Şerife Şeyda Zengin Acemoğlu

Objective: This study decisively analyzes capillaroscopy data from both healthy individuals and patients with systemic sclerosis, highlighting the differences between their dominant and non-dominant hands. Methods: The study comprised 117 healthy volunteers and 116 patients with systemic sclerosis, all recruited from a single center. Nailfold capillaroscopy was performed on 8 fingers (excluding the thumbs) at a magnification of 200x. Nailfold capillaroscopy data of the fingers of healthy and systemic sclerosis individuals were compared within their groups. Results: It has been observed that specific findings typically associated with systemic sclerosis were also present in healthy individuals. These findings appeared numerically more common in the dominant hand. In healthy volunteers, hemorrhage and neoangiogenesis were observed more frequently in the fingers of the dominant hand compared to the non-dominant hand. Additionally, while crossing and tortuosity were more commonly noted in the dominant hand (P = .056 for crossing; P = .703 for tortuosity). Conclusion: Abnormal capillaroscopy findings indicate microangiopathy, but this study shows they can also be seen in healthy individuals. Furthermore, this study shows that these findings are more frequent and pronounced in the dominant hand. This study is the first and only study in the literature to compare nailfold capillaroscopy features between the dominant and non-dominant hands.

Purpose: To investigate the effect of disease duration on retinal microvasculature in patients with systemic sclerosis (SSc), and to explore its correlation with nailfold videocapillaroscopy (NFC) findings and systemic organ involvement. Methods: Patients were divided into subgroups according to disease duration (≤5 years, >5 years, <10 years, ≥10 years). Retinal microvasculature was evaluated by OCT-A in the superficial (SCP) and deep (DCP) plexuses, and peripheral microcirculation was assessed by NFC. Correlations between retinal microvascular parameters, disease duration, systemic involvement, and nailfold capillary density were analyzed. Results: This cross-sectional study included 37 SSc patients without retinopathy and 37 healthy controls. The mean duration of disease was 10.5±7.4 (1-30, median: 10.5 years). Central foveal thickness was significantly higher in the SSc group than in controls (p < 0.001). The VD values of SSc patients in both plexuses were significantly lower compared to the healthy control group (p < 0.05, for all). In subgroup analyses, SCP VD was significantly higher in the whole, parafoveal, and perifoveal areas in the SSc-<10y group compared with the SSc-≥10y group (p=0.03, p=0.025, p=0.005). NFC data revealed that the mean capillary number was significantly higher in SSc-<10 y compared to SSc≥10 y (p=0.043). Capillary density was positively correlated with SCP VD (whole; r = 0.606, p < 0.001, parafovea; r=0.487 p=0.002, perifovea, r=0.603 p<0.001). Conclusion: The study findings indicate that SCP-VD may serve as a surrogate quantitative marker of systemic vascular involvement during the progressive course of SSc. OCT-A holds promise as a robust, non-invasive modality for disease monitoring and prognosis.

Background/Aims: Primary Sjögren’s syndrome (pSS) is an autoimmune disease that can affect several systems. The purpose of this study was to examine the connection between primary Sjögren’s disease activity and the CRP-albumin-lymphocyte index (CALLY) and the HALP (hemoglobin, albumin, lymphocyte, and platelet) score, 2 novel immunonutritional indicators that have not yet been applied to rheumatological disease activation. Materials and Methods: This cross-sectional study included 89 patients with pSS and 113 age- and sex-matched individuals. The relationship between haematological, inflammatory, immunonutritional biomarkers, and disease activation was investigated, as were the differences between the groups. Results: Eighty-nine patients (96.6% female, mean age 53.4 ± 15.0 years) and 113 control subjects (97.3% female, mean age 50.8 ± 14.9 years) were included in the study. The levels of C-reactive protein (CRP), erythrocyte sedimentation rate, red cell distribution width, neutrophil lymphocyte ratio, monocyte lymphocyte ratio, platelet lymphocyte ratio, and C-reactive protein albumin ratio were significantly higher in the group of patients with pSS compared to the control group (all; P < .001). Systemic immuneinflammation index and systemic inflammatory response index were significantly elevated in the patient cohort compared to the control group (P = .002 and P = .048, respectively). The CALLY index and HALP score were negatively correlated with EULAR Sjögren’s syndrome disease activity index (P < .001 for both). Conclusion: The CALLY index and HALP score represent a novel approach to assessing disease activity and prognosis in a number of conditions, including stroke, myocardial infarction, osteoarthritis, pulmonary thromboembolism, asthma, chronic obstructive pulmonary disease, and many types of cancer. They may also be useful as a guide to disease activity and monitoring in pSS.

The aim of this study was to explore the link between fear of falling and factors that may contribute to falls in patients with primary Sjögren’s syndrome (pSS). Our study included a total of 67 patients with pSS, aged between 18 and 65. The following tests were performed on each of them by the same researcher: (I) Pain Quality Assessment Scale (PQAS); (II) Berg Balance Scale (BBS); (III) Pittsburgh Sleep Quality Index (PSQI); (IV) Medical Outcomes Study 36-Item Short Form Health Survey (SF-36); (V) Tampa Kinesiophobia Fatigue Scale Questionnaire (TSK-F); (VI) International Falls Efficiency Scale (FES-I); (VII) Timed Up And Go Test (TUG). Disease activities were recorded using the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) criteria. The following factors were associated with a fear of falling: (I) Deterioration in sleep quality (p = 0.031), (II) A decline in general health perception (p < 0.001), (III) Increased severity of pain (p < 0.001), (IV) Kinesiophobia (p < 0.001), (V) Difficulties with timely getting up and walking (p < 0.001), (VI) Increased disease activity (p < 0.001). There is no information available regarding the prevalence or contributing factors of fear of falling in individuals with pSS. This is the first study to examine fear of falling and contributing factors cross-sectionally in a sample of adults with pSS. These findings could aid in the development of a screening instrument to find modifiable risk factors for individuals with pSS who are susceptible to falling anxiety.

Therapeutic plasmapheresis exchange (TPE) treatment is used successfully in many neurological diseases. At our center, TPE is used in many neurological cases in addition to various other diseases. In this study, data of patients who underwent TPE between January 2010 and December 2014 were analyzed. In total, 775 sessions, 114 cycles, and 86 patients’ date were evaluated and analyzed. The median age was 49.8 years. 75 patients were followed in the neurology department and 11 patients were followed in the internal medicine intensive care unit. The most common indications for plasmapheresis were myasthenia gravis, multiple sclerosis, and polyneuropathies (respectively, %35, %21, %9.3). In TPE, hypotension developed much less in those using Fresh Frozen Plasma (FFP) as replacement fluid compared to those using albumin [respectively, 2 (%0.9); 25(%4.4)] (p

Objectives: Connective tissue-associated interstitial lung diseases (CTD-ILD) are believed to be caused by microvascular damage. The objective of this study was to assess the nailfold capillaroscopy (NFC) pattern in patients diagnosed with both CTD-ILD and non-CTD-ILD to identify microvascular changes and determine the relation between capillaroscopic parameters, clinical variables, and disease-related measurements. Patients and methods: This cross-sectional study included 95 patients with interstitial lung disease who applied to our Rheumatology and Chest Clinics between September 2021 and July 2023. The patients were divided into two groups based on their diagnosis: non-CTD-ILD (group 1) and CTD-ILD (group 2). Nailfold capillaroscopy was performed. Results: Ninety-five patients, 49 (51% female, mean age 62.31 ± 11.027 years) in group 1 and 46 (69.6% female, mean age 62.09 ± 10.887 years) in group 2, were included in the study. Abnormal capillary morphologies were both detected in the CTD-ILD group and the non-CTD-ILD groups. In patients with a usual interstitial pneumonia (UIP) pattern on chest computed tomography (CT), tortuosity was higher than in patients with non-specific interstitial pneumonia (NSIP) (P = 0.041), and the proportion of tortuosity increased significantly as the duration of the disease increased (P = 0.016). Conclusion: Our study highlights capillaroscopic abnormalities alone may not be sufficient to differentiate CTD-ILD (other than systemic sclerosis) from non-CTD-ILD. The presence of NFC abnormalities in non-CTD-ILD may suggest that fibrotic lung disease could potentially play a role in the deterioration of the microvascular structure or abnormal angiogenesis. Our study demonstrated that a multidisciplinary approach, incorporating clinical, morphological, pathological, and serological evaluations, is necessary for interpreting ILD. Key Points• Capillaroscopic abnormalities can also be seen in non-CTD-ILD.• Capillaroscopy findings do not distinguish the non-Ssc etiology of ILD.• Nailfold capillaroscopy may have the potential to serve as a useful tool in predicting prognosis and monitoring the disease progression in patients with idiopathic pulmonary fibrosis (IPF).

Background Central sensitization has a major role in health-related parameters in musculoskeletal conditions. There is still a lack of understanding regarding the impact of central sensitization on the interpretation of disease activity and functional disability in primary Sjögren’s syndrome (pSS). Methods The Central Sensitization Inventory (CSI) was used to screen for central sensitization. Disease-related parameters, including objective tests, medication use, the EULAR SS Patient Reported Index (ESSPRI), and the EULAR SS Disease Activity Index (ESSDAI), were assessed. Functionality, quality of life, sleep, and mental health were evaluated by the Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Jenkins Sleep Evaluation Scale (JSS), and Hospital Anxiety and Depression Scale (HADS), respectively. The effect of central sensitization on functionality and disease activity measures was assessed by regression analyses. Results The frequency of central sensitization was 65% in patients with pSS (n = 60). Patients with central sensitization had higher HAQ-DI, ESSPRI, HADS, and JSS and lower SF-36 subdomain scores (p < 0.05 for all). A significant positive correlation was observed between the CSI score and the ESSPRI, JSS, HAQ-DI, and HADS scores (Spearman’s rho ranging from 0.342 to 0.739). The multiple regression analysis indicated that CSI was independently associated with HAQ-DI (adjusted R² = 0.19, B = 0.01) and ESSPRI (adjusted R² = 0.45, B = 0.08) (p < 0.001 for all). Conclusion This study confirms that central sensitization has a major impact on functionality and the interpretation of self-reported disease activity in pSS. When devising strategies for the management of patients with pSS, it is crucial to consider these close relationships. Key Points • The frequency of central sensitization accompanying primary Sjögren’s syndrome is considerable. • Central sensitization was independently associated with functionality and self-reported disease activity assessment. • This close association leads to challenges in functionality, evaluating treatment response, and planning or switching between therapies in primary Sjögren’s syndrome.

Purpose: The aim of this study was to detect infections requiring hospitalization in patients with ANCA-associated vasculitis (AAV). Materials and Methods: This is a single-center, retrospective study conducted in Turkish patients with AAV. Infection episodes requiring hospitalization, reproducing pathogens, laboratory findings, immunosuppressive treatments given for the treatment of vasculitis, and the relationship with the infection were evaluated. Results: Seventy-four patients diagnosed with AAV were included in the study. Hospitalization due to infection was observed in 36 of the patients. The coexistence of diabetes mellitus (DM) was found to be significantly higher in the infected patient group. Cyclophosphamide (CYC) treatment found to increase risk of infection. More than 80% of the infected patient group presented with renal involvement (80.6%). A total of 68 infectious episodes were seen in 36 patients. The most common involvement of infection was the respiratory tract with a rate of 70.6%. Gram-negative bacteria were the most common pathogen, especially Pseudomonas aeruginosa. With the effect of the pandemic, SARS-CoV-2 has come to the fore among viral infections. Aspergillosis was the most frequently detected among fungal infections. Besides, aspergillosis was the cause of 85.7% (6 episodes) of fungal infections. Lymphopenia was observed in 76.5% of the infection episodes. 57.4% of infections developed in the first year of the induction therapy. The most frequently used immunosuppressive therapy for the treatment of vasculitis in infectious episodes was CYC (41.2%). Conclusion: Managing infections during the vasculitis treatment is crucially important. Lymphopenia, kidney involvement, DM and immunosuppressive therapy are factors that increase the risk of infection. Clinicians should take preventive measure especially for respiratory tract infections and gram-negative bacteria as pathogens.