Development and Implementation of the AIDA International Registry for Patients With VEXAS Syndrome

Objective

The aim of this paper is to present the AutoInflammatory Disease Alliance (AIDA) international Registry dedicated to Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome, describing its design, construction, and modalities of dissemination.

Methods

This Registry is a clinical, physician-driven, population- and electronic-based instrument designed for the retrospective and prospective collection of real-life data. Data gathering is based on the Research Electronic Data Capture (REDCap) tool and is intended to obtain real-world evidence for daily patients' management. The Registry may potentially communicate with other on-line tools dedicated to VEXAS syndrome, thus enhancing international collaboration and data sharing for research purposes. The Registry is practical enough to be easily modified to meet future needs regarding VEXAS syndrome.

Results

To date (April 22^nd, 2022), 113 Centers from 23 Countries in 4 continents have been involved; 324 users (114 Principal Investigators, 205 Site Investigators, 2 Lead Investigators, and 3 data managers) are currently able to access the registry for data entry (or data sharing) and collection. The Registry includes 4,952 fields organized into 18 instruments designed to fully describe patient's details about demographics, clinical manifestations, symptoms, histologic details about skin and bone marrow biopsies and aspirate, laboratory features, complications, comorbidities, therapies, and healthcare access.

Conclusion

This international Registry for patients with VEXAS syndrome will allow the achievement of a comprehensive knowledge about this new disease, with the final goal to obtain real-world evidence for daily clinical practice, especially in relation to the comprehension of this disease about the natural history and the possible therapeutic approaches. This Project can be found on https://clinicaltrials.gov NCT05200715.

POS1274 A SINGLE CENTER COVID-19 VACCINE EXPERIENCE IN FAMILIAL MEDITERRANEAN FEVER PATIENTS

Background

To prevent COVID-19 disease SARS-CoV 2 vaccines put into use worldwide with emergency use authorizations despite ongoing safety concerns. Since pyrin mediated inflammasome response is dysregulated in FMF, exposure to SARS-CoV 2 proteins via vaccination may potentially trigger inflammation, leading to attacks and/or increased rate of adverse events (AE).

Objectives

Aim of this study to investigate frequency of adverse events and attacks related to vaccination in recipients of CoronaVac and BNT162b2 comparatively in our FMF patients.

Methods

Data regarding, number of vaccine doses, types of vaccines (CoronaVac or BNT162b2), presence of AEs and/or FMF attacks after any vaccine dose within a month, history of COVID-19 infection before or after vaccination, adherence to FMF treatment during vaccination were collected from hospital database or via telephone.

Results

A total of 161 vaccinated FMF patients were included. Mean ± SD age was 40.5 ± 11.7 years. 57.1% was female. 10.6% of the patients had chronic kidney disease and 9.3% had amyloidosis. Most common MEFV mutations were M694V heterozygous (27%) and M694V homozygous (21.6%). 93.2% of the patients were under colchicine, 21.8% under anti-interleukin 1 agents, 2.5% under TNF-a inhibitors. 96.3% of the patients adhered to FMF treatment during vaccination. Vaccination properties and data regarding adverse events are presented in Table 1. 57.8% of patients reported to suffer from an AE/attack after a vaccine dose. Number of patients with AE after BNT162b2 was significantly higher (p<0.001). None of the patients had severe AEs. 39 patients had COVID-19 infection prior to primary vaccination. 61.5% of these suffered from an adverse reaction/attack after vaccination, in comparison to 56.6% of the patients without prior COVID-19 infection (p=0.584). When patients with and without AEs/attacks were compared, no significant differences were observed regarding age, gender, body mass index, comorbidities, FMF treatments and total vaccine doses.

Table 1.

Adverse events and FMF attacks in a total of 161 vaccine recipients

BNT162b2CoronaVacpTotal vaccine doses, n213140Patients ever vaccinated with BNT162b2 and CoronaVac, n (%)117 (72.7)67 (41.6)Dose per patient, median (min-max)2 (1-4)2 (1-4)Patients with primary vaccination completed with BNT162b2 or CoronaVac, n (%)*88 (54.7)57 (35.4)Patients with a booster with BNT162b2 or CoronaVac, n (%)23 (14.2)14 (8.6)Patients vaccinated with BNT162b2 or CoronaVac alone, n(%)94 (58.4)44 (27.3)Patients with an adverse event after any vaccine dose of n (%)¶64/117 (54.7)20/67 (29.9)<0.001Adverse events, n (%)¶ Fever13 (11.1)6 (9.0)0.644 Malaise21 (17.9)4 (6.0)0.023 Local pain/arm pain17 (14.5)4 (6.0)0.079 Arthralgia19 (16.2)4 (6.0)0.043 Myalgia6 (5.1)0 (0.0)0.059 Headache11 (9.4)0 (0.0)0.010 Nausea6 (5.1)1 (1.5)0.215 Vomiting4 (3.4)1 (1.5)0.439 Others22 (18.9)7 (10.4)Patients with FMF attack within one month after any vaccine dose, n (%)¶26 (22.2)13 (19.4)0.653Time from vaccine dose to FMF attack, days, median (IQR)7.0 (12.5)10.0 (13.5)0.758

*9.9 % of the patients had only single dose of either vaccine, ¶Over 117 ever vaccinated with BNT162b2 and 67 ever with CoronaVac

Conclusion

We observed considerable number of FMF patients suffered from vaccine related AEs/attacks, particularly with BNT162b2. However, no serious AE was detected. Demographics, clinical characteristics and prior history of vaccination did not significantly affect AE/attack occurrence.

Acknowledgements

I have no acknowledgements to declare.

Disclosure of Interests

None declared

AB1088 COVID-19 VACCINATION OF SPONDYLOARTHRITIS PATIENTS RECEIVING BIOLOGICAL THERAPY: REAL-LIFE DATA

Background

Considering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged.

Objectives

Vaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed.

Methods

Adult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfizer-BioNTech) vaccine were included in our observational, multicenter, prospective study.

Results

A total of 287 patients (58.2% male; mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65; 22.6%) and DM (n:38; 13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sulfasalazine, and 12 (4.2%) patients were using leflunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infliximab (26.8%), adalimumab (23.3%) was the second (Table 1).

It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the first dose of vaccination is 11.5 days (5-19 IQR), between the first dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (p<0.001). While two of the patients who had COVID-19 infection in the pre-vaccination period required hospitalization, none of the patients who had COVID-19 in the post-vaccination period required hospitalization.

The rate of patients who developed side effects after the first dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically significant compared to inactivated virus vaccine in terms of both doses (p=0.011, p<0.001). Major side effects such as myocarditis, anaphylaxis-angioedema, myocardial infarction, and thrombosis were not observed in any of the patients included in the study. There was no evidence of disease activation in the median follow-up of 209 days (145-280 IQR) after vaccination.

Conclusion

During the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.

References

[1]Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 global rheumatology alliance vaccine survey. RMD Open. 2021;7(3):e001814.

[2]Shenoy P, Ahmed S, Paul A, et al. Inactivated vaccines may not provide adequate protection in immunosuppressed patients with rheumatic diseases. Ann Rheum Dis. 2021. doi:10.1136/annrheumdi s-2021-221496

Disclosure of Interests

None declared

AB0552 ELEVATED KYNURENINE LEVELS IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME

Background

Sjögren’s syndrome (SS) is a chronic autoimmune systemic inflammatory disease of unknown origin that predominantly affects the exocrine glands (mainly salivary and lacrimal glands). Primary Sjögren’s syndrome (pSS) is a disease whose etiology is not yet fully understood, as in most autoimmune diseases, where genetic, epigenetic and environmental factors are hypothesized to play to the pathogenesis of the disease. Metabolism of tryptophan (Trp) via the kynurenine (Kyn) pathway has been proposed to act a substantial role in inflammatory processes.

Objectives

In the present study, we investigated levels of Trp and its metabolites in the Kyn pathway in patients with pSS and in healthy controls. Also, the relationship between Trp metabolites and laboratory parameters, disease activity was evaluated in patients with pSS.

Methods

The study included 34 pSS patients and 42 healthy individuals, and serum Trp and Kyn concentrations were measured by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Trp degradation was predicted using the ratio of Kyn and Trp concentrations (Kyn/Trp). The EULAR Sjögren’s syndrome disease activity index (ESSDAI) and the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) were used to evaluate pSS activity.

Results

In our study, the mean serum Trp concentration was found to be considerably lower in the pSS group compared to the control group (p= 0.001). The levels of Kyn (p= 0.019) and Kyn/Trp ratio (p <0.001) were significantly higher in the pSS group compared to the control group (Table 1). Trp concentration was negatively correlated with physician global assessment (r=-0.568, p<0.001), positively correlated with albumin (r=0.384, p=0.025) and hemoglobin (p=0.396, r=0.020). The Kyn/Trp ratio was negatively correlated with CRP (r=-0.369, p=0.032). There was no correlation between the Trp pathway and disease activity parameters ESSDAI and ESRPI.

Table 1.

Comparison of the kynurenine pathway results of patients with Sjögren’s syndrome and the controls

Sjögren’s syndrome (n=34) median (IQR)Control(n=42) median (IQR)pKynurenine (ng/ml)485 (378-601)386 (356-496)0.019Tryptophan (ng/ml)10660 (9160- 12282)12258 (11442-14711)0.001Kynurenine/tryptophan ratio (%)4 (3-6)3 (3-4)<0.001

*Mann-Whitney U test

Conclusion

In conclusion, we found that kynurenine pathway metabolism was altered in patients with pSS. This suggests that tryptophan metabolism may be closely linked to the disease pathogenesis of pSS.

References

[1]Stefanski A-L, Tomiak C, Pleyer U, Dietrich T, Burmester GR, Dörner T. The diagnosis and treatment of Sjögren’s syndrome. Deutsches Ärzteblatt International. 2017;114(20):354.

[2]Maldini C, Seror R, Fain O, Dhote R, Amoura Z, De Bandt M, et al. Epidemiology of primary Sjögren’s syndrome in a French multiracial/multiethnic area. Arthritis care & research. 2014;66(3):454-63.

[3]Moffett JR, Namboodiri MA. Tryptophan and the immune response. Immunology and cell biology. 2003;81(4):247-65.

[4]Schroecksnadel K, Winkler C, Duftner C, Wirleitner B, Schirmer M, Fuchs D. Tryptophan degradation increases with stage in patients with rheumatoid arthritis. Clinical rheumatology. 2006;25(3):334-7.

Disclosure of Interests

None declared

AB0762 Incidence Of Anterior Uveitis In Axial Spondyloarthritis During Secukinumab Treatment: TWO YEARS REAL LIFE EXPERIENCE FROM TURKBIO REGISTRY

Background

Secukinumab (SEC), a human anti-IL-17A monoclonal antibody, has similar treatment response rates to tumor necrosis factor (TNF) inhibitors in patients with axial spondyloarthritis (SpA). However, the efficacy of SEC on anterior uveitis (AU) is unclear.

Objectives

This study aimed to evaluate the risk of new-onset or relapsing AU in axial SpA patients treated with SEC.

Methods

In this prospective cohort study, 130 axial SpA patients receiving SEC at the TURKBIO registry between 2019 and 2021 were evaluated. Demographic and clinical characteristics and data about the presence of AU pre or post-treatment were collected. The univariate and multivariate logistic regression analyses were performed to evaluate the predictors of AU development.

Results

The mean age of the patients (F/M: 59/71) was 47.4±10.9 years. The median follow-up time was 540 days (IQR: 330-630). SEC was the first biological agent in 50 (38.4%) patients and 35 (26.9%) patients were using at least one concomitant conventional synthetic DMARD (Table 1). While continued SEC therapy was in 93 (71.5%) patients, treatment withdrawal was in 37 cases (in 26 due to ineffectiveness, two adverse events and nine other reasons). Overall, 15(11.5%) patients had a history of AU before the SEC. During follow-up, AU attacks were seen in the 6 cases (4 were new-onset and 2 were flare) and 5 of these patients have a history of inadequate response to TNF inhibitors. The frequency of AU was calculated as 3.42 per 100 patient-years during SEC treatment. The only significant predictor of AU development was the baseline high C-reactive protein (CRP) level on multivariate analysis (p=0.003, OR: 1.063 [95% CI 1.021-1.107]).

Table 1.

Demographics and clinical characteristics of the patients

Total (n:191)Gender (F/M)59/71Age (years) (mean±SD)47.4±10.9Diagnosis; n (%)   AS125 (96.2)   nr-axSpA5 (3.8)BASDAI (mean±SD)47.2±20.48   Missing n (%)4 (3.07)ASDAS (mean±SD)3.32±0.92   Missing n (%)14 (10.7)C-reactive protein (mg/L) median (IQR)12.6 (4.67-22.62)Sedimentation (mm/h) median (IQR)22 (9-42)Concomitant csDMARDs n (%)35 (26.9)Secukinumab dose n (%)   150 mg120 (92.3)   300 mg10 (7.7)TNFi-naive patients n (%)50 (38.5)Number of previous bDMARDs n (%)   136 (27.7)   223 (17.7)   ≥ 321 (16.1)History of previous TNFi n (%)   Monoclonal TNFi64   Etanercept16

AS; Ankylosing spondylitis, nr-axSpA; Non radiographic axial spondyloarthritis, BASDAI; Bath Ankylosing Spondylitis Disease Activity Index, ASDAS; Ankylosing Spondylitis Disease Activity Score, csDMARD; conventional synthetic disease modifying anti-rheumatic drug, TNFi; Tumor necrosis factor inhibitors, bDMARD; biological DMARD. Datas were expressed as number (%), mean±SD or median (IQR).

Conclusion

In this real-life data from the TURKBIO registry, the incidence of AU in axial SpA patients treated with SEC was calculated as 3.42 per 100 patient-years. A high baseline CRP level was an independent factor for developing AU.

Disclosure of Interests

None declared

AB0161 THE RELATIONSHIP OF TRYPTOPHAN CATABOLISM WITH RHEUMATOİD ARTHRITIS DİSEASE ACTİVİTY ABSTRACT

Background

Tryptophan (Trp) is an essential amino acid. The immunosuppressive effect caused by Kynurenine (Kyn) and its metabolites formed by the catabolism of Trp is thought to be an important physiological mechanism.

Objectives

This study aims to evaluate the relationship of Kyn and its metabolites formed in Trp catabolism with rheumatoid arthritis (RA) disease activation and to investigate the usability of these markers in the diagnosis and treatment of RA.

Methods

50 RA patients followed in our rheumatology clinic and 41 healthy controls without chronic disease were included in this study. Disease Activity Score 28 (DAS28) was used to evaluate the association of Kyn metabolites and Indolamine 2,3 dioxygenase (IDO) enzyme activity with RA disease activity. The task of this enzyme is to provide Kyn formation with Trp catabolism.

Results

In this study, lower Trp levels were found in the RA group compared to the control group (11285.47±2318.93-13320.31±3771.27, respectively) compared to the Trp mean (p<0.01). In terms of the Kyn/Trp ratio, a significantly higher Kyn/Trp ratio (4.42±1.77-3.27±0.71, respectively) was found in the RA compared to the control group (p<0.001). There was no significant difference between the study groups in terms of Kyn averages (p>0.05). A significant correlation was found between Trp levels and morning stiffness (r: -0.321, p<0.05) and the DAS28 score (r:-0.566, p<0.01). A significant positive correlation was found between the Kyn/Trp ratio and C-reactive protein (r:0.317, p<0.05), sedimentation (r:0.319, p<0.05), morning stiffness (r:0.287, p<0.05) and DAS28 score (r:0.322, p<0.01).

Table 1.

Comparison of study parameters between RA and control group.

ParameterRheumatoid arthritisControl groupP-ValueTryptophan (ng/ml)11285,47±2318,9313320,31±3771,27<0.01Kynurenine (ng/ml)477,68±158,38437,51±162,10>0.05Kyn/Trp ratio4,42±1,773,27±0,71<0.001

All values were expressed as mean ± SD. All values were calculated using independent sample t-test for normal distribution.

Figure 1.

Correlation relationship between DAS 28 and Trp levels (r: -0,321, p < 0.01)

Conclusion

In this study, we observed that RA has a significant relationship with Trp levels and Kyn/Trp ratio. In addition to the literature, we found that RA activation indicator DAS28 score and Kyn/Trp ratio and Trp level showed a statistically significant correlation. Our study has shown that the Trp catabolic pathway can be an important field of study for more effective and safe treatment of RA.

References

[1]Smolen JS, Aletaha D, Barton A, Burmester G, Emery P, et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001. doi:10.1038/nrdp.2018.1

[2]Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med

[3]Murray PJ. Amino acid auxotrophy as a system of immunological control nodes. Nature immunology, 2016;17.2: 132-139. doi:10.1038/ni.3323

[4]Frumento G, Rotondo R, Tonetti M, Damonte G, Benatti U, et al. Tryptophan-derived catabolites are

[5]De Jong RA, Nijman HW, Boezen HM, Volmer M, Ten Hoor KA, et al. Serum tryptophan and kynurenine concentrations as parameters for indoleamine 2, 3-dioxygenase activity in patients with endometrial, ovarian, and vulvar cancer. International Journal of Gynecologic Cancer, 2011;21.7. doi:10.1097/IGC.0b013e31822017fb

[6]Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT., et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism, 2010;62.9:2569-2581. doi:10.1002/art.27584.

[7]Ozkan Y, Mete G, Sepici-Dincel A, Sepici V, Simsek B. Tryptophan degradation and neopterin levels in treated rheumatoid arthritis patients. Clinical rheumatology; 2012;31.1:29-34. doi:10.1007/s10067-011-1767-5

Trp: Tryptophan, DAS28: Disease Activity Score

Acknowledgements

This study was supported by the Scientific and Technological Research Council of Turkey (TUBITAK). The authors thank TUBITAK for its financial support

Disclosure of Interests

None declared

AB1142 EFFECTS OF SULFASALAZINE USED IN AXIAL SPONDYLOARTHRITIS ON COVID-19 OUTCOMES: REAL-LIFE DATA FROM A SINGLE CENTER

Background

Compared to biologic-agents, little is known about effects of sulfasalazine used for axial spondyloarthritis(AxSpA) on COVID-19 outcomes.

Objectives

So, we aimed to understand the impact of sulfasalazine on COVID-19 in AxSpA patients.

Methods

This was a retrospective study from a single center which included 2344 AxSpA patients. We analyzed 219 of 406 confirmed COVID-19 patients from March 2020 to July 2021. The primary outcome was COVID-19 severity in terms of COVID-19 pneumonia, hospitalization rate and length of hospitalization. Analyses were stratified according to use of sulfasalazine and/or biologic-agents.

Results

Most of the patients were male(59%) with a mean age of 45.0 years. Peripheral arthritis was present in 35% and uveitis in 15%. In total, sulfasalazine was used in 42% and biologic-agent in 42%. COVID-19 pneumonia detected in 16%, hospitalization required in 14% and median(IQR) duration of hospitalization was 10(8) days. Two patients died due to COVID-19. The sulfasalazine users had higher age, more frequent COVID-19 pneumonia, hospitalization and longer hospitalization. After biologic-agent users were excluded, the sulfasalazine group had again longer hospitalization. When patients regrouped as sulfasalazine monotherapy, sulfasalazine+biologic and biologic monotherapy, in pairwise comparisons, sulfasalazine monotherapy group had a higher frequency of COVID-19 pneumonia than biologic monotherapy group(p=0.008).

Conclusion

Although sulfasalazine seemed to be related with increased rates of COVID-19 pneumonia and hospitalization, this impact diminished after exclusion of biologic-agent users. Sulfasalazine monotherapy and sulfasalazine+biologic therapy might be associated with development of COVID-19 pneumonia, compared to biologic monotherapy. Our results imply sulfasalazine may be related with worse disease course AxSpA patients with COVID-19.

Disclosure of Interests

None declared

AB0157 PREVALENCE OF SARCOPENIA AND CLINICAL IMPLICATIONS IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS PATIENTS

Background:

The aim of this study is to determine the frequency of sarcopenia at the time of diagnosis in RA patients, evaluate the effects of sarcopenia on RA disease activity, prognosis and examine the factors that may be associated with sarcopenia.

Objectives:

To determine the frequency of sarcopenia at the time of diagnosis in rheumatoid arthritis (RA) patients, assessing disease activity and factors that may be associated with sarcopenia and observe effects of treatment on sarcopenia.

Methods:

A prospective study was conducted on RA patients with newly diagnosed. Patients were evaluated twice, at the time of diagnosis and three months after the initiation of treatment. Demographic data, anthropometric measurements, disease activity scores and sarcopenia status were recorded. Sarcopenia was evaluated with grip strength and bioelectric impedance. The results were also compared with healthy volunteers.

Results:

Hand grip strength (p<0.001), skeletal muscle mass (p=0.009) and skeletal muscle mass index (p=0.032) were found to be reduced in RA patients compared to the control group. The frequency of sarcopenia in RA at onset of diagnosis was found to be 31.5%. There was a significant decrease in the rate of sarcopenia after three months of treatment (31.5% versus 8.7%; p=0.046).

Conclusion:

Sarcopenia was found in approximately one third of the patients with newly diagnosed RA in our study. With treatment, sarcopenia improved significantly. RA patients should be evaluated in terms of sarcopenia besides evaluating joint and extra-articular findings at the time of diagnosis. Early detection and treatment planning may improve the quality of life.

Figure 1.

Distribution of skeletal muscle mass index (SMMI) and prevalence of sarcopenia in RA and control groups

Table 1.

Demographics, clinical features, anthropometric measurements and disease activity scores of sarcopenic and non-sarcopenic RA patients

RA without sarcopenian=37RA with sarcopenian=17pAge, mean (SD), years47,3 (12,8)58,0 (16)0,011*Gender, female, n (%)27 (73)9 (52,9)0,215Marital status, married, n (%)34 (91,9)13 (76,5)0,258Tobacco consumption, n (%) Active smoker10 (27)5 (29,4)0,086 Ex-smoker8 (21,6)8 (47,1) Never smoker19 (51,4)4 (23,5)Alcohol consumption, n (%) Active drinker2 (5,4)2 (11,8)0,244 Ex-drinker0 (0,0)1 (5,9) Never drinker35 (94,6)14 (82,4)Occupation, n (%) Worker15 (40,5)12 (70,6)0,060Height, mean (SD), meter1,6 (0,1)1,6 (0,1)0,664Weight, mean (SD), kg80,6 (17,7)65,3 (8,6)<0,001*BMI, mean (SD), kg/m231,4 (7,3)24,9 (3,2)<0,001*Obese, n (%)20 (54,1)2 (11,8)0,006*Waist circumference, mean (SD), cm97,1 (14,2)89,3 (12,8)0,058Hip circumference, mean (SD), cm108,1 (12,7)96,6 (5,1)0,001*Calf circumference, mean (SD), cm35,4 (5,1)29,6 (4,0)<0,001*Triceps skin thickness, median (min-max), mm22 (8-36)15 (6-31)0,022*Loss of muscle strength, n (%) Right10 (27,0)9 (52,9)0,076 Left12 (32,4)10 (58,8)0,081Dominant hand, right, n (%)33 (89,2)13 (76,5)0,418SMM, mean (SD)25,1 (5,8)21,9 (4,7)0,049*SMMI, mean (SD)9,6 (1,5)8,2 (1,2)<0,001*DAS 28 - CRP, median (min-max)4,4 (1,7-6,5)4,4 (2,4-6,3)0,860SDAI, median (min-max)36,1 (8,8-113)31,1 (17,1-113)0,668CDAI, median (min-max)23 (0-48)23 (6-39)0,993PrGA, median (min-max)6 (0-9)5 (2-10)0,627PtGA, median (min-max)8 (0-10)7 (4-10)0,666Presence of morning stiffness, n (%)32 (86,5)14 (82,4)0,999Swollen joint count, median (min-max)2 (0-10)4 (0-9)0,423Tender joint count, median (min-max)6 (0-20)7 (0-18)0,911

Disclosure of Interests:

None declared

AB0314 SEMAPHORIN 3A LEVELS IN LUPUS WITH AND WITHOUT SECONDARY ANTIPHOSPHOLIPID ANTIBODY SYNDROME AND RENAL INVOLVEMENT

Background:

In this study, we aimed to evaluate sema3A levels in SLE patients with and without renal involvementor secondary antiphospholipid antibody syndrome (APS), to further elucidate the contribution ofsema3A in etiopathogenesis these conditions

Objectives:

Aim of this study is to evaluate sema3A levels in systemic lupus erythematosus patients (SLE) with and without renal involvement and secondary antiphospholipid antibody syndrome (APS).

Methods:

SLE patients were grouped according to presence of secondary APS or renal involvement. The control group consisted of age-matched, non-smoker, healthy volunteers. Sema3A levels were compared among groups. All SLE patients were regrouped according to presence of thrombotic events, miscarriages and proteinuria and sema3A levels were investigated. Finally, sema3A levels of all SLE patients as a single group were compared to controls.

Results:

The mean sema3A values were 16.16±2.84 ng/dL in the control group, 11.28±5.23 ng/dL in SLE patients without nephritis and APS, 9.05±5.65 ng/dL in SLE with APS group, and 8.53±5.11 ng/dL in lupus nephritis group. When all three patient groups were examined as a single group, mean sema3A value was significantly lower than that of the control group. Sema3A was reduced in SLE patients with thromboembolism and/or miscarriage.

Conclusion:

Sema3A levels were lower in all patient groups compared to the control group. Moreover, the reduced sema3A levels in patients with a history of thromboembolism and/or miscarriage suggests that sema3A may play an important role in the pathogenesis of vasculopathy

Table 1.

Comparison of sema3A levels between SLE patient groups and control subjects

Patient groupsGroup A (N=20)Group B (N=20)Group C (N=19)Control (N=19)pSema3A, ng/dL, mean ± SD9.05 ± 5.6511.28 ± 5.238.53 ± 5.1116.16 ± 2.84Group A vscontrol<0.001Group B vscontrol<0.001Group C vscontrol<0.001Group A vs B = 0.203Group A vs C = 0.766Group B vs C = 0.106All patients (N=59)Control (N=19)<0.0019.64 ± 5.3816.16 ± 2.84Patients with thrombotic events and/or miscarriages (N=31)Patients without thrombotic events and/or miscarriages (N=48)0.0329.96 ± 5.1112.33 ± 5.84Patients with proteinuria and/or thrombotic events and/or miscarriages (N=45)Patients without proteinuria and/or thrombotic events and/or miscarriages (N=34)<0.0019.05 ± 5.0914.91± 4.50

Disclosure of Interests:

None declared

Thiol/disulfide homeostasis impaired in patients with primary Sjögren's syndrome

Background

Primary Sjögren's syndrome (pSS) is a disease associated with the overexpression of proinflammatory cytokines, and oxidative stress is one of the factors responsible for its etiopathogenesis. This study aimed to investigate the thiol/disulphide homeostasis in pSS patients.

Methods

The study included 68 pSS patients and 69 healthy controls. Thiol/disulphide homeostasis (total thiol, native thiol, and disulphide levels) was measured using the automatic spectrophotometric method developed by Erel and Neselioglu, and the results of the 2 groups were compared.

Results

The gender and age distributions of the pSS and control groups were similar (P = 0.988 and P = 0.065). Total thiol and native thiol levels were lower in the pSS group than in the control group (470.08 ± 33.65 µmol/L vs. 528.21 ± 44.99 µmol/L, P < 0.001, and 439.14 ± 30.67 µmol/L vs. 497.56 ± 46.70 µmol/L, P < 0.001, respectively). There were no differences in disulphide levels between groups [17.00 (range 0.70-217.0) µmol/L vs. 14.95 (range 2.10-40.10) µmol/L, P = 0.195].

Conclusions

It was concluded that the thiol/disulphide balance shifted towards disulphide in patients with pSS.

SAT0423 LONG-TERM SURVIVAL OF THE FIRST BIOLOGIC TREATMENT IN PSORIATIC ARTHRITIS AND THE EFFECT OF THE SELECTED TREATMENT ON DRUG SURVIVAL; TURKBIO REGISTRY

Background:

Currently, biologic treatments are used effectively in patients with psoriatic arthritis (PsA).

Objectives:

The aim of this study was to evaluate and compare long-term drug survival of the first biologic treatments including adalimumab, certolizumab, etanercept, golimumab, infliximab, secukinumab and ustekinumab in patients with PsA.

Methods:

PsA patients, electronically registered at each visit in the TURKBIO database between 2011 and 2019 were included in the study. PASW 18.0 for Windows was used for statistical analysis. Drug survival rates were calculated by Kaplan Meier method.

Results:

355 patients (227 women; axial PsA = 48, peripheral PsA = 307) were included in the study (Table 1). Adalimumab was the most commonly used first biologic treatment (n=125; 37.6%). The rate of drug survival was found to be 0.75 at month 60 in patients receiving the first biologic treatment (Figure 1). There was no significant difference in drug survival rate between tumor necrosis factor alpha inhibitor (TNFi) and non-TNFi biologic drugs (p=0.56). No difference was also found in drug survival rates between each biologic treatment.

Table 1.

Initial demographic and clinical datas of patients with PsA

PsA Patients (n=355)Females, n (%)227 (63,9)Age of diagnosis, years*34,6 (27-42)CRP baseline*6 mg/ L (3-15)ESR baseline*24 mm/h (10-38)Smoking, n (%)Current99 (28,5)Never192 (55,3)Previous56 (16,2)HLA B27 positivity,n (%)41 (26,4)First biologic agent, n (%)-TNFi332 (95,4)AdalimumabEtanercept125 (37,6)80 (24,1)Golimumab52 (15,6)Certolizumab44 (13,3)Infliximab31 (9,4)- Other biologic agents16 (4,6)Secukinumab13 (81,3)Ustekinumab3 (18,7)

*median (min-max)

Conclusion:

The results of this study establish that more than half of patients with PsA can remain in their initial biologic treatment over a long term. It has been observed that the choice of biologic treatment did not effect the drug survival in PsA.

Disclosure of Interests:

None declared

Impedance ratio: a novel marker and a powerful predictor of mortality in hemodialysis patients

PURPOSE

Impedance ratio (Imp-R) obtained by multifrequency bioimpedance analysis (BIA) has been shown to be associated with volume and nutrition status. In this prospective study, the predictive role of Imp-R for mortality in hemodialysis (HD) patients was investigated.

METHODS

Multifrequency (5-50-100-200 kHz) BIA was applied to 493 prevalent HD patients in March-April 2006. Imp-R was defined as the ratio of 200-5 kHz impedance values. Demographical, clinical and laboratory data at the time of the analysis were recorded. All-cause and cardiovascular (CV) mortality were assessed during 3 years of follow-up.

RESULTS

Mean age was 57.7 ± 13.9 years, HD duration 52.1 ± 42.6 months and prevalence of diabetes 21.7 %. Imp-R was negatively correlated with nutritional markers including albumin, creatinine and hemoglobin levels. In addition, there was a positive correlation between Imp-R and age, ratio of extracellular water to total body water and high-sensitive C-reactive protein. Over a mean follow-up period of 27.9 ± 11.1 months, 93 deaths (52 from CV reasons) were observed. In the multivariate analysis, Imp-R was significantly associated with all-cause and CV mortality after adjustments [HR 1.13, 95 % CI (1.04-1.23); p = 0.004 and HR 1.15, 95 % CI (1.03-1.27); p = 0.01, respectively]. The risk of all-cause mortality was 3.4 times higher in the fourth quartile of Imp-R (>83.5 %) compared to the first Imp-R quartile (<78.8 %) as reference. Cutoff value of Imp-R for all-cause mortality was 82.0 % with a sensitivity of 65.5 % and specificity of 64 %.

CONCLUSION

Impedance ratio measured by multifrequency in standardized conditions BIA is an independent and powerful predictor of both all-cause and CV mortality in hemodialysis patients.

Response rate of initial conventional treatments, disease course, and related factors of patients with adult-onset Still's disease: Data from a large multicenter cohort

BACKGROUND

Adult-onset Still's disease (AOSD) is a rare condition, and treatment choices are frequently dependent on expert opinions. The objectives of the present study were to assess treatment modalities, disease course, and the factors influencing the outcome of patients with AOSD.

METHODS

A multicenter study was used to reach sufficient patient numbers. The diagnosis of AOSD was based on the Yamaguchi criteria. The data collected included patient age, gender, age at the time of diagnosis, delay time for the diagnosis, typical AOSD rash, arthralgia, arthritis, myalgia, sore throat, lymphadenopathy, hepatomegaly, splenomegaly, pleuritis, pericarditis, and other rare findings. The laboratory findings of the patients were also recorded. The drugs initiated after the establishment of a diagnosis and the induction of remission with the first treatment was recorded. Disease patterns and related factors were also investigated. A multivariate analysis was performed to assess the factors related to remission.

RESULTS

The initial data of 356 patients (210 females; 59%) from 19 centers were evaluated. The median age at onset was 32 (16-88) years, and the median follow-up time was 22 months (0-180). Fever (95.8%), arthralgia (94.9%), typical AOSD rash (66.9%), arthritis (64.6%), sore throat (63.5%), and myalgia (52.8%) were the most frequent clinical features. It was found that 254 of the 306 patients (83.0%) displayed remission with the initial treatment, including corticosteroids plus methotrexate with or without other disease-modifying antirheumatic drugs. The multivariate analysis revealed that the male sex, delayed diagnosis of more than 6 months, failure to achieve remission with initial treatment, and arthritis involving wrist/elbow joints were related to the chronic disease course.

CONCLUSION

Induction of remission with initial treatment was achieved in the majority of AOSD patients. Failure to achieve remission with initial treatment as well as a delayed diagnosis implicated a chronic disease course in AOSD.

Brucellosis in spondyloarthritis mimicking an exacerbation

Spondyloarthritis are a group of chronic inflammatory diseases that affect the axial skeleton, entheses and peripheral joints and may have extraarticular manifestations such as uveitis, psoriasis and inflammatory bowel disease. Brucellosis is a systemic infectious disease, endemic in Middle East, Latin America, and Mediterranean countries, which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Some hallmarks of Brucellosis may mimic a spondyloarthritis flare. In this paper, authors present a clinical case of brucellosis occurring in a patient with spondyloarthritis. Clinical symptoms initially mimicked exacerbation of spondyloarthritis.

Co-existence of familial Mediterranean fever and multiple sclerosis in two patients

ABSTRACT Two female patients, aged 23 and 25 years-old diagnosed with Familial Mediterranean fever (FMF) were presented with ataxia and headache. Multiple sclerosis plaques were detected in their spinal and cranial MRI and diagnosis of multiple sclerosis was established. Genetic analysis demonstrated M694 V mutation (one homozygous and the other heterozygous) in both of the patients. Although it is quite rare, coexistence of familial Mediterranean fever and multiple sclerosis should be kept in the mind.

Assessment of the relationship between aortic stiffness and left ventricular functions with echocardiography in patients with Sjögren's syndrome

BACKGROUND AND AIM

Capable of multi-organ involvement in Sjogren's syndrome (SS), cardiac findings of pulmonary effusion, left ventricular diastolic dysfunction and pulmonary hypertension are seen in patients with SS. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta. In this study, our aim is to determine if there is any differences in AS and left ventricular function between patients diagnosed as SS and healthy control groups.

METHODS AND RESULTS

We enrolled 50 patients with SS and 47 healthy volunteers with similar demographic characteristics. It was found that isovolumetric relaxation time (IVRT) and deceleration time (DT) were significantly longer and early diastolic wave (E) was significantly lower in patients with SS, but there was no difference in the other parameters. When tissue Doppler echocardiography (TDE) findings were compared between the two groups, it was found that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em/Am ratio were significantly lower, and myocardial isovolumetric relaxation time (IVRTm) and myocardial performance index (MPI) values were significantly higher in patients with SS. A significant positive correlations between aortic strain and Sm (r = 0.35, P < 0.001), Em (r = 0.42, P < 0.001) and Em/Am (r = 0.26, P = 0.008) and negative correlations in IVRTm (r = -0.36, P < 0.001) and MPI (r = -0.24, P = 0.01) were detected. A significant positive correlation between aortic distensibility and Sm (r = 0.36, P < 0.001), Em (r = 0.44, P < 0.001), Em/Am (r = 0.26, P = 0.009) and negative correlation of IVRTm (r = -0.22, P = 0.02) were determined.

CONCLUSION

There is a significant relationship between AS and left ventricular diastolic dysfunction in patients with SS in this study. The parameters of aortic elasticity measured by 2D echocardiographic methods can be beneficial in predicting early cardiovascular risk in SS.

Peripheral blood mononuclear cell microchimerism in Turkish female patients with systemic sclerosis

OBJECTIVES

To investigate microchimerism (Mc) in peripheral blood mononuclear cells (PBMC) taken from female patients with systemic sclerosis (SSc) and healthy females. We also intended to research the association between Mc and the clinical subsets.

METHODS

This study included 50 females with lcSSc, 30 females with dcSSc and 40 healthy females. The Y-chromosome sequences were studied by RT-PCR in DNA obtained from PBMC.

RESULTS

Mc was found in 28 (35 %) patients and 8 (20 %) healthy controls as well as in 6 dcSSc patients with son(s) (27.3 %), 10 lcSSc patients with son(s) (32.3 %) and 7 control females with son(s) (18.9 %) (p > 0.05). Mc was detected in 6 nulliparous lcSSc patients (31.6 %) and in 1 nulliparous dcSSc patient (11.1 %) (p > 0.05). The mean time elapsed between the first pregnancy and the diagnosis of SSc was 3.5 (0-49) years in the Mc-positive patients and 14 (0-55) years in the negative patients (p = 0.020). The mean modified Rodnan skin scores (ModRSS) of the patients with and without Mc was 10 (4-24) and 13 (4-26), respectively (p = 0.038). The relationship between Mc and the system involvement, disease severity, autoantibody profile, number of children and age of children was not found.

CONCLUSIONS

Various etiological factors rather than just one play a role in the development of scleroderma. Mc is thought to be one factor that shortens the elapsed time of disease development in SSc. Mc is inversely related to the ModRSS, and no association was detected between Mc and autoantibodies or the clinical subsets.

Low plasma vitamin D levels in patients with familial Mediterranean fever

Familial Mediterranean fever (FMF) is an autosomal recessive, inherited autoinflammatory disease characterized by recurrent, self-limited attacks of fever and inflammation of serosal surfaces. There is an explosion of the data regarding inflammatory markers in FMF and clinical effects of chronic inflammation on the disease presentation. Vitamin D (vit D) is the common denomination of a group of sterols with a crucial role in phospho-calcium metabolism. There are some data about the importance of vit D in the initiation and propogation of a range of autoimmune diseases. The aim of the present study was to determine whether vit D deficiency is present in patients with FMF compared with healthy individuals. The study group included 99 patients with diagnosis of FMF attended to our outpatient Rheumatology and Nephrology Clinics of Atatürk Education and Research Hospital. The control group comprised 51 age- and sex-matched healthy people selected from hospital staff. Serum baseline 25-hydroxy vit D levels were measured by HPLC method using an Agilent 1100 Liquid Chromatograph. We found significantly lower serum 25-hydroxy vit D levels among FMF patients compared with matched controls and a high prevalence of vit D deficiency. This study demonstrated that vit D deficiency is frequent in patients with FMF than the healthy controls. It is convenient to look for vit D deficiency and to correct vit D nutritional status in FMF patients.

Successful treatment with anti-tumor necrosis factor (anti-TNF)-alpha of proteinuria in a patient with familial mediterranean fever (FMF) resistant to colchicine: anti-TNF drugs and FMF

Familial mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of fever, peritonitis, pleuritis, and genetically by autosomal recessive inheritance. The major renal involvement in FMF is the occurrence of amyloidosis that can be prevented by a daily regimen of colchicine. About 5-10% of cases with familial mediterranean fever may be resistant to colchicine. In literature, there is a controversy about the treatment of FMF patients resistant to colchicine. We describe a case with FMF, proteinuria, and bilateral sacroiliitis, which responded to anti-TNF (tumor necrosis factor)-alpha therapy with infliximab and etanercept.

Plasma paraoxonase activity in patients with systemic sclerosis

BACKGROUND & OBJECTIVE

Systemic sclerosis (SSc) is a connective tissue disease characterized vascular damage and fibrosis. The aim of this study was to investigate the possible relation between systemic sclerosis and paraoxonase which is an antioxidant enzyme on the HDL.

METHODS

Twenty nine patients with SSc and 16 healthy subjects (control group) participated in the study. Plasma cholesterol levels, anti-centromere antibody (ACA) levels and paraoxonase (PON) activities were measured.

RESULTS

Lower level of high-density lipoprotein (HDL) cholesterol was observed in ACA negative SSc patients than in controls. Paraoxonase activity in ACA positive patients was however found to increase relative to control and ACA negative patient groups.

INTERPRETATION & CONCLUSION

Our findings suggested that low HDL level in ACA negative SSc patients might be one of the factors leading to some vascular problems, and increased PON activity in ACA positive SSc group might have some role in the limitation of cutaneous sclerotic process observed in these patients. However, these preliminary findings need to be confirmed with a larger sample.

Erythema nodosum: an evaluation of 100 cases

OBJECTIVES

In this study, we investigated the clinical features, etiology, and also predictive factors of secondary erythema nodosum (EN) in patients with EN.

METHODS

A total of 100 patients (mean age: 37 years) diagnosed with EN between 1993 and 2004 in our clinic were included in the study prospectively. A skin biopsy was performed in 46 of the patients. Patients were considered to have secondary EN when an underlying condition was found, and to have primary EN when no such condition was found. For the diagnosis of the underlying diseases, the pertinent diagnostic criteria and/or diagnostic methods were used. Categorical and continuous variables were compared by using chi-square and Mann-Whitney U tests respectively. Multiple regression analysis was applied to the significantly different variables.

RESULTS

The majority of the patients were female (female/male: 6/1) and nearly half (47%) of the cases had a determined etiology. The leading etiology was poststreptococcal (11%), followed in decreasing order by primary tuberculosis (10%), sarcoidosis (10%), Behçet's syndrome (BS) (6%), drugs (5%), inflammatory bowel diseases (IBD) (3%), and pregnancy (2%). Fifteen (15%) patients complained of cough; the diagnosis was primary tuberculosis in eight cases and sarcoidosis in seven. Four patients with arthritis were diagnosed as having BS (in 3) and Crohn's disease (in 1). All the patients were followed for a mean duration of 4.5 years. The nodosities relapsed annually in 62% (33/53) of idiopathic EN patients but in only one (BS) in the secondary EN group. The histology was consistent with EN in all biopsied patients. Our study revealed that fever, leukocytosis, elevated CRP level, accelerated ESR, presence of cough, sore throat, diarrhea, arthritis, and pulmonary pathology were predictors of secondary EN. Recurrence in EN significantly predicted primary EN. All of the patients had bed rest and the majority was given an anti-inflammatory agent (naproxen sodium). The outcomes were usually favorable within 7 days. The patients with an underlying disease were given the specific treatment.

CONCLUSION

EN has been associated with numerous diseases. In order to reduce cost and duration of diagnosis, every centre should determine its own most frequent etiologic factors. Predictive variables for secondary EN should also be determined and an optimum management for such patients should be clarified. Our study revealed streptococcal pharyngitis, primary tuberculosis, sarcoidosis, IBD, and BS as the main etiologies of EN.

Rapid identification of hemoglobin variants by electrospray ionization mass spectrometry

The precise identification of human hemoglobin variants, over 700 human hemoglobin variants are known, is essential for prediction of their clinical and genetic significance. A systematic approach to their rapid identification is described. Traditionally this requires protein or DNA characterization which entails lengthy analytical procedures. To overcome these obstacles a rapid approach to variant hemoglobin identification has been developed using conventional phenotypic methods combined with electrospray ionization-mass spectrometry (ESI-MS). The latter requires only a small amount of whole blood (10 microl) but in most cases 2 microl would have been sufficient and no preanalytical steps, such as separation of red cells or globin chains, are necessary. Aged, hemolyzed blood samples can also be analyzed. This approach has been used to positively identify 95% of the variants in over 250 samples. The remaining 5% in which a variant was detected by phenotypic techniques were not resolved by mass spectrometry. Ninety-nine different abnormalities comprising 36 alpha-chain variants, 59 beta-chain variants (including 2 extensions), and 4 hybrid hemoglobins were identified. These include 15 novel variants. The application of ESI-MS described requires approximately 1 h to prepare and analyze each sample and has minimal reagent costs. The turnaround time on a single sample can be as little as 2 h. This technique can now be considered a useful additional tool for reference laboratories.

Genetic and acquired predisposing factors and treatment of osteoporosis in thalassaemia major

We have previously shown a high incidence of osteopenia and osteoporosis in patients with thalassaemia major. These bone changes, were more severe in males than females, in those with diabetes mellitus and with hypogonadal-hypogonadism. Our recent studies concern the relationship of erythroid activity, assessed by serum transferrin receptors as an overall measure of anaemia, to osteoporosis. Serum transferrin receptor levels correlated with the mean pre-transfusion haemoglobin level, but there was no correlation with the incidence of osteopenia and osteoporosis. As osteoporosis has a strong genetic component we have also studied the COLIA1 and COLIA2 genes which code for the major protein of bone (type 1 collagen). Studies by others have shown in non-thalassaemic patients that a polymorphism G-->T or TT in a regulatory region of COLIA1 at the recognition site for transcription factor Sp1 is associated with the presence of osteoporosis. Our studies suggest that Sp1 polymorphism is not specific to any one ethnic group; the polymorphism occurs more commonly in females (female to male ratio 2:1). In male thalassaemia major patients the presence of the Sp1 mutation was associated with more severe osteoporosis of the spine and the hip compared with female patients. There is failure of improvement in spinal osteoporosis with bisphosphonate therapy (intravenous Pamidronate) in male patients with the Sp1 mutation.

Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis

Mitral valve replacement with preserving all chordae tendineae in patients with mitral regurgitation has been proved to be beneficial for left ventricular performance in the postoperative period. To evaluate the effectiveness of this technique in patients with mitral stenosis a comparison of the hemodynamic and echocardiographic data between patients having operation with this technique (Group P, n = 15, mean age = 37.5 +/- 12 years), and those having operation with the conventional method of mitral valve replacement (Group C, n = 15, mean age = 39 +/- 10.4 years) was made. The study population was limited to patients who had no clinical evidence of coronary artery disease and if over 40 years of age had normal coronary artery anatomy on coronary arteriography; patients with no evidence of aortic stenosis and/or regurgitation; and patients who had pure mitral stenosis or mitral stenosis with slight regurgitation (Grade 2 or less) with a mean gradient across the mitral valve greater than 10 mmHg. Hemodynamic parameters improved in both groups after the operation. However, echocardiographic measurements obtained six months postoperatively revealed a significant decrease in left ventricular ejection fraction in Group C (61.33 +/- 9.29% preoperatively versus 53.2 +/- 10.3% postoperatively; p < 0.05). The difference between left ventricular ejection fraction diminution of the two groups was statistically significant (-0.71 +/- 6.28% in Group P versus -8.07 +/- 13.35% in Group C; p < 0.01). Left ventricular end systolic and end diastolic dimensions decreased in patients with preserved valves and increased in patients operated on with conventional method without reaching a statistical significance. Sizes of prosthetic valves inserted were in the same range and no significant differences were found in preoperative and postoperative comparison of the two groups in respect to effective mitral orifice area and transvalvular gradient. There were no evidence of prosthetic valve dysfunction and paravalvular leakage and no operative or late deaths. It is concluded that if it is suitable, mitral valve replacement with preservation of chordae tendineae is expected to have a beneficial effect on postoperative left ventricular performance in patients with mitral stenosis.