Search

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.

Objectives: To find out the effects and prevalence of disease-modifying antirheumatic drugs (DMARDs) and anti-TNF agents on hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients with rheumatic diseases (RD). Methods: This retrospective study was conducted on 1,548 RD patients. Patients’ medical records regarding immunological profiles, clinical courses, and outcomes, were obtained. In this research, the patient used conventional DMARDs (cDMARDs) and biological DMARDs (bDMARDs). A drug exposure was considered when a patient was administered GC, cDMARDs, or bDMARDs for > 4 weeks. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were measured. HBsAg, HBV DNA assay, anti-HCV and HIV were identified. Results: HBsAg was positive in 19 (37.3%) patients. Anti-HBs in 5 (9.8%) patients and anti-HBc IgG in 35 (68.6%) patients were positive. All patients with HBsAg positivity were receiving antiviral prophylaxis. Anti-HCV was positive in 25.5% (n = 13) of individuals . There was not any reactivation among the patients. No HBV reactivation was observed. Conclusions: Screening before treatment and give prophylaxis to patients who have occult hepatitis or hepatitis B, may be an important factor in the absence of reactivation. Hepatitis screening should be performed in all patients prior to biological treatment is initiated.

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.

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.

Juvenile idiopathic arthritis is a rheumatological disease that starts before 16 years and involves joints. Many complications such as bone erosions and joint destruction can be seen in the course of the disease. Herein, we presented a case of juvenile idiopathic arthritis complicated by atlantoaxial subluxation followed for 14 years.

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.

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

WOS: 000463722100007, PubMed ID: 30489254, Objective: Familial Mediterranean fever (FMF) is the most common autoinflammatory disease. Most of the identified disease-causing mutations are located on exon 10. As the number of studies about the effect of the exonal location of the mutation and its phenotypic expression is limited, we aimed to investigate whether the exonic location of the Mediterranean fever (MEFV) mutation has an effect on the clinical manifestation in patients with FMF. Methods: Study population was derived from the main FMF registry that included 2246 patients from 15 different rheumatology clinics. We categorized the mutations according to their exon locations and retrieved the clinical and demographic information from the database. Results: Patients having the MEFV mutations on exon 2 or 10 (n: 1526) were divided into three subgroups according to the location of the MEFV mutations: Group 1 (exon 2 mutations), Group 2 (exon 10 mutations), and Group 3 (both exon 2 and exon 10 mutations). Group 2 patients were of a significantly younger age at onset, and erysipel-like erythema, arthritis, amyloidosis, and a family history of FMF were more common in this group. Conclusion: Patients with FMF and exon 10 mutations show more severe clinical symptoms and outcome. Exon 2 mutations tend to have a better outcome.

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.

Contains fulltext : 251829.pdf (Publisher’s version ) (Open Access) OBJECTIVE: There is a lack of real-life studies on interleukin-17 (IL-17) inhibition in psoriatic arthritis (PsA). We assessed real-life 6- and 12-month effectiveness (i.e., retention, remission, low disease activity [LDA], and response rates) of the IL-17 inhibitor secukinumab in PsA patients overall and across 1) number of prior biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), 2) years since diagnosis, and 3) European registries. METHODS: Thirteen quality registries in rheumatology participating in the European Spondyloarthritis Research Collaboration Network provided longitudinal, observational data collected as part of routine care for secondary use. Data were pooled and analyzed with Kaplan-Meier plots, log rank tests, Cox regression, and multiple linear and logistic regression analyses. RESULTS: A total of 2,017 PsA patients started treatment with secukinumab between 2015 and 2018. Overall secukinumab retention rates were 86% and 76% after 6 and 12 months, respectively. Crude (LUNDEX adjusted) 6-month remission/LDA (LDA including remission) rates for the 28-joint Disease Activity Index for Psoriatic Arthritis, the Disease Activity Score in 28 joints using the C-reactive protein level, and the Simplified Disease Activity Index (SDAI) were 13%/46% (11%/39%), 36%/55% (30%/46%), and 13%/56% (11%/47%), and 12-month rates were 11%/46% (7%/31%), 39%/56% (26%/38%), and 16%/62% (10%/41%), respectively. Clinical Disease Activity Index remission/LDA rates were similar to the SDAI rates. Six-month American College of Rheumatology 20%/50%/70% improvement criteria responses were 34%/19%/11% (29%/16%/9%); 12-month rates were 37%/21%/11% (24%/14%/7%). Secukinumab effectiveness was significantly better for b/tsDMARD-naive patients, similar across time since diagnosis (4 years), and varied significantly across the European registries. CONCLUSION: In this large real-world study on secukinumab treatment in PsA, 6- and 12-month effectiveness was comparable to that in previous observational studies of tumor necrosis factor inhibitors. Retention, remission, LDA, and response rates were significantly better for b/tsDMARD-naive patients, were independent of time since diagnosis, and varied significantly across the European countries.

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.

Background:Tocilizumab (TCZ) is a human anti-interleukin (IL)-6 receptor antibody approved in Turkey for the treatment of rheumatoid arthritis (RA).Objectives:In this study our purpose was to describe the disease activity, quality of life (QoL), and retention rate in RA patients who were prescribed TCZ as first-line biologic treatment in a real-world setting.Methods:Anonymized patient registry of TURKBIO was used based in a national, multicenter, and retrospective context. We conducted a search in the registry between years 2013 and 2020 and included adult RA patients who were prescribed with TCZ as their first-line biologic treatment with a post-TCZ follow-up of at least 6 months. CDAI, DAS28-(ESR), and HAQ-DI scores in 6, 12, and 24 months were obtained. Pairwise comparison was carried out for survey scores across baseline and timepoints. Subgroup analysis for route of TCZ administration was performed. EULAR response criteria were used for response evaluation. Retention of TCZ was evaluated by Kaplan-Meier analysis.Results:Overall,130 patients with a mean RA duration of14 years were included in the study. 87.7% of the patients were female and mean age was53 (SD; 15.0). Median duration of follow-up was 18.5 months. Majority (90.8%) of patients were given tocilizumab via intravenous route at baseline. Number of patients with ongoing TCZ treatment and follow-up at 6, 12, and 24 months were 121 (93%), 85 (65%), and 46 (35%), respectively. Remission rates at 6, 12, and 24 months per CDAI (Conclusion:TCZ as a first-line biologic treatment was found to be clinically effective in this real-world study with a high retention rate. These results are in line with the results gathered from previous TCZ controlled and real-life studies in which TCZ was found clinically safe and effective.References:[1]Haraoui B, Casado G, Czirjak L, Taylor A, Dong L, Button P, Luder Y, Caporali R. Tocilizumab Patterns of Use, Effectiveness, and Safety in Patients with Rheumatoid Arthritis: Final Results from a Set of Multi-National Non-Interventional Studies. Rheumatol Ther. 2019 Jun;6(2):231-243.[2]Favalli EG, Raimondo MG, Becciolini A, Crotti C, Biggioggero M, Caporali R. The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives. Autoimmun Rev. 2017 Dec;16(12):1185-1195.[3]Haraoui B, Jamal S, Ahluwalia V, Fung D, Manchanda T, Khraishi M. Real-World Tocilizumab Use in Patients with Rheumatoid Arthritis in Canada: 12-Month Results from an Observational, Noninterventional Study. Rheumatol Ther. 2018 Dec; 5(2): 551–565.Disclosure of Interests:Ayten Yazici Speakers bureau: PFIZER, AbbVie, NOVARTIS, Özlem Özdemir Işik: None declared, Ediz Dalkiliç Speakers bureau: AbbVie, UCB Pharma, PFIZER, Roche, MSD, NOVARTIS, Süleyman Serdar Koca Speakers bureau: MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB Pharma, AMGEN, SANOFİ, Yavuz Pehlivan Speakers bureau: PFIZER, NOVARTIS, MSD, CELLTRION, Consultant of: PFIZER, Soner Şenel: None declared, Nevsun Inanc Speakers bureau: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Paid instructor for: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Consultant of: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Grant/research support from: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Servet Akar Speakers bureau: LILLY, MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, JANNSEN, UCB Pharma, AMGEN, Paid instructor for: LILLY, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB, AMGEN, Grant/research support from: PFIZER, Sema Yilmaz: None declared, Özgül Soysal Gündüz: None declared, Ayse Cefle Speakers bureau: UCB Pharma, PFIZER, MSD, AbbVie, AMGEN, NOVARTIS, Fatos Onen Speakers bureau: AbbVie, LILLY, MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, JANNSEN, UCB Pharma, AMGEN, İbrahim Etem-MENARINI, Paid instructor for: AbbVie, LILLY, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB Pharma, AMGEN, İbrahim Etem-MENARINI, Grant/research support from: PFIZER

Çalışma, Behçet hastalarının uyku kalitesi, depresyon düzeyleri ve etkileyen faktörleri belirlemek amacıyla tanımlayıcı olarak yapıldı. Çalışmaya katılmayı kabul eden 44 Behçet hastası çalışmaya dahil edildi. Çalışmanın verileri, araştırmacılar tarafından hazırlanan “Hasta Bilgi Formu”, “Pitsburg Uyku Kalitesi İndeksi (PUKİ)”, “Beck Depresyon Ölçeği (BDÖ)”, Behçet Hastalığı Yaşam Kalitesi Ölçeği (BHYKÖ)” ve “Behçet Hastalığı Güncel Aktivite Formu” ile toplandı. Verilerin değerlendirilmesinde, Mann Whitney U ve Spearman korelasyon analizleri yapıldı. Hastaların yaş ortalamasının 37,38±8,33 yıl, %90,9'unun erkek ve hastalık süresi ortalamasının 7,54±4,72 yıl olduğu belirlendi. Genital ülseri olan hastaların PUKİ puanının anlamlı olarak yüksek olduğu saptandı (p0,05). Hastalık aktivite skoru ile PUKİ, BDÖ, BHYKÖ puanları arasında anlamlı ilişki olduğu belirlendi (p, The study was carried out descriptively to determine the quality of sleep, depression levels and factors affecting Behçet patients. 44 Behçet patients who agreed to participate in the study were included in the study. The data of the study were collected with the “Patient Information Form” prepared by the researchers, “Pitsburg Sleep Quality Index”, “Beck Depression Scale Behçet's Disease Quality of Life Scale” and “Behçet's Disease Current Activity Form”. In the evaluation of the data, Mann Whitney U and Spearman correlation analyzes were performed. It was determined that the mean age of the patients was 37.38 ± 8.33 years, 90.9% of them were male and the mean duration of the disease was 7.54 ± 4.72 years. It was found that patients with genital ulcers had a significantly higher PSQI score (p 0.05). It was determined that there was a significant relationship between the disease activity score and PSQI, BDI, SCQQ scores (p

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

Çalışma, romatolojik hastalıklarda sosyal destek ve bakım veren yükü düzeylerinin belirlenmesi amacıyla tanımlayıcı olarak yapıldı. Çalış-maya 271 hasta ve yakını dahil edildi. Çalışmanın verileri, araştırmacılar tarafından hazırlanan “Hasta Tanıtım Formu”, “Hasta Yakını Tanıtım Formu” ile “Sağlığı Değerlendirme Anketi (HAQ)”, “Çok Boyutlu Algılanan Sosyal Destek Ölçeği” ve “Bakım Veren Yükü Ölçe-ği” ile toplandı. Verilerin değerlendirilmesinde, Mann Whitney U, Kruskal Wallis ve Spearman korelasyon analizleri yapıldı. Hasta yakınla-rının %82.3’ü kadın, hastaya yakınlığının ise çoğunluğunda eş/çocuk olduğu belirlendi. Hastalık tanısı açısından bakım yükünde anlamlı fark bulunamadı (p>0.05). Hastaların aktif hastalığı, eklem deformitesi, sistemik tutulumu, artmış semptom şiddetinin, bakım verenlerin ise; kötü ekonomik durumu, hasta ile birlikte yaşaması, bakım verme süresinin fazlalığı ve sosyal destek düzeyinin düşüklüğü bakım yükünü artıran faktörler olarak belirlendi. Fiziksel kısıtlılığın eşlik ettiği kronik hastalıklarda, hastanın olduğu kadar hastaya bakım verenin de olumsuz etkileneceği unutulmamalıdır.

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

Introduction: Spondylarthritis (SpA) comprises multiple divergent forms of inflammatory arthritis. ENA ranks in SpA group. It is aimed to present the features of 33 ENA cases which have been being monitored in our clinic, in this study. Method: Demographical and clinical features, presentation forms, of the 33 ENA cases who sought medical service in our polyclinic and diagnosed with ENA and treated with biological agents, have been recorded. It has been interrogated before biological agents treatment whether conventional DMARD’s (Disease-modifying antirheumatic drugs) were used. Results: Sixteen of the patients ( 48.4%) have been females, whereas 17 of them ( 51.6%) have been males. Eleven of the patients ( 33.3%) have been diagnosed with Crohn’s disease, whereas 22 of them (66.7%) with ulcerative colitis. Eighteen patients ( 54.5%) have presented with joint complaints and 13 of them ( 39.4%) with bowel complaints. The inquiry of the pre-treatments before the biological agents presented that 23 of them ( 69.7%) used nonsteroid anti-inflammatory drug (NSAID’s). Seventeen of the patients ( 51.5%) have used NSAID’s after IBD diagnosis whereas 4 patients ( 12.1%) had IBD inflammation symptoms as bleeding and diearrhea due to NSAID’s use after IBD diagnosis. Conclusion: Since there is a close link between SpA and ENA, patients should also be monitored in the aspect of bowel symptoms during the SpA course. It is needed to take into account the activation of intestinal symptoms as well, while deciding on the treatment of the patients with enteropathic arthritis.

Background:Choosing the best treatment strategy for a patient is one of the most difficult issues in modern rheumatology, as there are various factors affecting drug therapy in chronic diseases, such as efficacy, safety, and compliance. Physicians take care of long-term retention rate and responses for discontinuation of candidate drug.Objectives:The purpose of this study to assess the drug survival of certolizumab pegol (CZP) in patients with axial spondyloarthritis (ax-SpA) and to identify the predictors and reasons for discontinuation.Methods:Data on patient characteristics, demographics, diagnosis, duration of disease, treatment and outcomes have been collected since 2011 in Turkish Biologic (TURKBIO) Registry. By the end of December 2020, 410 ax-SpA patients received CZP and were included. Kaplan Meier plot was used for drug survival analysis. Cox regression analysis was performed to evaluate the predictor associated with drug survival.Results:During the median 54 months follow-up, 92 (22.4%) patients discontinued the CZP treatment. The reasons for discontinuation: ineffectivity was 58.7% (n=54), adverse events was 6.5%, pregnancy was 3.3% and surgery was 4.3%. The baseline characteristics of patients continue with CZP and discontinuation due to ineffectiveness were shown in the Table 1. Patients who discontinued CZP had higher HAQ, BASFI and BASDAI values. Moreover, they were more co-treated with NSAIDs and csDMARDs. At the month 36, retention rate of CZP was 71.5% in patients with ax-SpA (Figure 1).Conclusion:Real life experience from this nationwide TURKBIO registry show higher long-term retention rate of CZP in ax-SpA. Higher baseline disease activity and functional limitation predict discontinuation of CZP. Adding NSAIDs and csDMARDs to the treatment of the patient with poor prognosis cannot increase retention rates.Figure 1Drug survival of CZP in patients with Ax-SpATable 1.Baseline characteristics of ax-SpA patients who continue and discontinue CZPAll patients (n=410)Continue to CZP (n=318)Discontinue to CZP* (n=54)pFemales, n (%)185 (49,7)157 (49,4)28 (51,9)0,736Age, years42 (34-49)41 (34-49)45 (34-54)0,064Symptom duration, years11 (7-17)11 (6-16)12 (8,5-20)0,054HLA-B27, n (%)150 (63,8)129 (64,5)21 (60)0,609Previous bDMARDs, n (%)Adalimumab54 (14,5)42 (13,2)12 (22,2)0,082Etanercept53 (14,2)40 (12,6)13 (24,1)0,025Golimumab11 (3)7 (2,2)4 (7,4)0,060Infliximab39 (10,5)35 (11)4 (7,4)0,425Co-treated drugs, n (%)NSAID206 (55,4)169 (53,1)37 (68,5)0,036Methotrexate35 (9,4)22 (6,9)13 (24,1)Sulphasalazine61 (16,4)40 (12,6)21 (38,9)Leflunomide5 (1,3)2 (0,6)3 (5,6)0,023ESH, mm/h21,5 (10-37)21 (10-37)23 (10-34)0,999CRP, mg/dl7 (3-20)7 (3-20)7 (3-22)0,727HAQ0,63 (0,25-0,94)0,5 (0,25-0,88)0,75 (0,38-1,25)0,009BASFI21 (7-45)20,5 (6-41)31 (13-58)0,011BASDAI30,5 (13-52)30 (12-50)43 (23-61,5)0,002ASDAS2,7 (1,8-3,7)2,7 (1,8-3,6)2,9 (2,3-4)0,062*Discontinue due to ineffectivity.References:[1]Iannone F, et al. Effectiveness of Certolizumab-Pegol in Rheumatoid Arthritis, Spondyloarthritis, and Psoriatic Arthritis Based on the BIOPURE Registry: Can Early Response Predict Late Outcomes? Clin Drug Investig. 2019;39(6):565-575.Disclosure of Interests:None declared.

Background:Several factors such as effectiveness, safety and compliance affect the drug survival in chronic disorders. Physicians take care of long-term retention rate and responses for discontinuation of candidate drug. Identification of predictors of clinical response to certolizumab-pegol (CZP) may aid the decision-making process for treating patients psoriatic arthritis (PsA).Objectives:The purpose of this study to assess the drug survival of certolizumab pegol (CZP) in patients with PsA and to identify the predictors and reasons for discontinuation.Methods:Data on patient characteristics, demographics, diagnosis, disease duration, treatment and outcomes have been collected since 2011 in Turkish Biologic (TURKBIO) Registry. By the end of December 2020, 68 PsA patients received CZP and were included. Kaplan Meier plot was used for drug survival analysis. Cox regression analysis was performed to evaluate the predictors associated with drug survival.Results:During the median 47 months follow-up, 17 patients discontinued the CZP treatment. The reasons for discontinuation were ineffectivity (35.3%), adverse event (17.6%) and pregnancy (5.9%). The baseline characteristics of the patients who continued and discontinued CZP were shown in the Table 1. Patients who discontinued CZP had higher mean age and disease duration. HLA-B27 positive patients had lower retention rate while bDMARD naive patients had higher retention rate. At the month 36, retention rate of CZP was 61.6% on patients with PsA (Figure 1).Conclusion:Real life experience from this nationwide TURKBIO registry show that the retention rate of CZP in PsA are lower in older patients and with longer disease duration. Moreover, bDMARD naive patients have higher retention rate.Figure 1.Drug survival of CZP in patients with PsATable 1.Baseline characteristics of PsA patients who continue and discontinue CZPAll Patients (n=68)Continue to CZP (n=51)Discontinue to CZP (n=17)pFemales, n (%)52 (76,5)37 (72,5)15 (88,2)0,322Age, years44 (36-57)40 (35-53)51 (42-60)0,012Disease Duration, years9 (5-13)8 (5-12)14 (10,5-17)0,002Symptom duration, years11 (7-16)10 (7-15)15,5 (11,5-20)0,014Order of CZP in bDMARDs1 (1-2)1 (1-2)2 (1-2)0,062HLA-B27, n (%)9 (28,1)3 (14,3)6 (54,5)0,035ESR, mm/h23,5 (11-37)23 (9-35)24 (17-52)0,246Swollen Joint Counts, n0 (0-2)0 (0-2)1 (0-2)0,480Tender Joint Counts, n2 (0-4)1 (0-4)2 (1-5)0,143CRP, mg/dl4 (3-13,65)3,14 (3-13)5 (3-19)0,107HAQ0,63 (0,25-1)0,63 (0,25-1)0,75 (0,63-0,94)0,097VAS-Physicians20 (12-31,5)20 (12-26)30 (15-50)0,074VAS-Patient Global50 (27-70)50 (20-70)61,5 (46,5-70)0,342VAS-Patient Pain53 (28-75)50 (20-75)69 (49,5-75)0,122DAS-28-CRP3,35 (2,2-3,9)2,85 (2-3,8)3,6 (2,9-4,4)0,086BASFI15 (8-27)14 (5-26)23,5 (12-30,5)0,133BASDAI28 (16-40)27,5 (14-36)39 (22,5-41,5)0,060ASDAS2,7 (1,9-3,2)2,6 (1,9-3,1)3 (2,35-3,4)0,122DAPSA-2815,35 (7,2-21,9)14,9 (6,1-21,17)18,9 (14,15-29,3)0,108Disclosure of Interests:None declared.

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

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

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

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

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.

Çalışmada 30 yazar bulunmaktadır. Bu yazarlardan sadece Bursa Uludağ Üniversitesi mensuplarının girişleri yapılmıştır. Ankylosing spondylitis (AS) is a highly heritable immune-mediated arthritis common in Turkish and Iranian populations. Familial Mediterranean Fever (FMF) is an autosomal recessive autoinflammatory disease most common in people of Mediterranean origin. MEFV, an FMF-associated gene, is also a candidate gene for AS. We aimed to identify AS susceptibility loci and also examine the association between MEFV and AS in Turkish and Iranian cohorts. We performed genome-wide association studies in 1001 Turkish AS patients and 1011 Turkish controls, and 479 Iranian AS patients and 830 Iranian controls. Serum IL-1, IL-17 and IL-23 cytokine levels were quantified in Turkish samples. An association of major effect was observed with a novel rare coding variant in MEFV in the Turkish cohort (rs61752717, M694V, OR = 5.3, P = 7.63x10(-12)), Iranian cohort (OR = 2.9, P = 0.042), and combined dataset (OR = 5.1, P = 1.65x10(-13)). 99.6% of Turkish AS cases, and 96% of those carrying MEFV rs61752717 variants, did not have FMF. In Turkish subjects, the association of rs61752717 was particularly strong in HLA-B27-negative cases (OR = 7.8, P = 8.93x10(-15)), but also positive in HLA-B27-positive cases (OR = 4.3, P = 7.69x10(-8)). Serum IL-1, IL-17 and IL-23 levels were higher in AS cases than controls. Among AS cases, serum IL-1 and IL-23 levels were increased in MEFV 694V carriers compared with non-carriers. Our data suggest that FMF and AS have overlapping aetiopathogenic mechanisms. Functionally important MEFV mutations, such as M694V, lead to dysregulated inflammasome function and excessive IL-1 function. As IL-1 inhibition is effective in FMF, AS cases carrying FMF-associated MEFV variants may benefit from such therapy. Author summary Ankylosing spondylitis (AS) is a highly heritable immune-mediated arthritis. To identify new genetic associations with AS, we performed genome-wide association studies in Turkish and Iranian AS patients and controls. We identified a novel rare coding MEFV variant associated with AS. Rare polymorphisms of MEFV, which encodes the protein pyrin, are known to cause Familial Mediterranean Fever (FMF), a monogenic, autosomal recessive, autoinflammatory disease which can be complicated by arthritis. 99.6% of Turkish AS cases, and 96% of those carrying the MEFV variant, did not have FMF, and the association with AS remains excluding cases with FMF. In Turkish subjects, the MEFV variant association was particularly strong in HLA-B27-negative cases, but also positive in HLA-B27-positive cases. This represents the first rare variant association with AS, and has the highest odds ratio for AS of any non-MHC reported hitherto, indicating a major effect on disease pathogenesis. We assessed serum cytokine levels in the cohort, and found that IL-1, IL-17 and IL-23 levels were higher in AS cases. Furthermore, among AS cases, IL-1 and IL-23 levels were increased in MEFV variant carriers compared with non-carriers. This study has therapeutic implications; as IL-1 inhibition is effective in FMF, AS cases carrying FMF-associated MEFV variants may benefit from such therapy. National Health and Medical Research Council (NHMRC) of Australia Pfizer