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Öğe A single-center experience: Enteropathic arthritis in inflammatory bowel diseases(Elsevier, 2024) Cabuk, Baris; Gokten, Dilara Bulut; Solakoglu, Tevfik; Mete, Rafet; Kucukmetin, Nurten Turkel; Mercan, RidvanAim of the work: To ascertain the frequency of enteropathic arthritis among patients diagnosed with inflammatory bowel disease (IBD) and to investigate the relation between spondyloarthritis (SpA) and patients treated for IBD. Patients and methods: This study examined 124 adult patients with IBD. The evaluation encompassed both axial and peripheral SpA. Information pertaining to the patients ' age, gender, age at the time of IBD and SpA diagnosis, symptoms of inflammatory low back pain (iLBP), dactylitis, peripheral arthritis, history of uveitis, pelvic X-ray, sacroiliac joint magnetic resonance imaging (MRI), ankylosing spondylitis disease actviity score (ASDAS) and Bath ankylosing spondylitis disease actvity index (BASDAI) were compiled. Results: The IBD patients were 82 having ulcerative colitis (UC) and 42 Crohns disease (CD). 58 (46.8 %) were female and 66 (53.2 %) males. 36 (29 %) were diagnosed with SpA, 18 males and 18 females. The age of the patients was 49 +/- 11.2 years (18 -74 years). The duration of IBD was 5.96 +/- 5.54 years (1 -29 years). Sacroiliitis was assessed in 60 (48.3 %) patients using MRI. None of the patients had psoriasis or uveitis. Dactylitis was present in 1.6 % and enthesitis in 8 % of patients with IBD. In UC group, 18 (21.9 %) were diagnosed with SpA and in CD group, 18 (42.8 %) had SpA. No significant relationship was found between the diagnosis of UC/CD and the general SpA group. Conclusion: A considerable number of individuals with IBD also experience SpA. Any delay in diagnosing enteropathic arthritis could lead to functional limitations. Therefore, timely diagnosis is crucial to facilitate optimal treatment.Öğe Bilateral hand dactylitis: An unusual presentation of the great imitator: Tuberculosis(Oxford Univ Press, 2024) Gokten, Dilara Bulut; Kavak, Fatma Yumun; Mercan, RidvanThe incidence of tuberculosis in developed countries has decreased over the years due to the use of effective tuberculosis drugs and improvements in socio-economic conditions. However, with the ease of global transport and increased travel to countries with high tuberculosis prevalence, the reduction in extrapulmonary tuberculosis cases has been less significant compared with the overall decrease in tuberculosis cases. Extrapulmonary tuberculosis can manifest in a variety of ways. Tuberculous dactylitis, a rare form of tuberculous osteomyelitis, was first described by Rankin in 1886. It mainly affects the short tubular bones in the hands and feet of children and is sometimes called 'spina ventosa'. A 42-year-old male patient initially presented to an external centre reporting swelling and pain in the hand joints of one year's duration. Despite one year of treatment with leflunomide and methylprednisolone (16 mg) and a history of methotrexate use during this period, he experienced no improvement. The patient's condition worsened after the start of sulfasalazine. Dermatological examination was performed due to the presence of haemorrhagic crusted papules and plaques on the ventral surface of both hands. A wound culture was taken, but no bacterial growth was observed. One week after the initial evaluation, the patient complained of persistent foul-smelling nasal discharge, which led to an evaluation by the infectious disease department. At this time, the Quantiferon test was positive. Mycobacterial culture on Days 1 and 3 showed growth of the Mycobacterium tuberculosis complex.Öğe Could rituximab be a silver lining in refractory bone marrow fibrosis caused by lupus?(Turkish League Against Rheumatism, 2024) Gokten, Dilara Bulut; Kavak, Fatma Yumun; Mercan, Ridvan[Abstract Not Available]Öğe Rare combo: moyamoya and lupus in men(Springer London Ltd, 2024) Gokten, Dilara Bulut; Gokten, Murat; Deniz, Cigdem; Mercan, RidvanMoyamoya syndrome (MMS) is a rare, chronic, progressive cerebrovascular disorder characterized by stenosis at the apices of the intracranial internal carotid arteries, including the proximal anterior cerebral arteries and middle cerebral arteries. Cerebral angiography images are used for detection through measurement. Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause multisystemic involvement. The coexistence of SLE and MMS has been rarely reported in the literature. A 46-year-old male patient with malar rash, Raynaud phenomenon presented to the hospital with a complaint of weakness in the left lower extremity, which began 3 days before the date of the visit. In the diffusion magnetic resonance imaging, multiple diffusion restrictions were observed in the right frontal region. The patient underwent MR angiography, revealing stenosis in the terminal and supraclinoid segments of the right internal carotid artery, which made us consider moyamoya disease. This patient, with a malar rash and Raynaud's, a positive antibody profile, was diagnosed as a male with SLE accompanied by MMS.Öğe Salmonella osteomyelitis and retropharyngeal, epidural abscess that developed under biologic therapy(Sociedade Portuguesa de Reumatologia, 2023) Gökten, Dilara Bulut; Akdağ Kaval, Emine Melda; Mercan, RidvanSalmonella is still observed as an infectious agent in developing countries, often causing gastrointestinal infections. Extra-gastrointestinal infections are rare and spinal infections are even rarer. This case report describes a patient with rheumatoid arthritis who is actively receiving biologic therapy, presented with dysphagia, recurrent fevers, back and arm pain, weight loss and weakness and was diagnosed with retropharyngeal and epidural Salmonella infection. © 2023, Sociedade Portuguesa de Reumatologia. All rights reserved.Öğe Sarcoidosis from the Perspective of Rheumatology: Three Years of Experience(Galenos Publ House, 2024) Gokten, Dilara Bulut; Mercan, RidvanAim: The aim of this study is to shed light on sarcoidosis from a rheumatology perspective and to provide a better understanding of sarcoidosis from the perspective of a rheumatologist. Materials and Methods: The files of patients who applied to the rheumatology outpatient clinic with joint complaints between 2020 and 2023 and were diagnosed with sarcoidosis during follow-up or who were already diagnosed with sarcoidosis and had joint complaints during the course of the disease, were retrospectively examined. Results: Joint involvement was observed in all patients (100%). When patients were grouped according to the joints involved, it was found that 17 patients had ankle involvement (60.7%), six patients had metacarpophalangeal joint involvement (21.4%), four (14.2%) patients had wrist involvement, and three (10.7%) patients had knee involvement. Shoulder involvement was detected in one (3.5%) patient. Conclusion: Although sarcoidosis seems to primarily concern chest diseases, from the perspective of rheumatology, it is a very confusing and surprising disease with its heterogeneous nature and joint involvement. It is one of the diseases that should be kept in mind and further studied in rheumatology practice.Öğe Sistemik Lupus Eritematozus tanılı hastalarda hipermobilite sıklığı ve bu hastaların demografik, sosyal, klinik özellikleri(2024) Mercan, Ridvan; Gokten, Dilara Bulut; Kavak, Fatma YümünGiriş: Eklem hipermobilitesi, sık görülen bir fiziksel özelliktir. Benign eklem hipermobilite sendromu (BEHS) tek başına olabileceği gibi, müsküloskeletal ağrı ile birlikte veya kompleks fenotiplerin bir parçası olarak görülebilmektedir. Romatizmal hastalıklarda eklem laksiteleri yıllar içerisinde bazı çalışmalarda araştırılmıştır. Lupus tanılı hastaların vücut yapılarında görülen değişiklikler konusunda literatürde çalışmalar bulunmaktadır. Beighton skoru, lupus sürecinde görülen manifestasyonlardan etkilenmez ancak bu skorlama lupus semptomlarını da içermektedir. Bu nedenle skorlama ve lupus arasındaki ilişki kafa karıştırıcı olabilmektedir. Bu çalışmadaki amaç romatoloji polikliniğimizde takipli lupus tanılı hastaların hipermobilite sıklığını ortaya koymaktır. Yöntemler: Bu çalışmada, romatoloji polikliniğine 01.04.2023- 01.10.2023 tarihleri arasında başvurmuş 40 sistemik lupus eritematozus (SLE) tanılı hastanın dosyaları retrospektif olarak incelenmiştir. Retrospektif olarak incelenen dosyalardan, hastaların hipermobilitelerini gösteren Beighton skorları kaydedilmiştir. Bulgular: İncelememiz sonucunda hasta grubumuzun 20’sinin (%50) Beighton skorlarının dört ve üzeri olduğunu tespit ettik ve bu hastaları hipermobil olarak sınıflandırdık. Hastaları hipermobil olanlar ve olmayanlar olarak iki gruba ayırıp eklem ağrısı ve artrit yönünden baktığımızda, hipermobil olan yirmi kişinin dokuzunda (%45), hipermobil olmayan yirmi kişinin dördünde (%20) müsküloskeletal şikayet tespit ettik. Sonuç: Sonuç olarak, hipermobilite spektrum bozuklukları, ciddi müsküloskeletal ağrıya neden olabilmektedir. Bu durum ise sistemik lupus eritematozus seyrinde hastalığın oluşturduğu artralji, müsküler ağrı veya artritle karışabilmektedir. Bu durum ise klinisyenlerce hastalığın remisyona girmemesi olarak algılanabilir ve immünsüpresif tedavi verilmesi veya tedavide basamak artırılmasıyla sonuçlanabilir. Bu nedenle lupus seyrinde eşlik edebilen hipermobilitenin ayrıntılı şekilde incelenmesi gerekmektedir.
