The relationship between dietary inflammatory index scores and rheumatoid arthritis disease activity.

INTRODUCTION: Many patients diagnosed with rheumatoid arthritis (RA) report relief of symptoms after consuming certain foods. Diet plays a vital role in rheumatoid arthritis-related inflammation regulation. This study investigates the relationship between dietary inflammation index (DII) scores and RA disease activity. MATERIALS AND METHODS: Forty-one RA patients were enrolled in the study. The general inflammatory index of the diet was analyzed by recording the 24-h food consumption of the patients, and the nutrients were analyzed using the Nutrition Information Systems Package Program. Dietary inflammatory indices were calculated for each patient using the patients' macro and micronutrient intake levels. RA disease activity was assessed using the Disease Activity Score-28 (DAS-28). RESULTS: The DAS-28 score was lower in the anti-inflammatory diet group compared to the pro-inflammatory diet group (p=0.163). A weak but significant relationship was found between diet inflammation index score and DAS-28 (r=0.3468, p=0.0263). The effect of the dietary inflammatory index on the DAS-28 was 12.02%. Dietary iron, vitamin C, niacin, and magnesium intakes were statistically significantly higher in the quartile group that received an anti-inflammatory diet than in the quartile group that received a pro-inflammatory diet. The intake of some micronutrients, such as iron, zinc, magnesium, and folic acid, was significantly lower than the recommended values in all RA quartile groups. CONCLUSION: Our results suggest that reducing inflammation through the diet may have a weak but significant effect in controlling disease activity in RA patients.

Interstitial lung disease and associated factors in patients with Sjögren's syndrome.

BACKGROUND: Interstitial lung disease (ILD) is a common pulmonary manifestation of Sjögren's syndrome (SjS) and associated with an increased risk of death. Early detection and treatment of ILDs and knowing the risk factors are very important for prognosis in rheumatic diseases. AIMS: This study was performed to determine ILD and associated factors in patients with SjS. METHODS: Four hundred three SjS patients were evaluated in this cross-sectional cohort study. Clinical, laboratory, serological, and imaging features were compared of patients with and without pulmonary involvement. Logistic regression analyses were used to identify risk factors for lung involvement and to identify independent risk factors. RESULTS: Thirty-five (8.7%) of SjS patients had ILD and 368 (91.3%) had no ILD. The presence of Raynaud's phenomenon was significantly more common in ILD. The geriatric age group over the age of 65 years (OR 8198; 95% CI 3788-17,742; p < 0.001), Raynaud's phenomenon (OR 17,852; 95% CI 6155-51,779; p < 0.001), and smoking (OR 3598; 95% CI 1495-8657; p = 0.003) were risk factors to be associated for ILD in the multivariable analysis. The most common abnormality was non-specific interstitial pneumonia in 20 patients (57.1%) and usual interstitial pneumonia in 15 (42.9%) patients. CONCLUSIONS: The distribution of male patients compared to female patients was higher in patients with lung involvement than in patients without lung involvement. This may be related to older age, higher smoking rate, and longer nicotine consumption in men. Age, smoking, and severity of lung involvement are more important than inflammation status and autoantibodies for prognosis.

The relationship between peripheral T follicular helper cells and disease severity in systemic sclerosis.

We aimed to investigate the association between follicular T helper cells (Tfh) and disease severity in systemic sclerosis (SSc), a chronic connective tissue disease characterized by progressive fibrosis. While Tfh cells have been extensively studied in other autoimmune diseases, their role in SSc remains poorly understood. A cohort of 50 SSc patients, diagnosed based on the ACR/EULAR 2013 classification criteria, was included in the study. Patient data, including demographic information, comorbidities, treatment history and organ involvement, were collected. Disease severity was assessed using the modified Rodnan skin score and Medsger disease severity index. Statistical analyses were performed, considering a p value of < 0.05 as statistically significant. 38% had SSc with limited skin involvement, while 62% had SSc with extensive skin involvement. However, there were no statistically significant differences observed in the levels of CD4+ CXCR5+ , CD4+ ICOS+ , CD4+ CD40L+ and CD4+ PD+ lymphocytes between the two groups. Notably, SSc patients with Raynaud's phenomenon, digital ulcer and lung involvement exhibited higher levels of CD4+ CXCR5+ lymphocytes compared to those without these manifestations. Furthermore, a significant positive correlation was observed between CD4+ CXCR5+ lymphocyte levels and the severity of lung disease according to the Medsger disease severity index. Based on these findings, we conclude that elevated levels of Tfh cells are associated with lung involvement in SSc and there is a significant correlation between Tfh cell levels and the severity of lung disease. These observations suggest a potential role for Tfh cells in the pathogenesis of lung involvement in SSc and may guide the development of targeted therapies for this aspect of the disease.

Correlation of serum subfatin, cthrc1, ctrp3, ctrp6 levels with disease indices in patients with axial spondyloarthritis.

BACKGROUND: The study aimed to investigate novel biomarkers from the C1q TNF superfamily and evaluate their role in autoimmune inflammatory rheumatic diseases with the goal of identifying an effective biomarker to measure clinical disease activity and assess treatment efficacy. METHODS: Sixty-one Axial spondyloarthritis (AxSpa) patients and 30 healthy controls were enrolled in the study. The serum biomarkers subfatin, CTHRC1, CTRP3, CTRP6, IL-6, IL-17, and TNF-α and the disease indices BASDAI, BASFI, MASES, and ASDAS-ESR/CRP were evaluated and compared. The patients were then classified, and their serum biomarkers were assessed according to their ASDAS scores and their treatment regimens. RESULTS: Among the studied biomarkers, none showed a significant difference between the patients and the healthy controls. Although the difference was not statistically significant, the median values of serum subfatin, CTHRC1, CTRP3, CTRP6, IL-6, IL-17, and TNF-α were all found to be lower in the AxSpa patients than in the healthy controls. Furthermore, once the patients were classified regarding their disease activity, no correlation between the study biomarkers and levels of clinical disease indices was observed. Finally, biological treatments were found to affect the serum concentration of these biomarkers regardless of the level of disease activity. CONCLUSION: Novel adipokines and known modulators of inflammation, circulating subfatin, CTHRC1, CTRP3, CTRP6, IL-6, IL-17, and TNF-α levels may play a role in assessing treatment efficacy, especially in those treated with TNF-inhibitors. However, we failed to demonstrate a correlation between clinical disease activity and serum biomarker levels.

The effect of disease-modifying antirheumatic drugs on sleep and quality of life in older patients with rheumatoid arthritis.

Objective: The sleep quality is worse in rheumatoid arthritis (RA) patients than in healthy controls and it is more difficult to achieve a satisfactory quality of life after treatment with age. Our aim is to assess the quality of life and sleep in elderly onset RA patients and to analyze the effect of disease-modifying agents on sleep and quality of life. Methods: Thirty-four older patients with RA patients and 30 healthy controls are included in the study. Sleep quality was evaluated with the Pittsburg sleep quality index and quality of life with Short Form-36. Parametric/non-parametric tests and Spearman/Pearson correlation analysis were applied for the data according to the distribution. Results: While the rate of poor sleep quality before treatment was 67.6%, the rate was 26.5% after treatment. There was a statistically significant difference before and after treatment in terms of subjective sleep quality, sleep latency, sleep duration, sleep efficiency, and scores for sleep disturbance. The mean steroid dose and Disease Activity Score-28 were higher in patients with poor sleep quality than in patients with good sleep quality. Patients with poor sleep quality had lower mean physical function, pain, general health, social function, emotional role difficulties, and energy/vitality values than patients with good sleep quality. Conclusion: Both sleep and quality of life improved after treatment in older patients with RA patients. In older patients, it should be regularly evaluated in terms of sleep and quality of life and appropriate treatment should be provided.

The relationship between platelet distribution width and disease activity in patients with polymyositis.

Introduction: Muscle enzymes are an indicator of ongoing muscle damage and disease activity in patients with idiopathic inflammatory myopathy. Although platelet-related parameters have been shown to be useful as markers of disease activity in autoimmune diseases, the relationship between platelet distribution width (PDW) and disease activity has not been previously studied in polymyositis. We aimed to determine the relationship between PDW and disease activity in patients with polymyositis. Material and methods: Twenty-seven patients with polymyositis and thirty healthy controls were included in the study. Disease activity was evaluated using the myositis disease activity assessment Visual Analogue Scale (MYOACT) and the Myositis Intention to Treat Index (MITAX). The relationship between PDW and disease activity was evaluated using Pearson's or Spearman's correlation and reliability was assessed using correlation coefficients. Results: The mean platelet volume (MPV) and plateletcrit (PCT) were significantly higher and PDW was significantly lower in patients with polymyositis compared to the control group. The mean PDW levels were lower in patients with constitutional symptoms and arthralgia/arthritis (p < 0.005). Although PDW levels were lower in patients with mechanical hand, lung involvement, or dysphagia compared to patients without, there was no statistically significant difference between them. Platelet distribution width was found to be negatively correlated with disease activity. Conclusions: We found that PDW was negatively correlated with MYOACT and MITAX, widely used tools in assessing the disease activity of polymyositis. Based on this, PDW may be utilized as a non-invasive potential index to assess disease activity in patients with polymyositis.

Clinical and laboratory characteristics of chronic spontaneous urticaria with connective tissue diseases: A cross-sectional study.

Objectives: The aim of this study was to investigate the frequency of connective tissue diseases (CTDs) in patients with chronic spontaneous urticaria (CSU) and to evaluate clinical and laboratory characteristics of CSU accompanied by CTDs. Patients and methods: Between January 2017 and December 2020, a total of 390 CSU patients (120 males, 270 females; mean age: 38.9±13.7 years; range, 18 to 78 years) were included in the study. Clinical and laboratory characteristics of CSU in patients with and without CTD were analyzed. Results: A total of 6.4% patients (n=25) with CSU had CTD, and the rate was found to be 8.9% in female patients (n=24). In these patients, Sjögren syndrome (SS) was seen in 15 (5.5%), rheumatoid arthritis in five (1.85%), undifferentiated connective tissue disease in three (1.11%), and systemic lupus erythematosus in one (0.37%). Anti-thyroglobulin antibody, rheumatoid factor, anti-cyclic citrullinated peptide antibody, antinuclear antibody positivity, low complement 4 level, and erythrocyte sedimentation rate were significantly different between CSU patients with and without CTD (p=0.013, p<0.001, p<0.001, p<0.001, p=0.0182, p<0.001, respectively). Conclusion: Our study results suggest that CSU is associated with CTDs, particularly with Sjögren syndrome. Every patient diagnosed with CSU should be questioned about rheumatic symptoms, particularly female patients and those having later-onset CSU.

The role of albumin-to-globulin ratio in undifferentiated arthritis: Rheumatoid arthritis versus primary Sjögren syndrome.

Objectives: This study aims to compare initial albumin-to-globulin ratio (AGR) in patients with rheumatoid arthritis (RA) and primary Sjögren syndrome (pSS) presenting with undifferentiated arthritis (UA) and to investigate whether there was a difference in terms of AGR between the two patient groups and healthy controls. Patients and methods: Between January 2019 and December 2019, a total of 177 patients including 96 RA (10 males, 86 females; mean age: 53.6±10.8 years; range, 21 to 74 years) and 81 pSS (5 males, 76 females; mean age: 53.2±14.1 years; range, 23 to 79 years) and 82 healthy controls (20 males, 62 females; mean age: 50.5±13.6 years; range, 20 to 79 years) were included in this case-control study. Demographic characteristics, albumin, and globulin levels of all participants were recorded. The AGR, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-nuclear antibody (ANA), and anti-citrullinated protein antibodies (ACPA) were assessed. Results: The mean AGR was 1.50±0.16 in the control group, 1.48±0.24 in the RA group, and 1.30±0.23 in the pSS group, indicating a significant difference between the pSS and the other two groups (p<0.001). The receiver operating characteristic analysis revealed that the cut-off value for AGR was 1.39 (area under the curve=0.736) with a sensitivity of 0.642 and a specificity of 0.646 (p<0.001). The ESR and CRP values were higher (p<0.001), and ANA (p<0.001) and RF (p=0.003) positivity were lower in the RA group, compared to the pSS group. Conclusion: This study findings indicate that AGR is a helpful tool in the differential diagnosis of RA and pSS presenting with UA at the time of admission, and Sjögren syndrome should be considered in case of AGR ≤1.39.

Immature platelet fraction in rheumatoid arthritis with interstitial lung disease.

BACKGROUND: Platelets have an effect on the hemostatic defense of the lung. Immature platelet fractions (iPF) reflects the number of young platelets containing ribonucleic acid in the circulation and real-time production. Information about their roles in rheumatic diseases is limited and there are no studies on iPF in RA with interstitial lung disease (ILD). Our aim is to investigate the association between the iPF level and occurrence of ILD in RA and the correlation of iPF with disease activity in general or only in RA with ILD. METHODS: The study included 50 RA patients without ILD, 33 RA patients with ILD, and 30 healthy controls. Demographic data, Disease Activity Score 28 (DAS28), autoantibodies, and iPF were evaluated. ILD was diagnosed by using high-resolution computed tomography with clinical findings and chest X-ray. The samples were analyzed for complete blood count with platelet indices included, on Mindray BC-6800 hematology analyzer, Hamburg, Germany. RESULTS: iPF levels were higher in RA patients with ILD compared to healthy controls and RA patients without ILD. A weakly positive correlation between DAS28 with iPF was found in all RA patients. iPF levels were found as 2.85 to detect ILD with 66.7% sensitivity and 65% specificity. CONCLUSIONS: Our results showed that the iPF was detected higher in RA with ILD compared to RA without ILD. iPF, a routine cheap and easy test during hemogram, can provide important information in terms of disease activity and lung involvement in RA.

Immature platelet fraction in rheumatoid arthritis with interstitial lung disease / Fracción plaqueta inmadura en artritis reumatoide con enfermedad pulmonar intersticial

Background: Platelets have an effect on the hemostatic defense of the lung. Immature platelet fractions (iPF) reflects the number of young platelets containing ribonucleic acid in the circulation and real-time production. Information about their roles in rheumatic diseases is limited and there are no studies on iPF in RA with interstitial lung disease (ILD). Our aim is to investigate the association between the iPF level and occurrence of ILD in RA and the correlation of iPF with disease activity in general or only in RA with ILD. Methods: the study included 50 RA patients without ILD, 33 RA patients with ILD, and 30 healthy controls. Demographic data, Disease Activity Score 28 (DAS28), autoantibodies, and iPF were evaluated. ILD was diagnosed by using high-resolution computed tomography with clinical findings and chest X-ray. The samples were analyzed for complete blood count with platelet indices included, on Mindray BC-6800 hematology analyzer, Hamburg, Germany. Results: iPF levels were higher in RA patients with ILD compared to healthy controls and RA patients without ILD. A weakly positive correlation between DAS28 with iPF was found in all RA patients. iPF levels were found as 2.85 to detect ILD with 66.7% sensitivity and 65% specificity. Conclusions: Our results showed that the iPF was detected higher in RA with ILD compared to RA without ILD. iPF, a routine cheap and easy test during hemogram, can provide important information in terms of disease activity and lung involvement in RA.(AU)

Antecedentes: Las plaquetas tienen un efecto sobre la defensa hemostática del pulmón. Las fracciones de plaquetas inmaduras (FPi) reflejan el número de plaquetas jóvenes que contienen ácido ribonucleico en la circulación y la producción en tiempo real. La información sobre su papel en las enfermedades reumáticas es limitada y no existen estudios sobre la FPi en la AR con enfermedad pulmonar intersticial (EPI). Nuestro objetivo es investigar la asociación entre el nivel de FPi y la aparición de EPI en la AR y la correlación de la FPi con la actividad de la enfermedad en general o solo en la AR con EPI. Métodos: El estudio incluyó a 50 pacientes con AR sin EPI, 33 pacientes con AR con EPI y 30 controles sanos. Se evaluaron los datos demográficos, la puntuación de actividad de la enfermedad 28 (DAS28), los autoanticuerpos y la FPi. La EPI se diagnosticó mediante tomografía computarizada de alta resolución, con hallazgos clínicos y radiografía de tórax. Las muestras fueron analizadas para un recuento sanguíneo completo con índices de plaquetas incluidos, en el analizador de hematología Mindray BC-6800, Hamburgo, Alemania. Resultados: Los niveles de FPi fueron más altos en los pacientes con AR con EPI en comparación con los controles sanos y los pacientes con AR sin EPI. Se encontró una correlación débilmente positiva entre DAS28 y FPi en todos los pacientes con AR. Se encontró que los niveles de FPi eran de 2,85 para detectar ILD con una sensibilidad del 66,7% y una especificidad del 65%. Conclusiones: Nuestros resultados mostraron que la FPi se detectó más en AR con EPI en comparación con AR sin EPI. La FPi, una prueba de rutina barata y fácil durante el hemograma, puede proporcionar información importante en términos de la actividad de la enfermedad y la afectación pulmonar en la AR.(AU)

The Anxiety and Depression in Rheumatoid Arthritis Patients Treating with Disease-Modifying Anti-Rheumatic Drugs during the COVID-19 Pandemic.

Objective: Anxiety and depression are associated with the risk of illness, presence of physical symptoms, and poor health in the COVID-19 epidemic. Our aim is to assess the severity of anxiety and depression in rheumatoid arthritis (RA) patients treated with disease-modifying anti-rheumatic drugs during the COVID-19 pandemic. Material and methods: The study is a longitudinal, hospital-based survey study including 102 RA patients receiving disease-modifying anti-rheumatic drugs with a mean of 55,2±11,9 years. Demographic data, educational status, marital status, employment status, economic status, patients with psychiatric disorders (with the use of prescribed medication for treatment), and medications were recorded. The severity of depression and anxiety were evaluated with the Beck Anxiety and Depression Inventory at the first and second visit of the follow-up during the pandemic period. Results: The mean Beck depression inventory score was found to be higher in the conventional synthetic DMARDs group than in biological DMARDs (12,1±8,2 vs 11,6±9,2, p=0,554). 46 (65,7%) had mild to severe anxiety symptoms in RA patients treated with conventional synthetic DMARDs, on the first visit. There was no significant difference in anxiety and depression status between the first and second visits. The difference in anxiety and depression symptoms between RA patients receiving conventional synthetic and biological DMARDs does not attain statistical significance. Also, no significant differences were found in anxiety and depression scores in the comparisons for gender, education, marital, working, and economic status. Conclusions: The severity of depression and anxiety were higher in RA patients receiving conventional synthetic DMARDs and biological DMARDs during the COVID-19 pandemic. Also, RA patients are likely to experience anxiety and depression during the period of the pandemic.

Immature Platelet Fraction in Rheumatoid Arthritis with Interstitial Lung Disease.

BACKGROUND: Platelets have an effect on the hemostatic defense of the lung. Immature platelet fractions (iPF) reflects the number of young platelets containing ribonucleic acid in the circulation and real-time production. Information about their roles in rheumatic diseases is limited and there are no studies on iPF in RA with interstitial lung disease (ILD). Our aim is to investigate the association between the iPF level and occurrence of ILD in RA and the correlation of iPF with disease activity in general or only in RA with ILD. METHODS: The study included 50 RA patients without ILD, 33 RA patients with ILD, and 30 healthy controls. Demographic data, Disease Activity Score 28 (DAS28), autoantibodies, and iPF were evaluated. ILD was diagnosed by using high-resolution computed tomography with clinical findings and chest X-ray. The samples were analyzed for complete blood count with platelet indices included, on Mindray BC-6800 hematology analyzer, Hamburg, Germany. RESULTS: iPF levels were higher in RA patients with ILD compared to healthy controls and RA patients without ILD. A weakly positive correlation between DAS28 with iPF was found in all RA patients. iPF levels were found as 2.85 to detect ILD with 66.7% sensitivity and 65% specificity. CONCLUSIONS: Our results showed that the iPF was detected higher in RA with ILD compared to RA without ILD. iPF, a routine cheap and easy test during hemogram, can provide important information in terms of disease activity and lung involvement in RA.

Comparison of immunoglobulin E anti-thyroid peroxidase antibodies in patients with Hashimoto thyroiditis and chronic spontaneous urticaria.

BACKGROUND AND AIM: Chronic spontaneous urticaria (CSU) is a disease of unknown etiology and autoimmunity has been thought to be an etiological factor. Immunoglobulin E (IgE)-anti-thyroid peroxidase antibodies (anti-TPO) may play a role in the pathogenesis of certain cases of urticaria. The aim of this study is to investigate IgE-anti-TPO in patients with chronic spontaneous urticaria and in patients with Hashimoto's thyroiditis. METHODS: A total of 175 subjects were included in this study. 59 patients had chronic spontaneous urticaria without history of Hashimoto's thyroiditis, while 58 patients had Hashimoto's thyroiditis without history of urticaria. The control group consisted of 58 participants without history of Hashimoto's thyroiditis and urticaria. Serum IgE-anti-TPO levels were analyzed by site-directed IgE capture Enzyme-Linked Immunosorbent Assay technique. We used this technique by modifying it. RESULTS: IgE-anti-TPO antibodies were detected in all three groups and in all subjects. There was no significant difference between the three groups in terms of IgE-anti-TPO levels. Although total IgE and IgE-anti-TPO levels were higher in the IgG-anti-TPO positive chronic spontaneous urticaria, there was no significant difference. CONCLUSIONS: IgE-anti-TPO antibodies do not play a pathogenic role in the majority of patients with chronic spontaneous urticaria.

The association between chronic spontaneous urticaria and HLA class I and class II antigen

Background/aim: Chronic spontaneous urticaria (CSU) is a chronic disease with an unknown etiology. In human leukocyte antigen (HLA) system, the association of class I and class II antigens with autoimmune diseases has been identified and HLA antigens that have a tendency to or can prevent chronic urticaria have been studied. The aim of this study is to investigate the association between chronic spontaneous urticaria and HLA class I and class II antigens. Materials and methods: A total of 80 subjects, 40 patients with CSU and 40 healthy individuals were enrolled in the study. DNA sample isolation from blood was primarily done by the real-time polymerase chain reaction (RT-PCR) technique for the first time. Using HLA SSP Typing Kit (ROSE Cat. No: 800118) PCR technique, HLA-A, B, C, DRB and DQB alleles from DNA samples were analyzed. Results: The mean age was 36.80 ± 9.48 years and the duration of the disease was 4.26 ± 5.18 years. Among the HLA class I and class II antigens, HLA-A was detected significantly more often in the control group (P = 0.039). HLA-DRB1 was more often detected in the CSU group but no statistical difference (P > 0.05). Conclusion: It can be considered that HLA-DRB1 may have a tendency to CSU, while HLA-A might prevent the disease.

Rituximab therapy in rheumatoid arthritis and primary biliary cholangitis / Terapia con Rituximab en artritis reumatoide y colangitis biliar primaria

No disponible

Anti-interleukin-1 treatment among patients with familial Mediterranean fever resistant to colchicine treatment. Retrospective analysis.

BACKGROUND: Up to 5% of familial Mediterranean fever (FMF) cases are unresponsive to colchicine, through resistance, side effects and toxicity. Anakinra is an alternative treatment for FMF patients whose disease remains uncontrolled with colchicine. We aimed to evaluate anti-interleukin-1 treatment regarding clinical findings, laboratory parameters and quality of life (QoL) among FMF patients presenting resistance and toxicity towards colchicine. DESIGN AND SETTING: Descriptive observational study at the rheumatology clinic, Adnan Menderes University Medical School, Aydin, Turkey. METHODS: Among the patients included, age, sex, MEFV genotypes, acute-phase reactants, hepatic/renal function tests, average colchicine dose, disease duration, attack frequency, attack duration, disease severity, proteinuria, amyloidosis and QoL were evaluated. Colchicine resistance was defined as > 6 typical episodes/year or > 3 per 4-6 months. Kolmogorov-Smirnov, Friedman and two-way analysis of variance tests were used for statistical analyses. RESULTS: Between 2015 and 2017, 14 FMF patients receiving anakinra were enrolled. The mean colchicine dose was 1.7 ± 0.3 mg/day before use of anakinra. Ten patients were attack-free after treatment, while three showed reductions of at least 50% in attack frequency, attack duration and disease severity. Proteinuria levels in all patients with renal amyloidosis decreased after treatment. QoL among patients with renal amyloidosis differed significantly from QoL among non-amyloidosis patients. Mean visual analogue scale scores significantly improved in both groups after use of anakinra. CONCLUSIONS: Use of anakinra reduced attack frequency and proteinuria and acute-phase reactant levels, and improved QoL, with only a few uncomplicated side effects among colchicine-resistant or intolerant FMF patients. Injection-site reactions of severity insufficient to require discontinuation of treatment were seen.

Relationship between bone mineral density and anti-citrullinated protein antibody and rheumatoid factor in patients with rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is one of the causes of osteoporosis, and it leads to systemic bone loss. The anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) are associated with local and systemic low bone mineral density and osteoclast-mediated bone resorption independently of inflammation in patients with RA. In this article, we aimed to evaluate the relationship between the ACPA, RF, and systemic bone mineral density in patients with RA. METHODS: Ninety-three patients (6 male, 87 female) with RA were included in the study. The disease activity score 28-erythrocyte sedimentation rate and titers of RF, ACPA, and bone mineral density of the total hip, femoral neck, and lumbar areas were evaluated. The independent samples t-test, Mann-Whitney U-test, Spearman's correlation, and multivariable regression analysis were used for the statistical analysis. RESULTS: The RF and ACPA were positive in 40.9% and 48.4% of patients with RA, respectively. Disease activity was negatively correlated with the T- and Z-scores. The T- and Z-scores were lower in the seropositive group than in the seronegative group. The ACPA was negatively correlated with the T- and Z-scores of the femoral neck. There was a significant difference for the Z-score of the femoral neck in patients with ACPA and RF-positive patients compared to seronegative patients with RA. CONCLUSION: A low bone mineral density, especially in the femoral neck, is associated with the presence of ACPA and RF. It would be a more appropriate approach to carefully monitor osteoporosis in seropositive RA patients.

Comparison of Clinical and Laboratory Findings in Patients with Systemic Lupus Erythematosus with Regard to Age at Onset.

OBJECTIVE: Systemic lupus erythematosus (SLE) rarely has a late onset. Late-onset SLE (LSLE) has a milder course and less organ involvement. The purpose of the present study was to compare the clinical and laboratory (lab) findings of SLE regarding age at onset. MATERIALS AND METHODS: Seventy-two patients with SLE were included in the study. The age at onset was considered adult-onset SLE (ASLE) if it was <50 years and LSLE if it was ≥50 years. Lab parameters and clinical findings were compared accordingly. RESULTS: Overall, 41 (56.9%) patients had ASLE, and 31 (43.05%) patients had LSLE based on the age at onset. The ratio of female-to-male patients was higher in ASLE, and no significant difference was found with regard to gender distribution (12.6:1 and 5.2:1 for ASLE and LSLE, respectively; p=0.239). While malar rash and fever were more common in ASLE, no difference was found regarding the other clinical findings. Only IgG anti-cardiolipin was more common in LSE between the lab parameters. CONCLUSION: Although it is known that LSLE has a milder course and less organ involvement, there are differences in clinical and lab findings and organ involvement in various studies. The results of our study showed no significant difference in organ involvement between ASLE and LSLE.

Anti-interleukin-1 treatment among patients with familial Mediterranean fever resistant to colchicine treatment. Retrospective analysis

ABSTRACT BACKGROUND: Up to 5% of familial Mediterranean fever (FMF) cases are unresponsive to colchicine, through resistance, side effects and toxicity. Anakinra is an alternative treatment for FMF patients whose disease remains uncontrolled with colchicine. We aimed to evaluate anti-interleukin-1 treatment regarding clinical findings, laboratory parameters and quality of life (QoL) among FMF patients presenting resistance and toxicity towards colchicine. DESIGN AND SETTING: Descriptive observational study at the rheumatology clinic, Adnan Menderes University Medical School, Aydın, Turkey. METHODS: Among the patients included, age, sex, MEFV genotypes, acute-phase reactants, hepatic/renal function tests, average colchicine dose, disease duration, attack frequency, attack duration, disease severity, proteinuria, amyloidosis and QoL were evaluated. Colchicine resistance was defined as > 6 typical episodes/year or > 3 per 4-6 months. Kolmogorov-Smirnov, Friedman and two-way analysis of variance tests were used for statistical analyses. RESULTS: Between 2015 and 2017, 14 FMF patients receiving anakinra were enrolled. The mean colchicine dose was 1.7 ± 0.3 mg/day before use of anakinra. Ten patients were attack-free after treatment, while three showed reductions of at least 50% in attack frequency, attack duration and disease severity. Proteinuria levels in all patients with renal amyloidosis decreased after treatment. QoL among patients with renal amyloidosis differed significantly from QoL among non-amyloidosis patients. Mean visual analogue scale scores significantly improved in both groups after use of anakinra. CONCLUSIONS: Use of anakinra reduced attack frequency and proteinuria and acute-phase reactant levels, and improved QoL, with only a few uncomplicated side effects among colchicine-resistant or intolerant FMF patients. Injection-site reactions of severity insufficient to require discontinuation of treatment were seen.