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Akın Kağızmanlı G, Özalp Kızılay D, Besci Ö, Yüksek Acinikli K, Özen S, Demir K, Gökşen Şimşek RD, Böber E, Darcan Ş, Abacı A. Aromatase inhibitors: a useful additional therapeutic option for slowing down advanced bone age in boys with growth hormone deficiency. J Endocrinol Invest 2024; 47:1227-1235. [PMID: 38040920 DOI: 10.1007/s40618-023-02242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/05/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Aromatase inhibitors (AIs) have been used to slow down estrogen-dependent skeletal maturation in pubertal boys with short stature. In the literature, few data evaluate the effectiveness and safety of AIs in boys with growth hormone deficiency (GHD). This study aimed to evaluate the auxologic effects and short-term laboratory profiles of combined AI and rhGH therapy for 1 year in adolescent males with GHD. SUBJECTS AND METHODS Male subjects between the ages of 10 and 16 with GHD from two different centers were included in the study. Patients were divided into two groups: (i) those who only used recombinant human growth hormone (rhGH) therapy (Group I; G-I) and (ii) those who also used AI therapy (anastrozole or letrozole) along with rhGH (Group II; G-II). RESULTS Forty-one patients (G-I, 46%; G-II, 54%) were included in the study. All the subjects had isolated GHD. At the beginning of the treatment, the chronological ages (CAs) of the patients in the G-I and G-II groups were 11.8 (10.9-13.7) and 12.8 (12.0-14.3) years, respectively. The ratios of bone age (BA)/CA for the two groups were 0.8 (0.8-0.9) and 1.0 (0.9-1.1), respectively (p < 0.001). After the treatment, the height standard deviation (SD) scores and predicted adult height (PAH) significantly increased from baseline in all subjects in the G-I and G-II groups (p < 0.001; p < 0.001, respectively). There was no significant change in the ratio of BA/CA post-therapy in the G-I group (p = 0.1), while there was a significant decrease in the G-II group (p < 0.001). The growth velocities of the patients in the G-I and G-II groups were 9.1 (7.4-10.1) cm/year [1.5 (0.8-5.0) SD score] and 8.7 (7.5-9.9) cm/year [1.1 (0.3-3.1) SD score], respectively (p = 0.6). While post-therapy serum testosterone concentrations were seen to increase in the G-II group, none of the patients exhibited hematocrit above 50 percent, and the fasting glucose concentrations were normal. CONCLUSIONS When used in addition to rhGH therapy in boys with GHD and advanced BA, AIs were observed to slow down the tempo of BA maturation after 1 year, compared to those who received rhGH treatment alone. AI therapy was found to be safe during the 1-year observation period and thus could be considered for preserving growth potential in these patients.
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Affiliation(s)
- G Akın Kağızmanlı
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - D Özalp Kızılay
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ö Besci
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - K Yüksek Acinikli
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - S Özen
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, İzmir, Turkey
| | - K Demir
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - R D Gökşen Şimşek
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, İzmir, Turkey
| | - E Böber
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ş Darcan
- Department of Pediatric Endocrinology, Ege University Faculty of Medicine, İzmir, Turkey
| | - A Abacı
- Department of Pediatric Endocrinology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
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Doğan Y, Karaca NB, Buran S, Tüfekçi O, Atabey Gerlegiz EN, Aliyev E, Bayındır Y, Bilginer Y, Ünal E, Özen S. The Juvenile Arthritis Quality of Life Questionnaire in patients with juvenile idiopathic arthritis: Turkish version, validity, and reliability study. Clin Rheumatol 2024:10.1007/s10067-024-06962-z. [PMID: 38619726 DOI: 10.1007/s10067-024-06962-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/10/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION This study aimed to assess the cultural adaptation, validity, and reliability of the Turkish version of the Juvenile Arthritis Quality of Life Questionnaire (JAQQ) in patients with juvenile idiopathic arthritis (JIA). METHODS A total of 100 JIA patients (64% female), aged 9 to 18 years, participated in the study conducted at a tertiary care university hospital. The JAQQ was culturally adapted through a rigorous translation process and administered alongside established measures, including the Childhood Health Assessment Questionnaire (CHAQ), Juvenile Arthritis Biopsychosocial Questionnaire (JABQ), and Children's Depression Inventory (CDI). Validity and reliability were evaluated using Spearman's correlation coefficients, Cronbach's alpha, intraclass correlation coefficient (ICC), standard error of the mean (SEM), and minimal detectable change (MDC). RESULTS The Turkish version of JAQQ exhibited high convergent validity, correlating significantly with CHAQ, JABQ, and CDI. No floor or ceiling effects were observed in the total JAQQ score, indicating a balanced assessment. Internal consistency was excellent (Cronbach's α = 0.948), and test-retest reliability was satisfactory (ICC = 0.913). SEM and MDC95 values were 0.357 and 0.99, respectively. CONCLUSIONS The Turkish adaptation of JAQQ emerges as a valid and reliable instrument for comprehensively assessing the health-related quality of life in children and adolescents diagnosed with JIA. The questionnaire's robust psychometric properties, coupled with distinctive features like individualized assessment, highlight its potential as a valuable tool for both clinical assessment and scientific research in the field of pediatric rheumatology. Key Points • The Juvenile Arthritis Quality of Life Questionnaire (JAQQ) is an important scale that evaluates the quality of life of children with Juvenile Idiopathic Arthritis (JIA). • JAQQ is known and used in the field of pediatric rheumatology in Turkey, but its Turkish adaptation has not been made before. • Our study includes 100 JIA patients aged between 9 and 18 years and shows that the Turkish version of JAQQ is valid and reliable in measuring the quality of life of these children. • This research contributes to the accurate assessment of the quality of life in Turkish children diagnosed with JIA, providing valuable insights for both clinical and scientific studies.
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Affiliation(s)
- Yahya Doğan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
| | - Nur Banu Karaca
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sinan Buran
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Orkun Tüfekçi
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ege Nur Atabey Gerlegiz
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Emil Aliyev
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yağmur Bayındır
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Edibe Ünal
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Smith EMD, Aggarwal A, Ainsworth J, Al-Abadi E, Avcin T, Bortey L, Burnham J, Ciurtin C, Hedrich CM, Kamphuis S, Lambert L, Levy DM, Lewandowski L, Maxwell N, Morand E, Özen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington C, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW. Defining remission in childhood-onset lupus: PReS-endorsed consensus definitions by an international task force. Clin Immunol 2024; 263:110214. [PMID: 38604255 DOI: 10.1016/j.clim.2024.110214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To derive childhood-onset SLE (cSLE) specific remission definitions for future treat-to-target (T2T) trials, observational studies, and clinical practice. METHODS The cSLE International T2T Task Force conducted Delphi surveys exploring paediatric perspectives on adult-onset SLE remission targets. A modified nominal group technique was used to discuss, refine, and agree on the cSLE remission target criteria. RESULTS The Task Force proposed two definitions of remission: 'cSLE clinical remission on steroids (cCR)' and 'cSLE clinical remission off steroids (cCR-0)'. The common criteria are: (1) Clinical-SLEDAI-2 K = 0; (2) PGA score < 0.5 (0-3 scale); (4) stable antimalarials, immunosuppressive, and biologic therapy (changes due to side-effects, adherence, weight, or when building up to target dose allowed). Criterion (3) in cCR is the prednisolone dose ≤0.1 mg/kg/day (maximum 5 mg/day), whereas in cCR-0 it is zero. CONCLUSIONS cSLE definitions of remission have been proposed, maintaining sufficient alignment with the adult-SLE definition to facilitate life-course research.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Slovenia
| | - L Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Burnham
- Department of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Lambert
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - D M Levy
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - L Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - N Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - S Özen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - C E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - C Saad Magalhaes
- Paediatric Rheumatology Division, Botucatu Medical School, Sao Paulo State, University (UNESP), Sao Paulo, Brazil
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - C Scott
- Department of Pediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Şener S, Batu ED, Kaya Akca Ü, Atalay E, Kasap Cüceoğlu M, Balık Z, Başaran Ö, Karagöz T, Özsürekçi Y, Bilginer Y, Özen S. Differentiating Multisystem Inflammatory Syndrome in Children from Kawasaki Disease During the Pandemic. Turk Arch Pediatr 2024; 59:150-156. [PMID: 38454223 PMCID: PMC11059258 DOI: 10.5152/turkarchpediatr.2024.23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE We aimed to delineate the distinctive characteristics that aid in distinguishing between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) with KD-like manifestations during the pandemic. MATERIALS AND METHODS We evaluated KD patients and MIS-C patients with KD-like symptoms admitted during the pandemic (between January 2021 and December 2022). RESULTS Thirty-three MIS-C patients and 15 KD patients were included. Kawasaki disease patients were younger than MIS-C patients (3.4 vs. 7.6 years). Rash (P = .044, 100% vs. 75.7%), oral mucosal changes (P = .044, 100% vs. 75.7%), and cervical lymphadenopathy (P = .001, 93.3% vs. 42.4%) were more common in KD. Multisystem inflammatory syndrome in children: patients had more hypotension (P = .002, 45.4% vs. 0), gastrointestinal (P .001, 72.7% vs. 13.3%), and respiratory symptoms (P = .044, 24.2% vs. 0). Multisystem inflammatory syndrome in children patients also had low lymphocyte and thrombocyte counts and elevated levels of d-dimer, ferritin, and cardiac parameters, unlike KD patients. Multisystem inflammatory syndrome in children patients exhibited a notable reduction in left ventricular systolic function in echocardiography. Another significant difference with regard to management was the anakinra treatment, which was prescribed for MIS-C patients. CONCLUSION Although MIS-C patients might display a clinical resemblance to KD, several features could help differentiate between MIS-C and classical KD. Specific clinical (hypotension, gastrointestinal, and respiratory symptoms) and laboratory (low lymphocyte and thrombocyte counts with higher C-reactive protein, ferritin, d-dimer, and cardiac parameters) features are characteristic of MIS-C. In addition, divergence in management strategies is evident between the 2 diseases, as biologic drugs were more prevalently employed in MIS-C patients than in classical KD patients.
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Affiliation(s)
- Seher Şener
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ümmüşen Kaya Akca
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Müşerref Kasap Cüceoğlu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balık
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Karagöz
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Özsürekçi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Batu ED, Şener S, Arslanoglu Aydin E, Aliyev E, Bagrul İ, Türkmen Ş, Akgün Ö, Balık Z, Tanatar A, Bayındır Y, Kızıldağ Z, Torun R, Günalp A, Coşkuner T, İşgüder R, Aydın T, Haşlak F, Kasap Cüceoğlu M, Esen E, Akçay U, Başaran Ö, Pac Kısaarslan A, Akal F, Yüce D, Özdel S, Bülbül M, Bilginer Y, Aktay Ayaz N, Sözeri B, Kasapçopur Ö, Ünsal E, Özen S. A score for predicting colchicine resistance at the time of diagnosis in familial Mediterranean fever: data from the TURPAID registry. Rheumatology (Oxford) 2024; 63:791-797. [PMID: 37228026 PMCID: PMC10907807 DOI: 10.1093/rheumatology/kead242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/12/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Colchicine forms the mainstay of treatment in FMF. Approximately 5-10% of FMF patients are colchicine resistant and require anti-IL-1 drugs. We aimed to compare the characteristics of colchicine-resistant and colchicine-responsive patients and to develop a score for predicting colchicine resistance at the time of FMF diagnosis. METHODS FMF patients (0-18 years) enrolled in the Turkish Paediatric Autoinflammatory Diseases (TURPAID) registry were included. The predictive score for colchicine resistance was developed by using univariate/multivariate regression and receiver operating characteristics analyses. RESULTS A total of 3445 FMF patients [256 (7.4%) colchicine-resistant and 3189 colchicine-responsive) were included (female:male ratio 1.02; median age at diagnosis 67.4 months). Colchicine-resistant patients had longer, more frequent attacks and were younger at symptom onset and diagnosis (P < 0.05). Fever, erysipelas-like erythema, arthralgia, arthritis, myalgia, abdominal pain, diarrhoea, chest pain, comorbidities, parental consanguinity and homozygosity/compound heterozygosity for exon 10 MEFV mutations were significantly more prevalent among colchicine-resistant than colchicine-responsive patients (P < 0.05). Multivariate logistic regression analysis in the training cohort (n = 2684) showed that age at symptom onset, attack frequency, arthritis, chest pain and having two exon 10 mutations were the strongest predictors of colchicine resistance. The score including these items had a sensitivity of 81.3% and a specificity of 49.1%. In the validation cohort (n = 671), its sensitivity was 93.5% and specificity was 53.8%. CONCLUSION We developed a clinician-friendly and practical predictive score that could help us identify FMF patients with a greater risk of colchicine resistance and tailor disease management individually at the time of diagnosis.
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Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Şener
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elif Arslanoglu Aydin
- Department of Pediatrics, Division of Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Emil Aliyev
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlknur Bagrul
- Department of Pediatrics, Division of Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Şeyma Türkmen
- Department of Pediatrics, Division of Rheumatology, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Özlem Akgün
- Department of Pediatrics, Division of Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Balık
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Tanatar
- Department of Pediatrics, Division of Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Yağmur Bayındır
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zehra Kızıldağ
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Rüya Torun
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Aybüke Günalp
- Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Taner Coşkuner
- Department of Pediatrics, Division of Rheumatology, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Rana İşgüder
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Tuncay Aydın
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Fatih Haşlak
- Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Müşerref Kasap Cüceoğlu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esra Esen
- Department of Pediatrics, Division of Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ulaş Akçay
- Department of Pediatrics, Division of Rheumatology, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Özge Başaran
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysenur Pac Kısaarslan
- Department of Pediatrics, Division of Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Fuat Akal
- Department of Computer Engineering, Hacettepe University, Ankara, Turkey
| | - Deniz Yüce
- Department of Preventive Oncology, Hacettepe University, Ankara, Turkey
| | - Semanur Özdel
- Department of Pediatrics, Division of Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Mehmet Bülbül
- Department of Pediatrics, Division of Rheumatology, Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatrics, Division of Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatrics, Division of Rheumatology, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Erbil Ünsal
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Rech J, Schett G, Tufan A, Kuemmerle-Deschner JB, Özen S, Tascilar K, Geck L, Krickau T, Cohen E, Welzel T, Kuehn M, Vetterli M. Patient Experiences and Challenges in the Management of Autoinflammatory Diseases-Data from the International FMF & AID Global Association Survey. J Clin Med 2024; 13:1199. [PMID: 38592017 PMCID: PMC10931825 DOI: 10.3390/jcm13051199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Autoinflammatory diseases (AIDs) are rare, mostly genetic diseases that affect the innate immune system and are associated with inflammatory symptoms. Both paediatric and adult patients face daily challenges related to their disease, diagnosis and subsequent treatment. For this reason, a survey was developed in collaboration between the FMF & AID Global Association and the Erlangen Center for Periodic Systemic Autoinflammatory Diseases. METHODS The aim of the survey was to collect the personal assessment of affected patients with regard to their current status in terms of diagnostic timeframes, the interpretation of genetic tests, the number of misdiagnoses, and pain and fatigue despite treatment. RESULTS In total, data from 1043 AID patients (829 adults and 214 children/adolescents) from 52 countries were collected and analyzed. Familial Mediterranean fever (FMF) (521/50%) and Behçet's disease (311/30%) were the most frequently reported diseases. The average time to diagnosis was 3 years for children/adolescents and 14 years for adults. Prior to the diagnosis of autoinflammatory disease, patients received several misdiagnoses, including psychosomatic disorders. The vast majority of patients reported that genetic testing was available (92%), but only 69% were tested. A total of 217 patients reported that no increase in acute-phase reactants was detected during their disease episodes. The intensity of pain and fatigue was measured in AID patients and found to be high. A total of 88% of respondents received treatment again, while 8% reported no treatment. CONCLUSIONS AID patients, particularly adults, suffer from significant delays in diagnosis, misdiagnosis, and a variety of symptoms, including pain and fatigue. Based on the results presented, raising awareness of these diseases in the wider medical community is crucial to improving patient care and quality of life.
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Affiliation(s)
- Jürgen Rech
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (G.S.); (K.T.); (L.G.)
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Center for Rare Diseases Erlangen (ZSEER), Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (G.S.); (K.T.); (L.G.)
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Center for Rare Diseases Erlangen (ZSEER), Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Ankara, 06560 Ankara, Turkey;
| | - Jasmin B. Kuemmerle-Deschner
- Division of Pediatric Rheumatology, Autoinflammation Reference Center Tübingen, Department of Pediatrics, University Hospital Tübingen, 72016 Tübingen, Germany;
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, 06100 Ankara, Turkey;
| | - Koray Tascilar
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (G.S.); (K.T.); (L.G.)
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Center for Rare Diseases Erlangen (ZSEER), Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Leonie Geck
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (G.S.); (K.T.); (L.G.)
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Center for Rare Diseases Erlangen (ZSEER), Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Tobias Krickau
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Center for Rare Diseases Erlangen (ZSEER), Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Department of Paediatrics, Friedrich-Alexander University (FAU), Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Ellen Cohen
- FMF & AID Global Association, 8306 Zurich, Switzerland; (E.C.); (M.V.)
| | - Tatjana Welzel
- Pediatric Rheumatology, University Children’s Hospital Basel (UKBB), University of Basel, 4001 Basel, Switzerland;
| | | | - Malena Vetterli
- FMF & AID Global Association, 8306 Zurich, Switzerland; (E.C.); (M.V.)
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Aydıngöz Ü, Yıldız AE, Ayaz E, Batu ED, Özen S. Preferential involvement of the pelvis and hips along with active sacroiliitis in chronic nonbacterial osteomyelitis: MRI of 97 patients from a single tertiary referral center. Eur Radiol 2024:10.1007/s00330-023-10558-7. [PMID: 38180529 DOI: 10.1007/s00330-023-10558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To present MRI distribution of active osteitis in a single tertiary referral center cohort of patients with chronic nonbacterial osteomyelitis (CNO). METHODS Two musculoskeletal radiologists retrospectively reviewed MRI examinations of all patients with a final clinical diagnosis of CNO over 15 years. Sites of active osteitis at any time during the course of disease were divided into seven groups: (A) mandible, sternum, clavicles, or scapulas; (B) upper extremities; (C) subchondral sacrum and ilium immediately subjacent to sacroiliac joints (active osteitis denoting "active sacroiliitis" here); (D) pelvis and proximal 1/3 of femurs (excluding group C); (E) bones surrounding knees including distal 2/3 of femurs and 1/2 of proximal tibias and fibulas; (F) distal legs (including distal 1/2 of tibias and fibulas), ankles, or feet; (G) spine (excluding group C). Temporal changes of lesions in response to treatment (or other treatment-related changes such as pamidronate lines) were not within the scope of the study. RESULTS Among 97 CNO patients (53 males [55%], 44 females; age at onset, mean ± SD, 8.5 ± 3.2 years; age at diagnosis, 10.3 ± 3.3 years), whole-body (WB) MRI was performed in 92%, mostly following an initial targeted MRI (94%). A total of 557 (346 targeted and 211 WB) MRIs were analyzed. Biopsy was obtained in 39 patients (40%), all consistent with CNO or featuring supporting findings. The most common locations for active osteitis were groups D (78%; 95% CI 69‒85%) and C (72%; 95% CI 62‒80%). CONCLUSION Pelvis and hips were preferentially involved in this cohort of CNO patients along with a marked presence of active sacroiliitis. CLINICAL RELEVANCE STATEMENT When suggestive findings of CNO are identified elsewhere in the body, the next targeted site of MRI should be the pelvis (entirely including sacroiliac joints) and hips, if whole-body MRI is not available or feasible. KEY POINTS • Heavy reliance on MRI for diagnosis of CNO underscores the importance of suggestive distribution patterns. • Pelvis and hips are the most common (78%) sites of CNO involvement along with active sacroiliitis (72%). • Pelvis including sacroiliac joints and hips should be targeted on MRI when CNO is suspected.
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Affiliation(s)
- Üstün Aydıngöz
- Department of Radiology, Hacettepe University School of Medicine, 06230, Ankara, Turkey.
| | - Adalet Elçin Yıldız
- Department of Radiology, Hacettepe University School of Medicine, 06230, Ankara, Turkey
| | - Ercan Ayaz
- Department of Radiology, Hacettepe University School of Medicine, 06230, Ankara, Turkey
- Department of Radiology, Başakşehir Çam and Sakura City Hospital, 34480, Istanbul, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University School of Medicine, 06230, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University School of Medicine, 06230, Ankara, Turkey
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8
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Sözeri B, Şahin N, Açarı C, Avar Aydın PO, Baba O, Bağlan E, Bakkaloğlu S, Bakırcı S, Bilginer Y, Bozkaya BY, Çağlayan Ş, Çakan M, Çakmak F, Coşkuner T, Demir F, Demirkan FG, Doğantan Ş, Adıgüzel Dündar H, Ersözlü ED, Gücenmez S, Gürler O, İşgüder R, Küçük A, Kalyoncu M, Kılıç L, Kılıç SŞ, Kısaoğlu H, Paç Kısaarslan A, Kızıldağ Z, Kurtuluş D, Özdel S, Öztürk K, Şenol P, Tanatar A, Taşkın SN, Tuncer Kuru F, Türkuçar S, Ulu K, Ünsal E, Yazıcı A, Gezgin Yıldırım D, Yüksel S, Kasapçopur Ö, Özen S, Aktay Ayaz N, Sönmez HE. Towards a standardized program of transitional care for adolescents with juvenile idiopathic arthritis for Turkey: a national survey study. Pediatr Rheumatol Online J 2024; 22:7. [PMID: 38167070 PMCID: PMC10762787 DOI: 10.1186/s12969-023-00943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a prevalent childhood chronic arthritis, often persisting into adulthood. Effective transitional care becomes crucial as these patients transition from pediatric to adult healthcare systems. Despite the concept of transitional care being recognized, its real-world implementation remains inadequately explored. This study aims to evaluate the thoughts and practices of healthcare providers regarding transitional care for JIA patients. METHODS A cross-sectional survey was conducted among pediatric and adult rheumatologists in Turkey. Based on the American Academy of Pediatrics' six core elements of transitional care, the survey included 86 questions. The respondents' demographic data, attitudes towards transitional care, and practical implementation were assessed. RESULTS The survey included 48 rheumatologists, with 43.7% having a transition clinic. The main barriers to establishing transition programs were the absence of adult rheumatologists, lack of time, and financial constraints. Only 23.8% had a multidisciplinary team for transition care. Participants agreed on the importance of coordination and cooperation between pediatric and adult healthcare services. The timing of the transition process varied, with no consensus on when to initiate or complete it. Participants advocated for validated questionnaires adapted to local conditions to assess transition readiness. CONCLUSIONS The study sheds light on the challenges and perspectives surrounding transitional care for JIA patients in Turkey. Despite recognized needs and intentions, practical implementation remains limited due to various barriers. Cultural factors and resource constraints affect the transition process. While acknowledging the existing shortcomings, the research serves as a ground for further efforts to improve transitional care and ensure better outcomes for JIA patients transitioning into adulthood.
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Affiliation(s)
- Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ceyhun Açarı
- Department of Pediatric Rheumatology, Faculty of Medicine, Inönü University, Malatya, Turkey
| | | | - Ozge Baba
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, Etlik State Hospital, Ankara, Turkey
| | - Sevcan Bakkaloğlu
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sibel Bakırcı
- Department of Rheumatology, Antalya State Hospital, Antalya, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Yücel Bozkaya
- Department of Pediatric Rheumatology, Samsun Research and Training Hospital, Samsun, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Zeynep Kamil Research and Training Hospital, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Başakşehir Çam and Sakura State Hospital, Istanbul, Turkey
| | - Taner Coşkuner
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acıbadem Hospital, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şeyda Doğantan
- Department of Pediatric Rheumatology, Mersin City Hospital, Mersin, Turkey
| | - Hatice Adıgüzel Dündar
- Department of Pediatric Rheumatology, Behçet Uz Research and Training Hospital, Izmir, Turkey
| | - Emine Duygu Ersözlü
- Department of Rheumatology, Adana City Research and Training Hospital, Adana, Turkey
| | - Sercan Gücenmez
- Department of Rheumatology, Izmir Atatürk Research and Training Hospital, Izmir, Turkey
| | - Oğuz Gürler
- Department of Rheumatology, Medikal Park Hospital, Samsun, Turkey
| | - Rana İşgüder
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Adem Küçük
- Department of Rheumatology, Faculty of Medicine, Konya Selçuk University, Konya, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Levent Kılıç
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sara Şebnem Kılıç
- Department of Pediatric Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Hakan Kısaoğlu
- Department of Pediatric Rheumatology, Kayseri City Hospital, Kayseri, Turkey
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zehra Kızıldağ
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Duygu Kurtuluş
- Department of Physical Therapy and Rehabilitation, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Semanur Özdel
- Department of Pediatric Rheumatology, Etlik State Hospital, Ankara, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Göztepe Research and Training Hospital, Istanbul, Turkey
| | - Pelin Şenol
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Nur Taşkın
- Department of Pediatric Rheumatology, Eskişehir City Hospital, Eskişehir, Turkey
| | - Fatma Tuncer Kuru
- Department of Rheumatology, Osmaniye State Hospital, Osmaniye, Turkey
| | - Serkan Türkuçar
- Department of Pediatric Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Kadir Ulu
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Erbil Ünsal
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayten Yazıcı
- Department of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Deniz Gezgin Yıldırım
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Rheumatology, Faculty of Medicine, Onsekiz Mart University, Çanakkele, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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Sozeri B, Demir F, Barut K, Atalay E, Pac Kisaarslan A, Özdel S, Altuğ Gücenmez Ö, Makay B, Aktay Ayaz N, Haşlak F, Sağ E, Yıldız M, Kaya Akça Ü, Adroviç A, Bilginer Y, Poyrazoğlu H, Ünsal E, Kasapçopur Ö, Özen S. Evaluation of clinical outcomes in systemic juvenile idiopathic arthritis patients treated with biological agents in Turkey: the TURSIS study. Clin Exp Rheumatol 2024; 42:194-201. [PMID: 37497697 DOI: 10.55563/clinexprheumatol/j611kr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Biological drugs are one of the most effective treatment methods for systemic juvenile idiopathic arthritis (SJIA) and can significantly prevent morbidity and mortality. This study aimed to evaluate the efficacy and safety of biologics in patients with SJIA and provide real-life data that might help improve the outcomes. METHODS TURSIS was a retrospective multicentre study carried out in patients with SJIA for whom a biological treatment had been initiated between 1st March 2013 and 30th December 2018. Data include patients' characteristics, laboratory-clinical results, outcomes, and safety-related variables. The 24-month follow-up data of the patients and the efficacy and safety of biological drugs were evaluated. RESULTS 147 patients were enrolled. The clinical course of the disease was as follows; it was monocyclic in 38.1%, polycyclic in 49%, and persistent in 12.9% of patients. First-choice biologics were interleukin (IL)-1 blockers in the majority of patients (56.5%), followed by the anti-IL-6 (25.2%) and anti-TNF-alpha drugs (18.4%). Anakinra was the most preferred biologic agent in patients with macrophage activation syndrome (MAS), and tocilizumab was used more frequently in patients with persistent type (p=0.000 and p=0.003). The most frequent switch rate was seen in patients receiving anakinra (n=40/68, 58.8%), and it was most frequently switched to canakinumab (n=32/40, 80%). Better physician's global assessment scores were achieved in patients treated with anakinra in Month 3, compared to other treatments (p=0.04). CONCLUSIONS The results of our study support the efficacy of biological drugs in particular anti-IL-1 and anti-IL-6 drugs, in the treatment of SJIA. These treatments resulted in improvement in activity of disease and provide a considerable decrease in the frequency of MAS.
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Affiliation(s)
- Betül Sozeri
- Paediatric Rheumatology, University of Health Sciences, Istanbul, Umraniye Training and Research Hospital, Istanbul, Turkey.
| | - Ferhat Demir
- Paediatric Rheumatology, University of Health Sciences, Istanbul, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Kenan Barut
- Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Erdal Atalay
- Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Semanur Özdel
- Paediatric Rheumatology, Health Sciences University, Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Özge Altuğ Gücenmez
- Paediatric Rheumatology, Health Sciences University, Dr Behcet Uz Children's Hospital, Izmir, Turkey
| | - Balahan Makay
- Paediatric Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Nuray Aktay Ayaz
- Paediatric Rheumatology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Fatih Haşlak
- Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Erdal Sağ
- Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Yıldız
- Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ümmüşen Kaya Akça
- Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Amra Adroviç
- Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yelda Bilginer
- Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hakan Poyrazoğlu
- Paediatric Rheumatology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Erbil Ünsal
- Paediatric Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Özgür Kasapçopur
- Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seza Özen
- Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Batu ED, Sener S, Balık Z, Bayındır Y, Cam V, Kasap Cuceoglu M, Uysal O, Aliyev E, Basaran Ö, Bilginer Y, Özen S. Is it possible to predict a disease course prone to macrophage activation syndrome at systemic juvenile idiopathic arthritis diagnosis? Clin Rheumatol 2024; 43:415-421. [PMID: 38012469 DOI: 10.1007/s10067-023-06828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Macrophage activation syndrome (MAS) is a severe complication of systemic juvenile idiopathic arthritis (SJIA). We aimed to compare the characteristics of SJIA patients who developed MAS in the disease course to those who never experienced MAS. METHODS Patients with SJIA were included. The features of the patients at the time of SJIA diagnosis were compared. Multivariate logistic regression and ROC analyses were used while evaluating factors associated with MAS. RESULTS Overall, 126 SJIA patients (M/F:1.17) were included. Eighty-six (68.2%) never had MAS. At the time of SJIA diagnosis, age was younger; the duration of fever was longer; rash, hepatomegaly, and splenomegaly were more frequent and arthralgia/arthritis was less common among patients who had MAS in the follow-up than those who never had MAS. Also, white blood cell, neutrophil, and platelet counts and fibrinogen were lower, while transaminases, lactate dehydrogenase, triglyceride (TG), and ferritin levels were higher among patients with MAS than those without MAS. The multivariate regression analysis disclosed age at symptom onset, duration of fever, platelet count, TG and ferritin levels as independent MAS predictors. For ferritin level/platelet count (F/P) ratio at the time of SJIA diagnosis, a threshold of ≥1.1 performed best to predict a MAS-prone disease course with a sensitivity of 90% and a specificity of 82.6%. CONCLUSION The F/P ratio at the time of SJIA diagnosis may be a promising biomarker to predict MAS-prone disease course in SJIA. Determining MAS-prone patients at the time of SJIA diagnosis could assist physicians while tailoring SJIA treatment individually. Key points • Systemic juvenile idiopathic arthritis (SJIA) patients with macrophage activation syndrome (MAS) differ from SJIA patients who never have MAS, at the time of SJIA diagnosis. • It could be possible to predict a MAS-prone disease course at the time of SJIA diagnosis. • The ferritin/platelet ratio is a promising biomarker for predicting MAS-prone SJIA disease course.
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Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
| | - Seher Sener
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Yağmur Bayındır
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Veysel Cam
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Müşerref Kasap Cuceoglu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Ozan Uysal
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Emil Aliyev
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Özge Basaran
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
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Batu ED, Sener S, Özen S. Reply. Arthritis Rheumatol 2023; 75:2266. [PMID: 37441769 DOI: 10.1002/art.42647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Ezgi D Batu
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Sener
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Hacettepe University Faculty of Medicine, Ankara, Turkey
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12
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Şener S, Karaca NB, Kaşlı K, Özçadırcı A, Deniz Batu E, Başaran Ö, Bilginer Y, Özen S, Ünal E. Comparison of Biopsychosocial Characteristics of Children with Juvenile Idiopathic Arthritis According to Common Disease Subtypes. Turk Arch Pediatr 2023; 58:625-630. [PMID: 37850665 PMCID: PMC10724840 DOI: 10.5152/turkarchpediatr.2023.23087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/22/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE In this study, we assessed the functional and biopsychosocial characteristics of juvenile idiopathic arthritis (JIA) patients according to disease subtypes. MATERIALS AND METHODS Child Health Assessment Questionnaire (CHAQ), Juvenile Arthritis Disease Activity Score-71 (JADAS-71), and Juvenile Arthritis Biopsychosocial Questionnaire (JAB-Q) scales were administered to 304 JIA patients, and the subscale of JAB-Q was administered to their families. RESULTS The median age of JIA patients at diagnosis was 7.9 (5.5-13) years (female/male = 1.3). Most patients were under treatment (68.7%) and had inactive disease (69.3%). While there was no significant difference between JADAS-71 scores according to the JIA subtypes, total CHAQ scores in polyarticular JIA patients were higher than in systemic JIA patients (P = .005). Enthesitis-related arthritis (ERA) patients had higher JAB-Q fatigue total scores compared to systemic JJIA patients (P = .001). Juvenile Arthritis Biopsychosocial Questionnaire-child psychosocial status scores were higher in polyarticular JIA patients than oligoarticular and systemic JIA patients (P = .004 and P = .003, respectively), and they had higher JAB-Q child form total scores than systemic JIA patients (P = .006). In addition, systemic JIA patients' parents had higher JAB-Q family total scores compared to oligoarticular JIA patients' parents (P = .03). CONCLUSION Our results suggest that polyarticular JIA patients had higher CHAQ, JAB-Q psychosocial status, and child form total scores, and the JAB-Q fatigue score was higher in ERA patients. Also, JAB-Q-parent scores were higher in systemic JIA patients' parents. Biopsychosocial characteristics should be evaluated in both JIA patients and their parents.
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Affiliation(s)
- Seher Şener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nur Banu Karaca
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Kutay Kaşlı
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Aykut Özçadırcı
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Edibe Ünal
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
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Çevik NN, Aytekin E, Esenboğa S, Özbek B, Aytaç S, Özen S, Karagöz T, Cagdas D. COVID-19-related multiple inflammatory syndrome-C and pulmonary embolism in Aicardi-Goutries syndrome. Pediatr Pulmonol 2023; 58:3326-3329. [PMID: 37350359 DOI: 10.1002/ppul.26551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/05/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Nadira Nabiyeva Çevik
- Division of Immunology, Department of Pediatrics, Ihsan Dogramaci Childrens Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elif Aytekin
- Allergy and Immunology Department, Ankara Provincial Health Directorate Etlik City Hospital, Ankara, Turkey
| | - Saliha Esenboğa
- Division of Immunology, Department of Pediatrics, Ihsan Dogramaci Childrens Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Begüm Özbek
- Division of Pediatric Immunology, Institute of Child Health, Health Science Institute, Hacettepe University, Ankara, Turkey
| | - Selin Aytaç
- Department of Pediatrics, Division of Hematology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Karagöz
- Department of Pediatrics, Division of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Cagdas
- Division of Immunology, Department of Pediatrics, Ihsan Dogramaci Childrens Hospital, Hacettepe University Faculty of Medicine, Ankara, Turkey
- Division of Pediatric Immunology, Institute of Child Health, Health Science Institute, Hacettepe University, Ankara, Turkey
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Batu ED, Günalp A, Şahin S, Özdel S, Kızıldağ Z, Pac Kısaarslan A, Bağrul İ, Kasap Cuceoglu M, Tanatar A, Sonmez HE, Sag E, Demir S, Çelikel E, Cağlayan S, Çelikel Acar B, Sözeri B, Aktay Ayaz N, Bilginer Y, Poyrazoğlu MH, Ünsal E, Kasapçopur Ö, Özen S. Pediatric mixed connective tissue disease versus other overlap syndromes: a retrospective multicenter cohort study. Rheumatol Int 2023; 43:1485-1495. [PMID: 36906866 DOI: 10.1007/s00296-023-05300-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
Pediatric mixed connective tissue disease (MCTD) is a subgroup of overlap syndromes. We aimed to compare the characteristics and outcomes in children with MCTD and other overlap syndromes. All MCTD patients met either Kasukawa or Alarcon-Segovia and Villareal criteria. The patients with other overlap syndromes had the features of ≥ 2 autoimmune rheumatic diseases but did not meet MCTD diagnostic criteria. Thirty MCTD (F/M = 28/2) and thirty (F/M = 29/1) overlap patients were included (disease onset < 18 years). The most prominent phenotype at disease onset and the last visit was systemic lupus erythematosus (SLE) in the MCTD group; juvenile idiopathic arthritis and dermatomyositis/polymyositis, respectively, in the overlap group. At the last visit, systemic sclerosis (SSc) phenotype was more frequent among MCTD than overlap patients (60% vs. 33.3%; p = 0.038). The frequency of the predominant SLE phenotype had decreased (60% to 36.7%), while predominant SSc phenotype had increased (13.3% to 33.3%) during follow-up in MCTD patients. Weight loss (36.7% vs. 13.3%), digital ulcers (20% vs. 0), swollen hands (60% vs. 20%), Raynaud phenomenon (86.7% vs. 46.7%), hematologic involvement (70% vs. 26.7%), and anti-Sm positivity (29% vs. 3.3%) were more common, while Gottron papules (16.7% vs. 40%) were less frequent among MCTD than overlap patients (p < 0.05). A higher percentage of overlap patients achieved complete remission than MCTD patients (51.7% vs. 24.1%; p = 0.047). The disease phenotype and outcome differ between pediatric MCTD and other overlap syndromes where MCTD may be regarded as a more severe disease. Analyzing these patients could pave the way for early and effective treatment.
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Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
- Çocuk Romatoloji Bölümü, Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi, Kat: 3 Sıhhiye, 06100, Ankara, Turkey.
| | - Aybüke Günalp
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Sezgin Şahin
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Semanur Özdel
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Zehra Kızıldağ
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Aysenur Pac Kısaarslan
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Erciyes University, Kayseri, Turkey
| | - İlknur Bağrul
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Tanatar
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Hafize Emine Sonmez
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Kocaeli University, Kocaeli, Turkey
| | - Erdal Sag
- Ankara Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatrics, Division of Rheumatology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Elif Çelikel
- Ankara City Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Sengul Cağlayan
- Umraniye Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Istanbul, Turkey
| | - Banu Çelikel Acar
- Ankara City Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Ankara, Turkey
| | - Betül Sözeri
- Umraniye Research and Training Hospital, Department of Pediatrics, Division of Rheumatology, University of Health Sciences, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Hakan Poyrazoğlu
- Faculty of Medicine, Department of Pediatrics, Division of Rheumatology, Erciyes University, Kayseri, Turkey
| | - Erbil Ünsal
- Department of Pediatrics, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Özgür Kasapçopur
- Cerrahpasa Medical School, Department of Pediatrics, Division of Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Kocatürk B, Özmen F, Arditi M, Özen S. Editorial: Recent advances in pediatric inflammatory diseases. Front Pediatr 2023; 11:1237625. [PMID: 37576145 PMCID: PMC10421723 DOI: 10.3389/fped.2023.1237625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Begüm Kocatürk
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Füsun Özmen
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Moshe Arditi
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Seza Özen
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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16
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Kısaarslan AP, Çiçek SÖ, Batu ED, Şahin S, Gürgöze MK, Çetinkaya SB, Ekinci MK, Atmış B, Barut K, Adrovic A, Ağar BE, Şahin N, Demir F, Bağlan E, Kara MA, Selçuk ŞZ, Özdel S, Çomak E, Akkoyunlu B, Yener GO, Yıldırım DG, Öztürk K, Yıldız M, Haşlak F, Şener S, Kısaoğlu H, Baba Ö, Kızıldağ Z, İşgüder R, Çağlayan Ş, Bilgin RBG, Aytaç G, Yücel BB, Tanatar A, Sönmez HE, Çakan M, Kara A, Elmas AT, Kılıç BD, Ayaz NA, Kasap B, Acar BÇ, Ozkaya O, Yüksel S, Bakkaloğlu S, Aydoğ Ö, Aksu G, Akman S, Dönmez O, Bülbül M, Büyükçelik M, Tabel Y, Sözeri B, Kalyoncu M, Bilginer Y, Poyrazoğlu MH, Ünsal E, Kasapçopur Ö, Özen S, Düşünsel R. Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: A multicenter study. Joint Bone Spine 2023; 90:105559. [PMID: 36858168 DOI: 10.1016/j.jbspin.2023.105559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Neuropsychiatric (NP) involvement is a restricted area in juvenile-onset systemic lupus erythematosus (jSLE). AIM To investigate the prevalence, demographic and clinical features, and outcomes of the neurological involvement in the Turkish jSLE population. METHODS This study was based upon 24 referral centers' SLE cohorts, multicenter and multidisciplinary network in Turkey. Patient data were collected by a case report form which was standardized for NP definitions according to American Collage of Rheumatology (ACR). Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) neuropsychiatric part was used to determine NP damage. Variables were evaluated Ward's hierarchical clustering analyses, univariate, and multivariate logistic regression analyses. RESULTS A hundred forty-nine of 1107 jSLE patients had NP involvement (13.5%). The most common NPSLE findings were headache (50.3%), seizure (38.3%), and acute confusional state (33.6%). Five clusters were identified with all clinical and laboratory findings. The first two clusters involved neuropathies, demyelinating diseases, aseptic meningitis, and movement disorder. Cluster 3 involved headache, activity markers and other SLE involvements. Idiopathic intracranial hypertension, cerebrovascular disease, cognitive dysfunction, psychiatric disorders and SLE antibodies were in the fourth, and acute confusional state was in the fifth cluster. In multivariate analysis, APA positivity; OR: 2.820, (%95CI: 1.002-7.939), P: 0,050, plasmapheresis; OR: 13.804 (%95CI: 2.785-68.432), P: 0,001, SLEDAI scores; OR: 1.115 (%95CI: (1.049-1.186), P: 0,001 were associated with increased risk for neurologic sequelae. CONCLUSION We detected the prevalence of juvenile NPSLE manifestations in Turkey. We have identified five clusters that may shed light pathogenesis, treatment and prognosis of NP involvements. We also determined risk factors of neurological sequelae. Our study showed that new definitions NP involvements and sequelae for childhood period are needed.
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Affiliation(s)
| | | | - Ezgi D Batu
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezgin Şahin
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Metin K Gürgöze
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | | | | | - Bahriye Atmış
- Pediatric Nephrology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Kenan Barut
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Amra Adrovic
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Buket Esen Ağar
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Nihal Şahin
- Pediatric Rheumatology, Derince Educational and Research Hospital, Kocaeli, Turkey
| | - Ferhat Demir
- Pediatric Rheumatology, Acıbadem Hospital, Istanbul, Turkey
| | - Esra Bağlan
- Pediatric Rheumatology, Doctor Sami-Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Mehtap Akbalık Kara
- Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Şenay Zırhlı Selçuk
- Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Semanur Özdel
- Pediatric Rheumatology, Doctor Sami-Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Elif Çomak
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Betül Akkoyunlu
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Gülçin Otar Yener
- Pediatric Rheumatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey
| | | | - Kübra Öztürk
- Pediatric Rheumatology, Istanbul Medeniyet University, Göztepe Professor Doctor Süleyman-Yalçın City Hospital, İstanbul, Turkey
| | - Mehmet Yıldız
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Fatih Haşlak
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Seher Şener
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Kısaoğlu
- Pediatric Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Özge Baba
- Pediatric Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Zehra Kızıldağ
- Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Rana İşgüder
- Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Şengül Çağlayan
- Pediatric Rheumatology, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | | | - Gülçin Aytaç
- Pediatric Rheumatology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Burcu Bozkaya Yücel
- Pediatric Rheumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ayşe Tanatar
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Hafize E Sönmez
- Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mustafa Çakan
- Pediatric Rheumatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, İstanbul, Turkey
| | - Aslıhan Kara
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazıg, Turkey
| | - Ahmet T Elmas
- Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | | | - Nuray Aktay Ayaz
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Belde Kasap
- Pediatric Nephrology, Katip-Çelebi University, İzmir, Turkey
| | - Banu Çelikel Acar
- Pediatric Nephrology and Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Ozan Ozkaya
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, İstinye University, İstanbul, Turkey
| | - Selçuk Yüksel
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Sevcan Bakkaloğlu
- Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Özlem Aydoğ
- Pediatric Rheumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Güzide Aksu
- Pediatric Rheumatology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Sema Akman
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Dönmez
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Mehmet Bülbül
- Pediatric Rheumatology, Doctor Sami-Ulus Maternity and Child Health and Diseases Research and Training Hospital, Ankara, Turkey
| | - Mithat Büyükçelik
- Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Yılmaz Tabel
- Pediatric Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Betül Sözeri
- Pediatric Rheumatology, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | - Mukaddes Kalyoncu
- Pediatric Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yelda Bilginer
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muammer H Poyrazoğlu
- Pediatric Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Erbil Ünsal
- Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Özgür Kasapçopur
- Pediatric Rheumatology, Cerrahpasa Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Seza Özen
- Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ruhan Düşünsel
- Pediatric Nephrology and Rheumatology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
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17
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Batu ED, Sener S, Ozomay Baykal G, Arslanoglu Aydin E, Özdel S, Gagro A, Esen E, Heshin‐Bekenstein M, Akpınar Tekgöz N, Demirkan FG, Ozturk K, Vougiouka O, Sonmez HE, Maggio MC, Kaya Akca U, Jelusic M, Pac Kısaarslan A, Acar B, Aktay Ayaz N, Sözeri B, Özen S. The Characteristics of Patients With COVID-19-Associated Pediatric Vasculitis: An International, Multicenter Study. Arthritis Rheumatol 2023; 75:499-506. [PMID: 36457245 PMCID: PMC9877558 DOI: 10.1002/art.42411] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE COVID-19-associated pediatric vasculitis, other than Kawasaki disease (KD)-like vasculitis in multisystem inflammatory syndrome in children (MIS-C), is very rare. This study sought to analyze the characteristics, treatment, and outcomes in patients with COVID-19-associated pediatric vasculitis (excluding KD-like vasculitis in MIS-C). METHODS The inclusion criteria were as follows: 1) age <18 years at vasculitis onset; 2) evidence of vasculitis; 3) evidence of SARS-CoV-2 exposure; and 4) ≤3 months between SARS-CoV-2 exposure and vasculitis onset. Patients with MIS-C were excluded. The features of the subset of patients in our cohort who had COVID-19-associated pediatric IgA vasculitis/Henoch Schönlein purpura (IgAV/HSP) were compared against a pre-pandemic cohort of pediatric IgAV/HSP patients. RESULTS Forty-one patients (median age 8.3 years; male to female ratio 1.3) were included from 14 centers and 6 countries. The most frequent vasculitis subtype was IgAV/HSP (n = 30). The median duration between SARS-CoV-2 exposure and vasculitis onset was 13 days. Involvement of the skin (92.7%) and of the gastrointestinal system (61%) were the most common manifestations of vasculitis. Most patients (68.3%) received glucocorticoids, and 14.6% also received additional immunosuppressive drugs. Remission was achieved in all patients. All of the patients with IgAV/HSP in our cohort had skin manifestations, while 18 (60%) had gastrointestinal involvement and 13 (43.3%) had renal involvement. When we compared the features of this subset of 30 patients to those of a pre-pandemic pediatric IgAV/HSP cohort (n = 159), the clinical characteristics of fever and renal involvement were more common in our COVID-19-associated pediatric IgAV/HSP cohort (fever, 30% versus 5%, respectively [P < 0.001]; renal involvement, 43.3% versus 17.6%, respectively [P = 0.002]). Recovery without treatment and complete recovery were each less frequent among our COVID-19-associated pediatric IgAV/HSP patients compared to the pre-pandemic pediatric IgAV/HSP cohort (recovery without treatment, 10% versus 39%, respectively [P = 0.002]; complete recovery, 86.7% versus 99.4%, respectively [P = 0.002]). CONCLUSION This is the largest cohort of children with COVID-19-associated vasculitis (excluding MIS-C) studied to date. Our findings suggest that children with COVID-19-associated IgAV/HSP experience a more severe disease course compared to pediatric IgAV/HSP patients before the pandemic.
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Affiliation(s)
- Ezgi D. Batu
- Hacettepe University Faculty of MedicineAnkaraTurkey
| | - Seher Sener
- Hacettepe University Faculty of MedicineAnkaraTurkey
| | | | - Elif Arslanoglu Aydin
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training HospitalAnkaraTurkey
| | - Semanur Özdel
- Dr. Sami Ulus Maternity and Child Health and Diseases Research and Training HospitalAnkaraTurkey
| | - Alenka Gagro
- Children's Hospital Zagreb, Zagreb, Croatia, School of Medicine, University of Zagreb, Zagreb, Croatia, and Faculty of Medicine, Josip Juraj Strossmayer, Josipa Huttlera 4, University of OsijekOsijekCroatia
| | - Esra Esen
- Erciyes University Faculty of MedicineKayseriTurkey
| | | | | | | | - Kubra Ozturk
- Istanbul Medeniyet University, Goztepe Research and Training HospitalIstanbulTurkey
| | - Olga Vougiouka
- National Kapodistrian University School of Medicine, “P. A. Kyriakou” Children's HospitalAthensGreece
| | | | | | | | - Marija Jelusic
- University of Zagreb School of Medicine, University Hospital Centre ZagrebZagrebCroatia
| | | | | | | | - Betül Sözeri
- Umraniye Training and Research HospitalIstanbulTurkey
| | - Seza Özen
- Hacettepe University Faculty of MedicineAnkaraTurkey
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18
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Kaya Akca Ü, Deniz Batu E, Tanalı G, Atalay E, Kasap Cüceoğlu M, Sener S, Balık Z, Bayındır Y, Aliyev E, Başaran Ö, Bilginer Y, Özen S, Ozen S. Patients Without a Rheumatic Disease Diagnosis in a Pediatric Rheumatology Unit: Retrospective Analysis and Comparison Between Pre-pandemic and Pandemic Periods. Turk Arch Pediatr 2023; 58:49-55. [PMID: 36598211 PMCID: PMC9885826 DOI: 10.5152/turkarchpediatr.2022.22192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Children with suspicious complaints of rheumatic diseases are generally referred to
a pediatric rheumatologist. We aimed to evaluate the profile of patients referred to the pediatric rheumatology unit and were not diagnosed with a rheumatic disease and to assess the
impact of the coronavirus disease-2019 pandemic on referral complaints. MATERIALS AND METHODS All new outpatients who applied to the pediatric rheumatology department between March 2019 and February 2021 and were not diagnosed with rheumatic disease
were included. We also compared the frequency of admission symptoms during the pre-pandemic (March 2019-February 2020) and pandemic periods (March 2020-February 2021). RESULTS A total of 1089 patients without a rheumatic disease diagnosis (568 female, 52.2%;
median age 10.0 years) were included in this study. The most common complaint for referral was prolonged or recurrent fevers (13.4%) followed by anti-nuclear antibody positivity
(13.1%), arthralgia (13.0%), skin findings (7.5%), and the presence of heterozygous mutations
in the Mediterranean fever gene (6.9%). During the pandemic year, the number of patients
referred for back pain increased significantly (P = .028). A total of 682 of 1089 patients were
consulted from other departments in our center (62.6%). Of these, the most frequent consultation request was from general pediatrics (43.6%). The rheumatic disease was excluded in 11.3%
of the patients. CONCLUSION Prolonged or recurrent fever and anti-nuclear antibody positivity were the most
frequent complaints of referrals to a pediatric rheumatology unit in patients who did not have
a rheumatic disease. The rate of back pain was more common in children during the pandemic
period.
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Affiliation(s)
- Ümmüşen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gizem Tanalı
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muserref Kasap Cüceoğlu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seher Sener
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yağmur Bayındır
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emil Aliyev
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Özge Başaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Corresponding author:Seza Özen ✉
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Şener S, Başaran Ö, Batu ED, Cüceoğlu MK, Balık Z, Aliyev E, Bayındır Y, Bilginer Y, Özen S. Choice and switch of biologic drugs in juvenile idiopathic arthritis. Turk J Pediatr 2023; 65:980-989. [PMID: 38204313 DOI: 10.24953/turkjped.2023.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND In this study, we aimed to evaluate choices and changes of biologic drugs in juvenile idiopathic arthritis (JIA) patients according to disease subtypes. METHODS We retrospectively analyzed JIA patients who received biologic treatment between January 2004 and July 2022. RESULTS Of 294 JIA patients, 80 (27.2%) had systemic JIA, 68 (23.1%) had oligoarticular JIA, 61 (20.7%) had polyarticular JIA, 79 (26.9%) had enthesitis-associated arthritis (ERA), and six (2.1%) had psoriatic arthritis (PsA). Anakinra (n=66, 82.5%) was the most commonly preferred first line biologic in systemic JIA. Etanercept was the most frequently used biologic drug in patients with ERA (n=69, 87.3%), oligoarticular (n=37, 54.4%) and polyarticular JIA (n=43, 70.5%). Adalimumab was used as a first-line biologic drug in all PsA patients (n=6, 100%). One hundred-fourteen patients (38.8%) were switched to second-line and 29 (9.9%) to third-line biologic drugs. While the most common reason for switching to a second-line biologic was difficulty in usage of daily injections (n=37, 60.6%) in systemic JIA patients, it was an inadequate response to first biologics in non-systemic JIA patients (n=42, 79.2%). Side effects were detected in only seven patients (2.4%) during the follow-up. CONCLUSION In this study, we revealed the biologic drug usage and switch strategies in our JIA patients. Good responses were obtained in most of our patients with a reliable profile. However, studies on larger patient groups are needed to clarify these results.
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Affiliation(s)
- Seher Şener
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Özge Başaran
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Müşerref Kasap Cüceoğlu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Zeynep Balık
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Emil Aliyev
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Yağmur Bayındır
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
| | - Seza Özen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Türkiye
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Aygun FB, Kadayıfçılar S, Özen S. Spontaneous hyphema in juvenile idiopathic arthritis uveitis. Turk J Pediatr 2023; 65:161-164. [PMID: 36866998 DOI: 10.24953/turkjped.2022.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a rheumatic disease that may be associated with ocular involvement in childhood. Classical findings of JIA uveitis are cells and flare; hyphema, bleeding in the anterior chamber of the eye, is a rare finding. CASE An 8-year-old girl presented with 3+ cells and a flare in the anterior chamber. Topical corticosteroids were started. A follow-up examination 2 days later revealed hyphema in the affected eye. There was no history of trauma or drug use, and the laboratory test results did not suggest any hematological disease. Systemic evaluation resulted in the diagnosis of JIA by the rheumatology department. The findings regressed with systemic and topical treatment. CONCLUSIONS The most common cause of hyphema in childhood is trauma, but it can rarely be seen with anterior uveitis. This case highlights the importance of recognizing JIA-related uveitis in the differential diagnosis of hyphema in childhood.
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Affiliation(s)
- Figen Bezci Aygun
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara
| | - Sibel Kadayıfçılar
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara
| | - Seza Özen
- Pediatric Rheumatology Unit, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Türkiye
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21
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Türkuçar S, Kaya ÜA, Çakmak F, Haşlak F, Demir F, Karabulut E, Makay B, Bilginer Y, Ayaz NA, Sözeri B, Kasapçopur Ö, Karagöz T, Ünal N, Özen S, Ünsal E. Risk factors for coronary arterial involvement in Turkish children with Kawasaki disease: a multicenter retrospective study. Turk J Pediatr 2023; 65:64-72. [PMID: 36866986 DOI: 10.24953/turkjped.2021.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Coronary arterial lesions (CALs) are the major component of Kawasaki disease (KD), associated with significant morbidity, which affect a substantial proportion of patients despite proper treatment. The aim of this study was to define the risk factors for CALs in Turkish children with KD. METHODS Medical records of 399 KD patients from five pediatric rheumatology centers in Turkey were reviewed retrospectively. Demographic, clinical (including duration of fever before intravenous immunoglobulin [IVIG] and resistance to IVIG), laboratory and echocardiographic data were noted. RESULTS The patients with CALs were younger, had a higher male ratio and a longer duration of fever before IVIG. They also had higher lymphocyte and lower hemoglobin values before the initial treatment. Multiple logistic regression analyses defined the following three criteria as independent risk factors for predicting CALs in Turkish children with KD: age ≤12 months, male gender and duration of fever before IVIG ≥9.5 days. High sensitivity rates of elevated risk of CALs up to 94.5% were calculated despite specificity values falling to 16.5%, depending on which of these three parameters are taken into account. CONCLUSIONS Based on the demographic and clinical features, we established an easily applicable risk-scoring system for predicting CALs in Turkish children with KD. This may be useful for choosing appropriate treatment and follow-up for KD to prevent coronary artery involvement. Further studies will show whether these risk factors can be used in other Caucasian populations as well.
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Affiliation(s)
- Serkan Türkuçar
- Department of Pediatric Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Ümmüşen Akça Kaya
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara
| | - Figen Çakmak
- Department of Pediatric Rheumatology, İstanbul University Çapa Faculty of Medicine, İstanbul
| | - Fatih Haşlak
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, İstanbul
| | - Erdem Karabulut
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara
| | - Balahan Makay
- Department of Pediatric Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, İstanbul University Çapa Faculty of Medicine, İstanbul
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, İstanbul
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul
| | - Tevfik Karagöz
- Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara
| | - Nurettin Ünal
- Department of Pediatric Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara
| | - Erbil Ünsal
- Department of Pediatric Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir
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Şimşek-Onat P, Hizarcioglu-Gulsen H, Ergen YM, Gumus E, Özen H, Demir H, Özen S, Saltık-Temizel İN. Neutrophil-to-Lymphocyte Ratio: An Easy Marker for the Diagnosis and Monitoring of Inflammatory Bowel Disease in Children. Dig Dis Sci 2023; 68:233-239. [PMID: 35579794 DOI: 10.1007/s10620-022-07547-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is a simple and inexpensive inflammation biomarker that reflects systemic inflammation based on complete blood count values. AIMS In our study, we aimed to compare the NLR values in pediatric inflammatory bowel disease (IBD) and in healthy controls, and to define NLR levels in children with IBD during diagnosis, active disease, and remission. METHODS NLR values of patients with IBD at diagnosis, remission, and active disease of the patients were recorded retrospectively. Age- and sex-matched healthy subjects enrolled as the control group. RESULTS Sixty-three patients with IBD and 92 healthy subjects as the control group enrolled. The mean age of the patients with IBD was 9.31 ± 5.24 years, and 57.1% were males. The mean NLR values of the patients with IBD at diagnosis and remission were significantly higher than that of healthy controls (p < 0.001). The mean NLR values of the patients at diagnosis and active disease were significantly higher than that of during remission (p < 0.001). The best cutoff of NLR for prediction of diagnosis of IBD in children was 1.46 with a sensitivity of 86.2% and specificity of 93.5%. There was no significant difference regarding NLR between patients with IBD with and without associated diseases. At diagnosis the mean NLR level of patients with Crohn's disease was significantly higher than that of ulcerative colitis (p = 0.019). CONCLUSIONS It was shown for the first time that NLR levels were significantly increased at diagnosis and active disease of childhood IBD, compared to the remission period. We believe that NLR can be a non-invasive inflammatory biomarker that should be used in the initial evaluation and follow-up of the disease activity in children.
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Affiliation(s)
- Pınar Şimşek-Onat
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey.
| | - Hayriye Hizarcioglu-Gulsen
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Yasin Maruf Ergen
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Ersin Gumus
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Hülya Demir
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
| | - İnci Nur Saltık-Temizel
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Hacettepe University, Ankara, Turkey
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Çakmak F, Doğantan Ş, İşgüder R, Cüceoğlu MK, Çağlayan Ş, Sönmez HE, Akgün Ö, Sözeri B, Kısaarslan AP, Ünsal E, Özen S, Ayaz NA. 61 The nailfold videocapillaroscopy in pediatric Behçet’s disease: a multi-center study. Rheumatology (Oxford) 2022. [PMCID: PMC9539020 DOI: 10.1093/rheumatology/keac496.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Behçet's disease (BD) is a chronic inflammatory disease characterized by recurrent oral aphthous and genital ulcers accompanied by eye, joint, skin, gastrointestinal and central nervous system involvement. The vascular involvement may affect both the arterial and venous systems. Nailfold videocapillaroscopy (NVC) is an easy and non-invasive method used in the evaluation of microcirculation. With this study, we aimed to find the characteristics and prevalence of nailfold capillary alterations in patients with juvenile BD and to analyze their possible relationship between clinical characteristics and activity of the disease. Methods Patients aged 5–21 years with a diagnosis of juvenile BD and followed up for at least six months were included in the study. Demographic and clinical characteristics of the patients were recorded. NVC was performed on 8 fingers of both hands, excluding the thumbs, and four consecutive non overlapping fields for each of fingers were evaluated (32 fields per patient). Capillary density, capillary width (arterial width, venous width, apical loop), capillary morphology and the presence of meandering capillary, micro hemorrhage, avascular area, neoangiogenesis, capillary ramification were evaluated from the images. Capillary morphology were evaluated by classifying them into four groups as normal, minor abnormalities, major abnormalities and scleroderma pattern. The presence of abnormilities in at least two fingers were recorded as capillary abnormality. The semi quantitative rating score 1–3 was applied for each capillaroscopic alteration. Results 37 patients from 6 pediatric rheumatology centers were included in the study. The mean age of patients was 17 years (IOR 13–19) and 20 (54.1%) of them were girls. The patients were evaluated in four clusters according to their clinical presentations. Nineteen patients had mucocutaneous involvement, 9 patients had uveitis, 8 patients had vascular and neurological involvement, and 4 patients had gastrointestinal system involvement. During the follow-up period, genital ulcers developed in 22 patients, erythema nodosum in 9 patients, pseudofolliculitis in 18 patients, uveitis in 10 patients, vascular involvement in 8 patients, and neurological involvement in 5 patients. Anterior uveitis was present in five, posterior uveitis in three, panuveitis in one, and retinal vasculitis in three of the patients with ocular involvement. Four patients had lower extremity venous thrombosis, three patients had central nervous system (CNS) thrombosis, and one patient had both lower extremity and CNS thrombosis. When capillary morphology was evaluated; normal morphology was present in 16 patients, minor abnormality in 13 patients, and major abnormality in 8 patients. Median capillary density was 8, capillary length was 325 µm, arterial width was 12 µm, venous width was 16 µm, apical loop width was 18 µm, capillary width was 39 µm, and intercapillary distance was 107 µm. Neoagiogenesis was seen in 13 patients, enlarged capillaries in 12 patients, capillary meandering in 9 patients, bushy capillaries in 5 patients, bizarre capillaries in 4 patients, and microhemorrhage in 3 patients. Neoangiogenesis was found to be significantly more common in the NVC evaluation of patients with lower haemoglobin values at the time of diagnosis (p = 0.014). Conclusion NVC is an in vivo, non-invasive, and inexpensive imaging technique that allows the direct observation of the capillary network in living tissue throughout the skin and it may be preferred in juvenile BD for evaluating microvascular involvement.
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Affiliation(s)
- Figen Çakmak
- Istanbul University, Istanbul Faculty of Medicine, Pediatric Rheumatology
| | - Şeyda Doğantan
- Erciyes University, Faculty of Medicine Pediatric Rheumatology
| | - Rana İşgüder
- Dokuz Eylül Faculty of Medicine, Pediatric Rheumatology
| | | | - Şengül Çağlayan
- Ümraniye Health and Science Hospital, Pediatric Rheumatology
| | | | - Özlem Akgün
- Istanbul University, Istanbul Faculty of Medicine, Pediatric Rheumatology
| | - Betül Sözeri
- Ümraniye Health and Science Hospital, Pediatric Rheumatology
| | | | - Erbil Ünsal
- Dokuz Eylül Faculty of Medicine, Pediatric Rheumatology
| | - Seza Özen
- Hacettepe University, Faculty of Medicine, Pediatric Rheumatology
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Gürlevik SL, Günbey C, Ozsurekci Y, Kesici S, Gocmen R, Temucin Ç, Özen S, Cengiz AB, Yalnızoglu D. Neurologic manifestations in children with COVID-19. Eur J Paediatr Neurol 2022; 39:118-119. [PMID: 35781422 PMCID: PMC9190175 DOI: 10.1016/j.ejpn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sibel Laçinel Gürlevik
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey.
| | - Ceren Günbey
- Hacettepe University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Yasemin Ozsurekci
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Selman Kesici
- Hacettepe University Faculty of Medicine, Department of Pediatric Intensive Care Unit, Ankara, Turkey
| | - Rahsan Gocmen
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Çağrı Temucin
- Hacettepe University University Faculty of Medicine, Department of Neurology, Ankara, Turkey
| | - Seza Özen
- Hacettepe University Faculty of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - Ali Bulent Cengiz
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Dilek Yalnızoglu
- Hacettepe University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
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Demir S, Keskin A, Sağ E, Kaya Akca Ü, Atalay E, Cüceoğlu MK, Batu Akal ED, Özen S, Bilginer Y. The challenges in diagnosing pediatric primary antiphospholipid syndrome. Lupus 2022; 31:1269-1275. [PMID: 35746827 DOI: 10.1177/09612033221108853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric primary antiphospholipid syndrome (APS) is a very rare disease with significant distinctions from the APS in adults. Herein, we present our experience in the diagnosis and treatment of six pediatric primary APS patients, who met the updated Sapporo criteria for the APS diagnosis. One of them was also diagnosed as having probable catastrophic APS (CAPS) due to the involvement of three different organ systems simultaneously. Besides vascular involvement, four patients had thrombocytopenia, one had psychiatric disorder, and one had chorea and valvular heart disease. All patients received immunosuppressive treatment along with long-term anticoagulation therapy. Specific neurologic and hematologic manifestations that are not part of the classification criteria can be seen in children with primary APS. Therefore, using the adult criteria for diagnosing pediatric APS may result in missed or delayed diagnoses in children.
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Affiliation(s)
- Selcan Demir
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Armağan Keskin
- Department of Pediatrics, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Erdal Sağ
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Ümmüşen Kaya Akca
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Müşerref Kasap Cüceoğlu
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Ezgi Deniz Batu Akal
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Faculty of Medicine, 37515Hacettepe University, Ankara, Turkey
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Duran E, Yıldırım T, Taghiyeva A, Bilgin E, Arıcı M, Sağlam EA, Özen S, Üner M, Erdem Y, Kalyoncu U, Ertenli AI. Differences and similarities of proliferative and non-proliferative forms of biopsy-proven lupus nephritis: Single centre, cross-disciplinary experience. Lupus 2022; 31:1147-1156. [PMID: 35658643 PMCID: PMC9277329 DOI: 10.1177/09612033221106305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to compare clinical features, outcomes, treatments, and to define the predictive factors of complete renal response (CRR) in patients with proliferative and non-proliferative lupus nephritis (LN). METHODS Patients with systemic lupus erythematosus (SLE) followed between 2014 and 2020 at Hacettepe University Hospitals and who had a kidney biopsy were the subject of the study. One hundered and sixteen patients' kidney biopsies reported as LN were evaluated retrospectively. Clinical characteristics and laboratory values at the time of kidney biopsy, histopathological forms of LN, and renal response (complete or partial) were recorded. We analyzed the association between CRR rates during the 2-year follow-up after induction therapy and the predictive factors for CRR. RESULTS Of 116 (93 females, 23 males) patients, 95 (81.9%) were in the proliferative group (class III and IV) and 21 (18.1%) were in the non-proliferative group (class II and V). In the proliferative group, the percentage of the patients with elevated basal creatinine levels, median daily proteinuria, anti-double-stranded DNA (dsDNA) positivity, low C3 and C4 levels, the presence of active urinary sediment, and median renal SLE Disease Activity Index (SLEDAI) scores at the time of kidney biopsy were significantly higher than the non-proliferative group. Renal response status during the 2-year follow-up after induction therapy was available for 99 patients. During this time, 70 (70.7%) patients had achieved CRR and time-to-CRR was similar between the proliferative and non-proliferative groups (p = 0.64, log-rank test). The Cox proportional hazards model showed that achievement of CRR was associated with female gender [HR: 2.15 (1.19-3.89 95% CI), p = 0.011], newly diagnosed SLE with renal biopsy [HR: 2.15 (1.26-3.67 95% CI), p = 0.005], hypertension [HR: 0.40 (0.27-0.94 95% CI), p = 0.032], eGFR increase [HR: 1.01 (1.00-1.01 95% CI), p = 0.046], and the presence of active urinary sediment [HR: 0.46 (0.22-0.96 95% CI), p = 0.039]. CONCLUSIONS Achieving CRR was similar in proliferative and non-proliferative LN patients, although certain laboratory parameters differed at the onset. Our results indicated the importance of kidney biopsy in the decision-making of treatment of SLE patients with renal involvement and that the defined factors associated with CRR achievement help to predict good renal response.
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Affiliation(s)
- Emine Duran
- Department of Internal Medicine, Division of Rheumatology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tolga Yıldırım
- Department of Internal Medicine, Division of Nephrology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Taghiyeva
- Department of Internal Medicine, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emre Bilgin
- Department of Internal Medicine, Division of Rheumatology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Arıcı
- Department of Internal Medicine, Division of Nephrology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Emine Arzu Sağlam
- Department of Pathology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meral Üner
- Department of Pathology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yunus Erdem
- Department of Internal Medicine, Division of Nephrology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Ihsan Ertenli
- Department of Internal Medicine, Division of Rheumatology, RinggoldID:64005Hacettepe University Faculty of Medicine, Ankara, Turkey
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Duran E, Yildirim T, Taghiyeva A, Bilgin E, Arici M, Saglam A, Özen S, Üner M, Erdem Y, Kalyoncu U, Ertenli AI. POS0765 IS THERE ANY DIFFERENCE IN THE CLINICAL FEATURES AND OUTCOMES OF PROLIFERATIVE AND NON-PROLIFERATIVE FORMS OF LUPUS NEPHRITIS PROVEN BY BIOPSY? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundLupus nephritis (LN), which occurs in 60-70% of patients with systemic lupus erythematosus, is a major determinant of morbidity and mortality. There still are many uncertain aspects in clinical, pathological, and prognostic characteristics about LN.ObjectivesWe aimed to compare clinical features, outcomes, and to define the predictive factors of complete renal response (CRR) in patients with proliferative and non-proliferative LN.MethodsPatients with SLE followed between 2014 and 2020 at Hacettepe University Hospitals and who had a kidney biopsy were the subject of the study. One hundred and sixteen patients whose kidney biopsy reported as LN were evaluated retrospectively. Clinical features, laboratory values at the time of kidney biopsy, histopathological forms of LN, and renal response (complete or partial) were recorded. The predictive factors for CRR during the two-year follow-up after induction therapy were analyzed.ResultsOf 116 (93 females, 23 males) patients, 95 (81.9%) were in the proliferative (class III and IV) and 21 (18.1%) were in the non-proliferative group (class II and V). In the proliferative group, elevated basal creatinine, median daily proteinuria, anti-dsDNA positivity, low C3 and C4, the presence of active urinary sediment, and median renal SLE Disease Activity Index (SLEDAI) scores at the time of kidney biopsy were significantly higher than non-proliferative group. During the two-year follow-up after LN diagnosis, 70 patients achieved CRR and time-to-CRR was similar for the groups (p=0.64, log-rank). The Cox proportional hazards model showed that achieving CRR was associated with female gender [HR: 2.15 (1.19-3.89 95% CI), p=0.011], newly diagnosed SLE with renal biopsy [2.15 (1.26-3.67), p=0.005], hypertension [0.40 (0.27-0.94), p=0.032], eGFR increase [1.01 (1.00-1.01), p=0.046], and presence of active urinary sediment [0.46 (0.22-0.96), p=0.039].ConclusionAchieving CRR was similar in both the proliferative and non-proliferative LN patients although certain laboratory parameters differed at onset. Our results indicated the importance of kidney biopsy in the decision-making of treatment of SLE patients with renal involvement and that the defined factors associated with CRR achievement help to predict good renal response.Table 1.Demographic, clinical characteristics, and outcomes of the patients with LNVariables*All patientsProliferative LNNon-Proliferative LNpn=116n=95n=21Age at SLE diagnosis, years18.3 (16)19.2 (15)16 (16)0.32Sex, female93 (80.2)75 (78.9)18 (85.7)0.48Age at kidney biopsy, years21 (17.7)22 (17)18 (15)0.19Patients newly diagnosed SLE with renal biopsy65 (56)53 (55.8)12 (57.1)0.91Follow-up time for LN, years5.5 (8)5.1 (8.2)6.2 (5.1)0.80SLE disease duration8 (8.7)8.1 (9.6)7.9 (7.3)0.53Hypertension31 (26.7)26 (27.4)5 (23.8)0.74Laboratory values on the kidney biopsy Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.56 (0.1)0.006 Creatinine > UNL37 (32.5)34 (36.6)3 (14.3)0.04 eGFR (mL/min/1.73m2)113 (54)107 (54)129 (45)0.04 Albumin (g/dL)3.3 (1.1)3.1 (1.2)3.5 (1)0.09 24-hour urine protein, gr/day2.3 (3.3)2.4 (3.6)0.9 (1.8)0.03 Anti-dsDNA positivity94 (81)80 (87.9)14 (70)0.04 Low C3 and C4 levels93 (80.2)81 (88)12 (57.1)0.001 Active urinary sediment91 (83.5)78 (89.8)12 (57.1)<0.001Renal SLEDAI12 (8)12 (8)4 (4)<0.001During the two-year follow-up after LN diagnosis Complete renal response70 (70.7)56 (70.9)14 (70)0.99 Partial renal response23 (23.2)17 (21.5)6 (30)0.64 No response6 (6.1)6 (7.6)0NA Relapse20 (21.5)15 (20.5)5 (25)0.84 ESRD4(4)4 (4.2)0NA Death3 (3)3 (3.2)0NA* n (%), if otherwise specified; median (IQR) for numeric valuesESRD: End-stage renal disease, GFR: Glomerular filtration rate, LN: Lupus nephritis, SLE: Systemic lupus erythematosus, SLEDAI: Systemic Lupus Erythematosus Disease Activity Index; UNL: Upper normal limitFigure 1.Kaplan-Meier survival curve for complete renal response (CRR) achievement during the two-year follow-up according to the kidney biopsy resultsDisclosure of InterestsNone declared
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Miller Barmak A, Sztajnbok F, Özen S, Balik Z, Borzutzky A, Fogel L, Goldzweig O, Butbul Y. AB0595 INFANTILE TAKAYASU: CLINICAL FEATURES AND LONG TERM OUTCOME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTakayasu arteritis (TA) is a large vessel vasculitis rarely reported in children, and its incidence is extremely low in infants. Most articles on pediatric TA have not focused on infants. We present the largest case series of infantile TA aiming to characterize demographic and clinical data and compare it with existing data on older children.ObjectivesCharacterize demographic and clinical data reagrding TA and compare it with existing data on older childrenMethodsWe conducted an international multi-center retrospective cohort study. Epidemiological and clinical data were collected from patient charts by doctors from six centers.ResultsTwelve patients (50% female) meeting the ACR criteria of TA were included. Median age of symptom onset was 11 months, with a diagnostic delay of 4 months and median time of follow up of 7.5 years. The most common symptoms at presentation were hypertension, BP difference between upper and lower limbs, and fever. The arteries most commonly involved at diagnosis were the abdominal aorta, renal artery, and superior mesenteric artery. Different medications used included steroids, conventional and biological DMARDS, and other immunosuppressive therapies. Half of the patients received biologic agents of which infliximab had the highest complete remission rate (40%). Other medications resulting in complete remission were cyclophosphamide (40%) and methothrexate (38%). Invasive procedures were needed in 58% of patients. The most common complications were cardiac (50%), strokes (42%) and serious infections (33%). None of the patients died.ConclusionThis study presents the largest series of infantile TA. Compared to reported series on older children, infants with TA were more likely to receive biologic agents, develop complications and require invasive interventions.Disclosure of InterestsNone declared
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Romano M, Arici ZS, Piskin D, Alehashemi S, Aletaha D, Barron K, Benseler S, Berard R, Broderick L, Dedeoglu F, Diebold M, Durrant K, Ferguson P, Foell D, Hausmann J, Jones O, Kastner D, Lachmann HJ, Laxer R, Rivera D, Ruperto N, Simon A, Twilt M, Frenkel J, Hoffman H, De Jesus A, Kuemmerle-Deschner J, Özen S, Gattorno M, Goldbach-Mansky R, Demirkaya E. POS1372 THE 2021 EULAR AND ACR POINTS TO CONSIDER FOR DIAGNOSIS, MANAGEMENT AND MONITORING OF THE IL 1 MEDIATED AUTOINFLAMMATORY DISEASES: CAPS, TRAPS, MKD, AND DIRA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe Interleukin-1 (IL-1) mediated systemic autoinflammatory diseases (SAIDs), including the cryopyrin-associated periodic syndromes (CAPS), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), mevalonate kinase deficiency (MKD), and deficiency of the IL-1 receptor antagonist (DIRA) belong to a group of rare immunodysregulatory diseases that primarily present in early childhood with variable multiorgan involvement. When untreated, patients with severe clinical phenotypes have a poor prognosis, and diagnosis and management of these patients can be challenging. However, recently-approved treatments targeting the pro-inflammatory cytokine IL-1 have been life-changing and have significantly improved patient outcomes.ObjectivesWe aimed to establish evidence-based recommendations on diagnosis, treatment, and monitoring to standardize the management of these patients.MethodsA multinational, multidisciplinary task force consisting of physician experts including rheumatologists, patients or caregivers, and allied health care professionals was established. Evidence synthesis including systematic literature review and expert consensus (Delphi) via surveys were conducted. Consensus methodology was utilized to formulate and vote on statements to guide optimal patient care.ResultsThe task force devised five overarching principles, 14 statements related to diagnosis, 10 on therapy, and 9 focused on long-term monitoring that were evidence and/or consensus-based for patients with IL-1 mediated diseases. An outline was developed for disease-specific monitoring of inflammation-induced organ damage progression and reported therapies of CAPS, TRAPS, MKD, and DIRA.ConclusionThe 2021 EULAR/ACR points to consider provide state-of-the-art knowledge based on published data and expert opinion to guide diagnostic evaluation, treatment, and monitoring of patients with CAPS, TRAPS, MKD and DIRA, and inform the various stakeholders about optimized patient care to improve disease outcomes.References[1]Masters SL, Simon A, Aksentijevich I, et al. Horror autoinflammaticus: the molecular pathophysiology of autoinflammatory disease (*). Annu Rev Immunol 2009;27:621-68.Disclosure of Interestsmicol romano: None declared, Zehra Serap Arici: None declared, David Piskin: None declared, Sara Alehashemi: None declared, Daniel Aletaha Speakers bureau: Lilly, Merck, Pfizer, Roche, Sandoz, Consultant of: Abbvie, Amgen, Lilly, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, Sanofi, Karyl Barron: None declared, Susa Benseler: None declared, Roberta Berard Consultant of: Sandoz and Roche, Lori Broderick Grant/research support from: Novartis and Regeneron, Fatma Dedeoglu Consultant of: Novartis, Michelle Diebold: None declared, Karen Durrant: None declared, Polly Ferguson Consultant of: Novartis, Grant/research support from: NIH, CARRA, Inc, Dirk Foell Speakers bureau: Novartis, Peer Voice and SoBi, Consultant of: Boehringer Ingelheim, Chugai-Roche, Merck, Novartis, SoBi, Grant/research support from: Novartis and SoBi, Jonathan Hausmann Consultant of: Novartis, Biogen and Pfizer, Grant/research support from: CARRA, SoBi, Olcay Jones: None declared, Daniel Kastner: None declared, Helen J. Lachmann: None declared, Ronald Laxer Consultant of: SoBi, Novartis, Sanofi, Dorelia Rivera: None declared, Nicolino Ruperto Speakers bureau: Eli-Lilly, GSK, Pfizer SoBi and UCB, Consultant of: Ablynx, Amgen, Astrazeneca-Medimmune, Aurinia, Bayer, Bristol Myers and Squib, Cambridge Healthcare research, Celgene, Domain therapeutic, Eli-Lilly, EMD Serono, GSK, Idorsia, Janssen, Novartis, SoBi, Pfizer and UCB, Anna Simon: None declared, Marinka Twilt: None declared, Joost Frenkel: None declared, Hal Hoffman Consultant of: Novartis, Regeneron, SoBi, Aclaris, Grant/research support from: Bristol-Meyer-Squib, Jecure, Takeda and Zomagen, Adriana de Jesus: None declared, Jasmin Kuemmerle-Deschner Speakers bureau: Novartis and SoBi, Consultant of: Novartis and SoBi, Grant/research support from: Novartis and SoBi, Seza Özen Speakers bureau: Novartis and SoBi, Marco Gattorno Speakers bureau: Novartis and SoBi, Grant/research support from: Novartis, Raphaela goldbach-mansky: None declared, Erkan Demirkaya Grant/research support from: Sobi
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Yardimci GK, Sener S, Ayan G, Taghiyeva A, Acar Ozen NP, Batu ED, Kiliç L, Öncel Hİ, Tuncer A, Göçmen R, Karli Oğuz K, Bilginer Y, Kalyoncu U, Özen S, Bilgen ŞA. AB0548 A COMPARATIVE STUDY BETWEEN THE NEUROPSYCHIATRIC INVOLVEMENTS IN ADULT-ONSET AND CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNeuropsychiatric(NP) manifestations in systemic lupus erythematosus(SLE) encompass a wide spectrum of neurologic and psychiatric features.The nervous system is frequently affected by adult-onset and childhood-onset SLE patients,but disease course and clinical features may differ between both groups.ObjectivesThe aim of this study is to evaluate and compare NP manifestations in adult-onset and childhood-onset SLE patients.MethodsThe study included a retrospective analysis of medical records of adult-onset SLE patients and childhood-onset SLE patients following at Hacettepe University from Jan 2015 to Jan 2021.NP events were identified using the ACR established case definitions seen in SLE.Additionally, posterior reversible encephalopathy syndrome, cerebral venous thrombosis, small fiber neuropathy and pseudotumor cerebri were evaluated as having NPSLE in this study.NP were also divided into three categories:neurologic syndromes of the central nervous system, neurologic syndromes of the peripheral nervous system,and diffuse neuropsychological syndromes.Results1062 adult-onset and 161 childhood-onset SLE patients were followed-up median 150 (84-227) months.At least one neuropsychiatric event occurred in 101 (9.51%) adult-onset and 29 (18.01%) childhood-onset SLE patients (p=0.002). NP events were present before or around the time of SLE diagnosis 64.6% of the adult-onset patients and 72.4% of the childhood-onset patients.One-third of the patients in both groups were diagnosed with NPSLE during the follow-up.At the time of NPSLE diagnosis, 60.4% of adult-onset and 86.2% of childhood-onset patients had additional involvement other than neurologic manifestations and overall disease activity(SLEDAI-2k)was higher in childhood-onset patients (17vs.14p=0.036).Almost all patients in the pediatric group and half of the adult patients were given pulse corticosteroids.Cyclophosphamide was the most preferred regimen and was given to 36.6% of the adult patients and 75.9% of the pediatric patients.Rituximab (11.9% and 27.6%) and mycophenolate mofetil (13.9% and 3.4%) were other induction treatments.The adult-onset and childhood-onset NPSLE patients were followed-up median 105(54-165) and 80(40-132) months, respectively.On the last follow-up visit, disease damage scores (SLICC) were similar in both groups,with a median score of 2.ConclusionThe nervous system was more commonly involved in childhood-onset patients, and disease presentations vary significantly between adult-onset and childhood-onset NPSLE patients.Disease activity appeared to be more severe in children at diagnosis, but permanent organ damage was similar in both groups on follow-up.Table 1.Demographics, clinical features of adult-onset and childhood-onset NPSLE patientsAdult-onset NPSLE (n=101)Childhood-onset NPSLE (n=29)P valueCerebrovascular disease63 (62.4)8 (27.6)0.001Arterial cerebrovascular events44 (43.6)5 (17.2)0.007Central nervous system vasculitis25 (24.8)10 (34.5)0.209Parenchymal involvement18 (17.8)3 (10.3)0.256Demyelinating syndrome14 (13.9)2 (6.9)0.221Transient ischemic attack5 (5.0)-0.277Cerebral venous sinus thrombosis4 (4.0)6 (20.7)0.008Meningeal involvement5 (5.0)-0.277Posterior reversible encephalopathy syndrome3 (3.0)2 (6.9)0.310Pseudotumor cerebri7 (6.9)3 (10.3)0.393Idiopathic intracranial hypertension2 (2.0)3 (10.3)0.073Lupus headache38 (37.6)18 (62.1)0.017Acute confusional state13 (12.9)4 (13.8)0.555Cognitive dysfunction9 (8.9)1 (3.4)0.299Seizure disorders31 (30.7)11 (37.9)0.302Movement disorder (chorea)4 (4.0)2 (6.9)0.402Myasthenia gravis3 (3.0)-0.466Cranial neuropathy7 (6.9)3 (10.3)0.393Optic neuritis4 (4.0)1 (3.4)0.690Peripheral polyneuropathy9 (8.9)5 (17.2)0.173Mononeuritis multiplex1 (1.0)-0.777Myelopathy5 (5.0)2 (6.9)0.489Autonomic dysfunction---Small fiber neuropathy1 (1.0)-0.777Figure 1.Distribution of adult-onset and childhood-onset NPSLE patientsDisclosure of InterestsNone declared
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Sag E, Balik Z, Sener S, Kaya Akca U, Demir S, Kasap-Cuceoglu M, Atalay E, Bocutcu S, Vural T, Bilginer Y, Deleuran B, Özen S. POS0166 POLYARTICULAR JIA HAS A DISTINCT CO-INHIBITOR RECEPTOR PROFILE AMONG OTHER JIA SUBTYPES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundJuvenile idiopathic arthritis (JIA) is the most common inflammatory joint disease in children, driven by continuous T-cell activation.[1] T cell activation is counter-balanced by signals generated by co-inhibitory receptors (co-IRs) such CTLA-4, PD-1, LAG-3, and TIM-3.[2]ObjectivesWe aimed to identify the role of co-IRs in the pathogenesis of different subtypes of JIA.MethodsIn total, we included 107 patients with oligoarticular JIA (n=67), polyarticular JIA (n=12), enthesitis related arthritis (n=17), systemic JIA (n=11) and healthy controls (HC, n=10). We collected plasma samples from the patients during the active phase of their disease. We measured the soluble plasma levels of co-IRs by commercial pre-defined cytometric bead array kits and their cellular expression by flow cytometry in blood mononuclear cells. We compared the plasma levels and cellular expressions of different coIRs within different JIA subgroups.ResultsIL-2 levels were lower than HC in all JIA subgroups. The polyarticular JIA group distinguished from the four different JIA subgroups, by having different co-IR pattern. In this specific subgroup, CTLA4, PD-1 and 4-1BB levels were higher than other groups. Polyarticular JIA is the more chronic and severe form of JIA, especially when compared to oligoarticular JIA. (Figure 1).Figure 1.We investigated the correlations between disease activity markers and plasma co-IRs. Plasma TIM3 levels correlated with erythrocyte sedimentation rate, C-reactive proteins and JADAS in the polyarticular JIA group. In oligoarticular JIA group, JADASs correlated with plasma PD-1 levels, C-reactive protein with PD-L1 plasma levels. Erythrocyte sedimentation rates correlated with IL-2, CD86, PD-L1 and PD-1 plasma levels. There was no correlation between disease activity markers and co-IRs levels in the systemic JIA group and enthesitis related arthritis group.Finally, we analysed the cellular surface expression of different co-IRs on the PBMCs of different JIA subtypes. Similar to plasma levels, both the percentage and the MFI (mean fluorescence intensity) of CTLA4 expression was higher in polyarticular JIA subgroup.ConclusionThis is the first report studying the effects of different co-IRs in different subtypes of JIA. Polyarticular JIA patients had a different coIR profile, having more CTLA-4, PD-1 and 4-1BB in their plasma than the other subtypes of JIAReferences[1]Wedderburn, L.R., et al., Int Immunol, 2001. 13(12): p. 1541-50.[2]Wherry, E.J. and M. Kurachi, Nat Rev Immunol, 2015. 15(8): p. 486-99.AcknowledgementsThis work was supported by a research grant from FOREUM Foundation for Research in RheumatologyDisclosure of InterestsNone declared
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Katlan B, Kesici S, Karacanoğlu D, Oygar PD, Ünal Yüksekgönül A, Şener S, Aykan HH, Özsurekçi Y, Özen S, Bayrakci B. Early is superior to late plasma exchange for severe multisystem inflammatory syndrome in children. J Clin Apher 2022; 37:281-291. [PMID: 35174897 DOI: 10.1002/jca.21971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) can be life threatening in severe cases because of uncontrolled inflammation and multi-organ failure. In this study, we report the effect of plasma exchange in the treatment of MIS-C and to emphasize the effect of its early application on outcome. METHOD In this retrospective observational study, the medical records of children with severe MIS-C admitted to pediatric intensive care unit (PICU) between April 2020 and January 2021 were reviewed. Severe MIS-C patients were treated according to protocol consisting of plasma exchange (PE), intravenous immune globulin, steroids, and anakinra which we called the "PISA" protocol referring to the initials. The patients were divided into two groups as early plasma exchange (E-PE) and late plasma exchange (L-PE) according to the elapse time between hospital admission and the administration of PE. Groups were compared in terms of outcome variables. Primary study outcome was 28-day mortality. Secondary outcome variables were acute phase response time, length of immunomodulatory treatment, frequency of patients requiring mechanical ventilation (MV) and inotropic support, length of inotropic support and MV, length of hospital and PICU stays. RESULTS Eighteen pediatric patients with MIS-C were included in the study. Seventeen (95%) of the patients presented with decompensated shock and required inotropic support. One of the 17 patients needed extracorporeal membrane oxygenation support (ECMO) PISA protocol was used in all patients. There was no mortality in the E-PE group while the mortality rate was 20% in the L-PE group. Acute phase reactant response was faster in the E-PE group and immunomodulatory treatments could be reduced earlier; the frequency of patients requiring inotropic and mechanical ventilation (MV) support was lower in the E-PE group; the duration of inotropic support, duration of MV, and length of stay in hospital and PICU were significantly shorter in the E-PE group. CONCLUSION We suggest that in selected cases, timely administration of PE is a beneficial rescue therapy for MIS-C related hyperinflammation presenting with severe cardiovascular collapse.
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Affiliation(s)
- Banu Katlan
- Department of Pediatric Critical Care Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Life Support Practice and Research Center, Hacettepe University, Ankara, Turkey
| | - Dilek Karacanoğlu
- Department of Pediatric Critical Care Medicine, Hacettepe University, Ankara, Turkey
| | - Pembe Derin Oygar
- Department of Pediatric Infection Diseases, Hacettepe University, Ankara, Turkey
| | | | - Seher Şener
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | | | - Yasemin Özsurekçi
- Department of Pediatric Infection Diseases, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Life Support Practice and Research Center, Hacettepe University, Ankara, Turkey
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Batu ED, Kaya Akca U, Basaran O, Bilginer Y, Özen S. Probiotic use in the prophylaxis of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome: a retrospective cohort study. Rheumatol Int 2022; 42:1207-1211. [PMID: 34994815 DOI: 10.1007/s00296-021-05084-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is an autoinflammatory recurrent fever syndrome that mainly affects children. Probiotics are currently used to prevent upper respiratory tract infections and flares of diseases associated with immune dysregulation. We aimed to evaluate the response to probiotic treatment in PFAPA patients. Patients with PFAPA syndrome who received probiotics and were followed between July 2019 and July 2021 were included in this retrospective study. Demographic and clinical features and response to probiotics were assessed. Twenty out of 111 children with PFAPA syndrome (F/M:1) were included. The median (min-max) ages at symptoms onset and diagnosis were 24 (3-72) and 51.5 (11-120) months, respectively. All 20 patients received probiotics during the disease course. The probiotic preparation they received included a combination of two lactobacilli as Lactobacillus plantarum HEAL9 (Lp HEAL9) and Lactobacillus paracasei 8700:2 (Lpa 8700:2). The median age at probiotic onset was 60 (33-192) months, while the duration of probiotic use was 4.5 (3-19) months. All patients except one experienced a decrease in attack frequency with probiotic use. After probiotic treatment, the median number of episodes during 3 months decreased from 3 to 1 (p < 0.001). Eight (40%) patients had no attacks during the 3 months after probiotic initiation. And, 5 (45%) of 11 patients who had ≥ 1 attacks on probiotics mentioned that the attack severity decreased significantly after probiotic initiation. Our results suggest that probiotic strains Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2 could be beneficial in PFAPA patients by decreasing the attack frequency.
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Affiliation(s)
- Ezgi D Batu
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Ummusen Kaya Akca
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Ozge Basaran
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Seza Özen
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Kaykı G, Orhan D, Gülhan B, Topaloğlu R, Akçören Z, Düzova A, Özaltın F, Özen S, Bilginer Y, Güçer Ş. Glomerulonephritis with crescents in childhood; etiologies and significance of m2 macrophages. Turk J Pediatr 2022; 64:59-68. [DOI: 10.24953/turkjped.2020.2172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kocatürk B, Balık Z, Pişiren G, Kalyoncu U, Özmen F, Özen S. Spondyloarthritides: Theories and beyond. Front Pediatr 2022; 10:1074239. [PMID: 36619518 PMCID: PMC9816396 DOI: 10.3389/fped.2022.1074239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Spondyloarthritides (SpA) are a family of interrelated rheumatic disorders with a typical disease onset ranging from childhood to middle age. If left untreated, they lead to a severe decrease in patients' quality of life. A succesfull treatment strategy starts with an accurate diagnosis which is achieved through careful analysis of medical symptoms. Classification criterias are used to this process and are updated on a regular basis. Although there is a lack of definite knowledge on the disease etiology of SpA, several studies have paved the way for understanding plausible risk factors and developing treatment strategies. The significant increase of HLA-B27 positivity in SpA patients makes it a strong candidate as a predisposing factor and several theories have been proposed to explain HLA-B27 driven disease progression. However, the presence of HLA-B27 negative patients underlines the presence of additional risk factors. The current treatment options for SpAs are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), TNF inhibitors (TNFis), Disease-Modifying Anti-Rheumatic Drugs (DMARDs) and physiotherapy yet there are ongoing clinical trials. Anti IL17 drugs and targeted synthetic DMARDs such as JAK inhibitors are also emerging as treatment alternatives. This review discusses the current diagnosis criteria, treatment options and gives an overview of the previous findings and theories to clarify the possible contributors to SpA pathogenesis with a focus on Ankylosing Spondylitis (AS) and enthesitis-related arthritis (ERA).
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Affiliation(s)
- Begüm Kocatürk
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Zeynep Balık
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gaye Pişiren
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Füsun Özmen
- Department of Basic Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Başaran Ö, Bilginer Y, Özen S. Rare Autoinflammatory Diseases. Turk Arch Pediatr 2022; 57. [PMID: 35110074 PMCID: PMC8867516 DOI: 10.5152/turkarchpediatr.2021.21303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Systemic autoinflammatory diseases are disorders caused by dysregulation of the innate immune system leading to systemic inflammation. Since the first gene had been identified causing Familial Mediterranean Fever, the most common hereditary systemic autoinflammatory disease, advances in genomic techniques and awareness of the diseases have led to identifying more genes causing autoinflammatory conditions affecting different parts of the innate immune system. The aim of this review is to provide an update on some recently discovered autoinflammatory conditions and raise awareness for the clinicians. We focused on the actinopathies, interferonopathies, and NF-κB-mediated autoinflammatory diseases.
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Gurlevik SL, Ozsurekci Y, Sağ E, Derin Oygar P, Kesici S, Akca ÜK, Cuceoglu MK, Basaran O, Göncü S, Karakaya J, Cengiz AB, Özen S. The difference of the inflammatory milieu in MIS-C and severe COVID-19. Pediatr Res 2022; 92:1805-1814. [PMID: 35352005 PMCID: PMC8963396 DOI: 10.1038/s41390-022-02029-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) may have a severe course in children. Multisystem inflammatory syndrome in children (MIS-C) is the post-COVID complication characterized by an exaggerated inflammation, observed in children. However, data on the underlying pathophysiology are sparse. We therefore aimed to assess the cytokine and chemokine profiles of children with MIS-C and compare these to life-threatening severe SARS-CoV-2 and healthy controls (HCs) to shed light on disease pathophysiology. METHODS Samples of 31 children with MIS-C, 10 with severe/critical COVID-19 and 11 HCs were included. Cytokine and chemokine profiles were studied and compared in between groups. RESULTS Most cytokines and chemokines related to IL-1 family and IFN-γ pathway (including IL-18 and MIG/CXCL9) and IL-17A were significantly higher in the MIS-C group when compared to the severe/critical COVID-19 group and HCs. IP-10/CXCL10 and IL-10 were higher in both MIS-C patients and severe/critical COVID-19 compared to HCs. CONCLUSION Our results suggest that IL-1 and IFN-γ pathways play an important role in the pathophysiology of MIS-C. IMPACT This study defines a pattern of distinctive immune responses in children with MIS-C and in patients with severe/critical COVID-19. As the COVID-19 pandemic continues, biomarkers to identify MIS-C risk are needed to guide our management that study results may shed light on it.
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Affiliation(s)
- Sibel Lacinel Gurlevik
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erdal Sağ
- grid.413783.a0000 0004 0642 6432Pediatric Rheumatology Unit, Ankara Training and Research Hospital, Ankara, Turkey ,grid.14442.370000 0001 2342 7339Pediatric Rheumatology Unit, Translational Medicine Laboratories, Hacettepe University, Ankara, Turkey
| | - P. Derin Oygar
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ümmüşen Kaya Akca
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozge Basaran
- grid.14442.370000 0001 2342 7339Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sultan Göncü
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- grid.14442.370000 0001 2342 7339Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Bülent Cengiz
- grid.14442.370000 0001 2342 7339Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Özen
- Pediatric Rheumatology Unit, Translational Medicine Laboratories, Hacettepe University, Ankara, Turkey. .,Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Başaran Ö, Bilginer Y, Özen S. Rare Autoinflammatory Diseases. Turk Arch Pediatr 2021; 57:18-25. [DOI: 10.5152/turkarchpediatr.2022.21303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ağın A, Kadayıfçılar S, Baytaroğlu A, Deliktaş Ö, Demir S, Sağ E, Bilginer Y, Karakaya J, Özen S, Eldem B. Correction to: Assessment of systemic and ocular inflammation in juvenile idiopathic arthritis via choroidal vascularity index. Rheumatol Int 2021; 42:1197. [PMID: 34757433 DOI: 10.1007/s00296-021-05048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Abdullah Ağın
- Department of Ophthalmology, University of Health Sciences, Haseki Training and Research Hospital, Fatih, 34130, Istanbul, Turkey.
| | - Sibel Kadayıfçılar
- Department of Ophthalmology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey.
| | - Ata Baytaroğlu
- Department of Ophthalmology, Aydın State Hospital, 09100, Aydın, Turkey
| | - Özge Deliktaş
- Department of Ophthalmology, Tunceli State Hospital, 62000, Tunceli, Turkey
| | - Selcan Demir
- Department of Pediatrics, Pediatric Rheumatology Unit, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Erdal Sağ
- Department of Pediatrics, Pediatric Rheumatology Unit, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Pediatric Rheumatology Unit, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Pediatric Rheumatology Unit, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
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Akca ÜK, Batu ED, Kısaarslan AP, Poyrazoğlu H, Ayaz NA, Sözeri B, Sağ E, Atalay E, Demir S, Karadağ ŞG, Demir F, Bilginer Y, Gümrük F, Özen S. Hematological involvement in pediatric systemic lupus erythematosus: A multi-center study. Lupus 2021; 30:1983-1990. [PMID: 34459313 DOI: 10.1177/09612033211038824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Systemic lupus erythematosus (SLE) may present with features of several systems, including hematological manifestations. In this study, we aimed to evaluate the characteristics of hematological involvement and assess possible associations and correlations in pediatric SLE patients. Method: This is a retrospective multi-center study. The medical records of pediatric SLE patients followed between January 2000 and June 2020 were analyzed. All children fulfilled the criteria of the Systemic Lupus International Collaborating Clinics. Results: The study included 215 children with SLE, 118 of whom had hematological manifestations. Concomitant renal involvement and low C3 levels were significantly more frequent in patients with hematological involvement (p = 0.04, p = 0.008, respectively). Also, anti-cardiolipin, anti-beta-2-glycoprotein I (anti-β2 GP1), and anti-Sm antibody positivity, and the presence of lupus anticoagulant were more common in the group with hematological findings (p = 0.001 for anti-cardiolipin antibody positivity and p < 0.001 for the positivity of anti-β2 GP1 antibody, anti-Sm antibody, and lupus anticoagulant). The most common hematologic abnormality was anemia (n = 88, 74.5%), with autoimmune hemolytic anemia constituting the majority (n = 40). Corticosteroids followed by IVIG were the mainstay of treatment. In patients resistant to corticosteroid and IVIG treatments, the most preferred drug was rituximab. Low levels of C3, high SLEDAI score, high incidence of renal involvement, and positive antiphospholipid antibodies were associated with hematological involvement in the univariate analysis. The presence of antiphospholipid antibodies and high SLEDAI score were independently associated with hematological involvement in multivariate analysis (OR: 4.021; 95% CI: 2.041-7.921; p < 0.001 and OR: 1.136; 95% CI: 1.065-1.212; p < 0.001). Conclusion: Hematological abnormalities are frequently encountered in pediatric SLE. Positive antiphospholipid antibodies and high SLEDAI scores were associated with hematological involvement.
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Affiliation(s)
- Ümmüşen Kaya Akca
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Ayşenur Pac Kısaarslan
- Department of Pediatrics, Division of Rheumatology, 64212Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hakan Poyrazoğlu
- Department of Pediatrics, Division of Rheumatology, 64212Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatrics, Division of Rheumatology, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatrics, Division of Rheumatology, 64041Umraniye Training and Research Center, University of Health Sciences, Istanbul, Turkey
| | - Erdal Sağ
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatrics, Division of Rheumatology, 64041Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatrics, Division of Rheumatology, 64041Umraniye Training and Research Center, University of Health Sciences, Istanbul, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Fatma Gümrük
- Department of Pediatrics, Division of Hematology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, 37515Hacettepe University64005Faculty of Medicine, Ankara, Turkey
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Esmeray P, Keçeli Tİ, Tekçiçek M, Batu ED, Arıcı ZS, Ünlü HK, Özen S, Bilginer Y. Oral health status in children with familial Mediterranean fever. Turk J Pediatr 2021; 63:443-449. [PMID: 34254489 DOI: 10.24953/turkjped.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is the most common hereditary autoinflammatory disease. We aimed to investigate the oral health status and oral hygiene habits in children with FMF. METHODS In this cross-sectional study, 199 children with FMF, aged between 3-18 years, were included. Demographic findings and oral hygiene habits of children were questioned by face-to-face interview. Oral health status of patients was evaluated using decay-missing-filled index [DMFT (decay-missing-filled teeth), DMFS (decay-missing-filled teeth) for permanent; dmft, dmfs for primary teeth], the International Caries Detection and Assessment System (ICDAS-II) index, PUFA / pufa index [the presence of severely decayed teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f) and abscess (A/a)], gingival (GI) and plaque index (PI). In addition to these, occlusion, oral soft and hard tissues were examined. RESULTS One-hundred-nine (54.8%) of children had at least one decayed permanent tooth and 81.2% of children had at least one decayed primary tooth. The mean DMFT was 1.91±2.45, DMFS was 3.1±4.49, dmft was 3.95±3.54, dmfs was 8.62±8.88, PI was 1.17±0.44, GI was 0.85±0.39. Aphthous mouth ulcer occurred in 19 (9.5%) patients. Recurrent aphthous mouth ulcers were more frequent among patients with one exon-ten and one exon-two mutations than patients with one exon-10 mutation, two exon-ten mutations, or two exon-2 mutations (61.1% vs. 47.9%, 26.1%, 20%, respectively p < 0.001). Tooth decay was more frequent among patients who had attacks in the last six months than those who did not have any attacks during the last six months (97.4% vs. 87.7%, p=0.017). CONCLUSION Dental caries and periodontal disease, which are public health problems, were seen at a high percentage of children with FMF in our study.
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Affiliation(s)
- Pelin Esmeray
- Department of Pediatrics, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Tülin İleri Keçeli
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Meryem Tekçiçek
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zehra Serap Arıcı
- Şanlıurfa Training and Research Hospital, Department of Pediatric Rheumatology, Şanlıurfa, Turkey
| | | | - Seza Özen
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Taft J, Markson M, Legarda D, Patel R, Chan M, Malle L, Richardson A, Gruber C, Martín-Fernández M, Mancini GMS, van Laar JAM, van Pelt P, Buta S, Wokke BHA, Sabli IKD, Sancho-Shimizu V, Chavan PP, Schnappauf O, Khubchandani R, Cüceoğlu MK, Özen S, Kastner DL, Ting AT, Aksentijevich I, Hollink IHIM, Bogunovic D. Human TBK1 deficiency leads to autoinflammation driven by TNF-induced cell death. Cell 2021; 184:4447-4463.e20. [PMID: 34363755 DOI: 10.1016/j.cell.2021.07.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/11/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
TANK binding kinase 1 (TBK1) regulates IFN-I, NF-κB, and TNF-induced RIPK1-dependent cell death (RCD). In mice, biallelic loss of TBK1 is embryonically lethal. We discovered four humans, ages 32, 26, 7, and 8 from three unrelated consanguineous families with homozygous loss-of-function mutations in TBK1. All four patients suffer from chronic and systemic autoinflammation, but not severe viral infections. We demonstrate that TBK1 loss results in hypomorphic but sufficient IFN-I induction via RIG-I/MDA5, while the system retains near intact IL-6 induction through NF-κB. Autoinflammation is driven by TNF-induced RCD as patient-derived fibroblasts experienced higher rates of necroptosis in vitro, and CC3 was elevated in peripheral blood ex vivo. Treatment with anti-TNF dampened the baseline circulating inflammatory profile and ameliorated the clinical condition in vivo. These findings highlight the plasticity of the IFN-I response and underscore a cardinal role for TBK1 in the regulation of RCD.
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Affiliation(s)
- Justin Taft
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Michael Markson
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Diana Legarda
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Roosheel Patel
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mark Chan
- Department of Immunology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Louise Malle
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ashley Richardson
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Conor Gruber
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Marta Martín-Fernández
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Jan A M van Laar
- Department of Immunology, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Philomine van Pelt
- Department of Rheumatology, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Sofija Buta
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Beatrijs H A Wokke
- Department of Neurology, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Ira K D Sabli
- Department of Paediatric Infectious Diseases and Virology, Imperial College London, London, UK; Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Vanessa Sancho-Shimizu
- Department of Paediatric Infectious Diseases and Virology, Imperial College London, London, UK; Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Pallavi Pimpale Chavan
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA; Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India
| | - Oskar Schnappauf
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Raju Khubchandani
- Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India; Consultant Pediatrician, Jaslok and Breach Candy Hospitals, Mumbai, India
| | | | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Daniel L Kastner
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Adrian T Ting
- Department of Immunology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Iris H I M Hollink
- Department of Clinical Genetics, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Dusan Bogunovic
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Özen S, Sag E, Ben-Chetrit E, Gattorno M, Gül A, Hashkes PJ, Kone-Paut I, Lachmann HJ, Tsitsami E, Twilt M, Benedetti FD, Kuemmerle-Deschner JB. Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach. Rheumatology (Oxford) 2021; 60:3799-3808. [PMID: 33331943 DOI: 10.1093/rheumatology/keaa863] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/14/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Colchicine is the main treatment for FMF. Although a number of individuals with FMF are intolerant/resistant to colchicine, there is no standard definition of colchicine resistance/intolerance. We developed a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF that may serve as a guide for clinicians and health authorities. METHODS A set of statements was identified using a modified-Delphi consensus-based approach. The process involved development of an initial colchicine resistance/intolerance-related questionnaire derived from a systematic literature review. The questionnaire, which was completed by an international panel of 11 adult and paediatric rheumatologists with expertise in FMF, was analysed anonymously. The results informed draft consensus statements that were discussed by a round-table expert panel, using a nominal group technique to agree on the selection and wording of the final statements. RESULTS Consensus among the panel was achieved on eight core statements defining colchicine resistance/intolerance in patients with FMF. A definition of resistance was agreed upon that included recurrent clinical attacks (average one or more attacks per month over a 3-month period) or persistent laboratory inflammation in between attacks. Other core statements recognize the importance of assessing treatment adherence, and the impact of active disease and intolerance to colchicine on quality of life. CONCLUSION Based on expert opinion, a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF were identified to help guide clinicians and health authorities in the management of patients with FMF.
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Affiliation(s)
- Seza Özen
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University, Ankara 06100, Turkey
| | - Erdal Sag
- Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University, Ankara 06100, Turkey
| | - Eldad Ben-Chetrit
- Department of Rheumatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS, Genova, Italy
| | - Ahmet Gül
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Philip J Hashkes
- Pediatric Rheumatology Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Isabelle Kone-Paut
- Pediatric Rheumatology Unit and CEREMAIA, Bicêtre Hospital, APHP, Université Paris-Sud Saclay, Paris, France
| | - Helen J Lachmann
- National Amyloidosis Centre, Division of Medicine, The Royal Free Hospital & University College London, London, UK
| | - Elena Tsitsami
- 1st Department of Pediatrics, School of Medicine, University of Athens, Athens, Greece
| | - Marinka Twilt
- Alberta Children's Hospital, Alberta Children's Hospital Research Institute and University of Calgary, Calgary, Alberta, Canada
| | | | - Jasmin B Kuemmerle-Deschner
- Division of Paediatric Rheumatology, Department of Paediatrics and Autoinflammation Reference Center Tuebingen, University Hospital Tuebingen, Tuebingen, Germany
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Cagdas D, Halacli SO, Tan C, Esenboğa S, Karaatmaca B, Cetinkaya PG, Balcı-Hayta B, Ayhan A, Uner A, Orhan D, Boztug K, Özen S, Topaloğlu R, Sanal O, Tezcan İ. Diversity in STK4 Deficiency and Review of the Literature. J Allergy Clin Immunol Pract 2021; 9:3752-3766.e4. [PMID: 34146746 DOI: 10.1016/j.jaip.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Serine-threonine kinase-4 (STK4) deficiency is an autosomal recessive (AR) combined immunodeficiency (CID). OBJECTIVE We aimed to define characteristic clinical and laboratory features to aid the differential diagnosis and determine the most suitable therapy. METHODS In addition to nine patients diagnosed, we reviewed 15 patients from medical literature. We compared B lymphocyte subgroups of our cohort with age-matched healthy controls. RESULTS In our cohort, the median age at symptom onset and age of diagnosis are 6years-8months (mo)(6-248mo) and 7years-5mo (6-260mo), respectively. The main clinical findings were infections (9/9), autoimmune/inflammatory diseases (7/9), and atopy (4/9). CD4 lymphopenia (9/9), lymphopenia (7/9), intermittent eosinophilia (4/9), transient neutropenia (3/9), low immunoglobulin (Ig) M (4/9), and high IgE (4/9) were common. Decreased recent thymic emigrants, naive and central memory T cells, albeit increased effector memory T cells were present. The increase in plasmablasts (p=0.003) and the decrease in switched memory B cells (p=0.022) were significant. Out of a total of 24 patients, cutaneous viral infections (n=20), recurrent pneumonia (n=18), Epstein Barr Virus (EBV)-associated lymphoproliferation (n=11), atopic dermatitis (n=10), autoimmune cytopenia (n=7), and lymphoma (n=6) were frequently seen. Lymphopenia, CD4 lymphopenia, high Ig G, A, and E were the most common laboratory characteristics. CONCLUSION The differential diagnosis with AR-hyperimmunoglobulin E syndrome is crucial as atopy and CD4 lymphopenia are prominent in both diseases. Immunoglobulins and antibacterial/antiviral prophylaxis are the mainstays of treatment. Clinicians may use immunomodulatory therapies during inflammatory/autoimmune complications. However, more data is needed to recommend hematopoietic stem cell transplantation (HSCT) as a safe therapy.
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Affiliation(s)
- Deniz Cagdas
- Hacettepe University Medical School, Department of Pediatric Immunology; Hacettepe University Medical School, Institute of Child Health, Department of Pediatric Immunology.
| | - Sevil Oskay Halacli
- Hacettepe University Medical School, Institute of Child Health, Department of Pediatric Immunology
| | - Cagman Tan
- Hacettepe University Medical School, Institute of Child Health, Department of Pediatric Immunology
| | - Saliha Esenboğa
- Hacettepe University Medical School, Department of Pediatric Immunology
| | - Betül Karaatmaca
- Hacettepe University Medical School, Department of Pediatric Immunology
| | | | | | - Arzu Ayhan
- Hacettepe University Medical School, Department of Pediatric Pathology
| | - Aysegul Uner
- Hacettepe University Medical School, Department of Pediatric Pathology
| | - Diclehan Orhan
- Hacettepe University Medical School, Department of Pediatric Pathology
| | - Kaan Boztug
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences
| | - Seza Özen
- Hacettepe University Medical School, Department of Pediatric Rheumatology
| | - Rezan Topaloğlu
- Hacettepe University Medical School, Department of Pediatric Nephrology
| | - Ozden Sanal
- Hacettepe University Medical School, Department of Pediatric Immunology; Hacettepe University Medical School, Institute of Child Health, Department of Pediatric Immunology
| | - İlhan Tezcan
- Hacettepe University Medical School, Department of Pediatric Immunology; Hacettepe University Medical School, Institute of Child Health, Department of Pediatric Immunology
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Sag E, Yüksel K, Demir S, Ozdel S, Kaya Akca U, Atalay E, Kasap-Cuceoglu M, Topaloglu R, Bilginer Y, Özen S. OP0195 PLASMA CHECKPOINT PROTEIN LEVELS AND GALECTIN-9 IN JUVENILE SYSTEMIC LUPUS ERYTHEMATOSUS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic Lupus Erythematosus (SLE) is the prototype for a systemic autoimmune disease. SLE is a disease of the adaptive immune system where T lymphocyte dysfunction has an important role as well. Checkpoint proteins have become an important topic in the study of Tcell. The balance of T cell co-stimulatory and co-inhibitory receptors is important for the regulation of the adaptive immune system response.Objectives:In this study we aimed to assess the checkpoint proteins in childhood SLE patientsMethods:Fourty-nine jSLE patients together with 15 age- and gender- matched controls were included. Clinical features, disease activity scores and laboratory parameters were recorded both retrospectively and at the time of samplimg. Patient samples were collected at their last visit, Plasma CD25 (IL-2Rα), 4-1BB, B7.2 (CD86), TGF-β1, CTLA-4, PD-L1, PD-1, Tim-3, LAG- 3, Galectin-9 levels were studied by the cytometric bead-based multiplex assay panel according to manufacturer’s instruction (LEGENDplex HU Immune Checkpoint Panel 1 (10-plex); catalogue number 740962, Biolegend) and analysed by Novocyte 3005 flow cytometer. Two-step cluster analysis procedure was conducted over the chosen 7 symptom status and 3 clusters were chosen for the final analysisResults:A total of 49 patients (71.4% female) diagnosed with SLE according to the SLICC criteria and 15 healthy controls (73.3% female) were included in the study. The mean age of the patients was 17.7 ± 2.6 years and the controls was 13.3±1.4 years. The median disease duration was 5.7 years. At the time of sampling fifteen of the patients had a SLEDAI score of zero (no activity), 21 of them had between 1-5 (mild activity), 7 of them had between 6-10 (moderate activity), 5 of them had between 11-19 (high activity), 1 of them had >20 (very high activity).Galectin-9 and PD-L1 were significantly higher in SLE patients. Other checkpoint proteins and IL-2Rα were also higher but did not reach statistical significance. There were significant correlations between SLEDAI and IL-2Rα, Galectin-9 and PDL1. (Figure 1) There were three clinical clusters: Cluster 1 included patients with no major organ involvement, cluster 2 had predominantly haematological involvement (n=16) and cluster 3 (n=11) had predominantly renal involvement. Checkpoint proteins were not different among these three clusters.Figure 1.Table 1.Demographic, Clinical and Laboratory Features of Patients (n=49)Female gender, n (%)35 (%71.4)Mean age at diagnosis, years (mean±SD)12.5±3.3Mean age at the time of inclusion, years (mean±SD)17.7±2.6Duration of illness, years (median/IQR)5.7 (3.0-7.0) yearsActive system involvement at study,n (%) Renal14 (28.5) Skin11 (22.4) Musculoskeletal9 (18.3) Hematologic9 (18.3) Neurologic1 (2.0) Serositis1 (2.0)Laboratory findings (median/minimum-maximum) Hemoglobin, gr/dl12.7 (7.3-18.3) WBC, /mm36.900 (2.600-26.200) Platelet, /mm3252.000 (39.000-529.000) Erythrocyte sedimentation rate, mm/hour10 (1-71) C-reactive protein, mg/dl0.1 (0-21.1) Complement 3, mg/dl87.6 (25.4-186.0) Complement 4, mg/dl15.3 (0-45.8) Anti-ds DNA, IU/ml12.8 (0-741.7) SLEDAI score (mean±SD)4.69±6.69Conclusion:Our data supports that Galectin 9 and IL-2Rα are good markers for disease activity in childhood SLE. We need larger series to evaluate differences between disease clusters in SLE. We failed to show a significant correlation with checkpoint proteins and SLEDAI except for PDL1.References:[1]Sharabi A and Tsokos GC. T cell metabolism: new insights in systemic lupus erythematosus pathogenesis and therapy. Nature reviews Rheumatology 2020; 16: 100-112[2]Nishimura H, Nose M, Hiai H, et al. Development of lupus-like autoimmune diseases by disruption of the PD-1 gene encoding an ITIM motif-carrying immunoreceptor. Immunity 1999; 11: 141-151.[3]McKinney EF, Lee JC, Jayne DR, et al. T-cell exhaustion, co-stimulation and clinical outcome in autoimmunity and infection. Nature 2015[4]Wherry EJ and Kurachi M. Molecular and cellular insights into T cell exhaustion. Nat Rev Immunol 2015; 15: 486-499Disclosure of Interests:None declared
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Kasap-Cuceoglu M, Pehlivanturk-Kizilkan M, Sag E, Sener S, Balik Z, Akgul S, Derman O, Bilginer Y, Kanbur N, Özen S. AB0737 THE NAIL FOLD CAPILLAROSCOPIC FINDINGS OF ADOLESCENTS WITH ANOREXIA NERVOSA AND BULIMIA NERVOSA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The nail fold video capillaroscopy (NVC) is usually performed on patients with microcirculation problems, such as Raynaud’s phenomenon. It is also used to distinguish between primary and secondary Raynaud’s Phenomenon and identify the scleroderma pattern.Objectives:To describe the acute phase nail fold capillaroscopic findings of adolescents with anorexia nervosa (AN) and bulimia nervosa (BN) and to compare these findings with adolescents diagnosed with primary Reynaud’s phenomenon (RP).Methods:We included 17 AN, 2 BN patients and 6 adolescents with primary RP as a control group. The nail fold video capillaroscopy (NVC) data of three study groups were compared. AN and BN patients were classified according to DSM-5. The participants in these two groups were assessed for the presence of Reynaud’s phenomenon/acrocyanosis and the weight loss history (amount and duration), daily calorie intake, vital signs, hydration status, amenorrhea presence and time, the presence and frequency of compensatory behaviors, and drug usage were recorded. Adolescents with primary RP were diagnosed according to ‘International consensus criteria for the diagnosis of RP. The initial NVC was performed at the acute phase of AN and BN. For AN acute phase is defined as the period where the nutritional rehabilitation has not yet taken place. The NVC analysis was be performed with a digital USB microscopy by an expert blinded to the participant’s clinical status and diagnosis. Eight fingers were evaluated for each patient and average of all fingers’ scores were used as quantitative measures.Results:Among adolescents with AN, 14 of them had enlarged capillaries (capillary diameter 20-50 μm) and 6 of them had mild tortuosity (<50%) which were considered as minor capillaroscopic changes. 5 patients had at least one giant capillary (>50μm), 3 of them had microhemorrhages, 4 of them had capillary ramifications, and 1 of them had capillary disorganization which were considered as major capillaroscopic changes. Two adolescents had capillary loss (6 capillaries/mm). None of them had active or late phase scleroderma findings. In the primary RP group, there were minor findings as five adolescents had mild capillary dilation (capillary diameter 20-50 μm), and 5 had mild tortuosity (<50%). However, none had scleroderma (early-active-late phase) findings. Microangiopathy assessment scores revealed no difference between the AN patients with and without RP and primary RP patients.(Table 1) A positive correlation was found between capillary ramification scores and initial daily calorie intake (r: -0.47; p=0.04).Table 1.Measurements of capileroscopy findings according to patient groupsAN+RP+n=4AN+RP-n=13BNn=2Primer RP kontroln=6pMicroangiopathy score0.84 (IQR 0.98)0.92 (IQR 0.96)0.710.65 (IQR0.23)0.62•Capillary loss score0.22 (IQR 0.62)0.06 (IQR 0.41)0.150.0 (IQR 0.26)0.58•Capillary ramification score0.18 (IQR 0.25)0.13 (IQR 0.25)0.090.09 (IQR 0.18)0.88•Disorganized capillaries score0.38 (IQR 0.48)0.56 (IQR 0.68)0.460.43 (0.32)0.98Enlarged capillaries score (20-50 μm)0.56 (IQR 0.78)0.31 (IQR 0.72)0.730.58 (IQR 0.42)0.60Giant capillaries score (>50 μm)0.06 (IQR 0.22)0.00 (IQR 0.03)0.180.03 (0.14)0.14Microhaemorrhage score0.000.000.000.010.67Conclusion:Preliminary results of our study suggest that adolescents with AN are at risk for vasculopathy especially during the acute phase of the disease.References:[1]Smith V, et al Autoimmun Rev. 2020 Mar;19(3):102458.[2]American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub, ArlingtonAcknowledgements:Muserref Kasap-Cuceoglu and Melis Pehlivanturk-Kizilkan contributed equally.Disclosure of Interests:None declared
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Ozsurekci Y, Gürlevik S, Kesici S, Kaya Akca U, Oygar PD, Aykac K, Karacanoglu D, Saritas Nakip O, Ilbay S, Katlan B, Cengiz AB, Basaran Ö, Cura Yayla BC, Karakaya J, Bilginer Y, Bayrakci B, Ceyhan M, Özen S. POS1249 MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN DURING THE COVID-19 PANDEMIC IN TURKEY: FIRST REPORT FROM THE EASTERN MEDITERRANEAN. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The severity of COVID-19 symptoms can range from mild to severe. Severe COVID-19 cases with excessive hyperinflammation have many overlap features with multisystem inflammatory syndrome in children (MIS-C).Objectives:We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with MIS-C and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country.Methods:Children (aged <18 years) who diagnosed with MIS-C and severe/critical pediatric cases with COVID-19, were admitted to hospital between 26 March and 3 November 2020 were enrolled in the study.Results:A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only 3 deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral.Conclusion:Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count seem good diagnostic parameters for MIS-C cases.Disclosure of Interests:None declared
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Kaya Akca U, Sag E, Ünal Ş, Kasap-Cuceoglu M, Bilginer Y, Özen S. OP0168 THE ROLE OF VASCULAR INFLAMMATION MARKERS IN DEFICIENCY OF ADENOSINE DEAMINASE 2. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Deficiency of adenosine deaminase 2 (DADA2) is a monogenic autoinflammatory disease whose pathogenesis has not been clearly elucidated.Objectives:To investigate the role of vascular inflammatory factors in the pathogenesis of DADA2, to compare the vascular inflammation profiles of DADA2 patients with different phenotypes, and to compare DADA2 patients with classic polyarteritis nodosa (PAN).Methods:The study included eighteen DADA2 patients, ten PAN patients, and eight healthy controls. Plasma levels of sST2, sRAGE, Tie-2, sCD40L, Tie-1, sFlt-1, LIGHT, TNF-α, PlGF, IL-6, IL-18, IL-10, MCP-1 were studied by cytometric bead-based multiplex assay panel.Results:Among the DADA2 patients, five had hematological manifestations, 13 had vasculitic findings, and accompanying immunological findings were present in seven patients. Nine patients had neurological findings, five of whom had neuropathy. Hematological findings were Diamond-Blackfan anemia-like phenotype in four patients and bicytopenia (anemia and thrombocytopenia) in one patient. Disease characteristics of DADA2 and PAN patients revealed that neurological involvement and livedo reticularis were more frequent in DADA2 patients (p=0.034 and p=0.009, respectively), while myalgia was more common in PAN patients (p:0.001).Plasma levels of Tie-1 and sFlt-1 were higher in the overall DADA2 patients compared to healthy controls and PAN patients (p<0.001 and p=0.004, respectively). DADA2 patients with PAN-like features had higher sRAGE, Tie-2, and TNF-α levels compared to PAN patients (p=0.013, p=0.003, and p=0.001, respectively).There was no significant difference in the levels of vascular inflammation markers between DADA2 patients with vasculitis and hematological involvement except IL-18. The plasma IL-18 levels were higher in the DADA2 patients with hematological findings compared to vasculitic phenotype (p=0.001). Finally DADA2 patients with neuropathy had higher sRAGE concentrations than patients without neuropathy and healthy controls (p=0.03 and p=0.008, respectively).Conclusion:We suggest that the high plasma IL-18 levels may be associated with an activated IFN pathway, the pathogenesis of hematologic manifestations, and unresponsive to anti-TNF treatment. Higher concentrations of Tie-1, Tie-2, sFlt-1, sRAGE, and TNF-α distinguished DADA2 patients with PAN-like features from PAN patients. We identified sRAGE as a potential biomarker of neuropathy in DADA2 patients.References:[1]Pesciotta EN, Lam H-S, Kossenkov A, et al. In-Depth, Label-Free analysis of the erythrocyte cytoplasmic proteome in Diamond Blackfan Anemia identifies a unique inflammatory signature. PLoS One 2015;10(10):e0140036.[2]Haslbeck KM, Bierhaus A, Erwin S, et al. Receptor for advanced glycation endproduct (RAGE)–mediated nuclear factor-κB activation in vasculitic neuropathy. Muscle Nerve 2004;29(6):853-60.Disclosure of Interests:None declared
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Zhogova O, Kaya Akca U, Suspitsin E, Sag E, Nizhnik V, Tumakova A, Ivanoskiy S, Lagunova N, Bilginer Y, Özen S, Kostik M. POS1298 COMPARISON OF FMF CLINICAL FEATURES BETWEEN TURKISH AND CRIMEAN TATAR CHILDREN. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Crimean Tatars is an ethnic group in Russia. The presence of familial Mediterranean fever (FMF) has been recognized since 2016.Objectives:The study aimed to evaluate the prevalence and clinical features as well as genetic aspects of FMF in children of Crimean Tatar (CT) origin and compare them with a cohort from Turkey.Methods:This retrospective study included all FMF cases in patients of CT origin (n=18) diagnosed in Children’s Regional Hospital in Simferopol since 2016. We included 40 consecutive FMF cases between February-March 2020, diagnosed and followed at Hacettepe University, Ankara, Turkey. All children were less than 18 years old at the time of inclusion. The diagnosis of FMF was based on the EULAR criteria (2019). We excluded other autoinflammatory diseases and any doubtful cases. For assessment of MEFV alleles prevalence 127 healthy unrelated CT adults from different parts of Crimea peninsula were included. Sanger sequencing of MEFV exons 2 and 10 was performed in all the patients and controls.Results:FMF in CT was diagnosed with nearly 5 year-delay, despite the earlier age at onset. CT children had more frequent and prolonged fever, joint involvement (arthritis and arthralgia) and erysipeloid rash compared to Turkish, who had more attacks with chest pain and abdominal pain which last longer. (Table 1) CT had higher white blood cell count, C-reactive protein, erythrocyte sedimentation rate and lower hemoglobin. It might be explained by the fact that the majority of Crimean Tatars were admitted to the clinic during an attack, which was not always the case with Turkish children. Distribution of MEFV pathogenic alleles p.M694V, p.M680I, p.V726A in CT children was 81%, 9.5% and 9.5%, respectively, while in Turks it was 68.6%, 14.3% and 12.9%. Among the CT patients, proportion of homozygotes, compound-heterozygotes and heterozygotes were 11%, 6% and 83%, and among Turkish patients were 45%; 30%; and 25%, respectively. MEFV pathogenic variants were detected in 10.2% of healthy CT donors: 7.1% individuals had p.M694V, 1.6% - p.M680I, 1.6% - p.V726A. Comorbid diseases including IgA vasculitis, sacroiliitis, JIA, autoimmune hepatitis and inflammatory bowel disease were reported in 5.6% of CT and 10% of Turks. The colchicine treatment rate and regimen were similar, but CT received biologics more frequently (44%) than Turks (22.5%).Conclusion:CT is an ethnic group with a significant number of MEFV mutation carriers assuming the expected prevalence of FMF to be as high as 1:385. Thus, any periodic fever in CT patients should be considered as a sign of possible FMF. The clinical course of FMF has some peculiarities in CT patients.This work supported by the Russian Foundation for Basic Research (grant № 18-515-57001).Table 1.Comparative data of FMF patients with Turkish and Crimean Tatar originFMF featuresTurkish (n=40)Crimean Tatars (n=18)рFamily history of FMF, n (%)16 (40)9 (50)0.477Consanguinity, n (%)8 (20)6 (33)0.272Onset age, years3.3 (2; 5)1.3 (0; 4)0.040Age at FMF diagnosis, years4.7 (3; 8)9.6 (4; 14)0.005Diagnosis delay, years0.9 (0; 2)5.5 (2; 10)0.00001Fever, n (%)33 (83)18 (100)0.058Episode duration, days2.0 (2; 3)3.0 (3; 6)0.000003Fever duration, hours48.0 (48; 72)72.0 (72; 120)0.000002Chest pain, n (%)12 (30)1 (6)0.039Chest pain duration, hours48.0 (24; 72)0.0 (0; 0)0.000001Abdominal pain, n (%)30 (75)9 (50)0.061Abdominal pain duration, hours48.0 (24; 48)24.0 (24; 24)0.043Arthritis, n (%)10 (25)16 (89)0.000006Arthralgia, n (%)19 (48)17 (94)0.0007Erysipeloid rash, n (%)0 (0)9 (50)0.000001Disclosure of Interests:None declared
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Demirkaya E, Romano M, Swearingen C, Kasapcopur O, Makay B, Özen S, Yazici Y. POS1320 DIFFERENCES IN CLINICAL MANIFESTATION AND DISEASE ACTIVITY OF PEDIATRIC BEHÇET DISEASE: A CROSS-SECTIONAL COHORT COMPARISON BETWEEN TURKEY AND UNITED STATES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Behçet disease (BD) is a systemic inflammatory disease which is rare in children. It is also known a higher prevalence along the ancient Silk Road and the eastern Mediterranean, especially in Turkey. Despite the presence of diagnostic criteria, the diagnosis of pediatric BD is still difficult due to atypical findings and the heterogeneity of the disease. While descriptive cohort studies in pediatric BD exist, direct comparison studies of clinical manifestations and disease activity between patients from different countries are scarce.Objectives:We aimed to compare the main clinical features and activity of pediatric BD patients from Turkey versus United States (US).Methods:The BD was diagnosed before 18 years of age and based on expert opinion. Disease activity was assessed with Physician Global Assessment (PhGA), Parents/Patient Global Assessment (PWPGA) and Behçet’s Syndrome Activity Scale (BSAS) were administered to patients from both countries.Results:A total of 161 patients were included (61 from Turkey; 100 from US). Males were more prevalent among patients from Turkey than among patients from US (63.9% vs. 32%, respectively, p < 0.001). Disease duration at the diagnosis was significantly longer in US p=0.002). Oral aphthosis was the most common symptom in both groups (96.7% for Turkey and 73% for US), however a significant difference was found (p<0.001). Genital ulcers were documented in 47% of US patients and in 41.4% of Turkish patients (p=0.5). There were significant difference between two groups with regards to the ocular involvement: uveitis and posterior uveitis were more frequently in Turkish patients (p=<0.001 respectively) while retinal vasculitis was no seen in US patients (p<0.001). Erythema nodosum occurred more frequently in Turkish group (p<0.001). The pathergy test was reported as positive in 22 (37.3%) patients in Turkey and 2 (2.3%) in USA in our study (p<0.001). Gastrointestinal and neurological involvement did not differ between cohorts. The rate of colchicine and oral steroids was similar. Azathioprine, cyclosporine and methotrexate usage was more frequent in Turkey (p=0.005, p=0.007, p=0.033, respectively) and infliximab was administered just in the US cohort (p = 0.002). PhGA and BSAS scores were higher in patients from Turkey (p=0.003 and p=0.017 respectively) and no significant differences were seen in PWPGA scores.Conclusion:Disease activity and clinical features seem to be different between the two countries which may be linked to the environmental factors, referral patterns and immune system responses in the expression of this disease. The diagnosis of BD in the US was based on both fulfilling the ISBD criteria and in cases when criteria were not met, based on treating physician assessment, which can explain some of the differences in disease presentation. In addition, there were differences in regard to clinical practice and treatment patterns between two countries. Increasing knowledge about heterogeneity of BD will improve the ability of diagnosis, development of new diagnostic criteria, and management of BD.References:[1]Butbul Aviel Y et al, Semin Arthritis Rheum. 2020Disclosure of Interests:None declared
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