Duygu Tecer

Introduction: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) represents a heterogeneous group of small-vessel vasculitides characterised by systemic inflammation and multi-organ involvement. This study aimed to investigate the prognostic and clinical significance of haematological and biochemical indices – namely the neutrophil-to-lymphocyte ratio, platelet- to-lymphocyte ratio (PLR), haemoglobin–albumin–lymphocyte–platelet (HALP) score, neutrophil- to-albumin ratio, systemic immune-inflammation index (SII), C-reactive protein-to-albumin ratio, and albumin-to-globulin ratio (AGR) – measured at the time of diagnosis. We sought to determine their associations with disease activity, organ involvement, and overall prognosis in patients with AAV. Material and methods: A retrospective cohort study was conducted on 56 patients diagnosed with AAV between January 2020 and August 2025, according to the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria. Demographic, clinical, and laboratory data were extracted from medical records. Inflammatory and nutritional indices were calculated at diagnosis, and their correlations with disease activity (Birmingham Vasculitis Activity Score – BVAS), prognosis (Five-Factor Score – FFS), organ involvement, relapse, and mortality were analysed using appropriate statistical tests, including Spearman correlation and receiver operating characteristic analysis. Results: The mean age was 54.2 ±15.7 years, and 73.2% of patients had granulomatosis with polyangiitis. Renal and pulmonary involvements were most common. The relapse rate was 32%, and mortality was 12.5%. None of the indices showed significant predictive ability for relapse (area under the curve < 0.6). A moderate negative correlation was found between FFS and AGR ( = –0.31, p = 0.02) and between BVAS and HALP ( = –0.33, p = 0.01). The HALP and AGR were significantly lower in renal involvement, while PLR and SII were higher and HALP lower in pulmonary involvement. Conclusions: Inflammatory and nutritional indices at diagnosis may not predict relapse in AAV but may reflect disease activity and organ-specific involvement. These easily accessible parameters could serve as complementary biomarkers for early risk stratification, warranting validation in large prospective studies.

Objectives: Behçet's disease (BD) is a chronic, multisystem immune‐mediated vasculitis. A significant number of patients with BD have inflammatory comorbid (IC) disease that can affect the clinical course of the disease. In the current literature, there is no study which investigated IC disease in BD. It was aimed to show the prevalence and clinical spectrum of IC disease in patients with BD. Methods: A total of 1591 patients diagnosed with BD and followed at five tertiary healthcare facilities were enrolled in the study. Patients were divided according to the presence of IC disease. Demographic characteristics, clinical manifestations, and laboratory parameters were systematically noted from medical records. The activity of the disease was evaluated by Behçet's Disease Current Activity Form (BDCAF). Results: Inflammatory comorbid diseases were identified in 246 (15.3%) patients. The most common comorbidities were axial spondyloarthritis ( n = 115, 7.2%), familial Mediterranean fever (FMF) ( n = 38, 2.4%), and hidradenitis suppurativa ( n = 37, 2.3%). Patients with IC disease had a greater use of anti‐TNF treatment ( p = 0.03). In the multivariate analysis, older age, and longer disease duration were found to be significantly associated with IC disease in BD ( p < 0.05). Conclusion: BD can be associated with other inflammatory conditions. Furthermore, patients with inflammatory comorbidities were more likely to receive anti‐TNF therapy, although this may partly reflect treatment indications for the comorbid conditions themselves. Therefore, clinicians should remain vigilant for inflammatory comorbidities, as their recognition may have implications for therapeutic decision‐making.

Indoleamine 2-3 dioxygenase (IDO) plays a role in the degradation of tryptophan (Trp) to kynurenine (Kyn), which can be determined in blood samples, and has an efficient role in arranging the cellular immune response. This study aimed to evaluate Kyn, Trp and IDO levels in patients with psoriatic arthritis (PsA), primary Sjögren's syndrome (pSS) and rheumatoid arthritis (RA), which are all autoimmune rheumatological diseases. Materials and Methods: According to the classification criteria, patients diagnosed with RA (n=20), PsA (n=18) and pSS (n=19) were included in this study. Serum levels of Kyn (mmol/L) and Trp (mmol/L) were determined using HPLC-UV. IDO levels were calculated according to the Kyn/Trp ratio. Results: The mean and standard error values of Trp and Kyn for the PsA group were 0.048±0.002 and 0.039±0.004, respectively; for the pSS group, they were 0.042±0.003 and 0.020±0.001, respectively; and for the RA group, they were 0.042±0.002 and 0.026±0.001, respectively. The Kyn/Trp (IDO) values of the groups were calculated as 0.53±0.047 for pSS, 0.653±0.035 for RA, and 0.857±0.099 for PsA. Conclusion: Currently, abnormal Trp metabolism is considered a universal mechanism of disease causation. The relationship between the degrees of immune activation can be determined by measuring Trp, Kyn, and IDO under various pathological conditions. In our study, Trp values were the same in the pSS and RA groups but were higher in the PsA group; at the same time, the Kyn/Trp ratio was highest in PsA. We observed lower Kyn and IDO levels in the pSS group than in the other groups.

Takayasu arteritis (TAK) mostly affects the aorta and its major branches and has an unclear origin. This study aimed to compare the 1990 American College of Rheumatology (ACR) classification criteria with the 2022 ACR/European League Against Rheumatism (EULAR) classification criteria for TAK on the basis of clinical data analysis of patients with TAK and other major vascular diseases. This retrospective study was conducted in a single-center. The results included 34 TAK patients routinely followed at a tertiary rheumatology center from October 2017 to February 2024. The accuracy, sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) of the classification criteria were compared. The sensitivity (91.2%), specificity (90.9%), PPV (93.9%), NPV (86.9%), accuracy (94.4%) and AUC (0.983 (0.957-0.998)) of the 2022 ACR/EULAR classification criteria for TAK were higher than those of the 1990 ACR classification criteria for TAK (76.4%, 86.3%, 88.9%, 64.2% and 0.75, respectively), and the difference in AUC was statistically significant (0.860 (0.757-0.963), p < 0.001). This study found that the 2022 ACR/EULAR classification criteria were more suitable for our patient population and had better classification performance than those in 1990, which can be supported in clinical practice. Our study needs to be supported by future multicenter prospective studies with larger patient numbers.

Objective: The standardized phrasing for the patient’s global assessment of general health (PtGA-GH) is not defined yet, and the phrasing of question could vary the patient’s response. This study aimed to evaluate whether different phrasings of the PtGA-GH affect the patient’s rating, and whether PtGA-GH and patient’s global assessment of disease activity (PtGA-DA) could be used interchangeability to calculate the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS). Methods: In this retrospective cross-sectional study, the patient’s perception of their own general health was evaluated with PtGA-GH question (PtGA-GHQ) and the third question of RAPID3 (RAPID3-Q3). A difference ≥1 between PtGA-GHQ and RAPID3-Q3 was considered discordance. Lin’s concordance coefficient (LCC) and Bland–Altman plots were used to determine the equivalence. The kappa (κ) statistics were used to evaluate the level of agreement in disease activity classification. Results: Three-hundred twenty-one AS patients were included. Discordance was detected in 192 (59.8%) patients. Demographic and clinical characteristics were similar between concordant and discordant groups. In the sensitivity analysis, the number of discordant patients reduced to 91 (28.3%), but the patient’s characteristics remained similar between groups. The LCC of 0.792 and Bland–Altman’s limits of agreement of −4.169 to 3.172 indicated that PtGA-GHQ and RAPID3-Q3 are not interchangeable. The LCC was 0.750 for ASDAS-C-reactive protein (ASDAS-CRP) and RAPID3-Q3- based ASDAS-CRP, but the κ value was 0.190. The LCC was 0.982 for Ankylosing Spondylitis Disease Activity Score-erythrocyte sedimentation rate (ASDAS-ESR) and RAPID3-Q3-based ASDAS-ESR, and κ was 0.825 with 87.5% absolute agreement. Conclusion: Different question patterns may not be used interchangeability as individual variables for AS activity assessment. The RAPID3-Q3 may be used to calculate ASDAS-ESR.Cite this article as: Kaya MN, Tecer D, Ozgunen MS, Cinar M, Yılmaz S. The influence of different phrasing of the “patient global assessment of global health” on the patient’s rating and disease activity score in ankylosing spondylitis. Eur J Rheumatol. 2025, 12(3), 0133, doi: 10.5152/eurjrheum.2025.24133.