Background/Aim: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease, characterized by the production of numerous pro-inflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β), which lead to pathophysiological changes in innate and acquired immunity. The existing evidence shows that pro-inflammatory cytokines in rheumatoid arthritis impact monoaminergic neurotransmission, neurotropic factors, and synaptic activity, which may lead to the development of depression. Materials and Methods: In our study, we explored the association between TNF-α and IL-6, disease activity, and the degree of depression in patients with RA. The association between TNF-α and IL-6 and the Beck and Hamilton depression scales was analyzed in a group of 116 RA patients with depression. We investigated the same correlation in 45 patients with primary depression who represented the control group. Results: A Spearman test showed that IL-6 levels had a positive association with the Beck and Hamilton scales (p < 0.05) and that TNF-α had a positive association with the Hamilton scale (p < 0.05). Also, the Hamilton depression scale was the more sensitive scale in the detection of depressive symptoms. Conclusions: Our study indicates that elevated values of pro-inflammatory cytokines are associated with the degree of depression in patients with RA. Future preclinical and clinical studies will contribute to a better understanding of the pathophysiological mechanism of depression in patients with RA and may serve as the basis for new treatment modalities. By detecting depression promptly, with the help of the HAM-D as the more sensitive scale, we could influence the future modality of treatment, and with a multidisciplinary approach, we could ensure an improvement in the quality of life of patients with RA.

Introduction. Psoriatic arthritis is an inflammatory arthritis with a complex clinical presentation. The aim of this study was to assess the correlation between clinical features and bone density in patients with psoriatic arthritis, and to compare bone densitometry results with those of healthy controls. Material and Methods. The study included 20 patients with psoriatic arthritis and 14 healthy controls. Demographic and clinical data were collected, including nail changes and the Psoriasis Area and Severity index. All participants underwent dual-energy-X-ray absorptiometry and evaluation using the Fracture Risk Assessment Tool. Results. The mean age of participants was 58 ?} 9.1 years, with 55% being male. Rheumatoid factor was positive in 30% of patients, nail lesions were present in 60%, and the mean Psoriasis Area and Severity Index score was 10.37 ?} 10.13. A significant correlation was observed between rheumatoid factor positivity and reduced bone density (p = 0.002), as well as between nail lesions and higher fracture risk (p = 0.005). Higher psoriasis index scores were significantly associated with increased fracture risk (p = 0.03). No other statistically significant correlations were identified. Although differences were found in bone mineral density and Fracture Risk Assessment Tool scores between patients with psoriatic arthritis and controls, these did not reach statistical significance. Conclusion. This study demonstrated an association between reduced bone density and rheumatoid factor positivity, as well as a high fracture risk in psoriatic arthritis patients with nail lesions. These findings support the consideration of routine bone density assessment in diagnostic algorithm for psoriatic arthritis, particularly in patients with rheumatoid factor positivity and nail involvement.

Introduction. Systemic sclerosis (SS) is a complex autoimmune disease characterized by chronic progressive organic sclerosis. The aim of this paper is to show the correlation of ultrasound (US) parameters with Rodnan skin score (mRSS), as well as the clinical involvement of other organ systems. Methods. Our study included 24 patients diagnosed with SS and 24 healthy controls. We included demographic, clinical and laboratory parameters, individually and included in the European Scleroderma Trial and Research Disease Activity Index (EUSTAR-DAI) score. To measure skin involvement, we used the modified mRSS and skin ultrasound.Results. The skin thickness of patients and healthy controls measured by ultrasound showed statistically significant differences (p<0.001). Correlations between mRSS and anti-Scl-70 antibody (p=0.02) and between mRSS and diffusion capacity for carbon monoxide (DLCO) (p=0.03) were shown.Conclusion. In recent years, the importance of using skin ultrasound in patients with systemic sclerosis has been increasing, due to the fact that this technique can detect skin involvement in the early stages of the disease. The advantages of the method are availability and non-invasiveness, unlike skin biopsy. By standardizing ultrasound skin measurement, it would be possible to implement the method in daily clinical practice.

Background/Aim: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multisystemic involvement. Almost 50 % of patients who suffer from systemic lupus erythematosus have lupus nephritis (LN) as well. Mycophenolate mofetil (MMF) or intravenous cyclophosphamide (CYC) are recommended as preferred therapy. The aim of this study was to see how MMF and CYC, when compared, are efficient in dealing with LN. Methods: Study included 53 SLE patients with biopsy-proven class III and class IV LN. Twenty-two patients (42 %) were treated with MMF (dosage 2-3 g/day) and 31 patients (58 %) were treated with CYC (0.5 to 1.0 g/m2 in monthly pulses) in a 24-week induction study. Outcome of interest was the improvement in serum creatinine, proteinuria and creatinine clearance. Primary end point included complete renal remission defined as serum creatinine within 25 % of baseline before flare and proteinuria < 0.5 g/24 h. Secondary end point included complete renal remission in follow-up period. Results: The results revealed that response between two groups was not notably different (X2 = 0.151, p = 0.697). Four out of 22 patients (18.2 %) in MMF group and 7 out of 31 patients (22.6 %) in CYC group had complete renal remission. Most patients from both groups showed improvement from the clinical point of view. Secondary end point was also similar between treatment groups. Conclusion: The study showed same efficiency between these treatment groups, MMF and CYC as induction for LN. No crucial differences were identified between MMF and CYC groups in terms of renal remission.

Introduction: Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic therapy, while evidence supporting Saccharomyces boulardii for its prevention among hospitalized adults in resource-constrained settings remains limited. We evaluated the efficacy of Bularen^® in preventing AAD among hospitalized adults receiving systemic antibiotics. Methods: This single-center, randomized, double-blind, placebo-controlled trial was conducted at a tertiary care hospital in Bosnia and Herzegovina. Participants were randomly assigned to Bularen^® (S. boulardii) 250 mg twice daily or a matching placebo for 28 days. The primary outcome was at least one episode of AAD, defined as two or more loose or liquid stools within 24 h, during the 28-day follow-up. Results: Of 435 patients screened, 100 were randomized to Bularen^® (n = 51) or placebo (n = 49), and all completed follow-up. AAD occurred in 4/51 participants (7.8%) receiving Bularen^® and 35/49 (71.4%) receiving placebo (risk ratio, 0.11; 95% confidence interval, 0.04–0.29; p < 0.001), corresponding to an absolute risk reduction of 63.6 percentage points. During intravenous antibiotic therapy, AAD occurred in 0% versus 26.5% of participants, respectively (p < 0.001), and during oral therapy in 7.8% versus 51.0% (risk ratio, 0.15; 95% confidence interval, 0.06–0.41; p < 0.001). No toxin-positive Clostridioides difficile infections were identified. Conclusions: Bularen^® substantially reduced AAD incidence in this study population. Given the high placebo event rate and single-center design, confirmation in larger multicenter trials using standardized AAD definitions is warranted.