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Objective: Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, affecting many organs. Celiac disease (CD), which causes inflammatory damage to the small intestine, develops as a result of the immunological response to gluten. The incidence of CD has increased in pSS. This research aims to investigate the frequency of CD in pSS. Methods: This is a cross-sectional study conducted in a single-center between 2019 and 2020. A total of 90 patients diagnosed with pSS were questioned regarding CD symptoms. Laboratory tests and small bowel biopsies were requested from patients with suspected CD. Anti-gliadin immunoglobulin (Ig)A and IgG, anti-tissue transglutaminase (anti-TTG) IgA and IgG antibodies from celiac antibodies were evaluated using the ELISA method, and anti-endomysium IgA and IgG were evaluated by indirect immunofluorescence. Upper gastrointestinal endoscopy was performed in patients with CD symptoms and autoantibody positivity. The diagnosis of CD was made according to endoscopic biopsy results. Results: The pSS patients comprised 98% females, with a mean age of 51.6±11.5 years. The rates of CD symptoms were as follows: 10% loss of appetite, 13.3% abdominal pain, 11.1% diarrhea, 18.9% constipation, 37.8% flatulence, and 2.2% weight loss. Anti-gliadin IgA positivity was determined in 6.7%, anti-gliadin IgG in 6.7%, anti-endomysium IgA in 2.2%, anti-endomysium IgG in 15.6%, and IgA in 1.1%. Gastroscopy was planned for 43 patients with suspected CD based on clinical and laboratory findings. CD was diagnosed in two patients before this study; subsequently, four more patients were diagnosed with CD. Conclusion: The findings of this investigation revealed a 6.7% prevalence of CD in pSS. The diagnosis of CD in pSS was supported by histopathology. According to these findings, CD is more prevalent in pSS patients, and the risk of developing CD is higher than that in the general population.

Psoriatic arthritis (PsA) is a chronic inflammatory disease in the spondyloarthropathy group with the history of psoriasis. Although some PsA findings are similar to rheumatoid arthritis (RA), rheumatoid factor negativity, some radiological and clinical findings are different in PsA. There is no spesific laboratory examination for diagnosis of PsA. On the other hand, anti-cyclic citrullinated peptide (anti-CCP) antibody positivity is a spesific finding for the diagnosis of RA. Objectives: We aimed in this study to analyse the frequency of anti-CCP positivity in PsA and the association with clinical and radiological findings. Methods: The study group is consisted of 100 PsA patients, who fulfilled the CASPAR cirteria for PsA and 100 healthy controls (HC). We filled a form for all patients, which included clinical and laboratory findings of patients. We analyzed anti-CCP antibody with micro-ELISA in the sera of patients. Results: In our study, the anti-CCP positivity was detected in 15% of PsA group and 4% of healthy controls. The difference was statistically significant (p=0,014; OR=4.24, 95% CI=1.35–13.25). Nine out of 15 anti-CCP positive patients were female, the remaining 6 were male. Thirteen patients (86,7%) had peripheral arthritis, 1 patient (6,7%) had sacroiliitis, 1 patient (6,7%) had peripheral arthritis and sacroiliitis. 42,8% of PsA patients with peripheral arthritis had asymetric olygoarthritis (6/14), 28,5% had monoarthritis (4/14) and 28,5% had symetric polyarthritis (4/14). Anti-CCP antibody positivity had no effect on the involvement of peripheral arthritis. Sacroiliitis and dactilitis were more frequent in the anti-CCP negative group. No patient with dactylitis had anti-CCP positivity (p=0.005). While, 43,5% of RF positive patients were detected anti-CCP positivity, 6,5% of RF negative patients were detected anti-CCP positivity (p=0,000). Conclusions: Our data reveals that anti-CCP positivity is more frequent in PsA compared to HC. We found no statisticall association between anti-CCP positivity and clinical or radiological findings.

Abstract Background The clinical manifestations and course of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) exhibits considerable heterogeneity. In this study, we aimed to explore radiographic progression over a defined period, employing the Warrick score as a semi-quantitative measure in early RA-ILD, and to assess the associated risk factors for progression. Methods RA-ILD patients underwent consecutive Warrick scoring based on initial high-resolution computed tomography (HRCT) at diagnosis and the first follow-up. Associations between Warrick scores, pulmonary function tests, and patient characteristics were analyzed. The ROC curve assessed the predictive performance of the Warrick score change rate for ILD progression, while multivariable logistic regression analysis identified risk factors for progression. Results Significant correlations were found between Warrick scores and age at RA-ILD diagnosis, age at ILD diagnosis, and baseline DAS28-ESR. For the severity score, correlations were r = 0.359, r = 0.372, and r = 0.298 (p = 0.001, p 50 years (OR 7.7; p = 0.028) and baseline usual interstitial pneumonia (UIP) pattern (OR 3.1, p = 0.041) were identified as risk factors for progression. Conclusions Advanced age and UIP pattern were significant risk factors for progression. Warrick scoring may may help predict progression in RA-ILD, particularly through changes in severity, extent, and total scores. Due to the retrospective design and small sample size, further prospective studies with larger cohorts are needed to confirm these findings and validate Warrick scoring as a reliable marker for RA-ILD progression.

Abstract Background The field of transitional care for chronic conditions in adolescents, notably juvenile idiopathic arthritis (JIA), is rapidly growing. Transitioning these patients to adult healthcare systems presents significant challenges in practical implementation. Consequently, it would be appropriate for each country to develop a transition program tailored to its specific infrastructure. To pursue this goal, a Delphi study was conducted to identify the key components of transitional care in JIA. Methods Three panels and two rounds were held consisting of adolescents and young adults, parents, and clinicians (pediatric or adult rheumatologists). As a result, feedback on acceptance of the key statements of transitional care was obtained using the Delphi method. Results Out of 102 contacted, 88 (86.3%) participants responded to the Round 1 survey, which included 48 clinicians, 20 youths, and 20 parents. In Round 2, the number of clinicians dropped to 29, while the number of youths and parents remained constant. Based on expert opinions, 29 statements were selected for the first round. Statements that received ≥ 70% approval in the first round advanced to the next round. Sixteen statements did not achieve ≥ 70% approval. Of the remaining, 12 were reviewed in the second round, while four were excluded. Conclusion Although consensus has been reached on the basic transitional care issues for JIA patients, several issues still need to be agreed upon. Acceptance and applicability of the final 20-item checklist in clinical practice are critical for advancing JIA transition care in Turkey.

Objective: To evaluate the development of anti-drug antibodies (ADAb) against tumor necrosis factor inhibitors (TNFi) therapy during a 2-year period and search the factors linked to patients with axial spondyloarthritis (axSpA). Methods: Biologic-naive patients with axSpA were included in this observational study. Serum drug levels and ADAb were measured at weeks 12, 24, 52, and 104 of treatment by enzyme-linked immunosorbent assay (ELISA). The development of ADAb and factors related to ADAb over time were investigated using generalized estimating equations (GEE). Results: A total of 180 patients with axSpA (116 male, mean (±SD) 45.6 (±11.9) years) who started TNFi treatment (etanercept (32.2%), adalimumab (27.2%), golimumab (20.6%), infliximab (20%)) were included. In the etanercept treatment group, only 1 patient had ADAb at 12 weeks and 24 weeks. Anti-drug antibodies against TNFi drugs were present in the adalimumab group in 32.7% of patients and in the infliximab group in 21.2% of patients at 12 weeks, and the proportion of ADAb-positive patients were found to be stable throughout the follow-up for adalimumab- and infliximab-treated patients. In the golimumab group, one patient had ADAb against golimumab at 12 weeks and the proportion of ADAb-positive patients increased throughout follow-up. In longitudinal analysis, baseline age, TNFi type, longitudinal Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and ASDAS-CRP scores, serum C-eeactive protein (CRP) levels, presence of adverse events and treatment discontinuation were associated with the presence of ADAb. Conclusion: The development of ADAb against TNFi therapy is associated with younger age, high disease activity, the development of adverse events and more common treatment discontinuation in patients with axSpA during 2-year follow-up.

Abstract Clinical data on the use of tumour necrosis factor inhibitors (TNFi) in late-onset ankylosing spondylitis (LoAS) are limited. The present study aimed to evaluate efficacy, safety, and treatment adherence associated with the initial use of TNFi therapy in biologic naive patients diagnosed with LoAS. Patients whose age of onset was ≥ 45 years and

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by a wide range of clinical manifestations and a relapsing-remitting course. The peak incidence of SLE occurs during the reproductive years; however, it can develop at any age. Late-onset SLE, which is diagnosed at age 50 or older, accounts for approximately 20% of all SLE cases. The comparison between late-onset SLE patients and their early-onset counterparts has revealed distinct differences in clinical characteristics, comorbidities, and mortality rates. Late-onset SLE patients exhibit lower frequencies of mucocutaneous, renal, hematological, and neuropsychiatric symptoms but higher rates of serositis, peripheral polyneuropathy, cardiovascular diseases, and pulmonary involvement. Additionally, they experience a greater burden of comorbidities and increased mortality rates. Here, we review the clinical characteristics, comorbidities, and mortality of patients with late-onset SLE.

Abstract Background/Aim To investigate the frequency and clinical relevance of an extended autoantibody profile in patients with systemic sclerosis (SSc). Materials and Methods In this cross‐sectional study, serum from 100 consecutive patients was subjected to indirect immunofluorescence (IIF) (HEp‐20‐10/primate liver mosaic) and Systemic Sclerosis Profile by EUROIMMUN to evaluate anti‐nuclear antibodies (ANA) and autoantibodies against 13 different autoantibodies in patients with SSc less than 3 years. Results Ninety‐three of 100 patients were positive for ANA by IIF. Fifty‐three patients showed single positivity, 26 anti‐topoisomerase antibodies (anti‐Scl70 ab), 16 anticentromere antibodies (ACAs), six anti‐RNA polymerase III antibodies (anti‐RNAPIII ab), one anti‐Ku antibody, one anti‐PM/Scl100 antibody, two anti‐PM/Scl75 antibodies, one anti‐Ro52 antibody, whereas 32 patients had multiple autoantibody positivities. Among classic SSc‐specific autoantibodies, anti‐Scl70 and anti‐RNAPIII abs showed the highest cooccurrence (n = 4). One patient was simultaneously positive for anti‐RNAPIII ab and ACA, and one was positive for ACA and anti‐Scl70 ab. The clinical features were not statistically different between single and multiple autoantibody‐positivity for classic SSc‐specific autoantibodies (ACA, anti‐Scl70 ab, and anti‐RNAPIII ab), except for digital ulcer in the multiantibody positive ACA group (p = .019). Conclusion Based on our results, coexpression of autoantibodies is not uncommon in SSc patients. Although autoantibodies specific to SSc in early disease show generally known clinical features, it remains to be investigated how the coexpression of autoantibodies will affect clinical presentation.

Abstract Tocilizumab (TCZ) is a recombinant humanized monoclonal antibody that targets the IL-6 receptor. TCZ found to be efficacious and has a good tolerated safety profile in rheumatoid arthritis (RA) patients. The aim of this study was to describe the disease activity and retention rate in Turkish RA patients who were prescribed TCZ as first-line biologic treatment in a real-world setting. Secondary data obtained from adult RA patients’ files was used in a multicenter and retrospective context. Clinical Disease Activity Index (CDAI), Disease Activity Score in 28 joints with ESR (DAS28-ESR), and retention rates of TCZ were evaluated at related time points. 130 patients (87.7% female) with a mean age of 53 years (SD; 15.0) were included in the study. Mean RA duration was 14 years and median duration of follow-up was 18.5 months. Number of patients with ongoing TCZ treatment at 6, 12, and 24 months were 121 (93%), 85 (65%), and 46 (35%), respectively. Remission rates at 6, 12, and 24 months per CDAI (

Objective: Renal tubular acidosis (RTA) is a clinical manifestation that occurs with insufficiency in restoring bicarbonate or disruption in hydrogen ion elimination as a result of a disruption in tubulus functions, causing normal anion gap-opening metabolic acidosis. In the present study, we aimed to investigate the prevalence of RTA in the largest systemic lupus erythematosus (SLE) patient population to date. Materials and Methods: SLE patients, who were followed up in 2 different healthcare centers, were included. Patients with metabolic acidosis (pH

BackgroundThe course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses.ObjectiveIn this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs.MethodsBetween April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome.Results165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive.ConclusionsAmong IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome.

INTRODUCTION: The prevalence of Sjögren's syndrome (SS) in patients with the diagnosis of SpA has been reported to be higher than normal population. Yet, the vice-versa is unclear. In this study, we aimed to investigate the prevalence of IBP, radiologic sacroiliitis and SpA in patients with primary SS. METHODS: 85 patients followed at the rheumatology clinics of the Marmara and Kocaeli Universities with the diagnosis of primary SS between November 2011 and August 2012 were included in this study. The control group consisted of 100 age-and gender-matched patients. Inflammatory back pain and axial SpA were diagnosed according to the assessment of spondylo arthritis International Society (ASAS) criteria. RESULTS: 83 patients were (97%) female and 2 (3%) were male. Mean age of the patients was 49.1 (11) years. Mean disease duration was 7.3 (4) years. The patient and control groups were comparable in terms of age and gender (p = 0.05). Inflammatory back pain was observed in 21 (24.7%) of 85 primary SS patients and in 4 (4%) of 100 control subjects (p = 0.001), radiographic sacroiliitis was demonstrated in 9 (10.5%) of primary SS patients and 2 (2%) of the control subjects (p = 0.025). Remaining SpA findings were not encountered in either group. CONCLUSION: inflammatory back pain and radiologic sacroiliitis is increased in patients with primary SS. Whether IBP, SI joint inflammation and radiologic sacroiliitis is due to the co-existence of SpA and primary SS or IBP is an underdiagnosed clinical feature of SS deserves further studies of large patient numbers.