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To evaluate the choroidal and retinal layers with optical coherence tomography (OCT) and retinal microvascular structures with optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE) patients. In this prospective, cross-sectional and comparative study, a total of 35 SLE patients and 35 healthy control participants were included. SLE patients who were using hydroxychloroquine (HCQ) and/or immunosuppressive agents are evaluated with OCT and OCTA. SLE patients who have no HCQ maculopathy observed in OCT were included in the patient group. Mean macular thickness and ganglion cell inner plexiform layer (GC-IPL) thicknesses were thinner in the patient group. When the parameters obtained with OCTA were evaluated, vessel (VD) and perfusion density (PD) were significantly lower in the patient group. Central foveal thickness and foveal avascular zone parameters were negatively correlated. In addition, VD and PD, and GC-IPL thicknesses were positively correlated. Application of OCTA for the evaluation of microvasculature in SLE patients may be useful in subclinical changes.

Objective Sjogren syndrome is a systemic inflammatory disease causing gland dysfunction. Few (and contradictory) reports on the mucosal effects of Sjogren syndrome have appeared. Here, we objectively demonstrate nasal dryness in Sjogren syndrome patients and explore the effect of such dryness on olfaction. Methods Thirty-four consecutive patients with primary Sjogren syndrome were enrolled in this cross-sectional study. The control group consisted of 21 age- and sex-matched volunteers. Medical histories and nasal findings were recorded. The Connecticut Chemosensory Clinical Research Center test was used to evaluate olfactory function. All subjects underwent mucucociliary clearance analysis (the saccharin test and peak nasal inspiratory flowmetry). The intranasal Schirmer test was used to evaluate the nasal cavity. Results The nasal Schirmer test scores were 8.4 mm (right) and 8 mm (left) (P = .041, P = .016, respectively, compared to controls). The Chi-squared test revealed significant differences (compared to controls) in nasal dryness (P = .001), postnasal drip (P = .04), and smell (a decrease) (P = .005). Neither olfactory function nor mucociliary clearance differed between the groups. We noted a trend toward a positive correlation between olfactory function and the nasal Schirmer score but statistical significance was not attained. Conclusion The intranasal Schirmer test objectively showed that Sjogren syndrome patients exhibited nasal cavity dryness; this is useful in terms of follow-up. This did not affect olfactory function. Level of evidence 4 Laryngoscope, 131:370-373, 2021.

The aim of this study is to evaluate the retinal and choroidal structures in r- and nr-axSpA patients using spectral domain optical coherence tomography (SD-OCT) and to compare changes with healthy controls. In this cross-sectional study, 70 axSpA patients (50 radiographic- and 20 nr-axSpA) and 50 healthy control subjects were included. Choroidal thickness (ChT), macular thickness, retinal nerve fiber layer (RNFL), and the ganglion cell complex (GCC) were measured by SD-OCT. For ChT values, seven lines at nasal and temporal were drawn at 500-μm intervals, centering the subfoveal sclerochoroidal junction. Analysis of the data was performed with the SPSS program. Mann–Whitney U test was performed for comparison of non-normally distributed continuous data; Student’s t test was used for normal distributed data. No significant difference was observed between 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects (p 0.417). R-axSpA and nr-axSpA groups and control group were similar in terms of spherical equivalent, intraocular pressure, axial length, and body mass index (p 0.574, p 0.874, p 0.918, p 0.344, respectively). While mean macular and GCC thicknesses were significantly lower in the patient group than in the healthy group, there was no significant difference between the two groups in terms of RNFL thickness. The present study showed that there was no significant relationship between markers and scores indicating disease activity and ChT, MT, RNFL, and GCC thicknesses. However, an increase in choroidal thickness and involvement of the retinal layers has also been demonstrated in patients with spondyloarthritis. In addition, the relationship between disease activity and retinal layer involvement is remarkable in the r-axSpA group.

OBJECTIVE: To evaluate whether there is any difference between radiographic axial spondyloarthritis (r-axSpA), also termed ankylosing spondylitis (AS), and non-radiographic (nr-) axSpA, with respect to subclinial myocardial dysfunction using speckle tracking echocardiography (STE). METHODS: This was a cross-sectional case control study. We included 72 patients with AS, 38 patients with nr-axSpA, and 56 age-matched healthy subjects. Patients with cardiac disease and cardiac risk factors affecting STE were excluded. The disease burden evaluated by the BASDAI, BASFI, BAS-G, and ASAS-HI scores were comparable in both the r- and nr-axSpA groups. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population. RESULTS: Duration of the disease, the use of an anti-TNFα agent, and CRP levels were higher in patients with AS. Although the AS, nr-axSpA, and control groups had similar ejection fraction values (59±5.2, 60±4.6, 60±4.6, respectively, and p=0.499), the global longitudinal peak systolic strain (GLS) (20.5±3.3, 21.1±3.5, and 22.3±2.4, respectively, and p

Background This study aimed to examine fetomaternal outcomes in pregnant women in a large Turkish Takayasu arteritis (TAK) cohort and to evaluate the effects of pregnancy on the disease in those patients. Methods This is a cohort study involving 296 pregnancies of 112 TAK patients from 8 tertiary rheumatology centers in Turkey. Pregnancies were divided into 2 groups as pre-d (before disease onset) and post-d (after disease onset). In addition, post-d pregnancies were further divided into 2 subgroups according to fetomaternal complications (FMC) development status. Finally, patients were grouped into those with and without a history of pregnancy after disease onset. Results In post-d pregnancies, rates of worsening hypertension, new-onset hypertension, and preeclampsia were higher than in pre-d pregnancies (0.9% vs 16%, P < .001, 0.5% vs 5.3%, P = .012, and 0% vs 4%, P = .013, respectively). Patients with FMC were more likely to have renal artery involvement (65% vs 21%, P = .003). The patients who had post-d were younger, had longer disease duration, and had more relapses number than other patients (P < .001, P = .028, P = .016, respectively). Vasculitis Damage Index (VDI) results were similar in patients with or without post-d pregnancies. Conclusion Pregnancies after disease onset were found to be associated with HT and preeclampsia/eclampsia. HT-related FMCs are increased in TAK, and patients with renal artery involvement are at higher risk. The number of relapses increases in patients who become pregnant after disease onset, but pregnancy was not an independent risk factor for relapse. Pregnancy after the onset of disease had no negative effect on VDI.

Background: The characteristic lesion of pauci-immune glomerulonephritis is focal necrotizing and crescentic glomerulonephritis. The underlying mechanisms in the formation or progression of crescent formation need further investigations. Therefore, we aimed to evaluate the role of mammalian target of rapamycin (mTOR), which might be a potential therapeutic target, in kidney biopsies of patients with pauci-immune glomerulonephritis. Methods: The patients diagnosed as pauci-immune glomerulonephritis at an outpatient nephrology clinic were retrospectively reviewed and those patients who had a kidney biopsy before receiving an immunosuppressive treatment were included in the study. Kidney biopsy specimens were immunohistochemically stained with mTOR, antibodies of phosphatase and tensin homolog (PTEN) and transforming growth factor-β (TGF-β) and scored by an experienced renal pathologist. Results: In total, 54 patients with pauci-immune glomerulonephritis (28 [52%] female) were included. According to the histopathologic examination, 22% of our cases were classified as focal, 33% crescentic, 22% mixed, and 22% as sclerotic. The mTOR was expressed in substantial percentages of glomeruli of patients with pauci-immune glomerulonephritis. However, we observed PTEN expression in all samples and mTOR in all tubulointerstitial areas. mTOR expression was found to be related with the presence of crescentic and sclerotic changes observed in glomeruli and the degree of fibrosis in interstitial areas. Serum creatinine level or response to treatment was not found to be associated with mTOR pathway expression. Conclusion: Our results suggest that mTOR pathway may play role in the pathogenesis of pauci-immune glomerulonephritis, besides targeting this signaling may be an alternative option for those patients.

Objectives The aim was to compare the physical activity levels among radiographic axial spondyloarthritis (axSpA) patients, non-radiographic axSpA patients, and healthy controls and investigating the possible relationships between physical activity level and clinical features. Methods Thirty-four patients with radiographic axSpA (24 male), 33 patients with non-radiographic axSpA (23 male), and 35 age and sex-matched healthy controls (24 male) were included. The patients were assessed with Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, Ankylosing Spondylitis Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, Tampa Scale of Kinesiophobia. Physical activity was measured by using an accelerometer (Actigraph wGT3X-BT). Results Physical and disease-related characteristics were comparable between groups (p > .05). Radiographic axSpA patients showed lesser physical activity compared to non-radiographic axSpA patients and healthy controls (p .05). Physical activity levels were correlated with different clinical features for each sub-type of axSpA. Decreased spinal mobility is the most correlated disease characteristic with lower physical activity level for both sub-types. Conclusion It seems that disease sub-type in axSpA may alter the physical activity levels. Increasing physical activity levels might need different approaches for different sub-types of axSpA.

Background: the course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses. Objective: in this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs. Methods: between April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome. Results: 165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive. Conclusions: among IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome., NA

In patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and renal involvement, the development of end-stage renal disease (ESRD) remains an undesired issue. To date, reported predictors of renal outcome are mainly patients’ age, severe renal dysfunction and histopathological findings at presentation.1 2 Histopathological classification as defined by Berden et al was proposed to be helpful with the highest renal survival rates in the focal group and the poorest in the sclerotic group.3 4 Recently, Brix et al suggested the antineutrophil cytoplasmic antibody renal risk score (ARRS) to predict ESRD in patients with AAV.5 Unlike Berden's classification, ARRS combines histopathological findings (the percentage of normal glomeruli, tubular atrophy and interstitial fibrosis) with baseline glomerular filtration rate (GFR). Here, we aimed to assess the prognostic factors for renal survival and to evaluate the performances of Berden’s histopathological classification and ARRS for predicting ESRD. We reviewed the medical records of all patients diagnosed …

Background: Determining the level of physical activity (PA) is an essential part of patient evaluation in axial spondylarthritis (axSpA). Subjective and objective methods are both frequently used methods for evaluating PA. Although subjective methods are cost-effective and easy to use, their accuracy for measuring PA is still questionable. Objective: To investigate the concurrent criterion validity of a self-reported questionnaire (IPAQ-Short Form) when compared to an accelerometer (Actigraph wGT3X-BT) for measuring PA level in patients with axSpA. Design: Cross-sectional design. Methods: Fifty-eight patients with axSpA with a median age of 39.0 (IQR 25/75: 30.0/46.0) years were included in the study. An accelerometer (Actigraph wGT3X-BT) was attached to the waist of patients at their first visits and was removed at their second visits, seven days later. Patients were asked to complete the International Physical Activity Questionnaire Short Form (IPAQ) at their second visits. Results: No significant correlations were determined between IPAQ and accelerometer (p > 0.05), except for the moderate PA (rho: 0.367, p < 0.05), and total PA (rho: 0.330, p < 0.05). It was also observed that IPAQ was underestimating energy expenditure for all types of PA. Conclusion: IPAQ might not be a valid tool for measuring PA level in patients with axSpA. Disease-specific subjective methods for determining the PA should be developed and validated for those patients.

Splenic involvement is rarely reported in patients with ANCA-associated vasculitides (AAVs), particularly in those with granulomatosis with polyangiitis (GPA) and is in fact considered to be underestimated. We aimed to investigate the frequency of splenic lesions-mainly infarction-and related factors in patients with AAVs. Patients with AAV whose abdominal or thoracic computed tomographies (CTs) were performed at or after diagnosis were included in the study. CT images were examined for splenic lesions. Overall, 69 patients (median age at diagnosis 54 [IQR 24] years; 55% with GPA, 29% with microscopic polyangiitis, and 16% with renal-limited disease) were included in the analysis. Splenic pathologies were detected in 19 (28%) patients; 12/19 (63%) splenomegaly and 7/19 (37%) splenic infarction. All patients with splenic infarction exhibited GPA with PR3-ANCA-positive serology. Three of these seven patients had autosplenectomy. Patients with splenic infarction were younger at diagnosis (p = 0.018) with also significantly higher ear-nose-throat (ENT) (%100 vs 37; p = 0.002) and eye involvement (%50 vs %12; p = 0.044) than patients without splenic infarction. Splenic pathologies are not rare in AAVs. Furthermore, infarction can help separate GPA from MPA. In young patients with GPA, particularly those with ENT and eye involvements, physicians should consider splenic infarction.Key Points• Splenic infarction is more common than previously thought in ANCA-associated vasculitides, particularly in granulomatosis with polyangiitis.• Detecting splenic infarction can help differentiate granulomatosis with polyangiitis from other subgroups.

Background Management of enteropathic arthritis may be challenging due to differences in treatment response of inflammatory bowel diseases and arthritis to different therapeutic modalities, which may even cause worsening of some manifestations while improving others. Enteropathic arthritis was not addressed in the management recommendations for spondyloarthritis. Objectives The aim of this project was to develop a set of evidence based recommendations for the management of patients with enteropathic arthritis. Methods A task force was formed that included ten rheumatologists and 8 gastroenterologists. Research questions were determined using a Delphi approach. A systematic literature search, data extraction, and statistical analyses were performed according to a pre-specified protocol. Studies that assessed the efficacy of an intervention on inflammatory bowel disease related outcomes and/or spondyloarthritis relates outcomes in patients with enteropathic arthritis were included. Risk ratios were calculated for binary outcomes and mean difference for continuous outcomes, whenever possible. Results of the systematic literature review were presented to the experts and recommendations were formulated after thorough discussions and voting. Results A total of 4 overarching principles and 10 recommendations were formulated. The recommendations addressed the use of NSAIDs, corticosteroids, sulfasalazine and 5-ASA derivatives, TNF inhibitors, tofacitinib, secukinumab, ustekinumab and vedolizumab among patients with active inflammatory bowel disease, active arthritis, active disease regarding both inflammatory bowel disease and arthritis, and among patients in remission. Final voting showed good agreement among the group on all recommendations. Conclusion These recommendations are intended to help rheumatologists, gastroenterologists and other clinicians dealing with enteropathic arthritis and to point out to the shortcomings of the available data on the management of this challenging condition. Disclosure of Interests Gulen Hatemi Consultant for: Abbvie, Amgen, BMS, Janssen, MSD, Pfizer, UCB, Speakers bureau: Abbvie, Amgen, BMS, Jansen, MSD, Pfizer, UCB, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Hale Akpinar: None declared, Pamir Atagunduz: None declared, Goksel Bengi: None declared, Gercek Can: None declared, Aykut Ferhat Celik: None declared, Sinem Nihal Esatoglu: None declared, Onay Gercik: None declared, Hulya Hamzaoglu: None declared, Murat Inanc: None declared, Gokhan Kabacam: None declared, Ismail Hakki Kalkan: None declared, Levent Kilic: None declared, Fatos Onen: None declared, Ahmet Tezel: None declared, Murat Toruner: None declared, Sedat Kiraz: None declared

Background: Articular manifestations may differ in ulcerative colitis (UC) and Crohn’s disease (CD). Genetic and non-genetic factors like sex, smoking, and presence of HLA-B27 were previously shown to modify the expression of articular and other extraintestinal manifestations of IBD. Objectives: The aim of this study is to document disease features and factors affecting the expression of articular manifestations in Turkish patients with IBD-related (enteropathic) arthritis under treatment with disease modifying antirheumatic drugs (DMARDs). Methods: Data regarding enteropathic arthritis (EA) were collected from the TReasure database, a nation-wide multicenter observational registry of inflammatory arthritis patients. Results: Among 4066 patients with seronegative spondyloarthropaties (SpA), 156 (3.8%) had EA, not reflecting a true prevalence due to selection bias. Demographic and clinical features according to IBD groups were summarized in Table 1. Rates of presence of sacroiliitis were similar between patients with UC and CD (39.9% and 60.1%, p=0.086 respectively). Rates of HLA-B27 positivity were 31.6% and 7.1% in patients with and without radiographic sacroiliitis, respectively (p=0.101). Enthesitis, dactylitis, psoriasis, family history forSpA, ESR, CRP, BASDAI and aSDAS levels had similar distributions in patients with and without radiographic sacroiliitis. Rates of “never-smoked” (26.5% vs 64.7%) and “current smoking” (32.4% vs 17.6%) significantly differed in patients with and without sacroiliitis (overall p=0.012) Conclusion: Our data confirm an association between smoking status and disease manifestations, particularly radiographic sacroiliitis. References [1] Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol2009; 15: 2449-2455. Disclosure of interests: Orhan Kucuksahin: None declared, abdulsamet Erden: None declared, Ufuk Ilgen: None declared, Sedat Kiraz: None declared, ali Ihsan Ertenli: None declared, Nazife Sule Yasar Bilge: None declared, Timucin Kasifoglu: None declared, Ediz Dalkilic Grant/research support from: MSD and abbvie, Consultant for: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilufer alpay Kanitez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, abbvie,Celltrion, Novartis, Pamir atagunduz: None declared, Belkis Nihan Seniz: None declared, Burcu Yagiz: None declared, Suleyman Serdar Koca: None declared, Muhammet Cinar: None declared, askin ates: None declared, Servet akar Grant/research support from: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersozlu: None declared, Veli yazisiz: None declared, Gezmis Kimyon: None declared, Muge aydin: None declared, Ridvan Mercan: None declared, Burak Oz: None declared, Zeynel abidin akar: None declared, Omer Karadag: None declared, Bahar Kelesoglu: None declared, Sedat Yilmaz: None declared, Yavuz Pehlivan: None declared, Ender Terzioglu: None declared, Levent Kilic: None declared, Sukran Erten: None declared, Koray Tascilar: 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

Background: As a result of arterial ischemia, the frequencies of hypertension (HT), ischemic heart disease, congestive heart failure and atherosclerosis have been shown to increase and contribute to mortality in patients with Takayasu’s arteritis (TAK). Determining cardiovascular disease (CVD) and associated risk factors in TAK is important for a comprehensive treatment approach and better disease prognosis. Data about the effect of metabolic syndrome (MetS) which is known as a risk factor for CVD on TAK are limited. Objectives: The aim of this study was to determine the prevalence of MetS in patients with TAK and its effect on CVD and cumulative organ damage. Methods: A total of 122 TAK patients, followed by Turkish Takayasu Study Group in 7 tertiary Centers and diagnosed according to the 1990 ACR criteria were consecutively assessed for cumulative organ damage (VDI score), history of CVD and MetS as defined by the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III). CVD was defined as coronary artery disease or cerebrovascular event (myocardial infarction or stroke). Results: Eighty-seven percent of patients were female and the median age was 39 (17-65) years. The frequency of MetS was 14.7% and CVD was 13.1%. The median age, disease duration, smoking prevalence and CVD were found slightly higher in MetS group, without reaching statistical significance. There were no differences in VDI score between the groups (Table 1). Conclusion: MetS frequency in our TAK patients was observed to be less than the normal population data obtained from METSAR (Turkish MetS study in normal population) in Turkey (female: 39.6%, male: 28%). The discrepancy with SLE, which is another inflammatory autoimmune disease having a higher frequency of MetS related with organ damage, may be explained with the potentially more severe disease course in SLE patients requiring higher cumulative doses of glucocorticoids (1). Reference [1] Demir S, Artim-Esen B, Sahinkaya Y, Pehlivan O, Alpay-Kanitez N, Omma A, et al. Metabolic syndrome is not only a risk factor for cardiovascular diseases in systemic lupus erythematosus but is also associated with cumulative organ damage: a cross-sectional analysis of 311 patients. Lupus. 2016;25:177-84. Disclosure of Interests: Nilufer Alpay Kanitez: None declared, Sema Kaymaz Tahra: None declared, Ayten Yazici: None declared, Ayse Cefle: None declared, Mete Kara: None declared, Handan Yarkan-Tugsal: None declared, Onay Gercik: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Fatos Onen: None declared, Kenan Aksu: None declared, Gokhan Keser: None declared, Cemal Bes: None declared, Sevil Kamali: None declared, Fatma Alibaz-Oner: None declared, Haner Direskeneli: None declared

Background Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that mainly affects axial skeleton. Ocular inflammation is one of the most common extra-articular manifestations of axSpA, mainly form of acute anterior uveitis (AAU). However posterior segment of the eye was rarely evaluated. The inaccessibility of posterior structures like choroid and retina to direct examination led clinicians to use non-invasive imaging technics. Optical coherence tomography (OCT) is an imaging technology providing, high-resolution, and non-invasive cross-sectional view of microscopic, anterior and posterior ocular structures. Objectives To evaluate the retina and choroidal vascular structures in axSpA patients by using the advantage of OCT and to compare the changes (if any) with healthy control subjects. Methods In total 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic- and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects were included in the analysis. All patients underwent a detailed ophtalmalogic examination by the same opthtalmologist. All individuals with significant refractive errors (>3 diopters of spherical equivalent refraction) and intraocular pressure ≥21 mmHg were excluded from the analysis. Choroidal thicknes (ChT), macula, and the ganglion cell complex (GCC) were measured by spectral domain optic coherence tomography (SD-OCT) by the same experienced operator. Results Mean (± SD) BASDAI score was 3.6 ± 2.5, BASFI score was 3.4 ± 2.9, aSDAS-CRP was 2.6 ± 1.3 in axSpA patients and 14% of them has a history of aAU and 61% ever treated with TNFi agents. There was no significant difference between groups regarding refractive error (P=0.640), intraocular pressure (P=0.815) and BMI (P=0.124) that could affect the OCT measurements. ChT (P Conclusion Our results showed that beside anterior segment inflammation, posterior segment of the eye could be affected in both r- and nr-axSpA patients. Retina and choroidal vascular network forms the posterior segment of the eye. The thinning of GCC which form the inner neural layer of the retina is a good indicative of micro-neurotoxicity in axSpA. Elevation of the ChT may be an important indicator of inflammation. Acknowledgement None Disclosure of interests Berkay akmaz: None declared, Fahrettin akay: None declared, Dilek Solmaz: None declared, onay Gercik: None declared, Gokhan Kabadayi: None declared, Idil Kurut: None declared, Servet akar Grant/research support from: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Speakers bureau: Pfizer

Background IgG4-related disease is a recently recognised inflammatory disease of unkown etiology, often seen in men over the age of 50 and may affect many organs and systems with elevated serum IgG4 levels and typical histopathological features. Objectives The aim of this study is to determine the demographic and clinical characteristics of patients with IgG4-related disease. Methods Patients diagnosed as having Ig-G4-related disease by their typical histopathological findings and imaging features and/or increased serum IgG4 concentrations (> 135 mg/dl) from two university hospital in Izmir were included in the study. Results There were 53 patients with a mean age of 51.49 yrs (69.8% male). The most common involvement was retroperitoneal fibrosis (54.7%), followed by the cardiovascular system (CVS) involvement (45.3%) (Table 1). While 22 patients had at least two organ involvement, the most common association was retroperitoneal fibrosis and CVS involvement (15 patients). Serum IgG4 levels were studied in 36 patients (67.9%) and found to be higher levels in 20 patients. (55.5%) (Table 2). In 44 patients (83%), acute phase reactants (APRs) were increased at the time of the diagnosis. There was no correlation between the extent of the disease and serum IgG4 levels and initial erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) values. 28 patients (52.8%) were diagnosed by imaging, 9 (17%) by imaging and IgG4 elevation, 5 (9.4%) by imaging and histopathology, 10 (18.9%) by imaging, histopathology and IgG4 elevation and 1 patient (1.9%) by only histopathology. The most commonly (58.5%) used imaging method for diagnosis was computed tomography (CT). All the patients used initial glucocorticoid treatment.4 patients (7.5%) recieved only glucocorticoid,others were underwent the following treatments combined with glucocorticoid: azathioprine (AZA) (60.4%); methotrexate (mtx) (11.3%), rituximab (RTX) + AZA (9.4%), mtx + AZA (5.7%), RTX (3.8%) and infliximab (1.9%). In the follow-up, a significant decrease in acute phase reactants was found in 62% of the patients at their last visits. While 27.3% of the patients had complete remission, 36.4% had partial remission, 20.5% had stable course, 13.6% had progression in the disease and 2.3% had recurrence. In 18 patients (64.3%) out of 28 patients who were in partial or complete remission, remission was achieved by using glucocorticoid and AZA combination treatment. Conclusion In conclusion, we have described a considerably large serie of patients with IgG4-related disease from Turkey. The results of the study suggested that AZA and glucocorticoid combination treatment was commonly used in Turkish patients with IgG4-related disease and it might be a good treatment option to achieve remission. References [1] Terumi Kamisawaet al; IgG4-related disease, Lancet2015; 385: 1460–71 Disclosure of Interests Aydan Koken Avsar: None declared, Onay Gercik: None declared, Gercek Can: None declared, Berrin Zengin: None declared, Sinem Burcu Kocaer: None declared, Atilla Okan Kilic: None declared, Sadettin Uslu: None declared, Ali Karakas: None declared, Merih Birlik: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Fatos Onen: None declared

Background: In rheumatoid arthritis (RA), biologic DMARDs are important treatment options in resistant patients. Inefficacy or side effects may cause switching between these drugs. Objectives: This study aimed to determine features of patients switching from one biologic DMARD to another in RA treatment and to investigate associated reasons for switching. Methods: This multicenter, prospective observational cohort study used the TReasure database in which web-based registration of RA and spondyloarthritis patients are being performed in 15 centers across different regions of Turkey. In this study, data of RA patients switching from one biologic agent to another were analyzed. Demographic and clinical data, follow-up duration, time to switch, and reasons for switching were retrieved from the database. Results: Of the included 2115 RA patients, 829 (39.2%) switched between biologic agents (switched group) and 1286 (60.8%) continued to receive their current therapies (continued group). The median follow-up duration of all patients was 3.7 years and the median time to switch was 1.1 years. In the switched group, the proportion of females and the median HAQ-DI score were higher as well as disease duration was longer (Table 1). Among the biologic agents used at first, 60.9% of the patients were receiving an anti-TNF agent and 39.1% of the patients were receiving other biologic agents (Table 2, figure 1). In the switched group (n=829), the main reasons for switching were secondary inefficacy (n=269), primary inefficacy (n=238), and side effects (n=178) followed by primary or secondary unknown inefficacy (n=30), patient’s demand (n=21), physician’s request (n=16), willing to be pregnant (n=7), other (n=31), and unknown (n=54). Conclusion: The patients in the Treasure database were followed-up approximately 4 years and about one-third of the patients had to switch from one biologic DMARD to another. The main reasons for this switching were primary (29.2%) and secondary (33.0%) inefficacy and 20% of the patients had to switch due to side effects. According to the switching pattern, about half of the patients using an anti-TNF agent at first switched to another anti-TNF agent and the other half switched to other biologic agents. Disclosure of Interests: 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, Ali Ihsan Ertenli: None declared, Abdulsamet Erden: None declared, Orhan Kucuksahin: None declared, Timucin Kasifoglu: None declared, Ediz Dalkilic Grant/research support from: MSD and Abbvie, Consultant for: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilufer Alpay Kanitez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, Abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, Abbvie,Celltrion, Novartis, Pamir Atagunduz: None declared, Belkis Nihan Coskun: None declared, Burcu Yagiz: None declared, Suleyman Serdar Koca: None declared, Muhammet Cinar: None declared, Askin Ates: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersozlu: None declared, Veli Yazisiz: None declared, Gezmis Kimyon: None declared, Muge Aydin: None declared, Ridvan Mercan: None declared, Burak Oz: None declared, Nazife Sule Yasar Bilge: None declared, Zeynel Abidin Akar: None declared, Omer Karadag: None declared, Ayse Bahar Kelesoglu Dincer: None declared, Sedat Yilmaz: None declared, Ufuk Ilgen: None declared, Yavuz Pehlivan: None declared, Ender Terzioglu: None declared, Levent Kilic: None declared, Sukran Erten: None declared, Sedat Kiraz: None declared

Background Overall mortality in ANCA-associated vasculitis (AAV) over the last two decades has been reported to be decreasing with the use of immunosuppressive therapies. However, mortality rates remain high and most of the deaths occur in the first year after diagnosis despite treatment. Objectives In this study, we aimed to determine the prevalence of mortality in our AAV patients and to investigate the factors that may be associated with first-year and overall mortality. Methods Patients followed up in one center with the diagnosis of AAV were included in the study. Diagnostic subgroups were; granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), and renal-limited vasculitis (RLV). The clinical and demographic characteristics of the patients were collected retrospectively. Factors predictive of mortality were evaluated by Kaplan-Meier method and the Cox proportional hazard model. Results In total 104 (45 [43%] female and mean age 54.9 ± 15.4 years) AAV patients (51 GPA; 25 MPA; 27 RLV and 1 EGPA) were included in the analysis. ANCA positivity was detected in 81 (77.9%) patients with IIF and/or ELISA. ESRD had developed in 31 (32.3%) of AAV patients and in 37.8% of patients with renal involvement. Mortality rate was 14.4% in the first year after diagnosis and 27.9% during a median follow-up period of 1289 (5-5804) days. The age at diagnosis was the only significant predictor of first-year mortality (p=0.006). Univariate analysis revealed that overall mortality was associated with AAV subgroups (p = 0.035), renal (p = 0.046) (figure) and, ENT (ear-throat) involvement (p = 0.025), ESRD (p = 0.025) and hemodialysis at the time of diagnosis (p = 0.040). However Cox regression analysis showed age at diagnosis as the only significant predictor also of the overall mortality (P=0,001). Conclusion Our findings suggest that there could be some survival differences between AAV subgroups and patients with or without renal and ENT involvement. However, the age at diagnosis seems to be the only significant predictor of first-year and overall mortality in our AAV patients. *AAV: ANCA-Associated Vasculitis; GPA: Granulomatosis with PolyAngiitis; MPA: Microscopic PolyAngiitis; RLV: Renal Limited Vasculitis Disclosure of Interests Onay Gercik: None declared, Zeki Soypacaci: None declared, Fulya Cakalagaoglu: None declared, Gokhan Kabadayi: None declared, Idil Kurut: None declared, Dilek Solmaz: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer

Background Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a systemic necrotizing vasculitis of small and medium-sized arteries. Although, upper and lower respiratory tracts and kidneys are predominantly affected; other organs/systems can also be involved in the course of the disease and in some cases, it might be difficult to differentiate subgroups based on the clinical presentation. Splenic involvement has been rarely reported, mainly in patients with granulomatosis with polyangiitis (GPA), in fact, it was thought to be underestimated, as it is often asymptomatic. Objectives In this study, we aimed to investigate systematically the frequency of splenic infarct and related factors in our AAV patients. We also evaluated the role of splenic involvement in the differentiation of AAV subgroups. Methods Patients with a diagnosis of AAV in whom abdomen/thorax computed tomography (CT) was performed were included in the study. An experienced radiologist examined CT images for the presence of splenic involvement. The clinical and demographic data were retrospectively collected. Results In total 70 (30 [43%] female and mean age 56.1 ± 15.7 years) AAV patients (38 [54%] had granulomatosis with polyangiitis (GPA); 20 [29%] microscopic polyangiitis; 11 [16%] renal-limited disease and 1 [1%] eosinophilic granulomatosis with polyangiitis) were included in the analysis. Splenic pathologies including splenomegaly, hypodense lesion/s, lobulation, and infarction were seen in 21 (30%) patients with AAV. Splenic infarct was observed in seven (10%) patients and all had GPA with renal involvement and PR3ANCA positive. Three of them had total splenic infarct or auto-splenectomy. None of these patients had a history of endocarditis, shock or malignancy before CT. Splenic infarction was found to be negatively correlated with age at diagnosis (p=0.017; rho=-0.285), and positively associated with ENT (ear-nose-throat) (p= 0.002; rho=0,370) and eye involvements (p=0.013; rho=0,324). Conclusion Our results show that splenic pathologies might not be rare in AAV however, infarction can help to separate GPA from other AAVs. In young GPA patients, in particular, those with ENT and eye involvement, physicians should remember splenic infarction. Since almost half of our cases had severe infarction or autosplenectomy, clinicians might consider immunization in GPA patients for vaccine-preventable infections. References [1] Fishman D, Isenberg DA. Splenic involvement in rheumatic diseases. Semin Arthritis Rheum. 1997;27(3):141-55 [2] Ghinoi A, Pipitone N, Cavazza A, Boiardi L, Salvarani C. Wegener granulomatosis with spleen infarction: case report and review of the literature. Semin Arthritis Rheum. 2008;37(5):328-33 Disclosure of Interests Onay Gercik: None declared, Sebnem Karasu: None declared, Dilek Solmaz: None declared, Zeki Soypacaci: None declared, Fulya Cakalagaoglu: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer

Background Takayasu’ arteritis (TAK) is a rare vasculitis characterized by inflammation and obliteration of intermediate to large-size arteries. Even though more than 50% of patients with TAK have pulmonary artery involvement, non-vascular involvement and symptoms are uncommon. Objectives We aimed to investigate the frequency of non-vascular pulmonary involvement in TAK. Methods We assembled a retrospective cohort of patients with TAK from six different centers in Turkey. The demographics, clinical characteristics, treatment and outcomes of patients were abstracted from medical records, and the computed tomography findings were evaluated for pulmonary manifestations. Results As of January 2019, 197 TAK patients were recruited (mean age: 42.7±13.9 years [min-max: 17-75]) to the cohort, and 88.3% of them were female. Twenty-four patients had cough and/or dyspnea and four had hemoptysis as pulmonary symptoms. In CT assessment, parenchymal infiltrations were present in four (2%), pleural effusion in five (2.5%), nodule/cavity in one (0.5%), and pulmonary hemorrhage in one patient (0.5%). The patient who had pulmonary hemorrhage had also pleural effusion at the same time. In the whole cohort, 11.2% of patients (n=22) had pulmonary hypertension (PAH), three of them had cough and/or dyspnea and four of them had hemoptysis as a pulmonary symptom. Among patients with PAH, any pulmonary involvement in CT was more frequent compared to the rest of the patients (22.7% vs 5.1%, p Conclusion In this first assessment of Turkish TAK cohort, we observed non-vascular pulmonary involvement in about 5% of our patients and half of them were pleural effusions. The second most common manifestation was parenchymal infiltration with a frequency of 2%. Although rare, non-vascular pulmonary manifestations should also be investigated in TAK patients, especially in patients with pulmonary hypertension. References [1] Nakajima N. Takayasu Arteritis: Consideration of pulmonary involvement. Ann Vasc Dis2008;1(1):7-10. [2] Elsasser S, Soler M, Bollinger CT, et al. Takayasu disease with predominant pulmonary involvement. Respiration2000;67(2):213-5. Disclosure of Interests Ayten Yazici: None declared, Ayse Cefle: None declared, Sema Kaymaz Tahra: None declared, Nilufer Alpay Kanitez: None declared, Mete Kara: None declared, Onay Gercik: None declared, Handan Yarkan Tugsal: None declared, Fatos Onen: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Kenan Aksu: None declared, Gokhan Keser: None declared, Fatma Alibaz-Oner: None declared, Haner Direskeneli: None declared

Background In spondyloarthritis (SpA), biologic DMARDs are important treatment options in resistant patients. Inefficacy or side effects may cause switching between these drugs. Objectives This study aimed to determine features of patients switching from one biologic agent to another in SpA treatment and to investigate associated reasons. 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 15 centers across different regions of Turkey. In this study, data of SpA patients switching from one biologic agent to another were analyzed. Demographic and clinical data, follow-up duration, time to switch, and reasons for switching were retrieved from the database. Kaplan-Meier analysis was performed to show drug retention rates and Cox regression analysis was performed to investigate the factors affecting switching. Results Of the included 3138 SpA patients, 1165 (37.1%) switched to another biologic agent (switched group) and 1973 (62.9%) continued to receive their current therapies (continued group). The median follow-up duration of all patients was 3.8 years and the median time to switch was 1.0 years (0-13.4 years). According to the distribution of comorbidities, the rates of patients having diabetes mellitus, hyperlipidemia, asthma, gastrointestinal bleeding, and cancer were significantly higher in the switched group than those of in the continued group (8.4% vs. 5.8%, p=0.006; 14.5% vs. 9.2%, p In the switched group (n=1165), the main reasons for switching were secondary inefficacy (n=351), primary inefficacy (n=328), and side effects (n=267) followed by primary or secondary unknown inefficacy (n=57), physician’s request (n=45), patient’s demand (n=36), willing to be pregnant (n=9), other (n=37), and unknown (n=70). Conclusion In SpA patients, switching was frequent between anti-TNF agents and the median time to first switch was 1 year. Female gender, short disease duration, and lower BASDAI score were found to be the significant factors affecting switching from the anti-TNF agent used at first. The main reasons for this switching were primary (29.0%) and secondary (31.0%) inefficacy followed by side effects (23.6%). Switching between subcutaneous anti-TNF agents is generally less than switching from infliximab to another biologic agent. Disclosure of Interests 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, Sedat Kiraz: None declared, Abdulsamet Erden: None declared, Orhan Kucuksahin: None declared, Timucin Kasifoglu: None declared, Ediz Dalkilic Grant/research support from: MSD and Abbvie, Consultant for: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilufer Alpay Kanitez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, Abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, Abbvie,Celltrion, Novartis, Pamir Atagunduz: None declared, Belkis Nihan Coskun: None declared, Burcu Yagiz: None declared, Suleyman Serdar Koca: None declared, Muhammet Cinar: None declared, Askin Ates: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersozlu: None declared, Veli Yazisiz: None declared, Gezmis Kimyon: None declared, Muge Aydin: None declared, Ridvan Mercan: None declared, Burak Oz: None declared, Nazife Sule Yasar Bilge: None declared, Zeynel Abidin Akar: None declared, Omer Karadag: None declared, Ayse Bahar Kelesoglu Dincer: None declared, Sedat Yilmaz: None declared, Ufuk Ilgen: None declared, Yavuz Pehlivan: None declared, Ender Terzioglu: None declared, Levent Kilic: None declared, Sukran Erten: None declared, Ali Ihsan Ertenli: None declared

The mechanisms underlying new bone formation in individuals with axial spondyloarthritis (axSpA) remain unclear; however, low levels of sclerostin (SOST) may be associated with development of syndesmophytes in those with ankylosing spondylitis (AS). Expression of fibroblast growth factor-23 (FGF-23), another osteocyte factor, is high in those with osteoporosis and chronic renal failure, but levels in those with axSpA are unknown. To evaluate serum FGF-23 and SOST levels in axSpA patients, and to assess their relationship with inflammation and structural damage. In total, 109 axSpA patients (55 with AS and 54 with non-radiographic axSpA) and 57 healthy control (HC) subjects were included in the analysis. Serum concentrations of FGF-23 and SOST were measured and correlation analysis was performed. The presence of syndesmophytes and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) were used to assess structural damage. Levels of serum FGF-23 in axSpA patients were significantly higher than those in HCs [median (interquartile range—IQR) FGF-23 level, pg/ml; AxSpA = 144 (82.3–253.2), HC = 107 (63.3–192.8), p = 0.010]; however, there was no difference in SOST levels. FGF-23 levels correlated with the erythrocyte sedimentation rate (ESR) (r = 0.265, p = 0.006) and serum C-reactive protein (CRP) level (r = 0.229, p = 0.010). In the axSpA, SOST levels correlated negatively with mSASSS (r = − 0.283, p = 0.007), whereas those in the AS group correlated negatively with CRP (r = − 0.426, p = 0.001). Serum FGF-23 levels were high in axSpA patients. Increased FGF-23 was associated with inflammation, but not with SOST levels or disease activity. SOST correlated negatively with both inflammation and structural damage.

Cytomegalovirus infection, which can occur as a result of reactivation due to immunosuppressive treatment in patients with granulomatosis with polyangiitis, is a serious condition that should be kept in mind because of its fatal course. In this article, we report a 49-year-old male patient with a diagnosis of granulomatosis with polyangiitis who developed a life-threatening colonic ulcer due to cytomegalovirus colitis and a shrunken spleen with irregular contours that was detected on abdominal computed tomography. This is a rare case of cytomegalovirus disease in a patient with granulomatosis with polyangiitis and splenic necrosis.

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting sacroiliac joints and spine as well as peripheral joints and entheses. Tumour necrosis factor inhibitors (TNFi) are widely used in patients with persistently high disease activity despite non-steroidal anti-inflammatory drugs. Some patients fail to respond or loose responsiveness during therapy with TNFi. The development of anti-drug antibodies (ADA) might play a role in non-response or some adverse events. However it has never been evaluated for 2-years period.Objectives:Therefore, the aim of the present study was to evaluate the development of ADA against TNFi longitudinally during 2-years period in axSpA patients and factors associated with it.Methods:In total 180 axSpA patients according to ASAS classification criteria with a new TNFi prescription in the last two weeks period were included in this observational study. Clinical data and serum samples were collected at baseline and at every 12 weeks. Serum drug levels and ADAs were measured on 12, 24, 52 and 104 weeks of treatment by ELISA in one center to avoid inter-assay variability. The development of ADA over time was investigated by using generalized estimating equations (GEE) which is a technique for longitudinal data analysis allowing the use of all available data even deviated from normality.Results:180 biologic naive axSpA patients (116 male, median [IQR] 44,5 [14,5] years) who started anti-TNF agents (infliximab [20%], adalimumab [27,2%], etanercept [32,2%] and golimumab [20,6%]) were included in the analysis. In comparison to baseline values BASDAI, ASDAS-CRP and CRP values were significantly decreased in third months of follow-up (Figure 1). In total 172 patients had at 12 weeks, 154 at 24, 121 at 52, and 73 at 104 week serum samples available for ADA determination. In longitudinal analysis; baseline age and TNFi type, as well as longitudinal BASDAI, ASDAS, serum CRP levels and the development of adverse events and discontinuation of the drug were found to be associated with the development of ADA. In order to determine independent association/s with the development of ADA two longitudinal multivariable models were run; (a) with ASDAS as an activity measure, (b) with BASDAI and CRP levels and produced that all the variables were independently associated with longitudinally development of anti-drug antibodies (Table 1). Antibodies to adalimumab were related with lower serum drug levels.Conclusion:The results of the present study with up to 2 years of follow-up, revealed that the development of ADA against TNFi therapy is associated with high disease activity, the development of adverse events and treatment discontinuation in patients with axSpA. And etanercept might be negatively associated with the development of ADA.Table 1.Factors associated with the development of anti-drug antibodiesModel 1Model 2B95% CIPB95% CIPAge years-0.061-0.109;-0.0120.015-0.058-0.107;-0.0100.018TNFi Treatment ETN-1.981-4.369; -0.1340.104-2.475-4.791; -0.0760.036 ADA1.438-0.002; 0.4070.0731.275-0.119; -0.1600.064 INF1.5503.010; 3.1020.0501.2552.666; 2.6290.073 GOL0a0aPresence of advers event, no-0.824-1.451; -.01980.010-0.835-1.461; -0.2080.009TNF treatment discontinuation1.2890.043;2.5340.0431.248-0.075; 2.5710.065BASDAI0.0350.015; 0.0550.001CRP0.020-0.035; 0.0050.008ASDAS-CRP0.8520.466; 1.2380.0000a:set to zero because this parameter is redundant.Figure 1.Mean change in disease activity and CRP levels during follow-up duration. (P values for 3rd months BASDAIDisclosure of Interests:None declared

Background:Systemic sclerosis (SSc) is characterized by fibrosis of the skin, internal organs and vasculopathy. Invivo, the retina provides a unique opportunity to assess the microcirculation in the eye. Previous studies have been evaluated the changes in the retinal and choroid layer and showed thinning of the choroid layer and reduced retinal microvascular density.Objectives:To analysis the retinal and optic disc capillary network in patients with SSc without clinical signs of retinal involvement by using optical coherence tomography angiography (OCTA).Methods:In total 40 SSc patients who classified according to the ACR/EULAR criteria and 40 healthy control subjects were included in the analysis. All patients underwent a detailed ophthalmologic examination by the same ophthalmologist. After pupil dilatation, macular angiography was performed with 6x6 mm area scanning using standardized system and images of the retinal capillary plexus were analyzed by Cirrus OCTA software. Mean macular thickness, retinal nerve fiber layer (RNFL) and the Ganglion cell inner plexiform layer (GC-IPL), vessel density (VD), perfusion density (PD), optic disc PD, reflux index and foveal avascular zone (FAZ) parameters were measured by the same experienced operator.Results:There was no significant difference between SSc and controls in terms of age, sex, spherical equivalent (SE), intra ocular pressure (IOP), and axial length (AL). Central and mean macular thickness, nasal and inferior RNFL thicknesses were significantly thinner in SSc patients (Table). Additionally GC complex thicknesses were significantly thinner in all quadrants compared to controls.Central vessel density (CVD) and central perfusion density (CPD) values were found significantly decreased in all regions in patients with SSc. Optic disc perfusion density values were also decreased in SSc group. An inverse correlation was found between central macular thickness, FAZ area and perimeter values (rho:-0.300, p:0.007; rho:-0.276, p:0.013, respectively).There was no relationship between the disease duration and the OCTA measures.Conclusion:Vascular and perfusion density were found decreased in patient with SSC at the results of OCTA measures. These findings may help to understand vasculopathy in the pathogenesis of the disease and OCTA may be a new method providing objective and non-invasive information about capillary network in SSc.TableDemographic and ocular parameters of study populationParametersSSc(n = 40)Control(n = 40)pAge, years; mean (SD)47.2 (8.6)47.5 (8.1)0.631Male sex, n (%)24(60)16 (40)0.087Disease duration, months; mean (SD)81.3 (38.0)N/A-Foveal MT(µ)246.3 ± 19.4252.6 ± 15,30.033Average MT(µ)280.8 ± 12,4286.5± 8.70.008Vessel density (mm-1), 6 mm total area; mean (SD)17.60 ± 1.3118.66 ± 0.640.006Perfusion density, 6 mm total area; mean (SD)43.25 ± 3.3245.94 ± 1.520.002Circularity index; mean (SD)0.72 ±0.090.73 ± 0.060.049RNFL nasal (µ); mean (SD)74.37±12.3674.05±8.480.011RNFL inferior (µ); mean (SD)122.62±17.87127.40±12.630.023Inferior nasal GCC(µ); mean (SD)85.72 ± 8.5385.82 ± 4.840.001Inferior temporal GCC(µ); mean (SD)82.70 ± 8.6284.95 ± 4.150.001Superior nasal GCC(µ); mean (SD)86.35 ± 7.7386.8 ± 5.700.012Superior temporal GCC(µ); mean (SD)47.2 (8.6)47.5 (8.1)0.631MT: Maculer thickness; RNFL: Retinal nerve fiber layer; GCC: Ganglion cell complexDisclosure of Interests:None declared

Background:It is known that cardiovascular disease risk is increased in chronic inflammatory diseases. Additionally, regular exercise is one of the main components of the management of patients with axial spondyloarthritis (axSpA). However, it was reported that axSpA patients do not meet recommended physical activity levels. It is still unknown, whether the disease subgroups of axSpA play a role in participating in physical activity.Objectives:To compare the physical activity levels among radiographic, non-radiographic axSpA patients, and healthy controls.Methods:Thirty-three patients with radiographic axSpA (23 [70%] male), 33 patients with non-radiographic axSpA (23 [70%] male) and 33 age and sex matched healthy controls (23 male [70%]) were included in the study. axSpA patients were assessed regarding to disease activity (Bath Ankylosing Spondylitis Disease Activity Index; BASDAI), functional status (Bath Ankylosing Spondylitis Functional Index; BASFI), spinal mobility (Bath Ankylosing Spondylitis Metrology Index; BASMI). Physical activity level of all subjects was measured by using an accelerometer (Actigraph wGT3X-BT) which was worn on the waist for seven consecutive days.Results:The groups were similar in terms of physical characteristics (age and body mass index) (p>0.05). Disease related characteristics (BASMI, BASFI, BASDAI) were comparable between radiographic and non-radiographic axSpA patients (p>0.05). Radiographic axSpA patients showed lesser physical activity compared to non-radiographic axSpA patients and healthy controls (p0.05).Table 1.Comparison of GroupsRadiographic axSpA (n: 33)Median (IQR 25/75)Non-radiographic axSpA (n: 33)Median (IQR 25/75)Healthy Controls (n:33)Median (IQR 25/75)pPhysical CharacteristicsAge (years)41.0 (32.0/46.0)37.0 (32.0/40.0)33.0 (28.0/41.0)0.093*BMI (kg/m2)26.0 (22.9/29.6)26.3 (25.4/28.7)24.8 (22.3/26.9)0.064*Disease Related CharacteristicsBASMI (score)2.1 (1.5/3.9)1.5 (1.1/2.0)NA0.051**BASFI (score)2.4 (0.7/3.9)1.2 (0.6/2.9)NA0.267**BASDAI (score)3.6 (1.6/5.8)2.4 (1.4/5.4)NA0.519**Physical Activity LevelLight Physical Activity(min)2198.0 (1377.0/2658.0)2576.0#(1858.0/3690,0)2200.0 (1846.0/2762.0)0.015*Medium Physical Activity (min)188.0(109.0/304.0)264.0(216.0/446.0)363.0(267.0/491.0)##pVigorous Physical Activity (min)0.0(0.0/0.1)2.0(0.0/12.0)4.0(0.0/19.0)##0.009*Total Step Count (n)42481.0 (33651.0/57047.0)62872.0(53075.0/80160.0)#69710.0 (59943.0/85894.0)##p*Kruskal-Wallis Test, **Mann-Whitney U Test,#: difference between radiographic axSpA and non-radiographic axSpA,##: difference between radiographic axSpA and healthy controls, IQR 25/75: Interquartile range 25/75, BMI: Body Mass Index, BASMI: Bath Ankylosing Spondylitis Metrology Index, BASFI: Bath Ankylosing Spondylitis Functional Index, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, NA: Not Applicable, pConclusion:The results of the present study suggest that radiographic damage in axSpA may alter the physical activity levels. Every effort should be taken to increase physical activity levels in axSpA patients, especially in radiographic cases.Acknowledgments:This project was supported by Izmir Katip Celebi University Scientific Research Projects Coordinatorship.Disclosure of Interests:None declared

Background:One of the controversial matters in ANCA associated vasculitis is the definition of disease based on clinical characteristics since there is remarkable overlap between disease groups. For instance, single organ disease like renal limited vasculitis (RLV) is not take place most of the definitions or classification criteria.Objectives:The aim of this study to determine clinical subgroups that may incorporate different clinical phenotypes including RLV in AAV patients followed up in two tertiary centers.Methods:Baseline clinical features of AAV patients were studied. To analyse our data and identify sub-groups of AAV patients with similar clinical characteristics, a two-step cluster analysis using log-likelihood distance measures was performed. For clustering we evaluated the following variables: gender, age at symptom onset, the presence of major organ involvement (renal, upper and lower respiratory tract, skin, joint, eye) and ANCA specificity.Results:In total 165 (87 [53%] male, age at diagnosis 51.6± 15.2 years) out of 238 (126 [53%] male, age at diagnosis 51.3± 15.6 years) AAV patients included in the analysis. Some of the demographic and clinical characteristics were summarized in the table 1. There are two distinct cluster in AAV patients. Of 78% those AAV patients with MPO/pANCA, 56% with renal involvement and 89% without ENT involvement were in Cluster 1. Of 77% those patients with PR3/cANCA, 89% with arthritis, 74% with eye involvement, 83% with skin, 91% with upper, and 60% with lower respiratory tract involvement and 92% of those without renal disease were in Cluster 2. Most of the (89%) patients classified as MPA and all as RLV were repositioned in Cluster 1 and 74% of GPA and 64% of EGPA patients were in Cluster 2.Table 1.Baseline characteristics of 165patients with AAVAge at diagnosis, mean years ± SD, (n)51.6 ±15.2, 163Male, n (%)87 (52.7)Labaratory results at diagnosisGFR =100/145 (69)MPO-ANCA or p-ANCA /Pr3-ANCA or c-ANCA68 (41.2)/ 97 (58.8)Variants of AAVn (%)MPA26(15.8)GPA108 (65.5)EGPA11 (6.7)RLV20 (12.1)Organ systems involved at diagnosis n (%)Cutaneous24 (14.5)Eye23 (13.9)Ear, nose and throat90 (54.5)Low respiratory tract111 (67.3)Cardiovascular system5/163 (3.1)Gastrointestinal system10/164 (6.1)Renal129 (78.2)Peripheral nervous system16 (9.7)GFR: glomeruler filtration rate; ANCA: antineutrophil cytoplasmic antibodies; Pr3: proteinase 3; MPO: myeloperoxidase; p-ANCA: perinuclear ANCA; c-ANCA: cytoplasmic ANCA; MPA: Microscopic Polyangiitis; GPA: Granulamatosis and Polyangiitis; EGPA:Eosinophilic Granulomatosis with Polyangiitis; RLV: Renal limited vasculitisConclusion:Patients with AAV could be separated into two distinct categories. PR3 ANCA specificity and more organ/system involvement determine one and MPO ANCA specificity in renal disease define other subgroup.Figure. Determining characteristics of ANCA associated vasculitis clustersFigure.Disclosure of Interests:None declared

Background:Patients with inflammatory arthritis have increased risk of infections which may lead to morbidity and mortality. Some of those infections could be prevented by vaccination.Objectives:The main objectives of the present study were to investigate (a) the uptake rate of influenza and pneumococcal vaccination among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) attending a rheumatology outpatient clinic, (b) the factors associated with their vaccination rate and, (c) the attitudes of Turkish rheumatologists about vaccination.Methods:Patients, followed-up in a tertiary rheumatology outpatient clinic with the diagnosis of RA and SpA, volunteered for participating to study, were included in this cross-sectional study. Data regarding the socio-demographic and disease-related characteristics (including disease duration, medications used, and comorbid conditions) of the patients, vaccination history, the knowledge about the vaccination, and the factors potentially associated with the uptake of vaccination were collected by face-to-face interview using a standardized questionnaire. 102 out of 345 rheumatologists have participated in a web-based survey.Results:In total, we collected data from 387 patients (260 with SpA and 114 with RA; 204 [52.8%] female and mean age 46.6 ± 12.7 years). Only 123 (32.3%) of our patients were responded that their disease or treatment might be related to the increased risk for infectious diseases. Influenza and pneumococcal vaccines were administered to 71 (21.4%) and 21 (6.1%) patients, respectively. Vaccination for influenza was recommended by family physicians in 26 patients and by rheumatologists in 12 patients. Rate of influenza vaccination was significantly higher in patients >65 years (p=0.021) and with any co-morbid conditions (p=0.002). The main reasons reported by patients regarding not to be vaccination were (a) the belief that they did not need the vaccine (49.4% for influenza and 26.2% for pneumococcal vaccine), (b) the absence of recommendation from their physicians (24.1% for influenza and 26.2% for pneumococcal vaccine), (c) fear of adverse event of vaccination (28.8% for influenza and 3.2% for pneumococcal vaccine), and (d) lack of knowledge about vaccination (6.1% for influenza and 12.5% for pneumococcal vaccine). Even though 50% of rheumatologists who responded to the survey were aware of the presence of national vaccination recommendations, all of them stated that patients with inflammatory arthritis need to be vaccinated for both influenza and pneumococcal infections. Influenza and pneumococcal vaccines were administered to 23 (22.5%) and 4 (3.9%) rheumatologists, respectively.Conclusion:Although the knowledge and awareness about influenza and pneumococcal vaccinations were seemed to be high among rheumatologists, vaccination rates for both were insufficient in RA and SpA patients. There remains significant effort to improve vaccination rates and to prevent morbidity and mortality due to vaccine-preventable infections in inflammatory rheumatic diseases.References:[1]Van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–22.[2]MTT Nguyen, H Lindegaard, O Hendricks & N Friis-Møller. Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA), Scandinavian Journal of Rheumatology 2017;1–8.Disclosure of Interests:None declared

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

Background:Familial Mediterranean fever (FMF) is an auto-inflammatory disease commonly affects people from Mediterranean basin. It is characterized by acute self-limiting inflammatory attacks of serous membrane. Some recent studies showed diastolic dysfunction in patients with FMF however systolic function was rarely evaluated before.Objectives:To assess cardiac functions by using speckle tracking echocardiography (STE) in addition to routine measurements and to evaluate whether there is any difference between colchicine responsive patients and those with colchicine-resistant or severe disease.Methods:Seventy-four FMF patients (57 responsive [60% female and median age 35 [18-63] years], 17 resistant [53% female and median age 31 [20-49] years]) and 74 healthy controls ([53% female and median age 37 [22-55] years]) were included in the study. Patients with cardiac disease or risk factors affecting STE were excluded. Patients who had ≥1 attacks in three months despite ≥2 mg/day od colchicine or who were treated with IL-1 blocking agents were defined as colchicine resistant disease and who had amyloidosis (whom had proteinuria ≥500 mg/day in at least 2 occasion or biopsy-proven amyloidosis) defined as severe disease. Demographic and disease related characteristics were obtained by using a structured form. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population.Results:There was no significant difference between groups in terms of age and sex. Disease duration was not different between colchine responsive and resistant patients (median duration in resistant diasease was 11 years (1-27), in responsive patients 6 years (0-33) and, p: 0.133). Although ejection fraction was similar among groups, global longitudinal peak systolic strain; a marker of systolic function, was significantly lower in FMF patients in comparison with healthy subjects and this difference was due to colchicine resistant FMF patients (p0.05) (Table).Table.Comparison of standard and speckle tracking echocardiographic findings among groupsResponsive FMF (n: 57)Resistant FMF (n: 17)Healthy Controls (n: 74)LA31 (23-41)30 (26-35)31 (22-44)LVD43 (35-86)41 (38-48)43 (20-50)LVS26 (20-32)24 (18-31)26 (19-34)EF62 (40-77)64 (46-73)60 (52-70)E95 (23-148)98 (9-130)93 (57-130)A83 (26-153)79 (8-134)81 (57-120)DT187 (100-303) *183 (100-296)161 (100-254)ELateral14 (8-29)13 (10-23)14 (8-23)ALateral11 (5-18)10 (7-18)10 (6-17)ESeptal11 (6-20)9 (5-16)11 (5-16)ASeptal10 (5-17)10 (5-17)9 (4-23)GLS20 (8-55) *20 (15-32)22 (16-33)GCS21 (10-29)20 (11-42)20 (13-30)*Significant difference among groups, pConclusion:This study shows that there is subclinical myocardial dysfunction in FMF patients. Those patients with severe or colchicine resistant disease has a numerical but statistically different trend toward systolic dysfunction.Disclosure of Interests:None declared

OBJECTIVE: The objective of this study was to determine whether smoking was associated with the cumulative radiographic spinal damage and radiographic progression in patients with ankylosing spondylitis (AS). Thus, we conducted a systematic review and meta-analysis of the available studies to date. METHODS: An electronic search was conducted from inception to June 21, 2016, in EMBASE, the MEDLINE/PubMed Cochrane Central Register of Controlled Trials databases. Cross-sectional and longitudinal cohort studies investigating the association between smoking and cumulative spinal structural damage or radiographic progression were included. The outcome of interest was the presence of syndesmophytes in cross-sectional studies and radiographic progression in longitudinal studies. The quality assessment was done using the Agency for Healthcare Research and Quality checklist. The authors of potentially relevant studies were contacted regarding the unpublished data. Data from eligible cross-sectional studies were extracted and arranged in a 2x2 table. The odds ratios (ORs) and 95% confidence intervals (CIs) for the dichotomous outcome of interest were computed. RESULTS: The combined data of eight eligible cross-sectional studies for the assessment of association between smoking and cumulative spinal structural damage suggested a significant association (OR, 2.02; 95% CI, 1.51–2.70). No significant heterogeneity was detected between studies (I(2)=23.0%, p=0.25). The heterogeneity of the longitudinal study data did not permit us to undertake a meta-analysis. Hence, a qualitative review was performed. CONCLUSION: The results of our meta-analysis show that smoking is associated with increased cumulative spinal structural damage in patients with AS. Therefore, rheumatologists should encourage patients with AS to quit smoking.

Background To examine the activity of the mammalian target of rapamycin (mTOR) pathway and its regulators, transforming growth factor (TGF)-β1 and phosphatase and tensin homolog (PTEN), in minor salivary gland biopsies of Sjogren’s syndrome (SS) and systemic sclerosis (SSc) patients. Methods We retrospectively evaluated SS, SSc, and SS-SSc overlap patients admitted to our outpatient rheumatology clinic between January 2007 and December 2015 who underwent a minor salivary gland biopsy. Patient demographics and some clinical features were obtained from hospital records. Immunohistochemistry was used to analyze total mTOR, total PTEN, and TGF-β1 expression in the biopsied tissues. The biopsy specimens were also examined for the presence and degree of fibrosis. Results Minor salivary gland biopsies of 58 SS, 14 SSc, and 23 SS-SSc overlap patients were included in the study. There was no significant difference in mTOR expression between these groups (P = 0.622). PTEN protein was expressed in 87.2% of patients with SS, 57.9% with overlap syndrome, and 100% of the SSC patients, and these differences were statistically different (P = 0.023). Although ductal epithelial TGF-β1 expression was similar between the groups (P = 0.345), acinar cell expression was found to be more frequent in the SSc (72.7%) and overlap patients (85.7%) in comparison with the SS cases (58.2%; P = 0.004). Conclusion mTOR may be one of the common pathways in the pathology of both SS and SSc. Hence, there may be a role for mTOR inhibitors in the treatment of both diseases. Additionally, PTEN and TGF-β1 expression may be a distinctive feature of SSc.

Background Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that mainly affects axial skeleton. The disease is characterised by new bone formation; it usually starts with the bony fusion of sacroiliac joints (SIJs) and also causes syndesmophyte formation in the intervertebral space, enthesophytes in the tendon and ligament insertion sites. Underlying mechanisms of new bone formation in axSpA patients is not completely understood and low levels of sclerostin may be associated with the development of syndesmophyte in patients with ankylosing spondylitis (AS). Beside sclerostin another osteocyte factor is fibroblast growth factor-23 (FGF-23) and it has been first described as a phosphaturic hormone. It was also shown that FGF-23 may inhibit osteoblast differentiation and matrix mineralization. Objectives To evaluate serum FGF-23 and sclerostin levels in patients with axSpA and to compare them with those of healthy control subjects. We also assessed relationship between the serum FGF-23, sclerostin levels and disease related variables in particular the presence of structural changes. Methods In total 109 axSpA patients according to ASAS classification criteria and age- and sex-matched 57 healthy control subjects were included in the analysis. Subjects with renal failure and significant comorbid conditions and axial SpA patients who were using anti-TNF agents were excluded. Demographic and disease related characteristics were collected by using a standard questionnaire. Serum levels of FGF-23 and sclerostin were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kits in accordance with the supplier’s instructions. Results In the present study there were 55 patients with non-radiographic axSpA and 54 patients with AS. Serum levels of FGF-23 levels were significantly higher in axSpA patients than healthy subjects. Although there was a trend towards a lower sclerostin levels in axSpA patients this difference did not show statistical significance (table 1). In axSpA patients serum FGF-23 levels were found to be correlated with erythrocyte sedimentation rate (ESR) (p=0.006 and r=0.265), C-reactive protein (CRP) (p=0.017 and r=0.229) and patients’ height (p=0.027 and r=−0.221). There was no relationship between FGF-23 and mSASSS score or the presence of syndesmophyte. Subgroup analysis revealed that the duration of disease (p=0.005), ESR (p=0.007), CRP (p Conclusions Our results suggested that serum FGF-23 is increased in axSpA patients. And also disease activity may contribute to an up-regulation in serum FGF-23 levels. Disclosure of Interest None declared

Background Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) frequently affect the kidneys and renal involvement is an important factor regarding morbidity and mortality. Kidney lesion in AAV is characterised by necrotizing and crescentic glomerulonephritis by little or no immune deposition, and hence it was called pauci-immune glomerulonephritis (PIGN). The underlying mechanisms in the formation or progression of crescent formation need further investigations. Mammalian target of rapamycin (mTOR) is a serine/threonine kinase and plays role in the regulation of cell growth and proliferation. Objectives We aimed to evaluate the role of mTOR, which might be a potential therapeutic target, in kidney biopsies of patients with AAV. Methods The patients diagnosed as PIGN at an outpatient nephrology clinics of a tertiary hospital, between May 2009 and June 2016, were retrospectively reviewed and those patients who had a renal biopsy before receiving an immunosuppressive treatment were included in the study. Renal biopsy specimens were immunohistochemically stained with antibodies of mTOR, phosphatase and tensin homolog (PTEN) and transforming growth factor- β (TGF-β) and scored by an experienced renal pathologist. Results In total 54 patients with AAV ([52%] female) were included in the study. Twenty-five (46%) patients were diagnosed as granulomatosis with polyangiitis, 6 (11%) patients as microscopic polyangiitis, 16 (30%) patients as renal-limited disease, one (2%) patient as eosinophilic granulomatosis with polyangiitis. Six (11%) patients with PIGN could not be classified definitely. According to the histopathologic examination; 22% of the biopsies were classified as focal, 33% crescentic, 22% mixed and 22% as sclerotic. The mTOR was expressed in substantial percentages of glomeruli of patients with PIGN. However we observed PTEN expression in all samples and mTOR in all tubulointerstitial areas. mTOR expression was found to be related with the presence of crescentic and sclerotic changes observed in glomeruli and the degree of fibrosis in interstitial areas. In our study serum creatinine level or response to treatment were not found to be associated with mTOR pathway expression Conclusions Our study showed that glomerular or interstitial expression of PI3K/Akt/mTOR pathway may play a role in the pathogenesis of PIGN and mTORC1 inhibitors might provide a viable alternative for this disease. Disclosure of Interest None declared

Background Spondylartritis (SpA) are usually observed in young patients and a clinical onset after 45 years is rare. The average life expectancy is getting longer and the proportion of late onset of SpA in rheumatology practice may became more common. SpA patients with late onset may have a distinctive clinical pattern in terms of functional impairment, extra-articular disease, co-morbidities and treatment status. Objectives The aim of this study was to compare the drug survival and effectiveness of tumour necrosis factor (TNF) inhibitors in patients with late onset SpA (LoSpA) compared with early onset SpA (EoSpA). Methods TReasure is a prospective, multicenter biological treatments registry from Turkey since 2016. It includes 15 different rheumatology centres. Patients with SpA fulfilling the ASAS criteria from TReasure database were divided into two groups as LoSpA (symptom onset >45 years of age) and EoSpA (symptom onset ≤45 years of age). Drug retention rates of first TNF inhibitors were calculated using the time until drug discontinuation independent of the reason that drug interruption. Specific reasons for discontinuing drugs were also assessed. Results Of 1382 SpA patients treated with TNF inhibitors, 9.4% (n=130) were included in the LoSpA and 90.6% (n=1252) were included in the EoSpA group. LoSpA had more female, enthesitis and psoriasis The median treatment duration was 53 months in LoSpA and 61 months in EoSpA. The baseline disease activity measures were similar except from ASDAS-ESH which is higher in LoSpA (table 1). The rate of major treatment response (BASDAI50) was lower in LoSpA than EoSPA at the last visit (26.1% vs 46.2%; p=0.009). Regarding the survival rates of TNF inhibitors, there was no significant difference between the patient groups (figure 1). The major cause of discontinuation in both of groups was drug ineffectiveness (68.6% in LoSpa and 60% in EoSpA, p>0.05). Conclusions LoSpA patients were almost 10% of all biological registry. LoSpA patients were predominantly female, and they had relatively higher baseline disease activity and lower biological treatment response. On the other hand the drug survival rate and discontinuation reasons of TNF inhibitors in the LoSpA group was comparable to that in the younger group. Reference [1] - Chen HA, Chen CH, Liao HT, Lin YJ, Chen PC, Chen WS, et al. Clinical, functional, and radiographic differences among juvenile-onset, adult-onset, and late-onset ankylosing spondylitis. J Rheumatol. 2012; 39:1013–8 Disclosure of Interest None declared

Background Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that mainly affects axial skeleton. Although some differences like sex and objective signs of inflammation were described between these two subgroups, overall disease burden was found to be similar in radiographic (r-) and non-radiographic (nr-) axSPA patients. The association of chronic inflammation with cardiac dysfunction was well documented in many inflammatory rheumatic diseases. However it was not assessed in the subgroups of axSpA patients. Advanced two-dimensional (2D) speckle tracking echocardiographic analysis is more sensitive and accurate method of early detection of myocardial dysfunction than the conventional 2D transthoracic echocardiography (TTE). Objectives To evaluate the left ventricular function by using speckle tracking echocardiography in patients with both r- and nr-axSpA. Methods In total 64 patients with r-axSpA (70% male) and age– and sex-matched 27 patients with nr-axSpA (63% male) and 30 healthy control subjects (63% male) were included in the analysis. Patients with hypertension, diabetes and known cardiac disease were excluded. All patients underwent detailed echocardiographic examination including M-mode, pulsed-wave Doppler imaging, pulsed-wave tissue Doppler imaging and 2D speckle tracking. Results Age and sex distribution were not different between groups. Some demographic and disease related characteristics were shown in the table. BASDAI, BASFI, global assessment of disease activity and ASAS-HI scores were found to be similar between r- and nr-axSpA patient groups. Although ejection fraction (EF) (p=0.112) and the other echocardiographic variables were similar between groups, global longitudinal strain (GLS) (p=0.045) were found to be different among groups (table 1). Post-hoc analysis showed that GLS was similar between nr-axSpA and control groups however GLS was significantly low in r-axSpA patients. In univariate analysis GLS was correlated with age (p=0.025), EF (p Conclusions The results of the present study showed that left ventricular function had impaired in r-axSpA patients and speckle tracking echocardiography may be a useful tool for early demonstration of left ventricular dysfunction. Disclosure of Interest None declared

Background Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) are drugs of choice in the treatment of rheumatoid arthritis and their concomitant use with TNFi is also of unequivocal importance. On the other hand there is limited evidence regarding the efficacy of csDMARD in axial spondyloarthritis (SpA) and concomitant use with TNFi are not recommended. However recently there is conflicting results about the comedication with csDMARD on the TNFi drug survival in patients with AS. Objectives To evaluate the effect of concomitant csDMARD use on first TNFi drug survival in patients with spondyloarthritis. Methods The data of patients that have been included in two Turkish registries (TURKBIO (n=356) and TReasure (n=1382)) with the diagnosis of ankylosing spondylitis (AS) or SpA obtained. Drug survival was calculated from the date of first TNFi prescription to the last visit or until the stop date of first biologic agent. For drug survival analysis Kaplan-Meier method with log-rank test. Cox proportional hazard method was used to evaluate the relative effects of each covariate on the drug survival. Results In total 1738 patients (1040 [59.1%] male, median [range] age 3916–81 years) with SpA initiating first TNFi were included in the analysis. Median disease duration was 116 months. 690 (39.7%) patients received adalimumab, 387 (22.3%) etanercept, 324 (18.6%) infliximab, 202 (11.6%) golimumab and 135 (7.8%) certolizumab. At the time of first biologic prescription 794 (45.7%) were using sulfasalazine or methotrexate. Baseline median BASDAI score was 60 (0–100), BASFI score was 46 (0–100), patient global assessment of disease activity was 70 (0–100), ESR was 231–140 mm/h and median CRP value was 13 (0–659) mg/L. In our study group median drug survival time was 12 (0–205) months. In total 585 (33.7%) of our patients stop their first TNFi. 323 (55.2) patients discontinued the medication due to inefficacy, 133 (22.7) due to adverse effect. Drug survival was significantly better in patients using concomitant csDMARDs at baseline (with a median survival 104 vs 30 months; p Conclusions The results of present study showed that considerable amount of SpA patients were using csDMARDs at time of first TNFi initiating and drug survival was significantly better in those patients. Disclosure of Interest None declared

Background The Mammalian Target of Rapamycin (mTOR), a multiprotein complex, controls cell growth, proliferation, survival and plays an important role in immunity and inflammation. Transforming Growth Factor-β1 (TGF- β1) leads to an increase in mTOR levels by protein kinase B (PKB or Akt) pathway. Phosphatase and tensin homolog (PTEN) affects mTOR pathway by inhibiting Akt. Recently, increased activities of TGF-β1 and mTOR were established in a mouse model of SSc. However the role of mTOR pathway, which might be a potential treatment target, in the human salivary gland inflammation is not evaluated systematically before. Objectives Therefore, we aimed to examine the activity of mTOR pathway and TGF-β1 in human minor salivary gland biopsies of Sjogren9s Syndrome (SjS) and systemic sclerosis (SSc) patients. Methods Immunohistochemical technique was used to analyze the expression of mTOR, PTEN and TGF-β1 in human minor salivary gland biopsies of SjS, SSc and SjS-SSc overlap patients. Immunohistochemical staining was evaluated by light microscopy and staining intensity was scored semi-quantitatively (Figure 1). The biopsy specimens were also examined for the degree of fibrosis. Results Formalin fixed sections of minor salivary gland biopsies of 58 SjS (57 female [98.3%]), 14 SSc (13 female [92.8%]) and 23 SjS-SSc overlap patients (all female) were included in the study. All biopsy specimens of SjS and overlap patients had a focus score of ≥1. There is no significant difference regarding mTOR expression between groups (P=0.622). mTOR expression was found in 94.4% in SjS group, 100% in overlap and 90% in SSc patients. PTEN protein was expressed in 87.2% of patients with SjS, 57.9% of overlap and 100% of SSC patients and the difference was statistically different (P=0.023). Although ductal epithelial TGF-β1 expression was similar between groups (P=0.345), acinar cell expression is more frequent in SSc (72.7%) and overlap patients (85.7%) in comparison with SjS (58.2% and P=0.004). Additionally, most of the acinar TGF-β1 staining was strong positive in SSC patients (45.5% vs 19.0% and 3.6%). Conclusions The results of our study showed that mTOR may be one of the common pathways for the pathology/inflammation observed in both SjS and SSc. Thus, there may be a room for mTOR inhibitors for the treatment of both diseases. Additionally PTEN and TGF-β1 expression, in particular acinar TGF-β1 might be a distinctive feature of SSc. Disclosure of Interest None declared

Background Although anti-tumour necrosis factor agents (anti-TNFs) are very effective in most patients with ankylosing spondylitis (AS) significant proportion of patients quit the treatment due to non-response or adverse events. The development of anti-drug antibodies (ADAs) and low serum drug levels might have a mechanistic role in loss of efficacy of or the development of adverse events in patients treated with anti-TNFs. There is limited data regarding the immunogenicity of anti-TNFs in patients with AS. Objectives Therefore the aim of this study was to evaluatethe relationship between the formation of ADAs, serum through drug levels and clinical response to anti-TNFs in patients with AS. Methods In total 350 AS patients with a new anti-TNF agent prescription in the last two weeks period were planned to include this multi-center prospective observational cohort study. Herein we are presenting the data of first 102 patients who had >3months follow-up. Clinical data and serum samples were collected at baseline and at every three months of treatment. Serum drug levels and ADAs were measured by ELISA in one center to avoid inter-assay variability. Results 102 biologic naive AS patients (75 [74%] male, mean (±SD) age; 37.2±10.7 years) who started anti-TNF agents (14 infliximab [13.7%], 27 adalimumab [26.5%], 33 etanercept [32.4%] and 28 golimumab [27.5%]) were included in the present analysis. In comparison to baseline values BASDAI, ASDAS-CRP and CRP values were significantly decreased in third months of follow-up ( P P P P P =0.012 and ASDAS-CRP values were 2.7±1.3 vs 1.9±1.0; P =0.015). Conclusions ADAs against anti-TNF agents might develop as early as 12 weeks of treatment. Our results confirm that ADA development may hinder the anticipated response to anti-TNF agents in patients with AS. Disclosure of Interest None declared

Background Smoking may constitute a major risk factor for not only disease susceptibility but also disease severity in patients with ankylosing spondylitis (AS). Some previous cross-sectional and longitudinal studies suggested that smoking may be associated with cumulative spinal radiographic damage and regarded it as an independent predictor of spinal radiographic progression. Objectives The objective of this study is to determine whether smoking is associated with the cumulative radiographic spinal structural damage and radiographic progression in AS patients. In order to reach this objective, we conducted a systematic review and meta-analysis of the available studies to-date. Methods An electronic search was conducted from inception to June 21 2016 in EMBASE, MEDLINE/PubMed Cochrane Central Register of Controlled Trials databases. Cross-sectional and longitudinal cohort studies investigating the association between smoking and cumulative spinal structural damage or radiographic progression were included. The outcome of interest were the presence of syndesmophytes in cross-sectional studies and radiographic progression in longitudinal studies. Two independent reviewers carried out the screening process. The Quality assessment was done using The Agency for Healthcare Research and Quality (ARHQ) checklist and Newcastle-Ottawa scale. Authors of potential relevant studies were contacted for the unpublished data. Data from eligible cross-sectional studies were extracted and arranged in a 2x2 table. The odds ratios (ORs) and 95% confidence intervals (CIs) for the dichotomous outcome of interest were computed. Random-effects method was used to combine the outcome data in Comprehensive Meta Analysis Software Version 3.3.070. Results The combined data of eight eligible cross-sectional studies for the assessment of association between smoking and cumulative spinal structural damage suggested a significant association (OR, 2.02; 95% CI 1.51–2.70) (Figure 1). No significant heterogeneity was detected between studies (P=0.25, I2=23.0%). The data from the longitudinal studies investigating the association between smoking and spinal radiographic progression is still been assessed. Conclusions The preliminary results of our meta-analysis showed that smoking is associated with increased cumulative spinal structural damage in patients with AS. Rheumatologists should encourage AS patients to quit smoking. Disclosure of Interest None declared

Background Adipomyokines are proteins that are synthesized by and secreted from both skeletal muscle and adipose tissue, and show their effects through autocrine, paracrine or endocrine pathways (1). Irisin , a novel adipomyokine, is secreted in association with exercise from the skeletal muscle, and from the white fat tissue to help the brown fat tissue gain the energy expenditure phenotype (2). There is evidence that the irisin is associated with metabolic syndrome (MetS) and cardiovascular risk (3,4). Objectives Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD) and MetS compared with the general population (5,6). The aims of this study were to assess the serum level of irisin, and the possible relationships of irisin with disease activity in patients with RA. Methods Eighty four consecutive RA patients fulfilling the 2010 ACR/EULAR RA Classification Criteria were included in the study. Fifty age- and sex-matched healthy volunteers were enrolled as the control group. Disease duration, medications, history of traditional risk factors of CVD and demographic data of patients were noted. Body Mass Index (BMI) was calculated as “weight (kg)/height (m) 2 ”. HbA1c, lipid profile, insulin were measured. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA) Index. RA disease activity was assessed by disease activity score based on evaluation of 28 joints (DAS28). Serum irisin level was assessed by ELISA. Measurement of carotid intima media thickness by carotid doppler ultrasonography was performed by a radiologist for cardiovascular risk assessment. Results There was no significant difference between the groups in terms of BMI (p=0,20), HbA1c (p=0,15), lipid profiles (p Serum irisin levels were found to be significantly lower in RA patients (20,65 (minimum:16,94- maximum:99,35) ng/mL) than healthy controls (37,56 (18,37–84,70) ng/mL) (p Conclusions This study showed that irisin was significantly lower than controls. Irisin may be responsible for increased cardiovascular risk in RA patients. But before a definite judgment; prospective studies with a larger sample size assessing the exercise behaviour of patients and the presence of CVD are necessary. References Raschke S, Eckel J. Adipo-myokines: two sides of the same coin - mediators of inflammation and mediators of exercise. Mediators Inflamm. 2013;320724:1–16. Roca-Rivada A, et al. FNDC5/irisin is not only a myokine but also an adipokine. PLoS One. 2013; 8(4):e60563. Yan B, et al. Association of serum irisin with metabolic syndrome in obese Chinese adults. PLoS One. 2014 Apr 7;9(4):e94235. Deng W. Association of Serum Irisin Concentrations with Presence and Severity of Coronary Artery Disease. Med Sci Monit. 2016 Nov 5;22:4193–4197. Wolfe F,et al. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 2003;30: 36–40. Ozmen M, et al. Prevalence of the metabolic syndrome in rheumatoid arthritis. Eur J Rheum 2014; 1: 1–4. Disclosure of Interest None declared

Background Femoroacetabular impingement (FAI) is characterized by early pathologic contact of the proximal femur with the acetabulum. Pincer impingement is the acetabular cause of FAI.Whereas cam deformity seen as a flattening of the anterior contour of the head/neck junction or an osseous hump leading a decreased femoral head/neck offset. Patient with FAI presents with a hip or a trochanteric painusually in the sitting position or during or after activity. It might also be an important cause of hip osteoarthritis (OA). Objectives Therefore in this study we evaluated the frequency of pistol-grip deformity (PGD), described as the most characteristic feature of cam-type FAI, in axial spondyloarthritis (axSpA) patients as a potential alternative cause of hip or trochanteric pain. Methods A total 180 patients (107 [59%] male, mean age 41.9±12.8 years) with axSpA according to ASAS criteria and 198 patients (120 [61%] male, mean age 40.5±14.8 years) admitted to the emergency department (mostly due to trauma) and who had pelvic X-ray were included in the study.Patients with hip OA, hip prosthesis, acetabular protrusion or who have radiographs taken improper technique were excluded. An experienced radiologist assessed all anteroposterior pelvic radiographs. PGD was determined by demonstration of spherical or non spherical shape of femur head on AP pelvic radiography. Results The axSpA group consists 135 ankylosing spondylitis and 45 non-radiographic axSpA patients. The mean duration of symptoms was 13.8±11.3 years in axSpA patients. Radiographic findings of cam abnormality (figure) were significantly more frequent in axSpA patients in comparison with control subjects (30/150 [20%] vs 17/193 [9%] and P=0.004). Cam-type radiographic abnormality was only present 2 female control subjects and none of female axSpA patients. FAI was significantly correlated with the presence of HLA-B27 (r=0.213 and P=0.048), smoking (r=0.194 and P=0.018), height (r=0.283 and P=0.001) and gender (r=0.443 and P Conclusions Our results showed that radiographic findings compatible with PGD were frequent in axSpA patients. In addition to repetitive injury tothe proximal femoral physis, new bone formation may be responsible for increased FAI in axSpA.In axSpA patients with hip or trochanteric pain, FAI may be kept in mind as an alternative explanation of the symptoms. Disclosure of Interest None declared

e14681 Background: Monoclonal antibodies targeting either VEGF or EGFR have improved the treatment outcomes in patients with advanced colorectal cancer (CRC). Although cetuximab or panitumumab are ...