The aim of this study was to investigate the prevalence, predictors and radiological findings of primary Sjögren's syndrome (pSS)-associated lung involvement. This retrospective cohort study included 123 patients with demographic, clinical, laboratory and radiological data who were diagnosed with pSS. Lung involvement was defined based on the presence of pulmonary signs/symptoms and/or impaired pulmonary function tests along with alterations in high-resolution computerized tomography (HRCT). Thirty patients (24.4%) had pulmonary signs/symptoms at the initial presentation and/or during the follow-up period. Based on the criteria, 14 patients (11.4%) were defined as having pSS with lung involvement. The smoking rate, male/female ratio and the mean ages were found to be higher in patients with lung involvement (P < 0.05). Positive IgM-rheumatoid factor (RF), anti-La and anti-Ro results, the presence of hypergammaglobulinemia and lymphopenia had high specificity despite the low sensitivity rates to detect pSS-associated lung disease. A significant difference was found in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV(1)) results between the patients with and without lung involvement. Impaired FEV(1) had high specificity and positive predictive value compared to impaired FVC, particularly in non-smoker patients. The most frequent HRCT finding was ground-glass attenuation (64.3%). Other common findings were bronchiectasis, reticular pattern and honeycombing. The lesions involved predominantly the lower lobes. In conclusion, the presence of hypergammaglobulinemia and lymphopenia, positivity for RF, anti-La and anti-Ro, and impaired (FVC) and/or FEV(1) values could be the predictive parameters with a high specificity despite the low sensitivity rates. Smoking history, male gender and age are also risk factors. These parameters may be helpful to distinguish pSS-associated lung involvement from lung disorders unrelated to pSS.

Neurological involvement is a well-documented issue in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, little is known about the involvement of the autonomic nervous system. This study was conducted to investigate autonomic nervous system dysfunction in patients with RA and SLE. Twenty-six RA patients, 38 SLE patients and 40 healthy controls were recruited from our in- and out-patient departments. Heart rate variability (HRV) parameters (the power of the high- [HF] and low-frequency [LF] band of haemodynamic time series, the ratio between low- and high-frequency components [LF/HF ratio], the power spectral density), baroreflex sensitivity (BRS) and beat-to-beat blood pressures were assessed by a novel non-invasive haemodynamic monitoring tool (Task Force Monitor [TFM], CNSystems Medizintechnik GmbH, Graz, Austria). Autonomic nervous system dysfunction was determined according to classical Ewing autonomic test battery. Furthermore, we implemented a secondary autonomic test score by modifying the Ewing test battery with additional criteria. Both the classical and modified Ewing test batteries have revealed that the frequencies of autonomic neuropathy were significantly higher in patient groups compared with controls (p < 0.001). Evaluation by TFM revealed that deterioration of sophisticated autonomic parameters (such as HRV and BRS) were more pronounced in the patient groups compared with controls. There was a significant association between BRS and Ewing test scores and abnormal BRS results were more frequent in patients with autonomic dysfunction according to Ewing test batteries. No relation was found between autonomic neuropathy and disease duration, disease activity and autoantibody positivity. Consequently, we believe that further large-scale studies investigating cardiovascular autonomic neuropathy in rheumatic diseases should be carried out to verify our findings and manifest clinical consequences beyond these results.

This study was designed to investigate whether Foxp3( +) regulatory T (Treg) cells play a role in the histopathologic changes of primary Sjögren's Syndrome (pSS) and to evaluate other factors possibly associated with Foxp3(+) Treg cells in pSS patients. The number of FoxP3-expressing T cells in peripheral blood (PB) of 39 patients with pSS, 40 patients with rheumatoid arthritis (RA), and 28 healthy controls was measured by flow-cytometer analysis. FoxP3-expressing CD4(+)CD25(+) Treg cells were analyzed in minor salivary gland (SG) tissues of 39 pSS patients. Histopathologic changes were examined by light microscopy according to Chisholm's classification. Immunohistochemistry and immunofluorescence were performed to assess the Foxp3(+) Treg in SG biopsy specim-ens. The numbers of CD4(+) T cells and FoxP3-expressing CD4(+) T cells in PB were similar in all groups. Expression of CD25 on CD4(+) T cells in PB of patients with pSS and RA was significantly higher than in healthy controls, especially for RA patients. Immunohistochemistry and immunofluorescence showed that FoxP3(+) Treg were enriched in the SGs of pSS patients, with a positive correlation between the increase in FoxP3(+) Treg in SG and the Chisholm score in pSS (p < 0.001, r = +0.605). The increase of FoxP3( +) Treg cells in the SGs of pSS patients, which is correlated with gland infiltration, suggests that natural regulatory T cells play an important role in the pathogenesis of pSS. Further studies are required to explore the mechanisms that mediate the relationship between Treg and the pathogenesis of pSS.

BackgroundBehçet's disease does not have specific laboratory findings or a pathological physical examination sign. There are many suggested markers for inflammation in BD. Studies on this issue have shown that IL-6, IL-1β, TNF-α, thrombomodulin, E-selectin, VEGF, total homocysteine, α-1 antitrypsin, α-2 macroglobulin are the considered markers associated with BD. Recently, reports have concluded that the neutrophil/lymphocyte ratio (NLR) and mean platelet volume (MPV) are indicators for systemic inflammation. To the best of our knowledge, there is no research in the literature that evaluates both MPV and N/L ratio for patients with Behçet's disease.ObjectivesWith this retrospective study, we researched the effects of MPV and NLR on the activity of Behçet's disease and susceptibility to thrombosis.Methods186 patients with Behçet's disease, who met the inclusion criteria, were separated into two groups as following: 120 patients with active Behçet's disease (Group I) and 66 patients with inactive Behçet's disease (Group II). 79 healthy subjects as controls were included in the study.ResultsMPV was similar between all three groups. CRP was statistically higher in the active BD group when compared to the inactive BD group and the control group. CRP of the inactive BD and the healthy control group were similar. In addition, ESR was found higher than the control group in both active and inactive BD groups, whereas ESR of the active BD group was higher than the inactive BD group. N/L ratio was found statistically higher in the active BD group when compared to inactive BD and healthy control groups, while the N/L ratio of inactive BD and healthy control groups were found similar to each other. While MPV, CRP, and NLR didn't statistically differ between active BD subgroups with and without thrombosis, ESR was statistically and significantly higher in the active BD group with thrombosis when compared to the active BD group without thrombosis.Table 1.Study parameters in all groupsGroup I (n=120)Group II (n=66)Control (n=79)pMPV (f/L)8.16±1.098.39±0.868.47±0.870.66CRP (mg/L)0.51 (0.23-0.89)0.19 (0.04-0.36)0.13 (0.08-0.18)<0.001†ESR (mm/h)19.5 (12-20)13.0 (11-16)11.0 (9-13)<0.001‡NLR4.41 (2.77-6.20)1.82 (1.47-1.99)1.72 (1.32-2.04)<0.001††There was a statistically significant difference between group I with group II and group I with control but no statistically significant difference between group II and control.‡There was a statistically significant difference in all groups.ConclusionsThe data obtained from the present study showed that the patients with BD are exposed to chronic inflammation. And the N/L ratio may be a simple, inexpensive, and convenient diagnostic marker of active BD.Disclosure of InterestNone declared

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