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.

Quality of healthcare information on YouTube: psoriatic arthritis.

BACKGROUND: YouTube is an increasingly used platform for medical information. However, the validity of health-related information on psoriatic arthritis (PsA) on YouTube has not been determined. OBJECTIVE: The purpose of this study was to evaluate the accuracy and quality of YouTube videos concerning PsA. MATERIALS AND METHODS: A YouTube search was performed on April 18, 2021, using the keyword "psoriatic arthritis." Two independent raters accessed the content, source, and detailed characteristics of the included videos. The reliability and quality of the videos were analyzed using the modified DISCERN score, Journal of the American Medical Association benchmark criteria score, and global quality scale score. RESULTS: Of the 200 videos screened, 155 were included in the study after applying the exclusion criteria. A total of 132 (85.2%) videos revealed useful information about PsA, whereas the remaining 23 (14.8%) were misleading. Video interaction parameters including the median number of views, views per day, likes, dislikes, and comments demonstrated no significant difference between the two groups. The videos posted by universities and professional organizations displayed the highest reliability and quality scores. CONCLUSION: The majority of YouTube videos on PsA contained useful information. However, physicians should alert patients to the possibility of misinformation and non-validated sources. Professional organizations in the field of rheumatology, such as the American College of Rheumatology and European League Against Rheumatism, should consider collaborating with YouTube to deliver high-quality content.

Quality of English-language videos available on YouTube as a source of information on osteoporosis.

Osteoporosis awareness is essential for preventing osteoporotic fractures. Social media platforms have enormous potential to both support and deter patients' decisions on healthcare. The current study demonstrated that the majority of YouTube videos on osteoporosis provide useful information with sufficient quality. PURPOSE: YouTube is the most popular video-sharing platform for patients seeking online information about their medical condition. However, there are concerns regarding the accuracy and quality of YouTube content. We aimed to analyze the quality of English-language YouTube videos on osteoporosis. METHODS: A YouTube search was performed on April 21, 2021, using the keywords "osteoporosis," "osteoporosis exercise," "osteoporosis diet," and "osteoporosis treatment." The reviewers recorded the content, source, and detailed characteristics of the included videos. The reliability and quality of the videos were analyzed using the modified DISCERN score and Global Quality Scale (GQS) score by a rheumatologist and endocrinologist. RESULTS: Of the 400 videos screened, 238 were included in the study after applying the exclusion criteria. A total of 205 (86.1%) videos revealed useful information about osteoporosis whereas 33 (13.9%) were misleading. In terms of quality, 48% of the videos were of high quality, 34% were of moderate quality, and 18% were of low quality. The videos posted by universities and professional organizations had the highest modified DISCERN and GQS scores indicating high reliability and quality. CONCLUSION: This study demonstrated that the majority of YouTube videos on osteoporosis contained useful information with sufficient quality. However, physicians should be aware of misleading information and correct any misinformation during face-to-face meetings with patients. YouTube should consider creating partnerships with professional organizations in the field of osteoporosis to produce high-quality videos in line with their new health content policy.

Budd-Chiari syndrome in Behçet's disease: a retrospective multicenter study.

OBJECTIVE: To compare the clinical features, laboratory findings, and prognosis of Behçet's disease (BD) patients with and without Budd-Chiari syndrome (BCS). METHODS: This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017. RESULTS: Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p < 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14-47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%). CONCLUSION: To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.

Educational quality of YouTube videos on musculoskeletal ultrasound.

INTRODUCTION/OBJECTIVES: A progressively growing number of rheumatologists have integrated musculoskeletal ultrasound (MSUS) as a prized tool in their daily clinical practice over the past two decades. Lately, YouTube is often used by healthcare professionals as an educational tool. This study aimed to analyze the quality of educational information available on YouTube pertaining to MSUS. METHOD: We performed a search using the keyword "musculoskeletal ultrasound" on YouTube in January 2021. Of the first 200 videos screened, 147 met the inclusion criteria. The quality and reliability of the videos were evaluated using the global quality score (GQS) and modified DISCERN score, and their popularity was assessed using the Video Power Index (VPI). RESULTS: Of the 147 videos evaluated, 58 (39.5%) were of high quality, 30 (20.4%) were of moderate quality, while 59 (40.1%) were of low quality. The modified DISCERN score and the duration of the videos were significantly higher in the high-quality videos than the moderate- and low-quality videos (p < 0.001 for all). The median number of views per day, likes, comments, and the popularity of the videos assessed with VPI were significantly higher in the high- and moderate-quality group compared to the low-quality videos (p < 0.001, p < 0.001, p = 0.007, and p < 0.001, respectively). CONCLUSION: The quality of YouTube videos as an educational source on MSUS is unsatisfactory. Professional organizations and physicians should consider creating more high-quality MSUS videos. YouTube should consider filtering out poor-quality videos in collaboration with experts in the field. Key Points • Although rheumatologists are increasingly using ultrasound as an extension of their exam, accessing musculoskeletal ultrasound training is still facing some challenges. • YouTube is commonly used as an educational source by medical students and healthcare professionals. • Approximately 60% of the videos related to musculoskeletal ultrasound on YouTube revealed high and moderate quality, while the remaining 40% were of low quality and not suitable for medical education. • A filtering mechanism is required to improve the quality of YouTube content on MSUS.

YouTube as a source of information on gout: a quality analysis.

YouTube is a popular video-sharing platform commonly visited by patients and healthcare professionals for medical information. Gout is the most frequent cause of inflammatory arthritis in adults. However, the accuracy and quality of gout-related information on YouTube are not fully known. Thus, the aim of this study was to assess the reliability and quality of YouTube videos pertaining to gout. A YouTube search was conducted using the keywords "gout", "gout arthritis", "gout treatment", and "gout diet". Of the 240 videos screened, 114 that met the inclusion criteria were included in the study. The number of days since upload, number of views, likes, dislikes, comments and duration of the videos were recorded. A Modified DISCERN tool and the Global Quality Scale (GQS) were used to evaluate the reliability and quality of the videos. Of the 114 analyzed videos, 87.72% were deemed as useful while 12.28% contained misleading information with higher viewership. The most common topic was "gout diet". The majority of the videos demonstrated high quality (57.89%), followed by intermediate quality (28.95%) while the percentage of low-quality videos was 13.16%. Videos posted by academic institutions/professional organizations and physicians had higher modified DISCERN and GQS scores indicating higher reliability and quality. This study demonstrated that the majority of YouTube videos on gout provide useful information. However, physicians should be aware of the limited nature of YouTube and correct any misinformation during face-to-face meetings. YouTube should consider avoiding misleading videos using validity scales such as modified DISCERN and GQS.

The adaptation of the Postpartum-Specific Anxiety Scale into the Turkish language.

Background: The Postpartum Specific Anxiety Scale (PSAS) is used as a descriptive instrument to measure anxiety. Aim: The aim of this study was to examine the validity and reliability of the Turkish version of the PSAS. Study Design: The study is of methodological design. Methods: The study was conducted with 360 women who had given birth four months ago and presented at a Family Health Center. The validity analysis of the data was performed using the content validity index, exploratory factor analysis, confirmatory factor analysis, reliability analysis, Pearson's Moments Multiplication Correlation and Cronbach's Alpha Coefficient of Reliability. Correlation analysis, Cronbach's alpha analysis, and exploratory/confirmatory factor analysis were used in the evaluation of the data. Results: To assess the consistency of the scale over time, test-retest measurements were taken in a two-week interval. In the analysis of the internal consistency of the PSAS, Cronbach's alpha coefficient of reliability was .90 for maternal competence and attachment anxieties, .89 for infant safety and welfare anxieties, .83 for practical infant care anxieties, .83 for psychosocial adjustment to motherhood, and .94 for the overall scale. Conclusion: Our study has demonstrated that the Turkish version of the scale is a valid and reliable tool to use.

YouTube for information about side effects of biologic therapy: A social media analysis.

OBJECTIVE: Biologic therapies are one of the most significant breakthroughs in the treatment of rheumatic diseases, although there is still some uncertainty surrounding long-term patient safety. Recently, a growing number of patients browse the Internet as a source of health-related information. We aimed to assess the quality of information available on YouTube videos regarding the side effects of biologic therapy. METHODS: We used the keywords "biologic therapy side effects," "biologic therapy risks," "biologic therapy safety," "biologic agents side effects," "biologic agents risks," and "biologic agents safety." Also, the generic and commercial names of biologic agents were searched on YouTube in May 2020. The quality and reliability of the videos was assessed according to the global quality score (GQS), DISCERN score. Video Power Index (VPI) used to assess both the view and the like ratios of the videos. RESULTS: Seventy-five videos were evaluated. According to the GQS, 31 videos (40.3%) were of high quality, 18 videos (23.4%) were of intermediate quality, and 28 videos (36.4%) were of low quality. The GQS was significantly positively correlated with the DISCERN score (P < .001). VPI scores were not correlated with DISCERN (P = .268) and GQS scores (P = .411). CONCLUSION: YouTube videos on the side effects of biologic therapy are informative for patients and physicians. High-quality videos are more reliable but may not be as popular as expected.

Monocyte to Lymphocyte Ratio, Neutrophil to Lymphocyte Ratio, and Red Cell Distribution Width are the Associates with Gouty Arthritis.

BACKGROUND: Neutrophils, monocytes, and macrophages activations are associated with a gout attack. Monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), and mean platelet volume (MPV) are well-known inflammation markers. In this study, we aimed to investigate whether they could be a predictive marker to the gout attack. MATERIAL AND METHODS: A hundred and ten gout patients (male/female, 86/24) and 90 (male/female, 64/26) age-, gender-, and body mass index-matched volunteer controls were included in the study. Blood samples were obtained in the intercritical and attack period of the patients. Hemogram, serum uric acid (SUA), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) values were studied. RESULTS: In the attack period NLR (p < 0.001), PLR (p < 0.05), MLR (p < 0.001), RDW (p < 0.05), MPV (p < 0.05), ESR (p < 0.001), CRP (p < 0.001) and SUA (p < 0.001) values were significantly higher than intercritical period values. According to the results of regression analysis; There was an independent strong relationship between the gout attack and SUA, (Beta [ß] = 0.352, p < 0.001), ESR (ß = 0.329, p < 0.001), CRP (ß = 0.286, p < 0.001), MLR (ß = 0.126, p < 0.001), RDW (ß = 0.100, p = 0.003) and NLR (ß = 0.082, p = 0.014). CONCLUSIONS: MLR, RDW, and NLR may be a strong predictive marker for a gout attack. MPV and PLR values in the gout attack may be associated with systemic inflammation.

Patients' concerns regarding biological agents in rheumatology.

OBJECTIVE: The potential side effects of biological agents may increase the anxiety levels of patients and influence not only their desire to use these therapies but also their concordance to treatment. This study aimed to determine the level and prevalence of drug-related concern in patients treated with biological agents and to acquire additional information regarding the related causes. MATERIALS AND METHODS: A total of 1134 patients who were using biological agents for at least 3 months with a diagnosis of rheumatic diseases were enrolled. General anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI). RESULTS: The most common cause for drug-related concerns was the potential side effects of the drugs (59.5%). Among the potential side effects, cancer risk was the most common cause for concern (40.1%), followed by the risk of tuberculosis activation (30.7%). Anxiety levels were higher in patients who experienced side effects than in other patients, and this difference was statistically significant (P < 0.05). STAI trait and state scores were moderately correlated with anxiety levels related to the drug (P < 0.001). CONCLUSION: Anxiety related to biological agents may significantly affect the patients' anxiety levels. Awareness regarding the patients' concerns and expectations related to the drug is important to ensure drug adherence and concordance to treatment.

Ventricular repolarization disturbances after high dose intravenous methylprednisolone Theraphy.

OBJECTIVE: There are no randomized trials evaluating the effects of pulse steroid treatment on cardiac electrophysiologic functions. The data are limited only to case series. In this study, we sought to evaluate the effects of high dose intravenous methylprednisolone therapy on indices of ventricular repolarization. METHODS: Fifty patients with various autoimmune and inflammatory disorders were enrolled to the study. Electrocardiography (ECG) was obtained 4h before and 12h after the pulse steroid treatment. All ECGs were thoroughly evaluated by an experienced electrophysiologist. Indices of ventricular repolarization including QTc, JT, Tp-Te, Tp-Te/QTc were measured and compared with before and after-treatment ECGs. RESULTS: There were 36 female and 14 male patients. Mean age was 36±13years. Heart rate was significantly reduced after the therapy (87,16±17,45bpm vs 73,86±17,45 p:0,001). QT interval (361,0±29,91 vs 388,20±42,84 p:0,001) and corrected QT interval (QTc) was significantly prolonged (401,60±19,79 vs 413,72±26,38 p:0,01) after pulse steroid therapy. Also, JT interval (273,0±28,73 vs. 299,60±45,66 p:0,001) and JT interval index (JTI%) was significantly prolonged (118,18±17,54 vs. 110,56±13,92 p:0,01). Tp-e interval was significantly prolonged after high-dose steroid treatment (74,60±13,12 vs. 83,80±13,68 p:0.001). The ratio of Tp-Te to QTc was also significantly increased after pulse steroid therapy (0,18±0,03 vs 0,20±0,03 p:0,009). CONCLUSION: Our study shows that indices of ventricular repolarization are significantly prolonged after pulse steroid treatment. These findings indicate an increased risk of arrhythmias related to high dose intravenous methylprednisolone therapy.

Three cases of anti-TNF induced myositis and literature review / Três casos de miosite induzida pelo anti-TNF e revisão da literatura

Abstract Anti-tumor necrosis factor drugs are frequently preferred in the treatment of rheumatologic diseases and other inflammatory diseases. The development of myositis after using anti-tumor necrosis factor drugs is a rare clinical condition. Here we aimed to report cases who developed myositis after using anti-tumor necrosis factor drugs and review the current literature. We report two cases of rheumatoid arthritis and a case of ankylosing spondylitis developed idiopathic inflammatory myopathy following anti-tumor necrosis factor therapy. In conclusion, myositis could develop during anti-tumor necrosis factor therapy, so these patients should be evaluated carefully initially for myositis and should be closely monitored due to the potential for developing myositis in treatment process.

Resumo Os fármacos antifator de necrose tumoral (anti-TNF) são frequentemente preferidos no tratamento de doenças reumatológicas e outras doenças inflamatórias. O desenvolvimento de miosite após o uso de anti-FNT é uma condição clínica rara. Este estudo objetivou descrever casos de pacientes que desenvolveram miosite após o uso de anti-TNF e fazer uma revisão da literatura atual. Descrevem-se dois casos de artrite reumatoide (AR) e um caso de espondilite anquilosante (EA) que desenvolveram miopatia inflamatória idiopática após o tratamento com anti-TNF. Em conclusão, pode haver desenvolvimento de miosite durante o tratamento com anti-TNF, de modo que esses pacientes devem ser cuidadosamente avaliados inicialmente à procura de miosite e devem ser cuidadosamente monitorados em razão do potencial de desenvolvimento de miosite no processo de tratamento

Three cases of anti-TNF induced myositis and literature review.

Anti-tumor necrosis factor drugs are frequently preferred in the treatment of rheumatologic diseases and other inflammatory diseases. The development of myositis after using anti-tumor necrosis factor drugs is a rare clinical condition. Here we aimed to report cases who developed myositis after using anti-tumor necrosis factor drugs and review the current literature. We report two cases of rheumatoid arthritis and a case of ankylosing spondylitis developed idiopathic inflammatory myopathy following anti-tumor necrosis factor therapy. In conclusion, myositis could develop during anti-tumor necrosis factor therapy, so these patients should be evaluated carefully initially for myositis and should be closely monitored due to the potential for developing myositis in treatment process.

Rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies with hepatitis B and hepatitis C infection: Review.

BACKGROUND: Viruses are common and are involved in the etiology of idiopathic rheumatological diseases. Hepatitis B virus (HBV), a member of the family Hepadnaviridae and hepatitis C virus (HCV), play an important role in the undetermined etiology of arthritis. The clinical manifestations of hepatitis B and C show similarities with various diseases, such as rheumatic diseases. Anti-cyclic citrullinated peptide (anti-CCP) is a specific serological marker for rheumatoid arthritis. OBJECTIVES: The aim of this study was to analyze anti-CCP and rheumatoid factor (RF) levels in patients with a hepatitis B and C infection. MATERIAL AND METHODS: Forty-four patients with hepatitis B, 43 patients with hepatitis C, 25 patients with rheumatoid arthritis, and 46 healthy control serums and their RF and anti-CCP levels were compared. RF was measured by the nephelometer, which detects IgM-RF. Anti-CCP was measured using enzymelinked immunosorbent assay (ELISA) that is included in the second-generation anti-CCP antibody assays (anti-CCP2). RESULTS: The anti-CCP positivity levels were 20.5%, 32.5%, 72.4% and 10.9% for HBV, HCV and RA groups and healthy control group, respectively. When the groups were compared based on their RF positivity and anti-CCP positivity while the values for HBV and HCV group and healthy control group were the same, in RA group there is a significant difference to the rest of the groups (p < 0.01). CONCLUSIONS: Anti-CCP may be positive for HBV and HCV as well, but it is a sensitive and specific immunological marker for RA diagnosis, especially in high-titres.

Fatigue in Multiple Sclerosis: Is it related to cytokines and hypothalamic-pituitary-adrenal axis?

BACKGROUND: Fatigue is a common symptom of Multiple Sclerosis (MS) that diminishes the quality of life of patients, but its exact mechanism remains poorly understood. There is not a generally adopted scale to determine MS fatigue. Studies that investigated physiopathology of fatigue symptom have shown dysregulation of hypothalamic-pituitaryadrenal (HPA) axis. In the current study, we aimed to compare the results obtained with two separate scales, namely the Fatigue Severity Scale (FSS) and the Neurological Fatigue Index-Multiple Sclerosis (NFI-MS), and assess the relationship between fatigue and serum IL-1ß, TNF-α, IL-35, IL-2, IL-10, ACTH, cortisol, α-MSH, ß-MSH, γ-MSH and CLIP (Corticotropinlike intermediate lobe peptide) in MS patients categorized as fatigued and non-fatigued on the basis of FSS scores. METHODS: For the study, a total of 54 (29 females, 25 males) patients diagnosed with RRMS including 26 with fatigue symptom (48.1%), and 26 healthy controls (13 females, 13 males) were enrolled. A FSS score ≥36 was considered as cut-off score to separate fatigued patients from nonfatigued patients. RESULTS: A significant positive correlation was determined between FSS score and NFI-MS scale, NFI-MS 1, NFI-MS 2, NFI-MS 3 and NFI-MS 4 scores. IL-1ß, IL-10 and TNF-α levels did not differ between patient and control groups. IL-35 and IL-2 levels were significantly higher among MS patients (p<0.01). However, no difference was observed between fatigued and nonfatigued patients in the cytokines and HPA parameters studied. ACTH, cortisol and α-MSH were significantly higher in MS group (p=0.02, p<0.01 and p<0.01, respectively). CLIP level was significantly low in MS patient group (p<0.01). CONCLUSION: NFI-MS scale is equally sensitive as FSS scale for assessment of MS fatigue; thus, it may also be widely used to evaluate that symptom. Generally HPA axis is hyperactive in MS patients, but it is not correlated with fatigue in our study. For the first time, levels of CLIP (a type of melanocortin) are studied, and determined to be lower among MS patients. Elevated levels of IL-35 and IL-2 suggest that these cytokines may have a prominent role in MS pathophysiology and can be investigated as potential targets for development of novel therapies.

Three cases of anti-TNF induced myositis and literature review. / Três casos de miosite induzida pelo anti-TNF e revisão da literatura.

Anti-tumor necrosis factor (anti-TNF) drugs are frequently preferred in the treatment of rheumatologic diseases and other inflammatory diseases. The development of myositis after using anti-TNF is a rare clinical condition. Here we aimed to report cases who developed myositis after using anti-TNF and review the current literature. We report two cases of rheumatoid arthritis (RA) and a case of ankylosing spondylitis (AS) developed idiopathic inflammatory myopathy following anti-TNF therapy. In conclusion, myositis could develop during anti-TNF therapy, so these patients should be evaluated carefully initially for myositis and should be closely monitored due to the potential for developing myositis in treatment process.

Performance of the new American College of Rheumatology classification criteria in Turkish systemic sclerosis patients: a multicenter study.

In our study, we compared the sensitivity and specificity of the new ACR/EULAR 2013 criteria to the ACR 1980 criteria in our systemic sclerosis (SSc) population. Three rheumatology centers from Turkey participated into this study. The medical records of SSc patients diagnosed between 2008 and 2014 were retrospectively reviewed, and their features at disease onset were recorded. Patients admitted to each center within the same time period for conditions other than SSc, in whom ANA was positive and was deemed necessary within the diagnostic workup, were included as controls. One hundred and ninety-seven SSc patients (174 females, 23 males) and 103 controls (96 females, 7 males) were included. Limited cutaneous SSc was present in 68 % of patients, and 30.5 % had diffuse SSc. The sensitivity of ACR/EULAR 2013 and ACR 1980 criteria were, respectively, 94.4 and 85.3 % (p = 0.003). The specificity of ACR/EULAR 2013 and ACR 1980 criteria were, respectively, 98.1 and 100 %. According to the new criteria, 13 patients were misclassified; however, according to the ACR 1980 criteria, 29 patients were misclassified (p = 0.005). The sensitivity of ACR/EULAR 2013 criteria was significantly better than that of the ACR 1980 criteria in limited cutaneous SSc group (94.8 vs. 82.8 %). In patients whose disease duration was <3 years, the new criteria had better sensitivity than the previous criteria (92.7 vs. 78.1 %, p = 0.006). The new ACR/EULAR 2013 criteria for SSc had better sensitivity in Turkish SSc patients, and less patients were misclassified.

Relationship between periodontal destruction and gene mutations in patients with familial Mediterranean fever.

Recent studies have shown that genetic factors involved in the host responses might determine the disease severity for both familial Mediterranean fever (FMF) and periodontitis. The present study aimed to investigate the relationship of FMF with periodontitis and to search for the potential association between periodontitis and MEFV gene missense variations in patients with FMF. The study consisted of 97 FMF patients and 34 healthy volunteers. FMF patients were classified according to the kind of MEFV gene mutation: (1) patients with homozygous M694V gene mutation, (2) patients with heterozygous M694V gene mutation, and (3) patients with MEFV gene different mutations. Gingival Index (GI), Plaque Index (PI), probing pocket depth (PD), and clinical attachment level (CAL) were measured in all participants. The results of multivariate logistic regression showed a highly significant association between homozygous M694V gene mutation and periodontitis in FMF patients (p < 0.05). After adjusting for potential confounders (smoking, body weight, age, and gender), FMF patients with homozygous M694V gene mutation were 3.51 (1.08-11.45) times more likely to present periodontitis than the other FMF patients. These results indicate that the presence of homozygous M694V gene mutation seems to increase the risk for periodontitis in FMF patients.

Isotretinoin-induced Spondyloarthropathy-related Symptoms: A Prospective Study.

OBJECTIVE: Acne vulgaris is a chronic inflammatory disease involving the pilosebaceous unit of the skin. Isotretinoin is a systemic retinoid that is often used as an effective treatment option for severe and treatment-resistant acne. Isotretinoin may also cause rheumatologic symptoms. The aim of this prospective observational study was to present followup results regarding the rheumatologic symptoms of patients who received systemic therapy for the treatment of acne (isotretinoin and tetracycline). METHODS: For inclusion in the study, all consecutive patients with acne who were aged > 18 years were evaluated by the same dermatologist. The first 42 consecutive patients were included in the isotretinoin group, and after matching for age and sex, 32 consecutive patients were included in the tetracycline group. Isotretinoin treatment was planned as an average dose of 30 mg daily and a total dose of 120-150 mg/kg for 4-6 months. The patients were administered a dose of 1 g/day of tetracycline as 2 equal doses for 3 months. RESULTS: Forty-two patients diagnosed with acne vulgaris were treated with isotretinoin 20.6 ± 4.4 (male/female: 17/22), and 32 patients were treated with tetracycline 20.6 ± 2.7 (male/female: 8/24). There was no significant difference between the 2 groups with respect to age and sex. Unilateral Achilles enthesopathy developed in 3 patients, whereas both Achilles enthesopathy and unilateral sacroiliitis developed in 1 patient. Inflammatory back pain developed in 6 patients in the isotretinoin group. CONCLUSION: To our knowledge, this was the first prospective observational study that assessed the rheumatologic symptoms of isotretinoin treatment. The spondyloarthropathy findings were identified in 23.1% of the patients who used isotretinoin.