Browsing by Author "Bozkirli, Emine Duygu Ersozlu"

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Anti-Tumor Necrosis Factor Alpha Treatment and Tuberculin Skin Test
(2015) Bozkirli, Emine Duygu Ersozlu; Tufan, Muge Aydin; Ozisik, Lale; Sen, Nazan; Yucel, Ahmet Eftal
Purpose: The use of anti-tumor necrosis factor alpha (anti-TNF) drugs has been a milestone in the treatment of rheumatic diseases. Despite their strong efficacy, there are some factors restricting the use of anti-TNF agents. We must be careful especially for the granulomatous diseases which can be seen endemic in our country such as tuberculosis and leishmaniasis. In our country according to the RAED 2005 Consensus Meeting Reports, patients candidate for anti-TNF treatment are evaluated for both active and inactive tuberculosis before treatment and prophylaxis with isoniazid (INH) has been performed where indicated. Material and Methods: Tuberculin skin tests (TST) of 43 patients followed up in the Rheumatology Clinic and receiving anti-TNF therapy were repeated under treatment. Patients' pretreatment first TST results, drugs they used, INH prophylaxis state, smoking status and the duration of anti-TNF treatment were evaluated. Results: 14 patients (32.6%) were women, while 29 (67.4%) were men. The mean of first TST values were 11.72 +/- 90.3 mm (0-30) and the mean of second TST values were 12.06 +/- 12.4 mm (0-45). 48.8% of the patients were smoking and 74.4% of the patients had received INH prophylaxis for 9 months. The mean total duration of anti-TNF drug use was found as 22.67 +/- 19.11 (5-68) months. No statistically significant difference (p=0.888) was observed between the first pretreatment and second under treatment TST results of the patients. Discussion: Tuberculosis remains to be a serious public health problem for both our country and the whole world. For this reason in our country, a detailed assessment is performed for all patients before anti-TNF treatment. In our study patients who are planned to start anti-TNF therapy were assessed with their first TST values and INH prophylaxis were given to 32 patients (74.4%) before treatment. No statistically significant difference was observed between pre and post-treatment TST values when control TST were performed with the earliest after five months of treatment. These findings may suggest that there is no evident increase in the risk of tuberculosis for patients receiving anti-TNF treatment with appropriate INH prophylaxis.
Effects of Infliximab Treatment in Terms of Cardiovascular Risk and Insulin Resistance in Ankylosing Spondylitis Patients
(2014) Bozkirli, Emine Duygu Ersozlu; Bozkirli, Emre; Yucel, Ahmet Eftal; https://orcid.org/0000-0002-4860-9072; 24252046; E-9887-2014
Objective. To assess the effects of infliximab treatment on insulin sensitivity and cardiovascular risk factors in patients with ankylosing spondylitis (AS). Methods. In this prospective study, 30 consecutive AS patients (23 men and 7 women) fulfilling the modified 1984 New York criteria for AS were investigated. All patients were treated with intravenous infliximab. A complete biochemical profile and assesments were obtained before and after 12 weeks of infliximab therapy. The Homoeostasis Model Assessment of Insulin Resistance Index (HOMA-IR) was used to measure insulin resistance (IR). Framingham equation was used to assess cardiovascular risk factors. Results. After 12 weeks of infliximab treatment, there was no statistically significant difference in fasting insulin, HOMA-IR, lipid parameters, body-mass index, waist circumference and waist hip ratio, whereas fasting glucose levels (p = 0.001), triglycerides/high-density lipoprotein (HDL) ratio (p = 0.043) and total cholesterol/HDL (p = 0.041) ratio increased significantly from baseline. A significant decrease was observed for both systolic blood pressures (p < 0.001) and diastolic blood pressures (p = 0.003) in the 12th-week visit. A significant decrease was also found in terms of Framingham risk scores (p = 0.028) after treatment. Conclusions. Study results suggest that infliximab treatment may reduce cardiovascular risk and blood pressures without changing IR.
If Neurologists Establish The Diagnosis of Primary Sjogren's Syndrome?
(2014) Karaca, Sibel; Bozkirli, Emine Duygu Ersozlu; Goksel, Basak Karakurum; Tam, Meliha; Yucel, Ahmet Eftal
Introduction: Neurological involvements were shown in 20% of patients with Primary Sjogren's Syndrome (pSS). Neurological symptoms may be the first signs of pSS in 57% of the cases. In addition, early diagnosis and treatment of neurological disorders may save or improve the quality of life of these cases. There have been reports about the neurologic manifestations of pSS but little is known about the details of neurologically presented cases. Method: In this study, we described 11 pSS patients who presented with neurological manifestations. Results: Central nervous system (CNS) involvement was recorded in 7 (63.7%) and peripheric nervous system (PNS) involvement in 4 cases (36.4%). Conclusion: Our findings regarding the cases with neurological manifestations leading to the diagnosis of pSS suggest that 1) The frequency of CNS involvement was higher than that of PNS, and the most frequent clinical pictures of CNS involvement are Multiple Sclerosis (MS)-like illnesses and optic neuritis, 2) Guillain Barre Syndrome (GBS) was the most frequent disease of PNS involvement; 3) Mononeuropathy multiplex (MM) might be the first sign of pSS; 41 Neurologists should consider pSS in the differential diagnosis of cases with MS, optic neuritis, GBS and neuropathies of unknown causes including MM; 51 There is an urgent need of therapeutical guidelines for the cases with neurological involvement associated with pSS.
Serum Immunoglobulin G4 Levels are Elevated in Patients with Graves' Ophthalmopathy
(2015) Bozkirli, Emre; Bakiner, Okan Sefa; Bozkirli, Emine Duygu Ersozlu; Haydardedeoglu, Filiz Eksi; Sizmaz, Selcuk; Torun, Aysenur Izol; Ertorer, Melek Eda; 0000-0002-1644-6790; 0000-0002-0179-9673; 0000-0001-7357-8709; 25400133; E-9887-2014; AAK-5525-2021; AAK-5003-2021; ABI-3705-2020
Objective Recent studies have shown close association between serum Immunoglobulin G4 (IgG4) levels and forms of autoimmune thyroiditis. However, there are limited data about the relationship between IgG4 and Graves' ophthalmopathy (GO). In the present study, we aimed to determine the possible association between IgG4 and GO. Design Cross-sectional study. Patients Sixty-five patients with Graves' disease (GD) and 25 healthy controls were recruited into the study. Thirty-two of these patients had GO. Measurements Serum IgG4 levels, thyroid functions and thyroid volumes were measured in all participants. Ophthalmological examination including Hertel's exophthalmometer readings (HER), Schirmer's test (ST), 'NO SPECS' classification and clinical activity score evaluation (CAS) were performed to all patients with GD. Results IgG4 levels were significantly elevated in patients with Graves' disease compared to controls (P = 0.0001). Also, IgG4 levels were significantly higher in patients with and without GO when compared to control subjects (P = 0.0001 and P = 0.002, respectively). Furthermore, IgG4 levels were significantly higher in the GO group compared with GD patients without GO (P = 0.024). IgG4 levels were observed to increase in parallel to CAS. Compared with other GD patients, 15 GD patients with serum IgG4 levels >= 135 mg/dl had higher CAS scores (P = 0.012). None of the factors including, TSH, T3, T4 levels, thyroid volume, HER and ST measurements, affect IgG4 levels as an independent factor. Conclusion IgG4 levels are evidently increased in patients with GD, and there is a possible relationship between IgG4 and GO. Our results suggest that IgG4 may be helpful in screening GD patients with high risk for GO and may well become a good indicator for the selection of right medication in the future.