Low relapse rate in patients with giant cell arteritis in a multi-centre retrospective Turkish Registry

OBJECTIVES

Glucocorticoids (GC) are widely accepted as the standard first-line treatment for giant cell arteritis (GCA). However, relapse rates are reported up to 80% on GC-only protocol arms in controlled trials of tocilizumab and abatacept in 12-24 months. Herein, we aimed to assess the real-life relapse rates retrospectively in patients with GCA from Turkey.

METHODS

We assembled a retrospective cohort of patients with GCA diagnosed according to ACR 1990 criteria from tertiary rheumatology centres in Turkey. All clinical data were abstracted from medical records. Relapse was defined as any new manifestation or increased acutephase response leading to the change of the GC dose or use of a new therapeutic agent by the treating physician.

RESULTS

The study included 330 (F/M: 196/134) patients with GCA. The mean age at disease onset was 68.9±9 years. The most frequent symptom was headache. Polymyalgia rheumatica was also present in 81 (24.5%) patients. Elevation of acute phase reactants (ESR>50 mm/h or CRP>5 mg/l) was absent in 25 (7.6%) patients at diagnosis. Temporal artery biopsy was available in 241 (73%) patients, and 180 of them had positive histopathological findings for GCA. For remission induction, GC pulses (250-1000 methylprednisolone mg/3-7 days) were given to 69 (20.9%) patients, with further 0.5-1 mg/kg/day prednisolone continued in the whole group. Immunosuppressives as GC-sparing agents were used in 252 (76.4%) patients. During a follow-up of a median 26.5 (6-190) months, relapses occurred in 49 (18.8%) patients. No confounding factor was observed in relapse rates. GC treatment could be stopped in only 62 (23.8%) patients. Additionally, GC-related side effects developed in 64 (24.6%) patients, and 141 (66.2%) had at least one Vasculitis Damage Index (VDI) damage item present during follow-up.

CONCLUSIONS

In this first multi-centre series of GCA from Turkey, we observed that only one-fifth of patients had relapses during a mean follow-up of 26 months, with 76.4% given a GC-sparing IS agent at diagnosis. At the end of follow-up, GC-related side effects developed in one-fourth of patients. Our results suggest that patients with GCA had a low relapse rate in real-life experience of a multi-centre retrospective Turkish registry, however with a significant presence of GC-associated side effects during follow-up.

Use of nailfold video capillaroscopy in polycythemia vera

Objectives

In this study, we aimed to investigate capillary vessel diameters and structural changes of capillaries by using nailfold video capillaroscopy (NVC) in patients with polycythemia vera (PV).

Patients and methods

This cross-sectional study included a total of 24 patients (19 males, 5 females; mean age: 59.8±12.9 years; range, 50.2 to 68 years) who were diagnosed with PV and 15 healthy controls (11 males, 4 females; mean age: 40.7±5.1 years; range, 36 to 44 years) between June 2016 and February 2017. Nailfold video capillaroscopy was performed by an experienced rheumatologist who was blinded to clinical data. The apical, arterial, and venous limb diameters of capillaries were measured and microvascular changes of capillaries were scored.

Results

When capillaries were evaluated in terms of morphological structures, giant capillary was detected in 67% of the patients with PV and 0% in the control group (p<0.05). The arterial, venous, and apical diameters of the capillaries were significantly higher in the patients with PV compared to the control group (p<0.001).

Conclusion

The presence of giant capillaries and the marked increase of arterial, venous, and apical diameters of capillaries seem to be related to PV. As it additionally plays an important role in diagnosis, prognosis, and treatment monitoring of certain diseases, capillaroscopy can be considered to be a promising microcirculation biomarker.

Evaluation of salivary gland ultrasonography in primary Sjögren's syndrome: does it reflect clinical activity and outcome of the disease?

OBJECTIVES

To evaluate associations between salivary gland ultrasonography (SGUS) and clinical characteristics, disease activity and outcome in patients with primary Sjögren's syndrome (pSS).

METHODS

The parotid and submandibular salivary glands were examined by ultrasonography using two different scoring systems proposed by Hocevar et al. and Milic et al. on 85 pSS patients. Patients with inhomogeneity/hypoechoic areas with scores ≥2 in parotid and submandibular glands were classified as severe parotid or severe submandibular involvements, respectively. Disease activity and patient-reported severity were evaluated using the European League Against Rheumatism Sjögren's Disease Activity Index (ESSDAI) and the European League Against Rheumatism Sjögren's Patient Reported Index (ESSPRI). Salivary gland functional capacity was investigated by unstimulated whole saliva flow rate (U-WSFR).

RESULTS

Of the activity scores, ESSPRI dryness component was higher in pSS patients who had scores above the cut-off values for Hocevar (6.1±2.3 vs. 4.9±2.6, p=0.026). The patients with any type of systemic involvement more frequently showed higher SGUS scores, according to both Hocevar (72.4 vs. 44.6%, p=0.013) and Milic (75.9 vs. 51.8%, p=0.026). These patients also showed a higher percentage of severe parotid/submandibular changes on US imaging (65.5 vs. 33.9%, p=0.005 and 75.9 vs. 51.8%, p=0.026 respectively). Higher SGUS scores according to cut-off values of both scoring systems and severe parotid/submandibular involvements were associated with both anti-Ro or double anti-Ro/La autoantibodies and inversely associated with U-WSFR.

CONCLUSIONS

SGUS may be a useful imaging modality for the selection of patients with more severe disease status or who may require a tight follow-up schedule.

The relationship between vitamin D deficiency and erythrocyte sedimentation rate in patients with diabetes

Background/aim: Vitamin D deficiency in diabetic patients has been shown to be associated with some inflammatory markers. However, its relationship with erythrocyte sedimentation rate (ESR) is still unknown. The aim of this study was to investigate the relationship between vitamin D deficiency and ESR in patients with type 2 diabetes mellitus (T2DM). Materials and methods: This cross-sectional study was conducted with 294 consecutive patients with T2DM. Serum levels of 25-hydroxyvitamin D, glycemic parameters, lipids, ESR, and C-reactive protein were measured. Patients were evaluated according to 25-hydroxyvitamin D levels as having vitamin D deficiency, vitamin D insufficiency, and vitamin D sufficiency. Results: ESR was found to be higher in patients with vitamin D deficiency than in patients who were vitamin D-sufficient (P < 0.001), and ESR was negatively correlated with 25-hydroxyvitamin D level (r = –0.265, P < 0.001). HbA1c and postprandial glucose levels were higher in patients with vitamin D deficiency than vitamin D-sufficient patients (P = 0.005 and P = 0.019, respectively). In receiver operating curve analysis, an ESR value of 14.5 mm/h had 70.1% sensitivity and 50.3% specificity for the prediction of vitamin D deficiency. Conclusion: The present study revealed that ESR is higher in T2DM patients with vitamin D deficiency than patients with sufficient vitamin D. There was an inverse association between ESR and vitamin D levels. Furthermore, vitamin D deficiency was related to poor glycemic control.

A study of ergonomics factors in washbasin design

A 4-week UNESCO-sponsored mission to the Department of Architecture, Karadeniz Technical University in Eastern Turkey, gave an opportunity to apply ergonomics techniques to some aspects of that country's domestic washbasin design. The study was intended to provide experience in questionnaire design and administration, in the application of psycho-physical methods, and to highlight the importance of determining user characteristics and preferences with regard to the built environment. A field study elicited information on dimensions and positioning of existing wash-basins and ancillary equipment and the opinions of users as to the suitability of these features in relation to the activities performed. A laboratory study, using an adjustable rig permitting variation in the heights of basin, taps and mirror/shelf, followed. The data obtained on preferred heights of these items led to the conclusions that basin height should be increased to between 95 and 100 cm to satisfy the majority of users; tap height above the basin should be reduced to about 11 cm; the shelf and lower edge of a mirror sited above the basin should be 136 cm above the floor; and a clear space of 110 cm should be available between the front of the basin and a wall or other obstruction. Suggestions on other design aspects of the bathroom, resulting from the study, are discussed.