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Objective: Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behcet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment. Methods: Patients with BD (n = 205; 166 men, 39 women; age 39 6 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated. Results: Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-a use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010). Conclusions: Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-a also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS. (J Vasc Surg Venous Lymphat Disord 2021;9:1451-9.)

The present study aims to evaluate the relationship between Behçet's uveitis and lymphangiogenesis by determining levels of Vascular endothelial growth factor-C (VEGF-C, its receptors sVEGFR-2, sVEGFR-3 and lymphangiogenesis markers podoplanin (PDPN) and lymphatic vessel endothelial hyaluronan receptor 1(LYVE-1), and C-type lectin domain family 1 member B (CLEC2).55 patients with BD uveitis and 31 healthy control subjects were enrolled in the study.sVEGFR-2, sVEGFR-3, VEGF-C/sVEGFR-2 ratio, PDPN and LYVE-1 levels were higher in the patient group. A positive correlation was found between LYVE-1 and hsCRP levels. PDPN had a strong predictive value for progression with a cut-off value of 2 pg/mL, with 69% sensitivity and 68% specificity (p = 0.001).LYVE-1 and PDPN can be good representatives of the ongoing inflammatory processes in BD uveitis and point out that the disease can be related to lymphangiogenesis.

OBJECTIVE To evaluate the presence of sarcopenia in patients with rheumatoid arthritis (RA). METHOD This cross-sectional study included 100 patients with RA and 100 gender-matched healthy individuals. Sarcopenia was assessed by performing tests evaluating muscle strength, muscle mass, and physical performance, using the criteria determined by The European Working Group on Sarcopenia. Sarcopenia is defined as a decrease in muscle strength and muscle mass. On the other hand, presarcopenia is defined as a decrease in muscle strength with a normal muscle mass. RESULTS The participants comprised of 70 females and 30 males. The frequency of presarcopenia was 35% in the RA group and 9% in the control group (P

OBJECTIVES Behcet's disease (BD) is a type of systemic vasculitis and inflammatory disease of unknown etiology, which is associated with fatigue and lower quality of life (QoL). The aim of this study was to assess the relationship between Behcet's Disease Current Activity Form (BDCAF) and Behcet's Disease Quality of Life (BDQoL), depression, anxiety and fatigue in Behcet's disease. METHODS We conducted a cross-sectional study of 155 BD patients and 107 healthy subjects in a single center over a 1 year period. All participants completed the Multidimensional Assessment of Fatigue (MAF) questionnaire, and the Hospital Anxiety and Depression (HADS) scale. Disease activity in the BD patients was assessed using the BDCAF, and the physician's global assessment (PGA). BD patients also completed the BDQoL questionnaire. RESULTS There was no significant difference in age and gender between the groups. BD patients had significantly higher HADS-anxiety (HADS-A), HADS-depression (HADS-D) and MAF scores than the healthy control group (P

Background: the course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses. Objective: in this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs. Methods: between April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome. Results: 165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive. Conclusions: among IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome., NA

Interleukin-6 receptor antagonist, tocilizumab (TCZ), is known to be effective in the treatment of amyloidosis in patients with familial Mediterranean fever (FMF). But there are limited data about the effect of TCZ on frequency of attacks. In the current study, we aimed to find out whether TCZ therapy could decrease the frequency of recurrent attacks of FMF or not.The recorded files of 15 patients who had received intravenous TCZ for the improvement of amyloidosis associated with FMF, were evaluated retrospectively. Data of demographic and clinical characteristics of patients were archived from those files.Three female and 12 male patients received TCZ due to amyloidosis were included to the study. The mean age was 42.07 ± 14.37 years. All of the patients were in full compliance with colchicine treatment. According to international severity scoring system for FMF, all of the patients had severe disease. The frequency of attacks recorded was evaluated during TCZ treatment, and it was reported that one patient had no response, six patients had decreased attack frequency and eight patients had no attacks.Tocilizumab is found to be efficient on improvement of amyloidosis and decreasing the frequency of recurrent attacks in patients with FMF. Besides, TCZ is well tolerated among the patients. Further and prospective studies with larger sample are needed to support these results.

Fatigue is a symptom that affects the 40-80% of patients with rheumatoid arthritis (RA) and impairs the quality of life. The aim of this study was to assess multidimensional fatigue scales, the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS) and to evaluate their relationship with disease activity in Turkish RA patients. The study included 180 patients with RA. The Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) were used to evaluate disease activity. The participants comprised of 142 females and 38 males. The mean ± standard deviations of DAS28, CDAI, and SDAI were 3 ± 1.24, 9.51 ± 7.96, and 10.5 ± 8.38 respectively. All scales except the emotional subscale were correlated with disease activity. The emotional subscale correlated with CDAI and SDAI but not with DAS28. The results of the study indicated that fatigue and disease activity were correlated. Fatigue is a symptom that impairs the quality of life but it can be easily coped with by controlling disease activity. Thus, it should be assessed in a multidimensional perspective.

Introduction : Behçet’s disease (BD) is a complex multisystemic inflammatory disorder which is characterized by recurrent attacks of acute inflammation. As there is no universally recognized pathognomonic laboratory marker of BD, its diagnosis is still based on clinical findings. Aim : To evaluate the role of calprotectin and ischemia modified albumin (IMA) as biomarkers in the assessment of disease activity of BD. Material and methods : A total of 93 patients with BD and 62 age- and gender-matched healthy controls were included in the study. Disease activity was assessed with the BD Current Activity Form (BDCAF) score. Serum levels of calprotectin, high-sensitivity C-reactive protein (hsCRP) and IMA were measured in the patient and control groups. Results : Serum levels of calprotectin, IMA and hsCRP in patients with BD were higher than those of the healthy control group (p < 0.001 for all). No correlations between calprotectin and IMA, hsCRP, erythrocyte sedimentation rate, CRP, or BDCAF score were found. Conclusions : As the calprotectin level are increased in BD patients, it could be a candidate biomarker which plays a role in BD pathogenesis.

AIM The aims of the study are to investigate serum neopterin and ischemia modified albumin (IMA) levels in patients with immunoglobulin A vasculitis (IgAV) and evaluate the association of these markers with disease activity and relapse. METHOD Thirty-four consecutive adult patients (24 male and 10 female) admitted to the rheumatology clinic and met the IgAV American College of Rheumatology (ACR) criteria were enrolled in this cross-sectional study. Demographic and clinical features of IgAV and a control group were recorded into a predefined protocol. Disease activity was categorized as "remission" or "active" according to Birmingham Vasculitis Activity Score (BVAS). BVAS ≥ 1 was accepted as "active". Serum neopterin levels, high-sensitivity C-reactive protein (hsCRP) and IMA were evaluated according to BVAS and compared to the healthy control group. RESULTS Serum median (interquartile range) neopterin, IMA levels and hsCRP were higher in the study group than in control group (2.01 [12.5] ng/mL vs 1.77 [1.37] ng/mL, 0.67 [0.2] ng/mL vs. 0.43 [0.17] ng/mL, 5.6 [17.1] mg/L vs. 1.55 [1.6] mg/L, P = .095, P

Background:Sarcopenia is the progressive and generalized loss of muscle mass, strength and function especially among elderly population. Inflammation may lead to sarcopenia regardless of age.Objectives:To evaluate the frequency of sarcopenia and related factors in patients with primary Sjogren’s syndrome (SS).Methods:A total of 44 female patients with SS and 44 age matched female healthy controls were included in this cross-sectional study. Sarcopenia was evaluated by hand grip test, skeletal muscle index (SMI) and 6 meters gait speed (GS) test. According to recommendations of European Working Group on Sarcopenia in Older People (EWGSOP2) 2018, sarcopenia is defined as decrease in results of both hand grip test and SMI, whereas, probable sarcopenia is defined as only decrease in results of hand grip test. Mini Nutritional Assessment Short Form (MNA-SF) was used for evaluating nutritional statement. EULAR SS patient reported index (ESSPRI) and EULAR SS disease activity index (ESSDAI) used for evaluating disease activity. Patient global assessment (PGA) was assessed with visual analogue scale (VAS 0-10 cm). Patients with arthritis in dominant hand and/or ankle joints were excluded from the study.Results:The mean age of participants was 55.3±10.4 years. Eleven patients (25.0%) had probable sarcopenia in SS group and 2 (4.5%) in control group (p=0.007). Compared with healthy controls, SS patients had lower results of hand grip and 6 meters GS tests (p=0.005 and p2=0.13) and MNA was associated with SMI (p=0.005) (Table 2).Table 1.Factors associated with probable sarcopenia in Sjogren’s syndromeSjogren’s syndrome groupNo sarcopenia(n=33)Probable Sarcopenia(n=11)p-valueESSPRI pain*5 (0-10)7 (3-10)0.044bVAS patient*4 (0-10)6 (0-10)0.036bMNA SF, n (%)0.043CNormal nutritional status (12-14)32 (97)8 (72.7)Risk of malnutrition (8-11)1 (3)3 (27.3)ESSPRI: EULAR Sjogren’s Syndrome Patient Reported Index, VAS: Visual Analogue Scale, MNA SF: Mini Nutritional Assessment Short Form. *Variables given as median (minimum-maximum)aIndependent Samples Student t test,bMann-whitney U,CFisher’s Exact test.Table 2.Multivariate analysis for hand grip strength and SMI in patients with Sjogren’s syndromeUnstandardized Coefficients95% Confidence Interval for BStandardized Coefficientsp-valueBStd.ErrorLowerUpperBetaHand grip strengthConstant24,4921,69521,07127,914–ESSPRI pain-0,7070,282-1,276-0,139-0,3610,016SMIConstant5,4191,7051,9788,860–0.003MNA0,3800,127-1,276-0,1390,4190,005ESSPRI: EULAR Sjogren’s Syndrome Patient Reported Index, SMI: Skeletal Muscle Index, MNA: Mini Nutritional AssessmentConclusion:Risk of sarcopenia is increased in patients with SS. In the current study, it is shown that pain is related with sarcopenia. ESPPRI pain is a sign of continuing chronic inflammation in patients with SS. Malnutrition, which can indirectly related with SS, may also contribute to this process. Excessive pain may lead to decrease daily activities and nutritional status of patients with SS. Evaluating pain and patient’s global disease activity may help physicians to find out patients with increased risk for sarcopenia. Controlling disease activity and pain and preventing malnutrition may reduce the risk for development of sarcopenia.Acknowledgments :None to declareDisclosure of Interests: :None declared

Background:Sarcopenia is defined as the decrease in strength, mass and function of muscles and may be related with aging, chronic inflammation or malnutrition. Proinflammatory cytokines may be associated with development of sarcopenia.Objectives:The aim of this study was to evaluate sarcopenia in patients with Rheumatoid Arthritis (RA).Methods:One hundred patients with RA (30 Male/70 Female) and 100 healthy controls (30 Male/70 Female) were included in this cross sectional study. According to The European Working Group on Sarcopenia in Older People (EWGSOP2) 2018, three parameters; muscle strength, muscle mass and physical performance, which are evaluated by hand grip strength, Body Impedance Analyzer (BIA) and 6 meters gait speed test, respectively, are used to diagnose sarcopenia. Patients with arthritis in dominant hand joints and ankle joints were excluded. Sarcopenia is defined as the decrease of strength and mass of muscles. On the other hand patients with low muscle strength but normal muscle mass are defined as probable sarcopenia.Results:The mean age was 58.52±10.95 for patients and 56.62±10.08 for controls (p=0.203). Frequency of probable sarcopenia was 35 (35.0%) in RA and 9 (9.0%) in control group (p2=0.62) (Table 2).Table 1.Factors associated with sarcopenia in rheumatoid arthritisRheumatoid arthritis groupNo sarcopenia(n=65)Probable Sarcopenia(n=35)p-valueSex, n (%) Male24 (36.9)6 (17.1)0.04a Female41 (63.1)29 (82.9)Age*55.00 (25.00−82.00)63.00 (24.00−82.00)0.004bDisease duration (year)*4.00 (1.00−37.00)8.00 (1.00−41.00)0.037bDAS28 CRP*2.13 (1.08−4.69)2.55 (1.54−5.56)0.010bDAS28 ESR (mean±SD)2.63±0.943.36±1.00cCDAI*5 (0−25)9 (0−29)0.012bSDAI*5.09 (0.04−26.04)9.8 (0.39−31.7)0.006bHAQ*0.15 (0−1.05)0.4 (0−19.5)baPearson Chi-Square,bMann-Whitney U Test,cIndependent Samples t-Test. *Variables given as median (minimum-maximum) DAS: Disease activity score ESR:Erythrocyte sedimentation rate, CRP:C-reactive protein, CDAI: Clinical Disease Activity Index, SDAI: Simplified Disease Activity Index, HAQ: Health Assessmnet QuestionnaireTable 2.Multivariate analysis for hand grip test in patients with rheumatoid arthritisUnstandardized Coefficients95% CIStandardized Coefficientsp-valueBStd.ErrorLowerUpperBetaConstant53.653.8945.9361.37−Gender−13.061.41−15.86−10.26−0.60DAS28 CRP−3.210.70−4.61−1.82−0.29Age−0.220.06−0.33−0.10−0.23DAS: Disease activity score CRP:C-reactive proteinConclusion:Loss of muscle strength in patients with RA may be seen frequently. Longer disease duration and higher disease activity should lead to development of sarcopenia due to chronic inflammation. Sarcopenia potentially effects patients’ social lives and daily functions and conceive decrease quality of life. Physicians should be aware of development of sarcopenia during the course of the disease, and take into account the preservative and preventive methods against to sarcopenia including exercise and control of disease activity.Acknowledgments:None to declareDisclosure of Interests:None declared

Introduction Behcet's disease (BD) is a relapsing systemic inflammatory disorder. The diagnosis of BD is primarily based on clinical findings. Current biomarkers are not yet sufficient to diagnose and cannot anticipate the course of the disease and response to treatment. The aim of this study was to evaluate the relationship between the thiol-disulfide balance and disease activity and organ involvement in BD. Material and methods A hundred fifty patients with BD and 100 age- and gender-matched healthy controls were included in the study. Disease activity was assessed with the BD Current Activity form score. Serum levels of native thiol (NT), total thiol (TT), and disulfide were measured and the disulfide/native thiol, disulfide/total thiol and native thiol/total thiol levels were calculated for the patient and control groups. Results Native thiol, total thiol, native thiol/total thiol values of the BD patients were significantly lower than those of the control group. The disulfide/native thiol, disulfide/total thiol values of BD patients were higher compared to the control group and the disulfide value of the BD group was slightly higher compared to the control group. No correlation was determined between thiol levels and disease activity and organ involvement in BD. Conclusions In patients with Behcet's disease, the thiol-disulfide homeostasis balance shifted towards disulfide formation due to thiol oxidation. It may be used as a novel marker in BD because it is easy, practical, fully automated and relatively inexpensive.

Behçet's disease (BD) is a rare, chronic, inflammatory disorder characterized by multisystemic vasculitis including mucocutaneous, neurologic, and ophthalmic involvement. Our aim is to compare vascular endothelial growth factor (VEGF) and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) levels in BD, among the patients having or not having organ involvement, disease activation and especially vascular involvement. Fifty-five patients with BD, 25 of which were accompanied by vascular involvement, and 31 control subjects were included in the study. Disease activity was assessed with the Turkish version of Behçet Disease Current Activity Form (BDCAF) and active vasculitis lesions at the time of study were recorded. Age at diagnosis was 32.2 ± 4.6, while the mean duration of BD was 96.3 (72.3) months. The median for BDCAF score was 2.0 (range 0, 3.0), and 29 (52%) of patients had active BD. The serum VEGF and sVEGFR-1 levels in patients with BD were significantly higher than that in controls [(298 (338.5) pg/mL; 93 (93.5) pg/mL in patients and 136.2 (73) pg/mL; 56.5 (48.5) pg/mL in controls, respectively, p .001 for both values] while difference in VEGF/sVEGFR-1 ratio was obtained close to borderline of significance (p = .03). Our study is the first report indicating elevated serum VEGF, sVEGFR-1, and more importantly VEGF/sVEGFR-1 ratio could play an important role in the development of trombosis in BD. VEGF and/or sVEGFR-1 should not be evaluated independently in the same patient group and the ratio of these two parameters is a more important indicator, especially in the evaluation of BD especially with vascular involvement together with the duration of disease.