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.

The objective of this study is to evaluate the clinical presentations and adverse outcomes of Coronavirus Disease 2019 (COVID-19) in patients with systemic sclerosis (SSc) and assess the impact of SSc features on the clinical course of COVID-19.Materials and methods: In this multicenter, retrospective study, SSc patients with COVID-19 were included. Clinical features of SSc, along with detailed COVID-19 data, were extracted from medical records and patient interviews.Results: The study included 112 patients (mean age 51.4 ± 12.8 years; 90.2% female). SSc-associated interstitial lung disease (ILD) was evident in 57.1% of the patients. The findings revealed hospitalization in 25.5%, respiratory support in 16.3%, intensive care unit admission in 3.6%, and a mortality rate of 2.7% among SSc patients with COVID-19. Risk factors for respiratory failure, identified through univariate analysis, included ILD (OR: 7.49, 95% CI: 1.63–34.46), ≥1 comorbidity (OR: 4.55, 95% CI: 1.39–14.88), a higher physician global assessment score at the last outpatient visit (OR 2.73, 95% CI: 1.22–6.10), and the use of mycophenolate at the time of infection (OR: 5.16, 95 %CI: 1.79–14.99). Notably, ≥1 comorbidity emerged as the sole significant predictor of the need for respiratory support in COVID-19 (OR: 5.78, 95% CI: 1.14–29.23). In the early post-COVID-19 period, 17% of patients reported the progression of the Raynaud phenomenon, and 10.6% developed new digital ulcers. Furthermore, progression or new onset of dyspnea and cough were detected in 28.3% and 11.4% of patients, respectively.Conclusion: This study suggests a potential association between adverse outcomes of COVID-19 and SSc-related ILD, severe disease activity, and the use of mycophenolate. Additionally, it highlights that having comorbidities is an independent risk factor for the need for respiratory support in COVID-19 cases.

Aim:Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory breast disease. Histopathology is characterized by non-caseating granulomas. Although oral contraceptive use, pregnancy, breastfeeding history, high prolactin levels, smoking, and chemical irritation have been blamed for its etiology, it has not been fully elucidated. We studied the responses obtained using intralesional (IL) steroid application in addition to conventional treatments in patients with IGM referred to the rheumatology and radiology departments of Fırat University Research Hospital. Material and Methods:Seventy-six female patients diagnosed with IGM who were followed between January 2021 and May 2023 were included in the study. The pathologies of the patients, whose average age was 36.5±6.8 years, were compatible with IGM. In terms of differential diagnoses, other conditions that could cause granulomatous mastitis were excluded. The data obtained were analyzed with appropriate statistical methods using statistical package for social sciences (SPSS) for Windows 25. Results:Remission was achieved in 55.3% of patients (42 patients). While remission was observed in 61.6% of the patients who received IL steroids, remission was achieved in only 23.1% of the patients who did not receive IL steroids, and this rate was found to be statistically significant (p=0.010). There was no statistically significant difference between the treatments received by patients who achieved remission and those received by patients whose treatment continued (p>0.05). Conclusion:In our study, the treatments received by patients who were and were not administered IL steroids were similar, but a significant difference was observed in patients who were administered IL steroids in terms of achieving remission. This suggested that IL steroid administration would have a positive contribution to the treatment response.

Aim:The second-to fourth-digit ratio (2D:4D), the ratio of the second finger length to the fourth finger length, is associated with exposure to prenatal sex steroids. Rheumatoid arthritis (RA) is more common in women, suggesting the effect of hormonal factors. The aim of the present study was to determine whether 2D:4D, which is associated with sex hormone levels, is affected in patients with RA. Material and Methods:Digital images of the right and left hands of 205 RA patients (mean age 47.8±11.3 years; 84% female) and 205 age and gender matched healthy controls (mean age 47.3±11.6 years; 84% female) were obtained. 2D:4D was calculated by dividing the 2nd digit length by the 4th digit length. The 2D:4D difference between the right and left hand (ΔR-L 2D:4D) was obtained by subtracting the left hand 2D:4D ratio from the right hand 2D:4D ratio. Conclusion:The detected 2D:4D ratio differences suggest that prenatal estrogen/androgen balance may be altered in female patients with RA. To the best of our knowledge, this is the first study to evaluate 2D:4D change in patients with RA. Results:No difference was found between patients with RA and the control group in terms of the 2D:4D ratio in the right and left hand. In female patients with RA, ΔR-L 2D:4D was higher compared with the control group. For both hands, the 2D:4D increase rate in women compared to men was higher in patients with RA compared to the control groups.

A 43-year-old female patient is being followed up with a diagnosis of rheumatoid arthritis. She presented with ulcerated lesions on the lower extremity, diffuse subcutaneous nodules, dyspnea, hemoptysis, and fever. Cavitary lesions were detected on the chest X-ray and thoracic computed tomography (Figure 1). The biopsy sample taken from the lesion in the lung was interpreted as “tumor necrosis”. The biopsy sample from subcutaneous nodules was interpreted as ”T-cell/histiocyte-rich large B-cell lymphoma”. There may be some similarities between various lung cavitary lesions, knowledge of the possible causes and a systematic approach will help to narrow down the huge list of differential diagnoses. CAVITY mnemonics can be used for diseases that may cause cavitary lesions in the lung (Table 1) (1). Pulmonary cysts are mimics of emphysema, cystic bronchiectasis, and bullous lung cavitary lesions, and before diagnosing a cavitary lesion, it should be ensured that it is not one of these mimics.