Background: This study aimed to investigate the efficacy of local oxygen–ozone therapy in systemic sclerosis (SSc) patients with digital ulcers (DUs) who were resistant to medical therapy and had impairment in activities of daily living. Methods: Participants’ demographic data, and clinical parameters were recorded. Twenty-five SSc patients with DUs were randomized to the ozone group (I) (n = 13) to receive medical treatment plus local oxygen–ozone therapy and the control group (II) (n = 12) to receive medical treatment only. Hand functions were assessed using the Health Assessment Questionnaire (HAQ) and the Modified Hand Mobility in Scleroderma (HAMISm) test. Clinical parameters, HAQ, and mHAMIS scores were re-evaluated in participants 4 weeks after the initiation of treatment. Results: Demographic and clinical characteristics of the two groups showed no significant differences. At 4 weeks after the initial treatment, the efficacy rate was significantly higher in the ozone group than that in the control group (92% versus 42% P = 0.010). Clinical parameters, HAQ, and HAMISm scores were significantly improved in the treatment group compared to those in the control group (P < 0.05). Conclusion: Local oxygen–ozone therapy was effective in the treatment of SSc patients with resistant DUs and improved clinical parameters and functional disability.

Objective: Familial Mediterranean fever (FMF) is the most common disease that leads to secondary amyloidosis in Turkish population. The prognostic nutritional index (PNI) and the controlling nutritional status (CONUT) score were recently investigated in many clinical conditions as predictors of disease activity and prognosis of underlying disease. We aimed to evaluate these indexes in FMF patients. Methods: We included a total of 135 patients with FMF without amyloidosis at baseline. Demographic characteristics, particular attack features, treatment modalities, disease complications of patients, and a follow-up time for each patient were obtained. Disease complications were defined as amyloidosis or end stage renal disease. Baseline laboratory parameters in the attack-free period were used to assess the subclinical inflammation. Spearman’s rho correlation analysis was used for numerical variables. Univariate and multivariate logistic regression analyses were used to determine factors that had an impact on the development of amyloidosis. Receiver operating characteristic (ROC) curve analysis was used to discover the appropriate cutoff points of CONUT score and PNI for predicting the development of amyloidosis. Results: ROC analysis revealed that the optimal cutoff points for neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), CONUT score, and PNI were >1.9, >145, >2, and ≤54, respectively. The area under the curve values of CONUT score and PNI for predicting the development of amyloidosis were 0.830 (95% CI: 0.76-0.89, P < .001) and 0.940 (95% CI: 0.88-0.97, P < .001), respectively. Correlation analyses revealed significant positive correlations between CONUT score, NLR, and PLR. The high CONUT score was associated with the development of amyloidosis in FMF patients in addition to age and M694V homozygous mutation. Conclusion: Low PNI and high CONUT score at diagnosis may have a poor prognostic value for the development of amyloidosis in patients with FMF in addition to older age and M694V homozygous mutation. These indexes may be a useful and inexpensive screening biomarkers in clinical practice for predicting amyloidosis in patients with FMF. Cite this article as: Evaluation of the controlling nutritional status score and prognostic nutritional index in patients with Familial Mediterranean fever. Eur J Rheumatol. 2021;9(1):14-19.

Background: Paracetamol is widely used for acute pain management in orthopedic trauma; however, interindividual variability in analgesic response remains insufficiently understood. Cytochrome P450 2E1 (CYP2E1), a key enzyme involved in paracetamol metabolism and the formation of the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI), may contribute to this variability. This study aimed to investigate the relationship between CYP2E1 gene polymorphisms and the analgesic efficacy of paracetamol in patients with lower extremity fractures. Methods: A total of 127 patients with lower extremity fractures and 100 healthy controls were included. All patients received 1000 mg of intravenous paracetamol. Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline and at 30, 60, and 120 min after administration. Genotyping of CYP2E1 polymorphisms (*1A, *5B, *6, and *7B) was performed using PCR-RFLP. Differences in the VAS scores and analgesic response were analyzed according to genotype. Results: Paracetamol administration resulted in a significant reduction in pain scores at all time points (p < 0.001). Patients carrying the CYP2E15B variant exhibited significantly higher VAS scores and a weaker early analgesic response compared to non-carriers (p ≤ 0.001). Similarly, CYP2E11A carriers demonstrated higher pain scores across all time points (p < 0.05), although the magnitude of effect was less pronounced. No significant differences were observed for the CYP2E16 variant. Due to low frequency, CYP2E17B could not be reliably analyzed. Conclusions: Paracetamol is an effective analgesic in patients with lower extremity fractures; however, CYP2E1 polymorphisms may modulate individual pain perception and early analgesic response. In particular, the *5B and, to a lesser extent, *1A variants are associated with higher pain scores. These findings support the potential role of pharmacogenetic approaches in personalized pain management.

Objective: To identify clinical, serological, and pharmacological factors associated with dry eye disease (DED) in patients with rheumatoid arthritis (RA). Methods: In a retrospective cohort, 65 adults with RA (2010 American College of Rheumatology / European League Against Rheumatism criteria) underwent a TFOS DEWS II-based ocular surface workup, with 65 age- and sex-matched non-RA clinic participants for descriptive comparison. Group comparisons used t-test, Mann–Whitney U-test, χ2, or Fisher’s exact tests. A multivariable logistic regression model with anti-CCP positivity, smoking, anti-SSA, and age was fitted; discrimination was assessed by ROC analysis, and calibration by the Hosmer–Lemeshow test. Results: Dry eye disease was present in 19 of 65 RA patients (29.2%); for descriptive context, prevalence in 65 matched non-RA ophthalmology clinic participants was similar (27.7%; P = .85). Anti-CCP positivity (89.5% vs. 60.9%; P = .037) and cumulative pack-years (median 10.0 vs. 0.0; P = .032) separated RA-DED from RA without DED, whereas disease activity, glucocorticoid dose, methotrexate, and hydroxychloroquine exposure did not. Given only 19 events, the model was fitted with Firth penalized likelihood; anti-CCP positivity remained independently associated with DED (adjusted odds ratio (aOR) 4.20; 95% CI, 1.10-23.77; P = .035), and smoking showed a directionally consistent effect (aOR 2.42; 95% CI, 0.81-7.64). Model discrimination was moderate (AUC 0.757) with adequate calibration. Conclusion: Within this RA cohort, anti-CCP positivity was independently associated with DED, whereas cumulative tobacco exposure showed a directionally consistent association that did not reach independent significance. These findings support consideration of targeted ocular surface surveillance in anti-CCP–positive patients with a smoking history, pending confirmation in larger prospective studies.