and the activity and damage scores. RCLASI damage scores were statistically significantly higher in Anti-La/SS-B antibody positive patients. Conclusion: RCLASI is an appropriate scoring system to evaluate the cutaneous manifestations in patients with LE. The scores obtained from this scale may vary depending on gender, disease duration and presence of facial involvement.
