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To compare enteropathic spondylitis (ES) with psoriatic spondylitis (PS) and ankylosing spondylitis (AS), in patients on biological disease-modifying anti-rheumatic drug (bDMARD) treatment.Patients who were enrolled in the HUR-BIO registry were included. ES patients were considered as the main study group; AS and PS patients were included as the control groups. ES was defined as patients with inflammatory bowel disease (IBD) having inflammatory back pain/spine symptoms plus radiological sacroiliitis.Sixty-four ES patients (46.9% female), 128 AS patients (39.1% female), and 92 PS patients (62% female) were analysed. Baseline erythrocyte sedimentation rate (ESR) was significantly higher in the ES group than in the AS group. Both the baseline ESR and C-reactive protein were also higher in the ES group compared with the PS group. Among the first bDMARD use, infliximab use was higher in the ES group than the other groups. There was a marginal significant difference between the SpA subgroups in the retention rates of the first bDMARDs (log-rank, p=0.059). Ulcerative colitis was a significant predictor for switching of bDMARDs in comparison to Crohn's disease. Regarding the treatment responses, no significant differences were relevant for the three groups in terms of 50% improvement of the initial Bath Ankylosing Spondylitis Disease Activity Index score, the Assessment of Spondyloarthritis International Society partial remission score, and 20% improvement of ASAS score.A large majority of enteropathic spondyloarthritis patients on bDMARD treatment had radiographic sacroiliitis. ES patients had distinctive features that distinguish them from AS and PS patients.

The drug retention rate has been an important indicator for evaluating the treatment tolerance. Unfortunately, our knowledge of the secukinumab retention rate in radiographic axial spondyloarthritis (r-AxSpA) is limited. The objective of this study was to assess the retention rate of secukinumab and evaluate predictive factors of drug survival based on data from a real-life cohort. We retrospectively assessed 147 r-AxSpA patients between May 2018 and January 2020 from the HUR-BIO database. Secukinumab retention rates were analyzed using the Kaplan-Meier method and Cox proportional hazard model was used for predictors factors. The global retention rate of secukinumab was 55% at 12 months. r-AxSpA patients with obesity had a lower frequency of secukinumab discontinuation (29% vs. 50%, p = 0.013) in comparison r-AxSpA patients without obesity. In multivariate analysis, multiple TNFi usage had a higher risk of secukinumab discontinuation [HR 1.99 (1.09-3.62), p = 0.024]; on the other hand, obesity had a lower risk [HR 0.45 (0.27-0.90), p = 0.008]. Except for not using multiple TNFi, this real-life analysis showed for the first time that obesity is not an adverse risk factor for secukinumab drug retention in r-AxSpA. Secukinumab, which is an interleukin-17A inhibitor, could act via a different pathway than tumor necrosis factor inhibitors (TNFi). The identification of predictive factors such as obesity that may affect the individual drug selection may provide more appropriate biologic treatment strategies for r-AxSpA.

Takayasu's arteritis (TAK) is a chronic vasculitis, affecting predominantly the aorta and/or its major branches. The aim of this study was to compare the differences between childhood and adult onset TAK.We retrospectively evaluated 179 TAK patients followed between August 2005 and July 2019. Demographic characteristics, laboratory features, disease activity, echocardiographic data at diagnosis and treatment regimens in the disease course were compared between the paediatric and adult onset patients.Twenty-five paediatric-onset (18 years of age at diagnosis) and 154 adult-onset patients (≥18 years of age at diagnosis) were enrolled. The mean age at diagnosis for children and adults were 13.6±4 and 35.6±13, respectively. Paediatric onset TAK patients had more intense inflammation at the time of diagnosis reflected in their clinical findings. Acute phase reactants were high in all paediatric patients and significantly higher in patients with paediatric-onset TAK (p=0.006 and p=0.005, respectively). Abdominal predominant disease was more common in the paediatric group, in contrast, focal disease and aortic arch predominant disease were more common in the adult group. Ascending aortic dilatation, left ventricular hypertrophy and moderate-severe aortic insufficiency were more frequent in echocardiography findings of paediatric onset TAK patients. In comorbidities, hypertension was more common in paediatric TAK patients during follow-up, whereas cerebrovascular disease was more common in adult patients.Our paediatric onset TAK patients presented with a more severe inflammation and more widespread vascular involvement. Multicentre studies from different geographic areas are needed to verify our observation and understand the underlying causes.

This study aimed to compare Tuberculin Skin Test (TST) and QuantiFERON (R)-TB Gold In-Tube (QFT-GIT) test in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients scheduled for biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) in a Bacillus Calmette-Guerin-vaccinated population. Adult RA (n = 206) and SpA (n = 392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups. Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cutoff (p < 0.001). Only 8.9% and 15% of the patients with RA and SpA, respectively, tested positive by QFT-GIT. The two tests poorly agreed in both groups at a TST cutoff of 5 mm and increasing the TST cutoff only slightly increased the agreement. Among age, sex, education and smoking status, pre-biologic steroid and conventional DMARD use, disease group, and QFT-GIT positivity, which were associated with a 5 mm or higher TST, only disease group (SpA) and QFT-GIT positivity remained significant in multiple logistic regression. TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cutoff for both diseases could result in overestimating LTBI in SpA.

OBJECTIVES: To analyse the clinical and laboratory factors associated with bamboo spine. METHODS: Data of patients fulfilling the 2009 ASAS classification criteria for axial spondyloarthritis, registered in the national, multicentre, longitudinal, and observational database of TReasure was analysed. Radiographs were assessed using the Bath Ankylosing Spondylitis Radiologic Index (BASRI). Data of patients with a bamboo spine (Group 1) was compared to data derived from patients with a longstanding disease of at least 15 years but no syndesmophytes (Group 2). RESULTS: Out of the 5060 patients, 1246 had eligible radiographs. There were 111 patients (8.9%) with a bamboo spine. Male sex was more common among patients with bamboo spine. The median BMI of 27.7 (25.8-31.1) in Group1 was higher than the BMI of 25.9 (22.9-29.2) in Group 2 (p

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

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.

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.

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.

Most patients with inflammatory arthritis are at their reproductive ages. Use of anti-tumour necrosis factor alpha (anti-TNF-α) agents, one of the important treatment options for inflammatory arthritis, can cause foetal morbidity and mortality. While most studies on the effects of anti-TNF-α agents on pregnancy outcomes are about maternal exposure, the number of studies on the risks related to paternal exposure is insufficient. This study aimed to assess pregnancy periods and outcomes of the partners of male ankylosing spondylitis (AS) patients receiving anti-TNF-α treatment during the preconception period. Totally, 163 male AS patients using anti-TNF-α agents were identified from the Hacettepe University Biological Registry. Of these patients, 45 (27.6%) who declared that their partners got pregnant after initiation on anti-TNF-α agents were included. Data regarding demographics and drug exposure and pregnancy and infant outcomes were evaluated. Of 45 pregnancies, 39 (86.7%) resulted in healthy live births, 3 (6.7%) resulted in spontaneous abortion, and 3 (6.7%) were terminated with curettage. Of 39 live births, 34 (87.2%) were term and 5 (12.8%) were preterm, 30 (76.9%) had normal birth weight, 6 (15.4%) had low birth weight, and 3 (7.7%) had fetal macrosomia. No congenital malformations related to paternal exposure were observed. This study is valuable as being one of the studies providing pregnancy outcomes of partners of male AS patients receiving anti-TNF-α agents with its relatively high number of patients. The results suggested that paternal exposure to anti-TNF-α agents during preconception period could be safe on pregnancy outcomes.

Aim To determine the frequency and define the causes of pulmonary hypertension (PH) in patients with Takayasu arteritis (TA). Method Sixty-four TA patients were evaluated by transthoracic echocardiography (TTE). Having an estimated systolic pulmonary arterial pressure (sPAP) ≥40 mm Hg by echocardiography or if performed, mean PAP ≥25 mm Hg in right heart catheterization was defined as PH. Clinical, imaging and laboratory results of the TA patients were obtained from hospital files. Result In total, seven (10.9%) patients had PH. Four patients had PH due to left-sided heart disease (group 2 PH), three patients due to pulmonary arterial involvement (PAI; group 4 PH) and one patient due to atrial septal defect (group 1 PH). In one patient, combination of PAI, aortic insufficiency and pulmonary venous return anomaly was present and he was considered to have both group 2 and group 4 PH. PAI was more frequent (42.9% vs 15.7%) in patients with PH but the difference was not statistically significant. The percentage of patients treated with cyclophosphamide and/or biologics was higher in the group with PH as compared to the group without PH (P = 0.015). One patient with group 4 PH had been on pulmonary arterial hypertension (PAH)-specific agents for 8 years. Conclusion Pulmonary hypertension is not infrequent in TA patients and all the potential causes of PH should be carefully evaluated. Patients with severe or treatment-resistant disease are prone to have PH. PAH-specific agents may be effective in patients with group 4 PH.

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:Although focusing on the proliferative form of lupus nephritis (LN), recent reports also highlight the importance of recognizing and treating non-proliferative forms of LN.Objectives:In this study, we aimed to compare the clinical features and outcomes between proliferative and non-proliferative LN and to investigate the predictor factors of end stage renal disease (ESRD).Methods:This retrospective study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. 116 patients were diagnosed as LN. Biopsy findings had been classified according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classification. Demographics, disease involvements, laboratory values, treatment regimens, and outcomes in LN course were compared according to the proliferative and non-proliferative LN. Complete renal response within first 24 months was defined as ACR response criteria. Factors predicting the ESRD were analysed by the logistic regression analysis.Results:A total of 116 lupus nephritis patients were categorised class 3 (n=17, 14.7%) or 4 (n=77, 66.4%) as proliferative LN and class 2 (n=9, 7.8%) or 5 (n=13, 11.2%) as non-proliferative LN. Of these patients, 80.2% was female. Mean age at the SLE diagnosis and SLE manifestations were similar for both group. ANA (+) ≥ 1:320, ds-DNA level, APS antibodies, anti-Sm (+) were similar for proliferative and non-proliferative LN, but ds DNA positivity and low level of C3 and C4 were more frequent in proliferative LN. LN duration was similar. Median renal SLEDAI scores were higher in proliferative LN group. Induction treatment regimens included pulse steroid 72.3%, CyC 51.8%, MMF 24.6%, Rtx 6.1%, CsA 4.4%, and plasma exchange 12.9%. ESRD, renal transplantation and exitus were major complications of LN. Predictors of ESRD were duration of lupus nephritis (OR 1.32 [1.09-1.61]; 95% CI), decrease in GFR at the biopsy time (OR 0.97 [0.95-0.99]; 95% CI), and being in complete renal response within 24 months (OR 21.07 [2.28-194.36]; 95% CI).Conclusion:Unfortunately, LN patients still have worse outcomes, such as high ESRD rate, regarding to current effective immunosuppressive treatment regimens. Although patients’ number were not enough for conclusion, interestingly, worse outcomes were not related with proliferative or non-proliferative LN. Complete remission within 24 months was most relevant good prognostic factor, and clinicians should be kept in mind to these windows of opportunity period.Table 1.Demographic, clinical characteristics, and outcomes of the patients with lupus nephritisVariables*All patients (n=116)Class 3 or 4 LN (n=94)Class 2 or 5 LN (n=22)pAge at the SLE diagnosis, years22.5±13.123±13.320.3±140.32Sex, female93 (80.2)74 (78.7)19 (86.4)0.42SLE disease duration8 (8.7)8 (9.7)8.3 (7.5)0.66Lupus nephritis at diagnosis time67 (58.8)54 (58.7)13 (59.1)0.97Manifestation of SLE-Musculoscletal75 (66.4)63 (68.5)12 (57.1)0.32-Mucocutaneous60 (52.6)50 (54.3)10 (45.5)0.45-Hematologic47 (40.9)38 (40.4)9 (42.9)0.83-Serosal26 (23.2)21 (23.1)5 (23.8)0.94-Neurological6 (5.3)5 (5.4)1 (4.8)0.91Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.6 (0.2)0.01-GFR (ml/min)110 (67)92 (55)145 (59)0.03-≥ 60 ml/min79 (79.8)63 (77.8)16 (88.9)-30-59 ml/min8 (8.1)7 (8.6)1 (5.6)0.55-< 30 ml/min12 (12.1)11 (13.6)1 (5.6)-24-hour urine protein≥ 1 gr/day72 (71.3)62 (76.5)10 (52.6)0.04≥ 3 gr/day36 (35.6)32 (39)4 (21.1)0.14-Active urinary sediment91 (83.5)78 (89.7)13 (59.1)0.001Renal SLEDAI at the biopsy12 (8)12 (8)8 (8)0.001Lupus nephritis duration (years)5.5 (8)5.1 (8.3)6.4 (4.8)0.73Complete renal response within 24 months69 (71.1)55 (72.4)14 (66.7)0.61End-stage renal disease13 (11.2)11 (11.7)2 (9.1)0.72Renal transplantation5 (4.3)4 (4.3)1 (4.5)0.95Exitus8 (7)7 (7.5)1 (4.5)0.62*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity indexDisclosure of Interests:None declared

Background:Recent reports describe EGPA as having two subgroups as ANCA positive and ANCA negative. Furthermore, there could be differences in terms of clinical features and outcomes (1).Objectives:The aim of this study was to compare the clinical characteristics and outcomes of ANCA positive EGPA patients with those of ANCA negative ones.Methods:This retrospective, descriptive study included 50 EGPA patients (male/female:13/27) from our prospective vasculitis database from October 2014 (2). The patients had fulfilled the ACR 1990 or DCVAS criteria for EGPA. In addition to clinical features (activity index) and treatment regimens, outcomes of patients (relapse and damage) were also reviewed. For relapse-free survival analysis, time to first relapse was compared according to ANCA phenotype by Kaplan-Meier survival analysis.Results:Of the patients, 17 (34%) were in ANCA (+) group, 33 (66%) were in ANCA (-) group. Renal involvement and peripheral neuropathy were more frequent in ANCA (+) patients whereas ANCA (-) patients were significantly younger at the time of diagnosis and they had more nasal polyposis. The median BVAS at the EGPA diagnosis was significantly high in ANCA (+) group. All 3 of patients with cardiac involvement were in the ANCA (-) group but difference was found in terms of FFS and VDI between ANA (+) and (-) groups. However, pulse steroid and cyclophosphamide treatments were more commonly used in ANCA (+) group while mepolizumab were used in ¼ of ANCA (-) patients (Table 1). During median 47 (IQR 69.9) months follow up, about 40% of patients had at least one relapse but there was no difference for relapse-free survival rate according to the ANCA status (Figure 1).Table 1.Demographics and clinical characteristics of the patients with EGPA during disease courseCharacteristics*ANCA (+) (n=17)ANCA (-) (n=33)PAge at the diagnosis (years)53.8 ± 16.337.9 ± 14.30.001Sex, female10 (58.8)17 (51.5)0.62Asthma12 (70.6)29 (87.9)0.13Nazal polyp2 (11.8)15 (45.5)0.017Eosinophilia (>1000/μL)11 (64.7)27 (81.8)0.18Disease duration (years)4.1 (5.9)3.7 (5.9)0.69Organ specific involvement, % - Pulmonary76.578.80.85 - ENT82.487.90.59 - Renal52.93 - PNS47.19.10.002 - Cardiac09.1N/ABVAS at the diagnosis17 (13)9 (4)0.002Revized FFS - 011 (64.7)26 (78.8)0.28 - ≥ 16 (35.3)7 (78.8)VDI1 (1)1 (1)0.41Treatment regimens for induction, % - Pulse steroid64.711.20.002 - Cyclophosphamide58.818.20.004 - Rituximab11.830.21 - Mepolizumab012.1N/ATreatment regimens for maintenance, % - Rituximab11.830.21 - Mycophenolate mofetil35.330.002 - Mepolizumab024.2N/A - Azathioprine or methotrexate47.142.40.75Relapse, n (%)7 (41.2)12 (42.9)0.66Exitus, n (%)2 (11.8)1 (3)0.26* Med (IQR) for numerical data excluding age; mean ± SD for ageANCA: Antineutrophil cytoplasmic antibody, BVAS: Birmingham Vasculitis Activity Score, ENT: Ear, nose, and throat, IQR: Interquartile range, med: median, N/A: Not applicable, PNS: Peripheral nervous system, VDI: Vasculit damage indexConclusion:Not only clinical features and disease activity but also treatments received were significantly different between ANCA (+) and (-) patients. These results could partially define two distinct subgroups of EGPA. However, these groups were similar regarding damage and relapse.References:[1]Comarmond C, Pagnoux C, Khellaf M, Cordier JF, Hamidou M, Viallard JF, et al. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): Clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis and rheumatism. 2013;65(1):270-81.[2]Karadağ Ö, Bilgen SA, Armagan B, Sari A, Erden A, Batu E D et al. Two-year Results of a Prospective Vasculitis Cohort from Eastern Mediterranean: Demographic Characteristics and Distribution of the Vasculitides Frequencies. Rheumatology, 2017; 56(suppl_3), iii88-iii95.Figure 1.Kaplan-Meier relapse-free survival curve according to the ANCA statusDisclosure of Interests:None declared

Background:Renal biopsy is a cornerstone in the diagnosis and management of renal involvement in patients with systemic lupus erythematosus (SLE). However, non-lupus nephritis has been also observed in SLE patients with renal disease (1).Objectives:The aim of this study was to draw attention to the causes of non-lupus nephritis in SLE patients with kidney biopsy.Methods:This retrospective, descriptive study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. All patients had fulfilled the SLICC or EULAR/ACR criteria for SLE. According to the pathology report results, 116 of the patients were diagnosed with lupus nephritis (LN), 18 patients had non-lupus nephritis, 2 biopsies were normal, and 3 biopsies were insufficient. Demographics, SLE disease duration, and renal biopsy diagnosis were derived from our hospital medical records.Results:Of the 23 patients (female:18/male:5), the mean age at the SLE diagnosis was 30.5 years and the median SLE disease duration was 8.5 (11.6) years. Pathologic report findings were compatible with focal segmental glomerulosclerosis in 6 patients, membranous nephropathy with no cellular proliferation and inflammation in 4 patients, thrombotic microangiopathy in 3 patients, IgM nephropathy in 2 patients, tubulointerstitial nephritis in 2 patients, and proliferative glomerulonephritis with monoclonal IgG deposits in one patient. There were no different for SLE manifestation in both gropus. LN vs other renal pathologies laboratory comparing as follow: ANA (+) ≥ 1:320 89 (76.7%) vs 14 (60.9%), APS antibodies 31 (33.7%) vs 8 (57.1), anti-Sm (+) 8 (11.8%) vs 1 (4.3%) were similar for LN and other renal pathologies, but anti-ds-DNA positivity 94 (84.7%) vs 10 (50%), median ds-DNA level 421 (591) vs 150 (340) and low level of C3 and C4 were more frequent in LN (pConclusion:Various renal lesions unrelated to lupus nephritis can be observed in SLE patients. Renal biopsy plays a critical role in identifying these lesions, which may have prognostic and therapeutic implications distinctive from those of lupus nephritis. Also, anti ds-DNA positivity/level, low C3 and C4, active urinary sediment and renal SLEDAI scores may give us some clues in terms of renal pathology for SLE patients. Moreover, almost half of the patients without LN in renal biopsy have anti ds-DNA positivity.References:[1]Howell DN. Renal biopsy in patients with systemic lupus erythematosus: Not just lupus glomerulonephritis! Ultrastruct Pathol. 2017 Mar-Apr;41(2):135-146.Table 1.Demographic, clinical characteristics and results of patients with and without lupus nephritisVariables*Lupus nephritis(N=116)Other pathologies(N=23)PAge at the SLE diagnosis, years22.5±13.130.5±14.50.006Sex, female93 (80.2)18 (78.3)0.83SLE disease duration8 (8.7)8.5 (11.6)0.27Manifestation of SLE-Musculoscletal75 (66.4)14 (63.6)0.8-Mucocutaneous60 (52.6)9 (40.9)0.31-Hematologic47 (40.9)10 (43.5)0.49-Serosal26 (23.2)4 (17.4)0.54-Neurological6 (5.3)1 (4.3)0.85Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.9 (0.6)0.17-GFR (ml/min)110 (67)77 (65)0.06-24-hour urine protein≥ 1 gr/day72 (71.3)17 (77.3)0.63≥ 3 gr/day36 (35.6)11 (50)0.23-Active urinary sediment91 (83.5)6 (27.3)Renal SLEDAI at the biopsy12 (8)4 (4)End-stage renal disease13 (11.2)2 (8.7)0.72Renal transplantation5 (4.3)1 (4.3)0.99Exitus8 (7)1 (4.3)0.99*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity indexDisclosure 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: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

Background:The rate of co-occurrence of Familial Mediterranean Fever (FMF) and axial spondyloarthritis (axSpA) in adults is reported ranging from 0.5% to 7.5%. The clinical implications of this co-occurrence in the course of FMF is still a research question.Objectives:To compare of demographic and clinical features of patients with FMF and FMF+axSpA.Methods:A total of 9630 FMF patients was detected according to the ICD-10 code (E85.0) of FMF in Hacettepe University Hospital database. 241 of these patients also had axSpA according to the ICD-10 code (M45). FMF diagnosis was confirmed by Tel-Hashomer criteria. AxSpA was diagnosis was confirmed by either presence of sacroiliitis on sacroiliac radiography according to the Modified New York Criteria (mNY) or presence of active sacroiliitis according to ASAS criteria on magnetic resonance imaging. 136 patients were confirmed according to these criterias as having FMF+axSpA. As a control group, 231 consequent FMF patients without axSpA recorded on the “FMF in Central Anatolia (FiCA) database” and followed up at our center were included in the analysis. Demographic and clinical features of those patients in both groups were compared. pResults:136 patients were included in FMF+axSpA group and 231 patients were included in FMF group. 114 (83.8%) patients in FMF+axSpA group had radiographic sacroiliitis according to mNY criteria; median cervical mSASSS was 0 (available for 49 patients, min-max, 0-36), median lumber mSASSS was 4 (available for 121 patients, min-max, 0-36), 33 (27%) patients had cervical or lumber syndesmophyte. Twenty-six (19.1%) of these patients had radiologically documented inflammatory hip disease 12 (8.8%) of these patients underwent total hip replacement. Female gender was more prevalent in FMF+axSpA group (53.7% vs 32.5%, pConclusion:The coexistence of spondyloarthritis in FMF patients appears to be associated with the increased prevalence of amyloidosis. The inflammatory burden of a second disease and the increased prevalence of the homozygous M694V mutation may explain this risk.Table 1.Comparison of demographic and clinical features of two groups.FMF+AxSpA(n=136, 37.1%)FMF(n=231, 62.9%)pFemale, n(%)73 (53.7)75 (32.5)Age at FMF symptom onset, years med (IQR)12 (5-20)10 (6-18)0.046Symptom duration, years, med (IQR)24 (18-32)20 (14-29)0.007Age at FMF diagnosis, years, med (IQR)24 (13-33)20 (11-30)0.10Duration after diagnosis, years, med (IQR)16 (10-22)13 (7-17)FMF signs and symptoms, n(%)-Fever128 (94.1)204 (88.3)0.067-Abdominal pain123 (90.4)217 (93.9)0.21-Pleuritis31 (22.8)87 (37.7)0.003-Pericarditis3 (2.2)2 (1.0)0.34-Arthritis64 (47.1)92 (39.8)0.17-Erysipelas24 (17.6)38 (16.5)0.77-Febrile myalgia9 (6.6)13 (5.6)0.70Inflammatory back pain, n(%)92 (67.6)26 (11.3)Inflammatory bowel disease, n(%)6 (4.4)4 (1.7)0.12FMF family history, n(%)-Any degree66 (48.5)137 (59.8)0.04-First degree48 (35.8)97 (42.0)0.24-Second degree25 (18.7)86 (37.2)Number of attacks at recent year, med (min-max)1 (0-12)1 (0-10)0.13Amyloidosis9 (6.6)4 (1.7)0.014M694V status (N=273)-Present (one or two allels)91 (80.5)120 (75.0)0.28-Two allels45 (39.8)43 (28.9)0.02Disclosure of Interests:None declared

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

Background:In the last 20 years, there have been extraordinary improvements and practice-changing developments in the management of rheumatoid arthritis (RA). Exploring the pathogenetic mechanisms first enabled clinicians to use anti-tumor necrosis factor (TNF) alpha agents, then drugs targeting different molecules. Parallel to these developments, treatment guidelines have been changed accordingly. Meanwhile, how these developments have been reflected into the real-word practice is a question of interest.Objectives:In this study, we aimed to explore the first 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. In brief; demographic data, treatment-related data (including adverse events) and disease-related data of RA patients have been recorded in HUR-BIO. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. In this study, distribution of the first-line biologic agents 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 2080 RA patients was registered in HUR-BIO by the end of 2020. Of these patients, 79.5% was female. Mean age at the starting of bDMARD was 53.3 ± 17.8 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptide positivity was 67.6% and 61.0%, respectively. 65 (3.2%), 335 (16.1%), 858 (41.2%) and 822 (39.5%) patients were prescribed with their first 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 over time.Table 1.Distribution of first biologic DMARDs in RA patients according to 5-years periods2001-20052006-20102011-20152016-2020TotalAdalimumab15 (23.1)111 (33.0)187 (21.8)153 (18.6)466 (22.4)Etanercept30 (46.2)154 (45.8)229 (26.7)54 (6.6)467 (22.4)İnfliximab20 (30.8)58 (17.3)64 (7.5)7 (0.9)149 (7.1)Golimumab0037 (4.3)43 (5.2)80 (3.8)Certolizumab0037 (4.3)68 (8.3)105 (5.0)Anti-TNF65 (100)323 (96.4)554 (64.5)325 (39.5)1267 (60.9)Tofacitinib006 (0.7)212 (25.8)218 (10.5)Tocilizumab009 (1.0)102 (12.4)111 (5.3)Rituximab012 (3.6)136 (15.8)84 (10.2)232 (11.1)Abatacept00153 (17.8)99 (12.0)252 (12.1)Non-Anti-TNF012 (3.6)304 (35.5)497 (60.5)813 (39.1)Total65 (100)335 (100)858 (100)822 (100)2080 (100)Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015,Conclusion:Real-life practice in RA seems consistent with treatment guidelines. Use of non-Anti-TNF bDMARDs becoming more frequent year-by-year. Jak kinase inhibitor has rised through the last 5 years. Next decade may be the years of Jak kinases inhibitors.Disclosure of Interests:None declared

Background:Family history is one of the hallmarks of spondyloarthritis (SpA) and psoriatic arthritis (PsA) [1, 2]. Some patients have a strong family history that more than 2 relatives have spondyloarthritis related diseases. The effects of strong family history on SpA features were not known very well.Objectives:The aim of this study is to evaluate the effects of family history in SpA and PsA patients.Methods:HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005, and to date 3071 SpA and 526 PsA patients have been recorded. Demographic, clinical characteristics, disease activity parameters, a detailed family history of SpA and SpA features (presence of SpA including PsA, psoriasis, inflammatory bowel disease and uveitis) and laboratory data before anti-TNF treatments of the patients were noted.Results:2807 SpA (53.6% male) and 506 PsA (31.4% male) patients’ family history were available and analysed. A positive family history was noted in 27.6% of the SpA and 31.0% of the PsA patients (ns). 7.4% of the SpA patients and 8.9% of the PsA patients had family history in more than one relative (Table 1). In SpA patients with a family history, uveitis was more frequent than patients without (14.4% vs 10.6%, p=0.006). Except for a higher male predominance and uveitis (53% vs 32% p=0.006 and 9% vs 2% p=0.003 respectively) in patients with ≥2 relatives with SpA features, there were no differences in PsA patients regarding family history. The presence of family history and HLA-B27 (63.7% vs 37.6%, pConclusion:Family history was present in about one third of the patients of PsA and SpA. It is not uncommon for two or more family members to have a SpA feature. Presence of family history may be associated with some clinical conditions, such as uveitis.References:[1]Solmaz, D., et al., Impact of Having Family History of Psoriasis or Psoriatic Arthritis on Psoriatic Disease. Arthritis Care Res (Hoboken), 2020. 72(1): p. 63-68.[2]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.Table 1.Family history in PsA and SpA patientsPsA (n=506)SpA (n=2807)≥ 1 family history, n (%)157 (31.0)774 (27.6)≥1 first-degree relative, n (%)114 (22.5)489 (17.4)≥2 first-degree relatives, n (%)21 (4.2)77 (2.7)≥2 relatives (both first- and second-degree), n (%)45 (8.9)208 (7.4)Family history •Psoriasis, n (%)120 (23.7)155 (5.5) •Psoriatic arthritis, n (%)14 (2.8)9 (0.3) •Spondyloarthritis, n (%)38 (7.5)643 (22.9) •Inflammatory bowel disease, n (%)1 (0.2)10 (0.4) •Uveitis, n (%)02 (0.1)Disclosure of Interests:None declared.

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

Background:Obesity could be a risk factor for response to treatment and disease severity in psoriatic arthritis (PsA) because of potential pro-inflammatory effects of cytokines produced by adipose tissue (1).Objectives:This study aimed to assess association of demographic, clinical and disease activity indices with obesity in patients using biological disease-modifying antirheumatic drugs (bDMARD) treatment in HUR-BIO cohort.Methods:HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments since 2005. Until January 2020, HUR-BIO PsA registry enrolled 469 patients. Demographic, clinical, laboratory, therapeutic data were collected from this database which including tender/swollen joint counts, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Health Assessment Questionnaire (HAQ), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Disease Activity Score - 28 joint (DAS28), Disease Activity index for Psoriatic Arthritis - 28 joint score (DAPSA-28), Psoriatic Arthritis Impact of Disease 12-item questionnaire (PSAID-12). BMI≥30 was defined as obesity.Results:HUR-BIO PsA had 469 PsA patients and 441 patients with available BMI data were enrolled. Overall, 187/441 patients (42%) had obesity. The median follow-up period of obese and non-obese PsA patients was 7 (3-12) and 8 (4-12) years, respectively (p: 0.31). Obese patients were older at the age of PsA diagnosis (43 (33 - 53) vs 36 (28 – 45) years, pConclusion:Obesity was associated with higher disease activity and poorer effect of bDMARD treatment in patients with PsA. In obese PsA patients with high disease activity despite bDMARD therapy, intentional weight loss may be recommended as an adjunctive therapy.References:[1]Klingberg E, Bilberg A, Björkman S et al. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study.Arthritis research & therapy, 2019, 21.1: 17.Table.Baseline and last visit demographic, clinical and disease activity by BMI categoriesBMI > 30BMI < 30p-valueAge at PsA, years, median (Q1-Q3)43 (33-53.5)36 (28-45)0.000*Disease duration, years, median (Q1-Q3)7 (3-12)8 (4-12)0.31Gender (male/female, %)24/7636/640.008*Smoking Ever n, %102 (54.8)159 (62.8)0.091HLA B-27 (+) n, (%)7 (14)32 (35)0.006*Uveitis n, %4 (2.2)6 (2.4)0.571IBD n, %4 (2.1)6 (2.4)0.567PsA/Pso Family history n, %74 (39.6)84 (33.2)0.169Taking steroids before biological drugs n, %115 (61.5)156 (61.7)0.972BASDAI50% response n, %35 (31.8)61 (41)0.13Last HAQ score < 0.5 n, %91 (52.3)160 (68.1)0.001*Figure 1.Baseline and last visit disease activity by BMI categories p: 0.03* p: 0.01* p: 0.001* p: 0.002* *p < 0.05 BMI: Body mass index, DAS: Disease Activity Score, BASDAI: Bath Ankylosing Spondylitis Disease Activity Index, DAPSA: Disease Activity index for Psoriatic Arthritis, PSAID: Psoriatic Arthritis Impact of DiseaseFigure 2.Retention rate for biological DMARD by BMI categories Median of retention rate of first bDMARD: BMI > 30 kg/m2and < 30 kg/m254.2 and 79, respectively. Log rank p-value between BMI > 30 kg/m2and 2:0.03*Disclosure of Interests:Bayram Farisoğullari: None declared, Gözde Kübra Yardimci: None declared, Ertugrul Cagri Bolek: None declared, Emre Bilgin: None declared, Emine Duran: None declared, Gizem Ayan: None declared, Levent Kiliç: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Background:Patients with spondyloarthritis (SpA) have 3 important extra-articular involvement; psoriasis, uveitis and inflammatory bowel disease (IBD). Psoriatic arthritis (PsA) patients may have IBD, as well, and clinical features of PsA + IBD patients do not assess comprehensively, yet.Objectives:The purpose of this study is to determine the frequency and clinical features of concomitant PSA and IBD in a PsA biological DMARD cohort.Methods:Hacettepe University Rheumatology Biologic (HUR-BIO) is a single center biologic registry since 2005 and include 469 psoriatic arthritis patients to date. Demographics, clinical features, co-morbidities, laboratory and disease activity parameters collected from the database. The diagnosis of IBD was accepted with colonoscopy findings and pathology.Results:Overall, 469 PsA patients (70% females) with the mean age 47.7±12.4 years and [median (IQR)] disease duration 7 (3-11) years included in the study. Overall, 10/469 (5 male) PsA patients (2.1%) had IBD (7 (70%) with ulcerative colitis and 3 (30%) Crohn’s disease). Mean age of the patients was 53.3±10.0 years and mean disease duration was 9.0 ± 6.1 years. Six of ten patients were diagnosed with IBD before PsA and 4 of them were diagnosed with PsA first. Patients were followed-up for 3.7±2.8 years and bDMARD switch were made in 4 patients mostly due to primary inefficacy. bDMARD was discontinued in 2 patients (one for Crohn disease with fistula and one for drug induced SLE). According to DAPSA score 44% of the patients had low disease activity and 56% of the patients had moderate disease activity at last visit (9 patients were available). Sacroiliitis (70%) and severe radiographic hip (20%) involvement were common in PsA patients with IBD. Disease characteristics and demographic data are given in table 1.Table 1.Disease characteristics and demographic data of PsA patients with IBDAge (years) /sexDisease duration (years)IBD typeSacroiliitisLast visit treatments61/M16Crohn’s disease(+)Azathioprine, GC50/M5Ulcerative colitis(+), hipAdalimumab, GC59/F3Ulcerative colitis(+)Certolizumab, methotrexate40/F10Ulcerative colitis-Adalimumab, methotrexate71/M19Ulcerative colitis-Infliximab62/M13Crohn’s disease(+), hipAzathioprine, GC, sulphasalazine50/F1Ulcerative colitis-Adalimumab, GC59/M12Crohn’s disease(+)Secukinumab, GC45/F9Ulcerative colitis(+)Adalimumab, methotrexate, GC36/F5Ulcerative colitis(+)Infliximab, methotrexate, GCConclusion:In our single center biological registry, relatively small portion of PsA patients had concomitant IBD, however, those cases may have severe axial involvement, particularly in hip involvement, and further studies needed for these subgroup. Physician should be aware those SpA subgroup, because treatment choices, particularly IL-17 inhibitors may have some cautions patients with PsA and IBD.Disclosure of Interests:Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Berkan Armagan: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Levent Kiliç: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

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: Takayasu Arteritis (TAK) is a rare idiopathic granulomatous large vessel vasculitis and it is a clinically heterogenous disease. Various classifications and subsets which based on distribution of arterial lesions were defined in the literature in order to exhibit and predict different disease courses. Objectives: We aimed to validate a new disease subsets developed by Goel et al in our TAK series (1). Methods: We retrospectively evaluated the medical records of 164 TAK patients followed at Department of Rheumatology and Department of Pediatric Rheumatology in Hacettepe University, Ankara, Turkey between August 2005 and October 2018. The pediatric-onset ( Results: There were forty-two (25.6%), sixty-three (38.4%) and fifty-nine (36%) patients in Cluster 1, 2 and 3, respectively. Demographic and clinical data was summarized in Table-1. Cluster 1 included approximately half of patients (45.8%) with pediatric-onset TAK (p= 0.048). Baseline acute phase reactants (Erithrocyte Sedimentation Rate:ESR and C-reactive protein:CRP) and age at disease diagnosis were slightly lower in Cluster 1, however none of them did not reach statistical significance (p= 0.94, p=0.99 and 0.56, respectively). In contrast, cerebrovascular accident rates were slightly higher in Cluster 2 (p=0.24). Although anti-TNF biological agents were more frequently used for treatment in Cluster 1 (p=0.004), cyclophosphamide and/or overall biological agents usage was similar in three groups (p=0.15). Conclusion: Decision tree which defined by Goel et al. was applied to our single center pediatric and adult TAK cohort. In contrast to original validation cohorts, there was no difference among three clusters of our cohort except pediatric-onset disease and anti-TNF usage. Dissimilarities among the cohorts in terms of new classification system may be caused either number of patients or ethnic/regional differences. Reference [1] Goel R, Gribbons KB, Maksimowicz-McKinnon K, Hoffman GS, Kumar S, Joseph G, et al., editors. Discovery and Validation of Novel Disease Subsets in 806 Patients with Takayasu’s Arteritis across Four International Cohorts. ARTHRITIS & RHEUMATOLOGY; 2018: WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA. Disclosure of Interests: Ertugrul Cagri Bolek: None declared, Selcan Demir: None declared, Alper Sari: None declared, Ummusen Kaya Akca: None declared, Levent Kilic: None declared, Ali Akdogan: None declared, Sedat Kiraz: None declared, Omer Karadag: None declared, Seza Ozen Consultant for: Seza Ozen is receiving consultancy fees from Novartis, Speakers bureau: Roche

Objective Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) has been developed to be used in psoriatic arthritis in daily practice. The aim of the present study was to assess the change values of PsAID-12 in PsA patients continuing or discontinuing anti-TNF treatment. Methods We recruited patients from the Hacettepe University biological database (HUR-BIO). Overall, 70 PsA patients had PsAID-12 score before the initiation of the first anti-TNF treatment. Stopping or switching the anti-TNF treatment due to inefficacy was definitely considered a negative response. Changes were evaluated by the comparison with the baseline PsAID-12 score in compliance with the favorable and unfavorable responses to anti-TNF treatments. The standardized response mean (SRM) was used for determining the response. Results Seventy (78.6% female) patients were analyzed and their mean age was 45.5 years (12.0 years). The mean follow-up duration was 18.3 months (12.6 months). At baseline, the mean PsAID-12 score was 6.6 (1.5). Physicians stopped or switched the treatment in 28 patients (40.0%) due to the inefficacy of anti-TNF treatment. The ΔPsAID-12 score was 0.25 (1.71) in the patients discontinuing anti-TNF treatment and 3.52 (2.31) in the patients continuing their anti-TNF treatment (p

Reactive haemophagocytic syndrome (RHS) is a hyperinflammatory disorder often occurring in the background of several disorders such as infections, malignancies, and rheumatic diseases. Recently, a score known as the HScore was developed for the diagnosis of RHS. In the original study, most of the patients had underlying haematological malignancy or infection and the best cut-off value for the HScore was 169 (sensitivity 93%; specificity 86%). In this study we aimed to analyse the performance of the HScore in rheumatic disease-related RHS.The patients with rheumatic disorders evaluated in the Departments of Rheumatology and Paediatric Rheumatology at Hacettepe University, Ankara, Turkey between 2002 and 2014 were reviewed retrospectively. The first group (n = 30) consisted of patients with RHS; the control group (n = 64) included patients with active rheumatic diseases without RHS.In the RHS group, 14 (46.7%) had adult-onset Still's disease (AOSD), 10 (33.3%) systemic juvenile idiopathic arthritis (SJIA), and six (20%) systemic lupus erythematosus (SLE). The control group (n = 64) consisted of 32 (50%) AOSD, 13 (20.3%) SJIA, and 19 (29.7%) SLE patients. Applying the HScore to the RHS patients, the best cut-off value was 190.5 with a sensitivity of 96.7% and specificity of 98.4%. When we excluded the patients from the control group who had not had bone marrow aspiration (n = 23), the same cut-off (190.5) performed best (sensitivity 96.7%; specificity 97.6%). Applying the 2004 haemophagocytic lymphohistiocytosis (HLH-2004) criteria gave a sensitivity of 56.6% and a specificity of 100% in the whole study group.In our study, a cut-off value for the HScore different from the original study performed better. Further studies are warranted to determine optimum cut-off values in different studies.

Infectious diseases in any age group can be successfully prevented through immunization. Protection provided through immunization in childhood decreases over the years. Immunization in adulthood is important because of the growing elderly population, chronic diseases, and globalization. Recommendations on this subject are being constantly updated through scientific guidelines. Immunization in adulthood is also important in rheumatology. There is an increased risk not only of infection in rheumatic diseases but also of infections being more severe. Most infections, and their frequently observed complications, are among those diseases that can be prevented through immunization. The type of immunization, immunosuppressive/immunomodulatory therapy received by the patient, disease activity, and presence of chronic diseases affect the immunization process in patients with rheumatic diseases. This review will consider the immunization process followed in rheumatic diseases and also refer to its application.

Background:The frequency of pulmonary rheumatoid nodules closely relates to the diagnostic modality and changes from Objectives:The aim of this study was to describe the general features and localisation of pulmonary rheumatoid nodules in RA-ILD patients followed up in a single tertiary center.Methods:During January 2010 and March 2019, 826 RA patients had lung computerized tomography (CT) in Hacettepe University. Three radiologists re-evaluated lung CTs and 156/826 (18.8%) patients with had RA-ILD. Pulmonary nodules suggesting pulmonary rheumatoid nodules were identified by radiologist from lung CTs. In addition to demographic, clinical and laboratory data; number of the pulmonary rheumatoid nodules, size and localisation of the biggest nodule – named as dominant nodule-, type of ILD (UIP, NSIP and isolated airway disease (AD)) were recorded. p value less than 0.05 was considered as statistically significant.Results:Of 156 patients, 68 (26, 38.2% male) patients (43.5%) had at least one pulmonary rheumatoid nodule. The mean (SD) follow-up duration was 167 (88) months for RA, and 72 (46) months for RA-ILD. Thirty patients had UIP (44.1%), 31 (45.6%) had NSIP and 7 (10.3%) had AD pattern. 35 (51.5%) of patients had exposed smoking (current or past). Rheumatoid factor and anti-CCP were positive in 60/68 (88.2%) and 33/45 (73.3%) patients, respectively. Median number of nodules was 3 (2-3). Median size of the dominant nodule was 6.8 (5.0-11.5) mm. While 41 (60.3%) of dominant nodules localised in right lung, 27 (39.7%) of dominant nodules localised in left lung (p=0.09). In addition, right inferior lobe (21, 39.9%) was the most common localisation and right middle lobe (7, 10.3%) was the least common localisation of dominant nodule (Figure 1).Figure 1.Localisation of dominant pulmonary rheumatoid nodulesLUL: Left upper lobe, LİL: Left inferior lobe, RIL: Right inferior lobe, RML: Right middle lobe, RUL: Right upper lobeConclusion:We found a high prevalence of pulmonary rheumatoid nodules in RA-ILD patients and right inferior lobe was the most common localization of dominant nodules. Prospective studies are needed to determine how the presence and localization of pulmonary rheumatoid nodules affect the RA-ILD disease process.References:[1]Shaw M, Collins BF, Ho LA, Raghu G (2015) Rheumatoid arthritis-associated lung disease. Eur Respir Rev 24 (135):1-16.doi:10.1183/09059180.00008014Disclosure of Interests:Emre Bilgin: None declared, Mustafa Ekici: None declared, Yusuf Baytar: None declared, Emine Duran: None declared, Gamze Durhan: None declared, Ertugrul Cagri Bolek: None declared, Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Omer Karadag: None declared, Sedat Kiraz: None declared, Macit Ariyürek: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Ali İhsan Ertenli: None declared

Background:For inflammatory arthritis, drug retention is accepted as an important indicator of the effectiveness and safety of biological drugs.Objectives:The objective of this study was to determine of the effects first and overall bDMARD drug retention rate during concomitant csDMARD in psoriatic arthritis (PsA).Methods:HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments since 2005. All PsA patients (469) who enrolled in HUR-BIO registry and prescribed at least once biologic DMARD (bDMARD) were included in the study. The subjects were divided into two groups depending on whether or not to use csDMARDs (methotrexate, sulphasalazine or leflunomide) at the last control visit. Demographic, clinical and therapeutic data were collected from this database. Baseline disease activity before the first bDMARD initiation was assessed with DAPSA and PsAID-12.Table.Demographics, baseline and follow-up clinical characteristics of PsA patientsWith concomitant csDMARD n=288Without concomitant csDMARD n=167pAge (mean, SD)48.9 (12.1)45.1 (12.4)0.002Female n (%)204 (70.8)113 (67.7)0.48PsA disease duration (med, IQR)7 (13)7 (14.5)0.53Age at PsA diagnosis (mean, SD)39 (11.7)40.8 (12.9)0.81BMI (mean, SD)29.6 (6.0)29.2 (5.9)0.53Axial involvement n (%)68 (34.0)37 (44.6)0.09HLA-B 27 (+) n (%)21/76 (27.6)17/69 (24.6)0.68Duration of use first bDMARD (months) (med, IQR)22.4 (51.3)14.1 (31.4)0.003Duration of use overall bDMARD (months) (med, IQR)56.8 (69.4)24.4 (57.7)Switching bDMARD (+) n (%)148 (52.5)71 (42.8)0.04Initial DAPSA1(med, IQR)19.4 (11.7)17.3 (10.2)0.04Initial PSAID2(med, IQR)5.7 (3)5.6 (2.8)0.55Final visit PSAID3(med, IQR)2.8 (3.8)2 (5.7)0.41Final visit DAPSA4(med, IQR)Remission (n,%)Low disease activityModerate disease activityHigh disease activity10.2 (12.4)12.5 (12.5)0.01Remission (n,%)61 (23.9)111 (43.5)72 (28.2)11 (4.3)27 (17.6)59 (38.6)58 (37.9)9 (5.9)0.13Low disease activity111 (43.5)59 (38.6)Moderate disease activity72 (28.2)58 (37.9)High disease activity11 (4.3)9 (5.9)1: n=249,2: n=214,3: n=109,4: n=408pp=0.003Results:HUR-BIO PsA registry included 469 PsA patients. Baseline, clinical characteristics and follow-up parameters were given in Table. The using overall bDMARD were adalimumab 294 (62.0%), etanercept 135 (28.8%), infliximab 119 (25.4%), certolizumab pegol 107 (22.8%), secukinumab 67 (14.3%), golimumab 58 (12.4%), ustekinumab 25 (5.3%) and tofacitinib 11 (2.3%). Two hundred eighty eight (61.4%) patients used concomitant cDMARDs [methotrexate 176 (37.5%), leflunomide 94 (20.0%), sulphasalazine 35 (7.5%) and two csDMARD combination 17 (3.6%)]. The first-year retention rate of first bDMARD with or without concomitant csDMARDs were 88% and 80%, respectively. The median duration of first bDMARD retention with or without concomitant csDMARDs were 131.7 and 91.4 months, respectively (Figure). The first-year retention rate of overall bDMARDs with or without concomitant csDMARDs were 92% and 85%, respectively. The median drug retention rate of overall bDMARD in using csDMARD and not using csDMARD were 141.5 and 131.5 months, respectively. Retention rates (both for first bDMARD and overall bDMARDs) were significantly higher in concomitant csDMARDs using group (p=0.003 for first bDMARD retention, pConclusion:In this study, csDMARDs, either methotrexate or leflunomide/sulphasalazine have additional effect for both retention rate and treatment response of bDMARDs. On the other hand, using bDMARD monotherapy is relatively higher than rheumatoid artritis (1).Figure.Drug retention rate of the first bDMARD and overall bDMARDs according to concomitant csDMARD use (csDMARD:conventional synthetic Disease Modifiying Antirheumatic Drug)Disclosure of Interests:Emine Duran: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Arpaş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB