Ozlem Taskapilioglu

Background/Objectives: Neurological manifestations in rheumatoid arthritis (RA) are common, yet the clinical relevance of central nervous system (CNS) abnormalities detected on neuroimaging remains uncertain. We aimed to determine the prevalence and patterns of cranial magnetic resonance imaging (MRI) findings in RA patients treated with rituximab (RTX) and to assess whether these abnormalities are associated with disease-specific mechanisms or with age- and comorbidity-related factors. Methods: In this retrospective observational study, 84 RA patients who received RTX and had available pre-treatment cranial MRI underwent systematic evaluation. Imaging findings were classified by an experienced neuroradiologist blinded to clinical data and dichotomized as normal or abnormal, and white matter hyperintensities were graded semiquantitatively using a Fazekas-type scale. Factors independently associated with abnormal MRI were assessed by multivariable logistic regression. Results: Cranial MRI abnormalities were identified in 60 patients (71.5%), predominantly as nonspecific white matter hyperintensities (48 patients, 57.1%). In multivariable analysis, older age (adjusted odds ratio [aOR] 1.16 per year, 95% CI 1.08–1.25) and the presence of comorbidities (aOR 5.36, 95% CI 1.49–19.23) were independently associated with abnormal imaging (p < 0.001 and p = 0.010, respectively), whereas no association was found with disease duration, seropositivity, or extra-articular involvement. Imaging findings remained stable over time in the majority of the 39 patients (46.4%) who underwent follow-up imaging. Conclusions: Cranial MRI abnormalities are highly prevalent in RA and were associated primarily with age and comorbidity burden rather than with RA-specific inflammation; however, in the absence of a control group, we cannot determine whether their prevalence exceeds that of a comparable non-RA population. No treatment-related demyelinating disease or progressive multifocal leukoencephalopathy was observed, but the study was not designed to assess drug safety, and these findings should be interpreted as the absence of an observed imaging signal rather than as evidence of the neurological safety of rituximab. Cranial neuroimaging in RA should therefore be interpreted cautiously and in clinical context.

Introduction: Recent research into multiple sclerosis (MS) has focused on the role of microRNAs (miRNAs) in the development of the disease. This study was designed to analyze miR-146a expression in whole blood and fecal samples of patients with MS. The study aimed to analyze clinical data using the miR-146a expression values obtained. Subjects and Methods: This study included patients with relapsing–remitting MS (RRMS) (n = 53), clinically isolated syndrome (CIS) (n = 15), and healthy controls (n = 26). Total RNA was isolated from the participants' whole blood and fecal samples. RNA extraction was performed using QIAamp RNA Blood Mini Kits for blood samples and RNeasy PowerMicrobiome Kits for feces. miR-146a expressions were studied using real-time polymerase chain reaction. Finally, relative expression was correlated with clinicopathologic factors. Results: MiR-146a expression was significantly decreased in the whole blood (P < 0.001) and fecal samples (P = 0.036) of patients with RRMS. There was no significant difference in the miR-146a expression rate between patients with CIS and controls. Moreover, the miR-146a expression level in patients with RRMS was decreased compared with those with CIS (P < 0.001). A significant association was determined between miR-146a expression and sex in blood samples. When sex stratification was applied to expression values obtained from fecal samples, miR-146a expression was downregulated only in females (P = 0.008). Discussion: miRNAs play an essential role in maintaining the stable course of MS, and this process has some sex-specific differences. Expression of fecal miR-146a may be used as a biomarker to diagnose and predict prognosis in patients with RRMS.

Multiple sclerosis (MS) is an inflammatory, autoimmune demyelinating, and neurodegenerative disorder of the central nervous system. Interactions between environmental factors, predisposition genes, and determining genes appear to be involved in its etiology. Epigenetic mechanisms such as microRNA-mediated gene regulation can determine the susceptibility and severity of autoimmune diseases. Therefore, to determine the role of miR-146a and miR-155 in MS and its developmental stages, the expression levels in the serum of MS and clinically isolated syndrome (CIS) patients were compared with those of healthy controls. In the present study, the expression levels of miR-146a and miR-155 were assessed using quantitative Real-Time PCR in blood samples of 15 CIS patients and 61 relapsing-remitting multiple sclerosis (RRMS) patients alongside 32 healthy patients as controls. Furthermore, any associations with the clinicopathologic variables of the patients were also evaluated. Dysregulations were found only in the miR-146a and miR-155 expressions in the RRMS-Control group. When the RRMS patients were evaluated in terms of the characteristics of sex, annual attack rate, age of diagnosis, duration of follow-up, and immunomodulatory treatments used, no significant differences were observed. However, significant dysregulations were identified in miRNA expression in the vitamin D level, EDSS values, and the number of attacks. ROC curve analysis showed that miR-146a and miR-155 were significant in the RRMS-Control group for the area under the curve (AUC). It is possible that miR-146a may be associated with vitamin D deficiency and disease disability, while miR-155 may be associated with the number of attacks.

Introduction: Multiple Sclerosis (MS) is a multifactorial, immune-mediated disorder that occurs in genetically predisposed people. Vitamin D might be an important environmental factor in the development and prevention of MS disease. We aimed to investigate the role of vitamin D in MS disease activity. Material and Methods: The study was designed as a prospective study. Thirty-two patients and 15 healthy subjects were included. Variables were MS disease duration, number of relapses, Expanded Disability Status Scale (EDSS) scores, serum vitamin D levels, assessments through neuropsychological tests relevant to depression, cognition, anxiety and fatigue. Results: The mean age of the subjects was 32.6±6.9 years. A significant positive correlation was found between the vitamin D level during relapse and remission. A statistically significant difference was found between the patients in relapse and controls in serum vitamin D levels (p=0.002). A statistically significant difference was found between the patients in relapse and patients in remission, in serum vitamin D concentrations (p<0.001). Statistically significant differences were found between the patients in relapse and controls in MMSE, Beck Depression Inventory, Benedict's Cognition Test, Fatigue Severity Scale, PASAT, State-Trait Anxiety Inventory scores (p=0.01, p<0.001, p=0.01, p<0.001, p=0.007, p<0.001 and p<0.001, respectively). Conclusion: Vitamin D in association with other therapies may prevent the progression of MS-related disabilities and the relapses in RRMS. Vitamin D levels may have effects on the symptoms (depression, anxiety, cognitive deterioration, and fatigue) which are frequently seen in the course of MS.

Son yıllarda Multipl skleroz (MS) etyolojisinde, internal juguler ven (IJV) ve/veya azigos venlerde venöz drenaj bozukluğu olarak tanımlanan kronik serebrospinal venöz yetmezliğin (KSSVY) etkili olduğu ileri sürülmektedir. Bu teori, MS etyopatogenezinde etkili olduğu düşünülen otoimmün teoriyi toptan yadsıması nedeni ile ciddi tartışmalar başlatmıştır. Bu teori ile, MS etyopatogenezine farklı açılardan bakılması nedeniyle ilgi çekmiş ve bununla ilgili birçok çalışma başlatılmıştır. Çalışmamızda Doppler sonografi (DS), kranial MR venografi (MRV) ve selektif venografi (SV) ile MS hastalarında KSSVY’nin varlığının tespiti, ekstrakraniyal-intrakraniyal venöz yapıların yapısal- fonksiyonel açıdan incelenmesi, sağlıklı kişilerle karşılaştırılması amaçlanmıştır. 25 Relapsing Remitting MS hastasına DS, SV ve kraniyal MRV yapılırken, 20 sağlıklı kişiye kraniyal MR venografi ve Doppler sonografi yapıldı. Hastalarda DS’ de reflü varlığı açısından kontrol grubuna göre istatistiksel olarak anlamlı idi (p

Objectives: Multiple Sclerosis (MS) is a chronic disease which affects physical,psychological and social functioning of patients. In this study we aim to indicate psychiatric comorbidity, some psychosocial factors and their associations with quality of life in patients with MS. Methods: A total of 227 patients underwent psychiatric examination and the following scales were applied: Socio-demographic data form, Hospital Anxiety and Depression Scale (HADS), Multiple Sclerosis Quality of Life-54 (MSQOL-54), Psychosocial Adjustment to Illness Scale-Self report (PAIS-SR) and Multidimensional Scale of Perceived Social Support (MSPSS). Results: Among 227 patients with MS, 67.8% (n = 154) had psychiatric diagnosis; 24.2% (n = 55) had depression,19.8% (n = 45) had adjustment disorder, 14.9% (n = 34) had anxiety disorder, 7.1% (n=16) had dysthymic disorder and 1.8% (n = 4) had bipolar disorder. Patients with a psychiatric diagnosis had lower scores in role limitations due to emotional problems, emotional well-being, health perceptions, social function, cognitive function, health distress and mental health composite of MSQOL-54. PAIS-SR and MSPSS scores were significantly lower in MS patients with a psychiatric diagnosis. PAIS-SR scores were negatively correlated with role limitations-emotional, emotional well-being, social function, sexual function, satisfaction with sexual function, physical health composite and mental health composite scores of MSQOL-54. MSPSS total score was positively correlated with emotional well-being score of MSQOL-54. Conclusions: In MS patients, there is a high prevalence of psychopathology and it is associated with quality of life, perceived social support and psychosocial adjustment of the patients. Quality of life is reduced especially in emotional and mental aspects in patients with a psychiatric diagnosis. Diagnosis and treatment of psychopathology in MS patients seems crucial to decrease disease burden.