Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) > or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

Depression in dialysis patients.

Many psychiatric disorders can be seen in patients with chronic renal failure (CRF). Haemodialysis (HD), which is a renal replacement treatment, causes various psychiatric and psychosocial problems. Patients are dependent on treatment and the illness causes various problems. In addition, strict diet and continuous treatment are other stress factors (1,2). Various studies have been published in different regions and countries about the prevalence of depression and the relation between sociodemographic factors and depression in patients treated by continuous ambulatory peritoneal dialysis (CAPD), which has gradually become common in Turkey. However studies, which reflect the authors' region, have become necessary (2,3).

Chlamydial nucleic acids in synovium in osteoarthritis: what are the implications?

OBJECTIVE: To study whether there is evidence of bacterial DNA in some osteoarthritic (OA) joint tissues, and the clinical implications of finding bacterial DNA in this relatively noninflammatory disease. METHODS: Polymerase chain reaction (PCR) was used to detect DNA of Chlamydia trachomatis, Chlamydia pneumoniae, and other bacteria using panbacterial primers in synovial membranes and other articular tissues of 32 consecutive patients undergoing surgery for hip and knee OA. Patients were interviewed and examined postoperatively. Operative reports were reviewed and followup examinations were accomplished on all patients. RESULTS: Nine of 32 patients with OA (28.1%) had evidence for bacterial DNA in joint tissues with at least one set of primers for Chlamydia: 7 for C. trachomatis (21.9%), 2 for C. pneumoniae (6.2%). Five of 32 (15.6%) patients had postoperative complications; 3 of these were in patients who showed amplified DNA of C. trachomatis in joints and one in a patient in whom we detected Escherichia coli. CONCLUSION: C. trachomatis and C. pneumoniae nucleic acids can be present in joints in some cases of apparently classical OA. Whether chlamydial or other difficult to culture bacterial presence is associated with complications is suggested, but remains to be determined. Simple presence of C. trachomatis by PCR does not define a clinical syndrome or disease course.

Crystal deposition and osteoarthritis.

Calcium-containing crystals are commonly found in osteoarthritic (OA) joints. Although most often found in advanced OA, some calcium pyrophosphate dihydrate and apatite can be present in early stages. These crystals could be factors in pathogenesis of OA and even more likely in the progression of disease. Calcium pyrophosphate dihydrate apatites and other calcium phosphates can be mitogenic, can stimulate the release of metalloproteases, and might have mechanical abrasive effects.

Coexistence of hereditary multiple exostoses and ankylosing spondylitis.

We report a 50-year-old male patient with hereditary multiple exostoses (HME) and ankylosing spondylitis (AS). This is the first case reporting the coexistence of HME and AS. Our patient has multiple exostoses around the knee, elbow and wrist joints. At the age of 40 years, pain in the lower back associated with morning stiffness lasting about an hour and improving with exercise began. His son also has hereditary multiple exostoses but has no sign of AS. HME is an autosomal dominant disorder. AS has a remarkably strong association with the histocompatibility antigen HLA-B27. Owing to the different genetic mechanisms, it is not possible to differentiate between coincidence and association. Coexistence of HME and AS in our patient probably represents a coincidence rather than a real association.