AB0860-HPR IS THERE A RELATIONSHIP BETWEEN PHYSICAL ACTIVITY, SLEEP QUALITY, ANXIETY AND DEPRESSION IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER?

Background:

Maintenance of regular physical activity is associated with better physical and mental health (1). In addition, sleep disturbances and mood disorders are common in chronic inflammatory diseases (2).

Objectives:

The aim of this study was to determine the relationship between physical activity, sleep quality, anxiety and depression in patients with FMF.

Methods:

A total of 56 patients (30 female, 26 male) with Familial Mediterranean Fever (FMF) were enrolled in the study. They were diagnosed with FMF based on the Livneh diagnostic criteria (3). International Physical Activity Questionnaire - Short Form (IPAQ) was used to evaluate health-related physical activity. Patient-reported sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression in FMF patients. Patients who were 20-55 years old was included in the study.

Results:

The mean age was 32.23±9.87 years. The mean disease duration of the patients was 12.24±7.61 years. The education level of 51.8% (n=29) of the participants was undergraduate and above. The rate of those who did not work was 32.1% (n=18) and 48.2% (n=27) of the participants were married. The mean of scores of IPAQ was 2333.99±2640.29, the mean of PSQI was 6.14±3.66, the mean of HADS-Anxiety was 7.89±5.03 and HADS-Depression was 7.01±4.44. The patients were classified according to physical activity categories as low (25.0%, n=14), moderate (41,1% n=23) and high (33.9%, n=19). Physical activity categories were not found associated with PSQI (p=0.437), HADS-Anxiety (p=0.363) and HADS-Depression (p=0.861). The relationships of scores of IPAQ, PSQI and HADS were demonstrated Table 1.

Conclusion:

This study confirmed that patients with FMF suffer from sleep disturbances, anxiety and depression. In addition, sleep disturbances, anxiety and depression were not associated with physical activity category.

References:

[1]Sokka, Tuulikki, et al. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 2008, 59.1: 42-50.

[2]Kucuksahin, Orhan, et al. Incidence of sleep disturbances in patients with familial Mediterranean fever and the relation of sleep quality with disease activity. International journal of rheumatic diseases, 2018, 21.10: 1849-1856.

[3]Bashardoust, Bahman. Familial Mediterranean fever; diagnosis, treatment, and complications. Journal of nephropharmacology, 2015, 4.1: 5.

Table 1.

The correlations of IPAQ, PSQI and HADS scores.

HADS-DepressionHADS-AnxietyPSQIIPAQr-0.091-0.142-0.002p0.5050.2950.990PSQIr0.6890.615p0.0010.001HADS-Anxietyr0.681p0.001

-Pearson Correlation

Disclosure of Interests:

None declared

AB0715 THE PREVALENCE OF FIBROMIYALGIA IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER AND THE RELATIONSHIP BETWEEN FATIGUE AND QUALITY OF LIFE

Background:

Familial Mediterranean Fever (FMF) can cause various muscle diseases. Because it is a chronic auto inflammatory disease, painful trigger points may be encountered in the examination due to a decrease in the pain threshold (1-3).

Objectives:

The aim of this study was to determine the prevalence of Fibromiyalgia in patients with FMF, at the same time to identify the relationship between fatigue and quality of life.

Methods:

Sixtyseven patients (38 female, 29 male) with FMF were enrolled in the study. They were diagnosed with FMF based on the Livneh diagnostic criteria (4). Fibromyalgia involvement of the patients was evaluated according to the Fibromyalgia Impact Questionnaire (FIQ). Patients with diagnose with other chronic disease were excluded. Fatigue Severity Scale (FSS) was used to evaluate fatigue. Quality of life was evaluated with Short Form-36 (SF-36).

Results:

Respectively, the mean age, disease duration and body mass index were 34.46±12.69 years, 12.66±7.86 years and 24.96±5.42 kg/m2. In addition, 65% of the patients had no rheumatic disease in their family history. The mean of scores of FIQ was 38.66±25.14, the mean of FSS was 38.07±17.56, the mean of SF-36-PCS was 45.55±10.54 and SF36-MCS was 30.93±17.39. Patients were categorized as mild (n=28), moderate (n=24) and severe (n=15) affected according to their FİQ score. The relationships of scores of FIQ, FSS and SF-36 were demonstrated Table 1.

Conclusion:

Fibromyalgia symptoms can be seen in FMF. According to our results, it has been shown that patients with moderate and severe symptoms have increased fatigue levels and decreased quality of life. In the light of these results, we can say that also the fibromyalgia symptom of patients with FMF should be considered in the treatment.

References:

[1]Sari, Ismail; Birlik, Merih; Kasifoglu, Timucin. Familial Mediterranean fever: an updated review. European journal of rheumatology, 2014, 1.1: 21.

[2]Alayli G, Durmus D, Ozkaya O, Sen HE, Genc G, Kuru O. Frequency of juvenile fibromyalgia syndrome in children with familial Mediterranean fever: effects on depression and quality of life. Clin Exp Rheumatol 2011; 29: S127-32.

[3]Langevitz P, Buskila D, Finkelstein R, Zaks N, Neuman L, Sukenik S, et al. Fibromyalgia in familial Mediterranean fever. J Rheumatol 1994; 21: 1335-7.

[4]Bashardoust, Bahman. Familial Mediterranean fever; diagnosis, treatment, and complications. Journal of nephropharmacology, 2015, 4.1: 5.

Table 1.

The correlations of FIQ, FSS and SF-36 scores.

FSSSF-36 PCSSF-36 MCSFIQ-mildmean±sd23.78±14.8853.34±7.0140.98±13.73r0.595**-0.014-0.551**p0.0010.9440.002FIQ-moderatemean±sd45.75±10.8341.09±8.8938.13±9.19r0.053-0.379-0.145p0.8060.0680.498FIQ-severemean±sd52.46±10.1138.13±9.1920.32±15.68r0.622*-0.548*-0.268p0.0130.0350.333

-Pearson Correlation

Disclosure of Interests:

None declared

POS1381 BIOLOGIC TREATMENT OF ADULT-ONSET STILL’S DISEASE: A SINGLE CENTER EXPERIENCE

Background:

Even though corticosteroids and cDMARDs are effective for inducing remission in patients with Adult-Onset Still Disease (AOSD), relapse is common. Hence, maintaining the clinical stability is challenging. Almost all of the patients face side effects because of high dose steroid treatment. Biological DMARDs have been reported to be effective in refractory patients.

Objectives:

We aimed to evaluate the patients’ outcomes who were diagnosed with AOSD and treated with at least one bDMARDs in our tertiary center.

Methods:

Patients with AOSD who were followed in our clinic between 2007 and 2020 were screened retrospectively. For the diagnosis of AOSD, all of the patients fulfilled Yamaguchi criteria. The demographic characteristics, baseline and post-treatment clinical findings and outcomes were reported.

Results:

Twenty-eight patients (21 F, 7 M) were screened (Figure 1). The mean disease duration of the first bDMARD was 21,76 ± 28,05 months (mean ± SD). The mean duration of bDMARD treatment was 37,04 ± 30,75 months. The reasons for starting a bDMARD were systemic symptoms (%80) and chronic arthritis (%20). All of the patients used methotrexate (MTX) except one. This patient had macrophage activation syndrome during diagnosis and was treated with cyclosporine. All of the patients were treated with corticosteroids (34,28 ± 26,70 mg/d) and a cDMARD at initiation (22 of them MTX, 1 of them azathioprine, 2 of them cyclosporine and 1 of them IVIg). Anakinra was the most preferred biologic as a first-line treatment modality (TNF inhibitors=5, tocilizumab=4). The main reason for switching was loss of efficacy (8/22). Tocilizumab was the most used agent in 2nd line and canakinumab was in 3rd line. Twenty-two patients were in remission at last visit. Also, 15 patients were steroid-free, 14 patients were MTX-free. Patient global visual analogue scale, acute phase reactants and daily steroid dose were reduced significantly at last visit compared to the initial visit (Table 1).

Table 1.

Comparison of important laboratory findings and the mean steroid dose

Clinical findingAt initiation of bDMARDmean ± SDAt the last visitmean ± SDPG-VAS9.8 ± 0.82.3 ± 2.3ESR (mm/h)34,28 ± 33,9518.82 ± 11.60CRP (mg/l)70,76 ± 67,8013.44 ± 27.33Ferritin (ng/mL)1662 ± 1239275.7 ± 381.4Daily steroid dose (prednisolone, mg/d)34.28 ± 26.705.60 ± 8.60Figure 1.

Presenting signs and the symptoms of the patients

bDMARD treatment was terminated in 5 patients due to complete remission (n=2) and side effects (1 of them pneumonia, 1 of them EBER (+) Hodgkin Lymphoma and 1 of them tuberculosis). Six patients experienced local injection site reaction, none of them stopped treatment. Also, one patient died while she was in remission under anakinra treatment with an unknown cause.

Conclusion:

The most common presenting symptoms in our cohort were fever and salmon-colored rash. Tocilizumab is an alternative treatment modality in cases with chronic arthritis and IL-1 inhibitors are an alternative for systemic course of disease. bDMARDs, especially IL-1 inhibitors are highly effective for refractory patients with AOSD.

Disclosure of Interests:

None declared

POS0820 INFLIXIMAB FOR VASCULAR INVOLVEMENT IN BEHÇET SYNDROME

Background:

Vascular involvement is an important cause of morbidity and mortality in patients with Behçet syndrome (BS). TNF inhibitors have been reported to be effective for almost all serious manifestations of BS but data on vascular involvement is still limited.

Objectives:

To survey the efficacy and safety of infliximab (IFX) in BS patients with vascular involvement followed in a dedicated tertiary center.

Methods:

We reviewed the charts of all BS patients who used IFX and identified those who used this drug for vascular involvement. A standard form was used for extracting data on demographic and clinical features, type of vascular involvement, concomitant immunosuppressives, duration of IFX use, relapses, adverse events and outcome.

Results:

83 patients (67 men, 16 women, mean age 39.5 ± 8.4 SD years) had used IFX for vascular involvement. The number of patients with each type of vascular involvement as the main indication for IFX, and previous treatment modalities right before IFX are presented in the Table 1. 33 patients had more than 1 type of vascular lesion. Additional organ manifestations were eye involvement in 32, central nervous system involvement in 4 and gastrointestinal involvement in 3 patients. All but one patient used IFX at a dose of 5 mg/kg every 6-8 weeks. All patients used concomitant prednisolone and 51 received pulse methylprednisolone during induction. Other concomitant medications were azathioprine in 21 and mycophenolate mofetil in 4 patients. Outcome of IFX treatment at the end of a mean follow-up of 25.9 months (range 1-103) is tabulated according to arterial and venous involvement (Table 1). Overall, 57/83 (68%) patients obtained remission with no further relapses and IFX could be stopped in 12 (14%) of them. IFX was discontinued due to adverse events in 15 patients. These were allergic reactions in 8, tuberculosis, disseminated zona, lung adenocarcinoma, fibromyxoid sarcoma, heart failure, systemic lupus erythematosus, and palmoplantar pustulosis in 1 patient each. Three patients had died. Causes of death were lung adenocarcinoma in one patient and pulmonary hypertension related right heart failure due to pulmonary artery thrombosis in 2 patients.

Conclusion:

Infliximab seems to be beneficial in Behçet syndrome patients with vascular involvement, even in those who are refractory to immunosuppressives and corticosteroids. No further relapses occurred in 68% of the patients, and adverse events leading to discontinuation were observed in 18%.

Arterial Involvement (n=36)Venous Involvement (n=47)Main reason for infliximab usePulmonary artery aneurysm and/or thrombosis, n=29Peripheral artery aneurysm, n=4Aortic aneurysm, n=3Vena cava superior and/or inferior thrombosis, n=5Lower extremity DVT, n=24Budd-Chiari syndrome, n=4Intracardiac thrombosis, n=2Dural sinus thrombosis, n=7Leg ulcer, n=5Previous treatmentFirst line infliximab413Corticosteroids3438Cyclophosphamide (CYC)25 (15/25 refractory to CYC; 10/25 for maintenance after CYC)11 (8/11 refractory to CYC; 3/11 for maintenance after CYC)Interferon-alpha-13Azathioprine2117Mycophenolate Mofetil12Cyclosporine A-2None due to non-compliance21OutcomeRemission, still on infliximab1623Discontinued due to remission48Discontinued due to adverse events59Discontinued due to relapse53Discontinued due to non-compliance53Died2 (1 had previously discontinued due to relapse)1

Disclosure of Interests:

None declared

POS1369 ADULT-ONSET STILL’S DISEASE: A SINGLE-CENTER EXPERIENCE

Background:

Adult-Onset Still’s disease (AOSD) is an autoinflammatory condition characterized by fever, rash, and arthritis. The diagnosis of AOSD is made by excluding common causes of fever of unknown origin which are infections, malignancies, autoimmune conditions and medication adverse effects. As it is a diagnostic challenge, further data on highlighting clinical and laboratory findings are necessary on guiding clinicians.

Objectives:

Our main objective is to present our single tertiary center experience of patients diagnosed with AOSD.

Methods:

This retrospective study was conducted at a tertiary rheumatology center. Patients were diagnosed with AOSD using Yamaguchi’s criteria and followed between 2007 and 2020. Demographic, clinical and laboratory information was retrieved from the patient chars. Treatment-related and prognostic information were also noted with additional information from phone call interviews.

Results:

The study includes 69 patients (23 M, 46 F). The mean age of diagnosis was 33.86±14.3. The presenting signs and symptoms of the patients are shown in Figure 1. The laboratory findings supporting the diagnosis at initial encounter are summarized in Table 1. The mean corticosteroid dose at initial diagnosis was 29.7±18 mg. In addition to corticosteroid treatment these patients were followed with different glucocorticoid-sparing agents. Methotrexate was the choice of treatment in 54 patients with the mean dose of 14.5±3.43 mg. Eight patients were treated with leflunomide, seven with anti-TNF agents, seven with tocilizumab, nineteen with anakinra and four with canakinumab.

Figure 1.

The presenting signs and symptoms of the patients

Conclusion:

In conclusion, the most common presenting symptoms in our AOSD cohort were fever and salmon-colored rash. In the differential diagnosis of fever of unknown origin especially with rash, AOSD should be considered. Corticosteroid was the main treatment modality. In patients who are unresponsive to conventional immunosuppressive treatment, biologic agents can be an alternative.

Table 1.

The laboratory findings at initial encounter

Mean ± Standard DeviationFerritin (ng/mL)3179.46±6503.56ESR (mm/h)77.43±28.47CRP (mg/L)102.29±70.39Leukocyte Count (cells/L)13147.3±4640.9ESR (mm/h)80±28.48CRP (mg/L)105.15±54.67Leukocyte Count (cells/L)12427.14±6530.43

Disclosure of Interests:

None declared

AB0579 INSTRUMENTS FOR SCREENING PSORIATIC ARTHRITIS AMONG PATIENTS WITH PSORIASIS: A SYSTEMATIC LITERATURE REVIEW

Background:

Timely diagnosis is essential for the optimal management of psoriatic arthritis (PsA). Several instruments have been developed for screening PsA among patients with psoriasis. However, a delay in diagnosis is still frequently reported, possibly due to the lack of a wide use of these instruments.

Objectives:

We aimed to identify and compare the reported performance of these instruments with special emphasis on the PsA phenotypes.

Methods:

We conducted a systematic literature search on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis’. Two independent reviewers identified all studies published in English, that report on the validation, psychometric evaluation or use of an instrument for screening PsA. Any disagreements were resolved by the third investigator. Data on sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were extracted or calculated for each instrument. Additionally, instruments were assessed for their performance in patients with different disease phenotypes.

Results:

A total of 10754 references were screened, and 42 were identified that reported on 15 different screening instruments. Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST), Early Arthritis for Psoriatic Patients questionnaire (EARP) were the most commonly used instruments. There was important variability across studies regarding the sensitivity, specificity, PPV and NPV of these instruments based on the cut-offs for positivity, setting, patient population and disease phenotypes (Table 1). Specificity was higher when patients with a previous diagnosis of other rheumatic diseases were excluded. Lower sensitivity was reported among patients with shorter disease duration and when patients with a prior diagnosis of PsA were excluded from the study, whereas higher sensitivity was reported among patients with prior NSAID use. Screening tools showed differences in sensitivity in different domains (Figure 1).

Figure 1.

Performance Among Patients with Each Domain

Conclusion:

This systematic literature review revealed wide variability in the diagnostic estimates of currently available questionnaire-based screening instruments for identifying PsA among psoriasis patients, depending on study populations and disease phenotypes. There is an unmet need for a screening instrument with a better performance in all disease domains.

Table 1.

Diagnostic estimates of screening tools in different studies

InstrumentNumber of studiesSensitivity%Specificity%PPV%NPV%PASE1824-9138-9518-8813-96PEST1140 – 8537.2-98.623-9647.1-99.3EARP941-97.234-97.214-93.357.5-100TOPAS641-89.129.7-9025.7-91.868-81.6TOPAS-II444-95.880.5-9863.4-95.891-98PsA-Disk questionnaire187.246.458.678.5CONTEST270-76.556.5-9116-8968-95STRIPP191.593.379.697.5SiPAS179877390PASQ267-92.764-81.84383GEPARD277706680Swedish- Psoriasis Assessment Questionnaire163724585PAQ160622687.5SiPAT169699169A novel, short, and simple screening questionnaire186.971.35393.6

PASE: Psoriatic Arthritis Screening and Evaluation, PEST: Psoriasis Epidemiology Screening Tool, EARP: Early Arthritis for Psoriatic Patients questionnaire, TOPAS: Toronto Psoriatic Arthritis Screening Questionnaire, STRIPP: Screening Tool for Rheumatologic Investigation,

SIPAS: Simple Psoriatic Arthritis Screening questionnaire, PASQ: Psoriasis and Arthritis Screening Questionnaire, GEPARD: German Psoriatic Arthritis Diagnostic Questionnaire, PAQ: Psoriatic and Arthritic Questionnaire, SiPAT: Siriraj Psoriatic Arthritis Screening Tool

Disclosure of Interests:

None declared.

POS1351 CAUSES OF HOSPITALIZATION IN BEHÇET SYNDROME

Background:

The causes of hospitalization may provide important information on the course of diseases and treatment-related adverse effects.

Objectives:

We aimed to determine the causes and outcome of hospitalizations among patients with Behçet Syndrome (BS) in a dedicated center.

Methods:

We surveyed hospitalization records in our clinic between January 2002 and December 2019 and identified those with a diagnosis of BS. The records of these patients were reviewed for demographic and clinical features, causes of hospitalization and outcome. We divided hospitalization causes into 2 as being BS related (organ involvement or deterioration) and non-BS related (treatment complication or others).

Results:

Three-hundred and thirty BS patients (75% men, mean age 37.7 ±11.4 SD years) were hospitalized for a total of 456 times during 18 years. The mean disease duration was 10.8± 8.8 SD years. Two-hundred and ninety-one (64%) patients were using immunosuppressives (IS) with or without corticosteroids (CSs) and 72 (16%) of them were under biologic treatment at the time of hospitalization. The mean duration of hospitalization was 12.7±10.7 SD days. The reasons for hospitalization were directly related to BS in 259 patients (57%) and non-related to BS in 191 (42%). Six patients were hospitalized for both BS and non-BS related reasons at the same time. The most common reasons were vascular involvement (n=169, 64%) for BS related reasons and infections (n=64, 32%) for non-BS related reasons (Table 1). Patients hospitalized for BS related causes were younger (35.2±10.6 vs 41.1±11.7, p<0.001), had short mean disease duration (8.5±7.5 vs. 13.6±9.4 years, p<0.001), stayed shorter in the hospital (11.6±8.6 vs 14.0±12.9 days p=0.03) and had less frequent IS±CSs use (59% vs 70%, p=0.02) compared to those with non-BS related hospitalizations. There were no differences between the groups regarding gender distribution (203 M/62 F vs. 143 M/54 F) and use of biologic agents (15% vs 17%). Three patients died during hospitalization. The reasons were malignancy, infection and right heart failure due to pulmonary artery thrombosis and pulmonary hypertension, respectively.

Conclusion:

Vascular involvement is the leading cause of hospitalization among BS patients, followed by infections. The predominance of men among hospitalized patients underlines the relatively severe course of BS in men. The retrospective design and inclusion of patients who were hospitalized only in the rheumatology unit are limitations of this study.

Table 1.

Distributions of BS related and non-BS related reasons of hospitalizations

BS patients hospitalized with BS related reasons(n of pts=195, n of hospitalizations=265)*BS patients hospitalized with non-BS related reasons(n of pts=170, n of hospitalizations=197)*Causes of hospitalizations (per hospitalization)Vascular inv. (n=169, 64 %)Pulmonary artery inv. (n=64, 24 %)Deep vein thrombosis (n=39, 15 %)Budd-Chiari synd. (n=24, 9%)Vena cava inf. thrombosis (n=19, 7 %)Peripheral artery inv. (n=15, 6 %)Vena cava sup. thrombosis (n=14, 5 %)Aorta inv. (n=14, 5%)Coronary artery inv. (n=4, 2 %)Infection (n=64, 32%)Pneumonia (n=17, 8%)Tuberculosis (n=8, 4%)Urinary tract inf (n=7, 4%)Gastroenteritis (n=4, 2%)Osteomyelitis (n=3, 2%)Septic arthritis (n=3, 2%)Aspergillosis (n=2, 1%)Nocardia (n=1, 1%)Salmonella (n=1, 1%)Others (n=18, 9%)Neurologic inv. (n=50, 19 %)Parenchymal inv. (n=37, 14%)Dural sinus thrombosis (n=13, 5%)Drug side effects other than infections (n=29, 15 %)Interferon (n=10, 5%)Azathioprine (n=7, 4%)Cyclosporine (n=5, 3%)Steroid (n=3, 2%)TNF antagonists (n=3, 2%)IVIG (n=1, 1%)GI inv. (n=18, 7%)Additional rheumatologic diseases (n=17, 9%)Joint inv. (n=12, 5%)Renal disease (n=16, 8 %)Mucocutaneous inv. (n=10, 4%)Cardiovascular dis. (n=12, 6%)Eye inv. (n=8, 3%)Avascular necrosis (n=4, 2%)Others (n=8, 3%)Malignancy (n=11, 6%)Others (n=40, 20%)

*Some patients were hospitalized more than one times and for both BS related and non-BS related reasons at different time and had more than one type of BS related and/or non-BS related reasons.

Disclosure of Interests:

None declared

Dermatomyositis Associated With Papillary Thyroid Cancer: Systematic Review of the Literature and a Case Report

OBJECTIVE

There is a well-known association between malignancy and dermatomyositis but reports of an association between malignancies of the thyroid gland and dermatomyositis are very few. Here we describe a recent case of dermatomyositis found to have thyroid cancer during screening and review the clinical features of the similar cases in literature.

METHODS

The case history, treatment responses and follow up data are described. We performed a systematic literature review using the keywords (thyroid cancer OR thyroid carcinoma) AND dermatomyositis.

RESULTS

35 year old male presented with an acute onset of symptoms including facial rash, widespread myalgia, muscle weakness and dysphagia. Patient was diagnosed with dermatomyositis based on clinical findings, laboratory, electromyography and imaging results and immunosuppressive treatment initiated. Screening for cancer revealed a papillary thyroid carcinoma. Thyroidectomy was performed and immunosuppressive medication was gradually tapered and stopped. At 24 months following the diagnosis patient remains in remission. This is the 14th reported case of dermatomyositis and thyroid cancer in the English literature. Analysis of data from these 14 cases while revealing conflicting insights about the link between dermatomyositis and thyroid cancer do not rule out this possibility. Treatment of thyroid cancer appeared to have a significant influence on the course of dermatomyositis in at least six of these cases.

CONCLUSION

Better recognition of the link between dermatomyositis and thyroid cancer may allow physicians to protect some dermatomyositis patients from morbidity and mortality associated with immunosuppression.

Anakinra treatment in patients with familial Mediterranean fever: a single-centre experience

OBJECTIVES

Anakinra is proven to be effective in controlled trials in terms of attack frequency and subclinical inflammation in colchicine-resistant patients. The objective of this study was to review the patients followed in our single centre with FMF who received anakinra because of insufficient colchicine response.

METHODS

The study was conducted at a tertiary rheumatology centre experienced in autoinflammatory diseases. The patients were treated for at least 1 month with anakinra. Patients with amyloidosis and pregnancy were not included. Attack frequency, patient global assessment scales of disease severity and acute phase reactants were recorded before and throughout anakinra treatment. Criteria of treatment termination were side effects, disease remission, inadequate response, pregnancy plan and non-compliance.

RESULTS

One hundred and six patients diagnosed with FMF were treated with anakinra; 45.92% of the patients had a homozygous M694V mutation; 83 of the 98 patients tested for MEFV carried at least one copy of M694V. Attack frequency decreased while on anakinra treatment; in fact, no attacks were observed in 75 patients. Visual analogue scale score decreased from 7.49 (2.03) to 3.08 (2.82) (P = 0.001). Currently, 71 patients are still on anakinra treatment. Treatment of 34 patients was discontinued (32%). Insufficient response and side effects were the most common reasons for treatment discontinuation. All of the side effects observed were reversible and the patients alleviated after treatment cessation. In four patients, leukopenia was observed.

CONCLUSION

In patients who were refractory to colchicine, anti-IL-1 agent anakinra was shown to be effective and safe. The effectiveness of anakinra stems from preventing attacks and increasing the quality of life.

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.

Long term follow-up of Behçet's syndrome patients treated with cyclophosphamide

OBJECTIVES

CYC remains an important treatment option for Behçet's syndrome (BS) patients with life-threatening manifestations. However, adverse events may occur with CYC and this has led to increased use of biologic agents in other vasculitides. We investigated short and long term adverse events associated with CYC use in BS patients.

METHODS

We conducted a retrospective chart review of all BS patients treated with CYC between 1972 and 2006. Patients were called in and a standard form was used for collecting demographic characteristics, indication for CYC, its cumulative dose and short term adverse events, defined as those causing discontinuation of CYC, hospitalization and/or death, long term adverse events, including infertility and malignancy, and outcome.

RESULTS

Of 5790 BS patients, 198 (3.4%) had used at least one dose of CYC. Main indications were vascular or neurological involvement. After a median follow-up of 17 years, 52 (26%) patients had died, 113 (57%) could be contacted, and 33 (17%) were lost to follow-up. Vascular involvement was the leading cause of death (n = 27). Seventeen (9%) patients experienced short term adverse events with haemorrhagic cystitis being the most common. After a median follow-up of 25 years (interquartile range: 15-26 years), 17 malignancies occurred in 15 (8%) patients. Infertility was experienced by 26 (30%) patients.

CONCLUSION

Long term adverse events such as malignancy and infertility were major problems in our BS patients treated with CYC. These results underline the need for safer treatment modalities that are at least as effective as CYC.

Hereditary Bisalbuminemia in Sjögren’s Syndrome and Rheumatoid Arthritis

Bisalbuminemia is rare finding of bifid albumin bands in serum electrophoresis. The protein abnormality can be sporadic and inherited. So far, this albumin variant was not found to cause or coexist with a specific pathology. This is a case of bisalbuminemia in 43-year-old female patient with a past medical history of Rheumatoid Arthritis (RA) and Sjogren’s Syndrome (SS). Similar electrophoresis findings were seen in two siblings of the patient. Rheumatology focused work-up of the family was negative. We could not find an association between this blood protein variant and the patient’s rheumatologic condition. Bisalbuminemia should not be a concern to the rheumatologist as it does not hint towards pathology.

Safety and efficacy of anti-interleukin-1 treatment in 40 patients, followed in a single centre, with AA amyloidosis secondary to familial Mediterranean fever

OBJECTIVE

The main devastating complication of FMF is AA amyloidosis. Approximately 10-15% of the patients are either intolerant or have an insufficient response to colchicine treatment. The most promising alternative treatment approach is anti-IL-1 agents. The aim of this study was to evaluate the efficacy and safety of anti-IL-1 therapy in FMF amyloidosis.

METHODS

Forty-four patients with amyloidosis who had been treated with anti-IL-1 agents, anakinra and/or canakinumab, were assessed retrospectively for efficacy and safety. Five patients were on haemodialysis and four had received a renal transplant.

RESULTS

The mean duration of anti-IL-1 treatment was 21.4  (18) months. Among 35 patients who were not on dialysis, renal function was maintained or improved in 79.4% but deteriorated in 20.6%. Patients with creatinine levels below 1.5 mg/dl at onset benefitted more from IL-1 inhibition with regard to their kidney functions and acute phase reactants. No additional side effects were observed in patients with renal replacement treatments. The major side effect of anakinra was injection-site reaction observed in four patients.

CONCLUSION

Anti-IL-1 agents are well tolerated and effective in the treatment of amyloidosis secondary to FMF, including patients on dialysis and renal transplant recipients. This approach may improve the lifespan of transplanted kidneys in FMF patients.

Alendronate induced subacute cutaneous lupus erythematosus successfully treated with intravenous immunoglobulin

The subacute cutaneous lupus erythematosus (SCLE) is a distinct subtype of lupus erythematosus (LE) representing specific clinical and serological features. Almost 20%-30% of the cases with SCLE are predicted to associated with medications. Thiazide diuretics, terbinafine, antiepileptic, and proton pump inhibitors are the best-known drugs to induce drug-related SCLE. Herein we want to present a 65-year-old female with alendronate induced SCLE, resistant to classical therapies, and respond well to intravenous immunoglobulin (IVIG), suggesting that IVIG could be an alternative treatment in patients resistant to classical treatment protocols.

Familial Mediterranean Fever: Clinical State Of The Art

As the inflammation research improves year by year, so does our understanding of the autoinflammatory conditions. Over the past years, the number of monogenic autoinflammatory conditions snowballed thanks to our understanding of basic immunology and genetics. Familial Mediterranean Fever (FMF), being the entrance to this fascinating world, still has clinical relevance as it enables us to understand our approach to these patients, treatment modalities, and pathological mechanisms. This review can be used as a tool for clinicians already working with FMF patients to update themselves on recent scientific literature.

Clinical course of acute deep vein thrombosis of the legs in Behçet's syndrome

OBJECTIVES

Lower extremity deep vein thrombosis (LEDVT) is a serious complication of Behçet's syndrome. Management constitutes mainly of administration of immunosuppressives, but the predictors of relapse and the optimal choice of immunosuppressives remain unclear. In this prospective study, we aimed to detect the risk and predictors of relapse and treatment response to different modalities.

METHODS

All Behçet's syndrome patients who presented with a first episode of acute LEDVT between 2010 and 2014 were prospectively followed with a standard protocol. Acute LEDVT was confirmed by Doppler ultrasonography. Serial planned Doppler ultrasonography assessments were performed during follow-up and additionally repeated in case of clinical suspicion. Recanalization rate was assessed at each visit. Our first-line treatment strategy consisted of AZA and CSs. IFN-alpha was used in patients who were refractory to or could not tolerate AZA or had concomitant eye involvement requiring further treatment.

RESULTS

Thirty-three patients with LEDVT (26 M/7 F) were prospectively followed for 40.7 ± 13.4 months. Among the 33 patients, 23 relapses were observed in 15 patients. Relapse rates were 29%, 37% and 45% at 6, 12 and 24 months, respectively. Among the possible predictors of relapse, poor recanalization was the only significant factor [hazard ratio 4.34 (95% CI 1.96, 10.0)]. Overall 29 patients were treated with AZA and 17 with IFN-alpha. The relapse rate was lower and recanalization rate was higher with IFN-alpha compared with AZA (12% vs 45% and 86% vs 45%).

CONCLUSION

The relapse rate for LEDVT in Behçet's syndrome is high despite AZA treatment. IFN-alpha seems to be a promising agent for preventing LEDVT relapses and achieving good recanalization.

The efficacy of anti- IL-1 treatment in three patients with coexisting familial Mediterranean fever and multiple sclerosis

It has been reported that multiple sclerosis (MS) is more common among patients with familial Mediterranean fever (FMF) than expected in normal population. Also, an association between MEFV gene variants and disease severity in MS has been described. Excessive production of interleukin-1 (IL-1) beta is responsible for FMF pathogenesis, and anti-IL-1 treatment is an effective approach in colchicine-resistant FMF patients. Here, we describe three patients with FMF and coexisting MS who have been treated with anti-IL-1 agents. Our observations suggest that blocking IL-1 is a safe and an effective alternative for colchicine resistant FMF and probably also for associated MS.

FRI0296 AN ALTERNATIVE APPROACH TO SPONDYLOARTHRITIS TREATMENT: PAMIDRONATE CASE SERIES

Background:

Spondyloarthritis (SpA) is a common group of chronic inflammatory diseases with substantial morbidity seen in rheumatology clinics. Its standardized treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), TNF-alpha inhibitors and IL-17 inhibitors. However, some patients remain refractory to conventional treatments and these treatments are contraindicated in malignancies and infections, which indicates the need for new therapeutic approaches. Pamidronate, a bisphosphonate with antiosteoclastic action, has been found useful in a few studies (1-2).

Objectives:

The aim is to evaluate the effectiveness and safety of pamidronate treatment in SpA in a single tertiary center.

Methods:

SpA patients who were treated with pamidronate due to lack of response to standard treatment or in patients where standard treatment is contraindicated in 2014-2019 are evaluated retrospectively. Patients’ files were evaluated for the indications, efficacy and the side effects of pamidronate as well as for the clinical and demographic features. Pamidronate intravenous dose was 90 mg/month.

Patient ID#AgeSexComorbiditiesPrevious treatmentsDuration of pamidronate treatment(mo)PGAS before treatmentPGAS after treatment148MOP, FMFNSAID, IFX, ETN691266FOP, Rectum cancerNSAID, SSZ28104336MGastric cancerNSAID, SSZ, IFX101010457MCAD, IBDNSAID,SSZ,MTX, ADA, CZP254550MnoneNSAID, IFX692669MDM,HT,CMD, PsONSAID, SSZ3791762MBladder cancerNSAID494840MnoneNSAID,GOL,ETN266946MnoneNSAID,SSZ, MTX, ADA, CZP, IFX, ETN, ADA, GOL8521040MnoneNSAID,SSZ, ADA, GOL, CZP, ETN, IFX3861158FSLENSAID, HCQ, MTX387

Table. F: female M: male OP: osteopenia, FMF: familial Mediterranean fever, CAD: coronary artery disease, IBD: inflammatory bowel disease, DM: diabetes mellitus, HT: hypertension, CMD: chronic myeloproliferative disorder, PsO: psoriasis, SLE: systemic lupus erythematosus IFX: infliximab, ETN: etanercept, SSZ: sulfasalazine, NSAID: non-steroidal anti-inflammatory drug, MTX: methotrexate, ADA: adalimumab, CZP: sertolizumab, GOL: golimumab, HCQ: hydroxychloroquine, PGAS: Patient Global Assessment Score

Results:

There were 11 patients (9 male and 2 female). 4 patients were diagnosed as non-radiographic SpA. The mean disease duration was 29±12 years (range 12-49). The comorbidities of the patients included diabetes mellitus and hypertension in 1 patient, coronary artery disease in 1 patient, psoriasis in 1 patient, inflammatory bowel disease in 1 patient, Familial Mediterranean fever in 1 patient, systemic lupus erythematosus in 1 patient, and osteopenia in 2 patients. 3 of the patients had malignancies (bladder, rectum and stomach carcinomas) and 1 patient had chronic myeloproliferative disorder. 4 patients could never use the TNF-alpha inhibitors (1 rectum cancer, 1 bladder cancer, 1 systemic lupus erythematosus, 1 essential thrombocytemia). The median duration of pamidronate use was 6 (interquartile range 3-10). Mean Patient Global Assessment Score (PGAS) was 8±2 before the pamidronate treatment and 4±3 after the treatment (p<0.001). The treatment of 6 patients was terminated due to inadequate response which is shown in Table. One patient died from bladder carcinoma during follow-up.

Conclusion:

In SpA patients, with biological agents (anti-TNF, IL-17) being contraindicated due to malignancies and tuberculosis in some patients, alternative treatment methods such as pamidronate should be considered bearing in mind the results of our study showing the effectiveness and safety of it.

References:

[1]Maksymowych WP et al. A six-month randomized, controlled, double-blind, dose-response comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis. Arthritis Rheum 2002;46:766–73.

[2]Haibel H et al. Treatment of active ankylosing spondylitis with pamidronate. Rheumatology, Volume 42, Issue 8, August 2003, 1018–1020.

Disclosure of Interests:

None declared

AB1325-HPR THE TRANSITION FROM PEDIATRIC TO ADULT RHEUMATOLOGY OF 347 PATIENTS AT A SINGLE CENTER

Background:

Pediatric to adult rheumatology transition can be a challenge for both the patient and the clinician, especially in rheumatology as it includes chronic diseases with close follow-up.

Objectives:

The objective of this study is to understand our tertiary rheumatology center patient demographic transitioning from pediatric to adult rheumatology in order to design prospective studies enhancing the evidence of transition recommendations.

Methods:

Patients included in this study are regularly followed-up in our adult rheumatology clinic and were regularly followed up in our pediatric rheumatology clinic in the past. They were all diagnosed with a rheumatologic condition receiving treatment. The patient files were assessed to have a better understanding of their demographic, disease and treatment information.

Results:

Our cohort includes 347 patients diagnosed with a variety of conditions that are Familial Mediterranean Fever (FMF) (n=216), Juvenile Idiopathic Arthritis (JIA) (n=56), Juvenile Spondyloarthritis (jSPA) (n=39), Systemic Lupus Erythematosus (SLE) (n=20), Behçet’s Disease (n=7) and the rest of the rheumatologic conditions with less than 5 patients each. The mean age of the patients during transition, mean age of diagnosis, and follow-up duration are 21.34±1.7, 10.4±4.18, and 10.82±4.4 in respective order. The treatment regimens the patients received are summarized in Table 1.

Table 1.

Current Treatment Information of the Patients

Current Treatment InformationDMARD26Colchicine23Adalimumab21Etanercept10NSAID4Tocilizumab3Cyclophosphamide3Rituximab2Prednisolone7Mycophenolate Mofetil1Canakinumab1

Seven patients had FMF related attacks. In addition to attacks, one FMF patient had bilateral ankle pain and one patient had leg pain. One patient out of three diagnosed with Takayasu’s disease was still symptomatic. One patient had uveitis-related symptoms. One patient diagnosed with SLE had skin dryness. Furthermore, there were patients with sequelae formation. One patient diagnosed with oligoarticular JIA (oJIA) had bilateral hip sequela with the additional left hip prosthesis. One oJIA patient had micrognathia, and one had left knee sequela. One pJIA patient had small joint sequelae. One sJIA patient had bilateral hip sequelae. One jSPA patient had enthesopathy. One FMF patient had proteinuria due to amyloidosis formation. Another FMF patient had hip surgery due to sequela.

Conclusion:

Our center had patients with a variety of conditions with different natures of diseases. EULAR recommends the transition process to start no later than 14 years of age; however, this process started at the mean age of 21 in our patients. In most of these patients, especially the ones diagnosed with FMF, the control of disease activity was maintained. The transition of these different clinical entities might require certain amendments to the standard of care. For future references, we will be able to understand more about the adulthood prognosis of these clinical entities.

Disclosure of Interests:

None declared

FRI0498 DOES TESTING FOR SAA IS MORE BENEFICIAL THAN CRP FOR THE FOLLOW-UP OF FMF PATIENTS WITH M694V HETEROZYGOUS OR M694V HOMOZYGOUS MUTATIONS?

Background:

In order to follow subclinical inflammation and adjust the therapy for an optimal Familial Mediterranean Fever (FMF) disease control, clinicians seek for readily accessible, affordable and reproducible markers. C-reactive protein (CRP) is widely used for this purpose. Some suggest that CRP measures are not conclusive in all cases, especially at initial stages of inflammation. It is suggested that Serum Amyloid A (SAA) may be more reliable and sensitive in predicting an ongoing inflammation.

Objectives:

In order to evaluate and to compare the sensitivity of SAA and CRP in FMF patients with M694V homozygous and M694V heterozygous mutations respectively.

Methods:

Blood samples from 28 patients with M694V homozygous mutation and from 15 patients with M694V heterozygous mutation were obtained during a mean follow-up of 1 year. Multiple samples were drawn in both attacks and attack-free periods of FMF (153 from M694V Homozygous and 31 from M694V Heterozygous). For the analysis of the correlation, the folds of normal CRP and SAA levels were used. Serum levels of the given markers were measured with nephelometric kits (normal CRP levels <5 mg/L and SAA levels <6,8 mg/L). More than one-and-a-half-fold increase of CRP and SAA was defined as an active inflammation.

Results:

Except in one patient, all patients in the whole cohort were on prophylactic colchicine. Among 28 patients with M694V homozygous mutation, one patient was treated with adalimumab, and 12 patients with anti-IL-1 regimens. Among 15 patients with M694V heterozygous mutation, 4 were under anti-IL-1 treatment. There were a total of 183 measurements of CRP and SAA from 43 patients. Twenty-three measurements were obtained during the attack period in M694V homozygous group and the remaining 160 measurements were obtaine in attack-free period. The figure demonstrates the correlation between CRP and SAA results (r=0.745, p<0.001). Both acute phase reactants were increased in 69 measurements, while in 13, CRP was high but SAA was normal and in 31, SAA was high however CRP was within normal limits. The mean increase in CRP of the whole cohort was 2,37 ± 3,22-fold of the normal, whereas mean increase in SAA was 6,77 ± 13,23-fold of the normal.

Conclusion:

According to these results, serial testing of SAA does not provide any additional advantages over CRP. As it is readily accessible and affordable, CRP seems to be sufficient for the follow-up of FMF patients.

Figure:

Figure.

The folds CRP and SAA in whole M694V homozygous and heterozygous mutant population

Disclosure of Interests:

None declared

AB0055 SOLUBLE TREM-1 LEVELS IN FAMILIAL MEDITERRANEAN FEVER RELATED AA-AMYLOIDOSIS

Background:

Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) is a monocyte and neutrophil receptor functioning in innate immunity. TREM-1 produces proinflammatory cytokines and serves for neutrophil degranulation. TREM-1 activity is well known in the pathogenesis of sepsis; hence it can be also present in autoinflammatory diseases such as the most common monogenic one, Familial Mediterranean Fever (FMF).

Objectives:

The objective of this study is to measure soluble TREM-1 (sTREM-1) activity in severe FMF cases complicated with systemic AA-Amyloidosis.

Methods:

The cohort of the study includes regularly followed FMF related AA-Amyloidosis patients in a tertiary center outpatient rheumatology clinic. Soluble TREM-1 levels were measured using enzyme-linked immunosorbent assay (ELISA). In addition, demographic data, renal function tests, acute phase reactants, and medical prescription history was also noted and analyzed. None of the FMF diagnosed patients had an attack during the collection of the blood samples.

Results:

The patients were categorized into 4 groups: FMF related AA-Amyloidosis patients (A(+) FMF(+)), FMF unrelated AA-Amyloidosis (FMF(-) A(+)), FMF patients without Amyloidosis diagnosis (FMF(+) A (-)), and healthy controls (HC). The mean ages, TREM-1, C - reactive protein (CRP), and Creatinine levels of each group are shown in Table 1. TREM-1 levels were found to be significantly higher in A(+) FMF(+) group than FMF(+) A (-), and healthy control groups (p= 0.001 and 0.002). Nevertheless, this difference was not found in between A(+) FMF(+) and FMF(-) A(+) (p= 0.447). In addition, the TREM-1 levels of FMF(+) A (-), and healthy control groups were not different (0.532). In A(+) FMF(+) group, 36 patients used colchicine with the mean dose of 1.9±0.8 mg/day, 14 patients used anakinra, and 9 patients used canakinumab. In FMF(+) A (-) group all 20 patients used colchicine with the mean dose of 2.8±0.9 mg/day, 1 patient used anakinra, and 2 patients used canakinumab.

Table 1.

Clinical Features of Patients and TREM-1 levels

A(+) FMF(+)(n= 42)FMF(-) A(+)(n=5)FMF(+) A(-)(n=20)HC(n=20)Age43.9±12.954.8±1935.3±9.6435.4±6.57TREM-1735.3±566.51247.1±1349.2414.3±142.3439.2±104.6CRP11.1±14.251.3±98.325.8±541.8±1.7Creatinine1.6±1.83.28±4.170.7±0.150.7±0.15

Conclusion:

In conclusion, TREM-1 is a proinflammatory marker found significantly high in AA-amyloidosis patients regardless of their FMF diagnosis. TREM-1 may be useful in AA-amyloidosis follow-up and early diagnosis since currently there is a deficit of an early diagnostic marker of amyloidosis. This study is a cross-sectional one so it is hard to reach a conclusion on the effectiveness of TREM-1 during regular FMF follow-up for the secondary prevention of amyloidosis. However, the sensitivity of TREM-1 as a marker cannot be denied in amyloidosis.

Disclosure of Interests:

None declared

SAT0518 CANAKINUMAB TREATMENT IN ADULT PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: A SINGLE-CENTER STUDY

Background:

Familial Mediterranean Fever (FMF) is the most common autoinflammatory disease characterized by recurrent, self-remitting attacks of fever, serositis, arthritis, and erysipelas-like erythema. Canakinumab is an Interleukin-1β inhibitor that is shown to be effective and safe in treating colchicine resistant FMF patients.

Objectives:

The main objective of this study is to present the single tertiary center experience of adult FMF patients who received Canakinumab.

Methods:

The study is a retrospective analysis conducted at a tertiary rheumatology center experienced in FMF. The patients who had a clinical diagnosis of FMF and who were treated with at least a single subcutaneous injection of canakinumab were included. Patients with amyloidosis and pregnancy were excluded. In order to evaluate the disease status, acute phase reactants and patient-reported disease severity visual analog scale (VAS) scores were analyzed. Acute phase reactants were evaluated during attack-free periods. The VAS score was reported on a scale of 0-10, 10 meaning the disease at its most severe form, and 0 meaning the least.

Results:

Fifty-two patients (21 male, 31 female) with the mean age of 35.88±12.4 years, were included in this study. The presenting signs and symptoms of the patients are shown in Figure 1. The mean age of initial symptoms and diagnosis were 12.84±10.06 and 20.39±12.35 years in respective order. The treatment information of the patients before and during Canakinumab injections was shown in Table 1. The mean Erythrocyte Sedimentation Rate (ESR) decreased from 25.31±20.64 to 11.52±9.78 mm/hour. The mean C-reactive Protein (CRP) decreased from 28.18±47.04 to 2.02±2.31 mg/L (both p<0.0001). The mean VAS score decreased from 8.04±1.9 to 1.4±1.73 (p<0.0001). Canakinumab treatment was terminated in 33 patients, 22 of which was due to successful remission. The termination of the treatment was because of pregnancy or will of pregnancy in 4 patients, inadequate treatment response 3 patients, treatment noncompliance in 2 patients, chronic hepatitis C related cirrhosis in 1 patient, and change to a different biologic agent in 1 patient. The only side effect experienced was hallucinations in one patient who was already under remission.

Figure 1.

The Presenting Signs and Symptoms of the Patients

Table 1.

The Treatment Information of the Patients

Initial Mean Daily Colchicine Dose, mg (mean± standard deviation)1.68±0.46Mean Daily Colchicine Dose before Canakinumab Treatment, mg1.63±0.6The Mean Injection Number, n17.5±17.8Canakinumab Treatment Indication, n (%) Inadequate Response to Previous Treatment38 (73.08) Side Effect to Previous Treatment8 (15.38) Poly Arteritis Nodosa2 (3.85) Recurrent Pericarditis1 (1.92) CNS Vasculitis2 (3.85) Poor Anakinra Treatment Adherence1 (1.92) FMF Encephalopathy1 (1.92)

Conclusion:

Canakinumab seems effective in controlling the subclinical inflammation and raising the quality of life of the patient. It has a favorable side effect profile. According to our single-center, real-life data, Canakinumab can be used as an alternative treatment method in colchicine resistant patients.

Disclosure of Interests:

None declared