Abdurrahman Sadıç

Objective: This study aimed to investigate the frequency and progression of pelvic and hip entheseal structural changes in PsA patients initiating biologic therapy. Methods: Records from the Hacettepe University Rheumatology Biologic Therapy Registry (HUR-BIO) were retrospectively reviewed. PsA patients with pelvic radiographs obtained within ±1 year of biologic therapy initiation were included. Radiographs were assessed according to the modified New York criteria, and entheseal involvement at the ischium, symphysis pubis, iliac wings and greater/ lesses trochanter was graded from 0 (none) to 4 (florid new bone formation). Grade 2 or higher was considered clinically relevant. Demographic and clincal characteristics were compared between patients with/ without structural changes and progression of these lesions were assessed. Results: A total of 108 patients (68.5% female; mean age 41.5 ± 11.6 years; mean PsA duration 2.2 years) were included. Baseline mNY positivity was detected in 45.4%. Bilateral relevant entheseal involvement was observed in 21.9% at the ischium, 15.3% at the symphysis pubis, and 7.7% at the iliac wings. Greater trochanteric enthesopathy was 2% on the right side. Male patients, with higher BMI and older age with family history tended to have more structural lesions. After a mean follow-up of 38.6 months, data from 48 patients were available. Most progression was limited to a one-grade increase at the ischium (28%). Conclusion: Major pelvic entheseal lesions, predominantly at the ischium and symphysis pubis, are relatively common in PsA but show minimal radiographic progression under biologic therapy.

Purpose: Adrenal insufficiency (AI) is an endocrine condition requiring lifelong glucocorticoid replacement treatment. Long-term exposure to glucocorticoids may result in significant metabolic problems, such as insulin resistance, abdominal obesity, dyslipidemia, and increased cardiometabolic risk. The triglyceride–glucose (TyG) index is a simple, inexpensive marker of insulin resistance and metabolic syndrome (MetS), increasingly used in endocrine and metabolic research, but its role in AI remains insufficiently researched. This study aimed to assess the clinical utility of the TyG index in patients with AI. Method: This was a single-center, cross-sectional observational study including 58 patients with primary or secondary AI receiving glucocorticoid replacement therapy. Demographic, clinical, and anthropometric data were recorded, and body composition was assessed by bioelectrical impedance analysis. The TyG index was calculated using fasting triglyceride and glucose values. MetS was diagnosed according to the International Diabetes Federation 2009 criteria. The relationships between TyG and metabolic risk factors were examined, and TyG levels were investigated in the primary AI and secondary AI groups. The discriminative value of TyG for MetS was determined using receiver operating characteristic (ROC) analysis, including pairwise area under the curve (AUC) comparisons and the Youden-optimal threshold. Results: The mean age was 44.8 ± 15.6 years, and 28 patients (48.3%) were female. Secondary and primary AI were present in 53.4% and 46.6% of patients, respectively. MetS prevalence was 31.0%. TyG was higher in secondary AI compared with primary AI (8.8 ± 0.7 vs. 8.4 ± 0.5; p = 0.014). TyG values were higher in patients with elevated waist-to-height ratio (WHtR), high waist-to-hip ratio, obesity, and MetS ( p < 0.05). ROC analysis showed that TyG had the strongest discriminative value for identifying MetS (AUC = 0.840, 95% confidence interval [CI]: 0.722–0.959; p < 0.001), with a cut-off of 8.49 yielding 94.4% sensitivity and 67.5% specificity, followed by WHtR (AUC = 0.826, 95% CI: 0.719–0.932, p < 0.001) and body mass index (AUC = 0.757, 95% CI: 0.631–0.883, p = 0.002). Conclusion: This study evaluates TyG in AI and indicates which it is a simple, low-cost marker associated with metabolic risk. TyG may support early identification and risk stratification in this vulnerable population.

Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways.

The aim of this study was to determine the distribution different types of osteoproliferative lesions on the lumbar spine and their relations in patients with psoriatic arthritis (PsA) under biologic-disease-modifying anti-rheumatic drug therapy. T12-S1 corners were evaluated in 182/274 (66.4%) patients with lumbar radiographs. Lesions were determined as osteophyte (grade 0–3), erosion, sclerosis, squaring, corner syndesmophyte, and bridging syndesmophyte. Lesions with no clear distinction were defined as ambiguous. The mean (SD) age of 182 PsA (69.2% female) patients was 47.6 years (12.7), the mean age at diagnosis of PsA was 39.7 years (12.7). Of the patients, 112 (61.5%) met the criteria for mNY. Osteophytes were the most frequently detected lesions (42.3%), with 18.1% of patients having osteophyte grade 2 and above (mostly on L2-L4). Syndesmophytes were present in 24.2% of all patients (mostly on T12-L4), and ambiguous lesions were detected in 13 (4.7%) patients. Changes were observed in five ambiguous lesions in patients with follow-up lumbar radiography, four of them transformed into corner syndesmophytes at follow-up, and one was evaluated as osteophyte grade 2. Approximately one fifth of patients presented with significant degenerative new bone formation, and syndesmophytes were found in one fourth. In approximately 7% of all patients, lesions were ambiguous. The nature of these lesions needs to be evaluated in further imaging studies.