Clinical characteristics of patients with connective tissue disease-related interstitial lung disease: a retrospective analysis

INTRODUCTION

Interstitial lung disease is one of the most critical manifestations of connective tissue diseases that may cause morbidity and mortality. This study aimed to evaluate the clinical and demographic characteristics and treatment of the patients with connective tissue disease-related interstitial lung disease.

METHOD

This retrospective observational study included patients from the Gulhane Rheumatology Interstitial Lung Disease cohort between October 2016 and June 2023. The patients were assessed retrospectively.

RESULTS

A total of 173 patients were included in the study with a mean age of 63.4 ± 11.9 years. The frequencies of CTD were 34.1% Sjogren's syndrome, 30.1% rheumatoid arthritis, 25.4% systemic sclerosis, 5.8% undifferentiated connective tissue disease, 2.9% idiopathic inflammatory myositis, 1.2% mixt connective tissue disease, and 0.6% systemic lupus erythematosus in decreasing frequencies. Nonspecific interstitial pneumonia, which was the most common interstitial lung disease pattern in 103 (59.5%) patients, was most frequent among patients with SS and SSc (p < 0.001 vs. p < 0.001). Usual interstitial pneumonia was most frequent among patients with RA (p < 0.001). All patients received immunosuppressive treatment, most commonly azathioprine. 57.2% were using immunosuppressives for ILD. Six patients had mortality, and infections were the leading cause.

CONCLUSIONS

As a critical manifestation of connective tissue diseases, immunosuppressive treatment is indispensable in the management of interstitial lung diseases especially those at an increased risk for progression. The treatment approaches should be assessed in a patient-based way. The patients under immunosuppressive treatment should be cautiously followed for infections. Key Points • Interstitial lung disease is a noteworthy manifestation of connective tissue diseases. • The clinical findings, treatment requirements, and progression vary according to the severity of the disease. • Immunosuppressive treatment may be essential in patients with worsening symptoms, impaired pulmonary function tests, and radiological findings.

POS1184 EPIDEMIOLOGICAL CHARACTERISTICS OF VIRAL HEPATITIS IN PATIENTS WITH RHEUMATIC DISEASES – IMPLICATIONS FROM TREASURE DATABASE

Background

Recent epidemiological data on HBV and HCV in Turkey revealed that the seroprevalence rates of hepatitis B surface antigen and antibody against HCV were 4% and 1%, respectively, and seropositivity rates for hepatitis B surface antibody and hepatitis B core antibody were 31.9% and 30.6%, respectively. A previous multicenter nationwide study conducted in Turkey reported that the HBsAg positivity was determined in 2.3% of patients with rheumatoid arthritis (RA) and 3% of patients with ankylosing spondylitis (AS), and the anti-HCV positivity was detected in 1.1% of patients in each group. Given these rates, viral hepatitis is still considered a potential threat to patients with rheumatic diseases, specifically for the treatment-related viral reactivation.

Objectives

This study aimed to evaluate the serologic HBV and HCV frequency and clinical characteristics among our patients with RA or SpA and receive biological treatments based on this background.

Methods

The prospective TReasure database, which observationally collects data of patients with rheumatic diseases from fifteen centers across Turkey, was analyzed for viral hepatitis, patient characteristics, and treatments used. TReasure registry study protocol, and the data collection was started on December 2017. At the time of the analysis for this study was performed, the registry database included 3147 patients with RA and 6071 patients with SpA. For hepatitis B; Hepatitis B surface antigen (HBsAg), anti-HBV core antibody (anti-HBc) and anti-HBV surface antibody (Anti-HBs) tests were evaluated. HBV-DNA was studied in HBsAg positive patients. Anti-HCV antibody has been studied for HCV. The clinical and serological HBV reactivation in the follow-up of the patients was evaluated by looking at the HBV-DNA viral loads.

Results

A total of 9218 patients (3147 RA and 6071 patients with SpA) were included in the analyses. The screening rate for HBV was 97% in RA and 94.2% in SpA groups. HBsAg positivity rates were 2.6% and 2%, anti-HBs positivity rates were 32.3% and 34%, anti-HBc positivity rates were 20.3% and 12.5%, HBV DNA positivity rates were 3.5% and 12.5%, and anti-HCV positivity rates were 0.8% and 0.3% in these groups, respectively (Table 1).

Table 1.

Serological analyses in the study group

RASpApNn (%)Nn (%)Hepatitis testing28962809 (97.0)54445130 (94.2)<0.001HBsAg positivity275071 (2.6)501799 (2)0.080Anti-HBs positivity2708876 (32.3)48931663 (34)0.147Anti-HBc positivity2362480 (20.3)4194524 (12.5)<0.001HBV-DNA positivity45416 (3.5)63735 (5.5)0.129Anti-HCV positivity260222 (0.8)462716 (0.3)0.005

The HBsAg (+) patients were older and had higher comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, RF positivity was more in HBsAg(+) cases. The most frequently prescribed bDMARDS were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group, whereas adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. HBV reactivation was observed in one patient with during RA treatment, who received rituximab and prophylaxis with tenofovir.

Figure 1.

Prescription proportions of medications in the rheumatoid arthritis (RA) and spondyloarthritis (SpA) groups

Conclusion

The epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the most comprehensive registries in rheumatology practice. According to the results of our study; It can be thought that there is no risk in the choice of treatment by the rheumatologist in patients who receive appropriate prophylaxis.

Disclosure of Interests

None declared

AB0533 THE ASSESSMENT OF CLINICAL CHARACTERISTICS OF MALE SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background

Systemic lupus erythematosus (SLE) is a multisystemic chronic autoimmune disease that is nine times more frequent among females. Due to a female dominancy, the data regarding male patients is limited.

Objectives

This study aimed to evaluate the clinical characteristics of male patients with SLE.

Methods

This retrospective study included male SLE patients who followed up in a tertiary rheumatology outpatient clinic between October 2016 and December 2021. Those who met the Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. The data of the patients and SLE Disease Activity Index-2000 (SLEDAI-2K) values were obtained from files.

Results

There were 40 male SLE patients with a mean age of 42.7 ± 17.3 years. The median age of diagnosis was 30 years, and the median disease duration was 63.5 months (ranges between 5-444). The mean value of the SLICC score was 4.7 ± 0.8. The most frequent initial clinical manifestations were thrombocytopenia and photosensitivity, which were seen in 8 (9.6%) patients each (Table 1). Six (15%) patients had secondary antiphospholipid antibody syndrome. Thirty-five (87.5%) patients achieved remission, but 14 (35%) patients had at least one relapse in the follow-up period. The most frequent manifestation after relapse was nephritis in 9 (22.5%) patients that had no renal involvement at the time of diagnosis. The median SLEDAI score was 2 (ranges between 0-12). The most commonly preferred drug for the treatment was hydroxychloroquine and corticosteroids (92.5% for each). Nineteen (47.5%) patients received pulse steroids. Besides, the most frequently prescribed immunosuppressive drug was mycophenolate mofetil (37.5%). The rates of azathioprine, cyclophosphamide, methotrexate, cyclosporine A, rituximab, intravenous immunoglobulin, and leflunomide usage were 30%, 27.5%, 17.5%, 10%, 7.5%, 7.5%, 5%, respectively. Antinuclear antibody (ANA) was positive in 35 (87.5%) patients, and anti-dsDNA was positive in 9 (22.5%). The median level of anti-dsDNA titers was 40 IU/ml (ranges between 23-200). Other autoantibody positivity rates were; 12 (30%) for anti-Sm, 6 (15%) for anti-histon, 4 (10%) for anti-RNP and 4 (10%) for anti-nucleosome. Thirteen (32.5%) patients had low C3 levels, and 11 (27.5%) patients had low C4 levels. The hospitalisation rate was 55%, and no death was seen during follow-up.

Table 1.

Clinical characteristics of the patients (n=40)

CharacteristicsPatients   Clinical manifestations, n(%)InitialRelapseThrombocytopenia8 (20)None   Photosensitivity8 (20)None   Anemia7 (17.5)NoneMalar rash6 (15)2 (15)   Nephritis6 (15)9 (22.5)Arthiritis/synovitis5 (12.5)6 (15)Subacute lesions4 (10)2 (5)   Leukopenia/lymphopenia4 (10)NoneThrombosis3 (7.5)4 (10)Neurological involvement3 (7.5)NoneSerositis2 (5)2 (5)Pulmonery involvement2 (5)None   Discoid lupus erythematosus1 (2.5)1 (2.5)   Myositis1 (2.5)None

Conclusion

Since SLE is more prevalent among females, it may occur in male patients with mild or life-threatening manifestations. In the current study, the seropositivity was less than in the literature, which may indicate male patients should be cautiously evaluated. Although renal involvement is not an initial manifestation, it may develop during the follow-up.

Disclosure of Interests

None declared

POS1357 THE 10-YEAR OUTCOME OF PATIENTS WITH BEHCET’S SYNDROME: A SINGLE-CENTER EXPERIENCE

Background

Behcet’s syndrome (BS) is a vasculitis characterized by recurrent oral and genital ulcers, as well as ocular, cutaneous, vascular, gastrointestinal, musculoskeletal, and central nervous system manifestations.

Objectives

The study aimed to evaluate the 10-year outcome of patients with BS.

Methods

A cohort of 682 patients diagnosed with BS between January 2007 and December 2009 in the rheumatology outpatient clinic of Gulhane Training and Research Hospital were re-evaluated in November 2021. The data regarding the clinical course of 84 patients (84/682) were obtained from patients’ files and detailed telephone interviews.

Results

The study included 84 patients (63 male, 21 female) with a mean age of 47.1±10.6 years. The mean disease duration was 17.6±5.7 years. At the time of the diagnosis, the mean age of the patients was 29.5±9.4 years. Oral ulcer (100%), papulopustular lesions (82.1%), genital ulcer (77.4%), and erythema nodosum (59.5%) were the most frequent manifestations at the time of diagnosis. Ocular (46.4%), musculoskeletal (35.7%), vascular (19%), gastrointestinal (3.6%), and neurological (1.2%) manifestations were seen in decreasing frequency. The most frequent ocular disease was posterior uveitis, whereas superficial thrombophlebitis and deep venous thrombosis were the most prevalent forms of vascular involvement. One patient had transverse myelitis as neurological involvement. Colchicine (88.1%) and corticosteroids (57.1%) were the most preferred drugs for the initial treatment. Fifty-one (60.7%) patients received at least one immunosuppressive agent. After 10-year, there was a statistically significant decrease in all manifestations of BS (Table 1). Nevertheless, 9 (10.7%) patients (8 male, 1 female) had new clinical findings. Five patients had (5.9%) mucocutaneous, 2 (2.4 %) arthritis and 2 (2.4%) vascular lesions as new clinical manifestations. The mean age of the patients with newly onset clinical findings was 48±8.9 years. There was no statistically significant difference between patients with and without new clinical findings with respect to age (p=0.79). The new onset mucocutaneous manifestations were genital ulcer and erythema nodosum. Besides, new onset vascular lesions were superficial and deep venous thrombosis of the lower extremities. The mean age of the patients who developed venous thrombosis at the time of the assessment was 37.0±7.07 years. Vascular involvement was detected more frequently in younger patients (p=0.03). However, ocular involvement is a frequent symptom after mucocutaneous involvement at the beginning, none of the patients had new eye involvement at the end of the follow-up. Colchicine, corticosteroid, and azathioprine were associated with the highest drug survival. Twenty-one (41.1%) patients of who were administered immunosuppressive agents as initial therapy were still using immunosuppressives 10 year later. The most frequently prescribed immunosuppressives were azathioprine and cyclosporine during the follow-up.

Table 1.

Clinical manifestations of Behcet’s syndrome

InitialAfter 10 yearspNoYesOral ulceration, n (%)No000<0.001*Yes84 (100)42 (50)42 (50)Genital ulceration, n (%)No19 (22.7)16 (84.2)3 (15.8)<0.001**Yes65 (77.4)54 (83.1)11 (16.9)Erythema nodosum and Papulopustular lesions, n (%)No6 (7.1)4 (66.7)2 (33.3)<0.001**Yes78 (92.9)44 (56.4)34 (43.6)Arthritis, n (%)No54 (64.3)52 (96.3)2 (3.7)<0.001**Yes30 (35.7)21 (70)9 (30)Vascular involvement, n (%)No68 (81)66 (97.1)2 (2.9)0.013**Yes16 (19)12 (75)4 (25)Gastrointestinal involvement, n (%)No81 (96.4)81 (100)0<0.001*Yes3 (3.6)3 (100)0Ocular involvement, n (%)No45 (53.6)45 (100)0<0.001**Yes39 (46.4)29 (74.4)10 (25.6)Neurological involvement, n (%)No83 (98.8)83 (100)0<0.001*Yes1 (1.2)1 (100)0

*McNemar-Bowker Test, **McNemar Test

Conclusion

The frequency of newly onset clinical manifestations decreases with age in BS, especially after age 40. Besides, especially male Behcet’s patients should be followed-up regularly for complications that may develop regardless of age.

Disclosure of Interests

None declared

POS1195 CAN PRE-TREATMENT INFLAMMATORY BIOMARKER LEVELS GUIDE TO DETERMINE APPROPRIATE TIME OF TOCILIZUMAB THERAPY IN COVID-19

Background

Due to the pleiotropic cytokine interleukin-6 (IL-6) plays a pivotal role in the pathogenesis of COVID- 19, tocilizumab, an inhibitor of the IL-6 receptors, was considered as an attractive therapeutic option. When the inflammation cascade is excessive and therapy is delayed, the efforts for suppression of inflammation does not necessarily reduce mortality in all cases. Besides, early using anti-cytokine therapy may lead to both increased cost and risks including iatrogenic immunosuppression (1). Defining of patients who will benefit from tocilizumab and determining optimal timing of tocilizumab will prevent drug-related side effects and increased costs due to unnecessary drug use.

Objectives

To investigate the reliability of pre-treatment levels of prognostic nutritional index (PNI), C-reactive protein/albumin ratio (CAR), systemic immune-inflammatory index (SII), IL-6, lactate dehydrogenase (LDH) as a treatment response biomarker in hospitalized COVID-19 patients who administered tocilizumab.

Methods

One hundred thirty three COVID-19 patients received tocilizumab were included. The end-points of treatment effectiveness were evaluated with the rate of death and emerging need for mechanical ventilation at 28 days of hospitalization. To determine independent mortality risk factors, multivariate logistic regression analyzes were performed for statistically different variables among groups that were statistically different in univariate analysis. The capacity of IL-6, CAR, PNI, SII and LDH values in predicting of tocilizumab response in COVID-19 patients were analyzed using receiver operating characteristic (ROC) curve analysis.

Results

34 (25.56%) patients died after tocilizumab therapy. Patients who improved after tocilizumab were significantly younger and had significantly lower IL-6, LDH, SII, CAR and higher PNI than patients who died. In univariate analyses, mortality was significantly associated with age, IL-6, LDH, PNI, SII, CAR and CRP. In multivariate analysis, age (OR:1.070, 95%CI:1.019-1.124, p:0.007) and LDH (OR:1.006, 95CI%:1.003- 1.010, p<0.001) were found to be independent predictors of mortality after tocilizumab therapy. To identify of tocilizumab response in COVID-19 patients, IL6 had the highest area under curve (AUC) value (AUC:0.782, 95%CI:0694-0.870), followed by LDH (AUC:0.761, 95%CI:0.661-0.861), PNI (AUC:0.696, 95%CI:0.584-807), SII (AUC:0.671, 95%CI:0.551–0.790), CAR (AUC:0.682, 95%CI:0.578– 0.786) and CRP (AUC:0.643, 95%CI:0.535–0.751). Predictive performance of inflammatory biomarkers in the prediction of mortality after tocilizumab therapy was presented in Table 1.

Table 1.

Predictive performance of inflammatory biomarkers in the prediction of mortality after tocilizumab therapy

SensitivitySpecificityPLRNLRPPVNPVAccuracyDORIL-6 (pg/mL) >143.1264.71%84.85%4.270.4259.46%87.50%79.70%10.27LDH (U/L) >46073.53%71.72%2.600.3747.17%88.75 %72.18%7.04PNI<31.3555.88%79.80%2.770.5548.72%84.04%73.68%5.00SII>3895.9247.06%90.91%5.180.5864.00%83.33%79.70%8.89CAR>61.1561.76%67.68%1.910.5639.62%83.75%66.17%3.38

CAR: C-reactive protein/albumin ratio; DOR: diagnostic odds ratio; IL-6: interleukin-6; LDH: lactate dehydrogenase; NLR: negative likelihood ratio; NPV: negative predictive value; PLR: positive likelihood ratio; PNI: prognostic nutritional index; PPV: positive predictive value; SII: systemic immune-inflammatory index.

Conclusion

Although the patients with significantly lower IL-6, LDH, SII, CAR and higher PNI levels improved after tocilizumab therapy, only serum LDH levels and age were found to be as independent predictors of mortality. To specify the optimal time interval and the patients who will benefit from tocilizumab, these biomarkers may be used.

References

[1]van Eijk LE, Binkhorst M, Bourgonje AR, et al. COVID-19: immunopathology, pathophysiological mechanisms, and treatment options. J Pathol. 2021;254(4):307-31

Acknowledgements

I have no acknowledgments to declare.

Disclosure of Interests

None declared

AB1276 EVALUATION OF DRUG-FREE REMISSION RATES IN IDIOPATHIC GRANULOMATOUS MASTITIS

Background

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease. There is no clear consensus on its treatment yet (1).

Objectives

The aim of the study was to evaluate the rates of drug-free remission of the patients with IGM in a period of three-year follow-up.

Methods

A total of 76 patients who were followed-up with biopsy proven IGM, between February 2011 and November 2021 in rheumatology outpatient clinic of Gulhane Training and Research Hospital, were evaluated retrospectively. To analyze long-term outcomes, 55 patients who were followed up for 3 years were included in the study. Data regarding the demographic and clinical characteristics of the patients were obtained from patients’ files.

Results

The study included 55 female patients with a mean age of 36.8 ± 6.3 years. Forty-nine (89.1%) patients received immunosuppressive treatment, one (1.8%) patient received postoperative immunosuppressive treatment, 3 (5.4%) patients had immunosuppressive treatment due to recurrence after surgery, and 1 (1.8%) patient underwent only surgery. One (1.8%) patient had no treatment for IGM. Patients who received immunosuppressive drugs for initial treatment, 38 (69.1%) received methotrexate (MTX) and corticosteroids (CS), 7 (13.2%) received azathioprine (AZA) and CS, 3 (5.6%) received only CS and 1 (1.8%) received cyclosporine A (CsA) and CS. Four (7.2 %) patients had received MTX after surgery. At 3-year follow-up 54 (98.1%) patients were in drug-free remission. The median duration of drug-free remission in patients receiving MTX plus CS, CS, and azathioprine plus CS was 19.7, 32.9, and 14.7 months, respectively. One patient who received CsA plus CS was in drug-free remission for 28.3 months. The median duration of treatment with combination of CS and other immunosuppressives was 6.7 months. The median duration of immunosuppressive treatment was 15.8 months (Table 1). Recurrence was observed in 4 (80%) patients who did not receive immunosuppressive therapy after surgery. Three (75%) of these patients received MTX due to recurrence, and remission was achieved.

Table 1.

Duration of immunosuppressive treatment and drug-free remission of the patients

TreatmentDuration of immunosuppressives, (n=53)Duration of drug-free remission, (n=54)Only corticosteroids (month)*4.6 (2.9-5.8)32.9 (32.4-33.4)Methotrexate (month)*19.7 (2.8-32.4)19.7 (2.7-32.4)Azathioprine (month)*16.2 (11.0-30.1)14.7 (8.8-22.9)Cyclosporine (month)7.628.3Total (month)*15.8 (2.9-34.3)21.2 (2.7-36.6)

* Variables as median, (minimum - maximum)

Conclusion

Immunosuppressives provide a remarkably high sustained remission and maintain a longer drug-free remission in patients with IGM.

References

[1]Tekgöz E, Çolak S, Çinar M, Yilmaz S. Treatment of idiopathic granulomatous mastitis and factors related with disease recurrence. Turk J Med Sci. (2020) 50: 1380-1386.

Disclosure of Interests

None declared

Determination of serum vascular endothelial growth factor (VEGF) and VEGF receptor levels with VEGF gene polymorphisms in patients with Behçet's uveitis

BACKGROUND

Behçet's disease (BD) is a chronic inflammatory vasculitis affecting multiple organs. Uveitis is frequently seen in patients with BD, especially in Turkish population.

OBJECTIVES

To investigate vascular endothelial growth factor (VEGF) gene polymorphisms along with the levels of VEGF and VEGF receptors in patients with Behçet's uveitis (BU).

MATERIAL AND METHODS

Fifty-five BD-associated uveitis patients and 30 ageand sex-matched controls were included in this case-control study. The genotypes of the single nucleotide poymorphisms (SNPs): rs2010963 (+405G), rs3025039 (+936T) and rs699947 (-2598A) of the VEGF-A gene were determined using real-time polymerase chain reaction (RT-PCR) and serum levels of VEGF and VEGF receptors were measured using enzyme-linked immunosorbent assay (ELISA).

RESULTS

No associations of the VEGF gene polymorphisms were observed in BD uveitis patients, but arthritis was present in 53.3% of patients not possessing CT genotype in C3025039→T polymorphism (p = 0.024). Although there were no statistically significant differences in serum VEGF-A, VEGF-C and soluble vascular endothelial growth factor receptor-3 (sVEGFR-3) levels (p < 0.05), serum vascular endothelial growth factor receptor-1 (VEGFR-1) and sVEGFR-3 levels were significantly higher in the BD group (p < 0.001 and p = 0.001, respectively). In addition, VEGF-C/soluble vascular endothelial growth factor receptor-2 (sVEGFR-2) ratio was significantly higher (p < 0.001), while VEGF-A/VEGFR-1 and VEGF-C/sVEGFR-3 ratios were significantly lower (p < 0.001 and p = 0.033, respectively) in BD patients compared to controls. Also, VEGF-C/sVEGFR-3 (p = 0.024, r = 0.37) and VEGF-C/sVEGFR-2 (p = 0.020, r = 0.38) ratios were positively correlated with disease duration.

CONCLUSIONS

The significant changes in sVEGFR-3 levels and VEGF-C/sVEGFR-3 ratio has shown that lymphangiogenesis processes might take place in the pathogenesis of BD uveitis, and these parameters can be important indicators of evaluation of BD patients with uveitis together with disease duration.

Physicians' Biological Drug Preference in Patients With Rheumatoid Arthritis and Spondyloarthritis With a History of Malignancy: Perspectives From the Treasure Database

OBJECTIVE

Because of concerns about malignancy risks, using biological disease-modifying antirheumatic drugs (bDMARDs) in patients with a history of malignancy remains a challenging issue in rheumatology practice. This study aimed to investigate bDMARD preferences of physicians when treating of rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients with a history of malignancy.

METHODS

The data for this cross-sectional study were gathered from the TReasure database using a date range of December 2017 and January 2020. Biological disease-modifying antirheumatic drug preferences were analyzed for 40 RA patients and 25 SpA patients with a history of malignancy.

RESULTS

The most frequently prescribed bDMARD was rituximab, which was given to 28 RA patients (70%). For 25 patients (62.5%), the time between the diagnosis of malignancy and starting on a bDMARD regimen was less than 60 months, with a median interval of 43.5 months. Among SpA patients, the preferred bDMARDs were secukinumab and etanercept, which were each administered to 7 patients (28%). For 13 SpA patients (52%), the time between the diagnosis of malignancy and starting on bDMARDs was less than 60 months, with a median interval of 97 months.

CONCLUSIONS

The observed bDMARD preferences may be related to the therapeutic effects of rituximab on lymphoproliferative malignancies, the protective effects of secukinumab on tumor progression, and the short half-life of etanercept. Biological disease-modifying antirheumatic drugs should be used in RA and SpA patients with malignancy in case of high inflammatory activity.

The Risk of Presarcopenia Is Increased Among Female Patients With Primary Sjögren's Syndrome

OBJECTIVES

Sarcopenia is a progressive and generalized loss of muscle mass and function. The aim of this study was to evaluate the frequency of sarcopenia among patients with primary Sjögren's syndrome (SS) and the factors related with sarcopenia.

METHODS

Forty-four female patients with primary SS and 44 female control subjects were included in this cross-sectional study between February and August 2019. Sarcopenia was evaluated by the handgrip test, Skeletal Muscle Mass Index, and gait speed test.

RESULTS

Eleven patients (25.0%) had presarcopenia in the SS group and 2 (4.5%) in the control group (p = 0.007). Compared with control subjects, SS patients had lower results of hand grip and gait speed tests (p = 0.005 and p < 0.001, respectively). According to the Mini Nutritional Assessment Short Form, patients with presarcopenia had higher risk of malnutrition compared with patients without sarcopenia (p = 0.043). Patients with presarcopenia had higher scores in the European League Against Rheumatism Sjögren's Syndrome Patient-Reported Index pain domain and patient visual analog scale for global disease activity compared with patients without sarcopenia (p = 0.044 and p = 0.036, respectively). In multivariate regression analysis, European League Against Rheumatism Sjögren's Syndrome Patient-Reported Index pain was associated with hand grip strength (p = 0.016, R2 = 0.13) and Mini Nutritional Assessment Short Form was associated with Skeletal Muscle Mass Index (p = 0.005).

CONCLUSIONS

Risk of sarcopenia is increased in patients with SS. Pain and malnutrition may contribute to presarcopenia. Evaluating pain and patient's global disease activity may help physicians to determine patients with increased risk of sarcopenia. Controlling disease activity and pain and preventing malnutrition may reduce the risk of development of sarcopenia.

POS0935 DO PERIPHERAL AND EXTRA MUSCULOSKELETAL MANIFESTATIONS HAVE AN IMPACT ON BIOLOGIC DMARD PRESCRIBING PATTERNS IN AXIAL SPONDYLOARTHRITIS: THE RESULTS OF TREASURE EXPERIENCE

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease mainly affecting sacroiliac joints and spine. Peripheral arthritis, dactylitis and enthesitis may also occur. Extra musculoskeletal manifestations (EMMs; uveitis [AAU], inflammatory bowel disease [IBD] and psoriasis [Pso] are among the most common ones) are important features and might have an impact on the disease burden in patients with axSpA. The presence of EMM, in particular IBD and AAU could influence the choice of TNFi however little is known regarding the role of peripheral manifestations together with the EMM on the prescribing patterns in axSpA patients.

Objectives:

To examine the frequency of peripheral and EMMs in a real-world axSpA cohort and their effect on the choice of first advanced treatment.

Methods:

In total 1687 axSpA patients (58% male and the mean age (±SD) was 38.5 ± 10.9) who initiated his/her first biologic were included in the present analysis. The data for the current study was obtained from the TReasure web-based registry; in which RA and SpA patients treated with bDMARDs from different regions of Turkey. Baseline demographic, disease related characteristics, peripheral and EMMs were extracted. Characteristics of patients with and without peripheral/extra-musculoskelatal involvement were compared as well as factors/covariates associated with the choice of first TNFi and secukinumab was analysed.

Results:

Enthesis (28.2%) was found the most common peripheral manifestations and peripheral arthritis (26.4%) and hip arthritis (24.4%) followed it. Symptom duration to the first advanced treatment initiation was significantly shorter in axSpA patients with peripheral arthritis, enthesitis, dactylitis and psoriasis and longer in hip arthritis and AAU. HLA-B27 positivity was significantly lower in patients with arthritis, psoriasis and IBD and higher with hip arthritis and AAU. In multivariate analysis the presence of IBD is significantly associated with the preference of monoclonal TNFi (mab) over etanercept (ETA) (OR 5,770; 95%CI 1.788-18.616). However ETA was preferred in patients with hip arthritis (p=0.003), longer symptom duration (p=0.049), and using sulfasalazine (p=0.043). In comparison with mabs, secukinumab (SEC) prescription was found to be significantly associated with higher age (p=0.001), sulfasalazin (p=0.001) and methotrexate usage (p=0.053) among axSpA patients need their first advanced treatment.

Conclusion:

The results of the current study confirm the pathophsyologic associations of peripheral involvement and EMM in axSpA patients. Apart from hip arthritis the presence of IBD has an impact on the prescription of advanced treatment in real-life.

Table 1.

Clinical characteristics of patients in cohort

All patients(n=1678)Peripheral arthritis(n=445)Dactilitis(n=81)Enthesis(n=476)Uveitis(n=193)Psoriazis(n=152)IBD(n=78)Hip involvemet(n=412)Age, mean±SD38,5±10,938,3±11,637,4±11,137,9±10,741,3±11,439,9±11,341,6±12,239,2±11,2Male sex,n (%)974 (57,7)184 (41,3)34 (42)238 (50)96 (49,7)54 (35,5)43 (55,1)272 (66)Symptom duration, mean month±SD108,5±98,996,9±92,979,1±76,5100,4±92,7144,7±110,287,7±9494,5±98133,3±108,2HLA B27 positivity, n (%)621 (53,7)142 (46,3)27 (51,9)174 (49,4)104 (77)34 (36,2)16 (27,1)186 (59,8)Concomitant cDMARD usage (yes), n (%)420 (24,9)170 (38,2)39 (48,1)133 (27,9)53 (27,5)58 (38,2)24 (30,8)99 (24)BASDAİ,mean±SD5,1±2,55,1±35,3±3,15,3±2,94,7±2,55,6±2,44,8±2,35,3±2,1ASDAS-CRP, mean±SD3,1±1,52,6±1,92,5±1,82,8±1,72,9±1,73,4±1,33,1±1,53,7±1,4

Disclosure of Interests:

None declared

COVID-19 Among Patients With Inflammatory Rheumatic Diseases

Background

The course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses.

Objective

In this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs.

Methods

Between April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome.

Results

165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive.

Conclusions

Among IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome.

Predictors for the risk and severity of post-thrombotic syndrome in vascular Behçet's disease

OBJECTIVE

Deep vein thrombosis (DVT) of the lower extremities is the most common form of vascular involvement in Behçet disease (BD), frequently leading to post-thrombotic syndrome (PTS) as a disabling complication. We have described the clinical characteristics and predictors of PTS presence among patients with BD and lower extremity DVT. We also used venous Doppler ultrasound (US) examinations in our assessment.

METHODS

Patients with BD (n = 205; 166 men, 39 women; age 39 ± 9.5 years) and a history of DVT were investigated. The Villalta scale was used to assess the presence and severity of PTS. Doppler US examinations were performed within 1 week of the clinical evaluation. The total number of vessels with reflux, thrombi, recanalization, and collateral vessels were calculated.

RESULTS

Of the 205 patients with BD, 62% had had PTS and 18% had had severe PTS. Patients with PTS had had greater reflux (P = .054) and thrombosis (P = .02) scores compared with patients without PTS. Treatment with anticoagulation (AC), immunosuppressive (IS) therapy, or AC combined with IS drugs did not affect the occurrence of PTS. However, patients treated with IS therapy, with or without AC drugs, had a decreased incidence of severe PTS compared with the AC-only group (P = .017). Patients treated with AC plus IS agents also had increased collateral scores compared with patients treated with only IS drugs. Interferon-α use seemed to provide better recanalization scores compared with azathioprine only (1.0 [range, 0-14] vs 2.5 [range, 0-10]; P = .010).

CONCLUSION

Patients with BD and DVT have a high risk of developing severe PTS. IS treatment decreases the development of severe PTS. AC therapy might influence the course of PTS by increasing the collateral scores, and the use of interferon-α also increased recanalization scores. Routine assessment with Doppler US examinations could be helpful in the prediction of severe PTS.

AB0812 IS THE VISCERAL ADIPOSITY INDEX ASSOCIATED WITH THE PRESENCE OF CARDIOVASCULAR RISK SCORES AND COMORBIDITY IN PSORIATIC DISEASE?

Background:

Psoriatic disease (PsD) is a chronic immune-mediated inflammatory disorder and predominantly involves the skin and joints. There is a better known relationship between the severity of PsD with some comorbidities such as metabolic syndrome, cardiovascular disease and obesity. Visceral Adiposity Index (VAI) has been shown to be an important marker, gender- dependent for insulin resistance, adipose tissue function and distribution.

Objectives:

The aim of this study was to evaluate the relationship between the VAI and cardiovascular risk scores of patients with psoriatic arthritis.

Methods:

This study was conducted with 101 PsD patients who fulfilled the classification criteria for Psoriatic Arthritis (CASPAR) criteria and 98 healthy subjects. Demographic and clinical data were recorded. Disease activity was evaluated with the Health Assessment Questionnaire (HAQ), Disease Activity Index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Disease Activity Index (BASFI) and Psoriasis Area Severity Index (PASI). The SCORE, Framingham index, metabolic syndrome (MetS), Body mass index (BMI) and VAI values of the patients and the VAI values of the healthy subjects were calculated.

Results:

Mean BMI (kg/m2) was calculated as 29.63 5.66. According to the SCORE measurements, 53 (52.5%) patients were at low risk, 45 (44.6 %) at moderate risk, and 3 (3 %) at high risk. No patients were at very high risk. According to the Framingham score, 72 patients (71.3%) were at low risk, 22 patients (21.8%) at intermediate risk and 7 patients (6.9%) at high risk. The risk was found to be statistically significantly higher in the PsD group compared to the healthy control group in respect of metabolic syndrome, obesity (BMI >30) and VAI levels (p<0.05). Significantly higher VAI levels were determined in PsD patients with metabolic syndrome, BMI> 30 (obesity), diabetes mellitus and hypertension compared to without these comorbidities (p<0.05). A statistically significant correlation was determined between low and moderate risk Framingham score, and the VAI levels of PsD patients. Correlations were determined between disease activity and metabolic and cardiovascular risks of patients. A weak correlation was observed between VAI levels and the Framingham score (Table).

Conclusion:

Patients with psoriasis are more susceptible to obesity and other diseases such as metabolic syndrome, dyslipidemia, cardiovascular diseases, insulin resistance and diabetes. Therefore, control of bodyweight in PsD patients is important for management of the disease. Since VAI can be calculated simply from routinely taken measurements, the VAI level can be used to determine cardiovascular risk and VAI may also provide clues about comorbidities in patients with newly diagnosed PsD.

Table.

Correlations (r) between disease activity and metabolic and cardiovascular risks of patients

ParametersBASDAIPASIDAPSABASFIHAQVAISCOREFramingham risk scoreFramingham risk score0.020.0950.285**0.202**0.0670.299**0.5231SCORE-0.079-0.0260.0950.065-0.010.05810.523**VAI0.1280.1920.1010.1050.01910.0580.299**HAQ0.1290.1350.421**0.284**10.019-0.010.067BASFI0.764**0.140.484**10.284**0.1050.0650.202*DAPSA0.462**0.341**10.484**0.421**0.1010.0950.285**PASI0.09210.341**0.1400.1350.192-0.0260.095BASDAI10.0920.462**0.764**0.1290.128-0.0790.024

Abbreviation; VAI: Visceral Adiposity Index, SCORE: Systematic Coronary Risk Evaluation Index, Health Assessment Questionnaire (HAQ), Disease Activity Index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Disease Activity Index (BASFI) and Psoriasis Area Severity Index (PASI).*p<0.05, **p<0.001

Disclosure of Interests:

None declared

FRI0059 SARCOPENIA IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Sarcopenia is defined as the decrease in strength, mass and function of muscles and may be related with aging, chronic inflammation or malnutrition. Proinflammatory cytokines may be associated with development of sarcopenia.

Objectives:

The aim of this study was to evaluate sarcopenia in patients with Rheumatoid Arthritis (RA).

Methods:

One hundred patients with RA (30 Male/70 Female) and 100 healthy controls (30 Male/70 Female) were included in this cross sectional study. According to The European Working Group on Sarcopenia in Older People (EWGSOP2) 2018, three parameters; muscle strength, muscle mass and physical performance, which are evaluated by hand grip strength, Body Impedance Analyzer (BIA) and 6 meters gait speed test, respectively, are used to diagnose sarcopenia. Patients with arthritis in dominant hand joints and ankle joints were excluded. Sarcopenia is defined as the decrease of strength and mass of muscles. On the other hand patients with low muscle strength but normal muscle mass are defined as probable sarcopenia.

Results:

The mean age was 58.52±10.95 for patients and 56.62±10.08 for controls (p=0.203). Frequency of probable sarcopenia was 35 (35.0%) in RA and 9 (9.0%) in control group (p<0.001). Results of hand grip and 6 meters gait speed tests were lower in RA patients (p=0.002 and p<0.001 respectively). Frequency of probable sarcopenia was higher in females, older patients and patients with longer disease duration. Disease activity and Health Assessment Questionnaire scores were higher in patients with probable sarcopenia compared with patients with no sarcopenia (p<0.05) (Table 1). In multivariate regression analysis; age, gender and DAS28 ESR/CRP were associated with hand grip strength (p<0.001, R2=0.62) (Table 2).

Table 1.

Factors associated with sarcopenia in rheumatoid arthritis

Rheumatoid arthritis groupNo sarcopenia(n=65)Probable Sarcopenia(n=35)p-valueSex, n (%) Male24 (36.9)6 (17.1)0.04a Female41 (63.1)29 (82.9)Age*55.00 (25.00−82.00)63.00 (24.00−82.00)0.004bDisease duration (year)*4.00 (1.00−37.00)8.00 (1.00−41.00)0.037bDAS28 CRP*2.13 (1.08−4.69)2.55 (1.54−5.56)0.010bDAS28 ESR (mean±SD)2.63±0.943.36±1.00<0.001cCDAI*5 (0−25)9 (0−29)0.012bSDAI*5.09 (0.04−26.04)9.8 (0.39−31.7)0.006bHAQ*0.15 (0−1.05)0.4 (0−19.5)<0.001b

aPearson Chi-Square,bMann-Whitney U Test,cIndependent Samples t-Test. *Variables given as median (minimum-maximum) DAS: Disease activity score ESR:Erythrocyte sedimentation rate, CRP:C-reactive protein, CDAI: Clinical Disease Activity Index, SDAI: Simplified Disease Activity Index, HAQ: Health Assessmnet Questionnaire

Table 2.

Multivariate analysis for hand grip test in patients with rheumatoid arthritis

Unstandardized Coefficients95% CIStandardized Coefficientsp-valueBStd.ErrorLowerUpperBetaConstant53.653.8945.9361.37−<0.001Gender−13.061.41−15.86−10.26−0.60<0.001DAS28 CRP−3.210.70−4.61−1.82−0.29<0.001Age−0.220.06−0.33−0.10−0.23<0.001

DAS: Disease activity score CRP:C-reactive protein

Conclusion:

Loss of muscle strength in patients with RA may be seen frequently. Longer disease duration and higher disease activity should lead to development of sarcopenia due to chronic inflammation. Sarcopenia potentially effects patients’ social lives and daily functions and conceive decrease quality of life. Physicians should be aware of development of sarcopenia during the course of the disease, and take into account the preservative and preventive methods against to sarcopenia including exercise and control of disease activity.

Acknowledgments:

None to declare

Disclosure of Interests:

None declared

THU0289 PREDICTORS AND SEVERITY OF POST-THROMBOTIC SYNDROME IN VASCULAR BEHÇET’S DISEASE: RETROSPECTIVE MULTICENTER STUDY

Background:

Postthrombotic syndrome(PTS) defines chronic manifestations of venous insufficiency following deep vein thrombosis(DVT).It is the most frequent and disabling complication of DVT.

Objectives:

Aim of the study is to describe clinical characteristics and predictors of PTS,severe PTS among Behçet’s disease(BD)patients with known low extremity DVT.Also,to depict venous Doppler ultrasonography(US)findings and its association with the clinical characteristic and treatments.

Methods:

This retrospective multicenter study included 205(166men,39women;mean age 39±9.5 years)BD patients with DVT history.The Villalta scale was used to assess the presence and severity of PTS.Doppler US of bilateral legs are performed within 1 week of clinical evaluation.Total number of vessels with reflux,thrombi,recanalization and collaterals were calculated and presented as scores.

Results:

Of 205 BD patients with known DVT history; 127(62%) had PTS and 18% had severe PTS diagnosed by Villalta scale.(Table 1)

Table 1.

Demographic and Clinical Characteristics of Patients

Entire Study Population (n:205)PTS present (n:127)PTS absent (n:78)P valueSex(male,%)166,81%101,79.5%65,83.3%.584History of smoking,%105,52%64,51.2%41,53.2%.895BMI(n:198)26.2±4.626.7±525.6±3.8.123Disease duration,years9(5-15)10(5-16)8(5-13).205DVT following time years6(3-11)7(3-11.5)5(3-9).179Current age39±9.540.5±9.636.8±8.8.012Number of vascular events1(1-2)1(1-2)1(1-2).723VeinesQoL total82±16.375.8±1492.2±14.6<.001VeinesQoL symptom37.5±934.4±8.342.6±7.7<.001Doppler Findingsİliofemoral thrombi41,26.5%32,35%9,17%.014Bilateral involvement62,43.4%45,49%17,33%.080

All median values presented with interquartileranges(IQR)

Table 2 summarize multivariate logistic regression analyses for the risk of having PTS-moderate/severePTS.

Table 2.

Multivariate Regression Analysis of presence of PTS

Odds Ratio(with 95%CI)PCurrent age1.05(1.01-1.10).048BSAS1.06(1.04-1.10).000Bilateral Doppler USG involvement2.81(1.18-6.67).019İliofemoral thrombi2.74(1.02-7.38).045Moderate/severe PTSOdds RatiopBody mass index1.09(1.001-1.19).048IS0.10 (0.02-0.05).005

Severe PTS patients had increased reflux(p=.027) compared to mild group and decreased recanalization scores(p=.013)compared to moderate group(Figure1)Patients treated with AC+IS had increased recanalization(p:.078),collateral scores compared patients treated with only ISs(p=.004)(Figure2)

Conclusion:

After an acuteDVT,BD patients faced with high risk of having PTS,severe PTS.ISs decreases the risk of having PTS.Our results also suggest that AC treatment may decrease severity of PTS by increasing recanalization of thrombi.

Figure 1.

US scores for PTS absent and present group Reflux score(p=.054) and thrombosis scores(p=.02)

Figure 2.

US scores for treatment groups

References:

Disclosure of Interests:

None declared

AB0404 SARCOPENIA AND RELATED FACTORS AMONG PATIENTS WITH PRIMARY SJOGREN’S SYNDROME

Background:

Sarcopenia is the progressive and generalized loss of muscle mass, strength and function especially among elderly population. Inflammation may lead to sarcopenia regardless of age.

Objectives:

To evaluate the frequency of sarcopenia and related factors in patients with primary Sjogren’s syndrome (SS).

Methods:

A total of 44 female patients with SS and 44 age matched female healthy controls were included in this cross-sectional study. Sarcopenia was evaluated by hand grip test, skeletal muscle index (SMI) and 6 meters gait speed (GS) test. According to recommendations of European Working Group on Sarcopenia in Older People (EWGSOP2) 2018, sarcopenia is defined as decrease in results of both hand grip test and SMI, whereas, probable sarcopenia is defined as only decrease in results of hand grip test. Mini Nutritional Assessment Short Form (MNA-SF) was used for evaluating nutritional statement. EULAR SS patient reported index (ESSPRI) and EULAR SS disease activity index (ESSDAI) used for evaluating disease activity. Patient global assessment (PGA) was assessed with visual analogue scale (VAS 0-10 cm). Patients with arthritis in dominant hand and/or ankle joints were excluded from the study.

Results:

The mean age of participants was 55.3±10.4 years. Eleven patients (25.0%) had probable sarcopenia in SS group and 2 (4.5%) in control group (p=0.007). Compared with healthy controls, SS patients had lower results of hand grip and 6 meters GS tests (p=0.005 and p<0.001, respectively). According to Mini Nutritional Assessment Short Form (MNA-SF), patients with probable sarcopenia had higher risk for malnutrition compared with patients with no sarcopenia (p=0.043). Patients with probable sarcopenia had higher scores of ESSPRI pain domain and patient visual analogue scale for global disease activity compared with patients with no sarcopenia (p=0.044 and p=0.036, respectively) (Table 1). In multivariate regression analysis ESSPRI pain was associated with hand grip strength (p=0.016, R2=0.13) and MNA was associated with SMI (p=0.005) (Table 2).

Table 1.

Factors associated with probable sarcopenia in Sjogren’s syndrome

Sjogren’s syndrome groupNo sarcopenia(n=33)Probable Sarcopenia(n=11)p-valueESSPRI pain*5 (0-10)7 (3-10)0.044bVAS patient*4 (0-10)6 (0-10)0.036bMNA SF, n (%)0.043CNormal nutritional status (12-14)32 (97)8 (72.7)Risk of malnutrition (8-11)1 (3)3 (27.3)

ESSPRI: EULAR Sjogren’s Syndrome Patient Reported Index, VAS: Visual Analogue Scale, MNA SF: Mini Nutritional Assessment Short Form. *Variables given as median (minimum-maximum)aIndependent Samples Student t test,bMann-whitney U,CFisher’s Exact test.

Table 2.

Multivariate analysis for hand grip strength and SMI in patients with Sjogren’s syndrome

Unstandardized Coefficients95% Confidence Interval for BStandardized Coefficientsp-valueBStd.ErrorLowerUpperBetaHand grip strengthConstant24,4921,69521,07127,914–<0.001ESSPRI pain-0,7070,282-1,276-0,139-0,3610,016SMIConstant5,4191,7051,9788,860–0.003MNA0,3800,127-1,276-0,1390,4190,005

ESSPRI: EULAR Sjogren’s Syndrome Patient Reported Index, SMI: Skeletal Muscle Index, MNA: Mini Nutritional Assessment

Conclusion:

Risk of sarcopenia is increased in patients with SS. In the current study, it is shown that pain is related with sarcopenia. ESPPRI pain is a sign of continuing chronic inflammation in patients with SS. Malnutrition, which can indirectly related with SS, may also contribute to this process. Excessive pain may lead to decrease daily activities and nutritional status of patients with SS. Evaluating pain and patient’s global disease activity may help physicians to find out patients with increased risk for sarcopenia. Controlling disease activity and pain and preventing malnutrition may reduce the risk for development of sarcopenia.

Acknowledgments :

None to declare

Disclosure of Interests: :

None declared

Damage assessment in adult IgA vasculitis. Cross-sectional results of a multicentre cohort

OBJECTIVES

Immunoglobulin (Ig) A vasculitis affects children more commonly than adults and previous literature lacks any formal damage assessment. Our aim in this study is to investigate the disease course, relapse rates and prognostic factors in adult patients with IgA vasculitis and to evaluate the disease-related damage.

METHODS

We assembled a retrospective cohort of adult IgA vasculitis from six tertiary Rheumatology Centres in Turkey. The demographics, clinical characteristics, treatment and outcomes of patients were abstracted from medical records.

RESULTS

The study included 130 (male/female: 85/45) patients and the mean age was 42.2±17 years. Cutaneous manifestations and arthritis/arthralgia were the most common clinical manifestations. One hundred thirteen patients (86.9%) were treated with oral glucocorticoids (GC). As additional immunosuppressive (IS) agents, azathioprine was given to 44 (34.9%) and pulse cyclophosphamide to 18 (12.6%) patients. Seventy-nine patients (60%) had follow-up of median 15 (IQR 7-40) months. Twelve (15%) patients relapsed during follow-up. The mean VDI score was 0.4 in the last visit. Nineteen (24.7%) patients had at least one damage item at the end of follow-up. Most frequent damage items were renal 11 (42%), ocular 4 (15%) and cardiovascular 4 (15%).

CONCLUSIONS

In this cohort the most frequent damage item was renal and was related to the disease itself. Damage score was higher in patients with more severe disease and treated more aggressively. Our results suggest that more effective treatment options are needed in a subgroup of patients with IgA vasculitis to prevent the damage related with the vasculitis, especially with more severe disease.

The assessment of tocilizumab therapy on recurrent attacks of patients with familial Mediterranean fever: A retrospective study of 15 patients

AIM

Interleukin-6 receptor antagonist, tocilizumab (TCZ), is known to be effective in the treatment of amyloidosis in patients with familial Mediterranean fever (FMF). But there are limited data about the effect of TCZ on frequency of attacks. In the current study, we aimed to find out whether TCZ therapy could decrease the frequency of recurrent attacks of FMF or not.

MATERIALS AND METHODS

The recorded files of 15 patients who had received intravenous TCZ for the improvement of amyloidosis associated with FMF, were evaluated retrospectively. Data of demographic and clinical characteristics of patients were archived from those files.

RESULTS

Three female and 12 male patients received TCZ due to amyloidosis were included to the study. The mean age was 42.07 ± 14.37 years. All of the patients were in full compliance with colchicine treatment. According to international severity scoring system for FMF, all of the patients had severe disease. The frequency of attacks recorded was evaluated during TCZ treatment, and it was reported that one patient had no response, six patients had decreased attack frequency and eight patients had no attacks.

DISCUSSION

Tocilizumab is found to be efficient on improvement of amyloidosis and decreasing the frequency of recurrent attacks in patients with FMF. Besides, TCZ is well tolerated among the patients. Further and prospective studies with larger sample are needed to support these results.

An investigation of thiol/disulfide homeostasis in patients with Behçet's disease

INTRODUCTION

Behçet's disease (BD) is a relapsing systemic inflammatory disorder. The diagnosis of BD is primarily based on clinical findings. Current biomarkers are not yet sufficient to diagnose and cannot anticipate the course of the disease and response to treatment. The aim of this study was to evaluate the relationship between the thiol-disulfide balance and disease activity and organ involvement in BD.

MATERIAL AND METHODS

A hundred fifty patients with BD and 100 age- and gender-matched healthy controls were included in the study. Disease activity was assessed with the BD Current Activity form score. Serum levels of native thiol (NT), total thiol (TT), and disulfide were measured and the disulfide/native thiol, disulfide/total thiol and native thiol/total thiol levels were calculated for the patient and control groups.

RESULTS

Native thiol, total thiol, native thiol/total thiol values of the BD patients were significantly lower than those of the control group. The disulfide/native thiol, disulfide/total thiol values of BD patients were higher compared to the control group and the disulfide value of the BD group was slightly higher compared to the control group. No correlation was determined between thiol levels and disease activity and organ involvement in BD.

CONCLUSIONS

In patients with Behcet's disease, the thiol-disulfide homeostasis balance shifted towards disulfide formation due to thiol oxidation. It may be used as a novel marker in BD because it is easy, practical, fully automated and relatively inexpensive.

Serum neopterin and ischemia modified albumin levels are associated with the disease activity of adult immunoglobulin A vasculitis (Henoch-Schönlein purpura)

AIM

The aims of the study are to investigate serum neopterin and ischemia modified albumin (IMA) levels in patients with immunoglobulin A vasculitis (IgAV) and evaluate the association of these markers with disease activity and relapse.

METHOD

Thirty-four consecutive adult patients (24 male and 10 female) admitted to the rheumatology clinic and met the IgAV American College of Rheumatology (ACR) criteria were enrolled in this cross-sectional study. Demographic and clinical features of IgAV and a control group were recorded into a predefined protocol. Disease activity was categorized as "remission" or "active" according to Birmingham Vasculitis Activity Score (BVAS). BVAS ≥ 1 was accepted as "active". Serum neopterin levels, high-sensitivity C-reactive protein (hsCRP) and IMA were evaluated according to BVAS and compared to the healthy control group.

RESULTS

Serum median (interquartile range) neopterin, IMA levels and hsCRP were higher in the study group than in control group (2.01 [12.5] ng/mL vs 1.77 [1.37] ng/mL, 0.67 [0.2] ng/mL vs. 0.43 [0.17] ng/mL, 5.6 [17.1] mg/L vs. 1.55 [1.6] mg/L, P = .095, P < .001 and P = .002, respectively). When evaluated according to BVAS, IMA and hsCRP levels were significantly higher in the group with active disease (0.77 [0.12] vs 0.61 [0.13] and 14.85 [4.6], P = .009 and P = .03, respectively). Serum neopterin levels were significantly higher in the active group compared to BVAS (18.95 [32.36] vs 1.63 [1.48], P < .001).

CONCLUSION

Oxidative stress is important in IgAV pathogenesis. Roles of hsCRP, neopterin and IMA as potential markers of diagnosis and disease activity seem to be worth studying in future studies with larger study groups.

Vaspin, neutrophil gelatinase-associated lipocalin and apolipoprotein levels in patients with psoriatic arthritis

OBJECTIVES

To examine the relationship between disease activity and vaspin, neutrophil gelatinase-associated lipocalin (NGAL) and apolipoprotein levels in patients with psoriatic arthritis (PsA).

BACKGROUND

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, which is related with psoriasis. Adipokines are the mediators which play a role in metabolic homeostasis and inflammatory conditions.

METHODS

The levels of vaspin, NGAL, apolipoproteins and their correlations with disease activity were compared in 50 psoriatic arthritis patients and 36 healthy controls.

RESULTS

The levels of vaspin, NGAL and apolipoprotein B/A1 ratio were significantly higher in the patient group (p 0.05).

CONCLUSION

This is the first study to have compared vaspin and NGAL levels in patients with PsA. Vaspin and NGAL can be used as a biomarker in PsA. Vaspin, NGAL and dyslipoproteinemia are not correlated with disease activity (Tab. 3, Ref. 63).

The relationship of serum VEGF and sVEGFR-1 levels with vascular involvement in patients with Behçet's disease

Behçet's disease (BD) is a rare, chronic, inflammatory disorder characterized by multisystemic vasculitis including mucocutaneous, neurologic, and ophthalmic involvement. Our aim is to compare vascular endothelial growth factor (VEGF) and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) levels in BD, among the patients having or not having organ involvement, disease activation and especially vascular involvement. Fifty-five patients with BD, 25 of which were accompanied by vascular involvement, and 31 control subjects were included in the study. Disease activity was assessed with the Turkish version of Behçet Disease Current Activity Form (BDCAF) and active vasculitis lesions at the time of study were recorded. Age at diagnosis was 32.2 ± 4.6, while the mean duration of BD was 96.3 (72.3) months. The median for BDCAF score was 2.0 (range 0, 3.0), and 29 (52%) of patients had active BD. The serum VEGF and sVEGFR-1 levels in patients with BD were significantly higher than that in controls [(298 (338.5) pg/mL; 93 (93.5) pg/mL in patients and 136.2 (73) pg/mL; 56.5 (48.5) pg/mL in controls, respectively, p < .001 for both values] while difference in VEGF/sVEGFR-1 ratio was obtained close to borderline of significance (p = .03). Our study is the first report indicating elevated serum VEGF, sVEGFR-1, and more importantly VEGF/sVEGFR-1 ratio could play an important role in the development of trombosis in BD. VEGF and/or sVEGFR-1 should not be evaluated independently in the same patient group and the ratio of these two parameters is a more important indicator, especially in the evaluation of BD especially with vascular involvement together with the duration of disease.

Human colonic fibroblasts regulate stemness and chemotherapy resistance of colon cancer stem cells

There is increasing evidence that cancers are heterogeneous and contain a hierarchical organization consisting of cancer stem cells and their differentiated cell progeny. These cancer stem cells are at the core of the tumor as they represent the clonogenic cells within a tumor. Moreover, these cells are considered to contain selective therapy resistance, which suggests a pivotal role in therapy resistance and tumor relapse. Here we show that differentiated cells can re-acquire stemness through factors secreted from fibroblasts. This induced CSC state also coincides with re-acquisition of resistance to chemotherapy. Resistance induced in newly formed CSCs is mediated by the anti-apoptotic molecule BCLXL and inhibition of BCLXL with the BH3 mimetic ABT-737 sensitizes these cancer cells toward chemotherapy. These data point to an important interplay between tumor cells and their microenvironment in the regulation of stemness and therapy resistance.

The endothelial nitric oxide synthase (eNOS) polymorphism in otitis media with effusion (OME)

OBJECTIVES

Otitis media with effusion (OME) is the most common disease after viral infections of upper respiratory tract (URTI) in children. Studies indicate the important role of nitric oxide (NO) in the etiology of hearing loss. However, there is no study that focuses on the role of nitric oxide synthase (eNOS) polymorphisms in the cases with OME. The aim of the present study is to evaluate the eNOS polymorphisms in the pediatric patients with OME.

MATERIALS AND METHODS

Eighty-nine patients who are diagnosed with otitis media with effusion and 85 healthy subjects who are compatible in terms of age and gender were included in the study. All patients in the study were subjected to complete ear, nose, throat (ENT) and audiological examinations. DNA analysis was performed with polymerase chain reaction (PCR) technique from the blood samples. The PCR product was cut by restriction fragment length polymorphism (RFLP) with BanII enzyme and checked by agarose gel electrophoresis.

RESULTS

As a result of genetic analysis, there is no significant difference between patients and the controls in terms of eNOS Glu298Asp polymorphism (G/G, G/T, T/T). When these groups were compared in terms of allele distributions, a significant relationship was found between the patients and the controls (P=0.037).

CONCLUSION

To the best of our knowledge, G allele was identified as predisposing to the development of OME and this is the first report indicates the correlation between the eNOS G894T polymorphism and OME in Turkey.

Nano drug delivery systems and gamma radiation sterilization

In recent years, drug delivery systems such as liposomes and microparticles have been used in clinic for the treatment of different diseases and from a regulatory point of view, a parenterally applied drug and drug delivery systems must be sterile and pyrogen free. Radiation sterilization is a method recognized by pharmacopoeias to achieve sterility criteria of parenterals. It has the ability to kill microorganisms in therapeutic products. The ability of, however, irradiation might also affect the performance of drug delivery systems. One of the most critical points is irradiation dose, because certain undesirable chemical and physical changes may accompany with the irradiation, especially with the traditionally applied dose of 25 kGy. Its ionizing property may cause fragmentation of covalent bond. The care must be paid to the applied dose. In this research, the effects of gamma irradiation on different drug delivery systems such as chitosan microparticles, liposomes, niosomes and sphingosomes were investigated. According to the experimental data, it can be concluded that gamma irradiation can be a suitable sterilization technique for liposome, niosome and sphingosome dispersions. When all irradiated drug carrier systems were taken into consideration, chitosan glutamate microparticles were found as the most radioresistant drug delivery system among the others.

Can argyrophilic nucleolar organizing region-associated protein amount be used for the detection of cardiac damage?

Introduction:

Carbon monoxide (CO) is a colorless, tasteless, odorless, nonirritant gas and CO poisoning affects all organ systems.

Aim:

We aimed to detect any possible effects of CO exposure on the argyrophilic nucleolar organizing region (AgNOR)-associated protein synthesis of heart cells and whether there is any relationship between AgNOR protein amount and both carboxyhemoglobin (COHb) level and histopathological evaluation methods used for the detection of damage in heart tissue after CO exposure.

Materials and Methods:

The rats were divided into four groups (control, 1000, 3000, and 5000 ppm), each containing six rats. After CO intoxication, COHb levels were measured and the animals were killed on the 7th day. AgNOR staining was performed in the heart tissue. One hundred nuclei per rat were evaluated, and total AgNOR area/nuclear area and mean AgNOR number were analyzed for each nucleus. The CO exposure groups had significantly higher AgNOR values than the control group ( p < 0.0001). According to cardiomyopathy (CMY) scoring methods, the differences between groups 3 and 4 and groups 1 and 2 were significant ( p < 0.05). A significant positive correlation between AgNOR values and both CMY and COHb levels were detected.

Conclusion:

The detection of AgNOR protein amount may give information about the CMY levels and be used to detect the CO intoxication levels instead of COHb in later periods.

Assessment of patients who presented to the emergency department with mushroom poisoning

OBJECTIVE

This study aimed to assess the demographic characteristics, emergency department (ED) complaints, laboratory findings, and latent phase periods of patients who presented to the ED due to mushroom poisoning (MP) as well as the efficacy of conventional and hemofiltration therapies.

METHOD

The study was conducted on patients who presented to the ED with MP between 2010 and 2012. The patient's demographic characteristics, complaints at the ED, latent phases, laboratory findings, and treatments of MP cases were evaluated.

RESULTS

The mean age of patients was 38.03 ± 15.96, where 63.8% of them were female and 36.2% were male. Visits occurred most frequently in the autumn (32.6%). When presenting to the ED, the most frequent complaint was nausea-vomiting. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalised ratio (INR), and blood urea nitrogen values of patients with a latent phase between 0 h and 5 h were significantly lower than the values of patients with a latent phase between 6 h and 24 h. In this study, 62% of the patients (n = 36) had stomach lavage and received activated charcoal. Altogether, 55.2% of the patients had received conventional therapy, 37.9% of them received hemofiltration, and all of them received supportive treatment. The AST, ALT, and INR values of those who had received hemofiltration and conventional therapies were significantly higher than of those who received only supportive treatment (p < 0.01).

CONCLUSION

Hemofiltration, in combination with conventional therapy, seems to be an effective treatment for reducing mortality in suspected MP cases involving late acting toxins.

Electronic Transport Properties of ZnSe Layers on GaAs

The electronic transport properties of ZnSe layers grown by MBE on GaAs sub- strates are studied by small-signal ac admittance, dc current-voltage, and Hall effect measurements. This work is supplemented by a study of TEM and x-ray rocking curve data. We find that the transport characteristics are strongly affected by the proper- ties of the ZnSe/GaAs interface. From the dc and ac measurements, we determine the total barrier height at the interface of thick (1-6 µm) ZnSe layers on n+-GaAs, and find that it is in general voltage dependent. While some samples are found to have a very high peak mobility (> 10,000cm2 /Vsec), an anomalous reduction in the mobility in a large fraction of the samples is found, and attributed to the presence of non- uniform space charge regions.

Nerve conduction studies of the axillary, musculocutaneous and radial nerves in elite ice hockey players

AIM

The peripheral nerves of the upper extremity are exposed to acute and chronic mechanical injuries in ice hockey players, because of the high repetition of motions, high muscular forces and extreme shoulder positions. This study was performed to evaluate the effect of ice hockey playing on the axillary, musculocutaneous and radial nerves crossing the upper arm region.

METHODS

The ice hockey group consisted of 20 first-division male ice hockey players and the control group consisted of 20 non-active males. The neurophysiological study consisted of motor nerve conduction latency of the axillary, musculocutaneous and radial nerves.

RESULTS

The values of distal motor latency (DML) of the axillary, radial and musculocutaneous nerves were significantly prolonged in the ice hockey players compared with the controls. Ice hockey can repetitively stress the upper extremity during shooting, because of forceful throwing to move the puck from the stick blade to the opponent's net. The mechanism of prolonged DML in the axillary nerve may both tract and compress as the axillary nerve stretches across the humerus during movement. From this study it emerged that using the biceps and coracobrachialis muscles can create notable muscle compartment pressure on the musculocutaneus nerve. The significant differences detected in the neurophysiologic study of the musculocutaneous nerve between the ice hockey players and controls may reflect the fact that the forces acting on the shoulder and the elbow during ice hockey matches can effectively influence DML.

CONCLUSIONS

The authors suggest two plausible causes for prolonged radial nerve DML: direct compression by the hypertrophied triceps muscle and stretching of the arm. The study suggests it is likely that a combination of skeletal muscle hypertrophy and excessive biomechanical demands on neurological structures during ice hockey matches may be a major etiologic factor in compression of the axillary, musculocutaneous and radial nerves.

Investigation of structural and dynamic features of the radicals produced in gamma irradiated sulfanilamide: an ESR study

Characteristic features of the radiolytical intermediates produced in gamma irradiated solid sulfanilamide (SA) were investigated in the present work using ESR spectroscopy. SO(2), which is the most sensitive group to radiation of SA molecule, was found to be at the origin of radiation produced ionic radical species. The latters give rise to an axially symmetric and an isotropic ESR spectra so that their sum appears as a three line antisymmetric ESR spectrum. Heights of these lines measured with respect to the base line were used to monitor microwave, temperature, time-dependent and kinetic features of the radical species contributing to ESR spectrum. Based on the experimental results derived from this study, it was concluded that as in the case of other solid sulfonamides radiation, yield of solid SA is very low (G=0.5) compared with those obtained for sulfonamide aqueous solutions (G=3.5-5.1), so that SA and SA-containing drugs could be safely sterilized by radiation.

[Back ache in helicopter pilots]

Due to low back pain (LBP) and harmful effects of flying, questionnaires were sent to 71 helicopter pilots of the experimental group, 22 mechanics helicopter flyers and to the control group of 28 air-traffic controllers. The prevalence of LBP was the highest in helicopter pilots, then in helicomechanics and air-traffic controllers (53%, 50% and 36%). Effects of exposure to vibration, body posture and working load have not contributed significantly to the occurrence of LBP. LBP has not lead to an important difference in the strength of the back musculature, body mass index and spondylosis, that is, scoliosis. The necessity of further study of LBP and maintaining of specific preventive measures are indicated.

[Verification of vital capacity and 1 second forced expiratory volume values in 14,234 candidates for aviation school]

The values of vital capacity (VC), forced expiratory volume in the first second (FEV1) and Tiffeneau index (100xFEV1/VC) were determined in 14,234 examinees in the period 1977-1987. Examinations were performed using the Godart expirometer. After the statistical analysis of the results being performed, the unique table was made according to height and age of examinees. The examinees came from all regions of Yugoslavia. The results of the study can be used for establishment of standard values of pulmonary ventilation for candidates for aviation schools, i.e. for youngsters aging from 14 to 20 years.

[Amalgam: yesterday and today]

Recently some reports claim that mercury released from amalgam fillings cause adverse effect to the patient. Mercurial toxicity is a risk for dental personnel but it is completely preventable by using proper mercury hygiene. From the side of the patients, amount of mercury released from amalgam fillings is far to cause any adverse effect. The claims don't have scientific support. Hypersensitivity reactions to amalgam fillings are exceedingly rare. There is no alternative to dental amalgam in the posterior region and routine use of composite as an amalgam substitute can not be endorsed. Besides, when considered improved corrosion resistance and marginal endurance with high-copper types, amalgam is an effective and useful material.

Scattering of sharply focused beams by arbitrarily shaped dielectric particles: an exact solution

By expanding the incident focused beam field in terms of its plane wave spectrum and by using the technique we developed earlier to treat the problem of the scattering of plane waves by arbitrarily shaped dielectric obstacles, we have been successful in solving the problem of the scattering of sharply focused beams by arbitrarily shaped dielectric particles. It was found that the presence of the curvature of the incident wave front and the nonuniformity of the incident wave intensity affect greatly the scattering characteristics.

Scattering of a focused beam by moving particles

The scattering of a focused laser beam by moving particles is studied. A solution is given for a spherical scatterer that is small compared to the wavelength. Several numerical examples are given. It is concluded that for particles that have a short time of flight within the laser beam, the bandwidth and frequency spectrum of the scattered field is critically dependent on the laser beam shape. This fact is particularly important when information on the motion of small particles or macromolecules is to be inferred from the measured bandwidth and spectrum of the scattered field due to an incident wave that is not a plane wave.

Scattering of focused beams by tenuous particles

This paper deals with the problem of the scattering of focused laser beams by tenuous particles using an iterative technique. The results are shown to be accurate provided that (a) the polarizability of the particle medium is small and (b) the phase shift of the central ray is less than 2. It was found that when the size of the incident beam waist is close to that of the scatterer, the scattered field deviates significantly from that for the incident plane wave case. Specific examples are given.