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Background: Articular manifestations may differ in ulcerative colitis (UC) and Crohn’s disease (CD). Genetic and non-genetic factors like sex, smoking, and presence of HLA-B27 were previously shown to modify the expression of articular and other extraintestinal manifestations of IBD. Objectives: The aim of this study is to document disease features and factors affecting the expression of articular manifestations in Turkish patients with IBD-related (enteropathic) arthritis under treatment with disease modifying antirheumatic drugs (DMARDs). Methods: Data regarding enteropathic arthritis (EA) were collected from the TReasure database, a nation-wide multicenter observational registry of inflammatory arthritis patients. Results: Among 4066 patients with seronegative spondyloarthropaties (SpA), 156 (3.8%) had EA, not reflecting a true prevalence due to selection bias. Demographic and clinical features according to IBD groups were summarized in Table 1. Rates of presence of sacroiliitis were similar between patients with UC and CD (39.9% and 60.1%, p=0.086 respectively). Rates of HLA-B27 positivity were 31.6% and 7.1% in patients with and without radiographic sacroiliitis, respectively (p=0.101). Enthesitis, dactylitis, psoriasis, family history forSpA, ESR, CRP, BASDAI and aSDAS levels had similar distributions in patients with and without radiographic sacroiliitis. Rates of “never-smoked” (26.5% vs 64.7%) and “current smoking” (32.4% vs 17.6%) significantly differed in patients with and without sacroiliitis (overall p=0.012) Conclusion: Our data confirm an association between smoking status and disease manifestations, particularly radiographic sacroiliitis. References [1] Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol2009; 15: 2449-2455. Disclosure of interests: Orhan Kucuksahin: None declared, abdulsamet Erden: None declared, Ufuk Ilgen: None declared, Sedat Kiraz: None declared, ali Ihsan Ertenli: None declared, Nazife Sule Yasar Bilge: None declared, Timucin Kasifoglu: None declared, Ediz Dalkilic Grant/research support from: MSD and abbvie, Consultant for: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilufer alpay Kanitez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, abbvie,Celltrion, Novartis, Pamir atagunduz: None declared, Belkis Nihan Seniz: None declared, Burcu Yagiz: None declared, Suleyman Serdar Koca: None declared, Muhammet Cinar: None declared, askin ates: None declared, Servet akar Grant/research support from: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersozlu: None declared, Veli yazisiz: None declared, Gezmis Kimyon: None declared, Muge aydin: None declared, Ridvan Mercan: None declared, Burak Oz: None declared, Zeynel abidin akar: None declared, Omer Karadag: None declared, Bahar Kelesoglu: None declared, Sedat Yilmaz: None declared, Yavuz Pehlivan: None declared, Ender Terzioglu: None declared, Levent Kilic: None declared, Sukran Erten: None declared, Koray Tascilar: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer and abdi Ibrahim, Speakers bureau: MSD, abbvie, Roche, UCB, Novartis, Pfizer and abdi Ibrahim

Background Exercise programs have been being provided in Hacettepe University for 12 years. The group exercises were transformed into a book named as “Bilissel Egzersiz Terapi Yaklasimi (BETY) (1)” in 2014 and were registered as a trademark by the Turkish Patent Institute in 2015. This approach includes cognitive processes in pain management, clinical pilates exercises and awareness of mood state via dance therapy (2).When rheumatic patients participating in BETY sessions, they are evaluated with appropriate scales for their diseases and it is stated that these scales do not express enough the healing properties they feel with BETY. Objectives The aim was to develop a new scale assessing the biopsychosocial aspects of healing properties in rheumatic patients. Methods After 12 years of treatment, cognitive beliefs about health perceptions were gathered from the patients who participates in the BETY group for at least 5 years, with the open-ended question “What kind of changes did you make in this group?”. After elimination of similar sentences, 30 cognitive beliefs about different health perceptions were obtained. The newly developed scale was applied to 89 patients aged 18–69 years (42,94±12.85), who had different rheumatic diseases and were not included in the BETY group. Working questions were determined. Results The internal consistency was found to be 0.89. In this process, 5 items that didn9t work and had the same meaning were removed from the scale. After this, “What kind of improvements did you make in Daily life by participating in the BETY group?” question was asked to the patients participated in BETY group to narrow the expressions and 5 new sentences are determined. The scale was sent to 24 rheumatologists and 2 physiatrists for expert opinion. 15 rheumatologists and 1 physiatrist were returned. When the survey items were examined on a question-based basis, the acceptance rate of all questions was 70.83%. According to this result, the scale was finalized. Structural validity of the created draft will be investigated in the subheadings of functional activity, pain, sexual life, fear of movement, mood. Conclusions As a result, an original scale which will assess the biopsychosocial aspects of healing properties in rheumatic patients is developed. Our future purpose is to investigate the validation of this scale in different rheumatic diseases. References E.Unal (Ed.) Romatizmal Hastaliklarda Biyopsikososyal Model: Bilissel Egzersiz Terapi Yaklasimi (BETY), 2014, Pelikan Yayincilik, Ankara. ISBN: 9786056474101. Kisacik,P. Unal,E. Akman,U. Yapali,G. Karabulut,E. Akdogan,A. Investigatition the effects of a multidimensional exercise program on sypmtoms and antiinflammatory status in female patients with ankylosing spondylitis. Complementary Ther. Clin. Pract. 22(2016):38–43. Acknowledgements The authors declare that they have no conflict of interest. Disclosure of Interest None declared

Background Retention of biological drugs in inflammatory arthritis may be affected from different obvious and unknown factors. It can be related with patient characteritics or disease features. In ankylosing spondylitis (AS), retention rate of biological drugs may be related with extra-articular presentation of AS such as uveitis, as well. Objectives The objective of this study was to assess whether uveitis affected retention of adalimumab in AS patients in our single center biological cohort. Methods Hacettepe University Biological registry is single-center biological registry since 2005. HURBIO had 2165 spondyloarthritis patients of which 1190 patients had AS according to NY criteria. Until now, in 510 of 1190 patients have used adalimumab and 350 of 510 patients had available for uveitis. Patients were assessed for demographic characteristics, disease duration, HLA-B27, DMARD and biological usage, biological switch ratio. Baseline disease activity was assessed with BASDAI, BASFI VAS (pain, fatigue and patients global assessment), ESR and CRP. Patients were compared according to having uveitis or not. Retention rate of adalimumab assessed by Kaplan-Meier survival analysis. Results Total 350 (59.4% male) AS patients analyzed. Mean age was 43 (12), mean disease duration and symptom duration were 10.5 (7.8) and 14.8 (9.6) years, respectively. 52 patients (14.8%) had uveitis. Median adalimumab survival time according to having uveitis were 71.9 (95% CI 25.4–118.6) months vs 36.4 (95% CI 23.3–49.4) months (log-rank p=0.014) (figure). Patients with uveitis were more frequently male (18.2% vs 9.8%, p=0.03), HLA-B27 positive (75.0% vs 49.5%, p=0.022). Patients with uveitis had more frequently SpA family history, as well (23.1% vs 10.8%, p=0.003). Age (49 (11) vs 41 (11) years, p Conclusions Determination of possible risk factors for retention of TNFi drugs is an important clinical problem for routine practise. It is well known that adalimumab is one of the treatment option for uveitis whether uveitis related with SpA or not. Our biological cohort supported that AS patients with uveitis had better adalimumab survival. For routine practise, adalimumab could be considered for AS patients with uveitis. Disclosure of Interest None declared

Background Rituximab is one of the treatment options in rheumatoid arthritis (RA) patients and officially recommended as a maintanance treatment given every 6 months after the initial loading of first course. Objectives In this real life study, it was aimed to investigate the infusion frequency of rituximab maintanance treatment and possible effects on disease activity. Methods The HUR-BIO is a single-center biologic registry of Hacettepe University which is established in Ankara and in which patients have been prospectively recorded since 2012. This database has 1235 RA patient records as of August 2016. Rituximab was prescribed at least once in 273 (22.1%) patients. The residence address of 85 those patients was within the boundaries of center city (Ankara) and they were included in to the study. In our clinic, the dates and the DAS-28 scores at the time of rituximab courses were recorded. Rituximab infusion compliance was classified as; “regular ” if there is less than one month delay, “slightly irregular” if less than 3 months delay and “irregular” if more than 3 months delay. Results The mean age of the 85 patients (80% female) was 59.1 (10.1), the mean disease duration was 12.9 (8.6) years and 74.1% of patients were seropositive. 39/85 (46%) patients previously used at least one biological agent (46 (54%) patients were biologic naive before Rituximab therapy). Median rituximab course number was 3 (1–8). A total of 211 rituximab courses were given to 85 patients. Rituximab course number and percentage is shown in figure. The mean interval time between rituximab courses was 7.9 (2.8) months. Total of 102 (52.6%) courses were admistred at normal times regularly, 60 (30.9%) were slightly irregular and 32 (16.5%) were irregular. There was no significant difference between the mean DAS-28 responses in the time of the courses and the rituximab infusion compliances [in regular group mean DAS-28 was 3.31 (1,19), in slightly irregular group mean DAS-28 was 3.26 (1.35) and irregular group mean DAS-28 was 3,57 (1.34), p>0.05]. Before rituximab courses, 33.7% of patients had remission, 19.1% had low disease activity, 36.3% had moderate disease activity and 10.9% had high disease activity. Conclusions Rituximab administration was approximately 2 months delayed in RA patients who were living in center-city boundaries. The pre-treatment mean disease activity scores were similar, even if there was a delay in rituximab administration. In our center, about 85% of patients were taking RTX courses regular and/or slightly irregular and about half of the patients before treatment were in remission and/or low disease activity. Disclosure of Interest None declared

Background Therapeutic plasma exchange (TPE) offers an alternative therapeutic modality for patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (APS). However, there is conflicting evidence regarding its efficacy in different sub-phenotypes. Objectives This study aims to investigate the main clinical characteristics and outcomes of patients with different phenotypes of SLE and APS treated with TPE at a tertiary care centre. Methods Database of Blood and Apheresis Unit between 2001–2013 was screened for patients with SLE and primary APS. SLE disease activity index (SELENA-SLEDAI), the indications for treatment, complications and outcomes were obtained from review of medical records and phone calls. A total of 24 patients (SLE: 20, APS: 4) were recruited for the study. Results Mean ages of SLE (M/F: 1/19) and primary APS (PAPS) patients (M/F: 2/2) were 32.4±12.89 and 52.0±10.7, respectively. The main indications for TPE were haematologic, neurologic, pulmonary involvement and APS-related. TPE was preferred in 8 patients because of leukopenia, and co-infection. SLEDAI was significantly decreased after TPE (16.7±8.3 vs. 8.8±3.1, p=0.001). Both primary APS and SLE related CAPS patients had completely responded to TPE. Success rate of TPE in patients with thrombocytopenia were lower than patients with haemolytic anaemia. Median (IQR 25%>75%) TPE sessions were 6.5 (5–10.5). Conclusions This study suggests catastrophic antiphospholipid syndrome (CAPS) and other APS related problems respond well to the TPE treatment. TPE should be kept in mind for the treatment of patients with other features of SLE, especially those resistant to other agents and in the presence of leukopenia and psychosis Disclosure of Interest None declared

Background Patients treated with biologic agents have increased risk of developing active tuberculosis (TB). It is essential to screen patients for latent TB before starting a biologic drug. Population is vaccinated with BCG in Turkey and BCG vaccination decreases the specifity of tuberculin skin test. QuantiFERON-TB Gold In-Tube Assay (QFT) is an another good option to screen latent TB. Objectives The objective of this study was to assess reliability of QFT test for latent TB before biological treatment. Methods Hacettepe University Rheumatology Biologic Registry (HUR-BIO) is a single center biological registry since 2005. Between Nov 2011 and July 2015, 1347 patients were assessed by QFT for latent TB. All consecutive patients were evaluated by a standard questionnaire between July 2015 and October 2016. This questionnaire included demographic characteristics, medical and treatment history, symptoms of active TB. 671 patients were assessed by the physicians. TB status of other 676 patients were checked from Turkish national tuberculosis registery records. It9s an obligatory disposition for physicians to inform health ministery about TB cases and all TB patients must be recorded in those regitry. The mean TB incidance per year was calculated for every anti-TNF agents and non-TNF biological agents. Results Total 1347 (58.1% female) patients were recruited to study. Mean age was 42±12 years. Diagnosis were followed; RA 436 (32.4%), SpA 844 (62.5%), others 67 (5.1%). Total biological drug exposure was 2329 patient-years; adalimumab (660 years), etanercept (630 years), infliximab (426 years), golimumab (283 years), certolizumab (78 years), and total anti-TNF duration (2071 years). Non-TNFi exposure was 258 patient-years. Positive and indeterminate QFT results were found in 267 (19.8%) and 20 (1.5%) patients, respectively and those patients were prescribed INH prophylaxis. In addition, INH was prescribed to 37 (2.7%) patients according to chest X-Ray and physician decision. Pulmonary TB found in 3 of 1347 (0.22%) patients. TB was developed 38, 28 and 21 months after TNFi. The mean TB incidance per year was 128.8/100.000 for all biological drugs. The mean TB incidance per year according to QFT positive and negative patients were 181.8/100.000 vs 112.4/100.000. Conclusions According to QFT screening for latent TB, INH was started almost 20% of patients. However, if we used TST for latent TB test in BCG vaccinated countries, INH would started almost 70–80% of patients. Therefore QFT was a good tool for latent TB screening in BCG vaccinated countries. Consequently, QFT test seems acceptable to determinate latent TB during biological drug usage. In addition, TB incidance has increased almost 7 times of our national TB incidance. Disclosure of Interest None declared

Background Takayasu Arteritis is a rare large-vessel vasculitis variant that affects the aorta and its main branches and the pulmonary arteries. Antiphospholipid syndrome is characterized by obstetric and thrombotic complications in the presence of antiphospholipid antibodies, which consist of anticardiolipin antibody, lupus anticoagulant and anti -β2 glycoprotein I. The association of antiphospholipid antibodies and Takayasu arteritis is very rare and few cases decumented it, while others argued aganist such association. Objectives This study was planned to find out the prevelance of immunoglobulinIgM/G anti-cardiolipinantibodies, anti beta 2 glycoprotein- 1antibodies and lupus anticogulant and evaluate the relationship between these antibodies and disease severity/complications in Takayasu arteritis patients. Methods 53 patients with Takayasu arteritis patients were enrolled in this study. We obtained blood samples to detectIgM/G anti-cardiolipin antibodies, anti beta 2 glycoprotein 1 antibodies and lupus anticogulant (LA) levels from all patients during their routine control. ImmunoglobulinIgM/G anti-cardiolipin antibody, anti beta 2 glycoprotein 1 antibodies were measured by using a standardized enzyme-linked immunosorbent assay (ELISA) and lupus anticogulant was measured using the diluteRussell9s viper venom time (dRVVT). Results No patients was positive forIgM/G anti-cardiolipin antibody. Seven were positive immunoglobulin IgM anti beta 2 glycoprotein 1 antibodies, three were positive immunoglobulin IgG anti beta 2 glycoprotein 1 antibodies, one waspositive LA. All of the antibody titters were low. TA patients who had antibody positivity had longer disease duration (p Conclusions In this study that there were no association between the antibodies positivity and vascular involvement or disease complications and severity in TA patients. In conclusion we can not suggest the routine evaluation of antiphospholipid antibodies or lupus anticoagulant test during the follow-upTakayasu arteritis patients. These antibodies may only be measured in the presence of clinical suspicion. Disclosure of Interest None declared

Background Turkish Society of Rheumatology (TSR) proposed a guideline of recommendations for viral hepatitis screening before biological therapy in 2015. 1 Objectives The aim of this study was to assess results of viral hepatitis serological tests performed before biologics in RA patients. Methods HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective,single center database of biological treatments including 1229 RA patients by August 2016. Results of serological tests for HBV of 468 RA patients were evaluated. The guideline includes 5 groups according to hepatitis B virus (HBV) serology; group 1 –HBV seronegative [HbsAg (-),anti HbS (-), anti-Hbc total (-)], group 2-vaccinated [HBsAg (-), anti-HBs (+), anti-HBc total (-)], group 3-previous HBV infection [HBsAg (-), anti-HBs (-), anti-HBc total (+)], group 4- Chronic HBV infection [HBsAg (+), anti-HBs (-), anti-HBc total (+)], group 5- secondary immunity [HBsAg (-), anti-HBs (+), anti-HBc total (+)]. Patients were also classified according to risk for HBV reactivation as very high risk (Group 4 patients receiving rituximab), high risk (group 3 patients receiving rituximab) and medium risk (Group3 or Group 4 patients receiving TNFi or T-cell blockers,IL12/23 pathway inhibitor). Screening results for hepatitis C virus (HCV) were also evaluated. Results Among 1229 patients (79.7% female), mean age was 54.9±11.7 and mean disease duration was 12.3±8.2 years. In total, 104 (22.2%) of patients had received rituximab. Serology for HbsAg, anti-Hbs and anti-HbC were avaliable in 468 patients. There were 273 (58.3%) patients in group 1, 81 (17.3%) in group 2, 19 (4.1%) in group 3, 9 (1.9%) in group 4 and 86 (18.3%) in group 5. Table 1 represents distribution of patients according to HBV reactivation risk. Anti-HCV was positive in 21 (2.5%) of patients. Conclusions Among patients registered in HUR-BIO, 1.9% had chronic HBV infection and 2.5% anti-HCV positivity. 5.0% of them were under high and/or very high risk for HBV reactivation. Medium risk group which includes 17.0% of patients, seems to deserve most of the attention. Screening for viral hepatitis must be performed before biologics and TSR guideline may be useful in this matter. References Karadag O, Kasifoglu T et al. Guideline of the viral hepatitis screening before biologic agents use in patients with rheumatic diseases. RAED Journal;7:28–32. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is a chronic, erozive disorder which may lead to permanent joints damage. Health assessment questionnaire (HAQ) is frequently used for evaluating functional disability in RA patients. Objectives The aim of this study is to determine the effect of biologic treatment on functional disability in RA patients. Methods HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, monocentric database of biological treatments including 1229 RA patients by August 2016. 523 patients in whom HAQ assessment before biologics was avaliable, were recruited in this retrospective analysis. HAQ score ≥1.0 was defined as severe functional disability.1 HAQ assesment at last follow-up visit were evaluated. Demographic,clinical and serologic data of patients were also collected. Improvement of HAQ score 0,22 points or more was considered as clinically significant response to treatment.1 Results Among 523 patients (80.5% female), mean age was 52.6±12.5 and mean disease duration was 9.4±7.3 years. Seropositivity for RF and/or CCP was present in 67.2% of patients. At baseline visit, HAQ score was ≥1.0 in 268 patients (51.2%). Baseline and last follow-up HAQ scores were 1.07±0.62 and 0.64±0.57. Minimal clinically significant improvement of HAQ score was observed in 238/377 patients (63.1%). Clinically significant response was more frequent in patients with baseline HAQ score of ≥1 (153/195 (78.4%) vs 85/182 (46.7%), p Conclusions Functional disabilty was observed approximately half of patients. Clinically significant improvement was more frequent among patients with higher baseline HAQ scores particularly. Biologic treatment seems to be provide significant functional improvement. However significant functional disability persists in one fourth of patients. References Lillegraven S., Kvien T.K. Measuring disability and quality of life in established rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21:827–840. Disclosure of Interest None declared

Background Rheumatoid Arthritis Impact of Disease (RAID) is a composite index. There are seven domains of this index (pain, function, fatigue, sleep disturbance, physical wellbeing, psychological/emotional well-being and coping). Daily activity in last week is evaluated. This score, is reccommended to be used in clinical trials to measure the effect of RA. Objectives The aim of this study is to examine the relationship between RAID composite index and other indexes. Methods This study was carried out from the HUR-BIO reserved database since August, 2016. In addition to the demographic characteristics of the patients, DAS-28, HAQ-DI, pain, fatigue, Patient global Assesment (PGA), Tender joint counts (TJC), swollen joint counts (SJC), CRP and ESR are recorded. Since 2015, a RAID form is filled for our patients. While this composite scale was being created, Gazi University Turkey carried out Turkish validation, in the original study. RAID composite index includes 7 questions, each scored from 0 to 10, 0 being the best score while 10 points is worst. The relationship between RAID composite index and other indexes were studied with Spearman correlation test. Results HUR-BIO database containts 1235 RA patients as of August 2016. A RAID form was filled for 149 of these patients before initiating biological agent. 124 patients (83.2%) were female. Mean age was 49±13 years and mean disease duration was 7.8±7.2 years. Positive ACPA and RF ratios were detected as 48/104 (45.7%) and 78/137 (56.9%) respectively. 77.9% of our patients had education of high school or less. RAID average score was detected as 6.72 (1.98). In female patients RAID disease activity was significantly higher than in men [RAID 6.8 (2.0) vs. 5.9 (1.6), p=0.038]. There was no significant difference among RF, CCP positive patients and auto antibody-negative patients in terms of RAID disease activity. [RAID for RF + vs -; 6.75 (2.05) vs 6.68 (1.86), p=0.82, RAID for CCP + vs -; 6.74 (1.96) vs 6.98 (1.82), p=0.52]. RAID disease activity measurements were correlated moderately acute phase reactants, it was very weak. In table, it is grouped by level of education and re-evaluated. In those with an education higher than college, rising parameters were seen in good level of correlation. [RAID vs Pain, r =0.65, p Conclusions RAID has low correlation with other composite index such as DAS-28 score. RAID also has moderate correlation with pain, fatigue ad PGA VAS. On the other hand, patient with high education level had better perception for those patient reported composite index. RAID can be used confidently in these selected cases. Disclosure of Interest None declared