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Background/Aim: Adult-onset Still’s disease (AOSD) is a multi-systemic, autoinflammatory disorder. Several activity scores have been proposed but none of them have been adopted universally. Our aim was to create a clinician-friendly activity scoring system by using simple clinical and laboratory parameters. Methods: AODS patients according to Yamaguchi criteria were included in this cross-sectional, multi-center study. Derivation and validation cohorts were constituted. Demographic, clinical and laboratory evaluation at study visit; patients’, and physicians’ global assessments of disease activity (both VAS/ Likert scale) were recorded. To develop the score; ordinal logistic regression model was used to determine independent predictors of patient’ global assessments of disease activity. Clinically and statistically significant variables were weighted according to regression coefficients. Then, performance of the score was tested on the validation cohort. Results: Total of 197 consecutive AOSD patient (125 in derivation, 72 in validation cohorts) were included. Final Still Activity Score was fever (2 points), arthralgia (2 points, plus 1 point if arthritis was present in ≥2 joints), neutrophilia≥65% (1 point) and ferritin≥350 ng/mL (1 point) (maximum of 7 points). The SAS yielded an AUC value of 0.98(0.96-1.00) in the derivation cohort and 0.91(95%CI:0.85-0.98) in the validation cohort to discriminate high AOSD activity from moderate-inactive AOSD. Correlation of SAS with PtGA was 83% for the derivation cohort and 76% for the validation cohort. Conclusions: SAS has shown a good test performance to distinguish active AOSD patients from the others. SAS may be a useful method for evaluating disease activity of AOSD patients in daily practice. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The present study was conducted in compliance with the Helsinki Declaration and was approved by the Local Ethics Committee of Hacettepe University (GO- 20/824). A written informed consent form was completed by all participants.

Background/aim Gout may cause various radiographic abnormalities such as cartilage loss, spurs, sclerosis, and periostal new bone formation. The purpose of this study was to investigate the frequency of Achilles and plantar spurs and related factors in gout patients. Matherial and methods We performed a retrospective review of gout patients, treated at Hacettepe University hospitals between 2014 and 2019. We identified patients from the hospital records using the ICD-10 code (M10). Demographic and clinical features, comorbidities, and foot radiographies were collected. The radiographies were evaluated by a rheumatologist (U.K.) who was experienced in musculoskeletal radiography. Factors predicting the spurs were analyzed by logistic regression analysis. Results 181 patients who had lateral foot radiograph were included in this study. Eighty-one (44.7%) patients had score ≥ 2 Achilles spur, 81 (44.7%) patients had score ≥ 2 plantar spur, and 22 (12.1%) patients had no spur. Age, disease duration, duration between the gout diagnosis and appearing spur, the presence of metabolic comorbidities and hypertension were higher in both Achilles and plantar spurs than no spur group. Forty (22.1%) patients had score ≥ 2 both Achilles and plantar spur. In this group, the mean age was older and the proportion of metabolic comorbidities was higher than the groups of Achilles and plantar spur with a score 0 or 1. Predictor of the development of large or moderate-severe calcaneal spur was the existence of metabolic comorbidity [OR (95% CI): 3.49 (1.11–11.0) and p = 0.033]. Conclusion The presence of metabolic comorbidities increases the frequency of calcaneal spurs in gout patients. This condition can be explained by the impaired microvascular structure and increased hypoxia resulting in calcification on the tendon and ligament insertion sites.

Background/aim: to evaluate treatment adherence and predictors of drug discontinuation among patients with inflammatory arthritis receiving bDMARDs within the first 100 days after the announcement of the COVID-19 pandemic. Materials and methods: a total of 1871 patients recorded in TReasure registry for whom advanced therapy was prescribed for rheumatoid arthritis (RA) or spondyloarthritis (SpA) within the 3 months (6-9 months for rituximab) before the declaration of COVID-19 pandemic were evaluated, and 1394 (74.5%) responded to the phone survey. Patients' data regarding demographic, clinical characteristics and disease activity before the pandemic were recorded. The patients were inquired about the diagnosis of COVID-19, the rate of continuation on bDMARDs, the reasons for treatment discontinuation, if any, and the current general disease activity (visual analog scale, [VAS]). Results: a total of 1394 patients (493 RA [47.3% on anti-TNF] patients and 901 SpA [90.0% on anti-TNF] patients) were included in the study. Overall, 2.8% of the patients had symptoms suggesting COVID-19, and 2 (0.15%) patients had PCR-confirmed COVID-19. Overall, 18.1% of all patients (13.8% of the RA and 20.5% of the SpA; p = 0.003) discontinued their bDMARDs. In the SpA group, the patients who discontinued bDMARDs were younger (40 [21-73] vs. 44 years [20-79]; p = 0.005) and had higher general disease activity; however, no difference was relevant for RA patients. Conclusion: although the COVID-19 was quite uncommon in the first 100 days of the pandemic, nearly one-fifth of the patients discontinued bDMARDs within this period. The long-term effects of the pandemic should be monitored., Hacettepe Rheumatology Society

Behçet's disease (BD) is multisystemic vasculitis with heterogeneous clinical manifestations. We describe the case of a 26-year-old man who presented with Budd-Chiari syndrome (BCS) related to BD. The patient received infliximab (IFX) due to the severity of vascular involvement. Subsequently, after IFX therapy, hospital-acquired pneumonia, trapped lung, and fungal infection of the lung and central nervous system developed as complications. The patient benefited from a second course of IFX and clinical remission was achieved following early identification and treatment of complications. Data on the presentation and prognosis of BCS related to BD are extremely limited. Our case report supports the growing evidence that anti-TNF antibody is a promising treatment for BD-related BCS.Behçet's disease-related Budd-Chiari syndrome is a rare form of vascular involvement that severely affects mortality.Behçet's disease-related Budd-Chiari syndrome is frequently confused with idiopathic thrombosis and may be underdiagnosed.Infliximab could be a therapeutic option for refractory Behçet's disease with major vascular involvement, but the increased risk of opportunistic infections should be kept in mind.

Psoriatic arthritis (PsA) is a heterogeneous disease with both environmental and genetic factors playing a role in this diversity. The aim of this study is to compare the patient profiles and outcomes in PsA patients in three countries from three continents. PsA patients from Turkey (n = 184), Canada (n = 200), and Italy (n = 177) from the Psoriatic Arthritis-International Database (PsArt-ID) were compared for patient demographics, disease features, treatments, and minimal disease activity (MDA) rates. Patient profiles were different across countries, patients from Italy being older [median (Q1-Q3): 59 (51-65)] than patients from Turkey [48 (37-58)] and Canada [55 (44-65)] and Italian patients having more frequent comorbidities and being more frequently smokers. For disease phenotypes, patients from Italy had axial disease less frequently (12%) than others (Turkey 23%, Canada 52%). Similarly, disease activity in patients from Italy was higher with higher tender and swollen joint counts and body surface area for psoriasis. The lowest rate of biologic use was observed in Italy [ Italy: 18.4%, Turkey: 26.1%, Canada: 33.9%]. MDA was achieved more in Canada [OR (CI): Canada vs Italy = 3.326 (1.983-5.577); Canada vs Turkey = 2.392 (1.498-3.818); Turkey vs Italy = 1.391 (0.786-2.460)]. PsA patient characteristics differ across countries which may be leading to differences in treatments and MDA rates. The differences can be a combination of genetic or geographical differences as well as the demographics of the general population in that area. Therefore, the unmet needs of PsA patients may vary globally. Key Points • PsA disease characteristics, phenotypes, activity levels and treatments differ across countries. • Unmet needs of PsA need to be determined individually.

Peter C Taylor,1 Codrina Ancuta,2 Orsolya Nagy,3 María C de la Vega,4 Andrey Gordeev,5 Radka Janková,6 Umut Kalyoncu,7 Ivan Lagunes-Galindo,3 Jadranka Morović-Vergles,8 Mariana Peixoto GU e Silva de Souza,9 Bernadette Rojkovich,10 Prodromos Sidiropoulos,11 Atsushi Kawakami12 1Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; 2Department of Rheumatology, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania; 3AbbVie Inc, North Chicago, IL, USA; 4CEIM Investigaciones Medicas, Buenos Aires, Argentina; 5V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation; 6Department of Pediatric and Adult Rheumatology, Faculty Hospital Motol, Prague, Czech Republic; 7Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey; 8Department of Internal Medicine, Division of Clinical Immunology, Allergology and Rheumatology, Dubrava University Hospital, University of Zagreb School of Medicine, Zagreb, Croatia; 9Santa Casa de Belo Horizonte, Belo Horizonte, Brazil; 10Department of Rheumatology and Physiotherapy, Polyclinic of the Hospitaller Brothers of St. John of God, Semmelweis University, Budapest, Hungary; 11Faculty of Medicine, University of Crete, Heraklion, Greece; 12Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanCorrespondence: Peter C TaylorBotnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UKTel +44 1865 227323Email peter.taylor@kennedy.ox.ac.ukBackground: Patients’ needs and perspectives are important determinants of treatment success in rheumatoid arthritis (RA). Assessing patients’ perspectives can help identify unmet needs and enhance the understanding of treatment benefits.Objective: The SENSE study assessed the impact of inadequate response to disease-modifying antirheumatic drugs (DMARDs) on treatment satisfaction, disease outcomes, and patient perspectives related to RA disease management.Methods: SENSE was a noninterventional, cross-sectional study conducted in 18 countries across Europe, Asia, and South America. Adult patients with poorly controlled RA of moderate/high disease activity were eligible. Patient satisfaction was assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM v1.4). Treatment adherence, healthcare resource utilization (HRU), quality of life (QoL), work ability, digital health literacy (DHL), patient preference information, and treatment strategy were also assessed.Results: A total of 1624 patients were included in the study: most were female (84.2%) and middle-aged, and mean disease duration was 10.5 years. Mean TSQM global satisfaction subscore was 60.9, with only 13.5% of patients reporting good treatment satisfaction (TSQM global ≥ 80). The strongest predictor of good treatment satisfaction was treatment with advanced therapies. Most patients (87.4%) reported good treatment adherence. In general, patients had impaired QoL and work ability, high HRU, and 67.4% had poor DHL. Leading treatment expectations were “general improvement of arthritis” and “less joint pain”. Most patients preferred oral RA medications (60.7%) and rapid (≤ 1 week) onset of action (71.1%). “Increased risk for malignancies” and “increased risk for cardiovascular disease” were the least acceptable side effects. Despite suboptimal control, advanced therapies were only used in a minority of patients, and DMARD switches were planned for only half of the patients.Conclusion: Suboptimal disease control negatively impacts treatment satisfaction, work ability, QoL, and HRU. Data collected on patient perspectives may inform shared decision-making and optimize treat-to-target strategies for improving patient outcomes in RA.Keywords: adherence, digital health literacy, patient preference, rheumatoid arthritis, treatment satisfaction

Objectives Thrombotic events are common in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Warfarin is the most commonly used anticoagulant drug for thrombosis treatment, but it is can interact with many drugs, foods, or medicinal herbs. Herein, we presented a case with SLE and APS who was complicated by spinal and cerebral hematoma as a result of warfarin interaction. Case presentation Spinal subdural hematoma and frontal intraparenchymal hematoma were occurred in our patient, who was in remission for 2 years with rituximab, hydroxychloroquine and warfarin. We learned that she had been using some herbal products (shepherd’s purse and horsetail) and phenyramidol for a few days. Spinal and cerebral hematomas caused by the interaction of phenyramidol and warfarin were treated with fresh frozen plasma and vitamin K without the need for surgery. Conclusions The drug interactions with warfarin can cause fatal hemorrhagic or thrombotic events. Especially, the patients with SLE and/or APS using warfarin should be warned not to use different medications or herbal agents.

OBJECTIVE Sleep quality is diminished in patients with psoriatic arthritis (PsA) and close to 40% of PsA patients consider sleep difficulties a priority domain. This work analyzes determinants of impaired sleep in patients with PsA. METHODS This was a cross-sectional analysis of an observational study (ReFlap, NCT NCT03119805), which included adult patients with definite PsA with≥2 years disease duration from 14 countries. Sleep was assessed using the patient self-reported evaluation of sleep on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12). A score≥4 was considered as sleep impairment. Demographic and clinical variables associated to sleep impairment were assessed through univariate analysis and Poisson regression modeling leading to prevalence ratio (PR) [95% confidence interval]. RESULTS A total of 396 patients were analyzed: mean age 51.9±12.6 years, 51% were females, 59.7% were receiving biologic therapy, 53.3% had 1-5% of body surface area affected by psoriasis; 23.7% were in remission and 36.9% in low disease activity according to the Disease Activity in Psoriatic Arthritis (DAPSA) score. Median (25th-75th) patient's self-evaluation of sleep difficulties was 2 (0-6), 157 (39.6%) had sleep impairment. In the Poisson regression model, self-reported levels of anxiety (PR: 1.05 [1.02-1.08], P=0.003) and pain (PR: 1.06 [1.04-1.09], P

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

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

There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on ankylosing spondylitis (AS) and TMD relationship. We conducted this study to test the predictors of TMD in AS patients and its relationship with craniocervical posture. AS patients aged between 18 and 50 years consecutively admitted to our outpatient clinics were recruited. TMD was diagnosed by ‘Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)’. Spinal mobility was assessed by BASMI; disease activity by ASDAS-CRP and neck disability by Neck Disability Index. Craniocervical posture was assessed on lateral cervical X-ray by measuring the craniocervical angle, cervical curvature angle, suboccipital distance, atlas–axis distance, and anterior translation distance. A total of 98 (58.2% female) patients with a mean age of 37.4 ± 8.2 years were enrolled in this study. TMD was diagnosed in 58 (59.2%) patients. Spinal mobility and craniocervical posture measurements were similar among the two groups. Smoking, bruxism (in females), neck disability and AS disease activity (in males) were higher in TMD patients. Multivariate analysis revealed active smoking (aOR 6.9; 95% CI 1.8–25.6; p = 0.004), bruxism in females (aOR 17.9; 95% CI 2.0–159.2; p = 0.01), high ASDAS in males (aOR 11.8; 95% CI 1.2–122.5; p = 0.038) and neck disability (aOR 12.7; 95% CI 3.8–42.9; p

Objective. the effect of smoking in psoriatic arthritis (PsA) is under debate. Our aim was to test whether smoking is increased in axial PsA (axPsA). Methods. Included in the analysis were 1535 patients from PsArt-ID (PsA-International Database). the effect of smoking on axPsA (compared to other PsA phenotypes) and radiographic sacroiliitis were investigated. Results. Current smoking was more common in axPsA (28.6% vs 18.9%, p < 0.001). It also was found as an independent predictor of axPsA (OR 1.4) and radiographic sacroiliitis (OR 6.6). Conclusion. Current smoking is significantly associated with both axPsA and radiographic sacroiliitis in patients with PsA., Union ChimiqueBelge (UCB); Turkish Society for Rheumatology (TRD), D. Solmaz had funding from Union ChimiqueBelge (UCB) for an axial spondyloarthritis fellowship. S. Bakirci had funding from the Turkish Society for Rheumatology (TRD). S.Z. Aydin received honoraria from Abbvie, Celgene, UCB, Novartis, Jannsen, and Sanofi.

Background/Aim: Rheumatoid arthritis associated interstitial lung disease (RA-ILD) is a major concern in RA patients and events of ILD have been reported in patients treated with tofacitinib in RA clinical trials and in the post-marketing setting. The aim of this study was to assess the real-life efficacy and safety of tofacitinib in patients with RA-ILD. Methods RA patients with ILD diagnosis based on the HRCT images of the lungs from eight different centers recruited to study. As a control group, RA patients without ILD under tofacitinib was included. Demographic data, patients’ characteristics, available pulmonary function tests regarding RA and RA-ILD at the visit in which tofacitinib was initiated and for the last follow-up visit under tofacitinib were recorded. Reasons of tofacitinib discontinuation were also recorded. Drug retention rates were compared by log-rank test. p value

To compare the clinical features, laboratory findings, and prognosis of Behçet's disease (BD) patients with and without Budd-Chiari syndrome (BCS).This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017.Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14-47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%).To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.

Objective Because of concerns about malignancy risks, using biological disease-modifying antirheumatic drugs (bDMARDs) in patients with a history of malignancy remains a challenging issue in rheumatology practice. This study aimed to investigate bDMARD preferences of physicians when treating of rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients with a history of malignancy. Methods The data for this cross-sectional study were gathered from the TReasure database using a date range of December 2017 and January 2020. Biological disease-modifying antirheumatic drug preferences were analyzed for 40 RA patients and 25 SpA patients with a history of malignancy. Results The most frequently prescribed bDMARD was rituximab, which was given to 28 RA patients (70%). For 25 patients (62.5%), the time between the diagnosis of malignancy and starting on a bDMARD regimen was less than 60 months, with a median interval of 43.5 months. Among SpA patients, the preferred bDMARDs were secukinumab and etanercept, which were each administered to 7 patients (28%). For 13 SpA patients (52%), the time between the diagnosis of malignancy and starting on bDMARDs was less than 60 months, with a median interval of 97 months. Conclusions The observed bDMARD preferences may be related to the therapeutic effects of rituximab on lymphoproliferative malignancies, the protective effects of secukinumab on tumor progression, and the short half-life of etanercept. Biological disease-modifying antirheumatic drugs should be used in RA and SpA patients with malignancy in case of high inflammatory activity.

To understand change in work productivity, activity impairment, quality of life (QoL), and disease activity in patients with psoriatic arthritis (PsA) receiving anti-tumor necrosis factor (anti-TNF) treatment.One hundred twenty patients with PsA receiving anti-TNF therapy were recruited to this noninterventional, observational study. Work disability was assessed via the Work Productivity and Activity Impairment (WPAI) questionnaire and disease activity was calculated via the 28-joint Disease Activity Score using C-reactive protein (DAS28-CRP) and Disease Activity Index for Psoriatic Arthritis with 28 joints (DAPSA28) score. Patient-reported outcomes (PROs), from visual analog scores and Health Assessment Questionnaire-Disability Index scores, were evaluated to understand the clinical effectiveness at baseline and every 3 months until the month-9 final visit. The American College of Rheumatology (ACR)20/50/70 response criteria were assessed at month 9.A total of 120 patients (females, n = 73) were enrolled in the study. Mean (SD) age and disease duration were 41.6 ± 11.1 years and 6.9 ± 6.5 years, respectively. The most commonly used TNFα inhibitor was adalimumab (42.4%), followed by etanercept (25.8%). All WPAI questionnaire parameters were reduced at the follow-up visits compared with baseline (p 0.001 for all). PROs and disease activity indicators (DAS28-CRP and DAPSA28) significantly improved during the course of anti-TNF treatments (p 0.001 for all). Additionally, ACR20/50/70 responses were determined as 86.8%, 63.7%, and 41.8% of patients at the month-9 visit.The real-world data in PsA patients receiving anti-TNF treatment showed improvement in WPAI, QoL, and disease activity over 9 months of treatment.NCT02028169 Key Points • Psoriatic arthritis (PsA), with debilitating effects on quality of life, occurs mostly in young adults and has negative impacts on employment status and work productivity. • Early PsA diagnosis and treat-to-target treatment strategies aim to reduce pain and joint damage, as well as improve work productivity. • Real-world data on the impact of treatment with anti-tumor necrosis factor (anti-TNF) agents on work productivity in PsA in the literature is scarce. • Our study of real-world data in patients with PsA receiving anti-TNF treatment showed improvement in work productivity, as well as in clinical and patient-reported outcomes.

Aim: To evaluate the retention rate of golimumab (GLM) in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (ax-SpA). Materials & methods: Patients had received/were receiving GLM as their first or second biological drug for at least 3 months. We recorded demographic and clinical data, data on drug continuation and disease activity. Patients were classified as biologic-naive and biologic-experienced. Results: The study included 60 RA and 269 ax-SpA patients. At month 24, the retention rates were 67.2 and 57.1% (biologic-naive and biologic-experienced RA) and 74.8 and 80.4% (anti-TNF-naive and -experienced ax-SpA). No significant differences in retention were observed between the biologic-naive and -experienced groups for either disease. Conclusion: The results of this study confirm the effectiveness of GLM in the treatment of RA and axSpA with good retention rates at 2 years in a real-world setting in Turkey.

We wanted to see how close we could get to our goal of treating rheumatoid arthritis (RA) without the use of glucocorticoids (GCs) in the disease-modifying antirheumatic drugs (DMARDs) era using real-life data. Established in 2017, the TReasure database is a web-based, prospective, observational cohort for Turkey. As of May 2019, there were 2,690 RA patients recorded as receiving biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) therapy. At the start of the bDMARDs or tsDMARDs, patients with follow-up visits of at least 3 months were registered. At the time of registration and the last visit, doses of GCs were recorded and it was determined if the target dose of ≤ 7.5 mg was achieved. During registration and follow-up, 23.4% of the patients did not receive GCs and 76.5% of the patients received GCs at any time. GCs could be stopped after 59 (25–116) months in 28.4% of these patients, but 71.6% of patients were still using GC. The target GC dose could not be achieved in 18.2% of these patients (n = 352). The rate of continuing to use GC was significantly higher in women, in the elderly, those with rheumatoid factor (RF) positive, with higher Visual Analog Scale (VAS) pain and Disease Activity Score (DAS)-28. The initial GC dose of ≥ 7.5 mg/day was found to be crucial in not reaching the GC target dose (p

Objective: To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still's disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose. Methods: FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO. Results: We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30-57) and 45 (30-62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO. Conclusion: Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.

BackgroundThe objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients’ and physicians’ perspectives.MethodsIn ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA ResultsOf 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12–0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions.ConclusionIn this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.

WOS: 000463722100007, PubMed ID: 30489254, Objective: Familial Mediterranean fever (FMF) is the most common autoinflammatory disease. Most of the identified disease-causing mutations are located on exon 10. As the number of studies about the effect of the exonal location of the mutation and its phenotypic expression is limited, we aimed to investigate whether the exonic location of the Mediterranean fever (MEFV) mutation has an effect on the clinical manifestation in patients with FMF. Methods: Study population was derived from the main FMF registry that included 2246 patients from 15 different rheumatology clinics. We categorized the mutations according to their exon locations and retrieved the clinical and demographic information from the database. Results: Patients having the MEFV mutations on exon 2 or 10 (n: 1526) were divided into three subgroups according to the location of the MEFV mutations: Group 1 (exon 2 mutations), Group 2 (exon 10 mutations), and Group 3 (both exon 2 and exon 10 mutations). Group 2 patients were of a significantly younger age at onset, and erysipel-like erythema, arthritis, amyloidosis, and a family history of FMF were more common in this group. Conclusion: Patients with FMF and exon 10 mutations show more severe clinical symptoms and outcome. Exon 2 mutations tend to have a better outcome.

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

International audience; Objective: Sex differences may modify symptoms, disease expression, and treatment effects. The objective of this study was to evaluate the link between life impact and sex in psoriatic arthritis (PsA).Methods: Remission and Flare in Psoriatic Arthritis (ReFlaP; ClinicalTrials.gov identifier: NCT03119805) was a study in 14 countries of consecutive adult patients with definite PsA. Participants underwent comprehensive PsA assessment using the following measures: Disease Activity in Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), and Psoriatic Arthritis Impact of Disease (PsAID). Disease activity was compared by sex using t-tests or Wilcoxon tests. The association of PsAID with sex was analyzed using hierarchical generalized linear models.Results: Of 458 participants, 50.2% were male and the mean ± SD age was 53.1 ± 12.6 years. The mean ± SD PsA duration was 11 ± 8.2 years, and 51.5% of participants were being treated with biologic disease-modifying antirheumatic drugs. Women, compared to men, had worse mean ± SD Leeds Enthesitis Index scores (0.8 ± 1.7 versus 0.3 ± 0.9), pain on a numerical rating scale (NRS; range 0-10) (4.7 ± 2.7 versus 3.5 ± 2.7), HAQ DI scores (0.9 ± 0.7 versus 0.5 ± 0.6), fatigue on an NRS (5.2 ± 3 versus 3.3 ± 2.8), and PsAID scores (4.1 ± 2.4 versus 2.8 ± 2.3) (P < 0.001 for all). Women were also less frequently at treatment target compared to men according to DAPSA (cutoffs of ≤4 for remission and >4 and ≤14 for low disease activity; mean ± SD score 16.9 ± 14.9 in women versus 12.6 ± 16.6 in men) and MDA (25.7% versus 50.0%; P < 0.001 for all) scores. High life impact (PsAID score ≥4) was associated with female sex (odds ratio [OR] 2.3), enthesitis (OR 1.34), tender joints (OR 1.10)(P < 0.001 for all), and comorbidities (OR 1.22, P = 0.002).Conclusion: High life impact was independently associated with female sex, enthesitis, comorbidities, and tender joints. At treatment target, women had higher life impact compared to men. It is necessary for life impact to become a part of PsA treat-to-target strategies.

Background/aim: Peritonitis attacks of Familial Mediterranean Fever (FMF) usually requires emergency medical admissions and it's hard to distinguish a typical abdominal attack from surgical causes of acute abdomen. Therefore, history of abdominal surgery, particularly appendectomy, is very common in patients with FMF. However, history of appendectomy might also give some clues about the course of FMF in the adulthood. This study was to determine whether the history of appendectomy help to anticipate disease course of FMF in the adulthood. Materials and methods: All patients recruited from FMF in Central Anatolia (FiCA) cohort, comprising 971 adult subjects. All patients fulfilled the Tel Hashomer criteria. Demographic data, FMF disease characteristics, co-morbid conditions, past medical history, surgical history and disease complications were meticulously questioned and laboratory features and genotype data (if available) were recruited from patient files. Results: Appendectomy history was evident in 240 (24.7%) subjects. Disease onset was earlier and peritonitis is strikingly more prevalent (97.1% vs. 89.6%, p < 0.001) in appendectomized patients. These patients had reported almost two fold more frequent attacks in the last year compared to appendix intact patients (median 3.5 vs. 2 attacks, p = 0.001) without a difference in frequency of musculoskeletal and skin attacks. Severe disease was more common (10% vs. 5.9%, p = 0.038) due to involvement of more attack sites throughout the life and more frequent attacks. Appendectomy patients had used higher daily doses of colchicine to control disease (1.43 +/- 0.6 mg vs. 1.27 +/- 0.52 mg, p = 0.002) but colchicine resistance was also more common in these patients, 15% vs. 6.7% respectively, p < 0.001. Conclusion: Appendectomy history is common in FMF patients and associated with frequent serositis attacks in adulthood. These patients require higher colchicine doses with a lower rate of response and more need for Interleukin-1 antagonist therapies.

Spondyloarthritis (SpA) is a group of diseases with overlapping skeletal and extra-articular features. Acute anterior uveitis (AAU) is the most common extra-articular manifestation of SpA. The relation between AAU and SpA is well defined in the current literature. Our study aims to analyze the frequency and factors associated with AAU in different forms of SpA in a large nationwide cohort of Turkish SpA patients.Retrospective cohort study.The data were obtained from the TReasure database, which compiles data from records of the web-based Rheumatoid Arthritis (RA) and SpA patients treated with biological disease-modifying anti-rheumatismal drugs from different regions of Turkey. The clinical characteristics of SpA and uveitis are recorded.Data of the 4,297 SpA patients were included in the study. Overall, 475 of 4,297 patients (11.0%) had experienced 1 or more episodes of uveitis. SpA patients with older age (P.001), a smoking history (P = .004), delayed diagnosis (P = .001), longer disease duration (P.001), arthritis (P.001), positive HLA-B27 (P.001), a family history of SpA (P.001), and radiographic damage (presence of sacroiliitis, syndesmophytes, bamboo spine, hip involvement) (P.001 for all) more commonly had uveitis. On the other hand, uveitis was less prevalent in patients with psoriasis and psoriatic arthritis (P.001 for both).Uveitis may be the key feature leading to SpA diagnosis. Patients with radiographic damage and long disease duration have an increased risk for uveitis in both male and female SpA patients. Patients with uveitis should be referred to a rheumatologist for a thorough evaluation of SpA.

The Turkish population is vaccinated with Bacille Calmette-Guérin (BCG), and the BCG vaccination decreases the specificity of the tuberculin skin test (TST). The purpose of this study was to investigate the incidence of active tuberculosis (TBC) among rheumatic patients who were screened only with the QuantiFERON®-TB Gold In-Tube (QFT-GIT) test for latent TBC prior to biological treatment.The Hacettepe University Biological Database (HUR-BIO) was used for latent TBC assessment. Consecutive patients were evaluated from July 2015 to October 2016 by a questionnaire that included the patients' demographic characteristics, treatment history, and symptoms of active TBC. A total of 664 patients were interviewed by physicians. TBC statuses of the 671 non-interviewed patients were checked from the Turkish National Tuberculosis Registry records. Mean TBC incidence per year was calculated for anti-tumor necrosis factor-alpha (TNF-α) agents.A total of 1335 (58.2% female) patients with the mean age of 44.2 ± 12.9 years were included. Of the patients, 836 (62.6%) had spondyloarthropathy, 432 (32.4%) had rheumatoid arthritis, and 67 (5%) had other rheumatologic diseases. The total biological drug exposure was 2292 patient-years (2043 patient-years for anti-TNF-α, 249 patient-years for non-TNF-α inhibitors). Positive and indeterminate QFT-GIT results were found in 258 (19.3%) and 23 (1.7%) patients, respectively. The median follow-up time after the onset of biological agent was 19.4 months (IQR = 29.5). Pulmonary TBC was found in 3 (0.2%) of the 1335 patients. The annual incidence of TBC was 147/100,000 patient-years for all TNF-α inhibitors (249/100,000 and 123/100,000 patient-years for QFT-GIT-positive and negative patients, respectively).TBC incidence increased by nearly seven times the Turkish national TBC incidence. The QFT-GIT Test appears acceptable to determine latent TBC before biological agent use. Consequently, the QFT-GIT Test can be appropriately used in BCG-vaccinated countries. Key Points • Our study contributes to filling the gap in the literature by reflecting real-life data about TBC frequency after QFT-GIT use in patients receiving biological agents. • The frequency of active TBC will remain within acceptable limits when only QFT-GIT is used in the screening of latent TBC prior to the use of biological agents in a population where the majority are vaccinated with BCG. • Using the QFT-GIT alone for latent TBC screening prior to biologic treatment in countries with high BCG vaccination rates reduces the number of patients needing isoniazid (INH) treatment.

Background:SpA is the most frequent extra-intestinal manifestation in patients with IBD (1). Questioning IBD patients in terms of SpA and referring patients to the rheumatology clinic is important for early diagnosis and treatment management.Objectives:We aimed to diagnose SpA early by using the DETAIL questionnaire to IBD patients and to compare it with the study validated for each question (2).Methods:In the Hacettepe University Gastroenterology Clinic, patients with IBD were questioned for musculoskeletal symptoms between March 2019 and September 2020. For this purpose, a validated DETAIL questionnaire consisting of 6 questions was asked. Patients with at least 1 positive out of 6 questions were consulted in the rheumatology clinic, and patients were evaluated for SpA by physical examination, laboratory, and imaging. For each question in the detection of arthritis in inflammatory bowel diseases (DETAIL) questionnaire, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio (LR) were calculated.Results:217 IBD patients were included in the study. Twenty patients with previously known rheumatologic diseases were excluded from the study. 49 (24%) of the remaining 197 patients had a positive answer to at least one question in the DETAIL query. 39 (20%) of these patients were evaluated in the rheumatology clinic, and 16 (8.1%) of them were diagnosed with SpA (spondylitis: 9, peripheral arthritis: 7) (Figure 1). In the DETAIL questionnaire, two patients answered 5/6 yes, five patients answered 4/6 yes, eleven patients answered 3/6 yes, ten patients answered 2/6 yes, and eleven patients answered 1/6 yes. In the six items of DETAIL, the best performances in discriminating patients affected by SpA were found in the second and fourth questions (LR + 2.9 and 1.57, respectively) (Table 1).Conclusion:41% of IBD patients who answered yes to at least one question in the DETAIL questionnaire were diagnosed with SpA. Especially those with sausage fingers or low back pain for at least 3 months seem more likely probability to be diagnosed with SpA. Unlike the validated study, the probability of having diagnosis of SpA was not observed in questions five and six, which questioning the inflammatory back pain parameters. The DETAIL questionnaire may be used as a useful screening tool for the detection of SpA.References:[1]Fragoulis GE et al. Inflammatory bowel diseases and spondyloarthropathies: From pathogenesis to treatment. World J Gastroenterol. 2019;25(18):2162-76.[2]Benfaremo D et al. Multicenter validation of the DETAIL questionnaire for the screening of spondyloarthritis in patients with inflammatory bowel diseases. The Journal of Rheumatology, 2020.Table 1.Sensitivity, specificity, positive and negative predictive values, likelihood ratios of the DETAIL questionnaire both in our study and in the other studyDETAIL questionnaireQuestionsSensitivity(%)Specificity(%)Positive predictive value(%)Negative predictive value(%)Positive likelihood ratioNegative likelihood ratioCurrent studyOther studyCurrent studyOther studyCurrent studyOther studyCurrent studyOther studyCurrent studyOther studyCurrent studyOther study1. Have you ever had a finger or a toe and/or another joint swollen and painful for no apparent reason?68.869.634.867.742.34161.587.31.052.160.90.452. Occasionally, has an entire finger or toe becomes swollen, making it look like a ‘sausage’?12.527.495.789.266.745.161.179.22.92.550.910.813. Have you had pain in your heels?43.645.156.586.341.251.659.182.91.013.30.990.644. Have you ever had back pain lasting at least 3 months that was not injury related?7577.452.273.452.248.47590.91.572.90.480.315. Do you have low back pain in the morning and/or after resting that improves with exercise?43.682.356.567.741.245.159.192.21.012.50.990.266. Do you wake up at night because of low back pain?18.854.978.385.437.554.958.185.40.873.71.040.53Figure 1.Flow chart of IBD patients in the studyDisclosure of Interests:None declared.

Objective Joints with different sizes and anatomical locations can be affected in psoriatic arthritis (PsA). Our aim was to explore the effect of different joint patterns on patient-reported outcomes (PROs) in patients with mono-oligoarthritis. Methods Within PsArt-ID (Psoriatic Arthritis- International Database), 387/1670 patients who had mono-oligoarthritis (1-4 tender and swollen joints) were enrolled in cross-sectional assessment. the joints were categorized according to their size (small/large) and location (upper/lower extremity) and PROs, physician global assessment and C-reactive protein (CRP) were compared. Analysis was made by categorizing according to joint counts (1-2 joints/ 3-4 joints). Results the mean age (SD) was 46.9 (14.24) with a mean (SD) PsA duration of 3.93 (6.03) years. Within patients with 1-2 involved joints (n = 302), size of the joints only had an impact on CRP values with large joints having higher CRP (P = .005), similar to lower extremity involvement (P = .004). PROs were similar regardless of size or location if 1-2 joints were inflamed. Within patients with 3-4 involved joints (n = 85), patient global assessment (PGA), pain, fatigue and physician global assessment were higher in the group with large joints. Similarly, PGA, pain, and physician global assessment were higher in patients with lower extremity involvement as well as higher CRP values. Conclusion For PsA patients with 3-4 joints involved, lower extremity and large joints are associated with poorer outcomes with worse PROs, physician global assessment, and higher CRP. the size and anatomical location of the joints are less important for patients with 1-2 joints in terms of the PROs., Union Chimique Belge (UCB); Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK), This work was supported by the Union Chimique Belge (UCB) (to Dilek Solmaz for axial spondyloarthritis fellowship) and the Scientific and Technological Research Council of Turkey (TUBITAK) (to Sibel Bakirci).

Introduction/objectives Familial Mediterranean fever (FMF) is characterized by recurrent attacks of fever, serositis, and arthritis, but some patients may experience long-term complications of disease such as infertility/subfertility. The published data about FMF-associated infertility is still limited. The aim of this study is to investigate the frequency and to determine potential factors for FMF-associated infertility/subfertility. Methods We enrolled 971 adult patients with FMF. We defined infertility as the failure to conceive after 12 months of regular, unprotected intercourse. All patients fulfilled Tel Hashomer criteria. Demographic data, FMF disease characteristics and genotype data (if available), disease complications, laboratory parameters, and treatment features were recorded. Results There were 582 subjects eligible for the present study (mean age 41.05 +/- 10.6 years, 65.8% female). MEFV mutations were available in 482 subjects, and 74.9% of subjects were harboring M694 V mutation (25.1% homozygous for M694 V). Infertility was present in 64 patients (14.6% of females and 4% of males). Multivariate analysis showed female sex [odds ratio (OR), 4.47; 95% confidence interval (CI95%) 1.75-11.42; p = 0.002], FMF disease onset < 20 years [OR, 2.99; (CI95% 1.04-8.61);p = 0.04], disease severity (ISSF) [OR, 4.81; (CI95% 2.28-10.17); p < 0.001], and colchicine nonresponse [OR, 2.80; (CI95% 1.17-6.74) p = 0.021] were the independent predictors of infertility. We also observed reversal of infertility in five patients who were treated with IL-1 beta antagonists. Conclusion Disease severity, FMF disease onset < 20 years, colchicine nonresponse, and female sex were found to be the independent predictors of infertility. The value of effective therapeutic interventions must be determined to treat infertility in these patients.center dot The prevalence of infertility increased in female patients with FMF.center dot Female sex, FMF disease onset < 20 years, disease severity, and colchicine nonresponse were risk factors for FMF-associated infertility.center dot With effective treatment of FMF, reversal of infertility was observed in five patients.

Yildiz, Fatih/0000-0003-3628-8870; Cinar, Muhammet/0000-0002-6150-3539 WOS: 000537230800003 PubMed ID: 31922480 Objective: Our aim is to test the validity of the Psoriasis Symptom Inventory (PSI), a patient-reported outcome, to assess the psoriasis severity within the scope of rheumatology. Methods: Within the PsA international database (PSART-ID), 571 patients had PSI, while 322 of these also showed body surface area (BSA). Correlations between PSI, BSA, and other patient- and physician-reported outcomes were investigated. Results: There was a good correlation between PSI and BSA (r=0.546, p

Background/aim: Tumour necrosis factor inhibitors and anti-interleukin-6 (anti-IL-6) therapies are increasingly being used in Takayasu’s arteritis (TA) patients who are unresponsive to corticosteroids ± conventional immunosuppressive agents. The aim of this study is to assess the efficacy and safety of anti-IL-6 (tocilizumab) therapy in refractory TA patients in real life. Materials and methods: Fifteen TA patients (86.7% were female) who received at least 3 cycles of tocilizumab therapy were retrospectively assessed by clinical, laboratory, and radiological evaluations before and after tocilizumab therapy. Results: The median (min–max) age of the patients at evaluation was 35 (20–58) years and the median disease duration from diagnosis was 24 (12–168) months. The median (min.–max.) duration of follow-up after tocilizumab was 15 (3–42) months. There was a significant decrease in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and patient global visual analogue scale (VAS) scores of patients after tocilizumab therapy. The median (min.–max.) ESR was 26 (5–119) vs. 3 (2–49) mm/h, P = 0.02; CRP was 39.8 (2.4–149.0) vs. 7.9 (0–92.9) mg/L, P = 0.017; and patient global VAS was 50 (0–90) vs. 30 (0–60), P = 0.027, respectively. In 8 patients, ESR and CRP levels were in the normal range in the last control. Imaging modality results after tocilizumab were available for 9 patients; 8 patients were radiologically stable and regression was seen in 1 patient. Comparable imaging modality results before and after tocilizumab were available for 5 patients; 4 patients were radiologically stable and regression was seen in 1 patient. Radiological findings were consistent with laboratory responses. Glucocorticoid dosages decreased from a mean dosage of 16.2 (9.1) mg/day at baseline to 7.1 (3.8) mg/day (P = 0.001) at the last follow-up visit. There was no increase in the steroid dosage in any of the patients. All patients tolerated tocilizumab well. Conclusion: Based on retrospective real life data, anti-IL-6 (tocilizumab) appears to be an effective and tolerable treatment option in refractory TA patients.

Objectives: Behcet’s disease (BD) is a multi-systemic inflammatory disorder which can affect all types and sizes of vessels.The usage of TNF-α antagonists is increasing in different involvements of...

Background/Aim Neurological involvement (Neuro-Behcet's Disease: NBD) is a rare manifestation of Behcet's Disease (BD) and it is related with significant mortality and morbidity. We aimed to evaluate disease course and outcome of NBD patients registered in Hacettepe University Vasculitis Center (HUVAC) prospective database starting from October 2014. Methods Totally, 419 patients (329 of the patients had fulfilled the International Study Group (ISG) criteria and 90 patients were considered as incomplete BD) were recorded as BD to March 2018. We retrospectively reviewed the charts of 123 patients with neurological complaints/ symptoms according International Consensus Recommendations (ICR) Criteria for Neuro-Behcet's disease. In final analysis, 77 NBD patients (Definite NBD = 61, possible NBD = 16) were included. Demographics, clinical features, treatment characteristics, disability status and survival status of the patients were evaluated. Results Forty-seven (61%) of the patients were male. Median time to neurological involvement from first diagnosis of BD is 6 (IQR = 8.8) years in patients who had diagnosis of BD before neurological involvement. Distribution of NBD: parenchymal (pNBD), non-parenchymal (npNBD), mixed (mNBD) and peripheral nervous system (pnsNBD) were 47 (61%), 22 (28.6%), 5 (6.5%), 3 (3.9%), respectively. Eye involvement was more frequent in pNBD compared to npNBD. Brainstem (72.9%) was the most frequently affected parenchymal area and followed by cerebellum (43.8%) and diencephalon (37.5%). Twelve patients had spinal cord involvement (n = 12, 24.5%). Among the patients with pNBD and mNBD (total n = 52), 48 patients were considered as acute onset parenchymal disease and 4 patients were evaluated as chronic progressive disease. Fifty-eight percent of the patients with acute onset parenchymal disease had only one attack. Totally 14 BD patients deceased during a median 9.4 (IQR = 13) years disease duration and 9 of these patients had NBD (pNBD = 6, mNBD = 2, pnsNBD = 1). Corticosteroids (IV pulse = 75.5% and oral medium-high dose = 90%), alpha-interferon (76.9%), cyclophosphamide (57.1%), and TNF inhibitors (23.5%) were the most frequently preferred treatment options for pNBD. Conclusions Neurological involvement is seen about 5 years after the diagnosis of BD, and ocular involvement more commonly seen in these patients than non-NBD patients. More than half of the patients with acute onset parenchymal NBD had only one attack. No death was observed in the patients with non-parenchymal NBD. Biologic agents (Interferon-alpha and anti-TNF agents) were used in most patients.

Background: Relapsing polychondritis (RP) is a rare autoimmune disorder, and myelodysplastic syndrome (MDS) is accompanied by RP at variable rates. Herein, we report a case with RP and MDS who responded dramatically to 5-azacitidine for MDS. Case presentation: With conventional immunosuppressive treatment, our patient had several episodes of different side effects, including infections. With the diagnosis of MDS and initiation of azacitidine treatment, all the manifestations of RP disappeared, and remission was achieved for MDS. Although he had relapses of either RP or MDS after several years of azacitidine treatment, all relapses were controlled well with the initiation of azacitidine treatment every time. Conclusions: Azacitidine should be kept in mind as a treatment option for RP patients with MDS.

Tezcan, Mehmet Engin/0000-0002-1753-4936; TUFAN, Abdurrahman/0000-0001-6244-9362; SARI, Ismail/0000-0001-7737-4180; YILMAZ, Sedat/0000-0002-4691-3417 WOS: 000436403100017 PubMed: 28992387 ObjectiveApproximately 30-45% of patients with familial Mediterranean fever (FMF) have been reported to have attacks despite colchicine treatment. Currently, data on the treatment of colchicine-unresponsive or colchicine-intolerant FMF patients are limited; the most promising alternatives seem to be anti-interleukin-1 (anti-IL-1) agents. Here we report our experience with the off-label use of anti-IL-1 agents in a large group of FMF patients. MethodsIn all, 21 centers from different geographical regions of Turkey were included in the current study. The medical records of all FMF patients who had used anti-IL-1 treatment for at least 6 months were reviewed. ResultsIn total, 172 FMF patients (83 [48%] female, mean age 36.2 years [range 18-68]) were included in the analysis; mean age at symptom onset was 12.6 years (range 1-48), and the mean colchicine dose was 1.7 mg/day (range 0.5-4.0). Of these patients, 151 were treated with anakinra and 21 with canakinumab. Anti-IL-1 treatment was used because of colchicine-resistant disease in 84% and amyloidosis in 12% of subjects. During the mean 19.6 months of treatment (range 6-98), the yearly attack frequency was significantly reduced (from 16.8 to 2.4; P < 0.001), and 42.1% of colchicine-resistant FMF patients were attack free. Serum levels of C-reactive protein, erythrocyte sedimentation rate, and 24-hour urinary protein excretion (5,458.7 mg/24 hours before and 3,557.3 mg/24 hours after) were significantly reduced. ConclusionAnti-IL-1 treatment is an effective alternative for controlling attacks and decreasing proteinuria in colchicine-resistant FMF patients.

The use of anti-tumor necrosis factor alpha (anti-TNF-α) agents has increased during the past decade in rheumatology practice. Opportunistic infections have been reported with anti-TNF-α agents in clinical trials and post-marketing usage. Aspergillus infection is a rare opportunistic infection that is associated with immunosuppression, and there are reported cases of pulmonary aspergillosis in various rheumatic diseases treated with anti-TNF-α agents. Here, we present the first case of pulmonary aspergillosis associated with infliximab treatment in a patient with Still’s disease.

Background:Before using biological DMARDs, EULAR suggests the use of synthetic DMARDs (especially methotrexate) for RA and PsA [1-2].Objectives:It was aimed to evaluate the differences of disease duration and csDMARDs till first bDMARD in RA and PsA patients.Methods:HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 2070 RA and 520 PsA patients have been recorded. Demographic, clinical and laboratory data before bDMARDs of the patients were noted. When investigating the differences between groups, the effects of gender, age and disease duration wereadjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender, age and for indifference of the relevant groups by using prospensity score matching.Results:We incuded 481 RA, and 482 PsA age and gender matched patients in the study. Age, gender and disease duration information were given in the Table 1. 72.8% of the RA patients were RF or anti-CCP positive. Overall, 56.3, 100% of the RA, and PsA patients first biologic therapies were anti-TNFs, respectively. All RA patients started with csDMARDs before bDMARD treatments, whereas 450 of 482 (93.4%) PsA patients. Methotrexate was the anchor csDMARD for both diseases. RA patients more frequently used all csDMARDs included methotrexate, leflunomide, sulphasalazine hydroxychloroquine and corticosteroids as well. Median disease duration till bDMARD treatments in RA and PsA patients were 55 and 18.5 months respectively (pTable 1.emographic characteristics and csDMARDs before first bDMARDRA (n=481)PsA (n=482)P valueFemale, n (%)319 (66.3)332 (68.9)0.218Age, years (mean±SD)48.2 ± 13.547.4 ± 12.20.332Disease duration, years*10 (6-16)7 (3-12)0.000Symptom duration before diagnosis, years¥0 (0-1)1 (0-4)0.000*The period of time between diagnosis and bDMARD initiation, months¥55 (24-115)18.5 (8-58)0.000*The period of time between symptoms and bDMARD initiation, months¥70 (35-151)48 (20-124)0.000*MethotrexateEver n (%)400 (83.3)373 (77.5)0.015Just before bDMARD initiation n (%)251 (52.2)230 (47.7)0.093Hydroxychloroquine sulfateEver n (%)292 (60.8)170 (35.3)0.000*Just before bDMARD initiation n (%)262 (54.5)99 (20.5)0.000*LeflunomideEver n (%)237 (49.4)129 (26.8)0.000*Just before bDMARD initiation n (%)160 (33.3)96 (19.9)0.000*SulphasalazineEver n (%)353 (73.5)265 (55.1)0.000*Just before bDMARD initiation n (%)156 (32.4)146 (30.3)0.259*CorticosteroidsEver n (%)419 (87.3)281 (58.4)0.000*Just before bDMARD initiation n (%)335 (69.6)187 (38.8)0.000*¥Median (IQR)Conclusion:According to HUR-BIO real life data, for inflammatory arthritis patients who started bDMARDs, the periods of time between diagnosis and bDMARDs were more reasonable (18 months) in PsA patients than RA patient’s periods which were approximately three times longer. RA patients were used much more and longer duration of csDMARDs. This explicit distinction may be explained by synthetic DMARDs on activity differences between the RA and PsA.References:[1]Gossec, L., et al., EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 700-712.[2]Smolen, J.S., et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 685-699.Disclosure of Interests:None declared

Background:In the last 20 years, anti-tumor necrosis factor (TNF) alpha agents re-designed the management of rheumatoid arthritis (RA). Despite this, unmet needs in the management of RA brought several drugs targeting different molecules and cytokines. It is still a research question that how did these developments changed daily-practice in RA patients who are intolerant/unresponsive to the first biological disease modifying anti-rheumatic drugs (bDMARD).Objectives:In this study, we aimed to explore the second biologic agent trends of our 20-years of single-center experience.Methods:HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.Results:A total of 776 (776/2080, 37.3%) RA patients, who was prescribed a second biological agent, was registered in HUR-BIO by the end of 2020. Of these patients, 83.7% was female. Mean age at the starting of bDMARD was 53.1 ± 13.3 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptid positivity was 69.1% and 60.5%, respectively. Distribution of first-line bDMARDs was as follows: adalimumab 194 (24.9%), etanercept 209 (26.9%), infliximab 105 (13.5%), golimumab 39 (5.0%), certolizumab 35 (4.5%), abatacept 78 (10.0%), rituximab 46 (5.9%), tofacitinib 37 (4.7%), tocilizumab 33 (4.2%). 11 (1.4%), 85 (11.0%), 282 (36.3%) and 398 (51.3%) patients were prescribed with their second bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time.Table 1.Distribution of second biologic DMARDs in RA patients according to 5-years periods2001-20052006-20102011-20152016-2020TotalAdalimumab3 (27.3)15 (17.6)69 (23.9)77 (18.9)164 (20.8)Etanercept8 (72.7)35 (41.2)49 (17.0)41 (10.1)133 (16.8)İnfliximab012 (14.1)13 (4.5)25 (6.2)50 (5.4)Golimumab0019 (6.6)8 (2.0)27 (3.4)Certolizumab002 (0.7)26 (6.4)28 (3.5)Anti-TNF11 (100)62 (72.9)152 (53.9)177 (44.5)402 (51.8)Tofacitinib004 (1.4)73 (17.9)77 (9.7)Tocilizumab0012 (4.2)81(19.9)93 (11.7)Rituximab022 (25.9)53 (18.3)32 (7.8)107 (13.5)Abatacept01 (1.2)61 (21.1)35 (8.6)97 (12.2)Non-Anti-TNF023 (27.1)130 (46.1)221 (55.5)374 (48.2)Total11 (100)85 (100)282 (100)398 (100)776 (100)Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015Conclusion:As the choice of second-line biologic and targeted synthetic DMARD, non-Anti-TNF bDMARDs, especially tofacitinib and tocilizumab becoming more frequent year-by-year. Despite that, anti-TNF agents as a group are still highly-prescribed options as second-line bDMARD.Disclosure of Interests:None declared

Background:Psoriatic arthritis (PsA) is a multi-dimensional chronic disease, which can affect joints, skin and enthesis. Extrapolation of the positive treatment results of anti-tumor necrosis factor (TNF) alpha agents on spondyloarthritis and rheumatoid arthritis to the treatment practice of PsA lead to a new era for the management of PsA. However, unmet needs in the management of PsA lead to development of several drugs targeting different molecules and cytokines. The impact of these developments on PsA patients who are intolerant/unresponsive to the first biological disease-modifying anti-rheumatic drugs (bDMARD) still needs to be defined.Objectives:To explore the second biologic agent trends on PsA patients of our 10-years of single-center experience.Methods:HURBIO-PsA (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005 on PsA patients. Until the end of the 2020, 19 different rheumatologists contributed to the development of HURBIO-PsA. Anti-TNF drugs were approved as first line bDMARD for PsA patients. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2011. Also, demographic and serologic data of RA patients were reported.Results:A total of 225 PsA (225/443, 50.8%) patients, who was prescribed a second biological agent, was registered in HURBIO-PsA by the end of 2020. Of these patients, 74.7% was female. Mean age at the starting of bDMARD was 47.1 ± 11.6 years. 90 (40.0%) and 135 (60.0%) patients were prescribed with their second bDMARD in 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time, especially for secukinumab.Table 1.Distribution of second biologic DMARDs in PsA patients according to 5-years periods2011-20152016-2020TotalAdalimumab30 (33.3)33 (24.4)66 (29.3)Etanercept33 (36.7)8 (5.9)41 (18.2)Infliximab9 (10)15 (11.1)24 (10.6)Golimumab9 (10)5 (3.7)14 (6.2)Certolizumab5 (5.6)34 (25.2)39 (17.3)Anti-TNF86 (95.6)95 (70.4)181 (80.5)Secukinumab026 (19.3)26 (11.5)Ustekinumab010 (7.4)10 (4.4)Abatacept4 (4.4)2 (1.5)6 (2.6)Tofacitinib02 (1.5)2 (0.9)Non-Anti-TNF4 (4.4)40 (29.6)44 (19.5)Total90 (100)135 (100)225 (100)Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, secukinumab: 2018, ustekinumab: 2018; abatacept and tofacitinib were given with the permission from the Ministry of Health of Turkey for off-label use authorizationConclusion:Almost half of the PsA patients switched their anti-TNF drugs to others. Non-Anti-TNF bDMARDs, especially secukinumab, becoming more frequently used as a second-line biologic agent in PsA in recent years. These bDMARD prescription trend is appropriate to EULAR PsA recommendations.Disclosure of Interests:None declared.

Background:Anxiety is commonly observed, underestimated problem in patients with psoriatic arthritis (PsA). Overall rate has been reported around 20% [1]. However the data on anxiety in PsA patients requiring advanced treatment and change in response to therapy is scarce.Objectives:Our aim was to understand the frequency of anxiety before starting biologic agents and change in the anxiety scores with the treatment.Methods:PsA patients from the Hacettepe University biological database (HUR-BIO) were assessed for anxiety (score ≥ 4) using the patient self-reported measure of anxiety on a 0-10 numerical scale, included in the Psoriatic Arthritis Impact of Disease questionnaire (PSAID-12) [2]. The anxiety rate and scores were determined before starting biologic agents and at first visit in 6 months. Change in the scores were compared between patients according to the favourable treatment responses (Table 1). The correlation between the score-changes in anxiety and treatment response parameters was assessed by spearman correlation analysis.Results:From 520 patients registered, 147 [mean (SD) age 43.3 (12.4) years, 70.7% female] had anxiety score registered both at baseline and first visit in 6 months. Both the frequency and mean (SD) score of anxiety decreased at first visit [63.9% vs 41.4 %, 4.8(3.4) vs 3.2 (3.1) respectively, pTable 1.Patient characteristics at baseline and changes in the anxiety score according to treatment responseConclusion:Anxiety is a more frequent problem at the time of biologic initiation compared to rates observed in general PsA population which could be related to the high disease activity. The rates are still high in 6 months under treatment, however both the frequency and score of anxiety showed a decreasing trend parallel to the treatment response.References:[1]Zusman EZ, Howren AM, Park JYE,et. al (2020) Epidemiology of depression and anxiety in patients with psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 50 (6):1481-1488.[2]Gossec L, de Wit M, Kiltz U, Braun J, et al (2014) A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis 73 (6):1012-1019.Figure 1.Correlation between the score changesDisclosure of Interests:None declared.

Background:Obesity has been suggested to be a chronic inflamatory condition and therefore, obesity may be considered as a risk factor for developing immune-mediated diseases, including inflammatory arthritis. In larger biologic registiries, obesity was found frequently in psoriatic arthritis than other inflammatory diseases such as rheumatoid arthritis and spondyloarthritis. [1-4]. However, obesity may be a reason of aging, moreover, there are strong sex differences between those diseases.Objectives:The aim of this study was to evaluate the obesity rates in sex and aged matched patients with inflammatory arthritis before the initation of biological therapy.Methods:HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 5635 patients have been recorded. Demographic, clinical and laboratory data before bDMARD of SpA, RA and PsA patients were noted. The patients were divided into two groups: non-obese patients (2) and obese (≥30 kg/m2) patients. When investigeting the changes in BMI by diagnosis, the effects of gender and age were adjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender and age indifferences of the relevant groups by using propensity score.Results:5059 patients’ (1834 RA, 2741 SpA and 484 PsA) BMI data before the bDMARD treatments were avaliable and analysed. Baseline characteristics of RA, SpA and PsA patients were given in Table 1. 72.3% of the RA patients were seropositive. HLAB27 was positive in 64.7% and 22.9% of the SpA and PsA patients. Anti-TNF therapy was started as first bDMARD in 57.2% of the RA patients, others were started with non-Anti-TNF bDMARDs. In SpA (99.2%) and PsA (100%) patients anti-TNFs were the first biologics. Overall, the proportion of obese patients was significantly higher in RA and PsA than in SpA patients (Table 1) and age and sex affected BMI significantly (pTable 1.Baseline characteristics and BMI of the patientsRASpAPsApAll bDMARD patientsN18342741484Female, n (%)1470 (80.2)1257 (45.9)334 (69.0)0.000*Age, years*52.9±13.443.1±11.447.4±12.20.000*Disease duration, years¥11 (7-17)8 (5-13)7 (3-12)0.000*Body mass index*29.6 ± 6.527.7 ± 5.429.2 ± 5.80.000*Obesity, n (%)811 (44.2)815 (29.7)199 (41.1)0.000*Age and sex matched groupN481483484Female, n (%)315 (65.7)324 (67.1)334 (69.0)0.545Age, years*47 (36-59)48 (39-57)47 (38-56)0.691Disease duration, years¥10 (6-15)5 (5-13)7 (3-12)0.000*Body mass index*28.5 ± 6.128.5 ± 5.829.2 ± 5.80.150Obesity, n (%)183 (38.0)176 (36.4)199 (41.1)0.316* Mean ±S.D ¥Median (IQR)Conclusion:Although obesity was more frequently reported in RA and PsA patients, age and gender seemed to be the major factors in the occurrence of this difference rather than inflammatory arthritis subgroups. Therefore, when considering obesity as a factor in the registries, for instance biological registries, sex and age should be kept in mind.References:[1]Højgaard, P., et al., The influence of obesity on response to tumour necrosis factor-α inhibitors in psoriatic arthritis: results from the DANBIO and ICEBIO registries. Rheumatology (Oxford), 2016. 55(12): p. 2191-2199.[2]Liu, Y., et al., Impact of Obesity on Remission and Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken), 2017. 69(2): p. 157-165.[3]Moroni, L., N. Farina, and L. Dagna, Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clin Rheumatol, 2020. 39(4): p. 1039-1047.[4]Zurita Prada, P.A., et al., Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol, 2020.Figure 1.BMI regarding to sex and diseases subtypesDisclosure of Interests:None declared

Background:In psoriatic arthritis (PsA), EULAR recommendations are to aim for remission or low disease activity(1). Many treatments are now available, though some are costly and not widely available in all countries. Country of patient care, and in particular Gross Domestic Product (GDP) may be linked to PsA outcomes(2). Although patients with high disease activity are eligible for targeted therapies such as biologic disease-modifying anti-rheumatic drugs (bDMARDs), they may not be able to get the benefits from these efficacious treatments in all countries equally.Objectives:The objective was to explore the rate of PsA patients with high to moderate disease activity, not receiving bDMARDs across countries, and to assess the consequences on functional incapacity.Methods:This was a cross-sectional analysis of an observational study (ReFlap, NCT03119805)(3), which included adult patients with PsA with ≥ 2 years disease duration from 14 countries. One country was excluded from this analysis since only 7 patients were included. We explored the rate of patients with significant disease activity (i.e based on DAPSA > 14) and no ongoing bDMARD prescription. Countries of inclusion were analysed separately, and classified into tertiles by GDP/capita (lowest tertile: Brazil, Turkey, Russia, Romania, Estonia; middle tertile: Spain, Italy, UK, France; highest tertile: Canada, Germany, USA and Singapore). The rate of no bDMARDs - DAPSA > 14 patients was analysed by country and compared between the 3 tertiles of GDP/capita by parametric tests. Functional capacity (HAQ) was compared between no bDMARDs - DAPSA > 14 patients and the other patients (pooling patients with moderate or high disease activity with bDMARD, low disease activity and remission with or without bDMARD). There was no imputation of missing data.Results:Of the 459 patients, 429 had complete data available and were analysed: mean age 52.3 (SD 12.6) years, mean disease duration 10.2 (SD 8.2) years, 215 (50.1%) males. The rate of no bDMARDs - DAPSA > 14 patients was 18.4% (76/414). The rate ranged from 7.4% (UK and Spain) to 40% (Russia): Figure 1. A link was seen with the country and the tertiles of countries according to GDP/capita, with higher rate of no bDMARDs - DAPSA > 14 patients in the lowest GDP/capita countries (28.8%, 15.3% and 14.3% in the 3 GDP/capita tertiles, respectively, p=0.005; Figure 1). Of note, 40/76 no bDMARDs - DAPSA > 14 patients received a treatment intensification during the visit. Among no bDMARDs - DAPSA > 14 patients, functional incapacity was higher than in the other patients, as expected (mean HAQ 0.96 (SD 0.64) vs 0.57 (SD 0.63), pFigure 1.The size of the bubbles represent the number of patients per country (range, 13 to 89). The horizontal lines represent the mean proportion of patients with no bDMARDs – DAPSA > 14 for each tertiles of countries by GDP/capita.Conclusion:In this exploratory comparison of disease patterns and treatments choices in 13 countries, we observed that more PsA patients with high or moderate disease activity and living in low GDP/capita countries were less likely to be treated with bDMARDs. As a consequence, no bDMARDs – DAPSA > 14 patients had worse functional incapacity. Equitable access to bDMARDs should be aimed for all patients regardless of their country of origin.References:[1]Gossec L et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020 Jun;79(6):700-712.[2]Gossec L et al. Are There Country Differences in Disease Activity and Life Impact of Psoriatic Arthritis? An Analysis of 436 Patients from 14 Countries [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10).[3]Gorlier C et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis. 2019 Feb;78(2):201-208.Disclosure of Interests:None declared.

Background:Timely diagnosis is essential for the optimal management of psoriatic arthritis (PsA). Several instruments have been developed for screening PsA among patients with psoriasis. However, a delay in diagnosis is still frequently reported, possibly due to the lack of a wide use of these instruments.Objectives:We aimed to identify and compare the reported performance of these instruments with special emphasis on the PsA phenotypes.Methods:We conducted a systematic literature search on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis’. Two independent reviewers identified all studies published in English, that report on the validation, psychometric evaluation or use of an instrument for screening PsA. Any disagreements were resolved by the third investigator. Data on sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were extracted or calculated for each instrument. Additionally, instruments were assessed for their performance in patients with different disease phenotypes.Results:A total of 10754 references were screened, and 42 were identified that reported on 15 different screening instruments. Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST), Early Arthritis for Psoriatic Patients questionnaire (EARP) were the most commonly used instruments. There was important variability across studies regarding the sensitivity, specificity, PPV and NPV of these instruments based on the cut-offs for positivity, setting, patient population and disease phenotypes (Table 1). Specificity was higher when patients with a previous diagnosis of other rheumatic diseases were excluded. Lower sensitivity was reported among patients with shorter disease duration and when patients with a prior diagnosis of PsA were excluded from the study, whereas higher sensitivity was reported among patients with prior NSAID use. Screening tools showed differences in sensitivity in different domains (Figure 1).Figure 1.Performance Among Patients with Each DomainConclusion:This systematic literature review revealed wide variability in the diagnostic estimates of currently available questionnaire-based screening instruments for identifying PsA among psoriasis patients, depending on study populations and disease phenotypes. There is an unmet need for a screening instrument with a better performance in all disease domains.Table 1.Diagnostic estimates of screening tools in different studiesInstrumentNumber of studiesSensitivity%Specificity%PPV%NPV%PASE1824-9138-9518-8813-96PEST1140 – 8537.2-98.623-9647.1-99.3EARP941-97.234-97.214-93.357.5-100TOPAS641-89.129.7-9025.7-91.868-81.6TOPAS-II444-95.880.5-9863.4-95.891-98PsA-Disk questionnaire187.246.458.678.5CONTEST270-76.556.5-9116-8968-95STRIPP191.593.379.697.5SiPAS179877390PASQ267-92.764-81.84383GEPARD277706680Swedish- Psoriasis Assessment Questionnaire163724585PAQ160622687.5SiPAT169699169A novel, short, and simple screening questionnaire186.971.35393.6PASE: Psoriatic Arthritis Screening and Evaluation, PEST: Psoriasis Epidemiology Screening Tool, EARP: Early Arthritis for Psoriatic Patients questionnaire, TOPAS: Toronto Psoriatic Arthritis Screening Questionnaire, STRIPP: Screening Tool for Rheumatologic Investigation,SIPAS: Simple Psoriatic Arthritis Screening questionnaire, PASQ: Psoriasis and Arthritis Screening Questionnaire, GEPARD: German Psoriatic Arthritis Diagnostic Questionnaire, PAQ: Psoriatic and Arthritic Questionnaire, SiPAT: Siriraj Psoriatic Arthritis Screening ToolDisclosure of Interests:None declared.

Background:Axial spondyloarthritis (axSpA) may lead to linear radiographic progression and progress to advanced spinal disease and finally to the bamboo spine (1).Objectives:To assess the demographic, clinical, disease activity and retention rates of patients using biological disease-modifying antirheumatic drugs (bDMARD) with advanced spinal disease and bamboo spine in the Hacettepe University Rheumatology Biologic Registry (HUR-BIO) cohort.Methods:In the HUR-BIO spondyloarthritis (SpA) registry were available 2952 patients. Of these, 774 patients with lumbar and cervical radiographs were included in the study. Advanced spinal ankyloses (99 patients) was defined as the presence of at least two intervertebral adjacent bridges at the lumbar and/or cervical spine level without bamboo spine. Bamboo spine (78 patients) was defined with a complete fusion of all lumbar and cervical spines. In addition, patients who diagnosed with axSpA for at least 10 years but no develop syndesmophytes on lumbar and cervical spine (92 patients) were used as a control group.Results:Both the bamboo spine and advanced spinal disease had higher age, higher BMI, more smoking (ever) and hip involvement compared to the without syndesmophytes group. Acute phase reactants, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing spondylitis disease activity Score-CRP (ASDAS-CRP) parameters were similar at the beginning of bDMARD in all groups. BASFI was higher in the bamboo spine group than in the without syndesmophytes group at last visit (Table 1). There were no differences between all groups in terms of the retention rate of the first bDMARD (Log rank p=0.86) (Figure 1).Conclusion:Data on the use of bDMARDs in SpA patients with bamboo spine are limited. This study showed that bDMARDs are an effective treatment option in SpA patients with bamboo spine with high disease activity. Similar drug retention rates were found compared to SpA patients with no syndesmophytes. Although the disease activity decreased similar rates in the groups, functional limitation continued in approximately half of the patients in bamboo spine patients.References:[1]Braun J et al. Staging of patients with ankylosing spondylitis: a preliminary proposal. Annals of the rheumatic diseases, 2002, 61.suppl 3: iii19-iii23.Table 1.Demographic, clinical characteristics and response to treatment in SpA groups.Without syndesmophytesn= 92Advanced spinal diseasen= 99Bamboo spinen= 78pAge, years˚42.2 ± 8.851.3 ± 10.255.5 ± 9.3< 0.001*Age at disease onset, years˜25.01 (11)36.6 (20)33.3 (18)< 0.001*Male, n (%)55 (59.8)78 (78.8)66 (84.6)< 0.001*Disease duration, years˜13.8 (5)12.3 (15)17.6 (13)< 0.001*Delay in diagnosis, months˜12.02 (43)36.01 (89)36.01 (100)0.013*HLA-B27 positivity/total, n (%)21/42 (50)31/45 (69)16/28 (57)0.19BMI˜26.3 (8)29.7 (7)29.4 (7)< 0.001*Smoking (ever), n (%)56 (61)78 (79)58 (74)0.019*Hip involvement, positivity/total (%)11/84 (13.1)34/86 (39.5)37/75 (49.3)< 0.001*OnsetLastOnsetLastOnsetLastp (onset)p (last)ESR, mm/h˜21.5 (34)12.5 (18)25.5 (29)14.5 (17)23 (31)14 (14)0.60.59CRP, mg/dL˜1.5 (4)0.4 (0.6)1.7 (2)0.65 (1)1.8 (3)0.64 (0.8)0.40.001*ASDAS-CRP˜3.6 (0.8)1.9 (1)3.4 (0.9)2 (1.2)3.4 (0.8)1.9 (1.4)0.40.23BASDAI score˜5.7 (2.6)2.4 (4.5)5.6 (3.3)2.8 (3.1)5.6 (3.2)2.4 (3.3)10.31BASFI score˜5.4 (4)2 (4)4.5 (4)3 (4)6.5 (3)3.9 (4.5)0.10.002*BASFI score > 4, n (%)29 (59)23 (25)29 (56)32 (32)27 (75)36 (46)0.10.014*ASAS PR, n (%)26 (28)15 (15)17 (22)0.09*p ˚mean ± SD, ˜median (IQR) SD: Standard deviation; IQR: Inter-quartile range BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BASFI: Bath Ankylosing Spondylitis Functional Index; BMI: Body mass index; ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein; ASAS PR: Assessment in SpondyloArthritis International Society partial remission; ASDAS: Ankylosing spondylitis disease activity scoreFigure 1.Retention rate of the first bDMARDDisclosure of Interests:None declared