Cross-cultural adaptation, validity and rehability of the QUIPA tool: Turkish version

The Quality Indicators for Physiotherapy Management of Hip and Knee Osteoarthritis (QUIPA) is the only patient-reported outcome measure to assess the quality indicators of physiotherapy management of hip/knee osteoarthritis (OA). It consists of 3 subscales and a total of 18 questions. The purpose of this research was to translate and adapt the QUIPA into the Turkish language using a cross-cultural approach as well as test its validity and reliability for Turkish-speaking patients with hip/knee OA. Ninety-two patients with hip/knee OA were enrolled in the research. The cross-cultural adaptation of the QUIPA was performed according to guidelines defined by Beaton et al. Participants completed the QUIPA tool twice at an interval of 7 days. Test-retest reliability and internal consistency were determined by interpreting the intraclass correlation coefficient (ICC) and Cronbach’s alpha coefficient, respectively. Construct validity was tested via exploratory factor analysis. For the first, second, and third subscales and total score of QUIPA, ICC was found to be 0.895, 0.947, 0.665, and 0.925, respectively. Cronbach’s alpha coefficient was 0.682, 0.797, 0.593, and 0.812. The Exploratory Factor Analysis demonstrated that the QUIPA tool is based on 3 factors. These results indicate that the Turkish version of the QUIPA has excellent test-retest reliability and good internal consistency. Therefore, the Turkish version of the QUIPA seems to be a valid and reliable tool to assess the quality indicators of physiotherapy management of hip/knee OA in Turkish-speaking patients. It is intended to be used in clinical settings and research works.

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

POS1481-HPR CROSS-CULTURAL ADAPTATION, VALIDITY AND RELIABILITY OF THE QUIPA TOOL: TURKISH VERSION

Background

The Quality Indicators for Physiotherapy Management of Hip and Knee Osteoarthritis (QUIPA) is the only patient-reported outcome measure assessing the quality indicators of physiotherapy management of hip/knee osteoarthritis (OA). It consists of 3 subscales and a total of 18 questions.

Objectives

The purpose of this research was to translate and cross-culturally adapt the QUIPA into the Turkish language and test its validity and reliability in Turkish-speaking patients with hip/knee OA.

Methods

Ninety-two patients with hip/knee OA were enrolled in the research. The QUIPA was cross-culturally adapted according to guidelines defined by Beaton et al. Participants completed QUIPA tool twice, with an interval of 7 days. Construct validity was tested via Exploratory Factor Analysis. Test-retest reliability and internal consistency were determined interpreting Intraclass Correlation Coefficient (ICC) and Cronbach’s alpha coefficient, respectively.

Results

The Exploratory Factor Analysis demonstrated that QUIPA has 3 factors. For the first, second and third subscales and total score of QUIPA, ICC was found to be as 0.895, 0.947, 0.665, and 0.925, respectively. Cronbach’s alpha coefficient was determined to be as 0.682, 0.797, 0.593, and 0.812, respectively for the first, second and third subscales and total score of QUIPA. These results indicate that Turkish version of QUIPA has excellent test-retest reliability and good internal consistency.

Conclusion

Turkish version of the QUIPA determined to be a valid and reliable tool to assess the quality indicators of physiotherapy management of hip/knee OA in Turkish-speaking patients. It is suggested to be used in clinical settings and researchs.

References

[1]Teo PL, Hinman RS, Egerton T, et al. Patient-reported quality indicators to evaluate physiotherapy care for hip and/or knee osteoarthritis-development and evaluation of the QUIPA tool. BMC musculoskeletal disorders, 2020; 21(1):1-11.

[2]Beaton DE, Bombardier C, Guillemin F, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 2000; 25(24):3186-3191.

Table 1.

Test-retest reliability analysis of the QUIPA

QUIPAICC95% CI (Lower-upper bound)1st question0.8140.731-0.8732nd question0.6860.560-0.7803rd question0.7820.688-0.8504th question0.6550.521-0.7585th question0.7270.614-0.8116th question0.6160.471-0.7287th question0.7680.669-0.8418th question0.6310.490-0.7399th question0.7230.609-0.80810th question0.7850.692-0.85311th question0.8790.812-0.92312th question0.7720.674-0.84313th (a) question0.8420.770-0.89213th (b) question0.7520.615-0.84514th question0.5430.381-0.67215th question0.4980.327-0.63716th question0.5140.347-0.65017th question0.8660.804-0.9091st Subscale, (Q1-Q6)0.8950.845-0.9292nd Subscale, (Q7-Q13)0.9470.921-0.9653rd Subscale, (Q14-Q17)0.6650.534-0.765Total0.9250.888-0.950

ICC: Intraclass correlation coefficient, CI: Confidence interval

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

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

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

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.

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.

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.

Joint hypermobility and primary fibromyalgia: a clinical enigma

OBJECTIVE

To investigate the association of joint hypermobility (JH) and primary fibromyalgia (FM).

METHODS

Eighty-eight patients admitted with widespread pain and 90 matched healthy controls were blindly evaluated according to criteria for the presence of JH and FM.

RESULTS

Fifty-six patients initially recognized as having FM met the American College of Rheumatology (ACR) diagnostic criteria for FM and 6 of 90 healthy controls had these criteria at the subsequent blinded examination. The frequency of JH was 8% in patients with FM and 6% in subjects without FM (p > 0.05). Interestingly, JH was found in 10 of 32 "FM" patients (31%) who had not exactly met the ACR criteria for FM. The occurrence of JH was more common in these patients compared to controls (p < 0.001). In total, 16% of patients evaluated with widespread pain had associated with JH.

CONCLUSION

Some patients who have clinical symptoms of FM but do not exactly meet the ACR criteria could in fact have JH, and these patients may be misdiagnosed as having FM. Widespread pain is associated with JH in women under age 50, with some of them fulfilling ACR tender point criteria for FM.

Effects of interferon-alpha2a treatment on serum levels of tumor necrosis factor-alpha, tumor necrosis factor-alpha2 receptor, interleukin-2, interleukin-2 receptor, and E-selectin in Behçet's disease

This study was performed to investigate serum levels of various cytokines and E-selectin in patients with Behçet's disease (BD) before and after treatment with interferon-alpha2a (IFN-alpha). The study population consisted of 22 patients with active BD; 15 age- and sex-matched healthy adults served as the control group. IFN-alpha (3 million units subcutaneously) was given to all patients twice a week for 3 months. Twenty of twenty-two patients experienced clinical improvement with this therapy. Pre- and post-treatment serum levels of tumor necrosis factor-alpha (TNF-alpha), TNF-alpha2-receptor (TNFalpha2R), interleukin-2 (IL-2), IL-2 receptor (IL-2R), and E-selectin were measured by sandwich-type enzyme immunoassay. Baseline E-selectin, TNF-alpha, and TNF-alpha2R levels of the patients were increased in comparison with the control group and post-treatment values. However, IL-2 and IL-2R levels did not change either with treatment or compared with the control group levels. In conclusion, these results confirm the previously described efficacy of IFN-alpha in the treatment of BD. Serum levels of TNF-alpha, TNF-alpha2R, and E-selectin are prominently increased during active stage of the disease, indicating presence of immune system activation and endothelial injury/activation. Improvement of the pathological cytokinemia and endothelial disturbance accompany interferon-alpha-induced disease remission.

Five-year results of the treatment of 23 patients with immunoproliferative small intestinal disease: a Turkish experience

BACKGROUND

Currently, there is no agreement regarding optimal treatment strategies for immunoproliferative small intestinal disease (IPSID). In this article, the authors report the treatment outcomes of a group of 23 Turkish patients with IPSID.

METHODS

Between December 1988 and July 1993, 23 consecutive patients with IPSID, including 5 with secretory type, were included in the study. Seven patients with Stage A disease (according to the criteria of Galien et al.) received tetracycline (1 g/day, orally) for a median duration of 7 months (range, 6-11 months) initially, whereas the remaining patients (9 Stage B patients and 7 Stage C patients) received combination chemotherapy (cyclophosphamide, vincristine, procarbazine, and prednisolone [COPP regimen]) followed by tetracycline at a dose of 1 g/day for 6 more months in patients with complete response (CR) after the COPP regimen.

RESULTS

The median follow-up was 68 months (range, 38-89 months). As first-line therapy in Stage A patients, tetracycline yielded a 71% CR and 43% disease free survival (DFS) rate. Eleven of 16 patients (69%) with Stage B or C disease who received the COPP regimen achieved CR and only 2 patients had a recurrence (DFS rate of 56%). The 5-year overall survival (OAS) rate for the entire group was 70%, and the 5-year DFS rate for patients with CR was 75%. However, the median OAS for 3 patients with immunoblastic lymphoma was only 7 months.

CONCLUSIONS

The COPP regimen, with its acceptable toxicity, appears to be a good alternative as a first-line treatment for patients with Stage B or C IPSID with low grade lymphoma whereas tetracycline appears to be the initial treatment of choice for patients with Stage A disease.