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    Demographic, clinical, and serological features of Turkish patients with rheumatoid arthritis: evaluation of 165 patients
    (Springer London Ltd, 2011) Kobak, Senol
    The study was designed to describe demographic, clinical, serological, and radiological characteristics of patients with rheumatoid arthritis (RA) followed-up by a single institution. One hundred sixty-five patients, diagnosed as RA using ACR classification criteria, and followed-up in the rheumatology clinic between December 2005 and January 2010, were enrolled in the study. Of the patients, 125 were female, and 40 were male. Mean age of the patients was 52.5 years, and mean duration of the disease was 10.5 years. The most frequently involved joints were the wrist (95.2%), MCP (90.9%), and the PIP (92.6%). The knee and hip joint involvement rates were 44.8% and 23.6%, respectively. Patients (50.9%) were detected to have tenosynovitis. Involvement of the elbow joint was shown in 10.9% of the patients. The most common extra-articular manifestations were sicca symptom (40.6%) and carpal tunnel syndrome (35.7%), followed by pulmonary involvement (6.6%), vasculitis (3.6%), and Raynaud's phenomenon (1.2%). Rheumatoid nodules were detected in six patients (3.6%). One patient had Felty syndrome, and another patient had secondary amyloidosis. Patients (90.3%) had positive rheumatoid factor (RF), and 124 patients had positive anti-CCP antibody (75.2%). A more severe clinical course and a higher incidence of erosion, tenosynovitis, and deformities were detected in patients with anti-CCP antibody and positive RF (p = 0.03, p = 0.04, p = 0.01, p = 0.04, respectively). The wrist was the most frequently involved joint in our patients, and the most frequently seen extra-articular manifestation was sicca symptom. Presence of RF and anti-CCP antibody was associated with more severe disease including erosive and destructive arthropathy. Extra-articular involvement and presence of accompanying diseases increase the mortality.
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    Melkersson-Rosenthal Syndrome in a Patient with Systemic Lupus Erythematosus: A Rare Comorbidity
    (Turkish League Against Rheumatism, 2012) Degirmenci, Yildiz; Kobak, Senol; Ors, Ceyda Hayretdag; Karaman, Handan Ozisik
    Melkersson-Rosenthal syndrome (MRS) is a rare granulomatous disease characterized by recurrent orofacial edema, facial palsy, and a fissured tongue. In this article, we report a 23-year-old female case with recurrent peripheral facial palsy, mild orofacial edema, and a fissured tongue. She had spots in her feet with a history of oral aphthous ulcers and experienced a relapse once a year. The neuroimaging results were normal, however the laboratory examination indicated systemic lupus erythematosus (SLE). This rare case is presented to emphasize the complete triad of MRS concomitantly occurring with SLE in this patient.
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    Pulmonary Arterial Hypertension in Patients with Primary Sjogren's Syndrome
    (Hindawi Ltd, 2014) Kobak, Senol; Kalkan, Sezai; Kirilmaz, Bahadir; Orman, Mehmet; Ercan, Ertugurul
    Introduction. Primary Sjogren's syndrome (pSS) is an autoimmune epithelitis. Pulmonary arterial hypertension (PAH) is an important and severe complication, which is encountered in many collagen tissue disorders. Early diagnostic strategies are required to define it at the asymptomatic stage. Doppler echocardiography is an important, noninvasive screening test for PAH diagnosis. Objective. The aim of this present study is to define the frequency of PAH in patients with pSS and to reveal correlations with laboratory and clinical findings. Material and Methods. A total of 47 patients, who were diagnosed with pSS according to American-European Study Group criteria were enrolled in the study. After all patients were evaluated clinically and by laboratory tests, Doppler echocardiography was performed in the cardiology outpatient clinic. Systolic pulmonary artery pressure (SPAP) >30 mm Hg values, which were measured at the resting state, were accepted as significant for PAH. Results. Forty-seven patients with pSS were included in the study. The mean age of patients was 48 years and the mean disease duration was 5.3 years. PAH was defined in 11 of the 47 patients (23.4%). The SPAP value was over 35 mm Hg in 5 out of 11 patients, whereas six patients had SPAP measuring 30-35 mm Hg. While pulmonary hypertension was related with earlier age and shorter duration of disease (p = 0.04), there was no statistically significant correlation between SPAP increase and clinical findings (p > 0.05). Conclusion. We have defined high PAH frequency in patients with pSS. Since there are different data in the literature, it is obvious that large scale, multicentre studies are required.
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    Scleroderma renal crisis and ovarian hyperstimulation syndrome related to the use of clomiphene in a patient with scleroderma
    (Elsevier Doyma Sl, 2014) Kobak, Senol; Hacivelioglu, Servet; Gungor, Selen
    This paper presented a 28-year-old female with systemic sclerosis who developed scleroderma renal crisis and ovarian hyperstimulation syndrome following clomiphene administration. Urgent therapy including angiotensin-converting enzyme (ACE) inhibitors and supportive care resulted in regression and eventually resolution of all the clinical and laboratory symptoms. Although scleroderma renal crisis is a fatal complication of high-dose corticosteroids, rarely is this seen with the use of ACE inhibitors. This case report aimed to investigate the potential capacity of the selective oestrogen receptor modulator clomiphene to induce scleroderma renal crisis as well as corticosteroids. (C) 2012 Elsevier Espana, S.L. All rights reserved.
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    Severe candida laryngitis in a patient with rheumatoid arthritis treated with adalimumab
    (Aves, 2014) Kobak, Senol; Yilmaz, Hatice; Guclu, Oguz; Ogretmen, Zerrin
    Rheumatoid arthritis is a chronic erosive rheumatic disease that can present with polyarticular involvement. Anti-TNF-alpha drugs are used in cases that are resistant to traditional disease-modifying antirheumatic drugs (DMARDs). Anti-TNF-alpha drugs are groundbreaking drugs, the efficacy of which has been proven in the treatment of rheumatoid arthritis. However, the data concerning safety remain limited and contradictory. The risk of tuberculosis reactivation, various infections, as well as lymphoproliferative disease and/ or secondary malignancy is a matter of discussion. In this report, we report a 52-year-old male patient using adalimumab for active rheumatoid arthritis who presented to our polyclinic with generalized mouth and throat sores, hoarseness, and swallowing difficulty. Candida laryngitis was detected in the laryngoscopy and culture samples. Adalimumab was discontinued, and the infection was controlled with anti-fungal treatment.