Divergent perspectives: exploring the relationships between St. George's Respiratory Questionnaire and outcome measures in systemic sclerosis-associated interstitial lung disease

INTRODUCTION/OBJECTIVES

Controversy exists regarding the concordance of patient-reported outcome measures (PROMs) with other assessment parameters in systemic sclerosis-associated interstitial lung disease (SSc-ILD). This study aims to explore the association between the St. George's Respiratory Questionnaire (SGRQ) and various outcome measures in patients with SSc-ILD within a real-world cross-sectional setting.

METHOD

Patients with SSc-ILD were consecutively recruited from our SSc cohort. Simultaneous administration of SGRQ, scleroderma Health Assessment Questionnaire (sHAQ), respiratory visual analog scale (R-VAS), pulmonary function tests (PFTs), and the 6-min walking test (6-MWT) was conducted. The total extent of lung fibrosis was quantified using high-resolution computed tomography (HRCT) images. Relationships between SGRQ and functional, radiographic, and other patient-reported outcome measures were analyzed.

RESULTS

The total SGRQ score demonstrated correlations with forced vital capacity (FVC) and R-VAS (r =  - 0.397, p = 0.016 and r = 0.418, p = 0.027, respectively). Symptom score correlated with ILD-extension (r = 0.430, p = 0.005); activity score correlated with FVC and R-VAS (r =  - 0.502, p = 0.002 and r = 0.395, p = 0.038, respectively); impact score correlated with R-VAS (r = 0.386, p = 0.043). In patients with fibrosis extent exceeding 20%, total SGRQ score was associated with sHAQ and R-VAS (r = 0.398, p = 0.049; r = 0.524, p = 0.021, respectively), activity score with R-VAS (r = 0.478, p = 0.038), and impact score with 6-MWT-D and R-VAS (r =  - 0.489, p = 0.034; r = 0.545, p = 0.016, respectively). The symptom score and activity score demonstrated optimal performance in identifying patients with interstitial lung disease (ILD) extent exceeding 20% and forced vital capacity (FVC) less than 70% (area under the curve [AUC] 0.799, p = 0.002, and AUC 0.792, p = 0.03, respectively).

CONCLUSIONS

Our study reveals varying degrees of correlation between SGRQ and distinct outcome measures. Given the incomplete alignment of SGRQ with other outcome measures, an integrative approach utilizing existing criteria as complementary tools is recommended. Key Points • Patient-reported outcome measures (PROMs) derive from patients' subjective evaluations of the impact of the disease on their daily activities, social interactions, and psychological well-being. • PROMs frequently serve as outcome measures in randomized controlled trials, yet conflicting findings have emerged in relation to primary outcomes. • This study aims to assess the appropriateness and interrelation of PROMs with both radiological and functional outcome measures, providing insight into the current state of our patients in a real-life context. The investigation delves into the compatibility of these measures with each other.

Comparison of methotrexate and azathioprine as the first-line steroid-sparing immunosuppressive agents in patients with Takayasu's arteritis

BACKGROUND

Immunosuppressive (IS) agents are recommended for the first-line treatment of patients with active Takayasu's arteritis (TAK) together with glucocorticoids (GCs). However, there is limited data comparing the efficacy and outcomes of different IS agents for this purpose.

OBJECTIVES

In this study, we aimed to compare the outcomes of two most frequently used first-line IS agents, namely methotrexate (MTX) and azathioprine (AZA) in TAK patients.

METHODS

TAK patients who received any IS agent in addition to GCs as the initial therapy were included in this multicentre, retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a matched analysis (cc match) using variables 'age', 'gender' and 'diffuse aortic involvement' was performed between patients who received MTX or AZA as the first-line IS treatment.

RESULTS

We recruited 301 patients (F/M: 260/41, mean age: 42.2 ± 13.3 years) from 10 tertiary centres. As the first-line IS agent, 204 (67.8 %) patients received MTX, and 77 (25.6 %) received AZA. Less frequently used IS agents included cyclophosphamide in 17 (5.6 %), leflunomide in 2 (0.5 %) and mycophenolate mofetil in one patient. The remission, relapse, radiographic progression and adverse effect rates were similar between patients who received MTX and AZA as the first-line IS agent. Vascular surgery rate was significantly higher in the AZA group (23% vs. 9 %, p = 0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was significantly higher in the MTX group (76% vs 62 %, p = 0.034). Similarly, the rate of vascular surgery was higher in AZA group in matched analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42 %, p = 0.34). IS therapy was discontinued in 18 (12 MTX, 6 AZA) patients during the follow-up period due to remission. Among those patients, two patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of a mean 69.4 (±50.9) months of follow-up.

CONCLUSIONS

Remission, relapse, radiographic progression and drug survival rates of AZA and MTX were similar for patients with TAK receiving an IS agent as the first-line f therapy. The rate of vascular surgery was higher and the rate of GC dose reduction was lower with AZA compared to MTX at the end of the follow-up.

Characteristics and outcome of ANCA-associated vasculitides induced by anti-thyroid drugs: a multicentre retrospective case-control study

OBJECTIVE

Data on ANCA-associated vasculitis (AAV) induced by anti-thyroid drugs (ATD) are scarce. We aimed to describe the characteristics and outcome of these patients in comparison to primary AAV.

METHODS

We performed a retrospective multicentre study including patients with ATD-induced AAV. We focused on ATD-induced microscopic polyangiitis (MPA) and compared them with primary MPA by matching each case with four controls by gender and year of diagnosis.

RESULTS

Forty-five patients with ATD-induced AAV of whom 24 MPA were included. ANCA were positive in 44 patients (98%), including myeloperoxidase (MPO)-ANCA in 21 (47%), proteinase 3 (PR3)-ANCA in six (13%), and double positive MPO- and PR3-ANCA in 15 (33%). Main clinical manifestations were skin involvement (64%), arthralgia (51%) and glomerulonephritis (20%). ATD was discontinued in 98% of cases, allowing vasculitis remission in seven (16%). All the remaining patients achieved remission after glucocorticoids, in combination with rituximab in 11 (30%) or cyclophosphamide in four (11%). ATD were reintroduced in seven cases (16%) without any subsequent relapse. Compared with 96 matched primary MPA, ATD-induced MPA were younger at diagnosis (48 vs 65 years, P < 0.001), had more frequent cutaneous involvement (54 vs 25%, P = 0.007), but less frequent kidney (38 vs 73%, P = 0.02), and a lower risk of relapse (adjusted HR 0.07; 95% CI 0.01, 0.65, P = 0.019).

CONCLUSION

ATD-induced AAV were mainly MPA with MPO-ANCA, but double MPO- and PR3-ANCA positivity was frequent. The most common manifestations were skin and musculoskeletal manifestations. ATD-induced MPA were less severe and showed a lower risk of relapse than primary MPA.

Low relapse rate in patients with giant cell arteritis in a multi-centre retrospective Turkish Registry

OBJECTIVES

Glucocorticoids (GC) are widely accepted as the standard first-line treatment for giant cell arteritis (GCA). However, relapse rates are reported up to 80% on GC-only protocol arms in controlled trials of tocilizumab and abatacept in 12-24 months. Herein, we aimed to assess the real-life relapse rates retrospectively in patients with GCA from Turkey.

METHODS

We assembled a retrospective cohort of patients with GCA diagnosed according to ACR 1990 criteria from tertiary rheumatology centres in Turkey. All clinical data were abstracted from medical records. Relapse was defined as any new manifestation or increased acutephase response leading to the change of the GC dose or use of a new therapeutic agent by the treating physician.

RESULTS

The study included 330 (F/M: 196/134) patients with GCA. The mean age at disease onset was 68.9±9 years. The most frequent symptom was headache. Polymyalgia rheumatica was also present in 81 (24.5%) patients. Elevation of acute phase reactants (ESR>50 mm/h or CRP>5 mg/l) was absent in 25 (7.6%) patients at diagnosis. Temporal artery biopsy was available in 241 (73%) patients, and 180 of them had positive histopathological findings for GCA. For remission induction, GC pulses (250-1000 methylprednisolone mg/3-7 days) were given to 69 (20.9%) patients, with further 0.5-1 mg/kg/day prednisolone continued in the whole group. Immunosuppressives as GC-sparing agents were used in 252 (76.4%) patients. During a follow-up of a median 26.5 (6-190) months, relapses occurred in 49 (18.8%) patients. No confounding factor was observed in relapse rates. GC treatment could be stopped in only 62 (23.8%) patients. Additionally, GC-related side effects developed in 64 (24.6%) patients, and 141 (66.2%) had at least one Vasculitis Damage Index (VDI) damage item present during follow-up.

CONCLUSIONS

In this first multi-centre series of GCA from Turkey, we observed that only one-fifth of patients had relapses during a mean follow-up of 26 months, with 76.4% given a GC-sparing IS agent at diagnosis. At the end of follow-up, GC-related side effects developed in one-fourth of patients. Our results suggest that patients with GCA had a low relapse rate in real-life experience of a multi-centre retrospective Turkish registry, however with a significant presence of GC-associated side effects during follow-up.

Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO Registry

OBJECTIVES

The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS).

METHODS

We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m2], overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated.

RESULTS

There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 ± 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P = .003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P > .05).

CONCLUSIONS

This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients.

Analysis of clinical, immunological characteristics, damage, and survival in 300 Turkish systemic lupus erythematosus patients

OBJECTIVE

This retrospective study aimed to conduct a comprehensive analysis of Turkish Systemic Lupus Erythematosus (SLE) patients of Caucasian ethnicity, focusing on their clinical, immunological, and therapeutic characteristics, damage accural and mortality.

PATIENTS AND METHODS

We carried out a retrospective assessment of 300 SLE patients diagnosed between 2001 and 2017 at Kocaeli University Rheumatology Clinic. Demographic data, clinical manifestations, immunological profiles, treatment approaches, disease-related damage, and survival information were collected.

RESULTS

The study population had a significant female predominance (89%) with a mean age of disease onset of 35.4 (SD:13.3) years. Hematological (72.6%) and mucocutaneous (72%) manifestations were the most common clinical findings, followed by arthritis (66.3%). Females had higher frequency of photosensitivity (p = 0.019), malar rash (p < 0.001), and alopecia (p = 0.014). Anti-dsDNA antibodies were detected in 61.6% of patients, while 57% of patients had hypocomplementemia. Secondary antiphospholipid syndrome was observed in 15.3% of patients; the most common manifestations included deep venous thrombosis (32.6%) and cerebrovascular accidents (30.4%). Lupus Nephritis (LN) affected 40.3% of the cohort. The most common pathologic finding was Class IV LN (30.5%). Eventually, 13 (4.3%) patients developed chronic kidney disease (CKD) and 4 had renal replacement therapies. Patients with LN had higher usage of pulse steroids, azathioprin, mycophenolate mofetil, cyclophosphamide, and rituximab (p < 0.001 for each).  In the juvenile-onset group (n = 31, 10.3%), an increased occurrence of malar rash (p = 0.009), nephritis (p = 0.034), hypocomplementemia (p = 0.001), positive anti-dsDNA (p = 0.007), anti-Sm (p = 0.046), anti-rib-P (p = 0.014) antibodies were observed. At least one damage parameter was observed in 32.6% patients with musculoskeletal manifestations being the most common. Thirteen patients were diagnosed with various malignancies, with cervical cancer being the most common (4 cases). The total 5 and 10-year survival rates were 92.5% and 86.7%, respectively. However, patients with CKD, had lower survival rates; 75% at 3 years and 60% at 15 years. Regression analysis demonstrated an association of CKD and  history of infections with decreased survival (p = 0.02, each).

CONCLUSION

Ethnicity and geography influence the clinical diversity of SLE. Recognizing these disparities is crucial for tailoring patient care. Future inception cohort studies in Turkish SLE patients are necessary to address the limitations of retrospective research.

Gynecological symptoms in primary and secondary Sjögren's syndrome and the effect of the disease on sexuality

BACKGROUND

Sjögren's syndrome (SS) is an autoimmune systemic disease affecting many organs and systems, such as genital system.

AIM

This study aimed to present the gynecological symptoms of patients who were followed up in an outpatient clinic because of primary Sjögren's syndrome (pSS) and secondary Sjögren's syndrome (sSS) and to show how the disease affected sexuality.

METHODS

This study is a cross-sectional study conducted between 2019 and 2020. The study sample consisted of 60 pSS patients, 42 sSS patients, and 52 healthy control subjects.

OUTCOMES

All the participants were questioned about sexuality, and completed the 36-item Short Form Survey, Hospital Anxiety and Depression Scale, Health Assessment Questionnaire, and Modified Hill questionnaire.

RESULTS

The patients had a mean age of 55.6 ± 11.85 years in pSS, 59.39 ± 11.18 years in sSS, and 56.1 ± 10.46 years in healthy control subjects. Vaginal and vulvar dryness and dyspareunia were present at a significantly higher rate in SS, especially in pSS, compared with the control subjects. The Health Assessment Questionnaire score was significantly lower in the pSS group than in the sSS group. Arthralgia, myalgia, and fatigue were prominent in all SS patients.

CLINICAL IMPLICATIONS

Gynecological symptoms, sexual ability, and the effects of the disease on sexuality should be questioned in all SS patients.

STRENGTHS AND LIMITATIONS

It is very important that we evaluate the gynecological symptoms of both pSS and sSS patients and the effect of the disease on these symptoms. The small number of patients and healthy control subjects is a limitation.

CONCLUSION

The gynecological and musculoskeletal symptoms negatively affected sexuality in patients with pSS and sSS, and the negative effect of the disease on sexuality was more pronounced in the pSS group.

Radiological progression and predictive factors in psoriatic arthritis: insights from a decade-long retrospective cohort study

OBJECTIVES

Radiological alterations in psoriatic arthritis (PsA) are an established phenomenon frequently observed throughout the disease course. Our goal was to investigate the changes in the bone structure of PsA patients by conventional radiography.

METHODS

This study designed as a retrospective cohort study and cross-sectional evaluation for disease activity. The disease activity and the severity of skin and nail involvement were assessed. The Simplified Psoriatic Arthritis Radiographic Score (SPARS) was used to investigate the radiological progression. Logistic regression analysis was used to determine the predictors of radiological changes.

RESULTS

Joint space narrowing and bone proliferation in hands (p = 0.001 and p = 0.001, respectively) and joint space narrowing in feet (p = 0.047) were more common at the final evaluation than at the baseline assessment. Total scores of joint space narrowing and bone proliferation in hands and feet were higher at the last visit than at the initial assessment (p < 0.001). Male gender (p = 0.030, OR 4.32 (95%CI 1.15-16.15)], older age (for joint space narrowing [p = 0.026 OR 1.08 (95%CI 1.01-1.56)] and for proliferation [p = 0.025 OR 1.08 (95%CI 1.01-1.44)]), high Disease Activity index for Psoriatic Arthritis (DAPSA) scores at baseline [p = 0.032 OR 6.21 (95%CI 1.17-32.92)], and symmetrical polyarticular involvement at baseline [p = 0.025 OR 5.3 (95% CI 1.23-22.4)] were found as predictors of structural changes.

CONCLUSION

By the end of the decade, joint space narrowing and proliferation were observed to be more common than erosion. Male gender, older age, higher initial DAPSA scores, and initial polyarticular involvement were identified as predictors of radiological damage. Key Points • The radiological changes of Psoriatic arthritis are a well-known entity. However, studies investigating the progression of joint involvement over time are scarce. • This study reveals that joint space narrowing and proliferation are the most prominent radiological alterations in Psoriatic Arthritis patients at the end of the decade. • Male gender, older age, higher baseline DAPSA scores, and initial polyarticular involvement are predictive factors influencing the progression of bone destruction  in Psoriatic Arthritis patients.

Atezolizumab-induced myositis in a patient with small-cell lung cancer

OBJECTIVE

Myositis, an inflammatory disease affecting muscles, is a rare and potentially fatal immune-related adverse event associated with immune checkpoint inhibitors. There are limited data on its clinical features and management.

CASE PRESENTATION

Atezolizumab, in combination with etoposide and carboplatin, was initiated in the patient diagnosed with metastatic small-cell lung cancer. After four cycles, maintenance atezolizumab was initiated. At the third visit of the maintenance therapy, the patient reported weakness, edema, and tightness in the muscles that had progressed over the course of a week. Mild solid-food dysphagia was also observed. Neutrophilic leukocytosis with elevated creatine phosphokinase (9234 U/L), erythrocyte sedimentation rate (111 mm/h), and transaminase levels were observed. A diagnosis of myositis was considered based on clinical findings. Atezolizumab was omitted and an oral 0.5 mg/kg/day dose of methylprednisolone was administered. The myositis resolved within 10 days. During the treatment of myositis, the patient underwent prophylactic cranial irradiation. The steroid dose was tapered off within 35 days and then atezolizumab was restarted.

CONCLUSION

The literature contains only a few case reports about atezolizumab-induced myositis, highlighting the challenges in defining its clinical features and management. Prompt diagnosis and treatment are crucial to prevent severe complications, such as myocarditis or respiratory muscle paralysis.

Long-term efficacy of canakinumab in hyperimmunoglobulin D syndrome

Hyperimmunoglobulin D syndrome (HIDS) is a rare autoinflammatory disorder with autosomal recessive inheritance. It is caused by specific mutations in the mevalonate kinase gene (MVK). No treatment specific to HIDS has been approved to date; however, nonsteroidal anti-inflammatory drugs, steroids, colchicine, tumor necrosis factor-α inhibitors, and anti-interleukin-1 treatments are used, based on case reports and observational studies. Herein, we report a case with recurrent fever and arthritis attacks who did not respond to anakinra and was successfully treated with canakinumab. Long-term remission was achieved without any side effects with 300 mg canakinumab treatment every 4 weeks for 5 years.

Disease severity and genotype-phenotype correlation in adult patients with familial Mediterranean fever

OBJECTIVES

To assess the relationships of disease severity with genotype and phenotype in adult familial Mediterranean fever patients.

METHODS

Two-hundred seventy-five patients included in the study were divided into four groups according to their mutations: Group 1, M694V homozygous; Group 2, M694V-other; Group 3, other-other; and Group 4, no meaningful gene variants. Disease severity was evaluated using the Pras disease severity score. The association between Pras scores and other possible predictors was assessed by the multiple linear regression analysis.

RESULTS

In this study, 12.4% of all patients were in Group 1, 55.3% were in Group 2, 26.5% were in Group 3, and 5.8% were in Group 4. Pras scores were higher in Group 1 than in Groups 2, 3, and 4 (post hoc pairwise comparisons; P = .001, P < .001, and P = .001, respectively). Age at disease onset and age at diagnosis were found moderately and strongly correlated with Pras scores. Patients with moderate and severe disease were intensely involved in Group 1.

CONCLUSIONS

Higher Pras scores, earlier age of symptoms and diagnosis, more frequent arthritis and erysipelas-like erythema, and higher colchicine dose are closely associated with M694V homozygous familial Mediterranean fever patients. These patients also have mostly moderate and severe disease severity.

Unintentional Monotherapy in Rheumatoid Arthritis Patients Receiving Tofacitinib and Drug Survival Rate of Tofacitinib

OBJECTIVE

To determine the rate of unintentional monotherapy (UM; switching to monotherapy from combination therapy of patients' own volition) in rheumatoid arthritis patients receiving tofacitinib and to evaluate tofacitinib survival rate.

METHODS

This national, multicenter study included patients' data from the TURKBIO Registry. Demographics, clinical characteristics, disease duration and activity, comorbidities, and treatments were analyzed.

RESULTS

Data of 231 rheumatoid arthritis patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy on their own volition (UM); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The rate of comorbidities at the time of data retrieval was higher in the UM group than in the combination group (83.3% vs. 60.3%, p = 0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy ( p = 0.039; odds ratio, 3.29; 95% confidence interval, 1.06-10.18). The combination and UM groups did not differ regarding remission rate assessed by Disease Activity Score 28-joint count C-reactive protein (60.5% and 70%, respectively; p = 0.328). Drug survival rates of the UM and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with 1- and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the UM group.

CONCLUSIONS

Although 13.4% of the study population started monotherapy unintentionally, drug survival and remission rates of the UM and combination groups were not different. Comorbidity was a factor affecting transition from combination therapy to monotherapy.

Extended autoantibody panel in Turkish patients with early-stage systemic sclerosis: Coexpressions and their influences on clinical phenotypes

BACKGROUND/AIM

To investigate the frequency and clinical relevance of an extended autoantibody profile in patients with systemic sclerosis (SSc).

MATERIALS AND METHODS

In this cross-sectional study, serum from 100 consecutive patients was subjected to indirect immunofluorescence (IIF) (HEp-20-10/primate liver mosaic) and Systemic Sclerosis Profile by EUROIMMUN to evaluate anti-nuclear antibodies (ANA) and autoantibodies against 13 different autoantibodies in patients with SSc less than 3 years.

RESULTS

Ninety-three of 100 patients were positive for ANA by IIF. Fifty-three patients showed single positivity, 26 anti-topoisomerase antibodies (anti-Scl70 ab), 16 anticentromere antibodies (ACAs), six anti-RNA polymerase III antibodies (anti-RNAPIII ab), one anti-Ku antibody, one anti-PM/Scl100 antibody, two anti-PM/Scl75 antibodies, one anti-Ro52 antibody, whereas 32 patients had multiple autoantibody positivities. Among classic SSc-specific autoantibodies, anti-Scl70 and anti-RNAPIII abs showed the highest cooccurrence (n = 4). One patient was simultaneously positive for anti-RNAPIII ab and ACA, and one was positive for ACA and anti-Scl70 ab. The clinical features were not statistically different between single and multiple autoantibody-positivity for classic SSc-specific autoantibodies (ACA, anti-Scl70 ab, and anti-RNAPIII ab), except for digital ulcer in the multiantibody positive ACA group (p = .019).

CONCLUSION

Based on our results, coexpression of autoantibodies is not uncommon in SSc patients. Although autoantibodies specific to SSc in early disease show generally known clinical features, it remains to be investigated how the coexpression of autoantibodies will affect clinical presentation.

Sex-specific analysis in Behçet's disease reveals higher genetic risk in male patients

OBJECTIVES

Behçet's disease tends to be more severe in men than women. This study was undertaken to investigate sex-specific genetic effects in Behçet's disease.

METHODS

A total of 1762 male and 1216 female patients with Behçet's disease from six diverse populations were studied, with the majority of patients of Turkish origin. Genotyping was performed using an Infinium ImmunoArray-24 BeadChip, or extracted from available genotyping data. Following imputation and extensive quality control measures, genome-wide association analysis was performed comparing male to female patients in the Turkish cohort, followed by a meta-analysis of significant results in all six populations. In addition, a weighted genetic risk score for Behçet's disease was calculated and compared between male and female patients.

RESULTS

Genetic association analysis comparing male to female patients with Behçet's disease from Turkey revealed an association with male sex in HLA-B/MICA within the HLA region with a GWAS level of significance (rs2848712, OR = 1.46, P = 1.22 × 10-8). Meta-analysis of the effect in rs2848712 across six populations confirmed these results. Genetic risk score for Behçet's disease was significantly higher in male compared to female patients from Turkey. Higher genetic risk for Behçet's disease was observed in male patients in HLA-B/MICA (rs116799036, OR = 1.45, P = 1.95 × 10-8), HLA-C (rs12525170, OR = 1.46, P = 5.66 × 10-7), and KLRC4 (rs2617170, OR = 1.20, P = 0.019). In contrast, IFNGR1 (rs4896243, OR = 0.86, P = 0.011) was shown to confer higher genetic risk in female patients.

CONCLUSIONS

Male patients with Behçet's disease are characterized by higher genetic risk compared to female patients. This genetic difference, primarily derived from our Turkish cohort, is largely explained by risk within the HLA region. These data suggest that genetic factors might contribute to differences in disease presentation between men and women with Behçet's disease.

AB0665 Turkish validation of the ‘Cochin (Duruoz) hand function scale’ in patients with systemic sclerosis

Background

Hand impairment is the main challenge for patients with systemic sclerosis (SSc) and may arise from inflammatory arthritis, joint contractures, tendon friction rubs (TFRs), Raynaud’s phenomenon (RP), digital ulcers (DU), puffy hands, skin sclerosis, acro-osteolysis, or calcinosis. There is not yet a tool which can objectively measure hand functions in scleroderma patients both in daily practice and for research purposes.

Objectives

To adapt and validate the Turkish version of Cochin (Duruoz) hand function scale (CHFS) and contribute to the development of outcome measures with good metric properties assessing hand disability in SSc (1).

Methods

Ninety one consecutive patients who fulfilled the 2013 ACR/EULAR SSc classification criteria for SSc were enrolled in the study. Disease related involvements and physical examination findings of the patients were recorded. Participants filled out the self-administered questionnaire of the Turkish version of the CHFS. Modified Rodnan skin scores of the patients were calculated, bilateral hand extension and fingertip-palm distances were measured, grip strength was evaluated with hydrolic hand dynamometer. We evaluated convergent validity by testing the correlation between CHFS and related components of Short Form 36 version 2 (SF-36v2) and Scleroderma Health Assessment Questionnaire (sHAQ). Discriminant validity was evaluated by stratifying patients according to hand related involvements and disease subtypes. Thirty of the patients re-filled the CHFS questionnaire two weeks after the first visit.

Results

Demographic data and disease characteristics of the patients shown in Table 1. For the convergent validity, the CHFS significantly correlated with the sHAQ, Raynaud visual analog scale (VAS), digital ulser VAS, overall disease severity VAS, hand grip, hand extension measurements and fingertip-palm distances (Table 2). The instruments could discriminate between disease subtypes (10[0-24] / 2[0-19], p=0,038) and between the patients with and without contractures (11[0-24] / 2[0-9], p=0,023) for the discriminant validity. We demonstrated high reproducibility for CHFS (ICC = 0,894, 95% confidence interval = 0,779-0,949).

Table 1.

Demographic data and disease characteristics of the patients

Age (years)55.4±10.7Total mRSS6 ±5.1Sex (female)79 (%86.8)Right hand total mRSS2.2±1.7Diseasesubtype (diffuse)25(%27.5)Left hand total mRSS2.2±1.7PAH6 (%6.7)Right hand fingertip-palm distance (cm)1.3±1ILD41 (%45.6)Left hand fingertip-palm distance (cm)1.2±1.2ANA positivity88 (%96.7)Right hand extension (cm)17.7±2.5Arthritis1 (%1.1)Left hand extension (cm)18±2.3Sclerodactly79 (%86.8)Right hand hydrolic dynomometer pressure (kg)21.7±8.6Contracture26 (%28.6)Left hand hydrolic dynomometer pressure (kg)20.4±7.6Amputation12 (%13.2)SF 36 physical function51.7 ±24Active digitalulcer3 (%3.2)SF 36 role limitations due to physical health52±42Digitalulcerscar23 (%25.3)SF 36 role limitations due to emotional problems57.3±33.4Calcinosis10 (%11)SF 36 energy/fatigue46±23.3CHFS score3 [0-13]SF 36 emotional well-being60.4±21.2Raynaud’s phenomenon VAS0.8±0.9SF 36 social functioning70±26Digital ulcer VAS0.5±0.9SF 36 pain64±30Overall disease severity VAS0.9±0.9SF 36 general health44.3±21.7

PAH: Pulmoner arterial hypertension, ILD: Interstitial lung disease, ANA: Anti nuclear antibody, CHFS: Cochin hand function scale, mRSS: Modified Rodnan skin score, VAS: visual analog scale, SF36: short form 36

Conclusion

The Turkish version of the CHFS met the requirements of validity and reproducibility. With this study, we validated a scale which will contribute to the development of outcome measures with good metric properties assessing hand disability, disease evolution and treatment efficacy in our SSc patients.

References

[1]Duruöz MT, Poiraudeau S, Fermanian J, et al. Development andvalidationof a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996;23(7):1167-1172.

Disclosure of Interests

None declared

AB0581 TRACHEAL STENOSIS; AN IMPORTANT INVOLVEMENT IN GRANULOMATOSIS WITH POLYANGIITIS

Background

Granulomatosis with polyangiitis (GPA) is a granulomatous systemic vasculitis of unknown etiology that can affect many organs. Approximately 90% of patients with GPA have upper respiratory tract involvement, including the nasal cavity, sinuses, ear and trachea. Subglottic stenosis (SGS) may develop in some patients due to tracheal involvement.

Objectives

It is aimed to evaluate the general characteristics, treatments and disease prognosis of our GPA cases with tracheal stenosis as it is a significant cause of morbidity and mortality.

Methods

The data of 48 patients diagnosed with GPA between 2000-2021 were analyzed retrospectively and the data of 6 patients with tracheal stenosis (TS) were evaluated.

Results

TS was present in 13% of the patients. All patients with TS were female. The mean age of the patients with TS was 46.5±6.5 years, the mean age of disease onset was 35.5 ±13.4 years, and the mean disease duration was 10.8±10.2 years. Constitutional symptoms were in 17% of patients, and 17% had mastoiditis, sinusitis, otitis, bloody nasal discharge and renal involvement. None of the patients had hearing loss, skin, eye and neurological involvement. 83% of patients had limited disease. While all patients had SGS, one patient also had glottic and bronchial stenosis. The most common symptoms in patients were hoarseness and shortness of breath. All patients received systemic treatment according to their organ involvement, local treatment (dilatation, steroid injection) was also applied to two patients. All patients had anti-neutrophil cytoplasmic antibody (ANCA) positivity. When patients with and without tracheal stenosis were compared, there was a difference in terms of gender, lung and kidney involvement, presence of anemia, increased erythrocyte sedimentation rate, pANCA, cANCA and PR3-ANCA positivity, and myalgia. In addition, our patients with tracheal stenosis had a younger age of onset and a longer delay in diagnosis.

Conclusion

The incidence of SGS in large series has been reported as 8-23% of GPA patients.1,2 Although the number of cases in our study was small, this rate was 13%. Symptoms range from cough and shortness of breath to progressively life-threatening severe stridor. Early diagnosis and treatment are important. For this reason, TS is strongly emphasized.

References

[1]Girard C, Charles P, Terrier B, Bussonne G, Cohen P, Pagnoux C, et al. Tracheobronchial stenoses in granulomatosis with polyangiitis (Wegener’s). Medicine. 2015;34:1-6.

[2]Costantino CL, Niles JL, Wright CD, Mathisen DJ, Muniappan A. Subglottic stenosis in granulomatosis with polyangiitis: therole of laryngotracheal resection. Ann Thorac Surg 2018;105:249-53.

Table 1.

Comparison of data from GPA patients with and without tracheal stenosis

N(%)Tracheal Stenosis +GPA(n=6)Tracheal Stenosis - GPA (n=42)PGender Female6 (100)21(51)0.031  Male020(49)Mean Age46.5±6.555.6±13.20.095Symptom Onset Age35.5±13.449.3±14.50.041Delay in Diagnosis (months)44.2±6.59.98±14.80.023Myalgia2(33)33(81)0.030Fever1(17)21(51)0.194High ESR1(17)31(78)0.007High CRP5(50)32(80)0.138Anemia1(17)28(70)0.020Upper Respiratory Involvement6(100)24(59)0.074Lung Involvement3(50)36(90)0.037GIS involvement1(17)6(15)1Eye Involvement-11(27)NASkin Involvement-12(29)NAUrogenital Involvement-1(2)NANeurological Involvement-13(32)NARenal Involvement1(17)29(71)0.018ANCA positivity6(100)38(93)1  MPO-ANCA2(33)4(10)0.162  PR3-ANCA1(17)33(81)0.004  p-ANCA5(83)6(15)0.000  c-ANCA1(17)31(78)0.001

Disclosure of Interests

None declared

AB0420 UNINTENTIONAL MONOTHERAPY IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING TOFACITINIB AND DRUG SURVIVAL RATE OF TOFACITINIB

Background

Combination of MTX with a bDMARDs or tsDMARDs is considered the most effective treatment regimen currently available for patients with RA who have failed to respond to conventional DMARDs. However, approximately 30% of patients receive bDMARDs as monotherapy in daily clinical practice. Studies in the literature do not assess unintentional monotherapy in general. However, it is thought that some patients may switch to monotherapy unintentionally. In other words, some patients who are prescribed combination therapy switch to monotherapy without informing their physicians.

Objectives

To determine the rate of unintentional monotherapy in rheumatoid arthritis (RA) patients receiving tofacitinib and to evaluate tofacitinib survival rate.

Methods

This national, multicentre, retrospective study included patients’ data from the TURKBIO Registry. Data on demographics, clinical characteristics, disease duration and activity, comorbidities, and treatment were analysed.

Results

Data of 231 RA patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy of their own will (unintentional monotherapy); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The combination and unintentional monotherapy groups did not differ regarding remission rate assessed by DAS28-CRP (60.5% and 70%, respectively, p=0.328). The rate of comorbidities at the time of data retrieval was significantly higher in the unintentional monotherapy group compared with the combination group (83.3% vs. 60.3%, p=0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy (p=0.039, Odds ratio: 3.29, 95% CI: 1.06-10.18). Drug survival rates of the unintentional monotherapy and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with a 1-year and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the unintentional monotherapy group.

Conclusion

Although 13.4% of the study population started monotherapy unintentionally, drug survival rates of the unintentional monotherapy and combination groups were not different. Comorbidity was an important factor affecting transition from combination therapy to monotherapy.

This study was sponsored by Pfizer.

Figure 1.

Disclosure of Interests

Nevsun Inanc: None declared, Kerem Abacar: None declared, mehmet akif ozturk: None declared, Abdurrahman Tufan: None declared, Hazan Karadeniz: None declared, İsmail Sari: None declared, gercek can: None declared, Yesim Erez: None declared, yavuz Pehlivan: None declared, Ediz Dalkiliç: None declared, Tuğba Ocak: None declared, Ayse Cefle: None declared, Ayten Yazici Grant/research support from: Ayten Yazici has received project grant from Roche Pharmaceuticals, Turkey., Abdurrahman Senel: None declared, Servet Akar: None declared, Elif Durak Ediboglu: None declared, Süleyman Serdar Koca: None declared, Rabia Piskin Sagir: None declared, Sema Yilmaz: None declared, Semral Gulcemal: None declared, Özgül Soysal Gündüz: None declared, Canberk Sami Başibüyük Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Serdar Alkan Employee of: employee and shareholder of Pfizer Inc., Istanbul, Turkey., Teoman Yusuf Cesur Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Fatos Onen: 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

AB1526-HPR AWARENESS ASSESSMENT IN PATIENTS USING SUBCUTANEOUSLY ADMINISTERED BIOLOGICAL AGENTS ABOUT DRUG UTILIZATION

Background

Subcutaneous biological agents (SCBA) are commonly used in rheumatologic disorders, their storage in appropriate conditions and correct administration have importance. Informing the patient adequately and correctly is essential. Storing the drug in inappropriate conditions reduces its effectiveness, and affects the response to treatment (1).

When these treatments are initiated, information on all the mentioned topics is provided to the patients, and they undergo hands-on training. Finally, the patients is requestioned in outpatient follow-up about whether a problem has occurred or not (2).

Objectives

This study aimed to investigate the awareness of patients using SCBA about the drug’s utilization and storage conditions.

Methods

Demographic data of 100 patients diagnosed with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, using SCBA who presented to our outpatient clinic between January 2021 and June 2021,were recorded, and survey questions were asked.

Results

One hundred patients (46 females-54 males) were included in the study. Sixty-one patients were diagnosed with ankylosing spondylitis, 20 patients with rheumatoid arthritis, and 19 with psoriatic arthritis. The patients’ mean age was 44.6±11.07 years. The mean duration of SCBA use was 74.5 (2-222) months.

The patients’ replies to the survey questions are summarized in Table 1. Most patients performed the injection themselves in both genders, whereas some women received help from paramedics (p=0.041). Forty percent of the patients with education level of high school or higher had a concern regarding drug use, whereas this rate was 21% in patients with education level of primary school. It was determined that the anxiety level decreased with decreasing level of education (p=0.032).

Table 1.

The patients’ replies to the survey questions

N=100n (%)Rate of patients who read the patient consent form before starting the drug88 (88)Concern regarding drug use23 (23)Malignancy7 (7)Increase in infection7 (7)Tuberculosis70 (70)Not worriedThe person who informing patients on drug use88 (88)Nurse18 (18)Doctor7 (7)NurseanddoctorPatients who were informed about when to interrupt drug use86 (86)Situations where drug use is suspended84 (95,3)Flu and febril infection68 (79,1)Use of antibiotics39 (45,3)Herpes simplex virus infectionDrug storage65 (65)Refrigerator shelf31 (31)Refrigerator door4 (4)PharmacyState of waiting before administering the drug17 (17)Don’t wait71 (71)20-30 minutes at room temperature6 (6)>30 minutes at room temperature5 (5)Hand warming and then administration1 (1)Soak in hot waterRate of controlling the expiration date before administering the drug64 (64)Rate of patients who control the clarity of the drug75 (75)Rate of hand washing before administering the drug83 (83)Injection site cleaning6 (6)Don’t clean66 (66)With the swab from the drug box24 (24)With alcohol3 (3)With a wet wipe1 (1)With soapThe person performing the injection84 (84)The person11 (11)Person’s relative5 (5)Health personelThe patients who carry their medication in accordance with the cold chain rules during travel71 (100)

It was observed that in patients who used multiple SCBA for a long time, taking the drug out of the refrigerator and applying it after waiting for the optimum time, controlling the expiration date of the drug and hand washing before the application decreased over time.

Conclusion

Evaluating the patient’s SCBA treatment background is essential for correct treatment practice. Our study revealed that in forming patients on drug use not only initially but also at certain intervals is essential.

References

[1]From therapeutic patient education principles to educative attitude: the perceptions of health care professionals – a pragmatic approach for defining competencies and resources. Patient Preference and Adherence 2017:11 603–617.

[2]Adherence to Subcutaneous Anti-TNF Treatment in Chronic Inflammatory Rheumatism and Therapeutic Patient Education. Patient Preference and Adherence 2020:14 363–369.

Disclosure of Interests

None declared

POS0792 PULMONARY ARTERY INVOLVEMENT IN BEHCET’S DISEASE: SINGLE CENTER RESULTS

Background

Behcet’s disease (BD) is a multisystem inflammatory vasculitis. Skin, mucosa, eye, vascular area, joint, gastrointestinal system and central nervous system involvement is observed.

Objectives

In this study, we aimed to present the data of patients with pulmonary artery involvement (PAI) followed up with the diagnosis of BD.

Methods

The clinical, demographic and laboratory data of 394 patients with the diagnosis of BD, who were followed up in our rheumatology outpatient clinic between 2000 and 2020, were evaluated retrospectively.

Results

Of the patients followed up with the diagnosis of BD, 44% were female and 56% were male. Oral aphthous ulcers were found in 96%, genital ulcers in 65%, papulopustular lesions in 33%, erythema nodosum in 38%, and pathergy positivity in 47% of the patients.

PAI was detected in 3% (n:13) of the patients who were followed up with a diagnosis of BD. 69% of the patients who had PAI were male, and their mean diagnosis age was 27±9, disease duration was 10±4.7 years. Pulmonary artery aneurysm was observed in 62%, pulmonary artery thrombosis (PAT) was observed in 85%, and both conditions were observed in 46% of the patients. Oral aphthous ulcer were found in all patients, genital ulcers in 70%, papulopustular lesions in 23%, pathergy positivity in 39%, and erythema nodosum in 23%. One of the patients with PAI had hereditary thrombophilia and also lower extremity deep vein thrombosis (DVT). Cardiac involvement was in the form of intracardiac thrombus in patients with PAI.

Patients with and without PAI were compared in terms of clinical findings. A significant difference was observed in terms of DVT in the lower extremity, venous and cardiac involvement. The relationship between PAI and these involvements was also shown in the regression analysis (Table 1).

Table 1.

Comparison of data of patients with and without pulmonary artery involvement

N (%)Pulmonary Artery Involvement (+)Pulmonary Artery Involvement (-)POR (%95 CI)*N=13N=381Gender Female4(30)168(44)0.341 Male13(70)213(56)Family History2(15)46(12)0.664Oral Aphthous Ulcer13(100)366(96)1Genital Ulcer9(70)247(65)1Papulopustular lesion3(23)126(33)0.559Erythema Nodosum3(23)147(39)0.385Pathergy positivity5(39)180(47)0.738Uveitis-138(36)NARetinal Vasculitis-11(3)NAArthritis1(8)97(26)0.200Venous Involvement8(62)68(18)0.0017.365(2.33-23.20)Lower Extremity Deep Venous Thrombosis6(46)46(12)0.0036.24(2.01-19.38)Peripheral Artery Aneurysm-5(1)NAGIS involvement-17(5)NACardiac involvement3(23)4(1)0.00138.27(5.57-143.25)Cranial Involvement-24(6)NA

*Significant data in logistic regression analysis were presented, GIS: Gastrointestinal system

Cranial involvement was not detected in any of our patients with PAI. In subgroup analysis, a significant relationship was observed between PAT and intracardiac thrombus (p=0.001 OR:21.05 95%CI 3.4-130) and lower extremity DVT (p=0.001 OR: 8.79 95%CI 2.58-29.96).

Conclusion

PAI is rare but the most important involvement affecting mortality in BD patients. Recently, there has been an increase in the incidence of isolated PAT with the contribution of the developments in imaging methods.1 PAI is associated with lower extremity DVT, cerebral venous thrombosis and intracardiac thrombus.2 In our study, a significant correlation was found between PAI and the presence of venous involvement, lower extremity DVT and intracardiac thrombus.

References

[1]Ozguler Y, Seyahi E. Behçet’s Disease: Vascular involvement. Seyahi E, editor. Behçet’s Disease 1st ed. Ankara .Turkiye Clinics; 2020.p 43-7

[2]Tascilar K, Melikoglu M, Ugurlu S, Sut N, Caglar E, Yazici H. Vascular involvement in Behçet’s syndrome: a retrospective analysis of associations and the time course. Rheumatology (Oxford). 2014 Nov;53(11):2018-22

Disclosure of Interests

None declared

AB0821 The frequency of lumbosacral transitional vertebras in patients with ankylosing spondylitis

Background

Lumbosacral transitional vertebras (LSTVs) are anatomic variations observed at L5-S1 junction (1). The prevalence of LSVT ranges from 3.9% to 35.6%, indicating that this congenital anomaly is common in general population. LSVTs are well-defined anatomical differences causing low back pain and pelvic trauma (2). However, the studies assessing the influence of abnormal lumbosacral anatomy on low back pain and sacroiliac joints in patients with ankylosing spondylitis (AS) are scarce (3).

Objectives

The current study aimed to investigate the frequency of LSVTs and the their effects on clinical variables in AS patients.

Methods

The study was designed as a prospective cross-sectional study. 113 patients were included in the study. Demographic data, clinical variables, laboratory results were recorded. Disease activity (ASDAS-CRP and ASDAS-ESR), patients’ functionality (BASFI, BASMI), enthesitis (Leeds enthesitis index) and quality of life (SF-36, visual analogue scale) were evaluated. The baseline pelvic conventional radiographs and the sacroiliac magnetic resonance imaginings at the diagnosis were screened and assessed by two independent physicians. LSTVs were classified via Castellvi classification. Kappa coefficient was used to find the interobserver reliability.

Results

LSVTs were observed in 38 (33.6%) patients. Castellvi type Ia, Ib, IIa, IIb, IIIa, IIIb, and IV were found in 10 (8.8%), 7 (6.2%), 7 (6.2%), 6 (5.3%), 4 (3.5%), 1 (0.9%), and 3 (2.7%) patients, respectively. The kappa value for interobserver reliability was 0.69. There were not any differences between AS patients with and without LSVTs in terms of disease activity, functionality, and quality of life (Table 1). No statistically significant correlation was found between LSVTs identified by conventional radiography and sacroiliitis determined by MRI. When compared the patients according to Castellvi classification, visual analogue scale was higher in patients with IIIa than in patients with IV (p=0.013). Disease duration was longer in patients with Ib than in patients with Ia (p=0.029). ASDAS-CRP and ASDAS-ESR were higher in patients with IIIa than in patients with IV (p=0.008 and p=0.007).

Table 1.

The comparison of clinical characteristics between patients with and without LSVTs

Patients without LSVTs (n=75)Patients with LSVTs (n=38)pVAS3.0 (2.0−5.0)3.4 (1.0−6.0)0.734Disease duration (month)122.0 (60.0−180.0)120.0 (57.0−183.0)0.834ASDAS-CRP1.8 (1.2−2.5)1.8 (1.2−2.9)0.855ASDAS-ESR1.6 (1.2−2.5)1.6 (1.0−2.7)0.976CRP1.8 (0.8−5.3)2.5 (1.0−6.1)0.471BASMI2.9 (2.0−4.4)3.0 (2.1−4.0)0.796BASFI1.8 (0.7−4.6)2.1 (0.7−3.0)0.768SF-36Physical function80.0 (55.0−95.0)80.0 (63.8−95.0)0.765Role physical45.6 (0−100.0)50.0 (25.0−100.0)0.280Role emotional66.7 (0−100.0)33.0 (0−100.0)0.267Energy/fatigue50.0 (35.0−70.0)60.0 (38.8−71.3)0.201Mental health64.0 (48.0−76.0)68.0 (52.0−80.0)0.330Social functioning62.5 (50.0−87.5)75.0 (50.0−100.0)0.252Body pain67.5 (45.0−80.0)67.5 (45.0−90.0)0.751General health45.0 (35.0−65.0)50.0 (40.0−71.3)0.411

Values are given as median (interquartile range)

Conclusion

In AS patients, the frequency of LSVT is 33.6%, which is consistent with the general population. Type I, also known as a dysplastic transverse process, is the most observed type of LSVT. The presence of LSVTs is associated neither with clinical variables nor with sacroiliitis.

References

[1]Heaps BM, Feingold JD, Swartwout E, et al. Lumbosacral Transitional Vertebrae Predict Inferior Patient-Reported Outcomes After Hip Arthroscopy. Am J Sports Med. 2020;48(13):3272-3279

[2]Matson DM, Maccormick LM, Sembrano JN, Polly DW. Sacral Dysmorphism and Lumbosacral Transitional Vertebrae (LSTV) Review. Int J Spine Surg. 2020;14(Suppl 1):14-19. Published 2020

[3]Carvajal Alegria G, Voirin-Hertz M, Garrigues F, et al. Association of lumbosacral transitional vertebra and sacroiliitis in patients with inflammatory back pain suggesting axial spondyloarthritis. Rheumatology (Oxford). 2020;59(7):1679-1683.

Disclosure of Interests

None declared

AB0794 Hopelessness in patients with ankylosing spondylitis

Background

Ankylosing spondylitis (AS) is a chronic inflammatory disease leading to loss of function that is strongly related to impaired psychological status. Therefore, depression and anxiety are frequently investigated in these patients (1). However, hopelessness, regarded as a valuable psychological factor characterized by negative expectations and negative emotional states, was not well studied in AS patients(2).

Objectives

The aim of the study is to investigate the frequency of hopelessness in patients with AS and its relationship with clinical parameters and disease activity indices.

Methods

The study was designed as a prospective cross-sectional study. 113 AS patients were included in the study. Demographic data, clinical variables, laboratory results were recorded. Disease activity (ASDAS-CRP and ASDAS-ESR), patients’ functionality (BASFI, BASMI), enthesitis (Leeds enthesitis index) and quality of life (SF-36) were assessed. Hopelessness was evaluated by Beck hopelessness scale (BHS). The relation of BHS scores with the clinical variables was assessed. The strength of the correlations were regarded as very weak(0–0.19), weak(0.2–0.39), moderate(0.40–0.59), strong(0.6–0.79) and very strong(0.8-1). Multiple linear regression analysis was performed to find the association between BHS scores and other clinical variables.

Results

Minimal, mild, moderate, and severe hopelessness were observed in 46 (40.7%), 36 (31.9%), 22 (19.5%), and 9 (8.0%) patients, respectively. Disease duration (p=0.025), ASDAS-CRP (p=0.033), ASDAS-ESR (p=0.015), visual analogue scale (p=0.030), all SF-36 subscales (all p<0.025), BASFI (p=0.024), and BASMI (p=0.009) were statistically different among the groups. BHS scores were higher in patients with high and very high disease activity (p=0.027) (in pairwise comparison, inactive disease vs. high disease activity, p=0.035) (Figure 1). BHS scores showed weak correlation with ASDAS-CRP, ASDAS-ESR, visual analogue scale, BASMI, Leeds enthesitis index, and BASFI. Moreover, negative moderate correlations were detected between BHS scores and SF-36 subscales except social functioning and body pain, which were found weak correlation. In multiple linear regression analysis, BASMI-maximal intermalleolar distance, SF-36 energy, SF-36 mental health, and SF-36 general health were found associated with BHS scores (Table 1).

Table 1.

Multiple linear regression analysis to find predictors related to the Beck hopelessness scale scores

B95% CIpASDAS-CRP-0.063(-1.939) to 1.2820.687VAS-0.085(-0.722) to 0.3960.564BASMILateral spinal flexion0.311(-0.299) to 1.4790.191Tragus to wall distance0.157(-0.404) to 1.6020.239Modified Schober0.298(-0.114) to 1.3680.096Maximal intermalleolar distance0.2280.076 to 0.5570.010Cervical rotation0.092(-0.665) to 1.0850.635Total-0.730(-5.572) to 1.0420.177SF-36Physical function-0.024(-0.056) to 0.0460.840Role physical-0.114(-0.046) to 0.0170.364Role emotional-0.019(-0.029) to 0.0240.870Energy/fatigue-0.283(-0.125) to (-0.005)0.035Mental health-0.306(-0.142) to (-0.022)0.008Social functioning0.022(-0.033) to 0.0410.822Body pain0.182(-0.018) to 0.0860.192General health-0.344(-0.125) to (-0.030)0.002BASFI-0.085(-0.606) to 0.2480.408Figure 1.

Beck hopelessness scale scores according to disease activity subgroups

Conclusion

Higher level of hopelessness is strongly related to higher disease activity in AS patients. Furthermore, higher BHS scores are negatively correlated with SF-36 subscales. Especially, lower energy and impaired mental health are associated with higher level of hopelessness.

References

[1]Zhang L, Wu Y, Liu S, Zhu W. Prevalence of Depression in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Psychiatry Investig. 2019;16(8):565-574. doi:10.30773/pi.2019.06.05

[2]Balsamo M, Carlucci L, Innamorati M, Lester D, Pompili M. Further Insights Into the Beck Hopelessness Scale (BHS): Unidimensionality Among Psychiatric Inpatients. Front Psychiatry. 2020;11:727. Published 2020 Jul 31. doi:10.3389/fpsyt.2020.00727

Disclosure of Interests

None declared

POS0001 CAN SINGLE IMPUTATION TECHNIQUES FOR BASDAI COMPONENTS RELIABLY CALCULATE THE COMPOSITE SCORE IN AXIAL SPONDYLOARTHRITIS PATIENTS?

Background

In axial spondyloarthritis (axSpA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a key patient-reported outcome. However, one or more of its components may be missing when recorded in clinical practice.

Objectives

To determine whether an individual patient’s BASDAI at a given timepoint can be reliably calculated with different single imputation techniques and to explore the impact of the number of missing components and/or differences between missingness of individual components.

Methods

Real-life data from axSpA patients receiving tumour necrosis factor inhibitors (TNFi) from 13 countries in the European Spondyloarthritis (EuroSpA) Research Collaboration Network were utilized [1]. We studied missingness in BASDAI components based on simulations in a complete dataset, where we applied and expanded the approach of Ramiro et al. [2]. After introducing one or more missing components completely at random, BASDAI was calculated from the available components and with three different single imputation techniques: possible middle value (i.e. 50) of the component and mean and median of the available components. Differences between the observed (original) and calculated scores were assessed and correct classification of patients as having BASDAI<40 mm was additionally evaluated. For the setting with one missing component, differences arising between missing one of components 1-4 versus 5-6 were explored. Finally, the performance of imputations in relation to the values of the original score was investigated.

Results

A total of 19,894 axSpA patients with at least one complete BASDAI registration at any timepoint were included. 59,126 complete BASDAI registrations were utilized for the analyses with a mean BASDAI of 38.5 (standard deviation 25.9). Calculating BASDAI from the available components and imputing with mean or median showed similar levels of agreement (Table 1). When allowing one missing component, >90% had a difference of ≤6.9 mm between the original and calculated scores and >95% were correctly classified as BASDAI<40 (Table 1). However, separate analyses of components 1-4 and 5-6 as a function of the BASDAI score suggested that imputing any one of the first four BASDAI components resulted in a level of agreement <90% for specific BASDAI values while imputing one of the stiffness components 5-6 always reached a level of agreement >90% (Figure 1, upper panels). As expected, it was observed that regardless of the BASDAI component set to missing and the imputation technique used, correct classification of patients as BASDAI<40 was less than 95% for values around the cutoff (Figure 1, lower panels).

Table 1.

Level of agreement between the original and calculated BASDAI and correct classification for BASDAI<40 mm

Level of agreement with Dif≤6.9 mm* (%)Correct classification for BASDAI<40 mm** (%)1 missing componentAvailable93.996.9Value 5073.996.3Mean94.296.8Median93.196.82 missing componentsAvailable83.794.8Value 5040.792.8Mean83.594.8Median82.894.73 missing componentsAvailable71.992.6Value 5028.187.3Mean72.292.6Median69.792.2

* The levels of agreement with a difference (Dif) of ≤6.9 mm between the original and calculated scores were based on the half of the smallest detectable change. Agreement of >90% was considered as acceptable. ** Correct classification of >95% was considered as acceptable.

Figure 1.

Level of agreement between the original and calculated BASDAI and correct classification for BASDAI<40 mm as a function of the original score

Conclusion

BASDAI calculation with available components gave similar results to single imputation of missing components with mean or median. Only when missing one of BASDAI components 5 or 6, single imputation techniques can reliably calculate individual BASDAI scores. However, missing any single component value results in misclassification of patients with original BASDAI scores close to 40.

References

[1]Ørnbjerg et al. (2019). Ann Rheum Dis, 78(11), 1536-1544.

[2]Ramiro et al. (2014). Rheumatology, 53(2), 374-376.

Acknowledgements

Novartis Pharma AG and IQVIA for supporting the EuroSpA collaboration.

Disclosure of Interests

Stylianos Georgiadis Grant/research support from: Novartis, Myriam Riek Grant/research support from: Novartis, Christos Polysopoulos Grant/research support from: Novartis, Almut Scherer Grant/research support from: Novartis, Daniela Di Giuseppe: None declared, Gareth T. Jones Speakers bureau: Janssen, Grant/research support from: AbbVie, Pfizer, UCB, Amgen, GSK, Merete Lund Hetland Grant/research support from: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Merck, Celgene, Novartis, Simon Horskjær Rasmussen Grant/research support from: Novartis, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Bente Glintborg Grant/research support from: Pfizer, Abbvie, BMS, Anne Gitte Loft Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Karel Pavelka Speakers bureau: Pfizer, MSD, BMS, UCB, Amgen, Egis, Roche, AbbVie, Consultant of: Pfizer, MSD, BMS, UCB, Amgen, Egis, Roche, AbbVie, Jakub Zavada Speakers bureau: Abbvie, Elli-Lilly, Sandoz, Novartis, Egis, UCB, Consultant of: Abbvie, Elli-Lilly, Sandoz, Novartis, Egis, UCB, Merih Birlik: None declared, Ayten Yazici Grant/research support from: Roche, Brigitte Michelsen Grant/research support from: Novartis, Eirik kristianslund: None declared, Adrian Ciurea Speakers bureau: AbbVie, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Consultant of: AbbVie, Eli Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Michael J. Nissen Speakers bureau: AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Consultant of: AbbVie, Eli Lilly, Janssens, Novartis, Pfizer, Ana Maria Rodrigues Speakers bureau: Abbvie, Amgen, Consultant of: Abbvie, Amgen, Grant/research support from: Novartis, Pfizer, Amgen, Maria Jose Santos Speakers bureau: Abbvie, AstraZeneca, Lilly, Novartis, Pfizer, Gary Macfarlane Grant/research support from: GSK, Anna-Mari Hokkanen Grant/research support from: MSD, Heikki Relas Speakers bureau: Abbvie, Celgene, Pfizer, UCB, Viatris, Consultant of: Abbvie, Celgene, Pfizer, UCB, Viatris, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis, Pfizer, Corina Mogosan: None declared, Ziga Rotar Speakers bureau: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Consultant of: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek, Janssen, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz-Lek, Consultant of: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz-Lek, Björn Gudbjornsson Speakers bureau: Amgen, Novartis, Consultant of: Amgen, Novartis, Arni Jon Geirsson: None declared, Pasoon Hellamand Grant/research support from: Novartis, Marleen G.H. van de Sande Speakers bureau: Eli Lilly, Novartis, UCB, Janssen, Abbvie, Consultant of: Eli Lilly, Novartis, UCB, Janssen, Abbvie, Grant/research support from: Eli Lilly, Novartis, UCB, Janssen, Abbvie, Isabel Castrejon: None declared, Manuel Pombo-Suarez Consultant of: Abbvie, MSD, Roche, Bruno Frediani: None declared, Florenzo Iannone Speakers bureau: Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: Abbvie, Amgen, AstraZeneca, BMS, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis

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

AB0717 Developing a Deep Learning Model on Conventional X-Rays in the Diagnosis of Axial Spondyloarthritis

Background

Plain pelvic radiographs are the most common imaging modality used in the first line for diagnosis of axial Spondyloarthritis (axSpA). However, evaluation of the sacroiliac joint on two-dimensional plain radiographs may lead to misinterpretation among the evaluators.

Objectives

To investigate the diagnostic power of deep learning models in conventional radiographs of the patients with axSpA.

Methods

The study included 320 axSpA patients and 348 healthy controls (age; 34.5±15.3/38.2±10.6, p=0.072; gender (male) 53.8%/46.3%, p=0.064). Sacroiliitis was confirmed on sacroiliac MRI according to the Assessment of Spondyloarthritis International Society (ASAS) definition. The contrast equalization was preprocessed with the Clahel (Contrast-Limited Adaptive Histogram Equalization) filter. Then, classification was performed with Alexnet, VGG16, resnet101 and resnet50 models. As a result of the trials, the best result was achieved with resnet50. Four different filtering scenarios were applied (Clahel filter cliplimit 0.25, Clahel filter cliplimit 0.50, clahel filter 1.00 and no filter).Two different cropping processes were performed on the direct radiographs, and uncropped, cropped at pelvic borders, cropped images close to the sacroiliac joint were applied to the deep learning model. Meanwhile, all images were also evaluated by 3 rheumatologists for the presence of sacroiliitis.

Results

According to the results of 4 different scenarios studied with the Resnet50 model, the best result was obtained with the RESNET50 Model + Clahel filter clipLimit 0.50. With this model, after applying the clahel filter with a coefficient of 0.5 to the full resolution data, we achieved 0.8135 success in the separation of AS and normal. A kappa error of 0.0561, Cohen’s Kappa Error = 0.6267, Fscore 0.8022 (AS), 0.8253 (normal) were obtained. After applying the clahel filter with a coefficient of 0.5 with Resnet50 to the pelvic data, we achieved 0.625 success in separation of AS and normal. Kappa error 0.0694, Cohen’s Kappa Error=0.2400, Fscore 0.5399 (AS), 0.6838 (normal) values ​​were obtained. After applying the Clahel filter with a coefficient of 0.5 with Resnet50 to the sacroiliac data, we achieved 0.61 success in the separation of AS and normal. Kappa error 0.0696, Cohen’s Kappa Error=0.2131, Fscore 0.5517 (AS), 0.6549 (normal) values ​​were obtained. As a result of the evaluation of the radiographs by the clinician, Cohen’s kappa was 0.452 and accuracy was 0.73 for the first rheumatologist; Cohen’s kappa 0.132 and accuracy 0.56 for the second rheumatologist and Cohen’s kappa 0.362 and accuracy 0.68 for the third rheumatologist were found.

Conclusion

Application of RESNET50 Model + Clahel filter (‘clipLimit’, 0.5, ‘Distribution’, ‘rayleigh’) on uncropped images showed higher precision in diagnosing sacroiliitis from conventional radiographs compared to other filtering scenarios. Our results were found to have higher accuracy than the evaluation of three rheumatologists.

Table 1.

Precision and kappa values of Resnet50 model, 4 different filtering scenarios and 2 different clipping operations

AccuracyCohen’s kappa (CI)*RESNET50+no filter0.73060.4509 (0.3234-0.5785)*RESNET50 Model+ Clahel filter (0,25)0.69430.3889 (0.2590-0.5189)*RESNET50 Model+ Clahel filter (0,50)0.81350.6267 (0.4186-0.7555)*RESNET50 Model+ Clahel filter (1,00)0.68390.3552 (0.2213-0.4890)**RESNET50 Model+ Clahel filter (0,50)0.6250.2400 (0.1523-0.3245)***RESNET50 Model+ Clahel filter (0,50)0.6100.2131 (0.1121-0.3430)

* Uncropped sacroiliac X-Rays; ** Cropped X-Rays at the pelvic margins; *** Cropped X-Rays close to the sacroiliac joints

Figure 1.

Steps of deep learning model in X-Ray images

Disclosure of Interests

None declared

A real-life analysis of patients with rheumatologic diseases on biological treatments: Data from TURKBIO Registry

OBJECTIVE

TURKBIO registry, established in 2011, is the first nationwide biological database in Turkey. This study aimed to provide an overview of TURKBIO data collected by June 2018.

METHODS

The registry included adult patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), nonradiographic axial spondyloarthritis (nr-AxSpA), and psoriatic arthritis (PsA). Demographic and clinical features, disease activity markers, and other follow-up parameters, current and previous treat- ments, and adverse events were registered electronically at each visit using open-source software. The registration of patient-reported outcome measures was carried out electronically by the patients using touch screens.

RESULTS

TURKBIO registry included a total of 41,145 treatment series with biologicals. There were 2,588 patients with axSpA (2,459 AS and 129 nr-axSpA), 2,036 with RA, and 428 with PsA. The total number of patients, including those with other diagnoses, was 5,718. In the follow-up period, the number of patients and also visits steadily increased by years. The yearly mean number of visits per patient was found to be 2.3. Significant improvements in disease activity and health assessment parameters were observed following the biological treatments. Biologics were often given in combination with a con- ventional synthetic disease-modifying antirheumatic drug in patients with RA. Infections were the most commonly seen adverse events, followed by allergic reactions. Tuberculosis was observed in 12 patients, malignancy in 18, and treatment-related mortality in 31.

CONCLUSION

TURKBIO provided a valuable real-life experience with the use of biologics in rheumatic diseases in Turkey.

Factors associated with neurodevelopmental impairment in preterm infants with bronchopulmonary dysplasia

OBJECTIVE

Bronchopulmonary dysplasia (BPD) is a common and serious complication in preterm infants with very low birth weight and is known to lead to poor neurodevelopmental outcomes. This study aimed to identify factors associated with neurodevelopmental impairment (NDI) in patients with moderate to severe BPD.

SUBJECTS AND METHODS

A total of 83 preterm infants born between 24- and 29-weeks' gestation who were admitted to the neonatal intensive care unit and developed moderate/severe BPD between 2013 and 2017 were retrospectively evaluated. Developmental assessment was performed at 18 to 24 months of corrected age using the Bayley Scales of Infant Development II (BSID-II). Patients with NDI (n=41) and without NDI (n=42) were compared.

RESULTS

BSID-II Mental Development Index and Psychomotor Development Index scores were 87±11 and 83±8 in the non-NDI group and 57±12 and 52±8 in the NDI group, respectively (p<0.001). The NDI group had significantly lower birth weight (847±174 vs. 1012±192 g) and gestational age (26.1±1.3 and 27.6±1.6 weeks) compared to the non-NDI group (p<0.001). Intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, exposure to steroids, duration of respiratory support, and length of hospital stay were significantly higher in the NDI group (p<0.001).

CONCLUSIONS

Many of the conditions in this study were found to be associated with poor neurodevelopmental outcomes in patients with BPD, such as prolonged respiratory support, prolonged hospitalization, intraventricular hemorrhage, retinopathy, and steroid therapy, can be avoided or prevented with strict protocols and prevention strategies. Appropriate management of comorbid risk factors may help prevent poor neurodevelopmental outcomes.

The prevalence of non-vascular pulmonary manifestations in Takayasu's Arteritis patients: A Retrospective multi-centred Turkish cohort study

Objectives Takayasu's arteritis (TAK) is a rare vasculitis characterized by inflammation of intermediate- to large-size arteries. Although pulmonary artery involvement (PAI) is an expected finding in some TAK patients, data on non-vascular pulmonary involvement (NVPI) are limited. We aimed to investigate the frequency of NVPI, including parenchymal infiltration, nodules/cavities, pleural effusion, and haemorrhage, in TAK.Method We assembled a retrospective cohort of TAK patients from nine tertiary centres in Turkey. The demographics and clinical characteristics of patients were extracted from medical records and the imaging findings were evaluated for pulmonary manifestations.Results As of January 2021, 319 TAK patients (female/male 276/43; mean age 42.4 ± 13.5 years) were recruited. Eighty-two patients had cough and/or dyspnoea and four had haemoptysis as pulmonary symptoms. On computed tomography assessment, the overall frequency of NVPI was 7.2%; parenchymal infiltrations were present in 10 (3.1%), pleural effusion in eight (2.5%), nodules/cavities in six (1.9%), and pulmonary haemorrhage in four patients (1.3%). In the whole cohort, 10.3% of patients had pulmonary artery hypertension (PAH) and 5.6% had PAI. Among patients with PAH or PAI, the overall frequency of NVPI was significantly higher than in the rest of the group.Conclusions In this TAK cohort from Turkey, we observed NVPI in 7.2% of patients, with parenchymal infiltrations being the most common, followed by pleural effusion. Notably, NVPI was more frequent in patients with PAH or PAI. Although not as common as PAI, NVPI should be kept in mind, especially in TAK patients with PAH or PAI.

Biologic treatments in Takayasu's Arteritis: A comparative study of tumor necrosis factor inhibitors and tocilizumab

OBJECTIVE

To compare the treatment outcomes of TNF inhibitors and tocilizumab (TCZ) in patients with Takayasu arteritis.

METHODS

Takayasu arteritis patients who were refractory to conventional immunosuppressive (IS) drugs and received biologic treatment were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data during follow-up were recorded. Remission, glucocorticoid (GC) sparing effect, drug survival was compared between TNF inhibitor and TCZ treatments. Also, a subgroup matched comparison was performed between groups.

RESULTS

One hundred and eleven (F/M: 98/13) patients were enrolled. A total of 173 biologic treatment courses (77 infliximab, 49 TCZ, 33 adalimumab, 9 certolizumab, 3 rituximab, 1 ustekinumab and 1 anakinra) were given. Tocilizumab was chosen in 23 patients and TNF inhibitors were chosen in 88 patients as first-line biologic agent. Complete/partial remission rates between TCZ and TNF inhibitors were similar at 3rd month and at the end of the follow-up. GC dose decrease (≤4 mg) or discontinuation of GCs was achieved in a similar rate in both groups (TNF inhibitors vs TCZ: 78% vs 59%, p = 0.125). Drug survival rate was 56% in TNF inhibitors and 57% in TCZ group (p = 0.22). The use of concomitant conventional ISs did not affect the drug survival (HR =0.78, 95% CI =0.42-1.43, p = 0.42). The match analysis showed similar results between groups in terms of relapse, decrease in GC dose, surgery need and mortality.

CONCLUSION

The efficacy and safety outcomes and drug survival rates seem to be similar for TNF inhibitors and tocilizumab in patients with Takayasu arteritis.

The role of lactate dehydrogenase-to-albumin ratio in clinical evaluation of adult-onset Still's disease

OBJECTIVES

The aim of the study is to evaluate the importance of lactate dehydrogenase-to-albumin ratio (LAR) in patients with adult-onset Still's disease (AOSD) and to investigate the relationship between this ratio and clinical laboratory variables.

METHODS

The study design was retrospective cross-sectional. The demographic and clinical data, laboratory results and imaging findings were documented. Univariate and multinomial logistic regression analyses were performed to find the predictors, which could be useful to define the ferritin level and organ involvement. Receiver-operating characteristic (ROC) analysis was used to clarify the diagnostic ability of the LAR for ferritin level and organ involvement.

RESULTS

Fifty-eight patients with AOSD were evaluated. When patients were divided into two groups according to the serum ferritin level with a cut-off of 1500 ng/dL, lymphocyte count and albumin level were significantly less in patients who had higher ferritin levels (P = .015 and P = .005). In multinominal logistic regression analysis, AST, LDH and LAR were found as predictors for ferritin levels. When we compared LAR between patients with and without organ involvement, higher LAR was found in patients with HM, SM, serositis and MAS. Also, LAR was significantly higher in patients with higher ferritin levels (≥1500 ng/dL) than those without (P < .001). In ROC analysis, the cut-off point of LAR predicting the ferritin level was determined as 80.75 with 83.7% sensitivity and 80.0% specificity (AUC = 0.89, 95% CI 0.79-0.98, P < .001).

CONCLUSION

LAR can be a valuable inflammatory marker to determine AOSD patients with organ involvement and higher ferritin level.

Association of quantitative computed tomography ındices with lung function and extent of pulmonary fibrosis in patients with systemic sclerosis

OBJECTIVES

The aim was to investigate the discriminative value of a wide range of quantitative computed tomography (qCT) parameters in systemic sclerosis (SSc) patients with and without pulmonary fibrosis (PF) and their association with pulmonary function tests (PFTs) and visual fibrosis scores (VFS).

METHOD

Thoracic high-resolution computed tomography (HRCT) images of SSc patients with and without PF were analyzed with Vitrea® Advanced Visualization software. The mean lung attenuation (MLA), skewness, kurtosis, and threshold-based volumes [low-density volume (LDV), medium-density volume (MDV), and high-density volume (HDV)] derived from the attenuation histograms of the right and left lungs were evaluated separately. Visual scores were measured semi-quantitatively and the overall extent of pulmonary parenchymal abnormality was calculated.

RESULTS

Forty-one SSc patients with PF (85.4% female; mean age 50.4 ± 15.6 years) were compared with 94 without PF (88.3% female; mean age 50 ± 11.5 years). All qCT parameters were significantly different between those with and without PF (p < 0.05). Amongst the qCT measurements, R-MLA, L-MLA, R-MDV, L-MDV, and left total lung volume (L-TLV) correlated with all three of forced vital capacity, carbon monoxide diffusion capacity, and VFS, even after adjustment for sex and age (|r|> 0.300 and p < 0.05). R-MLA, L-MLA, R-HDV/TLV, and L-HDV/TLV exhibited diagnostic accuracy in discriminating patients with PF (AUC value > 0.7).

CONCLUSION

QCT parameters differentiated SSc patients with PF from the ones without and showed a good correlation with VFS. With the application of user-friendly and less operator-dependent software, qCT analysis may become an objective tool for analysis of PF in SSc, complementary to PFTs and VFS. Key Points • Quantitative computed tomography parameters can accurately and objectively differentiate between SSc patients with and without PF. • Furthermore, in SSc patients with fibrosis, a moderate to a high correlation was identified between many of the qCT parameters, PFT results, and VFS.

Genetic Association of a Gain-of-Function IFNGR1 Polymorphism and the Intergenic Region LNCAROD/DKK1 With Behçet's Disease

OBJECTIVE

Behçet's disease is a complex systemic inflammatory vasculitis of incompletely understood etiology. This study was undertaken to investigate genetic associations with Behçet's disease in a diverse multiethnic population.

METHODS

A total of 9,444 patients and controls from 7 different populations were included in this study. Genotyping was performed using an Infinium ImmunoArray-24 v.1.0 or v.2.0 BeadChip. Analysis of expression data from stimulated monocytes, and epigenetic and chromatin interaction analyses were performed.

RESULTS

We identified 2 novel genetic susceptibility loci for Behçet's disease, including a risk locus in IFNGR1 (rs4896243) (odds ratio [OR] 1.25; P = 2.42 × 10-9 ) and within the intergenic region LNCAROD/DKK1 (rs1660760) (OR 0.78; P = 2.75 × 10-8 ). The risk variants in IFNGR1 significantly increased IFNGR1 messenger RNA expression in lipopolysaccharide-stimulated monocytes. In addition, our results replicated the association (P < 5 × 10-8 ) of 6 previously identified susceptibility loci in Behçet's disease: IL10, IL23R, IL12A-AS1, CCR3, ADO, and LACC1, reinforcing the notion that these loci are strong genetic factors in Behçet's disease shared across ancestries. We also identified >30 genetic susceptibility loci with a suggestive level of association (P < 5 × 10-5 ), which will require replication. Finally, functional annotation of genetic susceptibility loci in Behçet's disease revealed their possible regulatory roles and suggested potential causal genes and molecular mechanisms that could be further investigated.

CONCLUSION

We performed the largest genetic association study in Behçet's disease to date. Our findings reveal novel putative functional variants associated with the disease and replicate and extend the genetic associations in other loci across multiple ancestries.

Risk factors of avascular necrosis in Takayasu arteritis: a cross sectional study

Takayasu arteritis (TA) is a large-cell vasculitis, and is not usually associated with avascular necrosis (AVN). The objective of the study was to investigate any association between TA and AVN, including the possible pathogenic effect of glucocorticoid (GCs) use. The study design was retrospective and cross sectional. TA patients were enrolled in the study. Demographic variables, disease activity, treatments, physician global assessment, Indian Takayasu Clinical activity score 2010, and Kerr criteria were recorded. Logistic regression analysis was performed to identify predictors of AVN. A total of 29 patients were assessed. AVN was observed in four (13.8%) patients with TA. Male gender and elevated C-reactive protein (CRP) were found to be significantly associated with AVN (p = 0.001 and p = 0.006, respectively). While type IIb TA was more common in patients with AVN (n = 2, 50%), type V was more likely in the absence of AVN (n = 13, 52%). Descending aorta and thoracic aorta were usually involved in patients with AVN (both, n = 3, 75%). In multivariate logistic regression, increased CRP levels were the only predictor for AVN (OR = 1.183, 95% Cl = 1.025-1.364, p = 0.021). No association was identified between AVN in TA patients and either duration or cumulative dose of GCs. The present study found that higher CRP levels and male gender were associated with AVN in patients with TA.

AB0362 DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF BEHCET’S DİSEASE PATIENTS

Background:

Behcet’s Disease (BD) is a systemic variable vessel vasculitis that involves the skin, mucosa, joints, eyes, arteries, veins, nervous system and the gastrointestinal system.

Objectives:

In this study we aimed to present variety of involvements in patients who were followed up in our outpatient clinic with a diagnosis of BD.

Methods:

Data of 394 patients diagnosed with BD between 2000-2020 were retrospectively reviewed clinical, demographic characteristics and systemic involvements.

Results:

In our study 43.7% of BD patients were female, 56.3% were male and the mean age was 40±11years, disease average age of onset 36.5±10.6, disease duration was 12.8±6.8years. It was observed mucocutaneus involvement 98% of the patients, uveitis in 35%, retinal vasculitis in 2.8%, arthritis in 24.9%, arterial occlusion in 2.3%, arterial aneurysm in 3.8%, venous involvement in 19.8%, gastrointestinal (GIS) involvement in 4.3%, cardiac involvement in 1.5%, and cranial involvement 7.1 (Table 1).

Table 1.

The Data of Behçet Disease

n (%)n= 394GenderFemale172 (43.7)Male222 (56.3)Family History48 (12.2)Fever & Weight Loss21 (5.3)Mucocutaneus involvement386 (98)Oral Aphthous Ulcer379 (96.2)Genital Ulcer256 (65)Papulopustular lesions129 (32.7)Erythema Nodosum-like lesions150 (38.1)Skin Pathergy Reaction185 (47)Uveitis138 (35)Retinal Vasculitis11 (2.8)Venous involvement76 (17.6)Thrombophlebitis30 (7.6)67 (17)Deep venous thrombosisArthritis98 (24.9)Monoarthritis74 (75.5)Oligoarthritis21 (21.4)Sacroiliitis3 (3.0)Artery Occlusion9 (2.3)Arterial Aneurysm15 (3.8)GIS involvement17 (4.3)İleum9 (2.3)Colon2 (0.5)Rectum1 (0.3)İleocolonic4 (1)Cardiac involvement6 (1.5)Pericarditis2 (0.5)Ventricular thrombosis3 (0.7)Atrial thrombosis1 (0.2)Cranial involvement24 (5.6)Parenchymal involvement13 (4.6)Cerebral Venous Thrombosis11 (2.8)Pulse steroid15 (3.8)1mg/kg steroid48 (12.2)Infliximab13 (3.3)Azathioprine184 (46.7)Cyclophosphamide31 (7.9)

When all patients evaluated in terms of renal findings, proteinuria was observed in 5 patients and hematuria was observed in 2 patients. 3 patients had proteinuria over than 500mg/day. Their renal biopsy findings; 2 of them were nonspecific involvements and one of them was minimal mesangioproliferative changes.

Conclusion:

As a multi-system disease, general data have been presented, as clinical symptoms involve almost all systems of the body (1).

References:

[1]Behcet’s disease Fereydoun Davatchi 1Int J Rheum Dis.2014 May;17(4):355-7. doi: 10.1111/1756-185X.12378.

Disclosure of Interests:

None declared

POS0892 QUANTITATIVE CT INDEXES: PROMISING TOOLS FOR OBJECTIVE ASSESSMENT OF PULMONARY FIBROSIS IN SYSTEMIC SCLEROSIS

Background:

Pulmonary fibrosis (PF) occurs in the majority of patients with SSc and is a leading cause of SSc-related death. SSc related PF has heterogeneous disease progression: many patients will have a chronic, indolent course while others may develop the progressive, life-threatening disease.

Objectives:

The objective of this study is to investigate the discrimination performance of quantitative CT indexes in identifying the parenchymal differences between the SSc and the control groups. We also aimed to demonstrate the correlation among quantitative indexes (QI), spirometric pulmonary function tests, and visual CT scores in patients with PF.

Methods:

A total of 135 SSc patients (female 87.4%; age, 50±13 years), 41 of whom had pulmonary fibrosis (PF), and 38 healthy subjects (female 89.5%; age, 52±6 years) were enrolled. All participants underwent volume thin-section CT in the supine position at full inspiration and spirometry. Quantitative indexes (QIs) were obtained using dedicated software for the segmentation of the lung (Vital Images Vitrea Workstation; Version 7.12.3.133). QIs included total lung volume (TLV), low attenuation (LA) volume (-1020 HU<pixel<-920 Hounsfield units [HU]), medium attenuation (MA) volume (-920 HU<pixel<-920 HU), and high attenuation (HA) volume (-720<pixel<0 HU). The global extent of pulmonary parenchymal abnormality was measured semiquantitatively by visual scoring (VS) and functional lung volume was derived. The functional lung volume, total MA volume, and ratio of total MA to total lung volume were assumed as the indexes of normal lung parenchyma.

Results:

MA volumes, HA volumes, total lung volumes and the ratio of MA volume to total lung volume differed significantly between the patients with PF, patients without PF, and the control group. In the PF group, FVC showed significant correlation with functional lung volume (r=0.45, p=0.014) and total MA volume (r=0.48, p=0.009); DLCO showed significant correlation with VS of normal lung parenchyma (r=0.65, p<0.001), functional lung volume (r=0.53, p=0.006), total MA volume (r=0.54, p=0.005) and ratio of total MA to total lung volume (r=0.42, p=0.031). The functioning lung volume obtained by VS and total MA volume showed excellent correlation (r=0.78, p<0.001).

Conclusion:

Quantitative indexes measured by soft-ware differentiated the patients with PF from the patients without PF and healthy subjects. The indexes used to evaluate the normal lung parenchyma showed a good correlation with pulmonary function test results. Quantitative indexes can be used as an objective complementary tool for the evaluation of the lung areas unaffected by PF.

Table 1.

Quantitative Indexes of CT in the Control, SSc without PF and SSc with PF Groups

ControlSSc without PFSSc with PFpRight lung LA volume (ml)372±375420±446254±3080.102Right lung MA volume (ml)1230±4081377±441987±451<0.001Right lung HA volume (ml)531±152494±177625±2150.004Left lung LA volume (ml)342±370367±383221±2710.089Left lung MA volume (ml)1014±3831170±433805±402<0.001Left lung HA volume (ml)563±176516±251620±2890.037Total lung LA volume (ml)712±736827±959517±6530.119Total lung MA volume (ml)2212±8632548±8621756±850<0.001Total lung HA volume (ml)1072±3431009±4061290±5220.005Total lung volume (ml)3996±12374385±12563563±12360.002Mean lung density (HU)-799±61.4-798±63-730±75<0.001Total MA volume/Total lung volume0.55±0.120.59±0.130.49±0.150.002Figure 1.

Segmentation of lung parenchyma

Disclosure of Interests:

None declared

AB0359 CRANIAL INVOLVEMENT IN BEHÇET’S DISEASE

Background:

Behçet’s disease (BD) is a vasculitic multisystem inflammatory disorder. It may also involve the skin, mucosa, eyes, blood vessels, joints, gastrointestinal system, and central nervous system (CNS).

Objectives:

In this study, we aimed to present CNS involvement data in patients followed up with a diagnosis of BD.

Methods:

The clinical, demographic, laboratory and medication data of 394 patients who were followed up with a diagnosis of BD in our rheumatology outpatient clinic between 2000 and 2020 were retrospectively evaluated.

Results:

CNS involvement was detected in %5.6(24) patients who were followed up with a diagnosis of BD. 66.7% of the patients were male, and their mean diagnosis age was 25.1±8.2 years, mean CNS involvement age was 28.39±9.6 years. Neurological symptoms occurred in an average of 3.3 years after the diagnosis of BD. Parenchymal involvement was present in 54.2% of the patients with CNS involvement, 45.8 % had cerebral venous thrombosis. Oral apthous ulcer was found in 91.7 % of the patients, genital ulcer in 70.8%, pathergy positivity in %45.8 papulopustular lesion in %37.5, erythema nodosum in %45.8. Patients with CNS involvement had headache, vision loss, diplopia, hemiparesis, epilepsy, proptosis, and ataxic gait and walking difficulty in 66.6%, 12.5%, 25%, 12.5%, 8.3%, 8.3% and 12.5%, respectively. Patients with and without CNS involvement were compared in terms of clinical findings and medications. A significant difference was observed in terms of cardiac involvement (Table 1). While one of the 2 patients with cardiac involvement had a thrombus in the right ventricle, the other had pericardial effusion. The patient with cardiac thrombus also had cerebral venous thrombus. Steroid, azathioprine, cyclophosphamide treatments have been used at a higher in patients with CNS involvement. In addition, the patients with parenchymal and cerebral venous involvement were compared in terms of clinical, demographics findings and medications. The presence of papulopustular lesions (9.1% vs 57.1%) and pathergy positivity (18.2% vs 71.4%) were higher in patients with parenchymal involvement (p:0.033, p: 0.020, respectively).

Table 1.

Comparison of data of patients with and without CNS involvement

n (%)CNS Involvement (+)n:24CNS Involvement (-)n:370PGender0.396 Female8(33.3)164(44.3) Male16(66.7)206(55.7)Oral Aphthous Ulcer22(91.7)357(96.5)0.230Genital Ulcer17(70.8)239(64.6)0.661Papulopustular lesion9(37.5)120(32.4)0.655Erythema Nodosum11(45.8)139(37.6)0.516Pathergy11(45.8)174(47)0.988Uveitis9(37.5)129(34.9)0.827Retinal Vasculitis1(4.2)10(2.7)0.504Arthritis3(12.5)95(25.7)0.221Deep Venous Involvement6(25)59(15.9)0.256Artery Occlusion1(4.2)8(2.2)0.436Arterial Aneurysm1(4.2)14(3.8)1GIS involvement2(8.3)15(4.1)0.277Cardiac involvement2(8.3)4(1.1)0.046

Conclusion:

It has been reported that neurological symptoms occur in an average of 2.5 to 6.5 years after the diagnosis of BD. On the other hand, it has been stated that neurological complications may be the first involvement in 3-33% of the cases and this situation will cause diagnostic difficulties1. These data are consistent with our study.

References:

[1]Noel N, Drier A, Wechsler B, ve ark. Neurological manifestations of Behcet’s disease. Rev Med Interne 2014;35(2):112–120.

Disclosure of Interests:

None declared

AB0356 VENOUS INVOLVEMENT IN BEHÇET’S DISEASE

Background:

Behçet’s disease (BD) is a vasculitic multisystem inflammatory disorder. It may also involve the skin, mucosa, eyes, blood vessels, joints, gastrointestinal system, and central nervous system.

Objectives:

In this study, we aimed to present venous involvement data in patients followed up with a diagnosis of BD.

Methods:

The clinical, demographic, laboratory and medication data of 394 patients who were followed up with a diagnosis of BD in our rheumatology outpatient clinic between 2000 and 2020 were retrospectively evaluated.

Results:

Venous involvement was detected in 17.6% (n:76) patients who were followed up with a diagnosis of BD. 75% of the patients were male, and their mean diagnosis age was 27.1±9.9, disease duration was 14.2±6.3 years. While the thrombosis of lower extremity veins, cervical veins, and vena cava were observed in 85.5% of BD patients, superficial thrombophlebitis was found in 31.6%. Cerebral venous involvement (CVI) was evaluated in cranial involvement. Oral aphthous ulcer was found in 97.4 % of the patients, genital ulcer in 65.8%, pathergy positivity in 44.7%, papulopustular lesion in 34.2%, erythema nodosum in 40.8%. 27.6% of the patients were evaluated for hereditary thrombophilia and 5.3% (n:7) had hereditary thrombophilia. Deep venous thrombosis was found in 85.7% (6/7) of these patients, renal artery occlusion in 14.3%, pulmonary artery thrombosis in 14.3%, and cerebral venous thrombosis in 28.6%. Patients with and without venous involvement were compared in terms of clinical findings. A significant difference was observed in terms of retinal vasculitis, artery occlusion, arterial aneurysm, family history for BD and gender. In logistic regression analysis, a significant relationship was observed between venous involvement and gender, family history, retinal vasculitis, artery occlusion, arterial aneurysm (Table1).

Table 1.

Comparison of data of patients with and without venous involvement

Venous Involvement (+)n:76Venous Involvement (-) n:318POR* (%95CI)Gender0.0002.78(1.58-4.88) Female19(25)153(48.1) Male57(75)165(51.9)Family History4(5.3)44(13.8)0.0490.035(0.12-0.99)Oral Aphthous Ulcer74(97.4)305(95.9)0,745Genital Ulcer50(65.8)206(64.8)0,894Papulopustular lesion26(34.2)103(32.4)0,786Erythema Nodosum31(40.8)119(37.4)0,601Pathergy34(44.7)151(47.5)0,772Uveitis20(26.3)118(37.1)0,083Retinal Vasculitis5(6.6)6(1.9)0.0363.66(1.08-12.33)Arthritis13(17.1)85(26.7)0,104Artery Occlusion6(7.9)3(0.9)0.0028.97(2.19-36.74)Arterial Aneurysm7(9.2)8(2.5)0.0133.93(1.37-11.20)Gastrointestinal involvement6(7.9)11(3.5)0,111Cardiac involvement3(3.9)3(0.9)0,089Cranial involvement7(9.2)17(5.3)0,282

* Significant data in logistic regression analysis were presented

Conclusion:

Superficial venous thrombosis and deep vein thrombosis are the most frequent vascular involvements in BD patients. Significant correlations exist between CVI and pulmonary artery involvement (PAI), intracardiac thrombosis and PAI. It should be recalled that lower extremity venous thrombosis is often present in these associations, and even precede them (1).

References:

[1]Seyahi E. Behçet’s disease: How to diagnose and treat vascular involvement. Best Practice & Research Clinical Rheumatology. 30 (2016) 279-295

Disclosure of Interests:

None declared

AB0229 A NATIONAL, MULTICENTER, SECONDARY DATA USE STUDY EVALUATING EFFICACY AND RETENTION OF FIRST-LINE BIOLOGIC TREATMENT WITH TOCILIZUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-LIFE SETTING FROM TURKBIO REGISTRY

Background:

Tocilizumab (TCZ) is a human anti-interleukin (IL)-6 receptor antibody approved in Turkey for the treatment of rheumatoid arthritis (RA).

Objectives:

In this study our purpose was to describe the disease activity, quality of life (QoL), and retention rate in RA patients who were prescribed TCZ as first-line biologic treatment in a real-world setting.

Methods:

Anonymized patient registry of TURKBIO was used based in a national, multicenter, and retrospective context. We conducted a search in the registry between years 2013 and 2020 and included adult RA patients who were prescribed with TCZ as their first-line biologic treatment with a post-TCZ follow-up of at least 6 months. CDAI, DAS28-(ESR), and HAQ-DI scores in 6, 12, and 24 months were obtained. Pairwise comparison was carried out for survey scores across baseline and timepoints. Subgroup analysis for route of TCZ administration was performed. EULAR response criteria were used for response evaluation. Retention of TCZ was evaluated by Kaplan-Meier analysis.

Results:

Overall,130 patients with a mean RA duration of14 years were included in the study. 87.7% of the patients were female and mean age was53 (SD; 15.0). Median duration of follow-up was 18.5 months. Majority (90.8%) of patients were given tocilizumab via intravenous route at baseline. Number of patients with ongoing TCZ treatment and follow-up at 6, 12, and 24 months were 121 (93%), 85 (65%), and 46 (35%), respectively. Remission rates at 6, 12, and 24 months per CDAI (<2.8) and DAS28-(ESR) (<2.6) scores were 61.5%, 44.6%, 30%, and 54.6%, 40.8%, 27.7%, respectively. CDAI, DAS28-(ESR) and HAQ-DI survey scores significantly improved at 6, 12 and 26 months, respectively (p<0.001) (Table 1) in both IV and SC TCZ subgroups. At 6, 12 and 24months 74.8%, 82.5% and 86.4% of patients achieved a EULAR good response respectively. Twenty-three patients (17.6%) discontinued TCZ at 24 months. Of these, 19 patients discontinued due to unsatisfactory response. Retention rates of TCZ at 6, 12, and 24 months were 93%, 84.3%, and 72.2%, respectively (Figure 1).

Conclusion:

TCZ as a first-line biologic treatment was found to be clinically effective in this real-world study with a high retention rate. These results are in line with the results gathered from previous TCZ controlled and real-life studies in which TCZ was found clinically safe and effective.

References:

[1]Haraoui B, Casado G, Czirjak L, Taylor A, Dong L, Button P, Luder Y, Caporali R. Tocilizumab Patterns of Use, Effectiveness, and Safety in Patients with Rheumatoid Arthritis: Final Results from a Set of Multi-National Non-Interventional Studies. Rheumatol Ther. 2019 Jun;6(2):231-243.

[2]Favalli EG, Raimondo MG, Becciolini A, Crotti C, Biggioggero M, Caporali R. The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives. Autoimmun Rev. 2017 Dec;16(12):1185-1195.

[3]Haraoui B, Jamal S, Ahluwalia V, Fung D, Manchanda T, Khraishi M. Real-World Tocilizumab Use in Patients with Rheumatoid Arthritis in Canada: 12-Month Results from an Observational, Noninterventional Study. Rheumatol Ther. 2018 Dec; 5(2): 551–565.

Disclosure of Interests:

Ayten Yazici Speakers bureau: PFIZER, AbbVie, NOVARTIS, Özlem Özdemir Işik: None declared, Ediz Dalkiliç Speakers bureau: AbbVie, UCB Pharma, PFIZER, Roche, MSD, NOVARTIS, Süleyman Serdar Koca Speakers bureau: MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB Pharma, AMGEN, SANOFİ, Yavuz Pehlivan Speakers bureau: PFIZER, NOVARTIS, MSD, CELLTRION, Consultant of: PFIZER, Soner Şenel: None declared, Nevsun Inanc Speakers bureau: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Paid instructor for: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Consultant of: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Grant/research support from: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Servet Akar Speakers bureau: LILLY, MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, JANNSEN, UCB Pharma, AMGEN, Paid instructor for: LILLY, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB, AMGEN, Grant/research support from: PFIZER, Sema Yilmaz: None declared, Özgül Soysal Gündüz: None declared, Ayse Cefle Speakers bureau: UCB Pharma, PFIZER, MSD, AbbVie, AMGEN, NOVARTIS, Fatos Onen Speakers bureau: AbbVie, LILLY, MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, JANNSEN, UCB Pharma, AMGEN, İbrahim Etem-MENARINI, Paid instructor for: AbbVie, LILLY, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB Pharma, AMGEN, İbrahim Etem-MENARINI, Grant/research support from: PFIZER

AB0479 LONGTERM RETENTION RATE OF CERTOLIZUMAB PEGOL IN AXIAL SPONDYLOARTHRITIS IS HIGHER: DATA FROM TURKBIO

Background:

Choosing the best treatment strategy for a patient is one of the most difficult issues in modern rheumatology, as there are various factors affecting drug therapy in chronic diseases, such as efficacy, safety, and compliance. Physicians take care of long-term retention rate and responses for discontinuation of candidate drug.

Objectives:

The purpose of this study to assess the drug survival of certolizumab pegol (CZP) in patients with axial spondyloarthritis (ax-SpA) and to identify the predictors and reasons for discontinuation.

Methods:

Data on patient characteristics, demographics, diagnosis, duration of disease, treatment and outcomes have been collected since 2011 in Turkish Biologic (TURKBIO) Registry. By the end of December 2020, 410 ax-SpA patients received CZP and were included. Kaplan Meier plot was used for drug survival analysis. Cox regression analysis was performed to evaluate the predictor associated with drug survival.

Results:

During the median 54 months follow-up, 92 (22.4%) patients discontinued the CZP treatment. The reasons for discontinuation: ineffectivity was 58.7% (n=54), adverse events was 6.5%, pregnancy was 3.3% and surgery was 4.3%. The baseline characteristics of patients continue with CZP and discontinuation due to ineffectiveness were shown in the Table 1. Patients who discontinued CZP had higher HAQ, BASFI and BASDAI values. Moreover, they were more co-treated with NSAIDs and csDMARDs. At the month 36, retention rate of CZP was 71.5% in patients with ax-SpA (Figure 1).

Conclusion:

Real life experience from this nationwide TURKBIO registry show higher long-term retention rate of CZP in ax-SpA. Higher baseline disease activity and functional limitation predict discontinuation of CZP. Adding NSAIDs and csDMARDs to the treatment of the patient with poor prognosis cannot increase retention rates.

Figure 1

Drug survival of CZP in patients with Ax-SpA

Table 1.

Baseline characteristics of ax-SpA patients who continue and discontinue CZP

All patients (n=410)Continue to CZP (n=318)Discontinue to CZP* (n=54)pFemales, n (%)185 (49,7)157 (49,4)28 (51,9)0,736Age, years42 (34-49)41 (34-49)45 (34-54)0,064Symptom duration, years11 (7-17)11 (6-16)12 (8,5-20)0,054HLA-B27, n (%)150 (63,8)129 (64,5)21 (60)0,609Previous bDMARDs, n (%)Adalimumab54 (14,5)42 (13,2)12 (22,2)0,082Etanercept53 (14,2)40 (12,6)13 (24,1)0,025Golimumab11 (3)7 (2,2)4 (7,4)0,060Infliximab39 (10,5)35 (11)4 (7,4)0,425Co-treated drugs, n (%)NSAID206 (55,4)169 (53,1)37 (68,5)0,036Methotrexate35 (9,4)22 (6,9)13 (24,1)<0,001Sulphasalazine61 (16,4)40 (12,6)21 (38,9)<0,001Leflunomide5 (1,3)2 (0,6)3 (5,6)0,023ESH, mm/h21,5 (10-37)21 (10-37)23 (10-34)0,999CRP, mg/dl7 (3-20)7 (3-20)7 (3-22)0,727HAQ0,63 (0,25-0,94)0,5 (0,25-0,88)0,75 (0,38-1,25)0,009BASFI21 (7-45)20,5 (6-41)31 (13-58)0,011BASDAI30,5 (13-52)30 (12-50)43 (23-61,5)0,002ASDAS2,7 (1,8-3,7)2,7 (1,8-3,6)2,9 (2,3-4)0,062

*Discontinue due to ineffectivity.

References:

[1]Iannone F, et al. Effectiveness of Certolizumab-Pegol in Rheumatoid Arthritis, Spondyloarthritis, and Psoriatic Arthritis Based on the BIOPURE Registry: Can Early Response Predict Late Outcomes? Clin Drug Investig. 2019;39(6):565-575.

Disclosure of Interests:

None declared.

Renal Tubular Acidosis in Patients with Systemic Lupus Erythematosus

OBJECTIVE

Renal tubular acidosis (RTA) is a clinical manifestation that occurs with insufficiency in restoring bicarbonate or disruption in hydrogen ion elimination as a result of a disruption in tubulus functions, causing normal anion gap-opening metabolic acidosis. In the present study, we aimed to investigate the prevalence of RTA in the largest systemic lupus erythematosus (SLE) patient population to date.

MATERIALS AND METHODS

SLE patients, who were followed up in 2 different healthcare centers, were included. Patients with metabolic acidosis (pH <7.35 and HCO3 <22 mEq/L) in venous blood gas analysis were determined. The serum and urine anion GAP of these patients were estimated, and the urine pH was assessed. RTA presence was evaluated as metabolic acidosis with a normal serum anion gap and a positive urine anion GAP.

RESULTS

A total of 108 patients were included in the present study. The mean age of the patients was 41.5 ± 1.2 and 87% were female. The SLE diagnosis duration was 75 ± 5 months. The mean creatinine value ​​was 0.6 ± 0.1 mg/dL and the mean eGFR was 111 ± 2 mL/min. According to the blood gas analysis, 18 patients (16.7% of the total) had RTA. Sixteen of these patients had type 1 RTA and 2 had type 2 RTA; type 4 RTA was not determined in any of the patients.

CONCLUSION

RTA should be considered in SLE patients even if they have normal eGFR values. This is the largest study to examine the prevalence of RTA in SLE patients in the literature.

Femoral vein wall thickness measurement: A new diagnostic tool for Behçet's disease

OBJECTIVES

Diagnosing Behçet's disease (BD) is a challenge, especially in countries with a low prevalence. Recently, venous wall thickness (VWT) in lower extremities has been shown to be increased in BD patients. In this study, we aimed to investigate the diagnostic performance of common femoral vein (CFV) thickness measurement in BD and whether it can be used as a diagnostic tool.

METHODS

. Patients with BD (n = 152), ankylosing spondylitis (n = 27), systemic vasculitides (n = 23), venous insufficiency (n = 29), antiphospholipid syndrome (APS; n = 43), deep vein thrombosis due to non-inflammatory causes (n = 25) and healthy controls (n = 51) were included in the study. Bilateral CFV thickness was measured with ultrasonography by a radiologist blinded to cases.

RESULTS

Bilateral CFV thickness was significantly increased in BD compared with all control groups (P < 0.001 for all). The area under the receiver operating characteristic curve for bilateral CFV thicknesses in all comparator groups was >0.95 for the cut-off value (0.5 mm). This cut-off value also performed well against all control groups with sensitivity rates >90%. The specificity rate was also >80% in all comparator groups except APS (positive predictive value: 79.2-76.5%, negative predictive value: 92-91.8% for right and left CFV, respectively).

CONCLUSION

Increased CFV thickness is a distinctive feature of BD and is rarely present in healthy and diseased controls, except APS. Our results suggest that CFV thickness measurement with ultrasonography, a non-invasive radiological modality, can be a diagnostic tool for BD with sensitivity and the specificity rates higher than 80% for the cut-off value ≥0.5 mm.

Software-based quantitative analysis of lung parenchyma in patients with systemic sclerosis may provide new generation data for pulmonary fibrosis

OBJECTIVES

To investigate lung volume and density in patients with SSc and changes in these parameters because of PF, using a software-aided image quantification method, and compare this with a matched healthy control group.

METHODS

Thoracic high-resolution computed tomography (HRCT) images of patients and controls were analysed using Myrian XP Lung 3D software. Right, and left lung densities and volumes were calculated separately by a blinded operator. Results were analysed between subgroups to investigate associations with the clinical features.

RESULTS

A total of 135 patients with SSc and 38 healthy controls (HC) were included. Characteristics of the SSc patients were 94 (69.6%) without PF, 85.4% female, mean age 49.8 (15.4) years; 41 (30.4%) with PF, 88.3% female, mean age 50.2 (11.5) years, and HC group were 89.5% Female, mean age 52.2 (5.8) years. The right and left lung densities were significantly higher, and right and left lung volumes were significantly lower in the SSc patients with signs of fibrosis than those without and HC (P < .001 and P < .001; P = .006 and P = .002, respectively). After excluding patients with PF, right and left lung densities and volumes differed significantly between diffuse cutaneous SSc, limited cutaneous SSc, and HC (P = .002 and P < .001; P = .045 and P = .044, respectively). Patients who developed PF during follow-up had significantly lower baseline right and left lung densities than those who did not (P = .018; P = .014, respectively). Forced vital capacity and carbon monoxide diffusing capacity showed a weak correlation with lung densities and volumes in patients without PF and moderate to high correlation in PF patients.

CONCLUSION

Lung density and volume in SSc patients changed significantly in those with PF and those without. Quantitative information extracted by soft-ware aided methods may contribute more to the detection, screening, and risk prediction in SSc-related PF.

Impact of discordance between patient's and evaluator's global assessment on treatment outcomes in 14 868 patients with spondyloarthritis

OBJECTIVES

To assess the impact of 'patient's minus evaluator's global assessment of disease activity' (ΔPEG) at treatment initiation on retention and remission rates of TNF inhibitors (TNFi) in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) patients across Europe.

METHODS

Real-life data from PsA and axSpA patients starting their first TNFi from 11 countries in the European Spondyloarthritis Research Collaboration Network were pooled. Retention rates were compared by Kaplan-Meier analyses with log-rank test and by Cox regression, and remission rates by χ2 test and by logistic regression across quartiles of baseline ΔPEG, separately in female and male PsA and axSpA patients.

RESULTS

We included 14 868 spondyloarthritis (5855 PsA, 9013 axSpA) patients. Baseline ΔPEG was negatively associated with 6/12/24-months' TNFi retention rates in female and male PsA and axSpA patients (P <0.001), with 6/12/24-months' BASDAI < 2 (P ≤0.002) and ASDAS < 1.3 (P ≤0.005) in axSpA patients, and with DAS28CRP(4)<2.6 (P ≤0.04) and DAPSA28 ≤ 4 (P ≤0.01), but not DAS28CRP(3)<2.6 (P ≥0.13) in PsA patients, with few exceptions on remission rates. Retention and remission rates were overall lower in female than male patients.

CONCLUSION

High baseline patient's compared with evaluator's global assessment was associated with lower 6/12/24-months' remission as well as retention rates of first TNFi in both PsA and axSpA patients. These results highlight the importance of discordance between patient's and evaluator's perspective on disease outcomes.

Identification of susceptibility loci for Takayasu arteritis through a large multi-ancestral genome-wide association study

Takayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 × 10^-5) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets.

Are there any clinical differences between ankylosing spondylitis patients and familial Mediterranean fever patients with ankylosing spondylitis?

OBJECTIVE

Familial Mediterranean Fever (FMF) is an autoinflammatory disease that is commonly present with recurrent episodes of fever, peritonitis, pleuritis or arthritis. Enthesitis and sacroilitis can also be seen in FMF. Spondylitis is a less common manifestation of joint involvement in FMF and there are controversial publications about whether this involvement is FMF-related or coincidentally. The aim of this study was to provide a comparison between ankylosing spondylitis (AS) patients and FMF patients with AS.

METHODS

A total of 404 patients who 360 of them was AS and 44 was FMF patients with AS (in accordance with Tel Hashomer) patients with AS (in accordance with modified New York criteria) were included in this study. All cases were evaluated retrospectively and patient's demographic and clinical data were recorded.

RESULTS

The mean age was 34.5 ± 8.6 years and 61.4% of patients were female in FMF group. In AS group, the mean age was 41.2 ± 10.8 years and 67.8% of patients were male. In AS group, 92% of patients had inflammatory back pain, 51% had hip pain, 30% had heel pain, 14% had peripheral arthritis and 11% had uveitis. In FMF group, 98% of patients had inflammatory back pain, 59% had hip pain, 48% had heel pain, 43% had peripheral arthritis and 4.5% had uveitis. Syndesmophyte and enthesitis on X-ray were seen in 18% and 22% of AS patients, and 7% and 41% of FMF patients with AS, respectively. There were significant differences between AS patients and FMF patients with AS in terms of heel pain (P: .017), peripheral arthritis (P: .000) and enthesitis (P: .006).

CONCLUSION

Peripheral arthritis and enthesitis were more frequent, and uveitis and syndesmophyte were less frequent in FMF patients with spondylitis than AS patients. When we look at gender differences, clinical and genetic features, it seems to be different condition from AS.

Sacroiliitis in Systemic Lupus Erythematosus Revisited

Objectives

This study aims to investigate the prevalence of inflammatory back pain (IBP) and sacroiliitis in a systemic lupus erythematosus (SLE) population as well as the association between IBP and the frequency of human leukocyte antigen B27 (HLA-B27).

Patients and methods

The study included 281 SLE patients (16 males, 265 females; mean age 39.9±11.9 years; range, 20 to 69 years) and 100 healthy controls (HCs) (2 males, 98 females; mean age 41.2±10.1 years; range, 19 to 64 years). Participants were administered a five-item Assessment of SpondyloArthritis international Society-IBP questionnaire. Patients and controls with IBP underwent detailed clinical and laboratory examinations to detect sacroiliitis. Radiographic evaluations were performed by a blinded rheumatologist and radiologist. Interobserver reliability was assessed with Cohen's kappa test.

Results

According to the questionnaire, IBP was present in 46 SLE patients (46/281; 16.3%) whereas none of the HC had IBP (p<0.001). In radiological assessment, 22 SLE patients (7.8%) had sacroiliitis detected by conventional X-ray and/or magnetic resonance imaging. Only one SLE patient with sacroiliitis had HLA-B27.

Conclusion

Our study showed that IBP is increased in SLE patients and IBP in SLE is not associated with HLA-B27.

FRI0473 ASSESSMENT OF FEMORAL VEIN WALL THICKNESS WITH DOPPLER US AS A DIAGNOSTIC TOOL FOR BEHCET’S DISEASE

Background:

Diagnosing Behcet’s disease(BD) is a challenge, especially in countries with a low prevalence. International Study Group Criteria, accepted to as diagnostic, has low sensitivity, especially in early cases when major organ involvement such as uveitis or deep vein thrombosis(DVT) presents alone. We recently published a controlled study of assessing venous wall thickness(VWT) as a surrogate marker of venous disease in BD with ultrasound(US) and observed a very sensitive and specific VWT in male BD patients. The common femoral vein(CFV) thickness measurement, as the primary site of US with the cut-off values > 0.48-0.49 mm, had a high area under the receiver operating characteristic curve(>0.8) with sensitivity and specificity of around 80%(1).

Objectives:

In this study, we aimed to investigate the diagnostic performance of CVF thickness measurement in BD including females comparing with multiple control disease groups.

Methods:

One hundred-ten patients with BD, 47 healthy controls(HC), 21 patients with systemic vasculitides, 28 patients with venous insufficiency,29 patients with antiphospholipid syndrome (APS) having DVT history, were included the study.Bilateral CFV thickness was measured with US by an experienced radiologist blinded to cases(Figure 1).

Figure 1.

Measurement of common femoral vein thickness

Results:

Bilateral CFV thickness was significantly higher in BD compared to all comparative groups (p<0.001 for all)(Table 1,Figure 2). No correlations were present between CFV thickness and both BSAS and CRP levels (p>0.05 for all). In only 2 (8%) patients with venous insufficiency and 2 (10%) patients with systemic vasculitis, bilateral CVF thickness was higher than the cut- off values. Interestingly, APS was the only control group with positivity, in 12 (41%) patients with APS, bilateral CFV thickness was higher than the cut-offs. There was no difference between male vs female BD patients regarding CFV thickness (right CFV:0.78 mm vs 0.79 mm,p=0.96, left CFV:0.78 vs 0.8, p=0.80). Although a higher CVF thickness tendency was observed in VBD, no statistically significant difference was present between BD patients with (n=40) and without (n=58) vascular involvement (right CFV:0.82±0.3 mm vs 0.75±0.3 mm, p=0.122, left CFV:0.84 ± 0.3 vs 0.76±0.3, p=0.165).

Table 1.

Venous Wall Measurements of Lower Extremity in Study Groups

Behcet’s Disease(n=110)Healthy Controls(n=47)Systemic Vasculitis(n=21)Venous Insufficiency(n=28)Anti-phospholipid Syndrome with DVT (n=29)Age (years)33.5 ± 630.1 ± 533.3 ± 736.7 ± 638.3± 9Gender, malen (%)89 (81)40 (85)12 (57)13 (46)9 (31)Body MassIndex, kg/m225.5 ± 424 ± 223.8 ± 3.527.7 ± 427.2 ± 7Right CFVThickness (mm)0.79 ± 0.30.34 ± 0.10.34 ± 0.150.38± 0.10.48 ± 0.15Left CFVThickness (mm)0.78 ± 0.30.3 ± 0.10.36 ± 0.140.38 ± 0.20.48 ± 0.15

CFV: Common Femoral vein, DVT:Deep Venous Thrombosis

Figure 2.

Distribution of common femoral vein thickness in study groups

Conclusion:

Increased CFV thickness is present in BD patients,independent of vascular involvement.We also found that CFV thickness is a distinctive feature of BD, rarely present in other inflammatory/vascular diseases such as ankylosing spondylitis (previously shown),systemic vasculitides and venous insufficiency(except APS with DVT).CFV thicknesses are easily and reliably measured by Doppler US. We, therefore, suggest that assessment of CFV can be a diagnostic tool for BD with a good sensitivity and specificity to differentiate BD from similar disorders.

References:

[1]Alibaz-Oner et al.Clinical Rheumatology (2019)38:1447–51.

Disclosure of Interests:

None declared

THU0378 DO COMORBIDITIES DECREASE THE FIRST TNF-INHIBITOR RETENTION AND TREATMENT RESPONSE IN AXIAL SPONDYLOARTHRITIS PATIENTS? DATA FROM TURKBIO

Background:

The frequency of comorbidities has increased in spondyloarthritis patients compared to the general population. The effect of comorbidities on tumour necrosis factor alpha inhibitor (TNFi) drug retention and treatment response has not been well evaluated.

Objectives:

The purpose of this study to assess the impact of comorbidities on the first TNFi drug survival and treatment response in patients with axial spondyloarthritis (axSpA) registered in theTURKBIOdatabase.

Methods:

In this study, the frequency of comorbidities, disease activity scores at baseline and month 6 and drug retention were recorded in AxSpA patients iniating first TNFi treatment between 2011 and 2019. Kaplan Meier plot and log rank tests were used for drug survival analysis. Cox regression analysis with HR was performed to evaluate the correlation between comorbidities and drug survival.

Results:

There were 2428 patients with AxSpA (39.3% female) who used their first TNFi during the study period. Among them, a total of 770 (31%) had at least one comorbid disease. Hypertension was the most common comorbidity (9.7%), followed by the affective disorders (8%) and chronic lung disease (5.8%). The baseline characteristics of patients are shown in Table 1.The presence of any comorbidity did not impact the first TNFi retention (Figure 1). When comorbidities were analysed seperately, we found that only history of cerebrovascular event was negatively associated with drug retention rate (HR: 6.9, p:0.008). There was no statistically significant difference in Bath AS Disease Activity Index 50% (BASDAI50) response between patients with and without comorbidity at 6 months. Less axSpA patients with comorbidity achieved a ASDAS score ≤ 2.1 compared to patients without comorbidity at 6 months.

Table 1.

Baseline Characteristics of Patients

Radiographic Spondyloarthritis, n (%)2318 (95.5)Female, n(%)954 (39.3)Age, year42.2±11.8Age at diagnosis, years32.5± 11.3Age at initial TNFi, years39.4 ± 11.1Symptom duration, years9.7± 7.5Time to initial TNFi, years7±6.8HLA-B27- positivity, n (%)1144 (47.1)Smokers, n (%)1068 (44)Baseline BASDAI35.5±22.2Baseline ASDAS-CRP2.8±1.1Baseline CRP (mg/L)15.7±24.4VAS global patient46.6±28.7

-Quantitative variables are presented as mean ± SD, and qualitative variables are presented as frequency and percentage

-ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score using C-reactive protein VAS, visual analogue scale

Conclusion:

The results of this study demonstrated that the presence of previous cerebrovascular event decreased the first TNFi survival in patients with axSpA. It also suggested that comorbidities might decrease TNFi treatment response.

Disclosure of Interests:

None declared

THU0390 THE INFLUENCE OF OBESITY ON RETENTION AND TREATMENT RESPONSE OF SECUKINUMAB IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: REAL LIFE DATA FROM THE TURKBIO REGISTRY

Background:

Axial spondyloarthritis (axSpA) is a chronic, inflammatory disease that primarily affects the axial skeleton. Secukinumab is a human monoclonal antibody that binds to the protein interleukin (IL)-17A. Although some studies showed that obesity had a negative effect on the efficacy of tumor necrosis factor alpha inhibitor (TNFα -i) treatment in AS patients (1), no data is available for secukinumab.

Objectives:

To evaluate the effect of obesity on the treatment response and drug survival of secukinumab in patients with axSpA.

Methods:

We performed an observational cohort study based on the TURKBIO between 2018-2020. A total of 185 patients were included in the study. The patients were divided into three groups as obese (BMI≥30 kg/m2), overweight (BMI:25-30 kg/m2), and normal (BMI<25 kg/m2). Disease activity was evaluated at baseline and 3, 6 and 12 months of secukinumab therapy. Clinical response was evaluated as achievement of BASDAI50, ASAS20/40, and ASDAS-Clinical and improvement (CII and MI) rates.

Results:

185 axSpA patients were identified in the registry; 135 (72%) had available BMI data. Thirty nine (28.8%) patients were obese. The mean age of obese patients was higher (p=0.002). The frequency of HLA-B27 and male gender was lower in obese group (p=0.012 and p=0.013, respectively). There was no significant difference between groups in terms of clinical response parameters at 3, 6 and 12 months (Table 1). Drug retention rates were higher in biologic naive patients(p=0.007) (Figure 1).

Table 1(BMI <25) (n=33)(BMI 25-30)(n=63)(BMI ≥ 30)(n=39)PAll patients (n=185)Age (years)40.2±11.345.7±11.750.0±10.60.002 *45.2±11Male Gender n (%)25 (75.8)34 (54.0)16 (41.1)0.012 **104 (56.2)HLA-B27 (+) n (%)14 (73.6)37 (84.0)11 (44.0)0.013 **76 (64.3)Prior Naive/1/≥2 bDMARD n (%)12 (36.3)/9 (27.3)/12 (36.3)17 (26.9)/13 (20.6)/33 (52.4)10 (25.6)/14 (35.8)/27 (69.2)0.30256 (30.3)/ 49 (26,5)/ 80 (43,2)ASAS20 response¶13 (61.9)/11 (57.9)/4 (57.1)19 (48.7)/16 (59.3)/8 (42.1)11 (40.7)/7 (29.1)/3 (50.0)0.345/0.073/0.88659 (518)/47 (49.5)/20 (42.6)ASAS40 response¶9 (42.9)/7 (36.8)/3 (42.9)15 (39.5)/10 (37)/1 (5.3)6 (24)/5 (20,8)/3 (50.0)0.334/0.386/0.01240 (35.0)/29 (30.5)/11 (23.4)BASDAI50 response ¶10 (47.6)/9 (47.4)/4 (57.1)15 (39.5)/11 (40.5)/3 (15.8)9 (34.6)/5 (21.7)/3 (50.0)0.634/0.192/0.07748 (42.1)/37 (38.9)/16 (34.0)ASDAS-CII ¶3 (14.3)/5 (26.3)/1 (14.3)6 (17.6)/8 (30.8)/5 (27.8)6 (23.1)/5 (21.7)/2 (33.3)0.237/0.162/0.53123 (21.4)/22 (23.6)/11 (23.9)ASDAS-MI ¶5 (23.8)/3 (15.8)/0 (0)8 (23.5)/6 (23.1)/2 (11.11 (3.8)/1 (4.3)/1 (16.7)0.237/0.162/0.53118 (16.8)/18 (19.3)/8 (17.4)

§; Mean±SD. ¶; at 3/6/12 Months, n (%),*One-way ANOVA test, ** Pearson Chi-Sqaure Test

Figure 1

Conclusion:

This study demonstrated that obesity had no impact on the efficacy and retention of secukinumab treatment in patients diagnosed with axSpA. The drug survival was found to be higher among biologic-naive axSpA patients compared to biologic-experienced.

References:

[1]Ottaviani S.et al. ‘’Body mass index influences the response to infliximab in ankylosing spondylitis’’,Arthritis Res Ther 2012; 14: R11

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

Table.

Comparison of demographic, laboratory findings and biological treatment

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

Acknowledgments :

None

Disclosure of Interests: :

None declared