Comparing clinical profiles in spondyloarthritis with Crohn's disease or ulcerative colitis: insights from the ASAS-PerSpA study.

Objectives: Assuming SpA manifestations may vary among patients with different inflammatory bowel disease (IBD) subtypes, we explored the clinical characteristics associated with the presence of Crohn's disease (CD) or ulcerative colitis (UC) in patients with spondyloarthritis (SpA). Methods: We included 3152 patients of ASAS-PerSpA study diagnosed with either axial SpA or peripheral SpA, according to their treating rheumatologist. Of these, 146 (4.6%) had confirmed IBD by endoscopy and were categorized into CD or UC groups. Demographics, clinical characteristics, treatments and patient-reported outcomes were compared between the two subgroups. Results: From 146 patients included in the current analysis, 87 (59.6%) had CD [75 (86.2%) axial SpA and 12 (13.8%) peripheral SpA], and 39 (26.7%) had UC [34 (87.2%) axial SpA and 5 (12.8%) peripheral SpA]. CD and UC groups had similar age with average of 44.9 (13.5) vs 44.0 (13.0) years, respectively, and a slight male predominance in CD (63.2%) compared with UC (51.3%). Diagnostic delay for SpA was 7.0 (6.9) years for CD and 8.8 (8.1) years for UC. Chronic back pain was the most reported symptom present in 95.4% of CD patients and 89.7% of UC patients. Both groups had similar musculoskeletal phenotyping, with higher frequency of psoriasis (15.4%) and uveitis 28.2% in UC; and higher tendency to be HLA-B27 positive in CD (51.9% in CD vs.s 39.4% in UC). Conclusion: In our analysis patients with SpA and concurrent CD or UC had mainly similar musculoskeletal phenotypes. However, they differ slightly in extra-musculoskeletal manifestations and HLA-B27 prevalence.

HLA-B51 Impact on Clinical Symptoms in Behcet's Disease.

OBJECTIVE: To investigate the association of HLA-B51-positivity to clinical manifestations of Behçet's disease (BD). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Clinic of Rheumatology, Diskapi Education and Research Hospital, Health Sciences University, Turkey, from December 2018 to December 2020. METHODOLOGY: Patients who had HLA-B5 genetic results and fulfilled the international criteria for BD were included in the study. HLA-B51 status was determined and compared with the symptomatology. RESULTS: Mean age of 204 cases was 39.9±11.4 years. There were 52.5% female and 47.5% male patients. One hundred (61.7%) patients were HLA-B51-positive. The frequency of papulopustular lesions (PPL), ocular involvement, neurologic involvement, and vascular involvement was significantly higher in HLA-B51-positive patients compared to HLA-B51 negative patients (p=0.044, 0.012, 0.039, and 0.022 respectively). HLA-B51-positivity was found to be a significant risk factor for PPL (OR and 95% CI:1.946 and 1.044-3.629), ocular involvement (OR and 95% CI:2.399 and 1.165-4.938), and neurological involvement (OR and 95% CI:5.404 and 1.119-26.093). Significant risk factors for vascular involvement were male gender (OR and 95% CI:2.810 and 1.403-5.627) and low age of disease onset (OR and 95% CI:0.935 and 0.894-0.979). CONCLUSION: Ocular, vascular, and neurological involvements are more common in patients with BD with HLA-B51-positive. HLA-B51 was found to be an independent risk factor for papulopustular lesion, ocular and neurological involvement, while the male gender was found to be an independent risk factor for vascular involvement. KEY WORDS: Behcet syndrome / genetics, HLA-B51, Neurologic involvement, Ocular involvement, Vascular involvement, Vasculitis* / diagnosis.

Relationship between disease impact scores and C-reactive protein/albumin ratio in patients with psoriatic arthritis.

AIM: To evaluate the relationships between the C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and Disease Activity in Psoriatic Arthritis (DAPSA) and Psoriatic Arthritis Impact of Disease 12-item-questionnaire (PsAID-12) scores in patients with psoriatic arthritis (PsA). METHODS: This cross-sectional study involved 160 (121 female) patients with PsA who were >18 years old and treated in the rheumatology clinic of Diskapi Yildirim Beyazit Education and Research Hospital between January 2020 and January 2021. Demographic and clinical data, PsAID-12 and DAPSA scores, CRP, erythrocyte sedimentation rate (ESR), albumin level, neutrophil, lymphocyte, and platelet counts were recorded. RESULTS: The mean age was 46.49±11.12 years; median (min-max) disease duration was 2 years (0.5-34). The PsAID score was ≥4 (high disease impact) in 74.4% of patients. Patients with high disease impact had significantly higher CRP, ESR, CAR, NLR, PLR, neutrophil counts, and DAPSA scores (P<0.001). PsAID scores significantly highly correlated with CRP (rho 0.864, P<0.001), DAPSA significantly highly correlated with the CAR (rho 0.890, P<0.001). Receiver operating characteristic curve analysis showed that the CAR (area under the curve [AUC] 0.901, P<0.05, 95% confidence interval [CI] 0.855-0.947, NLR (AUC 0.759, P<0.05, 95% CI 0.680-0.838), and PLR (AUC 0.686, P<0.05, 95% CI 0.591-0.782) predicted high disease impact. The cut-off value for the CAR was 0.98. CONCLUSION: The CAR can be useful in daily practice as a simple and quick assessment method to evaluate disease impact in PsA.

Could C-Reactive Protein/Albumin Ratio be an Indicator of Activation in Axial Spondyloarthritis?

OBJECTIVES:  To evaluate the relationship of C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in axial spondyloarthritis (Ax-SpA). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Clinic of Rheumatology, Diskapi Education and Research Hospital, Health Sciences University, Turkey during January 2020-2021. METHODOLOGY: One-hundred and nine patients aged >18 years were included. Age, gender, duration of disease, BASDAI scores were recorded. CRP, erythrocyte sedimentation rate (ESR), albumin values, leukocyte, neutrophil, lymphocyte, platelet counts were determined. RESULTS: The mean age and median disease duration of the patients were 45.03±10.63 and 5 (2-6.5) years, respectively. Among these, 28 (58.3%) female and 44 (72.1%) male patients were found to be HLA-B27 positive. BASDAI≥ 4 was observed in 61 (56%) patients and <4 in 48 (44%) patients. CRP, albumin, ESR, NLR and CAR values between the patient groups were significantly different. There was high correlation between BASDAI and CAR. There was a moderate correlation between CAR and BASDAI in the patient group with normal acute phase reactants. CONCLUSION: There is a significant correlation between CAR value and composite score such as BASDAI, which is commonly used to assess systemic inflammation in Ax-SpA. These methods are reliable, recognised by reimbursement institutions and include measurements that physicians can use practically in routine outpatient clinics. Key Words: Spondylitis, Ankylosing, HLA-B27 antigen, C-reactive protein/metabolism, Serum albumin/metabolism, Neutrophils, Lymphocytes, Platelet count.

Two cases of calcium pyrophosphate deposition disease (CPPD) presented with spondylodiscitis.

Calcium pyrophosphate deposition disease (CPPD) is a crystal arthropathy, and may present with various clinical manifestations such as asymptomatic CPPD, osteoarthritis with CPPD, acute CPPD crystal arthritis (formerly pseudogout), and chronic CPPD crystal inflammatory arthritis. It is known that aging, trauma and osteoarthritis are major risk factors for CPPD. Acute CPP arthritis may occur as monoarticular or oligoarticular and usually involves large peripheral joints such as the knees, wrists and ankles. CPPD is characterized by sudden onset of severe pain, swelling and periarticular erythema, and systemic symptoms such as fever, chills, and weakness may occur. On the other hand, axial CPPD has been reported rarely and most cases appear with symptoms related to a mass effect such as foramen magnum syndrome, spinal stenosis, radiculopathy, myelopathy, synovial cyst or cauda equina syndrome. In addition, there are fewer reported cases of spinal CPPD that cause neck and back pain. This clinical condition should be considered in the differential diagnosis of acute neck and back pain.

Effectiveness of Methotrexate in Idiopathic Granulomatous Mastitis Treatment.

BACKGROUND: Idiopathic granulomatous mastitis is a rare inflammatory disease of the breast, for which there is a lack of consensus on the treatment protocol; it requires long-term follow-up and is associated with a high rate of relapse after surgical treatment. In this study, we report on the largest single-center cohort of idiopathic granulomatous mastitis treated with steroids + methotrexate. METHODS: We retrospectively examined the data of 33 patients histopathologically diagnosed with idiopathic granulomatous mastitis who were evaluated by our Rheumatology or General Surgery Clinics between 2013 and 2016. RESULTS: Of the 33 female patients (age: 38.64 ± 6.9 years), 24 were admitted with an initial diagnosis of idiopathic granulomatous mastitis, whereas 9 were admitted after surgical treatment. Remission was achieved in 87.9% of patients with steroid + methotrexate treatment, and there were no relapses during the 24-months follow-up period. CONCLUSIONS: Steroid + methotrexate treatment is an effective and reliable method for ensuring long-term remission in patients with idiopathic granulomatous mastitis diagnosis.