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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: 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.

Abstract Background Juvenile idiopathic arthritis (JIA) is a prevalent childhood chronic arthritis, often persisting into adulthood. Effective transitional care becomes crucial as these patients transition from pediatric to adult healthcare systems. Despite the concept of transitional care being recognized, its real-world implementation remains inadequately explored. This study aims to evaluate the thoughts and practices of healthcare providers regarding transitional care for JIA patients. Methods A cross-sectional survey was conducted among pediatric and adult rheumatologists in Turkey. Based on the American Academy of Pediatrics’ six core elements of transitional care, the survey included 86 questions. The respondents’ demographic data, attitudes towards transitional care, and practical implementation were assessed. Results The survey included 48 rheumatologists, with 43.7% having a transition clinic. The main barriers to establishing transition programs were the absence of adult rheumatologists, lack of time, and financial constraints. Only 23.8% had a multidisciplinary team for transition care. Participants agreed on the importance of coordination and cooperation between pediatric and adult healthcare services. The timing of the transition process varied, with no consensus on when to initiate or complete it. Participants advocated for validated questionnaires adapted to local conditions to assess transition readiness. Conclusions The study sheds light on the challenges and perspectives surrounding transitional care for JIA patients in Turkey. Despite recognized needs and intentions, practical implementation remains limited due to various barriers. Cultural factors and resource constraints affect the transition process. While acknowledging the existing shortcomings, the research serves as a ground for further efforts to improve transitional care and ensure better outcomes for JIA patients transitioning into adulthood.

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.

Erişkin Still Hastalığı (ESH) yüksek ateş, döküntü, yaygın kas ve eklem ağrılarıyla seyreden, nadir görülen bir hastalıktır. Bu yazıda, benzer klinik ve laboratuar bulguları olan ve antienflamatuar tedaviye yanıt alınan dört ESH olgusu literatür eşliğinde sunulmuştur.

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/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