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Sistemik sklerozis (SS) organ fibrozislerinin görülebildiği kronik otoimmün bir konnektif doku hastalığıdır ve iskemik dijital ülser (DÜ) gelişimi riski yüksektir. SS’ a ikincil gelişen DÜ tedavisinde endotelin reseptör antagonisti olan bosentan kullanımı önerilmektedir. Çalışmamızda SS tanılı hastalarda görülen, tedavi yönetimi zor ve zahmetli olan DÜ tedavisinde bosentan kullanan hastaların uzun dönem verilerini sunarak, klinisyenlerin bosentan kullanımı sonucu karşılaşabilecekleri yan etkiler ve yönetimiyle ilgili farkındalık oluşturmayı amaçladık. Bosentan tedavisi sırasında gelişen en sık yan etkiler baş ağrısı, baş dönmesi, öksürük, nefes darlığı, senkop, flushing, karaciğer enzim yüksekliği, çarpıntı ve ödemdir. Çalışmamızda bosentanın güvenlik verileri yan etkiler üzerinden değerlendirilerek incelendi. Çalışmaya alınan 25 hastanın 24’ ü (%96) kadın olup, yaş ortalaması 52.08±15.35 yıl, hastalık ortalama takip süresi 15.16± 9.01 yıldı. Hastaların tamamı DÜ tedavisi için en az bir vazodilatatör ilaç kullanmıştı. Tüm hastaların kalsiyum kanal blokeri ve pentoxifilin kullanımı, 23(% 92) hastanın iloprost, 11(%44) hastanın ise sildenafil ve/veya tadalafil kullanımı vardı. Bosentan kullanırken takip süresince exitus olan beş(% 20) hasta vardı. Bu beş hastanın takipleri süresince yan etki gözlenmedi. Beş hastada ise farklı nedenlerle ilaç kesildi. Biri gebelik nedeniyle, diğeri ise kendini kötü hissettiğini söylediğinden kendi isteğiyle ilaç kesildi. Üç hastada ise çarpıntı, baş ağrısı ve aminotransferaz yüksekliği nedeniyle ilaç kesildi. Bosentan kullanımı DÜ gelişimini tek başına ya da diğer ilaçlarla kombine kullanıldığında azaltabilmektedir. Bosentanı kullanırken bir klinisyen için güvenlik açısından en önemli nokta gelişebilecek yan etkiler ve bunların yönetimidir. Çalışmamızda baş ağrısı, aminotransferaz yüksekliği ve çarpıntı görülen birer hasta vardı. Bu çalışmayla klinisyenlerin zor ve zahmetli bir tedavi yönetimi gerektiren dijital ülserler için bosentan kullanımında yan etkiler açısından daha dikkatli davranmaları gerektiği vurgulanmıştır.

Bu çalışmada, vasküler Behçet Hastalığı (BH) tanısı ile izlediğimiz hastaların klinik, demografik verilerinin değerlendirilmesi, relaps sıklığı ve kullanılan tedavilerle olan ilişkisinin irdelenmesi amaçlanmıştır. BH tanılı 512 hastanın dosyası geriye dönük incelenerek 68 vasküler tutulumlu Behçet hastası tespit edildi. Demografik özellikler, birinci vasküler olay ve varsa nüksü, tedavi protokolleri kaydedildi. Vasküler tutulum sıklığı %13,28’idi. Hastaların %85’i erkekti. En sık alt ekstremitelerde venöz tutulum görüldü (%77,9). İlk vasküler relaps, hastaların %29,4’inde, ikinci vasküler relaps ise %8,8’inde gelişti. Vasküler tutulumlu Behçet hastalarında vasküler tutulumun tespit edilmesini takiben hastaların %73,5’i sistemik immünsüpresif (İS) tedavi, %45,5’i antikoagülan tedavi almıştı. İS tedavi almayan grupta relaps riski anlamlı olarak yüksek bulundu. (p=0.001) Antikoagülan tedavi alan grupta relaps oranı daha fazla olmakla birlikte istatistiksel olarak anlamlı bir fark saptanmadı (p=0.61). Vasküler tutulum sıklıkla erkeklerde görülmektedir. Tedavide İS'ler ve antikoagülanlar kullanılmaktadır. İmmünsupresif tedavi kullanımı vasküler relaps riskini azaltabilir, ancak antikoagülan tedavinin ek faydası gösterilememiştir. Bu konuda daha fazla sayıda hasta ile yapılacak çok merkezli çalışmalara ihtiyaç vardır. In this study, we aimed to evaluate the clinical and demographic data of the patients followed up with the dia gnosis of Vascular Behçet's Disease (BD), and to examine the frequency of relapse and its relationship with the treatments used. The data of 512 patients diagnosed with BD were reviewed retrospectively, and 68 BD with vascular involvement were detected. Demographic characteristics, first vascular event, and recurrence, if any, and treatment protocols were recorded. The frequency of vascular involvement was 13.28%. 85% of the patients were man. Venous involvement was most common in the lower extremities. (77.9%) The first vascular relapse occurred in 29.4% of the patients, and the second vascular relapse occurred in 8.8%. After the first vascular event, 73.5% of the patients received systemic immunosuppressive therapy and 45.5% received anticoagulant therapy. The risk of relapse was found to be significantly higher in the group that did not receive immunosuppressive therapy. (p=0.001) Although the relapse rate was higher in the group receiving anticoagulant treatment, no statistic ally significant difference was found. (p=0.61) Vascular involvement often occurs in male patients. Immunosuppressive therapies an d anticoagu- lants are used in the treatment. The use of immunosuppressive therapy can reduce the risk of vascular relapse. No additional benefit of anticoagulant therapy was observed. Multicenter studies with larger numbers of patients are needed for a better understanding in this issue.

Objective: Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behcet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment. Methods: Patients with BD (n = 205; 166 men, 39 women; age 39 6 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated. Results: Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-a use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010). Conclusions: Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-a also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS. (J Vasc Surg Venous Lymphat Disord 2021;9:1451-9.)

Background Comparing treatment modalities is difficult in Behcet's syndrome, even if tumour necrosis factor-alpha (TNF-α) inhibitors are a treatment option for all involvements resistant to conventional therapy. This study evaluated how different departments dealt with treatment, particularly with TNF-α inhibitors. Material and Methods The study comprised 111 patients from our Behcet's syndrome cohort who were treated with TNF-α inhibitors between 2010 and 2019. Data on patients were retrieved retrospectively from the rheumatology, ophthalmology, and dermatology clinics' patient records. Results Patients followed up in rheumatology (n: 40) were classified as Group 1, and patients followed up in ophthalmology (n: 49) and dermatology (n: 5) as Group 2. In Group 1, genital ulcers, erythema nodosum (p=0.009, p=0.003, respectively), lower extremity deep vein thrombosis, arterial aneurysm and neurological involvement were more common (p=0.005, p=0.008, p=0.001, respectively). In Group 2, the use of cyclosporine and interferon-α before the anti-TNF agent was higher (p

Background Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. Objective This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. Methods Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. Results A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). Conclusion Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.

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

Due to toxicity, most disease-modifying antirheumatic drugs (DMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs) should not be administered in rheumatoid arthritis (RA) patients with chronic renal failure (CRF). Biological DMARDs are an effective RA treatment, but, their effects and safety on renal function are uncertain. Biologic therapies for RA and renal insufficiency are understudied. The study included 27 individuals with an eGFR of 60 ml/min/1.73 m2 for more than three months who were determined to have CRF among 700 patients with RA who used biological therapies and had regular visits between 2011 and 2018. The mean age of our patients was 63.58, and 70.37% of the patients were women. The mean duration of renal failure was 5.73±2.08 years. Renal failure was diagnosed following RA in 77.7% of the patients, with a mean time between diagnosis and renal failure of 11.52±7.35 years. The first three causes of renal failure were drug toxicity (25.9%), hypertension (HT) (25.9%), and diabetes mellitus (DM) (18.5%). Tumor necrosis factor inhibitors (TNFi) were the first and most commonly used biologic agents (66.6%). The most commonly used agent among TNFi was etanercept (44.4%). CRP and DAS-28 values reduced during a median 36-month biological agent follow-up period. When creatinine and eGFR values were examined at the first and last visit, creatinine decreased and eGFR increased. In this study, in which CRF progression improved, we intended to establish the efficacy, safety, and effect of biologic therapies on renal failure progression.

Aim of the study To investigate the efficacy of evaluating prognosis and response to lung cancer treatment using M30 and M65 antigens, which are indicators of necrosis. Material and methods Forty-eightpatients with lung cancer, who were planned to receive neoadjuvant chemotherapy, and 38 healthy volunteers were enrolled in the study. Using M30 and M65 levels, cytokeratin 18 levels were measured twice: before and 48 hours after the first chemotherapy treatment. Apoptotic and total necrosis levels were determined by measuring the M65 and M30 levels. Results The M30 and M65 antigen levels in the patient group were significantly higher than in the control group (p< 0.001). The M30 and M65 antigen levels were significantly higher 48 hours after the chemotherapy compared with before the chemotherapy (p< 0.001). There were no significant differences in M65 levels between patients who responded to treatment and patients who progressed. The M30 levels increased significantly in patients with disease progression (p= 0.694 and p = 0.024, respectively). No significant differences in serum M30 and M65 antigen levels were found when compared between the surviving and deceased patients (p = 0.126 and p = 0.340, respectively). Conclusions A significant increase was detected in serum M30 and M65 levels in patients with lung cancer. There was a greater increase in serum M30 levels in patients who did not respond to the chemotherapy. This result gives rise to the thought that evaluating apoptosis and total necrosis through M30 and M65 measurements alone only in patients receiving neoadjuvant chemotherapy would be insufficient for specifying the effectiveness of the treatment.

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

Hairy cell leukemia (HCL) is a rare chronic lymphoproliferative disease. LSV is characterized by inflammation of small vessels. Its association is rare in the literature and HCL can be seen in LSV etiology, although the relationship between the 2 diseases is far from clear. Here, we aimed to present a case with constitutional symptoms, palpable purpuric lesions on the body and diagnosed as HCL from bone marrow biopsy.

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

Introduction: We aimed to investigate the predictive effect of serum M30 and M65 antigens on long-term prognosis in patients with advanced stage lung cancer before and after the first dose of chemotherapy. Methods: Fourty eight patients with advanced stage lung cancer were included in the study. Demographic data and histopathological characteristics of the patients were recorded. Serum levels of M30 and M65 were studied in 48 patients before chemotherapy, and in 43 patients both before and 48 hours after chemotherapy. Long-term survival was evaluated using Kaplan-Meier curves. The effect of high or low M30, M65 levels and M30/M65 ratio on long-term survival was investigated. Results: The mean age of the patients at the time of diagnosis was 57.52 ± 9.38 years. Fourty six of the 48 patients were men. While M30 value before chemotherapy was 163.23 ± 112.30 U/l; It was measured as 249.74 ± 266.67 U/l 48 hours after chemotherapy (p

Bu çalışma, 2018 yılında Bursa'da düzenlenen Uludağ İç Hastalıkları Günleri’nde bildiri olarak sunulmuştur. Çalışmanın amacı, Romatoid artrit (RA) tedavisinde standart ilaç olan metotreksat (MTX) ile ilgili RA hastalarının bilgilerini bir anket aracılığıyla değerlendirmektir. Ağustos-Ekim 2017 tarihinde bir üniversite hastanesinde RA tanısı ile MTX kullanan hastalardan, MTX’in etki mekanizması, uygulama şekli, ilaç etkileşimi, yan etkileri, hastaların izlenme sıklığı ve yapılması gereken yaşam tarzı değişiklikleri ile ilgili soruları içeren anketi yanıtlamaları istendi. Yüz altmış iki hasta (144 kadın) çalışmaya dahil edildi. Ortalama hasta yaşı 52 (18-77), ortalama hastalık süresi 10.3 (1-40) yıl ve ortalama MTX kullanma süresi 7,1 (1-38) yıl idi. MTX’in hastalığı düzenleyen antiromatizmal bir ilaç olduğunu %50 hasta doğru yanıtladı. Uygulama sıklığının haftalık olduğunu %85; folik asid kullanımı gerekçesinin, tedavi toksisitesini azaltmak olduğunu ise %19 hasta belirtti ve yine sadece %11’i trimetoprim kontrendike olduğunu biliyordu. Hematolojik risklerden %11’i haberdardı ve %11’i aşırı duyarlılık pnömonisi riskinin farkındaydı. Laboratuvar testleri ile ilgili %51’inin bilgisi vardı. Doğurganlık çağında kadın ve erkeklerin MTX kullanırken kontrasepsiyon kullanması gerekliliğini bilenler %20 idi. %34’ü alkol tüketiminin sınırlı olması gerektiğini belirtti. Erkekler ve eğitim seviyesi yüksek olanlar istatistiksel olarak daha yüksek oranda doğru cevap verdi (p=0.019, p=0.000). Günlük pratikte RA hastalarında sıklıkla kullanılan MTX hakkında hastaların yetersiz bilgiye sahip olduğu görüldü. Özellikle ciddi yan etkiler, ilaç etkileşimleri ve doğum kontrolü gibi önemli konularda eksiklikler vardı. MTX’e ilişkin hasta bilgisi farklı eğitim araçlarını kullanarak düzenli olarak kontrol edilmeli ve desteklenmelidir. The aim of the study is to evaluate the rheumatoid arthritis (RA) patients' knowledge about methotrexate (MTX), the standard drug in the treatment of RA, through a questionnaire. In August-October 2017, patients who used MTX with a diagnosis of RA in a university hospital were asked to answer questionnaires about the mechanism of action of MTX, administration method, drug interaction, side effects, frequency of follow-up of patients and changes to the lifestyle that should be done. One hundred and sixty-two patients (144 women) were included in the study. The mean patient age was 52 (18-77) years, the mean disease duration was 10.3 (1-40) years, and the mean duration of MTX use was 7.1 (1-38) years. 50% of the patients correctly answered that MTX is an anti-inflammatory drug that regulates the disease. 85% of patients correctly responded to the weekly application frequency correctly.; 19% of the patients stated that the reason for using folic acid was to reduce the toxicity of the treatment and again only 11% knew that trimethoprim was contraindicated. 11% were aware of the hematological risks and 11% were aware of the risk of hypersensitivity pneumonia. 51% of them had knowledge about laboratory tests. 20% of women and men of childbearing age knew that they should use contraception while using MTX. 34% stated that alcohol consumption should be limited. Men and those with a high level of education gave a statistically higher rate of correct answers. (p=0.019, p=0.000) It was observed that the patients had insufficient knowledge about MTX, which is frequently used in RA patients in daily practice. There are shortcomings on important issues, especially serious side effects, drug interactions, and birth control. Patient information regarding MTX should be checked and supported regularly by using different training tools.

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.

Background: Rheumatoid arthritis is an important cause of disability and dependency in older adults. We aimed to assess dependency in activities of daily living in younger and older patients with rheumatoid arthritis and to seek factors underlying dependency in activities of daily living.Methods: In this cross-sectional study, we assessed dependency in basic and instrumental activities of daily living; disease activity; quality of life; depression; anxiety; and fatigue in the rheumatology clinic of a university hospital. Univariate analyses and a logistic regression analysis were performed to determine factors associated with dependency.Results: We enrolled 76 patients with a mean age of 57±11.1 (range 31-78). The rate of dependency in instrumental activities of daily living was high in younger (56.1%) and older (51.4%) patients. The rate of dependency in basic activities of daily living was 14.6% in younger and 14.3% in older patients. A higher depression score and female gender had significant associations with dependency in instrumental activities of daily living.Conclusion: The rate of dependency in basic and instrumental activities of daily living is high in younger and older patients with rheumatoid arthritis. Depression seems to be an independent and important factor underlying dependency. Further studies are needed to investigate the mechanisms of this association and test the effect of antidepressant treatment on dependency in rheumatoid arthritis.

We aim to investigate the relationship between pulmonary function and imaging parameters with symptom-related patient-reported outcome measures (PROs). We included 65 patients of rheumatoid arthritis (RA) and connective tissue disease (CTD) with and without interstitial lung disease (ILD) into this cross-sectional study. We evaluated the relationship between FVC, DLco, and PROs and compared to HRCT findings. PROs included visual analogue scale for breathing, modified Borg scale, medical research council dyspnea scale, St. George’s respiratory questionnaire (SGRQ), Leicester cough questionnaire, and Short Form 36 quality of life (SF-36 QoL). The mean age was 57.4 ± 9.7 and 61.9% (39/65) of patients had an established ILD. In RA-ILD group, SGRQ score was higher (p < 0.001) and SF-36 physical functioning score was lower (p = 0.02) than CTD-ILD group. In RA group, there was a significant correlation between FVC and SF-36 role functioning/physical score (r = 0.724, p = 0.012). In CTD group, SF-36 general health score was correlated with both FVC (r = 0.441, p = 0.045) and DLco (r = 0.485, p = 0.035), and also SF-36 physical functioning score was correlated with FVC (r = 0.441, p = 0.040). PROs were found to be similar between ILD and non-ILD patients. SF-36 QoL total and SGRQ outcomes were worse in non-ILD group. We concluded that PROs could be used to evaluate health-related quality of life (HRQoL) in RA- or CTD-related ILD. The physical health determinants of HRQoL are measurably worse in RA-ILD patients than in CTD patients. But, PROs may not be very helpful in differentiating patients with cough and/or shortness of breath due to ILD or non-ILD causes in RA/CTD. • HRQoL may be affected differently among specific subtypes of ILD. • PROs can be used to evaluate dyspnea and function of patients with RA- or CTD-related ILD but are not distinguished from patients with cough and/or shortness of breath due to non-ILD causes in RA/CTD.

OBJECTIVE Fasting may lead to some problems in patients who have to use drugs on a regular and continuous basis. The objective of this study is to identify rheumatology patients' attitudes toward Ramadan and fasting. METHOD The descriptive and cross-sectional study was conducted with 374 patients. The study data were collected using a questionnaire form. SPSS was used and percentage and Chi-square analyses were performed. RESULTS It was determined that 56.1% fasted during Ramadan. When asked about the effect of fasting on the disease, 88.4% of those who fasted answered "it had no effect", and 80.1% of those that did not fast said "it affected negatively" (P

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: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: 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

Hidradenitis suppurativa (HS) is a chronic, suppurative skin disease characterized by painful nodules, particularly in the axillae and groin. Isotretinoin can be used in the treatment of HS; however, it may paradoxically lead to skin lesions or worsen the existing lesions. Isotretinoin, which is commonly used in the treatment of severe acne, is associated with several side effects, including rheumatic side effects and rarely sacroiliitis. In this study, we discussed two cases who presented with low back pain after isotretinoin was used for the treatment of acne vulgaris. The patients did not have low back pain before isotretinoin use and did not have enthesitis, dactylitis, uveitis, psoriasis, recent infection, trauma, and family history spondylitis. HLA-B27 was negative. Bone-marrow edema was detected at the sacroiliac joint on magnetic resonance imaging. Because of these findings, sacroiliitis related to the drug was considered in our patients and isotretinoin treatments were discontinued. Because the patients' low back pain continued when they administered non-steroidal anti-inflammatory drugs, biological drug treatments were started. Both cases presented had a simultaneous HS lesion. After the treatment, both low back pain and HS lesions regressed. Patients with isotretinoin therapy should be alerted for inflammatory low back pain and HS lesions that may develop. We should note that biologic agents should be considered in the treatment of resistant cases.

Norofibromatozis Tip 1 (NF1) 17q11.2 geninde mutasyondan kaynaklanan otozomal dominant multisistemik bir hastaliktir (1). Insidansi yaklasik 2500-3500 canli dogumda 1 ve prevelansi 4000-5000 de 1dir. Karakteristik ozellikleri cafe´-au-lait lekeleri, kivrim yerlerinde koyulasma ve Lisch nodulleridir (iris hamartomazu). NF1 santral ve periferal sinir sistemi tumorleri (gliom ve norofibrom) uzerine tumor predispozan sendrom olarak dusunulse de pigmental anormallikler (cafe´-au-lait lekeleri, kivrim yerlerinde koyulasma ve Lisch nodulleri), iskelet anomalileri ve norodavranissal anomalileri (ogrenme guclugu, dikkat eksikligi hiperakivite bozuklugu) iceren genis nonneoplastik durumlari sergiler (2.3). NF1 in komplikasyonu olan endokrin bozukluklarinin ilk tanimlamalari 1970lere kadar gitmektedir, bunlarin bircogu izole vaka raporu veya vaka serisidir. Bu yazida klinigimizde optik gliomun eslik ettigi NF1 ile takip edilen 8 yas 6 aylik erkek hastanin izlemlerinde tespit edilen puberte prekoks durumunu ele aldik.

Aim Methotrexate (MTX) is the first-line disease-modifying antirheumatic drug in rheumatoid arthritis (RA). However, this anchor may cause some side effects that may range from nausea to mortality. The clinical features of MTX toxicity are under-researched. In this study, we aimed to find out the potential predisposing factors and outcomes of the MTX toxicity (n = 31). Methods The data were collected from 31 patients whose ages ranged from 25 to 81 years, who were suffering from immune-mediated inflammatory diseases and major MTX-related toxicity. Results Out of 31 patients, six (19.4%) used MTX every day, and 13 (41.9%) patients had renal insufficiency who were admitted to the hospital because of mucositis (90.3%) and fever (71%). While using MTX, 27 patients (87.1%) were discharged after the treatment and four patients (12.9%) died. Conclusions Although MTX has high efficacy for the toxicity ratio, wrong use and dosage of MTX may be harmful to patients. Thus, patients should be informed about the proper use of MTX.

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

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

Objective: We aimed to assess adalimumab(ADA) and infliximab(IFX) efficacy on the patients of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) by using erithrocyte sedimentation rate (ESR), C-reactive protein (CRP), interferon gamma (IF-?), interleukin-1 beta (IL-1s), interleukin 6 (IL- 6), matrix metalloproteinase 3 (MMP-3). Material and Method: Sixteen RA, 15 AS patients were enrolled to this study. ADA was used on the half of RA patients , IFX was used on the other half randomly. ADA was used on 7 AS patients and IFX was used on 8 AS patients randomly too. Blood samples were taken at the weeks of 0, 1, 4 and 12. ESR and CRP were calculated at the same time with controls. Blood samples were hidden at the -20°C to evaluate after. Results: There wasn’t any significant difference between the groups of RA and AS patients in terms of ESH and CRP levels (p>0.05). IF-? was found lower on both patient groups and IL-6 and IL-1s were not included statistical analysis due to the wide range of values. MMP-3 levels was found correlated with ESR and CRP levels in both treatment and patient groups. MMP -3 was more supressed at ADA treated group on AS patients according to the IFX group on AS patients significantly (p

Background Today, the immunosuppressive treatment agents became important for therapy of rheumatoid diseases. Theoretically, the use of these agents may result in reactivations be in patients that infected with Hepatitis B (HBV) and Hepatitis C (HCV) virus. Objectives We aimed to study the reactions during treatment and prevalence of HBV and HCV infections in rheumatology patients who are using immunosuppressive treatment. Methods The records of a total of 1146 patients who were taking an immunosuppressive treatment for a rheumatoid disease were reviewed retrospectively. The hepatitis serology, type of immunosuppressive treatment, the duration of treatment, liver function tests, complete blood count; HBV – DNA and HCV – DNA and antiviral agents and time of use (if patient is infected) were recorded. Results There were 682 (59.5%) women and 464 (40.5%) men, the mean age was 45.04±13.13. Ankylosing spondylitis (AS) was diagnosed in 453, rheumatoid arthritis (RA) in 365, psoriatic arthritis in 151, systemic lupus erythematosus in 43, vasculitis in 39, Behcet Disease in 26, systematic sclerosis in 18, myositis in 9, juvenile rheumatoid arthritis in 7, Sjogren Syndrome in 7, Still Disease in 3, familial mediterian fever in 6, retroperitoneal fibrosis in 1 and mixed connective tissue disease in 1 patient. The rate of HbsAg positivity was 1.8% in AS and 2.2% in RA; the rate of HCV positivity was 0.7% and 1.9% respectively. While HBsAg, AntiHBs and anti-HBcIgG was tested for 898 patients, in 28 patients (2.4%) HBsAg and AntiHBs were negative and anti-HBcIgG was positive. The liver function tests were increased in two occult hepatitis patients, and lamivudine was administered for one and tenofovir for another patient. HCV-RNA was found negative in 12 of 18 patients that positive for HCV. Only one patient had ribavirin + interferon treatment and no reactivation was detected during follow up. The mean length of immunsuppressive treatment was 22.26±18.21 months for HBV positive patients, 19.43±21.40 months for HCV positive patients and 20.94±19.7 months for occult hepatitis. Furthermore, we 10.1% of the patients were vaccinated, 13.4% had natural immunity and 50.7% of patients has not encounter with virus. Conclusions HBV prevelance was 3.99% and HCV prevelance was 0.95% in general population, although there is difference according to geographical region in our country. HBV prevelance was the highest 9.9% in southeast region and the lowest 0.7 – 2.5% in west region. Low HBV prevelance could be associated with included patients that was young and stay in west region. Because hepatit virus can be reactivate under immunsupressive treatment, patients should be scanned and be careful for occult hepatitis in these scans. References Vassilopoulos D, Calabrese LH. Viral hepatitis: review of arthritic complications and therapy for arthritis in the presence of active HBV/HCV. Curr Rheumatol Rep. 2013 Apr;15(4):319. Chen YM, Chen HH, Chen YH, Hsieh TY, Hsieh CW, Hung WT, Lan JL, Chen DY. A comparison of safety profiles of tumour necrosis factor α inhibitors and rituximab therapy in patients with rheumatoid arthritis and chronic hepatitis C. Ann Rheum Dis. 2015 Mar;74(3):626–7. Acknowledgements None. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is a chronical autoimmune disease that commonly presented with symmetrical polyarthritis of hands and feet. Pharmacological treatment options are non-steroid anti-inflammatory drugs (NSAIDs), glucocorticoids (GK) and disease modifying anti rheumatoid drugs (DMARDs) ([csDMARDs] or [tsDMARDs or [bDMARD]. Objectives In this study we aimed to review the use of NSAID and GK in our patients. Methods The patients who diagnosed as RA at our office were included in the study. Patients were classified with EULAR 2010 RA criteria. The demographics and medications of the patients were recorded. All patients we examined pain with visual analog scale (VAS), global assessment of patient and doctor, number of tender and swollen joints (28 joints), health assessment questionnaire (HAQ), C – reactive protein (CRP), eritrocyte sedimentation rate (ESR), rheumatoid factor (RF) and anti – CCP. We assessed activity of disease by using disease activity score DAS28. Results A total of 686 patients were enrolled in the study (580 female [84.5%], 106 male [15.5%]). Mean age was 53.23±12.21 and mean length of diagnosis was 10.74±7.59 months. The rate of extra-articular disease was 17.9% and the deformity rate was 31.3%. In all patients, activity of disease was mild in 55%, moderate in 37.8% and severe in 7.3% with regard to DAS28 score. The disease activity was mild in 54.6%, moderate in 43.11% and severe in 2.3% in patients who were using only NSAIDS. These rates of diseases activity was 57.2%, 40.7% and 2.1% in mild, moderate and severe disease respectively for the patients using only GK. In patients using both NSAIDs and GK, the disease activity was mild in 55%, moderate in 44% and severe in 1%. Comparison of the disease activity with medications revealed statistically significant difference in patients that using only NSAID and using both, but not in that using only steroid (respectively p: 0.022, p: 0.025, p: 0.46). Conclusions In our study we found that patients has mild activity of disease use highly rates of NSAID and GC. It is important for providing remission using NSAIDs and GC along with DMARD. Our results demonstrate use of both GK and NSAIDS results in better outcomes. References Singh JA, Saag KG, Bridges SL Jr et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016 Jan;68(1):1–26. Gaujoux-Viala C, Gossec L. When and for how long should glucocorticoids be used in rheumatoid arthritis? International guidelines and recommendations. Ann N Y Acad Sci. 2014 May; 1318:32–40. Acknowledgements None. Disclosure of Interest None declared

Aim. The aim of this study was to evaluate risk factors affecting graft and patient survival after transplantation from deceased donors. Methods. We retrospectively analyzed the outcomes of 186 transplantations from deceased donors performed at our center between 2006 and 2014. The recipients were divided into two groups: Group I (141 recipients without graft loss) and Group II (45 recipients with graft loss). Kaplan-Meier, log-rank test, and Cox proportional hazard regressions were used. Results. The characteristics of both groups were similar except renal resistive index at the last follow-ups. When graft survival and mortality at the first, third, and fifth years were analyzed, tacrolimus (Tac)-based regimens were superior to cyclosporine (CsA)-based regimens (P

Objective: Neutrophil lymphocyte ratio (NLR) has emerged as a valuable and reliable method for follow-up of systemic inflammatory disease. We herein aimed to evaluate the role of NLR in the clinical follow-up of inflammation and also to compare its relationship with other measures, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Material and Methods: A total of 35 active ankylosing spondylitis (AS) and 38 healthy volunteers were included in the study. The patient group was enrolled for treatment with one anti-tumor necrosis factor (TNF) drug. Total blood count, ESR, CRP, and BASDAI score were obtained before and 3 months following the treatment. NLR was found with a mathematical calculation of the ratio of neutrophils with lymphocytes. Results: The mean NLR value of the control group and patients was 1.90±0.89 and 2.67±1.17, respectively (p

Patients with connective tissue diseases (CTDs) may have prolonged corrected QT interval which indicates increased risk for ventricular arrhythmias. However, a more sensitive measure of ventricular repolarization, T-peak-to-end (Tpe) interval, has not been studied in CTDs. We aimed to investigate the relationship between ventricular repolarization abnormalities and anti-Ro52-positivity in subjects with connective tissue diseases (CTDs). We enrolled patients with anti-Ro52-positive CTDs, ANA-positive CTDs, and healthy subjects in this cross-sectional study. We excluded conditions potentially affecting the QT interval. We compared the ECG measures between the groups and performed analyses to define factors associated with ventricular repolarization measures. 15 ANA and anti-Ro52-positive, 39 ANA-positive and anti-Ro52-negative, and 22 healthy subjects were enrolled. None of the subjects had rhythm or conduction disturbances. Corrected QT intervals were similar between the groups. Tpe (84, 77.3, and 69.4 msn, respectively) and QT-dispersion (40, 27.2, and 20.1 msn, respectively) were higher in anti-Ro52-positive subjects compared with the ANA-positive and healthy subjects. Anti-Ro52 titers were correlated with Tpe and QT-dispersion (r = 0.52 and p < 0.001 for each). ANA and anti-Ro52-positivity were independently associated with higher Tpe (OR = 7.7, p = 0.001 and OR = 6.9, p = 0.001, respectively), corrected Tpe (OR = 11.3, p = 0.001 and OR = 8.4, p = 0.003, respectively), QT dispersion (OR = 7, p = 0.008 and OR = 13, p < 0.001, respectively), and QTc dispersion (OR = 9.1, p = 0.001 and OR = 14.1, p < 0.001, respectively). This study provides evidence that ANA positivity, especially when concomitant anti-Ro52-positivity is present, significantly deteriorates ventricular repolarization. The aforementioned ventricular repolarization abnormalities may render these subjects susceptible to serious rhythm or conduction disorders in the setting of predisposing conditions. Bursa Böbrek Vakfı

Objectives: This study aims to evaluate the role of neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) as activation and inflammatory markers in systemic lupus erythematosus (SLE) patients with nephritis. Patients and methods: A total of 108 SLE patients (8 males, 100 females; mean age 35.3 +/- 10.2 years; range 16 to 64 years) including 78 patients with renal involvement (8 males, 70 females; mean age 33.9 +/- 10.6 years; range 16 to 64 years) (SLEn+ group) and 30 patients without renal involvement (30 females; mean age 39.1 +/- 8.2 years; range 22 to 55 years) (SLEn-group) were included in this retrospective study. All patients' clinical characteristics and laboratory data which include erythrocyte sedimentation rate, C-reactive protein, white blood counts, neutrophil counts, lymphocyte counts, platelet counts, and MPV levels were obtained from medical records. The laboratory data at the highest proteinuria periods of the patients with renal involvement were recorded. Results: Mean MPV (SLEn+ = 9.1 +/- 2.2, SLEn-= 7.9 +/- 1.2, p= 0.001) and NLR (SLEn+ = 5.9 +/- 5.9, SLEn-= 2.6 +/- 2.5, p< 0.001) values were significantly higher in lupus nephritis group. Besides, a positive correlation between NLR and C-reactive protein was found in lupus nephritis group (r= 1.97, p= 0.045). Based on receiver operating characteristic curve with area under the curve of 0.76, cutoff NLR value of 1.93 had 83% sensitivity and 54% specificity [95% confidence interval, 0.66-0.85] in differentiating SLE patients with or without nephritis. Conclusion: Neutrophil to lymphocyte ratio and MPV may be discriminative for lupus nephritis. Also, NLR may be a predictor of lupus nephritis. Both MPV and NLR values may be affected by a great number of factors; therefore, further prospective studies are needed to evaluate the use of these parameters in SLE.