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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 BLK pathway-associated rs13277113 GA genotype is more frequent in SLE patients and associated with low gene expression and increased flares(Springer London Ltd, 2017) Pamuk, Omer Nuri; Gurkan, Hakan; Pamuk, Gulsum Emel; Tozkir, Hilmi; Duymaz, Julide; Yazar, MetinWe aimed to evaluate the relationship between some important genetic variations and expressions of these genes in our SLE population. We also determined their association with clinical parameters. Eighty-four SLE patients (79 F, 5 M) and 105 healthy controls (98 F, 7 M) were included in the study. rs13277113, rs2736340, rs7829816, rs6983130, rs2613310, and rs704853 polymorphisms, gene expressions of Src family kinases (Blk, Hck, Lck, and Lyn), and Syk kinases (Syk, ZAP70) were studied by real-time PCR. The heterozygous genotypic pattern (GA) for rs13277113 polymorphism was more frequent in patients with SLE when compared to that in controls (48.8 vs. 31.4%, p = 0.035). Other genotype variants were similar in SLE patients and controls. In the SLE group, the heterozygous genotype for rs13277113 was significantly less frequent in active SLE patients (58.8 vs. 26.7%, p = 0.01). SLE flares according to the SELENA-SLEDAI flare index were significantly more frequent in GA (rs13277113) (70 vs. 37%) and CT (rs2736340) genotypes (66.7 vs. 35.2%) than those in other genotypes (p values < 0.01). The relative expression of Blk gene was significantly decreased in the SLE group as compared to that in controls (0.52 times, 95%CI 0.19-0.85). The gene expressions of Blk and ZAP70 were significantly lower in SLE patients who had flares according to the SELENA-SLEDAI flare index when compared to those in others (p values 0.01 and 0.017). We observed more frequent heterozygous GA genotypic pattern (rs13277113) in our SLE patients compared to that in controls; and it was associated with disease flares. Blk gene expression in SLE was lower, especially in relapsing patients.Öğe BLK Pathway-Associated rs13277113 GA Genotype Is More Frequent in Systemic Lupus Erythematosus Patients and Associated with Low Gene Expression and Increased Flares(Wiley, 2015) Pamuk, Omer Nuri; Gurkan, Hakan; Balci, Mehmet Ali; Tozkir, Hilmi; Duymaz, Julide; Sari, Gulce; Yazar, Metin[Abstract Not Available]Öğe CASP10, LEF1, BCL2 genes are hypomethylated and CDKN2B is hypermethylated in chronic lymphocytic leukemia(Taylor & Francis Ltd, 2015) Pamuk, Gulsum Emel; Uyanik, Mehmet Sevki; Gurkan, Hakan; Duymaz, Julide; Tozkir, Hilmi; Pamuk, Omer Nuri[Abstract Not Available]Öğe Characteristics Predicting Tuberculosis Risk under Tumor Necrosis Factor-? Inhibitors: Report from a Large Multicenter Cohort with High Background Prevalence(J Rheumatol Publ Co, 2016) Kisacik, Bunyamin; Pamuk, Omer Nuri; Onat, Ahmet Mesut; Erer, Sait Burak; Hatemi, Gulen; Ozguler, Yesim; Pehlivan, YavuzObjective. Screening strategies for latent tuberculosis (TB) before starting tumor necrosis factor (TNF)-alpha inhibitors have decreased the prevalence of TB among patients who are treated with these agents. However, despite vigilant screening, TB continues to be an important problem, especially in parts of the world with a high background TB prevalence. The aim of this study was to determine the factors related to TB among a large multicenter cohort of patients who were treated with anti-TNF. Methods. Fifteen rheumatology centers participated in this study. Among the 10,434 patients who were treated with anti-TNF between September 2002 and September 2012, 73 (0.69%) had developed TB. We described the demographic features and disease characteristics of these 73 patients and compared them to 7695 patients who were treated with anti-TNF, did not develop TB, and had complete data available. Results. Among the 73 patients diagnosed with TB (39 men, 34 women, mean age 43.6 +/- 13 yrs), the most frequent diagnoses were ankylosing spondylitis (n = 38) and rheumatoid arthritis (n = 25). More than half of the patients had extrapulmonary TB (39/73, 53%). Six patients died (8.2%). In the logistic regression model, types of anti-TNF drugs [infliximab (IFX), OR 3.4, 95% CI 1.88-6.10, p = 0.001] and insufficient and irregular isoniazid use (<9 mos; OR 3.15, 95% CI 1.43-6.9, p = 0.004) were independent predictors of TB development. Conclusion. Our results suggest that TB is an important complication of anti-TNF therapies in Turkey. TB chemoprophylaxis less than 9 months and the use of IFX therapy were independent risk factors for TB development.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 Color and duplex doppler sonography to detect sacroiliitis and spinal inflammation in ankylosing spondylitis.: Can this method reveal response to anti-tumor necrosis factor therapy?(J Rheumatol Publ Co, 2007) Unlu, Ercument; Pamuk, Omer Nuri; Cakir, NecatiObjective. To investigate the role of color and duplex Doppler ultrasound (CDDUS) in the detection of sacroiliac (SI) and spinal inflammation, as well as response to anti-tumor necrosis factor (TNF) therapy in patients with ankylosing spondylitis (AS). Methods. We included 39 consecutive patients with AS followed at our center and 14 healthy controls. In the AS and control groups, blood vessels in SI joints and lumbar vertebral (LV) and thoracal vertebral (TV) paraspinal areas were investigated by CDDUS. When the artery was found, the resistive index (RI) was measured by CDDUS. Disease activity characteristics (ESR, CRP, BASDAI, and BASMI) were evaluated in patients with AS. In 11 patients for whom anti-TNF therapy was indicated, CDDUS measurements were performed before and on Week 12 of therapy. Results. In patients with AS, RI values of SI joints and of LV and TV areas were lower than in controls (all p <= 0.01). In AS patients with active disease according to BASDAI, RI values of TV (p = 0.0013) and LV (p = 0.027) were significantly lower than in the inactive group. In the group with active AS, SI RI was nonsignificantly lower (p = 0.16). After anti-TNF therapy, there were significant increases in mean SI RI (p = 0.028) and LV RI (p = 0.039), and a nonsignificant increase in TV RI (p > 0.05). Conclusion. CDDUS may be an alternative, less expensive, and easier method for detecting inflammation secondary to increased SI and spinal vascularization and in evaluating response to anti-TNF therapy in AS.Öğe The Comparative One-Year Drug Survival Rate of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis; Results from Turkbio Registry(Clinical & Exper Rheumatology, 2014) Sari, Ismail; Kalyoncu, Umut; Onat, Ahmet Mesut; Pamuk, Omer Nuri; Karadag, Omer; Kisacik, Bunyamin; Senel, Soner[Abstract Not Available]Öğe The Comparative One-Year Drug Survival Rate of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid arthritis and ankylosing spondylitis; results from Turkbio Registry.(Wiley, 2014) Sari, Ismail; Kalyoncu, Umut; Onat, Ahmet Mesut; Pamuk, Omer Nuri; Karadag, Omer; Kisacik, Bunyamin; Krogh, Niels Steen[Abstract Not Available]Öğe The correlation between ferritin level and acute phase parameters in rheumatoid arthritis and systemic lupus erythematosus(Aves, 2014) Seyhan, Serkan; Pamuk, Omer Nuri; Pamuk, Gulsum Emel; Cakir, NecatiObjective: In this study, we evaluated the relationship between ferritin levels and disease activation in rheumatoid arthritis (RA) patients. Material and Methods: We included 44 patients with RA, 20 patients with systemic lupus erythematosus (SLE), 25 patients with infection, 22 patients with malignancy, and 20 healthy control subjects. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), whole blood count, and serum iron parameters were determined in all cases. The joint findings in RA patients were recorded, and disease activity score (DAS) was calculated. In SLE patients, antinuclear antibody (ANA) and anti-dsDNA titers and C3 and C4 complement levels were determined. SLE disease activity index (SLEDAI) score was calculated. Results: Serum ferritin levels in the RA, SLE, and control groups were lower than those in the infection and malignancy groups (p< 0.05). The ferritin levels in the RA group did not differ significantly from the SLE and control groups. In RA patients, serum ferritin level had a positive correlation with ESR, CRP, RF, platelet count, and DAS score and had a negative correlation with hematocrit (all p values < 0.05). In SLE patients, on the other hand, serum ferritin had a positive correlation with ANA, anti-dsDNA, and SLEDAI (all p values < 0.05). According to DAS, ferritin level in inactive RA patients was lower than that in active RA patients. When transferrin saturation was considered, iron deficiency anemia was a quite frequent finding in both active and inactive RA patients. Conclusion: Interestingly, we observed that ferritin level in RA patients was similar to the control group; however, it was a good parameter of disease activation. This is because a reduction in storage iron and resultant iron deficiency anemia are very common in RA patients.Öğe CXCL12 rs18011157 polymorphism in patients with non-Hodgkin's lymphoma: Is it associated with poor outcome?(Wolters Kluwer Medknow Publications, 2018) Pamuk, Gulsum Emel; Tozkir, Hilmi; Uyanik, Mehmet Sevki; Gurkan, Hakan; Duymaz, Julide; Pamuk, Omer NuriObjective: We studied CXCL12-related rs18011157 polymorphism in non-Hodgkin lymphoma (NHL) patients. We also determined the effect of this polymorphism on clinical features and outcome of NHL. Methods: We included 90 NHL patients (54 males, 36 females) and 88 healthy controls (54 males, 34 females). CXCL12-related rs18011157 polymorphism was determined by polymerase chain reaction. Results: rs18011157 polymorphism was significantly more frequent in NHL patients with GA genotype than in healthy controls (37.8% vs. 20.5%, P = 0.011). The frequency of patients with initially high lactate dehydrogenase (LDH) level (65.8% vs. 38.5%) and extranodal involvement (61.1% vs. 43.8%) was significantly higher in the GA plus AA genotype groups when considered altogether (P = 0.01 and 0.09). Poor prognostic factors in univariate analysis were the presence of B symptoms, initially high International Prognostic Index (IPI), splenomegaly, nonresponse to first-line therapy, the presence of early relapse, and carrying A allele (GA plus AA genotypes). The independent prognostic factors in multivariate analysis were only early relapse and an initially high IPI score. Discussion: CXCL12 rs1801157 polymorphism which was found to be associated with extranodal involvement and increased LDH in NHL might be a marker of poor prognosis in patients with GA and AA genotypes. Conclusions: CXCL12-related rs18011517 polymorphism was more frequent in NHL patients: it might be associated with NHL pathogenesis and outcome.Öğe Decreased dickkopf-1 levels in chronic lymphocytic leukemia and increased osteopontin levels in non-Hodgkin's lymphoma at initial diagnosis: Could they be playing roles in pathogenesis?(Maney Publishing, 2015) Pamuk, Gulsum Emel; Uyanik, Mehmet Sevki; Pamuk, Omer Nuri; Maden, Muhammet; Tapan, UmitAims: We determined plasma levels of dickkopf-1 (DKK-1) and osteopontin (OPN) which have roles in the Wnt pathway in chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL) patients and in healthy controls. We also tested whether DKK-1 and OPN levels could be of clinical or prognostic significance in CLL and NHL. Methods: We included 36 CLL, 24 NHL patients, and 21 healthy controls. Patients' clinical and demographic features, treatment modalities, and response to treatment were recorded. DKK-1 and OPN levels in plasma obtained at initial diagnosis were determined with enzyme-linked immunosorbent assay. Results: CLL patients had significantly lower DKK-1 levels than NHL and control groups (P levels, respectively, 0.048 and 0.017). OPN level was significantly higher in NHL group than in CLL and control groups (P values, 0.017 and <0.001). CLL patients with early and late Rai stages of disease had similar DKK-1 and OPN levels. After a median follow-up of 48 months, 13 CLL patients died. Univariate analysis showed that advanced Rai stages and older age were significantly poor prognostic factors. DKK-1 level in CLL patients who have died was significantly lower than those who were alive (P = 0.035). NHL patients with extranodal involvement had significantly higher OPN levels than those with no involvement (P = 0.04). Conclusions: Our results demonstrated that the Wnt pathway inhibitor DKK-1 was decreased in CLL. OPN was increased in NHL and associated with extranodal involvement. In order to reveal the pathogenic and clinical roles of DKK-1 and OPN in CLL and NHL, larger studies need to be conducted.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 Development of Atherosclerotic Cardiovascular Mortality in Gouty Arthritis and Rheumatoid Arthritis Patients: Are They Associated With Mean Platelet Volume and Neutrophil-Lymphocyte Ratio? A Comparative Study(Turkish League Against Rheumatism, 2017) Maden, Muhammet; Pamuk, Gulsum Emel; Pamuk, Omer NuriObjectives: This study aims to evaluate the mean platelet volume (MPV) and neutrophil-lymphocyte ratio (NLR) in gouty arthritis (GA) and rheumatoid arthritis (RA) patients, as well as their relationship with atherosclerotic cardiovascular mortality (ACVM). Patients and methods: The study included 122 GA patients (96 males, 26 females; mean age 64.6 +/- 13.4 years; range 34 to 82 years), 82 RA patients (40 males, 42 females; mean age 62.1 +/- 12.1 years; range 29 to 83 years), and 61 healthy controls (34 males, 27 females; mean age 65.3 +/- 4.8 years; range 33 to 80 years). Clinical and ACVM data were obtained from medical charts. Erythrocyte sedimentation rate, C-reactive protein, MPV, and NLR were recorded at the time of diagnosis and one month after therapy. Results: Mean platelet volume in GA (8.49 +/- 1.5) and RA (7.98 +/- 0.99) groups were significantly lower than in healthy controls (9.8 +/- 15) (p< 0.001). NLR in healthy controls (1.9 +/- 0.74) was significantly lower than in GA (3.6 +/- 2.3) and RA (3.7 +/- 2.5) groups (p< 0.001). After treatment, MPV did not change significantly in GA and RA groups (p values > 0.05); however, NLR decreased in both groups (p< 0.001). Nine GA and 12 RA patients died from ACVM during follow-up. GA patients with ACVM were older and had more frequent hypertension, higher MPV, and higher intercritical CRP level. In multivariate analysis, MPV was an independent poor prognostic factor for ACVM in GA patients. Conclusion: Gouty arthritis and RA patients had significantly lower MPV and significantly higher NLR than controls. MPV might be used as a potential biomarker for the development of ACVM in GA.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 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.
