Search

Background:Beyond the joints, rheumatoid arthritis (RA) may affect lungs. Especially the involvement of the paranchyme, RA-associated interstitial lung disease (RA-ILD), is a major cause of mortality and morbidity. Tofacitinib, an oral JAK 1/3 inhibitor, has been used increasingly in the management of rheumatoid arthritis (RA) in recent years. Recently, a couple of animal and human studies reported promising results (1).Objectives:To assess the real-life efficacy and safety of tofacitinib in patients with RA-ILD in TReasure registry.Methods:This is a multicenter, observational study included RA patients with ILD diagnosis based on the HRCT images of the lungs, and were followed in 8 different centers participated in the TReasure database. Demographic data and patients’ characteristics regarding RA and RA-ILD at the visit in which tofacitinib was initiated and for the last follow-up visit under tofacitinib were recorded. Using the present study cohort, the RA patients with ILD receiving tofacitinib were compared with those without ILD receiving tofacitinib (controls) in terms of the general and disease-related characteristics and data of concomitant DMARD use. To evaluate retention rates of tofacitinib and reasons for discontinuation, data of the patients with RA-ILD in this study cohort were compared with the data of RA patients without ILD who were followed in Hacettepe University (major contributor of the TReasure registry). This research was funded by Pfizer.Results:A total of 47 RA patients with RA-ILD and a control group of 387 patients without ILD were included. The RA patients with ILD receiving tofacitinib were mostly male, older, and had higher baseline disease activity as compared with those without ILD (Table). The ILD pattern was known in 44 (93.6%) of 47 RA-ILD: 16 (36.3%) had UIP, 24 (54.5%) had NSIP, and 4 (9.1%) had airway disease. While 15 (31.9%) of the patients was asymptomatic, most common initial symptom was shortness of breath (in 14 (29.7%) patients). 18 patients had pre- and post-treatment FVC% and FEV1% values (with a median of 12 (9-19) months). Mean FEV1%; 82.1 vs. 82.8 (pre and post-treatment, respectively, p=0.079), mean FVC%; 79.8 vs. 82.8 (pre and post-treatment, respectively, p=0.014). To evaluate retention rates and reasons for discontinuation, 47 RA-ILD and 239 RA patients without ILD were analyzed. Retention rates were similar (p=0.21, log-rank) (Figure). Most common cause of tofacitinib discontinuation in RA-ILD group was infections (5 (25%) patients). Follow-up durations under tofacitinib were 15 (7-32) and 11 (4-24) months in ILD + and – groups, respectively. The rate of drug discontinuation due to infection in the RA patients with and without ILD was 6.3 per 100 patient-years and 2.4 per 100 patient-years, respectively.Table 1.Characteristics of the RA patients with and without ILD under tofacitinibVariablesRA-ILD(+) n=47RA-ILD(-) n=387pMale sex20 (42.6)69 (17.8)Age, years64 (57-69)56 (46-64)Disease duration for RA, months128 (78-212)110 (64-183)0.171Smoking statusNever smoker26 (55.3)211 (56.4)0.259 Current&Ex-smoker19 (44.7)163 (43.6)RF (+)36 (78.3)249 (68.8)0.187Anti-CCP (+)30 (65.2)196 (61.6)0.640RF positive or CCP (+)41 (87.2)242 (76.3)0.094Presence of comorbidity33 (70.2)203 (52.5)0.021DAS-28 before tofacitinib5.4 (4.6-6.22)4.36 (3.22-5.58)ESR before tofacitinib, mm/h38 (19-73)29 (17-45)0.029CRP before tofacitinib6.75 (1.63-24)9.95 (4.18-25.1)0.065Follow-up duration under tofacitinib15 (7-32)7 (3-12)Figure 1.Tofacitinib retention rates in the RA patients with and without ILDConclusion:In majority of patients, pulmonary functions remained stable during follow-up. Tofacitinib seems as a promising option for RA-ILD. High rate of discontinuation due infections was observed in RA-ILD patients under tofacitinib; however, it should be kept in mind that RA-ILD patients were older than RA patients without ILD.References:[1]Bejarano M, et al AB0418 ILD in Patients with RA Treated with tofacitinib. ARD;78:1672.Disclosure of Interests:Umut Kalyoncu Speakers bureau: Pfizer, Abbvie, UCB, Amgen, Emre Bilgin: None declared, Abdulsamet Erden: None declared, Hasan Satiş: None declared, abdurrahman tufan: None declared, Emre Tekgoz: None declared, Aşkin Ateş: None declared, Belkis Nihan Coşkun: None declared, Burcu Yağiz: None declared, Orhan Küçükşahin: None declared, Veli yazisiz: None declared, Gezmiş Kimyon: None declared, Cemal Bes: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease mainly affecting sacroiliac joints and spine. Peripheral arthritis, dactylitis and enthesitis may also occur. Extra musculoskeletal manifestations (EMMs; uveitis [AAU], inflammatory bowel disease [IBD] and psoriasis [Pso] are among the most common ones) are important features and might have an impact on the disease burden in patients with axSpA. The presence of EMM, in particular IBD and AAU could influence the choice of TNFi however little is known regarding the role of peripheral manifestations together with the EMM on the prescribing patterns in axSpA patients.Objectives:To examine the frequency of peripheral and EMMs in a real-world axSpA cohort and their effect on the choice of first advanced treatment.Methods:In total 1687 axSpA patients (58% male and the mean age (±SD) was 38.5 ± 10.9) who initiated his/her first biologic were included in the present analysis. The data for the current study was obtained from the TReasure web-based registry; in which RA and SpA patients treated with bDMARDs from different regions of Turkey. Baseline demographic, disease related characteristics, peripheral and EMMs were extracted. Characteristics of patients with and without peripheral/extra-musculoskelatal involvement were compared as well as factors/covariates associated with the choice of first TNFi and secukinumab was analysed.Results:Enthesis (28.2%) was found the most common peripheral manifestations and peripheral arthritis (26.4%) and hip arthritis (24.4%) followed it. Symptom duration to the first advanced treatment initiation was significantly shorter in axSpA patients with peripheral arthritis, enthesitis, dactylitis and psoriasis and longer in hip arthritis and AAU. HLA-B27 positivity was significantly lower in patients with arthritis, psoriasis and IBD and higher with hip arthritis and AAU. In multivariate analysis the presence of IBD is significantly associated with the preference of monoclonal TNFi (mab) over etanercept (ETA) (OR 5,770; 95%CI 1.788-18.616). However ETA was preferred in patients with hip arthritis (p=0.003), longer symptom duration (p=0.049), and using sulfasalazine (p=0.043). In comparison with mabs, secukinumab (SEC) prescription was found to be significantly associated with higher age (p=0.001), sulfasalazin (p=0.001) and methotrexate usage (p=0.053) among axSpA patients need their first advanced treatment.Conclusion:The results of the current study confirm the pathophsyologic associations of peripheral involvement and EMM in axSpA patients. Apart from hip arthritis the presence of IBD has an impact on the prescription of advanced treatment in real-life.Table 1.Clinical characteristics of patients in cohortAll patients(n=1678)Peripheral arthritis(n=445)Dactilitis(n=81)Enthesis(n=476)Uveitis(n=193)Psoriazis(n=152)IBD(n=78)Hip involvemet(n=412)Age, mean±SD38,5±10,938,3±11,637,4±11,137,9±10,741,3±11,439,9±11,341,6±12,239,2±11,2Male sex,n (%)974 (57,7)184 (41,3)34 (42)238 (50)96 (49,7)54 (35,5)43 (55,1)272 (66)Symptom duration, mean month±SD108,5±98,996,9±92,979,1±76,5100,4±92,7144,7±110,287,7±9494,5±98133,3±108,2HLA B27 positivity, n (%)621 (53,7)142 (46,3)27 (51,9)174 (49,4)104 (77)34 (36,2)16 (27,1)186 (59,8)Concomitant cDMARD usage (yes), n (%)420 (24,9)170 (38,2)39 (48,1)133 (27,9)53 (27,5)58 (38,2)24 (30,8)99 (24)BASDAİ,mean±SD5,1±2,55,1±35,3±3,15,3±2,94,7±2,55,6±2,44,8±2,35,3±2,1ASDAS-CRP, mean±SD3,1±1,52,6±1,92,5±1,82,8±1,72,9±1,73,4±1,33,1±1,53,7±1,4Disclosure of Interests:None declared

Background:Purpura are lesions that occur after bleeding on the skin, mucous or serosal surfaces. Purpura can be classified into 2 subgroups; which are linked to thrombocytopenia and non-trombocytopenic purpura. While thrombocytopenic purpura often occurs due to a hematological disease; in non-trombocytopenic purpura etiological causes are very variable, and systemic vasculitis has an important place among them.Objectives:The demographic features of the patients applying with purpura and the underlying causes and diseases were aimed to be revealed.Methods:44 consecutive patients (22 women, 22 men) who were admitted to the hospital in the last 6 months, due to purpura were evaluated. Average age of patients was 49.6 ± 19.6 years. Patients were questioned about a recent infection, drug use, concomitant or underlying diseases. The serological tests and other laboratory tests for etiology were performed and biopsy was taken from the skin lesions which are appropriate.Results:While 4 (9%) patients had widespread purpura on the trunk-upper-lower extremities, in 22 (50%) patients purpuric lesions were limited only to the lower limb. The period between the onset of the first symptom and the admission to the hospital was longer than 4 weeks in 35 (79.5%) patients, and shorter than 1 week in 9 (20.5%) patients. 24 (54%) patients had an anamnesis of infection 2-3 weeks before purpura, and 20 (45%) patients had an anamnesis of drug use. The most common accompanying symptom was abdominal pain and was present in 15 (34%) patients. Biopsy was performed from the skin lesion in 37 patients. Histopathological examination of all was compatible with leukocytoclastic vasculitis. In indirect immunofluorescence staining, 17 were found to be IgA positive. 2 (4.5%) patients were diagnosed PR3-ANCA positive granulomatosis with polyangiitis. 1 patient had Hepatitis B virus infection was detected in 1 patient (2.2%), HIV infection was detected in 1 patient (2.2%) and malignancy was detected in 1 patient (2.2%).Conclusion:In our study, the most common reason was found as IgA vasculitis in patients presenting with palpable purpura. Although vasculitic involvement was limited to the skin in most patients, organ-threatening systemic vasculitis was detected in a few patients. Patients applying with Purpura should be questioned for infection and drug use, should be examined for underlying diseases including systemic vasculitis, and closely monitored for organ involvement.Disclosure of Interests:None declared

Background:Biosimilar infliximab (bio-INF) was approved for all indications of the reference product in several countries. It has been marketed since 2014 in Turkey and used in the same indications with its bio-originator.Objectives:Herein, we aimed to analyse clinical features and the drug survival rates of spondyloarthritis patients who have recieved bio-INF.Methods:This multicenter, prospective observational cohort study used the TReasure database in which web-based registration of rheumatoid arthritis and SpA patients are being performed in 13 centers across different regions of Turkey. Age, gender, and acute phase responses (erythrocyte sedimentation rate and C-reactive protein), HAQ scores, VAS patient global, VAS fatigue, VAS pain, VAS physician global, BASDAI, BASFI, ASDAS ESH and ASDAS CRP values, clinical findings of SpA patients, number of patients who has received bio-INF as first line therapy or after switch, treatments which are used before bio-INF, the reasons for switching bio-INF to another biologic DMARD and drug survival rates were retrospectively evaluated.Results:A total number of 231 SpA (94 (40.7 %) female, 137 (59.3%) male, mean age 43±11 yrs) patients have received biosimilar infliximab in the database. Of the 231 patients 127 (55%) had received bio-INF as first line therapy, whereas 104 (46 (19.9%) 2ndchoice, 58 (25.1%) 3rdchoice) patients used switching after another biologic DMARD. Previously used biologic and synthetic DMARDs were adalimumab (28.6%), etanercept (22.5%), golimumab (9.1%), original infliximab (8.2%), secukinumab (13.4%), methotrexate (23.8%), leflunamid (10.4%), sulphasalazine (60.6%). The baseline and first visit (3. Months) diseases activity scores were shown in Table 1. Drug survival rates were 79.1 in 12. months, 65.5 in 24. months and 54.6 in 60. months. (Figure 1). The most common reasons for switching from biosimilar infliximab to another biologic DMARD is secondary (25(10.8%)), and primary ineffectiveness (22(9.5%)). Other reasons to discontinuation of treatment are psoriasis (5 (2.1%)), infusion reaction (3(1.2%)), allergic reaction (22(8.8 %)), chest pain (3(1.2%)), dyspnea (1 (0.4%)), vasculitis (1 (0.4%)) and patient or doctor wish (7 (3.4%)).Conclusion:The results of this real life data provides evidence that biosimilar infliximab is an effective and safe treatment option with long term use in SpA patients. Drug survival rates of bio-INF is similar to its bio-originator.Table 1.Disease activity scoresBaseline visit3.monthpmedian (Q1-Q3)median (Q1-Q3)HAQ score0,63 (0,4-1)0,25 (0-1)BASDAI6,2 (4,8-7)2,8 (1-5)BASFI5,05 (3,3-6)2,1 (0,45-4)VAS Patient Global70 (50-80)30 (10-50)VAS Doctor Global60 (40-70)30 (20-40)VAS Pain50 (3-80)30 (10-50)0,572VAS fatigue70 (50-80)40 (10-65)ESR24 (11-45)11 (6-23)CRP12,1 (4,4-30)3,91 (2,19-9)ASDAS ESR3,12 (2,51-4)2,05 (1,39-3)ASDAS CRP3,53 (2,86-4)2,21 (1,5-3)*Wilcoxon Signed Rank TestFigure 1.Drug survival ratesDisclosure of Interests:Nazife Sule Yasar Bilge: None declared, Timuçin Kaşifoğlu: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Ediz Dalkiliç: None declared, Cemal Bes: None declared, Hakan Emmungil: None declared, Belkis Nihan Seniz: None declared, Burcu Yağiz: None declared, Muhammet Çinar: None declared, Servet Akar: None declared, Önay Gerçik: None declared, Duygu Ersözlü: None declared, Gezmiş Kimyon: None declared, Ridvan Mercan: None declared, Omer Karadag: None declared, Yavuz Pehlivan: None declared, Levent Kiliç: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Background Gout is one of the most severe and frequent rheumatic diseases. Clinical manifestations of gout arise from uric acid crystal deposition in the musculoskeletal tissue. Many patients with gout have co-morbidities, including hypertension and chronic kidney disease (CKD). Objectives The goals when treating gout are no different in these patients, but the choice and dosage of drugs may need to be modified. In this study, we aimed to determine whether the chronic kidney disease affects or not the number of the gout attacks. Methods Consecutively 31 gout patients with CKD (group 1, n=31) and 46 gout patients without CKD (group 2, n=46) were enrolled in the study. The gout attack durations and the number of the gout attack in the last one year were compared among groups. Results The clinical, demographical and anthropometric variables were presented on table 1. There were no statistical differences in body mass index, use of diuretics and history of nephrolithiasis between two groups (p>0.05 for all). Compared to group 2, group 1 had statistically similar levels of the gout attack durations and the number of the gout attacks in the last one year (both p>0.05). In Bivariate Pearson correlation analysis; gout attack durations and the number of the gout attacks in the last one year were not correlated in any parameters in group 1 (p>0.05 for all). Conclusions The present study revealed that CKD does not affect the number of the attacks and the attack durations in gout patients. Future large scale multicenter randomized controlled studies are needed and warranted to clarify our results. Disclosure of Interest None declared

Background Familial Mediterranean fever (FMF) is the most frequent periodic febrile syndrome among the autoinflammatory disease, characterized by recurrent, self-limiting episodes of fever and serositis. FMF is a common disease in mediterranean countries although the diagnosis may be delayed due to especially patients-related reasons. Objectives In this study, we aimed to investigate the relationship between the diagnosis time and clinical features in patients with FMF. Methods Consecutively 44 patients diagnosed with FMF were recruited for this cohort study. The diagnosis time, clinical features, genetic mutations of MEFV genes and disease severity calculated with the Tel-Hashomer Severity Score were recorded retrospectively. The period from disease onset to diagnosis was named as undiagnosed time (UT). Correlation coefficients and significance were calculated by Pearson9s test to assess the differences between groups. For all the tests, a two-tailed p value of Results The mean age was 27.25±5.83 years, (59% female). The mean disease severity score was 6.25±2.06. Patient9s clinical features included fever (79.5%), peritonitis (95.4%), arthralgia and/or arthritis (36.6%), pleuritis (13.6%), and erysipelas-like erythema (13.6%). Genetic analysis of 44 patients revealed that M694V was the most frequent mutation (63.6%). The mean UT was found 12.72±7.08 years. Amyloidosis was diagnosed in 3 (6.8%) patients with UT of up to 27 years. There was a negative correlation between UT and disease severity (p Conclusions Our study, although a small patient group, suggested that the time from disease onset to diagnosis may still be longer in FMF. Disease severity is seen as an important factor for diagnosis time. Mild attacks or the lack of any symptom in the attack intervals may be reasons for late admission to physician. We have considered that emphasizing of patient education is substantial especially in countries which have high FMF prevalence. Disclosure of Interest None declared

Background There is not valid outcome measures for assessment Adult onset Still9s disease (AOSD) activity. The patients or physicians global view is relevant way to assess this kind of complex diseases. However, it is well known that there is discordance between patient and physician perspective for disease activity in different inflammatory diseases. Objectives Objective of this study was to evaluate agreement of patient and physician perspective in AOSD patients. Methods We conducted a cross-sectional, multicenter study for assessment of disease activity in AOSD patients. All AOSD patients were fulfilled Yamaguchi criteria. For every center, at least 20% of AOSD patients had to be an active state according to physician assessment. Age, sex, disease duration, current disease symptoms was recorded. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leucocyte, and ferritin level also recorded. Visual analog scale (VAS) (0–10 cm) used for physician and patient global assessment of disease activity. Disease activity status were also assessed by likert scale (as remission, low, moderate, severe, and more severe disease activity) for both patients and physician perspective. Patient global assessment VAS and physician global assessment were correlated by correlation coefficient (r). Agreement of disease activity level for patient and physician perspective were calculated with kappa. Kappa >0.6 was accepted as significant. Results One hundred thirty (83, 63.4% female) AOSD patients were enrolled. Mean age was 38 (14) years old and median disease duration was 3 years (0–29). Currently AOSD symptoms followed; fever 34 (26.2%), rash 28 (21.5%), arthritis 31 (23.8%), arthralgia 60 (46.2%), sore throat 28 (21.5), myalgia 42 (32.3), lympadenopathy 12 (9.2%), splenomegaly 17 (13.1%), hepatomegaly 7 (5.4%), pleuritic 3 (2.3%), hemophagocytic syndrome 2 (1.5%). ESR 47.7%, CRP 43.8%, ferritin 27.0%, and leucocyte 43.1% were higher than upper limit. Mean patient global assessment VAS was 3.53 (3.25), and mean physician global assessment VAS was 2.71 (2.95). Correlation coefficient (r) of patient and physican global VAS was 0.89. There was excellent agreement according to severe/more severe disease activity at patient and physician level (kappa 0.88 (CI 95% 0.79–0.98). There was also good to excellent agreement according to low disease activity/remission at patient and physician level (kappa 0.74 (CI 95% 0.62–0.86). Conclusions Although, features of AOSD seems more complex with constitutional symptoms, joint or reticuloendothelial system involvement, patients and physicians assess level of disease activity similarly. We thought, this results will be helpful for procedure of new composite index in AOSD. Disclosure of Interest None declared

Background Studies have shown moderate cognitive impairment in patients with Fibromyalgia syndrome (FMS). Mean platelet volume (MPV), a marker of platelet activation. Activated platelets may play role in neuroinflammation and cognitive dysfunction. In addition, recent clinical studies identified the relation between uric acid (UA) and cognitive impairment in neurological diseases. Objectives Our aim was to compare the serum UA and MPV levels between FMS patients and control subjects and to investigate the relationship between UA, MPV and cognitive impairment in patients with FMS. Methods A total of 54 premenopausal female patients with FMS diagnosed according to 1990, 2010 and 2013 ACR criteria referring to Physical Medicine and Rehabilitation outpatient clinic and 33 volunteer healthy control matched according to their ages and genders were enrolled. Visual Analog Scale (VAS), to assess pain and sleep quality, and Fibromyalgia Impact Questionnaire (FIQ), to evaluate the functional status, were used in both groups. We assessed the psychological status with Beck Depression Inventory (BDI) and the frequency of cognitive impairment was evaluated with Mini Mental State Examination (MMSE). Serum MPV, platelet and UA levels were measured. Results were evaluated considering the significance level p Results No statistically significant difference was observed demographic characteristics between FMS and control groups (p>0.05). Mean VAS pain and sleep quality of FMS group were determined significantly higher than control group (p 0.05). No significant correlation was determined between serum UA levels and VAS pain/sleep quality, FIQ, BDI and MMSE scores (p>0.05). Similarly, no significant correlation was found between serum MPV levels and VAS pain/sleep quality, FIQ, BDI and MMSE scores (p>0.05). Conclusions Our results suggest that there were no association between serum UA, MPV and cognitive impairment levels in FMS patients in comparison to control subjects. Many variables, such as age, pain, depression and poor functional status, likely contribute to the cognitive impairment in FMS. References Koc ER, Uzar E, Cirak Y, Parlak Demir Y, Ilhan A. The increase of mean platelet volume in patients with Alzheimer disease. Turk J Med Sci 2014;44(6):1060-6. Vannorsdall TD, Kueider AM, Carlson MC, Schretlen DJ. Higher baseline serum uric acid is associated with poorer cognition but not rates of cognitive decline in women.Exp Gerontol. 2014;60:136-9. Cicero AF, Desideri G, Grossi G, Urso R, Rosticci M, D9Addato S, Borghi C; The Brisighella Heart Study Group. Serum uric acid and impaired cognitive function in a cohort of healthy young elderly: data from the Brisighella Study. Intern Emerg Med 2014 Jul 2. Haliloglu S, Carlioglu A, Sahiner E, Karaaslan Y, Kosar A. Mean platelet volume in patients with fibromyalgia. Z Rheumatol 2014;73(8):742-5. Disclosure of Interest None declared

Background Adult onset Still disease (AOSD) is a rare disease. Its management is mostly based on expert opinion. Objectives To assess clinical features and management of AOSD in a large sample of patients. Methods Patients from 19 centers in Turkey participated this in retrospective study. All the patients fulfilled the Yamagushi criteria for AOSD. A case report form which included clinical data, laboratory features, disease patterns, and remission and relapse rates and treatment protocols was generated and sent to the participating centers. Responsible investigators of all centers searched their local database for AOSD. Disease patterns were assessed in patients with a follow-up longer than 12 months. Results A total of 356 patients, (210 female, 59%) with a mean (± SD) disease onset age of 31 ± 15 years and median follow-up duration of 22 (range: 0-180) months were enrolled. Of the 356 patients, remission rate after initial therapy could be assesed in 306 (85,9%) and data regarding the last visit were available in 254 patients (71.3%). Median lead time to diagnosis was 1 (range; 0-120) month. Main clinical features were as follows: fever (96%), arthralgia (95%), rash (67%), arthritis (65%), sore throat (64%), lymphadenopathy (28%), splenomegaly (25%). Abnormal laboratory findings were leucocytosis (85%), neutrophilia >80% (68%), anemia (65%), increased AST (49%), ALT (46%) and ferritin (96.7%). Disease pattern was assessed in 230 patients [chronic 19%, relapsing-remitting 32% and monocyclic 49%]. Patients with lead time to diagnosis longer than 3 months had more frequently chronic or relapsing pattern (21.8% vs 44.3% vs 51.1%, p Conclusions Monocyclic pattern was observed more frequently than reported in the literature. This may be due to the aggressive treatment protocols (steroid plus MTX and/or HCQ). Chronic/relapsing pattern seems to be associated with a longer delay in diagnosis. Early diagnosis and aggressive treatment are important for the management of AOSD. Disclosure of Interest None Declared