Objectives: This study aimed to investigate the first involved joints and associated factors in Turkish patients with rheumatoid arthritis (RA). Patients and methods: This retrospective cross-sectional study included 300 newly diagnosed and disease-modifying antirheumatic drug-naïve RA patients (240 females, 60 males; mean age: 54±1.2 years; range, 18 to 82 years). Baseline demographic, clinical, and laboratory data were evaluated between January 2022 and December 2022. The patients were divided into four groups according to autoantibody profile: antibody-negative patients (Group 1; both RF and anti-CCP were negative in this group of patients), RF-positive patients (Group 2), anti-CCP-positive patients (Group 3), and patients with dual seropositivity with RF and antiCCP (Group 4). The patients were also divided into two groups according to the size of the first affected joint: patients with SJI at diagnosis and patients without SJI involvement at diagnosis. Results: Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody positivity rates were 40.3% and 35.6%, respectively. The mean lag time to diagnosis was 25±36 months. At the disease onset, 20% of patients did not have small joint involvement (SJI). Seronegative patients tended to be female (p=0.001), had longer lag time (p=0.001), and had lower levels of C-reactive protein (p=0.025), white blood count (p=0.005), and neutrophil/lymphocyte ratio (p=0.001) compared to the dual seropositive group. Patients presenting with SJI had a younger age (p=0.002), tended to be female (p=0.001), and had lower RF (p=0.034) and anti-CCP (p=0.031) positivity. Only age (p=0.005) and dual seronegativity (RF and anti-CCP; p=0.035) were the independent predictors of SJI in multivariate analysis. Conclusion: The decreasing age and seronegative status were defined as independent risk factors of SJI at the onset of RA. Population-based, prospective studies are needed for earlier diagnosis.

There is no consensus on the classification of lupus arthritis (LA). In this study, we aimed to investigate patients with LA who were clinically and serologically very similar to those patients with rheumatoid arthritis (RA). The electronic medical files of systemic lupus erythematosus (SLE) patients from a single tertiary rheumatology department between 2017 and 2022 were reviewed. The inclusion criteria were being age ≥ 18 years, having nonerosive peripheral arthritis lasting longer than six months, and having dual seropositive (rheumatoid factor (RF) and anti-citrullinated protein antibody (anti-CCP)) serology. A nonerosive course of arthritis was demonstrated by both conventional radiography and joint ultrasound. Images were assessed by two blinded rheumatologists. Patients with drug-induced lupus and those with other rheumatologic diseases were excluded. The cases of 528 patients were reviewed, and eight patients were included in the study. All patients were female, and the median age was 48.5 years. The median SLE and arthritis durations were 12 and seven years, respectively. The most common SLE symptom was photosensitivity (n = 8). Only one patient had life-threatening involvement (LTI), which was a seizure and autoimmune haemolytic anaemia. All patients had arthritis affecting the wrist and hand. Anti-dsDNA was the most common anti-ENA antibody (n = 7), followed by anti-SSA (n = 5). The median RF and anti-CCP titres were 82.5 IU/ml and 81.5 U/ml, respectively. Five patients had high titres of autoantibodies, and only one patient had slight hypocomplementemia. Three patients needed biologic agents, and remission was achieved after treatment with rituximab. Despite a long arthritis duration and dual seropositive serology with high titres of RF and anti-CCP, our patients had SLE rather than rhupus syndrome. The low frequency of LTIs, such as lupus nephritis, was a remarkable feature of our patients. Lupus arthritis may be clinically and serologically indistinguishable from RA. Prospective studies are needed to better define LA.

Background/aim: Methotrexate (MTX) and leflunomide (LEF) are conventional synthetic disease-modifying antirheumatic drugs (DMARDs) commonly used for treating rheumatoid arthritis (RA) and psoriatic arthritis (PsA), either as monotherapies or in combination. This study aimed to compare the adverse effects (AEs) and efficacy of combined use of MTX plus LEF with monotherapy in RA and PsA patients. Materials and methods: This study included 528 patients (385 RA and 143 PsA) with at least 6 months of follow-up. Disease activity was assessed using DAS-28 CRP and DAPSA, and treatment-related AEs were classified based on specific MedDRA categories. Results: The cumulative incidence of AEs in patients with RA treated with MTX, LEF, and MTX plus LEF was 23.8%, 28.2%, and 19.2%, respectively; in PsA patients, 18.1%, 30%, and 23.3%, respectively. None of the groups were superior to each other in terms of general AEs between monotherapy and in combination. LEF monotherapy in RA was associated with more neurological AEs and hypertension. Compared to monotherapy, MTX plus LEF demonstrated greater reductions in disease activity, a more substantial decrease in glucocorticoid doses, and lower utilization of biological/targeted DMARDs (b/tsDMARDs) in both RA and PsA. In univariate analysis, MTX dosage, initial DAS28 CRP, and b/tsDMARD initiation were predictors of low disease activity (LDA) in RA. In multivariate analysis, MTX dosage (95% CI 1.02–1.59, OR = 1.27, p = 0.031) and initial DAS28-CRP (95% CI 2.14–10.90, OR = 4.38, p < 0.001) were found to be independently associated with LDA in RA. In PsA, the factors associated with LDA were initial DAPSA and disease duration in univariate analysis. Only disease duration was found to be an independent predictor in multivariate analysis (95% CI, 1.02–1.38, OR = 1.17 p = 0.039). Conclusion: Adding LEF to MTX or vice versa may serve as a valuable, safe, and effective alternative in situations where b/tsDMARD therapy is challenging.

Erythema nodosum (EN) is the most common panniculitis which affects individuals from all ages. Etiologically most of the cases are idiopathic EN and infections rank the second. Its clinical presentation is sudden, hot erythematous nodules or plaques in legs, knees or ankles with a diameter ranging between 1 and 5 cm. In the majority of cases, healing is observed within two to eight weeks without any scar tissues. It may occasionally manifest itself as the first symptom of systemic diseases such as sarcoidosis, inflammatory bowel diseases, Behçet’s disease, and other rheumatological conditions. Therefore, EN cases must be carefully examined in terms of their etiologies. Herein, we report an interesting Brucella case presenting as a EN case consulted for rheumatological etiology investigation.

Objectives: Rituximab is an effective biological agent for treating patients with rheumatoid arthritis (RA). Rheumatologists can avoid rituximab therapy because of infusion-related reactions (IRR). There is a lack of data about rituximab-related IRR, especially in rituximab-naïve patients with RA; therefore, we aimed to determine the frequency and associated factors of rituximab-related IRR in these patients. Methods: Baseline demographic, laboratory, and treatment data were noted. One course of rituximab was used in two infusions to 95 rituximab-naïve patients with RA. Standardized premedication was administered before infusions. Rates, severity, and management of IRR were recorded. Efficacy and infections were also noted if there were. Results: Ninety-four of 95 patients completed the rituximab course successfully. We observed a total of 23 IRRs in 20 patients. The frequency of IRR was 12.1%, and serious IRR was 0.52%. Grade 1-2-3 IRRs had a rate of 52.2%, 30.4%, and 17.4%, respectively; grade 4 or 5 IRR wasn’t detected. Age <60 years, anti-CCP <200U/ml and absence of biologic agent use before rituximab was significantly higher in patients with IRR than without IRR (p=0.01, p=0.002, p=0.01 respectively). We found out that if only the disease age is above 60 months, it is protective against IRR as per the results of multivariate model analysis. Conclusion: Results supported that rituximab is a safe biological agent option for patients with RA at secondary central hospitals. Identified risk factors of IRR need to be corroborated in larger studies for safer rituximab therapy.