Background: This study aimed to compare muscle quality between women with rheumatoid arthritis (RA) and age-matched healthy controls and to explore the associations with muscle strength and walking speed. Methods: Thirty women with RA and 30 healthy controls participated. Muscle thickness and echo intensity (EI) of the rectus femoris (RF), vastus medialis, tibialis anterior (TA), medial gastrocnemius (MG), and lateral gastrocnemius (LG) were assessed using B-mode ultrasonography. Disease activity was evaluated using the 28-joint Disease Activity Score. Isometric knee and ankle muscle strength were measured by handheld dynamometry and walking speed by the 20-meter Walk Test. Results: Women with RA exhibited significantly lower muscle thickness in the RF (1.08 vs. 1.51 cm; P = .032), TA (1.46 vs. 1.98 cm; P = .027), MG (1.09 vs. 1.53 cm; P = .040), and LG (0.86 vs. 1.13 cm; P = .013) compared with controls. Echo intensity values were significantly higher in the RA group across all muscles examined (all P < .05). Knee extensor strength (109.26 vs. 122.35 N; P = .004) and walking speed (1.09 vs. 1.98 m/s; P = .032) were also reduced in RA. Disease Activity Score correlated positively with EI (RF: rho = 0.425) and negatively with muscle thickness (RF: rho = −0.456). Conclusion: Women with RA show significant impairments in muscle quality, strength, and mobility, which worsen with increasing disease activity. Regular assessment of muscle morphology and functional performance may support early identification of functional decline and guide appropriate management strategies in this population. Cite this article as: Karapınar M, Ayyıldız VA, Alsa. A, Doğru A, Şahin M. Comparison of lower extremity muscle deterioration in women with rheumatoid arthritis and healthy controls: relationship with disease activity, muscle strength, and walking speed. Eurasian J Med. 2026, 58(3), 1144, doi: 10.5152/eurasianjmed.2026.251144.

Objective: This study aimed to evaluate the diagnostic accuracy of SARC-F and SARC-CalF as screening tools for sarcopenia in patients with rheumatoid arthritis using the European Working Group on Sarcopenia in Older People 2 algorithm as the reference standard. Method: A cross-sectional study was conducted among 106 patients with rheumatoid arthritis diagnosed according to the 2010 ACR/EULAR criteria. Sarcopenia was assessed through handgrip strength, appendicular skeletal muscle mass (via bioelectrical impedance analysis), and gait speed, following the EWGSOP2 "Find - Assess - Confirm - Severity" (F-A-C-S) model. The diagnostic performance of SARC-F and SARC-CalF was evaluated using sensitivity, specificity, positive and negative predictive values (PPV, NPV), and receiver operating characteristic (ROC) curves. Results: Among the participants, 43.3% had probable sarcopenia (low muscle strength), 15% had confirmed sarcopenia (low muscle strength plus low muscle mass), and 11.3% had severe sarcopenia (low strength, low mass, and poor physical performance), according to EWGSOP2 criteria. SARC-F showed high sensitivity (86.2%) and NPV (91.3%) for probable sarcopenia but had low specificity (54.5%) and poor discrimination for confirmed (AUC: 0.43) and severe (AUC: 0.44) cases. In contrast, SARC-CalF demonstrated improved specificity (90.7%) and better AUC (0.63) for confirmed sarcopenia, although sensitivity remained low (32.3%). Both tools showed limited performance in detecting severe sarcopenia. Conclusion: SARC-F, with its high sensitivity, can serve as a first-line physiotherapy screening tool to identify patients with rheumatoid arthritis at risk of sarcopenia, enabling timely referral for muscle-strengthening interventions. SARC-CalF offers greater specificity for confirmed cases and supports individualized exercise planning. As neither tool alone detects severe sarcopenia, a two-step approach combining both questionnaires with confirmatory assessments is recommended to enhance early detection and optimize functional outcomes in physiotherapy practice.

OBJECTIVES:Anti-topoisomerase I antibody (ATA) is typically associated with diffuse cutaneous systemic sclerosis (dcSSc). However, subset of limited cutaneous SSc (lcSSc) patients also present with ATA positivity. Emerging data suggest that ATA-positive lcSSc may represent a distinct or intermediate clinical phenotype. This study aimed to compare the demographic, clinical, and treatment features of early ATA-positive lcSSc patients with those of ACA-positive lcSSc and ATA-positive dcSSc patients. METHODS:Patients were recruited from the multicentre Turkish SOLAR cohort (Systemic sclerOsis Longitudinal Assessment Registry). Among 295 SSc patients screened, 172 were included: 74 ACA-positive lcSSc, 55 ATA-positive lcSSc, and 43 ATA-positive dcSSc. Demographic, clinical, and treatment-related variables were analysed and compared across groups. RESULTS:ATA-positive lcSSc patients were younger at the onset of Raynaud's phenomenon (RP) (p=0.042), the first non-RP symptom (p=0.016), and at diagnosis (p=0.018) compared with ACA-positive lcSSc patients. Interstitial lung disease (ILD) was significantly more frequent in ATA-positive lcSSc (74.5%) than ACA-positive lcSSc (8.1%, p<0.001) and was comparable to ATA-positive dcSSc. Modified Rodnan skin scores were highest in ATA-positive dcSSc but were also significantly elevated in ATA-positive lcSSc (p<0.001). Pitting scars were more frequent in dcSSc. Among patients with ILD, ATA-positive lcSSc and ATA-positive dcSSc showed similar HRCT patterns. ATA-positive lcSSc patients were more frequently treated with glucocorticoids and mycophenolate mofetil than ACA-positive lcSSc, whereas cyclophosphamide was highest in dcSSc. CONCLUSIONS:ATA-positive lcSSc patients exhibit a clinically distinct phenotype characterized by a substantial risk of internal organ involvement, despite having less extensive skin disease. Their overlap with dcSSc and divergence from ACA-positive lcSSc highlight the importance of incorporating both skin involvement and serologic subtyping into the early management and risk stratification of SSc.

Background/purpose : Interstitial lung disease (ILD) is an important factor determining the course of systemic sclerosis (SSc). Quantitative high-resolution computed tomography (HRCT) radiomics can aid in the detection of ILD, particularly when pulmonary function tests cannot be performed. The aim of this study is to develop machine learning (ML)-based models using only radiomic, only clinical, and radiomic+clinical combinations for the detection of ILD in SSc and to compare their performance. Materials and Methods This retrospective, single-center study included 67 SSc patients(38 ILD positive, 29 ILD negative; mean age 58 ± 13.9; 5 males). A total of 852 radiomic features were extracted from HRCT using whole-lung segmentation, and after feature selection, the performance of logistic regression(LR) models was evaluated using 5-fold cross-validation and out-of-fold(OOF) probabilities to calculate AUC, accuracy, and F1 score (radiomic only, clinical only, radiomic+clinical); thresholds were determined using the Youden index. Calibration and decision curve analysis(DCA) were performed, and binary AUC differences were tested using the De Long method. Results The radiomic model achieved an OOF AUC of 0.819, an accuracy of 0.821, and an F1 score of 0.838(sensitivity 0.816, specificity 0.828). The clinical model showed lower performance(AUC 0.760; accuracy 0.761; F1 score 0.771). The combined model achieved an AUC value of 0.825 with higher sensitivity (0.868) but lower specificity(0.655), resulting in 0.776 accuracy and 0.815 F1 score. The DeLong test showed no significant AUC differences between the models(all p > 0.05). Decision curve analysis results showed positive net benefit for all strategies at low to moderate thresholds, with largely overlapping curves. Conclusion HRCT radiomic features provided good discrimination for detecting ILD in SSc and performed better than clinical variables alone; adding clinical data slightly increased sensitivity without significantly increasing AUC. Radiomics-based approaches may provide a useful imaging biomarker for ILD detection, particularly in settings where pulmonary function testing is unavailable.

Background and Objectives: Autoimmune thyroid diseases are more prevalent in patients diagnosed with Sjögren disease (SD) than in the general population. SD and autoimmune thyroid diseases are two distinct yet interrelated autoimmune disorders. The objective of this study was to determine the frequency of autoimmune thyroiditis (AT), autoantibody relationships, and clinical features in patients with SD. Materials and Methods: The study included 525 patients. A retrospective evaluation was conducted on the demographic data, biochemical and serological tests, and pathological data of the patients. An anti-nuclear antibody (ANA) test was performed using the indirect immunofluorescence (IIF) method using HEp-2 (HEp-2000) cells as substrate. The Schirmer test and minor salivary gland biopsy were conducted on all patients. Results: AT was detected in 167 (31.8%) of 525 patients who participated in the study. The anti-nuclear antibody (ANA) test and anti-SS-A positivity rate were higher in the AT group (p value < 0.001 and 0.002 respectively). We found that the likelihood of developing AT increased as ANA titres increased. ANA positivity titres were found to be significant at 2+, 3+, and 4+ values (odd ratios 2.41, 3.40, and 4.21, respectively). Additionally, histological examination of salivary gland biopsies revealed a significantly higher prevalence of diffuse lymphocytic infiltration in the AT group. Conclusions: AT was present in 31% of patients with SD. The presence of ANA positivity, anti-SS-A positivity, and diffuse lymphocytic infiltration appears to exert an influence on the association between these two diseases.

OBJECTIVE:This retrospective study aimed to evaluate the comparison of functionality, mood, and biopsychosocial status in rheumatic patients with and without self-reported bowel problems and the evaluation of Bilişsel Egzersiz Terapi Yaklaşımı (BETY) - (Cognitive Exercise Therapy Approach in English)'s impact on these factors. METHODS:The study included 718 patients with eight different diagnoses of rheumatism. The presence of self-reported bowel problems in rheumatic patients was assessed with item 10 of the BETY-Biopsychosocial Questionnaire (BETY-BQ), functionality with the Health Assessment Questionnaire (HAQ), emotional status with the Hospital Anxiety and Depression Scale (HADS), and biopsychosocial status (BPS) with the BETY-BQ. Sixty-five rheumatic patients were included in BETY group exercise sessions for 3 months, 3 days a week. RESULTS:The rate of self-reporting bowel problems in the total cohort was 61.6%. Among all BPS parameters examined, a significant difference was found in favor of rheumatic individuals who did not report bowel symptoms (p <.005). All patients included in the BETY sessions achieved improvement in all parameters, including bowel symptoms (p <.005). CONCLUSIONS:Many patients suffered from bowel problems. The investigated parameters of rheumatic patients with bowel symptoms were negatively affected. BETY improved all parameters, including bowel symptoms. BPS features should be considered in disease management in rheumatic patients reporting bowel problems. BETY should be used as an exercise intervention based on the BPS model in these patients.

Amaç: Sekukinumab İnterlökin-17A’ ya bağlanan insan immünoglobulin G1 kappa monoklonal antikorudur. Bu çalışmada sekukinumab tedavisi kullanan psöriyatik artrit (PsA) hastalarının dermografik, klinik ve inflamatuvar paremetrelerini, tedaviye devam sürelerini ve yan etki profilini değerlendirmeyi amaçladık. Materyal-Metot: Çalışmaya 2006 CASPAR sınıflandırma kriterlerine göre PsA tanısı almış ve sekukinumab tedavisi kullanan hastalar dahil edildi. Tedavinin etkinliği ve güvenliği değerlendirildi. İlaç sağkalımı analiz edildi. Tedavi öncesi ve sonrası monosit/lenfosit oranı (MLO), nötrofil/lenfosit oranı (NLO), platelet/lenfosit oranı (PLO), sistemik immün inflamasyon indeksi(SII) (trombosit sayısı x nötrofil sayısı/ lenfosit sayısı), sistemik inflamatuvar cevap indeksi (SIRI) (nötrofil sayısı x monosit sayısı / lenfosit sayısı) inflamatuvar paremetreleri hesaplandı. Bulgular: Çalışmaya dahil edilen 41 PsA hastasının 45 ay süresince 29 (%70,7)’ unun sekukinumab tedavisine devam ettiği görüldü. Hastaların 12 (%29,3) tedaviyi bıraktı. Tedaviyi en sık bırakma nedeninin ilaç etkisizliği olduğu, yan etki olarak da dispeptik yakınmalar ve gastrointestinal yan etkiler olduğu tespit edildi. Tedavi öncesi ve sonrasında bakılan inflamatuvar paremetrelerde istatiksel olarak anlamlı bir farklılık saptanmadı. Sonuç: Çalışmamızda hastaların büyük bir kısmında daha önce bir biyolojik ajan kullanmış olmasına rağmen sekukinumab tedavisinde kalım oranlarının oldukça yüksek olduğu saptanmıştır. Sekukinumab, PsA tedavisinde etkili bir tedavi seçeneği olarak klinik kullanımımızda yer almaktadır.

Aim: The present study was conducted to determine the relationship between oesophageal diameter and disease findings in patients with systemic sclerosis. Material and Methods: The study included 86 patients. A retrospective evaluation was performed on the demographic data, biochemical and serological tests, and chest high-resolution computed tomography (HRCT) images of the patients. The presence of dilatation was defined as a measurement of over 10 mm in width. The oesophageal area was calculated at the level of the widest measurement. The relationship between oesophageal dilatation and digital ulcer (DU), pulmonary involvement, and pulmonary hypertension was evaluated. Results: The number of patients with supra-aortic and infra-aortic esophageal lateral, anteroposterior, and widest esophageal dilatation measurements above 10 mm was 49 (56.9%). The largest oesophageal area was found to be 173.6±90.7 mm2. The prevalence of DUs did not differ significantly between the groups with and without oesophageal dilatation. Pulmonary hypertension was detected in 22 (44.9%) patients with oesophageal dilatation and was found to be significantly higher in those without oesophageal dilatation (p=0.04). The extent of pulmonary involvement was significantly higher in the group with oesophageal dilatation (p=0.003). Conclusion: The oesophageal diameter has been demonstrated to be associated with pulmonary involvement. HRCT offers a valuable opportunity to assess the oesophagus. Further research is required to ascertain whether oesophageal diameter can be utilised in HRCT evaluations as a means of patient monitoring.

To determine the frequency of falls in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), investigate the risk factors for falls, and evaluate the relationship between falls and disease activity. This is a cross-sectional study, in which participants were included over a 12-month period. 100 patients with RA and 80 patients with PsA were evaluated. The relationship between the presence of fall history and disease activity scores and balance tests was analysed. The patients' fall risk was assessed through dynamic tests, including the Tandem Stance Test (TST), Tandem Walk Test (TWT), Timed Up and Go (TUG) Test, 5 times Sit-to-Stand Test (5XSST), and Tinetti Performance-Oriented Mobility Assessment (POMA). 33% of RA patients and 46.3% of PsA patients reported a history of falls. A higher frequency of falls (>2) was observed in patients with PsA (p=0.02). In the fall tests of PsA patients, the POMA was found to be significantly lower (medium risk), and the number of patients with TUG >12 seconds was found to be higher in patients with falls (p value 0.012 and 0.046 respectively). Patients who exhibited a fear of falling demonstrated a heightened degree of impairment in fall tests. Falls were associated with disease duration and HAQ score. PsA has been demonstrated to have a higher prevalence of falls in comparison with RA. PsA patients should be subjected to a more thorough questioning process to identify potential cases of falls.

Purpose: Periarticular and generalized osteoporosis are well-known comorbidities of rheumatoid arthritis (RA), associated with either the disease itself or glucocorticoid therapy. This study was performed to quantitatively evaluate changes in the jawbones of patients with RA using fractal analysis (FA). Materials and Methods: The study comprised 186 participants, including 144 women and 42 men. Of these, 93 were patients with RA and 93 were healthy controls. For the RA group, disease duration, laboratory findings, and medication use were recorded. Measurements of fractal dimension (FD), lacunarity (Lac), bone area fraction (BA/TA), and trabecular thickness (Tb.Th) were taken at the mandibular condyle and angle. These measurements were obtained from panoramic radiographs using ImageJ version 1.52p (National Institutes of Health, Bethesda, MD, USA). Results: Relative to control participants, patients with RA exhibited higher FD values for both mandibular condyle and angle regions (P<0.05). Conversely, the RA group displayed lower Lac values for both regions (P<0.05). Similarly, Tb.Th values were significantly lower in the RA patient group for both the condyle and the angle (P<0.05). Furthermore, a significant negative correlation was identified between disease duration and FD at the mandibular condyle (P<0.05). Conclusion: The results demonstrate that FA can be used to quantitatively assess changes in trabecular bone in the jawbones of patients with RA. Image analysis parameters derived from panoramic radiographs, including FA, Lac, BA/TA, and Tb.Th, hold promise in guiding patients with RA toward appropriate medical examinations.

PURPOSE:To assess the corneal parameters in rheumatoid arthritis (RA) patients. METHODS:We enrolled 64 patients with RA (32 receiving biologic and 32 receiving conventional drugs) and 32 healthy subjects. Keratometric values (anterior flat [K1], steep [K2], and mean keratometry [Km]), corneal thickness from the pupil center (CCT), apex (ACT), and the thinnest point (TCT), and corneal volume (CV) were measured and compared between the groups. RESULTS:K1, K2, and Km values were significantly higher in the RA group (P = 0.013, P = 0.048, P = 0.027, respectively). The means of CCT, ACT, TCT, and CV were significantly lower in RA patients (P < 0.001, P < 0.001, P < 0.001, P = 0.011, respectively). When we divided RA patients into two groups according to the treatment and compared them to controls, the differences in K1, CCT, ACT, TCT and CV were significant (P = 0.030, P = 0.005, P = 0.001, P = 0.001, P = 0.034, respectively). K1 and CV values of RA-biologic group were similar to the control group (P = 0.205 and P = 0.127, respectively). CONCLUSION:Biologic agents contribute to the improvement of K1 and CV values in patients with RA.

Relapsing polychondritis (RP) is an immune-mediated systemic disease characterized by recurrent attacks of inflammation of cartilage and proteoglycan-rich tissues, resulting in progressive anatomical deformation and functional impairment in the affected areas. The most common clinical features include ear and nasal chondritis, as well as polyarthritis, though potentially all cartilage areas can be affected. Delay in diagnosis is frequently encountered due to the progression of the disease and non-specific symptoms at the beginning. 30% of RP patients may have concomitant autoimmune disorders. In our case, a 42-year-old male patient diagnosed with RP was treated with methotrexate, leflunomide, tumor necrosis factor inhibitors and tociluzumab, but showed no improvement. Consequently, the patient was administered cyclophosphamide. Unfortunately, pneumomediastinum developed on the sixth day of treatment. The condition resolved without the need for surgical intervention. However, although the case received many treatments mentioned in the literature, he still did not go into complete remission.

Kas-İskelet Sistemi UltrasonuSibel BAKIRCI Romatolojide Eklem Dışı Ultrason Gökhan SARGIN Romatolojik Hastalıklarda Konvansiyonel Radyografi Atalay DOĞRU Kapilleroskopi Levent KILIÇ Manyetik Rezonans Görüntüleme Dilek SOLMAZ Romatizmal Hastalıklarda Akciğer Görüntülemeleri Veli YAZISIZ Ultrason Kılavuzluğunda Eklem Enjeksiyonları Duygu KURTULUŞ