HLA-B51 Impact on Clinical Symptoms in Behcet's Disease

OBJECTIVE

To investigate the association of HLA-B51-positivity to clinical manifestations of Behçet's disease (BD).

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Clinic of Rheumatology, Dıskapi Education and Research Hospital, Health Sciences University, Turkey, from December 2018 to December 2020.

METHODOLOGY

Patients who had HLA-B5 genetic results and fulfilled the international criteria for BD were included in the study. HLA-B51 status was determined and compared with the symptomatology.

RESULTS

Mean age of 204 cases was 39.9±11.4 years. There were 52.5% female and 47.5% male patients. One hundred (61.7%) patients were HLA-B51-positive. The frequency of papulopustular lesions (PPL), ocular involvement, neurologic involvement, and vascular involvement was significantly higher in HLA-B51-positive patients compared to HLA-B51 negative patients (p=0.044, 0.012, 0.039, and 0.022 respectively). HLA-B51-positivity was found to be a significant risk factor for PPL (OR and 95% CI:1.946 and 1.044-3.629), ocular involvement (OR and 95% CI:2.399 and 1.165-4.938), and neurological involvement (OR and 95% CI:5.404 and 1.119-26.093). Significant risk factors for vascular involvement were male gender (OR and 95% CI:2.810 and 1.403-5.627) and low age of disease onset (OR and 95% CI:0.935 and 0.894-0.979).

CONCLUSION

Ocular, vascular, and neurological involvements are more common in patients with BD with HLA-B51-positive. HLA-B51 was found to be an independent risk factor for papulopustular lesion, ocular and neurological involvement, while the male gender was found to be an independent risk factor for vascular involvement.

KEY WORDS

Behcet syndrome / genetics, HLA-B51, Neurologic involvement, Ocular involvement, Vascular involvement, Vasculitis* / diagnosis.

Relationship between disease impact scores and C-reactive protein/albumin ratio in patients with psoriatic arthritis

Aim

To evaluate the relationships between the C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and Disease Activity in Psoriatic Arthritis (DAPSA) and Psoriatic Arthritis Impact of Disease 12-item-questionnaire (PsAID-12) scores in patients with psoriatic arthritis (PsA).

Methods

This cross-sectional study involved 160 (121 female) patients with PsA who were >18 years old and treated in the rheumatology clinic of Dışkapı Yıldırım Beyazıt Education and Research Hospital between January 2020 and January 2021. Demographic and clinical data, PsAID-12 and DAPSA scores, CRP, erythrocyte sedimentation rate (ESR), albumin level, neutrophil, lymphocyte, and platelet counts were recorded.

Results

The mean age was 46.49 ± 11.12 years; median (min-max) disease duration was 2 years (0.5-34). The PsAID score was ≥4 (high disease impact) in 74.4% of patients. Patients with high disease impact had significantly higher CRP, ESR, CAR, NLR, PLR, neutrophil counts, and DAPSA scores (P < 0.001). PsAID scores significantly highly correlated with CRP (rho 0.864, P < 0.001), DAPSA significantly highly correlated with the CAR (rho 0.890, P < 0.001). Receiver operating characteristic curve analysis showed that the CAR (area under the curve [AUC] 0.901, P < 0.05, 95% confidence interval [CI] 0.855-0.947, NLR (AUC 0.759, P < 0.05, 95% CI 0.680-0.838), and PLR (AUC 0.686, P < 0.05, 95% CI 0.591-0.782) predicted high disease impact. The cut-off value for the CAR was 0.98.

Conclusion

The CAR can be useful in daily practice as a simple and quick assessment method to evaluate disease impact in PsA.

Investigation of the correlation between mood disorder symptoms and disease activity and functional status in rheumatoid arthritis patients

Background/aim

To investigate the correlation between depressive-anxiety symptoms, mixed features, disease activity, and functional status in patients with rheumatoid arthritis (RA) in the light of the shared underlying etiology in both disorders.

Materials and methods

The study included 556 patients with RA. RA disease activity was measured using the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), and the patients were evaluated by a Health Assessment Questionnaire (HAQ). The Hospital Anxiety and Depression Scale (HADS), Mood Disorder Questionnaire (MDQ), and Modified Hypomania Checklist (mHCL) were used to evaluate the mixed depression and bipolarity status of the patients.

Results

Of the patients, 430 (77.3%) were female and 126 (22.7%) were male. The median age was 57 years, the median HAQ score was 0.55 points, and the median DAS28-CRP score was 4.1 points. The evaluation of the patients by DAS28-CRP revealed that 58.5% of the patients had moderate and severe disease activity, while only 23.4% of them were in remission. The group using the combination of synthetic disease-modifying anti-rheumatic drugs (sDMARD) and steroid therapy had significantly higher HAD-depression, HAD-anxiety, mHCL, DAS28-CRP, HAQ, and MDQ scores than the group using sDMARD alone. The grouping of the patients based on the DAS28-CRP cut-off scores showed that the patients with moderate and severe disease activity had significantly higher HADS, mHCL, MDQ scores than those in remission and those with mild disease activity (p < 0.001).

Conclusion

Disease severity and functional status in RA can be affected by comorbid anxiety-depressive and mixed symptoms. Therefore, clinicians should consider screening the depressive-anxiety and mixed mood symptoms of RA patients. Moreover, patients who use steroid therapy are more susceptible to mood symptoms (anxiety, depression, bipolarity), which should also be considered during the follow-up of patients.

Could C-Reactive Protein/Albumin Ratio be an Indicator of Activation in Axial Spondyloarthritis?

OBJECTIVES

 To evaluate the relationship of C-reactive protein (CRP)/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in axial spondyloarthritis (Ax-SpA).

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Clinic of Rheumatology, Dışkapı Education and Research Hospital, Health Sciences University, Turkey during January 2020-2021.

METHODOLOGY

One-hundred and nine patients aged >18 years were included. Age, gender, duration of disease, BASDAI scores were recorded. CRP, erythrocyte sedimentation rate (ESR), albumin values, leukocyte, neutrophil, lymphocyte, platelet counts were determined.

RESULTS

The mean age and median disease duration of the patients were 45.03±10.63 and 5 (2-6.5) years, respectively. Among these, 28 (58.3%) female and 44 (72.1%) male patients were found to be HLA-B27 positive. BASDAI≥ 4 was observed in 61 (56%) patients and <4 in 48 (44%) patients. CRP, albumin, ESR, NLR and CAR values between the patient groups were significantly different. There was high correlation between BASDAI and CAR. There was a moderate correlation between CAR and BASDAI in the patient group with normal acute phase reactants.

CONCLUSION

There is a significant correlation between CAR value and composite score such as BASDAI, which is commonly used to assess systemic inflammation in Ax-SpA. These methods are reliable, recognised by reimbursement institutions and include measurements that physicians can use practically in routine outpatient clinics. Key Words: Spondylitis, Ankylosing, HLA-B27 antigen, C-reactive protein/metabolism, Serum albumin/metabolism, Neutrophils, Lymphocytes, Platelet count.

Diagnostic value of acustic radiation force impulse imaging in the assessment of salivary gland involvement in primary Sjögren's sydrome

AIMS

The aim of this study is to investigate the diagnostic value of Acoustic Radiation Force Impulse (ARFI) imaging in the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS).

MATERIAL AND METHODS

Twenty five patients with pSS and 25 healthy volunteers were included. First, echostructures and the thickness of the submandibular and parotid glands were evaluated by B-mode ultrasonography. Then, ARFI imaging with Virtual Touch Quantification® was performed. Ten independent shear wave velocity measurements were taken from each gland. Finally, the mean shear wavevelocity (SWV) values were calculated, and used for further analysis.

RESULTS

The mean SWV values of parotid and submandibular glands were significantly higher in the pSS patients than in the healthy control group (p<0.001). The cut-off of SWV values were calculated to be 1.98 m/s for submandibular glands, and 1.93 m/s for parotid glands. In pSS patients, the mean SWV values of parotid glands were higher than those of the submandibular glands (p<0.001) and no statistically significant relationships between symptom duration or the degree of xerostomia and mean SWV values of parotid and submandibularglands were found (all p>0.005).

CONCLUSIONS

Our findings indicate that ARFI imaging may provide a non-invasive, simple and fast means of assessment of glandular impairment as an alternative test when other salivary gland tests are inconclusive or cannot be performed. ARFI may be a valuable adjunct for the clinical diagnosis of pSS.

Spontaneous HBsAg seroconversion after severe flare of chronic hepatitis B infection

The results of the acute exacerbations of hepatitis B virus are varied from silent to severe acute hepatitis. HBsAg seroconversion induced by either antiviral drugs or occurred spontaneously, as a targeted end point of HBV infection management is infrequent. The affect of the severe hepatitic flare on HBsAg seroconversion was reported before, however the predictive markers of HBsAg seroconversion are not clear yet. The reasons of the spontaneously HBV re-activations, or its usual results are not known well. We, herein reported a case, with the high serum HBV DNA titer during an acute spontaneously induced severe exacerbation of HBV infection which spontaneously resulted in total HBV recovery.

Preoperative detection and management of tracheomalacia in advanced laryngotracheal stenosis

OBJECTIVE

To determine the predictive value of endoscopic examination and radiological imaging in the evaluation of substomal tracheomalacia in advanced laryngotracheal stenosis.

METHODS

Forty nine patients with advanced laryngotracheal stenosis were preoperatively evaluated with radiological (magnetic resonance imaging [MRI]) and endoscopy to determine the grade of laryngotracheal stenosis and presence of substomal tracheomalacia. The intraoperative findings were compared with the preoperative findings, and the percentage of operative plan changes was calculated.

RESULTS

In a preoperative evaluation, 37 patients were found to have no substomal tracheomalacia; but during the surgical procedure, we detected substomal tracheomalacia in 12 (32.4%) of these patients and changed our preoperative plan during the procedure (p < 0.05).

CONCLUSION

Laryngotracheal reconstruction plans are dependent on preoperative evaluations which can change significantly during the surgical procedure. Therefore, experienced physicians who can alter the preoperative plan immediately during the procedure and successfully perform an alternative procedure are necessary.