Yusuf Doğan

Background and Objectives: Vitamin D deficiency is common in systemic lupus erythematosus (SLE) and Behçet’s disease (BD). However, whether it is associated with the same clinical parameters in both conditions remains unknown. Our objective is to compare the clinical correlates of serum 25-hydroxyvitamin D [25(OH)D] levels in patients with SLE and BD. Materials and Methods: This exploratory cross-sectional study included 38 patients with SLE and 32 with BD. Spearman’s correlation analyses, partial correlations controlling for sex, and tertile analyses were performed separately for each disease group. Results: Vitamin D deficiency [25(OH)D < 20 ng/mL] was similarly prevalent in SLE (64.9%) and BD (62.5%). However, distinct disease-specific correlation profiles were noted. In SLE, serum 25(OH)D levels were inversely correlated with body mass index (BMI) (r = −0.47, p = 0.003) and parathyroid hormone (PTH) (r = −0.40, p = 0.01), with no significant associations with inflammatory or haematological parameters. In patients with BD, 25(OH)D levels were positively correlated with haemoglobin (r = 0.63, p < 0.001), haematocrit (r = 0.58, p < 0.001), ferritin (r = 0.47, p = 0.008), uric acid (r = 0.48, p = 0.005), transferrin saturation (r = 0.45, p = 0.02), and triglycerides (r = 0.44, p = 0.01), while they were inversely correlated with total iron-binding capacity (r = −0.50, p = 0.01) and erythrocyte sedimentation rate (ESR) (r = −0.44, p = 0.01). After adjusting for sex, the association between 25(OH)D and haemoglobin remained significant (partial r = 0.43, p = 0.01), as did the associations with haematocrit (partial r = 0.42, p = 0.02) and triglycerides (partial r = 0.43, p = 0.02). In contrast, the correlations with ferritin, ESR, uric acid, and transferrin saturation were attenuated and no longer statistically significant. Tertile analyses demonstrated dose–response relationships between vitamin D levels and BMI (p = 0.01) and PTH (p = 0.008) in SLE, and between vitamin D levels and haemoglobin (p = 0.001) and ferritin (p = 0.02) in BD. Conclusions: Despite the similar prevalence of vitamin D deficiency, patients with SLE and BD exhibit distinct vitamin D-associated clinical profiles. Vitamin D status was primarily associated with metabolic parameters in SLE and haematological parameters in BD. These disease-specific patterns may reflect differences in the underlying inflammatory pathways and pathophysiological mechanisms involved.

Objective: Interstitial lung disease (ILD) is the leading cause of mortality in systemic sclerosis (SSc). The Warrick semiquantitative scoring system and the Goh staging algorithm provide different approaches for assessing lung involvement on high-resolution computed tomography (HRCT). We compared their sensitivity for detecting radiological progression in SSc-ILD. Methods: We retrospectively analyzed 33 patients with SSc-ILD who underwent serial HRCT examinations. Each scan was evaluated using the Warrick score (0-30) and Goh staging (limited/extensive). Progression was defined as an increase of ≥ 3 points in the Warrick score or transition from limited to extensive disease by Goh staging. Comparative progression analysis was restricted to the 24 patients with baseline limited disease, as only these patients were eligible for Goh-defined progression. Progression rates were compared using the McNemar test, and receiver-operating characteristics analysis assessed Warrick score thresholds for identifying Goh-defined extensive disease. Results: The cohort included 33 patients (85% female; mean age 53.2 [SD 8.9] years), all with diffuse cutaneous SSc. At baseline, 24 (73%) had limited disease and 9 (27%) had extensive disease. Among patients with baseline limited disease, Warrick scoring identified progression in 15 (62%) compared with 8 (33%) by Goh staging (McNemar chi-square test 7.00, P = 0.01). All Goh progressors also fulfilled Warrick progression criteria, whereas 7 additional patients showed Warrick progression without stage transition. Among baseline extensive patients, 6 (67%) demonstrated further radiological worsening according to Warrick scoring. Follow-up Warrick scores showed excellent discrimination for Goh-defined extensive disease (area under the curve 0.94, 95% CI 0.86-1.00), with an optimal threshold of 20 points (sensitivity 88%, specificity 88%). Agreement between methods was substantial (Cohen κ 0.76). Conclusion: Warrick scoring was significantly more sensitive than Goh staging for detecting radiological progression in SSc-ILD and remained informative in patients already classified as having extensive disease, supporting its use in longitudinal monitoring.

Objective: Identify clinical and biochemical predictors of major adverse cardiovascular events in rheumatoid arthritis (2010–2024), quantifying the contributions of traditional risk factors (dyslipidemia, hypertension, diabetes) and RA-related (Rheumatoid Arthritis) disease characteristics. Methods: We conducted a retrospective cohort study of 232 adults with rheumatoid arthritis (RA) followed at our rheumatology clinic between January 2010 and March 2024. RA was classified by the 2010 ACR/EULAR criteria. Demographics (age, sex), disease duration, body mass index, smoking, and comorbidities (hypertension, diabetes, dyslipidemia, chronic kidney disease) were extracted from records. Baseline laboratories included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urea, creatinine, lipid profile (total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, triglycerides), uric acid, and HbA1c. Disease markers (RF, anti-CCP, HLA-B27), cumulative treatment exposure, treatment modifications, and use of csDMARDs (Disease-modifying antirheumatic drug), bDMARDs (Tumor Necrosis Factor (TNF/non-TNF)), and Januse Kinase (JAK) inhibitors were recorded. Patients were stratified by major adverse cardiovascular events (Major adverse cardiovascular events (MACE): non-fatal MI (Miyocardial Infarction), ischemic stroke, cardiovascular death, or coronary revascularization). Results: Results: MACE occurred in 41 patients. Compared with those without MACE, affected patients were older and had more treatment changes and prior biologic exposures. They showed worse renal indices (higher urea/creatinine) and an adverse metabolic profile— higher total cholesterol, LDL-cholesterol, triglycerides, and HbA1c. Sex, disease duration, Body Mass Index (BMI), ESR/CRP, time to first bDMARD, Aspartate Transaminase (AST), Alanine Transaminase (ALT), uric acid and HDL did not differ. Cardiometabolic comorbidities were strongly enriched among MACE cases (hypertension, diabetes, dyslipidemia). In multivariable logistic regression, dyslipidemia remained the only independent predictor of MACE (OR 27.04; 95% CI 9.18–79.68; p<0.001). Hypertension and the number of treatment modifications showed non-significant-trends. Conclusion: Conclusion: In RA, MACE was associated with older age and metabolic risk, but dyslipidemia was the only independent predictor. These findings support prioritizing lipid monitoring and cardiovascular risk management in routine RA care.

Background: Behçet’s disease is a multisystem inflammatory disorder with a variable clinical course. This study evaluated the association between inflammatory indices, clinical involvement, and mortality. Methods: This retrospective study included 444 patients with BD. Clinical characteristics and laboratory data were systematically retrieved from electronic medical record system. Inflammatory indices (NLR, PLR, SII) were calculated to reflect systemic inflammation. In addition, CRP-based composite indices (IBI-NLR and IBI-SII) were derived to integrate cellular and acute-phase inflammatory responses. Disease manifestations, major organ involvement, comorbidities, and mortality were recorded to comprehensively assess disease burden and clinical outcomes. Results: In multivariable analysis, vascular involvement was associated with increased ESR level (OR = 1.013, 95% CI: 1.002–1.024, p = 0.018), and male sex (OR = 3.22, 95% CI: 1.83–5.67, p < 0.001;). ROC analysis showed the highest discriminatory performance for vascular involvement, with IBI-NLR (AUC = 0.624, p < 0.001), IBI-SII (AUC = 0.609, p = 0.001) and NLR (AUC = 0.597, p = 0.004). Moreover, NLR (AUC = 0.571, p = 0.017), IBI-NLR (AUC = 0.576, p = 0.010), and IBI-SII (AUC = 0.562, p = 0.036) had modest discrimination for major organ involvement. In contrast, inflammatory indexes were not predictive for mortality (p > 0.05 for all). Mortality was independently associated with higher creatinine (OR = 1.086, p = 0.048), higher ESR (OR = 1.023, p = 0.046), and lower uric acid levels (OR = 0.454, p = 0.002). Conclusions: Inflammatory indices may not predict mortality in BD but can help identify vascular and major organ involvement. Male sex and ESR level are associated more severe disease, while mortality is associated with renal dysfunction and systemic inflammation in BD.

The development of inflammatory arthritis after bariatric surgery has been sporadically reported, but systematic clinical and imaging descriptions remain l

Background: Behçet’s disease is a multisystem inflammatory disorder with a variable clinical course. This study evaluated the association between inflammatory indices, clinical involvement, and mortality. Methods: This retrospective study included 444 patients with BD. Clinical characteristics and laboratory data were systematically retrieved from electronic medical record system. Inflammatory indices (NLR, PLR, SII) were calculated to reflect systemic inflammation. In addition, CRP-based composite indices (IBI-NLR and IBI-SII) were derived to integrate cellular and acute-phase inflammatory responses. Disease manifestations, major organ involvement, comorbidities, and mortality were recorded to comprehensively assess disease burden and clinical outcomes. Results: In multivariable analysis, vascular involvement was associated with increased ESR level (OR=1.013, 95% CI: 1.002–1.024, p=0.018), and male sex (OR=3.22, 95% CI: 1.83–5.67, pConclusions: Inflammatory indices may not predict mortality in BD but can help identify vascular and major organ involvement. Male sex and ESR level are associated more severe disease, while mortality is associated with renal dysfunction and systemic inflammation in BD.

To evaluate the potential efficacy of adjunctive ozone therapy combined with tocilizumab in treating refractory lower extremity ulcers in patients with diffuse systemic sclerosis (SSc). We report two female patients with diffuse SSc who developed refractory ulcers despite prior therapies, including azathioprine, mycophenolate mofetil, cyclophosphamide, and vasodilators. Both patients were receiving weekly subcutaneous tocilizumab (162 mg) when ozone therapy was introduced. The protocol consisted of major autohemotherapy with ozone (initial dose 15 µg/mL; maintenance dose 65 µg/mL), combined with ozone bagging. Treatment included 25 daily sessions, 25 twice-weekly sessions, and subsequent weekly maintenance sessions. Both patients exhibited significant ulcer healing, pain reduction, and improved mobility, suggesting synergistic effects beyond those of tocilizumab monotherapy. Refractory SSc-associated ulcers remain a therapeutic challenge. The combination of tocilizumab and ozone therapy may provide additional benefits through anti-inflammatory and microcirculatory mechanisms. Controlled trials are warranted.

Cavitary pulmonary nodules (CPN) represent a rare but clinically relevant manifestation of rheumatoid arthritis (RA), yet their radiological and serological predictors remain poorly defined. This study aimed to identify key clinical, immunological, and imaging features associated with CPN among RA patients presenting with pulmonary nodules (PN). This retrospective cohort included 156 RA patients with PN identified on thoracic computed tomography between 2010 and 2024. Clinical data, autoantibody status, treatment characteristics, and radiological parameters were compared between patients with and without CPN. CPN were detected in 9.0% (n = 14) of cases. Compared to patients without CPN, affected individuals had a significantly greater number of nodules, larger nodule diameters, and higher seropositivity for rheumatoid factor, anti-cyclic citrullinated peptide antibodies, and ANCA. The largest nodule diameter was the only independent predictor of cavitary transformation (OR: 1.59, 95% CI: 1.19-2.12; p = 0.002), with stronger effect sizes in penalized regression (OR: 6.69 per SD; 95% CI: 3.52-12.61). Despite limited sample size, ROC analysis identified an optimal cut-off of 18 mm, yielding excellent discriminative performance (AUC: 0.979; sensitivity: 92.9%, specificity: 95.8%), further supported by bootstrap validation. No significant differences in baseline treatments were observed, though greater variability in drug exposure and post-diagnostic therapy adjustments was noted in CPN-positive patients. Radiological morphology-particularly increased nodule size-alongside autoantibody positivity, are key correlates of cavitary transformation in RA-associated PN. These findings support the use of imaging-based risk stratification and highlight the need for prospective validation across broader RA populations. Key Points • CPN were detected in 9% of RA patients with PN on CT imaging • Larger PN diameter emerged as the principal independent predictor of cavitary transformation, with an18 mm cut-off providing high discriminative capacity (AUC = 0.979). • Seropositivity for RF, anti-CCP, and ANCA IFA was significantly associated with cavitation. • Greater heterogeneity in pre-diagnostic leflunomide exposure and more frequent post-diagnostictherapy modifications among CPN-positive patients suggest a dynamic and potentially treatmentinfluenceddisease pattern, possibly reflecting variability in therapeutic response over time.

Background/Objectives: Isthmin-1 (ISM1) is a secreted protein involved in immune regulation, inflammation, and angiogenesis. Although ISM1 has been implicated in chronic inflammatory conditions, its clinical relevance in rheumatoid arthritis (RA) remains unknown. This study aimed to evaluate serum ISM1 levels in RA patients and assess their associations with disease activity, autoantibody status, and inflammatory markers. Methods: This cross-sectional study included 90 RA patients fulfilling the 2010 ACR/EULAR criteria and 30 age- and sex-matched healthy controls. Serum ISM1 concentrations were measured using ELISA. Disease activity was assessed using DAS28-CRP and DAS28-ESR. Statistical analyses included group comparisons, correlation testing, multivariate linear regression, and ROC curve analysis to evaluate the predictive performance of ISM1 for remission or low disease activity. Results: Serum ISM1 levels were significantly lower in RA patients than in controls (454 ± 378 vs. 972 ± 809 ng/L, p < 0.001). ISM1 concentrations were inversely correlated with CRP, ESR, and both DAS28 indices. Multivariate regression confirmed independent associations between lower ISM1 concentrations and higher disease activity. ISM1 levels were significantly reduced in RF- and anti-CCP-positive patients, as well as in treatment-naïve early RA. ROC analysis identified a cut-off value of 673.73 ng/L for predicting remission or low disease activity, with an AUC of 0.713 (95% CI: 0.596–0.820), 100% specificity, and 38.9% sensitivity. Conclusions: This study is the first to demonstrate that serum ISM1 is independently associated with disease activity and autoantibody positivity in RA. High ISM1 levels may serve as a specific indicator of clinical remission or low disease activity, supporting its potential as a non-invasive biomarker for disease monitoring.

Aim:Behçet’s disease (BD) is characterized by the presence of skin and mucosal lesions, systemic inflammation, and vasculitis. The objective of this study was to examine changes in urotensin II (UII) and sclerostin levels in patients with BD and to assess their correlation with atherosclerosis. Material and Methods:The study population comprised 32 patients with BD, 39 with systemic lupus erythematosus, and 30 healthy controls. A series of clinical examinations were conducted, and blood samples were obtained to analyze UII and sclerostin levels by enzyme-linked immunosorbent assay. The carotid intima-media thickness (cIMT) was evaluated using Doppler ultrasonography. Results:UII levels were significantly elevated in the BD group compared with the other groups (p<0.001). Conversely, sclerostin levels were markedly diminished in the BD group (p<0.001). In the BD group, UII levels were positively correlated with cIMT (r=0.513, p<0.001), whereas sclerostin levels were negatively correlated with cIMT (r=-0.270, p=0.020). Conclusion:Elevated UII and reduced sclerostin levels are crucial biomarkers of atherosclerosis risk in individuals with BD. These findings help to elucidate the cardiovascular complications associated with BD.