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Objective Persistent inflammation is an insidious and less studied feature of FMF. We investigated clinical determinants of persistent inflammation and its associations with individual damage items. Methods This is a cross-sectional analysis of 917 FMF patients, who fulfilled the Tel Hashomer criteria and had at least 6 months’ follow-up. Patients were stratified based on whether they had persistent inflammation. We used logistic regression analysis to investigate independent predictors of persistent inflammation and the associated individual damage items. Results One hundred and forty-two (15%) patients had persistent inflammation. Active FMF (54%) was the most prominent reason for the persistent inflammation. Spondylarthritis (16%), other inflammatory arthritis (8%) and IBD (2%) were other frequent reasons. Male gender, history of exertional leg pain, inflammatory comorbidities, M694V homozygosity, colchicine resistance, lower education levels and musculoskeletal attack dominance were found to be the independent predictors of persistent inflammation. Earlier disease onset led to a tendency towards persistent inflammation. Patients with persistent inflammation were more likely to suffer damage. There is an increased risk of developing proteinuria, amyloidosis and renal insufficiency. Conclusion We identified, for the first time, the predictors of persistent inflammation in adult FMF patients and related individual damage items of the Autoinflammatory Disease Damage Index. Persistent inflammation is insidious and one of the chief causes of damage; therefore, especially patients with these predictors should be followed up more closely. If detected, underlying inflammatory comorbidities should be assessed meticulously as early detection and proper treatment strategies may favourably impact the natural history of the disease.

OBJECTIVE: Behçet’s disease (BD) is a chronic, multisystem disorder that can cause severe morbidity and mortality. Monitoring tools that measure disease activity are required for effective management of BD. We aimed to investigate the association of prognostic nutritional index (PNI) with disease activity in BD. METHODS: In this cross-sectional study, we enrolled 88 adult patients with BD and 51 healthy controls. The patients were divided into patients with active and inactive BD according to their disease activities. PNI was calculated using the following formula: 10×serum albumin (g/dL)+0.005×peripheral lymphocyte count (per mm3). To evaluate BD activity, the Behçet Disease Current Activity Form was used. The relations of BD activity with PNI, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein were investigated. A receiver operator characteristic curve analysis was used to define the optimum cutoff value of PNI for active BD. RESULTS: A total of 48 patients were classified as having active BD and 40 as having inactive BD. Patients with active BD had lower mean PNI than patients with inactive BD and healthy controls (51.8±4.2, 57.4±2.9, and 56.6±3.6, respectively; p

Background/aim Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in a substantial number of patients due to its side effects. In this study, we aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and cause permanent discontinuation. Materials and methods All patients were recruited from “FMF in Central Anatolia” (FiCA) cohort, 915 adults with a minimum follow- up time of 6 months during which they had obeyed all treatment instructions. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications, and treatment features were recorded on a web-based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed. Results Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows: diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in five (0.5%), and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male sex and obesity were found to be associated with liver toxicity, and having a normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine-intolerant patients, and they had reported more frequent attacks compared to those tolerating optimal doses. Conclusion Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing is associated with complications.

OBJECTIVE Lupus low disease activity state (LLDAS) is a potential treat-to-target goal in systemic lupus erythematosus (SLE). This study determined predictors of time to reach LLDAS in a longitudinal cohort. METHODS Patients were grouped according to LLDAS status at cohort entry. Those who did not satisfy LLDAS at cohort entry were analyzed prospectively. The Kaplan-Meier approach was used to estimate the time to LLDAS. Cox regression was used to identify patient characteristics that were associated with time to LLDAS. RESULTS The probability of LLDAS attainment within 1 year was 52% for Caucasians, 36% for African Americans, and 33% for SLE patients with renal involvement. The median time to LLDAS was 1.1 years. In multivariable models, African American ethnicity, baseline prednisone >10 mg daily, hypocomplementemia, baseline damage, and baseline renal activity remained significant predictors of longer time to attain LLDAS, while disease duration

Objectives: Treatment of connective tissue disease-related interstitial lung disease (CTD-ILD) remains challenging. The literature related to the immunosuppressive drugs is very limited in most CTDs and there is no previously reported study comparing induction regimens in patients with newly defined ‘interstitial pneumonia with autoimmune features (IPAF), We aimed to investigate the efficacy of azathioprine (AZA) used in induction regimens for interstitial lung disease in a variety of connective tissue disorders including IPAF, and compare it with cyclophosphamide (CYC) Methods. In a retrospective study, all patients presented with interstitial lung disease to the rheumatology and/or pulmonology departments in a tertiary referral centre, between 2009 and 2019. Five major CTD groups were defined; systemic sclerosis, rheumatoid arthritis (RA), primary Sjögren syndrome (pSS), inflammatory myositis (IMS) and interstitial pneumonia with autoimmune features (IPAF). All patients who satisfied one of these and received AZA or CYC for induction therapy for at least 6 months were included in the study. Treatment responses at six months and side effects were analyzed. Results: There were 1351 patients diagnosed with ILD. Of these, 328 patients were identified as CTD-ILD, satisfying the classification criteria of one of the CTDs. Among these, 57 patients received AZA and 79 patients received CYC for induction therapy. CYC treatment resulted in a 2.41 % increase in FVC, however, AZA resulted in a 1.44% decline in FVC predicted (p=0.041). Propensity score matching was used to reduce selection bias, AZA treatment was related to increased risk of progression (50% vs 13.5%, p:0.002). Conclusion: CYC is superior to AZA in induction therapy of CTD-ILD.

Objective: Prodrome is defined by manifestations that precede a familial Mediterranean fever (FMF) attack and predict its emergence. We aimed to determine the frequency, characteristics, and clinical determinants of prodrome in patients with FMF. Method: This cross-sectional study was conducted in a tertiary rheumatology clinic. During the clinical interview, all patients completed a standardized questionnaire about the pre-attack period. Prodrome was defined as the presence of any recurrent pre-attack manifestation occurring at least 4 h before an attack. Patients were classified according to whether they had prodrome of any kind of attack. Results: The study enrolled 401 patients aged 37.7 +/- 11.0 years (mean +/- sd). Male gender, M694V/M694V, homozygous MEFV mutation, peritonitis, pleuritis, and arthritis were more frequent in prodrome-positive patients. Altogether, 141 patients (35.2%) had prodrome. Male gender and ever having attack types of peritonitis or arthritis were independent clinical determinants of prodrome [relative risk (95% confidence interval): 1.72 (1.07-2.76), p = 0.02; 4.27 (1.80-10.1), p = 0.001; 1.77 (1.04-3.04), p = 0.04, respectively]. Age, MEFV mutations, pleuritis, and erysipelas-like erythema were not clinical determinants. Conclusions: All FMF patients, particularly males and patients who had peritonitis or arthritis at any time, should be questioned about prodrome. Prodrome should be analysed in terms of elucidating the pathogenesis of FMF and as an opportunity for a secondary prevention strategy for impending attacks. This study may shed light on prodrome for future cytokine or drug studies with the purpose of developing new cost-effective treatment protocols irrespective of colchicine resistance.

Defining predictors of damage would improve patient care. We applied damage indexes to patients with familial Mediterranean fever (FMF) and identified the predictors of damage.This is a cross-sectional analysis of 926 FMF patients, who fulfilled the Tel-Hashomer criteria and had at least six months of follow-up. Patients were stratified according to their damage status (damage vs. no damage) defined with autoinflammatory disease damage index (ADDI) and modified ADDI (excluding musculoskeletal pain). We used logistic regression analysis to investigate independent predictors of damage for both indexes.Mean disease duration was 21.6±11.9 years. 527 patients (57%) had damage according to ADDI. Median ADDI score was 1 (0-11). Most common FMF-related damages were observed in musculoskeletal, reproductive and kidney domains. Female gender, inflammatory comorbidity, colchicine resistance, colchicine nonadherence, musculoskeletal attack dominance, diagnostic delay, follow-up time, and smoking history remained independent predictors of damage according to ADDI score. The rate of patients with damage defined by modified ADDI was only to 23%. M694V/M694V homozygosity, female gender, musculoskeletal attack dominance, colchicine resistance, persistent inflammation, follow up time and family history of amyloidosis were found to be predictors of damage according to modified ADDI score.Our study is the first to apply comprehensive damage indexes to FMF patients and identified predictors of damage. Factors linked to a severe FMF phenotype, including M694V homozygosity and persistent inflammation, were associated with only modified ADDI. Our findings justify the concerns about musculoskeletal pain and might point to the need for re-evaluation of ADDI for FMF patients.

Background Granulomatosis with polyangiitis (GPA) is a granulomatous necrotizing vasculitis with high morbidity and mortality. Anti-neutrophil cytoplasmic antibody is a valuable diagnostic marker, however its titer lacks predictive value for the severity of organ involvement. Platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) has been regarded as a potential marker in assessing systemic inflammation. We aimed to explore the value of PLR and MPV in the assessment of disease activity and manifestations of disease in GPA. Methods 56 newly diagnosed GPA patients and 53 age-sex matched healthy controls were included in this retrospective and cross-sectional study with comparative group. Complete blood count was performed with Backman Coulter automatic analyzer, erythrocyte sedimentation rate (ESR) with Westergen method and C-reactive protein (CRP) levels with nephelometry. The PLR was calculated as the ratio of platelet and lymphocyte counts. Result Compared to control group, ESR, CRP and PLR were significantly higher and MPV significantly lower in GPA patients. In patients group, PLR was positively correlated with ESR and CRP (r = 0.39, p = 0.005 and r = 0.51, p r = − 0.31, p = 0.028 and r = − 0.34 p = 0.014, respectively). Patients with renal involvement had significantly higher PLR than patients without renal involvement (median:265.98, IQR:208.79 vs median:180.34 IQR:129.37, p = 0.02). PLR was negatively correlated with glomerular filtration rate (r = − 0.27, p = 0.009). A cut-off level of 204 for PLR had 65.6% sensitivity and 62.5 specificity to predict renal involvement. Conclusion PLR exhibit favorable diagnostic performance in predicting renal involvement in patients with GPA.

Aim The Lupus Low Disease Activity State (LLDAS) is a potential treat to target goal in systemic lupus erythematosus (SLE). SLE patients in LLDAS for more than half of the observation time have about a 50% lower risk of new organ damage and have reduced mortality. We identified predictors of being in LLDAS ≥50% of the observation time. Methods A total of 2228 SLE patients who had at least three clinical visits were included. Percentage of time in LLDAS was calculated based on the proportion of days under observation. LLDAS-50 was defined as being in LLDAS for ≥50% of the observation time. We used the stepwise selection procedure in logistic regression to identify predictors of LLDAS-50. Results A total of 1169 (52.5%) SLE patients, but only 37.6% of African Americans, achieved LLDAS-50. In the multivariable model, African American ethnicity, hypocomplementemia, serositis, renal activity, arthritis, anti-RNP, anti-dsDNA, vasculitis, malar rash, discoid rash, thrombocytopenia, and immunosuppressive use were negative predictors of LLDAS-50. Older age at diagnosis, longer disease duration, higher education level, and greater percentage of time taking hydroxychloroquine remained positive predictors of LLDAS-50. Conclusion In this large cohort, only 52.5% achieved LLDAS-50. This proportion was even less in African Americans. A higher percentage of time taking hydroxychloroquine was a modifiable positive predictor of LLDAS-50. Anti-RNP, anti-dsDNA, and low complement were negatively associated with LLDAS-50. Our findings further emphasize the importance of inclusion of African Americans in clinical trials and hydroxychloroquine adherence in both clinical practice and clinical trials.

Rheumatic diseases cause deformities in the hands and affect daily living activities. Therefore, assessment of hand disabilities is important in rheumatic disease. The aim of this study was to test the validity and reliability of the Turkish version of the A Score For Assessment and Quantification of Chronic Rheumatic Affections of the Hands (SACRAH). A translation and back-translation of the SACRAH were performed, according to the Beaton guidelines. Patients who were between 18-65 years old, who were literate in Turkish, who had rheumatic disease diagnosis and whose hands were affected, were included in the study. Patients who were using a splint during daytime were excluded from the study. They completed the Turkish version of Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH-T) once and the final version of the SACRAH Questionnaire twice with a 7 days’ interval. The internal consistency (Cronbach’s α) and reliability (test-retest reliability) of the questionnaire were assessed. Besides, correlations between SACRAH and DASH-T scores were analyzed using the Spearman correlation coefficient. One hundred and twenty patients participated in the study. The Turkish version of the SACRAH met set criteria of reliability and validity. Internal consistency was excellent (Cronbach’s α=0.88) and test-retest reliability were very good (r=0.73). SACRAH showed a positive and statistically significant correlation with DASH-T scores (r=0.83, p

Background Familial Mediterranean Fever (FMF) is the most frequent auto-inflammatory disease caused by MEFV gene mutations. Available reports investigated only specific components of damage such as amyloidosis. All possible organ targets of damage have not been entirely evaluated before. Such as Disease severity index which is emerged especially for FMF do not cover entire damage domains related to FMF. Recently, a new scoring system (Auto-inflammatory disease damage index) was developed and validated for autoinflammatory diseases. Objectives We aimed to investigate damage accrual caused by FMF and associated features with damage. Methods All patients recruited from FMF in Central Anatolia (FiCA) cohort, which is a duplication disabled, internal and externally controlled, cross-sectional, multicenter accessible web-based cohort. This study is comprising 970 adult patients (mean age 35.3 ±12.1 years, 61.5% female). Demographic data, FMF disease characteristics, co-morbid conditions, disease complications were meticulously questioned and laboratory features and genotype data (if available) were recruited from patient files. FMF caused damage was assessed by auto-inflammatory disease damage index (ADDI) which is recently validated. Association between damage and demographic, disease and treatment characteristics were analyzed. Results Proportions of FMF manifestations were fever 83.1%, peritonitis 91.5%, pleuritis 47.9%, arthritis 43.3% and skin rash 26.2%. Dominant attack types were fever in 6.2%, serositis in 65.7%, musculoskeletal in 16.8% and all types of attacks were common in rest of patients. MEFV mutations were available in 814 subjects and 75.9% of these subjects were harboring M694V mutation (42.5% homozygous for M694V). Among all 63.1% patients were well responded to colchicine and 8.8% were non-responders. Median ADDI score was 1 (min 0-max 11). Most common FMF related damages were observed in musculoskeletal, reproductive and kidney domains. Chronic musculoskeletal pain was present in 49%, joint deformity in 2.9%, infertility in 6.6%, amenorrhea in 3.9%, proteinuria in 6.9%, amyloidosis in 5.9% and renal failure in 3.7% of the patients. 411 (%42.3) of patients had no damage accrual. M694V homozygous mutation, male gender and colchicine nonresponse were found to be the independent predictors of damage. Conclusion M694V homozygous mutation, colchicine non-response and male gender are predictors of damage and effective therapeutic interventions must be undertaken to prevent from damage in these patients. Acknowledgement None Disclosure of Interests Hakan Babaoglu: None declared, Berkan Armagan: None declared, Erdal Bodakci: None declared, Timucin Kasifoglu: None declared, Hasan Satis: None declared, Nuh Atas: None declared, Alper Sari: None declared, Nazife Sule Yasar Bilge: None declared, Gozde Kubra Yardimci: None declared, reyhan bilici salman: None declared, Levent Kilic: None declared, mehmet akif ozturk: None declared, Berna Goker: None declared, seminur haznedaroglu: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, abdurrahman tufan: None declared

Background: Familial Mediterranean Fever (FMF) is the most frequent auto-inflammatory disease characterized by recurrent, self-limiting attacks of fever, peritonitis, pleuritis, synovitis, myalgia, and erysipelas-like erythema (ELE). Attacks has a robust inflammatory response which completely normalize when attacks subside. However, substantial number of FMF patients possess chronic persistent inflammation even in between attacks. Clinical significance of persistent inflammation and its contribution to damage accrual are yet to be determined. Objectives: We aimed to determine the prevalence and underlying factors of chronic persistent inflammation and its association with the domains of Auto-inflammatory disease damage index (ADDI) in a large cross-sectional multicenter cohort. Methods: All patients recruited from FMF in Central Anatolia (FiCA) cohort, which is a duplication disabled, internal and externally controlled, cross-sectional, multicenter accessible web-based cohort. Demographic data, disease characteristic, attack features (ever presented) were meticulously questioned. Genotype data (if available) and laboratory features including inflammatory markers were recorded. FMF related damage scores was assessed by auto-inflammatory disease damage index (ADDI) which is recently validated. Patients were stratified according to their antecedent acute phase responses as having persistent inflammation (PI group) or not, both groups compared in terms of disease characteristics, attack features, inflammatory comorbidities and damage domains. Results: Study is comprised 970 adult patients (mean age 35.3±12.1, 61% female). 54 of them were excluded for their first inclusion. 15% of patients had persistent inflammation. PI group had significantly younger age of diagnosis, male dominance, homozygous M694V, more frequent attacks it the last year, more pleuritis, arthritis, myalgia and ELE and more severe disease according to ISSF than other patients (Table-1). Moreover, colchicine resistance and ADDI damage scores were remarkably higher in PI group. In multi-variate analyzes colchicine resistance OR=2.71 [95%CI 1.38-5.35], ISSF OR=11.06 [95%CI 5.23-23.39], male gender OR= 2.38 [95%CI 1.51-3.76], homozygous M694V mutation OR= 2.31 [95%CI 1.41-3.78] and ELE OR= 1.72 [95%CI 1.04-2.857] found as independent predictors of persistent inflammation. PI group had more damage in multiple domains like joint restriction, musculoskeletal pain, proteinuria, amyloidosis, renal insufficiency and developmental delay. Same variables and persistent inflammation further analyzed in in terms of predicting the damage. Persistent inflammation found to be an independent predictor of proteinuria OR=2.02 [95%CI 1.05-3.90], amyloidosis OR=2.71 [95%CI, 1.34-5.48]), and renal insufficiency OR=4.36 [95%CI 1.84-10.32]. Conclusion: Persistent inflammation is relatively common in FMF patients particularly in those harboring M694V homozygous mutation and is associated with major complications of disease indicating poor prognosis. Acknowledgement: None Disclosure of Interests: Hakan Babaoglu: None declared, Berkan Armagan: None declared, Erdal Bodakci: None declared, Timucin Kasifoglu: None declared, Hasan Satis: None declared, Nuh Atas: None declared, Alper Sari: None declared, Nazife Sule Yasar Bilge: None declared, Gozde Kubra Yardimci: None declared, reyhan bilici salman: None declared, Levent Kilic: None declared, mehmet akif ozturk: None declared, Berna Goker: None declared, seminur haznedaroglu: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, abdurrahman tufan: None declared

Background: Scleroderma is a connective tissue disease that is characterized by fibrosis of the skin.The modified Rodnan Skin Score (mRSS) is a measure generally used to assess the skin thickness in patients with scleroderma.Data on the effectiveness of the mRSS training courses differ in the literature. Objectives: The objective of our study was to evaluate the effectiveness of the mRSS training course in rheumatology fellows in the rheumatology departments. Methods: The study included 6 fellows from the departments of rheumatology.Participants were given a 1-hour-long theoretical training, including dermal involvement, and mRSS assessment by 3 rheumatology experts experienced in scleroderma, which was followed by an applied training on 4 patients for one-hour.Participants scored two patients before and after training on a form, which included 17 domains with a total score-range between “0” and “51”. Then using the SPSS15 software program, inter-rater reliability was assessed with intraclass correlation(ICC) analysis for both pre- and post-training mRSS.Fleiss’ kappa was used to measure the degree of agreement according to 12 Rodnan score areas before and after the training. Results: The ICC value for pre-training and post-training total Rodnan scores was 0.867 (95% CI-0.625-1.00, P=0.05), and 0.905(95% CI 0.045-1.00, P=0.02), respectively. Individual analysis of score areas showed that after the training there was an increase in degree of agreement in some of these areas, while there was no difference in one area, and it decreased in others (Table 1). Conclusion: Several studies have demonstrated the applicability, reliability, and validity of mRSS, a measure of dermal involvement, and that evaluation of the score requires experience, and an attentive learning process.In the literature, the inter-rater ICC values during previous training courses are reported to range between 0.378 and 0.92(1). These studies show differences in terms of the number and experience of participants, number of patients, course-length, and repeated courses. Similar to the observation by Ionescu et al(2), the pre-training inter-observer ICC value was very high(0.867), and it increased to 0.905 after the training. Presence of an increase in some areas, and reduction in some others in individual analysis of areas after the training may suggests the need for repeated training. Our limitations were low number of participants and patients. We obtained very good inter-rater ICC values in the mRSS training course given to rheumatology fellows; however we may benefit from new studies for optimization of these conclusions by increasing the numbers of trainees, patients, and the lenght of courses. References [1] Czirjak, L., et al., the EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis. Ann Rheum Dis, 2007. [2] Ionescu, R., et al., Repeated teaching courses of the modified Rodnan skin score in systemic sclerosis. Clin Exp Rheumatol, 2010. Disclosure of interests: None declared

Background: Despite the improvements in classifying patients with primary Sjogren’s syndrome with usage of the new 2016 ACR/EULAR classification criteria, there remains to be a need for improvement and investigating the value of new modalities in diagnosing as well as classifiying these patients. Objectives: to investigate potential role of parotid elastography in diagnosis and classification of patients with primary Sjogren’s syndrome (pSs) Methods: This is a cross sectional analysis of patients with primary Sjogren’s syndrome followed up in our out-patient Rheumatology clinic. We performed chart reviews and retrospectively investigated the available data on files to search whether or not our clinically diagnosed patients satisfied the 2002 AEG and/or 2016 ACR/EULAR criteria sets. Ultrasonographic and elastographic evaluation of parotid and submandibular glands bilaterally were performed on consecutive patients with clinical diagnosis of pSs and contributions of these findings to classification criteria sets were interpereted Results: There were 95 pSs patients and 30 healthy gender and age matched controls. Strain ratio, shearwave velocity and Pascal values of the glands were examined. Parotid strain ratio, submandibular velocity and submandibular pascal values were statistically significantly different compared to healthy controls (Table).%86 of patients considered clinically as Sjogren syndrome satisfied 2016 ACR/EULAR (criteria patients) and%84 satisfied 2002 AER classification criteria. We grouped patients with respect to parotid strain ratio taking 1.0875 as the cut-off value. Those patients who did not satisfy 2016 ACR/EULAR criteria, but clinically diagnosed as pSs (non criteria pSs patients), also had significantly higher parotid strain ratio and submandibular velocity compared to healthy controls (p:0,016 and p Conclusion: Parotid shear elastography is an easy and nonivasive method and can be a useful tool for the diagnosis and classification of patients with pSs (1). References [1] Mossel E, Delli K, van Nimwegen JF, Stel AJ, Kroese FGM, Spijkervet FKL, Vissink A, Arends S, Bootsma H; EULAR US-pSS Study Group. Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjogren’s syndrome Ann Rheum Dis. 2017 Nov;76(11):1883-1889. doi: 10.1136/annrheumdis-2017-211250 Disclosure of Interests: None declared

Background/aim We aimed to assess the association between retinal vascular caliber (RVC) scores and disease activity in rheumatoid arthritis (RA) patients. Materials and methods Forty-seven RA patients, 32 systemic lupus erythematosus (SLE) patients, and 45 healthy people were enrolled. RA and SLE patients were subdivided into groups according to C-reactive protein (CRP) levels. RA patients were also grouped according to Disease Activity Score-28 (DAS-28). Fundus photography was performed for all patients. RVC was summarized as the central retinal artery and vein equivalents (CRAE and CRVE). Results Mean CRVE for RA patients was 213.3 ± 17.8 μm compared with 209.2 ± 14.1 μm for SLE and 217.5 ± 26.2 μm for the control group (P = 0.17). RVC scores did not differ between the CRP-high and CRP-low groups. As the RA disease activity increased, the widening of CRVE became more prominent and statistically significant. When the DAS-28 > 5.1 (CRVE, 220.4 (211.8–246.5) μm) group and DAS-28 ≤ 3.2 (CRVE, 214.4 (172.4–242.3) μm) group were compared, statistical significance was more pronounced (P = 0.03) than when comparing the DAS-28 > 3.2 and DAS-28 ≤ 3.2 groups (P = 0.05). Conclusions CRVE, which reflects systemic inflammation and possibly increased cardiovascular risk, was significantly increased in active RA patients. The association between retinal venular widening and disease activity, regardless of CRP, may be a sign that RA-related inflammation may have systemic vascular effects even with normal levels of CRP.

Background:Axial spondyloarthritis (axSpA) is a common chronic inflammatory disease of the axial skeleton. Some cytokines have important roles in initiation and progression of disease and are elevated in active disease. Additionally, Wnt signaling pathway inhibitors and noggin also appear to be involved in pathogenesis of ankylosing spondylitis. Anti-tumor necrosis factor-alpha (TNF) agents have dramatically improved the clinical outcome of axSpa; however, acceptable clinical improvement is not achieved in all patients and capacity of anti-TNF to slow or prevent structural damage still remains controversial.Objectives:To evaluate the effect of anti-TNF on inflammatory and noninflammatory milieu in patients with axSpA.Methods:In this prospective study we included 30 biologic treatment naive adult patients with axSpA and 30 healthy controls. All patients with high disease activity were treated with anti-TNF therapy for 6 months. Laboratory and clinical evaluation of all patients were performed at baseline and after 6 months of anti-TNF treatment. Following cytokines and wnt/BMP antagonists were measured; TNF-Alpha, COX-2, IL-6, IL-17, IL-22, IL-23, IL-33, dickkopf-1, sclerostin, noggin.Results:The mean age of patients with axSpA and healthy controls were 38.1±13.3 and 37.7±7.7 years, respectively (p>0.005). At baseline, the median (IQR) TNF-alpha was higher in axSpA patients when compared to healthy controls, 34.4 pg/ml (31.4-37.03) vs 18.1 pg/ml (12.1-28.4), (pConclusion:Elevation of some cytokines which are important in pathogenesis of axSpA and nonincrease in noggin with anti-TNF drugs may affect effectiveness of anti-TNF treatment.Table 1.Changes of cytokines, dickkopf-1, sclerostin and noggin with anti-TNF treatment.Pre-Anti-TNFPost-Anti-TNFP valueIL-645(39.1-68.8)47.6(27.3-61.1)0.750IL-1793.3 (85.1-104.8)102.1(86.6-114.6)0.026IL-22159,2 (151,9-178.4)183.5(156.3-304.6)0.033IL-2336.5 (26.1-52.9)41.3(28.4-55.5)0.658IL-33127.8 (106.6-186.1)147.06(128.5-213.4)0.016COX20.176 (0-0.374)0.202(0.051-1.151)0.469TNFalpha34.4(31.4-37.03)30.7(12.8-35.6)0.004Dickkopf-1446.7(356.9-529.3)881.3(663.1-972.2)Sclerostin312.4 (140.8-412.7)405.1(276.3-452.5)0.018Noggin48.3(17.04-153.9)31.2(11.3-103.7)0.264Disclosure of Interests:None declared

Background:Follow-up in all rheumatologic patients is critical, particularly Familial Mediterranean Fever (FMF). Current recommendations for all experts by the EULAR state that patients with FMF should be evaluated 6-monthly intervals to monitore the character and frequency of the attacks and the acute phase response. Disease-related complications such as amyloidosis can beasymptomaticand need only a careful follow-up.Objectives:to quantify this phenomenon and to find predictive factors of visit compliance in patients with FMF.Methods:The study included 474 adult patients with a diagnosis of FMF who followed at the outpatient rheumatology clinic of tertiary university hospital, from January 2018 to December 2018. . Demographic, socioeconomic data, familiy history, comorbid disease, medication history, characteristics, the International Severity Score for FMF (ISSF),autoinflammatory disease damage index (ADDI) were recorded. Visit compliance was defined as the presence of two visits in the outpatient rheumatology clinic for FMF last one year for the purposes set out in EULAR suggestion.Those who had fewer than two visits in the last one year were considered noncompliant.Results:230 (48.5%) were compliant while 244 (51.5 %) patients were noncompliant with their rheumatology visit. Both compliant and noncompliant patients had similar median age and disease duration. Female sex and being married was increased the visit compliance.The results of the logistic regression model exploring factors associated with compliance indicated that presence of family history in parents, absence of family history in sibling, treatment with biologic agents, other drug using,presence of more than 2 attacks except fever and adequate medical care were important predictors of visit compliance.Conclusion:In conclusion, if FMF patients visit compliance increase, their functionality, medication adherence and quality of life will increase and flares and complication of disease can decrease. Thus, we highlight some recommendations for FMF specialist, patients and health care providers to improve outcomes.Table 2.Multivariate logistic regression analysis for predictive factors of visit compliance of the patients with FMF, n=430Adj. OR%95 CI**pFamily history in parents(positive history vs negative)1,81,0-3,10.03Family history in sibling(negative history vs positive)1,91,2-3,10.004Comorbid disease status1,30,7-2,50.32Treatment(anakinra&canakinumab vs colchicine)3,71,7-8,20.001Drug using(other drugs vs FMF drugs)2,21,1-4,40.01More than 2 attacks except fever2,31,2-4,00.004Chronic peripheral arthritis2,30,8-6,60.10Proteinuria2,20,7-6,70.14Adequate medical care1,91,2-3,10.003Number of index flare within last 12-month0,90,9-1,00.38ISSF severity score0,80,7-1,10,30Disclosure of Interests:None declared

Background:Interstitial lung disease (ILD) is a common morbidity and mortalitiy reason for connective tissue disorders (CTD). Data related to treatment options in the literature is limitedObjectives:To describe the role of azathiopurine (AZA) in the first line treatment of connective tissue disease related interstitial lung disease CTD-ILD, comparing with cyclophosphamide (CYC)Methods:Between 2009 and 2019 all interstitial lung disease patients admitting rheumatology or pulmonology department were retrospectively evaluated. Among those patients,as an first line regimen treated with either azathiopurine or cyclophospamide were included. Primary end point was FVC percentage change at 6th month.Results:Among 328 CTD-ILD, 57 patients had AZA treat and 79 patients had CYC for the first line treatment. Patients treated with AZA tend to have limited disease and older age. CYC treatment had a mean of 2,41% increase in FVC but in AZA -1,44% decrease in FVC predicted (p:0,041) 5 major CTD groups were defined (systemic sclerosis (SSc), rheumatoid arthritis (RA), primer sjögren syndrome (pSS), dermatomyositis/ polimyositis (PM/DM), autoimmune features of intestitial lung disease (IPAF)). AZA had similar efficacy in, PM/DM and IPAF groups but worse outcome in SSc, RA and pSS compared to CYC.Conclusion:AZA treatment might be an option patients with limited disease extent and the diagnosis of PM/DM or IPAF. CYC was a better treatment in SSc, RA and pSS patientsReferences:[1]Kocheril, S.V., et al.,Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.Arthritis Care & Research: Official Journal of the American College of Rheumatology, 2005.53(4): p. 549-557.Table 1.CYC: treatment responses of cyclophosphamide and azathiopurine regimens AZA: azathiopurine CYC: cyclophosphamide, AZA: azathiopurine CTD: connective tissue disease, SSc:Systemic Sclerosis, RA: Rheumatoid Arthritis, pSS: primary sjogren syndrome, DM/PM/ASS: Dermatomyositis / Polimyositis/Antisynthetase Syndrome, IPAF: Idiopahtic interstital fibrosis with autoimmune feautres, FVC: forced vital capacityAZA(n:43)CYC (n:72)pProgression(overall)39,3%15,3%0,013SSc (n:47)60%11,9%0,029RA(n:16)62,5%25%>0,05pSS(n:16)71,4%11,1%0,035DM/PM/ASS(n:14)11,1%->0,05IPAF(n:20)28,6%23,1%>0,05FVC change (overall) (lt)-,129±0,7410,024±0,2490,189SSc (n:47)-0,086±1810,025±0,3510,286RA(n:16)-0,553±1,521-022±0,2620,341pSS(n:16)-0,328±0,2420,014±0,3130,167DM/PM/ASS(n:14)-0,0089±0,3700,120±0,0370,316IPAF(n:20)0,123±0,3200,120±0,1010,981FVC change (overall) (%)-1,44±10,652,41±7,550,041SSc (n:47)-3,00±3,672,23±8,270,031RA(n:16)-3,50±9,65-1,75±4,650,654pSS(n:16)-6,71±15,973,33±8,350,027DM/PM/ASS(n:14)0,00±11,854,40±2,700,313IPAF(n:20)2,06±9,045,28±6,700,380Disclosure of Interests:None declared

Background:Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in substantial number of patients, due to its side effects.Objectives:It was aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and permanent discontinuation.Methods:All patients were recruited from “FMF in Central Anatolia” (FiCA) cohort, 915 adult subjects with minimum follow up time of 6 months and had compliance of treatment were included. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications and treatment features were recorded on a web based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed.Results:Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows; diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in 5 (0.5%) and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male gender and obesity were found to be associated with liver toxicity and having normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine intolerant patients and they had reported more frequent attacks compared to those tolerating optimal doses.Conclusion:Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing associated with complications.References:[1] Sönmez, H.E., E.D. Batu, and S. Özen,Familial Mediterranean fever: current perspectives.Journal of inflammation research, 2016.9: p. 13.[2] Sari, İ., M. Birlik, and T. Kasifoğlu,Familial Mediterranean fever: an updated review.European journal of rheumatology, 2014.1(1): p. 21.[3] Ozen, S., et al.,EULAR recommendations for the management of familial Mediterranean fever.Annals of the rheumatic diseases, 2016.75(4): p. 644-651.Table 1.Prevalence of all side effects of colchicine and reasons for drug discontinuationSide effectAll side effectsN=172*Permanent cessationN=18*Diarrhea9911Liver toxicity544Leukopenia101Muscle toxicity52Skin reaction2-Nausea4-Infertility2-* some patients had more than one clinically significant side effectTable 2.Disease course in colchicine tolerant and intolerant patientsColchicine TolerantN=743Colchicine IntolerantN=172p valueChronic inflammation115 (15.4%)45 (26.1%)Number of attacks in the last year4.05±6.087.60±9.6Proteinuria44 (5.9 %)20 (11.6%)0.025Amyloidosis33 (% 4.4)23 (13.3%)ADDI (median)1 (1)1 (1)ADDI: auto-inflammatory disease damage index, FMF: familial Mediterranean feverDisclosure of Interests:Hasan Satiş: None declared, Berkan Armagan: None declared, Erdal Bodakci: None declared, Nuh Atas: None declared, Alper Sari: None declared, Dilek Yapar: None declared, Nazife Sule Yasar Bilge: None declared, reyhan bilici salman: None declared, Gözde Kübra Yardimci: None declared, Hakan Babaoglu: None declared, Levent Kiliç: None declared, mehmet akif ozturk: None declared, Berna Goker: None declared, seminur haznedaroglu: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Timuçin Kaşifoğlu: None declared, abdurrahman tufan: None declared

Background:Lung nodules in rheumatoid arthritis (RA), patients impose diagnostic and therapeutic challenges due to unpredictable outcome of these nodules. biologic (b) disease-modifying anti-rheumatic drugs (bDMARDs) are important therapeutic agents used in treatment of RA. There is hesitation about use of conventional synthetic DMARDs (csDMARD) and bDMARDs due to increased risk of nodules although their association remains unclear. There are scarce data on lung nodules observed in RA patients and systematic studies are needed.Objectives:The aim of this study is to evaluate effects of biologic treatments and conventional synthetic DMARDS on pulmonary nodules observed in rheumatoid arthritis patients.Methods:Electronic health records of RA patients who had had thorax computed tomography (CT) confirmed lung nodules in the last 5 years were retrospectively evaluated. Pre-treatment and post-treatment follow up CT images were meticulously examined for the number, size, attenuation, calcification, and cavitary formation. Demographic features, smoking status, disease characteristics and used medications were retrieved from file records. Clinical and laboratory findings, demographic features, treatment and follow-up duration, number of solid and cavitary nodules were compared between groups.Results:There were 21 patients in both biologic (11 females, mean age; 59.7±8.4) and csDMARD (12 females, mean age; 71.4±8.3) treated groups. There was no difference in frequency of nodule types and sizes between csDMARD and bDMARDs groups(table) despite csDMARD users were remarkably older. Administered biologic treatments were anti-TNF-alpha in 8, tofacitinib in 7, rituximab in 4, and abatacept in 2 patients. The most common types of nodules were solid and cavitary nodules, observed in 17 and 8 patients, respectively in biologic users. Calcific nodules were present in three patients, and ground glass nodules were observed in a single patient. Nodules were multiple in 12 patients and solitary in 9 patients. Calcific and ground glass nodules were all solitary in our study. Cavitary and solid nodules were concurrent in five patients. Median follow duration was 14(5-55) months. Progression was observed in small number of patients; three patients in receiving aTNFα, and one in rituximab(figure) and one in abatacept users. Interestingly none of patients receiving tofacitinib did not show progression. There was no difference regarding number of patients who progressed with either csDMARD or bDMARDs. None of the nodules showed malignant transformation within the observation period.Conclusion:In conclusion, risk of progression in lung nodules with biologic treatments is seem to be low, at least not more than csDMARD in short term and any malignant transformation was not observed in our study.References:[1]Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med. 2019 Sep;40(3):545-560. doi:10.1016/j.ccm.2019.05.003. Epub 2019 Jul 6. Review. PubMed PMID: 31376890.Table.Changes in nodule characteristics with respect to treatment groups.csDMARDbDMARDsSOLID NODULESPre-treatmentTotal number of nodules, n7254Post-treatmentCompletely diminished, n514Regressed, n512Stable, n3320Enlarged, n234Cavitary transformation64De novo solid nodules267CAVITARY NODULESPre-treatmentTotal number of nodules1016Post-treatmentCompletely diminished, n01Regressed05Stable48Enlarged, n62Newly formed cavitary nodules69***number less than calculated due to cavitation,**de novo 5 nodules, 4 transformation from solid nodulesFigure.Nodule progression in a patient receiving rituximab (white arrow)Disclosure of Interests:None declared

Background:Systemic sclerosis (SSc) is a complex disease, characterized by multi-system organ involvement including interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). The decrease in physical activity in SSc patients with lung involvement has been demonstrated by self-reported physical capacity and 6 min-walking test (6MWT) (1, 2). Commercial smart bands can provide data on daily physical activity, sleep characteristics, blood oxygen concentration and heart rate measurement, therefore may aid in monitoring disease activity.Objectives:The aim of this study is to evaluate physical activity in SSc patients by using a commercial smart band and investigate its association with clinical characteristics and patient-reported outcome measures of disease activityMethods:This prospective observational study included SSc patients with having a smartphone. Patients characteristics including age, sex, and organ involvements were recorded. Each participant was subjected to pulmonary function tests and 6MWT. All of patients answered Scleroderma Health Assessment Questionnaire (SHAQ, consisting of HAQ-Disability Index (DI) and visual analog scales (VAS) domains). All patients received Fitbit inspire HR smart band® which records the number of steps, heart rate, distance and was instructed to wear it continuously for one week. Tracked data was collected from smartphones via Fitbit application.Results:Fifteen SSc patients (14 females and 1 male) participated in the study, 8 (53.3%) had limited SSc and 7 (46.7) had diffuse SSc. The mean age was 48.5±15.5 and the median disease duration was 4 (min-max:1-9) years. Eleven (73.3%) patients had ILD and one patient had PAH. Musculoskeletal complaints were evident in two patients. Forced vital capacity (FVC, % predicted), diffusion capacity of lung for carbon monoxide (DLCO, %) in patients with ILD were significantly lower than patients without ILD median (IQR) 102 (30) vs 80 (27) p= 0.026, 57 (20) vs 95 (13), p= 0.002, respectively. The median distance of 6MWTs were 450 (225) vs 568 (102) in ILD and non-ILD groups. The median total weekly step counts of ILD patients were remarkably lower in ILD patients compared to non-ILD 36.137 (17.879) vs 58.114 (80.681) steps/week, (p= 0.01). Patients with ILD had a bit higher median heart rate compared to non-ILD, 73 (9) vs 67.5 (12). The total weekly step counts were correlated with pulmonary function tests, including forced expiratory volume in one second (FEV1%) (r= 0.57, p= 0.025), FVC (%) (r= 0.65, p= 0.009), and DLCO (%) (r= 0.70, p= 0.005), patient-reported disease severity (r=-0.66, p= 0.007), and breathing problem (r= -0.55, p= 0.03) domains of SHAQ. There was no correlation between weekly step counts and 6MWTConclusion:The assessment of physical activity with smart activity bands may help to identify SSc patients with ILD. Tracked physical activity using smart bands correlates with pulmonary function tests and performs better than 6MWT, suggesting it as a useful tool for the assessment of disease activity.References:[1]Battaglia S, Bellia M, Serafino-Agrusa L, Giardina A, Messina M, Cannizzaro F, et al. Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement.Clin Respir J(2017) 11(1):36-42.[2]Mainguy V, Provencher S, Maltais F, Malenfant S, Saey D. Assessment of daily life physical activities in pulmonary arterial hypertension.PLoS One(2011) 6(11):e27993.Disclosure of Interests:None declared

Objectives Takayasu arteritis and Spondyloarthritis are two distinct inflammatory diseases that affect the same age periods. Increasing number of reports on co-incident Takayasu arteritis-spondyloarthritis cases in literature raised the hypotheses about their association. The purpose of this study is to evaluate the incidence of spondyloarthropathy spectrum diseases in Takayasu arteritis patients. Methods Detailed clinical and demographic features of Takayasu arteritis patients were recorded and all were screened meticulously for the presence of spondyloarthropathy features following recommendations of Assessment of SpondyloArthritis international Society. Patients were questioned for inflammatory back pain, enthesitis, uveitis, inflammatory bowel disease, peripheral arthritis, and investigated accordingly with HLA-B27, plain X-rays and sacroiliac magnetic resonance imaging. Results A total of 69 Takayasu arteritis patients (65 female, 94.2%) were enrolled. After detailed investigation, 14 (20.3%) Takayasu arteritis patients fulfilled the Assessment of SpondyloArthritis international Society criteria for Spondyloarthropathy. Two of 14 (14.2%) spondyloarthropathy patients were positive for HLA-B27. Type 1 and type 2 Takayasu arteritis were more common in patients with diagnosis of both Takayasu arteritis and spondyloarthropathy than those without spondyloarthropathy. Most of patients with diagnosis of both these diseases required biologic therapies than patients with diagnosis of Takayasu arteritis alone (64.3% vs 29.1%, P = 0.014) due to refractory Takayasu arteritis. Conclusion Our results suggest a significant association between Takayasu arteritis and spondyloarthropathy. Possible shared genetic or immunopathogenic processes may explain this association, which merits further investigations.

Background IL-1 blocking agents have been shown to be effective in the prevention of attacks in colchicine-resistant FMF (crFMF) patients by their regular use. However, their high cost, side effects and treatment incompliance limit their use which might be overwhelmed by on-demand use of them which has not been reported in FMF patients. Herein, we evaluated the efficacy of on demand use of anakinra in crFMF patients. Methods Data were derived from Gazi FMF cohort which was established in the year 2010. From that date patients with FMF who were diagnosed according to the Tel Hashomer criteria were registered. Co-morbidities, detailed attack characteristics, type, duration, severity, treatments, laboratory parameters and impact of FMF on their life in terms of quality of life and work productivity were recorded either by FMF diary or a mobile phone application (FMF AIDD free to download from AppStore and Android market). A retrospective cohort analysis was made from records of patients who have ever been treated with IL-1 inhibitors. Results A total of 60 patients were treated with anakinra in our cohort and 15 patients were identified who were received on demand anakinra protocol. Rationale for on demand use of anakinra was prominent prodrome or trigger for attacks and patients’ personal claim. Six patients were switched from regular use and 9 were directly started as on demand use. All were using background colchicine in maximum tolerated doses. None of patients had evidence of persistently elevated acute phase reactants or proteinuria. The median duration of on demand anakinra use was 6 (min 3- max 36) months. Pre- and post- on demand anakinra periods were compared (table 1). Patient reported attack severity (p=0.002), duration (p=0.001), absenteeism (p=0.001) and presenteeism (p=0.002) were significantly improved but C-reactive protein (CRP) remained in the same levels. On demand anakinra prevented progression of prodromes to full-blown attacks which was demonstrated by decrease in the rate of attack/prodrome ratio (p=0.002). On demand anakinra can be continued in 10 subjects on long-term but continuous treatment was required in 5 subjects. Attack frequency and work productivity parameters are adjusted for 3 months intervals. VAS: visual analogue scale, CRP: C-reactive protein, AIDAI: autoinflammatory disease activity index Conclusions On demand anakinra significantly improved FMF attacks which suggest this approach would be of benefit in daily practice in selected patients. Disclosure of Interest None declared

Background Sleep disturbance is one of the most important geriatric syndromes and its evaluation is part of the routine comprehensive geriatric assessment (CGA). Elderly patients with poor sleep quality are at risk of worse clinical outcomes such as falling, impairment of activities of daily living, depression and anxiety. Rheumatoid arthritis (RA) is an inflammatory disorder characterised by joint pain and may worsen sleep quality. Previous clinical trials in the literature have shown that elderly patients with RA have poorer sleep quality compared to younger patients. However, there is lack of data on sleep quality of elderly patients with RA. Objectives We aimed to investigate sleep quality of elderly patients with and without RA and also explore the effects of sleep quality on quality of life (QoL) and its association with disease activity. Methods This study was conducted in the Geriatric and Rheumatology outpatient clinics at a tertiary University Hospital. Fifty elderly RA patients diagnosed according to the ACR criteria and 30 age-matched controls without inflammatory arthritis were included in the study. All patients underwent CGA including evaluation of Basic Activities of Daily Living (ADL), Instrumental ADL, Yesavage Depression Scale (YDS), Mini-Mental State Examination, handgrip strength and Mini-Nutritional Assessment-Short Form. Sleep quality was assessed by Pittsburg Sleep Quality Index (PSQI), disease activity with Disease Activity Score 28 (DAS28-CRP) and QoL with RA QoL questionnaire (RAQoL). Results The median age was 70 years (min-max: 65–86) and 62.5% was female. Age, gender and co-morbidities, such as hypertension, coronary artery disease, osteoporosis, urinary incontinence, depression and chronic obstructive pulmonary disease, and comprehensive geriatric assessment parameters were similar between two groups. Diabetes mellitus frequency was higher in the control group compared to RA patients (43.3% vs. 22.0%, p=0.044). Median PSQI global score was higher in elderly patients with RA compared to controls [9 (min-max: 1–20) vs. 5 (min-max: 1–13), p=0.029), indicating poorer sleep quality. In elderly patients with RA, DAS28-CRP score significantly correlated with PSQI global (r=0.514, p Conclusions Our results suggest that elderly patients with RA may have poorer sleep quality compared to elderly control patients. Disease activity of RA had adverse effects on both sleep quality and QoL. In daily practice, when evaluating an elderly RA patient, sleep quality should also be assessed. Further studies are needed to investigate if management of sleep disturbances improve quality of life in elderly patients with RA. Disclosure of Interest None declared

BackgroundFamilial Mediterranean fever (FMF) patients suffer from chronic complications of disease such as AA amyloidosis, chronic arthritis, and spondylitis. Reduced quality of life (QoL) is a feature of chronic diseases but it is also impaired in patients with FMF. Despite the regular use of colchicine at a maximal dose, about 10% of patients do not respond well or resistant to colchicine (crFMF). IL-1 inhibitors have been shown to be effective in controlling attacks in crFMF patients. Herein, we aimed to investigate QoL changes of crFMF patients with IL-1 inhibitors.MethodsAll patients were prospectively monitored for the frequency, duration, severity of attacks, patient global assessments (Visual Analog Scale; VAS), and laboratory features. Either anakinra or canakinumab was used as IL-1 antagonist treatments. Demographic information, MEFV gene mutations, attack characteristics, and previous treatments were registered. Short form-36 (SF-36) quality of life scale was implemented by the interviewer for evaluating the QoL before and 3months after the treatment.ResultsA total of 44 patients were included in this study. Striking improvements were detected in frequency, duration, and VAS severity of attacks (p

Background Systemic lupus erythematosus (SLE) is a chronic connective tissue disease with involvement of various organ systems and characteristically has a higher incidence in women than men 1 . The disease, as well as its treatment, could have significant effects on the quality of life of lupus patients. Objectives Here, we aimed to investigate the impact of SLE on quality of the social and family life of women. Methods One hundred and twenty women diagnosed with SLE were included in the study. A questionnaire including questions about family and social relations were applied and demographic information, educational status, marital status, organ involvement and treatment data were obtained. The results of this study are preliminary and the study is still ongoing. Results One hundred and twenty patients were studied. The average age was 37 (± 10). 77 patients were married, 29 patients were single, 12 patients were divorced and 2 patients were widows. 29% of the patients were employed. 10,8% of the patients declared having difficulty in accepting their illnesses. 94,8% of the married patients had nuclear families. Relationship with partners and family members detoriated in 15,5% of the married patients after the diagnosis of SLE. 10,7% of single patients ended their serious relationships and 28,6% developed negative thoughts about marriage after the diagnosis of SLE. 17,6% of the married patients were exposed to verbal or physical violence by their partners. 33% of the patients declared having worse social life compared to prior to diagnosis and 20,7% declared having poor relations with their friends due to their disease. 34.5% of the patients stated that they received psychological counseling after their diagnosis. No significant relationship was found between family problems, social activities, age and educational level. Conclusions Systemic lupus erythematosus is a connective tissue disease affecting various organ systems and leading to various comorbidities. Our results suggest that family and social relations detoriate in lupus patients due to their illness independent of their age and educational level. Over one third of the patients received psychological counseling after diagnosis. Moreover, results of this study suggest that having a diagnosis of lupus has substantial impact on the marital considerations. References Hochberg, Marc C. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis & Rheumatology 40.9 (1997): 1725–1725. Disclosure of Interest None declared

AIM To evaluate the relationship between serum adenosine deaminase (ADA) levels and histological features in patients with autoimmune hepatitis (AIH). METHODS A total of 80 subjects (52 AIH cases and 28 healthy controls) were included in the study. Patients were diagnosed according to the simplified criteria suggested by the International Autoimmune Hepatitis Group. All of the cases had been diagnosed with AIH between 2010-2015 at Hacettepe University, Department of Gastroenterology. Serum blood samples were collected and stored at -80 °C until the biochemical estimation of ADA activity. The diagnosis of patients was confirmed by liver biopsy. Serum ADA > 20 U/L was considered to be high level. RESULTS Mean serum ADA levels were significantly higher in AIH patients than those in healthy controls (25.4 ± 9.6 U/L vs 12.8 ± 2.2 U/L, P < 0.001). Serum ADA levels > 20 U/L were found in 63.5% AIH patients and in 0% healthy controls (P < 0.001). Mean serum ADA levels were significantly increased in each stage of histological activity: 15.2 ± 3.5 U/L for patients with mild interface hepatitis, 23.1 ± 10.0 U/L for patients with moderate interface hepatitis and 30.9 ± 7.0 U/L for patients with severe interface hepatitis (P < 0.001). Correlation analysis showed that there was a positive association between serum ADA levels and histological activity (r = 0.71, P < 0.001). Receiver operating characteristic analysis suggested that 24.5 U/L was the optimum cut-off point of ADA level for severe interface hepatitis (sensitivity 88%, specificity 85.2%, area under the curve: 0.88). CONCLUSION Because of the positive correlation with inflammatory activity, serum ADA level may be a potential biomarker for predicting or monitoring histological activity in patients with AIH.

Diuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout. METHODS: This was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5 mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis.We included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = - 0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = - 0.47, p = 0.833). There was no association with febuxostat (beta = - 0.116, p = 0.514).Diuretics do not appear to have a significant impact on managing gout.