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Adult onset Still's disease (AOSD) is a systemic inflammatory disease with unknown etiology and characterized by evanescent salmon pink rash, sore throat, liver dysfunction, lymphadenopathy, hepatosplenomegaly, arthritis, and leukocytosis. It is a diagnosis of exclusion; however, there are case reports in the literature about patients with malignancies and AOSD-like signs and symptoms. Here we report a patient with AOSD seems to be associated with sarcomatoid renal cell carcinoma. This phenomenon is not distinguishable from primary AOSD either in presentation or in treatment; except for the main purpose of the management should be targeted to the underlying malignancy. [ABSTRACT FROM AUTHOR]

Objective: Various types of scientific abstracts are selected and presented at meetings and listed in abstract books. Recently, a systematic review has shown that 45% of 30, 000 abstracts were published in a journal. The aim of this study was to determine the features of abstracts selected to be presented at a EULAR meeting (2008) and the corresponding publication rates. Methods: The EULAR 2008 Abstract Book was extracted, presented abstracts were assessed, their publication status was checked, and features related with publication rate were determined. The publication status of abstracts as of January 20, 2011, was verified using PubMed. Results: A total of l, 732 abstracts were assessed. Median publication duration was 13 (range: 0 to 31) months. Most of the abstracts (N = 339) were of multi-national origin. Sixty seven percent of abstracts were clinical and 563 (33%) abstracts were preclinical. We found that 601 of all abstracts (34. 7%) had been published in a journal, and most of were published in a rheumatology journal. Fifty-seven percent of published abstracts were in journals with an impact factor higher than 4. The publication rate was correlated with presentation type, number of centers involved, trial design, and number of patients enrolled. Conclusions: We found that the publication rate of EULAR 2008 abstracts at 30 months was approximately 35%. This is a high rate compared to a previously published systematic review that investigated the publication rate of studies initially presented as abstracts in medical meetings, which reported the publication rate at 24 and 36 months as 20.7% and 28.1%, respectively. More than half of the published abstracts were accepted by high-impact journals. Presentation type, number of centers, trial design, and enrolled patient numbers were all correlated with the rate of publication. [ABSTRACT FROM AUTHOR]

Although neurological involvement in Behçet's disease is not so uncommon, isolated spinal cord disease is quite rare and reported to be observed in about 2% of all cases with neurological involvement. Here we report a Behçet's patient with spinal cord disease presented with anterior spinal cord syndrome. This rare syndrome is caused by hypoperfusion of the anterior spinal artery and to our knowledge has not been previously reported in patients with Behçet's disease. This report defines the characteristic clinical features of this entity and emphasizes the importance of early immunosuppressive treatment and initiation of rehabilitation. [ABSTRACT FROM AUTHOR]

The vertical and horizontal changes in the subsurface resistivity of the Isparta alluvial plain (Çünür-Deregümü) was investigated by using the methods of vertical electrical sounding and combined sounding-profiling. The Schlumberger and dipoledipole electrode arrays were used for data collection. The measured apparent resistivity data were evaluated using the Zohdy's algorithm and IP2WIN program for one-dimensional interpretation and the damped least-squares inversion algorithm for twodimensional interpretation. One- and two-dimensional subsurface resistivity structures were performed utilizing the field geological data [ABSTRACT FROM AUTHOR]

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D3 vitamininin, her iki diyabet tipinin patofizyolojilerinde pankreas beta hücre disfonksiyonu, azalmış insülin etkisi ve sistemik inflamasyon gibi çeşitli mekanizmalar üzerinden hem doğrudan hem de dolaylı etkileri olduğu düşünülmektedir. Bu çalışmada, tip1 ve tip2 diyabet hastalarında D3 hipovitaminoz yaygınlığını ve vitamin D3 durumunun patogenez üzerinde etkisini değerlendirmeyi amaçladık. Çalışmaya, diyabet hastaları Dicle Üniversitesi Tıp Fakültesi Hastanesi Endokrinoloji Kliniğin'den dahil edildi. Bu çalışmada 18-65 yaş arasındaki 30 tip 1 ve 30 tip2 diyabet hastası araştırıldı. Tip 1 ve tip 2 diyabet hastaları ADA kriterlerine göre seçildi. Kontrol grubu; ailesinde diyabet öyküsü olmayan, açlık kan şekeri 100 mg/dl altında olan, gönüllü sağlıklı hastane personelinden oluşturuldu. D3 vitamini, yüksek performanslı sıvı kromatografisi yöntemiyle, serum IL-2R ve TNF-a seviyeleri ımmulate 1000 cihazında katı fazlı ve iki yerli chemiluminescent immünometrik metodla ölçüldü. Tip 1 ve tip 2 diyabet hastalarının vitamin D3 seviyesi, kontrol grubu ile kıyaslandığında anlamlı azaldığı görüldü (p<0.001, p=0.001). Tip 1 diyabet hastalarının serum IL-2R seviyesi, kontrol grubu ile kıyaslandığında anlamlı arttığı görüldü (p<0.001). Tip 2 diyabet hastalarının serum IL-2R seviyesi, kontrol grubu ile kıyaslandığında anlamlı farklılık görülmedi (p=0.307). Tip 1 ve Tip 2 diyabet hastalarının serum TNF-a seviyesi kontrol grubu ile kıyaslandığında anlamlı arttığı görüldü (p<0.001, p<0.001). Bizim çalışmamız tip 1 ve tip 2 diyabet hastalarının serum vitamin D3 seviyesinin kontrol grubuna göre daha azalmış olduğunu gösterdi ancak tip 1 ve tip 2 diyabet hastalarının serum TNF-a seviyesinin kontrol grubuna göre daha artmış olduğunu gösterdi. [ABSTRACT FROM AUTHOR]

Cholecalciferol is thought to have both direct and indirect effects on various mechanisms related to the pathophysiology of both types of diabetes, including pancreatic beta cell dysfunction, impaired insulin action and systemic inflammation. In this study, we aimed to assess the prevalence of hypovitaminosis D3 patients type 1 and type 2 diabetes and to assess the impact of cholecalciferol status on pathogenesis. This study, diabetic patients were recruited at the Department of Endocrinology, Faculty of Medicine Hospital, Dicle University. In this study we investigated thirty type 1 and thirty type 2 diabetic patients who were 18-65 years of age. Type 1 and type 2 diabetes patients in this study were diagnosed according to the ADA diagnostic criteria. Non-diabetes subjects as control were healthy volunteers from the hospital staff without any family history of diabetes, and with fasting plasma glucose concentrations below 100 mg/dl. Serum IL-2R and TNF-a levels were measured by using Immulate 1000 solid phase and two-site chemiluminescent immunometric assay method and serum cholecalciferol level was measured by an high-performance liquid chromatography method .Type 1 and type 2 diabetes patients showed significantly decreased cholecalciferol levels compared to control groups (p<0.001, p=0.001). Type 1 diabetes patients showed significantly increased serum IL-2R levels compared to control groups (p=0.001). Type 2 diabetes patients showed no significant differences serum IL-2R levels compared to control groups (p=0.307) Type 1 and type 2 diabetes patients showed significantly increased serum TNF-a levels compared to control groups (p<0.001, p=0.001). Our study showed that serum cholecalciferol level was lower among Type 1 and type 2 diabetes patients than among control subjects. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the presence of sarcopenia in patients with rheumatoid arthritis (RA). Method: This cross‐sectional study included 100 patients with RA and 100 gender‐matched healthy individuals. Sarcopenia was assessed by performing tests evaluating muscle strength, muscle mass, and physical performance, using the criteria determined by The European Working Group on Sarcopenia. Sarcopenia is defined as a decrease in muscle strength and muscle mass. On the other hand, presarcopenia is defined as a decrease in muscle strength with a normal muscle mass. Results: The participants comprised of 70 females and 30 males. The frequency of presarcopenia was 35% in the RA group and 9% in the control group (P <.001). Results of handgrip and gait speed tests were lower in the RA group than in the healthy control group (P =.002 and P <.001, respectively). Presarcopenia was seen at higher rates among female and older patients, and patients with longer disease duration. Disease activity scores were higher in patients with presarcopenia than in patients without sarcopenia (P <.05). In multivariate regression analysis for presarcopenia; a statistically significant association was found between handgrip test results and age, gender, and disease activity (P <.001, R2 =.62). Conclusions: Longer disease duration and higher disease activity may provoke the development of sarcopenia due to chronic inflammation in patients with RA. Physicians should be aware of the development of sarcopenia during the course of disease and take into account the preservative and preventive methods against sarcopenia by encouraging them about exercise along with controlling disease activity. [ABSTRACT FROM AUTHOR]

Background/aim: Idiopathic granulomatous mastitis is a rare, benign inflammatory disease of breast. There is no general agreement on the appropriate treatment choice. The aim of the study was to investigate the immunosuppressive administer for idiopathic granulomatous mastitis and risk factors related with disease recurrence. Materials and methods: The data of 53 patients with idiopathic granulomatous mastitis were evaluated for this cross-sectional retrospective study. Demographic features and clinical characteristics and course of the patients were obtained from file records. Results: The mean age of the patients was 37.2 ± 6.6 years. Fifty-one of 53 patients received immunosuppressive treatment with or without surgery. Forty-seven (88.6%) of the patients received only immunosuppressive treatment without surgery, while 4 (7.54%) patients received immunosuppressive treatment after surgery. Forty-one (77.3%) of 47 patients who had no surgical resection received methotrexate as immunosuppressive treatment. The other 6 (11.3%) patients received azathioprine or corticosteroid treatment. Complete or partial remission was observed in 50 (98%) of 51 patients who received immunosuppressive treatment, while only 1 (2%) patient did not reach remission. No factors were found related with recurrence of disease. Conclusion: Methotrexate seems to be efficient in the treatment of idiopathic granulomatous mastitis and provides drug-free remission. [ABSTRACT FROM AUTHOR]

Introduction: Interstitial lung disease is one of the most critical manifestations of connective tissue diseases that may cause morbidity and mortality. This study aimed to evaluate the clinical and demographic characteristics and treatment of the patients with connective tissue disease–related interstitial lung disease.This retrospective observational study included patients from the Gulhane Rheumatology Interstitial Lung Disease cohort between October 2016 and June 2023. The patients were assessed retrospectively.A total of 173 patients were included in the study with a mean age of 63.4 ± 11.9 years. The frequencies of CTD were 34.1% Sjogren’s syndrome, 30.1% rheumatoid arthritis, 25.4% systemic sclerosis, 5.8% undifferentiated connective tissue disease, 2.9% idiopathic inflammatory myositis, 1.2% mixt connective tissue disease, and 0.6% systemic lupus erythematosus in decreasing frequencies. Nonspecific interstitial pneumonia, which was the most common interstitial lung disease pattern in 103 (59.5%) patients, was most frequent among patients with SS and SSc (p < 0.001 vs. p < 0.001). Usual interstitial pneumonia was most frequent among patients with RA (p < 0.001). All patients received immunosuppressive treatment, most commonly azathioprine. 57.2% were using immunosuppressives for ILD. Six patients had mortality, and infections were the leading cause.As a critical manifestation of connective tissue diseases, immunosuppressive treatment is indispensable in the management of interstitial lung diseases especially those at an increased risk for progression. The treatment approaches should be assessed in a patient-based way. The patients under immunosuppressive treatment should be cautiously followed for infections.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.Method: Interstitial lung disease is one of the most critical manifestations of connective tissue diseases that may cause morbidity and mortality. This study aimed to evaluate the clinical and demographic characteristics and treatment of the patients with connective tissue disease–related interstitial lung disease.This retrospective observational study included patients from the Gulhane Rheumatology Interstitial Lung Disease cohort between October 2016 and June 2023. The patients were assessed retrospectively.A total of 173 patients were included in the study with a mean age of 63.4 ± 11.9 years. The frequencies of CTD were 34.1% Sjogren’s syndrome, 30.1% rheumatoid arthritis, 25.4% systemic sclerosis, 5.8% undifferentiated connective tissue disease, 2.9% idiopathic inflammatory myositis, 1.2% mixt connective tissue disease, and 0.6% systemic lupus erythematosus in decreasing frequencies. Nonspecific interstitial pneumonia, which was the most common interstitial lung disease pattern in 103 (59.5%) patients, was most frequent among patients with SS and SSc (p < 0.001 vs. p < 0.001). Usual interstitial pneumonia was most frequent among patients with RA (p < 0.001). All patients received immunosuppressive treatment, most commonly azathioprine. 57.2% were using immunosuppressives for ILD. Six patients had mortality, and infections were the leading cause.As a critical manifestation of connective tissue diseases, immunosuppressive treatment is indispensable in the management of interstitial lung diseases especially those at an increased risk for progression. The treatment approaches should be assessed in a patient-based way. The patients under immunosuppressive treatment should be cautiously followed for infections.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.Results: Interstitial lung disease is one of the most critical manifestations of connective tissue diseases that may cause morbidity and mortality. This study aimed to evaluate the clinical and demographic characteristics and treatment of the patients with connective tissue disease–related interstitial lung disease.This retrospective observational study included patients from the Gulhane Rheumatology Interstitial Lung Disease cohort between October 2016 and June 2023. The patients were assessed retrospectively.A total of 173 patients were included in the study with a mean age of 63.4 ± 11.9 years. The frequencies of CTD were 34.1% Sjogren’s syndrome, 30.1% rheumatoid arthritis, 25.4% systemic sclerosis, 5.8% undifferentiated connective tissue disease, 2.9% idiopathic inflammatory myositis, 1.2% mixt connective tissue disease, and 0.6% systemic lupus erythematosus in decreasing frequencies. Nonspecific interstitial pneumonia, which was the most common interstitial lung disease pattern in 103 (59.5%) patients, was most frequent among patients with SS and SSc (p < 0.001 vs. p < 0.001). Usual interstitial pneumonia was most frequent among patients with RA (p < 0.001). All patients received immunosuppressive treatment, most commonly azathioprine. 57.2% were using immunosuppressives for ILD. Six patients had mortality, and infections were the leading cause.As a critical manifestation of connective tissue diseases, immunosuppressive treatment is indispensable in the management of interstitial lung diseases especially those at an increased risk for progression. The treatment approaches should be assessed in a patient-based way. The patients under immunosuppressive treatment should be cautiously followed for infections.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.Conclusions: Interstitial lung disease is one of the most critical manifestations of connective tissue diseases that may cause morbidity and mortality. This study aimed to evaluate the clinical and demographic characteristics and treatment of the patients with connective tissue disease–related interstitial lung disease.This retrospective observational study included patients from the Gulhane Rheumatology Interstitial Lung Disease cohort between October 2016 and June 2023. The patients were assessed retrospectively.A total of 173 patients were included in the study with a mean age of 63.4 ± 11.9 years. The frequencies of CTD were 34.1% Sjogren’s syndrome, 30.1% rheumatoid arthritis, 25.4% systemic sclerosis, 5.8% undifferentiated connective tissue disease, 2.9% idiopathic inflammatory myositis, 1.2% mixt connective tissue disease, and 0.6% systemic lupus erythematosus in decreasing frequencies. Nonspecific interstitial pneumonia, which was the most common interstitial lung disease pattern in 103 (59.5%) patients, was most frequent among patients with SS and SSc (p < 0.001 vs. p < 0.001). Usual interstitial pneumonia was most frequent among patients with RA (p < 0.001). All patients received immunosuppressive treatment, most commonly azathioprine. 57.2% were using immunosuppressives for ILD. Six patients had mortality, and infections were the leading cause.As a critical manifestation of connective tissue diseases, immunosuppressive treatment is indispensable in the management of interstitial lung diseases especially those at an increased risk for progression. The treatment approaches should be assessed in a patient-based way. The patients under immunosuppressive treatment should be cautiously followed for infections.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.Key Points• Interstitial lung disease is a noteworthy manifestation of connective tissue diseases.• The clinical findings, treatment requirements, and progression vary according to the severity of the disease.• Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Cardiovascular diseases (CVD) are very common in the general population. Atherosclerosis is the main pathogenesis. Familial Mediterranean fever (FMF) is an autosomal recessive disease. The gene causing FMF, designated MEFV, encodes a protein called pyrin or marenostrin that is expressed mainly in myeloid bone marrow precursors, neutrophils and monocytes. We herein aimed to determine the prevalence of MEFV mutations (all exon 2, 10 mutations) in patients with early coronary heart disease (early CHD) and coronary heart disease (CHD) with multiple risk factors and among the healthy subjects as controls. Methods: A total of 197 patients and 119 healthy subjects were recruited and enrolled into three groups in terms of inclusion criteria. Ninety‐one patients diagnosed with early CHD enrolled into group one (men < 45 years of age, women < 40 years of age), 106 patients with CHD (men > 50 years of age) to group two and 119 healthy controls enrolled into group three. None of patients was diagnosed with FMF. The diagnosis of CHD was established on electrocardiographic changes, echocardiography and coronary angiography. Results: Thirty‐eight patients (41.8%) with early CHD, 17 patients (16%) with CHD and 24 healthy controls (20.2%) carried at least one mutated MEFV allele. Young patients with CHD have different risk factor profiles, clinical presentations and prognoses than older patients. Young patients with CHD usually have multiple risk factors. Conclusion: This study suggests that MEFV mutations in early CHD patients had significantly increased in contrast to CHD patients and healthy controls. [ABSTRACT FROM AUTHOR]

Retro-orbital granuloma is a rare and devastating component of granulomatosis with polyangiitis (GPA). Current medical treatment protocols are falling short, and outcomes are poor. The aim of the study was to investigate the frequency, clinical features, and treatment outcomes of retro-orbital granuloma in patients with GPA. This is a retrospective, multi-centre study, which involves GPA cohorts from five different clinics. Data were extracted from patient charts including history, physical examination, radiological-laboratory-histological findings, and treatment protocols. Major clinical outcome measures were changes in the volume of the granuloma on comparative MRI, and visual acuity on repeated ophthalmologic examinations. Among 141 GPA patients, nine (five females and four males) were diagnosed with a retro-orbital granuloma. Median duration of disease was 8 years. Proptosis and diplopia were the dominant presenting symptoms (77 %), followed by orbital pain (55 %). Three out of nine patients had isolated retro-orbital granulomas, without other organ involvement of GPA. Five patients received conventional pulse steroid and pulse cyclophosphamide (CYC) as the first-line remission induction therapy. Four of these patients had progressive disease, and a regression in granuloma size was observed in one patient using this regimen. Two patients were already receiving immunosuppressants when they were diagnosed with retro-orbital granuloma. Six patients had been treated with RTX as the second-line remission induction therapy. None of these patients had progression following RTX therapy. Three patients underwent orbital decompression surgery. The indication for the decision for surgery was either progressive loss of vision or intractable pain. Standard first-line chemotherapy (CYC and steroids) was ineffective against retro-orbital granuloma associated with GPA. RTX could be an alternative in these cases. Surgical intervention may help to decrease the morbidity. Further prospective studies with greater patient numbers are needed to test the clinical efficiency of RTX as a first-line remission induction chemotherapy. [ABSTRACT FROM AUTHOR]

Objectives Paraneoplastic arthritis ( PA) may mimic rheumatic diseases. While presenting the demographic and laboratory features of the patients diagnosed with PA, this study also aims to provide possible appropriate tools to differentiate the PA cases from early rheumatoid arthritis ( ERA). Methods Sixty-five patients with PA (male/female: 43/22) from 15 different rheumatology clinics and 50 consecutive patients with ERA (male/female: 13/37) fulfilling the 2010 American College of Rheumatology ( ACR) criteria for the diagnosis if the RA from Gaziantep Rheumatology Early Arthritis Trial ( GREAT) as controls who were diagnosed at least 12 months before, were enrolled into study. Results Mean ages of the patients with PA and ERA were 50.2 ± 15.3, and 42.7 ± 12.3, respectively, and the mean ages of the patients with PA were significantly higher than the ERA. Unlike the ERA patients, in our case series PA was predominantly observed among males. Oligoarthritis was significantly higher in solid tumors in contrast to ERA ( P = 0.001). Polyarthritis and symmetric arthritis were significantly higher in the ERA group in contrast to all malignancies ( P = 0.001). Rheumatoid factor ( RF) and anticyclic citrullinated peptide antibody (anti- CCP) positivity were significantly higher in the ERA group (each P = 0.001). Lactic dehydrogenase levels of hematologic malignancies were significantly higher than other groups (each, P = 0.001). Conclusions ERA patients had more symmetric joint involvement than PA; laboratory markers could be also an alternative where there is high RF and anti- CCP positivity with antibody levels among the ERA patients. Finally, the demographic features can be used as differentiating factors; ERA was seen predominantly among females aged 40-59 years which refers to young adults. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine the challenges experienced by women with systemic sclerosis, whose hands affected, while performing activities of daily living and their coping strategies. Background Many of the patients with systemic sclerosis experience difficulties in performing daily activities. One of the most important reasons for that is the impaired hand function due to their diseases. Design A descriptive cross-sectional design was conducted and questionnaire was used in this study. Methods The study was performed in a Rheumatology Department at a tertiary-care hospital in Turkey between April 2010-December 2011. Nineteen patients with systemic sclerosis with hand involvement were enrolled in this study. The data were collected by using both a demographic data form and an Evaluation of Daily Activity Questionnaire. Results According to Evaluation of Daily Activity Questionnaire, the most scored dimension that patients can do with much difficulty was 'eating' and the dimension that patients unable to do was 'washing/clothes care'. In 'eating' dimension, the most difficult activities were 'opening glass jar', 'opening juice bottle' and 'opening bottle' that requiring the movement of rotation. Their coping strategies for these activities were as follows: try to open with a towel, try to remove the edge of the palm with a knife, use the hand palm and help from someone else (spouse, neighbour, etc.). In 'washing/clothes care' dimension, the most difficult activities were 'turning up hem of a skirt', 'washing up in bowl' and 'cutting out material'. For these activities, they use some coping strategies such as getting help from tailor, washing in the machine instead of hand washing. Conclusion This study demonstrates that impaired hand function affects the daily life activities of patients with systemic sclerosis, and patients have developed some coping strategies to overcome these difficulties. Relevance to clinical practice The coping strategies used by patients can be helpful for the other patients with systemic sclerosis. [ABSTRACT FROM AUTHOR]

Angiogenesis is controlled by a variety of angiogenesis stimulators and inhibitors. The increased power Doppler (PD) signals determined by ultrasonography is an indirect marker of synovial vascularity in arthritis. We aimed to investigate relationship between ultrasonographic findings and synovial angiogenesis modulators. Thirteen Behcet's disease (BD), 15 spondyloarthropathy, 21 rheumatoid arthritis (RA), and 15 osteoarthritis (OA) patients with knee arthritis were included. Cumulative effusion, synovial hypertrophy, and PD signal scores were calculated in arthritic joints. In synovial fluid samples, angiogenesis inhibitors (angiostatin, thrombospondin-1, and endostatin) and stimulators [bFGF (basic fibroblast growth factor), angiopoietin-1] were studied. The comparisons between groups were made by Kruskal-Wallis test, and correlation analysis was calculated with Pearson and Spearman tests. Effusion scores were significantly higher in inflammatory arthritis than in OA. Synovial hypertrophy scores were higher in RA and spondylarthritis than in OA and BD. PD scores were not different between the groups. Synovial angiostatin and bFGF levels were significantly higher in patients with inflammatory arthritis than in OA. Cumulative effusion scores were positively correlated with angiopoietin-1, angiostatin, and bFGF and negatively correlated with thrombospondin-1 levels. Synovial hypertrophy scores were positively correlated with angiostatin and bFGF levels and negatively correlated with thrombospondin-1. No correlation was found between PD scores and modulators of angiogenesis. In large joints like knee, detecting PD signals alone was not sufficient to assess the angiogenesis. However, cumulative activity scores were positively correlated with angiogenesis stimulators. Therefore, when investigating the angiogenesis, PD technique should be added to gray-scale examinations. [ABSTRACT FROM AUTHOR]

Although the inflammatory cascade of familial Mediterranean fever (FMF) is partially understood, triggering factors of those attacks has not been studied well. It is supposed that physical stresses such as cold exposure, tiredness and emotional stresses could provoke attacks. This study is aimed to survey the factors regarded as triggering the attacks in patients with FMF and their relationship with MEFV gene mutations. Clinical findings and genetic mutations (consist of M694V, M694I, M680I, V726A, E148Q) of patients were recorded. Patients were questioned about cold exposure, emotional stress, tiredness, long-lasting standing, long-duration travel, starvation, high intake of food, trauma, and infection as triggering factors for the attacks with both serositis and musculoskeletal pain. The study is comprised of 275 FMF patients (male/female: 177/98). The most common triggering factors for the attacks with serositis were cold exposure (59.3 %), emotional stress (49.8 %), tiredness (40.0 %) and menstruation (33.7 % in females). Long-lasting standing (78.8 %), long-duration travel (64.1 %) and tiredness (47.8 %) were the triggering factors for the attacks with musculoskeletal symptoms. The relationships between MEFV mutations and triggering factors were found as M694V allele with starvation, E148Q allele with high intake of food and V726A allele with long-duration travel. The attacks with serositis seem to be triggered by those factors to which whole body exposed, whereas the attacks with musculoskeletal complaints seem to be triggered by those factors to which regional or local part of body exposed. Since the number of alleles was small, a clear conclusion for a relationship between a particular gene variant and a specific trigger was not made. [ABSTRACT FROM AUTHOR]

Adult-onset Still's disease is an acute, inflammatory, febrile disorder and it presents with variety of clinical courses. Not only flu-like symptoms but also myalgia, arthritis, lymphadenophaty may occur. High level of serum ferritine is one of the patognomonic features of the disease. We report a case with different clinical course and treatment. [ABSTRACT FROM AUTHOR]

In Behçet's disease, deep venous thrombosis occurs primarily in the lower extremities. Total recanalization rate is low, so thrombotic segment could be detected by imaging afterward. For disclosing vein involvement, leg swelling is commonly queried in the history taking in those patients. However, there are no data about the presence of 'silent' thrombosis in patients with BD. We aimed at investigating the integrity of venous vessels in BD, without any known vascular event by using Doppler ultrasonography (DU). Patients having past events revealed in the vascular questionnaire or physical findings attributable to vascular disease were excluded. Various degree of venous insufficiency was detected in 74 patients in BD (74%), 24 out of 33 patients (72%) in AS and in 8 out of 34 (25%) in HC group. All were at the lower extremities, and there is no difference in the frequency between BD and AS, while both were significantly higher than in HC ( P = 0.001, and 0.004, respectively). Six patients with BD (6%) have chronic venous thrombi at the lower extremities and none in either AS and HC. As a non-invasive method, DU of lower extremities may disclose 'silent' thrombosis. Venous insufficiency in those patients should be considered cautiously as an indicator of vein involvement. [ABSTRACT FROM AUTHOR]

Behçet’s disease is a systemic disease characterized by oral aphthosis, genital ulcers, ocular lesions, gastrointestinal, musculoskeletal, neurological and major vessel involvement. Arterial involvement, aneurysms and arterial thrombosis have been reported in 1.5–3% of patients. In this case report, we present a patient with ulnar arterial aneurysm associated with Behçet’s disease. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the applicability of the new 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria in Turkish adult patients previously diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Patients and methods: One hundred sixty-four patients (96 males, 68 females; mean age: 49.6±14.4 years; range, 18 to 87 years) diagnosed with AAV by experienced rheumatologists between July 2016 and May 2022 were included in this retrospective cross-sectional study and reclassified based on the 1990 ACR criteria, the European Medicines Agency (EMEA) algorithm, and the 2022 ACR/EULAR criteria. For external validation, 83 patients (48 males, 35 females; mean age: 47.3±17.5 years; range, 19 to 81 years) diagnosed with immunoglobulin (Ig)A vasculitis were included. Results: One hundred twenty-six (76.8%) patients had granulomatosis with polyangiitis (GPA), 13 (7.9%) patients had eosinophilic granulomatosis with polyangiitis (EGPA), and 25 (15.2%) patients had microscopic polyangiitis (MPA). According to the criteria, the number of unclassified patients was nine (5.5%) for both the 2022 ACR/EULAR AAV classification criteria and the EMEA algorithm. The new criteria had an almost perfect agreement with the clinician's diagnosis (Cohen's kappa coefficient [κ]=0.858 for GPA, κ=0.820 for EGPA, and κ=0.847 for MPA). The kappa statistics for agreement of 2022 ACR/EULAR classification criteria with the EMEA algorithm were found 0.794 for GPA, 0.820 for EGPA, and 0.700 for MPA. None of the 83 patients diagnosed with IgA vasculitis could be classified as GPA, EGPA, or MPA using the new ACR/EULAR AAV classification criteria. Conclusion: The 2022 ACR/EULAR classification criteria for AAV showed substantial or perfect agreement with the clinical diagnosis and the EMEA algorithm., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish League Against Rheumatism.)

Background/aim: The objective of this study is to evaluate the clinical presentations and adverse outcomes of Coronavirus Disease 2019 (COVID-19) in patients with systemic sclerosis (SSc) and assess the impact of SSc features on the clinical course of COVID-19., Materials and Methods: In this multicenter, retrospective study, SSc patients with COVID-19 were included. Clinical features of SSc, along with detailed COVID-19 data, were extracted from medical records and patient interviews., Results: The study included 112 patients (mean age 51.4 ± 12.8 years; 90.2% female). SSc-associated interstitial lung disease (ILD) was evident in 57.1% of the patients. The findings revealed hospitalization in 25.5%, respiratory support in 16.3%, intensive care unit admission in 3.6%, and a mortality rate of 2.7% among SSc patients with COVID-19. Risk factors for respiratory failure, identified through univariate analysis, included ILD (OR: 7.49, 95% CI: 1.63-34.46), ≥1 comorbidity (OR: 4.55, 95% CI: 1.39-14.88), a higher physician global assessment score at the last outpatient visit (OR 2.73, 95% CI: 1.22-6.10), and the use of mycophenolate at the time of infection (OR: 5.16, 95 %CI: 1.79-14.99). Notably, ≥1 comorbidity emerged as the sole significant predictor of the need for respiratory support in COVID-19 (OR: 5.78, 95% CI: 1.14-29.23). In the early post-COVID-19 period, 17% of patients reported the progression of the Raynaud phenomenon, and 10.6% developed new digital ulcers. Furthermore, progression or new onset of dyspnea and cough were detected in 28.3% and 11.4% of patients, respectively., Conclusion: This study suggests a potential association between adverse outcomes of COVID-19 and SSc-related ILD, severe disease activity, and the use of mycophenolate. Additionally, it highlights that having comorbidities is an independent risk factor for the need for respiratory support in COVID-19 cases., (© TÜBİTAK.)

Objectives: The study aimed to identify the interactions among treatment protocols and oral ulcer activity related factors in patients with Behçet's syndrome (BS) using the Classification and Regression Tree (CART) algorithm., Methods: In this cross-sectional study, 979 patients with BS were included from16 centres in Turkey, Jordan, Brazil and the United Kingdom. In the CART algorithm, activities of oral ulcer (active vs. inactive), genital ulcer (active vs. inactive), cutaneous involvement (active vs. inactive), musculoskeletal involvement (active vs. inactive), gender (male vs. female), disease severity (mucocutaneous and musculoskeletal involvement vs. major organ involvement), smoking habits (current smoker vs. non-smoker), tooth brushing habits (irregular vs. regular), were input variables. The treatment protocols regarding immunosuppressive (IS) or non-IS medications were the target variable used to split from parent nodes to purer child nodes in the study., Results: In mucocutaneous and musculoskeletal involvement (n=538), the ratio of IS use was higher in patients with irregular toothbrushing (ITB) habits (27.1%) than in patients with regular toothbrushing (RTB) habits (14.2%) in oral ulcer activity. In major organ involvement (n=441), male patients with ITB habits were more likely treated with IS medications compared to those with RTB habits (91.6% vs. 77.6%, respectively)., Conclusions: Male BS patients on IS who have major organ involvement and oral ulcer activity with mucocutaneous and musculoskeletal involvement have irregular toothbrushing habits. Improved oral hygiene practices should be considered to be an integral part for implementing patient empowerment strategies for BS.

Objective: We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences., Methods: A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments., Results: Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated ( P  < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching ( P  < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P  < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline., Conclusion: The oral route was more frequently preferred by patients compared with physicians, although patients' preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: Because of concerns about malignancy risks, using biological disease-modifying antirheumatic drugs (bDMARDs) in patients with a history of malignancy remains a challenging issue in rheumatology practice. This study aimed to investigate bDMARD preferences of physicians when treating of rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients with a history of malignancy., Methods: The data for this cross-sectional study were gathered from the TReasure database using a date range of December 2017 and January 2020. Biological disease-modifying antirheumatic drug preferences were analyzed for 40 RA patients and 25 SpA patients with a history of malignancy., Results: The most frequently prescribed bDMARD was rituximab, which was given to 28 RA patients (70%). For 25 patients (62.5%), the time between the diagnosis of malignancy and starting on a bDMARD regimen was less than 60 months, with a median interval of 43.5 months. Among SpA patients, the preferred bDMARDs were secukinumab and etanercept, which were each administered to 7 patients (28%). For 13 SpA patients (52%), the time between the diagnosis of malignancy and starting on bDMARDs was less than 60 months, with a median interval of 97 months., Conclusions: The observed bDMARD preferences may be related to the therapeutic effects of rituximab on lymphoproliferative malignancies, the protective effects of secukinumab on tumor progression, and the short half-life of etanercept. Biological disease-modifying antirheumatic drugs should be used in RA and SpA patients with malignancy in case of high inflammatory activity., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Sarcopenia is a progressive and generalized loss of muscle mass and function. The aim of this study was to evaluate the frequency of sarcopenia among patients with primary Sjögren's syndrome (SS) and the factors related with sarcopenia., Methods: Forty-four female patients with primary SS and 44 female control subjects were included in this cross-sectional study between February and August 2019. Sarcopenia was evaluated by the handgrip test, Skeletal Muscle Mass Index, and gait speed test., Results: Eleven patients (25.0%) had presarcopenia in the SS group and 2 (4.5%) in the control group (p = 0.007). Compared with control subjects, SS patients had lower results of hand grip and gait speed tests (p = 0.005 and p < 0.001, respectively). According to the Mini Nutritional Assessment Short Form, patients with presarcopenia had higher risk of malnutrition compared with patients without sarcopenia (p = 0.043). Patients with presarcopenia had higher scores in the European League Against Rheumatism Sjögren's Syndrome Patient-Reported Index pain domain and patient visual analog scale for global disease activity compared with patients without sarcopenia (p = 0.044 and p = 0.036, respectively). In multivariate regression analysis, European League Against Rheumatism Sjögren's Syndrome Patient-Reported Index pain was associated with hand grip strength (p = 0.016, R2 = 0.13) and Mini Nutritional Assessment Short Form was associated with Skeletal Muscle Mass Index (p = 0.005)., Conclusions: Risk of sarcopenia is increased in patients with SS. Pain and malnutrition may contribute to presarcopenia. Evaluating pain and patient's global disease activity may help physicians to determine patients with increased risk of sarcopenia. Controlling disease activity and pain and preventing malnutrition may reduce the risk of development of sarcopenia., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

We wanted to see how close we could get to our goal of treating rheumatoid arthritis (RA) without the use of glucocorticoids (GCs) in the disease-modifying antirheumatic drugs (DMARDs) era using real-life data. Established in 2017, the TReasure database is a web-based, prospective, observational cohort for Turkey. As of May 2019, there were 2,690 RA patients recorded as receiving biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) therapy. At the start of the bDMARDs or tsDMARDs, patients with follow-up visits of at least 3 months were registered. At the time of registration and the last visit, doses of GCs were recorded and it was determined if the target dose of ≤ 7.5 mg was achieved. During registration and follow-up, 23.4% of the patients did not receive GCs and 76.5% of the patients received GCs at any time. GCs could be stopped after 59 (25-116) months in 28.4% of these patients, but 71.6% of patients were still using GC. The target GC dose could not be achieved in 18.2% of these patients (n = 352). The rate of continuing to use GC was significantly higher in women, in the elderly, those with rheumatoid factor (RF) positive, with higher Visual Analog Scale (VAS) pain and Disease Activity Score (DAS)-28. The initial GC dose of ≥ 7.5 mg/day was found to be crucial in not reaching the GC target dose (p < 0.001, OR 39.0 (24.1-63.2)). The initial GC dose of ≥ 7.5 mg/day, female gender, age, RF positivity, high DAS28, and VAS pain level were all highly related for GC continuation. Despite the use of DMARDs, our data revealed that we are still far from achieving our goal of treating RA without using steroids., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: Interleukin-6 receptor antagonist, tocilizumab (TCZ), is known to be effective in the treatment of amyloidosis in patients with familial Mediterranean fever (FMF). But there are limited data about the effect of TCZ on frequency of attacks. In the current study, we aimed to find out whether TCZ therapy could decrease the frequency of recurrent attacks of FMF or not., Materials and Methods: The recorded files of 15 patients who had received intravenous TCZ for the improvement of amyloidosis associated with FMF, were evaluated retrospectively. Data of demographic and clinical characteristics of patients were archived from those files., Results: Three female and 12 male patients received TCZ due to amyloidosis were included to the study. The mean age was 42.07 ± 14.37 years. All of the patients were in full compliance with colchicine treatment. According to international severity scoring system for FMF, all of the patients had severe disease. The frequency of attacks recorded was evaluated during TCZ treatment, and it was reported that one patient had no response, six patients had decreased attack frequency and eight patients had no attacks., Discussion: Tocilizumab is found to be efficient on improvement of amyloidosis and decreasing the frequency of recurrent attacks in patients with FMF. Besides, TCZ is well tolerated among the patients. Further and prospective studies with larger sample are needed to support these results.

Introduction: Migraine pathogenesis still remains uncertain. Studies have found contradictory results regarding NO, S100B and NSE parameters in migraine patients. Therefore, in our study, we aimed to measure NO, S100B and NSE concentrations in migraine patients, compare them with the control group and find the relationship between these parameters., Materials and Methods: Fifty-two patients (35 women and 17 men) diagnosed with migraine according to the International Headache Classification II criteria were included in the study. 30 healthy participants without any history of disease were included in the control group. Serum NO, S100B and NSE levels were determined in all participants., Results: It was found that NO, S100B parameters increased compared to the control group, and NSE parameter decreased compared to the control group in the migraine patients participating in this study (p = 0,004, p = 0,002, p = 0,000) It was found that there was a moderate positive linear correlation between serum S100B and NSE in the migraine patients in our study (r = 442, p = 0.011)., Conclusion: In our study, the fact that there was a statistically significant difference in the NO, S100b and NSE parameters of migraine and control group patients indicates that these molecules can be effective in the pathogenesisof migraine. The moderate positive linear correlation found between serum S100B and NSE in migraine patients in our study demonstrates that these molecules together can be effective in the pathogenesis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this multicentre study was to understand patients' needs and to evaluate the oral ulcer activity with the Composite Index (CI), according to different treatment modalities in Behçet's syndrome (BS)., Methods: BS patients (n=834) from 12 centres participated in this cross-sectional study. Oral ulcer activity (active vs. inactive) and the CI (0: inactive vs. 1-10 points: active) were evaluated during the previous month. The effects of treatment protocols [non-immunosuppressive: non-IS vs. immunosuppressive: (ISs)], severity (mild vs. severe), disease duration (<5 years vs. ≥5 years) and smoking pattern (non-smoker vs. current smoker) were analysed for oral ulcer activity., Results: Oral ulcer activity was observed in 65.1% of the group (n=543). In both genders, the activity was higher in mild disease course with non-IS treatment group compared to severe course with ISs (p<0.05). As a resistant group, patients with mild disease course whose mucocutaneous symptoms were unresponsive to non-IS medications were treated with ISs in a limited period and achieved the highest CI scores in females. Oral ulcer activity and poor CI score were associated with disease duration less than 5 years compared to others in male patients (p<0.05)., Conclusions: Oral ulcer activity pattern is affected by both the combination of disease course, treatment protocols and disease duration. CI scores reflected the oral clinical activity and CI might be a candidate scale to evaluate the efficacy of treatments during the follow-up of oral ulcer activity in BS.

Both Behçet's disease (BD) and major depressive disorder (MDD) are diseases associated with nitric oxide (NO). We hypothesized that the comorbidity of MDD affects the levels of NO in BD. In this study, we investigate whether there was a difference in NO levels among BD patients with accompanying MDD, BD patients with no depressive symptoms and healthy control group. There was a significant difference in NO levels among BD and control group ( P < 0.05). Also, there was a significant difference between the BD group with MDD and BD group without psychiatric comorbidity in terms of NO levels ( P < 0.05). This study is interesting as it demonstrates that accompanying psychiatric comorbidity puts an additional NO burden on the shoulders of BD patients.