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Introduction: Patients with chronic inflammatory rheumatic diseases (CIRD) who receive intravenous therapy requiring hospitalization are likely to be more affected than those with receiving oral therapy during COVID-19 pandemic. We aimed to investigate the effect of the COVID-19 pandemic on adherence to treatment in patients with CIRD receiving intravenous treatments. Methods: We evaluated patients with CIRD who were treated with intravenous immunosuppressive therapy such as rituximab (RTX), cyclophosphamide (CTX), infliximab (IFX), tocilizumab (TCZ) and abatacept (ABA) in our inpatient rheumatology clinic. The patientsʼ medical treatment compliance and clinical follow-up were evaluated. Treatment discontinuation was decided according to postponement of at least one dose and discontinuation of CIRD treatments. Demographics and clinical characteristics were compared between treatment-incompliant (TI) and treatment-compliant (TC) groups. Results: A total of 181 CIRD patients were enrolled. Rheumatoid arthritis was the most common disease requiring intravenous immunosuppressive treatment followed by axial spondyloarthritis and Behçet’s disease. Joint involvement was the most common followed by lung and kidney involvements. Rituximab was the most widely used intravenous immunosuppressive treatment for the CIRD. 34% patients have postponed at least one dose of their intravenous CIRD treatment and 25% discontinued. Fear of COVID-19 and SARS-CoV-2 positivity were the most common reasons. The TI group had a longer disease duration and a higher frequency of inflammatory arthritis than the TC group (p=0.013 and p=0.044, respectively). Conclusions: Fear of COVID-19 and SARS-CoV-2 positivity seemed to be the major reasons for discontinuing/postponing intravenous treatments in CIRD patients. Patients with long disease duration and less systemic involvement may be more prone to discontinuing their treatments.

The purpose of this study was to determine possible cut-off levels of basal DHEA-S percentile rank in the differential diagnosis of patients with Cushing’s syndrome (CS) with ACTH levels in the gray zone and normal DHEA-S levels. In this retrospective study including 623 pathologically confirmed CS, the DHEA-S percentile rank was calculated in 389 patients with DHEA-S levels within reference interval. The patients were classified as group 1 (n=265 Cushing’s disease; CD), group 2 (n=104 adrenal CS) and group 3 (n=20 ectopic ACTH syndrome).ROC-curve analyses were used to calculate the optimal cut-off level of DHEA-S percentile rank in the reference interval in the differential diagnosis of CS, and the effectiveness of this cut-off level in the identification of the accurate etiology of CS was assessed in patients who were in gray zone according to their ACTH levels. The DHEA-S percentile rank in the reference interval were significantly lower in group 2 compared to the other two groups (p This study showed that the cut-off value of DHEA-S level less than 20% of the reference interval could be used for differential diagnosis of CD and adrenal CS with high sensitivity and specificity, and it should be taken into the initial evaluation.

Objective: Metabolic syndrome (MetS) is one of the preventable risk factors for cardiovascular disease (CVD). The aim of this study was to investigate the effect of MetS on CVD and cumulative organ damage in a multi-center, large cohort of patients with Takayasu arteritis (TAK). Methods: This is a cross-sectional study involving 192 consecutive TAK patients from seven tertiary rheumatology centers in Turkey. Clinical data of TAK patients fulfilling the 1990 American College of Rheumatology classification criteria were collected from medical records. They were evaluated for risk factors of CVD, disease activity, damage, and MetS at their last visits. Results: A total of 192 consecutive TAK patients were included in this study. One hundred and fifty-eight (82%) were female, the mean age was 43.3 +/- 13 years, and mean disease duration was 13.5 +/- 9.3 years. MetS was detected in 50 (26%) of the patients and CVD was detected in 28 (14.6%). The presence of MetS was detected as an independent risk factor for CVD (P < 0.001). In addition, the mean vasculitis damage index of the group with MetS was significantly higher than in the other patients (4.5 +/- 3.3 vs 3.2 +/- 2.2, respectively, P = 0.004). Conclusion: The presence of MetS in TAK is associated with increased CVD and disease damage. Awareness and management of MetS can improve disease prognosis in patients with TAK.

Introduction: One of the factors that may aggravate the clinical presentation in COVID-19 is the increased level of antiphospholipid antibodies (aPLs) and thrombotic events that can be seen with the disease. In our retrospective study, we aimed to evaluate the effect of aPLs on the clinical findings in patients with a diagnosis of COVID-19. Methodology: Seventy-three patients diagnosed with COVID-19 and examined for aPLs were included in the study. Patients were divided into two groups according to the test results of aPLs. Clinical and laboratory parameters were compared in both groups to reveal whether there was any difference between the groups. Results: There were 15 patients with a positive aPLs test. Dyspnea, nausea, vomiting, myalgia, and abdominal pain were significantly higher in the aPLs positive group than those with negative aPLs. The duration of hospital stays and the need for oxygen therapy of the patients in the aPLs positive group were significantly higher than the aPLs negative group. However, no difference was found between the two groups in terms of mechanical ventilation need, intensive care admission rate, thrombosis and mortality. In terms of laboratory findings, those with positive aPLs have higher median C-reactive protein (CRP) and ferritin values than those with negative aPLs. Conclusions: In our study group, we could not find a relationship between aPLs positivity and critical complications. According to our hypothesis, it may not be necessary to routinely examine aPLs in patients with a diagnosis of COVID-19 to determine the risk of thromboembolic complications.

Objectives We sought to evaluate the performance of the SLE Risk Probability Index (SLERPI) for identification of SLE in a large cohort of patients with UCTD. Methods The SLERPI was applied in a cohort of patients who met classification criteria for UCTD and did not fulfil any classification criteria for other defined CTD including SLE. Patients with a SLERPI score of >7 were ‘diagnosed’ as SLE. Patients diagnosed with SLE and those not were compared in terms of disease characteristics and index parameters. Results A total of 422 patients with UCTD were included in the study. Median (interquartile range) SLERPI was 4.25 (2.5) points, while 39 (9.2%) patients had a SLERPI score >7 and were diagnosed as SLE. Patients with younger age (P = 0.026) and presence of malar rash (P 500 mg/24 h (P = 0.001), thrombocytopenia (P = 0.009) or autoimmune haemolytic anaemia (P Conclusion SLERPI enabled a significant proportion of patients to be identified as SLE in our UCTD cohort. This new probability index may be useful for early identification of SLE among patients with signs of CTD without fulfilling any definite criteria set.

Aim of this study is to investigate COVID-19 outcomes in patients with antiphospholipid syndrome (APS).A retrospective cohort was formed from APS patients. Patients were screened for a record of positive SARS-CoV 2 PCR. In PCR‑positive patients, clinical data and information regarding COVID-19 outcomes were collected from medical records.A positive PCR test was detected in 9/53 APS patients, while 66.7 %, 33.3 % and 11.1 % of APS patients with COVID-19 were under hydroxychloroquine, LMWH or warfarin, and acetylsalicylic acid, respectively. There were 3/9 patients found to be hospitalized and one died. No new thrombotic event was reported in any of the patients during COVID-19 infection.Baseline use of hydroxychloroquine, antiaggregants and anticoagulants may be associated with an absence of new thrombotic event (Tab. 2, Ref. 33).

Behçet's disease (BD) is a chronic inflammatory vasculitis affecting multiple organs. Uveitis is frequently seen in patients with BD, especially in Turkish population.To investigate vascular endothelial growth factor (VEGF) gene polymorphisms along with the levels of VEGF and VEGF receptors in patients with Behçet's uveitis (BU).Fifty-five BD-associated uveitis patients and 30 ageand sex-matched controls were included in this case-control study. The genotypes of the single nucleotide poymorphisms (SNPs): rs2010963 (+405G), rs3025039 (+936T) and rs699947 (-2598A) of the VEGF-A gene were determined using real-time polymerase chain reaction (RT-PCR) and serum levels of VEGF and VEGF receptors were measured using enzyme-linked immunosorbent assay (ELISA).No associations of the VEGF gene polymorphisms were observed in BD uveitis patients, but arthritis was present in 53.3% of patients not possessing CT genotype in C3025039→T polymorphism (p = 0.024). Although there were no statistically significant differences in serum VEGF-A, VEGF-C and soluble vascular endothelial growth factor receptor-3 (sVEGFR-3) levels (p0.05), serum vascular endothelial growth factor receptor-1 (VEGFR-1) and sVEGFR-3 levels were significantly higher in the BD group (p0.001 and p = 0.001, respectively). In addition, VEGF-C/soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) ratio was significantly higher (p0.001), while VEGF-A/VEGFR-1 and VEGF-C/sVEGFR-3 ratios were significantly lower (p0.001 and p = 0.033, respectively) in BD patients compared to controls. Also, VEGF-C/sVEGFR-3 (p = 0.024, r = 0.37) and VEGF-C/sVEGFR-2 (p = 0.020, r = 0.38) ratios were positively correlated with disease duration.The significant changes in sVEGFR-3 levels and VEGF-C/sVEGFR-3 ratio has shown that lymphangiogenesis processes might take place in the pathogenesis of BD uveitis, and these parameters can be important indicators of evaluation of BD patients with uveitis together with disease duration.

Objective: Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behcet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment. Methods: Patients with BD (n = 205; 166 men, 39 women; age 39 6 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated. Results: Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-a use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010). Conclusions: Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-a also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS. (J Vasc Surg Venous Lymphat Disord 2021;9:1451-9.)

Hypoparathyroidism is an orphan disease with ill-defined epidemiology that is subject to geographic variability. We conducted this study to assess the demographics, etiologic distribution, treatment patterns and complication frequency of patients with chronic hypoparathyroidism in Turkey. This is a retrospective, cross-sectional database study, with collaboration of 30 endocrinology centers located in 20 cities across seven geographical regions of Turkey. A total of 830 adults (mean age 49.6 ± 13.5 years; female 81.2%) with hypoparathyroidism (mean duration 9.7 ± 9.0 years) were included in the final analysis. Hypoparathyroidism was predominantly surgery-induced (n = 686, 82.6%). The insulting surgeries was carried out mostly due to benign causes in postsurgical group (SG) (n = 504, 73.5%) while patients in nonsurgical group (NSG) was most frequently classified as idiopathic (n = 103, 71.5%). The treatment was highly dependent on calcium salts (n = 771, 92.9%), calcitriol (n = 786, 94.7%) and to a lower extent cholecalciferol use (n = 635, 76.5%) while the rate of parathyroid hormone (n = 2, 0.2%) use was low. Serum calcium levels were most frequently kept in the normal range (sCa 8.5–10.5 mg/dL, n = 383, 46.1%) which might be higher than desired for this patient group. NSG had a lower mean plasma PTH concentration (6.42 ± 5.53 vs. 9.09 ± 7.08 ng/l, p < 0.0001), higher daily intake of elementary calcium (2038 ± 1214 vs. 1846 ± 1355 mg/day, p = 0.0193) and calcitriol (0.78 ± 0.39 vs. 0.69 ± 0.38 mcg/day, p = 0.0057), a higher rate of chronic renal disease (9.7% vs. 3.6%, p = 0.0017), epilepsy (6.3% vs. 1.6%, p = 0.0009), intracranial calcifications (11.8% vs. 7.3%, p < 0.0001) and cataracts (22.2% vs. 13.7%, p = 0.0096) compared to SG. In conclusion, postsurgical hypoparathyroidism is the dominant etiology of hypoparathyroidism in Turkey while the nonsurgical patients have a higher disease burden with greater need for medications and increased risk of complications than the postsurgical patients. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Objectives The aim of this study is to investigate the outcomes of coronavirus disease 2019 (COVID-19) in our cohort of Behçet’s disease (BD) patients and to reveal the rate of BD exacerbations due to COVID-19. Methods Patients who have been followed with a diagnosis of BD were retrospectively investigated for a positive severe acute respiratory syndrome–coronavirus 2 polymerized chain reaction (PCR) test. Data regarding demographics, clinical features and COVID-19 outcomes were collected from medical records for patients with a positive PCR. PCR-positive patients were reached via phone numbers, and ‘Behçet’s Disease Current Activity Form’ (BDCAF) scores for pre- and post-COVID-19 BD symptoms were calculated. Results Out of a total 648 BD patients, 59 were detected to have a positive PCR test. Three of the 59 patients (5.0%) were found to be hospitalized, none of them was admitted to the ICU or died. An increasing trend in the frequency of comorbid diseases and older age was observed in hospitalized patients. 32.2% of BD patients suffered from exacerbation of at least one symptom related to BD. Conclusions We observed no ICU admission or mortality with COVID-19 in our BD patient cohort. A substantial number of patients suffered from exacerbation of BD symptoms.

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by frequent attacks and chronic inflammation. Subclinical inflammation continues during the attack-free period. Omentin is an anti-inflammatory adipokine, which plays important roles in the adjustments of glucose metabolism, cardiovascular homeostasis and atherosclerosis. The aim is to investigate the omentin levels in FMF patients and to assess the association with markers of subclinical inflammation in FMF patients such as serum amyloid A (SAA), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).This cross-sectional study included 54 consecutive adult FMF patients (27 male, 27 female) and 28 healthy individuals (16 male, 12 female). The FMF patients were separated into 3 groups: (1) attack-free group, (2) active-attack group and (3) colchicine-resistant group. Serum omentin levels were compared between the FMF patients and the healthy control group.A significant difference was determined between the FMF patients and healthy control subjects in terms of omentin levels (108.05 (19.97-343.22) vs. 199.5 (42.98-339.41) p 0.05). SAA values were significantly higher in the FMF patients compared with the healthy control group. When the FMF patients were examined as separate groups, serum omentin values were lower in the colchicine-resistant group than in the groups without resistance (76.64 (19.77-224.33) vs. 186.47 (28.41-343.21) p = 0.006).FMF patients with colchicine resistance are associated with decreased omentin concentrations, probably mediated by inflammation-driven mechanisms. Key Points • Omentin is a type of adipokine which has an anti-inflammatory effect by inhibiting the inflammatory cytokine network. • Decreased omentin levels are associated with increased obesity, insulin resistance and comorbidities. • We report that omentin levels fluctuate in various diseases. In addition, we have focused on the levels of omentin in patients with FMF, as it may act as a biomarker for colchicine resistance.

Vaccination represents a cornerstone in mastering the coronavirus disease 2019 (COVID-19) pandemic. There is a paucity of data regarding the safety of COVID-19 vaccines in patients with rheumatic diseases such as Behçet syndrome (BS). The present study aimed to investigate the side-effects and post-vaccine disease exacerbation rates of COVID-19 vaccines in a BS cohort.We retrospectively evaluated 450 BS patients followed in our clinic who met the criteria of the International Study Group. COVID-19 vaccination status, type of vaccine received (Pfizer-BioNTech vs CoronaVac), post-vaccine side-effects and exacerbations were evaluated by interviewing patients over the phone or face to face. Behçet's Disease Current Activity Form (BDCAF) scores were calculated for BS symptoms before and after vaccination.In all, 287 patients received at least one dose of the COVID-19 vaccine. Of the total number of COVID-19 vaccines (n = 639), 379 (59%) were Pfizer-BioNTech vaccines and 257 (41%) were CoronaVac vaccines. The number of side-effects after first, second, third and fourth vaccine doses were 151 (52.6%), 135 (49.4%), 29 (42.6%), and 3 (30%), respectively. BS exacerbation after first, second, third, and fourth vaccine doses were 151 (52.6%), 135 (49.4%), 16 (23.5%), and 3 (30%), respectively. Injection site pain/swelling was the most common side-effect at all vaccine doses followed by fatigue and arthralgia.COVID-19 vaccines are well tolerated in patients with BS, and more side-effects develop after mRNA vaccines. Regardless of the vaccine type, exacerbations after the COVID-19 vaccine are common, predominantly mucocutaneous and articular involvement, and exacerbations in the form of other organ involvement are rare.

AIM The aim of this study was to investigate relapse rates in azathioprine (AZA) maintenance therapy at different doses in Behcet's disease (BD) with venous involvement. METHOD Clinical records of patients who met the diagnostic criteria of International Study Group (ISG) for BD, were diagnosed with venous involvement of BD for at least 6 months and sustained clinical remission with AZA for at least 3 months were analyzed retrospectively. The analysis cohort was divided into 2 groups based on AZA dose (Group A: ≥ 2 mg/kg/d and Group B

The present study aims to evaluate the relationship between Behçet's uveitis and lymphangiogenesis by determining levels of Vascular endothelial growth factor-C (VEGF-C, its receptors sVEGFR-2, sVEGFR-3 and lymphangiogenesis markers podoplanin (PDPN) and lymphatic vessel endothelial hyaluronan receptor 1(LYVE-1), and C-type lectin domain family 1 member B (CLEC2).55 patients with BD uveitis and 31 healthy control subjects were enrolled in the study.sVEGFR-2, sVEGFR-3, VEGF-C/sVEGFR-2 ratio, PDPN and LYVE-1 levels were higher in the patient group. A positive correlation was found between LYVE-1 and hsCRP levels. PDPN had a strong predictive value for progression with a cut-off value of 2 pg/mL, with 69% sensitivity and 68% specificity (p = 0.001).LYVE-1 and PDPN can be good representatives of the ongoing inflammatory processes in BD uveitis and point out that the disease can be related to lymphangiogenesis.

Aim of this study is to investigate the course of coronavirus disease 2019 (COVID-19), in our cohort of familial Mediterranean fever (FMF) patients in means of mortality, admission to hospital and/or intensive care unit and length of hospital stay.A retrospective cohort was formed from patients who have previously been followed with a diagnosis of FMF. Patients of this cohort were retrospectively evaluated for a positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV 2) polymerized chain reaction (PCR) test result and information regarding hospitalisation, intensive care unit admission and mortality were collected from medical records.Out of a total 496 FMF patients, 34 were detected to have a positive SARS-CoV 2 PCR test. Eighty-five point three percent of these patients were under colchicine treatment and 17.6% were under interleukin (IL)—1 inhibitor treatment. Eight of the 34 patients (23.9%) were found to be hospitalized, one of them was admitted to the intensive care unit and died thereafter (2.9%). An increasing trend in the frequency of comorbid diseases (presence of at least one comorbidity 64.7% in all patients vs 75.0% in hospitalized patients) and IL-1 inhibitor usage (17.6% in all patients vs 50.0% in hospitalized patients) was observed in hospitalized patients.Rates of comorbid diseases and IL-1 inhibitor use for FMF were observed to be increased in FMF patients hospitalized for COVID-19.

To determine frequency of adverse events and attacks related to vaccination in recipients of CoronaVac and BNT162b2 in familial Mediterranean fever (FMF) patients, and to search whether history of prior COVID-19 or a booster dose increases occurrence of adverse events/attacks.FMF patients were surveyed for administration of any COVID-19 vaccine and vaccine-related adverse events or FMF attacks. Demographic, clinical, vaccine-related data, history of COVID-19 infection before or after vaccination, adherence to FMF treatment during vaccination were collected.A total of 161 vaccinated FMF patients were included. Ninety-three patients out of 161 had reported suffering from an adverse event/attack after a vaccine dose. There were 54.7% of BNT162b2 recipients who reported any adverse event after any vaccine dose in comparison to 29.9% of CoronaVac recipients (P .001). There were 22.2% of BNT162b2 recipients who reported suffering from a FMF attack within 1 month after vaccination in comparison to 19.4% of CoronaVac recipients (P = .653). When patients with or without adverse event/attack were compared, no significant differences were observed in means of demographics, comorbid diseases, disease duration, total vaccine doses, or treatments adhered to for FMF. Rates of adverse events/attacks were similar between patients with and without prior COVID-19. In booster recipients, adverse events/attacks were most frequent after the booster dose.A considerable number of FMF patients suffered from vaccine-related adverse events/attacks, particularly with BNT162b2. No serious events or mortalities due to vaccination were detected. Demographics, clinical characteristics and prior history of vaccination did not significantly affect these results. We observed an increased rate of adverse events/attacks with booster dose administration.

Background/aim: Multiple sclerosis (MS) is a demyelinating central nervous system disorder with few cases reported to have concomitant spondyloarthritis (SpA) spectrum disorders such as ankylosing spondylitis and psoriatic arthritis. The aim of this study is to evaluate the effectiveness of secukinumab in the treatment of MS and accompanying ankylosing spondylitis or psoriatic arthritis. Materials & methods: In addition to four cases of their own, the authors conducted a systematic literature search. Demographics, comorbidities, symptoms of MS and SpA, medical treatments and changes in clinical and laboratory findings with treatment were recorded. Results & conclusions: After secukinumab therapy, all patients were found to have treatment response regarding axial involvement, without any progression of MS observed. For both SpA spectrum diseases and MS, secukinumab may be an appropriate choice.

Aims. Acromegaly is associated with symptoms in many organs, including the heart, colon, skin, bones, and many joints. Patients with long-term treatment or biochemical control still suffer from acromegaly arthropathy (AA). Primarily, the weight-bearing joints of the lower extremity are affected and at last deformation emerges. The aim of this study is to detect the changes in the feet with pedabarography in patients with acromegaly. Materials and Methods. Nineteen patients with acromegaly (4 males and 15 females) and 13 healthy controls (1 male and 12 females) were included in the study ( p = 0.31 ). There was no difference between acromegaly patients and controls in terms of gender, age, and BMI; median age and BMI were (54 (20–67) vs. 52 (30–58), p = 0.85 ) and (32.5 (20.3–42.7) vs. 29.5 (22.4–38.6), p = 0.93 ), respectively. Static plantar pressures of bilateral foot of all participants in the standing position were measured by pedabarography. Results. In pedabarographic analysis, there were only significant difference in rearfoot surface right and rearfoot surface left ( p = 0.04 and p = 0.01 ), respectively. The mean of the right rearfoot surface (43.5 cm2 vs. 36.6 cm2) and the mean of the left rear foot surface were higher than the controls (47.4 cm2 vs. 40.2 cm2). Forefoot surface, forefoot load, forefoot weight ratio, rearfoot load, total foot surface, total load, total peak pressure, and total average pressure were higher in left foot in both groups, but there was no difference between the two groups. Conclusion. In our study, there was a significant difference between acromegaly patients and healthy controls, only on the right rarefoot surface and the left rarefoot surface, and was higher on the left in both groups. These patients often experience changes in the hindfoot and heel, and foot surface area and pressure distribution may vary. Early diagnosis and proper treatment of the disease can prevent the development of complications and improve the quality of life. Foot scanning using pedabarography in the management of AA is a useful tool that can be used to manufacture customized orthopedic insoles and ergonomic shoe designs to prevent irreversible damage and reduce overload and lower extremity pain.

Background This study aimed to examine fetomaternal outcomes in pregnant women in a large Turkish Takayasu arteritis (TAK) cohort and to evaluate the effects of pregnancy on the disease in those patients. Methods This is a cohort study involving 296 pregnancies of 112 TAK patients from 8 tertiary rheumatology centers in Turkey. Pregnancies were divided into 2 groups as pre-d (before disease onset) and post-d (after disease onset). In addition, post-d pregnancies were further divided into 2 subgroups according to fetomaternal complications (FMC) development status. Finally, patients were grouped into those with and without a history of pregnancy after disease onset. Results In post-d pregnancies, rates of worsening hypertension, new-onset hypertension, and preeclampsia were higher than in pre-d pregnancies (0.9% vs 16%, P < .001, 0.5% vs 5.3%, P = .012, and 0% vs 4%, P = .013, respectively). Patients with FMC were more likely to have renal artery involvement (65% vs 21%, P = .003). The patients who had post-d were younger, had longer disease duration, and had more relapses number than other patients (P < .001, P = .028, P = .016, respectively). Vasculitis Damage Index (VDI) results were similar in patients with or without post-d pregnancies. Conclusion Pregnancies after disease onset were found to be associated with HT and preeclampsia/eclampsia. HT-related FMCs are increased in TAK, and patients with renal artery involvement are at higher risk. The number of relapses increases in patients who become pregnant after disease onset, but pregnancy was not an independent risk factor for relapse. Pregnancy after the onset of disease had no negative effect on VDI.

© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.Protective neutralizing antibody titers reduce in time after COVID-19 vaccinations, as in individuals who have had COVID-19. This study aimed to evaluate the safety and immunogenicity of CoronaVac and TURKOVAC vaccines used as a booster dose after CoronaVac primary vaccination. This double-blind, randomized, controlled, phase II, multicenter study included healthy male and female adults (18–60 years) who were vaccinated with two doses of CoronaVac vaccine and did not exceed the duration of at least 90 days and a maximum of 270 days from the second dose of vaccination. Among 236 eligible volunteers, 222 were recruited for randomization between July 12, 2021 and September 10, 2021; 108 and 114 were randomized to the TURKOVAC and CoronaVac arms, respectively. The primary endpoint was adverse events (AEs) (ClinicalTrials.gov; Identifier: NCT04979949). On day 28, at the neutralizing antibody threshold of 1/6, the positivity rate reached 100% from 46.2% to 98.2% from 52.6% in the TURKOVAC and CoronaVac arms, respectively, against the Wuhan variant and the positivity rate reached 80.6% from 8.7% in the TURKOVAC arm vs. 71.9% from 14.0% in the CoronaVac arm against the Delta variant. IgG spike antibody positivity rate increased from 57.3% to 98.1% and from 57.9% to 97.4% in the TURKOVAC and CoronaVac arms, respectively. The TURKOVAC and CoronaVac arms were comparable regarding the frequency of overall AEs. Both vaccines administered as booster yielded higher antibody titers with acceptable safety profiles.

Background/aim: The most common causes of thyrotoxicosis include Graves' disease (GD), toxic multinodular goiter (TMNG), toxic adenoma (TA), and subacute granulomatous thyroiditis (SAT). In our study, we aimed to see whether neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) may be helpful in the differential diagnosis of these diseases.Materials and methods: We retrospectively analyzed the hospital records of the Endocrinology Clinic of our hospital between 2016 and 2019. We included data from 66 GD, 37 TA, and 35 SAT patients. We compared the data with those of 35 healthy subjects as controls.Results: NLR, MLR, and PLR were found to be higher in the SAT group when compared to other groups. The post hoc analysis of comparison of NLR, MLR, and PLR in each group showed that NLR and PLR were significantly different in the SAT group when compared to the GD, TA, and controls groups (P < 0.001, P = 0.003, and P < 0.001 for NLR respectively and P < 0.001 for PLR in all groups). MPV levels were different between groups (P = 0.007). However, the intergroup analysis (Tukey's test) failed to show a statistically significant difference for any of the groups. In patients with SAT, PLR and NLR were significantly higher than in the GD, TA, and control groups. MLR was also higher in SAT when compared to other groups, but the difference was not statistically significant. Conclusion: High PLR and NLR may be helpful to differentiate SAT from GD and TA, the other common causes of thyrotoxicosis.

Objective The aim of this study is to evaluate semaphorin 3A levels in patients with systemic lupus erythematosus (SLE) with and without renal involvement and secondary antiphospholipid antibody syndrome (APS). Methods Patients with SLE were grouped according to the presence of secondary APS or renal involvement. The control group consisted of age-matched, nonsmoking, healthy volunteers. Semaphorin 3A levels were compared among groups. All patients with SLE were regrouped according to the presence of thrombotic events, miscarriages, and proteinuria, and semaphorin 3A levels were investigated. Finally, semaphorin 3A levels of all patients with SLE as a single group were compared to those of the control patients. Results The mean semaphorin 3A values were 16.16 ± 2.84 ng/mL in the control group, 9.05 ± 5.65 ng/mL in patients with SLE without nephritis and APS, 11.28 ± 5.23 ng/mL in the SLE with APS group, and 8.53 ± 5.11 ng/mL in the lupus nephritis group. When all 3 patient groups were examined as a single group, the mean semaphorin 3A value was significantly lower than that of the control group. Semaphorin 3A was reduced in patients with SLE with thromboembolism and/or history of miscarriage. Conclusion Semaphorin 3A levels were lower in all patient groups compared to the control group. Moreover, the reduced semaphorin 3A levels in patients with a history of thromboembolism and/or miscarriage suggest that semaphorin 3A may play an important role in the pathogenesis of vasculopathy.

Studies regarding effectiveness of anakinra and tocilizumab treatments in coronavirus disease 2019 (COVID-19) have contradictory results. Furthermore, there is scarce comparative data regarding superiority of any agent. To further elucidate any superiority between these two agents, we retrospectively investigated and compared outcomes in hospitalized COVID-19 patients of our inpatient cohort who received anakinra or tocilizumab.This study was designed as a single-center, retrospective, cross-sectional cohort study. Hospitalized patients with confirmed diagnosis of COVID-19 who had Brescia-COVID respiratory severity scale score ≥3 and hyperinflammation (defined as elevation of C reactive protein ≥50 g/L or ferritin ≥700 ng/mL) and received anakinra or tocilizumab in addition to standard care were enrolled in the study. Length of hospital stay after initiation of antiinflammatory treatment, need for mechanical ventilation, need for intensive care unit admission, mortality were set as primary outcomes and compared between tocilizumab and anakinra recipients after propensity score matching.One hundred and six patients were placed in each group after propensity score matching. In the anakinra group, relative risk reduction for intensive care unit admission was 50% when compared to the tocilizumab group and the number needed to treat to avert an intensive care unit admission was 3 (95% CI, 2-5). In terms of mortality, a 52% relative risk reduction was observed with anakinra treatment and the number needed to treat to avert an intensive care unit admission was 8 (95% CI, 4-50). Significantly more patients were observed to receive glucocorticoids in the anakinra group.Anakinra administration in severe COVID-19 patients was significantly associated with better survival and greater clinical improvement compared to the tocilizumab administration in our study. Increased rate of glucocorticoid use in the anakinra group might have contributed to better outcomes.

Convalescent plasma (CP) might be an additional treatment modality in COVID-19. The aim of this study was to compare CP-related clinical characteristics and perinatal outcomes in pregnant women with mild or moderate-severe COVID-19.This prospective cohort study included 36 pregnant women (12 mild and 24 moderate-severe), who underwent CP therapy. The CP obtained from recently recovered donors was transfused to patients together with maximum supportive care and antiviral agents. The groups were then compared in respect of clinical characteristics, laboratory parameters, obstetric complications, and neonatal outcomes.Significant differences were determined between the groups in respect of systemic corticosteroids in COVID-19 treatment (41.7%, 87.5%, p = 0.004), oxygen (O2) support (0%, 91.7%, plt; 0.001), chest imaging (41.7%, 58.3%, p = 0.02), intensive care unit admission (0%, 20.8%, p = 0.03) and length of hospitalization (5.5 versus 9.5 days, plt; 0.001). The O2 saturation levels before and after administration of CP were significantly lower in the moderate-severe COVID-19 group (plt; 0.05). The O2 therapy time before and after administration of CP and total O2 therapy time were significantly lower in the mild COVID-19 group (plt; 0.05). Platelet, plateletcrit and lymphocyte counts were significantly higher in both the mild and moderate-severe COVID-19 groups after treatment compared to the pretreatment values (plt; 0.05).Although data on the results of CP treatment in pregnant women are somewhat limited, it has been suggested that early CP treatment may be associated with improvements in laboratory and ventilatory parameters in pregnant women with mild and moderate-severe COVID-19. Nevertheless, there is a need for further, randomized controlled studies on this subject with the inclusion of greater numbers of patients.

Objectives Takayasu's arteritis (TAK) is a rare vasculitis characterized by inflammation of intermediate- to large-size arteries. Although pulmonary artery involvement (PAI) is an expected finding in some TAK patients, data on non-vascular pulmonary involvement (NVPI) are limited. We aimed to investigate the frequency of NVPI, including parenchymal infiltration, nodules/cavities, pleural effusion, and haemorrhage, in TAK. Method We assembled a retrospective cohort of TAK patients from nine tertiary centres in Turkey. The demographics and clinical characteristics of patients were extracted from medical records and the imaging findings were evaluated for pulmonary manifestations. Results As of January 2021, 319 TAK patients (female/male 276/43; mean age 42.4 +/- 13.5 years) were recruited. Eighty-two patients had cough and/or dyspnoea and four had haemoptysis as pulmonary symptoms. On computed tomography assessment, the overall frequency of NVPI was 7.2%; parenchymal infiltrations were present in 10 (3.1%), pleural effusion in eight (2.5%), nodules/cavities in six (1.9%), and pulmonary haemorrhage in four patients (1.3%). In the whole cohort, 10.3% of patients had pulmonary artery hypertension (PAH) and 5.6% had PAI. Among patients with PAH or PAI, the overall frequency of NVPI was significantly higher than in the rest of the group. Conclusions In this TAK cohort from Turkey, we observed NVPI in 7.2% of patients, with parenchymal infiltrations being the most common, followed by pleural effusion. Notably, NVPI was more frequent in patients with PAH or PAI. Although not as common as PAI, NVPI should be kept in mind, especially in TAK patients with PAH or PAI.

Background: Diet can affect the body's acid-base balance due to its content of acid or base precursors. There is conflicting evidence for the role of metabolic acidosis in the development of cardiometabolic disorders, hypertension (HT), and insulin resistance (IR). Objective: We hypothesized that dietary acid load (DAL) is associated with adverse metabolic risk factors and aimed to investigate this in the elderly. Methods: A total of 114 elderly participants were included in the study. The participants were divided into four groups such as HT, diabetes (DM), both HT and DM, and healthy controls. Anthropometric, biochemical, and clinical findings were recorded. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) results were obtained from three-day, 24-hour dietary records via a nutrient database program. (BeBiS software program). Results: The groups were matched for age, gender, and BMI. There was a statistically significant difference between the groups regarding NEAP (p =0.01) and no significant difference for PRAL ( p = 0.086). The lowest NEAP and PRAL levels were seen in the control group while the highest in the HT group. Both NEAP and PRAL were correlated with waist circumference (r = 0,325, p = 0.001; r=0,231, p =0,016, respectively). Conclusion: Our data confirmed that subjects with HT and DM had diets with greater acid-forming potential. High NEAP may be a risk factor for chronic metabolic diseases, particularly HT. PRAL could not be shown as a significantly different marker in all participants. Dietary content has a significant contribution to the reduction of cardiovascular risk factors, such as HT, DM, and obesity.

Coronavirus disease 2019 (COVID-19) shares some clinical features with new-onset granulomatosis with polyangiitis (GPA) or GPA flare that may lead to a challenge in differential diagnosis. To date, little is known whether GPA can be induced by COVID-19. Herein, we aimed to seek the frequency and mortality rates of COVID-19 in our GPA cohort, and along with the literature cases, to evaluate clinical features and treatments of GPA patients with COVID-19. We also tried to identify clinical features of COVID-19 induced GPA.As of July 2021, we conducted a systematic literature review using different spelling combinations of "COVID-19 and GPA" in the PUBMED database. In total, 18 cases were found in the literature, 6 of them had COVID-19 induced GPA. The remaining 12 of literature cases and 6 cases in our GPA cohort (n = 81) had a COVID-19 infection while followed-up with GPA. We grouped these 18 patients as GPA+COVID-19.The frequency of COVID-19 was 7.4% in GPA cohort and mortality rate was 33% in GPA patients with COVID-19. The most common symptoms of GPA+COVID-19 patients were fever, cough, arthralgia/myalgia, and malaise. The most frequent treatments for GPA before the COVID-19 infection were steroids (72%) and rituximab (56%). Three patients who received rituximab also had COVID-19 reinfection. In the literature cases, mortality was observed in 4 (22%) of 18 patients with GPA+COVID-19. The most common symptoms of COVID-19 induced GPA were dyspnea, fever and cough.In our GPA cohort, we observed a higher mortality rate compared to global WHO data. In patients followed up with GPA, rituximab treatment may be precarious for both COVID-19 disease and reinfection. Our study also provided some clues about the diagnostic challenge of GPA induced by COVID-19.

Anakinra, which is an Interleukin-1 (IL-1) receptor antagonist with the advancing disease process, has started to be considered as an alternative treatment for Covid-19 patients with cytokine storms. We evaluated the effect of corticosteroids and IL-1 receptor blockage with anakinra on pregnant patients with Covid-19 at high risk for respiratory distress, ongoing fever, deterioration in their general condition and consequently maternal and fetal complications. Fourteen pregnant women who received anakinra (median dosage: 400 mg) and corticosteroid (methylprednisolone-median dosage: 80 mg) treatment were evaluated retrospectively. Patients were assessed according to the World Health Organization (WHO) scale. The mortality rate of the cohort was 7.1%, the median hospitalization period of the patients was 15 days and 2 patients had premature births. Covid-19 was found to have a similar spectrum of symptoms in pregnant and non-pregnant women, such as dyspnea, cough and fever. Our study was the first to analyze the combined treatment of corticosteroid and anakinra in pregnant patients with pneumonia from Covid-19 based on the WHO scoring system. Due to the obscurity in the treatment process in pregnant patients, studies are ongoing on managing Covid-19 infection in these patients. We presume that the early use of anakinra and corticosteroid treatments in patients severely infected with Covid-19 may have positive effects on disease progression and survival.

Physicians are challenged by the recognition and treatment of older patients with rheumatoid arthritis (RA). The aim of this case-control study was to evaluate the retention and safety of conventional disease-modifying anti-rheumatic drugs in older patients with RA.In this observational case-control study, we assessed older patients with RA (≥65 years) who were diagnosed in 3 different rheumatology centers from Turkey. Patients were divided as to those aged ≥65 years (elderly rheumatoid arthritis [ERA]) and those aged, NA

Background Positioning of the patient is a common strategy to increase oxygenation in the management of acute respiratory distress syndrome. The aim of this study is to demonstrate the effects of our positioning approach on disease outcomes in COVID‐19 patients with respiratory failure, by comparing patients compliant to positioning and not. Methods COVID‐19 patients who were admitted to our internal medicine inpatient clinic and developed hypoxaemia and underwent positioning during hospital stay were retrospectively investigated for compliance to positioning. Rates of mortality, intensive care unit admission, intubation, initiation of anti‐inflammatory treatment and length of hospital stay were compared between patients with and without compliance to positioning. Results A total of 144 patients were enrolled in this study (97 compliant with positioning, 47 incompliant with positioning). Rates of ICU admission (7.2% vs 25.5%, p

Introductions Results with convalescent plasma therapy in coronavirus disease 2019 (COVID-19) have been contradictory. Timing seems to be an important factor for COVID-19 convalescent plasma(CCP) to be effective. Aim of this study is to compare disease outcomes in hospitalized COVID-19 patients who were treated with CCP within first three or seven days of symptoms to patients with symptoms longer than seven days. Material and methods A multicenter retrospective study was conducted to evaluate disease outcomes in hospitalized COVID-19 patients who received CCP in addition to standard of care (SOC) approach. Patients were subgrouped according to time of CCP administration; within three days of symptoms, seven days of symptoms and after seven days of symptoms. A control group was formed from age, gender and comorbidity matched hospitalized patients who received SOC treatments without CCP. Length of hospital stay, rates of anti-inflammatory treatment initiation, intensive care unit (ICU) admission and mortality was set as outcome measures. Results A total of 223 patients were enrolled in this study, 113 patients received CCP (38 within three days, 63 within seven days, 50 after seven days of symptom onset). Rate of anti-inflammatory treatment initiation was significantly lower (38.1 % vs 62.7 %, p = 0.002, relative risk, 0.60,73; 95 % confidence interval [CI], 0.42 to 0.85) and length of hospital stay was significantly shorter (median(IQR) 8(4) days vs 9.5(5.25) days, p = 0.0025) in patients who received CCP within seven days of symptom onset when compared to SOC group. Conclusion CCP therapy may provide better outcomes when applied within seven days of symptoms.

To compare the clinical features, laboratory findings, and prognosis of Behçet's disease (BD) patients with and without Budd-Chiari syndrome (BCS).This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017.Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14-47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%).To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.

The aim of this study is to investigate post-COVID-19 antibody titers in patients who received convalescent plasma (CP) in addition to standard-of-care treatment.Hospitalized COVID-19 patients who received CP in addition to standard care were retrospectively investigated. Patients who received CP with a recorded total COVID-19 antibody test result after treatment were included. From among hospitalized COVID-19 patients who received only standard care with a recorded total COVID-19 antibody test result, a control group matched for age, gender, and comorbidities was formed. Total COVID-19 antibody index levels were compared.Thirty-three CP recipients were enrolled in the study. The control group consisted of 34 age-, gender-, and comorbidity-matched standard-care patients. Median total COVID-19 antibody index levels were significantly reduced in the CP group.Although CP therapy may have benefits for disease outcome, its potential ability to hamper long-term immunity may be a problem.Çalışmanın amacı tedavi sürecinde standart tedavilere ek olarak konvalesan plazma (KP) tedavisi uygulanan COVID-19 hastalarında takipte oluşan COVID-19 antikor düzeylerini incelemektir.Yatarak tedavi alan COVID-19 hastaları içinde standart tedavilere ek olarak KP tedavisi alanlar retrospektif olarak incelenmiştir ve takipte COVID-19 antikor düzeyleri bakılmış olanlar çalışmaya dahil edilmiştir. Aynı zaman zarfında yatarak takip edilen, standart tedavi alan ve takipte COVID-19 antikor düzeyi bakılmış olan COVID-19 hastaları arasından yaş, cinsiyet ve komorbidite sıklığı eşleştirilmiş bir kontrol grubu oluşturulmuştur. İki grup arasında COVID-19 antikor düzeyleri karşılaştırılmıştır.KP tedavisi alan ve takipte antikor düzeyleri bakılmış olan 33 COVID-19 hastası çalışmaya dahil edildi. Kontrol grubunda 34 hasta mevcuttu. Median total COVID-19 antikor indeks düzeyleri standart yaklaşıma ek olarak KP alan grupta anlamlı olarak düşük saptandı.KP tedavisinin COVID-19 hastalarında sonuçlar üzerine olumlu etkileri görülmekle beraber hastalık sonrasında azalmış antikor yanıtı, uzun dönem bağışıklık üzerine olumsuz etkilerin bir göstergesi olabilir.

Brachydactyly type E, which can be an isolated finding or part of a syndrome in combination with other clinical anomalies, involves metacarpals and metatarsals with or without short phalanges. Herein we report two unrelated Turkish females who presented with brachydactyly type E and vitamin D deficiency in the absence of marked alterations in serum calcium, phosphate, and parathyroid hormone. After excluding disease-causing variants in two candidate genes, PTHLH and PDE4D, we identified different pathogenic variants in TRPS1, the gene mutated in patients with tricho-rhino-phalangeal syndrome (TRPS). In one of the patients, who displayed severe brachydactyly and short stature, we identified a novel heterozygous missense pathogenic variant in exon 6 (c.2783A>G, p.Tyr928Cys), located within the GATA DNA-binding domain. The second patient, who had relatively milder brachydactyly and was of normal height, carried a heterozygous nonsense pathogenic variant in exon 4 (c. 1870C>T, p.Arg624Ter), which has been previously described. Both pathogenic variants segregated in affected family members. The patients additionally showed sparse hair and a bulbous nose, consistent with the clinical features of TRPS. Our findings, in addition to identifying the genetic cause of brachydactyly in two unrelated kindreds, emphasize the role of pathogenic TRPS1 variants in the development of brachydactyly type E and highlight the GATA DNA-binding region of TRPS1 protein with respect to phenotype-genotype correlation.

Background: Fibromyalgia syndrome (FMS) is an extra-articular rheumatological disease, characterized by widespread pain and somatic symptoms. The etiology has not yet been clarified. Oxidative stress may play an important role in FMS etiology. Thiol group is a very strong antioxidant. We aimed to investigate whether thiol/disulfide homeostasis in FMS is altered or not. Material and methods: A total of 80 female FMS patients and 64 healthy female control individuals were included in this study. Thiol and disulfide values were measured by Erel’s novel methods. Results: Native thiol (330.6 ± 46.1 vs. 356.8 ± 55.5 μmol/L, p = 0.005) and native thiol/total thiol (89.4 ± 3.2 vs. 93.3 ± 4.0, p < 0.001) levels of FMS patients were significantly lower when compared to the values of control group. However, disulfide (19.4 ± 6.3 vs. 12.2 ± 6.3 μmol/L, p < 0.001) levels of FMS patients were significantly higher than healthy individuals. A negative correlation was found between the native thiol/total thiol and fibromyalgia impact questionnaire (FIQ) score among the FMS patients. A positive correlation was found between disulfide values and FIQ score among the patients. Conclusions: In FMS patients, there was a significant correlation between the decrease in the thiol levels and an increase in the disulfide levels with the FIQ scores. We determined that thiol-disulfide rate was deteriorated in FMS patients and it increases in favor of disulfide amounts.

Background . Oxidative stress may play an important role in rheumatoid arthritis (RA) etiopathogenesis. The thiol group is a very strong antioxidant. In this study, we aimed to investigate the presence of oxidative stress in patients with RA by evaluating thiol/disulfide homeostasis. Material and methods . A total of 50 female RA patients and 50 healthy female controls were included in this study. Thiol and disulfide values were calculated utilizing novel methods. Results . Native thiol (p < 0.001) and total thiol (p < 0.001) levels of RA patients were significantly lower compared to values in the control group. However, the disulfide (p < 0.001) levels of RA patients were strongly higher than in healthy individuals. A negative correlation was found between thiol and disease activity score-28 among the patients, whereas a positive correlation was found between disulfide and disease activity score-28 among the patients. Conclusion . We found that the thiol–disulfide rate deteriorated in RA patients, with the proportion of disulfide increasing. There is a strong correlation between the decrease in thiol levels, increase in disulfide levels and the disease activity scores.

Coronavirus disease 2019 (COVID-19) and eosinophilic granulomatosis with polyangiitis (EGPA) share similarities in clinical, imaging findings and may present with respiratory distress. Differentiating a new-onset EGPA from COVID-19 during the current pandemic is a diagnostic challenge, particularly if other EGPA symptoms are overlooked. Here in this study we reviewed the literature regarding EGPA patients with COVID-19 and patients who diagnosed with EGPA or suffered an EGPA flare mimicking COVID-19. We conducted a literature survey in PUBMED database using meshed keywords "COVID-19" and "EGPA", "COVID-19" and "eosinophilic granulomatosis with polyangiitis", "COVID-19" and "Churg Strauss Syndrome", to reveal previously reported cases involving EGPA patients who had COVID-19 infection, patients who suspected to have COVID-19 but eventually diagnosed with EGPA and patients with a known diagnosis of EGPA who suffered a flare but a COVID-19 infection was suspected initially. A total of 11 cases (6 literature cases, 5 cases from our clinic) were included in our study. Seven (63.6%) of the cases were defined as COVID-19 mimicker and 4 (36.4%) were EGPA with COVID-19. All of the cases in EGPA with COVID-19 group had a history of asthma. All of them had a positive PCR result and ground-glass opacities in thorax CT. In COVID-19 mimicker group, six (85.7%) patients had a history of asthma and other EGPA features that were observed were eosinophilia in 6 (85.7%). Our study provided clues regarding the EGPA/COVID-19 diagnostic challenge which may be useful in the current pandemic. Since none of the findings in COVID-19 are disease-specific, other conditions like EGPA should not be overlooked particularly in PCR negative patients and clinical, laboratory and imaging findings should be interpreted carefully. Furthermore, we did not observe poor outcomes in EGPA patients who had COVID-19.

Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149–100 ng/mL; and group 3, 99–88 ng/mL. A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 ± 15.6 years). The average serum 25(OH)D level was 119.9 ± 33 (range, 88–455) ng/mL, and the average serum calcium level was 9.8 ± 0.7 (range, 8.1–13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 ± 64 ng/mL vs. 117.7 ± 31 ng/mL, p

Introduction: Effectiveness of hydroxychloroquine against SARS-CoV-2 has been highly controversial. In our research, we aimed to investigate the effects of hydroxychloroquine on disease outcomes in hospitalized patients with COVID-19. Methodology: A total of 393 hospitalized patients with COVID-19 were retrospectively assigned to the standard of care therapy group (n = 180) or the standard of care plus hydroxychloroquine group (n = 213). The standard of care therapy comprised favipiravir, low molecular weight heparin, acetylsalicylic acid. Status of oxygenation at baseline and on the seventh day, laboratory tests at baseline and at discharge were recorded. Length of hospital stay, administration of anti-inflammatory treatment, admission to the intensive care unit and 28th day mortality were set as primary endpoints. Results: There were no statistically significant differences between groups in terms of oxygen delivery route and mortality after seven days of treatment (p = 0.592). C-reactive protein levels of the standard of care plus hydroxychloroquine group were significantly lower than that of the standard of care group at discharge (p = 0.034). Patients in the standard of care plus hydroxychloroquine group had shorter hospital stay (p = 0.007). The standard of care plus hydroxychloroquine group was favored over standard of care group in terms of rate of intensive care unit admissions (21.7% vs. 10.8%; relative risk with 95% CI = 0.49 [0.31-0.80], p = 0.003). Conclusions: Hydroxychloroquine in addition to standard of care was associated with less intensive care unit admissions, early discharge and greater C-reactive protein reduction. There was no difference in 28-day mortality.

Introduction: Colchicine is an ancient agent with well-known anti-inflammatory effects and commonly used in treatment of hyperinflammatory conditions. It has been argued that colchicine could be an appropriate treatment option in COVID-19 to control hyperinflammatory response. Here in this study, we aimed to investigate the impact of colchicine on outcomes of COVID-19 in our inpatient cohort. Methodology: In this retrospective cohort study, hospitalized COVID-19 patients were investigated. Demographics, comorbidities, COVID-19 symptoms, laboratory findings on admission and discharge, baseline and seventh day oxygenation status, rates of mortality, intensive care unit admission, administration of other anti-inflammatory treatments and length of hospital stay were compared between patients who received standard of care medications and who received colchicine additionally. Results: Three hundred and thirty-six patients were included in the study (171 standard of care, 165 standard of care plus colchicine). The median length of hospital stay in colchicine group was significantly shorter. Rates of admission to intensive care unit, anti-inflammatory treatment administration and mortality did not differentiate between standard of care and colchicine groups. However, reduced rates of mortality and ICU admission were observed in patients who received colchicine with a dose of 1 mg/day when compared to patients who received 0.5 mg/day. Conclusions: Our study demonstrated that COVID-19 patients who received colchicine in addition to standard of care had shorter hospital stay. Our results further support the use of colchicine in treatment of COVID-19, particularly with a dose of 1 mg/day.

Background/aim: Atherosclerotic heart diseases can occur at an early age in patients with ankylosing spondylitis (AS). Flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) values are reliable markers for early detection of subclinical atherosclerosis in patients with AS. We aimed to investigate the relationship between visfatin levels and indirect markers of subclinical atherosclerosis and endothelial dysfunction in patients with AS. Materials and methods: Forty-two patients diagnosed with AS and 42 age, sex, and body mass index (BMI)-matched controls were included in the study. Visfatin levels, FMD, and cIMT were measured using appropriate methods. Results: Visfatin levels of the patients were significantly higher than controls (p < 0.001). FMD values in patients with AS were significantly lower (p = 0.007) whereas cIMT were significantly higher than the controls (p = 0.003). There was a negative relationship between FMD with visfatin levels (p = 0.004), BASDAI (p = 0.010), and BASFI (p = 0.007). There was a positive relationship between cIMT with visfatin (p = 0.005), BASDAI (p < 0.001), and BASFI (p < 0.001). There was a positive relationship between visfatin with BASDAI (p < 0.001), and BASFI (p < 0.001). Conclusion: Visfatin levels are increased and associated with impaired FMD and increased cIMT in patients with AS. Increased visfatin levels may be associated with subclinical atherosclerosis in AS.

Objective: To compare the treatment outcomes of TNF inhibitors and tocilizumab (TCZ) in patients with Takayasu arteritis. Methods: Takayasu arteritis patients who were refractory to conventional immunosuppressive (IS) drugs and received biologic treatment were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data during follow-up were recorded. Remission, glucocorticoid (GC) sparing effect, drug survival was compared between TNF inhibitor and TCZ treatments. Also, a subgroup matched comparison was performed between groups. Results: One hundred and eleven (F/M: 98/13) patients were enrolled. A total of 173 biologic treatment courses (77 infliximab, 49 TCZ, 33 adalimumab, 9 certolizumab, 3 rituximab, 1 ustekinumab and 1 anakinra) were given. Tocilizumab was chosen in 23 patients and TNF inhibitors were chosen in 88 patients as first line biologic agent. Complete/partial remission rates between TCZ and TNF inhibitors were similar at 3rd month and at the end of the follow-up. GC dose decrease (

AIM Increased bone turnover is a hallmark of hyperthyroidism. The underlying factors of how thyroid hormones affect bone cells are still under the spotlight. Previous studies indicated serum osteoprotegerin (OPG), receptor activator of NF-kB ligand (RANKL), and interleukin-6 (IL-6) as mediators of the effect of thyroid hormones on bone metabolism. Ultimately, the present research aimed to examine the association of IL-6 with OPG and RANKL in patients with hyperthyroidism. MATERIALS AND METHODS We carried out this study with 39 newly diagnosed and untreated Graves? patients and 43 healthy controls. In addition to routine tests, we measured serum OPG, RANKL, and IL-6 levels. RESULTS Mean age and gender distribution were similar in both groups. The hyperthyroid group had significantly higher OPG (p=0.002) and IL-6 (p

Objective Joints with different sizes and anatomical locations can be affected in psoriatic arthritis (PsA). Our aim was to explore the effect of different joint patterns on patient-reported outcomes (PROs) in patients with mono-oligoarthritis. Methods Within PsArt-ID (Psoriatic Arthritis- International Database), 387/1670 patients who had mono-oligoarthritis (1-4 tender and swollen joints) were enrolled in cross-sectional assessment. the joints were categorized according to their size (small/large) and location (upper/lower extremity) and PROs, physician global assessment and C-reactive protein (CRP) were compared. Analysis was made by categorizing according to joint counts (1-2 joints/ 3-4 joints). Results the mean age (SD) was 46.9 (14.24) with a mean (SD) PsA duration of 3.93 (6.03) years. Within patients with 1-2 involved joints (n = 302), size of the joints only had an impact on CRP values with large joints having higher CRP (P = .005), similar to lower extremity involvement (P = .004). PROs were similar regardless of size or location if 1-2 joints were inflamed. Within patients with 3-4 involved joints (n = 85), patient global assessment (PGA), pain, fatigue and physician global assessment were higher in the group with large joints. Similarly, PGA, pain, and physician global assessment were higher in patients with lower extremity involvement as well as higher CRP values. Conclusion For PsA patients with 3-4 joints involved, lower extremity and large joints are associated with poorer outcomes with worse PROs, physician global assessment, and higher CRP. the size and anatomical location of the joints are less important for patients with 1-2 joints in terms of the PROs., Union Chimique Belge (UCB); Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK), This work was supported by the Union Chimique Belge (UCB) (to Dilek Solmaz for axial spondyloarthritis fellowship) and the Scientific and Technological Research Council of Turkey (TUBITAK) (to Sibel Bakirci).

WOS: 000505281300007, PubMed: 30680951, Objective Psoriatic arthritis (PsA) has a genetic background. Approximately 40% of patients with psoriasis or PsA have a family history of psoriasis or PsA, which may affect disease features. The aim of this study was to assess the effects of family history of psoriasis and PsA on disease phenotypes. Methods Data from 1,393 patients recruited in the longitudinal, multicenter Psoriatic Arthritis International Database were analyzed. The effects of family history of psoriasis and/or PsA on characteristics of psoriasis and PsA were investigated using logistic regression. Results A total of 444 patients (31.9%) had a family history of psoriasis and/or PsA. These patients were more frequently women, had earlier onset of psoriasis, more frequent nail disease, enthesitis, and deformities, and less frequently achieved minimal disease activity. Among 444 patients, 335 only had psoriasis in their family, 74 had PsA, and 35 patients were not certain about having PsA and psoriasis in their family, so they were excluded from further analysis. In the multivariate analysis, family history of psoriasis was associated with younger age at onset of psoriasis (odds ratio [OR] 0.976) and presence of enthesitis (OR 1.931), whereas family history of PsA was associated with lower risk of plaque psoriasis (OR 0.417) and higher risk of deformities (OR 2.557). Family history of PsA versus psoriasis showed increased risk of deformities (OR 2.143) and lower risk of plaque psoriasis (OR 0.324). Conclusion Family history of psoriasis and PsA impacts skin phenotypes, musculoskeletal features, and disease severity. The link between family history of psoriasis/PsA and pustular/plaque phenotypes may point to a different genetic background and pathogenic mechanisms in these subsets., Turkish Society for Rheumatology; Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK), Supported by the Turkish Society for Rheumatology. Dr. Bakirci's work was supported by the Scientific and Technological Research Council of Turkey and the Turkish Society for Rheumatology.

OBJECTIVES Behcet's disease (BD) is a type of systemic vasculitis and inflammatory disease of unknown etiology, which is associated with fatigue and lower quality of life (QoL). The aim of this study was to assess the relationship between Behcet's Disease Current Activity Form (BDCAF) and Behcet's Disease Quality of Life (BDQoL), depression, anxiety and fatigue in Behcet's disease. METHODS We conducted a cross-sectional study of 155 BD patients and 107 healthy subjects in a single center over a 1 year period. All participants completed the Multidimensional Assessment of Fatigue (MAF) questionnaire, and the Hospital Anxiety and Depression (HADS) scale. Disease activity in the BD patients was assessed using the BDCAF, and the physician's global assessment (PGA). BD patients also completed the BDQoL questionnaire. RESULTS There was no significant difference in age and gender between the groups. BD patients had significantly higher HADS-anxiety (HADS-A), HADS-depression (HADS-D) and MAF scores than the healthy control group (P

Purpose: The aim of this study is to measure retinal vessel density and thickness of the macula by optical coherence tomography angiography in patients with rheumatoid arthritis taking hydroxychloroquine. Methods: The study included 40 patients with rheumatoid arthritis taking hydroxychloroquine and 20 age-, gender-, and axial length-matched control subjects. Patients were divided into two groups according to the duration of hydroxychloroquine use. Twenty four of the patients were taking hydroxychloroquine for more than 5 years (Group 1), and the rest of 16 were taking hydroxychloroquine for less than 5 years (Group 2). A total of 20 age- and gender-matched volunteers with similar axial length were selected as Group 3. All of the patients underwent optical coherence tomography angiography, and 3 mm × 3 mm scanning mode was chosen for analyzing vascular density and morphological characteristics on the choriocapillaris layer. In addition, Humphrey visual field 10–2 was evaluated in each subject. Results: The temporal deep vascular density was measured as 48.13% ± 8.5% in Group 1, 54.42% ± 10.3% in Group 2, and 60.35% ± 13.1% in Group 3. Deep temporal and deep hemi-inferior vascular density was significantly lower in Group 1 in comparison with Group 3 (p = 0.041 and p = 0.046, respectively). Visual field testing was normal in all patients. Conclusion: The optical coherence tomography angiography findings showed that the parafoveal deep temporal and deep hemi-inferior vascular plexus density was reduced in patients taking hydroxychloroquine for more than 5 years despite having normal perimetry. This observation, which can be obtained only through optical coherence tomography angiography, may be relevant to the early findings of hydroxychloroquine toxicity.

Fatigue is a symptom that affects the 40-80% of patients with rheumatoid arthritis (RA) and impairs the quality of life. The aim of this study was to assess multidimensional fatigue scales, the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS) and to evaluate their relationship with disease activity in Turkish RA patients. The study included 180 patients with RA. The Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) were used to evaluate disease activity. The participants comprised of 142 females and 38 males. The mean ± standard deviations of DAS28, CDAI, and SDAI were 3 ± 1.24, 9.51 ± 7.96, and 10.5 ± 8.38 respectively. All scales except the emotional subscale were correlated with disease activity. The emotional subscale correlated with CDAI and SDAI but not with DAS28. The results of the study indicated that fatigue and disease activity were correlated. Fatigue is a symptom that impairs the quality of life but it can be easily coped with by controlling disease activity. Thus, it should be assessed in a multidimensional perspective.