Inflammatory Rheumatological Diseases Research Articles

Patient-Reported Outcomes of Depression and Fibromyalgia Symptoms Do Not Predict Non-Inflammatory versus Inflammatory Diagnoses at Initial Rheumatology Consultation

Objective: The objective of this study was to assess the potential value of patient-reported outcomes (PROs) of depression, fibromyalgia symptoms, and pain in predicting non-inflammatory vs. inflammatory diagnoses in rheumatology patients. Methods: This retrospective, single-center study evaluated electronic health record (EHR) data from adults who were seen for their first rheumatology consultation and subsequently received a diagnosis of an inflammatory (e.g., rheumatoid arthritis or spondyloarthritis) or non-inflammatory (e.g., osteoarthritis or fibromyalgia) condition. The PROs evaluated included depressive symptoms (Patient Health Questionnaire-2 [PHQ-2]), fibromyalgia symptom severity (FM SS), and pain. Results: A total of 3669 patients were evaluated, including patients with (n = 984; 26.82%) and without (n = 2685; 73.18%) inflammatory rheumatologic disease, of whom 141 (3.8%) had fibromyalgia. The non-inflammatory subgroup reported higher FM SS scores, and the inflammatory subgroup had higher pain and inflammatory markers. Bivariate models based on PHQ-2 and FM SS had a very low specificity (0.3%) for predicting non-inflammatory conditions, resulting in the misclassification of >99% of inflammatory cases. Adding pain, inflammatory markers, and other relevant EHR variables increased specificity but still resulted in a high level of misclassification. Conclusions: The PROs evaluated in this study are not suitable for predicting non-inflammatory vs. inflammatory rheumatologic disease, even when combined with other EHR variables.

Utility of common investigations for suspected inflammatory arthritis in adults.

Inflammatory arthritis may be the principal feature or one component of an inflammatory rheumatological disease. It is a clinical diagnosis, principally made based on the patient's history and examination. Specific investigations, such as rheumatoid factor and human leucocyte antigen B27 gene, may support the diagnosis in the context of a suggestive clinical presentation, but a diagnosis cannot be made based on these tests alone because positive results may also be seen in healthy individuals. To reduce the likelihood of false positive results, laboratory and radiological investigations should be tailored to the suspected diagnosis based on pretest probability. While musculoskeletal symptoms are a common presentation in general practice, specific features that increase suspicion of an inflammatory arthritis include prolonged morning stiffness (more than 1 hour) that is improved by exercise or movement. A broad 'rheumatological panel' increases the likelihood of false positive results and should be avoided to prevent unnecessary further investigations and treatment, and unwarranted anxiety in both the patient and the doctor.

Genetic biomarkers for diagnosis and treatment of spondyloarthropathies in Moroccan population

BackgroundThe spondyloarthropathies (SpA) are inflammatory rheumatologic diseases whose pathogenesis comes from interaction between genetic and environmental factors. MethodsThis is a case-control analysis that aims to explore in Moroccan population the relationship of some allelic polymorphisms of the CTLA-4 CT60, FCGR3A-158G/T SNPs and HLA-B locus with SpA disease. Eighty-four Spa patients grouped according to pain site and 95 healthy individuals from Morocco were typed by sequence-based-typing methods. ResultsThe CTLA-4 CT60 investigation showed a significantly increased frequency of rs11571319 A allele in male patients with sacroiliitis (pcorr.=0.048, OR=2.756) and a protective role of A/G genotype in SPA patients with thoracic spine (pcorr.=0.016, OR=0.055) and peripheral joints pain (pcorr.=0.036 OR=0.068), compared to controls. Furthermore, a significant increase of A/A in rs3087243 was shown in male patients with peripheral joints pain (p = 0.035 OR = 4.45). Data from FCGR3A-158 analysis evidenced a reduction of T/T (F/F) genotype in patients with thoracic spine pain (p = 0.030, OR = 0.09) and a higher frequency of G/T (F/V) (p = 0.038 OR = 5.045) towards controls. With regard to HLA-B locus, we noticed a protective role of HLA-B*45:01 (pcorr. = 0.033,OR = 0.041) and an increased frequency of HLA-B*51 alleles (51:01, 51:02, 51:08, 51:09, 51:29) and B*52:01:01 (p = 0.041,OR = 2.714), in addition to HLA-B*27 alleles (p = 0.028, OR = 2.593) commonly associated with AS pathologies. ConclusionsOur data suggest the role of some additional CTLA-4, FCGR3A and HLA-B gene polymorphisms in SPA pathogenesis of Moroccan population, useful as new diagnostic biomarkers and targets for immunotherapy.

Development of a care protocol in pregnancy and chronic inflammatory arthritis, in a multidisciplinary work group

ObjectiveTo design a care protocol in Chronic Inflammatory Arthritis during the pre-conceptional period, pregnancy, postpartum and lactation. This protocol aims to be practical and applicable in consultations where patients with chronic inflammatory rheumatological diseases are treated, thus helping to better control these patients. Likewise, recommendations are offered on when patients could be consulted/referred to a specialized center by the physician. MethodsA multidisciplinary panel of expert physicians from different specialties identified the key points, analyzed the scientific evidence, and met to develop the care protocol. ResultsThe recommendations prepared have been divided into three blocks: rheumatology, gynecology and pediatrics. The first block has been divided into pre-pregnancy, pregnancy and postpartum visits. ConclusionsThis protocol tries to homogenize the follow-up of the patients from the moment of the gestational desire until the year of life of the infants. It is important to perform tests in patients of childbearing age and use drugs compatible with pregnancy. If appropriate, the patient should be referred to specialized units. Multidisciplinarity (rheumatology, gynecology and pediatrics) is essential to improve the control and monitoring of these patients and their offspring.

Multimodal ultrasound techniques for the differential diagnosis of splenic lesions - Adiagnostic challenge

Splenic tumors are rare and can pose adifferential diagnostic challenge, especially as an incidental imaging finding. Due to alack of large scale biopsy studies the available literature is limited with respect to clear imaging criteria for dignity. The present work is intended to show the chances of atargeted elicitation of the medical history as well as the possibilities and limitations of multimodal sonography in order to achieve the correct diagnosis of asplenic lesion using simple and gentle methods. Selective literature search and clinical case studies. In the differential diagnostics of focal splenic lesions, information about pre-existing hemato-oncological or inflammatory rheumatological diseases is essential in order to correctly classify incidental findings in particular. In addition to B‑mode ultrasound (B-US) and color-coded Doppler ultrasound (CD-US), contrast-enhanced ultrasound (CEUS) in particular provides crucial differential diagnostic information. While hyperechoic foci in B‑US or arterially hypervascularized splenic foci in CD-US/CEUS are usually benign, hypoechoic and arterially hypoperfused foci in CD-US/CEUS must be further clarified. Although the ultrasound-guided biopsy of the spleen has ahigher risk of bleeding than aliver biopsy, it is still the gentlest and most effective method for achieving the histological clarification of splenic lesions when the indications are correct. Through the combination of the medical history and multimodal ultrasound methods, if necessary supplemented by anultrasound-guided biopsy, focal splenic lesions can be successfully classified in most cases with adirect impact on further clinical procedures.

Tomographic Fibrosis Score in the Patients with Systemic Sclerosis-Associated Interstitial Lung Disease.

Various visual semi-quantitative staging systems based on high-resolution computed tomography are used to evaluate inflammatory rheumatologic disease-associated interstitial lung disease. We aimed in this retrospective study to evaluate whether tomographic fibrosis score, a new visual semi-quantitative staging system, was a predictor of mortality and the relationship between tomographic fibrosis score and respiratory function tests in patients with systemic sclerosis-associ- ated interstitial lung disease. The patients who have been followed up at a single-center rheumatology clinic for the last 5 years and met the American College of Rheumatology / European League Against Rheumatism (ACR-EULAR) 2013 systemic sclerosis classification criteria were included in the study. Clinical data were obtained retrospectively from patient records, including patients' characteristics, pulmonary function test (forced vital capacity), diffusing capacity of the lung for carbon monoxide test, high-reso- lution computed tomography results, medication history, and serological test results. High-resolution computed tomography of the patients diagnosed with interstitial lung disease were assessed for the study. The radiologists scored the extent of parenchymal abnormalities (ground glass opacification, reticulation, honeycombing, and consolidation) and calculated tomographic fibrosis score and also traction bronchiectasis score for each patient. Fifty-two patients (46 female, median age 60 (Q1-Q3:47-66) years) were included in this study. The median disease duration, follow-up time, interstitial lung disease duration, and time from sys- temic sclerosis diagnosis to interstitial lung disease diagnosis were 80 (59-143) months, 78 (50-119) months, 63 (43-81) months, and 4 (0-58) months, respectively. The median tomographic fibrosis score and traction bronchiectasis score of the patients were 3.08% (1.33-8.06) and 0 (0-2), respectively. There was a moderate direct correlation between tomographic fibrosis score and traction bronchiectasis score (r = +0.472, P < .001). Additionally, there was a mod- erate inverse correlation between tomographic fibrosis score and diffusing capacity of the lung for carbon monoxide at diagnosis (r = -0.554, P = .011). During the follow-up period, 12 (23%) patients died. Kaplan-Meier Test (P = 0.009) and Cox regression analysis (B: 4.673, 95% confidence interval, 1.321-16.529, P = .017) revealed that tomographic fibrosis score ≥ 5% was associated with mortality. Multivariate analysis was not performed due to the small number of patients. An inverse relationship was found between tomographic fibrosis score and diffusing capacity of the lung for carbon monoxide at diagnosis. The odds ratio for mortality was 4.7 when tomographic fibrosis score was ≥5%. Tomographic fibrosis score may be useful for predicting mor- tality and respiratory function in patients with systemic sclerosis-associated interstitial lung disease.

High 30-day readmission rates in hospitalized patients with heart failure: Strengthening the need for a multidisciplinary and integrated approach

Background: Heart failure (HF) is a common disease which is one of the most common causes of hospitalization. Although mortality rates are decreasing, readmission rates are still quite high. Objectives: We aimed to investigate the risk factors for readmission and death in patients who were hospitalized due to HF. Design and Setting: Retrospective study, Hacettepe University, Ankara, Turkey Methods: Patients hospitalized between 1 January 2014 to 31 December 2018 with the primary diagnosis of HF were included. Outcome variables were risk factors for 30-day all- caused readmission, 30-day HF related readmission, mortality. Results: All-cause 30-day readmission rate was 34.8% and HF-related 30-day readmission rate was 21.2%. The factors associated with increased all-caused 30-day readmission were male gender, hyperlipidemia, chronic liver disease, malignancy. The factors associated with increased HF-related 30-day readmission were hyperlipidemia, chronic liver disease, inflammatory rheumatologic diseases, malignancy. Use of ACE-i was found to be protective against all-cause and HF-related 30-day readmission. Factors associated with mortality were ejection fraction &lt;30%, chronic liver disease, acute kidney injury, hypoalbuminemia at the time of admission. Conclusions: Nearly one third of patients in this cohort who were hospitalized with a primary diagnosis of HF were readmitted in the following 30 days. Having certain chronic diseases and conditions were associated with an increased risk for readmission and mortality. These findings point out to the special needs of HF patients, who require a proactive, integrated and multidisciplinary management strategy to control the risk factors and to improve the inpatient and transitional stages in the hospital.

Ultra-high field magnetic resonance imaging of the quadriceps tendon enthesis in healthy subjects.

Although enthesitis is a hallmark of several rheumatologic conditions, current imaging methods are still unable to characterize entheses changes because of the corresponding short transverse relaxation times (T2). A growing number of MR studies have used Ultra-High Field (UHF) MRI in order to assess low-T2 tissues e.g., tendon but never in humans. The purpose of the present study was to assess in vivo the enthesis of the quadriceps tendon in healthy subjects using UHF MRI. Eleven healthy subjects volunteered in an osteoarthritis imaging study. The inclusion criteria were: no knee trauma, Lequesne index = 0, less than 3h of sport activities per week, and Kellgren and Lawrence grade = 0. 3D MR images were acquired at 7T using GRE sequences and a T2* mapping. Regions of interest i.e., trabecular bone, subchondral bone, enthesis, and tendon body were identified, and T2* values were quantified and compared. Quadriceps tendon enthesis was visible as a hyper-intense signal. The largest and the lowest T2* values were quantified in the subchondral bone region and the tendon body respectively. T2* value within subchondral bone was significantly higher than T2* value within the enthesis. T2* in subchondral bone region was significantly higher than the whole tendon body T2*. A T2* gradient was observed along the axis from the enthesis toward the tendon body. It illustrates different water biophysical properties. These results provide normative values which could be used in the field of inflammatory rheumatologic diseases and mechanical disorders affecting the tendon.

Calcification of Joints and Arteries (CALJA) Is a Rare Cause of Arthritis and Lower Limb Ischemia: Case Report and Literature Review

Calcification of Joints and Arteries (CALJA) is a rare disease that leads to chronic arthritis and lower limb claudication due to hydroxyapatite crystal deposition. The disease is caused by mutations in the 5-nucleotidase (NT5E) gene, which is responsible for pyrophosphate metabolism. Only 23 cases have been described so far. In this case report, we describe a new case of CALJA and provide a literature review. A 65-year-old woman was referred to the Rheumatology Unit with the diagnosis of seronegative oligo-arthritis. She complained of lower limb claudication, which was becoming progressively worse. Doppler ultrasound revealed bilateral obliteration of the popliteal and femoral arteries, and X-rays of the knees, hands, and feet showed extensive periarticular calcific deposits. The results of the NT5E gene analysis were positive for an inactivating variant, leading to the diagnosis of CALJA. The clinical features of CALJA are caused by hydroxyapatite crystal deposition at the periarticular and vascular levels due to abnormalities of pyrophosphate metabolism. Currently, no specific treatment is available, although a trial on the use of etidronate is ongoing. Patients with CALJA are often treated with immunosuppressant agents in the suspect of inflammatory rheumatologic diseases. Our case is the first in which clinical symptoms and a steady increase of inflammatory markers improved only after colchicine therapy initiation. It is crucial for the rheumatologist to recognize the features CALJA and keep it in mind in the differential diagnosis of patients with lower limb arterial insufficiency and arthritis or early osteoarthritis with joint calcification.

Effectiveness of hyperbaric oxygen therapy in bone marrow edemas of the knee: A retrospective study

Bone marrow edema (BME) is a self-limiting syndrome that can be caused by many pathological conditions. The most frequently seen symptom of BME is pain. Hyperbaric oxygen therapy (HBOT) is an available treatment. This study aims to present the clinical results of quantitatively evaluating the use of HBOT. We evaluated all BME patients 18 to 65 years old without osteoarthritis, inflammatory rheumatological disease, or malignancy diagnosed through magnetic resonance imaging. All were treated with acetylsalicylic acid (100 mg daily) and bisphosphonates (70 mg alendronate once a week) and were instructed to avoid weight-bearing activities. Some of the patients also received HBOT. We divided the patients into 2 groups: 1 group took HBOT; the other did not. We used the Wilcoxon test to compare groups. HBOT is an effective treatment option for BME. We quantitatively measured faster healing when HBOT was used for BME of the knee. There were no significant side effects.

Adherence to Vaccines in Adult Patients with Immune-Mediated Inflammatory Diseases: A Two-Year Prospective Portuguese Cohort Study

Patients with immune-mediated inflammatory diseases (IMIDs) treated with immunomodulatory therapy present an increased susceptibility to infections. Vaccination is a crucial element in the management of IMID patients; however, rates remain suboptimal. This study intended to clarify the adherence to prescribed vaccines. This prospective cohort study included 262 consecutive adults with inflammatory bowel disease and rheumatological diseases who underwent an infectious diseases evaluation before initiating or switching immunosuppressive/biological therapy. Vaccine prescription and adherence were assessed during an infectious diseases (ID) consultation using a real-world multidisciplinary clinical project. At baseline, less than 5% had all their vaccines up-to-date. More than 650 vaccines were prescribed to 250 (95.4%) patients. The most prescribed were pneumococcal and influenza vaccines, followed by hepatitis A and B vaccines. Adherence to each of the vaccines ranged from 69.1-87.3%. Complete adherence to vaccines occurred in 151 (60.4%) patients, while 190 (76%) got at least two-thirds of them. Twenty patients (8%) did not adhere to any of the vaccines. No significant differences were found in the adherence rates of patients with different sociodemographic and health-related determinants. ID physicians can play a role in the process of increasing vaccine prescription and adherence. However, more data on patients' beliefs and vaccine hesitancy, along with mobilization of all health care professionals and adequate local interventions, shall be considered to improve vaccine adherence.

Tumour Necrosis Factor Alpha (TNF-α) and Oral Squamous Cell Carcinoma.

Uncovering the inflammatory mechanisms underpinning initiation, progression, and promotion of oral squamous cell carcinoma (OSCC) development is fundamental to the rational pursuit of targeted therapeutics. Here we present a review of the current knowledge of the role of TNF-α in the aetiology, pathogenesis, and potential therapies with regards to OSCC. TNF-α is worthy of particular attention in OSCC, with its presence demonstrated to enhance cell proliferation and its downregulation demonstrated to inhibit proliferation and migration in other carcinomas in both in vitro and in vivo models and oral cancer patients. Increased TNF-α in the OSCC tumour microenvironment has been demonstrated to favour invasion through promotion of firstly the pro-inflammatory, pro-invasive phenotypes of OSCC cells and secondly its paracrine mechanism mediating recruitment and activation of inflammatory cells. Polymorphisms affecting the gene expression of TNF-α have been strongly associated with an increased risk for oral squamous cell carcinoma. A number of studies have considered TNF-α within biofluids, including saliva and serum, as a potential biomarker for the early detection of OSCC, as well as its staging, differentiation, and prognosis. The broad and multifaceted role that TNF-α plays in many inflammatory states presents an obvious confounder, particularly with demonstrated increased TNF-α levels in common oral disease states. Lastly, biologic agents targeting TNF-α are currently in clinical use for immune-mediated inflammatory rheumatological and gastrointestinal diseases. There is the potential that these biological agents might have an adjunctive role in OSCC prevention and treatment.

An Investigation of Diabetes Mellitus and Vitamin D Deficiency in Patients Presented to Internal Medicine Outpatient Clinic

Introduction: Vitamin D deficiency plays a role also in the occurrence of autoimmune diseases, including heart disease, cancer, inflammatory bowel diseases, diabetes, and rheumatological diseases. In addition, vitamin B12 deficiency, one of the autoimmune diseases, can also be seen in cases of Vitamin D deficiency. Furthermore, Vitamin D is also associated with insulin secretion and increased insulin sensitivity in target cells, and relevant studies reported Vitamin D deficiency at the initial stage of diabetes mellitus (DM). Accordingly, the present study aimed to investigate the relationship between Vitamin D, DM, Vitamin B12, and ferritin in patients presented to the internal medicine outpatient clinic. Materials and Methods: The data from adults aged 18 years and over, who presented to the Internal Medicine Outpatient Clinic of the Mersin City Training and Research Hospital between 01 June 2021 and 31 December 2021 were retrospectively investigated. Results: 476 (95.2%) patients had vitamin D levels below 30 ng/ml, 20 (4.0%) had vitamin B12 levels below 200 pg/ml, and 319 (63.8%) patients had ferritin levels below 20 ng/ml. There was a significant decrease in ferritin in female gender (p

Factors Influencing 1-Year Survival in Haemphagocytic Lymphohistiocytosis: A National Cohort Study in England

Background: Haemophagocytic lymphohistiocytosis (HLH) is a rapidly progressive, life-threatening clinical syndrome of excessive immune activation. Multiple predisposing factors influence the likelihood of any individual developing HLH at any time, encompassing genetic, auto-immune disease, immunosuppression and malignancy. In partnership with the National Congenital Anomalies and Rare Disease Registration Service (NCARDRS) we have undertaken a nationwide study in England of all cases of HLH diagnosed between 2003 and 2018, and modeled interactions of demographics and comorbidities with survival. Methods: Using national linked electronic health data from hospital admissions and death certification we identified cases of HLH that were diagnosed in England between 1st January 2003 and 31st December 2018 using a previously validated approach (Bishton et al Brit J Haem 2021). Patients of all ages admitted to hospital with an admission coded with HLH ICD-10 codes D76.1 and D76.2, or who died with a death code of D76.1, D76.2 or D76.3 provided in the latter situation there was confirmatory free text on the death certificate indicating HLH, were included. We calculated 1-year survival using Kaplan-Meier methods by calendar year, age group, sex and comorbidity (haematological malignancy, inflammatory rheumatological or bowel diseases (IBD). We modelled 1-year survival and the interactions between age and associated comorbidity using Cox regression. Results: There were 1628 people with HLH included in the analysis. 706 (68.6%) patients were aged ≥15 years, 920 (56.5%) were male and 855 (52.5%) had at least one associated comorbidities recorded. The most common comorbidities were lymphoma (n=270 [16.6%]), leukaemia (n=125 [7.7%]), systemic juvenile idiopathic arthritis (SJIA) (n=78 [4.8%]), IBD (n=70 [4.3%]), vasculitis (n=64 [3.9%]) and systemic lupus erythematosus (SLE) (n=47 [2.9%]). Overall, crude 1-year survival was 50% (95% CI 48-53%) with no improvement observed over the study period. Survival varied significantly with age (0-4, 61%; 5-14 76%; 15-54 61%; >55 24% p<0.01)(figure 1), sex (males, 46%, females, 55% p<0.01) and associated comorbidity (rheumatological/IBD, 69%, haematological malignancy 28%, other malignancy, 37% p <0.01). Those aged 0-14 and 15-54 years had a 3-fold increased risk of death at 1-year among HLH associated with haematological or non-haematological malignancy compared to rheumatological disease/IBD. Predicted 1-year survival decreased markedly with age in those with rheumatological disease/IBD (age 0-14, 84%; 15-54, 73%; >55, 27%) meaning survival for those aged >55 years was poor regardless of the underlying disease process. Notably there was no difference in outcomes by lymphoma subtype (B-cell, T-cell or Hodgkin lymphoma) in contrast to the auto-immune sub-groups, where outcomes for adult onset Stills disease and SJIA were excellent (77% and 89% respectively) whilst survival in rheumatoid arthritis (35%) and vasculitis (39%) were similar to non-haematological malignancy driven HLH. Conclusion: We provide the first estimates of survival for HLH by the associated trigger factors (vasculitis, rheumatoid arthritis, IBD, malignancy), on a national scale, and make the critical observation that outcomes have remained static for the study period. Furthermore outcomes for haematological malignancies are dismal regardless of disease subtype, whilst significant variation in outcomes for different auto-immune disease subtypes are seen indicating that the severe impact of this syndrome is not limited to those with underlying malignancy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Temporal Trends in the Incidence of Hemophagocytic Lymphohistiocytosis: A Nationwide Cohort Study From England 2003-2018.

Hemophagocytic lymphohistiocytosis (HLH) is rare, results in high mortality, and is increasingly being diagnosed. We aimed to quantify the incidence of diagnosed HLH and examine temporal trends in relation to age and associated diseases. Using national linked electronic health data from hospital admissions and death certification cases of HLH that were diagnosed in England between January 1, 2003, and December 31, 2018. We calculated incidence rates of diagnosed HLH per million population by calendar year, age group, sex, and associated comorbidity (hematological malignancy, inflammatory rheumatological or bowel diseases [IBD]). We modeled trends in incidence and the interactions between calendar year, age, and associated comorbidity using Poisson regression. There were 1674 people with HLH diagnosed in England between 2003 and 2018. The incidence rate quadrupled (incidence rate ratio [IRR] 2018 compared to 2003: 3.88, 95% confidence interval [CI] 2.91 to 5.28), increasing 11% annually (adjusted IRR 1.11, 95% CI 1.09 to 1.12). There was a transition across age groups with greater increases in those aged 5-14 years of HLH associated with rheumatological disease/IBD compared with hematological malignancy, with similar increases in HLH associated with both comorbidities for those 15-54, and greater increases in HLH associated with hematological malignancies for those 55 years and older. The incidence of HLH in England has quadrupled between 2003 and 2018. Substantial variation in the incidence occurred with inflammatory rheumatological diseases/IBD-associated HLH increasing more among the younger age groups, whereas in older age groups, the largest increase was seen with hematological malignancy-associated HLH.

Nöropatik ağrı aksiyal spondiloartritte gözden kaçan bir semptom mu?

Purpose: Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatologic disease. Pain is the most common symptom affecting quality of life in axSpA patients. It has been showed that pain is not always correlated with inflammation in patients. The aim of our study was to investigate the frequency of neuropathic pain in axSpA patients and relationship between neuropathic pain and patient characteristics.&#x0D; Materials and Methods: Patients diagnosed as axSpA according to the Assessment of SpondyloArthritis International Society classification criteria, who presented in our outpatients clinics from January to March 2019 were included in this study. The neuropathic component of pain was evaluated with Douleur Neuropathique en 4 Questions (DN4) questionnaire. &#x0D; Results: Eighty seven axSpA patients were included in the study. Thirty of patients had neuropathic pain according to DN4 questionnaire (DN4&gt;4). Neuropathic pain was higher in active disease group depending on both of ASDAS-CRP and BASDAI. DN4 score of patients was found moderately correlated with ASDAS-CRP and BASDAI score. A weak positive correlation was found between patients education level and DN4 score. &#x0D; Conclusion: We showed that neuropathic pain could be seen in patients with axSpA and it could be correlated with disease activity. The studies have proven that neuropathic pain could lead to impaired quality of life and social &amp; emotional functions. Patients with neuropathic pain could not benefit from antiinflammatory treatments. Therefore evaluating of neuropathic pain is important in axSpA patients. Further studies on management of neuropathic pain in axSpA patients are needed.

Single-center experience of COVID-19 vaccine in patients with inflammatory rheumatic disease: Real-life data

Background/Aim: Patients with rheumatic disease are at high risk of infection complications, and vaccines are essential to prevent these diseases. Moreover, biologic disease-modifying/targeted synthetic anti-rheumatic drugs (b/tsDMARDs) have been shown to reduce the immunogenicity of vaccines, although their effectiveness, side effects, and effects on disease activity are not yet clear. In this study, we aimed to investigate the incidence of post-vaccine side effects, disease exacerbation, and COVID-19 infection despite vaccination in patients with inflammatory rheumatic disease; the difference in vaccination effects between patients who received and did not receive b/tsDMARD treatments. Methods: Patients received b/tsDMARD (i.e., biologic group (BG)) (n = 194) who were admitted to the rheumatology outpatient clinic, were included in this study. All patients with inflammatory rheumatological disease, who did not receive b/tsDMARD (n = 185), but who applied to the rheumatology outpatient clinic during this time, were included in the non-biologic group (NG). Patients followed were included and evaluated cross-sectionally. Clinical and demographic characteristics, as well as type of COVID-19 vaccination, post-vaccine side effects, COVID-19 infection status before and after vaccination, and post-vaccine rheumatological disease exacerbation, were also evaluated. Results: In BG, 92.2% of patients were vaccinated, but for NG, 82.7% were vaccinated against COVID-19 patients with BG, 46.2% were vaccinated with CoronaVac vaccine alone, 51.4% with Pfizer/BioNTech BNT162b2 vaccine alone, and 37.4% with a combination of CoronaVac and BNT162b2 vaccines. In the NG, 53.8% of patients were vaccinated with CoronaVac vaccine alone, 48.6% with BNT162b2 vaccine alone, and 36.2% with a combination of CoronaVac and BNT162b2 vaccines. There was a significant difference between groups, according to vaccine types (P = 0.040), as this difference was due to a larger number of patients vaccinated with the CoronaVac + BNT162b2 combination for BG. Adverse effects were detected in 99 patients (55.9%) with BG and 95 patients (62.5%) with NG post-vaccination. There was no difference between BG and NG vaccines (CoronaVac, BNT162b2, or their combination) for adverse effects (P &gt; 0.05 for all). The vaccine with the most common adverse events was BNT162b2, for both BG and NG. The most common side effect was arm pain, significantly higher in BG (P = 0.014). Fever and rash were more common for NG (P = 0.017). Disease exacerbation was not observed with BG, whereas it was detected in 5 (1%) patients for NG that was different (P = 0.021). SARS-COV-2 infection was also significantly less common for BG vs. NG (15.3% vs. 20.3%) (P = 0.017). Despite COVID-19 vaccinations, 56 patients with BG and 62 patients with NG had COVID-19 (P = 0.005). Conclusion: Standardized vaccination comparisons could not be achieved, as patients using b/tsDMARD were vaccinated for fewer COVID-19 infections. Additionally, COVID-19 vaccines are well-tolerated in patients with rheumatological disease, with vaccine-related disease activity at 1%, only seen in those not using b/tsDMARDs.

Oral health in patients with severe inflammatory dermatologic and rheumatologic disease.

Poor oral health (OH) is a risk factor for systemic disease and lower quality of life (QoL). Patients with inflammatory dermatologic/rheumatologic diseases report more oral discomfort, dry mouth, and periodontal disease than controls. Medications used to treat these conditions can also adversely affect OH. The aim was to assess the OH of patients with chronic inflammatory dermatologic/rheumatologic diseases treated with systemic/biologic therapy, compared to controls. Patients with chronic inflammatory dermatologic/rheumatologic diseases treated with systemic/biologic therapy were recruited from outpatient clinics across two university hospitals. All patients had a standardized World Health Organisation OH assessment performed consisting of an OH exam and questionnaire. Age- and sex-matched controls without chronic inflammatory disease were recruited from a pigmented lesion clinic. Charts of patients with chronic inflammatory dermatologic/rheumatologic diseases were reviewed to assess OH documentation. One hundred patients were examined (50 cases and 50 controls). Patients with inflammatory dermatologic/rheumatologic diseases (cases) had poorer periodontal status (mean loss of attachment 6.9mm vs. 1.9mm controls, p=0.01), more missing teeth (mean 7.7 vs. 4.4 controls, p=0.029), more dry mouth (82% vs. 20% controls, p=0.001), and less frequent tooth brushing (60% vs. 80% controls, p=0.037). Of 250 patient charts which were reviewed, 98.4% (n=246) had no documentation of OH. Patients with severe inflammatory dermatologic/rheumatologic conditions have poorer OH and OH-related QoL. Clinicians should appreciate the risk of poor OH in this cohort and have a low threshold for involving OH professionals in care pathways for severe inflammatory disease.

Value of speckle tracking echocardiography for detection of clinically silent left ventricular dysfunction in patients with systemic lupus erythematosus

Background and Aims : Background: SLE is a chronic autoimmune inflammatory rheumatological disease. Characterized by autoantibodies directed against nuclear antigens. It is a disease of young women, with a peak incidence between the ages of 15 and 40 with a female: male ratio of 9:1. Cardiac involvement in patients with SLE is common. Subclinical involvement is more common than Clinically apparent cardiomyopathy or myocarditis Aim: Assess LV function in asymptomatic SLE patients by conventional, speckle tracking and tissue Doppler echocardiography.

An investigation of the relationship between rheumatological diseases and soluble receptor for advanced glycation end products.

Soluble receptor for advanced glycation end products (sRAGE) is one of the forms of RAGE. It is a trap receptor that has a role in inhibiting pro-inflammatory processes that will occur with the combination of RAGE and its ligands. Our study aims to examine the level of sRAGE in rheumatological inflammatory diseases and its relationship with these diseases. A total of 60 patients with Behçet's disease (BD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and 22 healthy control individuals were included in the study. Comorbidity status, sRAGE levels, disease activity scores, demographic and laboratory data of the patients were recorded. Serum sRAGE levels in these diseases and healthy controls were determined by Enzyme-Linked Immunosorbent Assay (ELISA) kit spectrophotometrically. Serum sRAGE levels in the patient groups were significantly higher when compared to the healthy control group (p < 0.001 for all). On the other hand, when the patient groups were compared with each other in terms of sRAGE levels, there was no significant difference (p > 0.05 for all). The serum sRAGE levels were not correlated with C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and disease activity scores (p > 0.05 for all). Serum sRAGE levels increased in BD and in other inflammatory rheumatological diseases. However, this increase does not directly correlate with inflammatory markers and disease activity scores. These results suggest that serum sRAGE level may not be used as a biomarker for disease activity in BD and in other rheumatological diseases.