Secondary amyloid A (AA) amyloidosis is a late and serious complication of poorly controlled, chronic inflammatory diseases. Rheumatoid arthritis (RA) patients with poorly controlled, longstanding disease and those with extra-articular manifestations are under risk for the development of AA amyloidosis. Although new drugs have proven to be significantly effective in the treatment of secondary AA amyloidosis, no treatment modality has proven to be ideal. To date, only in small case series preliminary clinical improvement have been shown with rituximab therapy for AA amyloidosis secondary to RA that is refractory to TNF-α inhibitors (TNF-i) therapy. In these case series, we assessed the efficacy and safety of rituximab therapy for patients with RA and secondary amyloidosis. Hacettepe University Biologic Registry was developed at 2005. The data of the RA patients who were prescribed a biological drug were recorded regularly. Patients with biopsy proven AA amyloidosis patients were screened. Of 1022 RA patients under biologic therapy, 0.7% patients had clinically apparent histologically confirmed amyloidosis. Four of seven patients who were prescribed rituximab at least one infusion enrolled to those case series. Two of four patients showed significant clinical improvement and one of them also had decrease in proteinuria and the other one had stable renal function and proteinuria. The main goal for the treatment of AA amyloidosis is to control the activity of the underlying disorder. In this study, we showed that rituximab may be an effective treatment in RA patients with amyloidosis who were unresponsive to conventional disease modifying anti-rheumatic drugs (DMARDs) and/or TNFi.

Background/aim: Avascular necrosis (AVN) is the death of bone due to compromise of blood flow. The etiology of AVN is multifactorial; corticosteroid usage is the second most significant factor after trauma, and systemic lupus erythematosus (SLE) is the most common underlying disease. The objective of this study was to assess the factors of AVN in SLE patients. Materials and methods: The study included 127 patients with SLE who fulfilled 1997 American College of Rheumatology (ACR) revised criteria. Demographic data, age at SLE diagnosis, disease duration, disease activity, body mass index, clinical findings, antiphospholipid syndrome, steroid usage, dose and duration, comorbid diseases, and smoking history were recorded. Results: AVN was found in 11 of 127 (8.7%) SLE patients. Hyperlipidemia (P < 0.001), cushingoid body habitus (P < 0.001), and proteinuria (P = 0.013) were found at higher rates in the AVN group. All of the 11 AVN cases had osteoporosis (P < 0.02). In multivariate regression analysis, daily steroid usage was the only factor for development of AVN in SLE. Conclusion: The hypothesis of our study was that an alternate day steroid regimen may decrease AVN frequency in SLE patients.

There are conflicting reports for the relationship of reflux and the gastric emptying rate. In addition, the acquisition period is not well defined for the gastroesophageal reflux studies. The aim of our study was to evaluate the temporal distribution of the reflux episodes and to evaluate whether the gastric emptying rate changed with the gastroesophageal reflux time or amount. We used radionuclide scintigraphy to evaluate 211 pediatric patients (0-10 years of age). Scintigraphic studies were performed by acquiring 15 s images for 1 h in a supine position after ingesting milk containing 0.5 mCi (18.5 MBq) Tc-99m colloid. Reflux episodes were calculated every 10 min for each patient who had reflux. The gastric emptying rate was measured by drawing an region of interest over the gastric activity. Gastric reflux was observed in 104 patients (49.28%). The number of reflux episodes was higher in the first and second 10 min (33.7 and 29.1% respectively). The lowest reflux episode was observed in the last 10 min (between 50 and 60 min) (2.6%) suggesting that the reflux episode was decreasing by the gastric emptying. Within the first 30 min, reflux was observed in 98 of 104 patients (94.23%). The gastric emptying rate was calculated to be 73 min in patients with a higher incidence of reflux and 62 min in patients who had delayed and lower incidence of reflux episodes. In 104 patients, the average gastric emptying rate was 71.60 min. There were no significant differences in the gastric emptying rates between patients who had reflux episodes beginning in the first 30 min of the study and those who had reflux episodes in the last 30 min of the study (P>0.05). This study has suggested that the number of reflux episodes were not related with the gastric emptying rate. However, reflux could be observed in a higher frequency before gastric emptying, which also suggested that a 30-min period may be sufficient when reflux is shown early. In negative cases, a 60-min acquisition time is recommended for the diagnosis of gastroesophageal reflux.

This study aims to investigate discriminatory ability of the Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Neutrophil Percentage-to-Albumin Ratio (NPAR), in differentiating Behçet's Syndrome (BS) organ involvements from mucocutaneous involvement. This retrospective cohort study analyzed 436 patients diagnosed with BS from 2018 to 2023. Patients were categorized into three groups based on organ involvement: vascular, only mucocutaneous, and other organ involvement. Receiver Operating Characteristic (ROC) analysis was used to evaluate the discriminatory ability (mucocutaneous vs rest, vascular vs rest). DeLong's test was used to determine statistical differences in discriminatory power between the models. Out of 436, 115 patients had vascular involvement. SII, SIRI, and NPAR were notably elevated in the vascular involvement group (p < 0.001). ROC analysis revealed that, SII, SIRI and NPAR showed discriminative ability for vascular involvement with AUCs of 0.87 for SII, 0.87 for SIRI, and 0.88 for NPAR. Pairwise comparisons using DeLong's test indicated that all three models performed similarly. SII, SIRI, and NPAR are promising noninvasive biomarkers for predicting vascular involvement. These indices, derived from routine laboratory tests, could enhance early screening and may improve patient outcomes by enabling timely intervention.

Background: The aim of this study is to determine the demographic, clinical and laboratory characteristics of the patients who followed up with the diagnosis of sarcoidosis, to investigate the distribution frequency of rheumatological findings and to examine the disease management from the perspective of rheumatology. Methods: Patients who were followed up with the diagnosis of sarcoidosis in the rheumatology clinic of Ankara City Hospital between November 2019 and November 2022 were evaluated. Demographic, clinical, radiological, serological, laboratory, and histopathological findings, and rheumatological, systemic, and locomotor system examination findings of the patients were obtained from the medical data registered in the hospital. Results: A total of seventy sarcoidosis patients (48.98 +/- 11.78 years, %75 female) were included in the study. Joint involvement was observed in 64.3% of cases, skin involvement in 48.6% of cases, and ocular involvement in 25.7% of cases. The ankle was the most frequently involved joint, followed by the knee and small joints in the foot. Corticosteroids were the most used therapeutic agent, and pulmonary and joint findings were the most common reasons for starting treatment. Conclusions: Sarcoidosis is a disease that mimics many diseases, misdiagnosis and treatment should be avoided with a good and fast differential diagnosis. Clinicians, especially rheumatologists, should remember sarcoidosis more frequently and keep it in mind in the differential diagnosis.