Search

BackgroundBiological therapies are the main treatment options for patients with active spondyloarthropathy (SpA) who do not respond to nonsteroidal anti-inflammatory drugs or conventional synthetic disease-modifying drugs. Kidney diseases are not a contraindication to biologic therapies. However, there are some safety concerns for these drugs for patients with advanced chronic kidney disease. De novo infection or recurrence of infections are the main challenges in patients with multiple comorbidities during biologic treatments. Neverthless, physicans should initiate these treatments in active and resistant diseases.ObjectivesHere, we evaluated which biologic therapies clinicians’ first option to initiate in SpA patients with advanced chronic kidney disease (CRD).MethodsTotal 140 patients of TREASURE database who fullfield axial and/or peripheral ASAS SpA criteria with glomerular filtration rate < 60 ml/dk (stage 3,4 or 5 CRD according to The National Kidney Foundation classification) were included to the study. Renal stages of the patients were evaluated when biologic therapy was initiated. Five anti-TNF (adalimumab, certolizumab, etanercept, golimumab, infliximab) and an interleukin-17A blocker (secukinumab) were on the market during the study. We evaluated physicans’ first choice for biologic therapy for patients with stage 3,4 and 5 CRD respectively.ResultsMore than two thirds of the patients had stage 3 CRD. Anti-TNF drugs were the first choice of biologic treatment in the patients with advanced CRD. Etanercept was started at most to the patients in general, in stage 3 and in stage 5 CRD groups. However, adalimumab was the first choise in stage 4 CRD. Both etanercept and adalimumab were the first drug of choise in three fourth of the stage 4 and stage 5 patients. All two patients on Il-17A blocker had stage 3 CRD (Table 1).Table 1.Drug of choise in the SpA patients with advanced chronic renal diseasesNTotal n (%)NStage 3 n (%)NStage 4 n (%)NStage 5 n (%)Adalimumab14044 (31.4)10830 (27.8)209 (45.0)125 (41.6)Etanersept52 (37.1)41 (38.0)5 (25.0)6 (50.0)Golimumab9 (6.0)7 (6.5)2 (10.0)0 (0)Infliksimab28 (20.0)23 (21.3)4 (20.0)1 (8.4)Secukinumab3 (2.1)3 (2.8)0 (0)0 (0)Sertolizumab4 (2.8)4 (3.7)0 (0)0 (0)ConclusionWe show that rheumatologists in the TREASURE group prefer to initiate anti-TNF drugs first in all advanced CRD stages. Etanercept was the first choice in these patients.References[1]Sieper J, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009 Jun;68 Suppl 2:ii1-44. doi: 10.1136/ard.2008.104018. PMID: 19433414.[2]Antoni C, Braun J. Side effects of anti-TNF therapy: current knowledge. Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S152-7. PMID: 12463468.[3]Kalyoncu U, et al. Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci. 2018 Aug 16;48(4):856-861. doi: 10.3906/sag-1807-200. PMID: 30119164.Disclosure of InterestsNone declared

BackgroundCostovertebral (CV), costotransverse (CTr), sternoclavicular (SC) and manubriosternal (MS) joint involvements may be in spondyloarthritis (SpA). However, the radiological and clinical characteristics of these involvements need further assessment.ObjectivesIn this study, we aimed to determine the characteristics of CV, CTr, SC, and MS joint involvements in SpA patients.MethodsSpA patients (searched from the hospital data-processing system according to ICD-10 system to determine the patients having M07 (enteropathic arthropathies), M45 (ankylosing spondylitis (AS)), M46 (other inflammatory spondylopathies) and/or M48 (other spondylopathies) codes) who have been requested a chest computed tomography (CT) for any reason between January 2010 and December 2020 included in this retrospective cross-sectional analysis. Chest CT reports were reviewed, and any CV, CTr, SC or MS joint involvement attributed to SpA accepted as positive CT for SpA involvement. Demographic/clinic data including smoking status, disease characteristics (duration, drug history, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and other related parameters) at the time of CT scan were collected and analyzed.ResultsAfter the confirmation of the diagnoses among 1700 patients, total of 339 SpA patients were included in the study. 244 were diagnosed with ankylosing spondylitis (AS), 66 with psoriatic arthritis (PsA), 14 with enteropathic arthritis, 13 with peripheral SpA, and 2 with non-radiographic axial SpA. According to CT reports, the number of patients with inflammatory changes in any of the CV, CTr, SC or MS joints on thoracic CT were 44. Of these patients, 42 were diagnosed with AS (95,5%), 1 with PsA (2,3%), and 1 (2,3%) with peripheral SpA. 39 CV, 9 SC, 5 MS joints, and 3 CTr joints were affected. Joint involvements (17%) were higher in patients with AS than in other patient groups (pTable 1.Demographic and clinical characteristics of patients with and without involvement on chest CTData are presented as median (25-75 percentile) or number (%)CT; computerized tomography, BMI; body mass index, ESR; erythrocyte sedimentation rate, CRP; C-reactive protein, BASDAI; Bath Ankylosing Spondylitis. Disease Activity Index, BASMI; Bath Ankylosing Spondylitis Metrology Index, BASFI; Bath Ankylosing Spondylitis Functional IndexConclusionIn this study, we have found that CV, CTr, SC, and MS joint involvement on thorax CT were more common in men and smokers and were associated with disease duration and appears to affect chest expansion and Schober’s tests. In previous studies, CV and CTr joint involvement in AS patients with chest pain were 80-82% and 60%, respectively [1,2]. Our study showed that 17% of AS patients had involvement regardless of pain symptoms. As this is the preliminary data and the CTs will be re-evaluated by our radiologist, we will be capable to report more unbiased results.References[1]Cerrahoglu L, Unlu Z, Can M, et al. (2002) Lumbar stiffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitis. Clin Rheumatol. 21(4):275-279.[2]Pascual E, Castellano JA, López E. (1992) Costovertebral joint changes in ankylosing spondylitis with thoracic pain. Br J Rheumatol. 31(6):413-415.Disclosure of InterestsNone declared

BackgroundThe frequency of pulmonary rheumatoid nodules closely relates to the diagnostic modality and changes from ObjectivesWe aimed to compare the disease and pulmonary rheumatoid nodule characteristics of seropositive and seronegative RA patients.MethodsIn this study, all RA patients - according to ICD-10 code - and had at least one chest computerized tomography (CT) were examined and revealed 4117 individual patients. First, RA diagnosis was confirmed according the patients’ history, physical examination, radiography and laboratory assessment. Then, chest CTs were examined by an experienced radiologist. To classify pulmonary nodules as ‘’pulmonary rheumatoid nodule’’, following inclusion and exclusion criteria were used; For inclusion: 1) nodules with changing dimension on follow-up, 2) At least two nodules with different dimensions, 3) Cavitary nodule at any chest CT. For exclusion: 1) Solitary nodules OR all nodules ≤ 5mm and without follow-up OR no change on follow-up. Biggest nodule was named as dominant nodule. Then, patients were grouped according to rheumatoid factor and anti-CCP status as seropositive (RF ± anti-CCP) and seronegative. Demographics, comorbidities, RA-spesific treatments and nodule characteristics were compared.ResultsOf 680 RA patients who had pulmonary nodule in chest CT, 208 (30.6%) patients were classified as having pulmonary rheumatoid nodule. 167 (80.3%) patients were seropositive. Demographic and comorbidity characteristics were similar among seronegative and seropositive patients (Table 1). Regarding RA-spesific treatments, methotrexate, leflunomide and rituximab were prescribed more frequently in seropositive patients. For nodule characteristics, seropositive patients had higher number of nodules (5 [1-48] vs 3 [1-27]; p=0.004), bigger dominant nodule (8 [3-95] vs 6 [3-45] mm; p=0.011), and higher percentage of cavitary nodule (28.7% vs 12.2%; p=0.03). Localization of the nodule was compareble.Table 1.Comparison of demographic, disease and nodule characteristics of seropositive and seronegative patients (n=208)Seropositive (n=167, 80.3%)Seronegative (n=41, 19.7%)P valueFemale, n(%)113 (67.7)28 (68.3)0.94Age at the time of CT (median, min-max)61 (24-83)59.7 (20-83)0.28Smoking (n=73)26 (43.3)4 (30.8)0.40- Never smoked34 (56.7)9 (69.2)- Ever smokedComorbidity (n=188)127 (84.7)30 (78.9)0.40- Hypertension72 (55.0)18 (58.1)0.91- Diabetes (n=166)25 (18.5)7 (22.6)0.79- CAD (n=165)30 (22.6)7 (21.9)0.93- Heart Failure (n=164)15 (11.4)6 (18.8)0.41- COPD (n=163)20 (15.2)1 (3.2)0.13- Asthma (n=160)15 (11.6)5 (16.1)0.54- CKD (n=169)20 (14.5)8 (25.8)0.22- ILD (n=202)54 (33.1)10 (25.6)0.37RA-spesific treatments (ever)90 (72.6)16 (55.2)0.07- Methotrexate (n=153)105 (64.0)12 (30.8)0.001- Leflunomide (n=208)117 (70.5)25 (61.0)0.06- Hydroxchloroquine (n=169)65 (47.4)11 (36.7)0.28- Sulfasalazine (n=167)39 (39.0)6 (27.3)0.30- TNFi (n=122)41 (39.8)2 (9.5)0.008- Rituximab (n=124)11 (9.9)2 (8.0)0.77- Tofacitinib (n=136)12 (11.9)2 (10.5)0.86- Abatacept (n=120)9 (8.5)2 (8.7)0.98- Tocilizumab (n=129)Number of nodules at baseline CT (median, min-max)5 (1-48)3 (1-27)0.004Diameter of dominant nodule (median, min-max) (mm)8 (3-95)6 (3-45)0.011Localization of dominant nodul64 (38.3)15 (36.6)0.84- Left or right?64 (38.3)12 (29.3)0.48◦ Left51 (30.5)16 (39.0)0.28- Upper, middle or lower?52 (31.1)13 (31.7)◦ Upper69 (41.3)21 (51.2)◦ Middle22 (13.2)7 (17.1)◦ Lower76 (45.5)13 (31.7)-Peripheral, central or subpleural◦ Peripheral◦ Central◦ SubpleuralCavitation48 (28.7)5 (12.2)0.03Calcification54 (32.5)12 (29.3)0.69CAD: Coronary artery disease, CKD: Chronic kidney disease,; ILD: Interstitial Lung Disaese,ConclusionAutoantibodies seem to have impact on the characteristics of pulmonary rheumatoid nodules. As there were different prescription patterns were seen in our study, effects of these treatment differences need to be determined.ReferencesDisclosure of InterestsNone declared

BackgroundInflammatory musculoskeletal diseases are frequent in the elderly population, and this number is expected to increase significantly near future. The exclusion of older adults from the studies due to their age and comorbidities causes insufficient data about this population. Insufficient data cause clinicians to have difficulties using and selecting biological therapy in the elderly patient group. In real life, physicians’ approaches to the selection and use of biological disease modifying anti-rheumatic drugs (DMARDs) in the geriatric population with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have not been well studied.ObjectivesTo compare the clinicians’ first choice of biological DMARDs in elderly and younger RA and PsA patients and investigate the drug survival of first biological DMARDs in both populations.MethodsThe traditional chronological age for the human to be classified in the geriatric population is ≥ 65 years (1). The TReasure web-based registry, created in 2017, is a multicenter observational cohort established to collect data on RA and spondyloarthritis (SpA) patients from the participating 17 rheumatology centers in different regions of Turkey. Physicians’ first choice biological and targeted synthetic DMARDs in younger and elderly patients with RA and PsA was evaluated using the descriptive statistical method. The survival of the first b/tsDMARDs was assessed using the Kaplan-Meier method.Results3136 RA and 738 PsA patients were evaluated. 12% of 3136 patients with RA were in the geriatric population. In patients with RA, the first choice of biologic DMARDs was adalimumab (20.6%), followed by etanercept (19.9%), and tofacitinib (13.6%) in patients < 65 years of age, while rituximab (24%) was the first choice in patients ≥ 65 years, tofacitinib (20.9%) in the second place and etanercept (13%) in the third. Of 738 PsA patients, 3% were over 65 years. Adalimumab (41.1%) was the first choice of Figure 1.Comparison of first bDMARD retention rates between ConclusionWith these findings, it is thought that in Turkey, the limited socioeconomic support in the geriatric patients has led physicians to prescribe treatments such as rituximab, which are administered in the hospital under the supervision of a physician, are relatively preferred in malignancies, and are considered to be relatively less risky in terms of tuberculosis. Adalimumab and etanercept were chosen in the first two lines in both geriatric and young populations in the patient group with PsA. While the drug survival was significantly higher in patients with RA geriatric age group than the younger group, in PsA in which tumor necrosis factor-alpha (TNF-α) inhibitors were chosen as initial therapy in both age groups was lower in the geriatric population.References[1]Kotsani et al. JCM 2021. https://doi.org/10.3390/jcm10143018Disclosure of InterestsNone declared

BackgroundPatients with inflammatory arthritis have an increased risk of cardiovascular disease. Dyslipidemia is one of the primary modifiable risk factors.ObjectivesComparasion of the frequency of dyslipidemia and the use of anti-hyperlipidemic agents in patients with Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) receiving bDMARDs.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005 and 581 (75.4% female) patients with RA and 520 (69.4% female) patients with PsA enrolled up to 2021 were analyzed. Dyslipidemia was defined according to the Turkish Endocrine and Metabolism society criteria (TC > 240, Triglycerides (Tg) > 150, LDL-C > 160, HDL-C (< 40 in men, < 50 in women) (1). The anti-hyperlipidemic (anti-HL) agents used by the patients during follow-up and at their last visit were recorded.ResultsThe mean (SD) age of the patients and diseases duration were as follows; RA vs. PsA [age: 52.1 (13.9) vs. 48.7 (12.5) years; disease duration: 5.3 (2.1) vs. 9.2 (6.4) years]. Lipid profiles were known in 289 (49.7%) patients with RA and in 175 (33.6%) patients with PsA at the initiaiton of bDMARD. Lipid profiles were evaluated in 356 (61.2%) patients with RA and 226 (43.4%) patients with PsA during follow-up and at the last visit. Lipid profiles were similar in patients with RA and PsA at the initiation of bDMARDs (Table 1). At the initiation of bDMARD, 29 (5.0%) of RA patients and 10 (3.2%) of PsA patients were receiving anti-HL agents. During the entire follow-up, 65 (12.6%) patients with RA and 22 (4.8%) patients with PsA have used anti-HL agents (pTable 1.Lipid values in patients with RA and PsA at the initiation of bDMARD and at the last visitRheumatoid arthritis, n (%)Psoriatic arthritis, n (%)p1*p2**Lipid valuesbDMARD initiationLast visitbDMARD initiationLast visitTotal Cholesterol> 24047/270(17.4)98/339 (28.9)32/161(19.8)57/203 (28.1)0.300.13Triglyseride> 15062/242 (25.6)108/320 (33.7)45/159 (28.3)80/193 (41.4)0.790.20HDL-C< 40 (males),< 50 (females)88/267 (32.9)70/343 (20.4)57/157 (36.3)20/207 (9.6)0.480.001LDL-C > 16053/289 (18.3)91/356 (25.6)43/175 (24.5)65/226 (28.7)0.380.55*p1, bDMARD initiation visit comparison**p2, last visit comparisonConclusionIn real-life cohort, lipid profile was not assesed in half of the patients during entire follow-up. Although, LDL-C levels are high in about a quarter of the patients in both groups, use of anti-hyperlipidemic drug was inadequate. This is even more evident in PsA patients. Despite the significant emphasis on comorbidities in treatment guidelines, there is still a long way to go in real life.References[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021,Disclosure of InterestsNone declared

BackgroundData regarding the prevalence and especially incidence of osteoporosis in Spondylarthritis (SPA) is scarce and very divergent among studies from different patient populations (1).ObjectivesIn this study, we aimed to compare demographic, disease and laboratory characteristics of SpA patients regarding their bone mineral densitometry (BMD) categories and find out incidence of osteoporosis in the follow-up BMD of patients who were not found to have osteoporosis at baseline.MethodsBetween 2010-2021, patients with a SPA diagnosis in the HUR-BIO database were searched. HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2010. Patients with BMD measurement were included in the study. Follow-up BMD scores were also documented. The patients were divided into 3 groups as normal, osteopenia and osteoporosis in accordance with the WHO criteria (2). Demographic characteristics, comorbidities, laboratory data and drugs in each group were documented.Results3245 patients were reviewed. BMD was measured at least once in 118 patients out of 3245 (3.6%) patients. When the groups classified, 34 patients (28.8%) were included in the normal, 49 (41.5%) osteopenia and 35 (29.7%) osteoporosis groups. Patients with normal BMD was younger than both groups. Diabetes and hypertension were more prevalent in patients with osteopenia. The BMI was significantly lower in the osteoporosis group. 25 patients with normal and osteopenia in baseline BMD measurement had at least 1 follow-up BMD measurement. During the total follow-up of 91 patient-years, 3 patients had osteoporosis, revealing a the incidence of 3.3% in 100 patient-years.ConclusionIn our study, the incidence of OP development in SPA patients was found to be 3.3%. Frequency of osteoporosis was 29.7% among SpA patients with BMD measurement (118/3245; 3.6%), however; only 40% of them had appropriate treatment. Osteoporosis seems as an overlooked and undertreated comorbidity of SpA.Table 1.Comparison of spondyloarthritis patients according to BMD scores (normal, osteopenia and osteoporosis) according to baseline BMD assessmentNORMAL Number, (%)OSTEOPENIA Number, (%)OSTEOPOROSIS Number, (%)P VALUENumber of Patients34 (28.8)49 (41.5)35(29.7)Age47,5 (27-70)63 (45-79)58 (20-75)0.00*Gender (Female)24 (70.6)34 (69.4)23 (65.7)Diabetes Mellitus3 (8.8)14 (29.2)1 (2.9)0.00*Hypertension11 (32.4)28 (58.3)5 (14.3)0.00*Chronic Renal Failure2 (6.9)1 (2.7)1 (5.3)0.81Chronic Ostructive Pulmonary Disease4 (13.8)4 (10.8)1 (5.3)0.30Coronary Artery Disease0 (0)5 (12.5)3 (15)0.27Malignancy1 (3.6)1 (2.9)1 (4.2)1.0Smoking21 (61.8)23 (47.9)21 (63.6)0.379 (26.5)13 (27.1)5 (15.2)4 (11.8)12 (25)7 (21.2)Calcium mg/dl9.4 (8.2-10.2)9.5 (8.7-10.4)9.7 (8.1-10.4)0.49Phosphorus mg/dl3.5 (3-4.4)3.4 (2.6-5)3.8 (2.9-4.9)0.25Vitamin D ng/ml16 (7.4-64.4)21.2 (5-69.6)15.8 (5.8-49.1)0.66ALP IU/ml89.5 (54-137)89.5(53-169)80 (50-239)0.43Albumin g/dl4.2 (1.7-4.7)4.2 (3.3-8.4)4.2 (2-4.8)0.43TSH mU/ml1.5 (0.8-4.1)2.3 (0.1-9.7)2 (0.7-3.3)0.71Body Mass Index (BMI) kg/m229 (17-41.2)28.3 (20-44.6)25.1(15.8-43.2)0,06*Steroids4 (11.8)8 (16.3)2 (5.7)0.33Anti-TNF25 (73.5)35 (71.4)26 (74.3)0,95D Vitamin7 (20.6)14 (28.6)10 (28.6)0.67Calcium4 (11.8)5 (10.2)6 (17.1)0.63Bisphosphonate0 (0)4 (8.2)14 (40)0,00*Data was represented as median (minimum-maximum) or n(%)References[1]Hu LY, Chen PM, Shen CC, et all. Should clinicians pay more attention to the potential underdiagnosis of osteoporosis in patients with ankylosing spondylitis? A national population-based study in Taiwan. PoleS one 2019:6;14[2]Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield.Disclosure of InterestsNone declared

BackgroundThe ultimate goal of treatment in axial spondyloarthritis (axSpA) is sustained remission. Data on predictors of sustained remission are scarce in axSpA.ObjectivesTo determine predictors of sustained remission in people with axSpA after treatment with their first biological disease-modifying anti-rheumatic drug (bDMARD).MethodsHacettepe University Rheumatology Biologic Registry (HUR-BIO) is a prospective, single center registry of rheumatic disease patients treated with bDMARDs. Patients with axSpA were selected and sustained remission defined as attainment of Assessment of SpondyloArthritis International Society partial remission (ASAS-PR) and/or Ankylosing Spondylitis (AS) Disease Activity Score C-reactive protein Inactive Disease (ASDAS-ID) for two or more consecutive visits spanning ≥6 months during follow-up. Patients achieving and not achieving sustained remission were compared using the independent t-test. Multivariable logistic regression analysis was performed to determine independent factors predictive of sustained remission. Variables with a p-valueResultsData on 990 patients with sustained remission data were available. Of these, 299 (30%) were in sustained remission, while 691 (70%) were not. Patients in sustained remission were younger, had earlier disease onset, were more frequently male, had lower BMI and were more frequently HLA-B27 positive, compared to patients not in sustained remission. Furthermore, at the start of bDMARD treatment, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and patient global assessment (PGA, 0-10 scale) were lower, while acute phase reactants (ESR and CRP) were higher, in the sustained remission group. In multivariable analysis, male gender (OR 2.2, 95% CI 1.21-3.95), concomitant conventional synthetic DMARD (csDMARD) use (OR 3.63, 95% CI 1.29-10.19), PGA (OR 0.96, 95% CI 0.95-0.98), and early achievement (between 3-6 months) of remission (OR 13.1, 95% CI 7.13-24.02) were independently associated with sustained remission (Table 1, model 1). In the model without the variable early achievement of remission (Table 1, model 2), similar and a few additional associations were described: age at diagnosis (OR 0.97, 95% CI 0.96-0.99), male gender (OR 2.31, 95% CI 1.60-3.35), concomitant csDMARD use (OR 1.88 95% CI 1.23-2.86), PGA (OR 0.98, 95% CI 0.97-0.99), BASDAI (OR 0.87, 95% CI 0.78-0.96), and baseline symptom duration (OR 0.97, 95% CI 0.94-0.99).Table 1.Multivariable analysis (best-fit model) of predictors of sustained remissionModel 1Model 2CovariatesMultivariable Analysis (n= 541)Multivariable Analysis (n=739)OR (95% CI)p-valueOR (95% CI)p-valueAge at diagnosisNSNS0.97 (0.96-0.99)0.006Male sex2.84 (1.71-4.70)2.31 (1.60-3.35)Concomitant csDMARD use (at baseline or follow-up)2.94 (1.57-5.51)0.0011.88 (1.23-2.86)0.003Baseline PGA0.97 (0.96-0.98)0.98 (0.97-0.99)0.002Baseline BASDAINSNS0.87 (0.78-0.96)0.009Baseline symptom durationNSNS0.97 (0.94-0.99)0.021Achievement of remission at 3-6 months after baseline11.70 (7.11-19.23)NANANA: not applicable; NS: not selected (not contributing to the model). Baseline refers to start of bDMARD treatment.ConclusionThis study demonstrates that patients in sustained remission after starting bDMARD treatment have distinctive characteristics compared to patients not in sustained remission. These data can be used to aid clinical and personalized management of axSpA, and to facilitate better communicate between health care professionals and patients regarding the course and prognosis of their condition.Disclosure of InterestsBayram Farisogullari: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Zehra Özsoy: None declared, Gullu Sandal Uzun: None declared, Mustafa Ekici: None declared, Erdinc Unaldi: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Apraş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu: None declared, Pedro M Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB

BackgroundTNF inhibitors (TNFi) is highly effective in inflammatory arthritis (IA) treatment. However, concerns are raised about the possible association between TNFi and hematologic malignancies (HMs).ObjectivesTo assess the incidence of HMs among IA patients receiving TNFi compared with the general Turkish population.MethodsHUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (bDMARD) registry since 2005. Patients with IA including rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) patients who had at least 1 visit after the TNFi usage were screened from 2005 to November 2021. HM diagnosis was determined from the each patient files according to the hematologists’ decision and/or bone marrow/lymph node biopsy. Demografic data, disease characteristics, and death status were recorded. Standardized incidence rates (SIR) were calculated after adjustment for age and gender and compared with age- and gender-specific SIR values abstracted from the 2017 Turkish National Cancer Registry (TNCR).ResultsOf the 6139 patients registered in the HUR-BIO database, 5355 [3116 female (58.2%)] used any TNFi at least once. Median follow-up duration was 2.6 years for all patients receiving TNFi. 13 patients [8 (61.5%) female] had HM on follow-up. In these patients, median age at the IA onset was 38 (range 26 to 67) and the number of patients with SpA, RA, and PsA was 7, 4, and 2, respectively. The median duration of IA was 17.7 years (range 1 to 33). The median age at the HM onset was 55.5 (range 38 to 76) and the type of HM as follow: 8 lymphoma, 2 multiple myeloma, 1 large granular lymphocytic leukemia, 1 plasma cell dyscrasia, and 1 myelodysplastic syndrome. The median duration of the TNFi usage onset to HM was 36 (range 4-112) months. The TNFi was as follows: etanercept (n=8), adalimumab (n=6), infliximab (n=4), golimumab (n=1), and certolizumab (n=1). 5 patients used more than one TNFi. Patients using TNFi had an increased incidence for HMs (SIR 4.23, 95% CI 2.35-7.05). These results were also valid for both gender. 10 patients with HMs were under the age of 65. In this group, there was a higher incidence of HMs in both men (SIR 5.15, 95% CI 1.88-11.43) and women (SIR 4.76, 95% CI 1.74-10.55). 5 patients deceased on follow-up.ConclusionThe risk of HMs in inflammatory arthritis patients receiving TNFi being four times higher in comparison with the general Turkish population. There is a plethora of information that discusses the association between HMs and rheumatic disease. To determine whether the increased risk is from rheumatic disease or from TNFi usage, it would be ideal to compare patients receiving TNFi with bDMARD naive IA patients.Table 1.SIR for diferent age cut-ofs in both sexes for patients with hematologic malignanciesGenderAgeObserved/expected casesSIR%95 confidence intervalTotalAll ages*13/3.074.232.35-7.05Male20-64 years (n=2059)5/0.975.151.88-11.43≥ 65 years (n=180)0/0.39NA-Overall (n=2239)5/1.363.671.34-8.14Female20-64 years (n=2667)5/1.054.761.74-10.55≥ 65 years (n=449)3/0.664.541.15-12.37Overall (n=3116)8/1.714.672.17-8.88*: Includes patients ≥18 years.NA: Not applicable, SIR: standardized incidence ratesFigure 1.Cumulative number of hematologic malignancies in function of time from start of first anti-TNF therapyDisclosure of InterestsNone declared

BackgroundRecent epidemiological data on HBV and HCV in Turkey revealed that the seroprevalence rates of hepatitis B surface antigen and antibody against HCV were 4% and 1%, respectively, and seropositivity rates for hepatitis B surface antibody and hepatitis B core antibody were 31.9% and 30.6%, respectively. A previous multicenter nationwide study conducted in Turkey reported that the HBsAg positivity was determined in 2.3% of patients with rheumatoid arthritis (RA) and 3% of patients with ankylosing spondylitis (AS), and the anti-HCV positivity was detected in 1.1% of patients in each group. Given these rates, viral hepatitis is still considered a potential threat to patients with rheumatic diseases, specifically for the treatment-related viral reactivation.ObjectivesThis study aimed to evaluate the serologic HBV and HCV frequency and clinical characteristics among our patients with RA or SpA and receive biological treatments based on this background.MethodsThe prospective TReasure database, which observationally collects data of patients with rheumatic diseases from fifteen centers across Turkey, was analyzed for viral hepatitis, patient characteristics, and treatments used. TReasure registry study protocol, and the data collection was started on December 2017. At the time of the analysis for this study was performed, the registry database included 3147 patients with RA and 6071 patients with SpA. For hepatitis B; Hepatitis B surface antigen (HBsAg), anti-HBV core antibody (anti-HBc) and anti-HBV surface antibody (Anti-HBs) tests were evaluated. HBV-DNA was studied in HBsAg positive patients. Anti-HCV antibody has been studied for HCV. The clinical and serological HBV reactivation in the follow-up of the patients was evaluated by looking at the HBV-DNA viral loads.ResultsA total of 9218 patients (3147 RA and 6071 patients with SpA) were included in the analyses. The screening rate for HBV was 97% in RA and 94.2% in SpA groups. HBsAg positivity rates were 2.6% and 2%, anti-HBs positivity rates were 32.3% and 34%, anti-HBc positivity rates were 20.3% and 12.5%, HBV DNA positivity rates were 3.5% and 12.5%, and anti-HCV positivity rates were 0.8% and 0.3% in these groups, respectively (Table 1).Table 1.Serological analyses in the study groupRASpApNn (%)Nn (%)Hepatitis testing28962809 (97.0)54445130 (94.2)HBsAg positivity275071 (2.6)501799 (2)0.080Anti-HBs positivity2708876 (32.3)48931663 (34)0.147Anti-HBc positivity2362480 (20.3)4194524 (12.5)HBV-DNA positivity45416 (3.5)63735 (5.5)0.129Anti-HCV positivity260222 (0.8)462716 (0.3)0.005The HBsAg (+) patients were older and had higher comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, RF positivity was more in HBsAg(+) cases. The most frequently prescribed bDMARDS were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group, whereas adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. HBV reactivation was observed in one patient with during RA treatment, who received rituximab and prophylaxis with tenofovir.Figure 1.Prescription proportions of medications in the rheumatoid arthritis (RA) and spondyloarthritis (SpA) groupsConclusionThe epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the most comprehensive registries in rheumatology practice. According to the results of our study; It can be thought that there is no risk in the choice of treatment by the rheumatologist in patients who receive appropriate prophylaxis.Disclosure of InterestsNone declared

BackgroundAccording to international recommendations, co-morbidities must be taken into account in the management of patients with inflammatory arthritis.ObjectivesTo evaluate the distribution of pre-treatment comorbidities in the bDMARD cohort including patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).MethodsThe Hacettepe University biological database (HUR-BIO) was established in 2005, 581(75.4% female) patients with RA and 520 (69.4%female) patients with PsA enrolled up to 2021 were analyzed. Diagnosis of RA and PsA were based on the clinical evaluation of the rheumatologist who followed the patients. Comorbidities of the patients were reviewed retrospectively from the biological database, hospital electronic records, ICD-10 diagnostic codes and prescriptions of patients. Diabetes mellitus (DM), Hypertension (HT), Dyslipidemia (DL), Coronary artery disease (CAD), Body mass index (BMI) and smoking were recorded. DL was grouped in terms of lipid values ​​according to the classification of the Turkish Society of Endocrinology and Metabolism Dyslipidemia Guide(1). Detection of coronary artery disease before the age of 55 in men and of 65 in women was classified as premature - CAD. Data on Chronic Kidney Disease, obstructive pulmonary disease, Cerebro-vascular disease, Thyroid Diseases were also recorded. The Charlson comorbidity index (CCI) was calculated by summing the comorbidities in the patients’ medical history before the bDMARDs.ResultsThe distribution of comorbidities in patients with RA and PsA prior to initiation of bDMARDs was given in Table 1. Patients with RA were older and smoking was more common. HT(28.5% for RA, 21.9% for PsA) and thyroid diseases (22.7% for RA, 14.7% for PsA) were the most comorbidities in both groups. Compared to PsA, patients with RA had higher rate of comorbidities (64.8% vs. 40.4%, pTable 1.Comorbidities in RA and PsA patientsFeaturesRA n=581PsA n=520pGender, female n (%)438 (75.4)361 (69.4)0.027Age at PsA diagnosis, mean (SD) years46.7 (13.7)39.3 (12.0)Age at bDMARD start, mean (SD) years49.5 (13.8)42.2 (12.3)CCI-No comorbidity205/581 (35.2)290/486 (59.6)-1 comorbidity145/581 (24.9)90/486 (18.5)-≥ 2 comorbidity231/581 (39.7)106/486 (21.8)CCI mean, (SD)1.56 (1.77)0.78 (1.18)Smoking (ever), n292/581282/506BMI, mean (SD)29.3 (6.7)29.6 (5.9)0.50BMI ≥ 30 n261/577221/4980.77Diabetes Mellitus, n68/58149/4020.30Hypertension, n166/581110/5020.012Dyslipidemia* n-High TC47/27032/1610.30-High TG62/24245/1590.79-High LDL -C53/289(43/1750.38-Low HDL-C88/26757/1570.48Uric acid (>6 mg/dl), n150/554136/4370.16CAD n59/52432/4860.010Premature CAD, n39/58118/4860.030CKD, nG1 (GFR > 90)437/5230G2 (GFR 60-90)68/5230G3a (GFR 45-60)11/5230G3b (GFR 30-45)5/52328/370G4 (GFR 15-30)2/523342/370Lung disease, n-COPD15/5193/4850.007-Asthma66/52019/485Thyroid disease, n132/58165/440*TC > 240, TG 150-499, LDL-C> 160, HDL-C erkek < 40, kadin < 50CCI: Charlson comorbidity index, CAD: Coronary artery disease, CKD: Chronic Kidney Disease, COPD: Chronic Obstructive pulmonary diseaseConclusionThe burden of comorbidities in patients with RA before bDMARDs is more pronounced than in patients with PsA. Although, cardiovascular risk factors were similar, with the exception of hypertension and smoking, the age-adjusted CCI was 3.96 times higher in patients with RA than in patients with PsA.References[1]TEMD Obesity Guideline, L.M., Hypertension Working Group, TEMD Dyslipidemia Diagnosis and Treatment Guideline. 9th ed. 2021Disclosure of InterestsNone declared

BackgroundDyslipidemia is the leading treatable-modifiable factor among comorbidities in Psoriatic arthritis (PsA) patients. International treatment recommendations have left the management of dyslipidemia to national guidelines and especially to the rheumatologists.ObjectivesIn this study, we aimed to determine the frequency of dyslipidemia and the rates of initiation of treatment within the indication in PsA patients using bDMARDs.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by therheumatologist. Lipid profiles of PsA patients were evaluated at diagnosis, during the first bDMARD initiation, and at the last visit. Total cholesterol (TC), Triglyserides (TG), HDL-C and LDL-C values were grouped as optimal, borderline, high and severely high according to the Turkish Endocrine and Metabolism society criteria (1).ResultsLipid profile values ​​of PsA patients were known at diagnosis (n=159, 30.6%), in the initial bDMARD baseline (n=161, 30.9%), and at the last visit (n=203, 39.0%). The time to diagnosis of PsA and first bDMARD use was 2.8 years, and the time between the start of bDMARD and the last visit was 3.7 years. Accordingly, the rates of high TC, borderline TG, and high LDL increased over time. Rates at the time of PsA diagnosis, first bDMARD onset and at the last visit are as follows; high TC (14.3%, 17.1% and 28.0%), borderline TG (20.4%, 27.7% and 40.5%) and high LDL (17.0, 24.0% and 27.9%). On the other hand, low HDL-C slightly improved in men (33.3%, 29.4% and 23.1%), but did not show a significant change in women. While LDL-C level was >160 in 24.0% of patients who were started on bDMARD, anti-hyperlipidemic drug was started in only 6.2% of them. A similar situation persisted at the last visit (27.9% had LDL-C levels >160, but 10.8% received anti-hyperlipidemic therapy) (Table 1).Table 1.Lipid levels and changes over timeLipid levelsAt the time of diagnosis n= 159At the time of bDMARD initiation n=161bDMARD last visit n= 203Total Cholesterol (TC) mean (SD)195 (42)201 (43)214 (47)- TC < 200 (optimal) (%)56.552.845.3- TC 200-239 (borderline) (%)27.230.125.7-- TC > 240 (high) (%)14.317.128.0Triglyceride (TG) mean (SD)115 (52)132 (90)158 (103)- TG < 150 (optimal) (%)79.671.758.0- TG 150-499 (borderline) (%)20.427.740.5- TG 500-880 (high) (%)001.0-- TG ≥ 880 (severely high) (%)00.60.5HDL-C mean (SD)51.8 (13.1)50.6 (13.0)53.2 (12.5)- ≥60 (optimal) (%)20.620.425.6- 40-59 (borderline) in men (%)54.660.852.3- 50-59 (borderline) in women (%)32.324.530.3- Male < 40 (low) (%)33.329.423.1-- Women < 50 (low) (%)32.339.633.8LDL-C mean (SD)126 (33)132 (37)139 (36)- LDL-C < 100 (optimal) (%)21.421.114.2- LDL 130-159 (borderline) (%)22.525.127.0- LDL 160-190 (high) (%)17.024.027.9-- LDL > 190 (very high) (%)4.46.38.4Anti-hyperlipidemic drug n (%)5 (3.1)10 (6.2)22 (10.8)ConclusionAmong the modifiable risk factors for cardiovascular comorbidities in PsA patients, the leading risk factor is dyslipidemia. On the other hand, dyslipidemic drug use rates in daily practice are significantly lower. Although attention is paid to the management of comorbidities in all recommendations, there is still work to be done in real life.References[1]TEMD Obezite, L.M., Hipertansiyon Çalişma Grubu, TEMD DİSLİPİDEMİ TANI VE TEDAVİ KILAVUZU. 9 ed, ed. 2021, Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği. 159.Disclosure of InterestsNone declared

BackgroundThe incidence of co-occurrence of FMF and axial spondyloarthritis (axSpA) in adults is reported to be 0.5-7.5%. M694V mutation is the most frequent variant in patients with FMF+AxSpA (1).ObjectivesTo evaluate the association of demographic and clinical characteristics of patients with FMF+axSpA with the M694V mutation.MethodsA total of 9630 FMF patients were identified according to the ICD-10 code (E85.0) in the electronic database of Hacettepe University Hospital. 7525 patients aged ResultsOf 113 patients with known MEFV gene result, 91 (80.5%) were M694V (+), 22 (19.5%) were M694V (-), 45 (39.8%) were homozygous for M694V. In the M694V (+) group, symptom onset and diagnosis of both FMF and axSpA were at an earlier age compared to M694V (-) patients (pTable 1.FeaturesM694V (+) (n=91)M694V (-) (n=22)P1M694V Homozygous (n=45)M694V Nonhomozygous (n=68)P2Age at FMF symptom onset [years, med (25-75)]11 (5-18)21 (8-30)0,0057 (1-42)18 (3-53)Age at FMF diagnosis [years, med (25-75)]18 (10-27)33 (27-38)12 (1-42)28 (3-59)Age at AxSpA symptom onset [years, med (25-75)]20 (15-25)29 (24-38)20 (5-50)22 (5-58)0,43Age at AxSpA diagnosis [years, med (25-75)]24 (19-33)37 (28-44)23 (11-51)29 (7-59)0,039Fever n (%)84 (92,3)21 (95,5)0,6044 (97,8)61 (89,7)0,10Abdominal pain n (%)80 (87,9)20 (90,9)0,7043 (95,6)57 (83,8)0,056Peripheral arthritis n (%)45 (49,5)7 (31,8)0,1324 (53,3)28 (41,2)0,20Erysipelas n (%)19 (20,9)2 (9,1)20,213 (28.9)8 (11,8)0,02Enthesitis n (%)21 (23,1)4 (18,2)0,6211 (24,4)14 (20,6)0,63Uveitis n (%)11 (12,1)4 (18,2)0,454 (8,9)11 (16,2)0,26Psoriasis n (%)6 (6,6)1 (4,5)0,722 (4,4)5 (7,4)0,82HLA-B27 (+) n (%)25 (27,3)4 (18,2)0,542/15 (13,3)12/40 (30)0,30Syndesmophyte n (%)20/82 (24,4)6/19 (31,6)0,527/43 (16,3)19/59 (32,2)0,07Total ankylosis n (%)4/83 (4,8)1/19 (5,3)0,941/43 (2,3)4/59 (6,8)0,39Moderate to severe hip disease*n (%)22 (24,2)2 (9,1)0,1212/45 (26,7)12 (17,6)0,25Total hip replacement n (%)10 (11,0)1 (4,5)0,364 (8,9)7 (10,3)0,80* BASRI-hip score ≥3 on any sideConclusionFMF and SpA symptoms appear at an earlier age in M694V positive patients. The M694V mutation is associated with severe disease and early disease onset.References[1]Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C. The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis. Clin Rheumatol. 2009;28(1):41-6.Disclosure of InterestsNone declared

BackgroundRheumatic disesases may involve multiple systems and chronic kidney disease (CKD) can be seen during the course of diseases. Accompanying CKD affects the the choice of treatments in patients with rheumatic disease. There is limited data on the use of biological DMARDs in rheumatic patients with chronic kidney disease.ObjectivesTo determine the preferred first and second bDMARDs in patients in the CKD in the bDMARD cohort.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005. A total of 2160 RA patients, 3744 SPA patients, were registered in HUR-BIO until November 2021. The CKD was confirmed and classified according to 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. . Patients were evaluated for the presence of CKB before the initiation of bDmard and during follow-up under bDMARDs. Age and sex matched RA patients without CKD were selected for the control group.Results142/5904 (2.4%) patients have CKD. 102(%71.8) patients had CKD prior to initiation of bDMARD and 40 (28.1%) patients had developed during follow-up. The median time to CKD development after starting bDMARD was 4.13 years(±4.05). Of the patients with CKD, 98 (69.0%) had RA and 44 (31.0%) had SpA. RA patients followed for CKD were older than SpA (66.0 (±11.1) vs 59.1 (±13.0) years, p=0.001), female gender was more common (73.5% vs 36.4%, pTable 1.Relationship between remission according to bDMARD and CKDRheumatoid arthritispSpondyloarthritispw CKD n=98wo CKD n=91w CKD n=44(%)wo CKD n=80(%)pEtanercept, n(%)34 (34.6)30 (33.0)0.4617 (38.6)22 (27.5)P=0.14Adalimumab, n(%)17(17.3)17 (18.7)0,4810 (22.7)22 (27.5)P=0.36Infliximab,n(%)3 (3)8 (8.8)0.8514(31.8)32 (40.0)p=0.24Golimumab, n(%)4 (4)3 (3.3)0,541 (2.2)3 (3.8)p=0.55Certolizumab, n(%)0 (0)3 (3.3)0,111 (2.2)1 (1.3)p=0.58Anti-TNF therapy, n(%)58 (59.2)61 (67.0)0,6143800.352Non-TNF biologics, n(%)40 (40,8)30 (33.0)0,13100.355Rituximab, n(%)14 (14.3)12 (13.2)0,57Abatacept, n(%)14(14.3)12 (13.2)0,49Tocilizumab, n(%)6 (6.1)10.0411(2.2)p=0.35Jak-kinase inhibitors, n(%)6(6.1)5 (5.5)0.55ConclusionIn our biologic cohort, 2% of patients with RA and SpA had accompanying CKD. In one-third of the patients with CKD, it was developed during the follow-up after bDMARDs. In patients with RA, there was no difference in terms of TNFi and non-TNF-i preferences. It should be kept in mind that CKD may develop during the follow-up of patients using bDMARDs.References[1]Ye W, Zhuang J, Yu Yet all Gender and chronic kidney disease in ankylosing spondylitis: a single-center retrospectively study. BMC Nephrol. 2019 Dec 9;20[2]Chebotareva NV, Guliaev SVet al. [Chronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants]. Ter Arkh. 2019 May 15;91(5)Disclosure of InterestsNone declared

BackgroundPurified protein derivative skin test (PPD) or interferon gamma release assays (IGRAs) are used as diagnostic tools to detect latent tuberculosis. QuantiFERON-TB Gold Plus (QFT-Plus) is a new test that detects latent tuberculosis. Antigens of Mycobacterium tuberculosis (ESAT-6 and CFP-10) are used. The test contains two tubes: TB1 and TB2. TB1 tube contains peptides of these antigens that induce CD4+T cell response while TB2 tube contains peptides designed to stimulate both CD4+ and CD8+ T cells. The amount of interferon gamma releases from those cells are determined by ELISA method. In patients with recent exposure to tuberculosis, there is an increased amount of CD8+ expression in comparison to patients with past exposure to tuberculosis.ObjectivesTo investigate the additional impact of stimulating CD8+ lymphocytes with QFT-Plus test in order to detect latent tuberculosis in patients with inflammatory rheumatic diseases.MethodsHacettepe University Rheumatology Biologic Registry Database (HURBIO) database was used in this study. QFT-Plus test of patients with rheumatoid arthritis (RA) and spondyloarthritis (SPA) between January 2018 and March 2021 during work up before biologic/targeted therapy were analysed, retrospectively. Positivity of any of tubes has been reported as QFT (+). The impact of each tube on QFT positivity is analysed.Results1480 patients (946 (64%) SPA, 534 (36%) RA) were enrolled. 957 patients were women. The median age was 45 (min-max:18-82). Totally 12.2% of patients had been reported as QFT(+). In 6% of QFT (+) patients only TB2 tube is positive (Table 1).Table 1.The impact of each tube on QFT-Plus positivityQFT-Plus test (n=1480)Negative86.2%Indeterminate1.5%PositiveOnly TB1 tube positivity8% of positively reported patients12.2% of all patientsOnly TB2 tube positivity6% of positively reported patientsTB1 and TB2 positivity86% of positively reported patientsConclusionDisease inflammatory cascades along with ongoing usage of immunosuppressive agents could affect results of QFT-plus assay in rheumatic diseases. TB2 tubes stimulating CD8(+) T lymphocytes have additional impact in detecting latent TB infection in patients with RA and SpA.Disclosure of InterestsNone declared

BackgroundComorbidities are common in psoriatic disease, needed to be recognized and managed to effectively when treating psoriatic arthritis (PsA) patients. However, the data on the impact of particular comorbidities on the disease activity in patients requiring bDMARDs are very small.ObjectivesOur aim was to understand the relationship between the disease activity and comorbidities in PsA patients under bDMARDs.MethodsThe Hacettepe University biological database (HUR-BIO), was established in 2005 and data of 520 PsA patients included until 2021 were analyzed. In all included patients, the diagnosis of PsA was made by the rheumatologist. DAS-28 score (at the last visit) and all comorbidities were documented after bDMARD initiation. Multivariate analysis was performed to understand comorbidities that have impact on DAS-28 remission.ResultsThere were 469 patients with a known DAS-28 score median (IQR) 28 (61) months after bDMARD initiation. It was detected in 214/469 (45.6%) patients with a DAS-28 score below 2.6. Patients in remission of DAS-28 were younger, remission was less frequent in women, and comorbidities, mainly BMI, Diabetes Mellitus (DM) and hypertension, were also found less frequent (Table 1). In the multivariate analysis, no determining factor was found in male gender. On the other hand, in females, smoking, presence of comorbidity, Body mass index (BMI) at the start of bDMARDs, age at onset of bDMARDs, DM at the start of bDMARDs, HT at the start of bDMARDs, coronary artery disease, and cardiovascular risk factors were included in the analysis and revealed, bDMARD baseline BMI [OR 1.06 (95% CI 1.02-1.11), p= 0.004] and presence of bDMARD baseline DM [OR 3.08 (95% CI 1.14-8.30), p=0.026] had significant impact on DAS-28 remission.Table 1.Relationship between remission according to DAS-28 score and comorbiditiesParametersDAS-28 ≤ 2.6 (n=214)DAS-28 > 2.6 (n=255)pAge, mean (SD), years43.8 (11.7)47.5 (12.5)0.001Age at PsA diagnosis, mean (SD), years36.8 (11.5)41.6 (11.7)Gender, female, n(%)115 (53.7)211 (82.7)Comorbidity count1.54 (0.98)1.98 (1.31)Comorbidity (yes/no)67 (31.9)118 (47.6)0.001Comorbidity distribution0.001-No143 (68.1)130 (52.4)-1 Comorbidity38 (18.1)47 (19.0)-≥ 2 Comorbidity17 (8.1)36 (14.5)-≥ 3 Comorbidity12 (5.7)35 (14.1)Body Mass Index (BMI)28.1 (5.4)30.3 (5.9)BMI > 30, n(%)70 (32.9)123 (48.4)0.001Diabetes Mellitus, n(%)10 (4.7)35 (13.7)0.001Hypertension, n(%)29 (13.6)71 (27.8)Total cholesterol > 240, n(%)8 (10.5)22 (28.6)0.019Thyroid Disease20 (9,8)43 (17,3)0,02ConclusionPrevious data showed that obesity, hypertension and at least 1 point from charlson comorbidity index are poor prognositc factors for treatment outcomes (1). Our data showed that BMI and presence of DM were determined as factors affecting bDMARD treatment response in female PsA patients.References[1]Ballegaard C, et al. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford). 2021 Jul 1;60(7):3289-3300.Disclosure of InterestsNone declared