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ObjectiveTo examine the performance in adults of the European Alliance of Associations for Rheumatology (EULAR)/Pediatric Rheumatology European Society (PReS)-endorsed Ankara 2008 classification criteria for IgA vasculitis (IgAV).MethodsThe EULAR/PReS/Ankara 2008 classification criteria for IgAV were applied to patients enrolled in an international observational cohort which included patients with IgAV and comparators with other forms of small-vessel and medium-vessel vasculitis. After the initial assessment of the performance of the criteria, possible revisions to increase the performance were tested. The revised criteria were then assessed in an independent validation cohort within a multicentre Turkish vasculitis registry.ResultsThe dataset consisted of 178 IgAV cases and 1705 comparators. The Ankara 2008 criteria require skin involvement plus one of the following four criteria: abdominal pain, a biopsy showing IgA deposition, arthritis or arthralgia, or renal involvement (any haematuria and/or proteinuria). The specificity of the criteria improved when a positive test for anti-neutrophil cytoplasmic autoantibody or blood cryoglobulins was considered an exclusion criterion. The revised criteria had a sensitivity of 76.4% (95% CI 69.8% to 82.2%) and a specificity of 94.5% (95.0% CI 93.4% to 95.1%). In the validation set, the sensitivity and specificity of the revised criteria were 97.8% (95% CI 94.0% to 99.0%) and 85.0% (95.0% CI 78.0% to 90.0%), respectively.ConclusionThe revised EULAR/PReS-endorsed Ankara 2008 IgAV classification criteria perform well in adults with IgAV and are appropriate for use in clinical research.

Background This study investigates the long-term functional and transthoracic echocardiographic (TTE) progression in Behcet’s disease (BD) patients with pulmonary hypertension (PH), aiming to address knowledge gaps regarding PH in BD. Methods This study included 17 BD patients with PH detected by TTE and 6 patients with pulmonary artery involvement but without PH from a previous study at Hacettepe University. PH was defined as an estimated systolic pulmonary artery pressure (sPAP) ≥ 40 mmHg. TTE was conducted by a cardiologist blinded to clinical information, with sPAP calculated using the simplified Bernoulli equation. Right heart catheterization was performed only in two patients who underwent pulmonary endarterectomy operations. Results All 23 patients were reached by telephone, and 13 of the 17 with PH attended the clinic for reevaluation and a TTE was performed. After 5 years, all patients were alive. Clinical worsening or FC progression was not observed in any patient with PH except the ones with Group IV PH. Pulmonary endarterectomy (PEA) was performed in 2 of the 4 Group IV PH patients during follow-up. Additional Group II PH diagnosed due to mitral valve disease in a patient with Group IV PH. Other than the ones who underwent PEA there were no increase in sPAP of the BD patients with PH. Among patients with PAI but without PH during first evaluation; only one was mildly symptomatic after 5 years who had a normal sPAP. Conclusion Progressive PH was observed only in Group IV PH patients, while other groups remained generally asymptomatic. Although the number of patients enrolled in this study is limited implementation of TEE to the follow-up of BD patients with PAI for screening and monitoring PH can be beneficial for early diagnosis and defining treatment strategy.

Objective: To assess age-related differences in demographic, clinical, and treatment characteristics of systemic lupus erythematosus (SLE) patients and evaluate outcomes based on age at disease onset. Methods: Patients diagnosed with SLE who met 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were retrospectively evaluated. Patients were classified based on age at onset: adult-onset (18-49 years) and late-onset (≥50 years). Demographic, clinical, laboratory characteristics and outcomes of adult and late-onset groups were compared. Disease damage was evaluated with the SLICC/American College of Rheumatology damage index (SDI). To assess the effect of age on mortality, Cox regression analysis was performed with the selected variables that were causally associated with the outcome. Results: Among 519 patients, 88.1% were female, with a mean diagnosis age of 36.6 years. Adult-onset SLE represented 82.3% of cases, while 17.7% had late-onset disease. Neurological involvement was more frequent in adult-onset SLE (25.8% vs. 16.3%), as was renal involvement (41.1% vs. 26.1%). Anti-ribonucleoprotein antibodies were more prevalent in adult-onset SLE (24.7% vs. 7.1%, p<0.001). Damage accrual was observed in 40.3% of patients, without significant differences in SDI scores between groups. After a median follow-up of 9.2 years, 10.8% of patients died, with a higher mortality rate in late-onset SLE (20.7% vs. 8.7%, p=0.001). Cox regression showed age at SLE onset was independently associated with increased mortality (hazard ratio: 1.09, 95% confidence interval: 1.06-1.11, p<0.001). Conclusion: Age at SLE onset is associated with distinct clinical features and outcomes. Late-onset SLE patients experience higher mortality, emphasizing the need for age-specific approaches in SLE management.

Objective: This study evaluates the effectiveness, retention rate and safety of baricitinib, including a comparison between baricitinib and a tumour necrosis factor inhibitor (adalimumab) in a real-life cohort of patients with rheumatoid arthritis (RA). Methods: RA patients from the Hacettepe University Biological Prospective Database who received at least one dose of baricitinib or adalimumab between June 2020 and January 2023 were analyzed. Drug survival analysis included patients with at least one dose, while efficacy and safety analyses required at least one follow-up visit. Adverse events, major adverse cardiovascular events (MACE), malignancies, and medication adherence were assessed. The European Alliance of Associations for Rheumatology (EULAR) response classified patients as either good responders or non-responders. Results: A total of 280 patients (86 baricitinib, 194 adalimumab) were included, with a mean age of 52.4 (±13.6) years; 77.5% were female. Baricitinib significantly improved disease activity parameters. High patient global assessment [odds ratio (OR): 1.05 (95% confidence interval (CI): 1.02-1.09)] predicted a good response, while RF positivity [OR: 7.66 (95% CI: 1.46-40.07)] indicated a poor response. MACE occurred in 2 patients (2.5%) on baricitinib and in 4 patients (2.5%) on adalimumab, with rates of 15.3 and 9.1 per 1000 patient-years, respectively (p=0.20). Conclusion: Baricitinib improved disease activity parameters and a high patient global assessment predicted a good EULAR response. MACE incidence was comparable to that with adalimumab.

[LANGUAGE=”English”]ObjectiveDiagnosis of spondylodiscitis is usually possible radiographically with magnetic resonance imaging (MRI). However, the first imaging method evaluated in daily practice is conventional radiography. The aim of the study was to determine the sensitivity and specificity of detecting infectious or rheumatological spondylodiscitis in the lumbar region with conventional radiography by rheumatologists.MethodsAmong 102 patients with spondylodiscitis on lumbosacral (LS) MRI, 23 patients who also underwent simultaneous conventional LS radiography were included. TThe control group consisted of 52 outpatients with no evidence of spondylodiscitis on LS MRI. Eleven rheumatologists blindly evaluated conventional LS radiographs. Sensitivity, specificity, positive, and negative predictive values of LS conventional radiography were calculated.ResultsWhile the cause was infection in 8/23 (34.7%) of spondylodiscitis patients, it was spondyloarthritis in 15/23 (65.2%). According to LS MRI findings, 23 patients had spondylodiscitis in a total of 31 vertebral units. When we evaluated the detection of spondylodiscitis according to the vertebral unit level, it was mostly at one level [14 (60.8%)], primarily at the L4-5 vertebral unit [13 (56.5%)]. The sensitivity of detecting LS spondylodiscitis on conventional radiography was found to be 52% (30-65), and the specificity was 86% (59-94). While the median (minimum-maximum) sensitivity was 75.0 (50.0-87.5) in patients with infectious spondylodiscitis, it was 46.6 (13.3-76.9) in patients with spondylodiscitis due to spondyloarthritis.ConclusionClinicians can miss spondylodiscitis. Although it is evaluated with conventional radiography in the first stage in the presence of appropriate clinical findings, the clinician should be careful and consider more advanced approaches.[LANGUAGE=”Turkish”]AmaçSpondilodiskit tanısı genellikle manyetik rezonans görüntüleme (MRG) ile radyografik olarak mümkündür. Ancak günlük pratikte ilk değerlendirilen görüntüleme yöntemi konvansiyonel radyografidir. Bu çalışmanın amacı lomber bölgedeki enfeksiyöz veya romatolojik spondilodiskitlerin romatolog tarafından konvansiyonel radyografi ile saptanmasının duyarlılığını ve özgüllüğünü belirlemektir.Yöntem:Lumbosakral (LS) MRG’de spondilodiskit saptanan 102 hasta içerisinden eş zamanlı konvansiyonel LS grafisi çekilen 23 hasta çalışmaya dahil edildi. Kontrol grubunda LS MR’de spondilodiskit olmayan 52 hasta dahil edildi. On bir romatolog konvansiyonel LS radyografilerini değerlendirdi. LS konvansiyonel radyografinin duyarlılığı, özgüllüğü, pozitif ve negatif prediktif değeri hesaplandı.BulgularSpondilodiskit hastalarının 8/23’ünde (%34,7) neden enfeksiyon iken, 15/23’ünde (%65,2) spondiloartritti. LS MR bulgularına göre 23 hastada toplam 31 vertebral ünitede spondilodiskit mevcuttu. Spondilodiskiti, vertebral ünite seviyesine göre değerlendirdiğimizde en fazla tek seviyede [14 (%60,8)], en fazla L4-5 vertebral ünitede [813 (%56,5)] görüldü. Konvansiyonel radyografide LS spondilodiskitini saptamanın duyarlılığı %52 (30-65), özgüllüğü ise %86 (59-94) olarak bulunmuştur. Enfeksiyöz spondilodiskitli hastalarda ortanca (minimum-maksimum) duyarlılık 75,0 (50,0-87,5) iken, spondiloartrite bağlı spondilodiskitli hastalarda 46,6 (13,3-76,9) idi.SonuçKlinisyenler spondilodiskiti gözden kaçırabilmektedir. Uygun klinik bulguların varlığında ilk aşamada konvansiyonel radyografi ile değerlendirilse de daha ileri tetkikler açısından klinisyenin dikkatli olması gerekir.

Inflammatory arthritis (IA) is associated with an increased risk for certain malignancies, particularly lymphoma, due to underlying chronic inflammation. Conventional and targeted therapies used in IA modulate the immune system, raising concerns about the development of de novo malignancies or the progression of pre-existing ones. Managing IA patients with a history of cancer remains one of the most challenging areas for clinicians, and while international guidelines exist, they generally focus on a narrower scope. This report is the first comprehensive consensus report from Türkiye to address the relationship between IA and malignancy across a wide spectrum, including baseline risk, treatment-related risk, management of patients with a history of cancer, treatment during active malignancy, premalignant lesions, and family history. Based on a systematic literature review, this report provides evidence-based, practical recommendations for specific scenarios frequently encountered in daily practice—such as cancer development during active treatment, premalignant lesions, and family history—which are often narrowly addressed in existing international guidelines. This report will help rheumatologists standardize decision-making processes regarding the coexistence of IA and malignancy, enabling them to take safer clinical steps. By promoting risk individualization and shared decision-making between patients and clinicians, it will strengthen personalized treatment approaches that ensure both effective control of rheumatic disease and oncologic safety.

Objective: Diagnosis of spondylodiscitis is usually possible radiographically with magnetic resonance imaging (MRI). However, the first imaging method evaluated in daily practice is conventional radiography. The aim of the study was to determine the sensitivity and specificity of detecting infectious or rheumatological spondylodiscitis in the lumbar region with conventional radiography by rheumatologists. Methods: Among 102 patients with spondylodiscitis on lumbosacral (LS) MRI, 23 patients who also underwent simultaneous conventional LS radiography were included. TThe control group consisted of 52 outpatients with no evidence of spondylodiscitis on LS MRI. Eleven rheumatologists blindly evaluated conventional LS radiographs. Sensitivity, specificity, positive, and negative predictive values of LS conventional radiography were calculated. Results: While the cause was infection in 8/23 (34.7%) of spondylodiscitis patients, it was spondyloarthritis in 15/23 (65.2%). According to LS MRI findings, 23 patients had spondylodiscitis in a total of 31 vertebral units. When we evaluated the detection of spondylodiscitis according to the vertebral unit level, it was mostly at one level [14 (60.8%)], primarily at the L4-5 vertebral unit [13 (56.5%)]. The sensitivity of detecting LS spondylodiscitis on conventional radiography was found to be 52% (30-65), and the specificity was 86% (59-94). While the median (minimum-maximum) sensitivity was 75.0 (50.0-87.5) in patients with infectious spondylodiscitis, it was 46.6 (13.3-76.9) in patients with spondylodiscitis due to spondyloarthritis. Conclusion: Clinicians can miss spondylodiscitis. Although it is evaluated with conventional radiography in the first stage in the presence of appropriate clinical findings, the clinician should be careful and consider more advanced approaches. Keywords: Spondyloarthritis, spondylitis, inflammation, sensitivity and specificity Amac: Spondilodiskit tanisi genellikle manyetik rezonans goruntuleme (MRG) ile radyografik olarak mumkundur. Ancak gunluk pratikte ilk degerlendirilen goruntuleme yontemi konvansiyonel radyografidir. Bu calismanin amaci lomber bolgedeki enfeksiyoz veya romatolojik spondilodiskitlerin romatolog tarafindan konvansiyonel radyografi ile saptanmasinin duyarliligini ve ozgullugunu belirlemektir. Yontem: Lumbosakral (LS) MRG'de spondilodiskit saptanan 102 hasta icerisinden es zamanli konvansiyonel LS grafisi cekilen 23 hasta calismaya dahil edildi. Kontrol grubunda LS MR'de spondilodiskit olmayan 52 hasta dahil edildi. On bir romatolog konvansiyonel LS radyografilerini degerlendirdi. LS konvansiyonel radyografinin duyarliligi, ozgullugu, pozitif ve negatif prediktif degeri hesaplandi. Bulgular: Spondilodiskit hastalarinin 8/23'unde (%34,7) neden enfeksiyon iken, 15/23'unde (%65,2) spondiloartritti. LS MR bulgularina gore 23 hastada toplam 31 vertebral unitede spondilodiskit mevcuttu. Spondilodiskiti, vertebral unite seviyesine gore degerlendirdigimizde en fazla tek seviyede [14 (%60,8)], en fazla L4-5 vertebral unitede [813 (%56,5)] goruldu. Konvansiyonel radyografide LS spondilodiskitini saptamanin duyarliligi %52 (30-65), ozgullugu ise %86 (59-94) olarak bulunmustur. Enfeksiyoz spondilodiskitli hastalarda ortanca (minimum-maksimum) duyarlilik 75,0 (50,0-87,5) iken, spondiloartrite bagli spondilodiskitli hastalarda 46,6 (13,3-76,9) idi. Sonuc: Klinisyenler spondilodiskiti gozden kacirabilmektedir. Uygun klinik bulgularin varliginda ilk asamada konvansiyonel radyografi ile degerlendirilse de daha ileri tetkikler acisindan klinisyenin dikkatli olmasi gerekir. Anahtar Kelimeler: Spondiloartrit, spondilit, enflamasyon, duyarlilik ve ozgulluk

Objective: To assess age-related differences in demographic, clinical, and treatment characteristics of systemic lupus erythematosus (SLE) patients and evaluate outcomes based on age at disease onset. Methods: Patients diagnosed with SLE who met 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were retrospectively evaluated. Patients were classified based on age at onset: adult-onset (18-49 years) and late-onset ([greater than or equal to] 50 years). Demographic, clinical, laboratory characteristics and outcomes of adult and late-onset groups were compared. Disease damage was evaluated with the SLICC/American College of Rheumatology damage index (SDI). To assess the effect of age on mortality, Cox regression analysis was performed with the selected variables that were causally associated with the outcome. Results: Among 519 patients, 88.1% were female, with a mean diagnosis age of 36.6 years. Adult-onset SLE represented 82.3% of cases, while 17.7% had late-onset disease. Neurological involvement was more frequent in adult-onset SLE (25.8% vs. 16.3%), as was renal involvement (41.1% vs. 26.1%). Anti-ribonucleoprotein antibodies were more prevalent in adult-onset SLE (24.7% vs. 7.1%, p<0.001). Damage accrual was observed in 40.3% of patients, without significant differences in SDI scores between groups. After a median follow-up of 9.2 years, 10.8% of patients died, with a higher mortality rate in late-onset SLE (20.7% vs. 8.7%, p=0.001). Cox regression showed age at SLE onset was independently associated with increased mortality (hazard ratio: 1.09, 95% confidence interval: 1.06-1.11, p<0.001). Conclusion: Age at SLE onset is associated with distinct clinical features and outcomes. Late-onset SLE patients experience higher mortality, emphasizing the need for age-specific approaches in SLE management. Keywords: Systemic lupus eryhthematosus, age at onset, damage, mortality Amac: Bu calismanin amaci, sistemik lupus eritematozus (SLE) hastalarinda yasa bagli demografik, klinik ve tedavi ozelliklerindeki farkliliklari degerlendirmek ve hastalik baslangic yasina gore prognozu incelemektir. Yontem: 2012 Sistemik Lupus Uluslararasi Isbirligi Klinikleri (SLICC) kriterlerini karsilayan SLE tanili hastalar retrospektif olarak degerlendirildi. Hastalar, hastalik baslangic yaslarina gore yetiskin baslangicli (18-49 yas) ve gec baslangicli ([greater than or equal to] 50 yas) olmak uzere siniflandirildi. Yetiskin ve gec baslangicli gruplarin demografik, klinik, laboratuvar ozellikleri ve sonuclari karsilastirildi. Hastaliga bagli hasar, SLICC/Amerikan Romatoloji Koleji hasar indeksi (SDI) ile degerlendirildi. Yasin mortalite uzerindeki etkisini incelemek icin, sonucla nedensel iliskili degiskenlerin dahil edildigi Cox regresyon analizi uygulandi. Bulgular: Toplam 519 hastanin %88,1'i kadin olup, ortalama tani yasi 36,6 yil olarak belirlendi. Hastalarin %82,3'u yetiskin baslangicli, %17,7'si ise gec baslangicli SLE grubundaydi. Norolojik tutulum yetiskin baslangicli SLE'de daha sik goruldu (%25,8'e karsi %16,3), ayni sekilde renal tutulum da daha yuksekti (%41,1'e karsi %26,1). Anti-ribonukleoprotein antikorlari yetiskin baslangicli grupta daha yaygindi (%24,7'ye karsi %7,1, p<0,001). Hasar birikimi %40,3 hastada gozlenmis olup, gruplar arasinda SDI skorlarinda anlamli bir fark bulunmadi. Ortalama 9,2 yillik takip suresi sonunda, hastalarin %10,8'i hayatini kaybetti ve gec baslangicli SLE grubunda mortalite orani daha yuksekti (%20,7'ye karsi %8,7, p=0,001). Cox regresyon analizi, SLE baslangic yasinin bagimsiz olarak artmis mortalite ile iliskili oldugunu gosterdi (risk orani: 1,09, %95 guven araligi: 1,06-1,11, p<0,001). Sonuc: Bu calismada, SLE baslangic yasi, klinik ozellikler ve prognoz uzerinde farkliliklarla iliskili olarak bulunmustur. Gec baslangicli SLE hastalarinda yuksek mortalite gozlenmis olup, bu sonuc yasa ozgu yaklasimlarin gerekliligini vurgulamaktadir. Anahtar Kelimeler: Sistemik lupus eritematozus, hastalik baslangic yasi, hasar, mortalite

Objective: This study evaluates the effectiveness, retention rate and safety of baricitinib, including a comparison between baricitinib and a tumour necrosis factor inhibitor (adalimumab) in a real-life cohort of patients with rheumatoid arthritis (RA). Methods: RA patients from the Hacettepe University Biological Prospective Database who received at least one dose of baricitinib or adalimumab between June 2020 and January 2023 were analyzed. Drug survival analysis included patients with at least one dose, while efficacy and safety analyses required at least one follow-up visit. Adverse events, major adverse cardiovascular events (MACE), malignancies, and medication adherence were assessed. The European Alliance of Associations for Rheumatology (EULAR) response classified patients as either good responders or non- responders. Results: A total of 280 patients (86 baricitinib, 194 adalimumab) were included, with a mean age of 52.4 ([+ or -]13.6) years; 77.5% were female. Baricitinib significantly improved disease activity parameters. High patient global assessment [odds ratio (OR): 1.05 (95% confidence interval (CI): 1.021.09)] predicted a good response, while RF positivity [OR: 7.66 (95% CI: 1.4640.07)] indicated a poor response. MACE occurred in 2 patients (2.5[degrees]%) on baricitinib and in 4 patients (2.5%) on adalimumab, with rates of 15.3 and 9.1 per 1000 patient-years, respectively (p=0.20). Conclusion: Baricitinib improved disease activity parameters and a high patient global assessment predicted a good EULAR response. MACE incidence was comparable to that with adalimumab. Keywords: Rheumatoid arthritis, baricitinib, real life, major adverse cardiovascular events, adverse events Amac: Bu calisma, romatoid artrit (RA) hastalarinin gercek yasam kosullarinda tedavisinde barisitinibin guvenliligini, etkililigini ve tedavide kaliciligini degerlendirmek; barisitinib icinde ve bir tumor nekroz faktoru inhibitoru (adalimumab) ile karsilastirmayi amaclamaktadir. Yontem: Haziran 2020 ile Ocak 2023 arasinda en az bir doz barisitinib veya adalimumab alan Hacettepe Universitesi Biyolojik Prospektif Veritabani'ndan RA hastalari analiz edildi. Ilac sagkalimi analizi en az bir doz baricitinib ve adalimumab alan hastalari icerirken, etkililik ve guvenlilik analizleri icin en az bir takip viziti bulunmasi gerekiyordu. Advers olaylar, major olumsuz kardiyovaskuler olaylar (MACE), maligniteler ve ilaca uyum degerlendirildi. Avrupa Romatoloji Dernekleri Birligi (EULAR) yaniti, iyi yanit verenler veya yanit vermeyenler olarak siniflandirdi. Bulgular: Toplam 280 hasta (86 barisitinib, 194 adalimumab) calismaya dahil edildi; ortalama yas 52,4 ([+ or -]13,6) yil olup hastalarin %77,5'i kadindi. Barisitinib, hastalik aktivitesi parametrelerini anlamli duzeyde iyilestirdi. Yuksek hasta global degerlendirmesi iyi yaniti ongordu [risk orani (OR): 0,95 (%95 guven araligi (GA): 0,92-0,98)], RF pozitifligi ise kotu yaniti isaret etti [OR: 7,66 (%95 GA: 1,46-40,07)]. MACE, barisitinib kullanan 2 hastada (%2,5) ve adalimumab kullanan 4 hastada (%2,5) goruldu; oranlar sirasiyla 1000 hasta-yil basina 15,3 ve 9,1 idi (p=0,20). Sonuc: Barisitinib tedavisi hastalik aktivitesi gostergelerinde duzelme sagladi ve yuksek hasta global degerlendirmesi iyi EULAR yanitinin ongordurucusuydu. MACE sikligi adalimumab ile benzerdi. Anahtar Kelimeler: Romatoid artrit, baricitinib, gercek yasam, major kardiyak olaylar, advers olaylar

Inflammatory arthritis (IA) is associated with an increased risk for certain malignancies, particularly lymphoma, due to underlying chronic inflammation. Conventional and targeted therapies used in IA modulate the immune system, raising concerns about the development of de novo malignancies or the progression of pre-existing ones. Managing IA patients with a history of cancer remains one of the most challenging areas for clinicians, and while international guidelines exist, they generally focus on a narrower scope. This report is the first comprehensive consensus report from Turkiye to address the relationship between IA and malignancy across a wide spectrum, including baseline risk, treatment-related risk, management of patients with a history of cancer, treatment during active malignancy, premalignant lesions, and family history. Based on a systematic literature review, this report provides evidence-based, practical recommendations for specific scenarios frequently encountered in daily practice–such as cancer development during active treatment, premalignant lesions, and family history–which are often narrowly addressed in existing international guidelines. This report will help rheumatologists standardize decision-making processes regarding the coexistence of IA and malignancy, enabling them to take safer clinical steps. By promoting risk individualization and shared decision -making between patients and clinicians, it will strengthen personalized treatment approaches that ensure both effective control of rheumatic disease and oncologic safety.