Sibel Bakirci

Background and Objectives: Variation in RANK/RANKL/OPG signaling may contribute to rheumatoid arthritis (RA) heterogeneity. We examined whether recorded TNFRSF11A exon 5–flanking variant carrier status was associated with six-month clinical outcomes in treatment-naïve RA. Materials and Methods: This prospective cohort included 57 patients: 10 carriers and 47 non-carriers. The primary outcome was six-month DAS28-CRP. Welch tests, Fisher’s exact tests, effect sizes, 95% confidence intervals, and exploratory baseline-adjusted models were used; missing outcomes were not imputed. Results: Carriers had lower six-month DAS28-CRP than non-carriers (2.53 ± 0.98 [n=10] vs 2.85 ± 0.99 [n=37]) and lower CRP (6.58 ± 6.96 vs 7.59 ± 9.29 mg/L). DAS28-CRP < 2.6 occurred in 60.0% of carriers and 35.1% of non-carriers (OR, 2.769; 95% CI, 0.660–11.618). High activity, recorded deformity, and biologic initiation were 10.0% vs 35.1%, 10.0% vs 29.8%, and 20.0% vs 36.1%, respectively. The composite score was 3.60 ± 1.08 vs 2.83 ± 1.07 (d=0.720; p=0.064). The adjusted DAS28-CRP coefficient was −0.165 (95% CI, −0.850 to 0.520; p=0.629). Conclusions: The carrier pattern suggests a more favorable short-term RA profile, but remains hypothesis-generating and requires prospective validation.

Introduction: Entheses, the sites where tendons, ligaments, and joint capsules insert into bone, are highly susceptible to mechanical stress. While enthesitis is a cardinal feature of spondyloarthritis (SpA), repetitive mechanical loading in elite athletes can also induce entheseal changes. High-resolution ultrasound (US) allows for detailed assessment of entheseal inflammation and structural damage. However, the specific impact of sport-specific loading patterns on differentiating physiological entheseal adaptation from early pathology in asymptomatic elite athletes remains a critical area for investigation. Material and methods: This cross-sectional study evaluated 87 elite athletes from various sports (athletics, basketball, cycling, golf, handball, climbing, ar-chery) and 49 sedentary controls. Elite status was defined as training > 10 h/week for over 5 years. All participants underwent US evaluation of 20 bilateral entheseal sites. US findings were scored semi-quantitatively (0–3) for inflammation (hypoechogenicity, thickening, power Doppler [PD] signals) and damage (calcifications, erosions, enthesophytes) according to OMERACT definitions. Athletes were grouped by dominant extremity use (upper, lower, or both). Statistical comparisons and linear regression analyses were performed to identify associations between entheseal scores and demographic/training variables. Results: Elite athletes exhibited significantly higher entheseal inflammation and damage scores compared to sedentary controls (p < 0.05). Athletes practicing upper extremity-dominant sports (e.g., archery, climbing) showed significantly higher upper extremity inflam-mation (median [IQR], 1 [0–3] vs. 0 [0–1.5]; p = 0.010) and damage scores (median [IQR], 0 [0–3] vs. 0 [0–0]; p < 0.001) than con-trols. Similarly, lower extremity-dominant athletes (e.g., athletics, cycling) had significantly higher lower extremity inflammation scores (median [IQR], 2 [1–4] vs. 0 [0–1]; p < 0.001). Linear regression revealed that upper extremity inflammation was inde-pendently associated with age and weekly training duration, while lower extremity inflammation was solely associated with body mass index (BMI). Notably, a high prevalence of US abnormalities was observed despite many athletes being asymptomatic. Conclusions: Sport-specific mechanical loading is strongly associated with localized entheseal changes detectable by US in elite athletes. These findings underscore the importance of contextualizing US results within an athlete’s specific sport and loading history to distinguish between subclinical entheseal adaptation and true pathology.

Background: This proof-of-concept study examined the association between CT-derived sarcopenia indices and achievement of Patient Acceptable Symptom State (PASS) in a metabolically homogeneous subgroup of patients with psoriatic arthritis (PsA) receiving biologic therapy. Methods: We retrospectively analyzed 26 PsA patients without diabetes, hypertension, or thyroid disorders who were treated with TNF or IL-17 inhibitors and underwent opportunistic CT imaging at the L2 vertebral level. Body composition parameters included total abdominal muscle area (TAMA), subcutaneous adipose tissue (SAT), and sarcopenia index (SI = TAMA/height²). PASS achievement at 12 weeks was assessed retrospectively. Receiver operating characteristic (ROC) analysis was performed. Results: Fourteen patients achieved PASS. Compared with non-achievers, these patients had significantly higher TAMA, SAT, and SI values (all p < 0.05). ROC analysis identified an SI threshold of 4657.5 cm²/m² (sensitivity 78.6%, specificity 83.3%, p = 0.003). Conclusions: In this metabolically homogeneous PsA subgroup, higher CT-derived muscle mass measures were associated with PASS achievement at 12 weeks. These findings are hypothesis-generating and require validation in larger prospective cohorts.

Introduction: This study aimed to evaluate ultrasonographic entheseal abnormalities in patients with radiographic axial spondyloarthritis (r-axSpA) who were in clinical remission for at least 6 months and receiving either nonsteroidal anti-inflammatory drugs (NSAIDs) or biologic agents. Material and methods: Seventy-two r-axSpA patients were included, divided into NSAID users (n = 23) and biologic agent users (n = 49). Demographic and clinical data were recorded. Ultrasound assessment was performed bilaterally at 10 entheseal sites using a 7–13 MHz linear probe. Elementary lesions defined by OMERACT – hypoechogenicity, thickening, power Doppler (PD) signal, calcification, enthesophyte, and bone erosion – were evaluated and scored on a scale of 0–3. Inflammation scores included hypoechogenicity, thickening, and PD signal; chronicity scores included bone erosion, enthesophyte, and calcification. Results: A total of 720 entheseal sites were analyzed. The quadriceps tendon was the most frequently affected site (98.6%), followed by the distal patellar tendon (94.4%), Achilles tendon (70.8%), and plantar fascia (70.8%). Hypoechogenicity, thickening, enthesophyte formation, and bone erosion were the most common abnormalities, while PD signals and calcifications were rare. Nonsteroidal anti-inflammatory drug users showed significantly higher C-reactive protein (CRP) (0.62 ±0.53 vs. 0.41 ±0.27 mg/dl, p = 0.027) and erythrocyte sedimentation rate (ESR) levels (11.91 ±7.72 vs. 7.65 ±5.66 mm/h, p = 0.010) than biologic users, despite similar Axial Spondyloarthritis Disease Acti­vity Score with CRP score. Mean inflammation, tissue damage, and total ultrasound (US) enthesitis scores were 4.85 ±4.37, 6.44 ±4.44, and 11.24 ±8.21, respectively, with no significant difference between treatment groups. Seven biologic-treated, overweight, or obese patients had markedly elevated total US scores (30.43 ±5.83), suggesting persistent entheseal inflammation and structural damage. Conclusions: Ultrasound-based enthesitis scoring may reveal subclinical disease activity in r-axSpA patients in remission, highlighting the added value of integrating musculoskeletal US into disease monitoring.

Sarcoidosis,tenosynovitis,nodular sarcoidosis,isolated sarcoidosis

Objectives: In this study, we aimed to investigate capillary vessel diameters and structural changes of capillaries by using nailfold video capillaroscopy (NVC) in patients with polycythemia vera (PV). Patients and Methods: This cross-sectional study included a total of 24 patients (19 males, 5 females; mean age: 59.8±12.9 years; range, 50.2 to 68 years) who were diagnosed with PV and 15 healthy controls (11 males, 4 females; mean age: 40.7±5.1 years; range, 36 to 44 years) between June 2016 and February 2017. Nailfold video capillaroscopy was performed by an experienced rheumatologist who was blinded to clinical data. The apical, arterial, and venous limb diameters of capillaries were measured and microvascular changes of capillaries were scored. Results: When capillaries were evaluated in terms of morphological structures, giant capillary was detected in 67% of the patients with PV and 0% in the control group (p

Objective To compare the clinical features, laboratory findings, and prognosis of Behçet’s disease (BD) patients with and without Budd–Chiari syndrome (BCS). Methods This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017. Results Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p < 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14–47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%). Conclusion To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.

The temporal relationship between the onset of skin psoriasis (Pso) and psoriatic arthritis (PsA) is a long and well‐known feature of psoriatic disease. Psoriatic skin lesions emerge years before the development of musculoskeletal manifestations in nearly 75% of PsA patients. While skin and joint manifestations develop within one year in 15‐20% of the patients, joint manifestations precede the skin involvement by a year or more in about 10% of the patients (1).

Objective.: We aimed to investigate the prevalence of ultrasonographic (US) lesions in healthy entheses and contributing factors.Methods.: US scans were performed on 960 entheses of 80 healthy subjects. Factors contributing to entheseal changes were investigated with regression analysis.Results.: Thickening (20.4% of the entheses) and enthesophytes (23.1%) were the most common inflammatory and structural damage lesions, respectively. Age (p < 0.001), male sex (p = 0.003), body mass index (BMI; p = 0.001), and high physical activity (p = 0.007) were independent predictors of enthesitis scores on US.Conclusion.: The effects of age, sex, BMI, and physical activity on the entheses need to be considered when differentiating disease from health.