Iffet Merve Uçar Baytaroğlu

Systemic inflammatory indices derived from complete blood count have emerged as biomarkers in autoimmune conditions, but their relationship with ultrasonographic thyroid morphology in Graves’ disease (GD) remains unexplored. Our goal is to examine associations between inflammatory indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic inflammatory index [SII], pan-immune-inflammation value [PIV]) and thyroid ultrasonographic parameters in newly diagnosed GD. This cross-sectional study included 66 newly diagnosed GD patients. Thyroid ultrasonography assessed volume, isthmus thickness, homogeneity, and Doppler vascularity. Spearman correlations with FDR correction and linear regression adjusted for age, sex, fT4, fT3, and TSI were performed. Mean age was 45.7 ± 15.3 years (80.3% female). PLR showed inverse correlation with thyroid volume (ρ = −0.346, p = 0.004) but did not survive FDR correction (pFDR = 0.071). In fully adjusted regression (age, sex, fT4, fT3, TSI), NLR was independently associated with isthmus thickness (β = 0.681, p = 0.0077, pFDR = 0.031). No inflammatory index independently predicted thyroid volume, homogeneity score, or Doppler vascularity score. NLR is independently associated with isthmus thickness in newly diagnosed GD, suggesting a link between neutrophil-mediated systemic inflammation and focal thyroid structural changes at disease onset.

Objective: To identify clinical, serological, and pharmacological factors associated with dry eye disease (DED) in patients with rheumatoid arthritis (RA). Methods: In a retrospective cohort, 65 adults with RA (2010 American College of Rheumatology / European League Against Rheumatism criteria) underwent a TFOS DEWS II-based ocular surface workup, with 65 age- and sex-matched non-RA clinic participants for descriptive comparison. Group comparisons used t-test, Mann–Whitney U-test, χ2, or Fisher’s exact tests. A multivariable logistic regression model with anti-CCP positivity, smoking, anti-SSA, and age was fitted; discrimination was assessed by ROC analysis, and calibration by the Hosmer–Lemeshow test. Results: Dry eye disease was present in 19 of 65 RA patients (29.2%); for descriptive context, prevalence in 65 matched non-RA ophthalmology clinic participants was similar (27.7%; P = .85). Anti-CCP positivity (89.5% vs. 60.9%; P = .037) and cumulative pack-years (median 10.0 vs. 0.0; P = .032) separated RA-DED from RA without DED, whereas disease activity, glucocorticoid dose, methotrexate, and hydroxychloroquine exposure did not. Given only 19 events, the model was fitted with Firth penalized likelihood; anti-CCP positivity remained independently associated with DED (adjusted odds ratio (aOR) 4.20; 95% CI, 1.10-23.77; P = .035), and smoking showed a directionally consistent effect (aOR 2.42; 95% CI, 0.81-7.64). Model discrimination was moderate (AUC 0.757) with adequate calibration. Conclusion: Within this RA cohort, anti-CCP positivity was independently associated with DED, whereas cumulative tobacco exposure showed a directionally consistent association that did not reach independent significance. These findings support consideration of targeted ocular surface surveillance in anti-CCP–positive patients with a smoking history, pending confirmation in larger prospective studies.

Non-infectious ocular inflammatory conditions, including uveitis, scleritis, and retinal vasculitis, are a heterogeneous group of immune-mediated diseases that together account for a substantial sh...

Most RA-ILD biomarker studies enroll patients receiving treatment, which may alter inflammatory activity. We investigated whether calprotectin, sialic acid, and pannexin-1 show treatment-adjusted cross-sectional associations with ILD status in patients receiving treatment for RA. This cross-sectional case-control study included 154 participants (49 patients with HRCT-confirmed RA-ILD, 55 RA patients without ILD, 50 healthy controls). Serum biomarkers were measured by ELISA. The primary multivariate logistic regression model for ILD status within the RA cohort was adjusted for age, sex, smoking status, and binary biologic DMARD and corticosteroid use, with VIF, L1/L2 penalized, parsimonious model, rituximab-exclusion resampling, and bootstrap-CI ROC sensitivity analyses. In Bonferroni-corrected pairwise testing between RA-ILD and RA without ILD, no biomarker reached p<0.017 (ESR p=0.97, CRP p=0.72, calprotectin p=0.092, sialic acid p=0.90, pannexin-1 p=0.066). After adjustment, three biomarkers showed independent associations with ILD: lower calprotectin (OR=0.21, 95% CI 0.08–0.57, p=0.002, q=0.006), higher age-adjusted sialic acid (OR=2.57, 1.22–5.45, p=0.013, q=0.020), and lower pannexin-1 (OR=0.52, 0.28–0.94, p=0.029, q=0.029). All VIFs were below 1.25; Ridge and Lasso regression retained the same three biomarkers. AUCs were modest, with all five 95% CIs including 0.50 (pannexin-1 0.61; calprotectin 0.60). These findings indicate that serum calprotectin, sialic acid, and pannexin-1 carry weak conditional associations with ILD status in patients receiving RA treatment. However, their discriminatory performance is insufficient for standalone clinical use.

Objective: Cognitive intrusion of pain, autobiographical memory, and aggression have not been simultaneously compared in rheumatic diseases. We compared these constructs across rheumatoid arthritis (RA), psoriatic arthritis (PsA), osteoarthritis (OA), and fibromyalgia (FM) and identified disease-specific predictors. Methods: Two hundred twenty-five patients (62 RA, 52 PsA, 56 OA, 55 FM) were assessed (May to October 2025) with the Experience of Cognitive Intrusion of Pain Scale (ECIPS), Autobiographical Memory Questionnaire (AMQ), Buss-Perry Aggression Scale (BPAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Visual Analog Scale (VAS). Disease burden was measured with the Disease Activity Score 28-C-reactive protein (DAS28-CRP), Disease Activity Index for Psoriatic Arthritis (DAPSA), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Fibromyalgia Impact Questionnaire (FIQ). Analysis of variance and covariance (ANOVA, ANCOVA; age, sex, depression, anxiety) and multiple regression were applied with Benjamini-Hochberg false discovery rate (FDR) correction. Results: After adjustment, ECIPS did not differ across groups ( F _3,217 =0.63, p =0.595, partial η²=0.009). Hostility differences attenuated after mood adjustment ( p =0.784). Scene imagery differed among groups ( p =0.023). Physical aggression (β=0.270, p =0.005) and memory rehearsal (β=0.653, p p =0.006) and FIQ in FM (β=0.401, p =0.003). No medication subgroup differences emerged. Conclusions: Cognitive pain intrusion did not differ across rheumatic diseases after mood adjustment (partial η²=0.009). Because the ECIPS lacks rheumatology validation, this may reflect limited measurement sensitivity, residual confounding, or insufficient power rather than true equivalence. Disease activity was independently associated with cognitive intrusion in RA and FM. Rheumatology-specific psychometric validation is warranted.

OBJECTIVE: To retrospectively evaluate retinal nerve fiber layer (RNFL) changes over one year in fibromyalgia (FM) patients compared to healthy controls, assess correlations between clinical parameters and RNFL measurements, and investigate potential treatment-related effects. MATERIALS and METHODS: This retrospective cohort study analyzed medical records of 44 female FM patients and 44 age-matched healthy controls who underwent serial optical coherence tomography (OCT) examinations. RNFL thickness measurements obtained using Canon-OCT HS100 at baseline and one-year follow-up were extracted from the database. Clinical data including Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), disease duration, and medication use were collected from patient records. Statistical analyses included Mann-Whitney U tests, Wilcoxon signed-rank tests, Kruskal- Wallis tests, and Spearman correlations.RESULTS: No significant baseline differences in RNFL parameters were observed between groups. However, FM patients showed significantly greater RNFL thinning in nasal (Δ: -1.51±1.01 vs - 0.74±0.66 μm, p<0.001) and superior (Δ: -2.49±1.66 vs -1.09±1.08 μm, p<0.001) sectors compared to controls. Disease duration correlated positively with average (r=0.308, p=0.042) and temporal (r=0.342, p=0.023) RNFL change. Pregabalin users showed greater RNFL reduction in nasal (p=0.016) and inferior (p=0.031) sectors.CONCLUSION: FM patients demonstrate accelerated RNFL thinning over one year, particularly in nasal and superior sectors. Disease duration influences this progression. These findings may be consistent with the hypothesis of ongoing neurodegenerative processes in FM, though the small effect sizes warrant cautious interpretation. The results highlight OCT as a potential monitoring tool.

Cataract surgery in eyes affected by uveitis presents unique challenges, but the non-ocular factors influencing postoperative recovery are not fully understood. While earlier studies have mainly focused on ocular prognostic factors, variables such as cumulative inflammatory burden, phacoemulsification energy, and systemic immunomodulation have not been thoroughly evaluated. This study aims to identify independent predictors of visual outcomes and steroid-free recovery time after cataract surgery for uveitic cataracts. This retrospective study included 54 eyes of adults with uveitis-associated cataracts who underwent phacoemulsification with intraocular lens (IOL) implantation at a single center. The primary outcomes were postoperative month-1 best-corrected visual acuity (BCVA) and steroid-free recovery time. Multivariable regression analysis identified independent predictors among preoperative BCVA, uveitis attack count, cumulative dissipated energy (CDE), and immunomodulatory therapy type. All patients on bDMARDs had been receiving therapy for at least 3 months prior to surgery and continued their regimen perioperatively. The mean age of the patients was 38.6 ± 7.9 years. The diagnoses included axial spondyloarthritis (40.7%), Behçet’s disease (33.3%), juvenile idiopathic arthritis (11.1%), idiopathic uveitis (11.1%), and sarcoidosis (3.7%). Visual acuity improved from 0.23 ± 0.12 to 0.86 ± 0.12 (p2=0.63) included preoperative BCVA (β = +0.254, p = 0.016), uveitis attack count (β = −0.014, p = 0.015), and CDE (β=−0.009, p2=0.70) was predicted by attack count (β=+1.29 days/attack, p=0.002), CDE (β = +0.95 days/unit, p<0.001), and biologic DMARD therapy (β=−5.09 days, p=0.006). Cumulative inflammatory burden and surgical complexity independently predict postoperative recovery in uveitic cataract surgery. Biologic DMARD therapy was linked to faster steroid-free recovery in this observational cohort, supporting further research into optimizing systemic immunomodulation before surgery. Prospective studies with larger sample sizes are needed to confirm these results.

Letters to the Editor; Authors: I.M. Uçar Baytaroğlu, A. Baytaroğlu, Ş.N. Çiftci, M.Ü. Kurban, S. Tüner, G. Alp

Merkel Cell Carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine malignancy strongly associated with immunosuppression.

Aims: This study aimed to assess the coping strategies and solution-focused thinking skills of patients with AS and to examine the relationship between these psychological characteristics and clinical disease severity, as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Functional Index (BASFI). Methods: This cross-sectional study included 128 patients with AS from a rheumatology outpatient clinic. Data were collected on demographics, disease activity (BASDAI), functional status (BASFI), solution-focused thinking (SFI), and coping strategies (COPE-R). The analysis involved descriptive statistics, Pearson correlation analysis, and structural equation modeling (SEM). Results: The mean age of the cohort was 42.4 years, and 48% were female. They presented with moderate disease activity (mean BASDAI: 4.8 ± 2.1) and mild-to-moderate functional impairment (mean BASFI: 3.9 ± 1.8). Adaptive psychological traits, such as Goal Orientation (SFI), were strongly and positively correlated with proactive coping strategies like Self-Help (r = 0.52) and Approach Coping (r = 0.47). Conversely, Problem Disengagement was positively associated with maladaptive styles like avoidance (r = 0.41) and self-punishment (r = 0.33). Goal Orientation was negatively correlated with both disease activity (r = -0.42) and functional impairment (r = -0.39), while avoidance coping showed the strongest positive correlation with poorer outcomes (r = 0.48 for BASDAI and r = 0.45 for BASFI). The SEM analysis confirmed that adaptive strategies predicted better outcomes, whereas maladaptive strategies, like avoidance, predicted worse clinical status. Conclusions: Coping styles and solution-focused thinking are significant and modifiable predictors of disease severity in patients with AS. Adaptive strategies such as goal orientation appear to be protective, while maladaptive strategies, particularly avoidance, are associated with a greater disease burden. These findings underscore the importance of integrating psychological interventions into multidisciplinary care to improve patient-centered management and potentially disrupt the cycle of inflammation and disability in AS.