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Öğe An autumn tale: geriatric rheumatoid arthritis(Sage Publications Ltd, 2018) Kobak, Şenol; Bes, CemalRheumatoid arthritis (RA) is a chronic inflammatory disease characterized by erosive arthritis and systemic organ involvement. The disease may affect all ages and both sexes; usually it is seen in young women aged 25-45. Recent studies have shown that RA is among the most common inflammatory disease in older age groups. While elderly-onset rheumatoid arthritis (EORA) is still discussed in the literature, it is generally accepted as a disease beginning after 65 years of age. Compared with young-onset rheumatoid arthritis (YORA), it was found that EORA had different characteristics. EORA is characterized by more equal gender distribution, higher frequency of acute onset with constitutional symptoms, more frequent involvement of large joints, and lower frequency of rheumatoid factor (RF) positivity. Earlier diagnosis, less erosive disease and less disease-modifying antirheumatic drug usage were reported as distinguishing EORA from YORA patients. These various clinical presentations may cause difficulties in diagnosis and differential diagnosis of EORA. However, different clinical and treatment approaches may be needed in these patients. In this article, the clinical and laboratory characteristics, prognosis and treatment principles of EORA will be discussed in light of recent literature data.Öğe Catch the rainbow: prognostic factor of sarcoidosis(2020) Kobak, ŞenolSarcoidosis is a systemic, chronic, inflammatory disease characterized by noncaseating granuloma formations. The fact that the etiopathogenesis of the disease has not been elucidated yet brings it many theories and assumptions. Being a systemic disease and ability to involve many organs and systems, it attracts the attention of physicians from different branches. In addition to lung involvement, skin, eye, heart, and locomotor system involvement is an important clinical finding. Sarcoidosis may present with very different clinical presentations, and therefore, it is one of the important "imitators" in the medical literature. I like sarcoidosis as a "rainbow," it is a disease that contains the characteristics of many diseases. Different clinical, radiological, and laboratory prognostic factors (lupus pernio, chronic uveitis, late-onset disease, chronic hypercalcemia, nephrocalcinosis, Afro-American race, progressive pulmonary sarcoidosis, radiologic Stage 4, bone involvement, neurosarcoidosis, cardiac involvement, and chronic respiratory failure) have been defined in this "rainbow." Early identification of these factors plays an important role in the determination of treatment strategies, morbidity, and mortality of the disease. In this article, clinical, genetic, laboratory, and radiological factors that determine the prognosis of sarcoidosis are discussed in light of the latest data in the literature.Öğe Characteristics of Turkish patients with elderly onset psoriatic arthritis A retrospective cohort study(Lippincott Williams & Wilkins, 2017) Kobak, Şenol; Yıldız, Fidan; Karaarslan, Ahmet; Semiz, Hüseyin; Orman, MehmetPsoriatic arthritis (PsA) is a chronic inflamatory disease characterized with axial and peripheral joints involvement. It rarely affects patients older than 65 years old. The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset psoriatic arthritis (EOPsA) and young-onset (YOPsA) patients. A total of 180 patients diagnosed with PsA according to CASPAR criteria and followed-up in single center were included in this study. The patients with initial symptoms started after age 65 were accepted as EOPsA. Demographic, clinic, and laboratory data and the medications which the patients received were recorded and retrospectively evaluated. Nineteen (10.5%) of 180 patients were diagnosed as EOPsA, and 161 (89.5%) patients were evaluated as YOPsA. The mean patient age was 42.1years for the YOPsA group and 68.3 years for the elderly onset group. Mean duration of disease was 5.6 years for the early onset group and 1.3 years for the elderly onset group (P=.001). Fourteen (73.3%) of 19 EOPsA patients were female and 5 of them were male. Higher rates of fatique, pain scores, comorbid diseases, and acute phase reactants elevation were detected in EOPsA patients comparing to YOPsA (P=. 000, P=.000, P=.001, and P=.001, respectively). YOPsA patients have more dactilitis, nail involvement, elevated PASI scores, and smoking habitus when compared with EOPsA patients (P=.019, P=.03, P=.005, P=.004, respectively). In terms of the treatment options chosen, there was no significant difference in the use of nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids (CS), methotrexate (MTX), and sulfasalazine (SSL), but there was a more frequent use of anti-tumor necrosis factor-alpha in the YOPsA group. YOPsA and EOPsA patients may presented with different clinical and laboratory features. EOPsA patients are characterized with higher rates of fatigue, pain scores, comorbid diseases, and acute phase reactants and less dactilitis, nail involvement, and anti-TNFalpha usage.Öğe The clinical characteristics of sarcoid arthropathy based on a prospective cohort study(Sage Publications Ltd, 2016) Kobak, Şenol; Sever, Fidan; Usluer, Ozan; Göksel, Tuncay; Orman, MehmetBackground: Sarcoidosis is known as a Th1-mediated disease, which can mimic many primary rheumatologic diseases or sometimes co-exist with them. Clinical characteristics of sarcoid arthropathy are not well described and the studies reported in the literature so far are mostly based on data from referrals. The aim of this study was to evaluate the incidence and clinical characteristics of sarcoid arthropathy. Methods: All our patients were prospectively evaluated in our rheumatology outpatient center from 2011 to 2015. A total of 114 (32 male) patients with sarcoidosis who were admitted to our clinic were included in the study. Clinical, demographical, laboratory, radiological and histological data of these patients obtained during 4-year follow-up and treatment period were compiled and analyzed. Results: The mean patient age was 48.1 years (range, 20-82 years), and the mean disease duration was 40.5 months (range, 1-300 months). Sarcoid arthritis was observed in 71 (62.3%), and arthralgia in 106 (92.9%) patients. Out of the 71 patients with arthritis, 61 (85.9%) had involvement of ankle, 7 (9.8%) knee, 2 (2.8%) wrist, MCP and PIP joints, and 1 (1.4%) had shoulder periarthritis. Oligoarthritis (two to four joints) was the most common pattern followed by monoarthritis and polyarthritis. Arthritis and erytjhema nodosum and arthritis and female sex was found to be correlated (p = 0.03 and p = 0.001). Again, in patients with arthritis, even higher levels of CRP/ESR as well as ANA and RF positivity were observed (p = 0.03, p = 0.01, p = 0.01, and p = 0.02, respectively). A total of 11 patients had another rheumatic pathology concurrent with sarcoidosis. Conclusions: Inflammatory arthritis occurs in a majority of patients with sarcoidosis. Acute arthritis with bilateral ankle involvement is the most common pattern of sarcoid arthropathy. Sarcoidosis can mimic many primary rheumatic diseases or may coexist with them. Sarcoidosis should be considered not only as a mimicker but also as a Th1-mediated primary rheumatologic pathology.Öğe Coexistence of sarcoidosis and adult onset still disease(Elsevier Espana Slu, 2019) Semiz, Hüseyin; Kobak, ŞenolSarcoidosis is a chronic, inflammatory disease with unknown cause characterized by non-caseating granuloma formations. It can be presented with bilateral hilar lymphadenopathy, skin lesions, eye involvement and locomotor system findings. Adult onset Still disease (AOSD) is a chronic inflammatory disease which presents with fever, arthritis and typical skin rashes. The disease is rare and can be mis-diagnosed due to the absence of typical clinical and laboratory findings. The association of sarcoidosis and AOSD has not been previously reported in the literature. Herein we reported the development of AOSD in a patient followed by the diagnosis of sarcoidosis. The patient did not respond to high-dose corticosteroids and methotrexate therapy, and the disease was under control with anti-IL-6 (Tocilizumab) drug. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.Öğe Coexistence of sarcoidosis and gouty arthritis(Elsevier Espana Slu, 2019) Semiz, Hüseyin; Kobak, ŞenolSarcoidosis is an inflammatory disease with unknown cause characterized by non-caseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, the involvement of eye and symptoms on the locomotor system. Gouty arthritis is an autoinflammatory disease characterized by hyperuricemia, recurrent arthritis attacks and the deposition of monosodium urate crystals in the joints and the surrounding tissues. We reported the coexistence of sarcoidosis and gouty arthritis in this paper. (C) 2017 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.Öğe Coexistence of sarcoidosis and hashimoto thyroiditis(Pagepress Publ, 2018) Semiz, Hüseyin; Yalcin, Mehmet Akif; Kobak, ŞenolSarcoidosis is a chronic, inflammatory disease with unknown cause characterized by non-caseating granuloma formations. It can present with bilateral hilar lymphadenopathy, skin lesions, eye involvement and locomotor system findings. Hashimoto thyroiditis is an organ-specific autoimmune disease characterized by increased autoantibody synthesis. Sarcoidosis can involve different endocrine glands. Thyroid gland involvement may lead to increased thyroid function disorders and autoantibodies. Herein, we report an 80-year-old female patient with sarcoidosis and Hashimoto coexistence.Öğe Comment on "Colchicine may not be effective in COVID-19 infection; it may even be harmful?"(Springer London Ltd, 2020) Kobak, ŞenolWe read with great interest the report by Cure et al. which speculated that colchicine may not be effective in COVID-19 infection [1]. The main argument of the authors is that colchicine may have not increased the intracellular pH enough and cannot prevent the binding of the virus to the target angiotensin converting enzyme 2(ACE2) receptors. Also, they suggest that colchicine may increase the risk of acute respiratory distress syndrome(ARDS) and disseminated intravascular coagulation(DIC) which may occur during COVID-19 infection. We have not agreed with the authors at these points. Fırst, the colchicine and anti-malarial drugs both may increase the intracellular pH by different mechanisms. There are no studies investigating the intracellular concentration of colchicine in corona infection, while such data exist regarding chloroquine [2]. So, this view is only an author’s hypothesis that is not based on scientific data. Second, there is no any data supporting Cure et al. that colchicine increases the risk of ARDS and DIC in COVID-19 patients. On the contrary, we hypothesize that colchicine may protect rheumatic patients from COVID-19 or perhaps cause them to pass in a milder form of disease. COVID-19 is not only a viral infection, it is an autoinflammatory/autoimmune process that develops as a result of immune system dysfunction, cytokine release syndrome, and hemophagocytic lymphohistiocytosis [3]. It acts by binding toACE2 receptors in target organs such as lung alveolar type 2 cells [4].When COVID-19 is passed into the cell via ACE2, activation of NLRP3 inflammasome is triggered by immunological mechanisms. The presence of high NLRP3- induced pro-inflammatory cytokines (IL-1, IL-1beta) in the sera of COVID-19 patients supports this hypothesis [5]. Colchicine is an anti-inflammatory agent that inhibit the microtubuleÖğe Concomitant autoimmune diseases in patients with sarcoidosis(Bmj Publishing Group, 2017) Kobak, Şenol; Sever, Fidan; Semiz, Hüseyin; Orman, Mehmet NurullahSarcoidosis is a chronic granulomatous disease characterized by non-caseating granuloma formation. It can mimic many rheumatic diseases and/or may be coexist with them. There are limited data in the literature about the association of sarcoidosis with autoimmune diseases.Öğe Concomitant autoimmune diseases in patients with sarcoidosis in Turkey(Turkish League Against Rheumatism, 2020) Yıldız, Fidan; Kobak, Şenol; Semiz, Hüseyin; Orman, MehmetObjectives: This study aims to determine the frequency and characteristics of autoimmune diseases associated with sarcoidosis patients. Patients and methods: The study included 131 sarcoidosis patients (36 males, 95 females; mean age 46.1 years; range, 20 to 82 years). Demographic, clinical, laboratory and radiological data of patients were evaluated retrospectively. The characteristics of autoimmune diseases associated with sarcoidosis (sarcoidosis-overlap group) patients and isolated sarcoidosis (isolated sarcoidosis group) were analyzed and compared. Results: Concomitant autoimmune diseases were detected in 15 (11.5%) (5 males, 10 females; mean age 50.8 years; range, 26 to 58 years) of the 131 patients with sarcoidosis and their mean disease duration was three months (range, 1 to 30 months). When compared with isolated sarcoidosis patients, more hand finger joint involvement, rheumatoid factor (RF) positivity, higher erythrocyte sedimentation rate (ESR) and less nonsteroidal anti-inflammatory drugs (NSAIDs) usage were found in the sarcoidosis-overlap group (p= 0.035, p=0.049, p= 0.015, p=0.018, respectively). There were no statistically significant differences between the two groups when evaluated for demographic, clinical parameters and disease-modifying antirheumatic drugs usage. Conclusion: Concomitant autoimmune diseases in patients with sarcoidosis may be rarely seen. These patients are characterized with more hand finger joint involvement, RF positivity, higher ESR and less NSAIDs usage. Multicenter, prospective studies involving large numbers of patients are needed to understand whether the association of sarcoidosis-autoimmune diseases is based only on coincidence or on a common etiopathogenesis.Öğe COVID-19 infection in a patient with FMF: does colchicine have a protective effect?(2021) Kobak, ŞenolWe read with great interest the report by Monti et al on the 320 rheumatic patients treated with various disease-modifying anti-rheumatic drugs (DMARDs) in the era of COVID-19 infection.1 They suggest that patients with chronic arthritis receiving MARDs may not have an increased risk of severe COVID-19. We agree that patients under DMARD treatment should be closely monitored since data are lacking. Also, we hypothesise that some DMARDs (especially colchicine) may protect rheumatic atients from COVID-19 or perhaps cause them to pass in a milder form of the isease. COVID-19 is not just a simple viral infection; it is an autoinflammatory/autoimmune process that develops as a result of immune system dysfunction, cytokine release syndrome and haemophagocytic lymphohistiocytosis.2 Herein we reported COVID-19 infection in a patient with familial Mediterranean fever (FMF) under treatment with colchicine.Öğe Demographic, clinical, and laboratory characteristics of elderly onset psoriatic arthritis(Bmj Publishing Group, 2017) Kobak, Şenol; Orman, Mehmet AkifBackground: Psoriatic arthritis (PsA) is a chronic in?amatory disease characterized with axial and peripheral joints involvement. It is rarely affects patients older than 65 years old. Objectives: The purpose of this study is to compare and evaluate the demographic,clinicalandlaboratoryfeaturesofelderly-onsetpsoriaticarthritis(EOPsA) and young-onset (YOPsA) patients. Methods: One hundred and eighty patients diagnosed with PsA according to CASPAR criteria and followed-up in single center were included in this study. The patients with initial symptoms started after age 65 were accepted as EOPsA. Demographic,clinical,andlaboratorydataandthemedicationswhichthepatients recieved were recorded and retrospectively evaluated. Results: Nineteen (10.5%)of 180 patients were diagnosed as EOPsA, and 161 (89.5%) patients were evaluated as YOPsA. Mean patient age was 42.1years for YOPsA group and 68.3years for elderly onset group. Mean duration of disease was 5.6 years for early onset group and 1.3 years for elderly onset group (p=0.001). Fourteen (73.3%) of 19 EOPsA patients were female and 5 of them were male. Higher rates of fatique, pain scores, comorbid diseases and acute phase reactants were detected in EOPsA patients comparing to YOPsA (p=0.000, p=0.000, p=0.001 and p=0.001 respectively). YOPsA patients have more dactilitis, nail involvement, elevated PASI scores, and smoking habitus when comparedwithEOPsApatients(p=0.019,p=0.03,p=0.005,p=0.004respectively). In terms of the treatment options chosen, there was no signi?cant difference in the use of non-steroidal anti-in?ammatory drugs (NSAIDs), corticosteroids (CS), methotrexate (MTX), and sulfasalazine (SSL), but there was a more frequent use of anti-tumor necrosis factor -alpha in YOPsA group. Conclusions: Herein we showed that YOPsA and EOPsA patients may have different demographic, clinical, and laboratory features. EOPsA patients are characterized with higher rates of fatique, pain scores, comorbid diseases, and acute phase reactants and less dactilitis, nail involvement and anti-TNF-alpha usage.Öğe Development of hodgkin lymphoma in a patient with sarcoidosis(Pagepress Publ, 2017) Gediz, Feyza; Yılmaz, Ayce Feride; Payzin, Bahriye; Yüksel, Temiz; ÇallI, Aylin Orgen; Kobak, ŞenolSarcoidosis is a chronic granulomatous disease of unknown etiology characterized by non-caseified granulomas in many different organs and systems. The disease most frequently manifests with bilateral hilar lymphadenopathy and infiltrations in the lungs and skin, as well as with eye lesions. It may mimic a number of systemic diseases and/or accompany them. The development of lymphoma in patients with sarcoidosis or the co-occurrence of both diseases is rarely reported in the literature. In this paper we report a female patient followed up with sarcoidosis for three years who developed Hodgkin lymphoma, according to the results of the investigations and biopsy results.Öğe Elderly - onset sarcoidosis: a single center comparative study(Ediciones Doyma, S.L., 2020) Kobak, Şenol; Yıldız, Fidan; Semiz, Hüseyin; Orman, Mehmet AkifObjectives: Sarcoidosis rarely affect patients older than 65 years old. The purpose of this study is to compare and evaluate the demographic, clinical and laboratory features of elderly-onset (EOS) and young-onset sarcoidosis (YOS) patients. Methods: One hundred and thirty one patients diagnosed with sarcoidosis according to clinical, radiologic and histopathological evaluation were included in this study. The patients with initial symptoms started after age 65 were accepted as EOS. Results: Twenty (15.3%) of 131 patients were diagnosed as EOS, and 111 (84.7%) patients were evaluated as YOS. Fifteen of 20 EOS patients were female and 5 of them were male. Average duration of the disease was determined as 38.4 months for YOS and 22.5 months for EOS (p = 0.556). Delay of the diagnosis was 12 months for YOS while it was 3 months for EOS (p = 0.001). Higher rates of fatique, comorbid diseases and more hydroxychloroquine (HQ) use were detected in EOS patients comparing to YOS (p = 0.010, p = 0.003 and p = 0.039 respectively). Conclusions: EOS patients are characterized with higher rates of fatique and comorbid diseases, less inflammatory sign and delayed diagnosis, and less DMARDs use. © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de ReumatologíaÖğe Elderly - onset sarcoidosis: a single center comparative study(Wiley, 2017) Kobak, Şenol; Yıldız, Fidan; Semiz, Hüseyin; Orman, Mehmet[No Abstract Available]Öğe Elderly - onset sarcoidosis: a single center comparative study(Bmj Publishing Group, 2017) Kobak, Şenol; Sever, Fidan; Semiz, Hüseyin; Orman, Mehmet AkifSarcoidosis is a chronic granulomatous inflamatory disease characterized with non-caseified granuloma formation. It is rarely affects patients older than 65 years old.Öğe Familial sarcoidosis: report of a mother and her son(Aves, 2017) Akyıldız, Ekin; Kobak, ŞenolSarcoidosis is a chronic, multisystemic inflammatory disease, characterized with noncaseating granulomas. The pathogenesis of the disease is not yet clear, however, the main hypothesis is impaired and inadequate immune response developing against different environmental triggers in genetically predisposed people. The role of genetic factors in the development of sarcoidosis is well known. Over many years, familial sarcoidosis cases have been reported in various studies. In this report, we present familial sarcoidosis cases in a mother and her son.Öğe Familial sarcoidosis: Report of a mother and her son(AVES Yayıncılık, 2017) Akyıldız, Ekin; Kobak, ŞenolSarcoidosis is a chronic, multisystemic inflammatory disease, characterized with noncaseating granulomas. The pathogenesis of the disease is not yet clear, however, the main hypothesis is impaired and inadequate immune response developing against different environmental triggers in genetically predisposed people. The role of genetic factors in the development of sarcoidosis is well known. Over many years, familial sarcoidosis cases have been reported in various studies. In this report, we present familial sarcoidosis cases in a mother and her sonÖğe Hyponatremia as presentation in a patient with neurosarcoidosis(Elsevier Doyma Sl, 2017) Akyıldız, Ekin; Yalçın, Murat; Sever, Fidan; Semiz, Hüseyin; Kobak, ŞenolSarcoidosis is an inflammatory disease with unknown cause characterized by non-caseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, eye and musculoskeletal system involvement. Hypercalcemia and hypercalciuria are important electrolyte imbalances resulting from sarcoidosis and sometimes they may cause nephrolitiasis and kidney failure. Hyponatremia, although being quite rare, has been found in some patients with sarcoidosis. Herein, we have reported a patient with neurosarcoidosis who presented with hyponatremia and responded well to corticosteroid treatment. (C) 2016 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.Öğe Immune checkpoint inhibitors-related rheumatic diseases: what rheumatologist should know?(Bentham Science Publ Ltd, 2019) Gediz, Füsun; Kobak, ŞenolImmune checkpoint inhibitors are revolutionized drugs for cancer immunotherapy in the last years. The mechanism of action of CPIs including the limitation of the activation of Tcells, and thus enhancing the self-immune response against tumour cells. Checkpointinhibitors(CPIs) may dysregulate the immune system, resulting in some toxicities. These toxicities or side effects are called Immune-related Adverse Events (IRAEs) that can potentially affect any organ and tissue. Rheumatic diseases due to checkpoint inhibitors are also reported in the literature. The spectrum of rheumatic manifestations are quite wide; the most common are arthralgia/arthritis, myalgia/myositis, polimyalgia rheumatica, lupus, rheumatoid arthritis, Sjogren's syndrome. At the same time, these drugs can also cause an exacerbation of known rheumatologic disease. Treatment approaches for developing rheumatic findings due to checkpoint inhibitors should be multidisciplinary. There should be a close relationship between oncologists who follow-up these patients and rheumatologists. The rheumatic manifestations should be defined and treated early. In general, the musculoskeletal side effects are transient and may regress after stopping CPIs. The most commonly used medications are corticosteroids. Immunosuppressive drugs (HQ, MTX, anti-TNF-alpha, anti-IL-6) should be preferred when treatment is unresponsive or as steroid-sparing agents. The aim of this review was to evaluate the checkpoint inhibitors-related rheumatologic findings and therapeutic strategies in light of recent literature data.
