AB1272 FACTORS AFFECTING PATIENT-ACCEPTABLE SYMPTOM STATES IN FAMILIAL MEDITERRANEAN FEVER

Background

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of fever, serositis, and musculoskeletal symptoms (1, 2). Arthritis is the most common musculoskeletal symptom of attacks and also included in diagnostic criteria of FMF (3). If it is specifically queried, myalgia may be detected in up to 20-25% of the patients with FMF.(4,5).

Objectives

In our study, we aim to assess the localization of attack-related myalgia and associated parameters in patients with FMF.

Methods

A total of 349 consecutive patients followed by FMF in our clinic were enrolled in the study and asked for attack-induced myalgia and if present, localization of muscle groups on the mannequin body parts diagram.

Attack frequency, duration, and disease activity were evaluated with the AutoInflammatory Diseases Activity Index (AIDAI) scoring system (6). Patients were also asked for work/study day loss during attacks and patient acceptable symptom state (PASS) status (7).

Results

126 patients showed attack myalgia (36%); attack duration, frequency, severity were significantly higher in patients with attack-myalgia (p<0,005). Most common muscle groups were calves, lower back, and latissimus dorsi muscles in order. Myalgia was most commonly accompanied by arthritis (p<0,002). Patients with myalgia have a higher frequency of colchicine resistance and work/study day loss due to attacks.

Conclusion

Our results conclude that myalgia is an important domain of attacks and causes absenteeism and uncontrolled disease activity. Treatment of myalgia attacks may provide controlled disease activity, and prevent absenteeism from work/school.

References

[1]El-Shanti H, Majeed HA, El-Khateeb M. Familial mediterranean fever in Arabs.Lancet. 2006;367(9515):1016–24.

[2]Majeed HA, Al-Qudah AK, Qubain H, Shahin HM. The clinical patterns of myalgia in children with familial Mediterranean fever. Semin Arthritis Rheum. 2000;30(2):138–43.

[3]Gattorno M, Hofer M, Federici S, Vanoni F et al. Eurofever Registry and the Paediatric Rheumatology International Trials Organisation (PRINTO). Classification criteria for autoinflammatory recurrent fevers. Ann Rheum Dis. 2019 Aug;78(8):1025-1032. doi: 10.1136/annrheumdis-2019-215048.

[4]Zemer D. Muscle pains in familial Mediterranean fever. Harefuah 1984; 106: 232-233.

[5]Majeed HA. Differential diagnosis of fever of unknown origin in children. Curr Opin Rheumatol 2000; 12: 439-444.

[6]Piram M, Frenkel J, Gattorno M et al. EUROFEVER and EUROTRAPS networks. A preliminary score for the assessment of disease activity in hereditary recurrent fevers: results from the AIDAI (Auto-Inflammatory Diseases Activity Index) Consensus Conference. Ann Rheum Dis. 2011 Feb;70(2):309-14. doi: 10.1136/ard.2010.132613.

[7]Salaffi F, Carotti M, Gutierrez M, Di Carlo M, De Angelis R. (2015) Patient Acceptable Symptom State in Self-Report Questionnaires and Composite Clinical Disease Index for Assessing Rheumatoid Arthritis Activity: Identification of Cut-Off Points for Routine Care. Biomed Res Int. 2015:930756. doi: 10.1155/2015/930756.

Table 1.

Comparison of clinical and laboratory parameters between patients with /without myalgia attacks

Patients with myalgia attackPatients without myalgia attackp valueAge (years)36,33 ±10, 6837,9±11, 48>0,05Sex (female/male)78/43138/87>0,05Follow-up time (years)16,117,6>0,05Dominant attack(number)Peritonitis4255>0,05Arthritis11390,012Pleuritis1310>0,05Only fever47>0,05AIDAI score (mean, 0-175)127,4080,68<0,05VAS score for pain (median score, during attack. 0-10)85<0,05Colchicine resistance (number ofpatients)69250,003Colchicine-resistant29840,002Colchicine-sensitivePASS status (number)Need additional treatment4160,016Satisfied from treatment34740,010Work/study day loss (number)4860,003

Acknowledgements

All study population signed informed consent for both participation and publication. Local Ethical Committee of the university approved the study.

Disclosure of Interests

None declared

POS1328 DO IL-1 ANTAGONISTS DEFINITELY PROTECT FROM THE DEVELOPMENT OF NEW DAMAGE: A SINGLE-CENTER STUDY

Background

Ongoing inflammatory episodes of familial Mediterranean fever (FMF) disease can cause damage in nearly all organ systems. Colchicine and interleukin1β blocking agents are successfully used to control the disease activity [1]. Although the effect of IL-1 blockers are known for controlling disease activity and amyloidosis [2], it is unclear whether they prevent organ damage

Objectives

In our study, we assessed the organ damage in patients with FMF treated with colchicine and IL-1 antagonists (IL-1A). It was evaluated whether new damage occurred after IL-1 antagonist treatment.

Methods

A total of 111 patients fulfilling Tel-Hashomer criteria and treated with IL-1A due to colchicine resistance were included in the study. All patients were also treated with colchicine with a maximum-tolerable dose. Patients were grouped according to their recent damage status (no damage, pre-existing damage, and damage developed under IL-1A treatment). The degree of damage was determined using Autoinflammatory Disease Damage Index (ADDI) and modified form of ADDI (mADDI) [3, 4].

Results

44 patients (42,3%) had damage according to the modified ADDI (mADDI) index; three patients experienced new damage under IL-1 antagonist treatment while four patients showed progression of damage and mADDI score.

In patients with a positive mADDI score, the most common damage was amyloidosis (n=28, 63%), the second most frequent was musculoskeletal findings (N=14, 31%), and the third was infertility (N=2, 0,04%). The most common domains of FMF-related damage with IL-1 antagonist treatment were musculoskeletal (n=4), renal (n=2) and reproductive system (n=2)

Conclusion

Our study was the first study to evaluate the progression of damage in patients with FMF and treated- with IL-1 antagonists. Although it is known that IL-1A is effective in colchicine-resistant patients, physicians should be aware that damage can still develop under IL-1A treatment.

References

[1]Chae JJ, Aksentijevich I, Kastner DL. Advances in the understanding of familial Mediterranean fever and possibilities for targeted therapy. Br J Haematol 2009; 146:467–78.

[2]Ozcakar ZB, Ozdel S, Yilmaz S, Kurt-Sukur ED, Ekim M et al. Anti-IL-1 treatment in familial Mediterranean fever and related amyloidosis. Clinical Rheumatology 2016; 35 (2): 441- 446. doi: 10.1007/s10067-014-2772-2

[3]Ter Haar NM, Annink KV, Al-Mayouf SM et al.: Development of the autoinflammatory disease damage index (ADDI). Ann Rheum Dis 2017; 76: 821-30

[4]Babaoglu H, Armagan B, Bodakci E, Satis H, Atas N, Sari A, Yasar Bilge NS, Bilici Salman R, Yardimci GK, Avanoglu Guler A, Karadeniz H, Kilic L, Ozturk MA, Goker B, Haznedaroglu S, Kalyoncu U, Kasifoglu T, Tufan A. Factors associated with damage in patients with familial Mediterranean fever. Clin Exp Rheumatol. 2020 Sep-Oct;38 Suppl 127(5):42-48.

Table 1.

Comparison of clinical and laboratory parameters between groups according to damage

No damageNew damageAny damageP valueAge (years)48,456,467,50,002Sex (K/E)34/332/525/19NSFollow-up time (years)4043560,33Dominant attack typePeritonitis(63,7%)NAArthritis(34,1%)NSPersistent inflammation33,642,344,30,05AIDAI score394048NSMutationsM694V/M694V26214NSM694V/any44438M694V/M680I314M680I/any119

•SAIDAI: Auto-Inflammatory Diseases Activity Index

Acknowledgements

All participants were confirmed for both participation and publication. Local Ethical Committee approved the study

Disclosure of Interests

None declared

POS0940 THE IMPACT OF TUMOUR NECROSIS FACTOR-ALPHA INHIBITOR TREATMENT ON WNT SIGNALING INHIBITORS, NOGGIN AND CYTOKINE LEVELS IN AXIAL SPONDYLOARTHRITIS

Background:

Axial spondyloarthritis (axSpA) is a common chronic inflammatory disease of the axial skeleton. Some cytokines have important roles in initiation and progression of disease and are elevated in active disease. Additionally, Wnt signaling pathway inhibitors and noggin also appear to be involved in pathogenesis of ankylosing spondylitis. Anti-tumor necrosis factor-alpha (TNF) agents have dramatically improved the clinical outcome of axSpa; however, acceptable clinical improvement is not achieved in all patients and capacity of anti-TNF to slow or prevent structural damage still remains controversial.

Objectives:

To evaluate the effect of anti-TNF on inflammatory and noninflammatory milieu in patients with axSpA.

Methods:

In this prospective study we included 30 biologic treatment naive adult patients with axSpA and 30 healthy controls. All patients with high disease activity were treated with anti-TNF therapy for 6 months. Laboratory and clinical evaluation of all patients were performed at baseline and after 6 months of anti-TNF treatment. Following cytokines and wnt/BMP antagonists were measured; TNF-Alpha, COX-2, IL-6, IL-17, IL-22, IL-23, IL-33, dickkopf-1, sclerostin, noggin.

Results:

The mean age of patients with axSpA and healthy controls were 38.1±13.3 and 37.7±7.7 years, respectively (p>0.005). At baseline, the median (IQR) TNF-alpha was higher in axSpA patients when compared to healthy controls, 34.4 pg/ml (31.4-37.03) vs 18.1 pg/ml (12.1-28.4), (p<0.001), while the median (IQR) dickkopf-1 and sclerostin were lower in axSpA patients, 446.7 pg/ml (356.9-529.3) vs 1088.7 pg/ml (951.7-1244.4), (p<0.001) and 312.4 pg/ml (140.8-412.7) vs 412.3 pg/ml (295.4-512.8), (p<0.001), respectively. IL-17, IL-22, IL-33, dickkopf-1 and sclerostin increased with anti-TNF treatment (table 1).

Conclusion:

Elevation of some cytokines which are important in pathogenesis of axSpA and nonincrease in noggin with anti-TNF drugs may affect effectiveness of anti-TNF treatment.

Table 1.

Changes of cytokines, dickkopf-1, sclerostin and noggin with anti-TNF treatment.

Pre-Anti-TNFPost-Anti-TNFP valueIL-645(39.1-68.8)47.6(27.3-61.1)0.750IL-1793.3 (85.1-104.8)102.1(86.6-114.6)0.026IL-22159,2 (151,9-178.4)183.5(156.3-304.6)0.033IL-2336.5 (26.1-52.9)41.3(28.4-55.5)0.658IL-33127.8 (106.6-186.1)147.06(128.5-213.4)0.016COX20.176 (0-0.374)0.202(0.051-1.151)0.469TNFalpha34.4(31.4-37.03)30.7(12.8-35.6)0.004Dickkopf-1446.7(356.9-529.3)881.3(663.1-972.2)<0.001Sclerostin312.4 (140.8-412.7)405.1(276.3-452.5)0.018Noggin48.3(17.04-153.9)31.2(11.3-103.7)0.264

Disclosure of Interests:

None declared

AB0300 LUPUS DISEASE ACTIVITY CORRELATES WITH QUALITY OF LIFE BUT NOT WITH HEALTH LITERACY STATUS

Background:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology that can affect any organ of the body. SLE is associated with adverse effects on both health and non-health-related quality of life (HRQOL and non-HRQOL). Lupus PRO is a patient reported outcome measure that has been validated in many languages. It has 44 items that cover both HRQOL and non-HRQOL (1). Health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. Multiple studies indicate that people with limited health literacy have worse health status and higher rates of hospitalization (2).

Objectives:

We aimed to evaluate the relationship between the LLDAS (Lupus Low Disease Activity State) criteria and the Lupus PRO test, as well as the health literacy status of lupus patients.

Methods:

83 SLE patients (94% women) were included in the study. We performed Lupus PRO and the European Health Literacy Survey tests during the routine follow-up visits of lupus patients to our rheumatology outpatient clinic and admissions to rheumatology inpatient clinic. Available clinical data on medical records were obtained, physician global assessments (PGA) were recorded by the attending physician.

Results:

LLDAS criteria strongly and inversely correlated with the total score, as well as the mood subunit of the Lupus PRO. Similarly, it also significantly inversely correlated with the body appearence and goals subunits. Health literacy status of the patients did not correlate with their LLDAS scores, ie their disease activities.

Conclusion:

Our results suggest that lupus disease activity, assessed by LLDAS criteria, significantly correlates with measures of quality of life, spesicifically Lupus PRO test, but not with health literacy status. Further studies are needed to evaluate if health literacy is related with damage, hospitalization or mortality associated with lupus.

References:

[1]Jolly M, Pickard AS, Block JA, Kumar RB, Mikolaitis RA, Wilke CT, et al., editors. Disease-specific patient reported outcome tools for systemic lupus erythematosus. Seminars in arthritis and rheumatism; 2012: Elsevier.

[2]Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. Journal of general internal medicine. 2005;20(2):175-84.

Disclosure of Interests:

None declared

AB0097 DIAGNOSTIC ACCURACY OF SERUM MARKERS IN LARGE VESSEL VASCULITIS AND CORRELATION WITH PET IMAGING

Background:

The onset of symptoms in large-vessel vasculitis (LVV) tends to be subacute, which often leads to a delay in diagnosis, during which time vascular disease may start and progress to become symptomatic. PET/CT has been recognised since the 2003s as a promising tool in evaluating of LVV. There is no gold standard diagnostic laboratory tests for this patient group, novel markers for active LVV is needed.

Objectives:

to investigate the association between vascular inflammation, as detected by PET imaging and interleukin-6 (IL-6), pentraxin3 (PTX3), and B-cell-activating-factor (BAFF) in subjects with LVV.

Methods:

The study included 67 patients patients with newly diagnosed GCA (n= 27) or TA (n=9) and healthy control (n= 31) who had been referred to the Rheumatology Unit at Gazi University, between December 2017 and August 2020. PET images obtained from an 29 patients (22 with GCA and 7 with TA) who had not received any corticosteroid treatment prior to PET imaging and blood sampling. IL-6, PTX3, and BAFF levels were determined quantitatively by enzyme-linked immunosorbent assay (ELISA) kits.

Results:

36 patients with LVV (20 females,16 males; age 64,5±16,6) and 31 HC (14 females,17 males; age37,1±9,6) were analysed. Serum levels of IL-6,PTX3, BAFF, ESR and CRP are increased in patients with newly diagnosed LVV compared with those in control subjects. In a ROC analysis, serum IL-6 provided excellent discrimination of newly diagnosed LVV patients from HC, as indicated by AUCs>0.90. Serum BAFF also accurately distinguished newly diagnosed LVV patients from HC with AUCs>0.80. Serum PTX3 did not provide an AUC>0.80. In this study, we correlate vascular inflammation, as detected by PET imaging in newly diagnosed LVV patients, with the ESR, CRP. PTX3, IL-6 and BAFF. As a result, none of these markers has been associated with vascular inflammation as measured using PET.

Conclusion:

In conclusion, our study shows that serum levels of PTX3, IL-6 and BAFF are increased in most LVV patients. The diagnostic value of BAFF and IL-6, both separately and in combination, should be further evaluated in larger cohorts of LVV patients, as well as in patients with infections or other inflammatory conditions. However, none of these markers has been associated with vascular inflammation as measured using PET.

Disclosure of Interests:

None declared

POS1193 CLINICAL FEATURES AND THE COURSE OF COVID-19 IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background:

The novel coronavirus 2019 (COVID-19) has a wide range of clinical presentation from asymptomatic or mild viral infection to severe life-threating complications, including acute respiratory distress syndrome (ARDS), which develop as a result of immune system dysregulation, exaggerated immune response, and cytokine release syndrome [1]. Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disorder characterized by dysfunction of the innate immune system and excessive production of proinflammatory cytokines, including interleukin (IL)-1β, IL-6, interferon-gamma, and tumor necrosis factor-alpha, all of which have increased in severe cases in COVID-19 [1-3].

Objectives:

The aim of this study is to report clinical characteristics and outcome of FMF patients with COVID-19.

Methods:

This study included 48 consecutive FMF patients who were diagnosed COVID-19 by SARS-CoV-2 nucleic acid RT-PCR in nasopharyngeal swab or sputum, or symptoms and computed tomography findings suggestive for COVID-19. Data on demographic and clinical characteristics of FMF disease, clinical course and outcome of COVID-19 were evaluated.

Results:

The median age of patients was 35.5 (29-43.5) years, ranging from 18 to 87 years. The median disease duration of FMF was 10 (6-16) years. The most common presenting symptoms and signs of patients during attacks were peritonitis (85.5%), fever (81.3%), and pleuritis (48%). Twelve (25%) patients had amyloidosis. Comorbidities were present in half of patients with ankylosing spondylitis (21%) and hypertension (17%) being the most frequently seen. Two-third of patients (66%) were in remission for FMF. The median dosage of colchicine treatment for FMF was 1.5 (IQR 1) mg/day. 90% of patients continued colchicine treatment for FMF during the COVID-19 course. The baseline characteristics and treatment modalities of patients were demonstrated in Table 1. Forty-six patients presented with at least one COVID-19 symptoms. Fever (73%), myalgia/arthralgia (69%), and cough (60%) were the most common symptoms. 16 patients were admitted at hospital, 5 of them required oxygen therapy and 2 patients with amyloidosis developed ARDS and went to intensive care unit (ICU) for invasive mechanical ventilation (IMV). One patient who had been followed-up at ICU died.

Conclusion:

Our FMF patients with COVID-19 have similar clinical features and outcomes as general population. Dysregulation of innate immune system in FMF might not be risk factors for COVID-19. Besides, colchicine and IL-1 inhibitors intake might have protective and preventive effects on COVID-19 progression.

Table 1.

Baseline characteristics, treatment modalities and outcome of patients

Age years, median (IQR)39.4 (15)Gender (F/M)25/23FMF Disease duration, years, median (IQR)10 (10)Mutations*Monoallelic mutation, n (%)6 (14)Biallelic mutation, n (%)34 (81)Homozygous M694V mutation18 (43)Heterozygous M694V mutation15 (36)Comorbidities, n (%)24 (50)FMF treatmentColchicine 1 mg/day, n (%)17 (35.5)Colchicine 1.5 mg/day, n (%)18 (37.5)Colchicine 2 mg/day, n (%)13 (27) Anakinra, n (%)12 (25)Canakinumab, n (%)3 (6.3)Positive SARS-Cov-2 RT-PCR, n (%)42 (87.5)Interstitial pneumonia in CT scan, n (%)15 (31.3)COVID-19 treatment, n (%)46 (95.8)Outpatient treatment, n (%)32 (66.7)Hospitalized, not required supplemental oxygen, n (%)9 (18.8)Hospitalized, required supplemental oxygen, n (%)5 (10.4)ICU, required IMV, n (%)2 (4.2)OutcomeRecovered, n (%)47 (98)Deceased, n (%)1 (2)Complications, n (%)3 (6.3)

*42 patients were included in the analysis

References:

[1]Tufan A, Avanoğlu Güler A, Matucci-Cerinic M. COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs. Turkish journal of medical sciences. 2020;50:620-632.

[2]Hausmann JS. Targeting cytokines to treat autoinflammatory diseases. Clinical immunology (Orlando, Fla.). 2019;206:23-32.

[3]Tufan A, Lachmann HJ. Familial Mediterranean fever, from pathogenesis to treatment: a contemporary review. Turkish journal of medical sciences. 2020;50:1591-1610.

Disclosure of Interests:

None declared.

SAT0097 DO COMORBIDITIES IMPACT PERSISTENCE OF FIRST TUMOR NECROSIS FACTOR INHIBITOR TREATMENT IN RHEUMATOID ARTHRITIS? DATA FROM TURKBIO

Background:

Studies indicate that patients with rheumatoid arthritis (RA) are at increased risk of developing several comorbid disorders. Comorbidities affect treatment decisions, the effectiveness of the treatment, quality of life, RA prognosis, and survival rate [1].

Objectives:

The aim of thisstudyto investigate the impact of comorbidity on the first TNF inhibitor treatment persistence in RA.

Methods:

In the TURKBIO database, patients with an ICD 10-diagnosis of RA (M05 or M06) who started TNF inhibitor therapy between January 2011 and June 2019 were enrolled. Demographic and clinical characteristics, acute phase reactants, disease activity scores (DAS 28 CRP, HAQ, CDAI, VAS global), initial comorbidities and numbers, drug persistence, were evaluated. Kaplan-Meier plots and Cox proportional hazard regression analyses were performed.

Results:

A total of 1172 patients >18 years of age treated with TNF-α inhibitors were included in the study. The most prevalent comorbidities were: hypertension in 262 patients (32.6%), obesity in 254 (32.6%), osteoporosis in 178 (22.3%), chronic lung disease in 143 (17.9%) and depression in 126 (15.8%). The baseline characteristics are summarised in Table 1. The presence of comorbidity did not affect the survival rate of the first TNF inhibitor therapy in the RA patients (p: 0.65). Comorbidities had no effect on DAS28 CRP (> 1.2 reduction) responses at 6 and 12 months of treatment (p: 0.18, p: 0.83, respectively). As the mean disease duration increases, the persistence of the first TNF inhibitor decreases by 5%.

Conclusion:

This study demonstrated the increasing burden of comorbidities in RA. However, it suggested that the presence and number of comorbidities did not influence the rate of persistence in the first TNF inhibitor drug and the response to treatment.

References:

[1] Gabriel, S.E. and K. Michaud,Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases.Arthritis research & therapy, 2009.11(3): p. 229.

Disclosure of Interests:

None declared

SAT0128 ARE THERE ANY DIFFERENCES BETWEEN ADULT-ONSET RHEUMATOID ARTHRITIS PATIENTS AND LATE-ONSET RHEUMATOID ARTHRITIS PATIENTS IN TERMS OF USE OF BIOLOGICAL DRUGS AND DRUG RETENTION RATE? RESULTS FROM THE TURKBIO REGISTRY

Background:

Rheumatoid arthritis(RA) is one of the most frequent rheumatic disease, and the age of onset is between 30-50 years old. Late-onset RA(LORA) is usually defined as RA with onset at age 60 or over.

Objectives:

To investigate the choice, effectiveness and the retention rate of biological drugs in LORA patients.

Methods:

TURKBIO registry is the Turkish version of Danish DANBIO rheumatological database which has been established in 2011. We studied RA patients in TURKBIO registry cohort between the dates of 2011 and 2020. All patients fulfilled the American College of Rheumatology criteria for RA and were classified into two groups based on their age at symptom onset: adult-onset RA(>18-<60 years; AORA) and LORA(≥60 years). In both groups, demographical, clinical and laboratory variables; disease activity, current and previous treatment were compared.

Results:

From 10 centers, 2111 RA patients recruited, and 8.8% of them was LORA patients. In LORA, the frequency of female was less than AORA. While, there was no difference between LORA and AORA in terms of erosion presence and RF positivity, antiCCP positivity was more frequent in LORA group. The use of antiTNF was lower, and the use of rituximab was more frequent in LORA. At 12 months after bDMARDs therapy, serum CRP and ESR levels and DAS28-CRP showed higher changes compared to baseline values in LORA. Although the mortality rate was higher in LORA, the adverse reactions were reported to be higher in AORA, and most common advers reaction was infections in both groups(Table). The longest survival was observed in infliximab and rituximab(median 22 and 20months) in LORA, in rituximab and golimumab(median 16 and 12months) in AORA.

Conclusion:

The frequency of LORA who uses bDMARDs was 8.8% in our database. In the elderly patient population, there are some reservations about the use of biological drugs in general due to several co-morbidities and concommitant drug used. Although data on this issue are limited, appropriate biological use can be effective and reliable in required patients.

References:

[1]Zulfigar AA, Niazi R, Pennaforte JL, Andres E. Late-onset rheumatoid arthritis: clinical, biyological, and therapeutic features about a retrospecttive study. Geriatr Psychol Neuropsychiatr Viell 2019;17:51-62

Table.

Comparison of demographic, laboratory findings and biological treatment

(median;25-75)n(%)AORA (<60)(n:1925)LORA (≥60)(n:186)pAge (year)54 (43-61)71 (68-74)<0.001Disease duration (year)11.4 (7-18)6 (4-9)<0.001Gender (Female)1562 (81)124 (67)<0.001Anti-CCP positivity747 (62)65 (72)0.044RF positivity721 (61)63 (70)0.085Erosion presence486 (56)41 (62)0.955Drug survival (months)18 (6-44)18 (4-31)0.046Concomitant csDMARDsMTX629 (34)39 (22)0.001SZP146 (8)13 (7)0.781LEF501 (27)35 (20)0.032bDMARDsAntiTNF1068 (56)73 (39)<0,001TCZ304 (16)20 (11)0,069TOFA294 (15)27 (15)0,784RTX439 (23)57 (31)0,016ABA298 (16)34 (18)0,317Response ΔESH-6 (-21-4)-18 (-36--3)0.016(12 months) ΔCRP-2 (-12-0.6)-9.3 (-28--0.1)0.014ΔDAS28-CRP-1.3 (-3--0.1)-2.2 (-3--1)0.023ΔHAQ-0.3 (-0.8-0)-0.4 (-0.8--0.1)0.114Adverse effects440 (23)32 (17)0.077Malignancy9 (0,5)3 (1.6)0.082Infection192 (10)10 (5)0.042Allergy63 (3)4 (2)0.404Dermatitis62 (3)1 (0,5)0.040Death18 (0.9)7 (4)0.004Other136 (7)11 (6)0.556

Acknowledgments :

None

Disclosure of Interests: :

None declared

AB1065 VISIT COMPLIANCE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: RESULTS FROM A GAZI UNIVERSITY FMF COHORT

Background:

Follow-up in all rheumatologic patients is critical, particularly Familial Mediterranean Fever (FMF). Current recommendations for all experts by the EULAR state that patients with FMF should be evaluated 6-monthly intervals to monitore the character and frequency of the attacks and the acute phase response. Disease-related complications such as amyloidosis can beasymptomaticand need only a careful follow-up.

Objectives:

to quantify this phenomenon and to find predictive factors of visit compliance in patients with FMF.

Methods:

The study included 474 adult patients with a diagnosis of FMF who followed at the outpatient rheumatology clinic of tertiary university hospital, from January 2018 to December 2018. . Demographic, socioeconomic data, familiy history, comorbid disease, medication history, characteristics, the International Severity Score for FMF (ISSF),autoinflammatory disease damage index (ADDI) were recorded. Visit compliance was defined as the presence of two visits in the outpatient rheumatology clinic for FMF last one year for the purposes set out in EULAR suggestion.Those who had fewer than two visits in the last one year were considered noncompliant.

Results:

230 (48.5%) were compliant while 244 (51.5 %) patients were noncompliant with their rheumatology visit. Both compliant and noncompliant patients had similar median age and disease duration. Female sex and being married was increased the visit compliance.The results of the logistic regression model exploring factors associated with compliance indicated that presence of family history in parents, absence of family history in sibling, treatment with biologic agents, other drug using,presence of more than 2 attacks except fever and adequate medical care were important predictors of visit compliance.

Conclusion:

In conclusion, if FMF patients visit compliance increase, their functionality, medication adherence and quality of life will increase and flares and complication of disease can decrease. Thus, we highlight some recommendations for FMF specialist, patients and health care providers to improve outcomes.

Table 2.

Multivariate logistic regression analysis for predictive factors of visit compliance of the patients with FMF, n=430

Adj. OR%95 CI**pFamily history in parents(positive history vs negative)1,81,0-3,10.03Family history in sibling(negative history vs positive)1,91,2-3,10.004Comorbid disease status1,30,7-2,50.32Treatment(anakinra&canakinumab vs colchicine)3,71,7-8,20.001Drug using(other drugs vs FMF drugs)2,21,1-4,40.01More than 2 attacks except fever2,31,2-4,00.004Chronic peripheral arthritis2,30,8-6,60.10Proteinuria2,20,7-6,70.14Adequate medical care1,91,2-3,10.003Number of index flare within last 12-month0,90,9-1,00.38ISSF severity score0,80,7-1,10,30

Disclosure of Interests:

None declared

AB0548 ASSESMENT OF THE PHYSICAL ACTIVITY IN SYSTEMIC SCLEROSIS PATIENTS BY USING COMMERCIAL SMART BANDS AND ITS ASSOCIATION WITH DISEASE CHARACTERISTICS: A PILOT STUDY

Background:

Systemic sclerosis (SSc) is a complex disease, characterized by multi-system organ involvement including interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). The decrease in physical activity in SSc patients with lung involvement has been demonstrated by self-reported physical capacity and 6 min-walking test (6MWT) (1, 2). Commercial smart bands can provide data on daily physical activity, sleep characteristics, blood oxygen concentration and heart rate measurement, therefore may aid in monitoring disease activity.

Objectives:

The aim of this study is to evaluate physical activity in SSc patients by using a commercial smart band and investigate its association with clinical characteristics and patient-reported outcome measures of disease activity

Methods:

This prospective observational study included SSc patients with having a smartphone. Patients characteristics including age, sex, and organ involvements were recorded. Each participant was subjected to pulmonary function tests and 6MWT. All of patients answered Scleroderma Health Assessment Questionnaire (SHAQ, consisting of HAQ-Disability Index (DI) and visual analog scales (VAS) domains). All patients received Fitbit inspire HR smart band® which records the number of steps, heart rate, distance and was instructed to wear it continuously for one week. Tracked data was collected from smartphones via Fitbit application.

Results:

Fifteen SSc patients (14 females and 1 male) participated in the study, 8 (53.3%) had limited SSc and 7 (46.7) had diffuse SSc. The mean age was 48.5±15.5 and the median disease duration was 4 (min-max:1-9) years. Eleven (73.3%) patients had ILD and one patient had PAH. Musculoskeletal complaints were evident in two patients. Forced vital capacity (FVC, % predicted), diffusion capacity of lung for carbon monoxide (DLCO, %) in patients with ILD were significantly lower than patients without ILD median (IQR) 102 (30) vs 80 (27) p= 0.026, 57 (20) vs 95 (13), p= 0.002, respectively. The median distance of 6MWTs were 450 (225) vs 568 (102) in ILD and non-ILD groups. The median total weekly step counts of ILD patients were remarkably lower in ILD patients compared to non-ILD 36.137 (17.879) vs 58.114 (80.681) steps/week, (p= 0.01). Patients with ILD had a bit higher median heart rate compared to non-ILD, 73 (9) vs 67.5 (12). The total weekly step counts were correlated with pulmonary function tests, including forced expiratory volume in one second (FEV1%) (r= 0.57, p= 0.025), FVC (%) (r= 0.65, p= 0.009), and DLCO (%) (r= 0.70, p= 0.005), patient-reported disease severity (r=-0.66, p= 0.007), and breathing problem (r= -0.55, p= 0.03) domains of SHAQ. There was no correlation between weekly step counts and 6MWT

Conclusion:

The assessment of physical activity with smart activity bands may help to identify SSc patients with ILD. Tracked physical activity using smart bands correlates with pulmonary function tests and performs better than 6MWT, suggesting it as a useful tool for the assessment of disease activity.

References:

[1]Battaglia S, Bellia M, Serafino-Agrusa L, Giardina A, Messina M, Cannizzaro F, et al. Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement.Clin Respir J(2017) 11(1):36-42.

[2]Mainguy V, Provencher S, Maltais F, Malenfant S, Saey D. Assessment of daily life physical activities in pulmonary arterial hypertension.PLoS One(2011) 6(11):e27993.

Disclosure of Interests:

None declared

AB1013 CYCLOPHOSPHAMIDE VS AZATHIOPRINE FOR THE TREATMENT OF CONNECTIVE TISSUE RELATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) is a common morbidity and mortalitiy reason for connective tissue disorders (CTD). Data related to treatment options in the literature is limited

Objectives:

To describe the role of azathiopurine (AZA) in the first line treatment of connective tissue disease related interstitial lung disease CTD-ILD, comparing with cyclophosphamide (CYC)

Methods:

Between 2009 and 2019 all interstitial lung disease patients admitting rheumatology or pulmonology department were retrospectively evaluated. Among those patients,as an first line regimen treated with either azathiopurine or cyclophospamide were included. Primary end point was FVC percentage change at 6th month.

Results:

Among 328 CTD-ILD, 57 patients had AZA treat and 79 patients had CYC for the first line treatment. Patients treated with AZA tend to have limited disease and older age. CYC treatment had a mean of 2,41% increase in FVC but in AZA -1,44% decrease in FVC predicted (p:0,041) 5 major CTD groups were defined (systemic sclerosis (SSc), rheumatoid arthritis (RA), primer sjögren syndrome (pSS), dermatomyositis/ polimyositis (PM/DM), autoimmune features of intestitial lung disease (IPAF)). AZA had similar efficacy in, PM/DM and IPAF groups but worse outcome in SSc, RA and pSS compared to CYC.

Conclusion:

AZA treatment might be an option patients with limited disease extent and the diagnosis of PM/DM or IPAF. CYC was a better treatment in SSc, RA and pSS patients

References:

[1]Kocheril, S.V., et al.,Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.Arthritis Care & Research: Official Journal of the American College of Rheumatology, 2005.53(4): p. 549-557.

Table 1.

CYC: treatment responses of cyclophosphamide and azathiopurine regimens AZA: azathiopurine CYC: cyclophosphamide, AZA: azathiopurine CTD: connective tissue disease, SSc:Systemic Sclerosis, RA: Rheumatoid Arthritis, pSS: primary sjogren syndrome, DM/PM/ASS: Dermatomyositis / Polimyositis/Antisynthetase Syndrome, IPAF: Idiopahtic interstital fibrosis with autoimmune feautres, FVC: forced vital capacity

AZA(n:43)CYC (n:72)pProgression(overall)39,3%15,3%0,013SSc (n:47)60%11,9%0,029RA(n:16)62,5%25%>0,05pSS(n:16)71,4%11,1%0,035DM/PM/ASS(n:14)11,1%->0,05IPAF(n:20)28,6%23,1%>0,05FVC change (overall) (lt)-,129±0,7410,024±0,2490,189SSc (n:47)-0,086±1810,025±0,3510,286RA(n:16)-0,553±1,521-022±0,2620,341pSS(n:16)-0,328±0,2420,014±0,3130,167DM/PM/ASS(n:14)-0,0089±0,3700,120±0,0370,316IPAF(n:20)0,123±0,3200,120±0,1010,981FVC change (overall) (%)-1,44±10,652,41±7,550,041SSc (n:47)-3,00±3,672,23±8,270,031RA(n:16)-3,50±9,65-1,75±4,650,654pSS(n:16)-6,71±15,973,33±8,350,027DM/PM/ASS(n:14)0,00±11,854,40±2,700,313IPAF(n:20)2,06±9,045,28±6,700,380

Disclosure of Interests:

None declared

FRI0109 TEMPORAL CHANGES IN LUNG NODULES DETECTED IN INDIVIDUALS WITH RHEUMATOID ARTHRITIS WITH BIOLOGIC DMARD TREATMENTS

Background:

Lung nodules in rheumatoid arthritis (RA), patients impose diagnostic and therapeutic challenges due to unpredictable outcome of these nodules. biologic (b) disease-modifying anti-rheumatic drugs (bDMARDs) are important therapeutic agents used in treatment of RA. There is hesitation about use of conventional synthetic DMARDs (csDMARD) and bDMARDs due to increased risk of nodules although their association remains unclear. There are scarce data on lung nodules observed in RA patients and systematic studies are needed.

Objectives:

The aim of this study is to evaluate effects of biologic treatments and conventional synthetic DMARDS on pulmonary nodules observed in rheumatoid arthritis patients.

Methods:

Electronic health records of RA patients who had had thorax computed tomography (CT) confirmed lung nodules in the last 5 years were retrospectively evaluated. Pre-treatment and post-treatment follow up CT images were meticulously examined for the number, size, attenuation, calcification, and cavitary formation. Demographic features, smoking status, disease characteristics and used medications were retrieved from file records. Clinical and laboratory findings, demographic features, treatment and follow-up duration, number of solid and cavitary nodules were compared between groups.

Results:

There were 21 patients in both biologic (11 females, mean age; 59.7±8.4) and csDMARD (12 females, mean age; 71.4±8.3) treated groups. There was no difference in frequency of nodule types and sizes between csDMARD and bDMARDs groups(table) despite csDMARD users were remarkably older. Administered biologic treatments were anti-TNF-alpha in 8, tofacitinib in 7, rituximab in 4, and abatacept in 2 patients. The most common types of nodules were solid and cavitary nodules, observed in 17 and 8 patients, respectively in biologic users. Calcific nodules were present in three patients, and ground glass nodules were observed in a single patient. Nodules were multiple in 12 patients and solitary in 9 patients. Calcific and ground glass nodules were all solitary in our study. Cavitary and solid nodules were concurrent in five patients. Median follow duration was 14(5-55) months. Progression was observed in small number of patients; three patients in receiving aTNFα, and one in rituximab(figure) and one in abatacept users. Interestingly none of patients receiving tofacitinib did not show progression. There was no difference regarding number of patients who progressed with either csDMARD or bDMARDs. None of the nodules showed malignant transformation within the observation period.

Conclusion:

In conclusion, risk of progression in lung nodules with biologic treatments is seem to be low, at least not more than csDMARD in short term and any malignant transformation was not observed in our study.

References:

[1]Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med. 2019 Sep;40(3):545-560. doi:10.1016/j.ccm.2019.05.003. Epub 2019 Jul 6. Review. PubMed PMID: 31376890.

Table.

Changes in nodule characteristics with respect to treatment groups.

csDMARDbDMARDsSOLID NODULESPre-treatmentTotal number of nodules, n7254Post-treatmentCompletely diminished, n514Regressed, n512Stable, n3320Enlarged, n234Cavitary transformation64De novo solid nodules267CAVITARY NODULESPre-treatmentTotal number of nodules1016Post-treatmentCompletely diminished, n01Regressed05Stable48Enlarged, n62Newly formed cavitary nodules69**

*number less than calculated due to cavitation,**de novo 5 nodules, 4 transformation from solid nodules

Figure.

Nodule progression in a patient receiving rituximab (white arrow)

Disclosure of Interests:

None declared

FRI0507 COLCHICINE INTOLERANCE IN FMF PATIENTS AND PRIMARY OBSTACLES FOR OPTIMAL DOSING

Background:

Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in substantial number of patients, due to its side effects.

Objectives:

It was aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and permanent discontinuation.

Methods:

All patients were recruited from “FMF in Central Anatolia” (FiCA) cohort, 915 adult subjects with minimum follow up time of 6 months and had compliance of treatment were included. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications and treatment features were recorded on a web based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed.

Results:

Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows; diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in 5 (0.5%) and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male gender and obesity were found to be associated with liver toxicity and having normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine intolerant patients and they had reported more frequent attacks compared to those tolerating optimal doses.

Conclusion:

Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing associated with complications.

References:

[1] Sönmez, H.E., E.D. Batu, and S. Özen,Familial Mediterranean fever: current perspectives.Journal of inflammation research, 2016.9: p. 13.

[2] Sari, İ., M. Birlik, and T. Kasifoğlu,Familial Mediterranean fever: an updated review.European journal of rheumatology, 2014.1(1): p. 21.

[3] Ozen, S., et al.,EULAR recommendations for the management of familial Mediterranean fever.Annals of the rheumatic diseases, 2016.75(4): p. 644-651.

Table 1.

Prevalence of all side effects of colchicine and reasons for drug discontinuation

Side effectAll side effectsN=172*Permanent cessationN=18*Diarrhea9911Liver toxicity544Leukopenia101Muscle toxicity52Skin reaction2-Nausea4-Infertility2-

* some patients had more than one clinically significant side effect

Table 2.

Disease course in colchicine tolerant and intolerant patients

Colchicine TolerantN=743Colchicine IntolerantN=172p valueChronic inflammation115 (15.4%)45 (26.1%)<0.001Number of attacks in the last year4.05±6.087.60±9.6<0.001Proteinuria44 (5.9 %)20 (11.6%)0.025Amyloidosis33 (% 4.4)23 (13.3%)<0.001ADDI (median)1 (1)1 (1)<0.001

ADDI: auto-inflammatory disease damage index, FMF: familial Mediterranean fever

Disclosure of Interests:

Hasan Satiş: None declared, Berkan Armagan: None declared, Erdal Bodakci: None declared, Nuh Atas: None declared, Alper Sari: None declared, Dilek Yapar: None declared, Nazife Sule Yasar Bilge: None declared, reyhan bilici salman: None declared, Gözde Kübra Yardimci: None declared, Hakan Babaoglu: None declared, Levent Kiliç: None declared, mehmet akif ozturk: None declared, Berna Goker: None declared, seminur haznedaroglu: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Timuçin Kaşifoğlu: None declared, abdurrahman tufan: None declared

SAT0544 USE OF BIOLOGICAL DMARDS IN PATIENTS WITH ADULT-ONSET STILL’S DISEASE: RESULTS FROM TURKBIO REGISTRY

Background:

Adult-onset Still’s disease (AOSD) is a rare multisystemic inflammatory disorder, and is diagnosed by exclusion. AOSD is generally treated with nonsteroidal antiinflammatory drugs, corticosteroids, and conventional disease modifiying antirheumatic drugs (cDMARDs). Biological disease modifiying antirheumatic drug (bDMARD) therapy are recommended in AOSD patients who are refractory to tradional therapy, and bDMARDs is becoming increasingly important in AOSD treatment.

Objectives:

To evaluate the use of bDMARDs and drug survival in AOSD patients.

Methods:

TURKBIO registry is the Turkish version of Danish DANBIO rheumatological database which has been established in 2011. All patients with AOSD who received biological agents registered in TURKBIO registry between dates of October 2011 and October 2019 were included in this study. The demographic data, response of therapy, frequency of using and switching biological agents were collected.

Results:

As of October, 21 AOSD patients were recruited. Mean age of patients was 34.6±7.3 (min-max: 24-49) years, mean disease duration was 9.3±7.4 (min-max: 1-22) years, and 57.1% of patients was female. Mean duration from onset to start of bDMARDs was 7±6.1 (min-max: 0.5-21) years. It was observed that 13 patients (61.9%) received tocilizumab (TCZ), 6 patients (28.6%) received IL-1 inhibitors (5 anakinra and one canakinumab), 2 patients (9.5%) received certolizumab and one patient (4.8%) received etanercept as a first-line bDMARDs. The most frequently used biological agents in current treatment were as follows: 52.4% of patients received TCZ and 33.3% received IL-1 inhibitors (4 anakinra, 3 canakinumab), and the most frequently used concomitant drugs were methotrexate (47.6%) and hydroxychloroquine (14.3%). The switching rate was 33.3%, and in half of them the reason of switching was adverse events. The median drug survival for bDMARDs was 28.6 months (Table).

Table.

Demographic, laboratory features and management of AOSD

(median;25-75)n=21Age (year)34.7 (28.3-40.6)Gender (Female) n(%)12 (57.1)Disease duration (year)8 (2-17)Duration from onset to start of bDMARs (year)6 (1.5-10)ESR (on onset)44 (21-66)CRP (on onset)65 (3.1-108)Current bDMARDs n(%) Tocilizumab11(52.4) IL-1 inhibitors7 (33.3) Etanercept1 (4.8) Certolizumab2 (9.5)Concomitant cDMARD n(%) Methotrexate10 (47.6) Leflunomide4 (19) Sulfasalazine1 (4.8) Hydroxychloroquine3 (14.3)bDMARDs Survival (months)28.6 (5.5-75)Switching Rate n(%)7 (33.3)Adverse Event n(%)3 (14.3)

Conclusion:

This is the first evaluation of AOSD patients who used biological agents from TURKBIO registry. According our data, TCZ and anti-IL1 agents were the most frequent biological choices. The limitation of this study was the low number of the patients with AOSD who used biological agents.

References:

[1].Zhou S, Qiao J, Bai J, Wu Y, Fang H. Biological therapy of traditional therapy-resistant adult-onset Still’s disease: an evidence-based review. Ther Clin Risk Manag 2018;14:167-71.

Acknowledgments:

None

Disclosure of Interests:

None declared

SAT0509 MYCOPHENOLATE MOFETIL VERSUS AZATHIOPURINE FOR THE MAINTENANCE TREATMENT OF CONNECTIVE-TISSUE RELATED INTERSTITIAL LUNG DISEASE FOLLOWING CYCLOPHOSPHAMIDE TREATMENT

Background:

Cyclophosphamide (CYC) had a good response rates when used as an induction regimen for the treatment of connective tissue related interstitial lung disease (CTD-ILD). But the safety profile of CYC necessitates the usage of a second line treatment for maintenance

Objectives:

To compare the effect of mycophonetil (MMF) and azatiyopurin (AZA) for maintanance therapy following cyclophsphomide treatment in CTD-ILD

Methods:

Between 2009 and 2019 all interstitial lung disease patients admitting rheumatology or pulmonology department were retrospectively evaluated and patients treated with cyclophospamide as an induction regimen and having not progression were selected. Among those, as a second line regimen treated with MMF or AZA were included. Primary end point was treatment responses at 6th months

Results:

68 patients treated with CYC for the first line treatment. 46 patients treated with either MMF (n:22) or AZA (n:24) for the maintenance. Scleroderma patients were the largest group and consituted 63% of the population. MMF group had worse FVC values and more involvement in lung paranchyme at the begining of the treatment. In univariate analysis FVC (lt) values and lung involvement (%) on HRCT at the start of the treatment, and disease subtype were associated significantly with treatment responses.After adjusted with these factors, in multivariate analysis, AZA treatment was associated with the increased risk of progression (odds ratio 5,8, 95% CI 1,061-31,09) as compared with MMF treatment

Conclusion:

MMF had better results compared to AZA in the treatment of CTD-ILD,after the usage of CYC treatment.

References:

[1]Barnes, H., et al.,Cyclophosphamide for connective tissue disease-associated interstitial lung disease.Cochrane Database Syst Rev, 2018.1(1): p. Cd010908.

Table 1.

Patient and disease characteristics at the start of the treatment and treatment responses at the 6th months of the treatment: FVC forced vital capacity

MMF (22)AZA (24)pLung involvement (%)36%23,3%0,022FVC (lt)1,962,550,021FVC (%)71%81%<0,001FVC change at 6th month (lt)-,02-0,190,051FVC change at 6th month (%)-0,42-5,810,068Progression23,8%50%0,118

Disclosure of Interests:

None declared

Validity and reliability study of the Turkish version of SACRAH (Score for Assessment and quantification of Chronic Rheumatic Affections of the Hands)

Rheumatic diseases cause deformities in the hands and affect daily living activities. Therefore, assessment of hand disabilities is important in rheumatic disease. The aim of this study was to test the validity and reliability of the Turkish version of the A Score For Assessment and Quantification of Chronic Rheumatic Affections of the Hands (SACRAH). A translation and back-translation of the SACRAH were performed, according to the Beaton guidelines. Patients who were between 18-65 years old, who were literate in Turkish, who had rheumatic disease diagnosis and whose hands were affected, were included in the study. Patients who were using a splint during daytime were excluded from the study. They completed the Turkish version of Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH-T) once and the final version of the SACRAH Questionnaire twice with a 7 days' interval. The internal consistency (Cronbach's α) and reliability (test-retest reliability) of the questionnaire were assessed. Besides, correlations between SACRAH and DASH-T scores were analyzed using the Spearman correlation coefficient. One hundred and twenty patients participated in the study. The Turkish version of the SACRAH met set criteria of reliability and validity. Internal consistency was excellent (Cronbach's α=0.88) and test-retest reliability were very good (r=0.73). SACRAH showed a positive and statistically significant correlation with DASH-T scores (r=0.83, p<0.001). Our results show that the Turkish version of the SACRAH has excellent test-retest reliability and validity. As a result of this study we determined that SACRAH is a valid and reliable instrument for assessing functional status and subjective manual function in Turkish-speaking patients.

Frequency, characteristics, and clinical determinants of 'prodrome' in familial Mediterranean fever patients

Objective: Prodrome is defined by manifestations that precede a familial Mediterranean fever (FMF) attack and predict its emergence. We aimed to determine the frequency, characteristics, and clinical determinants of prodrome in patients with FMF.Method: This cross-sectional study was conducted in a tertiary rheumatology clinic. During the clinical interview, all patients completed a standardized questionnaire about the pre-attack period. Prodrome was defined as the presence of any recurrent pre-attack manifestation occurring at least 4 h before an attack. Patients were classified according to whether they had prodrome of any kind of attack.Results: The study enrolled 401 patients aged 37.7 ± 11.0 years (mean ± sd). Male gender, M694V/M694V, homozygous MEFV mutation, peritonitis, pleuritis, and arthritis were more frequent in prodrome-positive patients. Altogether, 141 patients (35.2%) had prodrome. Male gender and ever having attack types of peritonitis or arthritis were independent clinical determinants of prodrome [relative risk (95% confidence interval): 1.72 (1.07-2.76), p = 0.02; 4.27 (1.80-10.1), p = 0.001; 1.77 (1.04-3.04), p = 0.04, respectively]. Age, MEFV mutations, pleuritis, and erysipelas-like erythema were not clinical determinants.Conclusions: All FMF patients, particularly males and patients who had peritonitis or arthritis at any time, should be questioned about prodrome. Prodrome should be analysed in terms of elucidating the pathogenesis of FMF and as an opportunity for a secondary prevention strategy for impending attacks. This study may shed light on prodrome for future cytokine or drug studies with the purpose of developing new cost-effective treatment protocols irrespective of colchicine resistance.

Chronic inflammation in adult familial Mediterranean fever patients: underlying causes and association with amyloidosis

Background: Chronic inflammation, as determined by persistently elevated acute-phase reactants in attack-free periods, can occasionally be observed in patients with familial Mediterranean fever (FMF) and is suggested to be a risk factor for the development of amyloidosis. We aimed to investigate the underlying causes of chronic inflammation in FMF patients and its association with amyloidosis in long-term follow-up. Method: Electronic medical records of FMF patients who had regular follow-up for ≥ 5 years in our cohort were utilized. As part of routine evaluation, detailed history, physical examination, and pertinent laboratory and radiographic investigations were performed in all patients to determine potential causes of elevated C-reactive protein (CRP) levels. Results: The study included 146 FMF patients who had no evidence of amyloidosis at baseline and had regular follow-up for ≥ 5 years. Thirty-seven patients (25.3%) were found to have chronic inflammation in the disease course. Twenty-five (67.5%) of them had either very frequent attacks or chronic manifestations of disease. In the entire study group, amyloidosis developed in five patients (3.42%) during the 5 year follow-up, four in the FMF with chronic inflammation group (10.8%), and only one of the 109 patients without chronic inflammation (odds ratio 13.09, 95% confidence interval 1.41-121.2). Conclusions: The results suggest that persistently high CRP levels during the attack-free periods may be a strong risk factor for the development of amyloidosis in patients with FMF. The vast majority of FMF patients with chronic inflammation had active FMF.

Disease-specific quality of life in patients with lupus nephritis

Background

Patient-reported outcomes in lupus nephritis (LN) are not well studied. Studies with disease-targeted PRO tool in LN do not exist. Herein, we describe quality of life (QOL: HRQOL & non-HRQOL) among LN patients using LupusPRO.

Methods

International, cross-sectional data from 1259 patients with systemic lupus erythematosus (SLE) and LupusPRO were compared, stratified by (a) presence of LN (ACR classification criteria (ACR-LN)) at any time and, (b) active LN (on SLEDAI) at study visit. Damage was assessed by SLICC/ACR-SDI. Multivariate regression analyses for QOL against ACR-LN (active LN) after adjusting for age, gender, ethnicity and country of recruitment were performed.

Results

Mean (SD) age was 41.7 (13.5) yrs, 93% were women. Five hundred and thirty-nine of 1259 SLE patients had ACR-LN. ACR-LN group was younger, were more often on immunosuppressive medications, had worse QOL on lupus medications and procreation than non-ACR-LN patients. HRQOL and non-HRQOL scores were similar in both groups. One hundred and twenty-nine of 539 ACR-LN patients had active LN. Active LN group was younger, had greater disease activity and had worse HRQOL and non-HRQOL compared to patients without active LN. Specific domains adversely affected were lupus symptoms, lupus medications, procreation, emotional health, body image and desires-goals domains. Patients with ACR-LN and active LN fared significantly worse in lupus medications and procreation HRQOL domains, even after adjusting for age, ethnicity, gender and country of recruitment.

Conclusions

Lupus nephritis patients have poor QOL. Patients with active LN have worse HRQOL and non-HRQOL. Most domains affected are not included in the generic QOL tools used in SLE. LN patients must receive discussion on lupus medications and procreation issues. Patients with active LN need comprehensive assessments and addressal of QOL, along with treatment for active LN.

The relationship between hip joint space width, center edge angle and acetabular depth

OBJECTIVE

Radiographic parameters used to define acetabular dysplasia may be related to anthropological characteristics independent of dysplasia. The goal of the present study was to investigate the relationship between the minimal joint space width (JSW) of the hip and the parameters that define acetabular dysplasia, in clinically normal subjects.

DESIGN

One hundred and eighteen patients who underwent supine abdominal radiography for non-rheumatological indications and had no hip pain or history of hip arthritis were evaluated. JSW was quantified manually using dial calipers, and center edge (CE) angle and acetabular depth were measured for each hip.

RESULTS

CE angle, but not acetabular depth, correlated (inversely) with the minimal hip JSW (r=-0.26 and -0.20, P=0.005 and 0.038, R (right) and L (left) hips, respectively). CE angle inversely correlated with the pelvic width (r=-0.27 and 0.27, P=0.003 and 0.004, R and L hips, respectively) and acetabular depth correlated with subject's height (r=0.27 and 0.42, P=0.008 and <0.001 R and L hips, respectively) and leg length (r=0.27 and 0.45, P=0.008 and <0.001, R and L hips, respectively). Also, pelvic width correlated significantly with the JSW (r=0.27 and 0.20, P=0.003 and 0.033, for R and L hips, respectively).

CONCLUSIONS

The radiographic parameters used to define acetabular dysplasia, CE angle and acetabular depth, are strongly associated with anthropological variables and CE angle is associated with minimal JSW of the hip. It is important to recognize that height and limb length variability may affect radiographic parameters of acetabular dysplasia, and thus may falsely suggest the presence of anatomic abnormalities in some patients.

Bone mineral density in the proximal tibia varies as a function of static alignment and knee adduction angular momentum in individuals with medial knee osteoarthritis

Based on the premise that bone mass and bone geometry are related to load history and that subchondral bone may play a role in osteoarthritis (OA), we sought to determine if static and dynamic markers of knee joint loads explain variance in the medial-to-lateral ratio of proximal tibial bone mineral density (BMD) in subjects with mild and moderate medial knee OA. We utilized two surrogate markers of dynamic load, the peak knee adduction moment and the knee adduction angular momentum, the latter being the time integral of the frontal plane knee joint moment. BMD for medial and lateral regions of the proximal tibial plateau and one distal region in the tibial shaft was measured in 84 symptomatic subjects with Kellgren and Lawrence radiographic OA grades of 2 or 3. Utilizing gait analysis, the peak knee adduction moment (the external adduction moment of greatest magnitude) and the time integral of the frontal plane knee joint moment (the angular momentum) over the entire stance phase as well as for each of the four subdivisions of stance were calculated. The BMD ratio was not significantly different in grade 2 (1.32 +/- 0.27) and grade 3 knees (1.47 +/- 0.40) (P = 0.215). BMD of the tibial shaft was not correlated with any loading parameter or static alignment. Of all the surrogate gait markers of dynamic load, the knee adduction angular momentum in terminal stance explained the most variance (20%) in the medial-to-lateral BMD ratio (adjusted r(2) = 0.196, P < 0.001). The knee adduction angular momentum for the entire stance phase explained 18% of the variance in the BMD ratio (adjusted r(2) = 0.178, P < 0.001), 10% more variance than explained by the overall peak knee adduction moment (adjusted r(2) = 0.081, P < 0.001). 18% of the variance in the BMD ratio was also explained by the knee alignment angle (adjusted r(2) = 0.183, P < 0.001), and the total explanatory power was increased to 22% when the knee adduction angular momentum in terminal stance was added (change in r(2) = 0.041, P < 0.05, total adjusted r(2) = 0.215, P < 0.001). The BMD ratio and its relationship to dynamic and static markers of loading were independent of height, weight, and the body mass index, demonstrating that both dynamic markers of knee loading as well as knee alignment explained variance in the tibial BMD ratio independent of body size.

Serum interleukin 17 and interleukin 18 levels in familial Mediterranean fever

OBJECTIVE

Familial Mediterranean fever (FMF) attacks are characterized by serosal inflammation rich in PMNL leukocytes and activation of a definite cytokine network. Moreover, there is sustained inflammation in attack-free FMF patients. Interleukin (IL)-17 and IL-18 are recently described proinflammatory cytokines, which can modulate certain neutrophil functions. In this study we measured serum levels of IL-17 and IL-18 in FMF patients.

METHODS

The study groups comprised of 18 FMF patients in attack-free period (mean age: 30.2 +/- 9.5 years; male/female: 10/8), and 18 patients with an acute FMF attack (mean age: 25.4 +/- 4.9 years; male/female: 10/8). Twenty age-matched healthy subjects were included as a control group (male/female: 10/10). Levels of IL-17 and IL-18 were determined by commercial ELISA kits (Biosource International, USA).

RESULTS

Serum IL-17 levels were 42.8 +/- 3.7, 42.7 +/- 3.2, and 39.9 +/- 2.3 pg/mL for FMF patients in attack-free period, FMF patients with acute attack, and healthy controls, respectively. Serum IL-18 levels were 878.8 +/- 315.0, 854.2 +/- 261.4, and 314.6 +/- 80.8 pg/mL for FMF patients in an attack-free period, FMF patients with acute attack, and healthy controls, respectively. Levels of both IL-17 and IL-18 were significantly higher in FMF patients with and without acute attack compared to control group (p < 0.05). Concentrations of those cytokines were comparable in FMF patients with acute attack and in attack-free period (p > 0.05).

CONCLUSION

Our data suggest that IL-17 and IL-18 contribute to the cytokine network in the inflammatory cascade of FMF. However, their roles for the initiation of FMF attacks remain to be established.

The effects of rofecoxib on 24-h ambulatory blood pressure and heart rate monitoring in patients with hypertension and osteoarthritis

The aim of the study was to investigate the effects of the cylooxygenase (COX)-2 specific inhibitor rofecoxib, on blood pressure (BP) and heart rate (HR) in patients with well-controlled hypertension and osteoarthritis via 24-h ambulatory monitoring. Thirty patients with well controlled hypertension were included. Fifteen patients had osteoarthritis and were recommended by their rheumatologists to take rofecoxib 12.5 mg/day (rofecoxib group). The control group consisted of 15 patients who had hypertension but no clinical osteoarthritis and did not receive any anti-inflammatory drugs. Twenty-four-hour ambulatory monitoring of BP and HR were performed on the day before initiation of rofecoxib therapy and on days 3 and 14 of COX-2 therapy. The control group underwent 24-h monitoring three times at similar intervals. Antihypertensive medications were continued. On day 3 of rofecoxib therapy, mean HR for both daytime and nighttime were lower than those at baseline. On day 14, the changes in mean HR did not differ from baseline values. Similarly, diastolic BP (daytime and nighttime) on day 3 appeared to be lower than at baseline. However this difference was not observed on day 14, and mean daytime and nighttime diastolic BP returned to baseline values. There was no statistically significant difference in the mean arterial pressure or systolic BP recordings on days 3 or 14 than at baseline. Rofecoxib 12.5 mg/day did not significantly increase BP during 24-h ambulatory BP monitoring in patients with well-controlled hypertension and osteoarthritis.