Süleyman Serdar Koca

Background and Objectives: Vitamin D deficiency is common in systemic lupus erythematosus (SLE) and Behçet’s disease (BD). However, whether it is associated with the same clinical parameters in both conditions remains unknown. Our objective is to compare the clinical correlates of serum 25-hydroxyvitamin D [25(OH)D] levels in patients with SLE and BD. Materials and Methods: This exploratory cross-sectional study included 38 patients with SLE and 32 with BD. Spearman’s correlation analyses, partial correlations controlling for sex, and tertile analyses were performed separately for each disease group. Results: Vitamin D deficiency [25(OH)D < 20 ng/mL] was similarly prevalent in SLE (64.9%) and BD (62.5%). However, distinct disease-specific correlation profiles were noted. In SLE, serum 25(OH)D levels were inversely correlated with body mass index (BMI) (r = −0.47, p = 0.003) and parathyroid hormone (PTH) (r = −0.40, p = 0.01), with no significant associations with inflammatory or haematological parameters. In patients with BD, 25(OH)D levels were positively correlated with haemoglobin (r = 0.63, p < 0.001), haematocrit (r = 0.58, p < 0.001), ferritin (r = 0.47, p = 0.008), uric acid (r = 0.48, p = 0.005), transferrin saturation (r = 0.45, p = 0.02), and triglycerides (r = 0.44, p = 0.01), while they were inversely correlated with total iron-binding capacity (r = −0.50, p = 0.01) and erythrocyte sedimentation rate (ESR) (r = −0.44, p = 0.01). After adjusting for sex, the association between 25(OH)D and haemoglobin remained significant (partial r = 0.43, p = 0.01), as did the associations with haematocrit (partial r = 0.42, p = 0.02) and triglycerides (partial r = 0.43, p = 0.02). In contrast, the correlations with ferritin, ESR, uric acid, and transferrin saturation were attenuated and no longer statistically significant. Tertile analyses demonstrated dose–response relationships between vitamin D levels and BMI (p = 0.01) and PTH (p = 0.008) in SLE, and between vitamin D levels and haemoglobin (p = 0.001) and ferritin (p = 0.02) in BD. Conclusions: Despite the similar prevalence of vitamin D deficiency, patients with SLE and BD exhibit distinct vitamin D-associated clinical profiles. Vitamin D status was primarily associated with metabolic parameters in SLE and haematological parameters in BD. These disease-specific patterns may reflect differences in the underlying inflammatory pathways and pathophysiological mechanisms involved.

Objective: Interstitial lung disease (ILD) is the leading cause of mortality in systemic sclerosis (SSc). The Warrick semiquantitative scoring system and the Goh staging algorithm provide different approaches for assessing lung involvement on high-resolution computed tomography (HRCT). We compared their sensitivity for detecting radiological progression in SSc-ILD. Methods: We retrospectively analyzed 33 patients with SSc-ILD who underwent serial HRCT examinations. Each scan was evaluated using the Warrick score (0-30) and Goh staging (limited/extensive). Progression was defined as an increase of ≥ 3 points in the Warrick score or transition from limited to extensive disease by Goh staging. Comparative progression analysis was restricted to the 24 patients with baseline limited disease, as only these patients were eligible for Goh-defined progression. Progression rates were compared using the McNemar test, and receiver-operating characteristics analysis assessed Warrick score thresholds for identifying Goh-defined extensive disease. Results: The cohort included 33 patients (85% female; mean age 53.2 [SD 8.9] years), all with diffuse cutaneous SSc. At baseline, 24 (73%) had limited disease and 9 (27%) had extensive disease. Among patients with baseline limited disease, Warrick scoring identified progression in 15 (62%) compared with 8 (33%) by Goh staging (McNemar chi-square test 7.00, P = 0.01). All Goh progressors also fulfilled Warrick progression criteria, whereas 7 additional patients showed Warrick progression without stage transition. Among baseline extensive patients, 6 (67%) demonstrated further radiological worsening according to Warrick scoring. Follow-up Warrick scores showed excellent discrimination for Goh-defined extensive disease (area under the curve 0.94, 95% CI 0.86-1.00), with an optimal threshold of 20 points (sensitivity 88%, specificity 88%). Agreement between methods was substantial (Cohen κ 0.76). Conclusion: Warrick scoring was significantly more sensitive than Goh staging for detecting radiological progression in SSc-ILD and remained informative in patients already classified as having extensive disease, supporting its use in longitudinal monitoring.

Aim: Aim: This study aimed to investigate the relationship between respiratory muscle strength and kinesiophobia in patients with Systemic Sclerosis (SSc) and to determine whether pulmonary function parameters influence movement-related fear in this population. Methods: : A cross-sectional study was conducted with 20 patients diagnosed with SSc. Respiratory muscle strength was evaluated by measuring maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a digital mouth pressure meter. Pulmonary function, including forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO), was assessed via spirometry. Kinesiophobia levels were determined using the Tampa Scale of Kinesiophobia (TSK). Fatigue and dyspnea levels were also recorded as secondary clinical outcomes. Results: Results: High levels of kinesiophobia were prevalent among the participants. However, correlation analysis revealed no significant association between kinesiophobia scores and MIP, MEP, or FVC values (p > 0.05). Although pulmonary involvement was characterized by significant impairments in respiratory function and increased fatigue, these physiological deficits did not appear to be the primary drivers of kinesiophobia. Conclusion: Conclusion: Kinesiophobia in SSc patients appears to follow a course independent of objective pulmonary function and respiratory muscle strength. These findings suggest that movement-related fear is a distinct biopsychosocial construct in SSc that requires specific attention regardless of the severity of lung involvement.

Background/Objectives: The purpose of this study was to compare the prevalence of sarcopenia and frailty in patients with acromegaly and hypopituitarism to healthy controls. Methods: This descriptive, comparative study included 32 patients with acromegaly, 24 patients with hypopituitarism, and 28 healthy volunteers who had undergone abdominal computed tomography (CT) within a month of their presentation at the endocrinology outpatient clinic between October 2023 and October 2024. The Tilburg Frailty Indicator was used to measure frailty. Sarcopenia was assessed using a dynamometer to measure handgrip strength and a CT-derived skeletal muscle index (SMI) at the L3 spinal level to measure muscle mass. Results: Both the hypopituitarism (7.5 ± 2.8) and acromegaly (7 ± 2.7) groups had substantially greater frailty ratings than the controls (4.8 ± 2.9) (p = 0.015). Frailty prevalence was 43% in the control group, 75% in acromegaly, and 83% in hypopituitarism (p = 0.019). The hypopituitarism group’s muscle strength (20.8 ± 7.4 kg) was substantially lower than that of the acromegaly (37.5 ± 14.3 kg) and control groups (36.4 ± 9.6 kg) (p < 0.001). Patients with hypopituitarism had substantially lower SMI values (45.1 ± 11.3 cm²/m²) than those with acromegaly (53 ± 8.9 cm²/m²) (p = 0.04). A total of 50% of the control group, 9% of those with acromegaly, and 54% of those with hypopituitarism had probable or confirmed sarcopenia (p < 0.001). Conclusions: This study shows that frailty is more prevalent in patients with acromegaly and hypopituitarism than in healthy controls, with sarcopenia being especially noticeable in hypopituitarism. After adjusting for age and sex, the association with frailty remained significant for hypopituitarism (OR = 5.24, p = 0.021) while acromegaly showed a borderline trend (OR = 3.00, p = 0.076). These results imply that pituitary hormones might contribute to maintaining the functional ability and integrity of the musculoskeletal system. Further research in prospective studies using population-based controls is necessary to examine screening for frailty and sarcopenia in patients with pituitary diseases.

Background: Behçet’s disease is a multisystem inflammatory disorder with a variable clinical course. This study evaluated the association between inflammatory indices, clinical involvement, and mortality. Methods: This retrospective study included 444 patients with BD. Clinical characteristics and laboratory data were systematically retrieved from electronic medical record system. Inflammatory indices (NLR, PLR, SII) were calculated to reflect systemic inflammation. In addition, CRP-based composite indices (IBI-NLR and IBI-SII) were derived to integrate cellular and acute-phase inflammatory responses. Disease manifestations, major organ involvement, comorbidities, and mortality were recorded to comprehensively assess disease burden and clinical outcomes. Results: In multivariable analysis, vascular involvement was associated with increased ESR level (OR = 1.013, 95% CI: 1.002–1.024, p = 0.018), and male sex (OR = 3.22, 95% CI: 1.83–5.67, p < 0.001;). ROC analysis showed the highest discriminatory performance for vascular involvement, with IBI-NLR (AUC = 0.624, p < 0.001), IBI-SII (AUC = 0.609, p = 0.001) and NLR (AUC = 0.597, p = 0.004). Moreover, NLR (AUC = 0.571, p = 0.017), IBI-NLR (AUC = 0.576, p = 0.010), and IBI-SII (AUC = 0.562, p = 0.036) had modest discrimination for major organ involvement. In contrast, inflammatory indexes were not predictive for mortality (p > 0.05 for all). Mortality was independently associated with higher creatinine (OR = 1.086, p = 0.048), higher ESR (OR = 1.023, p = 0.046), and lower uric acid levels (OR = 0.454, p = 0.002). Conclusions: Inflammatory indices may not predict mortality in BD but can help identify vascular and major organ involvement. Male sex and ESR level are associated more severe disease, while mortality is associated with renal dysfunction and systemic inflammation in BD.

The development of inflammatory arthritis after bariatric surgery has been sporadically reported, but systematic clinical and imaging descriptions remain l

Background: Behçet’s disease is a multisystem inflammatory disorder with a variable clinical course. This study evaluated the association between inflammatory indices, clinical involvement, and mortality. Methods: This retrospective study included 444 patients with BD. Clinical characteristics and laboratory data were systematically retrieved from electronic medical record system. Inflammatory indices (NLR, PLR, SII) were calculated to reflect systemic inflammation. In addition, CRP-based composite indices (IBI-NLR and IBI-SII) were derived to integrate cellular and acute-phase inflammatory responses. Disease manifestations, major organ involvement, comorbidities, and mortality were recorded to comprehensively assess disease burden and clinical outcomes. Results: In multivariable analysis, vascular involvement was associated with increased ESR level (OR=1.013, 95% CI: 1.002–1.024, p=0.018), and male sex (OR=3.22, 95% CI: 1.83–5.67, pConclusions: Inflammatory indices may not predict mortality in BD but can help identify vascular and major organ involvement. Male sex and ESR level are associated more severe disease, while mortality is associated with renal dysfunction and systemic inflammation in BD.

This study aimed to evaluate the clinical approaches, decision-making processes, and interdisciplinary collaboration patterns of rheumatologists in Turkiye in the context of uveitis management. A cross-sectional, descriptive study was conducted using a structured 24-item online questionnaire developed based on current literature and expert consensus. A total of 113 rheumatologists from various institutions across Turkiye completed the survey. Participants were divided into two groups based on clinical experience (≤5 years vs. >5 years). The survey explored topics such as clinical exposure to uveitis, referral practices, diagnostic and treatment approaches, collaboration with ophthalmologists, and perceived need for further education. Rheumatologists with greater clinical experience reported more frequent uveitis cases and were more likely to initiate biological therapy. Immediate referral to ophthalmologists was the predominant approach across both groups; however, communication difficulties were cited as a major barrier to effective interdisciplinary collaboration. Adalimumab emerged as the most commonly prescribed biological agent, particularly in Behçet's disease. Financial barriers, such as the cost of medications and reimbursement issues, were frequently reported as limiting factors. A strong demand for further education on uveitis was noted, especially among early-career rheumatologists, with multidisciplinary meetings and online modules being the most preferred formats. The findings highlight variability in clinical practices and underline the need for enhanced coordination between rheumatologists and ophthalmologists. Addressing communication barriers and implementing standardized treatment protocols, supported by targeted educational initiatives, may improve collaborative care and patient outcomes in uveitis management.

Cavitary pulmonary nodules (CPN) represent a rare but clinically relevant manifestation of rheumatoid arthritis (RA), yet their radiological and serological predictors remain poorly defined. This study aimed to identify key clinical, immunological, and imaging features associated with CPN among RA patients presenting with pulmonary nodules (PN). This retrospective cohort included 156 RA patients with PN identified on thoracic computed tomography between 2010 and 2024. Clinical data, autoantibody status, treatment characteristics, and radiological parameters were compared between patients with and without CPN. CPN were detected in 9.0% (n = 14) of cases. Compared to patients without CPN, affected individuals had a significantly greater number of nodules, larger nodule diameters, and higher seropositivity for rheumatoid factor, anti-cyclic citrullinated peptide antibodies, and ANCA. The largest nodule diameter was the only independent predictor of cavitary transformation (OR: 1.59, 95% CI: 1.19-2.12; p = 0.002), with stronger effect sizes in penalized regression (OR: 6.69 per SD; 95% CI: 3.52-12.61). Despite limited sample size, ROC analysis identified an optimal cut-off of 18 mm, yielding excellent discriminative performance (AUC: 0.979; sensitivity: 92.9%, specificity: 95.8%), further supported by bootstrap validation. No significant differences in baseline treatments were observed, though greater variability in drug exposure and post-diagnostic therapy adjustments was noted in CPN-positive patients. Radiological morphology-particularly increased nodule size-alongside autoantibody positivity, are key correlates of cavitary transformation in RA-associated PN. These findings support the use of imaging-based risk stratification and highlight the need for prospective validation across broader RA populations. Key Points • CPN were detected in 9% of RA patients with PN on CT imaging • Larger PN diameter emerged as the principal independent predictor of cavitary transformation, with an18 mm cut-off providing high discriminative capacity (AUC = 0.979). • Seropositivity for RF, anti-CCP, and ANCA IFA was significantly associated with cavitation. • Greater heterogeneity in pre-diagnostic leflunomide exposure and more frequent post-diagnostictherapy modifications among CPN-positive patients suggest a dynamic and potentially treatmentinfluenceddisease pattern, possibly reflecting variability in therapeutic response over time.