AB0717 Developing a Deep Learning Model on Conventional X-Rays in the Diagnosis of Axial Spondyloarthritis

Background

Plain pelvic radiographs are the most common imaging modality used in the first line for diagnosis of axial Spondyloarthritis (axSpA). However, evaluation of the sacroiliac joint on two-dimensional plain radiographs may lead to misinterpretation among the evaluators.

Objectives

To investigate the diagnostic power of deep learning models in conventional radiographs of the patients with axSpA.

Methods

The study included 320 axSpA patients and 348 healthy controls (age; 34.5±15.3/38.2±10.6, p=0.072; gender (male) 53.8%/46.3%, p=0.064). Sacroiliitis was confirmed on sacroiliac MRI according to the Assessment of Spondyloarthritis International Society (ASAS) definition. The contrast equalization was preprocessed with the Clahel (Contrast-Limited Adaptive Histogram Equalization) filter. Then, classification was performed with Alexnet, VGG16, resnet101 and resnet50 models. As a result of the trials, the best result was achieved with resnet50. Four different filtering scenarios were applied (Clahel filter cliplimit 0.25, Clahel filter cliplimit 0.50, clahel filter 1.00 and no filter).Two different cropping processes were performed on the direct radiographs, and uncropped, cropped at pelvic borders, cropped images close to the sacroiliac joint were applied to the deep learning model. Meanwhile, all images were also evaluated by 3 rheumatologists for the presence of sacroiliitis.

Results

According to the results of 4 different scenarios studied with the Resnet50 model, the best result was obtained with the RESNET50 Model + Clahel filter clipLimit 0.50. With this model, after applying the clahel filter with a coefficient of 0.5 to the full resolution data, we achieved 0.8135 success in the separation of AS and normal. A kappa error of 0.0561, Cohen’s Kappa Error = 0.6267, Fscore 0.8022 (AS), 0.8253 (normal) were obtained. After applying the clahel filter with a coefficient of 0.5 with Resnet50 to the pelvic data, we achieved 0.625 success in separation of AS and normal. Kappa error 0.0694, Cohen’s Kappa Error=0.2400, Fscore 0.5399 (AS), 0.6838 (normal) values ​​were obtained. After applying the Clahel filter with a coefficient of 0.5 with Resnet50 to the sacroiliac data, we achieved 0.61 success in the separation of AS and normal. Kappa error 0.0696, Cohen’s Kappa Error=0.2131, Fscore 0.5517 (AS), 0.6549 (normal) values ​​were obtained. As a result of the evaluation of the radiographs by the clinician, Cohen’s kappa was 0.452 and accuracy was 0.73 for the first rheumatologist; Cohen’s kappa 0.132 and accuracy 0.56 for the second rheumatologist and Cohen’s kappa 0.362 and accuracy 0.68 for the third rheumatologist were found.

Conclusion

Application of RESNET50 Model + Clahel filter (‘clipLimit’, 0.5, ‘Distribution’, ‘rayleigh’) on uncropped images showed higher precision in diagnosing sacroiliitis from conventional radiographs compared to other filtering scenarios. Our results were found to have higher accuracy than the evaluation of three rheumatologists.

Table 1.

Precision and kappa values of Resnet50 model, 4 different filtering scenarios and 2 different clipping operations

AccuracyCohen’s kappa (CI)*RESNET50+no filter0.73060.4509 (0.3234-0.5785)*RESNET50 Model+ Clahel filter (0,25)0.69430.3889 (0.2590-0.5189)*RESNET50 Model+ Clahel filter (0,50)0.81350.6267 (0.4186-0.7555)*RESNET50 Model+ Clahel filter (1,00)0.68390.3552 (0.2213-0.4890)**RESNET50 Model+ Clahel filter (0,50)0.6250.2400 (0.1523-0.3245)***RESNET50 Model+ Clahel filter (0,50)0.6100.2131 (0.1121-0.3430)

* Uncropped sacroiliac X-Rays; ** Cropped X-Rays at the pelvic margins; *** Cropped X-Rays close to the sacroiliac joints

Figure 1.

Steps of deep learning model in X-Ray images

Disclosure of Interests

None declared

A real-life analysis of patients with rheumatologic diseases on biological treatments: Data from TURKBIO Registry

OBJECTIVE

TURKBIO registry, established in 2011, is the first nationwide biological database in Turkey. This study aimed to provide an overview of TURKBIO data collected by June 2018.

METHODS

The registry included adult patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), nonradiographic axial spondyloarthritis (nr-AxSpA), and psoriatic arthritis (PsA). Demographic and clinical features, disease activity markers, and other follow-up parameters, current and previous treat- ments, and adverse events were registered electronically at each visit using open-source software. The registration of patient-reported outcome measures was carried out electronically by the patients using touch screens.

RESULTS

TURKBIO registry included a total of 41,145 treatment series with biologicals. There were 2,588 patients with axSpA (2,459 AS and 129 nr-axSpA), 2,036 with RA, and 428 with PsA. The total number of patients, including those with other diagnoses, was 5,718. In the follow-up period, the number of patients and also visits steadily increased by years. The yearly mean number of visits per patient was found to be 2.3. Significant improvements in disease activity and health assessment parameters were observed following the biological treatments. Biologics were often given in combination with a con- ventional synthetic disease-modifying antirheumatic drug in patients with RA. Infections were the most commonly seen adverse events, followed by allergic reactions. Tuberculosis was observed in 12 patients, malignancy in 18, and treatment-related mortality in 31.

CONCLUSION

TURKBIO provided a valuable real-life experience with the use of biologics in rheumatic diseases in Turkey.

Factors associated with neurodevelopmental impairment in preterm infants with bronchopulmonary dysplasia

OBJECTIVE

Bronchopulmonary dysplasia (BPD) is a common and serious complication in preterm infants with very low birth weight and is known to lead to poor neurodevelopmental outcomes. This study aimed to identify factors associated with neurodevelopmental impairment (NDI) in patients with moderate to severe BPD.

SUBJECTS AND METHODS

A total of 83 preterm infants born between 24- and 29-weeks' gestation who were admitted to the neonatal intensive care unit and developed moderate/severe BPD between 2013 and 2017 were retrospectively evaluated. Developmental assessment was performed at 18 to 24 months of corrected age using the Bayley Scales of Infant Development II (BSID-II). Patients with NDI (n=41) and without NDI (n=42) were compared.

RESULTS

BSID-II Mental Development Index and Psychomotor Development Index scores were 87±11 and 83±8 in the non-NDI group and 57±12 and 52±8 in the NDI group, respectively (p<0.001). The NDI group had significantly lower birth weight (847±174 vs. 1012±192 g) and gestational age (26.1±1.3 and 27.6±1.6 weeks) compared to the non-NDI group (p<0.001). Intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, exposure to steroids, duration of respiratory support, and length of hospital stay were significantly higher in the NDI group (p<0.001).

CONCLUSIONS

Many of the conditions in this study were found to be associated with poor neurodevelopmental outcomes in patients with BPD, such as prolonged respiratory support, prolonged hospitalization, intraventricular hemorrhage, retinopathy, and steroid therapy, can be avoided or prevented with strict protocols and prevention strategies. Appropriate management of comorbid risk factors may help prevent poor neurodevelopmental outcomes.

The prevalence of non-vascular pulmonary manifestations in Takayasu's Arteritis patients: A Retrospective multi-centred Turkish cohort study

Objectives Takayasu's arteritis (TAK) is a rare vasculitis characterized by inflammation of intermediate- to large-size arteries. Although pulmonary artery involvement (PAI) is an expected finding in some TAK patients, data on non-vascular pulmonary involvement (NVPI) are limited. We aimed to investigate the frequency of NVPI, including parenchymal infiltration, nodules/cavities, pleural effusion, and haemorrhage, in TAK.Method We assembled a retrospective cohort of TAK patients from nine tertiary centres in Turkey. The demographics and clinical characteristics of patients were extracted from medical records and the imaging findings were evaluated for pulmonary manifestations.Results As of January 2021, 319 TAK patients (female/male 276/43; mean age 42.4 ± 13.5 years) were recruited. Eighty-two patients had cough and/or dyspnoea and four had haemoptysis as pulmonary symptoms. On computed tomography assessment, the overall frequency of NVPI was 7.2%; parenchymal infiltrations were present in 10 (3.1%), pleural effusion in eight (2.5%), nodules/cavities in six (1.9%), and pulmonary haemorrhage in four patients (1.3%). In the whole cohort, 10.3% of patients had pulmonary artery hypertension (PAH) and 5.6% had PAI. Among patients with PAH or PAI, the overall frequency of NVPI was significantly higher than in the rest of the group.Conclusions In this TAK cohort from Turkey, we observed NVPI in 7.2% of patients, with parenchymal infiltrations being the most common, followed by pleural effusion. Notably, NVPI was more frequent in patients with PAH or PAI. Although not as common as PAI, NVPI should be kept in mind, especially in TAK patients with PAH or PAI.

Biologic treatments in Takayasu's Arteritis: A comparative study of tumor necrosis factor inhibitors and tocilizumab

OBJECTIVE

To compare the treatment outcomes of TNF inhibitors and tocilizumab (TCZ) in patients with Takayasu arteritis.

METHODS

Takayasu arteritis patients who were refractory to conventional immunosuppressive (IS) drugs and received biologic treatment were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data during follow-up were recorded. Remission, glucocorticoid (GC) sparing effect, drug survival was compared between TNF inhibitor and TCZ treatments. Also, a subgroup matched comparison was performed between groups.

RESULTS

One hundred and eleven (F/M: 98/13) patients were enrolled. A total of 173 biologic treatment courses (77 infliximab, 49 TCZ, 33 adalimumab, 9 certolizumab, 3 rituximab, 1 ustekinumab and 1 anakinra) were given. Tocilizumab was chosen in 23 patients and TNF inhibitors were chosen in 88 patients as first-line biologic agent. Complete/partial remission rates between TCZ and TNF inhibitors were similar at 3rd month and at the end of the follow-up. GC dose decrease (≤4 mg) or discontinuation of GCs was achieved in a similar rate in both groups (TNF inhibitors vs TCZ: 78% vs 59%, p = 0.125). Drug survival rate was 56% in TNF inhibitors and 57% in TCZ group (p = 0.22). The use of concomitant conventional ISs did not affect the drug survival (HR =0.78, 95% CI =0.42-1.43, p = 0.42). The match analysis showed similar results between groups in terms of relapse, decrease in GC dose, surgery need and mortality.

CONCLUSION

The efficacy and safety outcomes and drug survival rates seem to be similar for TNF inhibitors and tocilizumab in patients with Takayasu arteritis.

The role of lactate dehydrogenase-to-albumin ratio in clinical evaluation of adult-onset Still's disease

OBJECTIVES

The aim of the study is to evaluate the importance of lactate dehydrogenase-to-albumin ratio (LAR) in patients with adult-onset Still's disease (AOSD) and to investigate the relationship between this ratio and clinical laboratory variables.

METHODS

The study design was retrospective cross-sectional. The demographic and clinical data, laboratory results and imaging findings were documented. Univariate and multinomial logistic regression analyses were performed to find the predictors, which could be useful to define the ferritin level and organ involvement. Receiver-operating characteristic (ROC) analysis was used to clarify the diagnostic ability of the LAR for ferritin level and organ involvement.

RESULTS

Fifty-eight patients with AOSD were evaluated. When patients were divided into two groups according to the serum ferritin level with a cut-off of 1500 ng/dL, lymphocyte count and albumin level were significantly less in patients who had higher ferritin levels (P = .015 and P = .005). In multinominal logistic regression analysis, AST, LDH and LAR were found as predictors for ferritin levels. When we compared LAR between patients with and without organ involvement, higher LAR was found in patients with HM, SM, serositis and MAS. Also, LAR was significantly higher in patients with higher ferritin levels (≥1500 ng/dL) than those without (P < .001). In ROC analysis, the cut-off point of LAR predicting the ferritin level was determined as 80.75 with 83.7% sensitivity and 80.0% specificity (AUC = 0.89, 95% CI 0.79-0.98, P < .001).

CONCLUSION

LAR can be a valuable inflammatory marker to determine AOSD patients with organ involvement and higher ferritin level.

Association of quantitative computed tomography ındices with lung function and extent of pulmonary fibrosis in patients with systemic sclerosis

OBJECTIVES

The aim was to investigate the discriminative value of a wide range of quantitative computed tomography (qCT) parameters in systemic sclerosis (SSc) patients with and without pulmonary fibrosis (PF) and their association with pulmonary function tests (PFTs) and visual fibrosis scores (VFS).

METHOD

Thoracic high-resolution computed tomography (HRCT) images of SSc patients with and without PF were analyzed with Vitrea® Advanced Visualization software. The mean lung attenuation (MLA), skewness, kurtosis, and threshold-based volumes [low-density volume (LDV), medium-density volume (MDV), and high-density volume (HDV)] derived from the attenuation histograms of the right and left lungs were evaluated separately. Visual scores were measured semi-quantitatively and the overall extent of pulmonary parenchymal abnormality was calculated.

RESULTS

Forty-one SSc patients with PF (85.4% female; mean age 50.4 ± 15.6 years) were compared with 94 without PF (88.3% female; mean age 50 ± 11.5 years). All qCT parameters were significantly different between those with and without PF (p < 0.05). Amongst the qCT measurements, R-MLA, L-MLA, R-MDV, L-MDV, and left total lung volume (L-TLV) correlated with all three of forced vital capacity, carbon monoxide diffusion capacity, and VFS, even after adjustment for sex and age (|r|> 0.300 and p < 0.05). R-MLA, L-MLA, R-HDV/TLV, and L-HDV/TLV exhibited diagnostic accuracy in discriminating patients with PF (AUC value > 0.7).

CONCLUSION

QCT parameters differentiated SSc patients with PF from the ones without and showed a good correlation with VFS. With the application of user-friendly and less operator-dependent software, qCT analysis may become an objective tool for analysis of PF in SSc, complementary to PFTs and VFS. Key Points • Quantitative computed tomography parameters can accurately and objectively differentiate between SSc patients with and without PF. • Furthermore, in SSc patients with fibrosis, a moderate to a high correlation was identified between many of the qCT parameters, PFT results, and VFS.

Genetic Association of a Gain-of-Function IFNGR1 Polymorphism and the Intergenic Region LNCAROD/DKK1 With Behçet's Disease

OBJECTIVE

Behçet's disease is a complex systemic inflammatory vasculitis of incompletely understood etiology. This study was undertaken to investigate genetic associations with Behçet's disease in a diverse multiethnic population.

METHODS

A total of 9,444 patients and controls from 7 different populations were included in this study. Genotyping was performed using an Infinium ImmunoArray-24 v.1.0 or v.2.0 BeadChip. Analysis of expression data from stimulated monocytes, and epigenetic and chromatin interaction analyses were performed.

RESULTS

We identified 2 novel genetic susceptibility loci for Behçet's disease, including a risk locus in IFNGR1 (rs4896243) (odds ratio [OR] 1.25; P = 2.42 × 10-9 ) and within the intergenic region LNCAROD/DKK1 (rs1660760) (OR 0.78; P = 2.75 × 10-8 ). The risk variants in IFNGR1 significantly increased IFNGR1 messenger RNA expression in lipopolysaccharide-stimulated monocytes. In addition, our results replicated the association (P < 5 × 10-8 ) of 6 previously identified susceptibility loci in Behçet's disease: IL10, IL23R, IL12A-AS1, CCR3, ADO, and LACC1, reinforcing the notion that these loci are strong genetic factors in Behçet's disease shared across ancestries. We also identified >30 genetic susceptibility loci with a suggestive level of association (P < 5 × 10-5 ), which will require replication. Finally, functional annotation of genetic susceptibility loci in Behçet's disease revealed their possible regulatory roles and suggested potential causal genes and molecular mechanisms that could be further investigated.

CONCLUSION

We performed the largest genetic association study in Behçet's disease to date. Our findings reveal novel putative functional variants associated with the disease and replicate and extend the genetic associations in other loci across multiple ancestries.

Risk factors of avascular necrosis in Takayasu arteritis: a cross sectional study

Takayasu arteritis (TA) is a large-cell vasculitis, and is not usually associated with avascular necrosis (AVN). The objective of the study was to investigate any association between TA and AVN, including the possible pathogenic effect of glucocorticoid (GCs) use. The study design was retrospective and cross sectional. TA patients were enrolled in the study. Demographic variables, disease activity, treatments, physician global assessment, Indian Takayasu Clinical activity score 2010, and Kerr criteria were recorded. Logistic regression analysis was performed to identify predictors of AVN. A total of 29 patients were assessed. AVN was observed in four (13.8%) patients with TA. Male gender and elevated C-reactive protein (CRP) were found to be significantly associated with AVN (p = 0.001 and p = 0.006, respectively). While type IIb TA was more common in patients with AVN (n = 2, 50%), type V was more likely in the absence of AVN (n = 13, 52%). Descending aorta and thoracic aorta were usually involved in patients with AVN (both, n = 3, 75%). In multivariate logistic regression, increased CRP levels were the only predictor for AVN (OR = 1.183, 95% Cl = 1.025-1.364, p = 0.021). No association was identified between AVN in TA patients and either duration or cumulative dose of GCs. The present study found that higher CRP levels and male gender were associated with AVN in patients with TA.

AB0362 DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF BEHCET’S DİSEASE PATIENTS

Background:

Behcet’s Disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and the gastrointestinal system.

Objectives:

In this study we aimed to present variety of involvements in patients who were followed up in our outpatient clinic with a diagnosis of BD.

Methods:

Data of 394 patients diagnosed with BD between 2000-2020 were retrospectively reviewed clinical, demographic characteristics and systemic involvements.

Results:

In our study 43.7% of BD patients were female, 56.3% were male and the mean age was 40±11years, disease average age of onset 36.5±10.6, disease duration was 12.8±6.8years. It was observed mucocutaneus involvement 98% of the patients, uveitis in 35%, retinal vasculitis in 2.8%, arthritis in 24.9%, arterial occlusion in 2.3%, arterial aneurysm in 3.8%, venous involvement in 19.8%, gastrointestinal (GIS) involvement in 4.3%, cardiac involvement in 1.5%, and cranial involvement 7.1 (Table 1).

Table 1.

The Data of Behçet Disease

n (%)n= 394GenderFemale172 (43.7)Male222 (56.3)Family History48 (12.2)Fever & Weight Loss21 (5.3)Mucocutaneus involvement386 (98)Oral Aphthous Ulcer379 (96.2)Genital Ulcer256 (65)Papulopustular lesions129 (32.7)Erythema Nodosum-like lesions150 (38.1)Skin Pathergy Reaction185 (47)Uveitis138 (35)Retinal Vasculitis11 (2.8)Venous involvement76 (17.6)Thrombophlebitis30 (7.6)67 (17)Deep venous thrombosisArthritis98 (24.9)Monoarthritis74 (75.5)Oligoarthritis21 (21.4)Sacroiliitis3 (3.0)Artery Occlusion9 (2.3)Arterial Aneurysm15 (3.8)GIS involvement17 (4.3)İleum9 (2.3)Colon2 (0.5)Rectum1 (0.3)İleocolonic4 (1)Cardiac involvement6 (1.5)Pericarditis2 (0.5)Ventricular thrombosis3 (0.7)Atrial thrombosis1 (0.2)Cranial involvement24 (5.6)Parenchymal involvement13 (4.6)Cerebral Venous Thrombosis11 (2.8)Pulse steroid15 (3.8)1mg/kg steroid48 (12.2)Infliximab13 (3.3)Azathioprine184 (46.7)Cyclophosphamide31 (7.9)

When all patients evaluated in terms of renal findings, proteinuria was observed in 5 patients and hematuria was observed in 2 patients. 3 patients had proteinuria over than 500mg/day. Their renal biopsy findings; 2 of them were nonspecific involvements and one of them was minimal mesangioproliferative changes.

Conclusion:

As a multi-system disease, general data have been presented, as clinical symptoms involve almost all systems of the body (1).

References:

[1]Behcet’s disease Fereydoun Davatchi 1Int J Rheum Dis.2014 May;17(4):355-7. doi: 10.1111/1756-185X.12378.

Disclosure of Interests:

None declared

POS0892 QUANTITATIVE CT INDEXES: PROMISING TOOLS FOR OBJECTIVE ASSESSMENT OF PULMONARY FIBROSIS IN SYSTEMIC SCLEROSIS

Background:

Pulmonary fibrosis (PF) occurs in the majority of patients with SSc and is a leading cause of SSc-related death. SSc related PF has heterogeneous disease progression: many patients will have a chronic, indolent course while others may develop the progressive, life-threatening disease.

Objectives:

The objective of this study is to investigate the discrimination performance of quantitative CT indexes in identifying the parenchymal differences between the SSc and the control groups. We also aimed to demonstrate the correlation among quantitative indexes (QI), spirometric pulmonary function tests, and visual CT scores in patients with PF.

Methods:

A total of 135 SSc patients (female 87.4%; age, 50±13 years), 41 of whom had pulmonary fibrosis (PF), and 38 healthy subjects (female 89.5%; age, 52±6 years) were enrolled. All participants underwent volume thin-section CT in the supine position at full inspiration and spirometry. Quantitative indexes (QIs) were obtained using dedicated software for the segmentation of the lung (Vital Images Vitrea Workstation; Version 7.12.3.133). QIs included total lung volume (TLV), low attenuation (LA) volume (-1020 HU<pixel<-920 Hounsfield units [HU]), medium attenuation (MA) volume (-920 HU<pixel<-920 HU), and high attenuation (HA) volume (-720<pixel<0 HU). The global extent of pulmonary parenchymal abnormality was measured semiquantitatively by visual scoring (VS) and functional lung volume was derived. The functional lung volume, total MA volume, and ratio of total MA to total lung volume were assumed as the indexes of normal lung parenchyma.

Results:

MA volumes, HA volumes, total lung volumes and the ratio of MA volume to total lung volume differed significantly between the patients with PF, patients without PF, and the control group. In the PF group, FVC showed significant correlation with functional lung volume (r=0.45, p=0.014) and total MA volume (r=0.48, p=0.009); DLCO showed significant correlation with VS of normal lung parenchyma (r=0.65, p<0.001), functional lung volume (r=0.53, p=0.006), total MA volume (r=0.54, p=0.005) and ratio of total MA to total lung volume (r=0.42, p=0.031). The functioning lung volume obtained by VS and total MA volume showed excellent correlation (r=0.78, p<0.001).

Conclusion:

Quantitative indexes measured by soft-ware differentiated the patients with PF from the patients without PF and healthy subjects. The indexes used to evaluate the normal lung parenchyma showed a good correlation with pulmonary function test results. Quantitative indexes can be used as an objective complementary tool for the evaluation of the lung areas unaffected by PF.

Table 1.

Quantitative Indexes of CT in the Control, SSc without PF and SSc with PF Groups

ControlSSc without PFSSc with PFpRight lung LA volume (ml)372±375420±446254±3080.102Right lung MA volume (ml)1230±4081377±441987±451<0.001Right lung HA volume (ml)531±152494±177625±2150.004Left lung LA volume (ml)342±370367±383221±2710.089Left lung MA volume (ml)1014±3831170±433805±402<0.001Left lung HA volume (ml)563±176516±251620±2890.037Total lung LA volume (ml)712±736827±959517±6530.119Total lung MA volume (ml)2212±8632548±8621756±850<0.001Total lung HA volume (ml)1072±3431009±4061290±5220.005Total lung volume (ml)3996±12374385±12563563±12360.002Mean lung density (HU)-799±61.4-798±63-730±75<0.001Total MA volume/Total lung volume0.55±0.120.59±0.130.49±0.150.002Figure 1.

Segmentation of lung parenchyma

Disclosure of Interests:

None declared

AB0359 CRANIAL INVOLVEMENT IN BEHÇET’S DISEASE

Background:

Behçet’s disease (BD) is a vasculitic multisystem inflammatory disorder. It may also involve the skin, mucosa, eyes, blood vessels, joints, gastrointestinal system, and central nervous system (CNS).

Objectives:

In this study, we aimed to present CNS involvement data in patients followed up with a diagnosis of BD.

Methods:

The clinical, demographic, laboratory and medication data of 394 patients who were followed up with a diagnosis of BD in our rheumatology outpatient clinic between 2000 and 2020 were retrospectively evaluated.

Results:

CNS involvement was detected in %5.6(24) patients who were followed up with a diagnosis of BD. 66.7% of the patients were male, and their mean diagnosis age was 25.1±8.2 years, mean CNS involvement age was 28.39±9.6 years. Neurological symptoms occurred in an average of 3.3 years after the diagnosis of BD. Parenchymal involvement was present in 54.2% of the patients with CNS involvement, 45.8 % had cerebral venous thrombosis. Oral apthous ulcer was found in 91.7 % of the patients, genital ulcer in 70.8%, pathergy positivity in %45.8 papulopustular lesion in %37.5, erythema nodosum in %45.8. Patients with CNS involvement had headache, vision loss, diplopia, hemiparesis, epilepsy, proptosis, and ataxic gait and walking difficulty in 66.6%, 12.5%, 25%, 12.5%, 8.3%, 8.3% and 12.5%, respectively. Patients with and without CNS involvement were compared in terms of clinical findings and medications. A significant difference was observed in terms of cardiac involvement (Table 1). While one of the 2 patients with cardiac involvement had a thrombus in the right ventricle, the other had pericardial effusion. The patient with cardiac thrombus also had cerebral venous thrombus. Steroid, azathioprine, cyclophosphamide treatments have been used at a higher in patients with CNS involvement. In addition, the patients with parenchymal and cerebral venous involvement were compared in terms of clinical, demographics findings and medications. The presence of papulopustular lesions (9.1% vs 57.1%) and pathergy positivity (18.2% vs 71.4%) were higher in patients with parenchymal involvement (p:0.033, p: 0.020, respectively).

Table 1.

Comparison of data of patients with and without CNS involvement

n (%)CNS Involvement (+)n:24CNS Involvement (-)n:370PGender0.396 Female8(33.3)164(44.3) Male16(66.7)206(55.7)Oral Aphthous Ulcer22(91.7)357(96.5)0.230Genital Ulcer17(70.8)239(64.6)0.661Papulopustular lesion9(37.5)120(32.4)0.655Erythema Nodosum11(45.8)139(37.6)0.516Pathergy11(45.8)174(47)0.988Uveitis9(37.5)129(34.9)0.827Retinal Vasculitis1(4.2)10(2.7)0.504Arthritis3(12.5)95(25.7)0.221Deep Venous Involvement6(25)59(15.9)0.256Artery Occlusion1(4.2)8(2.2)0.436Arterial Aneurysm1(4.2)14(3.8)1GIS involvement2(8.3)15(4.1)0.277Cardiac involvement2(8.3)4(1.1)0.046

Conclusion:

It has been reported that neurological symptoms occur in an average of 2.5 to 6.5 years after the diagnosis of BD. On the other hand, it has been stated that neurological complications may be the first involvement in 3-33% of the cases and this situation will cause diagnostic difficulties1. These data are consistent with our study.

References:

[1]Noel N, Drier A, Wechsler B, ve ark. Neurological manifestations of Behcet’s disease. Rev Med Interne 2014;35(2):112–120.

Disclosure of Interests:

None declared

AB0356 VENOUS INVOLVEMENT IN BEHÇET’S DISEASE

Background:

Behçet’s disease (BD) is a vasculitic multisystem inflammatory disorder. It may also involve the skin, mucosa, eyes, blood vessels, joints, gastrointestinal system, and central nervous system.

Objectives:

In this study, we aimed to present venous involvement data in patients followed up with a diagnosis of BD.

Methods:

The clinical, demographic, laboratory and medication data of 394 patients who were followed up with a diagnosis of BD in our rheumatology outpatient clinic between 2000 and 2020 were retrospectively evaluated.

Results:

Venous involvement was detected in 17.6% (n:76) patients who were followed up with a diagnosis of BD. 75% of the patients were male, and their mean diagnosis age was 27.1±9.9, disease duration was 14.2±6.3 years. While the thrombosis of lower extremity veins, cervical veins, and vena cava were observed in 85.5% of BD patients, superficial thrombophlebitis was found in 31.6%. Cerebral venous involvement (CVI) was evaluated in cranial involvement. Oral aphthous ulcer was found in 97.4 % of the patients, genital ulcer in 65.8%, pathergy positivity in 44.7%, papulopustular lesion in 34.2%, erythema nodosum in 40.8%. 27.6% of the patients were evaluated for hereditary thrombophilia and 5.3% (n:7) had hereditary thrombophilia. Deep venous thrombosis was found in 85.7% (6/7) of these patients, renal artery occlusion in 14.3%, pulmonary artery thrombosis in 14.3%, and cerebral venous thrombosis in 28.6%. Patients with and without venous involvement were compared in terms of clinical findings. A significant difference was observed in terms of retinal vasculitis, artery occlusion, arterial aneurysm, family history for BD and gender. In logistic regression analysis, a significant relationship was observed between venous involvement and gender, family history, retinal vasculitis, artery occlusion, arterial aneurysm (Table1).

Table 1.

Comparison of data of patients with and without venous involvement

Venous Involvement (+)n:76Venous Involvement (-) n:318POR* (%95CI)Gender0.0002.78(1.58-4.88) Female19(25)153(48.1) Male57(75)165(51.9)Family History4(5.3)44(13.8)0.0490.035(0.12-0.99)Oral Aphthous Ulcer74(97.4)305(95.9)0,745Genital Ulcer50(65.8)206(64.8)0,894Papulopustular lesion26(34.2)103(32.4)0,786Erythema Nodosum31(40.8)119(37.4)0,601Pathergy34(44.7)151(47.5)0,772Uveitis20(26.3)118(37.1)0,083Retinal Vasculitis5(6.6)6(1.9)0.0363.66(1.08-12.33)Arthritis13(17.1)85(26.7)0,104Artery Occlusion6(7.9)3(0.9)0.0028.97(2.19-36.74)Arterial Aneurysm7(9.2)8(2.5)0.0133.93(1.37-11.20)Gastrointestinal involvement6(7.9)11(3.5)0,111Cardiac involvement3(3.9)3(0.9)0,089Cranial involvement7(9.2)17(5.3)0,282

* Significant data in logistic regression analysis were presented

Conclusion:

Superficial venous thrombosis and deep vein thrombosis are the most frequent vascular involvements in BD patients. Significant correlations exist between CVI and pulmonary artery involvement (PAI), intracardiac thrombosis and PAI. It should be recalled that lower extremity venous thrombosis is often present in these associations, and even precede them (1).

References:

[1]Seyahi E. Behçet’s disease: How to diagnose and treat vascular involvement. Best Practice & Research Clinical Rheumatology. 30 (2016) 279-295

Disclosure of Interests:

None declared

AB0229 A NATIONAL, MULTICENTER, SECONDARY DATA USE STUDY EVALUATING EFFICACY AND RETENTION OF FIRST-LINE BIOLOGIC TREATMENT WITH TOCILIZUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-LIFE SETTING FROM TURKBIO REGISTRY

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 (<2.8) and DAS28-(ESR) (<2.6) scores were 61.5%, 44.6%, 30%, and 54.6%, 40.8%, 27.7%, respectively. CDAI, DAS28-(ESR) and HAQ-DI survey scores significantly improved at 6, 12 and 26 months, respectively (p<0.001) (Table 1) in both IV and SC TCZ subgroups. At 6, 12 and 24months 74.8%, 82.5% and 86.4% of patients achieved a EULAR good response respectively. Twenty-three patients (17.6%) discontinued TCZ at 24 months. Of these, 19 patients discontinued due to unsatisfactory response. Retention rates of TCZ at 6, 12, and 24 months were 93%, 84.3%, and 72.2%, respectively (Figure 1).

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

AB0479 LONGTERM RETENTION RATE OF CERTOLIZUMAB PEGOL IN AXIAL SPONDYLOARTHRITIS IS HIGHER: DATA FROM TURKBIO

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 1

Drug survival of CZP in patients with Ax-SpA

Table 1.

Baseline characteristics of ax-SpA patients who continue and discontinue CZP

All 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)<0,001Sulphasalazine61 (16,4)40 (12,6)21 (38,9)<0,001Leflunomide5 (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.

Renal Tubular Acidosis in Patients with Systemic Lupus Erythematosus

OBJECTIVE

Renal tubular acidosis (RTA) is a clinical manifestation that occurs with insufficiency in restoring bicarbonate or disruption in hydrogen ion elimination as a result of a disruption in tubulus functions, causing normal anion gap-opening metabolic acidosis. In the present study, we aimed to investigate the prevalence of RTA in the largest systemic lupus erythematosus (SLE) patient population to date.

MATERIALS AND METHODS

SLE patients, who were followed up in 2 different healthcare centers, were included. Patients with metabolic acidosis (pH <7.35 and HCO3 <22 mEq/L) in venous blood gas analysis were determined. The serum and urine anion GAP of these patients were estimated, and the urine pH was assessed. RTA presence was evaluated as metabolic acidosis with a normal serum anion gap and a positive urine anion GAP.

RESULTS

A total of 108 patients were included in the present study. The mean age of the patients was 41.5 ± 1.2 and 87% were female. The SLE diagnosis duration was 75 ± 5 months. The mean creatinine value ​​was 0.6 ± 0.1 mg/dL and the mean eGFR was 111 ± 2 mL/min. According to the blood gas analysis, 18 patients (16.7% of the total) had RTA. Sixteen of these patients had type 1 RTA and 2 had type 2 RTA; type 4 RTA was not determined in any of the patients.

CONCLUSION

RTA should be considered in SLE patients even if they have normal eGFR values. This is the largest study to examine the prevalence of RTA in SLE patients in the literature.

Femoral vein wall thickness measurement: A new diagnostic tool for Behçet's disease

OBJECTIVES

Diagnosing Behçet's disease (BD) is a challenge, especially in countries with a low prevalence. Recently, venous wall thickness (VWT) in lower extremities has been shown to be increased in BD patients. In this study, we aimed to investigate the diagnostic performance of common femoral vein (CFV) thickness measurement in BD and whether it can be used as a diagnostic tool.

METHODS

. Patients with BD (n = 152), ankylosing spondylitis (n = 27), systemic vasculitides (n = 23), venous insufficiency (n = 29), antiphospholipid syndrome (APS; n = 43), deep vein thrombosis due to non-inflammatory causes (n = 25) and healthy controls (n = 51) were included in the study. Bilateral CFV thickness was measured with ultrasonography by a radiologist blinded to cases.

RESULTS

Bilateral CFV thickness was significantly increased in BD compared with all control groups (P < 0.001 for all). The area under the receiver operating characteristic curve for bilateral CFV thicknesses in all comparator groups was >0.95 for the cut-off value (0.5 mm). This cut-off value also performed well against all control groups with sensitivity rates >90%. The specificity rate was also >80% in all comparator groups except APS (positive predictive value: 79.2-76.5%, negative predictive value: 92-91.8% for right and left CFV, respectively).

CONCLUSION

Increased CFV thickness is a distinctive feature of BD and is rarely present in healthy and diseased controls, except APS. Our results suggest that CFV thickness measurement with ultrasonography, a non-invasive radiological modality, can be a diagnostic tool for BD with sensitivity and the specificity rates higher than 80% for the cut-off value ≥0.5 mm.

Software-based quantitative analysis of lung parenchyma in patients with systemic sclerosis may provide new generation data for pulmonary fibrosis

OBJECTIVES

To investigate lung volume and density in patients with SSc and changes in these parameters because of PF, using a software-aided image quantification method, and compare this with a matched healthy control group.

METHODS

Thoracic high-resolution computed tomography (HRCT) images of patients and controls were analysed using Myrian XP Lung 3D software. Right, and left lung densities and volumes were calculated separately by a blinded operator. Results were analysed between subgroups to investigate associations with the clinical features.

RESULTS

A total of 135 patients with SSc and 38 healthy controls (HC) were included. Characteristics of the SSc patients were 94 (69.6%) without PF, 85.4% female, mean age 49.8 (15.4) years; 41 (30.4%) with PF, 88.3% female, mean age 50.2 (11.5) years, and HC group were 89.5% Female, mean age 52.2 (5.8) years. The right and left lung densities were significantly higher, and right and left lung volumes were significantly lower in the SSc patients with signs of fibrosis than those without and HC (P < .001 and P < .001; P = .006 and P = .002, respectively). After excluding patients with PF, right and left lung densities and volumes differed significantly between diffuse cutaneous SSc, limited cutaneous SSc, and HC (P = .002 and P < .001; P = .045 and P = .044, respectively). Patients who developed PF during follow-up had significantly lower baseline right and left lung densities than those who did not (P = .018; P = .014, respectively). Forced vital capacity and carbon monoxide diffusing capacity showed a weak correlation with lung densities and volumes in patients without PF and moderate to high correlation in PF patients.

CONCLUSION

Lung density and volume in SSc patients changed significantly in those with PF and those without. Quantitative information extracted by soft-ware aided methods may contribute more to the detection, screening, and risk prediction in SSc-related PF.

Impact of discordance between patient's and evaluator's global assessment on treatment outcomes in 14 868 patients with spondyloarthritis

OBJECTIVES

To assess the impact of 'patient's minus evaluator's global assessment of disease activity' (ΔPEG) at treatment initiation on retention and remission rates of TNF inhibitors (TNFi) in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) patients across Europe.

METHODS

Real-life data from PsA and axSpA patients starting their first TNFi from 11 countries in the European Spondyloarthritis Research Collaboration Network were pooled. Retention rates were compared by Kaplan-Meier analyses with log-rank test and by Cox regression, and remission rates by χ2 test and by logistic regression across quartiles of baseline ΔPEG, separately in female and male PsA and axSpA patients.

RESULTS

We included 14 868 spondyloarthritis (5855 PsA, 9013 axSpA) patients. Baseline ΔPEG was negatively associated with 6/12/24-months' TNFi retention rates in female and male PsA and axSpA patients (P <0.001), with 6/12/24-months' BASDAI < 2 (P ≤0.002) and ASDAS < 1.3 (P ≤0.005) in axSpA patients, and with DAS28CRP(4)<2.6 (P ≤0.04) and DAPSA28 ≤ 4 (P ≤0.01), but not DAS28CRP(3)<2.6 (P ≥0.13) in PsA patients, with few exceptions on remission rates. Retention and remission rates were overall lower in female than male patients.

CONCLUSION

High baseline patient's compared with evaluator's global assessment was associated with lower 6/12/24-months' remission as well as retention rates of first TNFi in both PsA and axSpA patients. These results highlight the importance of discordance between patient's and evaluator's perspective on disease outcomes.

Identification of susceptibility loci for Takayasu arteritis through a large multi-ancestral genome-wide association study

Takayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 × 10^-5) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets.

Are there any clinical differences between ankylosing spondylitis patients and familial Mediterranean fever patients with ankylosing spondylitis?

OBJECTIVE

Familial Mediterranean Fever (FMF) is an autoinflammatory disease that is commonly present with recurrent episodes of fever, peritonitis, pleuritis or arthritis. Enthesitis and sacroilitis can also be seen in FMF. Spondylitis is a less common manifestation of joint involvement in FMF and there are controversial publications about whether this involvement is FMF-related or coincidentally. The aim of this study was to provide a comparison between ankylosing spondylitis (AS) patients and FMF patients with AS.

METHODS

A total of 404 patients who 360 of them was AS and 44 was FMF patients with AS (in accordance with Tel Hashomer) patients with AS (in accordance with modified New York criteria) were included in this study. All cases were evaluated retrospectively and patient's demographic and clinical data were recorded.

RESULTS

The mean age was 34.5 ± 8.6 years and 61.4% of patients were female in FMF group. In AS group, the mean age was 41.2 ± 10.8 years and 67.8% of patients were male. In AS group, 92% of patients had inflammatory back pain, 51% had hip pain, 30% had heel pain, 14% had peripheral arthritis and 11% had uveitis. In FMF group, 98% of patients had inflammatory back pain, 59% had hip pain, 48% had heel pain, 43% had peripheral arthritis and 4.5% had uveitis. Syndesmophyte and enthesitis on X-ray were seen in 18% and 22% of AS patients, and 7% and 41% of FMF patients with AS, respectively. There were significant differences between AS patients and FMF patients with AS in terms of heel pain (P: .017), peripheral arthritis (P: .000) and enthesitis (P: .006).

CONCLUSION

Peripheral arthritis and enthesitis were more frequent, and uveitis and syndesmophyte were less frequent in FMF patients with spondylitis than AS patients. When we look at gender differences, clinical and genetic features, it seems to be different condition from AS.

Sacroiliitis in Systemic Lupus Erythematosus Revisited

Objectives

This study aims to investigate the prevalence of inflammatory back pain (IBP) and sacroiliitis in a systemic lupus erythematosus (SLE) population as well as the association between IBP and the frequency of human leukocyte antigen B27 (HLA-B27).

Patients and methods

The study included 281 SLE patients (16 males, 265 females; mean age 39.9±11.9 years; range, 20 to 69 years) and 100 healthy controls (HCs) (2 males, 98 females; mean age 41.2±10.1 years; range, 19 to 64 years). Participants were administered a five-item Assessment of SpondyloArthritis international Society-IBP questionnaire. Patients and controls with IBP underwent detailed clinical and laboratory examinations to detect sacroiliitis. Radiographic evaluations were performed by a blinded rheumatologist and radiologist. Interobserver reliability was assessed with Cohen's kappa test.

Results

According to the questionnaire, IBP was present in 46 SLE patients (46/281; 16.3%) whereas none of the HC had IBP (p<0.001). In radiological assessment, 22 SLE patients (7.8%) had sacroiliitis detected by conventional X-ray and/or magnetic resonance imaging. Only one SLE patient with sacroiliitis had HLA-B27.

Conclusion

Our study showed that IBP is increased in SLE patients and IBP in SLE is not associated with HLA-B27.

FRI0473 ASSESSMENT OF FEMORAL VEIN WALL THICKNESS WITH DOPPLER US AS A DIAGNOSTIC TOOL FOR BEHCET’S DISEASE

Background:

Diagnosing Behcet’s disease(BD) is a challenge, especially in countries with a low prevalence. International Study Group Criteria, accepted to as diagnostic, has low sensitivity, especially in early cases when major organ involvement such as uveitis or deep vein thrombosis(DVT) presents alone. We recently published a controlled study of assessing venous wall thickness(VWT) as a surrogate marker of venous disease in BD with ultrasound(US) and observed a very sensitive and specific VWT in male BD patients. The common femoral vein(CFV) thickness measurement, as the primary site of US with the cut-off values > 0.48-0.49 mm, had a high area under the receiver operating characteristic curve(>0.8) with sensitivity and specificity of around 80%(1).

Objectives:

In this study, we aimed to investigate the diagnostic performance of CVF thickness measurement in BD including females comparing with multiple control disease groups.

Methods:

One hundred-ten patients with BD, 47 healthy controls(HC), 21 patients with systemic vasculitides, 28 patients with venous insufficiency,29 patients with antiphospholipid syndrome (APS) having DVT history, were included the study.Bilateral CFV thickness was measured with US by an experienced radiologist blinded to cases(Figure 1).

Figure 1.

Measurement of common femoral vein thickness

Results:

Bilateral CFV thickness was significantly higher in BD compared to all comparative groups (p<0.001 for all)(Table 1,Figure 2). No correlations were present between CFV thickness and both BSAS and CRP levels (p>0.05 for all). In only 2 (8%) patients with venous insufficiency and 2 (10%) patients with systemic vasculitis, bilateral CVF thickness was higher than the cut- off values. Interestingly, APS was the only control group with positivity, in 12 (41%) patients with APS, bilateral CFV thickness was higher than the cut-offs. There was no difference between male vs female BD patients regarding CFV thickness (right CFV:0.78 mm vs 0.79 mm,p=0.96, left CFV:0.78 vs 0.8, p=0.80). Although a higher CVF thickness tendency was observed in VBD, no statistically significant difference was present between BD patients with (n=40) and without (n=58) vascular involvement (right CFV:0.82±0.3 mm vs 0.75±0.3 mm, p=0.122, left CFV:0.84 ± 0.3 vs 0.76±0.3, p=0.165).

Table 1.

Venous Wall Measurements of Lower Extremity in Study Groups

Behcet’s Disease(n=110)Healthy Controls(n=47)Systemic Vasculitis(n=21)Venous Insufficiency(n=28)Anti-phospholipid Syndrome with DVT (n=29)Age (years)33.5 ± 630.1 ± 533.3 ± 736.7 ± 638.3± 9Gender, malen (%)89 (81)40 (85)12 (57)13 (46)9 (31)Body MassIndex, kg/m225.5 ± 424 ± 223.8 ± 3.527.7 ± 427.2 ± 7Right CFVThickness (mm)0.79 ± 0.30.34 ± 0.10.34 ± 0.150.38± 0.10.48 ± 0.15Left CFVThickness (mm)0.78 ± 0.30.3 ± 0.10.36 ± 0.140.38 ± 0.20.48 ± 0.15

CFV: Common Femoral vein, DVT:Deep Venous Thrombosis

Figure 2.

Distribution of common femoral vein thickness in study groups

Conclusion:

Increased CFV thickness is present in BD patients,independent of vascular involvement.We also found that CFV thickness is a distinctive feature of BD, rarely present in other inflammatory/vascular diseases such as ankylosing spondylitis (previously shown),systemic vasculitides and venous insufficiency(except APS with DVT).CFV thicknesses are easily and reliably measured by Doppler US. We, therefore, suggest that assessment of CFV can be a diagnostic tool for BD with a good sensitivity and specificity to differentiate BD from similar disorders.

References:

[1]Alibaz-Oner et al.Clinical Rheumatology (2019)38:1447–51.

Disclosure of Interests:

None declared

THU0378 DO COMORBIDITIES DECREASE THE FIRST TNF-INHIBITOR RETENTION AND TREATMENT RESPONSE IN AXIAL SPONDYLOARTHRITIS PATIENTS? DATA FROM TURKBIO

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 Patients

Radiographic 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 scale

Conclusion:

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

THU0390 THE INFLUENCE OF OBESITY ON RETENTION AND TREATMENT RESPONSE OF SECUKINUMAB IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: REAL LIFE DATA FROM THE TURKBIO REGISTRY

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 (BMI<25 kg/m2). 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 <25) (n=33)(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 Test

Figure 1

Conclusion:

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: R11

Disclosure of Interests:

None declared