Aims Adult-onset Still's disease (AOSD) is a rare and non-familial auto-inflammatory disorder. Increased levels of IL-6 and other pro-inflammatory cytokines have been shown in AOSD. To evaluate the efficacy and safety profile of tocilizumab (TCZ), an IL-6 receptor antagonist monoclonal antibody, in AOSD. Methods Thirty-nine patients followed up with the diagnosis of AOSD between 2013 and 2019 were retrospectively evaluated and the 16 patients (10 Female/6 Male) treated with TCZ for refractory AOSD were included in the study group. Among the remaining 23 patients 16 had non-biological treatments and had no important complications at the presentation. TCZ was given to patients at a dose of 4-8 mg/kg every 4 weeks. Patients were evaluated after 3-6 months of TCZ treatment for side effects, inflammatory and clinical response and concomitant treatments. Results In TCZ (+) patients, the majority were female (62.5%), the mean age at disease onset was 38.5 +/- 17.9 (20-81) years, and the most common symptoms and signs were myalgia (81.3%), fever (81.3%) and skin eruptions (75%). There was no difference between TCZ (+) and TCZ (-) groups for age, sex and clinical presentations. There was a significant decrease in dose of prednisolone, sedimentation rate, leucocyte count, C-reactive protein and ferritin levels and improvement in all clinical complaints after TCZ treatment. There were no relapses during the treatment. Three patients are in remission and under follow-up without any treatment after cessation of TCZ (4 months-3 years). No exacerbation of disease yet seen in those patients. Conclusions TCZ is an effective and well-tolerated treatment option for treatment resistant AOSD and contributes to the glucocorticoid-sparing. Since TCZ is a new drug in the treatment of AOSD, further studies are needed to assess whether the complications reported during the treatment are because of TCZ or natural course of the disease or coincidental findings.

Objectives:Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast disease of unknown etiology. There is no standardized treatment because its etiology is still unclear. In this multicenter study, we presented the demographic, treatment, and follow-up characteristics of IGM cases monitored by rheumatology clinics. Material and Methods:This retrospective study was conducted in 13 different rheumatology centers. A total of 108 patients with IGM were included in the study. Demographic and clinical data were retrospectively obtained from patient files. Results:The most commonly administered drugs were, in order of frequency, corticosteroid (CS) (91.7%), methotrexate (MTX) (74.1%), antibiotics (63%), non-steroidal anti-inflammatory drugs (41.7%), azathioprine (AZA) (13.9%), colchicine (5.6%), and tumor necrosis factor (TNF) inhibitors (0.9%). The most commonly used form of immunosuppressive (IS) treatment was the MTX and CS combination 78 (72.2%). The ratio of patients receiving CS alone was 19 (17.6%). The ratio of patients who were operated on only and did not use IS drugs was 6.5%. The ratio of patients who received no treatment was 2.8%. Among the drugs used, MTX and CS alone use were independent risk factors for relapse; (p=0.027, p=0.011, respectively). The relapse rate was higher in patients receiving CS alone. Conclusion:IS drugs including CS, MTX, AZA, and TNF inhibitors seem to be efficient for treating IGM. CS alone use is associated with relapse, and the use of other IS drugs such as MTX is particularly effective in reducing relapse in IGM.

Full Papers; Authors: S. Zontul, E. Inanç, A. Can, Ş.T. Tay, H. Çolak, T. Cumurcu, S. Yolbas

Background/Objectives: Delayed diagnosis in psoriatic arthritis (PsA) is associated with significant health consequences. We hypothesize that musculoskeletal (MSK) surgery rates may be higher during the diagnostic delay period. This study aimed to compare the frequency of MSK surgeries in PsA patients during the period of diagnostic delay with the frequency of MSK surgeries post-diagnosis. Methods: This retrospective cohort study included PsA patients who fulfilled CASPAR criteria and were followed up on in our outpatient clinic. The pre-diagnosis symptomatic period was considered as the period of diagnostic delay. Data on MSK surgeries were obtained from patient records. The annual number of surgeries was calculated separately for the diagnostic delay and post-diagnosis periods. Results: The study included 84 PsA patients. The mean diagnostic delay in PsA patients was 7.49 years. During this period, 27.4% of patients underwent at least one MSK surgery. The mean annual number of MSK surgeries was significantly higher during the diagnostic delay period compared to the post-diagnosis period (Z = −3.18, p = 0.001, r = 0.35). Conclusions: Following PsA diagnosis, a reduction in MSK surgery rates was observed compared to during the diagnostic delay period. This suggests that inflammatory symptoms in PsA patients, which could have been managed with medical therapy, may have led to avoidable MSK surgeries. These findings highlight the potential for early diagnosis to reduce the rate of musculoskeletal surgery and associated healthcare costs.

Amaç: Bu çalışmanın amacı, ankilozan spondilit tanılı hastalarda uyku kalitesinin hastalık parametreleri ve uyku bozukluğu yapabilecek diğer bazı nedenler ile olan ilişkisini değerlendirmektir. Gereç ve yöntem: Çalışmaya takipleri devam eden 122 ankilozan spondilit hastası dahil edildi. Hastalar pittsburg uyku kalitesi indeksine göre uyku kalitesi iyi olanlar ve kötü olanlar olmak üzere 2 gruba ayrıldı. Hastalar yaş, cinsiyet, boy, kilo, medeni hal, eğitim durumu, tanı tarihi, tanı konulan merkez, bugüne kadar aldıkları medikal tedaviler, tedaviye bağlı yan etkiler, geçirdiği cerrahi operasyonlar ve başka bilinen kronik hastalık açısından sorgulandı. Ayrıca bu hastalardan alınan rutin kan tetkiklerinden CBC, AST, ALT, BUN, Kreatinin, sedimentasyon, CRP olgu rapor formuna kaydedildi. Hastalar VAS, short form-36 (SF-36), Uluslararası Huzursuz Bacak Sendromu Çalışma Grubu kriterleri anketi, beck depresyon, beck anksiyete, BASMI, BASFI, BASDAI ölçekleri ile değerlendirildi. Gruplar bu ölçeklerden elde edilen sonuçlar ile karşılaştırıldı. Bulgular: Hastalarda genel popülasyona göre daha yüksek oranda kötü uyku kalitesi ve huzursuz bacak sendromu saptandı. Gruplar arasında ağrı, yaşam kalitesi, depresyon, anksiyete, BASFİ ve BASDAİ açısından istatistiksel olarak anlamlı fark saptandı. BASMI ve huzursuz bacak sendromu açısından ise anlamlı fark saptanmadı. Sonuç: Bu bulgulardan yola çıkarak AS hastalarında uyku bozukluklarına sık rastlandığı ve bunun ağrı, hastalık aktivitesi, anksiyete, depresyon, kötü yaşam kalitesi ve fonksiyonel durum ile yakından ilişkili olduğu saptanmıştır. Ayrıca huzursuz bacak sendromunun AS hastalarında sık rastlanan bir durum olduğu sonucuna varılmıştır.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.