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Background/Purpose: Our objective was to investigate real‐world outcomes and treatment strategies in individuals affected by DADA2 using over 10‐year period real‐life experience. Methods: This descriptive analysis encompassed all adult/pediatric patients with DADA2 from our Vasculitis Research Center prospective database. Patients on anti‐TNF therapy have been specifically examined, analyzing the treatment's duration, indications, and outcomes. Treatment responses were based on physicians' assessments and categorized as full response (symptom‐free with normal acute phase reactants) or partial/no response. Results: Totally 32 patients (Adult/Childhood age: 19/13) were analyzed. Anti‐TNF agents were prescribed to 27 of the 32 patients. Over a median follow‐up of 58 months on anti‐TNF therapy, 10 patients (35.7%) exhibited a complete response, predominantly in cases with nervous system or skin involvement. Partial responses were observed in the other 10 patients (35.7%). Currently, 20/ 27 patients remain on anti‐TNF treatment. Among the seven who are not on anti‐TNF now: five died (four of them with a late diagnosis, one could not continue due to cardiomyopathy), one refused treatment and one had a cure after bone marrow transplantation. We have become aware that four patients increased their dose interval and one returned to the normal interval after an increase in CRP. The first patient was diagnosed in 2013 and over the last 10 years, 6/32 (18.8%) of the patients died. Conclusion: Anti‐TNF treatment is beneficial for vasculitic and inflammatory lesions. The clinical course of patients is diverse, especially if the diagnosis is delayed, with a mortality rate of up to 20% over a 10‐year period. [ABSTRACT FROM AUTHOR]

Objective Diagnosis of spondylodiscitis is usually possible radiographically with magnetic resonance imaging (MRI). However, the first imaging method evaluated in daily practice is conventional radiography. The aim of the study was to determine the sensitivity and specificity of detecting infectious or rheumatological spondylodiscitis in the lumbar region with conventional radiography by rheumatologists. Methods Among 102 patients with spondylodiscitis on lumbosacral (LS) MRI, 23 patients who also underwent simultaneous conventional LS radiography were included. TThe control group consisted of 52 outpatients with no evidence of spondylodiscitis on LS MRI. Eleven rheumatologists blindly evaluated conventional LS radiographs. Sensitivity, specificity, positive, and negative predictive values of LS conventional radiography were calculated. Results While the cause was infection in 8/23 (34.7%) of spondylodiscitis patients, it was spondyloarthritis in 15/23 (65.2%). According to LS MRI findings, 23 patients had spondylodiscitis in a total of 31 vertebral units. When we evaluated the detection of spondylodiscitis according to the vertebral unit level, it was mostly at one level [14 (60.8%)], primarily at the L4-5 vertebral unit [13 (56.5%)]. The sensitivity of detecting LS spondylodiscitis on conventional radiography was found to be 52% (30-65), and the specificity was 86% (59-94). While the median (minimum-maximum) sensitivity was 75.0 (50.0-87.5) in patients with infectious spondylodiscitis, it was 46.6 (13.3-76.9) in patients with spondylodiscitis due to spondyloarthritis. Conclusion Clinicians can miss spondylodiscitis. Although it is evaluated with conventional radiography in the first stage in the presence of appropriate clinical findings, the clinician should be careful and consider more advanced approaches. Keywords:Spondyloarthritis, spondylitis, inflammation, sensitivity and specificity: [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the risk of liver fibrosis and associated factors with the non‐invasive fibrosis score‐4 (FIB‐4) index in patients with inflammatory arthritis using methotrexate (MTX). Methods: Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) who were followed up in the rheumatology outpatient clinic, who were on methotrexate only and for whom FIB‐4 index was could be calculated at methotrexate initiation and follow‐up were included. The FIB‐4 index was calculated according to the following formula: age (years) × AST(IU/L)/(platelet count(10 (9)/L) × √ALT(IU/L)). The patients' demographics, comorbidities, other treatments, cumulative MTX dose, and reasons for MTX cessation were assessed. For the multivariate analysis, possible factors associated with intermediate‐high risk FIB‐4 index at last visit were determined. Results: A total of 107 patients were enrolled in the study, of whom 82 (76.6%) had RA and 25 (23.4%) had PsA. At the initiation of MTX, 24 (22.4%) patients had intermediate‐high risk FIB‐4 index. Comorbidities and the rate of ≥3–4 Charlson comorbidity index were more common in patients with intermediate‐high risk FIB‐4 index. A total of 37 (34.5%) patients had intermediate‐high risk FIB‐4 index at the last visit after median 3.6 (0.3–22.06) years follow‐up. The median cumulative MTX dose was 2550 mg (1050–13.991). Cumulative MTX dose [OR 1.18 (1.01–1.33), p =.03] and diabetes mellitus [OR 4.60 (1.74–12.50), p =.002] were associated factors with intermediate‐high risk FIB‐4 index. The concomitant use of hydroxychloroquine (HCQ) was found to be a low‐risk factor for FIB‐4 index [OR 0.28 (0.10–0.78) p =.015]. Conclusion: The FIB‐4 index is a non‐invasive method that can be used in daily rheumatology practice for the evaluation and follow‐up of patients who will use methotrexate. Comorbidities and cumulative MTX dose seem to be related with the risk of liver fibrosis. Concomitant use of HCQ with MTX may reduce the risk of liver fibrosis. [ABSTRACT FROM AUTHOR]

Objectives: An acidogenic diet, by disrupting the blood pH equilibrium, can contribute to metabolic acidosis and lead to inflammation. Therefore, we hypothesized that dietary acid load (DAL) increases disease activity and inflammation in psoriatic arthritis (PsA) patients. Methods: This study was conducted with 58 obese/overweight patients, aged 20–65 years. Dietary intake was assessed using a 3-consecutive-day 24-hour recall. The DAL was evaluated through the PRAL (potential renal acid load) and NEAP (net endogenous acid production) and divided into the low and high groups by their median values. The disease activity assessments, anthropometric measurements, dietary data, and blood parameters of patients were recorded and compared at the low and high DAL groups. Results: We observed that patients in the high NEAP and PRAL groups had worse PsA pattern scores (P < 0.05). Also, PRAL and NEAP scores were positively associated with Disease Activity Index for Psoriatic Arthritis, Health Assessment Questionnaire, and Psoriatic Arthritis Impact of Disease-12 (PSAID-12) scores. After adjusting age, sex, smoking, and body mass index, 1 mEq increase in PRAL and NEAP was associated with an elevation of Disease Activity Index for Psoriatic Arthritis (0.506 and 0.486 points, respectively). Conclusions: These results showed a close relationship between DAL and PsA symptoms. An acidogenic diet may negatively affect PsA prognosis. Healthy eating recommendations should be part of the management of the disease. [ABSTRACT FROM AUTHOR]

Background/aim: Rheumatoid factor (RF) and anticitrullinated peptide (anti-CCP) are specific for rheumatoid arthritis (RA) diagnosis. However, they could be positive in other diseases and even in healthy populations. The aim was to investigate the prevalence of positive RF and anti-CCP antibodies in persons admitted to hospital for any reason and on a national scale. Materials and methods: The National Electronic Health Database, which contains the clinical records of over 80 million people, was used to design this multicenter, retrospective cohort study. The subjects included in the study were divided into age groups according to 10-year periods. RA cases were identified using ICD-10 codes that included M05, M06, M08, and their subgroups. RF and anti-CCP positivity were evaluated in terms of their contribution to the risk of being diagnosed with RA, with the change according to age and sex. Results: During the 1.1.2018-31.12.2021 period, 13,918,072 RF tests were performed in 11,849,440 people, whereas 1,183,607 anti-CCP tests were performed in 1,020,967 people. Moreover, 797,089 people had both tests performed at least once. The RF positivity rate in patients who only requested RF tests was 14.72% and it was 35.04% for anti-CCP positivity in those who only requested anti-CCP tests. The rate of concomitant RF and anti-CCP positivity was 22.56%. An RA diagnosis was made in 27.8% of RF-positive people, 39.73% of anti-CCP-positive people, and 56.6% of co-RF and anti-CCP-positive people. RF positivity and concomitant RF and anti-CCP positivity increased with age and were more common in females. Conclusion: RF and anti-CCP positivity may be seen in a healthy population with female predominance. As age increases, the risk of RF positivity rises, but anti-CCP positivity does not change. Concomitant RF and anti-CCP positivity shows the highest risk of RA development with respect to either antibody positivity alone. [ABSTRACT FROM AUTHOR]

Objective: We describe the demographics, clinical features, disease course, and survival of polyarteritis nodosa (PAN) through an international collaboration (GLOBAL‐PAN). Methods: Patients with PAN were recruited between 1990 and 2020 from observational cohorts of nine countries across Europe, Japan, and North America. Eligibility was retrospectively defined using the European Medicines Agency classification algorithm. Patients with PAN related to hepatitis B virus (n = 12) and two monogenic diseases mimicking PAN, deficiency of adenosine deaminase 2 enzyme (n = 16) or familial Mediterranean fever (n = 11), were excluded. Data regarding organ involvement, relapse, disease‐related damage, and survival were analyzed. Results: Three hundred fifty‐eight patients (female:male ratio 174:184), including those with systemic PAN (sPAN, n = 282) and cutaneous PAN (n = 76), were included. Twenty‐five were pediatric onset. Mean ± SD age at diagnosis was 44.3 ± 18.1 years. Constitutional symptoms (71.5%), cutaneous involvement (70.5%), musculoskeletal findings (69.1%), and neurologic features (48.0%) were common manifestations. Among patients with sPAN, gastrointestinal involvement and proteinuria over 400 mg/day were reported in 52.2% and 11.2%, respectively. During a median (interquartile range) 59.6 (99.5) months of follow‐up, relapse occurred in 48.5% of patients. One, 5‐ and 10‐year survival rates for sPAN were 97.1%, 94.0%, and 89.0%, respectively. Predictors of death for sPAN included age ≥65 years at diagnosis, serum creatinine at diagnosis >140 μmol/L, gastrointestinal manifestations, and central nervous system (CNS) involvement. Conclusion: The spectrum of PAN remains a complex, multifaceted disease. Relapse is common. Age ≥65 years and serum creatinine >140 μmol/L at diagnosis, as well as gastrointestinal and CNS involvement, are independent predictors of death in sPAN. [ABSTRACT FROM AUTHOR]

Objective The rate of pleuroparenchymal involvement in patients with SpA varies widely, from 0% to 85%. The most common form is apical fibrobullous disease (AFLD). The aim of this study was to determine the incidence of AFLD and associated factors in SpA patients under and/or planned to start biologic DMARDs (bDMARDs) therapy. Methods The records of 3021 SPA patients registered with HUR-BIO who had indication of bDMARDs between 2010 and 2021 were scanned. The study included 2489 patients with at least one chest radiograph (X-ray). Patient demographics, comorbidities, laboratory data, bDMARDs used, baseline DASs, and purified protein derivative and/or QuantiFERON test results before initiation of bDMARDs were recorded. Results Of the 2489 patients, 36 (1.4%) were found to have AFLD by X-ray and/or CT. The mean disease duration was 11.7 (7.1) years. Patients with AFLD were more likely to be male [28 (77.8%) vs 1321 (53.9%), P  = 0.004], older [56.3 (10.5) years vs 44.8 (11.4) years, P  < 0.001], heavy smokers [27 (79.4%) vs 1468 (60.9%), P  = 0.028] and have had longer disease duration [17. 7 (9.7) years vs 11.6 (7) years, P  = 0.001]. QuantiFERON positivity was higher in the AFLD group [9 (36%) vs 309 (16.1%), P  = 0.013]. While treatment with adalimumab was less preferred in those with AFLD, treatment with etanercept was more frequently preferred. Conclusion As the radiological findings of AFLD can be confused with those of tuberculosis, special attention should be paid to differentiating between tuberculosis and the disease in males and in patients who have had long disease duration. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the choice of biologic/targeted synthetic disease‐modifying anti‐rheumatic drugs (b/ts‐DMARDs), factors associated with the development of chronic kidney disease (CKD), and mortality in RA patients with CKD receiving b/ts‐DMARDs. Methods: Two thousand one hundred forty‐one RA (79.4% female) patients were included in the analysis from the HUR‐BIO prospective registry. Patients were divided into the CKD group and the non‐CKD group. Age and gender‐matched patients were selected from the non‐CKD group, and then three main groups were determined. CKD was staged according to the glomerular filtration rate criteria. The clinical characteristics of the patients, disease activities, treatment choices, drug retention rate, and mortality rates were compared between the groups. Results: CKD was detected in 90/2141 (4.2%) RA patients on b/ts‐DMARDs. Forty patients (2.3%) developed CKD during follow‐up after the initiation of b/ts‐DMARDs. In the CKD group, anti‐TNF agents were chosen as the first‐line b/ts‐DMARDs therapy in 64.4% of patients, with etanercept leading in 31 (34.4%) patients. In multivariate analysis, age at the start of treatment, DAS‐28‐ESR at last visit, amyloidosis, hypertension, and history of smoking were the factors associated with the development of CKD in RA patients receiving b/ts‐DMARDs. The mortality rate in RA‐CKD patients until the onset of the pandemic was 15.41 per 1000 patient years, whereas it was 85.9 per 1000 patient years after the pandemic. Conclusion: Comorbidities and control of disease activity are critical in the development of CKD in RA patients receiving b/ts‐DMARDs. While there was no significant difference in mortality rate between CKD and non‐CKD patients, the overall mortality rate increased after the COVID‐19 pandemic duration in both groups. [ABSTRACT FROM AUTHOR]