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OBJECTIVE: To evaluate whether there is any difference between radiographic axial spondyloarthritis (r-axSpA), also termed ankylosing spondylitis (AS), and non-radiographic (nr-) axSpA, with respect to subclinial myocardial dysfunction using speckle tracking echocardiography (STE). METHODS: This was a cross-sectional case control study. We included 72 patients with AS, 38 patients with nr-axSpA, and 56 age-matched healthy subjects. Patients with cardiac disease and cardiac risk factors affecting STE were excluded. The disease burden evaluated by the BASDAI, BASFI, BAS-G, and ASAS-HI scores were comparable in both the r- and nr-axSpA groups. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population. RESULTS: Duration of the disease, the use of an anti-TNFα agent, and CRP levels were higher in patients with AS. Although the AS, nr-axSpA, and control groups had similar ejection fraction values (59±5.2, 60±4.6, 60±4.6, respectively, and p=0.499), the global longitudinal peak systolic strain (GLS) (20.5±3.3, 21.1±3.5, and 22.3±2.4, respectively, and p

WOS: 000463722100007, PubMed ID: 30489254, Objective: Familial Mediterranean fever (FMF) is the most common autoinflammatory disease. Most of the identified disease-causing mutations are located on exon 10. As the number of studies about the effect of the exonal location of the mutation and its phenotypic expression is limited, we aimed to investigate whether the exonic location of the Mediterranean fever (MEFV) mutation has an effect on the clinical manifestation in patients with FMF. Methods: Study population was derived from the main FMF registry that included 2246 patients from 15 different rheumatology clinics. We categorized the mutations according to their exon locations and retrieved the clinical and demographic information from the database. Results: Patients having the MEFV mutations on exon 2 or 10 (n: 1526) were divided into three subgroups according to the location of the MEFV mutations: Group 1 (exon 2 mutations), Group 2 (exon 10 mutations), and Group 3 (both exon 2 and exon 10 mutations). Group 2 patients were of a significantly younger age at onset, and erysipel-like erythema, arthritis, amyloidosis, and a family history of FMF were more common in this group. Conclusion: Patients with FMF and exon 10 mutations show more severe clinical symptoms and outcome. Exon 2 mutations tend to have a better outcome.

Infectious diseases in any age group can be successfully prevented through immunization. Protection provided through immunization in childhood decreases over the years. Immunization in adulthood is important because of the growing elderly population, chronic diseases, and globalization. Recommendations on this subject are being constantly updated through scientific guidelines. Immunization in adulthood is also important in rheumatology. There is an increased risk not only of infection in rheumatic diseases but also of infections being more severe. Most infections, and their frequently observed complications, are among those diseases that can be prevented through immunization. The type of immunization, immunosuppressive/immunomodulatory therapy received by the patient, disease activity, and presence of chronic diseases affect the immunization process in patients with rheumatic diseases. This review will consider the immunization process followed in rheumatic diseases and also refer to its application.

OBJECTIVE Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine and sacroiliac joints of unknown etiology. Recent studies have reported increased oxidative stress, which is implicated in the pathogenesis of a number of diseases, in AS. The purpose of this study was to investigate oxidative stress and related factors in AS. MATERIAL AND METHODS Eighty-five patients with AS [36 (16-64) years; 65 male/20 female] and 56 healthy subjects [36 (21-63) years; 39 male/17 female] with no known cardiovascular risk factors were enrolled. Serum total oxidant status (TOS) and total anti-oxidant status (TAS) were studied. The Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis disease activity index (BASDAI), and Bath ankylosing spondylitis metrology index (BASMI) were calculated. A logistic regression model was used to identify the independent risk factors for TOS. RESULTS No differences were observed in terms of demographic characteristics, laboratory findings, or TAS concentrations between the patient and control groups. However, the serum TOS levels were significantly higher in the AS group than in the controls (p=0.003). The comparison of cases of active (BASDAI ≥4) and inactive AS revealed significantly higher TOS levels in the active disease group. The TOS and TAS concentrations did not differ between patients treated with biological agents and those treated with conventional agents. Correlation analysis yielded significant correlations between TOS and TAS, BASMI, BASFI, BASDAI, erythrocyte sedimentation rate (ESR), and high-sensitive C-reactive protein (hs-CRP) (p

Objective: Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Increased body fat, particularly its central distribution, is a well-known risk factor for CVD. A change in body composition in RA has been described previously. However, in most of these studies, age- and sex- but not body mass index (BMI)-matched controls were used. The aim of this study was to evaluate body composition in RA patients and compare it with age-, sex-, and BMI-matched controls. Material and Methods: Sixty-five RA patients (55 females and 10 males; mean age 54.9 ± 10.8) and 31 healthy controls (25 females, 6 males; 53.8±8.6) were included in this study. Mean disease duration was 9.2±9.6 years. Body composition was assessed by anthropometric methods (skinfold thicknesses, body circumferences), bioimpedance analysis, and dual-energy X-ray absorptiometry (DXA). Visceral adipose tissue (VAT) was assessed with computed tomography. Results: There were no significant differences for total body fatness, regional fat distribution, and total body water and fat-free mass between RA patients and control subjects. Bone mineral content (BMC), assessed by DXA, was significantly lower in RA patients (p=0.004). Clinical disease activity indices and steroid treatment do not affect soft tissue body composition or BMC. Conclusion: At least some RA patients do not have soft tissue composition alterations and may have similar health risks in comparison with subjects with similar age, sex, and total adiposity.

A 43-year-old female presented with progressive left buttock pain for 6 months. Her pain was worse at night and was not relieved by activity. She had morning stiffness for 5–10 min. She had no constitutional symptoms, history of peripheral arthritis, dactylitis, enthesitis, psoriasis, and inflammatory bowel disease. She denied having a past or family history of tuberculosis (Tb). She was administered with sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs), but her condition did not improve. Laboratory examination revealed an ESR of 21 mm/h and a CRP of 1.43 mg/dL (normal range, 0.0–0.8 mg/dL). Pelvic antero-posterior radiograph showed minimal sclerosis with joint space changes of the left sacroiliac joint (SIJ). Paracoronal T1-weighted (Figure 1a) and short tau inversion recovery (STIR) (Figure 1b) magnetic resonance (MR) images revealed joint space enlargement with increased joint fluid in the left SIJ as well as heterogeneous bone marrow edema and hyperintense lesion spreading to periarticular soft tissues. Gadolinium-enhanced axial fat suppressed T1-weighted MR image of SIJs (Figure 1c) showed a smooth thin-rimmed enhancement area extending anteriorly from the left SIJ to the iliacus muscle and extending laterally to gluteal muscles that was compatible with cold abscess. Extensive destruction of both iliac and sacral bones of the left SIJ was also visualized in the axial computed tomography (CT) images (Figure 1d) obtained during CT guided biopsy procedure. Culture of the biopsy material yielded Mycobacterium tuberculosis, and the patient was administered with a four-drug anti-tuberculous therapy. Musculoskeletal involvement is uncommon and accounts for 1%–3% of all Tb (1) cases, and SIJ Tb was reported in approximately 10% (2) of the musculoskeletal Tb cases. Early diagnosis of SIJ Tb is extremely difficult mainly because of the non-specific nature of the symptoms. Although the culture is the gold standard for the diagnosis, CT and MR may be complementary for the diagnosis. The severe joint destruction and a cold abscess with a smooth thin-rimmed enhancement may be suggestive of Tb (3).

A 39-year-old female presented with malaise, weight loss, and generalized joint pain. Symptoms started 6 months prior to presentation and progressed over time. Laboratory tests revealed increased C-reactive protein (43.4 mg/L) and lactate dehydrogenase (330 U/L). Chest imaging showed mediastinal lymphadenopathy and nodular infiltration in the parenchyma of both lungs. Due to the subtle loss of weight and results of other imaging studies, positron emission tomography (PET) with fluorodeoxyglucose (FDG) was performed. Pathological FDG uptakes were observed in the cervical, hilar, and intraabdominal lymph nodes, lung parenchyma, liver, humerus, and ilium (Figure 1A). The patient was diagnosed as sarcoidosis according to the histopathological examination of a mediastinal lymph node. Corticosteroid and azathioprine were prescribed. Four months after treatment, a control PET scan was performed (Figure 1B). There was dramatic improvement in all anatomical sites compared with the first scan, correlating with symptom relief. In conclusion, PET scan may be a useful tool for monitoring disease activity in widespread sarcoidosis.