OBJECTIVES:Salivary gland ultrasonography is a promising non-invasive modality for the evaluation of Sjögren's disease (SjD), but its diagnostic utility is limited by operator dependency. This study aimed to evaluate the classification performance of radiomics-based machine learning using parotid gland ultrasonography and to compare it with conventional visual assessment. METHODS:A total of 866 parotid gland ultrasound images from 202 participants were included: 123 patients fulfilling the 2016 ACR/EULAR criteria for SjD, 33 healthy controls, 24 non-Sjögren sicca patients, and 22 incomplete SjD cases. A total of 104 radiomic features describing intensity, texture, and micro-texture patterns were extracted. A 5-fold soft-voting SVM ensemble was trained on confirmed SjD and healthy participants; non-Sjögren sicca and incomplete SjD cases were reserved for the held-out test set. SHAP analysis was used for model interpretability. RESULTS:The SVM ensemble achieved an area under the receiver operating characteristic curve (AUC) of 0.99 for binary classification between SjD and healthy controls, with 0.94 accuracy, 0.86 sensitivity, and 0.96 specificity, outperforming radiologist assessments (accuracy: 0.62 and 0.72). SHAP analysis identified intensity dispersion metrics, GLCM-based texture features, and LBP micro-texture patterns as the strongest predictors. PCA and feature-level analyses demonstrated substantial overlap in radiomic features between non-Sjögren sicca and confirmed SjD patients. CONCLUSION:Radiomics-based machine learning demonstrated high classification performance for distinguishing SjD from healthy controls using parotid gland ultrasonography. Quantitative ultrasound analysis may serve as an objective adjunctive tool in SjD assessment, although validation in larger multicenter cohorts is required.

Background/Objective: Canakinumab (CAN), a monoclonal antibody targeting interleukin-1 beta, has demonstrated efficacy in various autoinflammatory diseases (AIDs), particularly in inadequate response to colchicine in familial Mediterranean fever (FMF). This study aimed to evaluate the indications, efficacy, and safety of CAN based on real-life experience from a tertiary rheumatology clinic.Methods: This single-center study included 54 patients treated with CAN between May 2020 and September 2024. Patients were grouped as MEFV-positive FMF (n=42), MEFV-negative FMF (n=7), non-FMF autoinflammatory diseases (n=2), and adult-onset Still's disease (AOSD; n=3). Demographic and clinical data, treatment indications, response patterns, laboratory parameters, and adverse events were analyzed.Results: CAN was initiated mainly due to adverse effects (40.5%) or inadequate response (42.8%) to anakinra and colchicine. The median duration of CAN therapy was 22 months. Among MEFV-positive FMF patients, 81% achieved a complete response and 19% partial response. CAN significantly reduced attack frequency and duration, and improved inflammatory markers (CRP, ESR, WBC, and neutrophil count). Proteinuria decreased in a statistically significant but clinically modest manner following CAN treatment. Only 1 patient experienced reversible cytopenia. Dose intervals were successfully prolonged in 54.8% of MEFV-positive patients without loss of efficacy.Conclusions: Canakinumab is an effective and well-tolerated IL-1 beta inhibitor in FMF and other AIDs, particularly in patients who are inadequately responsive or intolerant to colchicine and anakinra. Real-world experience supports its sustained efficacy and the feasibility of dose interval extension in selected cases.

Background/Objectives: Early identification of vasculitic acute kidney injury (AKI) is crucial for timely immunosuppression and improved renal outcomes; however, noninvasive adjunctive diagnostic tools remain limited. Renal elastography, a noninvasive technique that quantifies renal cortical stiffness, has been primarily investigated in chronic kidney disease, whereas evidence in acute kidney injury is scarce. This study aimed to evaluate the diagnostic utility of renal shear wave elastography for differentiating vasculitic from non-vasculitic AKI and to explore the association between baseline renal cortical stiffness and vasculitic renal outcomes. Materials and Methods: This prospective observational study included three groups: vasculitic AKI, non-vasculitic AKI, and healthy controls. Renal cortical stiffness was measured at admission using two-dimensional shear-wave elastography (2D-SWE) by radiologists blinded to clinical information. After clinicopathological confirmation of definitive diagnoses, between-group comparisons were performed and the diagnostic performance of elastography was evaluated. Additionally, in a biopsy-confirmed immunoglobulin A vasculitis nephritis (IgAVN) cohort (n = 12), baseline elastography measurements were examined in relation to one-year renal outcomes to explore potential prognostic associations. Results: The vasculitic AKI group exhibited significantly higher mean renal cortical stiffness values (9.5 ± 1.9 kPa) compared with both healthy controls (5.53 ± 0.92 kPa) and the non-vasculitic AKI group (6.61 ± 1.89 kPa) (both p < 0.01). Mean renal cortical stiffness demonstrated good diagnostic performance for distinguishing vasculitic from non-vasculitic AKI (AUC 0.86, 95% CI 0.73-0.97), with an optimal threshold of 6.79 kPa yielding 91% sensitivity and 72% specificity. In the prospective one-year follow-up of the IgAVN subcohort (n = 12), patients with unfavorable renal outcomes tended to have higher baseline renal cortical stiffness compared with those with favorable outcomes [median (min-max), 11.2 (10.8-13.3) vs. 9.1 (5.6-11.2), p = 0.046]. Conclusions: These findings suggest that renal elastography may aid in distinguishing vasculitic from non-vasculitic acute kidney injury and may provide exploratory information on the relationship between baseline cortical stiffness and renal outcomes in IgAVN.

Background/Objectives: A limited number of previous studies have reported high rates of end-stage renal disease (ESRD) in adults with IgA vasculitis nephritis (IgAVN). Despite the high prevalence of the disease and the high rates of ESRD reported in the literature, no specific guidelines for adult patients have been established and there is no consensus on the management of the disease. This study aimed to prospectively investigate adults with IgAVN from a broad perspective. Methods: This investigation was designed as a prospective observational study and was conducted between 01.02.2022 and 01.10.2024. A total of 49 newly diagnosed adult (>18 years) patients with IgAVN were regularly followed up. At the end of the study, the renal remission rates, factors influencing remission, treatment data, treatment-related adverse events, and disease outcomes were determined. Results: The median follow-up time was 22 (IQR: 11–24) months. A total of 42 patients (87%) received immunosuppressive treatment in addition to the initial glucocorticoid treatment. Azathioprine (AZA) was the preferred (41%) first steroid-sparing agent. ESRD occurred in only one patient (2%), while a total of ten patients (20%) had an unfavorable outcome. The rate of nephrotic-range proteinuria (NRP) was significantly higher in the patients who did not achieve renal remission at the end of the 12-month follow-up period (9,7% vs. 60%; p = 0.02) and NRP was an independent risk factor for unfavorable outcomes [OR: 17.18; 95% CI: 1.31–224.95; p = 0.03]. A total of 16% of the patients developed an infection that required hospitalization during follow-up; these patients had a higher rate of IgAVN-associated acute kidney injury (62.5% vs. 22%; p = 0.02) and were significantly older (mean: 46 ± 15.3 vs. 65 ± 13.3; p = 0.002). One patient died of sepsis at 4 months and another died of a myocardial infarction at 32 months. Conclusions: These results suggest that adults with IgVAN do not have a high rate of ESRD if they receive effective immunosuppressive therapy. However, immunosuppressive therapy is associated with an increased risk of infection, particularly in the elderly. The presence of NRP is associated with lower long-term remission rates and has a predictive value for unfavorable outcomes.

Background/Objective: Pulmonary involvement of Beh & ccedil;et disease (BD) typically manifests as vascular involvement in the form of pulmonary artery thrombosis and/or aneurysm, although various parenchymal lung findings may also be observed. We aimed to analyze the indications for imaging and thoracic computed tomography (TCT) findings in BD patients.Methods: In this medical records review, single-center, comparative cohort study, 196 BD patients who underwent TCT for any reason between July 2020 and July 2024 were included. The patients' demographic data, disease-related clinical features, indications for TCT, and TCT findings were recorded.Results: The mean age of the patients was 40.0 +/- 12.0 years, with a female-to-male ratio of 56/140 and disease duration of 8.9 +/- 9.1 years. The most common indications for TCT imaging were suspected pulmonary vascular involvement (PVI) (139/196), unexplained acute phase elevation (46/196), and infection (36/196). PVI was present in 23 patients. Patients with PVI also exhibited additional parenchymal findings. Ground-glass opacities and atelectasis were significantly more common in patients with PVI compared with those without.Conclusion: TCT imaging is essential for identifying both vascular and parenchymal pulmonary complications in BD, especially in patients with atypical symptoms or elevated inflammatory markers.

BACKGROUND/OBJECTIVE:Canakinumab (CAN), a monoclonal antibody targeting interleukin-1β, has demonstrated efficacy in various autoinflammatory diseases (AIDs), particularly in inadequate response to colchicine in familial Mediterranean fever (FMF). This study aimed to evaluate the indications, efficacy, and safety of CAN based on real-life experience from a tertiary rheumatology clinic. METHODS:This single-center study included 54 patients treated with CAN between May 2020 and September 2024. Patients were grouped as MEFV-positive FMF (n=42), MEFV-negative FMF (n=7), non-FMF autoinflammatory diseases (n=2), and adult-onset Still's disease (AOSD; n=3). Demographic and clinical data, treatment indications, response patterns, laboratory parameters, and adverse events were analyzed. RESULTS:CAN was initiated mainly due to adverse effects (40.5%) or inadequate response (42.8%) to anakinra and colchicine. The median duration of CAN therapy was 22 months. Among MEFV-positive FMF patients, 81% achieved a complete response and 19% partial response. CAN significantly reduced attack frequency and duration, and improved inflammatory markers (CRP, ESR, WBC, and neutrophil count). Proteinuria decreased in a statistically significant but clinically modest manner following CAN treatment. Only 1 patient experienced reversible cytopenia. Dose intervals were successfully prolonged in 54.8% of MEFV-positive patients without loss of efficacy. CONCLUSIONS:Canakinumab is an effective and well-tolerated IL-1β inhibitor in FMF and other AIDs, particularly in patients who are inadequately responsive or intolerant to colchicine and anakinra. Real-world experience supports its sustained efficacy and the feasibility of dose interval extension in selected cases.

Objective: Interstitial lung disease (ILD) is one of the most challenging involvement of autoimmune rheumatic diseases (ARDs) and could lead to significant morbidity and mortality. In this article, a collaborative work of tertiary rheumatology and pulmonology centers describing demographic, serological, and radiological findings of patients with ARD associated with ILD (ARD-ILD) is presented. Methods: A descriptive, retrospective study, and data related to demographics, clinical, laboratory, radiologic, or histopathological findings of ILD were collected from the study participants' charts. Results: Around 212 patients with ARD-ILD were evaluated. Of the patients, 172 (81.1%) were female and 40 (18.9%) were male. The distribution of the rheumatic diseases was as follows: systemic sclerosis in 114 (53.8%), rheumatoid arthritis in 47 (22.2%), Sjögren's syndrome in 14 (6.6%), inflammatory myopathy in 16 (7.5%) patients, interstitial pneumonia with autoimmune features (IPAF) in 9 (4%) patients, undifferentiated connective tissue disease in 8 (3.8%), and systemic lupus erythematosus in 4 (1.9%). According to the radiological patterns, 71.7% of the patients had nonspecific interstitial pneumonia (NSIP), 13.7% had definite usual interstitial pneumonia (UIP), 8.5% had probable UIP, 3.8% had lymphocytic interstitial pneumonia, 1.9% had organizing pneumonia, and 0.5% had an atypical pattern. Conclusion: This study showed that the most common rheumatic disease causing ILD is still systemic sclerosis, and NSIP is more prominent as a radiological pattern. IPAF, a disease that has entered the literature in recent years, is also an important type of ILD. Given the multisystemic involvement of ARDs, collaboration among different disciplines is undoubtedly crucial in the diagnosis and management of these diseases.

OBJECTIVES:Recurrent monoarthritis (RM) is a major challenge of many rheumatic diseases. Ablation is a well-known technique in the treatment of benign or malign lesions of different aetiologies. We aimed to investigate the success and safety of microwave ablation (MWA) as an adjunctive therapy in a cohort of medical treatment-resistant RM. METHODS:Patients with RM associated with different inflammatory diseases were included. MWA was performed after measuring the size of synovial hypertrophy with 15 or 20 W power and different durations until microbubbles were shown, indicating necrosis. Both clinical and radiologic data were recorded. RESULTS:We applied MWA in total of 24 knee joints of 10 female and 12 male patients aged between 22 and 71 years. Median IA aspiration (IAA) need in the last 6 months before MWA was 5 (0-15). The median follow-up was 10 (3-16) months. Overall IAA count in the last 6 months before MWA in total of 144 months was 129, and decreased to 7 in post-MWA in total of 226 months (0.89 vs 0.03 per month, P < 0.001). The second MWA session was needed for three patients and a third session for one. Functional disability and pain scores were improved significantly (median score from 9 to 1, P < 0.00001, in both). In MRI, follow-up significant regression in synovial hypertrophy size was shown especially after the 6th month. No complication was observed during the procedure or follow-up. CONCLUSION:As a less invasive technique compared with the surgical approach, MWA of synovial hypertrophy showed significant clinical improvement in RM safely. MWA seems promising as a treatment option candidate in the management of RM.

BACKGROUND/OBJECTIVE:Pulmonary involvement of Behçet disease (BD) typically manifests as vascular involvement in the form of pulmonary artery thrombosis and/or aneurysm, although various parenchymal lung findings may also be observed. We aimed to analyze the indications for imaging and thoracic computed tomography (TCT) findings in BD patients. METHODS:In this medical records review, single-center, comparative cohort study, 196 BD patients who underwent TCT for any reason between July 2020 and July 2024 were included. The patients' demographic data, disease-related clinical features, indications for TCT, and TCT findings were recorded. RESULTS:The mean age of the patients was 40.0 ± 12.0 years, with a female-to-male ratio of 56/140 and disease duration of 8.9 ± 9.1 years. The most common indications for TCT imaging were suspected pulmonary vascular involvement (PVI) (139/196), unexplained acute phase elevation (46/196), and infection (36/196). PVI was present in 23 patients. Patients with PVI also exhibited additional parenchymal findings. Ground-glass opacities and atelectasis were significantly more common in patients with PVI compared with those without. CONCLUSION:TCT imaging is essential for identifying both vascular and parenchymal pulmonary complications in BD, especially in patients with atypical symptoms or elevated inflammatory markers.

Journal Article Corrected proof Microwave ablation of synovial hypertrophy in recurrent monoarthritis: preliminary results of a new technique in rheumatology Get access Rabia Deniz, Rabia Deniz Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, TurkeyDepartment of Medical Biology and Genetics, Marmara University, Istanbul, Turkey Correspondence to: Rabia Deniz, Department of Rheumatology, Başakşehir Çam and Sakura City Hospital, Başakşehir Olimpiyat Bulvarı Yolu, 34480 Istanbul, Turkey. E-mail: dr.rabiadeniz@gmail.com https://orcid.org/0000-0003-4537-894X Search for other works by this author on: Oxford Academic PubMed Google Scholar Tevfik Güzelbey, Tevfik Güzelbey Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0001-5330-169X Search for other works by this author on: Oxford Academic PubMed Google Scholar İlhan Nahit Mutlu, İlhan Nahit Mutlu Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0002-9326-5432 Search for other works by this author on: Oxford Academic PubMed Google Scholar Bilgin Karaalioğlu, Bilgin Karaalioğlu Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0001-7584-8549 Search for other works by this author on: Oxford Academic PubMed Google Scholar Duygu Sevinç Özgür, Duygu Sevinç Özgür Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0002-1294-926X Search for other works by this author on: Oxford Academic PubMed Google Scholar Gamze Akkuzu, Gamze Akkuzu Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0002-2133-0282 Search for other works by this author on: Oxford Academic PubMed Google Scholar Fatih Yıldırım, Fatih Yıldırım Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0003-3909-7500 Search for other works by this author on: Oxford Academic PubMed Google Scholar Kübra Kalkan, Kübra Kalkan Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0002-0013-2076 Search for other works by this author on: Oxford Academic PubMed Google Scholar Özgür Kılıçkesmez, Özgür Kılıçkesmez Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0003-4658-2192 Search for other works by this author on: Oxford Academic PubMed Google Scholar Cemal Bes Cemal Bes Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey https://orcid.org/0000-0002-1730-2991 Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, kead559, https://doi.org/10.1093/rheumatology/kead559 Published: 13 October 2023 Article history Accepted: 06 October 2023 Published: 13 October 2023 Corrected and typeset: 26 October 2023

Objective: Sarcoidosis is a chronic inflammatory disease that affects many organs and systems, especially the lungs, lymph nodes and musculoskeletal system. Musculoskeletal system involvement patterns in sarcoidosis are not well defined and literature data are limited in terms of clinical features. This study aimed to investigate the clinical and demographic characteristics of sarcoidosis patients with musculoskeletal system involvement. Methods: One hundred and four patients with sarcoidosis who were followed up in our clinic between June 2020 and January 2024 were evaluated retrospectively. Forty-four sarcoidosis patients aged >18 years with objectively detected musculoskeletal system involvement were included in the study. The musculoskeletal system involvement patterns, clinical and laboratory findings, and demographic characteristics of the patients were analyzed. Results: Musculoskeletal involvement was found in 44 of the 104 sarcoidosis patients (42%). Of the 44 patients with musculoskeletal involvement, 37 (77.3%) were female, the mean age was 46.9±12.2 years, and the mean follow-up time was 14±11.8 months. The most common objective musculoskeletal pathology was chronic arthritis (17%), mostly in the form of chronic oligoarthritis. Wrist (50% vs. 3.8%, p=0.001) and metacarpophalangeal joint involvement (38.9% vs. 0, p=0.001) were significantly higher in patients with chronic arthritis than in patients with acute arthritis. While joint involvement starting as monoarthritis was an independent negative predictor for the development of chronic arthritis [odds ratio (OR): 0.046, 95% confidence interval (CI): 0.003-0.815, p=0.036], the presence of obesity at baseline was a positive predictor for the development of chronic arthritis (OR: 11.968, 95% CI: 1.069-133.960, p=0.044). Conclusion: Sarcoidosis can present with a wide range of musculoskeletal manifestations. The most common musculoskeletal pathologies in sarcoidosis are acute and chronic arthritis. Sarcoidosis patients presenting with monoarthritis do not usually develop chronic arthritis. Patients with chronic sarcoid arthritis initially present more hand-joint involvement. Obesity is a risk factor for the development of chronic arthritis.

Objectives: Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease affecting both genders in reproductive age. In this study, we aimed to investigate the relation between FMF and pregnancy on both maternal and fetal aspects. Material and methods: In this retrospective, single-center, descriptive study we analysed total of 95 pregnancies of 40 FMF patients. Clinical and demographic data were obtained from patients’ records. To prevent recall bias, only the last pregnancy of each patient was evaluated for disease activity and use or revision of medications during pregnancy. Results: The median age of the patients at diagnosis was 22 and the first pregnancy age was 26 years. The median duration of FMF at last pregnancy was 8 (0–23) years. Eight (20%) patients had at least 1 pregnancy via assisted reproductive techniques (IVF), while 34 (85%) patients had at least 1 spontaneous pregnancy. While 32 patients were in remission (80%) before pregnancy, 8 were clinically active (20%). Improvement in clinical course and attack frequency during pregnancy was observed in 23 patients (57.5%), stable course in 10 (25.0%), and worsening in 7 (17.5%). The rate of live birth was 70.0%, abortus was 28.9%, preterm labor was 8.1%, pre-eclampsia was 5.0%, and only 1 achondroplasia as congenital fetal abnormality was observed. Conclusion: FMF did not constitute a contraindication for pregnancy. The most important obstetric problems, complications, and negative fetal outcomes in the course of pregnancy are increased IVF requirement, abortion, and cesarean rates. There is no increase in the risk of congenital malformations due to FMF itself or use of colchicine.

Background: Interstitial lung disease (ILD) encompasses a wide variety of parenchymal lung pathologies with different clinical, histological, radiological and serological features. In terms of diagnosis and the proper selection of treatment, the key point is to know the underlying ethiology, Rheumatic diseases are a systemic inflammatory group of diseases that affect all organs and systems, including the lung. Although such diseases show up by different symptoms such as arthritis, pleuritis, photosensitivity, constitutional symptoms, raynoud's phenomenon, sicca, musculoskeletal weakness present the diseases, from months to years ago before these symptoms disease may show-up itself by isolated pulmonary involment. Objectives: In this study, we aimed to identify both underlying rheumatological diseases and interstitial pneumania with autoimmune features (IPAF) in newly diagnosed ILD patients and thus to increase awareness. Methods: Data of 215 patients with newly diagnosed ILD who were evaluated by a pulmonologist and referred to the rheumatology clinic were included in the study. All patients evaluated by both pulmonologist and rheumatologist with history, physical examination, blood tests, pulmonary function tests, serological tests, high-resolution computed tomography (HRCT) and biopsies, if needed. Results: Within this study, ILD diagnosed patients includes 90 woman and 125 men with and average age of 62 were evaluated (SD: 11.27). 22 of 215 (10.2 %) patients were diagnosed with specific rheumatologic disease (2.7% rheumatoid arthritis, 1.86 % sjogren syndrome, 2.3% microscopic polyangiitis, 0.9 % systemic sclerosis, 0.4% granulomatosis with polyangiitis, 0.4% systemic lupus erythematosus 1.4 % idiopathic inflammatory myopathies). Rheumatological assesments showed that in 42,3% of them interstitial pneumania with autoimmune features (IPAF) were detected. As a result of our study we have also diagnosed non-specific interstitial pneumonia (NSIP) in 67.9% patients where 48,6% of them were cellular NSIP and rest of the patients were fibroting NSIP. Steroid treatment was started to the 53.8% of patient diagnosed by IPAF and 69.3% of these patients received non-steroid maintenance therapy. Conclusion: In terms of the understanding ethiology of ILD, it is important to add routine rheumatology evaluations in patients with newly diagnosed. The determination and treatment of rheumatological disease that cause ILD will prevent the possible complications in further times caused by rheumatologic diseases. We believe that a multidisciplinary approach may be important in diagnostic studies of IPAF in order to increase diagnostic confidence. If ILD is cause due to rhemautological pathology, it should be evaluated for immunsupresive treatment rather than the follow-up or antifibrotic treatments. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

The triad of ascites, pleural effusion, and elevated cancer antigen-125 (CA-125) levels in the absence of ovarian malignancy in systemic lupus erythematosus patients is specifically named pseudo-pseudo Meigs' syndrome (PPMS) or Tjalma syndrome. In this case we reported a 33 years female patient with pleural effusion lasting for 3 years and new onset progressive massive ascites and increased level of CA-125. After she was evaluated for an underlying benign and malign ovarian tumor or any other malignancies, serologic tests were requested with respect to progressive renal dysfunction, proteinuria, lymphopenia, anemia, and effusion. She was diagnosed with systemic lupus erythamatosus (SLE) and renal biopsy showed class-V lupus nephritis. Immunosuppressive treatment led to improvement in both SLE activity and components of PPMS, including massive ascites and pleural effusion and without the need of diuretics. Co-existence of unexplained CA-125 increase, pleural effusion, and ascites might be related to PPMS and detailed examination to exclude malignancy and early and effective treatment of SLE are the mainstay of management.

Background: Recurrent monoarthritis (RM) causes serious disability in many rheumatic diseases. Local interventions, namely intra-articular synovial fluid aspiration (IAA) and intra-articular corticosteroid injection (IAS) are frequently used to control single-joint involvement. Although medical (chemical or radiation) or surgical (arthroscopic or open) synovectomy are options in cases that cannot be controlled with local and systemic medical treatments, it is gradually abandoned due to both unfavorable long-term results and complications.Ablation is a well-known minimally invasive technique in the treatment of benign or malign lesions of different etiologies and has been recently started to be used in muskuloskeletal disorders. Until now, most experience is on osteoarthritis used to relieve pain resistant to conventional treatment. Also, in a small case series pigmented villonodular synovitis (PVNS) was treated successfully with radiofrequency ablation (RFA). Objectives: We aimed to to investigate the use and safety of microwave ablation (MWA) as an adjunctive therapy in medical treatment resistant RM. Methods: Rheumatoid arthritis, spondyloartropathy, Behçet’s disease, juvenile idiopathic arthritis, and undifferrentiated inflammatory monoarthritis patients with RM attacks were included. MWA was performed after measuring size of synovial hypertrophy with proper power and duration until microbubbles were shown indicating necrosis. Patients’ demographics, treatments, IAA, complications, functional disability and pain scores, routine laboratory parameters, ultrasonography and magnetic resonance images were recorded. Results: We applied MWA in totally 17 knee joints of 6 female and 10 male patients aged between 22-71 years. Pre-procedure IAA need in last 6 months was median 5 (3-11). In one patient MWA was applied only to reduce synovial hypertrophy volume without a need for frequent IAA need. Second MWA session was needed in 3 patients and third session in 1 patient. The median follow-up was 9 (4-13) months. Six post-procedure IAA were performed in overall follow-up; in two patient in second MWA session, in one patient at 10 th month, and 3 in first 3 months of follow-up. Overall IAA count in last 6 months before MWA in total 102 months was 93 and it decreased to 6 in post-MWA follow-up in total 148 months (p<0.001). In 8 patients, short time low-dose additional corticosteroid were given for different reasons, especially in first 3 months. Functional disability and pain scores were improved significantly (median score from 9 to 1, p<0.00001, in both, Figure 1). In MRI follow-up significant regression in synovial hypertrophy volume was shown especially after 6 th months (figure 2). No complication was observed during procedure or follow-up. Conclusion: As a less invasive technique, MWA technique did not lead to any important adverse effects and seems as a promising adjunctive treatment in RM resistant to medical treatment and synovial hypertrophy in rheumatic diseases in whom synovectomy was not suitable. The number of monoarthritis attacks, size of synovial hypertrophy, the need of intraarticular corticosteroid injection, and IAA were decreased, and both functional disability and pain scores were dramatically improved. Long-term results and replication of these findings in different centers and larger patient cohorts are expected to verify these favorable outcomes and the applicability of the MWA technique. Acknowledgements: NIL. Disclosure of Interests: None declared.Figure 1Two examples of patients with their pre-procedure and post-procedure 6th month MRI images. The figure 1a and 1c shows pre-procedure, and 1b and 1d post-procedure 6th-month T1 weighted contrast enhanced MR images in axial plane. In both patients synovial hypertrophy and contrast enhancement were regressed significantly. Figure 2Functional disability (a) and pain scores (b) of patients before MWA procedure and at 1st, 3rd, 6th, and 12th month visits. 0 means no functional disability or pain, and 10 is the worst possible funcitonal disability or pain, in both.

Rheumatoid arthritis (RA) is a chronic, inflammatory systemic disorder of synovial joints and results in polyarthritis, chronical degeneration, and finally deformities and ankylosis in severe cases. Synovitis and pannus formation are results of inflammatory changes and lead into restriction in joint movement. Shoulders are among the later affected and larger joints and formation of synovitis in early active stages and pannus in later stages might be concluded with frozen shoulder and severe impairment in functionality. These late-term changes cannot be controlled with systemic or local anti-inflammatory agents and synovectomy is chosen in some cases. However, the results are not satisfactory and recurrence is common. In this case report, we presented a case of RA with severe shoulder pain, restricted movement due to synovial hypertrophy, and pannus formation which are resistant to local and systemic interventions and not suitable for surgical or chemical synovectomy. Microwave ablation (MWA) was performed successfully without any complication and she well responded in terms of DAS-28, functional, and pain scores. Range of motion and funcitonal restriction were recovered. This case report describes the use and promising results of MWA in RA with severe synovial hypertrophy and pannus formation even in the absence of active arthritis and effusion. MWA is a safe and minimally invasive technique that can be easily performed in coordinance of rheumatologists and interventional radiologists in proper cases.

Behcet's syndrome is a variable vessel vasculitis characterized by recurrent oral and genital ulcers with concomitant skin, ocular, neurologic, gastrointestinal, and joint involvement. Herein, we present a patient who was diagnosed with Behcet's syndrome, which with magnetic resonance angiography showed occlusion of the right subclavian artery at the level of the thoracic outlet and reverse flow in the right vertebral artery consistent with subclavian steal syndrome. In addition, partial narrowing was noted in the left renal artery. The distribution of arterial involvement resembled Takayasu's arteritis, although the presence of mucocutaneous lesions, male gender, history of deep vein thrombosis, and HLA-B51 positivity favored a diagnosis of vasculo-Behçet's syndrome. We treated the patient with methylprednisolone and cyclophosphamide. After the regression of vascular inflammation with immunosuppressive therapy, stenting was performed in the left renal artery.