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Background Quality of life is commonly impaired in patients with chronic inflammatory diseases. The disease itself as well as the drugs used may be responsible for this impairment. Behcet9s syndrome (BS) is a multisystem vasculitis with a wide variety of manifestations including oral ulcers, genital ulcers, nodular lesions, papulopustular lesions, arthritis, uveitis, venous thrombosis, arterial aneurysms, neurologic and gastrointestinal involvement. Determining the factors affecting quality of life in BS patients, would help developing effective management strategies. Objectives We aimed to determine the factors that impair quality of life (QoL) in BS. Methods Short- Form 36 (SF-36) physical component score (PCS) and mental component score (MCS) and Behcet Disease Quality of Life (BDQoL) questionnaires were filled by consecutive BS patients attending our outpatient clinic. Socioeconomic factors, each type of organ involvement during the disease course, during the last 4 weeks, disabilities caused by each, treatment modalities and overall disease activity were tested with regression analysis as possible determinants of QoL. Results 453 patients (M/F: 240/213, mean age: 38.2±10.8) were included in our study. 223 patients had eye involvement, 94 patients had vascular involvement, 102 patients had joint involvement, 28 patients had neurologic involvement, 2 patients had gastrointestinal involvement and 127 patients had only mucocutaneous involvement without organ involvement. Determinants of BDQoL in the whole group were BSAS, household income, perceived sufficiency income, neurologic damage, mucocutaneous involvement (R2: 0.38, p Conclusions In addition to overall disease activity in women mucocutaneous and neurologic involvement and in men neurologic and vascular damage and joint attack seem to impair quality of life in BS. Determining the factors predicting the quality of life are important for developing management strategies and also may help determining the items that need to be addressed while developing outcome measures. Disclosure of Interest None declared

Background Patients9 perceptions about the side effects of drugs can have major impact on compliance to treatment. This becomes especially important with newer therapies. Objectives To evaluate the frequency of patient concerns about drug-related side effects among anti-TNF users and to delineate the factors predicting an increase in concerns aboutanti-TNF drugs. Methods Rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)patients who were using TNF-alpha antagonists and who attended our outpatient clinic for their routine visits were included. We questioned whether the subjects were satisfied with their drugs (rated from 0 to 3), concerned with the side effects at the beginning of treatment and at present (rated from 0 to 3), and if concerned, we asked them to specify the particular side effects that they had concerns on. In addition, disease activity in the preceding one week was assessed with “Rapid Assessment of Patient Index Data” (RAPID3). Perceptions and attitudes towards the drugs were assessed with “Beliefs about Medicines Questionnaire” (BMQ). Data regarding demographic features, disease duration, duration of drug therapy, and side effects that had been experienced during follow-up were collected from patient records.Having a score of ≥2 points in drug satisfaction or concern were tabulated as the presence of satisfaction or concern. Multivariate linear regression analysis was used to determine the factors associated with increased concerns about anti-TNF drugs. Results We surveyed 100 patients (75 with AS, 21 with RA, 4 with PsA) who were currently using anti-TNF drugs (56infliximab; 26etanercept; 13adalimumab; and 5 golimumab). Demographic and clinical features as well as the number of patients with at least 2 points of concern scores, RAPID3 and BMQ scores are given in the table. Ninety percent of patients reported that they were satisfied with their anti-TNF medication.The most commonly feared side effects were neoplasms (52%), tuberculosis (42%), and damage to liver and kidneys (32%). Univariate analysis revealed that having AS was associated with a lower rate of concerns (p=0.006, β=0.278, 95%CI=0.072-0.408) and having concerns at the beginning of anti-TNF treatment was associated with higher rate of concerns at the time of interview (p=0.001, β=0.335, 95%CI=0.124-0.490). The presence of concerns at the onset of treatment predicted higher concern scores at the time of interview in multiple regression (p=0.01, β=0.279, 95%CI=0.064-0.458). Conclusions Around one half of our patients reported that they were concerned about drug related adverse events at the initiation of anti-TNF drugs and this continued in one third after a mean duration of 44.19 months of treatment. The risk of cancer and tuberculosis were two major side effects that the patients were most concerned. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4131

Background The introduction of TNF inhibitors into clinical practice has revolutionalised the treatment of most inflammatory diseases. However, these drugs are associated with various and potentially serious side effects. Despite being rare, demyelinating neuroinflammatory disordes including multiple sclerosis, optic neuritis, transverse myelitis, polyradiculoneuropathy, and Guillain-Barre Syndrome (GBS) have been reported after using anti-TNF drugs, particularly with infliximab. Adalimumab is a newer fully humanised monoclonal anti-TNF antibody and to date, transverse myelitis during the course of adalimumab treatment has never been reported. Herein, we describe a patient who received adalimumab for management of his ankylosing spondylitis (AS) and developed synchronous transverse myelitis and GBS after therapy. Case Report A 69-year old male with a 30-year history of AS, was admitted to neurology clinic with lower extremity weakness. Physical examination revealed bilateral 5/5 and 0/5 motor strengths in upper and lower extremities, respectively. He did not have sphincteric or sensorial deficits, cerebellar symptoms, or aphasia. He had received adalimumab treatment for 8 months (40 mg subcutaneously every 2 weeks) which controlled his refractory AS symptoms, but the patient had stopped taking the drug 3 months before the onset of his symptoms. MRI showed increased signal intensity at distal spinal cord which supported the diagnosis of myelitis. After one week course of pulse steroids, the patient responded well and gained full strength. One month later, he presented again with bilateral lower extremity weakness and falls, and physical examination showed full strength in upper extremity and muscle strength was 2/5 on right and 0/5 on left lower extremity. He had hypotonia and hyporeflexia on the right and areflexia on the left lower extremity. Repeated MRI scan showed regressed spinal lesion, lumbar puncture revealed elevated protein levels (107 mg/dL) and EMG was compatible with GBS. The patient received intravenous immunoglobulin and showed gradual improvement in lower extremity muscle strength. Conclusion Central and peripheral progressive demyelinating neuroinflammatory lesions might occur during anti-TNF treatment, with the latter being more common than central nervous system involvement. There are a few reports indicating an association between adalimumab and GBS in patients with rheumatoid arthritis, but synchronous occurence of transverse myelitis and GBS is so unusual, and both diseases responded well to standard measures.

Background An increased frequency of depression has been reported in Behcet’s syndrome (BS) (1). While an increased suicidal ideation has been reported in other chronic rheumatologic conditions (2), this has been not studied in patients with BS. Objectives To evaluate the frequency of suicidal ideation among BS patients and to delineate the factors predicting an increase in suicidal ideation. Methods The frequency of suicidal ideation was evaluated with a standard questionnaire that was previously used (2), among BS patients with and without major organ involvement, ankylosing spondylitis (AS) patients who attended our outpatient clinic for their routine visits and a group of healthy controls. We questioned whether the subjects 1) thought that life was not worth living, 2) thought about ending their lives within the previous year, 3) ever planned to end their lives and if yes, whether they had planned to end their lives before the onset of their disease. In addition, Beck depression inventory (BDI) and Behcet’s disease quality of life (BDQoL) questionnaires were filled. Disease activity was assessed using the Behcet’s disease current activity form (BDCAF) for BS patients and BASDAI and BASFI for AS patients. Results We surveyed 240 BS patients who had only mucocutaneous symptoms, 63 BS patients with active major organ involvement (30 eye, 31 vascular, 7 neurologic involvement), 50 patients with AS, and 106 healthy controls (Table). Number of subjects who answered affirmatively to the second and third questions were significantly higher among BS patients with active major organ involvement compared to the other groups (p Conclusions The frequency of suicidal ideation is increased among BS patients who have major organ involvement. This increase in suicidal ideation is correlated with higher disease activity and increased depression scores. Longitudinal studies are required for determining whether the frequency of suicidal ideation decreases with treatment and improvement in disease activity. References Calikoglu E, et al. Dermatology.2001;203:238-40. Xie, et al. Rheumatol Int. 2012 Sep;32(9):2707-14 Disclosure of Interest None Declared

Background Behcet’s Syndrome (BS) follows an active course during the child-bearing years in both men and women. Whether fertility is decreased among the BS patients due to the condition itself or to the frequently used medications like cyclophosphamide (CYC), azathioprine or colchicine is not clear. Objectives To determine the infertility rate, and the effect of drugs and types of organ involvement on fertility in BS patients. Methods We included BS patients with and without major organ involvement, familial Mediterranean fever (FMF), ankylosing spondylitis (AS) patients and healthy controls recruited from hospital staff. In order to show a 20% increase in infertility in BS with 0.05 alpha and 80% power, we calculated that each group should contain at least 125 individuals. Among patients who visited the clinic for routine controls, individuals with an even waiting list number were selected. A structured interview was performed by two physicians and medical records were reviewed. Infertility was defined as the inability to conceive after one year of unprotected intercourse. We compared the differences in the proportion of individuals who had never conceived in their lifetime, who had a successful conception but became infertile after disease onset, and individuals who conceived late or with assisted reproductive technology (ART), between BS and control groups. Finally infertility was separately assessed in a group of 62 patients who had used CYC and was compared to that observed among patients with major organ involvement who were CYC naive. Multivariate logistic regression analysis was used to determine the association of infertility with involved organs and the drugs which were used. Results The numbers of subjects who were not able to ever conceive, who were not able to conceive only after disease onset, and who were able to conceive late or only with ART were not increased among patients with BS (Table). There were more FMF patients who conceived late or only with ART. Average number of children, miscarriages, terminations and ectopic pregnancies were not significantly different in patients with BS. The number of infants with reported congenital anomalies was not increased in BS patients and the most commonly reported anomalies were cardiovascular defects and cleft lip/palate. Univariate logistic regression showed an increased risk of infertility with CYC (OR 6.1, %95 CI 0.7-54.2), however this effect was not confirmed in multivariate analysis. This was attributed to a type II error caused by the low number of patients who had used CYC. Finally the infertility was higher among the separate group of 62 CYC users as compared to the patients with major organ disease who were CYC naive (7/20 vs 3/60 among those who atttempted to conceive, p=0.002) Conclusions Infertility rate is not appreciably increased among BS patients as compared to FMF patients, AS patients and healthy controls. Major organ involvement does not seem to affect this. CYC is the only drug which seems to decrease fertility in BS. Disclosure of Interest : None Declared