Bleaching versus color change resistant adhesive in the discoloration of bracket-bonded tooth surfaces: an in vitro study

OBJECTIVES

The aim of this study was to compare the effect of office bleaching of teeth bonded with Transbond XTTM (3M Unitek, Monrovia, CA, USA) (TRXT) and the use of color change resistant Orthocem (FGM, Joinville, Brazil) in bracket bonding on coffee-induced enamel discoloration.

MATERIALS AND METHODS

Eighty premolars were distributed in equal numbers (n = 20) to group 1 (TRXT + distilled water), group 2 (TRXT + coffee solution), group 3 (TRXT + coffee solution + bleaching), and group 4 (Orthocem + coffee solution). Color was measured using a SpectroShade Micro (MHT, International, Verona, Italy) device at the beginning (T0), after coloring (T1), after bleaching (T1B), and after debonding (T2). ΔE color change values were calculated as T1-T0, T1B-T0 and T2-T0 differences. The conformity of the data to the normal distribution was examined with the Shapiro-Wilk test. Multiple comparisons were made with Tamhane's T2 test and Tukey's HSD test using one-way analysis of variance in the comparison of normally distributed data, and multiple comparisons were made with Dunn's test using the Kruskal-Wallis H test for comparison of non-normally distributed data. The significance level was set at p < 0.050.

RESULTS

A statistically significant (p < 0.001) difference was found between the T1-T0 and T2-T0 stages for group 1-4 ΔE values. A statistically significant (p < 0.001) difference was also found when the T1B-T0 ΔE values of group 3 were compared with the T1-T0 ΔE values of groups 1, 2, and 4.

CONCLUSIONS

After coffee-induced enamel discoloration, bleaching of teeth bonded with TRXT produced acceptable color difference of the incisal, middle, and gingival regions of the crown. In teeth bonded with Orthocem, acceptable color difference was seen only in the middle of the crown.

CLINICAL RELEVANCE

The presented study will guide the clinician on how enamel discoloration side effect of fixed orthodontic appliance can reduce.

Bonded lingual retainer adhesives and discoloration : An in vitro study

PURPOSE

This in vitro study was conducted to compare the discoloration of a flowable self-adhesive composite, a highly filled composite adhesive, and a liquid polish applied highly filled composite adhesive for bonded lingual retainers.

METHODS

Thirty composite discs were fabricated and divided into three groups: group 1, flowable self-adhesive (GC Ortho Connect™ Flow [GCO], GC Orthodontics, Tokyo, Japan); group 2, highly filled composite adhesive (Transbond™ LR [TLR], 3M Unitek, Monrovia, CA, USA); and group 3, highly filled composite adhesive with liquid polish (TLR and BisCover LV™ [TLRB], BISCO Inc, Schaumburg, IL, USA). L*a*b* values were measured by spectrophotometer prior to (T0) and following (T1) immersion in coffee. T1 - T0 differences were calculated as ∆L*, ∆a*, ∆b*, and ∆E*ab values. The Shapiro-Wilk test was performed to determine whether the data were normally distributed. The values that did not fit the normal distribution were evaluated with the Kruskal-Wallis one-way analysis of variance (ANOVA), and Dunn's test was used for multiple comparisons. The level of significance was p < 0.05.

RESULTS

The difference between the TLR and TLRB groups was statistically significant for ∆E*ab (P = 0.007). ∆E*ab value of TLR group was greater than ∆E*ab value of TLRB group. The differences between the GCO and TLR groups (p = 0.001) and the TLR and TLRB groups (p = 0.010) were statistically significant for ∆a*. ∆a* values of GCO and TLRB groups were greater than ∆a* value of TLR group. The difference between the TLR and TLRB groups was statistically significant (p = 0.003) for ∆b*. ∆b* value of TLR group was greater than ∆b* value of TLRB group.

CONCLUSIONS

Using a Transbond LR polished with BisCover LV or only GC Ortho Connect Flow for lingual retainer bonding reduces coffee-induced discoloration.

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

AB1301 DETERMINING THE RELATIONSHIP BETWEEN SERUM INTERLEUKIN 33 LEVELS AND CLINICAL FEATURES OF THE DISEASE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background

Familial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by recurrent fever, serositis, arthritis and erysipelas-like erythema caused by mutations over activating caspase-1. As Interleukin (IL)-1 beta, IL-33 is a nuclear cytokine from IL-1 family which is activated by caspase-1. IL-33 is known to take part in pathogenesis of several rheumatic diseases.

Objectives

The aim of this research is determining the relationship between serum IL-33 levels and clinical features of the disease in patients with FMF disease.

Methods

The research involved 54 FMF patients and 29 healthy volunteers. Serum IL-33 levels were evaluated in both patients and healthy individuals, and its relationship between clinical and laboratory features of FMF.

Results

28 out of 54 patients (%51.8) had favorable response to colchicine while 26 patients (%48.2) had colchicine resistant disease. FMF patients had lower IL-33 levels compared to healthy control group (p= 0.06). There were no difference between colchicine responsive and resistant patients (p=0.12) and no association was found between clinical features and serum IL-33 levels. Additionally, IL-33 did not correlated with C-reactive protein and disease activity assessed by autoinflammatory disease activity index.

Conclusion

No association was found between serum IL-33 levels and FMF disease features and laboratory findings. This may be due to the small size of our patient group, the involvement of IL-33 in tissue homeostasis as well as inflammation, and the use of higher doses of colchicine in the resistant disease group than in the remission group. Additional research is needed to determine IL-33’s role in FMF pathogenesis and its relationship with clinical and laboratory features.

References

[1]Ozdogan, H. and S. Ugurlu, Familial Mediterranean Fever. Presse Med, 2019. 48(1 Pt 2): p. e61-e76.

[2]Cayrol, C. and J.P. Girard, Interleukin-33 (IL-33): A nuclear cytokine from the IL-1 family. Immunol Rev, 2018. 281(1): p. 154-168.

[3]Duan, L., et al., The role of IL-33 in rheumatic diseases. Clin Dev Immunol, 2013. 2013: p. 924363.

Acknowledgements

None of the authors obtained any financial support.

Disclosure of Interests

None declared

AB1302 EVALUATING THE CLINICAL UTILITY OF PATIENT ACCEPTABLE SYMPTOM STATE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background

Familial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of fever, serositis, arthritis and erysipelas-like erythema. Patient acceptable symptom state (PASS) is a disease evaluation method to assess disease activity with a simple question especially in rheumatic diseases.

Objectives

We aimed to investigate clinical utility of PASS in FMF patients.

Methods

The research involved 54 FMF patients. Patient acceptable symptom state was applied to all patients in the study. The answers to PASS were compared with the patients clinical and laboratory features.

Results

28 out of 54 patients (51.8%) were colchicine responsive whereas, 26 patients (48.2%) had colchicine resistant disease. The number of patients who answered yes to PASS (I’m happy with my current disease condition) was 32 (59%), while answered no (I need further treatment options) was 22 (41%). Considering the disease severity assessed with International severity scoring FMF (ISSF) of those who answered yes, 22 (68%) patients had mild disease, 10 patients had moderate (32%) disease, and there was no patient with severe disease in this group. Among those who answered no, 3 (14%) had mild disease, 14 (63%) had moderate disease, and 5 (23%) had severe disease (p <0.001). When the CRP levels of the patients were compared, the median CRP value of those who answered yes was found to be 4.45 mg/L, and the median value of CRP for those who answered no was 11.25 mg/L (p= 0.04).

Sensitivity and specificity of PASS for detecting patients in remission was 78% and 61% respectively. Moreover, PASS had a positive and negative predictive value of %68 and %72 respectively, for determining patients in remission. If cut off level of CRP was chosen as 6.5 mg/L for answering “yes” to PASS, sensitivity of test has been found to be 62.5% while the specificity is 59.1%. On the other hand, if cut off level of CRP is selected as 9.35 mg/L; sensitivity and specificity of the test was found as 75% and 72.7% respectively (p=0.045).

Conclusion

Patient acceptable symptom state is found beneficial in evulation these patients simply and swiftly especially in terms of distinguishing severe FMF disease. In FMF, laboratory remission is as important as clinical remission, therefore, PASS by alone, is not sufficient for making treatment decisions and should be supported by inflammatory markers.

References

[1]Ozdogan, H. and S. Ugurlu, Familial Mediterranean Fever. Presse Med, 2019. 48(1 Pt 2): p. e61-e76.

[2]Lubrano, E., et al., Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices. RMD Open, 2020. 6(1).

[3]Salaffi, F., et al., Patient Acceptable Symptom State in Self-Report Questionnaires and Composite Clinical Disease Index for Assessing Rheumatoid Arthritis Activity: Identification of Cut-Off Points for Routine Care. Biomed Res Int, 2015. 2015: p. 930756.

[4]Maksymowych, W.P., et al., Evaluation and validation of the patient acceptable symptom state (PASS) in patients with ankylosing spondylitis. Arthritis Rheum, 2007. 57(1): p. 133-9.

Acknowledgements

None of authors obtained any financial support

Disclosure of Interests

None declared

POS0940 THE IMPACT OF TUMOUR NECROSIS FACTOR-ALPHA INHIBITOR TREATMENT ON WNT SIGNALING INHIBITORS, NOGGIN AND CYTOKINE LEVELS IN AXIAL SPONDYLOARTHRITIS

Background:

Axial spondyloarthritis (axSpA) is a common chronic inflammatory disease of the axial skeleton. Some cytokines have important roles in initiation and progression of disease and are elevated in active disease. Additionally, Wnt signaling pathway inhibitors and noggin also appear to be involved in pathogenesis of ankylosing spondylitis. Anti-tumor necrosis factor-alpha (TNF) agents have dramatically improved the clinical outcome of axSpa; however, acceptable clinical improvement is not achieved in all patients and capacity of anti-TNF to slow or prevent structural damage still remains controversial.

Objectives:

To evaluate the effect of anti-TNF on inflammatory and noninflammatory milieu in patients with axSpA.

Methods:

In this prospective study we included 30 biologic treatment naive adult patients with axSpA and 30 healthy controls. All patients with high disease activity were treated with anti-TNF therapy for 6 months. Laboratory and clinical evaluation of all patients were performed at baseline and after 6 months of anti-TNF treatment. Following cytokines and wnt/BMP antagonists were measured; TNF-Alpha, COX-2, IL-6, IL-17, IL-22, IL-23, IL-33, dickkopf-1, sclerostin, noggin.

Results:

The mean age of patients with axSpA and healthy controls were 38.1±13.3 and 37.7±7.7 years, respectively (p>0.005). At baseline, the median (IQR) TNF-alpha was higher in axSpA patients when compared to healthy controls, 34.4 pg/ml (31.4-37.03) vs 18.1 pg/ml (12.1-28.4), (p<0.001), while the median (IQR) dickkopf-1 and sclerostin were lower in axSpA patients, 446.7 pg/ml (356.9-529.3) vs 1088.7 pg/ml (951.7-1244.4), (p<0.001) and 312.4 pg/ml (140.8-412.7) vs 412.3 pg/ml (295.4-512.8), (p<0.001), respectively. IL-17, IL-22, IL-33, dickkopf-1 and sclerostin increased with anti-TNF treatment (table 1).

Conclusion:

Elevation of some cytokines which are important in pathogenesis of axSpA and nonincrease in noggin with anti-TNF drugs may affect effectiveness of anti-TNF treatment.

Table 1.

Changes of cytokines, dickkopf-1, sclerostin and noggin with anti-TNF treatment.

Pre-Anti-TNFPost-Anti-TNFP valueIL-645(39.1-68.8)47.6(27.3-61.1)0.750IL-1793.3 (85.1-104.8)102.1(86.6-114.6)0.026IL-22159,2 (151,9-178.4)183.5(156.3-304.6)0.033IL-2336.5 (26.1-52.9)41.3(28.4-55.5)0.658IL-33127.8 (106.6-186.1)147.06(128.5-213.4)0.016COX20.176 (0-0.374)0.202(0.051-1.151)0.469TNFalpha34.4(31.4-37.03)30.7(12.8-35.6)0.004Dickkopf-1446.7(356.9-529.3)881.3(663.1-972.2)<0.001Sclerostin312.4 (140.8-412.7)405.1(276.3-452.5)0.018Noggin48.3(17.04-153.9)31.2(11.3-103.7)0.264

Disclosure of Interests:

None declared

AB0300 LUPUS DISEASE ACTIVITY CORRELATES WITH QUALITY OF LIFE BUT NOT WITH HEALTH LITERACY STATUS

Background:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown etiology that can affect any organ of the body. SLE is associated with adverse effects on both health and non-health-related quality of life (HRQOL and non-HRQOL). Lupus PRO is a patient reported outcome measure that has been validated in many languages. It has 44 items that cover both HRQOL and non-HRQOL (1). Health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. Multiple studies indicate that people with limited health literacy have worse health status and higher rates of hospitalization (2).

Objectives:

We aimed to evaluate the relationship between the LLDAS (Lupus Low Disease Activity State) criteria and the Lupus PRO test, as well as the health literacy status of lupus patients.

Methods:

83 SLE patients (94% women) were included in the study. We performed Lupus PRO and the European Health Literacy Survey tests during the routine follow-up visits of lupus patients to our rheumatology outpatient clinic and admissions to rheumatology inpatient clinic. Available clinical data on medical records were obtained, physician global assessments (PGA) were recorded by the attending physician.

Results:

LLDAS criteria strongly and inversely correlated with the total score, as well as the mood subunit of the Lupus PRO. Similarly, it also significantly inversely correlated with the body appearence and goals subunits. Health literacy status of the patients did not correlate with their LLDAS scores, ie their disease activities.

Conclusion:

Our results suggest that lupus disease activity, assessed by LLDAS criteria, significantly correlates with measures of quality of life, spesicifically Lupus PRO test, but not with health literacy status. Further studies are needed to evaluate if health literacy is related with damage, hospitalization or mortality associated with lupus.

References:

[1]Jolly M, Pickard AS, Block JA, Kumar RB, Mikolaitis RA, Wilke CT, et al., editors. Disease-specific patient reported outcome tools for systemic lupus erythematosus. Seminars in arthritis and rheumatism; 2012: Elsevier.

[2]Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. Journal of general internal medicine. 2005;20(2):175-84.

Disclosure of Interests:

None declared

AB0097 DIAGNOSTIC ACCURACY OF SERUM MARKERS IN LARGE VESSEL VASCULITIS AND CORRELATION WITH PET IMAGING

Background:

The onset of symptoms in large-vessel vasculitis (LVV) tends to be subacute, which often leads to a delay in diagnosis, during which time vascular disease may start and progress to become symptomatic. PET/CT has been recognised since the 2003s as a promising tool in evaluating of LVV. There is no gold standard diagnostic laboratory tests for this patient group, novel markers for active LVV is needed.

Objectives:

to investigate the association between vascular inflammation, as detected by PET imaging and interleukin-6 (IL-6), pentraxin3 (PTX3), and B-cell-activating-factor (BAFF) in subjects with LVV.

Methods:

The study included 67 patients patients with newly diagnosed GCA (n= 27) or TA (n=9) and healthy control (n= 31) who had been referred to the Rheumatology Unit at Gazi University, between December 2017 and August 2020. PET images obtained from an 29 patients (22 with GCA and 7 with TA) who had not received any corticosteroid treatment prior to PET imaging and blood sampling. IL-6, PTX3, and BAFF levels were determined quantitatively by enzyme-linked immunosorbent assay (ELISA) kits.

Results:

36 patients with LVV (20 females,16 males; age 64,5±16,6) and 31 HC (14 females,17 males; age37,1±9,6) were analysed. Serum levels of IL-6,PTX3, BAFF, ESR and CRP are increased in patients with newly diagnosed LVV compared with those in control subjects. In a ROC analysis, serum IL-6 provided excellent discrimination of newly diagnosed LVV patients from HC, as indicated by AUCs>0.90. Serum BAFF also accurately distinguished newly diagnosed LVV patients from HC with AUCs>0.80. Serum PTX3 did not provide an AUC>0.80. In this study, we correlate vascular inflammation, as detected by PET imaging in newly diagnosed LVV patients, with the ESR, CRP. PTX3, IL-6 and BAFF. As a result, none of these markers has been associated with vascular inflammation as measured using PET.

Conclusion:

In conclusion, our study shows that serum levels of PTX3, IL-6 and BAFF are increased in most LVV patients. The diagnostic value of BAFF and IL-6, both separately and in combination, should be further evaluated in larger cohorts of LVV patients, as well as in patients with infections or other inflammatory conditions. However, none of these markers has been associated with vascular inflammation as measured using PET.

Disclosure of Interests:

None declared

POS1193 CLINICAL FEATURES AND THE COURSE OF COVID-19 IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER

Background:

The novel coronavirus 2019 (COVID-19) has a wide range of clinical presentation from asymptomatic or mild viral infection to severe life-threating complications, including acute respiratory distress syndrome (ARDS), which develop as a result of immune system dysregulation, exaggerated immune response, and cytokine release syndrome [1]. Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disorder characterized by dysfunction of the innate immune system and excessive production of proinflammatory cytokines, including interleukin (IL)-1β, IL-6, interferon-gamma, and tumor necrosis factor-alpha, all of which have increased in severe cases in COVID-19 [1-3].

Objectives:

The aim of this study is to report clinical characteristics and outcome of FMF patients with COVID-19.

Methods:

This study included 48 consecutive FMF patients who were diagnosed COVID-19 by SARS-CoV-2 nucleic acid RT-PCR in nasopharyngeal swab or sputum, or symptoms and computed tomography findings suggestive for COVID-19. Data on demographic and clinical characteristics of FMF disease, clinical course and outcome of COVID-19 were evaluated.

Results:

The median age of patients was 35.5 (29-43.5) years, ranging from 18 to 87 years. The median disease duration of FMF was 10 (6-16) years. The most common presenting symptoms and signs of patients during attacks were peritonitis (85.5%), fever (81.3%), and pleuritis (48%). Twelve (25%) patients had amyloidosis. Comorbidities were present in half of patients with ankylosing spondylitis (21%) and hypertension (17%) being the most frequently seen. Two-third of patients (66%) were in remission for FMF. The median dosage of colchicine treatment for FMF was 1.5 (IQR 1) mg/day. 90% of patients continued colchicine treatment for FMF during the COVID-19 course. The baseline characteristics and treatment modalities of patients were demonstrated in Table 1. Forty-six patients presented with at least one COVID-19 symptoms. Fever (73%), myalgia/arthralgia (69%), and cough (60%) were the most common symptoms. 16 patients were admitted at hospital, 5 of them required oxygen therapy and 2 patients with amyloidosis developed ARDS and went to intensive care unit (ICU) for invasive mechanical ventilation (IMV). One patient who had been followed-up at ICU died.

Conclusion:

Our FMF patients with COVID-19 have similar clinical features and outcomes as general population. Dysregulation of innate immune system in FMF might not be risk factors for COVID-19. Besides, colchicine and IL-1 inhibitors intake might have protective and preventive effects on COVID-19 progression.

Table 1.

Baseline characteristics, treatment modalities and outcome of patients

Age years, median (IQR)39.4 (15)Gender (F/M)25/23FMF Disease duration, years, median (IQR)10 (10)Mutations*Monoallelic mutation, n (%)6 (14)Biallelic mutation, n (%)34 (81)Homozygous M694V mutation18 (43)Heterozygous M694V mutation15 (36)Comorbidities, n (%)24 (50)FMF treatmentColchicine 1 mg/day, n (%)17 (35.5)Colchicine 1.5 mg/day, n (%)18 (37.5)Colchicine 2 mg/day, n (%)13 (27) Anakinra, n (%)12 (25)Canakinumab, n (%)3 (6.3)Positive SARS-Cov-2 RT-PCR, n (%)42 (87.5)Interstitial pneumonia in CT scan, n (%)15 (31.3)COVID-19 treatment, n (%)46 (95.8)Outpatient treatment, n (%)32 (66.7)Hospitalized, not required supplemental oxygen, n (%)9 (18.8)Hospitalized, required supplemental oxygen, n (%)5 (10.4)ICU, required IMV, n (%)2 (4.2)OutcomeRecovered, n (%)47 (98)Deceased, n (%)1 (2)Complications, n (%)3 (6.3)

*42 patients were included in the analysis

References:

[1]Tufan A, Avanoğlu Güler A, Matucci-Cerinic M. COVID-19, immune system response, hyperinflammation and repurposing antirheumatic drugs. Turkish journal of medical sciences. 2020;50:620-632.

[2]Hausmann JS. Targeting cytokines to treat autoinflammatory diseases. Clinical immunology (Orlando, Fla.). 2019;206:23-32.

[3]Tufan A, Lachmann HJ. Familial Mediterranean fever, from pathogenesis to treatment: a contemporary review. Turkish journal of medical sciences. 2020;50:1591-1610.

Disclosure of Interests:

None declared.

Knowledge levels and attitudes of adult individuals about cancer and its risk factors

Background

Cancer maintains its importance as a major public health issue in the world and developing countries such as Turkey. Determining individuals' knowledge and attitudes about cancer is very important for cancer prevention. Research on knowledge and attitudes plays an important role in the development of targeted policies in the fight against cancer.

Aims

The aim of this study was to determine the knowledge and attitudes of adult individuals about cancer and its risk factors.

Methods

The study was conducted descriptively in the city center of Trabzon. The study population and sample consisted of 105.071 and 1200 adults aged 40 and over living in the city center, respectively. For the sample selection, multistage randomized sampling method was used. The data were collected using a questionnaire, which was developed by the researchers after reviewing the literature and receiving expert opinions. The findings were presented as descriptive statistics with numbers, percentages, and averages.

Results

It was found that 45.7% of the participants smoked, 9.1% consumed alcohol, 40.8% consumed acidic foods, 33.0% had family history of cancer in first degree relatives, and 28.5% had cancer-related death in first degree relatives. The participants stated that cancer was the most fatal disease and listed the first three cancer-causing factors as cigarettes (95.7%), mobile phones (90.4%) and alcohol (90.2%). 62.4% of them did not know the symptoms of cancer, and 86.4% and 76.4% believed that 'sadness and stress cause cancer' and 'cancer is inherited', respectively.

Conclusion

The study revealed that adult individuals had a significant level of false and incomplete information about cancer, and their behaviors having risk factors for cancer could not be altered and transformed into appropriate ones. Therefore, it is thought that informative studies on cancer should be carried out continuously to carry out the fight against cancer successfully.

AB1065 VISIT COMPLIANCE IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER: RESULTS FROM A GAZI UNIVERSITY FMF COHORT

Background:

Follow-up in all rheumatologic patients is critical, particularly Familial Mediterranean Fever (FMF). Current recommendations for all experts by the EULAR state that patients with FMF should be evaluated 6-monthly intervals to monitore the character and frequency of the attacks and the acute phase response. Disease-related complications such as amyloidosis can beasymptomaticand need only a careful follow-up.

Objectives:

to quantify this phenomenon and to find predictive factors of visit compliance in patients with FMF.

Methods:

The study included 474 adult patients with a diagnosis of FMF who followed at the outpatient rheumatology clinic of tertiary university hospital, from January 2018 to December 2018. . Demographic, socioeconomic data, familiy history, comorbid disease, medication history, characteristics, the International Severity Score for FMF (ISSF),autoinflammatory disease damage index (ADDI) were recorded. Visit compliance was defined as the presence of two visits in the outpatient rheumatology clinic for FMF last one year for the purposes set out in EULAR suggestion.Those who had fewer than two visits in the last one year were considered noncompliant.

Results:

230 (48.5%) were compliant while 244 (51.5 %) patients were noncompliant with their rheumatology visit. Both compliant and noncompliant patients had similar median age and disease duration. Female sex and being married was increased the visit compliance.The results of the logistic regression model exploring factors associated with compliance indicated that presence of family history in parents, absence of family history in sibling, treatment with biologic agents, other drug using,presence of more than 2 attacks except fever and adequate medical care were important predictors of visit compliance.

Conclusion:

In conclusion, if FMF patients visit compliance increase, their functionality, medication adherence and quality of life will increase and flares and complication of disease can decrease. Thus, we highlight some recommendations for FMF specialist, patients and health care providers to improve outcomes.

Table 2.

Multivariate logistic regression analysis for predictive factors of visit compliance of the patients with FMF, n=430

Adj. OR%95 CI**pFamily history in parents(positive history vs negative)1,81,0-3,10.03Family history in sibling(negative history vs positive)1,91,2-3,10.004Comorbid disease status1,30,7-2,50.32Treatment(anakinra&canakinumab vs colchicine)3,71,7-8,20.001Drug using(other drugs vs FMF drugs)2,21,1-4,40.01More than 2 attacks except fever2,31,2-4,00.004Chronic peripheral arthritis2,30,8-6,60.10Proteinuria2,20,7-6,70.14Adequate medical care1,91,2-3,10.003Number of index flare within last 12-month0,90,9-1,00.38ISSF severity score0,80,7-1,10,30

Disclosure of Interests:

None declared

AB0548 ASSESMENT OF THE PHYSICAL ACTIVITY IN SYSTEMIC SCLEROSIS PATIENTS BY USING COMMERCIAL SMART BANDS AND ITS ASSOCIATION WITH DISEASE CHARACTERISTICS: A PILOT STUDY

Background:

Systemic sclerosis (SSc) is a complex disease, characterized by multi-system organ involvement including interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). The decrease in physical activity in SSc patients with lung involvement has been demonstrated by self-reported physical capacity and 6 min-walking test (6MWT) (1, 2). Commercial smart bands can provide data on daily physical activity, sleep characteristics, blood oxygen concentration and heart rate measurement, therefore may aid in monitoring disease activity.

Objectives:

The aim of this study is to evaluate physical activity in SSc patients by using a commercial smart band and investigate its association with clinical characteristics and patient-reported outcome measures of disease activity

Methods:

This prospective observational study included SSc patients with having a smartphone. Patients characteristics including age, sex, and organ involvements were recorded. Each participant was subjected to pulmonary function tests and 6MWT. All of patients answered Scleroderma Health Assessment Questionnaire (SHAQ, consisting of HAQ-Disability Index (DI) and visual analog scales (VAS) domains). All patients received Fitbit inspire HR smart band® which records the number of steps, heart rate, distance and was instructed to wear it continuously for one week. Tracked data was collected from smartphones via Fitbit application.

Results:

Fifteen SSc patients (14 females and 1 male) participated in the study, 8 (53.3%) had limited SSc and 7 (46.7) had diffuse SSc. The mean age was 48.5±15.5 and the median disease duration was 4 (min-max:1-9) years. Eleven (73.3%) patients had ILD and one patient had PAH. Musculoskeletal complaints were evident in two patients. Forced vital capacity (FVC, % predicted), diffusion capacity of lung for carbon monoxide (DLCO, %) in patients with ILD were significantly lower than patients without ILD median (IQR) 102 (30) vs 80 (27) p= 0.026, 57 (20) vs 95 (13), p= 0.002, respectively. The median distance of 6MWTs were 450 (225) vs 568 (102) in ILD and non-ILD groups. The median total weekly step counts of ILD patients were remarkably lower in ILD patients compared to non-ILD 36.137 (17.879) vs 58.114 (80.681) steps/week, (p= 0.01). Patients with ILD had a bit higher median heart rate compared to non-ILD, 73 (9) vs 67.5 (12). The total weekly step counts were correlated with pulmonary function tests, including forced expiratory volume in one second (FEV1%) (r= 0.57, p= 0.025), FVC (%) (r= 0.65, p= 0.009), and DLCO (%) (r= 0.70, p= 0.005), patient-reported disease severity (r=-0.66, p= 0.007), and breathing problem (r= -0.55, p= 0.03) domains of SHAQ. There was no correlation between weekly step counts and 6MWT

Conclusion:

The assessment of physical activity with smart activity bands may help to identify SSc patients with ILD. Tracked physical activity using smart bands correlates with pulmonary function tests and performs better than 6MWT, suggesting it as a useful tool for the assessment of disease activity.

References:

[1]Battaglia S, Bellia M, Serafino-Agrusa L, Giardina A, Messina M, Cannizzaro F, et al. Physical capacity in performing daily activities is reduced in scleroderma patients with early lung involvement.Clin Respir J(2017) 11(1):36-42.

[2]Mainguy V, Provencher S, Maltais F, Malenfant S, Saey D. Assessment of daily life physical activities in pulmonary arterial hypertension.PLoS One(2011) 6(11):e27993.

Disclosure of Interests:

None declared

AB1013 CYCLOPHOSPHAMIDE VS AZATHIOPRINE FOR THE TREATMENT OF CONNECTIVE TISSUE RELATED INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) is a common morbidity and mortalitiy reason for connective tissue disorders (CTD). Data related to treatment options in the literature is limited

Objectives:

To describe the role of azathiopurine (AZA) in the first line treatment of connective tissue disease related interstitial lung disease CTD-ILD, comparing with cyclophosphamide (CYC)

Methods:

Between 2009 and 2019 all interstitial lung disease patients admitting rheumatology or pulmonology department were retrospectively evaluated. Among those patients,as an first line regimen treated with either azathiopurine or cyclophospamide were included. Primary end point was FVC percentage change at 6th month.

Results:

Among 328 CTD-ILD, 57 patients had AZA treat and 79 patients had CYC for the first line treatment. Patients treated with AZA tend to have limited disease and older age. CYC treatment had a mean of 2,41% increase in FVC but in AZA -1,44% decrease in FVC predicted (p:0,041) 5 major CTD groups were defined (systemic sclerosis (SSc), rheumatoid arthritis (RA), primer sjögren syndrome (pSS), dermatomyositis/ polimyositis (PM/DM), autoimmune features of intestitial lung disease (IPAF)). AZA had similar efficacy in, PM/DM and IPAF groups but worse outcome in SSc, RA and pSS compared to CYC.

Conclusion:

AZA treatment might be an option patients with limited disease extent and the diagnosis of PM/DM or IPAF. CYC was a better treatment in SSc, RA and pSS patients

References:

[1]Kocheril, S.V., et al.,Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.Arthritis Care & Research: Official Journal of the American College of Rheumatology, 2005.53(4): p. 549-557.

Table 1.

CYC: treatment responses of cyclophosphamide and azathiopurine regimens AZA: azathiopurine CYC: cyclophosphamide, AZA: azathiopurine CTD: connective tissue disease, SSc:Systemic Sclerosis, RA: Rheumatoid Arthritis, pSS: primary sjogren syndrome, DM/PM/ASS: Dermatomyositis / Polimyositis/Antisynthetase Syndrome, IPAF: Idiopahtic interstital fibrosis with autoimmune feautres, FVC: forced vital capacity

AZA(n:43)CYC (n:72)pProgression(overall)39,3%15,3%0,013SSc (n:47)60%11,9%0,029RA(n:16)62,5%25%>0,05pSS(n:16)71,4%11,1%0,035DM/PM/ASS(n:14)11,1%->0,05IPAF(n:20)28,6%23,1%>0,05FVC change (overall) (lt)-,129±0,7410,024±0,2490,189SSc (n:47)-0,086±1810,025±0,3510,286RA(n:16)-0,553±1,521-022±0,2620,341pSS(n:16)-0,328±0,2420,014±0,3130,167DM/PM/ASS(n:14)-0,0089±0,3700,120±0,0370,316IPAF(n:20)0,123±0,3200,120±0,1010,981FVC change (overall) (%)-1,44±10,652,41±7,550,041SSc (n:47)-3,00±3,672,23±8,270,031RA(n:16)-3,50±9,65-1,75±4,650,654pSS(n:16)-6,71±15,973,33±8,350,027DM/PM/ASS(n:14)0,00±11,854,40±2,700,313IPAF(n:20)2,06±9,045,28±6,700,380

Disclosure of Interests:

None declared

FRI0109 TEMPORAL CHANGES IN LUNG NODULES DETECTED IN INDIVIDUALS WITH RHEUMATOID ARTHRITIS WITH BIOLOGIC DMARD TREATMENTS

Background:

Lung nodules in rheumatoid arthritis (RA), patients impose diagnostic and therapeutic challenges due to unpredictable outcome of these nodules. biologic (b) disease-modifying anti-rheumatic drugs (bDMARDs) are important therapeutic agents used in treatment of RA. There is hesitation about use of conventional synthetic DMARDs (csDMARD) and bDMARDs due to increased risk of nodules although their association remains unclear. There are scarce data on lung nodules observed in RA patients and systematic studies are needed.

Objectives:

The aim of this study is to evaluate effects of biologic treatments and conventional synthetic DMARDS on pulmonary nodules observed in rheumatoid arthritis patients.

Methods:

Electronic health records of RA patients who had had thorax computed tomography (CT) confirmed lung nodules in the last 5 years were retrospectively evaluated. Pre-treatment and post-treatment follow up CT images were meticulously examined for the number, size, attenuation, calcification, and cavitary formation. Demographic features, smoking status, disease characteristics and used medications were retrieved from file records. Clinical and laboratory findings, demographic features, treatment and follow-up duration, number of solid and cavitary nodules were compared between groups.

Results:

There were 21 patients in both biologic (11 females, mean age; 59.7±8.4) and csDMARD (12 females, mean age; 71.4±8.3) treated groups. There was no difference in frequency of nodule types and sizes between csDMARD and bDMARDs groups(table) despite csDMARD users were remarkably older. Administered biologic treatments were anti-TNF-alpha in 8, tofacitinib in 7, rituximab in 4, and abatacept in 2 patients. The most common types of nodules were solid and cavitary nodules, observed in 17 and 8 patients, respectively in biologic users. Calcific nodules were present in three patients, and ground glass nodules were observed in a single patient. Nodules were multiple in 12 patients and solitary in 9 patients. Calcific and ground glass nodules were all solitary in our study. Cavitary and solid nodules were concurrent in five patients. Median follow duration was 14(5-55) months. Progression was observed in small number of patients; three patients in receiving aTNFα, and one in rituximab(figure) and one in abatacept users. Interestingly none of patients receiving tofacitinib did not show progression. There was no difference regarding number of patients who progressed with either csDMARD or bDMARDs. None of the nodules showed malignant transformation within the observation period.

Conclusion:

In conclusion, risk of progression in lung nodules with biologic treatments is seem to be low, at least not more than csDMARD in short term and any malignant transformation was not observed in our study.

References:

[1]Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med. 2019 Sep;40(3):545-560. doi:10.1016/j.ccm.2019.05.003. Epub 2019 Jul 6. Review. PubMed PMID: 31376890.

Table.

Changes in nodule characteristics with respect to treatment groups.

csDMARDbDMARDsSOLID NODULESPre-treatmentTotal number of nodules, n7254Post-treatmentCompletely diminished, n514Regressed, n512Stable, n3320Enlarged, n234Cavitary transformation64De novo solid nodules267CAVITARY NODULESPre-treatmentTotal number of nodules1016Post-treatmentCompletely diminished, n01Regressed05Stable48Enlarged, n62Newly formed cavitary nodules69**

*number less than calculated due to cavitation,**de novo 5 nodules, 4 transformation from solid nodules

Figure.

Nodule progression in a patient receiving rituximab (white arrow)

Disclosure of Interests:

None declared

SAT0509 MYCOPHENOLATE MOFETIL VERSUS AZATHIOPURINE FOR THE MAINTENANCE TREATMENT OF CONNECTIVE-TISSUE RELATED INTERSTITIAL LUNG DISEASE FOLLOWING CYCLOPHOSPHAMIDE TREATMENT

Background:

Cyclophosphamide (CYC) had a good response rates when used as an induction regimen for the treatment of connective tissue related interstitial lung disease (CTD-ILD). But the safety profile of CYC necessitates the usage of a second line treatment for maintenance

Objectives:

To compare the effect of mycophonetil (MMF) and azatiyopurin (AZA) for maintanance therapy following cyclophsphomide treatment in CTD-ILD

Methods:

Between 2009 and 2019 all interstitial lung disease patients admitting rheumatology or pulmonology department were retrospectively evaluated and patients treated with cyclophospamide as an induction regimen and having not progression were selected. Among those, as a second line regimen treated with MMF or AZA were included. Primary end point was treatment responses at 6th months

Results:

68 patients treated with CYC for the first line treatment. 46 patients treated with either MMF (n:22) or AZA (n:24) for the maintenance. Scleroderma patients were the largest group and consituted 63% of the population. MMF group had worse FVC values and more involvement in lung paranchyme at the begining of the treatment. In univariate analysis FVC (lt) values and lung involvement (%) on HRCT at the start of the treatment, and disease subtype were associated significantly with treatment responses.After adjusted with these factors, in multivariate analysis, AZA treatment was associated with the increased risk of progression (odds ratio 5,8, 95% CI 1,061-31,09) as compared with MMF treatment

Conclusion:

MMF had better results compared to AZA in the treatment of CTD-ILD,after the usage of CYC treatment.

References:

[1]Barnes, H., et al.,Cyclophosphamide for connective tissue disease-associated interstitial lung disease.Cochrane Database Syst Rev, 2018.1(1): p. Cd010908.

Table 1.

Patient and disease characteristics at the start of the treatment and treatment responses at the 6th months of the treatment: FVC forced vital capacity

MMF (22)AZA (24)pLung involvement (%)36%23,3%0,022FVC (lt)1,962,550,021FVC (%)71%81%<0,001FVC change at 6th month (lt)-,02-0,190,051FVC change at 6th month (%)-0,42-5,810,068Progression23,8%50%0,118

Disclosure of Interests:

None declared

Frequency, characteristics, and clinical determinants of 'prodrome' in familial Mediterranean fever patients

Objective: Prodrome is defined by manifestations that precede a familial Mediterranean fever (FMF) attack and predict its emergence. We aimed to determine the frequency, characteristics, and clinical determinants of prodrome in patients with FMF.Method: This cross-sectional study was conducted in a tertiary rheumatology clinic. During the clinical interview, all patients completed a standardized questionnaire about the pre-attack period. Prodrome was defined as the presence of any recurrent pre-attack manifestation occurring at least 4 h before an attack. Patients were classified according to whether they had prodrome of any kind of attack.Results: The study enrolled 401 patients aged 37.7 ± 11.0 years (mean ± sd). Male gender, M694V/M694V, homozygous MEFV mutation, peritonitis, pleuritis, and arthritis were more frequent in prodrome-positive patients. Altogether, 141 patients (35.2%) had prodrome. Male gender and ever having attack types of peritonitis or arthritis were independent clinical determinants of prodrome [relative risk (95% confidence interval): 1.72 (1.07-2.76), p = 0.02; 4.27 (1.80-10.1), p = 0.001; 1.77 (1.04-3.04), p = 0.04, respectively]. Age, MEFV mutations, pleuritis, and erysipelas-like erythema were not clinical determinants.Conclusions: All FMF patients, particularly males and patients who had peritonitis or arthritis at any time, should be questioned about prodrome. Prodrome should be analysed in terms of elucidating the pathogenesis of FMF and as an opportunity for a secondary prevention strategy for impending attacks. This study may shed light on prodrome for future cytokine or drug studies with the purpose of developing new cost-effective treatment protocols irrespective of colchicine resistance.

Comparison of volume controlled with pressure controlled ventilation during one-lung anaesthesia

Pressure controlled ventilation (PCV) is an alternative mode of ventilation which is used widely in severe respiratory failure. In this study, PCV was used for one-lung anaesthesia and its effects on airway pressures, arterial oxygenation and haemodynamic state were compared with volume controlled ventilation (VCV). We studied 48 patients undergoing thoracotomy. After two-lung ventilation with VCV, patients were allocated randomly to one of two groups. In the first group (n = 24), one-lung ventilation was started by VCV and the ventilation mode was then switched to PCV. Ventilation modes were performed in the opposite order in the second group (n = 24). We observed that peak airway pressure (P = 0.000001), plateau pressure (P = 0.01) and pulmonary shunt (P = 0.03) were significantly higher during VCV, whereas arterial oxygen tension (P = 0.02) was significantly higher during PCV. Peak airway pressure (Paw) decreased consistently during PCV in every patient and the percentage reduction in Paw was 4-35% (mean 16.1 (SD 8.4) %). Arterial oxygen tension increased in 31 patients using PCV and the improvement in arterial oxygenation during PCV correlated inversely with preoperative respiratory function tests. We conclude that PCV appeared to be an alternative to VCV in patients requiring one-lung anaesthesia and may be superior to VCV in patients with respiratory disease.