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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:Suboptimal control of RA may lead to severe and progressive articular damage, loss of function, and deterioration of the quality of life (QoL).Objectives:To assess treatment satisfaction, sociodemographic, clinical, health care resource utilization, and QoL characteristics of patients with sub-optimally controlled RA and treated with conventional synthetic and/or biologic DMARDs.Methods:This study was an international, multicenter, cross-sectional, non-interventional study. Adult RA patients with moderate to severe disease activity (DAS28>3.2) were enrolled. Patient satisfaction was evaluated with Treatment Satisfaction Questionnaire for Medication (TSQM, version 1.4) with a scale ranging from 0 (indicating poor satisfaction) to 100 (indicating perfect satisfaction). Patients were questioned regarding treatment adherence, patient preferences, and expectations. Workability was evaluated using Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis (WPAI-RA, version 2.0). Short Form 36 (V2) survey were performed to all patients.Results:One hundred sixty-four patients were included in the study and most (78.0%) were female. The median age was 57.0 years, ranging between 22.0 and 84.0 years. Half of the patients (50.6%) were primary school graduates and 6.1% were unemployed due to RA and seeking work. Median time since RA diagnosis was 8.0 years and mean (±SD) DAS28-CRP score was 4.8 (±1.0). Mean total activity impairment was 54.9% (±27.4). In the past 3 months from enrollment, the mean number of healthcare professional and emergency room visits were 1.8 (±1.1) and 1.8 (±1.3), respectively. Mean number and length of hospitalizations in the previous 3 months were 1.1 (±0.3) times and 8.3 (±7.2) days, respectively. Mean TSQM scores were 53.5 (±21.4) for effectiveness, 86.0 (±26.7) for side effects, 67.8 (±16.5) for convenience, and 57.7 (±22.0) for global satisfaction. The leading expectation was ‘lasting relief of RA symptoms’ (mean score: 5.8). Preferred time until the effect of onset was ‘up to 1 week’ for 76.2% of the patients. Most of the patients (57.9%) preferred oral administrations and the most preferred frequency of administration was ‘once per day’ (46.3%). Mean physical and mental component summary scores for Short Form 36 (V2) survey were 37.9 (±8.3) and 40.1 (±10.7).Conclusion:Two-thirds of the patients with RA who have suboptimal responses are not satisfied with their treatments. Moreover, oral and once-daily treatment approaches stand out in patient preferences. Finally, suboptimal control leads to deterioration in clinical characteristics, workability, and QoL of patients with RA.Acknowledgements:The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication. All authors have received research funding for this study. The authors wish to thank B. Murat Ozdemir of Monitor CRO for medical editing and reviewing services of this manuscript. AbbVie provided funding to Monitor CRO for this work.Disclosure of Interests:Umut Kalyoncu Speakers bureau: AbbVie, Pfizer, UCB, Novartis, and Janssen, Consultant of: AbbVie, Pfizer, UCB, Novartis, and Lilly, Grant/research support from: AbbVie, Pfizer, and Janssen, Adem Kucuk Speakers bureau: AbbVie, Gokhan Sargin: None declared, Fatih Ozdener Speakers bureau: UCB, Nutricia Advanced Medical Nutrition, Grant/research support from: Nutricia Advanced Medical Nutrition, Servet Yolbaş Speakers bureau: AbbVie, UCB, Pfizer, and MSD, Berna Yurttas: None declared, Sezin Turan: None declared, Gezmiş Kimyon Speakers bureau: AbbVie, Amgen, Pfizer, Novartis, UCB, MSD, Johnson and Johnson, and Celltrion, Consultant of: Amgen, and Pfizer, ALI SAHIN Speakers bureau: Roche, Pfizer, and AbbVie, Consultant of: Roche and Pfizer, Sedat Yilmaz Speakers bureau: UCB, Pfizer, AbbVie, MSD, Novartis, and Celltrion, Consultant of: Pfizer and Novartis, Ridvan Mercan Speakers bureau: AbbVie, Novartis, MSD, Pfizer, UCB, Roche, Amgen, and Celltrion, Consultant of: Novartis, MSD, Pfizer, and Celltrion, Hakan Emmungil Speakers bureau: AbbVie, Pfizer, Novartis, and MSD, Muhammet Çinar Speakers bureau: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, Grant/research support from: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, İlhan Sezer Speakers bureau: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Consultant of: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Timuçin Kaşifoğlu Speakers bureau: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Fulya Cosan Speakers bureau: AbbVie, Pfizer, Novartis, UCB, and MSD, Taskin Senturk: None declared, Nevsun Inanc Speakers bureau: AbbVie, UCB, Novartis, Pfizer, Roche, Lilly and MSD, Consultant of: Roche and Pfizer, Grant/research support from: Roche and Pfizer

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:Although psoriatic arthritis (PsA) may be seen at any decades, juvenil onset PsA is relatively rare. Moreover, there were no more data about clinical features, treatments, and course in juvenile PsA when they reached to adult age.Objectives:The objective of this study was to assess and compare demographic and clinical features for juvenile onset PsA and adult onset PsA.Methods:PsART-ID is a multicenter, international database, investigating the disease characteristic in real life (1). Briefly, demographic data, PsA subtypes, uveitis, enthesitis, dactylitis, Co-morbidities, disease activity scores (TJC, SJC, VAS-pain, VAS patients and physician global assessments, VAS-fatigue, BASDAI), and functional status (HAQ-DI, BASFI) were recorded. Psoriasis and PsA starting age were noted, as well. Patients were classified as juvenile PsA or juvenile PsO (under 18 years old). Results were compared regarding to juvenile versus adult onset age.Results:Overall, 1644 PsA patients were included to study, 301/1644 (18.3%) patients had juvenile onset psoriasis. Of 39/1644 (2.4%) patients had juvenile onset PsA, as well. As expected, juvenile onset PsA patients were younger, however PsA disease duration were longer than adult onset PsA patients. There were no any difference between demographic and clinical data, except BMI and enthesitis were less frequently at the juvenile onset PsA groups. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used more frequently bDMARDs.Table.Comparison of demographic and clinical characteristics of juvenile and adult-onset psoriatic arthritisJuvenile onsetAdult onsetpN (%)39 (2.4)1605 (97.6)Female Sex n (%)24 (61.5)1006 (62.7)0.884PsA beginning age mean (SD)13.3 ± 3.8542.3 ± 12.9Current age mean (SD)26.6 ±10.747.3 ±13.07Duration of psoriasis (years)17.10 ± 11.2614.75 ± 11.780.124Duration of psoriatic arthritis (years)13.5 ±115.06 ± 6.7Cigarette smoking (ever) n (%)15/38641/14940.72Education duration/year (mean,SD)10.09 ± 3.679.52 ± 4.810.464BMI (kg/m2) (mean, SD)24.5 ±5.128.3 ± 5.21Family history of PsO/PsA n (%)15 (38.5)559 (34.9)0.642Nail involvement n (%)18 (46.2)762 (47.5)0.864Dactilitis n (%)9 (23.7)367 (24)0.958Entesitis n (%)3 (7.9)384 (25.7)0.013Uveitis n (%)-13 (4.3)0.713Axial involvement (%)15 (38.5)464 (29)0.199Methotrexate36 (92.3)1348 (84)0.162Sulfasalazine17 (43.6)612 (38.1)0.488Leflunomide14 (35.9)379 (23.6)0.076Biologic DMARDs102 (33.9)358 (26.8)0.013Conclusion:Although psoriasis may be seen frequently in the juvenile age, juvenile onset PsA was not so frequent in our PsA cohort. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used bDMARDs more frequently.References:[1]Kalyoncu U et al. The Psoriatic Arthritis Registry of Turkey: results of a multicenter registry on 1081 patients. Rheumatology. 2017;56:279-286.Disclosure of Interests:Serpil ERGULU EŞMEN: None declared, Ozun Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Sule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Mehmet Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

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:Methotrexate (MTX) is the most common first-line disease-modified anti-rheumatic drugs in psoriatic arthritis (PsA), despite the controversies.Objectives:In this study, we aimed to determine the rate of withdrawal rate of MTX in PsA and reasons for discontinuing.Objectives:In this study, we aimed to determine the rate of withdrawal rate of MTX in PsA and reasons for discontinuing.Methods:A large prospective international multicenter PsA registry was used for this study. Data were collected either at enrolment, based on history, or prospectively if there was a follow up. We analyzed the frequency of MTX usage, discontinuation and the reason for discontinuation. The time on MTX was compared according to the reason of discontinuation (inefficacy vs side effects) using Kaplan-Meier and Cox regression analyses to identify risk factors for discontinuation.Results:At the time of analyses, 1670 patients had been recruited to the registry and 1359 PsA patients had used MTX during the course of the disease (81.3%). Within these, 942 (69.3%) were still on MTX at the time of analysis, and 417 (30.7%) patients have discontinued (Table). The most common reasons for withdrawal were side effects (219/417, 52.5%) and ineffectiveness (88/417, 21.1%). Other reasons included pregnancy, remission, self-decision (11.9% for all). For 60 patients (14.3%), the reason could not be identified. In patients who were still on MTX, the median duration of MTX therapy was 31 months (IQR=59) compared to 17 months (IQR=43) in the withdrawal group. The most common side effects were gastrointestinal symptoms (47%) and abnormal liver function tests (25%). There was a significant difference in survival plots (Log-rank p=0.026) with discontinuing due to side effects occurring earlier than inefficacy (Figure 1). In cox regression model, longer disease duration was found as an independent predictor of MTX discontinuation due to all reasons [Hazard Ratio (HR)=1.01, 95% Confidence interval (CI)=1.0-1.02; p=0.003].Conclusion:MTX is frequently used on PsA treatment, despite the controversies in the literature. One third of patients with PsA discontinue MTX, most commonly due to side effects or inefficacy. Patients discontinue MTX earlier in case of having side effects. Longer disease duration is linked to MTX discontinuation.Table.Demographics and disease characteristics of study groupsAll patientsn=1359Still on MTXn=942Withdrawal MTX any reasonn=417pAge, mean (SD)46.4 (13.4)46.1 (13.4)47.7 (14.0)0.038Male gender, n (%)523 (38.5)360 (38.2)163 (39.1)0.761Ever smoking, n (%)569/1258 (46.2)390/861 (45.3)179/397 (45.1)0.966Psoriasis duration (years), mean (SD)14.2 (11.7)14.0 (11.2)16.4 (12.7)0.003Polyarthritis, n (%)657/1343 (48.9)471/931 (50.6)186/412 (45.1)0.066Axial disease, n (%)388/1343 (28.9)267/931 (28.7)121/412 (29.4)0.797Nail involvement (ever), n (%)644 (47.8)435 (46.6)209 (50.5)0.191Swollen Joint Count, mean (SD)1.5 (2.6)1.4 (2.6)2.0 (3.2)Tender Joint Count, mean (SD)3.0 (4.4)3.5 (5.0)4.2 (5.4)HAQ, mean (SD)0.6 (0.6)0.7 (0.7)0.8 (0.7)0.035BASDAI,mean (SD)37 (22)39 (23)46 (25)0.001Disclosure of Interests:Dilek Solmaz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Ilaria Tinazzi: None declared, Ozun Bayindir: None declared, Ediz Dalkiliç: None declared, Atalay Dogru: None declared, Cem Özişler: None declared, Gezmiş Kimyon: None declared, Gozde Yildirim Cetin Speakers bureau: AbbVie, Novartis, Pfizer, Roche, UCB, MSD, Ahmet Omma: None declared, Emine Figen Tarhan: None declared, Levent Kiliç: None declared, Servet Akar: None declared, Sema Yilmaz: None declared, Meryem Can: None declared, Sule Yavuz: None declared, Orhan Küçükşahin: None declared, Sibel Bakirci: None declared, Sibel Aydin: None declared

Background:Serum autoantibodies closely reflect patterns of organ involvement and disease progression in systemic sclerosis (SSc). The entire autoantibody profile is less well defined in many cohorts and the data regarding their clinical associations and frequencies is limited.Objectives:To determine the autoantibody profile of patients with SSc, as well as their clinical associations, in well-characterized inception- cohort with disease duration less than 3 years.Methods:Serum samples of 100 patients out of 105 enrolled in the study were analyzed for ANA patterns with indirect immunofluorescence (IIF) assay using HEp-20-10/primate liver mosaic IIFT kit. Sera of 96 patients were subjected to commercial line immunoassay to quantify autoantibodies against 13 different autoantigens.Results:92 (92%) out of 100 patients were positive for ANA by IIF (Table 1). The speckled staining was the most pattern followed by nucleolar in 10 patients, centromere in 4, reticular in 1, nuclear in 2 and homogenous in 1. All patients (n= 96) patients were positive for at least 1 autoantibody by immunoblotting (Table 2). Twenty-two (49%) of patients with antiTopo I, 12 (44%) of the patients with antiCENP and 4 (22%) of the patients with antiRNAPIII were single positive. There was no difference in terms of the clinical findings when the patients with single and coexpression of these antibodies were compared. The distributions of the most frequent autoantibodies are shown in Figure 1. Interstitial lung disease was more frequent in the patients positive for anti-Topo I (78.8%) and anti-RNAPIII (27.3%). One of the two patients with breast cancer was anti-RNAPIII positive and none of the patients have diagnosed scleroderma renal crisis. Anti-Topo I was more common in patients with dcSSc (75%) and anti-CENP in lcSSc (46.4%).Table 1.Demographic, clinical and laboratory characteristics of the SSc patients.Sex Female N, %91 (86.7%) Male N, %14 (13.3) Female-to-male ratioAge, mean±SD years48.6±12.7Disease duration, mean±SD years2±1.4Disease classification N, % Diffuse39 (36.5%) Limited65 (62.5%) Sine scleroderma1 (1%)Interstitial lung disease37 (34.3%)Pulmonary arterial hypertension3 (2.8%)Scleroderma renal crisis0Digital ulcer14 (13.3%)Raynaud phenomenon105(100%)Telengiectasia31 (28.8%)Calcinosis1 (1%)Malignancy3 (2.9%)Antinuclear antibody profile N*, % Positive92 (92%)Staining pattern Speckled65 (65%) Nucleolar13 (13%) Centromere29 (29%) Homogeneous3 (3%) Reticular3 (3%)Table 2.Numbers and combinations of autoantibodies identified in the 96 SSc patients.Topo-ICENPRNAP IIIFibrillarinNOR90Th/ToPm/SclKuPDGFRRo52Topo-I22170159507CENP12202222011RNAPIII40121307Fibrillarin0000000NOR90011002Th/To04202Pm/Scl4306Ku102PDGFR00Ro522Single positive221240004102Total452718058179024Figure 1.Diagram of disease-related antibodies against the four main autoantibodies [anti-centromere (antiCENP) anti-Topoisomerase I (antiTopo I), anti-RNA polymerase III (antiRNAP III) and anti-Ro52).Conclusion:We presented the clinical and serologic features of the Turkish SSc patients from a new inception cohort. Clinical features of the SSc patients with single or multiple antibody positivity were not different.References:NoneDisclosure of Interests:None declared

Background Comorbidities are frequent in Psoriatic arthritis (PsA) and can have an impact on morbidity and mortality. Objectives We aimed to investigate the frequency of different comorbidities in PsA, how comorbidities have an impact on PsA features and which factors were associated with the occurrence of comorbidities in a large number of patients, using PsART (Psoriatic Arthritis Registry of Turkey)registry. Methods PsART is a national, web-based registry where consecutive patients with PsA are recruited and demographic, clinical and therapeutic information are collected as well as comorbidities. The following comorbidities are questioned: Hypertension (HT), hyperlipidemia, depression, diabetes mellitus (DM), hyperuricemia, coronary arterial disease, liver disease, cerebrovascular accident, cancer, and depression. BMI more than 30 is recorded as obesity. Patients with or without comorbidities were compared for their demographic features and outcome tools. Results One thousand and sixty-nine patients whom comorbidity data were available were analyzed. Within these 693 (64.8%) were women. Mean (SD) age was 46.9 (12.8), with a median (range) PsA duration 45 (0–545) months. The number of patients with 1, 2 and 3 comorbidities were 642 (60.1%), 345 (32.3%), and was 191 (17.9%), respectively. Frequency of comorbidities was obesity in 327 (30.6%), HT in 256 (23.9%), hyperlipidemia in 199 (18.6%), depression in 188 (17.6%), DM in 161 (15.1%), hyperuricemia in 74 (6.9%), coronary artery disease in 39 (3.6%), liver disease 38 (3.6%), cerebrovascular event in 19 (1.8%), and cancer history 16 (1.5%). Patients with at least one comorbidity were older (51.1 (11.8) vs 40.9 (11.7), p Conclusions Our registry supported that comorbidities are frequent in PsA increasing the complexity of the disease and have an impact on the disease severity. Patients with comorbidities are less educated showing that education and awareness are important to improve patient outcomes in PsA in long term. Disclosure of Interest None declared

Background PsART (PsA registry of Turkey) is a multicenter web-based registry. Objectives The objective of this registry is to assess characteristics of PsA and compare the differences among genders in our population. Methods PsART was established in 2014 including 32 rheumatology centers. Detailed data regarding demographics for the skin and joint disease, disease activity assessments and treatment choices were collected. Results One thousand and eighty-one patients (64.7% women) with a median (range) PsA duration for 3.7 (0–45) years were enrolled. Median psoriasis duration was 13 (0–59) years. The most frequent type of PsA was polyarticular 437 (40.5%) followed by oligoarticular 407 (37.7%) and axial disease 372 (34.4%). Patients with a combination of axial and peripheral disease had a longer disease duration than patients with one type of joint disease (52 (0–545) vs 42 (0–486) months, p=0.008). Mean (SD) swollen and tender joint counts were 1.7 (3) and 3.6 (4.8). 38.6% of patients were on csDMARD monotherapy, 7.1% were anti-TNF monotherapy and 22.5% were using anti-TNF plus csDMARD combinations. Within items included in the minimal disease activity, only 17.6%>67% of patients had inactive disease state. The major differences among genders were women being older (48.3 (12.8) VS 44.4 (12.5), P Conclusions PsART had similarities with the previously published registries, supporting its external validity. Women having more fatigue and worse functioning and as well as the high percentage of active disease state point out to the unmet need in treatment of PsA. Disclosure of Interest None declared

Background Skin involvement in psoriatic arthritis (PsA) has significant impacts on health-related quality of lives in addition to the joint involvement. Due to this impact, it9s important to assess the severity of psoriasis to fully capture disease activity in PsA. In this study we aimed to test the validity of “Psoriasis symptom inventory” (PSI) in a cohort of patients with PsA. Methods PsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre, nationwide study in Turkey on patients with PsA. Patients are consecutively recruited to this registry, if they are diagnosed as PsA, regardless of any other disease characteristics. In this registry, PSI data was available in 237 patients. For the PSI the following items were scored on a scale between 0-4, by the patient: itching, redness, scaling, burning, stinging, cracking,flaking and pain. The PSI score was calculated as a sum of these items and ranged between 0-32. The correlations between PSI and other outcome measures were investigated. Results The mean (SD) age and BMI were 44.7 (12.3) and 28.7 (5.6), respectively. Sixty-six percent of the patients were female. The duration of psoriasis in this group was 167.3 (124.2) months. Mean (SD) PSI scores were 6.7 (6.7) with a range of 0-32. PSI scores were found to be significantly correlated to patient (R=0.338) and physician global assessments (R:0.342), fatique (R=0.226), pain (R=0.334) (p Conclusions PSI has a good construct validity in comparison to other clinical assessment tools. Due to its high feasibility, PSI can be a useful tool to investigate and record the severity of psoriasis in PsA in clinical practice. Disclosure of Interest None declared

Background Antimalarials have been reported to worsen preexisting psoriasis, therefore is commonly avoided by the clinicians in the treatment of psoriatic arthritis (PsA). With the lack of any solid evidence, this precludes the potential use of hydroxychloroquine (HQ) as a part of the treatment. Objectives We aimed to analyze PsA patients who are treated with HQ, identify the time on drug and reasons of discontinuation of HQ. Methods PsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre, nationwide study in Turkey on patients with PsA. Patients are consecutively recruited to this registry, if they are diagnosed as PsA, regardless of any disease characteristics. From the registry, patients who have ever used HQ were identified including the time on HQ, whether they still continue to treatment, and the reasons of discontinuation in case of a withdrawal. Results Until December 2014, 746 patients were recruited. 114 patients (15.3%) were either currently using or have been used HQ previously. 51.8% of these patients were currently using HQ (fig 1). The distribution of joint patterns were 50.9% polyarthritis, 30.7% oligoarthritis, 2.6% monoarthritis, 13.2% distal interphalangeal joint involvement, 26.3% axial disease, including patients who had combinations of different patterns. Joint patterns were not different among patients who had ever used HQ or not. The duration of HQ treatment was 41.4 (SD:38.4) months among current users vs 45.6 (SD:51.2) months in withdrawers. The reason of discontinuity could be identified in 44/55 among non-users. Within these 44 patients the most frequent reason was inefficacy (n=25) and incompliance of the patient (n=7). Retinopathy was observed in 5 patients. Liver function test abnormalities, pregnancy, hyperpigmentation of the skin, step down for being in remission and nausea were observed in 1 case each and were reported to be the reason of stopping the treatment. There were only 2 cases who had to discontinue treatment because of an increase in psoriatic lesions. One of these patients used HQ for one month and the other patient for 21 months. Conclusions These data show that only 2/114 patients had an increase in psoriatic lesions in PsA in a mean duration of 3.5 years due to the HQ treatment suggesting that HQ is a safe treatment choice in PsA. The efficacy and added benefits of HQ in terms of reducing cardiovascular risk factors cannot be enclosed with this registry. Disclosure of Interest None declared

Background Rheumatic diseases are prevalent especially in the fertile ages for women. Biologic DMARDs (disease modifying anti-rheumatic drugs) are commonly used in the treatment of these patients and there is a growing concern while safety data in pregnancy is insufficient. Objectives We herein documented our anti-TNF (tumor necrosis factor) drugs data whom using/used biologic drugs; adalimumab (ADA), infliximab (INF), etanercept (ETA), golimumab (GOL) and others in their pregnancy. Methods 653 women with a history of biologic DMARD exposure were included (until December 2014) and 47 conception were documented form the medical files. 4 of patients whom couldn9t be reached due to loss of follow up were excluded. Abortion was classified depending to patient9s statements and medical reports. Age, pregnancy age, abortion with and before biologics, complications, disease activity, smoking, HAQ score, drug exposure were analyzed. Patients with secondary causes for miscarriage were also excluded. Results Mean (33.3±10.3) and pregnancy age (31.9±9.9), disease distribution (22 AS, 14 RA, 5 PsA, 1 Behcet9s disease, 1 Takayasu), drug exposure (20 ADA, 13 INF, 7 ETA, 3 GOL) was found and 7 miscarriages in 7 of the patients (5 AS, 2 RA) and 1 premature birth were detected. Mean abortion time was 7.2±3.2 weeks. 3 patients ADA, 2 patients INF, 1 patient ETA and 1 patient GOL usage was defined. Mean abortion age was 35.3±7.7 and that was higher than the other patients but there was not statistical significance. Disease activity, HAQ scores, smoking was not different between two groups. Conclusions Anti-TNF drugs are well tolerated during pregnancy. However the wonder for the safety still exists. Elevated abortion rate in the late pregnancy with these drugs are remarkable. The discrepancy for each drug and its9 own risk could not be demonstrated due to a need with higher patient numbers. References Ostensen M, Forger F. How safe are anti-rheumatic drugs during pregnancy?. Curr Opin Pharmacol. 2013 Jun;13(3):470-5. Chambers CD, Johnson DL. Emerging data on the use of anti-tumor necrosis factor-alpha medications in pregnancy. Birth Defects Res A Clin Mol Teratol. 2012 Aug;94(8):607-11. Disclosure of Interest None declared

Objectives To evaluate the diagnostic and discriminative ability of the new 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) classification criteria compared to previous five diagnostic/classification criteria for PMR in a multi-centre prospective study. Methods Patients older than 50 years of age (n=163), presenting with new onset (symptom duration ≤24 weeks) bilateral shoulder pain with elevated acute phase reactants were enrolled from 15 rheumatology clinics in Turkey. Patients were prospectively followed and the diagnosis of PMR was established when the diagnosis was maintained without an alternative diagnosis at 6 months of follow-up. Those who were diagnosed as other than PMR at the 6th month were designated as control group. All patients were classified by each of the six different criteria for PMR and 2010 ACR/EULAR Rheumatoid arthritis (RA) classification criteria. Results Of the 163 patients with new-onset (mean symptom duration 10.9±7.5 weeks) bilateral shoulder pain 92 (56.4%) patients were diagnosed as PMR and 71 (43.6%) were diagnosed as nonPMR (RA: n=26). The discriminative ability as estimated by the area under the receiver operating characteristic (ROC) curve, was better for the Chuang criteria (0.83) than 2012 EULAR/ACR clinical criteria for PMR (0.69), Jones (0.68), Bird (0.68) and Nobunaga (0.77) criteria (Table 1). The 2012 EULAR/ACR clinical criteria for PMR had a sensitivity of 90.2% and a specificity of 49.3%. Jones and Chuang criteria had the highest specificity (91.5 and 87.3%, respectively). The specificity of the new 2012 EULAR/ACR clinical criteria for PMR slightly increased to 53.8% in RA patients. Although the new 2010 ACR/EULAR RA classification criteria classified only 9 out of 92 PMR patients as RA, the new 2012 EULAR/ACR clinical criteria for PMR classified 12 out of 26 RA patients as PMR. Conclusions The new 2012 EULAR/ACR clinical classification criteria for PMR can classify PMR patients with high sensitivity, however, its ability to discriminate PMR from other inflammatory conditions with shoulder pain, especially RA is poor. Other criteria sets, Jones or Nabunaga criteria, despite involvement of similar clinical parameters, perform better in discriminating PMR from RA and other inflammatory/noninflammatory articular diseases. Our results, therefore, suggest that in seronegative patients with bilateral shoulder pain and acute-phase response, differential diagnosis of PMR and RA may require imaging (as proposed also in the other version of the new criteria) or biomarker studies. Disclosure of Interest None declared

Background Anti-tumor necrosis factor (anti-TNF) drugs are frequently preferred in the treatment of rheumatologic diseases and other inflammatory diseases (1). The development of myositis after using anti-TNF is a rare clinical condition. Objectives To report cases followed up who developed myositis after using anti-TNF. To review the current literature Anti-TNF Induced Myositis. Methods Case 1: A 30-year-old male patient had been followed-up with the diagnosis of AS for ten years. The patient had taken a total of 20 (2.5 months) doses of etanercept treatment and the patient had complaints of weakness, fatigue, difficulty in climbing the stairs and sitting within the last three weeks. Creatinine kinase (CK) was 6035 U/L. The deltoid muscle biopsy was consistent with polymyositis. Case 2: A 20-year-old female patient had been followed-up with the diagnosis of RA for two years. Following adalimumab treatment, the complaints related to joints completely had regressed and in the sixth month of treatment, the patient had the complaints of weakness, fatigue, which had gradually increased within the last two weeks. CK was 4772 U/L. The deltoid muscle biopsy was consistent with myositis. Case 3: A 44-year-old female had been followed-up with the diagnosis of RA for approximately seven years. Following adalimumab treatment, all complaints related to the joints had decreased. However, the patient had had the complaints of eruption in the arms, forehead, and around the nose, on the metacarpopharyngeal joints of hand, fatigue, difficulty in climbing the stairs, sitting, and dyspnea, which increased with effort within last four weeks. CK was 1563 U/L. Muscle biopsy were consistent with dermatomyositis. Results In the literature, six cases of inflammatory myositis related to anti-TNF treatment have been reported (2-7). PM (polymyositis, 6) developed in the majority of the patients and DM (dermatomyositis, 3) developed in the minority. The cases in the literature in which myositis developed following anti-TNF use were summarized in Table 1. Conclusions In conclusion, myositis could develop during anti-TNF therapy. Especially in patients diagnosed with RA and who are anti jo-1 positive, more care should be taken in this aspect. In these cases anti-TNF therapy could be the triggering factors for myositis and interstitial fibrosis. References Reimold AM. New indications for treatment of chronic inflammation by TNF-alpha blockade. Am J Med Sci 2003;325:75-92. Ishikawa Y, Yukawa N, Ohmura K, Hosono Y, Imura Y, Kawabata D, Nojima T, Fujii T, Usui T, Mimori T. Etanercept-induced anti-Jo-1-antibody-positive polymyositis in a patient with rheumatoid arthritis: a case report and review of the literature. Clin Rheumatol. 2010 May;29(5):563-6. doi: 10.1007/s10067-009-1370-1. Epub 2010 Feb 9. Disclosure of Interest None declared

Background Currently 3 sets of criteria are available for inflammatory back pain (IBP) in spondyloarthritis: Calin, Berlin and the ASAS criteria. The performances of these criterias in differentiating IBP in psoriatic arthritis (PsA) with chronic low back pain (CLBP) is currently not known. Objectives The objective of this study was to assess performance of those 3 different criteria in a large multicentre PsA cohort. Methods PsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre, nationwide study in Turkey on patients with PsA. Patients are consecutively recruited to this registry, if they are diagnosed as PsA, regardless of any other disease characteristics. In this registry, CLBP was defined as back pain lasting for more than 3 months. All relevant data for IBP according to Calin, Berlin and ASAS criteria for IBP were collected. Results PsARTcohort included 746 PsA (35.3% male) patients. Overall, 170 of 746 (22.9%) of patients had CLBP. Median PsA duration was 47 (0-538) months. Patients with CLBP were more frequently males (44.4% vs 32.5%, p=0.004), more frequently had pitting (54.5% vs 41.3%, p=0.014) and less frequently had polyarthritis (26.3% vs 51.3%, p Conclusions Both Calin and Berlin criteria seem to be effective questionaires for evaluating IBP in PsA patients with CLBP. However, ASAS criteria did not perform well particularly in female patients. For this reason, the gender distribution may be an important aspect to consider when recruting patients in clinical trials as well as guiding physicians in clinical practice. Disclosure of Interest None declared

Background In contrast to many European countries, patients can easily admit to secondary and tertiary centers without referral by the primary care in Turkey. Therefore we also compared the management options for gout preferred in different clinical specialties. Objectives In this study we investigated how gout is treated in Turkey. Methods 319 consecutive patients were included in this multicenter study (mean age 58.60±12.8 years, 44 females, 272 males). All patients filled a standard questionnaire. Results 53 patients were first admitted to primary care (16.6%), 101 patients to orthopedics (31.7%), 29 patients to physical therapy and rehabilitation (9.1%), 70 patients to internal medicine (21.9%), 49 patients to rheumatology departments (15.4%), and 17 patients to other clinical specialties (5.3%). Among those 313 patients admitting to health care with acute gout attack, 40 patients were referred the patient to another center without any treatment (12.8%). Referral rate remarkably higher in the primare care (%28.8). NSAIDs were the most common drugs prescribed for acute attack (60.06%), followed by colchicine (58.15). Allopurinol was given in 12.8%, and steroids in 7.99% of patients during acute attack. Regarding long term treatment, 92 patients had never been treated with allopurinol (28.8%). 29.1% (37/127) patients having less than 2 attacks per year and 28.6% (55/192) of patients having two or more attacks per year had never been treated with allopurinol (p>0.05). Only 89 patients (27.9%) were treated with allopurinol by their first physicians, and 138 patients (43.3%) were treated with allopurinol later in a different specialty. Prescription of allopurinol was more common among the rheumatologists. Diet and life style modifications were recommended in 118 of the patients (37%) by their first physicians. 171 patients (53.6%) were later recommended diet and life style modifications during their follow up in a different clinical specialty (total 289 patients, 90.6%). Diet and life style modifications were recommended more commonly in rheumatology (41 patients, 83.7%). 183 (57.4%) were treated with colchicine by their first physicians, and 114 patients (35.7%) were treated with colchicine by a physician of different specialty (total 297 patients, 93.1%). Significantly more patients were treated with colchicine than with allopurinol during long term management (p Conclusions Treatment of gout appears suboptimal in primary care, and more than 25% of patients were referred without any treatment. Long term management also appears suboptimal in both primary care and among some specialists such as orthopedics. Only a minority of patients were recommended allopurinol and/or life style modifications by the doctors first diagnosed gout. Although long term treatment appears better among rheumatologist, still a considerable number of patients were not recommended uric acid lowering approaches in the rheumatology clinics. Disclosure of Interest None declared

Background Introduction of biological agents in the last 15 years lead to significant advances in the treatment of many rheumatic diseases. These novel agents enable dramatic improvements in patients9 socio-economic life in addition to reduction in pain, improvement in physical functions and quality of life. Objectives The purpose of this study is to investigate positive effects of biologic agents in social, family and business life. Methods Patients who were using biological agents (adalimumab, etanercept, golimumab, infliximab and rituximab) at least for 3 months with the diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) were enrolled to the study. The demographic features, disease and biologic usage duration, previous biologic treatments and side effects were recorded to a special form. General anxiety levels evaluated with state and trait anxiety inventory (STAI). Patients9 anxiety levels about biological treatments were evaluated with visual analog scale (0-10 cm) and multiple-choice questions were asked to determine their thoughts related to the drug side effects. Results A total of 473 patients (256 female-52.1% and 217 male-47.9%) with the diagnosis of RA (n:132), AS (n:239) and PsA (n: 40) were enrolled to the study. Ninety five patients were using adalimumab, 140 patients were using etanercept, 42 patients golimumab, 132 patients infliximab and 44 patients were using rituximab at the time of study. Most of the patients (88.7%) were eager about using biologic treatments and 87% of patients were thinking that their wellness is related to their drug. 84.5% of patients reported improvement in their family life, 86.3% in social life and 82.% of patients reported reduction in the number of absenteeism of work (Table 1). Approximately half of the patients were expressed their feelings with positive emotions like, “I felt good”, “I felt very happy”, “my pain was reduced”, “I was relieved”, “I felt the joy of life” under biologic therapy. Conclusions Besides clinical, radiological and functional improvements, biological therapies provide valuable improvement in psychosocial status of the patients. Patients and physicians expectations from the treatment may vary accordingly. Thus, positive effects in family, social and business life may be the primary goal of the treatment for the patients. The results obtained from this study shed light on positive experiences and expectations of patients9 about the biologic treatments. In clinical practice, when managing treatment targets according to disease activity, treatment effects on psychosocial factors should not be ignored. References Marshall NJ, Wilson G, Lapworth K, Kay LJ. Patients9 perceptions of treatment with anti-TNF therapy for rheumatoid arthritis: a qualitative stud, Rheumatology, 2004 Aug;43(8):1034-8. Epub 2004 May 18 Arkell P, Ryan S, Brownfield A, Cadwgan A, Packham J. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication – “It could give me two heads and I9d still try it!”. BMC Musculoskelet Disord. 2013 May 10;14:165 Disclosure of Interest None declared

Background Psoriatic arthritis is a complex disease with a wide range of manifestations. In this inception cohort of PsA patients we aimed to identify the initial manifestations as well as disease activity characteristics and compare with an unselected group of patients with longstanding disease. Methods PsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre study in Turkey on patients with PsA. Patients are consecutively recruited to this registry. Patients who have been newly diagnosed with PsA have been identified, and their characteristics were compared with longstanding disease. Results Within 746 patients recruited, 111 (14.9%) had a new diagnosis for PsA. Patients in the inception cohort were significantly younger than the rest of the cohort (p=0.03) (table). Females were 53.2% of the inception and 66.8% of the non-inception cohort (p=0.007). For types of joint patterns, 14.4% of the inception cohort had only axial involvement whereas this was seen in 8.2% for the other group (p=0.05). The other joint patterns were comparable among groups. Both groups had similar tender and swollen joint counts, BASDAI and BASFI. Patient (p=0.002) and physician global assessments (p Conclusions More patients present with sole axial involvement at the beginning, which may explain the higher disease activity agreed by the patient and the physician despite similar tender and swollen joint counts. Females may have a different perception of the disease with worse patient global assessments and fatigue in longstanding disease. Disclosure of Interest None declared

Background The alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) have been previously investigated in patients with rheumatoid arthritis (RA); however their potential role on diseases activity has not been studied yet (1-2). Objectives Presented study aimed to investigate the correlation of ALP and GGT with disease activity (as assessed by DAS28) and acute phase reactants in patients with RA. Methods In total 81 newly diagnosed RA patients (male/female: 70/11), who fulfilled the 1987 American College of Rheumatology (ACR) classification criteria, as well as 32 healthy controls (male/female: 26/6) enrolled into study. Disease activity was assessed by DAS28. Demographic data, levels of ALP, GGT, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and DAS28 scores were obtained from the patient files when first diagnosed and compared with each other. Results Comparing RA patients with the control group, the ESR, and the levels of CRP, ALP and GGT were found higher in the RA group as compared to the control group. But only ESR and CRP levels were found statistical significance higher (p Conclusions In this study we found that levels of ALP and GGT were correlated with ESR and CRP levels although DAS28 disease activity criteria wasn9t found to be positively correlated with ALP and GGT levels. In RA patients levels of ALP and GGT may be used as disease activity indicators like ESR and CRP. However, more comprehensive studies are needed to make definite correlations between DAS 28, disease activity criteria, and levels of ALP and GGT. References Richardson C, Emery P. Laboratory markers of disease activity. J Rheumatol (suppl 44) 1996; 23: 23-30. Pepys MB. Rheumatoid arthritis: The role of acute phase proteins. Br J Rheumatol 32 1993; (suppl 3): 1-2. Disclosure of Interest None declared

Background Extra-intestinal involvement is frequent in inflammatory bowel disease (IBD). The most common findings among these are musculoskeletal findings. Enthesitis spondyloarthritis (SpA) is one of the major findings of the disease. It has been demonstrated that vitamin D (Vit D) has effects on the immune system and vitamin D deficiency could be an important factor in the development of autoimmune rheumatologic diseases and in the progression of the disease. Objectives The current study aimed to investigate the frequency of enthesopathy in patients with IBD and the relationship between vitamin D and enthesopathy. Methods The current study included 100 patients with IBD (52 with ulcerative colitis (UC) and 48 with Crohn9s disease (CD)) and 30 individuals as the control group. The ultrasonographic (US) evaluation of the patients was conducted by an experienced rheumatologist who was aware of the clinical conditions of the patients. The OMERACT enthesopathy scoring system was used for the evaluation of the Achilles tendon. Vitamin D levels 100 ng/ml was accepted as excessive. Results The mean age of the patients was 37.2 years for males and 40.1 years for females. US examination was performed in 200 heel regions of 100 patients. There was power Doppler (PD) change in 38 patients with UC and gray scale change in 20 patients in the US examination. PD change was detected in 12 patients with CD and gray scale change was detected in 12 patients. There was US change in 16 (30.8%) patients with UC and 9 (18.8%) patients with CD. The mean total US score of 52 patients with UC was 1.98±0.6, and that of 48 patients with CH was 0.83±0.7; the total US score of the control group was 0. The mean total US score of the patients with UC and CD was statistically different from the control group (p Conclusions In the current study enthesitis was detected in 25% of the patients with asymptomatic IBD. There was no relation between the vitamin D levels, IBD, or enthesopathy. References Greenstein AJ, Janowitz HD, Sachar DB. The ekstraintestinal complications of Crohn9s disease and ulcerative colitis:a study of 700 patients. Medicine. 1976;55:401-12. Salvarani C, Vlachonikolis IG, van der Heijde DM, et al. Musculoskeletal manifestations in a population- based cohort of inflammatory bowel disease patients. Scand J Gastroenterol. 2001;36:1307-13. D9Agostino MA, Olivieri I. Enthesitis. Best Pract Res Clin Rheumatol. 2006 Jun;20(3):473-86. Gatenby P, Lucas R, Swaminathan A. Vitamin D deficiency and risk for rheumatic diseases: an update. Curr Opin Rheumatol. 2013 Mar;25(2):184-91. Disclosure of Interest None declared

Background Systemic sclerosis (SSc) is a systemic autoimmune disease with a variety of clinical findings that may shorten the life. Autoantibody tests and digital capilloroscopy facilitated to diagnose this life threating disease. The progression in treatment modalities and supportive care methods yielded a better survival. However, major organ involvement such as pulmonary hypertension and diffuse interstitial lung disease still carries severe risk for mortality. The survival data and causes of death in patients with SSc is still not available in Turkey. Objectives We aimed to evaluate the factors affecting survival in SSc in 2 different rheumatology clinics. Methods All patients who fulfilled the ACR 1980 criteria and classified with SSc since 2003 to 2014 were evaluated (totally 277 patients). The demographic features including autoantibodies of SSc patients and the mortality date were recorded from medical charts. Factors affecting the survival were calculated statistically by Kaplan-Meier test. Results Women (249; 89.9%) outnumbered men (28; 10.1%) significantly. The mean age at the time of diagnosis was 50.7+13.8 years old. 159 (57.4%) patients were classified as diffuse SSc, 110 patients (39.7%) were limited SSc and 8 patients were diagnosed as sine scleroderma (2.9%). 40 (14.4%) of the SSc patients were smoking. Prominent clinical manifestations were sclerodactily (94%), telangiectasis (49.8%), digital ulcers (37.5%), pulmonary fibrosis (35.5%), pulmonary hypertension (33.9%), dysphagia (22.7%), auto-amputation (9%), pleural effusion (6.1%), renal crisis (2.5%), inflammatory myositis (1.8%). At the time of diagnosis 90.6% of SSc patients were ANA positive; 63 (22.7%) were anti-centromere positive, 86 (31%) were anti-Scl-70 positive and 19 (6.9%) were anti-RNP positive. Anti-Ro antibody was positive in 24 (8.7%) and anti-La antibody was positive in 6 (2.2%) patients. The mean follow-up from the time of diagnosis was 42.4+31.6 months and the median follow-up was 36 months (1-132 months). There were a total of 47 deaths in our cohort (17%). Overall, 5 years survival was 80.1% and 10 years survival was 73.5%. The probability of survival was reduced in men (5-year survival: 62% vs 82%, not-significant, p=0.09), in patients with pulmonary fibrosis (5-year survival: 69.8% vs. 85.5%, p=0.008), renal crisis (28.6% vs 81.5%, p Cox regression analysis showed that male sex (OR: 2.38, 95%CI: 1.09-5.3, p=0.03), pulmonary hypertension (OR: 0.29, 95%CI: 1.64-3.4, p=0.001) and essential hypertension (OR: 5.07, 95%CI: 2.4-10.09, p Conclusions In our SSc patients, we observed reduced survival in male SSc patients and patients with pulmonary hypertension and essential hypertension. Any antibody including anti-centromer and Scl-70 were not meaningful. 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