Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

BACKGROUND

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

METHODS

For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU.

FINDINGS

For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier.

INTERPRETATION

Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes.

FUNDING

British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

AB1082 FREQUENCY AND SEVERITY OF COVID-19 IN PATIENTS WITH VARIOUS RHEUMATIC DISEASES TREATED REGULARLY WITH COLCHICINE OR HYDROXYCHLOROQUINE

Background

Several anti-inflammatory drugs which were targeted different mechanisms and investigated for both prevention and treatment for COVID-19.

Objectives

The current study aimed to investigate whether patients regularly using colchicine or hydroxychloroquine (HCQ) have an advantage of protection from COVID-19 or developing less severe disease.

Methods

Patients who were taking colchicine or HCQ regularly for a rheumatic disease including Familial Mediterranean Fever, Behçet’s syndrome, Systemic Lupus Erythematosus, Rheumatoid Arthritis and Sjogren’s syndrome as well as their healthy household contacts as the control group were included into the study. The clinical data regarding COVID-19 were collected using a standard form, and serum samples were analyzed for anti-SARS-COV-2 nucleocapsid IgG. Patients treated with any biologic or immunosuppressive treatments were not included into the study.

Results

A total of 635 regular colchicine users with their 643 household contacts and 317 regular HCQ users with their 333 household contacts were analyzed. Anti-SARS-Cov2 IgG was positive in 43 (6.8%) regular colchicine users and 35 (5.4%) household contacts (OR=1.3; 95% CI:0.8-2; p=0.3) (Table 1). COVID-19 related symptoms were described by 29 (67.4%) of the patients and 17 (48.6%) household contacts (OR=2.2; 95% CI:0.9-5.5; p=0.09), and hospital admission was observed in five (11.6%) and one (2.9%) of these subjects (OR=4.5; 95% CI:0.5-40.2; p=0.1), respectively (Figure 1). Seropositive subjects were observed in 22 (6.9%) regular HCQ users and 24 (7.2%) household contacts (OR=1.1; CI:0.6-1.9; p=0.8) (Table 1). COVID-19-related symptoms occurred in 16 (72.7%) of the 22 patients and 12 (50%) of 24 household contacts (OR=2.7; 95% CI:0.8-9.1; p=0.1). Three patients (13.6%) were admitted to hospital, while one household contact (4.2%) was hospitalized (OR=3.6; 95% CI:0.3- 37.8; p=0.2) (Figure 1). Disease-specific analyses disclosed that there was no significant difference in terms of COVID-19 frequency and severity between a particular disease subset and household contacts (Table 1). Univariate logistic regression analysis showed no effect of age and gender on the SARS-CoV-2 seroprevalence rate among regular colchicine or HCQ users and household contacts (p=0.2 and p=0.7, respectively for colchicine users versus contacts, p=0.7 and p=0.3, respectively for HCQ users versus contacts).

Figure 1.

Severity of COVID-19 in regular colchicine or HCQ users and these patients’ household contacts

Table 1.

Disease specific outcomes of the entire cohort

VariableFMF (n=373)FMF HHC* (n=386)PBehcet Patients (n=262)Behcet HHC (N=257)PSLE Patients (N=197)SLE HH (n=221)pRA Patients (n=79)RA HH (n=73)PSjögren patients (N=41)Sjögren HH (N=39)pAge, mean ± SD years36.4 ± 13.236.3 ± 16.10.942.9 ± 11.438.1 ± 15.20.00144.2 ± 12.639.4 ± 170.00253.9 ± 10.340.3 ± 16.60.00157.1 ± 11.246.2 ± 16.10.001Gender, n (%) Female249 (66.8)173 (44.8)0.001160 (61.1)118 (45.9)0.001184 (93.4)75 (33.9)0.00173 (61.1)20 (27.4)0.00141 (100)10 (25.1)0.001Positive antibody to SARS-COV-2, n (%)25 (6.7)23 (5.9)0.618 (6.9)12 (4.7)0.314 (7.1)19 (8.6)0.64 (5.1)2 (2.7)0.54 (9.8)3 (7.7)0.9Symptomatic COVID-19 in seropositive cases, n (%)18 (72)10 (43.4)0.0411 (61.1)7 (58.3)0.611 (78.6)9 (47.3)0.073 (75)0 (0)0.42 (50)3 (100)0.4Hospital admission in seropositive cases, n (%)1 (3.8)0 (0)-4 (22.2)1 (8.3)0.32 (14.3)0 (0)0.21 (25)0 (0)-1 (25)1 (33.3)0.3Mean colchicine dose, mg/day ± SD1.5 ± 0.4--1.4 ±0.4-----------Mean duration of colchicine usage, years ± SD11.3 ± 8.3--10.4 ± 7.7-----------Mean HCQ dose, mg/day ± SD------263.6 ± 95.1--255 ± 90.8--273.7 ± 132.5--Mean duration of HCQ usage, years ± SD------10.1 ± 6.6--7.3 ± 5.2--9 ± 6.3--

HCQ hydroxychloroquine, FMF familial mediterranean fever, HHC household contacts, RA rheumatoid arthritis, SLE systemic lupus erythematosus

Conclusion

Being on a regular treatment of colchicine or HCQ was not resulted in the prevention of COVID-19 or amelioration of its manifestations.

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

AB1271 PREVALENCE OF RHEUMATOLOGIC DISEASES IN PATIENTS PRESENTING WITH UVEITIS

Background

Uveitis may occur in the course of systemic inflammatory rheumatic diseases, or it may be the first clinical presentation of these diseases.

Objectives

To determine the prevalence of systemic inflammatory rheumatic disease in patients whose initial clinical manifestation is non-infectious uveitis.

Methods

Adult patients diagnosed with non-infectious uveitis in Dokuz Eylul University Ophthalmology Department and referred to investigate the etiology of rheumatological disease were included in the study. Demographic and clinical features, laboratory and imaging findings of the patients were examined.

Results

106 patients diagnosed with uveitis (42.4% anterior uveitis, 2.8% intermediate uveitis, 19.8% posterior uveitis, 34.9% panuveitis) were included in the study. 52.8% of the patients were male and the mean age was 40.19±14.82 years. The mean age of uveitis attack was 38.7±15.02 years. 33% of the patients were diagnosed with rheumatologic disease (10 SpA, 17 Behçet’s Disease, two vasculitis, two sarcoidosis, three undifferentiated connective tissue disease, one rheumatoid arthritis). SpA was diagnosed in 20% of patients presenting with anterior uveitis. Behçet’s disease was detected in 27% of patients referred with panuveitis and in 33.3% of patients whose first clinical finding was posterior chamber involvement. Bilateral uveitis was detected in two-thirds of patients with posterior chamber affected, and it tends to recur more (p=0.014).

Conclusion

A rheumatological disease was detected in approximately one-third of the patients presenting with uveitis. Investigation of patients referred for uveitis in terms of systemic rheumatological diseases is very important as it may change the diagnosis and treatment process.

Disclosure of Interests

None declared

AB0769 Treatment outcomes of patients with biological therapy during pregnancy and effect of pregnancy planning on treatment preferance of rheumatologists

Background

Rheumatic diseases occur mostly in adults at reproductive age. In addition to the impact of disease course on fetal and maternal health, safety concerns regarding the effects of biological drugs on the course of pregnancy have come to the fore with the introduction and widespread use of them. Unlike other biological treatments, all tumor necrosis factor (TNF) antagonists can be used during pregnancy.

Objectives

To investigate clinical features, treatment characteristics and pregnancy outcomes of patients with biological treatment and evaluate impact of planning pregnancy on treatment preferance.

Methods

The study was planned between January 2015 and December 2021. Patients who received biological treatment at conception were determined retrospectively. Demographycal data, clinical features, treatment characteristics and pregnancy outcomes were recorded.

Results

15 patients (mean age 37.2±4) were included. Mean age at diagnosis was 25.6±5.4 and age at gestational was 33±3.9. Mean follow-up duration was 96±55 months. Median period of biological therapy was found 37 (1-156) months. Six (40%) patients were diagnosed with Axial Spondyloarthritis, 6 (40%) Psoriatic Arthritis, 1 (6.6%) Rheumatoid arthritis. While 12 (80%) patients had planned (wanted) pregnancies, 10 (66%) patients were evaluated as eligible for pregnancy in terms of rheumatological disease by rheumatologists. 13 (86.6%) patients were in remission/partial remission before pregnancy. 5 (33.3%) patients were using steroid and disease modifying anti-rheumatic drugs (DMARDs) were stopped before conception. 10 (66.6%) patients were receiving certolizumab, 4 (26.7%) patients were receiving adalimumab. It was found that the treatment of the patient who received rituximab was interrupted due to the pregnancy planning. While certolizumab treatment continued in 6 (60%) patients during pregnancy, the treatment of patients receiving adalimumab was discontinued within first trimester. Activation of disease was occurred in 2 patients whose therapy interrupted. Biological treatment was restarted during pregnancy in 3 of 9 patients whose biological treatment was discontinued. No perinatal complication was developed except premature rupture of membranes in one patient. It was observed that all infants were healthy at birth, but baby of the mother who received certolizumab was diagnosed mental retardation in early childhood.

Conclusion

In this study, it was established that the majority of patients using TNF antagonist during pregnancy;

In this study, it was concluded that having a pregnancy plan may be an important factor for rheumatologists to decide type of TNF antagonist, and physicians tend to prefer certolizumab in patients with pregnancy plan.

Table 1.

Baseline clinical and treatment characteristics

Age, years37.2±4Age, at diagnosis25.6±5.4Age, at gestation33±3.9Follow-up duration, months96±55Biologic treatment duration, months37 (1-156)Rheumatologic diseasen (%) -Spondyloarthritis6 (40) -Psoriatic arthritis6 (40) -Rheumatoid arthritis1 (6.6) -Behcet disease1 (6.6) -Systemic lupus eritematosus1 (6.6)Biologic treatmentn (%) -Certolizumab*10 (66.6) -Adalimumab*4 (26.7)Discontinuation of treatment9 (60)Restart3 (33.3)Disease activityRemission/partial remission*13 (86.6)Activation during pregnancy3 (20)*At conception

Disclosure of Interests

None declared

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

Background

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

Objectives

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

Methods

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

Results

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

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

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

Conclusion

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

References

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

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

Disclosure of Interests

None declared

AB0938 A new screening tool for Psoriatic Arthritis in Psoriasis Patients: TurPAS

Background

Psoriatic arthritis (PsA) is a heterogenous disease with different disease manifestations. Several tools have been developed for screening of PsA in patients with psoriasis with variable performances. An optimal screening tool for PsA is still an unmet need.

Objectives

We aimed to develop a new screening tool in Turkish which could detect different domains involved.

Methods

A core group was determined including 11 rheumatologists/10 dermatologist and a systematic literature review on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis` was performed. The review revealed tools named PEST, PASE, EARP, STRIPP, SIPAS, SIPAT, TOPAS-II, GEPARD, PASQ, CONTEST, A novel, short, and simple screening questionnaire. Each item of those tools were included in the Delphi set. After the 3 rounds of Delphi, a new set of screening questionss was developed.

Results

Overall 85 items were inquired, including questions on joint, dactylitis, enthesitis, back, skin-nail domains as well as morning stiffness, function, treatment and others for the first round of Delphi. Seventeen experts (9 dermatologists/ 8 rheumatologists from the core group) and fifteen patients (Female/Male= 9/6) answered the Delphi (mean (SD) age of 39.3 (10.9) participated to the first round. The involvemet types were peripheral (73.4%), axial (40%), entheseal (33.4) and dactylitis was present in 14% of the patients. As a result of this first evaluation, 44 out of 85 questions were selected and carried to second round The distribution of these questions was as follows; joint question n=13, skin and nail involvement n=6, dactylitis n=5, morning stiffness n=5, axial n=3, enthesitis n=2, general questions n=5. These questions were sent to the members through rheumatology and dermatology societies. In total, 85 rheumatology specialists and 48 dermatology specialists answered the questions in the second round. At the second tour, the number of questions was reduced from 44 to 22. The distribution of the questions was as follows; Skin and nail involvement n=5, dactylitis n=3, joint question n=2, axial involvement n=2, morning stiffness n=2, axial involvement and morning stiffness n=2, enthesitis n=1, general questions n=5. A consensus meeting was held to discuss 22 questions determined at the end of the second round within the initial core group. Each question was handled one by one, some of the questions were combined, if necessary, adapted to Turkish. The tool was given its final form. The final version of the questionnaire consists of 6 questions. (Table 1).

Table 1.

The new screening tool

DomainTurkish versionEnglish versionJointEl/ayak parmaklarinizda ya da herhangi bir ekleminizde hiç şişlik veya ağri oldu mu?Have you ever had swelling or pain in your fingers/toes or any of your joints?DactylitisResimde gösterildiği gibi el veya ayak parmağinizda sosis şeklinde şişlik oldu mu?Have you had a sausage-shaped swelling on your fingers or toes as shown in the picture?EnthesitisTopuk ağriniz olur mu?Do you have heel pain?Axial involvement and morning stiffnessBelinizde, sirtinizda veya boynunuzda istirahatle artan, özellikle sabaha karşi kötüleşen veya sabahlari hareketinizi kisitlayan ağriniz olur mu?Do you have pain in your lower back, back, or neck that increases with rest, worsens especially in the morning, or restricts your movement in the morning?Drug useEklem şikayetleriniz için zaman zaman ilaç kullanir misiniz?Do you take medication for your joint complaints from time to time?History of rheumatic diseaseSize daha önce iltihapli romatizma tanisi konuldu mu?Have you ever been diagnosed with a rheumatic disease before?

Conclusion

A new screening tool targeting different domains in Psoriatic disease was developed in Turkish. While cultural differences play an important role in screening, we believe that the first tool developed in Turkish will be helpful in clinical practice and research settings. Further assessments will be done to understand its validity and reliability within a large cohort of psoriatic patients.

Disclosure of Interests

None declared

AB1106 HOW HAS THE COVID-19 PANDEMIC AFFECTED OUR RHEUMATOLOGY PATIENTS USING BIOLOGICAL/TARGETED DMARDS?

Background

Bioinformatics data, which are becoming more detailed day by day, show that male gender, advanced age, smoking, and comorbidities are associated with poor outcome of COVID-19. However, it is well known that the active disease state that may occur as a result of discontinuing the drugs also increases the susceptibility to infection.

Objectives

It was aimed to investigate the effects of the COVID-19 pandemic on the course and treatment of rheumatic disease in patients with inflammatory rheumatic musculoskeletal disease (iRMD) using biological or targeted synthetic DMARDs (b/tsDMARDs).

Methods

The study was carried out in two stages: while investigating the delay of b/tsDMARD treatment in the first 3 months of the pandemic with the fear of infected by SARS-Cov-2 in the first stage, in the second stage, it was investigated whether all patients who decided to continue treatment after interruption in the 12-month period.

Results

A total of 521 patients were included in the study. It was seen that the iRMD diagnosis were listed as SpA (54.3%), RA (25.7%), PsA (8.4%), vasculitis (6.1%), and others (5.4%). The overall 12-month drug retention rate was 92.3%. Concurrent use of hydroxychloroquine (HCQ) (HR=1.49), iv bDMARD use (HR=1.34), and a history of discontinuation of drug in the first 3 months of the pandemic (HR=1.19) were determined as factors that reduced 12-month drug retention rates.

During a total of 12 months, 34 (6.5%) of patients had COVID-19. COVID-19 was severe in 7 patients and 5 of these patients died.The use of GC (HR=3.81) and having a diagnosis of ILD/COPD (HR=4.96) were found to increase the risk of infected by SARS-CoV-2.

Table 1.

Comparison of demographic and clinical characteristics of patients with COVID-19

DemographicsCOVID-19 (-) (n=487)COVID-19 (+) (n=34)PMedian (Min./Max.)Median (Min./Max.)Age48 (18-86)48 (18-82)0.615Disease Duration130 (22-478)144 (48-519)0.573b/ts DMARD Duration45 (12-192)26 (14-170)0.253GC dose, mg4 (1-16)4 (2-16)0.863n (%)n (%)Gender, F259190.909COVID-19 diagnosis and outcomeHospitalization─11 (32.3)─Mortality─5 (14.7)─Active disease (anytime during the pandemic)82 (16.4)9 (26.5)0.246ILD and/or COPD14 (2.9)4 (8.9)0.002n (%)n (%)b/tsDMARD type0.049TNFi382 (78.4)15 (44.1)0.243Tocilizumab19 (3.9)2 (5.9)0.684Abatacept13 (2.7)1 (2.9)0.886Rituximab9 (1.8)6 (17.6)0.001GC83 (17.0)17 (50.1)0.001

Conclusion

The results of this study with a long follow-up period suggest that the retention rates of b/tsDMARD treatment increased with good communication with iRMD patients during the COVID-19 pandemic.

References

[1]Favalli EG, et al. (2020) Arthritis Rheumatol 72:1600–1606.

[2]Landewé RB, et al. Ann Rheum Dis 79:851–858.

Disclosure of Interests

None declared

AB1342 THE EVALUATION OF 18F-PET-CT USE IN RHEUMATOLOGY CLINICAL PRACTICE WITH DEMOGRAPHIC AND CLINICAL FINDINGS

Background

There is an increasing number of studies in the literature on the use of 18 F-FDG-PET/CT in the diagnosis and treatment follow-up of inflammatory rheumatic and musculoskeletal diseases (iRMD) (1). PET/CT do have an important place in the diagnosis of large-vessel vasculitis (LVV), which shows increased involvement in the walls of large vessels (2).

Objectives

In this study, the aim was to evaluate the demographic, clinical, and laboratory characteristics, compatibility of PET/CT with other imaging methods, and the role of PET/CT in treatment follow-up of the patients who underwent PET/CT at the Rheumatology Clinic between 01.01.2010 and 31.12.2020.

Methods

The patients’ age, gender, comorbidities, iRMD types, medications, PET/CT, and ages at the time of iRMD diagnosis were collected. In addition, the compatibility of PET/CT with other imaging methods (MR angiography, Doppler US, and CT angiography) was evaluated in vasculitis subgroups. Control PET/CT images of the patients were evaluated by comparing them with previous imaging findings.

Results

A total of 280 patients, 179 (63.9%) women, with a mean age of 58±15 years, underwent PET/CT in the rheumatology department. 202 (72.1%) patients had a diagnosis of iRMD before PET/CT. After PET/CT, 40 (48.2%) patients were diagnosed with a new iRMD, and 43 (41.8%) were diagnosed with a non-iRMD. No rheumatic disease was detected in 33 (11.8%) patients.

iRMD diagnosed by PET/CT are respectively; LVV (n=11), IgG4-RD (n=10), sarcoidosis (n=9), and other (n=10). It was determined that 22 (26.5%) of newly diagnosed patients other than iRMD had malignancy [Bronchial (n=8), lymphoma (n=3), breast (n=3), other (n=8) cancer].

PET/CT revealed lymphadenopathy (LAP) in 119 of 165 patients who underwent the scan to exclude malignancy, and 22 of 91 patients who underwent PET/CT for rheumatologic diagnosis. LAP was found in 45% of those diagnosed with iRMD and 74.4% of those diagnosed with non-iRMD (p=0.002).

PET/CT imaging was performed on 18 patients for follow-up. The treatment of 4 out of 18 patients with follow-up PET/CT and 76 out of 280 total patients was changed after imaging. In patients with a diagnosis of giant cell arteritis (GCA), the compatibility of PET/CT with MRA was 62.5%, while its agreement with CTA was 100%, and with Doppler US was 40%. In patients diagnosed with Takayasu’s arteritis, the compatibility of PET/CT with MRA was 40%, while its compatibility with CTA was 50% and with Doppler USG was 38%.

Conclusion

PET/CT imaging was found to be an important adjunctive examination in the diagnosis and follow-up of sarcoidosis, LVV, and IgG4-RD in patients evaluated in the rheumatology clinic. It has been observed that it is often used in the diagnosis and follow-up of RA, SpA, and autoinflammatory diseases, to investigate the malignancies accompanying rheumatic diseases and to evaluate the characteristics of LAP. PET/CT findings provide significant benefits to the clinician in the early diagnosis of iRMDs and differentiation of malignant and/or infectious etiologies.

References

[1]Jamar F, et al. EANM/SNMMI Guideline for 18 F-FDG Use in Inflammation and Infection. J Nucl Med. 2013 Apr;54(4):647–58.

[2]Schönau V, et al. Ann Rheum Dis. 2018 Jan;77(1):70–7.

Table 1.DemographicsAge (mean±SD.)58±15Female/Male179 (63.9)/101 (36.1)CRP (mg/L), median (Min.-Max.)16.9 (0.2-431)ESR (mm/h), median (Min.-Max.)43 (1-120)iRMD Subgroups, n (%)Connective Tissue Disease70 (28.4)Vasculitis63 (25.5)Rheumatoid Arthritis28 (11.3)İgG4-RD and Retroperitoneal Fibrosis22 (8.9)Spondyloarthropathies21 (8.5)Sarcoidosis16 (6.5)Polymyalgia Rheumatica8 (3.2)Others (Autoinflammatory Fever Syndromes, Crystal Arthropathies, CVID)19 (7.7)Reason for PET/CT scan, n (%)For Rheumatologic Diagnosis91 (32.5)Scan to Exclude Malignancy165 (58.9)Treatment Response Evaluation24 (8.6)PET/CT SUVmaxValuesiRMD SUVmax, median (Min.-Max.)4.6 (3.3-7.2)Malignancy SUVmax, median (Min.-Max.)8 (6.1-10.6)

*iRMD: inflammatory rheumatic and musculoskeletal diseases

Disclosure of Interests

None declared

AB1295 TREATMENT OUTCOMES OF ADULT-ONSET STILL’S DISEASE PATIENTS WITH BIOLOGICAL THERAPY

Background

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder with heterogeneous distrubition (1). Due to rarity of AOSD and limited controlled study about efficacy of biologic treatment in AOSD, management of refractory AOSD patients poses several challenges.

Objectives

The aim of this study to investigate clinical characteristics and treatment outcomes of AOSD patients who receive biological therapy.

Methods

Patients were identified who met Yamaguchi classification criteria between January 2010 and December 2021 from our database. AOSD patients treated with biologic treatment were included in this study. Demographic data, clinical features and treatment characteristics were recorded.

Results

49 AOSD patients were identified from database. 9 AOSD patients with biologic therapy (7 female, mean age 42.3±19) were included in this study. Mean age at diagnosis was 31.5± 16.7 and mean follow-up period was 9.3± 5.5 years. Median drug retention duration was found 95 (5-150) months. It was established that all patients used high dose steroid at diagnosis and 3 (33.3%) out of them received pulse steroid therapy. Initial therapy was methotrexate for all patients and leflunomid was used secondly as monotherapy or combination therapy after methotrexate inefficacy. It was observed that indication for biologic therapy was arthritis and systemic inflammatuar symptoms in 5 patients. 4 patients was initiated biologic therapy for refractory arthritis without systemic inflammation findings. First biologic agents were tocilizumab and etanercept in 3 patients, infliximab and anakinra in 2 patients. It was shown that biological therapy was switched in 3 patients due to inefficacy and 2 patients because of side effects. Allergic reaction developed in 2 patients treated with infliximab and infliximab switched to adalimumab and etanercept. Biological therapy was discontinued in 2 patients due to remission, and patients remained in remission after cessation of biological agent. None of patients had serious infection. Hemophagocytic syndrome was developed in only one patient during disease course.

Conclusion

According to our cohort, one of five AOSD patients received biological therapy during follow-up. Our results revealed that the need for biologic therapy during the course of the disease is not uncommon in AOSD, and that biologic therapy is essential for maintaining remission in resistant patients.

References

[1]Efthimiou P, Georgy S. Pathogenesis and management of adult-onset Still’s disease. Semin Arthritis Rheum. 2006 Dec;36(3):144-52. doi: 10.1016/j.semarthrit.2006.07.001. Epub 2006 Sep 1. PMID: 16949136.

Table 1.

Baseline clinical and treatment characteristics (n=9)

Female, n (%)7 (77.7)Age, years42.3±19Age at diagnosis, years31.5± 16.7Smokers, n (%)6 (66.6)Drug retantion duration, months95 (5-150)Follow-up time, years9.3± 5.5Treatment characteristicn (%)Biologic therapy indication -Systemic inflammation findings5 (55.5) -Refractory arthritis4 (44.4)İnitial biologic therapy Etanercept3 (33.3) Tocilizumab3 (33.3) Infliximab2 (22.2) Anakinra2 (22.2)Switching agent5 (55.5)Cessation of biologic therapy3 (33.3)

Disclosure of Interests

None declared

AB1312 HIGH PREVALENCE OF iRMD IN SARCOIDOSIS PATIENTS

Background

Sarcoidosis is a chronic granulomatous disease that primarily affects the lungs and lymph nodes, and can affect any organ and system (1). The incidence of concomitant iRMD is increased in patients with sarcoidosis. Anti-nuclear antibody (ANA) test are frequently used markers for inflammatory rheumatic diseases (iRMDs) (2). The relationship of this association with ANA is not clear.

Objectives

We aimed to determine the frequency of ANA in sarcoidosis patients and its possible correlation with clinical and laboratory data, and also to reveal the severity of osteoporosis in patients with sarcoidosis.

Methods

Ninety sarcoidosis patients, who were followed up in rheumatology clinic were included in this study. ANA were determined with indirect immunofluorescent method and 1/160 titration was accepted as positive. Demographic, clinical, serological, and bone mineral densitometry (BMD) results of all patients were recorded. BMD results were obtained from the images taken before the last date or osteoporotic fracture of the patients.

Results

Average age of the 90 patients (79 females) with sarcoidosis was 57.5 (IQR: 51–66) years, and median disease duration was 7.6 (IQR: 4-19) years. 28 (31.1%) patients had a diagnosis of extrapulmonary sarcoidosis (Most commonly skin, n=20, 71.4%). 21 patients had BMD values consistent with osteoporosis, while 9 patients had osteoporotic fractures. In 18 (20%) patients, rheumatologic autoimmune disease combined with sarcoidosis was found. SpA was diagnosed in 6 patients, RA in 2 patients, Lofgren Syndrome in 2 patients, SjS in 2 patients, systemic sclerosis in 1 patient, and morphea in 1 patient. Other rheumatological diseases were found as uBDH, polymyositis, Gout, Behçet’s Disease and FMF. ANA test was performed in a total of 83 patients. ANA positivity was found in 30 (36.1%) patients with sarcoidosis (1/100-1/320 in 12 patients; >1/320 in 18 patients). There was no significant relationship between ANA positivity and gender distribution, age, disease duration, development of extrapulmonary sarcoidosis, refractory disease status, and laboratory findings at the time of diagnosis. It was found that ANA positivity at diagnosis time for sarcoidosis increased the risk of developing iRMD 4.8 times in patients [HR: 4.8, CI 95% (1.455-15.833), p=0.009].

Conclusion

In sarcoidosis, ANA positivity is of great importance in the determination of accompanying iRMDs. It was found that ANA positivity at the time of diagnosis in sarcoidosis patients increased the risk of developing rheumatological autoimmune disease 4.8 fold. Since these patients receive long-term moderate-high-dose steroid-based treatments, they should be closely monitored and screened for osteoporosis.

References

[1]Wessendorf TE, et al. Clin Rev Allergy Immunol. 2015 Aug 18;49(1):54–62.

[2]Kobak S, et al. Autoimmune Dis. 2014;2014:1–4.

Table 1.

Distribution of clinical features of patients with sarcoidosis according to ANA results

ANA (-) (n=53)ANA (+) (n=30)n (%)n (%)p valueGenderFemale46 (86.8)27 (90)>0.05Male7 (13.2)3 (10)Rheumatic DiseaseNo48 (90.6)20 (66.7)0.009 (HR: 4.8, CI 95% (1.455-15.833)*Yes5 (9.4)10 (33.3)Refractory DiseaseNo35 (66)19 (63.3)Yes18 (34)11 (9.1)BMD-DEXANormal16 (43.2)12 (60)0.630Osteopenia14 (37.8)4 (20)Osteoporosis7 (18.9)4 (20)Osteoporotic FractureNo46 (86.8)28 (93.3)0.477Yes7 (13.2)2 (6.7)Median (IQR)Median (IQR)p valueAge (year)56.5 (51/64)58 (51/66)0.836Follow-up duration (year)6 (4/10)6 (2/9)0.718Age at diagnosis (year)45.5 (38/55)49 (36/55)0.861Calcium (mg/dL)9.585 (9.25/9.9)9.4 (9.17/9.76)0.13825 (OH)D (pg/ml)15.5 (10.1/24)8 (6/12)0.005Phosphorus (mg/dL)3.65 (3.245/3.98)3.75 (3.3/4.1)0.17ACE (mcg/L)60 (32/87)59.595 (34/88.225)0.876ESR (mm/h)23 (15/39)29 (22/48)0.171CRP (mg/dL)4.8 (2.3/17)5.4 (2.7/24)0.343

*Multivariate regression analysis

Disclosure of Interests

None declared

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

Background

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

Objectives

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

Methods

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

Results

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

Table 1.

Demographics and clinical characteristics of the patients

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

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

Conclusion

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

Disclosure of Interests

None declared

POS0016 COMMON VARIABLE IMMUNODEFICIENCY DISEASE FROM THE PERSPECTIVE OF RHEUMATOLOGY

Background

Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by impaired B cell differentiation and immunoglobulin production. In addition to increased susceptibility to infection, patients also have an increased tendency to autoimmune disease. Since rheumatological findings usually start earlier than other autoimmunities, it is very important to increase the awareness of rheumatologists about this disease, for accurate diagnosis and to prevent delay in treatment.

Objectives

To increase the awareness of rheumatologists about the main symptoms and findings of CVID.

Methods

Adult patients referred to the rheumatology department since January 2015 were included in the study. Demographic and clinical characteristics (infections, pulmonary and extrapulmonary granulomatous involvement, autoimmune manifestations), laboratory and imaging findings and treatments of the patients were analyzed.

Results

Ten adult patients with CVID were included in the study. The gender distribution of the patients was similar and the median age was 38±10.0 years. The mean duration of diagnosis was 123.5±89.3 months. At least one autoimmune manifestation was observed in 80% of the patients. In the follow-up period, 40% of the patients developed arthritis. Involvement of lower extremity joints such as knee and ankle was more prominent. While all patients were given 0.8 g/kg/3 weeks of intravenous immunoglobulin, 80% required immunosuppressive therapy for autoimmune manifestations. The demographic and clinical characteristics of the patients are summarized in Table 1.

Table 1.

Autoimmune manifestations of common variable immunodeficiency patients

Case 1Case 2Case 3Case 4Case 5Case 6Case 7Case 8Case 9Case 10Age/Sex36/F43/F40/M25/M23/M36/M41/M57/F35/F48/FSymptom duration (years)121111417121113127Diagnosis duration (years)61183171091112Sinopulmonary infection++++++++++GI infection-+-+-++---Other infections++-++-++-+Pulmonary Involvementlymphocytic ILDnodule*bronchiectasis--bronchiectasisbronchiectasiscavitationnodulenodule-Extrapulmonary Granulomabrain parenchyma, bone marrow, liver, spleen, skinliver, spleen-renal°, liver-**bone-ᵜlymph node--Autoimmune manifestations-monoarthritis,chronic ileitisoligoarthritis,atrophic gastritis,chronic ileitisalopecia, thyroiditis,bilateral anterior uveitis-oligoarthritis,autoimmune neutropenia,chronic ileitis,kounis syndromeoligoarthritis,autoimmune neutropeniaoligoarthritis, thyroiditis,sicca syndrome,recurrent scleritiscolitis-Cirrhosis of the liver++---+----Lymphadenopathy++++-+++++Splenomegaly++++-++-+-Immunosuppressive TreatmentSteroid, AZA, CSA, AdalimumabSteroidSteroid, SSZSteroid, MMF, CYC-Steroid, SSZ, MTX, LEF, CSASteroidSteroid, MTX, AZA, CSASteroid, AZA-

Abbreviations: AZA-azathioprine, CSA-cyclosporine, CYC-cyclophosphamide, F-female, GI-gastrointestinal, ILD-interstitial lung disease, LEF-leflunomide, M-male, MTX-methotrexate, SSZ-sulfasalazine

*right lower lobectomy, ** right foot 5th toe enucleation, ᵜ mediastinoscopic lymph node biopsy ° interstitial granulomatous nephritis

Conclusion

Autoimmune diseases can be seen in patients with CVID, and sometimes this may be the first presentation of CVID. Heterogeneous clinical findings of the disease may lead to delay in diagnosis. Clinicians should be more careful about the different manifestations of CVID to avoid delay in diagnosis.

Disclosure of Interests

None declared

The Bad Bug is Back: Acinetobacter Baumannii Bacteremia Outbreak during the COVID-19 Pandemic in an Intensive Care Unit

Background

Epidemiology of nosocomial infections may show variability because of under-estimation of infection control measures (ICMs) in coronavirus disease 19 (COVID-19) outbreak.

Aim

To investigate the Acinetobacter bacteremia outbreak developed in an intensive care unit (ICU) between March 20 to May 15, 2020, examine the risk factors, and re-evaluate ICM retrospectively.

Material and Methods

A retrospective cohort analysis was conducted to determine the risk factors, pulsed field gel electrophoresis (PFGE) was performed for analysis of the outbreak, ICM practices were observed by a team, and infection control interventions were undertaken.

Results

Acinetobacter bacteremia developed in 17 patients (21.5%) within 79 COVID-19 patients included in the study. The mean age of the bacteremic patients was 67.3 (SD = 14.82) years, and 82.4% of them were male; of these, 15 died, leading to 88.2% mortality. The bacteremia rate was higher compared with a 14-month period preceding the COVID-19 pandemic (17/79 versus 12/580 patients, respectively). PFGE revealed that the outbreak was polyclonal. On multi-variate analysis, the bacteremia development rate was 13.7 and 5.06 times higher with central venous catheter (CVC) use and in patients with chronic obstructive pulmonary disease (COPD), respectively. The mortality rate was higher in bacteremic patients (p = 0.0016). It was observed that ICMs were not followed completely, especially change of gloves and hand hygiene. Contamination of A. baumannii was observed in 38% of the gloves.

Conclusion

COPD and CVC use were determined as risk factors for Acinetobacter bacteremia development, and failures in ICM may have led to cross-contamination of endemic A. baumannii. The outbreak could be controlled within 3 weeks of interventions.

Emergency response, intervention, and societal recovery in Greece and Turkey after the 30th October 2020, MW = 7.0, Samos (Aegean Sea) earthquake

On 30 October 2020, an M_w = 7.0 earthquake struck the Eastern Aegean Sea with considerable impact on Samos Island in Greece and the area of Izmir in Turkey. It was the most lethal seismic event in 2020 worldwide, and the largest and most destructive in the Aegean Sea since the 1955 earthquake that also affected both countries. The Civil Protection authorities in Greece and Turkey were effectively mobilized responding to the earthquake emergency. The main response actions comprised initial announcements of the earthquake and first assessment of the impact, provision of civil protection guidelines through emergency communication services, search and rescue operations,medical care, set up of emergency shelters and provisions of essential supplies, psychological support, as well as education, training activities and financial support to the affected population. From the comparison of the Civil Protection framework and the implemented response actions, it is seen that actions at both sides of the eastern Aegean Sea, followed a single-hazard approach in disaster management with similar response activities coordinated by a main Civil Protection agency, which was in close cooperation with the respective authorities at a national, regional and local level. Based on the presented information, it is concluded that the post-earthquake response and emergency management were satisfactory in both countries, with valuable lessons learnt ahead of the next major earthquake. To this end, many aspects can be further addressed to enhance community resilience and introduce a multi-hazard approach in (natural and man-made) disaster management.

Knowledge and attitudes towards oral and dental health among seventh and eighth grade students compared with their teeth examination

AIM

Oral and dental heath are important aspects of general health and impact the quality of life and well-being. In this study, we aimed to assess the level of knowledge and attitudes towards oral and dental health and to examine the relative effect of social-behavioural risk factors on caries and other teeth problems among seventh and eighth grade students.

METHODS

Study Design: The study population consisted of all seventh and eighth graders who started the 2011 school year in Sarigol village of the Manisa city, Turkey (n = 377). Data were gathered by questionnaires which were carried out before tooth examination. Associations between sociodemographic characteristics, knowledge items, attitudinal factors and number of dental caries, dental fillings and teeth loss were studied.

RESULTS

Oral health was worse among females (p=0.002). As the number of children under care increased in the house, the number of dental filling and teeth loss increased in the students (p= 0.001 and p=0.021). Education of mothers of students who had worse dental health was significantly lower compared to the others (p=0.029). Among students who had four and more dental caries and dental fillings, frequency of dentist visit was lower (p= 0.034 and p= 0.005). Among students who had more dental caries, the knowledge that consumption of acidic beverages is not good for oral health was less prevalent (p=0.011).

STATISTICS

Associations between sociodemographic characteristics, knowledge items, attitudinal factors and number of dental caries, dental fillings and teeth loss were studied using chi-square test.

CONCLUSIONS

Health authorities should strengthen the implementation of oral disease prevention and oral health promotion programs rather than traditional curative care. Community-oriented education programs for students and their families are crucial for this purpose.

POS0750 THE CHARACTERISTICS OF SYSTEMIC LUPUS ERYTHEMATOSUS WHO HAVE CONSTITUTIONAL SYMPTOMS AND LYMPHADENOPATHY

Background:

Systemic lupus erythematosus (SLE) is the prototype of systemic autoimmune diseases. It may affect any organ system and may present with a variety of clinical symptoms. Lymphadenopathy (LAP) is a nonspecific finding of SLE and often associated to the active disease state. LAP associated SLE pose a significant diagnostic challenge especially in the presence of constitutional symptoms.

Objectives:

In this retrospective cohort study, we evaluated the clinical and imaging characteristics of SLE patients who presented with LAP and constitutional symptoms.

Methods:

SLE Patients with lymphadenopathy who had constitutional symptoms were reviewed retrospectively. The characteristics of the patients such as age, sex, disease duration, clinical features, and laboratory tests including autoantibodies against ANA, dsDNA and ENA were recorded. Imaging findings such as positron emission tomography–computed tomography (PET/CT), thoracal or abdominal CT or diagnostic lymph node biopsy were identified.

Results:

There were 28 patients in this study. The mean age at the time of LAP was 38.9±15.2 years, 22 (78.6%) were female. All patients were fulfilling SLICC 2012 classification criteria for SLE. LAP was the presenting feature of SLE in 15 (53.6%) patients. The most common clinical features associated with LAP were arthritis (42.8%), fever (35.7%), acute lupus rash (32.1%) and serositis (28.5%). There were 11 (39.2%) who had significant proteinuria and 4 (14.3%) had class III or IV renal histology. Anti-phospholipid antibodies were present in nearly one-third of the patients and 12 of them had venous or arterial thrombosis or pregnancy co-morbidity. Cervical LAP was present in 57.1%, axillary LAP in 82.1% and inguinal in 36%. On CT, the prevalence of thoracal and abdominal LAP and hepatomegaly and splenomegaly were 61.5%, 37,5%, 40% and 16% respectively. The pericardial and pleural effusion and intra-abdominal free fluid were 19.2%, 30.8% and 10.2% respectively. There were 19 (67.8%) patients who underwent PET/CT imaging and all were reported as reactive LAP. In terms of SUV max 7 (36.8%) of them had a threshold ≥2.5. 17 (60.7%) patients required lymph node biopsy; 2 did not include lymphoid tissue, 4 (30.7%) with atypical lymphoid hyperplasia suggestive of viral infection and remaining were reactive lymphoid hyperplasia. Autoantibody testing showed that anti-dsDNA was positive in 66.7% and the most common anti-ENAs were anti-nucleosome (35.7%) and anti-Sm-RNP (35.7%) followed by anti-SSA (25%), anti-ribosomal P (17.9%) and anti-histone (14%). The clinical and laboratory features of the clinical and laboratory features of the group is summarized in Table 1.

Table 1.

Data at the time of LAP

Age, years38.9±15.2Disease duration, months3 (2- 300)SLE-DAI, median (min-max)9 (2-30)Sex, female n(%)22 (78.6)Clinical featuresn (%)Acute cutaneous9 (32.1)Arthritis12 (42.8)Fever10 (35.7)Other constitutional symptoms18 (64.2)Serositis8 (28.5)Renal involvement11 (39.2)Neurologic involvement1 (3.6)Leucopenia7 (25.0)Trombositopenia5 (17.8)Hemolitic anemia7 (25.0)ANA (+)>1/32028 (100)Anti-dsDNA (+)18 (66.7)Anti-Sm(+)5 (17.9)Anti-phospholipid antibody (+)9 (32.1)Low complement16 (88.5)

Conclusion:

We showed that SLE patients who had constitutional findings and LAP could be the presenting feature and may confer a significant diagnostic challenge in which the patients might require invasive procedures and advanced imaging modalities. PET/CT revealed reactive changes in lymph nodes in all patients but lymph node biopsy revealed atypical changes in some patients suggestive of viral infections. On the other hand, LAP patients with constitutional symptoms represents a severe phonotype of the SLE as there were significant renal and thrombotic disease.

Disclosure of Interests:

None declared

AB0459 ARTICULAR INVOLVEMENT IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

SSc (systemic sclerosis) is a connective tissue disease characterized by small vessel vasculopathy, production of autoantibodies, and fibroblast dysfunction leading to increased deposition of extracellular matrix in the skin and internal organs mainly. Therewithal, many SSc patients develop musculoskeletal symptoms during the course of their illness. Different rheumatic complaints such as arthralgia, arthritis, contractures, tendon friction rubs, calcinosis, and acroosteolysis can be seen as musculoskeletal symptoms in SSc patients [1].

Objectives:

To provide an overview of the spectrum of articular involvement in SSc and determine the relationship between these involvements and Rheumatoid factor (RF) and Anti-cyclic citrullinated peptide (Anti-CCP) positivity and organ involvements.

Methods:

We performed a retrospective cohort study involving 232 SSc patients who were followed up in our department of rheumatology between 2000 and 2020 years. The patients were divided into two groups as limited and diffuse SSc. Age, gender, weight, height, smoking habits, duration of illness, follow-up duration, other systemic organ involvement, and radiographic findings were recorded. Diagnostic tests such as RF, Anti-CCP, ANA, ENA panel tests, direct radiographs were examined.

Results:

The mean age of the patients was 59.9 ± 12.8 and 88.4% of them were women. 69.3% of patients were limited SSc. At any stage of the disease, 39.1% of all patients had arthralgia and 34.1% had arthritis. The arthritis rate was similar between the SSc groups (p = 0.396). RF and anti-CCP positivity rates were similar between the SSc groups. Although RF and anti-CCP positivity rates were higher in the patient group with arthritis, it was not statistically significant (respectively p=0.563, p=0.072). Interestingly, the lung involvement rate was higher in patients with arthritis (63.3% versus 46.4%) (p=0.015). Other clinical, demographic characteristics, laboratory, and radiographic findings of the patients are shown in Table 1.

Conclusion:

Articular involvement in SSc is a common clinical feature seen in one-third of patients regardless of the type of disease. Although RF and Anti-CCP positivity are more common in patients with arthritis, it was not statistically significant. Interestingly, arthritis is a more common manifestation in patients with lung involvement.

References:

[1]R. D. Sandler, M. Matucci-Cerinic, and M. Hughes, “Musculoskeletal hand involvement in systemic sclerosis,” Seminars in Arthritis and Rheumatism, vol. 50, no. 2. 2020, doi: 10.1016/j.semarthrit.2019.11.003.

Table 1.

Demographic and clinical characteristics of b/tsDMARDs patients

Table-1Limited SSc(n=161)Diffuse SSc(n=71)All patients(n=232)PAge (years) (Mean±SD)60.5 ± 12.758.6 ± 12.959.9 ± 12,80.295Disease duration (years) (Mean±SD)11.5 ± 6.612.4 ± 8.111.8 ± 7,10.384Weight (kg) (Mean±SD)68.2 ± 13.366.2 ± 15.667.6 ± 14.10.331BMI (kg/m2) (Mean±SD)27.6 ± 5.526.2 ± 6.127.1 ± 5.70.102Female, n (%)146 (90.7)59 (83.1205 (88.4)0.097Current and ex smoker, n (%)60 (37.2)18 (25.4)78 (33.6)0.077Digital ulcer, n (%)53 (32.9)34 (47.9)87 (37.5)0.03*Contracture on hand28 (17.4)28 (39.4)56 (24.1)<0,001*Arthralgia, n (%)63 (39.1)29 (31.5)92 (39.7)0.806Arthritis, n (%)52 (32.3)27 (38)79 (34.1)0.396Joint space narrowing on X-ray, n (%)44 (51.2)30 (63.8)74 (55.6)0.160Joint erosion on X-ray, n (%)17 (19.8)14 (29.8)31 (23.3)0.205Acroosteolysis on X-ray, n (%)9 (10.5)16 (34)25 (18.8)0.001*ANA positivity, n (%)155 (96.3)69 (97.2)224 (96.6)0.728Anti-Scl positivity, n (%)41 (28.7)48 (71.6)89 (42.4)<0.001*Anti-centromere positivity, n (%)65 (45.5)10 (14.9)75 (35.7)<0.001*RF positivity, n (%)27 (17.5)14 (20.6)41 (18.5)0.589Anti-CCP positivity, n (%)16 (12.7)7 (11.3)23 (12.2)0.782

P*Independent Samples t Test, Pearson Chi-Square Test, BMI; Body mass index, ANA; Anti nuclear antibody,

RF; Rheumatoid factor, Anti-CCP;Anti- Cyclic citrullinated peptide

Disclosure of Interests:

None declared.

AB0708 HIGH DRUG RETENTION RATES DESPITE B/TSDMARD INTERRUPTIONS IN COVID-19 PANDEMIC CHAOS

Background:

A significant increased risk of COVID-19 related adverse outcomes of the biological or target-directed synthetic DMARDs (b/tsDMARDs) has not yet been reported. For this reason, it is recommended to continue b/tsDMARD treatments with maximum compliance with pandemic measures.

Objectives:

The aim of this study was to evaluate the effects of patients using b/tsDMARDs on drug survival and rheumatic disease control during pandemic.

Methods:

In this study, patients diagnosed with rheumatic disease using b/tsDMARDs and who were followed up during the 12-month period (January 2020-2021) including the onset of the Covid-19 pandemic at Dokuz Eylul University Faculty of Medicine Rheumatology Clinic were evaluated. In the first 3 months of the pandemic (March-June 2020), the patients skipped at least 2 cycles of treatment with the fear of Covid-19 infection except for infection / surgical reasons was considered as a disruption of the drug. The drug retention rates of the patients on b/tsDMARDs treatments during the pandemic process and the factors affecting this situation were evaluated.

Results:

The rate of disrupting their b/tsDMARDs was higher in patients> 65 years of age, with a diagnosis of RA and who needed to come to the hospital for bDMARD treatment (p=0.007, p=0.015 and p=0.004, respectively).

The overall 1-year b/tsDMARD retention rates was found 91%. It was determined that a history of interruption in b/tsDMARD treatments in the first 3 months of the pandemic [OR: 1.28 (CI: 1.042-8.71), p=0.014] and the need to come to the hospital to receive bDMARD [OR: 0.59 (CI: 0.64-13.11), p=0.041] caused unresponsiveness to return to the same bDMARD treatment and a significant increase in the risk of discontinuation of the biologic treatment.

Conclusion:

We conclude that it is important for patients to continue taking b/tsDMARD treatments without interruption in the days past abnormal periods such as pandemic conditions and to make sufficient effort for minimum dose of CS and low disease activity by determining patient-based risk.

Table 1.

Demographic and clinical characteristics of b/tsDMARDs patients

Total (n=521)b/tsDMARD Continue (n=424) (82.4%)b/tsDMARD Interruption (+) (n=97) (17.6%)PMedian (Min./Max.)Median (Min./Max.)Median (Min./Max.)Age, years48 (18/86)47 (18/82)52 (21/81)0.008tDisease Duration, years11,2 (2/43.3)130 (22/490)142 (22/519)0.41tb/ts DMARD Duration, months40 (12/192)40 (12/192)40 (12/156)0.176tn (%)n (%)n (%)Female278 (53.4)225 (53.1)53 (54.6)0.826Most common rheumatic diseases AxSpa or other SpA283 (54.3)232 (54.7)51 (52.6)0.737 RA134 (25.7)100 (23.6)34 (35.1)0.015l PsA44 (8.4)40 (9.4)4 (4.1)0.109 Vasculitis32 (6.1)27 (6.4)5 (5.2)0.817 Others28 (5.4)25 (5.9)3 (3.1)0.338b/tsDMARD at Hospital/Health center140 (26.9)102 (24.1)38 (39.2)0.004l(OR: 0.59)b/tsDMARD administration route (IV)137 (26.3)100 (23.6)37 (38.1)0.005lActive/Progressive Disease92 (17.7)14 (3.3)78 (80.4)<0.001l(OR: 4.8)Start/continue with the same b/tsDMARD55 (10.6)3 (0.7)52 (53.6)<0.001pUnresponsiveness, b/tsDMARD switch16 (3.1)9 (2.1)7 (7.2)0.017pb/tsDMARD stopped permanently/deceased29 (5.6)9 (2.1)20 (20.6)<0.001ffb/tsDMARD retention (Total)474 (91)406 (95.8)68 (70.1)<0.001

tIndependent Samples t Test (Bootstrap), pPearson Chi-Square Test (Monte Carlo), ffFisher freeman Halton Test (Monte Carlo), lLinear-by-Linear Association Test(Monte Carlo, Exact), SD.: Standard deviation; * OR, Odds Ratio,

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Figure 1.

Performance Among Patients with Each Domain

Conclusion:

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

Table 1.

Diagnostic estimates of screening tools in different studies

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

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

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

Disclosure of Interests:

None declared.

AB0437 OESOPHAGEAL DILATATION ON HIGH-RESOLUTION CT CHEST IN SYSTEMIC SCLEROSIS: SIGNIFICANT INDEX?

Background:

Systemic sclerosis (SSc) is chronic, autoimmun multisystem disorder presented by thickening and fibrosis of the skin and internal organs. Esophageal involvement is one of the most common manifestation. Esophageal enlargement on HRCT is a common finding in scleroderma patients and may also be associated with other scleroderma-related clinical findings (1).

Objectives:

The aim of this study to evaluate the association between esophageal dilatation on chest HRCT at diagnosis with the other SSc features.

Methods:

The study was planned for SSc patients registered between October 2007 and September 2020 in Dokuz Eylul University Rheumatology Department database. Demographics, clinical features and medical history were recorded. The baseline HRCT reports were screened in terms of esophageal dilatation. Then, the initial HRCT images were assessed for esophageal dilatation by an experienced chest radiologist according to recommendation of Pitrez et al.

Results:

In our study, there were 233 SSc patients (f:206 M:27, mean age 59.9±12.7 years) 71 (31.4%) of them diagnosed with diffuse disease. Median follow-up of study was 73 (1-272) months. Esophageal dilatation on HRCT was detected in 60 (25.8%) of SSc patients. 67 out of 155 patients (43.2%) had proof of esophageal involvement in esophageal transit scintigraphy. There is no statistical correlation was found between esophageal dilatation on HRCT with gender, smoking, arthritis, pulmonary hypertension and autoantibody subtypes. Development of digital ulcer and telangiectasia is statistically higher in SSc patients with oesophageal dilatation on baseline chest HRCT (p=0.001 and p=0.039, respectively). There was a positive correlation between Modified Rodnan Skin Score (mRss) and esophageal dilatation (r=0.213, p: 0.004).

Conclusion:

HRCT can be a reproducible and non-invasive method for evaluating esophageal dilatation. Presence of esophageal dilatation at baseline HRCT might be indicative for pulmonary involvement and SSc related gastrointestinal complications. Consecutive chest HCRT should be evaluated to obtain more reliable data about the relationship between esophageal dilatation and SSc related clinical features.

References:

[1]Pitrez EH, Bredemeier M, Xavier RM et al.Ooesophageal dysmotility in systemic sclerosis:comparison of HRCT and scintigraphy. Br J Radiol 2006; 79: 719–24.

Table 1.

Clinical and demographic characteristics of the presence of esophageal dilatation on HRCT

Esophageal dilatation on HRCTTotal (n=233)Yes (n=60, 25.8%)No (n=173, 74.2%)pMean±SD.Mean±SD.Mean±SD.Age, years59.9±12.759.7±12.260.1 ±12.6>0.05n%n%n%Female20688,4%5388,3%14986,1%>0.05Smoking7933,9%1931,7%6034,7%>0.05Diffuse SSc7130,5%2338,3%4425,4%>0.05Overlap syndrome3314,2%813,3%2514,5%>0.05Pulmonary fibrosis11850,6%4270,0%7643,9%>0.05Arthritis8034,3%2338,3%5632,4%>0.05Telengiectasia15667,0%4880,0%10560,7%0,039Digital ulcer8737,3%3456,7%5129,5%0,001Anti-Scl 70 (+)8938,2%2846,7%5934,1%>0.05Anti-centromer (+)7532,2%1525,0%5934,1%>0.05

Disclosure of Interests:

None declared

SAT0097 DO COMORBIDITIES IMPACT PERSISTENCE OF FIRST TUMOR NECROSIS FACTOR INHIBITOR TREATMENT IN RHEUMATOID ARTHRITIS? DATA FROM TURKBIO

Background:

Studies indicate that patients with rheumatoid arthritis (RA) are at increased risk of developing several comorbid disorders. Comorbidities affect treatment decisions, the effectiveness of the treatment, quality of life, RA prognosis, and survival rate [1].

Objectives:

The aim of thisstudyto investigate the impact of comorbidity on the first TNF inhibitor treatment persistence in RA.

Methods:

In the TURKBIO database, patients with an ICD 10-diagnosis of RA (M05 or M06) who started TNF inhibitor therapy between January 2011 and June 2019 were enrolled. Demographic and clinical characteristics, acute phase reactants, disease activity scores (DAS 28 CRP, HAQ, CDAI, VAS global), initial comorbidities and numbers, drug persistence, were evaluated. Kaplan-Meier plots and Cox proportional hazard regression analyses were performed.

Results:

A total of 1172 patients >18 years of age treated with TNF-α inhibitors were included in the study. The most prevalent comorbidities were: hypertension in 262 patients (32.6%), obesity in 254 (32.6%), osteoporosis in 178 (22.3%), chronic lung disease in 143 (17.9%) and depression in 126 (15.8%). The baseline characteristics are summarised in Table 1. The presence of comorbidity did not affect the survival rate of the first TNF inhibitor therapy in the RA patients (p: 0.65). Comorbidities had no effect on DAS28 CRP (> 1.2 reduction) responses at 6 and 12 months of treatment (p: 0.18, p: 0.83, respectively). As the mean disease duration increases, the persistence of the first TNF inhibitor decreases by 5%.

Conclusion:

This study demonstrated the increasing burden of comorbidities in RA. However, it suggested that the presence and number of comorbidities did not influence the rate of persistence in the first TNF inhibitor drug and the response to treatment.

References:

[1] Gabriel, S.E. and K. Michaud,Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases.Arthritis research & therapy, 2009.11(3): p. 229.

Disclosure of Interests:

None declared

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

FRI0099 THE IMPACT OF BIOLOGICAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS ON THE COURSE OF RHEUMATOID ARTHRITIS-ASSOCIATED LUNG DISEASE

Background:

Pulmonary involvement is one of the frequent extra-articular manifestations of rheumatoid arthritis (RA) (1). Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effectively used in the treatment of musculoskeletal findings of RA but their effect on RA-associated lung disease is unclear.

Objectives:

The aim of this retrospective study is to evaluate and compare different bDMARD treatments used in RA patients with RA-associated lung disease.

Methods:

All RA patients who received bDMARDs between 2008 and 2018 in a single rheumatology centre and had thorax high-resolution computed tomography (HRCT) were reviewed for the findings of lung involvement. Patients with positive finding were included in the study. Following the biologic treatment, whether there was a progression/regression in lung involvement was evaluated by comparing the baseline and the latest thorax HRCT findings. Clinical and laboratory data were collected from medical records.

Results:

A total of 40 patients (mean age:62.4 years; 72.5% women) were included in the study. Clinical and demographic characteristics of patients are summarized in Table 1. During the mean 107.43 ± 65 months follow-up period, HRCT findings remained stable in 31 patients (76%) and improved in one (2.5%), while 7 patients (17.5%) had progress in their lung involvement. When patients with and without progress were compared, lung involvement at the diagnosis of RA and the presence of respiratory symptoms at bDMARDs initation was found to be more frequent in the first group (p=0.023 and p=0.020, respectively). Mean ESH values at bDMARDs initation were also higher in patients who had progress (p=0.006). There was no significant difference between the groups in the age, sex, type of bDMARDs used or other baseline laboratory data. Logistic regression analysis showed that lung involvement at the diagnosis of RA was a significiant independent risk factor for the progress (OR: 11.0, 95% CI=1.48-81.60). There was no statistically difference on progression of HRCT findings between patients received TNFi (n=22) and non-TNFi biologics (n=18), (p=1.00). The mean drug survival of first bDMARD also was not statistically different between groups (40.83±21.6 months in non-TNFi group and 42.23±40.50 months in TNFi group (p=0.90)). 5/18 (%27.8) patients in the non-TNFi group and 1/22 (%4.5) in TNFi group had died during the follow-up (p=0.14)

Table 1.

Demographic and clinic characteristics of the patients at the Initiation of BDMARDs.

CharacteristicsN=40Male/Female, n11/29Age at bDMARDs initiation, years (mean±SD)56,51±10.53Age at the diagnosis, years (mean±SD)49,38±11,7Disease duration at bDMARDs initiation, years (mean±SD)7,15±5,53Past or current smoker, n (%)21/40 (52.5)RF positivity, n (%)29/40 (72.5)ACPA positivity, n (%)35/39 (89.7)Anti-SSA positivity n (%)3/9 (33.3)Patients with Sjögren’s syndrome, n (%)5/10 (50)ESR at bDMARDs initiation, (mm/h)38,37 ± 22,2CRP at bDMARDs initiation, (mg/l)16,08 ± 14,54DAS28 at bDMARDs initiation3,68 ± 1,1Respiratory symptom at bDMARDs initation, n(%)12/40 (30)Lung involvement at the diagnosis, n (%)8/25 (24,2)Concomitant steroid, n (%)37/40 (92.5)Concomitant MTX, n (%)16/40 (40)Concomitant other csDMARDs, n (%)31/40 (%77,5)Initiated bDMARDs, TNFi/nonTNFi, n22/18RA-lung involvement type based on HRCT findings, n (%)-Rheumatoid nodulosis17 (42.5)-ILD-ground-glass opacity12 (30)-ILD-honeycombing11 (27.5)

Conclusion:

This study showed that the impact of TNFi and non-TNFi biologic treatments on the course of RA-assosiated lung involvement is similar. It also suggested that lung involvement at the diagnosis of RA was a significiant risk factor for the progress of the pulmonary disease.

References:

[1]Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extraarticular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62(8):722–7

Disclosure of Interests:

None declared

SAT0344 LIMITED JOINT MOBILITY OF HAND IN SYSTEMIC SCLEROSIS PATIENTS BY USING “PRAYER” AND “TABLE TOP” SIGNS

Background:

Limited joint mobility (LJM) is a musculoskeletal disorder caused by flexion contractures of hand is a common complication in systemic sclerosis (SSc) patients. The distal parts of the upper limb (hands and fingers) is the most involved site in SSc.

Objectives:

In this study, we aimed to evaluate LJM in SSc patients and to determine the relationship between the clinical features of the disease.

Methods:

A total of 113 patients (>18 years old) diagnosed with diffuse cutaneous systemic sclerosis (DcSSc) and limited cutaneous systemic sclerosis (LcSSc) and 104 healthy controls were included in this study. LJM was evaluated with “prayer sign” and “table top sign” tests. LJM staging was done by Rosenbloom classification method(1, 2). LJM (+) and LJM (-) patients were compared in terms of demographic findings (gender, age and duration of disease), laboratory results (ESR, CRP, ANA, anti-topoisomerase I and anti-centromere) and modified Rodnan Skin Score (mRSS) results.

Results:

In our study, a total of 113 patients diagnosed with SSc and 104 healthy controls with similar age and gender distribution were included. While LJM (+) was detected in 75 (66.4%) (LcSSc = 38, DcSSc = 37) of the patients diagnosed with SSc, LJM (mild) (+) was detected in 3 (2.8%) of the control group. One of these people had right 2nd DIF joint contracture due to osteoarthritis, and 1 patient was found to have simple contractures due to minor hand injury previously (Table 1). A statistically significant difference was observed in between LcSSc and DcSSc patients according to the presence of LJM (p<0.001) (Table 2). There was a moderate positivity relationship between LJM and mRSS (LcSSc: r=0.449 ve p<0.001, DcSSc: r= 0.565 ve p<0.001) (Figure 1).

Table 1.

Comparison of demographic findings between SSc and Control group

SSc Group (n=113)Control Group (n=104)p valueAge, year57.02 ± 11.5858.47 ± 11.260.061Gender (F / M)98 (86.7) / 15 (13.3)65 (62.5) / 39 (37.5)0.064CRP (mg/L)5.45 ± 5.392.14 ± 1.12<0.001ESR (mm/hr)25.19 ± 18.914.46 ± 10.090.024Smoking, n (%)Smoker89 (78.8)70 (67.3)0.464Non-Smoker24 (21.2)34 (32.7)LJM (Absent / Present)Present75 (66.4)3 (2.8)<0.001Absent38 (33.6)101 (97.2)Rosenbloom classificationLcSSc (n=71) (%)DcSSc (n=42) (%)Total (n=113) (%)Normal46.511.933.6Mild22.514.319.5Moderate23.933.327.4Severe7.140.519.5Table 2.

Comparison of demographic and clinical findings LJM(-) and LJM(+) in SSc

LJM (-) (n=38)LJM (+) (n=75)p valueAge, year54.16 ± 11.8258.47 ± 11.260.061SSc Typen (%)n (%)LcSSc, n (%)DcSSc, n (%)33 (56.8)38 (50.7)<0.0015 (13.2)37 (49.3)Gender,F/M (%)37 (97.3) / 1 (2.7)61 (81.3) / 14 (18.7)0.018Raynaud’s (symptom duration), month148 (44-456)150 (35-588)0.990Non-raynaud (symptom duration), month108 (28-458)138 (38-447)0.132mRSS, median2 (0-14)8 (0-36)<0.001CRP (mg/L)4.21 ± 4.486.08 ± 5.710.069ESR (mm/hr)19.74 ± 1027.95 ± 21.60.270Renal crisis, n (%)1 (2.6)4 (5.3)0.662PAH, n (%)8 (21.1)14 (18.7)0.762ANA positivity, n (%)36 (94.7)70 (93.3)1Anti-centromere positivity, n (%)18 (47.4)19 (25.3)0.01Anti-topoisomerase-1, n (%)8 (21)34(45.3)0.01Smoking, n (%)n (%)n (%)Non-smoker30(78.9)59 (78.7)0.970Smoker8 (21.1)16 (21.3)Figure 1.

Conclusion:

In our study, it was found that LJM staging positively correlated with mRSS and DcSSc patients had more severe LJM findings than LcSSc. We conclude that “prayer sign” and “table top sign” tests used in hand evaluation in SSc patients have similar clinical results with mRSS and can be easily performed in daily practice in about 3 minutes.

References:

[1]Rosenbloom AL. Limitation of finger joint mobility in diabetes mellitus. The Journal of diabetic complications 1989; 3: 77-87.

[2]Nashel J, Steen V. Scleroderma mimics. Current rheumatology reports 2012; 14: 39-46.

Disclosure of Interests:

None declared

AB0202 GENETIC SUSCEPTIBILITY AND PHENOTYPE OF RHEUMATOID ARTHRITIS IN DANISH AND TURKISH PATIENTS

Background:

Previous studies indicate that genetic susceptibility and phenotype of rheumatoid arthritis (RA) differ between the populations.

Objectives:

To compare the clinical, serologic expression and the presence of shared epitopes (SE) of incident RA in two different populations, one from Northern and the other from Southern Europe.

Methods:

Data on incident RA patients fulfilling EULAR/ACR 2010 classifications criteria for RA were collected at Rheumatology Departments in Denmark and Turkey in 2015-2016. Patients were assessed using the same standardized protocol in both populations. SE carrier status were assigned, according to the du Montcel classification based, into six allele groups:S1, S2,S3D,S3PandX, where S2 and S3P are RA risk-enhancing alleles and S1 and S3D are RA protective alleles of the shared epitope(1).

Results:

109 incident RA patients from Denmark and 114 incident RA patients from Turkey were enrolled. Genetic data were available from 87% of the patients.

Table 1.

Characteristics of incident rheumatoid arthritis patients in Denmark and Turkey

Danish patientsn=109Turkish patientsn=114P-valueAge at diagnosis, years60 (49-69)52 (43-64)0.003Female, %64740.12Symptom duration, months7 (4-21)6 (2-22)0.6Smoking status Never smoker, %43440.98 Former smoker, %28310.68 Current smoker, %29250.54VAS pain (0-100 mm)45 (28-66)60 (41-72)0.01VAS fatigue (0-100 mm)51 (29-69)50 (20-70)0.32VAS global, patient (0-100 mm)60 (31-80)60 (41-73)0.77Swollen joint count (0-28)7 (4-11)3 (1-6)<0.00001Tender joint count (0-28)7 (3-11)5 (2-8)0.04HAQ score (0-3)0.75 (0.34-1.25)1.0 (0.25-1.75)0.02DAS284.7 (4.1-5.5)4.3 (3.3-5.2)0.01CRP, mg/l7 (3.0-18.5)8 (3.1-22.6)0.54IgM RF positive, %70660.58ACPA positive, %63750.1

Medians (interquartile range) for continuous variables

VAS – Visual Analog Scale, HAQ - Health Assessment Questionnaire, DAS28 - Disease Activity Score 28 joints, CRP – C-reactive protein, RF – Rheumatoid Factor, ACPA - Anti-Citrullinated Protein Antibodies.

Table 2.

Shared epitope allele carrier frequencies.

AlleleDanish patientsn=98Turkish patientsn=95P-valueS1, % (n)19 (37)22 (42)0,43S2, % (n)26 (51)8 (16)<0,00001S3D, % (n)6 (12)21 (39)0,000029S3P, % (n)27 (52)29 (56)0,52X, % (n)22 (44)19 (37)0,47

We found no associations between the risk-enhancing alleles and the presence of IgM rheumatoid factor or ACPA.

Conclusion:

The Turkish patients were younger and had lower disease activity than Danish at the time of diagnosis. Our study found an enhanced genetic susceptibility to RA in Danish compared to Turkish patients with a higher prevalence of risk-enhancing RA alleles and a lower prevalence of protective alleles.

References:

[1]Tezenas du Montcel S, Michou L, Petit-Teixeira E, Osorio J, Lemaire I, Lasbleiz S, et al. New classification of HLA–DRB1 alleles supports the shared epitope hypothesis of rheumatoid arthritis susceptibility.Arthritis Rheum2005; 52: 1063–8.

Disclosure of Interests:

None declared

AB1071 COEXISTENCE OF FAMILIAL MEDITERRANEAN FEVER WITH SPONDYLOARTHRITIS: CLINICAL CHARACTERISTIC AND TREATMENT OUTCOMES

Background:

Studies indicate that there is an association with spondyloarthritis (SpA) and familial mediterranean fever (FMF) based on the following: 1) increased incidence of sacroiliitis in FMF, 2) MEFV gene mutations are significantly increased in ankylosing spondylitis (AS) and 3) both SpA and FMF show some common clinical manifestations such as the pattern of arthritis. However, characteristics of SpA associated with FMF such as clinical characteristics and treatment outcomes have been poorly documented and additional data is required on this topic.

Objectives:

To study the clinical and treatment characteristics of patients associated with FMF and SpA.

Methods:

Twenty-eight patients with FMF and SpA who were registered in our database were included in the study. Demographic, clinical, and laboratory data were collected. HLA-B27, MEFV gene mutations were recorded. Pelvic radiographs and sacroiliac joint magnetic resonance imaging (MRI) (if present) were scored based on the modified New York criteria (mNYc) and ASAS MRI definitions respectively. Treatment data were also recorded.

Results:

There were 28 FMF-SpA patients in the study (mean age 45.1±16.4 years, 57.2% male). The mean age of onset of FMF and SpA were 31.9±17.9 and 35.5±16.2 years respectively. SpA patients were predominantly axial (n=21, 75%), and only 7 (25%) were mainly peripheral type. Fifteen (53.5%) patients were satisfying mNYc for AS. Four (14%) patients were fulfilling ASAS non radiographic axial SpA definition. Bone marrow edema was detected in (36%) of the patients who underwent MRI (n=14). Two (7.1%) patients had SpA symptoms but did not classify into any of the ASAS arms. Arthritis observed in 19 (67.8%) patients with mostly in oligoarthritis type (79%). Ankle and knees were the most affected joints. Total hip replacement was present in 7% of the patients. Amyloidosis confirmed by biopsy was detected in 4 (14%) patients. Enthesitis (11%), uveitis (11%), Chron’s disease (7%), dactylitis (3%), and psoriasis (3%) was also noted. Nearly %30 patients required non IL-1 biologic therapy (BTx) to control SpA symptoms (axial 70%, peripheral 30%). 40% of the patients needed to switch non IL-1 BTx to another biologic agent because of lack of efficacy on SpA symptoms (25%) or due to the adverse event (25%) and active FMF not responding to non IL-1 biological agent (50%).

Conclusion:

We showed the following: 1) more female predominance in FMF-SpA patients compared to classic SpA, 2) FMF-SpA patients had lower frequency of HLA B27, 3) up to %30 of the patients required non-IL-1 BTx to control SpA symptoms and 4) in patients on non IL-1 BTx FMF symptoms responded in 80%.

Table 1.

The clinical characteristics of FMF-SPA patients

Age*45.1±16.4Male, n (%)16 (57.2)SpA symptom duration,years*9.5±7.0FMF symptom duration,years*12.6±9.6HLA-B27 positivity, n (%)5 (29.4)Mainly axial involvement, n (%)21 (75)Mainly peripheral involvement, n (%)7(25)mNY positivity, n (%)15 (53.5)MEFV (M694V) mutation18MEFV (non M694V) mutation19Amyloidosis, n (%)4 (14.2)Non IL-1 biological treatment for SpA symptoms, n (%)10 (35.7)

*(mean ±S.D)

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Initial demographic and clinical datas of patients with PsA

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

*median (min-max)

Conclusion:

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

Disclosure of Interests:

None declared

The opinions of adults about the ban on cigarette sales to minors

BACKGROUND

Selling of tobacco products to minors has been banned since 1996 by the tobacco control law in Turkey. However, it is also important for the public to support practices that prevent the access of tobacco products to minors. In addition, every individual has the responsibility of carrying out society based programs that restrict access to tobacco products especially to children and the youths. Social sensitivity is considered an important factor in the prevention of tobacco use. This study aims to learn about the opinions and attitudes of adults with regards to minors access to tobacco products.

METHODS

The study was a descriptive study conducted in nine city centers in Turkey. The total number of participants reached was 3241. The questionnaire was developed by the research team and consisted of 22 questions concerning knowledge and behaviors of adults on restriction of tobacco sales to minors and their observations with regards tobacco sales to minors. Data was collected through face to face interview. Pearson chi-square test was used for the bivariate analysis whereas logistic regression was investigate the relationship between "the participant's response against tobacco sales to minors" and the following explanatory variables; "age", "educational status", "income level", "working status", "minors access to cigarettes", "smoking ratio in high school" and "sales of tobacco to minors".

RESULTS

More than half of the participants (60.5%) belonged to the age group 25-44 years, 61.3% graduated from high school or university. Most of the participants were smoker (39.2%) or ex-smoker (19.1%), and 41.7% of the participants was non-smoker. A greater proportion of the participants (76.2%) believed that smoking prevalence was greater than 40% among high school students. One in four (27.8%) adults did not know that tobacco control law bans sell of tobacco products to minors in Turkey. More than half of the participants (57.1%) ever witnessed tobacco sales to minors and 63.6% of them did not act when confronted with the event. Almost all (96.8%) of the respondents thought that access of minors to tobacco products was not difficult. The results of logistic regression of participant's response against tobacco sales to minor and related factors for current smokers showed that respondents who believed smoking ratio in high school was 4-5 adolescent out of 10 (aOR: 1.59; 95% CI: 1.09-2.34) were more likely to give a warning or informing the police or other people as compared to respondents whose perception on the smoking ratio among high school students was 6-7 adolescents out of 10. The results of logistic regression of non-smokers' response against tobacco sales to minor were who are from higher educational level, higher economic status, working status and who believed smoking ratio in high school was 4-5 adolescent out of 10 and 2-3 adolescent out of 10 were more likely to give a warning or informing the police or other people as compared to the others.

CONCLUSIONS

Although laws prohibiting the sale of tobacco products to the under age group is very important with regards to accessibility of minors to tobacco products, most of the study participants believed that minors can still easily access tobacco products, and more than half of the participants did not act when confronted with the event. The education, information and monitoring program most especially as it concerns salesman, should be reviewed and strengthened to obey the rules on sales of tobacco products to minors. Education program should be carried out to increase the knowledge and awareness of the community for sale of tobacco to minors. Social sensitivity is important for the prevention of tobacco use and every individual have a responsibility in carrying out this society based program, most especially as it related to prevention of tobacco usage among children and youths.

Turkish Final Year Medical Students' Exposure to and Attitudes Concerning Drug Company Interactions: A Perspective from a Minimally Regulated Environment for Medical Students

Interactions between drug companies and medical students may affect evidence-based medical practice and patient safety. The aim of this study was to assess drug company-medical student interactions in a medical faculty where limited specific national or institutional regulations apply between drug companies and medical students. The objectives of the study were to determine the exposure and attitudes of final year medical students in terms of drug company-medical student and physician interactions, to identify factors affecting those attitudes and to provide data for policymakers working on the regulation of interactions between drug companies and medical students. This anonymous questionnaire-based study of 154 medical final year medical students at the Karadeniz Technical University Medical Faculty, Trabzon, Turkey, in April and May 2015 attracted a response rate of 92.2% (n/N, 154/164). Exposure to interaction with a pharmaceutical representative was reported by 90.3% (139/154) of students, and 68.8% (106/154) reported experiencing such interaction alongside a resident. In addition, 83.7% (128/153) of students reported an interaction during internship. Furthermore, 69.9% (107/153) of students agreed that interactions influence physicians' prescription preferences, while 33.1% (51/154) thought that a medical student should never accept a gift from a drug company and 24.7% (38/154) agreed with the proposition that "drug companies should not hold activities in medical faculties". Students with rational prescription training expressed greater agreement with the statement "I am skeptical concerning the information provided by drug companies during interactions" than those who had not received such training, and this finding was supported by logistic regression [O.R.(C.I), p -3.7(1.2-11.5), p = 0.022]. Acceptance of advertisement brochures was found to significantly reduce the level of agreement with the proposition that "A physician should not accept any gift from a drug company." (0.3[0.1-0.9], p = 0.030). In summary, exposure to drug companies was widespread among our final year medical students who, like students in both Western and non-Western societies, hold permissive attitudes concerning accepting gifts, and drug advertising brochures may relax those permissive attitudes still further. Rational prescription training was useful in generating rational attitudes. Policies concerning drug company-medical student relationships should be developed in Turkey as well as internationally.

The Effect of Empathy Training on the Empathic Skills of Nurses

Background

The profound impact of empathy training on quality nursing care has been recognized. Studies have shown that there has been little improvement in nurses’ communication skills, and that they should work to enhance this area. Relevant training will lead to an improvement in nurses’ empathic skills, which in turn, will enable them to understand their patients better, establish positive interpersonal relationships with them, and boost their professional satisfaction.

Objectives

To reveal the effect of empathy training on the empathic skills of nurses.

Patients and Methods

This study was conducted as an experimental design. The research sample consisted of 48 nurses working at the pediatric clinics of Farabi hospital of Karadeniz Technical University in Turkey (N = 83). Two groups, an experimental group (group 1) and a control group (group 2) were determined after questionnaires were supplied to all nurses in the study sample. At first, it was intended to select these groups using a random method. However, since this may have meant that the experimental and control groups were formed from nurses working in the same service, the two groups were selected from different services to avoid possible interaction between them. The nurses in the Group 1 were provided with empathy training through group and creative drama techniques. Pre-tests and post-tests were conducted on both groups. Data was collected via a questionnaire designed around the topic “empathic skill scale-ESS”, developed by Dokmen. The Kolmogorov Smirnov test was employed to assess whether the measurable data was suitable for normal distribution. Data was presented as numbers and percentage distributions, as mean ± standard deviation and Chi-square, and as student t tests and paired t tests. The level of significance was accepted as P < 0.05.

Results

The nurses in the experimental group had a mean score of 146.7 ± 38.8 and 169.5 ± 22.1 in the ESS pre-test and post-test, respectively. Although the nurses in the control group had a pre-test mean score of 133.7 ± 37.1, which increased to 135.1 ± 51.7 after the training, no statistically significant difference was found (P = 0.886). A comparison of the groups indicated that they scored similarly in the pre-test. However, the experimental group scored significantly higher than the control group in the post-test (P = 0.270 and P = 0.015, respectively).

Conclusions

In the light of these findings, it is recommended that communication skills should be widely included in in-service training programs; similar studies should be conducted on broader control groups formed through randomization; and a comparison should be made between the findings.

Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: short-term complications

PURPOSE

To compare the complications occurring within the first 3 months of corneal collagen crosslinking (CXL) performed with mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal in keratoconus patients.

SETTING

Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey.

DESIGN

Nonrandomized retrospective clinical study.

METHODS

Eyes of consecutive progressive keratoconus patients who had PTK or mechanical epithelial removal followed by CXL were included. All patients were examined regularly until epithelial healing. Detailed ophthalmologic examinations were performed preoperatively and 1 and 3 months postoperatively.

RESULTS

The study comprised 499 eyes (302 patients) that had transepithelial PTK (Group 1, 153 eyes) or mechanical epithelial removal (Group 2, 256 eyes) followed by CXL. Delayed epithelial healing occurred in 15.0% of eyes in Group 1 and 3.5% of eyes in Group 2 (P = .001). Epithelial hypertrophy occurred in 24.8% of eyes and 3.5% of eyes, respectively (P = .001). Salzmann-like epithelial nodules (2.6%), epithelial herpetic keratitis (1.9%), anterior uveitis (1.9%), and elevated intraocular pressure (1.9%) occurred in Group 1 only and infective keratitis (0.8%) in Group 2 only. Marked stromal edema and peripheral sterile infiltrates occurred at similar rates in both groups (P = .567 and P = .479, respectively). Grade 1+ corneal haze was significantly high in Group 2. Grade 2+ and 3+ haze was significantly high in Group 1 (P = .001).

CONCLUSIONS

Ocular surface healing disorders were the most common early complications of CXL. Short-term complications were higher with the transepithelial PTK epithelial removal technique than with mechanical epithelial removal.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Polymorphisms in the IL28B gene (rs12979860, rs8099917) and the virological response to pegylated interferon therapy in hepatitis D virus patients

AIM

Few data are available regarding the effects of interleukin 28B (IL28B) polymorphisms in chronic hepatitis D (CHD) patients. This study investigated the relationship between IL28B poly-morphisms and the response of patients with CHD infections to pegylated interferon (PEG-IFN) therapy.

MATERIALS AND METHODS

A total of 101 CHD patients were -selected, 80 of whom (46 males ; median age 41 years) satisfied the inclusion criteria and were enrolled in the study. Thirty-seven patients were treated with peg-IFNα for at least 12 months and were followed for a median of 18 months (range, 12-30 months). The primary treatment endpoint was the suppression of HDV replication, as documented by the loss of detectable HDV RNA in serum. Genotyping was used to analyse the IL28B polymorphisms rs12979860 and rs8099917 according to the virological response.

RESULTS

After treatment, a sustained viral response (SVR) was achieved in 19 (51%) of the patients treated with PEG-INF. The IL28B genotypes in the 80 patients were as follows : CC in 36 (45%), CT in 33 (41%) and TT in 11 (14%) for rs12979860, and GG in 4 (5%), GT in 27 (34%) and TT in 49 (61%) for rs8099917. SVR was achieved in 5 (26%), 10 (53%) and 4 (21%) patients with CC, CT and TT at rs12979860, respectively, and one (5%), nine (47%) and nine (47%) patients with GG, GT and TT at rs8099917, respectively. There were differences in the SVR among genotypes (rs12979860 and rs8099917 ; chi-squared test, p = 0.047).

CONCLUSION

IL28B predicts the PEG-IFN response in patients with CHD infection.

The evaluation of the effects of daytime sleepiness, anxiety and depression on the quality of life in 112 emergency medical staff

Introduction

One hundred and twelve emergency medical staff are faced with many physical and mental problems due to the deterioration of their sleep-wake cycle and getting out of their usual work and social life.

Objectives

The aim of this study was to examine the effects of anxiety, depression, day time sleepiness on the quality of life in 112 emergency medical staff.

Methods

Target population of this cross-sectional study was the 112 emergency medical staff in the province of Rize. We tried to obtain all the universe (n = 154), so the sample was not selected. One hundred and four people (67%) participated in the study. In the data form, Epworth sleepiness scale, Beck Anxiety Inventory, Beck Depression Inventory and the SF-36 quality of life questionnaire were applied.

Results

The prevalence of pathological sleepiness was 14.4% (n = 15), the prevalence of anxiety was 39,8% (n = 41), the prevalence depression was 20,2% (n = 21), respectively (Table 1).

Conclusion

Based on high levels of anxiety and depression that reduces quality of life compared to the general population in 112 emergency services workers, motivational programs, coping strategies, psychological counseling services are required. Also, against the psychosocial risk factors forming anxiety and depression in the working life, organizational measures must be taken.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Validity and Reliability of the Turkish Version of Needs Based Biopsychosocial Distress Instrument for Cancer Patients (CANDI)

Background

Needs based biopsychosocial distress instrument for cancer patients (CANDI) is a scale based on needs arising due to the effects of cancer.

Objectives

The aim of this research was to determine the reliability and validity of the CANDI scale in the Turkish language.

Patients and Methods

The study was performed with the participation of 172 cancer patients aged 18 and over. Factor analysis (principal components analysis) was used to assess construct validity. Criterion validities were tested by computing Spearman correlation between CANDI and hospital anxiety depression scale (HADS), and brief symptom inventory (BSI) (convergent validity) and quality of life scales (FACT-G) (divergent validity). Test-retest reliabilities and internal consistencies were measured with intraclass correlation (ICC) and Cronbach-α.

Results

A three-factor solution (emotional, physical and social) was found with factor analysis. Internal reliability (α = 0.94) and test-retest reliability (ICC = 0.87) were significantly high. Correlations between CANDI and HADS (rs = 0.67), and BSI (rs = 0.69) and FACT-G (rs = -0.76) were moderate and significant in the expected direction.

Conclusions

CANDI is a valid and reliable scale in cancer patients with a three-factor structure (emotional, physical and social) in the Turkish language.

Are the last grade medical students aware of the danger of synthetic cannabinoids?

Synthetic cannabinoids are drugs which are increasingly used by especially adolescents and young people. In recent years hospital admissions even concluding with deaths have been observed. Therefore, the awareness of medical students, who will be in challenge with this new drug abuse, is an important issue. The aim of this study is to figure out the awareness of the last grade medical students and its correlates. This is a questionnaire based descriptive study with the participation of 148 students at Karadeniz Technical University Medical Faculty, Turkey. An awareness score was produced to measure awareness (cronbach alpha = 0.67). The 17.6% (26/148) of students who reported not knowing what synthetic cannabinoids were and hearing the name for the first time in this study. The 16.4% of students assumed that synthetic cannabinoid use was legal, and 16.2% assumed that synthetic cannabinoids are not drugs. The internet (including social media) (48.6%) and pharmacology lectures (40.5%) were identified as the most stated sources of information. The students who have synthetic cannabinoid user friends and social media account have significantly higher awareness scores (p < 0.05 for both). Last grade medical students have a lack of awareness towards synthetic cannabinoids which is an increasing threat that they have to challenge.

Comparison of colorectal neoplastic polyps and adenocarcinoma with regard to NLR and PLR

OBJECTIVE

Cancer-related inflammation affects many aspects of malignancy, including proliferation and survival of malignant cells, angiogenesis, and therapeutic response. Some biomarkers representing the degree of systemic inflammation, such as the Glasgow prognostic score, NLR and PLR, have been shown to have prognostic value in many kinds of cancer patients. Aim of this study to investigate to compare neutrophil/leukocyte (NLR) and platelet/lymphocyte (PLR) ratios of the patients with colorectal neoplastic polyps and colorectal cancer (CRC) and tried to determine whether this could be used as a biomarker in follow up of the patients with neoplastic polyps.

PATIENTS AND METHODS

A total of 100 colorectal polyps, 113 colorectal cancers and 124 healthy controls were included in the study. Exculusion criteria were endocrinologic or metabolic diseases, acute or chronic diseases, hypertension and atherosclerotic heart diseases, renal diseases. Blood count parameters of the patients were measured. The NLR was calculated as a simple ratio between the absolute neutrophil and the absolute lymphocyte counts. The PLR was defined as the platelet counts to lymphocyte ratio.

RESULTS

A statistically significant difference was not detected between Group A and C with regard to NLR and PLR. NLR and PLR were found statistically significantly high in Group B (CRC), Group A (colorectal polyp) and Group C (healthy individuals) (p < 0.001 and p < 0.001). Our study showed that the optimum NLR cut-off point for neoplastic polyps was 2.28 (sensitivity: 68.7%, specificity: 42.3%). When the sensitivity and specificity levels of the PLR were assessed, they were 68.7% and 46.5% for neoplastic polyps, 80% and 68.9% for colorectal cancer.

CONCLUSIONS

NLR and PLR may be used for follow up conversion of colonic and rectal neoplastic polyps to invasive tumor.

Chronic hepatitis B associated with hepatic steatosis, insulin resistance, necroinflammation and fibrosis

BACKGROUND

The effect of hepatitis B virus (HBV) infection on fatty liver disease is unclear.

OBJECTIVES

The aim of this study was to investigate the viral and host causes of fatty liver in chronic hepatitis B (CHB) patients. This study included 88 CHB patients of which 17 were not treated. Liver biopsy was performed in each patient. Group 1 included those with hepatic steatosis (n=28) and group 2 those without hepatic steatosis. The groups were compared in terms of age, body mass index (BMI), Homeostasis Model Assessment- Insulin Resistance (HOMA-IR), viral load, biochemical parameters and histological findings. Patients in group 1 were subdivided according to the degree of steatosis as follows: grade 1 (15 patients, 53.6%), grade 2 (6 patients, 21.4%), and grade 3 (7 patients, 25%).

RESULTS

In group 1 (n=28), mean age, BMI, cholesterol, and HOMA-IR were found to be significantly higher than in group 2 (n=60). There were no significant differences in the positivity of viral load, HbeAg, treatment, fibrosis and other laboratory parameters between the two groups. HOMA-IR was the only independent predictive factor of liver steatosis in patients with CHB in logistic regression analysis.

CONCLUSION

Hepatic steatosis in CHB patients was associated with host metabolic factors.

Prevalence of gestational diabetes mellitus and associated risk factors in Turkish women: the Trabzon GDM Study

INTRODUCTION

The aim of this study was to investigate the prevalence of gestational diabetes mellitus (GDM) in Turkish pregnant women in the Trabzon Region and further to identify population-specific risk factors for GDM.

MATERIAL AND METHODS

In this prospective cross-sectional survey, universal screening for GDM was performed in 815 pregnant women. Screening was done with a 50-g oral glucose challenge test (GCT) with a 140 mg/dl cut-off point, then a diagnostic 100 g oral glucose tolerance test (OGTT) was performed according to Carpenter and Coustan (CC) criteria.

RESULTS

The GCT was positive in 182 (22.3%) cases. The OGTT was performed on the 182 screen-positive pregnant women. Thirty-five were diagnosed with GDM on the basis of their results for a prevalence of 4.3% (35/815). Of the pregnancies with negative GCT but having high risk factors for GDM (n = 31), 4 were diagnosed with GDM (0.5%). Prevalence of GDM was found to be 4.8% (n = 39) for all pregnant women. Gestational diabetes mellitus was positively associated with advanced maternal age (p < 0.001), prepregnancy body mass index (p < 0.001), cessation of cigarette smoking (p < 0.001), excessive weight gain during pregnancy (p = 0.003), previous history of GDM (p < 0.001), history of selected medical conditions (p = 0.018), family history of diabetes (FHD) (p < 0.001), and existence of at least one high risk factor for GDM (p < 0.001). In multiple logistic regression analysis, independent predictors for GDM were maternal age, cessation of cigarette smoking, increasing prepregnancy body mass index, weight gain of more than 8 kg during pregnancy, GDM history in previous pregnancies and a history of diabetes in first-degree relatives of pregnant women.

CONCLUSIONS

The prevalence of GDM in Trabzon province was found as moderate. Commonly recognized risk factors including older age, prepregnancy obesity, FHD and past history of GDM, are valid for our urban Turkish population. Also, excessive weight gain in pregnancy and cigarette cessation were observed to be nontradional risk factors of GDM. It was concluded that all pregnant women should be screened for GDM if prevalence was not low.