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

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.

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

Objective We aimed to evaluate quality of life (QoL), disease activity, compliance to treatment, patient and physician preferences for route of administration (RoA), status of health and pain in RA patients starting advanced treatments or needing a switch, and the factors associated with patient preferences. Methods A multicentre, prospective, observational and 1-year follow-up study was conducted, between 2015 and 2020, in adult RA patients using advanced treatments for the first time or needing a switch in their current treatments. All the data collected were entered into electronic case report forms. DAS in 28 joints with ESR [DAS28-4(ESR)], EuroQol 5-Dimensional Questionnaire (EQ-5D), HAQ Disability Index (HAQ-DI), Compliance Questionnaire for Rheumatology (CQR-19), Work Productivity and Activity Impairment Instrument (WPAI) and Patient Global Assessment-Visual Analogue Scale (PGA-VAS) questionnaires were used for longitudinal assessments. Results Four hundred and fifty-nine patients were enrolled. Three hundred and eight patients (67.1%) attended the final study visit at 12 months and were included for comparative analyses. Irrespective of RoA, the disease activity and QoL improved significantly at 12 months, whereas compliance worsened. At baseline and 12 months, EQ-5D and DAS28-4(ESR) scores were significantly correlated (P < 0.001). The WPAI scores changed significantly in favour of better outcomes over 12 months after initiation of advanced treatment or switching (P < 0.001). A higher proportion of patients preferred an oral RoA, in comparison to physicians (53.6% vs 31.4%; P < 0.001). Patient and physician RoA preferences were independent of gender, age, disease duration, advanced treatment type and the EQ-5D-3L, DAS28-4(ESR), HAQ-DI, PGA-VAS and CQR-19 scores at baseline. Conclusion The oral route was more frequently preferred by patients compared with physicians, although patients' preference rates showed a slight increase towards the end of the treatment, which might be an important factor for RA outcomes. Better control of disease activity and QoL were achieved at 12 months, regardless of RoA. Lay Summary What does this mean for patients? People with rheumatoid arthritis (RA) and their physicians can have different views throughout the patient journey, whether deciding the main treatment objective, switching a drug or deciding the route of drug administration. However, data are limited in this area. For this purpose, we have conducted a survey study to identify differences between the views of patients and physicians on the management of RA. In this study, we have shown that RA medication compliance decreases over time, irrespective of medication route. This is similar to other studies. We also spotted that there are different routes of drug adminstration (RoA) preferred: a higher proportion of patients preferred an oral RoA compared with physicians (53.6% vs 31.4%, respectively). Patient and physician RoA preferences were not related to gender, age, disease duration, treatment type and disease activity. By surveying patients and physicians at the same time, we have identified their differences better compared with previous studies. Patient preferences should have a major impact on disease management, and the results of this study might encourage patients to discuss their thoughts and preferences with their clinicians to achieve a better outcome., Pfizer; Pleksus CRO Inc., Pfizer has supported funding of this manuscript. Editorial/medical writing support was provided by Pleksus CRO Inc., and it was funded by Pfizer.

PubMedID: 31651120 Background/aim: Rheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation. The study aimed to assess serum 14-3-3eta, anti-CarP, and anti-Sa in seronegative RA (SNRA) patients who were treatment-naïve as well as in healthy subjects. This is the first study in the literature to examine these autoantibodies together in SNRA patients. Materials and methods: Forty-five treatment-naïve SNRA patients and 45 healthy subjects were recruited. Drugs change the levels of autoantibodies; therefore, patients who took any medication had been excluded from our study. Anti-carbamylated protein, anti-Sa, and 14-3-3eta were measured by using three different ELISA kits. Results: Median serum concentration of healthy controls in 14-3-3eta was 0.02 (0.02–0.27) ng/mL. Median serum concentration of SNRA patients in 14-3-3eta was 1.00 (0.48–1.28) ng/mL. Data were analyzed with Mann–Whitney U tests; the P-value was

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

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

Background: Several societies published recommendations for latent tuberculosis infection (LTBI) screening before biological and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) but not for other inflammatory arthritides such as spondyloarthritis (SpA). Using RA guidelines could result in overestimating Tuberculin Skin Test (TST) positivity in SpA. This study aimed to compare the distribution of TST results in SpA and RA patients along with comparison in terms of QuantiFERON®-TB Gold In-Tube (QFT-GIT) test in a Bacillus Calmette-Guérin-vaccinated population.Methods: 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.Results: 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 cut-off (pConclusions: 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 cut-off for both diseases could result in overestimating LTBI in SpA.

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

The temporal relationship between the onset of skin psoriasis (Pso) and psoriatic arthritis (PsA) is a long and well-known feature of psoriatic disease. Psoriatic skin lesions emerge years before the development of musculoskeletal manifestations in nearly 75% of PsA patients. While skin and joint manifestations develop within one year in 15-20% of the patients, joint manifestations precede the skin involvement by a year or more in about 10% of the patients (1).

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

WOS: 000505281300007, PubMed: 30680951, Objective Psoriatic arthritis (PsA) has a genetic background. Approximately 40% of patients with psoriasis or PsA have a family history of psoriasis or PsA, which may affect disease features. The aim of this study was to assess the effects of family history of psoriasis and PsA on disease phenotypes. Methods Data from 1,393 patients recruited in the longitudinal, multicenter Psoriatic Arthritis International Database were analyzed. The effects of family history of psoriasis and/or PsA on characteristics of psoriasis and PsA were investigated using logistic regression. Results A total of 444 patients (31.9%) had a family history of psoriasis and/or PsA. These patients were more frequently women, had earlier onset of psoriasis, more frequent nail disease, enthesitis, and deformities, and less frequently achieved minimal disease activity. Among 444 patients, 335 only had psoriasis in their family, 74 had PsA, and 35 patients were not certain about having PsA and psoriasis in their family, so they were excluded from further analysis. In the multivariate analysis, family history of psoriasis was associated with younger age at onset of psoriasis (odds ratio [OR] 0.976) and presence of enthesitis (OR 1.931), whereas family history of PsA was associated with lower risk of plaque psoriasis (OR 0.417) and higher risk of deformities (OR 2.557). Family history of PsA versus psoriasis showed increased risk of deformities (OR 2.143) and lower risk of plaque psoriasis (OR 0.324). Conclusion Family history of psoriasis and PsA impacts skin phenotypes, musculoskeletal features, and disease severity. The link between family history of psoriasis/PsA and pustular/plaque phenotypes may point to a different genetic background and pathogenic mechanisms in these subsets., Turkish Society for Rheumatology; Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK), Supported by the Turkish Society for Rheumatology. Dr. Bakirci's work was supported by the Scientific and Technological Research Council of Turkey and the Turkish Society for Rheumatology.

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

WOS: 000397050600018, PubMed ID: 27794533, Objective. The aim was to assess the characteristics of PsA, find out how well the disease is controlled in real life, demonstrate the treatments and identify the unmet needs. Methods. The PsA registry of Turkey is a multicentre Web-based registry established in 2014 and including 32 rheumatology centres. Detailed data regarding demographics for skin and joint disease, disease activity assessments and treatment choices were collected. Results. One thousand and eighty-one patients (64.7% women) with a mean (S.D.) PsA duration of 5.8 (6.7) years were enrolled. The most frequent type of PsA was polyarticular [437 (40.5%)], followed by oligoarticular [407 (37.7%)] and axial disease [372 (34.4%)]. The mean (S.D.) swollen and tender joint counts were 1.7 (3) and 3.6 (4.8), respectively. Of these patients, 38.6% were on conventional synthetic DMARD monotherapy, 7.1% were on anti-TNF monotherapy, and 22.5% were using anti-TNF plus conventional synthetic DMARD combinations. According to DAS28, 86 (12.4%) patients had high and 105 (15.2%) had moderate disease activity. Low disease activity was achieved in 317 (45.7%) patients, and 185 (26.7%) were in remission. Minimal disease activity data could be calculated in 247 patients, 105 of whom (42.5%) had minimal disease activity. The major differences among sexes were that women were older and had less frequent axial disease, more fatigue, higher HAQ scores and less remission. Conclusion. The PsA registry of Turkey had similarities with previously published registries, supporting its external validity. The finding that women had more fatigue and worse functioning as well as the high percentage of active disease state highlight the unmet need in treatment of PsA.

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

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

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

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

Background Psoriatic arthritis (PsA) has a genetic background, approximately 40% of patients having a family history of psoriasis or PsA in first-degree relatives, which may impact the disease features. Objectives The aim of this study was to evaluate the effects of family history of psoriasis or PsA on the disease phenotypes. Methods The demographic and clinical data were retrieved from the longitudinal, multicenter PsArt-ID (Psoriatic Arthritis-International Database). Family history of psoriasis and PsA were investigated for 1st and 2nd degree relatives separately. The effect of the family history of psoriasis and/or PsA on disease phenotypes and severity were analysed, calculating the relative risks (RR). Results 1393 patients had the data for family history, 444 (31.9%) of whom was positive for psoriasis and/or PsA. The majority of the family history was only psoriasis (333/444; 75%) and 58.5% (260/444) of the patients had first-degree relatives affected. There was no differences in maternal or parental transmission rates however women had more psoriasis and/or PsA in their family (67.3% vs 32.7% p: 0.028). Patients with a family history had an earlier onset of age for psoriasis (29±14.8 vs 31±14.9 p: 0.007), more frequent nail involvement (50.7% vs 29.6% p: 0.032), more frequent enthesitis (28.2% vs 17.7% p Conclusions The family history of psoriasis and PsA has impacts on skin phenotypes, musculoskeletal features and the disease severity. The differences between family history of psoriasis and PsA and pustular vs plaque phenotypes may point out to a different genetic background and pathogenic mechanisms in these subsets. Disclosure of Interest None declared

Background The environmental and genetic factors play a crucial role in the pathogenesis of psoriatic arthritis (PsA) which may cause a difference in disease characteristics for patients from different geographical regions. Objectives The aim of the study was to explore the disease characteristics, treatment choices and comorbidities in patients with PsA in different countries to see the impact of geographic factors. Methods PsArt-ID (Psoriatic Arthritis- International Database) is a prospective, multicentre registry in PsA, which was initially developed in Turkey in 2014, with participation of Canada since 2015 and Italy since 2017. Patients with PsA are consecutively registered to this registry with the aim of investigating the real-life data. Patient characteristics across Turkey (n=1283) and Canada (n=119) are compared for this analysis. Results Canadian patients were older at the time of recruitment (Table). They also were more frequently smokers, had higher duration of education and higher BMI than patients in Turkey. Patients in Canada had more frequent polyarthritis (66.7% vs 39.6%, p Conclusions Geographical differences have impacts on the disease features in PsA, which may be due to genetic, environmental and cultural differences. The treatments are comparable suggesting a similar approach by the physicians. Disclosure of Interest None declared

Objectives: Ankylosing spondylitis is a chronic inflammatory disease which physically, psychologically, and socially affects the patient's life. Previous studies have reported a correlation between ankylosing spondylitis and depression. In this study we investigated the effect of infliximab on depression in ankylosing spondylitis patients. Methods: A total of 29 patients with ankylosing spondylitis were enrolled in this prospective study. Infliximab was administered intravenously at a dose of 5 mg/kg at baseline, weeks 2 and 6. The measurements of morning stiffness, modified Schober’s test, chest expansion, erythrocyte sedimentation rate, C-reactive protein, Bath ankylosing spondylitis disease activity index, Bath ankylosing spondylitis functional index and Beck depression inventory scores were compared with baseline and 12th week. Results: The modified Schober’s test and chest expansion increased, the morning stiffness duration, erythrocyte sedimentation rate and C-reactive protein levels decreased after infliximab treatment (p < 0.001, respectively). There was statistically significant decrease in Bath ankylosing spondylitis disease activity index, Bath ankylosing spondylitis functional index and Beck depression invantory scores of patients after 12 weeks (p < 0.001, respectively). Conclusion: Infliximab can improve depression and its symptoms in patients with ankylosing spondylitis.