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Frosted branch angiitis (FBA) is a rare type of severe retinal vasculitis characterized with a widespread perivascular translucent sheathing in association with a variable degree of anterior and/or posterior segment inflammation. Secondary type of FBA is the term coined for the patients with various underlying autoimmune diseases or viral infections. We aim to describe the clinical course of a case with a unilateral frosted branch angiitis most likely associated with the hyperhomocysteinemia and methylene tetrahydrofolate reductase mutation who initially presented us with a unilateral central retinal vein occlusion-like appearance. A 37-year-old otherwise healthy woman presented with a left central retinal vein occlusion-like appearance. Extensive systemic and coagulation work up was unremarkable except for the elevated plasma homocysteine level and heterozygous methylene tetrahydrofolate reductase gene mutation. A week later, a full-blown picture of frosted branch angiitis was established. A successful visual and anatomic outcome was achieved with the pulse and then oral steroids, oral azathioprine, and multiple intravitreal aflibercept injections. Two key messages can be considered. First, central retinal vein occlusion-like presentation can be the very early phase of clinical evolution of FBA, and second, patients with FBA should also be evaluated for possible coagulation abnormalities.

To determine limited joint mobility (LJM) of the hand in patients with systemic sclerosis (SSc).LJM was evaluated with "prayer sign" and "tabletop sign" tests. LJM staging was done by Rosenbloom classification method. LJM (+) and LJM (-) patients were compared in terms of demographic findings (gender, age and duration of disease), laboratory results (ESR, CRP, anti-nuclear antibody (ANA), anti-topoisomerase I and anti-centromere), and modified Rodnan skin score (mRss) results.In our study, a total of 217 patients, including 113 patients with a diagnosis of SSc, and 104 as a healthy control group with similar age and gender distribution to these patients, were included. A total of 113 (F=98, M=15) patients (limited cutaneous SSc (lcSSc=71), diffuse cutaneous SSc (dcSSc=42)) were included in this study and LJM positivity was found in 66.4% (lcSSc=38, dcSSc=37). A statistically significant difference was observed in between lcSSc and dcSSc patients according to the presence of LJM (p0.001). There was a moderate positivity relationship between LJM and mRss (lcSSc r=0.449, p0.001; dcSSc r=0.565, p0.001).In our study, it was found that LJM staging correlated with mRss and dcSSc patients had more severe LJM findings than lcSSc. We conclude that "prayer sign" and "tabletop sign" tests used in hand evaluation in SSc patients have similar clinical results with mRss and can be simple bedside tests in daily practice. Key Points • This is the first study examining limited joint mobility (LJM) with "prayer sign" and "tabletop sign" tests in systemic sclerosis (SSc) patients. • "Prayer sign" and "tabletop sign" tests can be easily performed in daily practice. • We found Rosenbloom LJM staging correlated with modified Rodnan skin score. LJM of the hand can be a good prognostic indicator for early stage SSc patients.

BackgroundErosions and sclerosis are early manifestations of radiographic progression, which can form syndesmophytes that bridge between the vertebrae and eventually lead to spinal fusion or the characteristic bamboo spine appearance in some patients.Bridging syndesmophytes in the spinal column plays a key role in the progression of AS.1 The development of ankylosis in the axial skeleton is considered to be the most important long-term outcome parameter for axial pondyloarthritis (axSpA).2ObjectivesIn this study, we aimed to evaluate patients with ankylosing spondylitis (AS) diagnosed with grade 4 sacroiliitis followed in our rheumatology clinic, without spinal column involvement and with complete spinal ankylosis (bamboo vertebra), together with their clinical, demographic and laboratory findings.MethodsA total of 202 patients with unilateral/bilateral grade 4 sacroiliitis, who were registered in the Dokuz Eylul University Hospital data system, diagnosed with AS according to the modified New York criteria, were included in the study. Cervical, dorsal and lumbar radiographs of all patients were evaluated for structural damage, in addition to lateral and anteroposterior aspects, as well as posterior and facet joint involvement. In the study, all radiographs were evaluated twice at separate times.ResultsIt was found that 19 (9.5%) patients had no involvement of the spinal column and 19 (9.5%) had spinal fusion appearance. It was determined that patients with spinal fusion were older (p0.05).There was no significant difference between the patients with complete spinal fusion and no spinal involvement in terms of right and left hip BASRI scores (p>0.05).Table 1.DemographicsSpinal Involvement (-) (n=19)Full Spinal Involvement (+) (n=19)pn (%)n (%)Age ≤4517 (89.5)0 (0)AUC (SH.): 0.945 (0.040) >452 (10.5)19 (100)10.5 (2.8-39.2) OOSex (Erkek)12 (63.1)18 (94.7)0.04210.5 (1.14-96.56) OOCRP11 (57.9)12 (63.2)0.999HLA-B2710 (64.3)9 (60.0)0.831Psoriasis1 (5.2)1 (5.3)-Family History4 (21)0 (0)-Alcohol1 (5.2)2 (10.5)-Cigarette7 (36.8)4 (21.1)0.475Dactylitis1 (5.2)0 (0)-Enthesitis0 (0)1 (5.3)-Uveitis3 (15.7)4 (21.1)0.234IBD3 (15.7)0 (0)-HT1 (5.2)7 (36.8)0.044DM1 (5.2)5 (26.3)0.182CHD0 (0)2 (10.5)-Aortic Failure1 (5.2)0 (0)-Mann-Whitney U Test (Monte Carlo), ROC (Receiver Operating Curve) Analysis (Honley&Mc Nell - Youden index J); AUC:Area under the ROC curve; OR: Odds Ratio; RC: ROC Curve Analyze, IBD: Inflammatory Bowel Disease, HT: Hypertension, DM: Diabetes Mellitus, CHD: Coronary Heart Disease, CRP: C-Reaktif Protein, n:Number, %: PercentConclusionIn our study, we reached four important clinical results: (1) Spinal fusion was observed in 9.5% of the patients with bilateral Grade 4 sacroiliitis diagnosed with AS, 9.5% had no spinal involvement and 81% had varying degrees of spinal injury. (2) Anti-TNF treatment responses were similar in patients with spinal fusion and no spinal involvement. (3) Except for being >45 years old and having a male gender, no other factor was found to predict the development of spinal fusion. (4) There was no difference in the degree of hip involvement between patients with complete spinal fusion and no spinal involvement.References[1]Siré E Van Der Heijde, D. et al. Modified stoke ankylosing spondylitis spinal score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis.[2]Ramiro, S. et al. Spinal radiographic progression in early axial Spondyloarthritis: Five-year results from the DESIR cohort. Arthritis Care Res. (Hoboken).71, 1678–1684 (2019).Disclosure of InterestsNone declared

BackgroundEvidence reveals sex differences in physiology, disease presentation and response to treatment in axial spondyloarthritis (axSpA). Pooled data from four randomized controlled trials demonstrated reduced treatment efficacy of a tumor necrosis factor inhibitor (TNFi) in females compared to males with ankylosing spondylitis1. However, real-life evidence confirming these data in large cohorts is scarce. We sought to validate prior studies using data from a large multinational cohort based on real-life clinical practice.ObjectivesTo investigate sex differences in treatment response and drug retention rates in clinical practice among patients with axSpA, treated with their first TNFi.MethodsData from biologic-naïve axSpA patients initiating a TNFi in the EuroSpA registries were pooled. In the primary analysis, propensity-score weighting was applied to assess the causal effect of sex on clinically important improvement (CII) according to ASDAS-CRP at 6 months. A generalized linear regression model was used to estimate the causal risk difference (RD) and relative risk (RR) of sex on CII. Possible covariates influencing the outcome were determined a priori and selected based on availability in the database (ResultsIn total, 6,451 axSpA patients with available data on ASDAS-CRP at baseline and 6 months were assessed for treatment response. Baseline characteristics are shown in the Table 1. In the adjusted analysis, the probability for females to have CII was 15% (RR, 0.85; 95% confidence interval [CI], 0.82 to 0.89) lower compared to males and the difference in probability for having CII was 9.4 percentage points (RD, 0.094; 95% CI, 0.069 to 0.12). The survival analysis included 28,608 axSpA patients with available data on retention rates. The TNFi 6/12/24-month retention rates were significantly lower in females (81%/69%/58%) compared to males (89%/81%/72%), see Figure 1.Table 1.FemaleMaleMean (SD), Median [IQR] or percentagesMean (SD), Median [IQR] or percentagesAge (years)42.0 (12.1)41.4 (12.3)Fulfilment of mNYC66%80%Disease duration (years)2.0 [1.0, 7.0]3.0 [1.0, 9.0]TNFi start year Start 1999-20097.2%9.8% Start 2010-201326%27% Start 2014-201637%36% Start 2017-202030%27%BASDAI, mm59 (20)54 (21)BASFI, mm48 (25)46 (24)ASDAS, units3.5 (0.9)3.5 (1.0)CRP (mg/L)6.7 [2.5, 16.0]11.9 [4.0, 25.0]SJC (0-28)0 [0, 0]0 [0, 0]TJC (0-28)0 [0, 2]0 [0, 1]VAS pain, mm63 (22)59 (24)VAS fatigue, mm65 (25)59 (26)mNYC, modified New York criteria; TNFi, tumor necrosis factor inhibitor; BASDAI, Bath Ankylosing Spondylitis Disease Activity Indexf; BASFI, Bath Ankylosing Spondylitis Functional Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; CRP, C-reactive protein; SJC, swollen joint count; TJC, tender joint count; VAS, visual analogue scale.ConclusionTreatment efficacy and retention rates are lower among female patients with axSpA initiating their first TNFi. Females presented with lower C-reactive protein levels and higher scores on patient reported outcomes at baseline, reflecting differences in disease expression. Recognizing these sex differences is of relevance for customized patient care and may improve patient education.References[1]van der Horst-Bruinsma et al. Ann Rheum Dis. 2013 Jul;72(7):1221-4.AcknowledgementsNovartis Pharma AG and IQVIA for supporting the EuroSpA collaboration.Disclosure of InterestsPasoon Hellamand Grant/research support from: Novartis, Marleen G.H. van de Sande Speakers bureau: UCB, Consultant of: Abbvie, Eli Lily, Novartis and UCB, Grant/research support from: Novartis, Janssen, UCB and Eli Lilly, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Thomas Klausch: None declared, Michael Nurmohamed Speakers bureau: Abbvie, Janssen and Celgene, Consultant of: Abbvie, Grant/research support from: Abbvie, Amgen, Pfizer, Galapagos, BMS, Ronald van Vollenhoven Consultant of: AbbVie, AstraZeneca, Biogen, BMS, Galapagos, Janssen, Miltenyi, Pfizer, UCB and speaker fees from Abbvie, Galapagos, GSK, Janssen, Pfizer, R-Pharma and UCB, Grant/research support from: BMS, GSK and UCB, Dan Nordström Consultant of: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Anna-Mari Hokkanen Grant/research support from: MSD, Maria Jose Santos Speakers bureau: Abbvie, AstraZeneca, Lilly, Novartis and Pfizer, Elsa Vieira-Sousa Speakers bureau: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Consultant of: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Grant/research support from: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Anne Gitte Loft Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: Novartis, Bente Glintborg Grant/research support from: Pfizer, Abbvie and BMS, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, BMS, Merck, Celgene and Novartis, Ulf Lindström: None declared, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly and Novartis, Brigitte Michelsen Grant/research support from: Novartis, Adrian Ciurea Speakers bureau: AbbVie and Novartis, Michael J. Nissen Speakers bureau: AbbVie, Eli Lilly, Janssens, Novartis and Pfizer, Consultant of: AbbVie, Eli Lilly, Janssens, Novartis and Pfizer, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis and Pfizer, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis and Pfizer, Corina Mogosan Speakers bureau: AbbVie, Ewopharma, Lilly, Novartis and Pfizer, Consultant of: AbbVie, Ewopharma, Lilly, Novartis and Pfizer, Gary Macfarlane Grant/research support from: GSK, Gareth T. Jones Grant/research support from: AbbVie, Pfizer, UCB, Amgen and GSK, Karin Laas Speakers bureau: Amgen, Janssen, Novartis and Abbvie, Ziga Rotar Speakers bureau: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek and Janssen, Consultant of: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek and Janssen, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi and Sandoz-Lek, Consultant of: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi and Sandoz-Lek, Isabel Castrejon Speakers bureau: Eli Lilly, BMS, Janssen, MSD and Abbvie, Consultant of: Eli Lilly, BMS, Janssen, MSD and Abbvie, Manuel Pombo-Suarez Consultant of: Abbvie, MSD and Roche, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Consultant of: Amgen and Novartis, Arni Jon Geirsson: None declared, Eirik kristianslund: None declared, Jiří Vencovský Speakers bureau: Abbvie, Argenx, Boehringer-Ingelheim, Eli-Lilly, Gilead, MSD, Novartis, Octapharma, Pfizer, Roche, Sanofi and UCB, Consultant of: Abbvie, Argenx, Boehringer-Ingelheim, Eli-Lilly, Gilead, MSD, Novartis, Octapharma, Pfizer, Roche, Sanofi and UCB, Lucie Nekvindova: None declared, Semih Gulle: None declared, Berrin Zengin: None declared, Merete Lund Hetland Grant/research support from: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz and Novartis, Irene van der Horst-Bruinsma Speakers bureau: BMS, AbbVie, Pfizer and MSD, Consultant of: Abbvie, UCB, MSD, Novartis and Lilly, Grant/research support from: MSD, Pfizer, AbbVie and UCB.

BackgroundSarcoidosis is a chronic granulomatous disease that primarily affects the lungs and lymph nodes, and can affect any organ and system (1). The incidence of concomitant iRMD is increased in patients with sarcoidosis. Anti-nuclear antibody (ANA) test are frequently used markers for inflammatory rheumatic diseases (iRMDs) (2). The relationship of this association with ANA is not clear.ObjectivesWe aimed to determine the frequency of ANA in sarcoidosis patients and its possible correlation with clinical and laboratory data, and also to reveal the severity of osteoporosis in patients with sarcoidosis.MethodsNinety sarcoidosis patients, who were followed up in rheumatology clinic were included in this study. ANA were determined with indirect immunofluorescent method and 1/160 titration was accepted as positive. Demographic, clinical, serological, and bone mineral densitometry (BMD) results of all patients were recorded. BMD results were obtained from the images taken before the last date or osteoporotic fracture of the patients.ResultsAverage age of the 90 patients (79 females) with sarcoidosis was 57.5 (IQR: 51–66) years, and median disease duration was 7.6 (IQR: 4-19) years. 28 (31.1%) patients had a diagnosis of extrapulmonary sarcoidosis (Most commonly skin, n=20, 71.4%). 21 patients had BMD values consistent with osteoporosis, while 9 patients had osteoporotic fractures. In 18 (20%) patients, rheumatologic autoimmune disease combined with sarcoidosis was found. SpA was diagnosed in 6 patients, RA in 2 patients, Lofgren Syndrome in 2 patients, SjS in 2 patients, systemic sclerosis in 1 patient, and morphea in 1 patient. Other rheumatological diseases were found as uBDH, polymyositis, Gout, Behçet’s Disease and FMF. ANA test was performed in a total of 83 patients. ANA positivity was found in 30 (36.1%) patients with sarcoidosis (1/100-1/320 in 12 patients; >1/320 in 18 patients). There was no significant relationship between ANA positivity and gender distribution, age, disease duration, development of extrapulmonary sarcoidosis, refractory disease status, and laboratory findings at the time of diagnosis. It was found that ANA positivity at diagnosis time for sarcoidosis increased the risk of developing iRMD 4.8 times in patients [HR: 4.8, CI 95% (1.455-15.833), p=0.009].ConclusionIn sarcoidosis, ANA positivity is of great importance in the determination of accompanying iRMDs. It was found that ANA positivity at the time of diagnosis in sarcoidosis patients increased the risk of developing rheumatological autoimmune disease 4.8 fold. Since these patients receive long-term moderate-high-dose steroid-based treatments, they should be closely monitored and screened for osteoporosis.References[1]Wessendorf TE, et al. Clin Rev Allergy Immunol. 2015 Aug 18;49(1):54–62.[2]Kobak S, et al. Autoimmune Dis. 2014;2014:1–4.Table 1.Distribution of clinical features of patients with sarcoidosis according to ANA resultsANA (-) (n=53)ANA (+) (n=30)n (%)n (%)p valueGenderFemale46 (86.8)27 (90)>0.05Male7 (13.2)3 (10)Rheumatic DiseaseNo48 (90.6)20 (66.7)0.009 (HR: 4.8, CI 95% (1.455-15.833)*Yes5 (9.4)10 (33.3)Refractory DiseaseNo35 (66)19 (63.3)Yes18 (34)11 (9.1)BMD-DEXANormal16 (43.2)12 (60)0.630Osteopenia14 (37.8)4 (20)Osteoporosis7 (18.9)4 (20)Osteoporotic FractureNo46 (86.8)28 (93.3)0.477Yes7 (13.2)2 (6.7)Median (IQR)Median (IQR)p valueAge (year)56.5 (51/64)58 (51/66)0.836Follow-up duration (year)6 (4/10)6 (2/9)0.718Age at diagnosis (year)45.5 (38/55)49 (36/55)0.861Calcium (mg/dL)9.585 (9.25/9.9)9.4 (9.17/9.76)0.13825 (OH)D (pg/ml)15.5 (10.1/24)8 (6/12)0.005Phosphorus (mg/dL)3.65 (3.245/3.98)3.75 (3.3/4.1)0.17ACE (mcg/L)60 (32/87)59.595 (34/88.225)0.876ESR (mm/h)23 (15/39)29 (22/48)0.171CRP (mg/dL)4.8 (2.3/17)5.4 (2.7/24)0.343*Multivariate regression analysisDisclosure of InterestsNone declared

BackgroundBioinformatics data, which are becoming more detailed day by day, show that male gender, advanced age, smoking, and comorbidities are associated with poor outcome of COVID-19. However, it is well known that the active disease state that may occur as a result of discontinuing the drugs also increases the susceptibility to infection.ObjectivesIt was aimed to investigate the effects of the COVID-19 pandemic on the course and treatment of rheumatic disease in patients with inflammatory rheumatic musculoskeletal disease (iRMD) using biological or targeted synthetic DMARDs (b/tsDMARDs).MethodsThe study was carried out in two stages: while investigating the delay of b/tsDMARD treatment in the first 3 months of the pandemic with the fear of infected by SARS-Cov-2 in the first stage, in the second stage, it was investigated whether all patients who decided to continue treatment after interruption in the 12-month period.ResultsA total of 521 patients were included in the study. It was seen that the iRMD diagnosis were listed as SpA (54.3%), RA (25.7%), PsA (8.4%), vasculitis (6.1%), and others (5.4%). The overall 12-month drug retention rate was 92.3%. Concurrent use of hydroxychloroquine (HCQ) (HR=1.49), iv bDMARD use (HR=1.34), and a history of discontinuation of drug in the first 3 months of the pandemic (HR=1.19) were determined as factors that reduced 12-month drug retention rates.During a total of 12 months, 34 (6.5%) of patients had COVID-19. COVID-19 was severe in 7 patients and 5 of these patients died.The use of GC (HR=3.81) and having a diagnosis of ILD/COPD (HR=4.96) were found to increase the risk of infected by SARS-CoV-2.Table 1.Comparison of demographic and clinical characteristics of patients with COVID-19DemographicsCOVID-19 (-) (n=487)COVID-19 (+) (n=34)PMedian (Min./Max.)Median (Min./Max.)Age48 (18-86)48 (18-82)0.615Disease Duration130 (22-478)144 (48-519)0.573b/ts DMARD Duration45 (12-192)26 (14-170)0.253GC dose, mg4 (1-16)4 (2-16)0.863n (%)n (%)Gender, F259190.909COVID-19 diagnosis and outcomeHospitalization─11 (32.3)─Mortality─5 (14.7)─Active disease (anytime during the pandemic)82 (16.4)9 (26.5)0.246ILD and/or COPD14 (2.9)4 (8.9)0.002n (%)n (%)b/tsDMARD type0.049TNFi382 (78.4)15 (44.1)0.243Tocilizumab19 (3.9)2 (5.9)0.684Abatacept13 (2.7)1 (2.9)0.886Rituximab9 (1.8)6 (17.6)0.001GC83 (17.0)17 (50.1)0.001ConclusionThe results of this study with a long follow-up period suggest that the retention rates of b/tsDMARD treatment increased with good communication with iRMD patients during the COVID-19 pandemic.References[1]Favalli EG, et al. (2020) Arthritis Rheumatol 72:1600–1606.[2]Landewé RB, et al. Ann Rheum Dis 79:851–858.Disclosure of InterestsNone declared

BackgroundConsidering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged.ObjectivesVaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed.MethodsAdult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfizer-BioNTech) vaccine were included in our observational, multicenter, prospective study.ResultsA total of 287 patients (58.2% male; mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65; 22.6%) and DM (n:38; 13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sulfasalazine, and 12 (4.2%) patients were using leflunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infliximab (26.8%), adalimumab (23.3%) was the second (Table 1).It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the first dose of vaccination is 11.5 days (5-19 IQR), between the first dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (pThe rate of patients who developed side effects after the first dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically significant compared to inactivated virus vaccine in terms of both doses (p=0.011, pConclusionDuring the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.References[1]Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 global rheumatology alliance vaccine survey. RMD Open. 2021;7(3):e001814.[2]Shenoy P, Ahmed S, Paul A, et al. Inactivated vaccines may not provide adequate protection in immunosuppressed patients with rheumatic diseases. Ann Rheum Dis. 2021. doi:10.1136/annrheumdi s-2021-221496Disclosure of InterestsNone declared

BackgroundThere is an increasing number of studies in the literature on the use of 18 F-FDG-PET/CT in the diagnosis and treatment follow-up of inflammatory rheumatic and musculoskeletal diseases (iRMD) (1). PET/CT do have an important place in the diagnosis of large-vessel vasculitis (LVV), which shows increased involvement in the walls of large vessels (2).ObjectivesIn this study, the aim was to evaluate the demographic, clinical, and laboratory characteristics, compatibility of PET/CT with other imaging methods, and the role of PET/CT in treatment follow-up of the patients who underwent PET/CT at the Rheumatology Clinic between 01.01.2010 and 31.12.2020.MethodsThe patients’ age, gender, comorbidities, iRMD types, medications, PET/CT, and ages at the time of iRMD diagnosis were collected. In addition, the compatibility of PET/CT with other imaging methods (MR angiography, Doppler US, and CT angiography) was evaluated in vasculitis subgroups. Control PET/CT images of the patients were evaluated by comparing them with previous imaging findings.ResultsA total of 280 patients, 179 (63.9%) women, with a mean age of 58±15 years, underwent PET/CT in the rheumatology department. 202 (72.1%) patients had a diagnosis of iRMD before PET/CT. After PET/CT, 40 (48.2%) patients were diagnosed with a new iRMD, and 43 (41.8%) were diagnosed with a non-iRMD. No rheumatic disease was detected in 33 (11.8%) patients.iRMD diagnosed by PET/CT are respectively; LVV (n=11), IgG4-RD (n=10), sarcoidosis (n=9), and other (n=10). It was determined that 22 (26.5%) of newly diagnosed patients other than iRMD had malignancy [Bronchial (n=8), lymphoma (n=3), breast (n=3), other (n=8) cancer].PET/CT revealed lymphadenopathy (LAP) in 119 of 165 patients who underwent the scan to exclude malignancy, and 22 of 91 patients who underwent PET/CT for rheumatologic diagnosis. LAP was found in 45% of those diagnosed with iRMD and 74.4% of those diagnosed with non-iRMD (p=0.002).PET/CT imaging was performed on 18 patients for follow-up. The treatment of 4 out of 18 patients with follow-up PET/CT and 76 out of 280 total patients was changed after imaging. In patients with a diagnosis of giant cell arteritis (GCA), the compatibility of PET/CT with MRA was 62.5%, while its agreement with CTA was 100%, and with Doppler US was 40%. In patients diagnosed with Takayasu’s arteritis, the compatibility of PET/CT with MRA was 40%, while its compatibility with CTA was 50% and with Doppler USG was 38%.ConclusionPET/CT imaging was found to be an important adjunctive examination in the diagnosis and follow-up of sarcoidosis, LVV, and IgG4-RD in patients evaluated in the rheumatology clinic. It has been observed that it is often used in the diagnosis and follow-up of RA, SpA, and autoinflammatory diseases, to investigate the malignancies accompanying rheumatic diseases and to evaluate the characteristics of LAP. PET/CT findings provide significant benefits to the clinician in the early diagnosis of iRMDs and differentiation of malignant and/or infectious etiologies.References[1]Jamar F, et al. EANM/SNMMI Guideline for 18 F-FDG Use in Inflammation and Infection. J Nucl Med. 2013 Apr;54(4):647–58.[2]Schönau V, et al. Ann Rheum Dis. 2018 Jan;77(1):70–7.Table 1.DemographicsAge (mean±SD.)58±15Female/Male179 (63.9)/101 (36.1)CRP (mg/L), median (Min.-Max.)16.9 (0.2-431)ESR (mm/h), median (Min.-Max.)43 (1-120)iRMD Subgroups, n (%)Connective Tissue Disease70 (28.4)Vasculitis63 (25.5)Rheumatoid Arthritis28 (11.3)İgG4-RD and Retroperitoneal Fibrosis22 (8.9)Spondyloarthropathies21 (8.5)Sarcoidosis16 (6.5)Polymyalgia Rheumatica8 (3.2)Others (Autoinflammatory Fever Syndromes, Crystal Arthropathies, CVID)19 (7.7)Reason for PET/CT scan, n (%)For Rheumatologic Diagnosis91 (32.5)Scan to Exclude Malignancy165 (58.9)Treatment Response Evaluation24 (8.6)PET/CT SUVmaxValuesiRMD SUVmax, median (Min.-Max.)4.6 (3.3-7.2)Malignancy SUVmax, median (Min.-Max.)8 (6.1-10.6)*iRMD: inflammatory rheumatic and musculoskeletal diseasesDisclosure of InterestsNone declared

Background:The frequency of comorbidities has increased in spondyloarthritis patients compared to the general population. The effect of comorbidities on tumour necrosis factor alpha inhibitor (TNFi) drug retention and treatment response has not been well evaluated.Objectives:The purpose of this study to assess the impact of comorbidities on the first TNFi drug survival and treatment response in patients with axial spondyloarthritis (axSpA) registered in theTURKBIOdatabase.Methods:In this study, the frequency of comorbidities, disease activity scores at baseline and month 6 and drug retention were recorded in AxSpA patients iniating first TNFi treatment between 2011 and 2019. Kaplan Meier plot and log rank tests were used for drug survival analysis. Cox regression analysis with HR was performed to evaluate the correlation between comorbidities and drug survival.Results:There were 2428 patients with AxSpA (39.3% female) who used their first TNFi during the study period. Among them, a total of 770 (31%) had at least one comorbid disease. Hypertension was the most common comorbidity (9.7%), followed by the affective disorders (8%) and chronic lung disease (5.8%). The baseline characteristics of patients are shown in Table 1.The presence of any comorbidity did not impact the first TNFi retention (Figure 1). When comorbidities were analysed seperately, we found that only history of cerebrovascular event was negatively associated with drug retention rate (HR: 6.9, p:0.008). There was no statistically significant difference in Bath AS Disease Activity Index 50% (BASDAI50) response between patients with and without comorbidity at 6 months. Less axSpA patients with comorbidity achieved a ASDAS score ≤ 2.1 compared to patients without comorbidity at 6 months.Table 1.Baseline Characteristics of PatientsRadiographic Spondyloarthritis, n (%)2318 (95.5)Female, n(%)954 (39.3)Age, year42.2±11.8Age at diagnosis, years32.5± 11.3Age at initial TNFi, years39.4 ± 11.1Symptom duration, years9.7± 7.5Time to initial TNFi, years7±6.8HLA-B27- positivity, n (%)1144 (47.1)Smokers, n (%)1068 (44)Baseline BASDAI35.5±22.2Baseline ASDAS-CRP2.8±1.1Baseline CRP (mg/L)15.7±24.4VAS global patient46.6±28.7-Quantitative variables are presented as mean ± SD, and qualitative variables are presented as frequency and percentage-ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score using C-reactive protein VAS, visual analogue scaleConclusion:The results of this study demonstrated that the presence of previous cerebrovascular event decreased the first TNFi survival in patients with axSpA. It also suggested that comorbidities might decrease TNFi treatment response.Disclosure of Interests:None declared

Background:Currently, biologic treatments are used effectively in patients with psoriatic arthritis (PsA).Objectives:The aim of this study was to evaluate and compare long-term drug survival of the first biologic treatments including adalimumab, certolizumab, etanercept, golimumab, infliximab, secukinumab and ustekinumab in patients with PsA.Methods:PsA patients, electronically registered at each visit in the TURKBIO database between 2011 and 2019 were included in the study. PASW 18.0 for Windows was used for statistical analysis. Drug survival rates were calculated by Kaplan Meier method.Results:355 patients (227 women; axial PsA = 48, peripheral PsA = 307) were included in the study (Table 1). Adalimumab was the most commonly used first biologic treatment (n=125; 37.6%). The rate of drug survival was found to be 0.75 at month 60 in patients receiving the first biologic treatment (Figure 1). There was no significant difference in drug survival rate between tumor necrosis factor alpha inhibitor (TNFi) and non-TNFi biologic drugs (p=0.56). No difference was also found in drug survival rates between each biologic treatment.Table 1.Initial demographic and clinical datas of patients with PsAPsA Patients (n=355)Females, n (%)227 (63,9)Age of diagnosis, years*34,6 (27-42)CRP baseline*6 mg/ L (3-15)ESR baseline*24 mm/h (10-38)Smoking, n (%)Current99 (28,5)Never192 (55,3)Previous56 (16,2)HLA B27 positivity,n (%)41 (26,4)First biologic agent, n (%)-TNFi332 (95,4)AdalimumabEtanercept125 (37,6)80 (24,1)Golimumab52 (15,6)Certolizumab44 (13,3)Infliximab31 (9,4)- Other biologic agents16 (4,6)Secukinumab13 (81,3)Ustekinumab3 (18,7)*median (min-max)Conclusion:The results of this study establish that more than half of patients with PsA can remain in their initial biologic treatment over a long term. It has been observed that the choice of biologic treatment did not effect the drug survival in PsA.Disclosure of Interests:None declared

Background The first symptoms of ankylosing spondylitis (AS) patients usually begin prior to 45 years, but can occur later in life. Objectives The purpose of this study is to evaluate the efficacy and safety of anti-TNFα treatment in late-onset AS (LoAS) patients in comparison to those with adult onset AS (AoAS). Methods We studied AS patients in TURKBIO registry between the dates of January 2011 and November 2018. All the patients fulfilled the modified New York criteria for AS 1 and were classified into 2 groups based on their age at symptom onset: AoAS (age>16 but ≤45 years); and LoAS (age>45 years). In both groups, the following data were compared: (1) epidemiological variables (2) clinical manifestations, including signs and symptoms at diagnosis; (3) laboratory results (4) disease activity markers and follow-up parameters (BASDAI, ASDAS-CRP and HAQ); (5) previous and current treatments (6) adverse events. Results A total of 2551 AS patients (91,1% with AoAS and 8.9% with LoAS) were included in the study. LoAS group had more female patients, older age, shorter disease duration and diagnostic delay, higher initial ESR and less HLA-B27 positivity compared to the AoAS (Table 1). Peripheral arthritis (not statistically significant) and dactylitis was seen more common in the LoAS. The frequency of other involvements was similar between the groups (Table1). The frequency of using drugs was similar between each groups although the use of glucocorticoids and sulphasalazine was more common in the LoAS. Switching from the first anti-TNFα treatment to the second one was more common in the AoAS. However, there was found no significant difference between the two groups in 2 or more switch ratios (Table 1). At the latest visit after the anti-TNFα therapy, the mean improvement in BASDAI was significantly higher in the AoAS (Table 2). A total of 10 (4.4%) serious adverse events were reported in LoAS and 39 (1.7%) in AoAS patients in the follow-up (HR: 2.62; 95% CI: 1.32–5.18). Severe infections were the most commonly seen serious adverse events (1.3% in LoAS and 0.8% in AoAS), followed by allergic reactions (0.9% in LoAS and 0.3% in AoAS). Tuberculosis was observed in 2 patients (0.9%) in LoAS and 9 (0.4%) in AoAS, malignancy in 3 patients (1.3%) in LoAS and 6 (0.3%) in AoAS. Conclusion Our data showed that almost 8.9% of the patients with AS had late-onset of symptoms. The results suggested that LoAS patients might have different demographic, clinical features, disease activity parameters at baseline. The frequency of anti-TNFα use and response rate to the treatment was also similar in LoAS to those in AoAS patients. The LoAS patients seem to have more common severe adverse events compared to the AOAS patients possibly related to their older age. References [1] Van der Linden S, Valkenburg HA. Evaluation of diagnostic criteria for AS. Arthritis Rheum1984; 27: 361–368. Disclosure of Interests Sadettin Uslu: None declared, Gercek Can: None declared, Ayse Cefle: None declared, Sema Yilmaz: None declared, Sinem Burcu Kocaer: None declared, Tuba Yuce Inel: None declared, Semih Gulle: None declared, Suleyman Serdar Koca: None declared, Servet Yolbas: None declared, Mehmet Akif Ozturk: None declared, Soner Senel: None declared, Nevsun Inanc: 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, Ozgul Soysal: None declared, abdurrahman tufan: 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, Merih Birlik: None declared, Ismail Sari: None declared, Nurullah Akkoc: None declared, Fatos Onen: None declared

Background:Systemic lupus erythematosus (SLE) is the prototype of systemic autoimmune diseases. It may affect any organ system and may present with a variety of clinical symptoms. Lymphadenopathy (LAP) is a nonspecific finding of SLE and often associated to the active disease state. LAP associated SLE pose a significant diagnostic challenge especially in the presence of constitutional symptoms.Objectives:In this retrospective cohort study, we evaluated the clinical and imaging characteristics of SLE patients who presented with LAP and constitutional symptoms.Methods:SLE Patients with lymphadenopathy who had constitutional symptoms were reviewed retrospectively. The characteristics of the patients such as age, sex, disease duration, clinical features, and laboratory tests including autoantibodies against ANA, dsDNA and ENA were recorded. Imaging findings such as positron emission tomography–computed tomography (PET/CT), thoracal or abdominal CT or diagnostic lymph node biopsy were identified.Results:There were 28 patients in this study. The mean age at the time of LAP was 38.9±15.2 years, 22 (78.6%) were female. All patients were fulfilling SLICC 2012 classification criteria for SLE. LAP was the presenting feature of SLE in 15 (53.6%) patients. The most common clinical features associated with LAP were arthritis (42.8%), fever (35.7%), acute lupus rash (32.1%) and serositis (28.5%). There were 11 (39.2%) who had significant proteinuria and 4 (14.3%) had class III or IV renal histology. Anti-phospholipid antibodies were present in nearly one-third of the patients and 12 of them had venous or arterial thrombosis or pregnancy co-morbidity. Cervical LAP was present in 57.1%, axillary LAP in 82.1% and inguinal in 36%. On CT, the prevalence of thoracal and abdominal LAP and hepatomegaly and splenomegaly were 61.5%, 37,5%, 40% and 16% respectively. The pericardial and pleural effusion and intra-abdominal free fluid were 19.2%, 30.8% and 10.2% respectively. There were 19 (67.8%) patients who underwent PET/CT imaging and all were reported as reactive LAP. In terms of SUV max 7 (36.8%) of them had a threshold ≥2.5. 17 (60.7%) patients required lymph node biopsy; 2 did not include lymphoid tissue, 4 (30.7%) with atypical lymphoid hyperplasia suggestive of viral infection and remaining were reactive lymphoid hyperplasia. Autoantibody testing showed that anti-dsDNA was positive in 66.7% and the most common anti-ENAs were anti-nucleosome (35.7%) and anti-Sm-RNP (35.7%) followed by anti-SSA (25%), anti-ribosomal P (17.9%) and anti-histone (14%). The clinical and laboratory features of the clinical and laboratory features of the group is summarized in Table 1.Table 1.Data at the time of LAPAge, years38.9±15.2Disease duration, months3 (2- 300)SLE-DAI, median (min-max)9 (2-30)Sex, female n(%)22 (78.6)Clinical featuresn (%)Acute cutaneous9 (32.1)Arthritis12 (42.8)Fever10 (35.7)Other constitutional symptoms18 (64.2)Serositis8 (28.5)Renal involvement11 (39.2)Neurologic involvement1 (3.6)Leucopenia7 (25.0)Trombositopenia5 (17.8)Hemolitic anemia7 (25.0)ANA (+)>1/32028 (100)Anti-dsDNA (+)18 (66.7)Anti-Sm(+)5 (17.9)Anti-phospholipid antibody (+)9 (32.1)Low complement16 (88.5)Conclusion:We showed that SLE patients who had constitutional findings and LAP could be the presenting feature and may confer a significant diagnostic challenge in which the patients might require invasive procedures and advanced imaging modalities. PET/CT revealed reactive changes in lymph nodes in all patients but lymph node biopsy revealed atypical changes in some patients suggestive of viral infections. On the other hand, LAP patients with constitutional symptoms represents a severe phonotype of the SLE as there were significant renal and thrombotic disease.Disclosure of Interests:None declared

Background:Systemic sclerosis (SSc) is chronic, autoimmun multisystem disorder presented by thickening and fibrosis of the skin and internal organs. Esophageal involvement is one of the most common manifestation. Esophageal enlargement on HRCT is a common finding in scleroderma patients and may also be associated with other scleroderma-related clinical findings (1).Objectives:The aim of this study to evaluate the association between esophageal dilatation on chest HRCT at diagnosis with the other SSc features.Methods:The study was planned for SSc patients registered between October 2007 and September 2020 in Dokuz Eylul University Rheumatology Department database. Demographics, clinical features and medical history were recorded. The baseline HRCT reports were screened in terms of esophageal dilatation. Then, the initial HRCT images were assessed for esophageal dilatation by an experienced chest radiologist according to recommendation of Pitrez et al.Results:In our study, there were 233 SSc patients (f:206 M:27, mean age 59.9±12.7 years) 71 (31.4%) of them diagnosed with diffuse disease. Median follow-up of study was 73 (1-272) months. Esophageal dilatation on HRCT was detected in 60 (25.8%) of SSc patients. 67 out of 155 patients (43.2%) had proof of esophageal involvement in esophageal transit scintigraphy. There is no statistical correlation was found between esophageal dilatation on HRCT with gender, smoking, arthritis, pulmonary hypertension and autoantibody subtypes. Development of digital ulcer and telangiectasia is statistically higher in SSc patients with oesophageal dilatation on baseline chest HRCT (p=0.001 and p=0.039, respectively). There was a positive correlation between Modified Rodnan Skin Score (mRss) and esophageal dilatation (r=0.213, p: 0.004).Conclusion:HRCT can be a reproducible and non-invasive method for evaluating esophageal dilatation. Presence of esophageal dilatation at baseline HRCT might be indicative for pulmonary involvement and SSc related gastrointestinal complications. Consecutive chest HCRT should be evaluated to obtain more reliable data about the relationship between esophageal dilatation and SSc related clinical features.References:[1]Pitrez EH, Bredemeier M, Xavier RM et al.Ooesophageal dysmotility in systemic sclerosis:comparison of HRCT and scintigraphy. Br J Radiol 2006; 79: 719–24.Table 1.Clinical and demographic characteristics of the presence of esophageal dilatation on HRCTEsophageal dilatation on HRCTTotal (n=233)Yes (n=60, 25.8%)No (n=173, 74.2%)pMean±SD.Mean±SD.Mean±SD.Age, years59.9±12.759.7±12.260.1 ±12.6>0.05n%n%n%Female20688,4%5388,3%14986,1%>0.05Smoking7933,9%1931,7%6034,7%>0.05Diffuse SSc7130,5%2338,3%4425,4%>0.05Overlap syndrome3314,2%813,3%2514,5%>0.05Pulmonary fibrosis11850,6%4270,0%7643,9%>0.05Arthritis8034,3%2338,3%5632,4%>0.05Telengiectasia15667,0%4880,0%10560,7%0,039Digital ulcer8737,3%3456,7%5129,5%0,001Anti-Scl 70 (+)8938,2%2846,7%5934,1%>0.05Anti-centromer (+)7532,2%1525,0%5934,1%>0.05Disclosure of Interests:None declared

Background:A significant increased risk of COVID-19 related adverse outcomes of the biological or target-directed synthetic DMARDs (b/tsDMARDs) has not yet been reported. For this reason, it is recommended to continue b/tsDMARD treatments with maximum compliance with pandemic measures.Objectives:The aim of this study was to evaluate the effects of patients using b/tsDMARDs on drug survival and rheumatic disease control during pandemic.Methods:In this study, patients diagnosed with rheumatic disease using b/tsDMARDs and who were followed up during the 12-month period (January 2020-2021) including the onset of the Covid-19 pandemic at Dokuz Eylul University Faculty of Medicine Rheumatology Clinic were evaluated. In the first 3 months of the pandemic (March-June 2020), the patients skipped at least 2 cycles of treatment with the fear of Covid-19 infection except for infection / surgical reasons was considered as a disruption of the drug. The drug retention rates of the patients on b/tsDMARDs treatments during the pandemic process and the factors affecting this situation were evaluated.Results:The rate of disrupting their b/tsDMARDs was higher in patients> 65 years of age, with a diagnosis of RA and who needed to come to the hospital for bDMARD treatment (p=0.007, p=0.015 and p=0.004, respectively).The overall 1-year b/tsDMARD retention rates was found 91%. It was determined that a history of interruption in b/tsDMARD treatments in the first 3 months of the pandemic [OR: 1.28 (CI: 1.042-8.71), p=0.014] and the need to come to the hospital to receive bDMARD [OR: 0.59 (CI: 0.64-13.11), p=0.041] caused unresponsiveness to return to the same bDMARD treatment and a significant increase in the risk of discontinuation of the biologic treatment.Conclusion:We conclude that it is important for patients to continue taking b/tsDMARD treatments without interruption in the days past abnormal periods such as pandemic conditions and to make sufficient effort for minimum dose of CS and low disease activity by determining patient-based risk.Table 1.Demographic and clinical characteristics of b/tsDMARDs patientsTotal (n=521)b/tsDMARD Continue (n=424) (82.4%)b/tsDMARD Interruption (+) (n=97) (17.6%)PMedian (Min./Max.)Median (Min./Max.)Median (Min./Max.)Age, years48 (18/86)47 (18/82)52 (21/81)0.008tDisease Duration, years11,2 (2/43.3)130 (22/490)142 (22/519)0.41tb/ts DMARD Duration, months40 (12/192)40 (12/192)40 (12/156)0.176tn (%)n (%)n (%)Female278 (53.4)225 (53.1)53 (54.6)0.826Most common rheumatic diseases AxSpa or other SpA283 (54.3)232 (54.7)51 (52.6)0.737 RA134 (25.7)100 (23.6)34 (35.1)0.015l PsA44 (8.4)40 (9.4)4 (4.1)0.109 Vasculitis32 (6.1)27 (6.4)5 (5.2)0.817 Others28 (5.4)25 (5.9)3 (3.1)0.338b/tsDMARD at Hospital/Health center140 (26.9)102 (24.1)38 (39.2)0.004l(OR: 0.59)b/tsDMARD administration route (IV)137 (26.3)100 (23.6)37 (38.1)0.005lActive/Progressive Disease92 (17.7)14 (3.3)78 (80.4)l(OR: 4.8)Start/continue with the same b/tsDMARD55 (10.6)3 (0.7)52 (53.6)pUnresponsiveness, b/tsDMARD switch16 (3.1)9 (2.1)7 (7.2)0.017pb/tsDMARD stopped permanently/deceased29 (5.6)9 (2.1)20 (20.6)ffb/tsDMARD retention (Total)474 (91)406 (95.8)68 (70.1)tIndependent Samples t Test (Bootstrap), pPearson Chi-Square Test (Monte Carlo), ffFisher freeman Halton Test (Monte Carlo), lLinear-by-Linear Association Test(Monte Carlo, Exact), SD.: Standard deviation; * OR, Odds Ratio,Disclosure of Interests:None declared

Background:Studies indicate that patients with rheumatoid arthritis (RA) are at increased risk of developing several comorbid disorders. Comorbidities affect treatment decisions, the effectiveness of the treatment, quality of life, RA prognosis, and survival rate [1].Objectives:The aim of thisstudyto investigate the impact of comorbidity on the first TNF inhibitor treatment persistence in RA.Methods:In the TURKBIO database, patients with an ICD 10-diagnosis of RA (M05 or M06) who started TNF inhibitor therapy between January 2011 and June 2019 were enrolled. Demographic and clinical characteristics, acute phase reactants, disease activity scores (DAS 28 CRP, HAQ, CDAI, VAS global), initial comorbidities and numbers, drug persistence, were evaluated. Kaplan-Meier plots and Cox proportional hazard regression analyses were performed.Results:A total of 1172 patients >18 years of age treated with TNF-α inhibitors were included in the study. The most prevalent comorbidities were: hypertension in 262 patients (32.6%), obesity in 254 (32.6%), osteoporosis in 178 (22.3%), chronic lung disease in 143 (17.9%) and depression in 126 (15.8%). The baseline characteristics are summarised in Table 1. The presence of comorbidity did not affect the survival rate of the first TNF inhibitor therapy in the RA patients (p: 0.65). Comorbidities had no effect on DAS28 CRP (> 1.2 reduction) responses at 6 and 12 months of treatment (p: 0.18, p: 0.83, respectively). As the mean disease duration increases, the persistence of the first TNF inhibitor decreases by 5%.Conclusion:This study demonstrated the increasing burden of comorbidities in RA. However, it suggested that the presence and number of comorbidities did not influence the rate of persistence in the first TNF inhibitor drug and the response to treatment.References:[1] Gabriel, S.E. and K. Michaud,Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases.Arthritis research & therapy, 2009.11(3): p. 229.Disclosure of Interests:None declared

Background:Axial spondyloarthritis (axSpA) is a chronic, inflammatory disease that primarily affects the axial skeleton. Secukinumab is a human monoclonal antibody that binds to the protein interleukin (IL)-17A. Although some studies showed that obesity had a negative effect on the efficacy of tumor necrosis factor alpha inhibitor (TNFα -i) treatment in AS patients (1), no data is available for secukinumab.Objectives:To evaluate the effect of obesity on the treatment response and drug survival of secukinumab in patients with axSpA.Methods:We performed an observational cohort study based on the TURKBIO between 2018-2020. A total of 185 patients were included in the study. The patients were divided into three groups as obese (BMI≥30 kg/m2), overweight (BMI:25-30 kg/m2), and normal (BMI2). Disease activity was evaluated at baseline and 3, 6 and 12 months of secukinumab therapy. Clinical response was evaluated as achievement of BASDAI50, ASAS20/40, and ASDAS-Clinical and improvement (CII and MI) rates.Results:185 axSpA patients were identified in the registry; 135 (72%) had available BMI data. Thirty nine (28.8%) patients were obese. The mean age of obese patients was higher (p=0.002). The frequency of HLA-B27 and male gender was lower in obese group (p=0.012 and p=0.013, respectively). There was no significant difference between groups in terms of clinical response parameters at 3, 6 and 12 months (Table 1). Drug retention rates were higher in biologic naive patients(p=0.007) (Figure 1).Table 1(BMI )(BMI 25-30)(n=63)(BMI ≥ 30)(n=39)PAll patients (n=185)Age (years)40.2±11.345.7±11.750.0±10.60.002 *45.2±11Male Gender n (%)25 (75.8)34 (54.0)16 (41.1)0.012 **104 (56.2)HLA-B27 (+) n (%)14 (73.6)37 (84.0)11 (44.0)0.013 **76 (64.3)Prior Naive/1/≥2 bDMARD n (%)12 (36.3)/9 (27.3)/12 (36.3)17 (26.9)/13 (20.6)/33 (52.4)10 (25.6)/14 (35.8)/27 (69.2)0.30256 (30.3)/ 49 (26,5)/ 80 (43,2)ASAS20 response¶13 (61.9)/11 (57.9)/4 (57.1)19 (48.7)/16 (59.3)/8 (42.1)11 (40.7)/7 (29.1)/3 (50.0)0.345/0.073/0.88659 (518)/47 (49.5)/20 (42.6)ASAS40 response¶9 (42.9)/7 (36.8)/3 (42.9)15 (39.5)/10 (37)/1 (5.3)6 (24)/5 (20,8)/3 (50.0)0.334/0.386/0.01240 (35.0)/29 (30.5)/11 (23.4)BASDAI50 response ¶10 (47.6)/9 (47.4)/4 (57.1)15 (39.5)/11 (40.5)/3 (15.8)9 (34.6)/5 (21.7)/3 (50.0)0.634/0.192/0.07748 (42.1)/37 (38.9)/16 (34.0)ASDAS-CII ¶3 (14.3)/5 (26.3)/1 (14.3)6 (17.6)/8 (30.8)/5 (27.8)6 (23.1)/5 (21.7)/2 (33.3)0.237/0.162/0.53123 (21.4)/22 (23.6)/11 (23.9)ASDAS-MI ¶5 (23.8)/3 (15.8)/0 (0)8 (23.5)/6 (23.1)/2 (11.11 (3.8)/1 (4.3)/1 (16.7)0.237/0.162/0.53118 (16.8)/18 (19.3)/8 (17.4)§; Mean±SD. ¶; at 3/6/12 Months, n (%),*One-way ANOVA test, ** Pearson Chi-Sqaure TestFigure 1Conclusion:This study demonstrated that obesity had no impact on the efficacy and retention of secukinumab treatment in patients diagnosed with axSpA. The drug survival was found to be higher among biologic-naive axSpA patients compared to biologic-experienced.References:[1]Ottaviani S.et al. ‘’Body mass index influences the response to infliximab in ankylosing spondylitis’’,Arthritis Res Ther 2012; 14: R11Disclosure of Interests:None declared

Background:Limited joint mobility (LJM) is a musculoskeletal disorder caused by flexion contractures of hand is a common complication in systemic sclerosis (SSc) patients. The distal parts of the upper limb (hands and fingers) is the most involved site in SSc.Objectives:In this study, we aimed to evaluate LJM in SSc patients and to determine the relationship between the clinical features of the disease.Methods:A total of 113 patients (>18 years old) diagnosed with diffuse cutaneous systemic sclerosis (DcSSc) and limited cutaneous systemic sclerosis (LcSSc) and 104 healthy controls were included in this study. LJM was evaluated with “prayer sign” and “table top sign” tests. LJM staging was done by Rosenbloom classification method(1, 2). LJM (+) and LJM (-) patients were compared in terms of demographic findings (gender, age and duration of disease), laboratory results (ESR, CRP, ANA, anti-topoisomerase I and anti-centromere) and modified Rodnan Skin Score (mRSS) results.Results:In our study, a total of 113 patients diagnosed with SSc and 104 healthy controls with similar age and gender distribution were included. While LJM (+) was detected in 75 (66.4%) (LcSSc = 38, DcSSc = 37) of the patients diagnosed with SSc, LJM (mild) (+) was detected in 3 (2.8%) of the control group. One of these people had right 2nd DIF joint contracture due to osteoarthritis, and 1 patient was found to have simple contractures due to minor hand injury previously (Table 1). A statistically significant difference was observed in between LcSSc and DcSSc patients according to the presence of LJM (pTable 1.Comparison of demographic findings between SSc and Control groupSSc Group (n=113)Control Group (n=104)p valueAge, year57.02 ± 11.5858.47 ± 11.260.061Gender (F / M)98 (86.7) / 15 (13.3)65 (62.5) / 39 (37.5)0.064CRP (mg/L)5.45 ± 5.392.14 ± 1.12ESR (mm/hr)25.19 ± 18.914.46 ± 10.090.024Smoking, n (%)Smoker89 (78.8)70 (67.3)0.464Non-Smoker24 (21.2)34 (32.7)LJM (Absent / Present)Present75 (66.4)3 (2.8)Absent38 (33.6)101 (97.2)Rosenbloom classificationLcSSc (n=71) (%)DcSSc (n=42) (%)Total (n=113) (%)Normal46.511.933.6Mild22.514.319.5Moderate23.933.327.4Severe7.140.519.5Table 2.Comparison of demographic and clinical findings LJM(-) and LJM(+) in SScLJM (-) (n=38)LJM (+) (n=75)p valueAge, year54.16 ± 11.8258.47 ± 11.260.061SSc Typen (%)n (%)LcSSc, n (%)DcSSc, n (%)33 (56.8)38 (50.7)5 (13.2)37 (49.3)Gender,F/M (%)37 (97.3) / 1 (2.7)61 (81.3) / 14 (18.7)0.018Raynaud’s (symptom duration), month148 (44-456)150 (35-588)0.990Non-raynaud (symptom duration), month108 (28-458)138 (38-447)0.132mRSS, median2 (0-14)8 (0-36)CRP (mg/L)4.21 ± 4.486.08 ± 5.710.069ESR (mm/hr)19.74 ± 1027.95 ± 21.60.270Renal crisis, n (%)1 (2.6)4 (5.3)0.662PAH, n (%)8 (21.1)14 (18.7)0.762ANA positivity, n (%)36 (94.7)70 (93.3)1Anti-centromere positivity, n (%)18 (47.4)19 (25.3)0.01Anti-topoisomerase-1, n (%)8 (21)34(45.3)0.01Smoking, n (%)n (%)n (%)Non-smoker30(78.9)59 (78.7)0.970Smoker8 (21.1)16 (21.3)Figure 1.Conclusion:In our study, it was found that LJM staging positively correlated with mRSS and DcSSc patients had more severe LJM findings than LcSSc. We conclude that “prayer sign” and “table top sign” tests used in hand evaluation in SSc patients have similar clinical results with mRSS and can be easily performed in daily practice in about 3 minutes.References:[1]Rosenbloom AL. Limitation of finger joint mobility in diabetes mellitus. The Journal of diabetic complications 1989; 3: 77-87.[2]Nashel J, Steen V. Scleroderma mimics. Current rheumatology reports 2012; 14: 39-46.Disclosure of Interests:None declared

Background:Treatment options for axial spondyloarthritis (axSpA) is currently limited, and up to 40% of the patients require biologic therapies to control symptoms. Early commencement of biologics suggested to have higher response rates but data regarding this subject is limited.Objectives:The primary aim was to investigate tumor necrosis factor inhibitor (TNFi) response and retention rates in axSpA patients who were treated in the early disease period (symptom duration (≤5 years). Our secondary aim was to identify factors predicting response to TNFi.Methods:Adult axial SpA patients who started TNFi treatments within the five years of their symptoms were identified and defined as “Group 1”. Patients whose TNFi treatments started five years after their initial symptoms served as a control group (Group 2: 5-10 years and Group3: ≥10 years). Response and survival rates at 6, 12, and 24 months were calculated. Predictors of response on TNFi survival at 24 months were also analyzed.Results:There was a total of 364 axiSpA (Group 1: 95, Group 2: 82 and Group 3: 187) patients in the study (69.8% male, 46.8±12.6 years). Group 1 patients tended to be younger, with a lower baseline CRP titers and lower HLA–B27 rate compared to the other groups. Drug survival rates were similar between the groups. This finding also remained similar when AS and nraxSpA patients analyzed separately. However, regardless of symptom duration, the drug retention rates were significantly higher in the AS group than in nraxSpA (Table 2). ASAS40 responses were higher in Group 1 than in Group 3 both at 12 and 24 months. Predictors of response based on ASAS40 at 24 months were treatment within the five years of the symptoms (OR:2.2) and age at baseline (OR:0.97) in univariate analysis. However, baseline ASDAS (OR:1.4) was the only factor in multiple regression.Conclusion:In this study we showed the following: 1) TNFi started in the early disease course resulted in a better ASAS40 response at both 12 and 24 months, 2) TNFi timing (started in the early or late disease period) seems not affecting drug retention rates, and 3) baseline disease activity is the most important predictor in achieving ASAS40 response at 24 months.Disclosure of Interests:None declared

Objective To analyze the dermatologic lesions and possible effects of immunosuppression treatment and p53 gene mutations on dermatologic findings in renal transplant recipients. Materials and Methods The study included 163 renal transplant recipients. After dermatologic examination, cultures, and histopathologic and genetic analyses were performed. A single-strand conformation polymorphism technique was used to analyze p53 gene mutations. Patients were categorized into 3 groups according to time since the transplantation procedure. Results were analyzed using the χ 2 test, using a software program (SPSS version 13.0; SPSS, Inc, Chicago, Illinois). Results Mean (SD) age of the 163 transplant recipients (65 women and 98 men) was 40 (11) years, and posttransplantation follow-up was 65 (55) months. The most frequently observed drug-related lesion was hypertrichosis, in 46 of 150 patients. Of 115 lesions, the most commonly observed were verruca vulgaris (n = 34) from viruses, and pityriasis versicolor (n = 21) from superficial fungal infections. Of the total group, 20 patients (12.2%) were mutation carriers. Compared with the entire cohort, the group with premalignant lesions demonstrated more p53 mutations (11% vs 50%; P = .004). Patients given cyclosporine therapy exhibited more premalignant or malignant cutaneous lesions compared with patients who received other agents ( P = .03). Conclusion Patients carrying p53 mutations developed a malignant lesion in the late posttransplantation period, which suggests the importance of prediction of risk.

Aim. The aim of this study was to evaluate the long-term medical risks of living-related donors in our center. Patients and Methods. 185 living-related donors participated in the study. The factors assessed were creatinine clearance rate (CrCl), serum creatinine (SCr), BUN, hematocrit levels, proteinuria, microalbuminuria and hypertension rates, and renal parenchyma thickness and kidney dimensions predonation as well as at the last follow-up. In addition, we examined postoperative complications. A lombotomy incision was the choice for donor nephrectomy procedure routinely. Results. The mean length of hospital stay after donor nephrectomy was 3.2 ± 0.6 days (range, 2-5 days). Seven donors readmitted during the first month after operation with surgical site infection were treated successfully. Four donors were reoperated for incisional hernia repairs and discharged without complication. The mean follow-up period was 61.6 ± 50.4 months (range, 2-180 months). Mean ages of the donors at operation and at the last follow-up were 50.9 ± 12.7 years (range, 20-81 years) and 56.5 ± 11.9 years (range, 29-77 years), respectively. The male-to-female ratio was 0.69. Mean SCr levels and CrCl rates predonation and at the last follow-up were 0.83 ± 0.22 mg/dL versus 1.1 ± 0.2 mg/dL (P

Objective. The aim of this study was to investigate the quality of life of renal donors during long-term follow-up. Patients and Methods. The short form health survey (SF-36) questionnaire was compared between renal donors and the general population. We evaluated the relationship to postoperative complications and preoperative information with the quality of life. Results. Fifty renal donors of mean age 55.8 ± 12 years (range, 29-70 years) had a mean follow-up of 55.1 ± 47.2 months (range, 12-168 months). Complications after donor nephrectomy were related with physical function loss (r = - .397; P

This study focuses on an educational prototype set in the processes laboratory of Mechatronic Engineering Department of Kocaeli University besides giving brief information about the definition and structure of SCADA system. By means of this prototype, the students can create their own designs and try them on a real system.