Emine Gözde Aydemir Gülöksüz

Serum amyloid A and systemic immune-inflammation index for the evaluation of subclinical inflammation in attack-free familial Mediterranean fever: A real-life cohort study - Journal of Turkish Society for Rheumatology

Background: Atlantoaxial instability (AAI) is a well-recognized complication of rheumatoid arthritis (RA); however, its occurrence in elderly individuals without inflammatory rheumatic disease remains insufficiently investigated. Age-related degenerative and biomechanical changes may predispose geriatric patients to upper cervical instability independent of RA. This study aimed to evaluate the prevalence of radiographic atlantoaxial subluxation (AAS) in geriatric patients with and without RA and to assess whether radiographic AAS may be underrecognized in older adults without rheumatoid arthritis. Methods: In this retrospective cross-sectional study, patients who underwent cervical computed tomography or magnetic resonance imaging between January and September 2024 were evaluated. The study population included 206 patients aged ≥ 65 years with RA, 168 age-matched non-RA individuals, and 183 non-RA individuals younger than 65 years. Radiographic atlantodental interval measurements were obtained using standardized techniques, and AAS was defined as an interval exceeding 3 mm. Multivariable logistic regression analysis was performed with adjustment for sex. Results: Atlantoaxial subluxation was detected in 25.7% of geriatric RA patients, 12.5% of geriatric non-RA individuals, and 6.0% of younger non-RA individuals ( p < 0.001). Compared with younger non-RA individuals, geriatric patients with RA had significantly higher odds of radiographic AAS (OR 5.39, 95% CI 2.72–10.69), as did geriatric non-RA individuals (OR 2.27, 95% CI 1.06–4.86). Advanced cervical imaging was infrequently requested because of a prior clinical suspicion of atlantoaxial instability (AAI). Conclusions: Radiographic atlantoaxial subluxation (AAS) was observed not only in patients with rheumatoid arthritis but also in older adults without RA undergoing advanced cervical imaging. These findings suggest that radiographic AAS may be more frequently observed among older adults undergoing advanced cervical imaging than is generally appreciated. However, the observed prevalence should not be interpreted as representative of the general geriatric population. Further prospective studies are warranted to determine the clinical significance of radiographic AAS and its implications for patient management.

Background and Objectives: To evaluate the concordance and relative performance of the 2023 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria compared with the revised Sapporo (2006) criteria and to identify potential risk factors for recurrent thrombosis among patients classified as antiphospholipid syndrome (APS) according to the 2023 criteria. Materials and Methods: This retrospective cohort study included 82 patients with documented antiphospholipid antibody (aPL) positivity between October 2022 and August 2024. The revised Sapporo criteria were used as the comparator classification system to evaluate the concordance and relative performance of the 2023 ACR/EULAR criteria. Secondary analyses were restricted to patients fulfilling the 2023 criteria (n = 55), in whom clinical characteristics and potential risk factors for recurrent thrombosis were evaluated. Results: Of the 82 aPL-positive patients, 9 fulfilled only the revised Sapporo criteria, 1 fulfilled only the 2023 criteria, 54 met both criteria sets, and 18 met neither. Using the revised Sapporo criteria as the comparator, the 2023 criteria demonstrated a relative sensitivity of 85.7% and relative specificity of 95.0%. Positive and negative agreement rates were 98.2% and 66.7%, respectively. Among patients classified as APS according to the 2023 criteria, disease duration was significantly longer in patients with recurrent thrombosis in univariate analysis (p = 0.028); however, this association did not remain significant after multivariable adjustment. Conclusions: The 2023 ACR/EULAR criteria demonstrated higher relative specificity but lower relative sensitivity compared with the revised Sapporo criteria. No independent predictor of recurrent thrombosis was identified after multivariable adjustment, although the limited number of outcome events may have reduced statistical power. However, most recurrent thrombotic events occurred in patients with subtherapeutic INR levels, suggesting the importance of careful anticoagulation management in patients with APS.

Primary Sjögren disease (pSjD) is a systemic autoimmune disease with heterogeneous clinical, serological, and hematological manifestations. Because symptom onset and diagnostic delay may be difficult to determine retrospectively, age at diagnosis may provide a pragmatic framework for describing clinical heterogeneity. This study compared clinical, serological, and hematological profiles across diagnosis-age groups in pSjD. This retrospective cross-sectional study included 258 patients with definite primary Sjögren disease fulfilling the 2016 ACR/EULAR classification criteria after exclusion of cases with uncertain primary/secondary status. Patients were stratified according to age at diagnosis into young-adult (< 40 years, n = 54), middle-age (40-59 years, n = 137), and late (≥ 60 years, n = 67) groups. Demographic, clinical, serological, hematological, and composite inflammatory indices were compared. Logistic regression was used to evaluate exploratory sex-adjusted associations with pulmonary involvement. ROC analysis was performed to evaluate the modest discriminative performance of RDW-SD for late versus young-adult diagnosis-age groups. Pulmonary involvement was observed in 2/54 (3.7%) young-adult, 7/137 (5.1%) middle-age, and 19/67 (28.4%) late diagnosis-age patients (p < 0.001). In exploratory sex-adjusted logistic regression, late diagnosis-age was associated with pulmonary involvement compared with young-adult diagnosis-age (OR 8.20, 95% CI 1.75-38.32), whereas middle-age diagnosis was not (OR 1.34, 95% CI 0.26-6.83). Extraglandular involvement also differed across groups (31.5%, 16.8%, and 35.8%, respectively; p = 0.006). Corticosteroid exposure was more frequent in the late diagnosis-age group (7.4%, 18.2%, and 32.8%; p = 0.002), but was interpreted as a treatment variable rather than an intrinsic disease phenotype. CRP, neutrophil count, monocyte count, RDW-SD, NLR, SIRI, SII, and AISI differed across groups. RDW-SD showed only modest discriminatory ability for late versus young-adult diagnosis-age groups (AUC 0.645, 95% CI 0.538-0.746). Autoantibody profiles were broadly comparable, although anti- SSB/La positivity was more frequent in the young-adult group. In this single-center cohort, age at diagnosis was associated with differences in selected clinical and hematological characteristics in pSjD. Late diagnosis-age was associated with a higher frequency of clinically recognized pulmonary involvement; however, this finding should be interpreted cautiously because smoking data were incomplete, HRCT screening was not systematic, age-related comorbidities were more common in older patients, and reverse causality related to ILD workup cannot be excluded. RDW-SD should be considered an exploratory CBC-derived marker with modest performance rather than a clinically established biomarker.

Purpose To evaluate choroidal thickness (CT) and choroidal vascularity index (CVI) in patients with primary Sjögren’s syndrome (pSS), and to compare these parameters with healthy controls. Methods This study included 35 pSS patients and 37 healthy controls. CVI measurements were performed using enhanced depth imaging optical coherence tomography (EDI-OCT). The peripapillary nasal (PPN) and temporal (PPT) regions, with a width of 1000 µm, were analyzed, along with subfoveal (SF) areas at 500, 1000, and 1500 µm. The EDI-OCT images were transferred to ImageJ software for image binarization and CVI calculation. Subfoveal choroidal thickness (SFCT) was also measured. Results There was no statistical difference in age, gender and BMI distribution between the groups (all p > 0.05). All CVI values at 5 different measurement points ​​(SF 500 µm, SF 1000 µm, SF 1500 µm, PPN and PPT) were significantly lower in the pSS group (p = 0.01, p = 0.07, p = 0.017, p = 0.03 and p = 0.019, respectively). SFCT values ​​were found to be significantly lower in the patient group (326.2 ± 89.4 µm vs 380.6 ± 78.2 µm, p = 0.008). A significant positive correlation was found between SFCT measurements and PPN CVI and PPT CVI values (r = 0.515, p = 0.002; r = 0.493, p = 0.003, respectively). Conclusion We detected significantly thinned CT and decreased CVI values ​​in patients with pSS, for the first time. As a result of our study, CT and CVI measurements may become parameters that can be used in the follow-up of pSS patients in whom no pathology is detected in routine eye examination and perhaps in the evaluation of treatment response.

Objectives: To determine the frequency of development of hypogammaglobulinemia in rheumatoid arthritis (RA) patients receiving rituximab (RTX) and to examine the relation between the development of hypogammaglobulinemia and RTX treatment response. Methods: The data of 165 RA patients who applied to our outpatient clinic between January 2010 and June 2021, and who received at least 2 courses of RTX with an interval of 6 months, were retrospectively evaluated. The demographic, clinical, and laboratory data, as well as treatment characteristics, were collected. Results: Of 165 patients, 35 (21.2%) developed hypogammaglobulinemia. In the multivariable analysis examining the risk factors for the development of hypogammaglobulinemia in RA patients receiving RTX, it was determined that having pre-treatment IgG value below 10.5 g/l (OR= 4.24 (95% CI 1.69–10.66) and the increase in the number of RTX courses (OR= 1.1 (95% CI 1.01–1.22) were independently associated risk factors. During their follow-up, patients who developed hypogammaglobulinemia and those who did not were compared. No difference was observed between DAS28-ESR levels, but CRP levels were significantly lower in the group that developed hypogammaglobulinemia. Conclusions: In this study, there was no difference in DAS28-ESR levels between patients with and without hypogammaglobulinemia, although a difference was observed in acute phase reactants, which are more objective parameters. This may be due to subjective parameters in DAS28-ESR scoring or other concomitant conditions such as fibromyalgia. Therefore, additional objective findings or methods may guide the evaluation of treatment response.

The aim of the study was to compare the hand function (grip strength and grip endurance, manual dexterity, and perceived hand functional disability) of participants with gout, rheumatoid arthritis, and healthy control. Grip strength and grip endurance were assessed using a hand dynamometer, while manual dexterity was evaluated through the Nine-Hole Peg Test. Perceived hand functional disability was measured using the Duruöz Hand Index. The grip strength was similar between gout and healthy control (p>0.05). Dominant and non-dominant grip endurance in gout were lower than healthy control (p=0.008, p=0.001). The dominant placing, removing, and total Nine-Hole Peg Test time of gout compared to healthy control were higher (p=0.001, p<0.001, and p<0.001). The non-dominant placing, removing, and total Nine-Hole Peg Test time of gout were higher than healthy control (p=0.002, p=0.004, and p=0.002). The Duruöz Hand Index in gout was higher than healthy control (p=0.002), but lower than rheumatoid arthritis (p=0.008). Our findings indicate that individuals with gout experience impairments in grip strength, manual dexterity, and perceived hand function. Assessing hand function during clinical examinations of patients with gout should be considered.

Purpose: The aim of this study was to determine the association of rheumatoid arthritis–related lung disease (RA-LD) and its subtypes with all-cause mortality. Materials and Methods: For the present analyses, patients with RA who underwent computed tomography of the chest (chest-CT) were evaluated. RA-LD was defined in 4 subtypes as follows: interstitial lung disease (RA-ILD), airway disease (RA-AD), rheumatoid pulmonary nodules (RA-PN), and RA-related pleural disease (RA-PD). The date of RA-LD diagnosis was considered the date of the first chest-CT detecting the pathology. To assess the factors associated with mortality, multivariable logistic regression analyses were performed with variables selected based on their causal associations with the outcome. Results: Of 576 RA patients, 253 (43.9%) had RA-LD (38.7% male; mean age at RA-LD diagnosis, 59.9 ± 9.8 years). The most common subtype was RA-AD, which was detected in 119 (47.0%) patients followed by 107 (42.3%) with RA-ILD, 70 (27.7%) with RA-PN, and 31 (12.3%) with RA-PD. Sixty-one (24.1%) patients had 2+ subtypes. After median follow-up of 10.2 years, 97 (16.8%) died. The existence of at least 1 subtype and 2+ subtypes increased the all-cause mortality, as indicated by odds ratios of 1.60 (95% confidence interval [CI], 1.03–2.48) and 2.39 (95% CI, 1.26–4.54), respectively. Among RA-LD patients, RA-ILD and RA-PD were associated with increased mortality (odds ratios were 2.20 [95% CI, 1.18–4.08] and 1.62 [95% CI, 0.70–3.75], respectively). Conclusions: In this study, RA-AD was the most common subtype, and the presence of RA-LD increased mortality. This effect was particularly pronounced in patients with RA-ILD and RA-PD or those presenting with 2+ subtypes.