No abstract

In recent years, neutrophil-lymphocyte rate (NLR) and platelet-lymphocyte rate (PLR) are reported to be increasing in plenty of rheumatological diseases and the latter rates to be disease activity indicators. In our study, we aimed to search for the difference in NLR and PLR before and after the treatment, their relationship with the disease activity and their seasonal differences in patients using anti-TNF medication for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) while. METHOD: Sixty-eight RA and 203 AS patients using anti-TNF medication for at least 6 months were included in the study. Patients with acute infection, diabetes, hypertension, cancer, renal failure and liver failure were excluded from the study. NLR, PLR, seasonal differences and the disease activities of the patients were evaluated retrospectively. RESULTS: We determined that NLR and PLR are strongly correlated with disease activity, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). In addition, we determined that disease activity, thrombocytes and PLR are increased in spring and winter, especially in patients with RA. CONCLUSION: NLR and PLR are simple, cheap, and easily accessible parameters which can be used to evaluate disease activity and treatment response before and after anti-TNF treatment. Further studies are needed to enlighten the effect of seasonal differences on disease activity (Tab. 2, Fig. 2, Ref. 43).

Rheumatoid arthritis (RA) is a progressive, systemic inflammatory disease with articular and extra-articular involvement. The skin is the most common location of extra-articular involvement and subcutaneous nodules are seen in 25% of RA patients. These are granulomatous nodules below the skin, often seen in extensor areas under external pressure and they may also be seen in the elbow 1 They were also reported in the lungs, the heart and the meniscus. 2 Compared to rheumatoid nodules, accelerated nodules have a more rapid onset and growth, are smaller and follow a different distribution (hand, foot, and ear). 3 Accelerated nodules can be seen with methotrexate (MTX), anti-tumor necrosis factor (anti-TNF) drugs and occasionally with leflunomide and azathioprine treatment. 4,5 The case presented here is a patient with RA who developed accelerated nodulosis with the use of MTX that exacerbated with the later use of etanercept and leflunomide.

We report a case of reactive arthritis following tetanus vaccination. A healthy 55-year-old woman presented with pain and acute swelling of the right knee two days after receiving a tetanus vaccination. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor and human leukocyte antigen B-27 were negative. Her arthritis improved with the administration of nonsteroidal anti-inflammatory drugs. One week later the knee swelling and pain had settled. Reactive arthritis may occur after tetanus vaccination.

Coexistence of ankylosing spondylitis with connective tissue diseases is very rare. Here, in this study, we describe a coexistence of ankylosing spondylitis and discoid lupus erythematosus in a 35-year-old man. He presented with a 5-year history of low back pain and concurrent development of a discoid rash. Inflammatory low back pain, HLA-B27 positivity and bilateral active sacroiliitis confirmed the diagnosis of ankylosing spondylitis. Discoid lupus erythematosus was diagnosed based on a skin biopsy. There are reports of discoid lupus associated with medications, particularly with tumour necrosis factor-alpha (TNF-α) blocking drugs. However, the patient presented here had coexistence of ankylosing spondylitis and discoid lupus before starting such treatments.