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Objectives: Inflammation is the main cause of systemic damage in SARS-COV2 infections. Steroid treatment has been shown to reduce mortality in COVID-19. However, there is no index to monitor treatment responses to steroids. Here, we evaluated the validity of serial C-reactive-protein (CRP) follow-up for predicting the outcome in the patients receiving steroid therapy. Material and methods: In our retrospective cohort study, four hundred twenty-five patients were included. All patients received dexamethasone 6 mg/day or equivalent dose of steroid as much as needed with the onset of hypoxia (SaO2 ≤ 93%). We divided patients into two groups according to outcome (deceased/discharged). We then compared demographic, clinical and laboratory features between the groups. Lastly, we evaluated the thresholds of CRP decline associated with COVID-19 associated mortality at 3th, 5th days and at the end of treatment. Results: COVID 19 associated mortality rate of the cohort was 6.1% (26/425). In multivariate analysis, in which survival was evaluated, parameters related to death due to COVID-19 in the steroid group were high NEWS-2 score (0.82, CI 95 % 0.68-0.97, p=0.02), increased Charlson comorbidity index (0.68,CI 95% 0.51-0.90,p= 0.007) and absolute CRP level at the end of treatment (0.97,CI 95%, p

To describe the safety and efficacy of intralesional rituximab (anti-CD 20 monoclonal antibody) therapy in a patient with conjunctival extranodal marginal zone lymphoma.A single case report from a tertiary referral center.A 43 years old female patient with low-grade conjunctival extranodal marginal zone lymphoma who was completely and safely treated with intralesional rituximab therapy was presented. After four injections per week, intralesional rituximab injections were given monthly, and the treatment was completed in 6 months. Near-total regression was achieved at the end of the tenth cycle. No recurrence was observed during the 20-month follow-up period.The intralesional rituximab is a cost-effective and well-tolerated treatment for low-grade conjunctival lymphoma. The intralesional rituximab therapy may be prefer in the patients with low grade conjunctival lymphoma instead of radiotherapy. There will be needed further researches in this area.

Introduction Exertional leg pain (ELP) and enthesitis are musculoskeletal findings in familial Mediterranean fever (FMF). They are not accepted as principal treatment targets. In this study, we assessed the effectiveness of treatments on ELP and enthesitis. Material and methods We have included 218 FMF patients to the study. We retrospectively compared the FMF attacks’ frequency, duration and intensity (FMF attack VAS score) and levels of ELP VAS and enthesitis VAS scores between pre-treatment stage and while patients were on treatment at the last visit. Results Forty-nine (22.5%) and 52 (23.9%) of the patients had enthesitis and ELP respectively. All patients were on colchicine treatment. Serositis attacks respond the treatments significantly. Moreover, both ELP VAS scores (p = 0.002) and enthesis VAS scores (p = 0.17) were improved with treatment. But only improvement in ELP VAS scores was significant. Conclusion FMF treatments had favourable effect on ELP and enthesitis in FMF patients. However, the response rates would be inadequate. Therefore, there would be unmet need for treatment of both conditions.

Rheumatoid arthritis (RA) is related to cardiovascular disease and results in increased mortality rates. Ischemia, autonomic nervous system dysfunction, impaired cardiac ionic currents, and genetic predisposition may be the underlying mechanisms. Proarrhythmic ventricular electrophysiological remodeling detected on the basis of Tp‑e interval, Tp-e/QT, and Tp-e/QTc ratios plays a key role in the prognosis. Our aim was to assess proarrhythmic ventricular electrophysiological remodeling in patients with RA, a well-known chronic inflammatory disorder. A total of 163 patients with RA and 47 patients as a control group were included in this retrospective study. Proarrhythmic ventricular electrophysiological remodeling markers were evaluated in both groups along with baseline demographic and clinical variables. Patients using medication or with chronic disorders that can affect ventricular repolarization markers were excluded. The patients with RA had prolonged Tp‑e interval (66 ms [44–80]; 80 ms [78–96], p

Sarcoidosis is a chronic granulomatous multisystem inflammatory disease. An association between sarcoidosis and subclinical atherosclerosis has recently been demonstrated. However, there are limited publications on metabolic syndrome (MetS) and its metabolic changes in sarcoidosis. In this study, we evaluated our hypothesis that the frequency of MetS may also be increased in treatment-naive, newly diagnosed sarcoidosis patients.We included 133 newly diagnosed sarcoidosis patients, 133 age- and sex-matched controls, and 51 untreated rheumatoid arthritis (RA) patients as diseased controls. We then compared the frequency of MetS and MetS-related items in the three groups. The criteria defined for metabolic syndrome in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III report (ATP III) were used to diagnose MetS.MetS was more common in sarcoidosis than controls (odds ratio, OR: 5.3; 95% confidence interval, CI 95%: 2.4-11.5; p 0.001) and was similar to RA. In addition, triglyceride and glucose levels, diastolic blood pressure measurements, and waist circumference of female sarcoidosis patients were significantly higher than in controls.We show that MetS is a frequent feature of sarcoidosis even before treatment is started. Therefore, clinicians should be aware of MetS both during treatment and during the course of the disease to reduce the risk of cardiovascular events.HINTERGRUND: Bei der Sarkoidose handelt es sich um eine chronische granulomatöse entzündliche Multisystemerkrankung. Ein Zusammenhang zwischen Sarkoidose und subklinischer Arteriosklerose wurde vor Kurzem nachgewiesen. Es gibt jedoch nur begrenzt Publikationen zum metabolischen Syndrom (MetS) und zu dadurch verursachten Stoffwechselveränderungen bei Sarkoidose. In der vorliegenden Studie untersuchten die Autoren ihre Hypothese, dass die Häufigkeit des MetS möglicherweise auch bei therapienaiven Patienten mit der neu gestellten Diagnose Sarkoidose erhöht sei.In die Studie einbezogen wurden 133 Patienten mit Erstdiagnose einer Sarkoidose, 133 nach Alter und Geschlecht entsprechend ausgewählte Kontrollen und 51 unbehandelte Patienten mit rheumatoider Arthritis (RA) als erkrankte Kontrollpersonen. Dann wurde die Häufigkeit des MetS und von MetS-bezogenen Kriterien in den 3 Gruppen verglichen. Für die Diagnose MetS wurden die Kriterien des Berichts zum US-amerikanischen National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) zur Definition eines MetS verwendet.Ein MetS trat häufiger bei Sarkoidosepatienten als bei Kontrollen auf (Odds Ratio, OR: 5,3; 95%-Konfidenzintervall, 95%-KI: 2,4–11,5; p 0,001) und war ähnlich häufig wie bei RA-Patienten. Außerdem waren die Werte für Triglyzeride und Glukose, diastolischen Blutdruck und Taillenumfang bei weiblichen Patienten mit Sarkoidose signifikant höher als bei den Kontrollen.Es wird von den Autoren gezeigt, dass das MetS ein häufiges Merkmal der Sarkoidose schon vor Beginn der Behandlung darstellt. Daher sollten klinisch Tätige sowohl während der Therapie als auch während des Krankheitsverlaufs an ein MetS denken, um das Risiko von Herz-Kreislauf-Ereignissen zu senken.

OBJECTIVES The cross-sectional study aimed to assess myocardial functions using global longitudinal strain (GLS) echocardiography and arrhythmia parameters with treatment naive newly diagnosed rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD). METHODS Seventy seven newly diagnosed treatment-naive RA patients were enrolled. Disease severity was evaluated according to rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) positivity, and Disease Activity Score 28 C-reactive protein (DAS28 CRP). Myocardial functions were assessed using conventional echocardiography and GLS technique and electrocardiogram parameters cQT and Tp-e/cQT. RESULTS Twenty three patients had severe disease while 54 patients were non-severe. The Left Ventricle GLS (17.98 ± 1.24 vs 21.29 ± 1.03, P

Summary Background & aim Obesity is a risk factor for both cardiovascular mortality and poor disease control. Unfavourable eating behaviours may have a role in obesity and increase the risk for obesity. In this study, we evaluated the eating behaviours of the patients with rheumatoid arthritis and compare these with controls. Also, we assessed the eating behaviour differences between obese and non-obese rheumatoid arthritis patients. Methods It was a cross sectional case control study. We enrolled 157 rheumatoid arthritis patients and 60 controls to the study in one year period. We evaluated the eating behaviours of the patients with Three-Factor Eating Questionnaire R-18. Firstly, we compared eating behaviours of the rheumatoid arthritis patients with controls, and then we evaluated the differences in eating features between obese rheumatoid arthritis patients with non-obese rheumatoid arthritis patients. We compared the continuous variables with Mann–Whitney u test. Furthermore, categorical variables were compared with Chi-square test. Results Sixty-three (40.2%) of the rheumatoid arthritis patients were obese. Eating behaviours of rheumatoid arthritis patients and controls were similar, out of uncontrolled eating score. This score was found higher in control group than rheumatoid arthritis patients (p = 0.01). Moreover, emotional eating domain scores were higher in obese RA patients (p = 0.04). Conclusions Even though there were no negative eating features in general rheumatoid arthritis population, obese rheumatoid arthritis patients may have an emotional eating problem. Herein, treatments that address psychosomatic sides of eating may be effective for treatment of obesity in rheumatoid arthritis.

Hyperuricemia and chronic deposition of monosodium urate crystals are the main cause of the gout. Urate lowering therapy (ULT) is the mainstay of chronic gout treatment. In this study, we evaluated demographic features and disease properties of the patients that would relate with the success of ULT. Sixty-six gout patients on pharmacologic ULT were enrolled in the study. Non-adherence to pharmacologic ULT was an exclusion criterium. Demographic and therapeutic features and co-illnesses and disease features of the patients were obtained during the study. Then, we compared these parameters between the patients with successful ULT and inadequate ULT. Adherence to diet was found different between the groups (OR, 7.00; CL%95 2.27 - 21.56). All other features including maximum allopurinol dosage were similar. We found that diet was the only factor that relate with success of ULT, while patients were on pharmacologic ULT. Non-adherence to both pharmacologic and non-pharmacologic measures is the main problem during ULT. Therefore, clinicians should emphasize the importance of all segments of ULT, including diet with informing patients during visits about the nature of disease and benefits of ULT.

Rheumatoid arthritis (RA) is related to cardiovascular disease and results in increased mortality rates. Ischemia, autonomic nervous system dysfunction, impaired cardiac ionic currents, and genetic predisposition may be the underlying mechanisms. Proarrhythmic ventricular electrophysiological remodeling detected on the basis of Tp‑e interval, Tp-e/QT, and Tp-e/QTc ratios plays a key role in the prognosis. Our aim was to assess proarrhythmic ventricular electrophysiological remodeling in patients with RA, a well-known chronic inflammatory disorder.A total of 163 patients with RA and 47 patients as a control group were included in this retrospective study. Proarrhythmic ventricular electrophysiological remodeling markers were evaluated in both groups along with baseline demographic and clinical variables. Patients using medication or with chronic disorders that can affect ventricular repolarization markers were excluded.The patients with RA had prolonged Tp‑e interval (66 ms [44-80]; 80 ms [78-96], p 0.001) and increased Tp-e/QT ratio (0.18 [0.12-0.22]; 0.22 [0.20-0.24], p 0.001) and Tp-e/QTc ratio (0.16 [0.11-0.19]; 0.20 [0.17-0.22], p 0.001) compared to the control group.The Tp‑e interval and Tp-e/QT ratio, which may help to clarify the pathophysiological mechanisms of ventricular arrhythmias, were increased in patients with RA.HINTERGRUND: Die rheumatoide Arthritis (RA) ist mit Herz-Kreislauf-Erkrankungen vergesellschaftet und führt zu einer erhöhten Mortalitätsrate. Ischämie, eine Funktionsstörung des autonomen Nervensystems, beeinträchtigte kardiale Ionenströme und genetische Prädisposition sind möglicherweise die zugrunde liegenden Mechanismen. Proarrhythmisches ventrikuläres elektrophysiologisches Remodeling, das auf der Grundlage des Tp-e-Intervalls, des Tp-e/QT- und des Tp-e/QTc-Verhältnisses diagnostiziert wird, spielt eine wesentliche Rolle für die Prognose. Ziel der vorliegenden Arbeit war es, das proarrhythmische ventrikuläre elektrophysiologische Remodeling bei Patienten mit RA als einer bekannten chronischen entzündlichen Erkrankung zu untersuchen.In diese retrospektive Studie wurden 163 Patienten mit RA und 47 Patienten als Kontrollgruppe einbezogen. Marker für das proarrhythmische ventrikuläre elektrophysiologische Remodeling wurden in beiden Gruppen zusammen mit demografischen und klinischen Ausgangsparametern untersucht. Patienten, die Medikamente nehmen, oder mit chronischen Krankheiten, die ventrikuläre Repolarisationsmarker beeinflussen können, wurden aus der Studie ausgeschlossen.Die RA-Patienten wiesen im Vergleich mit der Kontrollgruppe ein verlängertes Tp-e-Intervall auf (66 ms [44–80]; 80 ms [78–96], p 0,001) und ein erhöhtes Tp-e/QT-Verhältnis (0,18 [0,12–0,22]; 0,22 [0,20–0,24]; p 0,001) sowie Tp-e/QTc-Verhältnis (0,16 [0,11–0,19]; 0,20 [0,17–0,22], p 0,001).Das Tp-e-Intervall und das Tp-e/QT-Verhältnis, die dazu beitragen können, die pathophysiologischen Mechanismen ventrikulärer Arrhythmien zu entschlüsseln, waren bei Patienten mit RA erhöht.

Early diagnosis of familial Mediterranean fever (FMF) is crucial for preventing both recurrent attacks of polyserositis and complications in the course of the disease such as amyloidosis. Pre-diagnostical knowledge about the disease may assist early diagnosis. In this study, we evaluated the importance of pre-diagnostical knowledge about FMF for early diagnosis. We enrolled 138 FMF patients to the study. Then, the patients were dichotomized according to the patients’ FMF knowledge before diagnosis. We found that 40 (28.9%) of the patients were informed of the disease before diagnosis. Thirty-six of those patients got the data from their family members with FMF. Both demographic and disease-related features were similar between the groups. Furthermore, pre-diagnostic knowledge about FMF did not assist for early diagnosis of FMF. Interestingly, only half of the patients with history of FMF in family members were informed of the disease before diagnosis. Therefore, genetic consultation and patient education with questioning the patients for family history during medical evaluation may help early diagnosis in FMF.

Colchicine may prevent both recurrent serositis attacks and secondary amyloidosis in familial Mediterranean fever (FMF). Furthermore, colchicine may decrease the frequency of atrial fibrillation in some groups of patients without FMF. However, there is no study that evaluates the effect of colchicine on arrhythmogenic electrocardiographic indices in FMF. In this study, we evaluated the impact of 1 year of colchicine treatment on atrial and ventricular arrhythmogenic electrocardiographic (ECG) parameters in newly diagnosed FMF patients.We enrolled 28 newly diagnosed FMF (20 female, mean age 31.4 ± 8.2 years) patients who fulfilled the modified Tel Hashomer criteria. Electrocardiographic, demographic and laboratory parameters were obtained at the first visit and at the end of the 1‑year colchicine treatment. Herein, we assessed P wave dispersion (Pd) for atrial arrhythmia risk and peak-to-end interval of T wave (Tp-E), Tp-E/QT, Tp-E/QTc values for ventricular arrhythmia risk.Colchicine treatment significantly decreased Tp-E and Tp-E/QT values (p = 0.02 and p = 0.01, respectively) by the end of the 1‑year treatment. However, Pd values did not change with treatment.Colchicine treatment may have a favourable effect on ventricular repolarisation indices that relate to ventricular arrhythmia and sudden death.ZIEL DER ARBEIT: Mit Colchizin lassen sich möglicherweise sowohl rezidivierende Serositisschübe als auch die sekundäre Amyloidose bei familiärem Mittelmeerfieber (FMF) verhindern. Außerdem kann Colchizin die Häufigkeit von Vorhofflimmern bei einigen Gruppen von Patienten ohne FMF senken. Jedoch liegt bisher keine Studie zur Wirkung von Colchizin auf arrhythmogene elektrokardiographische (EKG-)Hinweise bei FMF vor. In der vorliegenden Studie untersuchten die Autoren den Einfluss einer einjährigen Colchizinbehandlung auf atriale und ventrikuläre arrhythmogene EKG-Parameter bei Patienten mit neu diagnostiziertem FMF.Dazu wurden 28 Patienten mit neu diagnostiziertem FMF (20 w., Durchschnittsalter: 31,4 ± 8,2 Jahre) in die Studie einbezogen, die die modifizierten Tel-Hashomer-Kriterien erfüllten. Elektrokardiographische, demografische und Laborparameter wurden bei der Erstvorstellung und am Ende der einjährigen Behandlung mit Colchizin erhoben. Dabei wurde die P‑Wellen-Dispersion (Pd) hinsichtlich des Risikos atrialer Arrhythmien und das Intervall zwischen Spitze und Ende der T‑Welle („peak-to-end interval of T wave“, Tp-E) sowie das Verhältnis von Tp-E zum QT-Intervall (Tp-E/QT) und zum frequenzkorrigierten QT-Intervall (Tp-E/QTc) hinsichtlich des Risikos ventrikulärer Arrhythmien untersucht.Unter Colchizinbehandlung erwiesen sich der Tp-E- und der Tp-E/QT-Wert am Ende der einjährigen Therapie als signifikant niedriger (p = 0,02 bzw. p = 0,01). Allerdings veränderten sich die Pd-Werte unter der Therapie nicht.Colchizin hat möglicherweise positive Wirkungen auf ventrikuläre Repolarisationsparameter, die in Zusammenhang mit ventrikulären Arrhythmien und plötzlichem Herztod stehen.

High-dose steroid has been shown to reduce the mortality rate in Corona virus disease 2019 (COVID-19) patients who need oxygen support. Here, we evaluated the effectiveness of pulse-steroid in case of unresponsiveness to treatment with high dose steroid.The study is a retrospective controlled trial. We divided the patients in 3 groups: standard-care therapy alone, high-dose steroid treatment (6 mg/day dexamethasone equivalent), and pulse-steroid treatment (250 mg/day methyl-prednisolone). One hundred and fifty patients were enrolled in each group. All patients were hospitalized and needed oxygen support. We matched the patients according to disease severity at the onset of hypoxia, weight of co-morbidities, age, and sex. We then compared 3 groups in terms of mortality, length of hospitalization, need for intensive care unit (ICU) admission and mechanical ventilation (MV), length of stay in ICU, and duration of MV.The pulse-steroid group had shorter ICU stay. The median ICU stay was 9.0 (CI 95% 6.0–12.0) days in standard-care group, 8.0 (CI 95% 5.0–13.0) days in high-dose steroid group and 4.5(CI %95 3.0–8.0) days in pulse-steroid group. Moreover, although patients in pulse-steroid group were initially unresponsive to high dose steroid therapy, they achieved similar results compared to the high-dose steroid group in other outcomes except for length of hospital stay.Pulse-steroid treatment would be an option for COVID-19 patients who do not respond to the initial high-dose steroid treatment.

Familial Mediterranean fever (FMF) is an auto-inflammatory disease that is also characterized with some of the common musculoskeletal features of spondyloarthritis (SpA). Enthesitis is the hallmark of SpA. Recently, it was postulated that exertional leg pain is a possible sign of lower extremity enthesitis associated with FMF severity. In this study, we have evaluated the association between the enthesitis, enthesitis score and disease severity in FMF patients.We enrolled 238 FMF patients that fulfilled the modified Tel-Hashomer criteria. We assessed the presence of enthesitis at the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) defined sites with standard palpation method. Then, FMF patients dichotomised two groups as enthesitis group and controls. Herein, we evaluated the enthesis extensity with MASES. FMF disease severity was determined via the international severity scoring system for FMF (ISSF). Firstly, we have compared demographic properties, disease-related features and ISSF scores of the groups. Then, we have correlated ISSF with MASES in enthesitis group.We showed that 54 (22.6%) of 238 patients had enthesitis. The demographic features were similar between the groups. The enthesitis group had higher ISSF scores (p 0.001); higher frequency of fever (p = 0.004), exertional leg pain (p 0.001), myalgia (p 0.001) and arthritis (p = 0.01); and more intense, widespread, frequent and longer attacks compared with controls. Moreover, there was a weak correlation between ISSF and MASES in the patients with enthesitis.Enthesitis may be a sign of more severe FMF phenotype and frequently associated with other musculoskeletal manifestations resemble SpA. Key points •More than one-fifth of the patients with FMF would suffer from enthesitis. •The FMF patients with enthesitis had higher ISSF scores; higher frequency of fever, exertional leg pain, myalgia and arthritis; and more intense, widespread, frequent and longer attacks as compared with controls. •Enthesitis may be a sign of more severe FMF phenotype and frequently associated with other SpA-like musculoskeletal feature.

In this study, we present a case of bilateral optic neuropathy and macular ischemia in the right eye associated with neurosarcoidosis. A 26-year-old woman presented to our clinic with complaints of bilateral blurred vision. Bilateral granulomatous anterior uveitis, vitritis, optic neuropathy, and macular ischemia were detected in the right eye in slit-lamp examination. She also reported complaints of fever, weakness, sweating, arthralgia, and headache for 2 months. She was referred to the pulmonary diseases unit of our hospital due to hilar lymphadenopathy seen in her chest x-ray, and biopsies were taken for diagnostic purposes. Histological analysis of the mediastinal lymph node biopsies revealed chronic, non-caseating, granulomatous inflammation. Furthermore, the patient was referred to a neurologist due to concomitant complaint of intense headaches. She was diagnosed with neurosarcoidosis supported by findings on cranial magnetic resonance imaging and lumbar puncture. She received a 3-day course of high-dose (1 g/day) intravenous steroid treatment (methylprednisolone) followed by a tapering dose of oral prednisone. The patient began receiving oral methotrexate 15 mg/week as a steroid-sparing agent. Significant improvement in neurological and ophthalmological symptoms occurred in the first week of treatment. In this case report, we emphasized that neurosarcoidosis should be included in the differential diagnosis of patients with both bilateral optic neuropathy and macular ischemia. Furthermore, early diagnosis and timely treatment of neurosarcoidosis are important for favorable visual outcomes.

Immunoglobulin A (Ig A) nephropathy is the most frequent primary glomerulonephritis. Renal limited disease is the most widespread clinical form of the disease. Pulmonary involvement may also be seen concomitantly and capillaritis with pulmonary hemorrhage is the most frequent pulmonary involvement. In this paper, for the first time in literature, we describe an Ig A nephropathy patient with multiple pulmonary cavities as one of the presenting features of the disease. Also, no other etiology for the cavities was found other than Ig A nephropathy. Herein, possible pathogenesis might be capillaritis or deposition of immune complexes. As a result, it should be kept in mind that pulmonary cavity may be the presenting feature of Ig A nephropathy especially with other frequent signs of the disease.

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

Objectives This study aims to compare fear-avoidance (FA) beliefs of rheumatoid arthritis (RA) patients with osteoarthritis (OA) of hand patients and fibromyalgia (FM) patients and evaluate its relationship with RA activity and duration. Patients and methods The study included 206 patients with RA (34 males, 172 females; mean age 49 years; range 20 to 72 years), 57 patients with FM (57 females; mean age 48 years; range 20 to 71 years), and 50 patients with OA of hand (4 males, 46 females; mean age 43 years; range 43 to 77 years). FA beliefs were assessed with modified Fear-Avoidance Belief Questionnaire (mFABQ). RA patients were dichotomized according to disease activity and disease duration separately; cutoff values were disease activity score 28 of 3.2 and six months of disease activity, respectively. Results Modified Fear-Avoidance Belief Questionnaire scores were similar in patients with RA, OA of hand, and FM. RA patients in non-remission group had higher mFABQ scores. Moreover, mFABQ scores were similar in RA patients with early and established disease groups. Conclusion Fear-avoidance beliefs of patients with RA were similar with OA of hand patients and FM patients. However, higher disease activity in RA was related with escalated FA beliefs. Further studies focusing on pathophysiology of FA beliefs in patients with RA are warranted for effective pain management of RA.

Relapsing polychondritis (RP) is a rare multisystemic disease. It affects cartilage and proteoglycan-rich structures. Ocular findings are the most frequent systemic involvement of the disease. The most common ocular manifestations are episcleritis and scleritis. During the course of the disease, uveitis may also be seen. However, as far as we know, nongranulomatous anterior uveitis with hypopyon is an uncommon ocular finding. In this article, we report a 27-year-old male patient who presented with hypopyon anterior uveitis as a revealing manifestation of RP.

Pulmonary involvement, mainly originating from vasculitis, is one of the features of Behçet’s syndrome (BS). We describe, for the first time in literature, computerised tomography images of a male BS patient with multiple pulmonary cystic lesions possibly originated from vasculitis or bronchiolar stenosis.

Background: Osteoarthritis (OA) is characterized by progressive destruction of the articular cartilage, and chondrocytes, the only cells in articular cartilage, are in charge of maintaining the homeostasis of articular cartilage via modulating extracellular matrix anabolism and catabolism [1]. Due to the association of the degree of oxidative degeneration of chondrocytes and OA, preventing impaired redox signalling and oxidative death of chondrocyte are suggested as potential targets to relieve OA[2]. In this respect, some photochemicals have been shown to be potential agents for preventing or treating OA due to their antioxidant and anti-inflammatory properties [3]. Objectives: We studied the effects of an antioxidant S-allyl-cysteine (SAC), a major sulphur-containing amino acid compound of garlic[4], on the redox system, and its associations with the proliferation rate and index of human OA chondrocytes(OACs). Methods: Chondrocytes were isolated from the joint cartilages of OA patients (grade 4, meanage= 66 years, BMI= 29.7 ± 4.4 kg/m2).The alterations in cell proliferation (MTT), adhesion profile (RTCA-iCELLigence System), reactive oxygen species generation (ROS), lipid hydroperoxide levels (LPO), HNE-protein adduct levels (HNE), AGE-protein adduct levels(AGE), 3-nitrotyrosine levels (3-NT),glutathione peroxidase activity (GPx), and inflammatory progenitors ICE/caspase-1 (ELISA) were determined. Results: SAC increased OAC’s proliferation rate and adhesion profile at relatively low concentrations (1, 10 and 100 nM),but inhibited at higher concentrations (1-100 μM). SAC (1 nM-10 μM) inhibited ROS, LPO and 3-NT, but not HNE- and AGE-modified proteins levels. SAC increased GPx but drastically down regulated ICE/caspase-1, indicating a potential redox regulating and anti-inflammatory effect. Conclusion: Results suggest that SAC has favourable effects on OA chondrocytes through protecting proliferation capacity and ameliorating redox-mediated inflammatory pathways. Further studies are needed to investigate its therapeutic potential in patients with OA. References [1] Lepetsos P, Papavassiliou AG. ROS/oxidative stress signalling in osteoarthritis. Biochim Biophys Acta. 2016 Apr;1862(4):576-591. [2] Drevet S, et al. Reactive oxygen species and NADPH oxidase 4 involvement in osteoarthritis. Exp Gerontol. 2018Oct1;111:107-117. [3] Goker B, et al. Luteolin Modulates Glyco-Lipo-Oxidative Protein Modifications and Inhibits Inflammatory Cytokine Release in Human Osteoarthritic Articular Chondrocytes: Comparison with Colchicine. 2018 ACR/ARHP Annual Meeting. Abstract Number: 1990. [4] QianYQ, et al. Down regulating PI3K/Akt/NF-κB signalling with allicin for ameliorating the progression of osteoarthritis: in vitro and vivo studies. Food Funct. 2018Sep19;9(9):4865-4875. Acknowledgement: Supported by TUBITAK (The Scientific and Technological Research Council of Turkey) Project No: 315S012 Disclosure of Interests: None declared

Background Both genetic and environmental factors may have roles in the pathogenesis of Behcet’s Syndrome (BS). Likewise, occurrence of different clinical cluster of BS may be also influenced by the combination of these two factors. But we do not know the weight of the factors during the emergence of the disease and clinical clusters. Objectives We conducted a study for evaluating the frequency of family history for BS in different clinical BS clusters. Furthermore, we assessed the hypothesis that “BS patients in the same family generally accumulate in the similar clinical cluster.” Methods Eighty-five patients and their relatives in our BS cohort were participated to the study. We used international Study Group Criteria for Behcet Disease (ISBD) criteria (1) for classifying our index patients and their first and second degree relatives as BS. We sub-classified BS patient to mucocutenous, vascular, acne-arthritis-enthesis, eye, neurologic, intestinal and undetermined clusters (2). Firstly, we re-evaluated the family history of our BS patients. Then, the relatives of the patients with already known BS or with having symptoms related with BS were interviewed with phone. All participants have been informed about the study and we have taken consent from them. Results Twenty-two (25.9%) of the patients had first or second degree relatives with BS. Furthermore, 27 (31.8%) of our patient were classified to mucocutenaous cluster. In our study, the BS patient with enthesis-arthritis-acne cluster had highest frequency (44.4%) of family history. However, there was no apparent accumulation of similar findings in index BS cases and their close relatives (Table). Conclusion According to result of these studies, there was no finding that supports the hypothesis“BS patients in the same family generally accumulate in the similar clinical cluster”. Still genetic may have major role in the emerging of the BS, such as it is accepted as a member of a group of diseases called MHC-I –opathy (3). However, like most of the diseases, genetic background is not enough for the expression of full-blown disease. Briefly, even in the similar genetic background, multiple and separate hits of environmental or non-genetic factors may take role in the pathogenesis. References [1] Criteria for diagnosis of Behcet’s disease. International Study Group for Behcet’s Disease. Lancet. 1990;335(8697):1078-80. [2] Tunc R, Keyman E, Melikoglu M, Fresko I, Yazici H. Target organ associations in Turkish patients with Behcet’s disease: a cross sectional study by exploratory factor analysis. J Rheumatol. 2002;29(11):2393-6. [3] McGonagle D, aydin SZ, Gul a, Mahr a, Direskeneli H. ‘MHC-I-opathy’-unified concept for spondyloarthritis and Behcet disease. Nature reviews Rheumatology. 2015;11(12):731-40. Acknowledgement None Disclosure of interests None declared

Remission is the goal of therapy in patients with rheumatoid arthritis (RA). However, drug free remission has not been investigated adequately. Early and intensive treatment may increase the chances of successful drug free remission. Effect of long term remission while on medical therapy on the success of drug withdrawal has not been previously evaluated in RA. Long term immune suppression has been shown to have beneficial effects on relapse rates in other diseases with dysregulated immune tolerance. Therefore, drug withdrawal could be an acceptable option in RA patients in long term remission.

Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis. However, no study has primarily focused on the effect of baseline electrolyte abnormalities on disease outcome. In this study, we assessed the validity of the hypothesis that baseline electrolyte imbalances may be related to unfavourable outcomes in hospitalized COVID-19 patients. Design of the study was retrospective and observational. We included 408 hospitalized individuals with COVID-19 over 18 years old. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes on requirement for intensive care unit and mechanical ventilation, hospitalization duration and treatment outcome were evaluated. Patients were clustered based on electrolyte levels and clusters were compared according to outcome variables. Frequency of other severe disease indices was compared between the clusters. Lastly, we evaluated the independent factors related to COVID-19-associated deaths with multivariate analyses. In all, 228 (55.8%) of the patients had at least one electrolyte imbalance at baseline. Hyponatraemia was the most frequent electrolyte abnormality. Patients with hyponatraemia, hypochloraemia or hypocalcaemia had, respectively, more frequent requirement for intensive care unit and mechanical ventilation, higher mortality rate and longer hospitalization. The clusters associated with electrolyte abnormalities had unfavourable outcomes. Also, Clinical and laboratory features associated with severe disease were detected more often in those clusters. Hyponatraemia was an independent factor related to death from COVID-19 (OR 10.33; 95% CI 1.62–65.62; p 0.01). Furthermore, baseline electrolyte imbalances, primarily hyponatraemia, were related to poor prognosis in COVID-19 and baseline electrolyte assessment would be beneficial for evaluating the risk of severe COVID-19., Highlights • More than half of the hospitalized COVID-19 patients had electrolyte abnormalities. • Hyponatraemia was the most frequent electrolyte anomaly. • Hyponatraemia, hypochloraemia and hypocalcaemia were related to unfavorable outcomes in COVID-19 patients. • Hyponatraemia is one of the independent factors related to death from COVID-19.

Background:Familial Mediterranean fever (FMF) is an auto inflammatory disease with recurrent attacks of serositis. Frequent attacks and disease related sequels may be associated with co-morbidities in FMF patients.Objectives:One of the tools for evaluating the FMF severity is the international severity scoring system for FMF (ISSF)1. This score includes disease related sequels, acute phase measurements, attack features and exertional leg pain. Therefore, more severe disease may be link with subclinical inflammation, amyloidosis and frequent, prolonged and widespread attacks. All these components may augment the frequency of non-disease related co-morbidities.Methods:We enrolled 158 FMF patients who fulfilled modifiedTel-HashomerDiagnosisCriteria2. The patients dichotomized based upon disease severity (mild disease or severe disease). Patients with ISSF scores lower or equal to 2 were accepted to have mild disease. Then, we compared frequency of non-disease related co-morbidities between the groups. These co-morbidities arehypertension, hypothyroidism, hyperthyroidism cardiovascular diseases, coronary artery diseases, cerebrovascular diseases, chronic renal disease (non-FMF related), chronic obstructive pulmonary diseases, and diabetes mellitus. This study was approved by the Local Research Ethics Committee and carried out in compliance with the Helsinki Declaration. All the patients gave written informed consent. P-value lower than 0.05 was considered as statistically significant.Results:Demographic features, disease duration, smoking history and body mass index (BMI) were similar between the groups. Frequency of co-morbidity in severe disease group was statistically higher than mild disease group (p=0.02). Most frequent co-morbidity was hypertension in both groups.Table.Features of mild and severe FMF groupsMild (n=135)Severe (n=23)pGender (M/F)47/8811/120.23Age36.4±11.336.5±14.30.68Smoking (%)38 (28.1)5 (21.7)0.52BMI (kg/m2)24.3±9.224.0±8.90.34Disease duration (year)7.7±11.38.6±14.30.09Amyloidosis (%)2 (1.4)3 (13.0)0.02Exon 10 homozygote (%)35 (25.9)9 (39.1)0.19Colchicine dosage (mg/day)1.2±0.41.4±0.50.02ISSF scores0.7 ±0.73.4±0.5Co-morbidity (%)25 (18.5)9 (39.1)0.02Conclusion:In our FMF patient cohort, we found that severity of the disease may be associated with higher frequency of co-morbidities. Therefore, clinicians should be aware of the high possibility of co-morbidities in patients with more severe FMF and addressed these co-morbidities timely and properly.References:[1]Demirkaya E, et al. Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF). Ann Rheum Dis 2016;75:1051-6.[2]Berkun Y, et al. Diagnostic criteria of familial Mediterranean fever. Autoimmun Rev 2014;13:388-90.Acknowledgments:NoneDisclosure of Interests:None declared

Objectives Corticosteroids (CS) are accepted as the standard first-line treatment for giant cell arteritis (GCA). However, controlled trials of tocilizumab and abatacept demonstrated relapse rates of up to 70%–80% in patients on CS-only protocols in 12–24 months. Though level of evidence is low and not suggested by guidelines (except for methotrexate), conventional immunosuppressives (ISs) are also commonly used. We aimed to assess the relapse rates in patients with GCA in routine practice, retrospectively. Methods We assembled a retrospective cohort of patients with GCA from Turkey. All data was abstracted from records. Relapse was defined as any new manifestation or increased acute-phase response leading to the change of the CS dose or use of a new therapeutic agent by the treating physician. Results The study included 156 (F/M: 95/61) patients with GCA (table 1). The mean age at disease onset was 67.8±9.1 years. Polimyalgia Rheumatica was also present in 48 (30,8%) patients. Diagnosis was proven histopathologically in 99 patients.All patients received 1 mg/kg/day CS for remission induction, additional CS pulses were given to 36 (23.1%) patients. Conventional ISs including methotrexate and azathioprine were used in 89 (56.1%) and 26 (16.6%) patients respectively, while 10 (6.4%) patients received biologic treatments (8 tocilizumab,2 etanercept). Fourty-four (28.2%) patients used only CS during follow-up. Follow-up of at least 6 months was available for 132 patients, and median follow-up duration was 35 (6–268) months. Relapses occurred in 27 (20.5%) patients during follow-up. Mortality rate was 7.5% (n=10) during follow-up. VDI score was 2.4±1.7. Main causes of damage were related to CS treatments such as cataract, osteoporosis and diabetes mellitus. Conclusions In this first multi-centre series of GCA from Turkey, we observed that only one fifth of patients had relapses during a mean follow-up of 35 months. This lower relapse frequency suggests a different clinical spectrum in routine practice compared to patients included in controlled trials. Our results also suggest that there is a clear need for a steroid sparing agent in patients with GCA, that is a older aged population prone to CS side effects. Disclosure of Interest None declared

Background Chronic deposition of monosodium urate crystals, in case of hyperuricemia, is the main cause of the gout. 1 Furthermore, lowering uric acid to the targeted levels is the main therapeutic objective in chronic gout treatment. Uric acid lowering treatment (ULT) has three main arms: Practicing lifestyle modifications, pharmacologic ULT and targeting co-morbid illnesses. 2 Thus, patients’ medical and therapeutic properties may have a role in successful ULT. Objectives We evaluated the demographic and therapeutic properties; co-illnesses and disease features of the patients that would relate with the success of ULT. Then, we compared these parameters between the gout patients with successful ULT and inadequate ULT. Methods 66 gout patients on pharmacologic ULT were enrolled to the study. Non-adherence to pharmacologic ULT was accepted an exclusion criteria. Demographic and therapeutic features; co-illnesses and disease features of the patients were obtained during the study. Then, we compared these parameters between the patients with successful ULT and inadequate ULT. Results Adherence to diet was found different between groups (OR, 7.00; CL%95 2.27–21.56). All other features including maximum allopurinol dosage were similar. Only one patient from sucessful ULT group and none of the patients in inadequate group had an drinking habit. Conclusions We found that diet was the only factor that relate with success of ULT while patients were on pharmacologic ULT. So, clinicians should emphasise the importance of all part of ULT including diet with informing patients about the nature of disease and benefits of ULT during visits. References [1] Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet2016; 388: 2039–52. [2] Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken)2012; 64: 1431–46. Acknowledgements None Disclosure of Interest None declared

Background The purpose of this study is to investigate whether oral colchicine has an effect on peripapillary retinal nerve fiber layer (pRNFL) thickness of familial Mediterranean fever (FMF) patients. Methods We conducted a cross sectional study by comparing pRNFL thickness of FMF patients on colchicine (treated group), newly diagnosed colchicine naïve FMF patients (untreated group) and healthy controls. The study included 66 FMF patients and 32 healthy control subjects. Treated FMF patients were grouped according to colchicine use, duration of use and dosage. pRNFL thickness of the patients and controls were measured by using optical coherence tomography and the measurements were compared. Results No statistically significant difference was found between the pRNFL thickness in untreated group, treated group and the healthy control group (all p > 0.05). No statistically significant difference was found between pRNFL thickness in the healthy control group and FMF patients grouped according to duration or dosage of colchicine use (all p > 0.05). Conclusions According to our study, FMF and oral colchicine use had no statistically significant effect on pRNFL thickness.

INTRODUCTION Familial Mediterranean fever (FMF) is characterized by recurrent attacks of polyserositis. Even though clinical assessment is accepted to be the most important factor in the diagnosis of FMF, some diagnostic procedures may help the physician. In this study, we aimed to compare the number of diagnostic procedures performed and number of physician referrals in early diagnosed and late diagnosed cases. Furthermore, we assessed which diagnostic approaches would affect the decision-making of physicians in the early diagnosed patients. MATERIALS AND METHODS We enrolled into the study 143 FMF patients who met the Tel-Hashomer Criteria. Demographic variables, MEFV mutations (when available), diagnostic procedures (if performed) and specialist referrals were evaluated. Early diagnosis was defined as establishment of definite diagnosis within a 5-year period after the appearance of the first symptom. RESULTS Early diagnosed were referred to physicians less often, and except for genetic testing, had fewer diagnostic procedures. In addition to clinical features, MEFV testing was found to be the only method that might influence the diagnosis by a physician. CONCLUSIONS MEFV gene assessment, unlike other diagnostic procedures, might support physicians in the early diagnosis of FMF. Especially in atypical cases, MEFV gene assessment might be considered for diagnosis of FMF.