Low relapse rate in patients with giant cell arteritis in a multi-centre retrospective Turkish Registry.

OBJECTIVES: Glucocorticoids (GC) are widely accepted as the standard first-line treatment for giant cell arteritis (GCA). However, relapse rates are reported up to 80% on GC-only protocol arms in controlled trials of tocilizumab and abatacept in 12-24 months. Herein, we aimed to assess the real-life relapse rates retrospectively in patients with GCA from Turkey. METHODS: We assembled a retrospective cohort of patients with GCA diagnosed according to ACR 1990 criteria from tertiary rheumatology centres in Turkey. All clinical data were abstracted from medical records. Relapse was defined as any new manifestation or increased acutephase response leading to the change of the GC dose or use of a new therapeutic agent by the treating physician. RESULTS: The study included 330 (F/M: 196/134) patients with GCA. The mean age at disease onset was 68.9±9 years. The most frequent symptom was headache. Polymyalgia rheumatica was also present in 81 (24.5%) patients. Elevation of acute phase reactants (ESR>50 mm/h or CRP>5 mg/l) was absent in 25 (7.6%) patients at diagnosis. Temporal artery biopsy was available in 241 (73%) patients, and 180 of them had positive histopathological findings for GCA. For remission induction, GC pulses (250-1000 methylprednisolone mg/3-7 days) were given to 69 (20.9%) patients, with further 0.5-1 mg/kg/day prednisolone continued in the whole group. Immunosuppressives as GC-sparing agents were used in 252 (76.4%) patients. During a follow-up of a median 26.5 (6-190) months, relapses occurred in 49 (18.8%) patients. No confounding factor was observed in relapse rates. GC treatment could be stopped in only 62 (23.8%) patients. Additionally, GC-related side effects developed in 64 (24.6%) patients, and 141 (66.2%) had at least one Vasculitis Damage Index (VDI) damage item present during follow-up. CONCLUSIONS: In this first multi-centre series of GCA from Turkey, we observed that only one-fifth of patients had relapses during a mean follow-up of 26 months, with 76.4% given a GC-sparing IS agent at diagnosis. At the end of follow-up, GC-related side effects developed in one-fourth of patients. Our results suggest that patients with GCA had a low relapse rate in real-life experience of a multi-centre retrospective Turkish registry, however with a significant presence of GC-associated side effects during follow-up.

The correlation of plasma atherogenic index and obesity in patients with familial Mediterranean fever.

BACKGROUND: The plasma atherogenic index (PAI) is associated with cardiovascular diseases. This study evaluated the relationship between PAI and obesity in patients with familial Mediterranean fever (FMF) and its advantage over conventional lipid components in predicting obesity. METHODS: The cross-sectional study included 164 FMF patients in the attack-free period and a control group of 160 healthy individuals. Serum lipid components were measured, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). PAI was calculated as log 10 (TG/HDL-C). The relationship between PAI, four conventional lipid profiles, and obesity was evaluated. RESULTS: The mean PAI values (p = 0.003), frequency of obesity (p = 0.005), TC (p = 0.008), TG (p = 0.000), and LDL-C (p = 0.005) values were determined to be statistically significantly higher in the FMF patients than in the control group. The FMF patients with a higher PAI value had a higher risk of obesity, systolic and diastolic blood pressure, TC, and LDL-C, and lower HDL-C (p < 0.001). The Pearson coefficient for PAI (r = 0.854; p < 0.001) was calculated as an explanatory percentage on the variable of obesity of r2 = 0.730. There was a stronger relationship between obesity and PAI than conventional lipid components (p < 0.001). CONCLUSION: We have found that the PAI, BMI, TC, TG, and LDL-C values of the FMF patients were determined to be higher. The higher PAI was strongly correlated to obesity in FMF patients. The first time in FMF patients, PAI showed increased sensitivity to predict obesity, higher than conventional lipid components. It can be a promising biomarker for obesity compared to other lipid components. A low-cost and readily available index derived from routine (TG and HDL-C) tests are advantages in identifying obesity in FMF patients. Key Points • The PAI is valuable for atherosclerotic CVD risk management in patients with rheumatismal diseases. • A correlation is found between PAI level and obesity, and it is used as a biomarker for obesity in the healthy population. • The PAI revealed increased sensitivity to predict obesity, higher than conventional lipid components in FMF patients.

Galectin-3: can it be a diagnostic tool for pneumonia in covid-19 patients?

Background/aim: Biochemical markers are needed to show lung involvement in COVID-19 disease. Galectin-3 is known to play a key role in the inflammation and fibrosis process. We aimed to evaluate the predictive role of galectin-3 levels for pneumonia in patients with COVID-19. Materials and methods: Total of 176 patients with COVID-19, confirmed with reverse transcriptase polymerase chain reaction, admitted to the Erzurum Regional Training and Research Hospital was analyzed. The study was designed as a cross sectional. The baseline data of laboratory examinations, including galectin-3 were collected at the time of diagnosis. CT images evaluated by a single radiologist according to the recommendation of the Radiological Society of North America Expert Consensus Document for pulmonary involvement. The severity of COVID-19 pneumonia was assessed using the total severity score. Results: The mean galectin-3 level in patients with typical pneumonia was found to be significantly higher than those patients with atypical (p < 0.01) and indeterminate appearance (p < 0.01) and patients without pneumonia (p < 0.01). The severity of lung involvement was significantly associated with Galectin-3 levels (p < 0.01 r: 0.76). Stepwise logistic regression model showed that the levels of ferritin (odds ratio [OR] = 0.05, p: 0.08) and galectin-3 (OR = 0.1, p < 0.01) were significantly and independently associated with typical pneumoniain COVID-19 patients. When COVID-19 patients were evaluated in terms of typical pneumonia, we determined a cut-off value of 18.9 ng/mL for galectin-3 via ROC analysis (87% sensitivity; 73% specificity; area under curve (AUC): 0.89; p < 0.001). Conclusion: Galectin-3 was found as a diagnostic tool for COVID-19 associated typical pneumonia and as an indicator of both pneumonia and its severity.

Relationship between Metabolic Syndrome and Uric Acid Levels in Patients with Familial Mediterranean Fever.

BACKGROUND: This study aims to investigate the prevalence of metabolic syndrome (MetS) in familial Mediterranean fever (FMF) and the relationship between serum uric acid (SUA) concentrations and MetS status by sex in patients with FMF. METHODS: This cross-sectional study included all attack-free patients previously diagnosed with FMF who referred to the rheumatology clinic for follow-up between October 2018 and January 2019. This study included 154 patients with FMF (66 males and 88 females) and 154 controls (62 males and 92 females) with similar age and sex. RESULTS: MetS was more prevalent among the FMF patients compared to the controls (42.90% [95% CI: 34.9-51.1%) vs. 28.57% [95% CI: 21.6-36.4%); OR=1.88, 95% Cl: 1.17-3.01, P=0.009]. In the FMF group, we found higher SUA, number of MetS components, body mass index (BMI), waist circumference (WC), and insulin compared to the control group (P<0.001, P<0.001, P=0.018, P=0.002, P=0.008, respectively). The prevalence of MetS (men: P<0.001, women: P<0.001) and number of MetS components (men: P<0.001, women: P<0.001) were significantly increased with increasing SUA quartiles in both sexes. CONCLUSION: The prevalence of MetS was higher in patients with FMF, and the prevalence of MetS and number of MetS components were significantly increased with increasing SUA quartiles in both men and women with FMF. SUA levels, as a biochemical marker, could be a strong and independent predictor of MetS in patients with FMF, and may provide substantial help with early diagnosis and management of MetS.

The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis.

BACKGROUND This study aimed to evaluate the ratio of C-reactive protein (CRP) to albumin, inflammatory markers, and parameters from the complete blood count (CBC) in patients with Takayasu arteritis and the association with disease activity. MATERIAL AND METHODS A retrospective study included thirty-two patients with Takayasu arteritis and 32 healthy controls. Clinical and demographic characteristics of patients with Takayasu arteritis were recorded at baseline, before medication and on remission. Similar data were obtained for the controls at recruitment. Remission was defined as more than six months of stable disease without new vascular lesions in patients who previously had active disease. Kerr's criteria were used to define active Takayasu arteritis. RESULTS In patients with Takayasu arteritis, the erythrocyte sedimentation rate (ESR), CRP, CRP/albumin ratio, red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) were significantly higher, and albumin and MPV were significantly lower compared with controls. The ESR, CRP, CRP/albumin ratio, NLR, PLR, and MLR were decreased in remission, whereas MPV was increased. CRP and the CRP/albumin ratio were positively correlated and albumin and MPV were negatively correlated with disease activity. The CRP/albumin ratio had the highest correlation with disease activity in Takayasu arteritis. The CRP/albumin ratio, RDW, NLR, PLR, and MLR were positively correlated with CRP and ESR. CONCLUSIONS The CRP/albumin ratio, RDW, NLR, PLR, MLR, and MPV were markers of remission of active disease, and the CRP/albumin ratio, total albumin, and MPV were markers of disease activity in Takayasu arteritis.

Foot functions in ankylosing spondylitis.

ABTRACT: AIM: Because of the wide diversity of developmental stages in spondyloarthropathies (SpA), clinical and radiographic weak correlations are often found in the development of enthesopathies. In this study, foot functions of ankylosing spondylitis (AS) patients were analyzed with clinical and radiological features. METHOD: Sixty-two AS patients and 39 age-matched, gender-matched, and body mass index (BMI)-matched healthy volunteers were included in this study. Acute-phase reactant levels of participants were recorded. The disease activity and functionality were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Foot functional index (FFI) and timed up and go test (TUG) were performed by the same educated nurse. Radiographically, the SpA-tarsal radiographic index (TRI) and the calcaneal inclination angle (CIA) were measured by the same physician to assess midfoot and arches. RESULTS: FFI subscores and total, TUG results, and CIA measurements were found to be significantly higher in the AS group (p < 0.05). FFI-pain, FFI-disability, and FFI-activity limitation subscores were significantly and positively correlated with BASDAI and BASFI scores (p < 0.05). Radiological changes ranging from grade 1 to grade 4 were detected in 68% of the AS paients according to TRI. Nineteen AS patients had pes planus and 26 AS patients had pes cavus deformity. CONCLUSION: The foot and ankle are frequently affected during the course of AS. Foot involvement and its functional impacts should be assessed regardless of the disease activity parameters in AS patients.