Heat shock proteins (HSPs) are intracellular proteins with pro- and anti-inflammatory actions, playing an important role in the pathogenesis of Behcet's disease (BD). Diagnosis of BD uveitis in early stages is still problematic, thus this study was undertaken to determine diagnostic values of serum HSP- and anti-HSP-70 in BD uveitis. Serum levels of HSP- and anti-HSP-70 were measured in 53 patients with BD (26 with and 27 without uveitis). In control group, 25 age- and sex-matched idiopathic uveitis patients were enrolled consecutively. Both groups had no medical problems save uveitis at the time of sampling. Confounders like medications were analysed subsequently. HSP- and anti-HSP-70 values were measured by commercial ELISA kits. Data were analysed by spss 11.5 and medcalc 11.5.1 software. The Mean HSP-70 serum levels were different among aforementioned subgroups (P = 0.001, anova). They were elevated in BD uveitis compared with BD without uveitis (4.84 ± 4.21 versus 2.24 ± 2.08 ng/ml; P = 0.045). HSP-70 in sera of BD uveitis was also higher than that parameter in patients with idiopathic uveitis (4.84 ± 4.21 versus 2.37 ± 3.30 ng/ml; P = 0.001; cut-off point value 1.0 9 ng/ml, 95% CI 0.61–0.86, P = 0.0002, ß = 0.06). However, there was not any statistical difference among those groups in the serum anti-HSP-70 levels (P = 0.63, anova). Multiple regression analysis demonstrated that among different confounders, only prednisolone increases and BD uveitis decreases HSP-70 levels independently. This prospective cross-sectional study suggested that HSP-70 serum level is impressed over the course of BD uveitis, and it could be utilized to diagnose or predict developing it.

Objectives To present the clinical characteristics, disease course, management, and outcomes of COVID-19 infection in patients with Behcet’s disease (BD). Methods In this retrospective cohort study, we retrieved BD patients with definite diagnosis of COVID-19 infection. Demographic data, comorbidities, features related both to BD and COVID-19 infection, treatments, and outcomes were collected. Comparisons between patients with or without hospitalization were performed. All statistical analyzes were performed using SPSS version 25. We considered p < 0.05 statistically significant. Results We identified 61 episodes of COVID-19 infection in 59 BD patients. The prevalence was 0.69%. The median age was 45 years (IQR = 20), and the median disease duration was 162 months (IQR = 195). BD features were similar except for higher rate of arterial involvement and positive pathergy test in infected patients. Thirty-five episodes (62.5%) happened in non-active patients; 39% had a comorbid disease. COVID manifestations were the same as the general population. Flu-like symptoms were the most common (85%), followed by fever (66%), ageusia/anosmia (56%), headache (51%), and pulmonary involvement (48%). There was no change in BD symptoms in 74%. Fifteen patients (25.4%) were hospitalized, and one patient (1.7%) died. Receiving glucocorticoids (p < 0.03) and cytotoxic drugs (p < 0.02) were associated with an increased rate of hospitalization. Conclusion The incidence of COVID-19 infection in BD patients was not higher than general population in Iran. They showed milder form of disease with lower morbidity and mortality rate. Most were on immunosuppressive drugs, or had a comorbidity apart from BD. No significant effect on BD course was shown. Key Points • The incidence of COVID-19 infection in patients with Behcet’s disease is not higher. • They showed milder form of infection with lower morbidity and mortality rate. • No significant effect on Behcet’s disease course was shown with COVID19 infection. • BD patients can be managed according to the guidelines used for general population.

Background/objective: Osteoporosis is a global health concern with an increasing prevalence worldwide. Denosumab is an antiresoptive agent that has been demonstrated to be effective and safe in osteoporotic patients. This study aimed to compare the efficacy and safety of the biosimilar denosumab candidate (Arylia) to the originator product (Prolia®) in postmenopausal osteoporotic patients. Methods: In this randomized, double-blind, active-controlled, noninferiority trial, postmenopausal osteoporotic patients received 60 mg of subcutaneous Arylia or Prolia® at months 0, 6, and 12 and were followed up for 18 months. The primary endpoint was the noninferiority of the biosimilar product to the reference product in the percentage change of bone mineral density (BMD) in 18 months at the lumbar spine (L₁-L₄), total hip, and femoral neck. The secondary endpoints were safety assessment, the incidence of new vertebral fractures, and the trend of bone turnover markers (BTMs). Results: A total of 190 patients were randomized to receive either biosimilar (n = 95) or reference (n = 95) denosumab. In the per-protocol (PP) analysis, the lower limits of the 95% two-sided confidence intervals of the difference between Arylia and Prolia® in increasing BMD were greater than the predetermined noninferiority margin of − 1.78 at the lumbar spine, total hip, and femoral neck sites (mean differences [95% CIs] of 0.39 [− 1.34 to 2.11], 0.04 [− 1.61 to 1.69], and 0.41 [− 1.58 to 2.40], respectively). The two products were also comparable in terms of safety, new vertebral fractures, and trend of BTMs. Conclusion: The efficacy of the biosimilar denosumab was shown to be noninferior to that of the reference denosumab, with a comparable safety profile at 18 months. Trial registration: ClinicalTrials.gov, NCT03293108; Registration date: 2017–09-19.