Akin Erdal

Ataturk University, Kalikala, Erzurum, Turkey

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Publications (30)30.21 Total impact

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    ABSTRACT: Objective: Recent studies suggest that endogenous melatonin (MLT) production might play a role in the etiology of rheumatoid arthritis (RA). However, the role of MLT in RA pathogenesis remains unclear. This study was performed to determine MLT serum levels in RA patients. Materials and Methods: Twenty nine patients with RA and in 25 age- and sex-matched healthy controls were included in our study. Blood samples of the participants collected at 8AM. MLT was measured by enzyme-linked immunosorbent assay (ELISA). The MLT levels of the patients with RA were compared with healthy age- and sex-matched controls. The Mann-Whitney U-test was used to compare the data between the two groups. Results: MLT concentrations were significantly higher in RA patients than in the controls (p<0.05). Conclusion: Our results suggest that the higher blood concentrations of MLT in RA patients, especially in the early morning, may help to explain the morning stiffness and joint swelling. Turk J Phys Med Rehab 2013;59:42-4.
    No preview · Article · Mar 2013 · FTR - Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi
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    ABSTRACT: Henoch-Schölein purpura (HSP) is the most common systemic vasculitis of childhood, affecting the small blood vessels. The disease is a clinical syndrome characterized by multiple organ involvement including the skin, joints, gastrointestinal tract, and the kidneys. Headache and behavioral changes can be frequently seen during the course of the disease, but severe neurological signs such as seizures, focal neurologic deficits, intracerebral hematoma, mononeuropathies, and polyradiculoneuropathies are the rare complications of HSP. In this report, we described a 17-year-old girl with HSP who presented with seizures and disturbance of consciousness. The subsequent magnetic resonance imaging of the brain demonstrated findings consistent with cerebral vasculitis. The pulse steroid therapy was performed immediately after the diagnosis and clinical improvement was achieved rapidly. In conclusion, we suggest that cerebral vasculitis should be considered in all HSP patients with neurological symptoms and signs. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing.
    No preview · Article · Dec 2012 · FTR - Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi
  • Tuba Baykal · Kazim Senel · Filiz Alp · Akin Erdal · Mahir Ugur
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    ABSTRACT: Background: Recently, it has been recognized that vitamin D not only is important for calcium metabolism and maintenance of bone healthy, but also plays an important role in reducing risk of many chronic diseases including rheumatoid arthritis (RA), systemic lupus erythematosus, insulin-dependent diabetes mellitus, multiple sclerosis, several cancers, heart and infectious diseases. In RA, the role of vitamin D is undefined. Methods: The objective of this present study was to determine serum 25-hydroxyvitamin D (25(OH)D) concentrations in patients with RA and to establish its correlation with disease activity. This study was performed on fifty-five consecutive patients RA fulfilling the American Collage of Rheumatology (ACR) criteria for the classification of RA and forty-five healthy subjects. Serum 25(OH)D levels were measured using Elecsys 25(OH)D reactive kit. Disease activity was assessed according to DAS28, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The association between serum levels of 25(OH)D and age, gender, disease duration and disease activity parameters were established. Results: The mean serum 25(OH)D levels were significantly decreased in RA patients compared to healthy controls (p < 0.01) and were associated with higher levels of parathyroid hormone. Vitamin D deficiency (i.e. < 30 ng/ml) was found in 50 patients (90.9 %). Serum levels of vitamin D lower than 20 ng/ml were found in 72 % of patients. We did not find the correlation between serum 25(OH)D levels and disease activity parameters. Conclusions: Our findings have demonstrated that serum 25(OH)D levels is highly prevalent in patient with RA. We believe that it will be helpful to investigate the vitamin D levels in order to determine the osteomalacia risk of RA patients (Tab. 2, Ref. 11).
    No preview · Article · Oct 2012 · Bratislavske lekarske listy
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    ABSTRACT: Brucellosis is a zoonotic disease and still a major public health problem in many geographic areas including Mediterranean basin and Middle East. Brucellosis causes multisystemic involvement and although rare central nervous system involvement causes serious manifestations. Neurobrucellosis occurs less than 5% of patients and presents with meningitis,encephalitis, myelitis, myelopathy, stroke, paraplegia, radiculoneuritis, intracerebral abscess, epidural abscess, demyelination and cranial nerve involvement or any combination of these manifestations. Spastic paraparesis and the sensorineural involvement are rarely reported in the literature. Herein we present a 28 years-old man with spastic paraparesis and sensorineural hearing loss due to neurobrucellosis. The patient was treated with antibiotics combination for 6 months and underwent rehabilitation program. Neurobrucellosis should be ruled out in patients with unexplained neurological symptoms and/or sensorineuralhearing loss particularly in those living in endemic areas.
    No preview · Article · Oct 2012 · Journal of Back and Musculoskeletal Rehabilitation
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    ABSTRACT: Objectives The aim of this study was to assess the point prevalences of hay fever, asthma, and atopic dermatitis in OA, RA, and AS, and to compare with healthy controls. Methods A total of 935 patients and healthy controls were included. Demographic and clinical features were recorded, and a questionnaire assessing the existence of atopic disorders like asthma, hay fever, and atopic dermatitis in all groups was applied. “Either atopy” implied that an individual was either diagnosed with or had symptoms of one or more of these disorders, such as asthma, hay fever, or atopic dermatitis. Results When compared to the controls, only patients with AS had an increased risk for hay fever (OR 1.52, 95 % CI 1.00–2.41). Patients with RA had increased risks for hay fever, atopic dermatitis, and either atopy compared to the patients with OA (2.14, 95 % CI 1.18–3.89; 1.77, 95 % CI 1.00–3.18; and 3.45, 95 % CI 1.10–10.87, respectively). Steroid use had no effect on the prevalence of atopic disorders in patients with RA. Conclusions Patients with OA, RA, and AS seem to have similar risks for asthma, atopic dermatitis, and either atopy to healthy controls. However, the prevalence of hay fever may increase in AS. Patients with RA have a higher risk of atopy than patients with OA.
    No preview · Article · May 2012 · Modern Rheumatology
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    ABSTRACT: The fibromyalgia syndrome (FMS) is a chronic, widespread pain disorder of unknown etiology. It has been suggest that familial component, environmental factors, endocrine and neurotransmitter alterations, and psychological factors may contribute to the development of FMS. The role of melatonin in FMS is unclear. Some studies describe a lower nocturnal peak and a decreased secretion of melatonin in women with FMS when compared with healthy matched controls. The aim of the present study was to determine the possible role of melatonin in FMS patients. We examined the characteristics and levels of melatonin in 25 consecutive premenopausal women with FMS. Serum blood samples were collected from 25 patients and 20 the age and gender matched healthy controls. Melatonin levels were measured by enzyme-linked immunosorbent assay. Then, the results were compared with those from healthy subjects. Serum melatonin levels of FMS patients were not statistically different from those of controls (P > 0.05). No association was observed between melatonin levels of patients with FMS and disease duration, sleep disturbances, fatigue, and pain scores. Our results demonstrate that melatonin levels were similar in patients with FMS and healthy controls. Further studies are needed to determine the possible role of melatonin.
    No preview · Article · Dec 2011 · Rheumatology International
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    ABSTRACT: Background: Arthritis in familial Mediterranean fever (FMF) is typically monoarticular, of sudden onset, self-limiting, rarely destructive, and a frequent manifestation of FMF. The mechanisms governing the initiation and resolution of this highly inflammatory disease entity are not fully understood. Therefore, to decipher the complexity of articular autoinflammation, we defined inflammatory cells and some mediators of inflammation and apoptosis in the synovial membrane of a patient with FMF. Methods: A synovial tissue sample obtained from an inflamed hip joint of a boy homozygous for mutation M694I in pyrin/marenostrin was studied by immunohistochemistry using commercially available antibodies specific for tryptase, CD68, CD3, CD20 and CD138. With the same technique, we also analyzed the expression and distribution of myeloperoxidase, lysozyme, galectin-1, galectin-3, p65 (RelA)/NF-κB, iNOS, COX-2 and activated caspase-3. Results: Abundant neutrophils, macrophages and mast cells, but also B cells were observed, which were more numerous than T lymphocytes or plasma cells. Neutrophils had no granules containing myeloperoxidase or lysozyme in their cytoplasm. Galectin-1 was found in many mononuclear cells sparse throughout the synovial tissue, whereas the expression of galectin-3 was less prominent and scattered. Neither of the galectins was detected in neutrophils. p65 (RelA)/NF-κB and iNOS were both up-regulated in most of the inflammatory cells, whereas COX-2 expression was low, and cleaved caspase-3, used as proxy to demonstrate intrinsic apoptosis, was undetectable. Conclusions: The exquisitely inflammatory, yet non-destructive character of FMF arthritis may correlate with the presence of non-pathogenic neutrophils lacking effector molecules and the preferential expression of iNOS and anti-inflammatory galectin-1 in regulatory cells of the innate immune system, most likely in macrophages. Intrinsic apoptosis seemed irrelevant for controlling synovial autoinflammation, but regulation through pyroptosis, mast cells and the adaptive immune system are possible alternatives.
    Full-text · Article · Feb 2011 · Rheumatology
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    ABSTRACT: Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of life in patients with RA and also to assess which quality of life (QoL) instrument - disease specific and generic - is more prone to this effect. A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire. Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. There was significant association between anxiety and depression with worsening in both disease specific and generic health related quality of life. However, RAQoL showed more association with depression and anxiety levels. Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is much more influenced by depression and anxiety.
    No preview · Article · Jan 2011 · Journal of Back and Musculoskeletal Rehabilitation
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    ABSTRACT: The aim of this study was to investigate the indicative value of the patient-reported outcome instruments (PROs) on disease activity in rheumatoid arthritis (RA). Three hundred sixty eight patients with RA were included in this cross-sectional study. Disease activity was evaluated using both the Disease Activity Score 28 (DAS 28) and the Clinical Disease Activity Index (CDAI). Patients who had DAS 28 score < 3.60 points and CDAI score <10.00 points were allocated into the "low disease activity" group and those who had DAS 28 score > or = 3.60 points and CDAI score > or = 10.00 points into the "moderate or high disease activity" group. The Health Assessment Questionnaire (HAQ), Nottingham Health Profile (NHP), Rheumatoid Arthritis Quality of Life (RAQoL), and Short Form 36 (SF 36) were used as PROs. Logistic regression analysis was used to find variables, which had an indicative value for disease activity. HAQ, pain and emotional reaction subscales of NHP, and bodily pain, general health and social functioning subscales of SF 36 had independent indicative values, when DAS 28 was used as dependent variable. On the other hand, HAQ, pain and emotional reaction subscales of NHP, and general health and emotional role limitation subscales of SF 36 had indicative values when CDAI was used as dependent variable. DAS 28 and CDAI both showed HAQ as the parameter with the highest odds ratio (OR). But RAQoL had shown no independent indicative value for projecting disease activity. It was concluded that HAQ could determine disease activity in RA better than other PROs included in this study (Tab. 4, Ref. 36).
    No preview · Article · Jan 2011 · Bratislavske lekarske listy
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    ABSTRACT: Objective: Complex regional pain syndrome (CRPS) is one of the chronic pain disorders. The etiopathogenesis of CRPS is still undefined. Epidemiologic and clinical studies support that vitamin D is an important enviromental factor that can increase the prevelans of certain diseases. In our literature searche, we not found the link between vitamin D status and CRPS. This study was designed to investigate whether CRPS could be linked to vitamin D. Material and Methods: A total of 25 patients (15 women and 10 men) with CRPS who fulfilled the modified International Association for the Study of Pain (IASP) criteria and 20 age and sex matched healthy controls were enrolled. The medical history, demografic features, clinical and laboratory results of the patients were recorded. Serum 25-hydroxyvitamin D (25 (OH) D) levels <30 ng/ml and 20 ng/ml were defined as vitamin D insufficiency and deficiency, respectively. Results: This study was performed 25 consecutive CRPS patients and 20 healthy subjiects. The patients' ages ranged from 21 to 55 years, mean 39 years and mean duration of symptoms was 5 months. CRPS developed after a traumatic events in 90% of the patients. The mean serum 25 (OH) D levels were significantly decreased in CRPS patients compared with healthy controls (14.4 ng/ml, 19.3 ng/ml, p< 0.05). Approximately 80% of CRPS patients had less than 30 ng/ml of serum 25 (OH) D. Serum levels of vitamin D of less than 20 ng/ml were found in 60% of patients. In both groups, a reduction was seen with age. Conclusion: Our results have demonstrate that 25 (OH) D levels were significantly decreased in CRPS patients compared with healthy controls. Our findings suggest a possible link between vitamin D and CRPS. We suggest that our results should be support by future researches.
    No preview · Article · Sep 2010 · Journal of Rheumatology and Medical Rehabilitation
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    ABSTRACT: To investigate discrimination ability of the Assessment of Spondyloarthritis International Society (ASAS) endorsed disease activity score (ASDAS) versions evaluating low and high disease activity in an unselected group of patients with ankylosing spondylitis (AS). Patients consecutively included into the joint database of five university hospitals were analyzed for low or high disease activity according to different criteria. Standardized mean differences (SMD) for two ASDAS versions were evaluated. The ASDAS versions (back pain, morning stiffness, patient global pain, pain/swelling of peripheral joints, plus either erythrocyte sedimentation rate or C-reactive protein) discriminated high and low disease activity in subgroups according to Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and ASAS remission/partial remission criteria. ASDAS versions were also not influenced by peripheral arthritis and correlated well with other outcome measurements and acute-phase reactants. The ASDAS versions performed better than patient-reported measures or acute-phase reactants discriminating high and low disease activity status. Both ASDAS versions, consisting of both patient-reported data and acute-phase reactants, performed well in discriminating low and high disease activity. Further longitudinal data may better estimate the usefulness of ASDAS to assess disease activity subgroups and treatment response.
    No preview · Article · Aug 2010 · International Journal of Rheumatic Diseases
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    ABSTRACT: Familial Mediterranean fever (FMF) is an autosomal, recessively inherited multisystem disease that affects various groups of people originating from the Mediterranean Sea region, most specifically those of Jewish, Turkish, Armenian, and Arabic ethnicity. Recurrent attacks of fever and sterile polyserositis of the peritoneum, synovial membranes, and pleura are the main clinical features, although the clinical features of FMF have been expanded in recent years to also include severe myalgia, scrotal swelling, cardiac involvement, and protracted febrile myalgia syndrome (PFMS). PFMS is seen in only a small percentage of FMF patients and is characterized by severe debilitating myalgia of the upper and lower extremities and high fever, occasionally accompanied by abdominal pain, diarrhea, arthritis/arthralgia, and transient vasculitic purpura mimicking Henoch-Schönlein purpura (HSP). Here, we report on a patient with FMF who also presents with PFMS, which is an uncommon and severe manifestation of the disease.
    No preview · Article · Mar 2010 · Modern Rheumatology
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    ABSTRACT: This study investigated the presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in familial Mediterranean fever (FMF) patients and controls. Forty-nine patients with FMF were enrolled (23 had a history of arthritis during attacks and 26 had no such history). Two control groups were enrolled: 20 patients with rheumatoid arthritis (RA) and 30 healthy individuals. Clinical and laboratory assessments of the FMF patients were performed during attack-free periods. Erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), rheumatoid factor (RF), and anti-CCP antibody levels were measured. In RA patients' ESR and CRP levels, frequency of RF, and anti-CCP antibody levels were significantly higher than in both FMF patients and healthy controls (p 0.001). Moreover, anti-CCP was negative in all healthy controls as well as in all FMF patients. Our results show that anti-CCP antibodies are not associated with FMF.
    No preview · Article · Jan 2010 · Journal of Back and Musculoskeletal Rehabilitation

  • No preview · Article · Dec 2009 · Revue du Rhumatisme
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    ABSTRACT: To assess the frequency of juvenile onset ankylosing spondylitis (JOAS) in Turkish patients with AS and to compare with adult onset AS (AOAS) in a cross-sectional study design. A total of 322 patients were recruited from the joint database of 5 university hospitals in eastern Turkey. Patients with JOAS (n = 43, 13.4%) had significantly longer diagnostic delay (9.21 vs 5.08 yrs), less severe axial involvement and more prevalent uveitis (OR 2.92, 95% CI 1.25-6.79), and peripheral involvement at onset (OR 3.25, 95% CI 1.51-6.98, adjusted for current age; and OR 2.26, 95% CI 1.07-4.76, adjusted for disease duration). Patients with AOAS had higher radiographic scores and more restricted clinimetrics but similar functional limitations and quality of life. JOAS and AOAS had distinctive courses and Turkish patients with AS had similar features compared to other Caucasian patient populations.
    No preview · Article · Nov 2009 · The Journal of Rheumatology
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    ABSTRACT: This study was carried out to determine the serum levels of melatonin (MLT) in patients with ankylosing spondilitis (AS) and to evaluate its correlation with disease activity. We assessed clinical characteristics and labaratory parameters. Serum samples from 36 patients (25 males, 11 females) with active AS and 25 healthy subjects (18 males, 7 females) were collected. MLT levels were measured by enzyme-linked immunosorbent assay, and disease activity of AS was assessed according to the Bath AS disease activity index (BASDAI), the erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Then, the results were compared with those from 25 healty controls. The serum levels of MLT were significantly increased in AS patients as compared to healthy controls (p < 0.05). MLT levels were correlated with BASDAI (r = 0.871, p < 0.001) and CRP levels (r = 0.691, p < 0.001), but not with ESR, in patients with AS. Our results suggest a possible role for this immunoregulatory hormone in the disease activity in AS patients.
    No preview · Article · Oct 2009 · Rheumatology International

  • No preview · Article · Aug 2009 · Joint, bone, spine: revue du rhumatisme
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    ABSTRACT: The purpose of this, open-label, non-comparative study, was to evaluate the efficacy on quality of life and the efficacy of gabapentin monotherapy in patients with chronic radiculopathy. Thirty-five patients with radicular pain and diagnosed as L4, L5 or S1 radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for eight-week trial period. Quality of life, functional disability and psychological mood of the patients were assessed using the Nottingham Healthy Profile (NHP), Oswestry Low Back Pain Disability Questionnaire (ODQ) and Beck Depression Inventory (BDI). Of the patients (n = 35), 25 were females and 10 were males (mean age: 41.8 +/- 10.4, range: 24-60 years); mean radiculopathy duration was 16.4 +/- 14.2 months (range: 3-48 months). The pain intensity at rest, quality of life, functional disability and depression scores were determined significantly improved after treatment and 4 months compared to baseline scores (p < 0.001). 1.5 points compared to baseline for at pain rest and 15 points improvement on the ODQ were obtained. Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy.
    Preview · Article · Jan 2009 · Journal of Back and Musculoskeletal Rehabilitation
  • Akin Erdal · Kadir Yildirim · Saliha Karatay
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    ABSTRACT: Objective: Depression is a common disorder affecting 5-9% of women and 1-2% of men. Osteoporosis is a condition characterized by bone fragility and increased risk of bone fracture There might be some behavioral and neuroendocrine system changes in depression which are risk factors for decreased bone mineral density. This study was performed to determine whether women with current or past major depression have demonstrable decreases in bone density. Methods: We measured bone mineral density at the hip and spine in 20 premenopausal women with past or current major depression and 20 premenopausal healthy women matched for age and body-mass index and using dual-energy x-ray absorptiometry. Results: The mean BMD values at lumbar region were 0.93 ± 0.09 gr/cm2 for the patient group and 0.98 ± 0.04 gr/cm2 for the control group. And the mean BMD values at left hip region were 0.85 ± 0.14 gr/cm2 for the patient group and 0.92 ± 0.07 gr/cm2 for the control group. The mean BMD values at lumbar region and at left hip region in patient group were both statistically lower than controls (p< 0.05). Conclusions: We concluded that patients with past or current major depression may have low bone mineral density so this may be a risk factor for osteoporosis.
    No preview · Article · Jan 2007 · Journal of Back and Musculoskeletal Rehabilitation
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    ABSTRACT: The objective of the study was to compare the effects of alendronate, risedronate and calcitonin on biochemical markers of bone turnover and bone mineral density (BMD) in postmenopausal osteoporosis. The patients (n=200) were equally divided to one of four treatment groups: alendronate 10 mg/daily, risedronate 5 mg/daily, calcitonin 200 IU/daily and control group for 12 months. All groups also received 1000 mg of calcium/daily. The control group received only 1000 mg calcium/daily. Serum osteocalcin (OC), bone specific alkaline phosphatase (BSAP) and urinary deoxypyridinoline (uDPD) levels were determined. There are increases in BMD at two regions, at the end of 12 months in four groups. The mean increases in BMD at 12 months, at the lumbar spine and hip respectively, were: alendronate (p < 0.05, p < 0.001), risedronate (p < 0.001, p < 0.01), calcitonin (p < 0.05, p < 0.01) and control group (p < 0.05 for both site). In comparison with control group, the mean changes in BMD at the spine and hip were greater in the other groups (p < 0.05 for both region). uDPD levels were gradually reduced at the end of study in all groups (p < 0.01 for three groups), while no significant change was found in calcium group. The treatment with alendronate produced significantly greater increases in total hip BMD than did risedronate and calcitonin and tretment with risedronate produced significantly greater increases in lumbar spine BMD than did alendronate and calcitonin over 12 months. This study demonstrated the efficacy of alendronate, risedronate and calcitonin in preventing the bone loss related to postmenopausal osteoporosis.
    No preview · Article · Jan 2005 · Journal of Back and Musculoskeletal Rehabilitation