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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 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.

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.

Aim of the work: Hepatic involvement is uncommon in patients with SSc and often associated with primary biliary cholangitis (PBC) an association known as 'Reynold's syndrome'. Anti-mitochondrial antibody (AMA) and anti-centromere antibody (ACA) indicate increased PBC risk in SSc patients. This study aimed to evaluate the relationship between SSc and PBC, and also associated antibodies. Patients and methods: In this study, 128 SSc patients with diffuse cutaneous (dcSSc n = 59) and limited cutaneous (lcSSc n = 69) subtypes were enrolled. PBC was diagnosed with any 2 of the following: cholestasis based on alkaline phosphatase elevation, presence of AMA and histologic evidence of destruction of interlobular bile ducts and nonsuppurative destructive cholangitis. Results: The mean age of the patients was 54.8 ± 13.2 years and disease duration 2.4 ± 1.4 years and they were 106 (82.8%) females and 22 males. ANA was positive in 80.4% of all patients, anti-Scl-70 in 36.7% and ACA in 37.5%. PBC was present in 8 patients (4 in each subtype). In patients with PBC, ACA was positive in 75% compared to 35% in those without (p = 0.03). The gamma-glutamyltransferase (GGT) and direct bilirubin were significantly higher in those with Reynolds syndrome (57.5 ± 26.9 U/L and 0.3 ± 0.1 mg/dl) compared to those without (19.7 ± 9.7 U/L and 0.19 ± 0.1 mg/dl; p

Objective: To investigate anxiety, sleep quality, and their relationship with inflammation in patients with Takayasu’s arteritis (TA).Methods: Twenty-four patients diagnosed with TA and sex-aged matched healthy controls were enrolled in the study. The quality of sleep was evaluated by Pittsburgh sleep quality index (PSQI), and anxiety were assessed by The Spielberger State-Trait Anxiety Inventory and Hamilton Anxiety Rating Scale. Chi-square, Pearson/Spearman's correlation, Student's t-test, and Mann-Whitney U test were used for statistical analysis.Results: The levels of anxiety and overall PSQI scores were significantly higher in TA than in healthy controls. Sleep disturbance was identified in half of the TA patients. The presence of systemic findings, CRP, and all subscale items of Hamilton Anxiety Rating Scale and Spielberger State-Trait Anxiety Inventory were found to be higher in TA patients with poor sleepers compared to good sleepers. There was a significant correlation between all components of PSQI and anxiety scores.Conclusions: The present study has demonstrated higher anxiety scores and poor sleep quality among patients in TA compared with healthy controls. It seems that many PSQI parameters have significantly impaired in TA. TA patients with systemic findings and high inflammation should be evaluated for poor sleep quality. Also, remission in disease activity may be associated with better sleep and less anxiety scores.

Introduction:The endothelial damage, changes in vascular permeability and plaque formation are caused by the effects of cytokines and chemokines that plays role in chronic inflammation in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). It has been reported that arterial stiffness and the level of cell adhesion molecules are affected by inflammation. In this study, we aimed to determine the relationship between vascular endothelial growth factor (VEGF), E-selectin, arterial stiffness and disease activity in patients with rheumatic diseases.Methods:Thirteen patients diagnosed with AS, 28 patients diagnosed with RA and 30 healthy controls were included in the study. Arterial stiffness, VEGF, E-selectin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated in all patients and healthy controls. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Disease Activity Score-28 (DAS-28) were calculated in patients with rheumatic diseases. The level of serum VEGF and E-selectin were determined by ELISA, and arterial stiffness was measured by oscillometric method. The data were statistically evaluated by using Student t-test, Mann-Whitney U Test and Wilcoxon test.Results:DAS-28, BASDAI, ESR and CRP levels were significantly decreased on the 3rd month of treatment in all patients (p

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

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.

Aim: Anti-tumor necrosis factor-alpha (Anti-TNF-α) therapy has achieved an important position, are widely used for ankylosing spondylitis (AS) patients. TNF-α inhibition improves clinical outcomes and has differential effects on haematopoiesis. Information about effects on eosinophils is limited. The aim of our study is to determine the relationship between blood eosinophil counts in AS patients treated with TNF-α inhibitors. Methods: Seventy-five patients diagnosed with AS according to modified New York criteria were enrolled in this study. Disease activity was assessed by BASDAI, and erythrocyte sedimentation rate, C-reactive protein of patients were evaluated. All data were analyzed with Spearman’s correlation and Friedman's Two-Way by using SPSS version 19.0 statistical software, and p 0.05). It counts lower before anti-TNF-α therapy compare with post-treatment (130/mm3, 140/mm3 and 190/mm3, respectively). There was no statistically significant difference between pre- and 3rd month (p > 0.05), while correlation was found between pre- and 6th month, and also 3rd month and 6th month (p

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.

Introduction Suppression of free immunoglobulin E (IgE) levels and an increase in total IgE levels are observed during omalizumab treatment. However, whether omalizumab has any effect on other immunoglobulins is unknown. Aim To investigate the effect of omalizumab treatment on serum IgE and other immunoglobulins, and demonstrate any association with response to treatment in patients with chronic spontaneous urticaria (CSU). Material and methods The study included 41 patients diagnosed with CSU. Baseline and post-12-week-treatment total IgE, IgA, IgM, and IgG levels and blood eosinophil, neutrophil, lymphocyte and platelet levels were compared. Patients were grouped based on weekly urticaria activity score (UAS-7) responses and these parameters were compared. Results There was a significant increase in baseline and post-12-week-treatment total IgE levels, while there was no significant difference in other immunoglobulin levels. A significant reduction was found in neutrophil counts after the treatment, whereas there was no significant difference in eosinophil, lymphocyte and platelet levels. There was no difference in these parameters between groups with complete response and without complete response. Conclusions Omalizumab treatment can also be used in patients with immunoglobulin deficiency. Due to the observed reduction in neutrophil counts after the treatment, patients must be closely followed for whole blood parameters.

Introduction Before starting tumour necrosis factor (TNF)-α blocking agents, standard tests should be used for the diagnosis of tuberculosis infection. The specificity of traditional tuberculin skin test (TST) is low in immunosuppressed patients due to prior Bacille Calmette Guerin (BCG) vaccination, non-tuberculous mycobacteria infections, false positive and negative results. In this study, we aimed to compare TST and Interferon-Gamma Release Assay (IGRA) tests for detecting latent tuberculosis infection in patients with rheumatic disease planned to receive TNF-α blocking agents. Materials and Methods One hundred and nine patients (45 male, 64 female) with the diagnosis of rheumatoid arthritis (RA) (n= 70) and ankylosing spondylitis (AS) (n= 39) were included in the study. Age, sex, number of BCG scar, results of TST (using the Mantoux method), QuantiFERON-TB Gold test and T-SPOT.TB test were recorded for all patients. Correlation between the tests was assessed by Pearson correlation coefficient. Result The mean age of RA and AS patients were 50 ± 13 (19-78 years). The prevalence of latent tuberculosis was 43.1% for TST, 39.4% for QuantiFERON-TB Gold test and 13.8% for T-SPOT.TB test, compared with the evaluation using the composite criteria such as close contact with active tuberculosis infection and/or suspicious fibrotic/calcific lesions on chest X-Ray without active tuberculosis infection. There was a moderate correlation between BCG scar number and TST (p< 0.001, r= 0.495), T-SPOT.TB test and QuantiFERON-TB Gold test (p= 0.007, r= 0.406), T-SPOT.TB test and composite criteria (p= 0.024, r= 0.343). The specificity of QuantiFERON-TB Gold test was 85.7%, and sensitivity was 73.9% for all patients with rheumatic disease. It was 73.5% and 66.7% for T-SPOT.TB test, respectively. The specificity of TST was 60.3% and sensitivity was 47.8% for TST. Conclusions IGRA tests are not affected prior vaccination and useful for detecting latent tuberculosis infection in patients treated with corticosteroid due to lack of correlation between test negativity and corticosteroid therapy. Also, they are useful tests for diagnosis of latent tuberculosis infection as an alternative to TST due to their specificity and sensitivity.

Background Systemic sclerosis (SSc) has increased risk of morbidity and mortality due to pulmonary fibrosis, pulmonary arterial hypertension, renal crisis, infections and malignancies. Chemical exposure, smoking and cytotoxic drugs increase the malignancy risk in rheumatic diseases including SSc. We aim to evaluate characteristics, identify risk factors and mortality in SSc patients with malignancies. Methods One hundred and fifty-three patients with SSc (24 male, 129 female, with mean age of 56.4 ± 12.9 years) according to 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for SSc were enrolled in this study. Clinical, demographic, laboratory and radiological characteristics of the patients were evaluated by using SPSS 17.0. Chi-square test was used to compare qualitative data and descriptive statistics are shown as n (%). Results Seven cases of cancer (three male, four female, with mean age of 51.2 ± 7.0 years) were identified. The tumor types included lung cancer, gastrointestinal tract cancer (gastric adenocarcinoma and gastric neuroendocrine tumor), myelodysplastic syndrome and malignant melanoma (eye and skin). Five (3.4%) died due to infection, cardiopulmonary involvement and renal crisis. Six of them had a diffuse cutaneous SSc clinical subtype, and the ratio for anti-Scl-70 was 71.4%. There was no significant relationship between age, sex, anti-Scl-70, pulmonary and cardiac involvement between cancer and non-cancer patients. Conclusions The malignancies may occur before, together or after the diagnosis of SSc. Both of these disorders have increased morbidity and mortality compared with the general population. Rational treatment, monitoring and reducing the risk factors may prevent the development of malignancy. Also, the clinical features, risk factors and prevalence ratios are similar to that reported by large cohorts.

ResumoA primeira International Chapel Hill Consensus Conference (CHHC) ocorreu em 1994. Fizeram‐se sugestões sobre a nomenclatura das vasculites sistêmicas. Na segunda CHHC, 2012, adicionaram‐se importantes categorias à classificação da vasculite e fizeram‐se várias mudanças em nomes de doenças que não estavam incluídas na CHCC 1994. Introduziu‐se uma nova nomenclatura em vez de se usarem nomes como Churg‐Strauss e Wegener. Também foram adicionadas novas categorias, como de Behçet e Cogan etc. Essas pessoas são homenageadas pela classificação. Elas contribuíram para a ciência com seus estudos de caso, artigos científicos e observações. Este artigo analisa apenas epônimos presentes na classificação atual das vasculites. O objetivo é prestar informações sobre os cientistas mencionados na classificação das vasculites.AbstractThe first International Chapel Hill Consensus Conference (CHHC) was held in 1994. There have been suggestions about the nomenclature of systemic vasculitis. Important categories were added to the classification of vasculitis, and many changes were made for disease names in the second CHHC 2012, which were not included in the CHCC 1994. The new nomenclature was introduced instead of being referred to by many names such as Churg‐Strauss and Wegener”s. New categories such as Behçet”s and Cogan etc. were also added. These people are honored by the classification. They contribute to science through their case studies, scientific articles, and observations. This article reviews only eponyms present in the current classification of vasculitis. The aim of this paper is to give information about scientists mentioned in the classification of vasculitis.

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting sacroiliac joints and spine as well as peripheral joints and entheses. Tumour necrosis factor inhibitors (TNFi) are widely used in patients with persistently high disease activity despite non-steroidal anti-inflammatory drugs. Some patients fail to respond or loose responsiveness during therapy with TNFi. The development of anti-drug antibodies (ADA) might play a role in non-response or some adverse events. However it has never been evaluated for 2-years period.Objectives:Therefore, the aim of the present study was to evaluate the development of ADA against TNFi longitudinally during 2-years period in axSpA patients and factors associated with it.Methods:In total 180 axSpA patients according to ASAS classification criteria with a new TNFi prescription in the last two weeks period were included in this observational study. Clinical data and serum samples were collected at baseline and at every 12 weeks. Serum drug levels and ADAs were measured on 12, 24, 52 and 104 weeks of treatment by ELISA in one center to avoid inter-assay variability. The development of ADA over time was investigated by using generalized estimating equations (GEE) which is a technique for longitudinal data analysis allowing the use of all available data even deviated from normality.Results:180 biologic naive axSpA patients (116 male, median [IQR] 44,5 [14,5] years) who started anti-TNF agents (infliximab [20%], adalimumab [27,2%], etanercept [32,2%] and golimumab [20,6%]) were included in the analysis. In comparison to baseline values BASDAI, ASDAS-CRP and CRP values were significantly decreased in third months of follow-up (Figure 1). In total 172 patients had at 12 weeks, 154 at 24, 121 at 52, and 73 at 104 week serum samples available for ADA determination. In longitudinal analysis; baseline age and TNFi type, as well as longitudinal BASDAI, ASDAS, serum CRP levels and the development of adverse events and discontinuation of the drug were found to be associated with the development of ADA. In order to determine independent association/s with the development of ADA two longitudinal multivariable models were run; (a) with ASDAS as an activity measure, (b) with BASDAI and CRP levels and produced that all the variables were independently associated with longitudinally development of anti-drug antibodies (Table 1). Antibodies to adalimumab were related with lower serum drug levels.Conclusion:The results of the present study with up to 2 years of follow-up, revealed that the development of ADA against TNFi therapy is associated with high disease activity, the development of adverse events and treatment discontinuation in patients with axSpA. And etanercept might be negatively associated with the development of ADA.Table 1.Factors associated with the development of anti-drug antibodiesModel 1Model 2B95% CIPB95% CIPAge years-0.061-0.109;-0.0120.015-0.058-0.107;-0.0100.018TNFi Treatment ETN-1.981-4.369; -0.1340.104-2.475-4.791; -0.0760.036 ADA1.438-0.002; 0.4070.0731.275-0.119; -0.1600.064 INF1.5503.010; 3.1020.0501.2552.666; 2.6290.073 GOL0a0aPresence of advers event, no-0.824-1.451; -.01980.010-0.835-1.461; -0.2080.009TNF treatment discontinuation1.2890.043;2.5340.0431.248-0.075; 2.5710.065BASDAI0.0350.015; 0.0550.001CRP0.020-0.035; 0.0050.008ASDAS-CRP0.8520.466; 1.2380.0000a:set to zero because this parameter is redundant.Figure 1.Mean change in disease activity and CRP levels during follow-up duration. (P values for 3rd months BASDAIDisclosure of Interests:None declared

Background:Suboptimal control of RA may lead to severe and progressive articular damage, loss of function, and deterioration of the quality of life (QoL).Objectives:To assess treatment satisfaction, sociodemographic, clinical, health care resource utilization, and QoL characteristics of patients with sub-optimally controlled RA and treated with conventional synthetic and/or biologic DMARDs.Methods:This study was an international, multicenter, cross-sectional, non-interventional study. Adult RA patients with moderate to severe disease activity (DAS28>3.2) were enrolled. Patient satisfaction was evaluated with Treatment Satisfaction Questionnaire for Medication (TSQM, version 1.4) with a scale ranging from 0 (indicating poor satisfaction) to 100 (indicating perfect satisfaction). Patients were questioned regarding treatment adherence, patient preferences, and expectations. Workability was evaluated using Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis (WPAI-RA, version 2.0). Short Form 36 (V2) survey were performed to all patients.Results:One hundred sixty-four patients were included in the study and most (78.0%) were female. The median age was 57.0 years, ranging between 22.0 and 84.0 years. Half of the patients (50.6%) were primary school graduates and 6.1% were unemployed due to RA and seeking work. Median time since RA diagnosis was 8.0 years and mean (±SD) DAS28-CRP score was 4.8 (±1.0). Mean total activity impairment was 54.9% (±27.4). In the past 3 months from enrollment, the mean number of healthcare professional and emergency room visits were 1.8 (±1.1) and 1.8 (±1.3), respectively. Mean number and length of hospitalizations in the previous 3 months were 1.1 (±0.3) times and 8.3 (±7.2) days, respectively. Mean TSQM scores were 53.5 (±21.4) for effectiveness, 86.0 (±26.7) for side effects, 67.8 (±16.5) for convenience, and 57.7 (±22.0) for global satisfaction. The leading expectation was ‘lasting relief of RA symptoms’ (mean score: 5.8). Preferred time until the effect of onset was ‘up to 1 week’ for 76.2% of the patients. Most of the patients (57.9%) preferred oral administrations and the most preferred frequency of administration was ‘once per day’ (46.3%). Mean physical and mental component summary scores for Short Form 36 (V2) survey were 37.9 (±8.3) and 40.1 (±10.7).Conclusion:Two-thirds of the patients with RA who have suboptimal responses are not satisfied with their treatments. Moreover, oral and once-daily treatment approaches stand out in patient preferences. Finally, suboptimal control leads to deterioration in clinical characteristics, workability, and QoL of patients with RA.Acknowledgements:The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication. All authors have received research funding for this study. The authors wish to thank B. Murat Ozdemir of Monitor CRO for medical editing and reviewing services of this manuscript. AbbVie provided funding to Monitor CRO for this work.Disclosure of Interests:Umut Kalyoncu Speakers bureau: AbbVie, Pfizer, UCB, Novartis, and Janssen, Consultant of: AbbVie, Pfizer, UCB, Novartis, and Lilly, Grant/research support from: AbbVie, Pfizer, and Janssen, Adem Kucuk Speakers bureau: AbbVie, Gokhan Sargin: None declared, Fatih Ozdener Speakers bureau: UCB, Nutricia Advanced Medical Nutrition, Grant/research support from: Nutricia Advanced Medical Nutrition, Servet Yolbaş Speakers bureau: AbbVie, UCB, Pfizer, and MSD, Berna Yurttas: None declared, Sezin Turan: None declared, Gezmiş Kimyon Speakers bureau: AbbVie, Amgen, Pfizer, Novartis, UCB, MSD, Johnson and Johnson, and Celltrion, Consultant of: Amgen, and Pfizer, ALI SAHIN Speakers bureau: Roche, Pfizer, and AbbVie, Consultant of: Roche and Pfizer, Sedat Yilmaz Speakers bureau: UCB, Pfizer, AbbVie, MSD, Novartis, and Celltrion, Consultant of: Pfizer and Novartis, Ridvan Mercan Speakers bureau: AbbVie, Novartis, MSD, Pfizer, UCB, Roche, Amgen, and Celltrion, Consultant of: Novartis, MSD, Pfizer, and Celltrion, Hakan Emmungil Speakers bureau: AbbVie, Pfizer, Novartis, and MSD, Muhammet Çinar Speakers bureau: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, Grant/research support from: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, İlhan Sezer Speakers bureau: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Consultant of: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Timuçin Kaşifoğlu Speakers bureau: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Fulya Cosan Speakers bureau: AbbVie, Pfizer, Novartis, UCB, and MSD, Taskin Senturk: None declared, Nevsun Inanc Speakers bureau: AbbVie, UCB, Novartis, Pfizer, Roche, Lilly and MSD, Consultant of: Roche and Pfizer, Grant/research support from: Roche and Pfizer

Background. Some patients may have psychosomatic complaints due to their previous experiences during the drug hypersensitivity reaction. Worry about being hurt due to an administered drug is termed nocebo effect, which is the opposite of the placebo effect. In our study, we investigated the effect of distraction on symptoms during drug provocation test.Methods. Our study included 112 patients who underwent DPTs for alternative purposes in our clinic. Previous hypersensitivity reactions of all the patients had objective signs. Patients were divided into two groups for the DPT. Sixty-three patients were kept busy during the test, performing tasks such as filling questionnaires, arranging files in alphabetical and numerical order, and doing archiving (Group 1). Forty-nine patients did not perform any tasks during the test (Group 2). Reactions that occurred during the test were recorded. Results. During the DPT, 5 patients in Group 1 (5/63, 7.9%) and 17 patients in Group 2 (17/49, 34.7%), i.e. a total of 22 patients (22/112, 19.6%), had a reaction. There was a statistically significant difference between Group 1 and Group 2 according to the frequency of the reaction development.Conclusions. Patient psychosomatic complaints during DPTs are proportional to their association with previous allergic reactions. In order to prevent such reactions, it may be beneficial to keep the patients busy with an activity in order to distract them during the test.

Pustulotic arthro-osteitis (PAO) is a rare chronic inflammatory disease, which has now been classified as a seronegative spondyloarthritis. The sternoclavicular and sternocostal joints, pelvis, vertebra, hip, and long bones are affected. Skin findings of the disease are accepted as a variant of pustular psoriasis, but some authors have suggested that palmoplantar pustulosis (PPP) is a different entity. The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome should be considered in the differential diagnosis. PAO differs from SAPHO by the absence of hyperostosis and the difference in skin manifestations. Here, we aimed to present a 34-year-old female patient with a diagnosis of PAO with typical skin findings and joint involvement.

Amac: Anti-TNF tedaviler gunumuzde romatizmal hastaliklarin tedavisinde etkin olarak kullanilmaktadir. Kullaniminin artmasi ve uzun surekli takiplerde tedavi ile iliskili bazi yan etkiler de ortaya cikmaktadir. Bu yan etkilerden birisi de otoimmunite gelisimidir. Bu calismanin amaci romatizmal hastaliklari nedeniyle anti-TNF tedavi alan hastalarda otoimmunite gelisim sikligini belirlemektir. Gerec ve Yontem: Calismaya romatoid artrit ve ankilozan spondilit hastaliklari nedeniyle anti-TNF tedavi almakta olan 67 hasta dahil edildi. Otuz iki hasta romatoid artrit, 35 hasta ankilozan spondilit idi. Otuz bes hasta infliximab, 16 hasta adalimumab, 16 hasta etanercept almaktaydi. Hastalik gruplarina ve anti-TNF tiplerine gore hastalar gruplara ayrildi. ANA ve anti-dsDNA immunfloresan metodla, ACA ise ELISA yontemi ile calisildi. Bulgular: ANA pozitifliginde anti-TNF tedavi oncesi %10.4 iken, tedavi sonrasinda %40.3 olarak anlamli bir artis tespit edildi. Yalnizca bir hastada anti-dsDNA pozitifligi saptandi. ACA ise hastalarin hicbirinde pozitif degildi. Diger iki anti-TNF'ye kiyasla ANA pozitiflesmesi infliximab kullanan hastalarda belirgindi. ANA pozitifligi saptanan hastalarin hicbirinde lupusa ait klinik mevcut degildi. ANA pozitiflesmesi ile anti-TNF tedavi ile birlikte kullanilan metotrexat ve kortikosteroid kullanimi arasinda, romatizmal hastalik tipi arasinda bir iliski saptanmadi. Sonuc: Anti-TNF tedaviler, otoantikor gelisimini belirgin olarak arttirmaktadir. Ancak anti-TNF tedavilerin tetikledigi lupus gelisimi nadirdir.

Background Sulfasalazine (SSZ), which has an arylamine sulfonamide structure, is an anti-inflammatory drug used in the treatment of many rheumatic diseases. Various adverse effects have been reported related to SSZ. In the present study, we aimed to define the frequency of SSZ-related hypersensitivity reaction in patients with rheumatoid arthritis and ankylosing spondylitis. Methods A total of 136 patients were included in this study. During follow-ups, reaction type, reaction duration, and drug doses were recorded in patients who developed hypersensitivity reactions. Drugs were discontinued in patients who developed reactions, and they were treated with antihistaminics and/or corticosteroids, according to requirements. Drug provocation tests with the drugs and aminosalicylic acid were performed in patients with negative skin prick test individually. Results A total of 136 patients, with ages ranging from 19 to 71 years (mean, 41.97 [SD, 12.04] years), were included in the study. Hypersensitivity reactions according to the drug provocation test were found against SSZ in 12 patients (8.8%). The SSZ-related hypersensitivity reaction types were urticaria in 7 patients, urticaria and angioedema in 4 patients, and pruritus in 1 patient. Conclusions Sulfasalazine is widely used by rheumatologists in the treatment of rheumatic diseases. Whereas the frequency of sulfonamide-related hypersensitivity reactions was reported as 3.0% in the population, we detected hypersensitivity reactions to be 8.8% with SSZ usage in rheumatic diseases.

OBJECTIVE T cell abnormal activation is thought to have a main role in the etiology of ankylosing spondylitis (AS). While cytotoxic T lymphocyte-associated molecule-4 (CTLA-4) is suppressing the immune system, in previous studies serum soluble CTLA-4 (sCTLA-4) was detected at high amounts in autoimmune disorders. We sought to evaluate the association between soluble CTLA-4 in serum and disease activity in AS patients. METHODS Thirty-eight patients with AS, 28 rheumatoid arthritis (RA) patients, and 27 disease-free controls were enrolled to the study. The levels of sCTLA-4 were determined for each participant using an enzyme-linked immunosorbent assay. The erythrocyte sedimentation rate (ESR), C-reactive peptide, and demographic characteristics were documented. The data were analyzed by using relevant statistical methods. RESULTS In comparison with RA patients and controls, patients with AS showed high sCTLA-4 levels (p

Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may be used as indicators of inflammatory markers and disease activity due to inflammatory changes in neutrophils, platelets and lymphocytes. Our aim is to investigate the relationship between NLR, PLR ratio and disease activity in RA patients treated with rituximab. Methods Thirty-eight patients (8 male, 30 female, mean age 56.8 ± 11.8 years) diagnosed with RA and 30 healthy controls were included in the study. Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR), lymphocyte, neutrophil, platelet counts, ESR, C-reactive protein (CRP), PLR, and NLR were evaluated before and after rituximab in RA patients. The relationship between all parameters was assessed by Pearson's correlation, Wilcoxon signed-rank, Mann-Whitney U and paired t tests. Results The levels of CRP, ESR, and DAS28-ESR decreased significantly at 6 months of rituximab treatment compared to pre-treatment. NLR and PLR ratios were higher in patients with RA than the control group. The median levels were 33.5 mm/hour, 5.7 mg/dL, and 3.7 respectively after 6 months of rituximab treatment. And, the levels were lower than baseline treatment. There was a significant correlation between the levels of DAS28-ESR and NLR, DAS28-ESR and PLR before and after treatment. Conclusions The NLR and PLR were higher than healthy controls and correlated with DAS28-ESR in patients with RA. These parameters which are indicative of disease activity decrease with rituximab and correlate with disease activity at 6 months. The NLR and PLR may be useful indices to evaluate RA disease activity treated with rituximab.

Amaç:Antinükleer antikor, sistemik romatizmal hastalıkların tanı ve tedavisinde yıllardır kullanılmaktadır. İndirekt immünfloresan (IIF) yöntem antinükleer antikor (ANA) varlığını tespit etmede altın standart yöntemdir. Bu çalışmanın amacı sistemik romatizmal hastalıklarda ANA boyanma tipleri, titrasyon ve antikor tiplerinin ilişkisini araştırmaktır. Gereç ve yöntem:Çalışmaya Eylül-Aralık 2015 tarihleri arasında kliniğimize başvuran, ANA sonucu pozitif olup subgrup analizi yapılmış olan, yeni sistemik romatizmal hastalık tanısı konulmuş toplam 215 hasta dahil edildi. ANA, IIF yöntemiyle, ANA subgrupları immünblot yöntemi ile ticari kitler kullanılarak çalışıldı. ANA boyanma tipleri, titrasyon ve antikor tipleri, sistemik romatizmal hastalık tipleri ile karşılaştırıldı. Bulgular:Çalışmamızda en sık ANA boyanma tipi granüler (%34.3) ve homojen (%33.5) özellikte olup, antikor analizinde en sık R0-52 (%28.8), SS-A (%24.1) ve ds-DNA (%19.06) pozitifliği saptandı. ANA titrasyonu, sıklık sırasına göre 1/100, 1/320, 1/1000 ve üstü şeklinde idi. Sonuç:Spesifik antikor pozitifliklerinin en sık sistemik lupus eritematozus ve sistemik skleroderma’da görülmesine rağmen, değişen oranlarda tüm sistemik romatizmal hastalıklarda saptanması, tanı ve izlemde ANA’nın klinikle birlikte değerlendirilmesi gerektiğinin önemini göstermektedir., Purpose:Antinuclear antibodies have been used for years for diagnosis and follow-up of systemic rheumatic diseases. Indirect immunofluorescence assay (IIF) is the gold standard to reveal the presence of ANA (ANA). This study intends to investigate by the IF-ANA method the relation of ANA staining patterns, titration and antibodies types with systemic rheumatic diseases. Materials and methods:The study included 215 patients, who were being followed up in our clinic with the diagnosis of systemic rheumatic disease between September 2015 and December 2015, who had an ANApositive test and underwent subgroup analysis. ANA was tested using IIF method and ANA profile was tested by using a commercial kit with immunoblotting. ANA staining patterns, titration results, and results of antibodies types were compared with types of systemic rheumatic disease. Results:In the study, the most frequent ANA staining pattern was granular (34.4%) and homogeneous (33.5%) while the most frequent result in the subgroup analysis was R0-52 (28.8%), SS-A (24.1%), and ds-DNA (19.06%) positive. The most frequent ANA titration was 1/100, 1/320, 1/1000 and above, respectively. Conclusion:Although specific antibody positivity is higher in SLE and SSc, the existence of specific antibodies in different percentages in all the rheumatic diseases indicates the importance of using ANA with the clinic findings in the diagnosis and follow-up of systemic rheumatic disease.

Hemophagocytic syndrome (HS) and Adult-onset Still’s disease (AOSD) are both rarely systemic inflammatory disorders. It may be difficult to differentiate these inflammatory disorders from each other. There are some signs that may help clinicians in the diagnosis such as high ferritin levels for AOSD, and leukopenia, thrombocytopenia, hypertriglyceridemia for HS. Hemophagocytic syndrome secondary to Adult-onset Still’s disease was reported rarely in literature. In this article, we aimed to report a patient of 65-year old female diagnosed with HS and AOSD with extremely high serum ferritin levels.

Background Although anti-tumour necrosis factor agents (anti-TNFs) are very effective in most patients with ankylosing spondylitis (AS) significant proportion of patients quit the treatment due to non-response or adverse events. The development of anti-drug antibodies (ADAs) and low serum drug levels might have a mechanistic role in loss of efficacy of or the development of adverse events in patients treated with anti-TNFs. There is limited data regarding the immunogenicity of anti-TNFs in patients with AS. Objectives Therefore the aim of this study was to evaluatethe relationship between the formation of ADAs, serum through drug levels and clinical response to anti-TNFs in patients with AS. Methods In total 350 AS patients with a new anti-TNF agent prescription in the last two weeks period were planned to include this multi-center prospective observational cohort study. Herein we are presenting the data of first 102 patients who had >3months follow-up. Clinical data and serum samples were collected at baseline and at every three months of treatment. Serum drug levels and ADAs were measured by ELISA in one center to avoid inter-assay variability. Results 102 biologic naive AS patients (75 [74%] male, mean (±SD) age; 37.2±10.7 years) who started anti-TNF agents (14 infliximab [13.7%], 27 adalimumab [26.5%], 33 etanercept [32.4%] and 28 golimumab [27.5%]) were included in the present analysis. In comparison to baseline values BASDAI, ASDAS-CRP and CRP values were significantly decreased in third months of follow-up ( P P P P P =0.012 and ASDAS-CRP values were 2.7±1.3 vs 1.9±1.0; P =0.015). Conclusions ADAs against anti-TNF agents might develop as early as 12 weeks of treatment. Our results confirm that ADA development may hinder the anticipated response to anti-TNF agents in patients with AS. Disclosure of Interest None declared

Background and aims Several cytokines such as IL-10, IL-17, IL-23, and vitamin D have been suspected in the pathogenesis of SLE. However, the association between these cytokines, vitamin D and disease activity is unknown. We aimed to determine the association between IL-10, IL-17, IL-23, vitamin D and SLEDAI score. Methods We included 40 patients with SLE and 20 healthy controls in the study. Clinical and laboratory parameters and, SLEDAI score were evaluated. Serum IL-10, IL-17 and IL-23 were measured by nephelometry and vitamin D by HPLC. Mann-Whitney U and Kolmogorov-Smirnov test were used for statistical analysis. Results The level of vitamin D was significantly lower (p=0003), and IL-23 was significantly higher (p=0001) in SLE patients compared to healthy controls. There was no significant difference for IL-10 and IL-17 between both group (p>0,05). However, a significant correlation between vitamin D and disease duration (p=0,02), and between IL-23 and vitamin D (p=0019) were found among SLE patients. Vitamin D levels were correlated with SLEDAI score and IL-23 in patients group. Conclusions Although there are studies suppporting the role of IL-10 and IL-17 in the pathogenesis of SLE in the literature, there was no significant difference between patients and healthy controls in our study. IL-23 levels were significantly higher, whereas vitamin D levels were significantly lower in SLE patients than in the control group. Also vitamin D levels were negative correlated with duration of disease and IL-23. Levels of IL-23 may be used to evaluated the disease activity, or may be a promising therapeutic approach for SLE patients.

Background and aims Sulfonamide related allergic drug reactions are common, and their rate is reported to be 3.0% for the general population. Sulfasalazine (SSZ), which is an inflammatory drug in the arylamine sulfonamide structure, is being used for the treatment of many rheumatic diseases. In this study, we aimed to determine the frequency of sulfasalazine-related hypersensitivity reactions in patients with rheumatic disease. Methods A total of 136 patients (84 RA and 52 AS) were included in this study. Patients were screened for those who recently started using sulfasalazine treatment. The type of the reaction, duration of the reaction, administered medicines, and their doses were recorded in patients with detected hypersensitivity during the follow-up. The drug was stopped and anti-histaminic and/or corticosteroid treatment was administered as needed. In patients with a negative prick test, a drug provocation test (DPT) was performed after drugs were stopped and amino salicylic acid. Results A total of 136 patients, with ages ranging from 19 to 71 (mean 41.97±12.04), were included in the study. Hypersensitivity reaction was observed in 12/136 (8.8%) of the patients. The SSZ related hypersensitivity reaction types were: urticaria in 7 patients, urticaria and angioedema in 4 patients, and pruritus in 1 patient. Conclusions Sulfasalazine is widely used by rheumatologists in treatment of rheumatic diseases. These reactions might be ignored because, when type 1 reaction occurs, the patient has the possibility of changing to alternative treatments. Patients who have SSZ-related allergic reactions should be advised to avoid sulfanilamide antibiotics such as sulfamethoxazole.

We present a case of 45-year-old female patient with the diagnosis of seropositive rheumatoid arthritis, who was admitted to our rheumatology department with exacerbation of the disease. The patient’s disease activity score (DAS 28) was 6.9. Physical examination revealed changes in the lung auscultation as a rough breathing sound at the middle and lower lobe of the right lung. Chest X-ray revealed multiple nodular densities in both lungs. Lung biopsy was performed for the diagnosis and revealed necrotizing granulomas with central fibrinoid necrosis surrounded by epithelioid cells. Such a histopathological picture is typical for rheumatoid nodules. Finally the patient was treated with rituximab, with significant improvement.

WOS: 000399829800001, PubMed ID: 28289872, Patients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 +/- 2.3 vs 4.3 +/- 5.9 years) (p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features., Rheumatology Society of Turkey (TRD), This study was funded by the Rheumatology Society of Turkey (TRD) (award recipient is Yasemin Kabasakal, M.D.).

It has been reported that von Willebrand factor (vWf) plays a role in the development of complications of diabetes mellitus. The relationships between vWf and polyneuropathy, nephropathy, and retinopathy were investigated in the patients with type 2 diabetes mellitus. 58 patients with type 2 diabetes mellitus (22 men and 36 women, mean age 54 ± 9 ) and 30 healthy nondiabetic controls (12 men and 18 women, mean age 40 ± 11) were admitted to this study. They were examined by an internist, a neurologist and an ophtalmologist for complications of diabetes mellitus. Electromyography was performed to all the patients. The mean vWf levels of the patients and control group were 1.48 ± 0.55 and 1.25 ± 0.32 IU/mL respectively. There was no significant difference between the two groups (p= 0.146). Diabetic retinopathy in 18 patients (31%), polyneuropathy in 20 patients (34.5%), trap neuropathy in 5 patients (8.6%), microalbuminuria in 9 patients (15.5%), macroalbuminuria in 2 patients (3.5%) and normoalbuminuria in 47 patients (81%) were detected. The difference between vWf levels of the patients with retinopathy and without retinopathy were not statistically significant (p= 0.913). There was no significant difference between patients with polyneuropathy and without polyneuropathy group (p= 0.737). There was also no difference between trap neuropathy and without trap neuropathy (p= 0.431), and between polyneuropathy and trap neuropathy (p= 0.246) patient subgroups. The vWf levels in normoalbuminuric, microalbuminuric and macroalbuminuric patient groups were not different (p values: 0.526, 0.392 and 0.759 respectively). vWf levels between patients with complications of diabetes mellitus and control group were not different (p0.05). There was not a significant correlation between the vWf level and body mass index, serum glucose, triglycerides, total cholesterol, HDL-C, LDL-C, VLDL-C, platelet counts, fibrinogen levels, prothrombin and activated thromboplastin times in 33 patients with any complication of diabetes mellitus (p0.05). We conclude that, vWf has not an effect in the development of complications in patients with diabetes mellitus.

OBJECTIVE In rheumatoid arthritis (RA), endothelial dysfunction caused by the inflammatory process increases the risk of cardiovascular disease. Asymmetric Dimethylarginine (ADMA) leads to vascular dysfunction, whereas atherosclerosis and increased ADMA is associated with cardiovascular disease risk factors. Flow-mediated Dilation (FMD) is a radiological method to demonstrate endothelial dysfunction. In the present study, we assessed the availability of ADMA as a marker for endothelial dysfunction in RA patients. ADMA can be used as a simple and cheaper method for the determination of endothelial dysfunction. MATERIAL AND METHODS Forty patients (1 male, 39 female) diagnosed with RA according to the classification criteria and 29 healthy volunteers (2 males, 27 females) were included in this study. ADMA was studied by enzyme-linked immunosorbent assay (ELISA). Chi-square, Fisher's exact test, Mann-Whitney U test, and Spearman's correlation tests were used for analytical analysis, and p

A 69-year-old female patient was admitted to our clinic with photosensitivity, symmetric erosive polyarthritis, and cutaneous vasculitis of lower extremities. Rhupus syndrome was diagnosed, and Chiari's network in the right atrium and interatrial septum patent foramen ovale was achieved on transthoracic and transesophageal echocardiography. If it is thought that increased prevalence of antiphospholipid antibodies in patients with rhupus, this congenital remnant is important for the thrombosis risk, cardiac event, and stroke. The association of both diseases may lead to more serious events and cause worse prognosis. Here, our aim is to present a 69-year-old female patient with rhupus syndrome presenting with cutaneous vasculitis and Chiari's network in the right atrium.