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ABSTRACT: The mainstay of RA treatment is the disease-modifying antirheumatic drugs, and triple DMARD combination is now known to be better than monotherapies. Our aim in this trial was to report our clinical experience with triple DMARD therapy for resistant rheumatoid arthritis. Data of 140 patients with RA resistant to methotrexate and steroid combination were evaluated retrospectively. One hundred and nineteen (85 %) were female, and the median age at diagnosis was 56 (29-82) years. The median time between the diagnosis and beginning of triple therapy was 45.5 (6-564) months. Fifty-two (37.1 %) patients (group 1) on triple therapy protocol achieved remission, but the others (88; 62.9 %) (group 2) did not. The mean DAS28 scores for the study group before triple DMARD therapy and after 12 months under triple DMARD therapy were 4.93 and 3.24, respectively. The DAS28 scores after 12 months for groups 1 and 2 were 2.57 and 3.64. The median follow-up period for patients in group 1 was 60 months (23-118), and the mean DAS28 score at the time of the analysis for group 1 was 2.36. Triple DMARD combination may save one-third of the MTX-resistant RA patients from the serious side effects and the cost of anti-TNF.
Rheumatology International 11/2012; · 1.88 Impact Factor
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ABSTRACT: Giant cell arteritis (GCA), previously Horton's disease, is a systemic vasculitis affecting the middle-sized or large arteries in patients older than 50 years of age. The mainstay of the treatment of GCA is glucocorticoid therapy. Herein, we present a case with giant cell arteritis resistant to oral and intravenous steroid, intravenous cyclophosphamide and mycophenolate mofetil, but successfully treated with tocilizumab.
Rheumatology International 09/2012; · 1.88 Impact Factor
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ABSTRACT: Progressive systemic sclerosis is a multisystem disease characterized by vascular abnormalities, connective tissue sclerosis, atrophy, and presence of autoantibodies. Our clinic has been treating these patients for nearly 30 years, and we wanted to present the clinical and laboratory features of our patients and also to discuss the difference between Turkish patients and others. Systemic sclerosis patients who have applied to our rheumatology clinic from April 1981 to December 2010 were all collected in a medical database, and the data of 169 patients were analyzed. The clinical situations of these patients were all analyzed retrospectively, and their treatment protocols, survival analysis, laboratory data, and radiologic evaluations were all recorded. Totally, 196 patients applied to our clinic with a diagnosis of SSc, but 27 of them gave up coming follow-up visits, and the remaining 169 patients were all analyzed; 153 (90.5%) were women, the median age of diagnosis was 39 (17-75), and 79.3% had diffuse type of SSc. Of all, 159 (94.1%) patients had Raynaud's phenomenon, and 119 (70.4%) had radiologically proved pulmonary fibrosis; 82.2% were positive for ANA and 63.9% were positive for antitopoisomerase-1 antibody. The mean follow-up period was 109 (9-516) months, and 155 (91.7%) patients were still alive at the time of analysis. Only 2 patients had renal crisis, and 6 (3.55%) patients developed secondary malignancies due to cyclophosphamide therapy. We presented our 30-year experience with SSc patients, their survival results, laboratory and clinical aspects, and also the difference of our Turkish SSc patients with the others in the world.
Rheumatology International 12/2011; · 1.88 Impact Factor
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ABSTRACT: Progressive systemic sclerosis is a multisystem disease characterized by vascular abnormalities, connective tissue sclerosis, atrophy, and the presence of autoantibodies. Up to now, symptomatic therapy was the mainstay, but immunosuppressive therapies have shown encouraging results in the inhibition of the disease progression. Our clinic has been treating these patients with methylprednisolone and cyclophosphamide followed by azathiopurine or mycophenolate mophetyl after 2 years (MPC-MMA combination) for nearly 30 years, and we wanted to present the treatment results of our patients. Systemic sclerosis patients who have applied to our rheumatology clinic from April 1981 to December 2010 were all treated with MPC-MMA combination therapy. All the data were checked, and the data of 169 patients were reached. The clinical situations of these patients were all analyzed retrospectively, and their treatment protocols, survival analysis, laboratory data, and radiologic evaluations were all recorded. The 10-year survival rate was 90.3%, and the estimated median survival was 96 ± 6,214 months. The mean pulmonary hypertension at the time of diagnosis and at the end was 26.03-26.4 mmHg (P = 0.989). Only 6 (3.55%) patients developed secondary malignancies due to cyclophosphamide therapy (two breast, one bladder, one lung cancer, one mesothelioma, and one acute lymphoblastic lymphoma). MPC-MMA combination is an effective and a relatively safe option for patients with systemic sclerosis.
Rheumatology International 11/2011; · 1.88 Impact Factor
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ABSTRACT: Behçet's disease (BD) may cause uveitis and retinal vasculitis in nearly half of the patients. Uveitis is one of the most serious complications that can lead to blindness. Sildenafil (Viagra(R)) and the other phosphodiesterase type 5 (PDE5) inhibitors are the first-line options for the treatment of erectile dysfunction, but transient visual symptoms and serious ocular side effects have been reported in PDE5 inhibitor users. Herein, we report a case with BD who applied to our outpatient unit with recurrent uveitis after sildenafil therapy.
Rheumatology International 11/2011; · 1.88 Impact Factor
