Infliximab as successful treatment option in a case of adenosine deaminase 2 deficiency

Deficiency of adenosine deaminase 2 (DADA2) is a recessively inherited autoinflammatory disease characterized by systemic inflammation and immunodeficiency. Infliximab proved to be favorable in the treatment of this condition. This case report is concerned with a DADA2 deficient patient treated with infliximab. This is a rare case of DADA2 in a 32-year-old female patient. The patient was admitted with a clinical presentation of erythema, ulcers, and pruritus on both legs and ankles, accompanied by red ulcerative oral lesions, fatigue, malaise, and dizziness. The patient's genetic analysis was positive for DADA2. Treatment based on TNF-α inhibition was highly effective for this patient. We used laboratory testing and punch biopsy as differential diagnostic tools, where antinuclear antibody positivity, high prolactin levels, and high serum C-reactive protein were observed. The punch biopsy revealed both orthohyperkeratosis and parahyperkeratosis of the dermis, diffuse core fragments, plasma in the stratum corneum, and hypergranulous acanthosis. DADA2 treatment is centered on tumor necrosis factor α suppression. Although high-dose systemic glucocorticoids can reduce inflammation in the initial stages of the disease, most patients have a resistant or relapsing response to tapering attempts. The prevalence of undiagnosed cases of autoinflammatory diseases is anticipated to diminish with the growing awareness of them.

Juvenile and adult-onset scleroderma: different clinical phenotypes

OBJECTIVES

Systemic sclerosis (SSc) represents extremely rare disease with majority of data coming from adults. Studies comparing juvenile- (jSSc) and adult-onset (aSSc) patients are limited. We aimed to compare clinical features, treatment modalities and survival rates of jSSc and aSSc patients.

METHODS

A retrospective study among pediatric and adult Scl patients has been performed. Demographic characteristics, clinical features, autoantibody profiles, and treatment data were retrieved from the databases. Survival analysis was done using Kaplan-Meier plot and factors associated with mortality were identified with multiple regression analysis.

RESULTS

A total of 158 adults and 58 juvenile Scl patients were identified. The mean age at the disease onset was 37±14.7 vs. 8.8 ± 4.1 years, mean age at diagnosis 42±15.2 vs. 10.4 ± 3.8 years and mean follow-up duration was 6.3 ± 4.9 years vs. 6.6 ± 4.9 years for aSSc and jSSc patients, respectively. The frequency of interstitial lung disease (ILD) (50.9% vs 30%, p<0.001) and systemic hypertension (17.9% vs 0, p = 0.009) was significantly higher among aSSc. While aSSc patients had presented mostly with limited cutaneous subset (74.1%), diffuse cutaneous subset was the dominant subset among jSSc (76.7%), (p<0.001). The mortality rate was significantly higher among adults (p = 0.005). The ILD (p = 0.03) and cardiac insufficiency (p = 0.05) were independent risk factors of mortality in both aSSc and jSSc patients.

CONCLUSION

Juvenile and adult-onset Scl represent rarely seen conditions with different clinical phenotypes. Pediatric patients with LS are more commonly seen by pediatric rheumatologists, in contrary to adults. Diffuse disease subset is the dominant form among juvenile patients, whereas limited form is the main disease subset among adults. On the other hand, juvenile-onset patients have a better survival than those with adult-onset.

AB1470 DOES TESTING FOR SAA IS MORE BENEFICIAL THAN CRP FOR THE FOLLOW-UP OF PATIENTS WITH FMF?

Background

In order to follow subclinical inflammation and adjust the therapy for an optimal disease control, clinicians seek for readily accessible, affordable and reproducible markers. C reactive protein (CRP) is widely used for this purpose. Some suggest that the Serum Amyloid A (SAA) is preferable to CRP as a biomarker of inflammation in FMF patients1.

Objectives

To evaluate and to compare the sensitivity of the serum SAA and CRP levels in FMF patients.

Methods

Serum SAA and CRP levels were measured in 45 patients. 153 measurements from 28 patients with M694V homozygous mutation and 74 measurements from 17 patients with M694V heterozygous mutation were obtained during a mean follow-up of 1 year. For the analysis, the folds of normal CRP and SAA values were used for correlation. Serum levels of the given markers were measured with nephelometric kits (normal CRP levels < 5 mg/L and SAA levels < 6,8 mg/L). More than one and half fold increasement of CRP and SAA was defined as an active inflammation. The correlation coefficients and their significance were calculated using the Spearman test.

Results

Except a patient, all patients in whole cohort were on prophylactic colchicine. Among 28 patients with M694V homozygous mutation, a patient with adalimumab, 12 (42,8%) patients with anti-IL-1 regimens. Of the 17 patients with M694V heterozygous mutation, four (23,5%) were under anti-IL-1 treatment. There was a total of 227 measurements of CRP and SAA from 45 patients. Twenty-five (11%) measurements were obtained during the attack period in and the remaining 202 measurements were collected in attack free period. Figure 1 demonstrates the correlation between CRP and SAA levels (r=0.8, p< 0,001). Both acute phase reactants were increased in 72 (31,7%) measurements, while in 13 (5,7%) CRP level was high but SAA level was normal and in 31 (13,6%) SAA level was high however CRP level was within the normal limits. The vast majority (30:31) of high SAA with normal CRP levels were observed in patients with M694V homozgous mutation. The mean increase in CRP of the entire cohort was 2,06 ± 3,34-fold, whereas mean increase in SAA was 6,23 ± 15,04-fold of the normal levels.

Figure 1.

The folds of the serum CRP and SAA levels in the entire cohort.

Conclusion

According to our results, serial testing of SAA does not provide any additional advantages over CRP. Readily accessible and affordable bio-marker CRP seems to be sufficient for follow-up of patients with FMF.

References

[1]DOI: 10.1038/nrrheum.2010.181

Disclosure of Interests

None declared

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

AB1492 COMPARISON OF TELEREHABILITATION METHODS FOR SYSTEMIC SCLEROSIS PATIENTS IN THE COVID-19 ERA: A RANDOMIZED CONTROLLED STUDY

Background

Scleroderma (SSc) is an autoimmune connective tissue disease progressing with fibrosis. SSc patients need to be protected from epidemic diseases as well as rehabilitation needs. For this reason, it is important for them to continue their exercises in an environment where they can be both rehabilitated and protected from infectious diseases.

Objectives

In this study, it was aimed to reveal the effects of exercises performed by telerehabilitation on individuals with Scleroderma with hand involvement and to compare the effects of real-time telerehabilitation (RTT) and asynchronous telerehabilitation (AT).

Methods

Forty-two participants with a mean age of 44.17±11.05 years were included in the study. The patients were divided into three groups and followed for 8 weeks. RTT was applied to the 1st group and AT was applied to the 2nd group, and the 3rd group was the control group. Participants’ finger and wrist joint range of motion (ROM) were evaluated with a goniometer, upper extremity functions were evaluated with Scleroderma Hand Mobility Test (HAMIS), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and 9Hole Peg Test (9HPT), grip strength was evaluated with a dynamometer, superficial sense of touch was evaluated with the Semmes Weinstein Monofilament test, activities of daily living (ADL) were evaluated with the Michigan Hand Outcomes Questionnaire (MHQ), and general health status was evaluated with the Scleroderma Health Assessment Questionnaire (SHAQ).

Results

There were improvements in finger and wrist ROM, upper extremity functions and ADL parameters in the RTT group; and there were improvement in finger ROM and hand functions in the AT group (p<0.05). Wrist radial deviation ROM decreased in the control group (p<0.05). Significant differences were noted between the groups in finger ROM and upper extremity functions after treatment (p<0.05).

Conclusion

Our study shows that exercises performed via RTT and AT are effective in individuals with Scleroderma with hand involvement, and RTT has additional benefits.

References

[1]Sendur N, Sendur UG. Scleroderma. Turkiye Klinikleri J Dermatol. 2018;15-20.

[2]Baron M, Lee P, Keystone EC. The articular manifestations of progressive systemic sclerosis (scleroderma). Ann Rheum Dis. 1982;41(2):147-152.

[3]Spinella A, Magnani L, De Pinto M, et al. Management of Systemic Sclerosis Patients in the COVID-19 Era: The Experience of an Expert Specialist Reference Center. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine 2021; 15:1–3.

[4]Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020;26(5):309-313.

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

AB1305 A SYSTEMATIC REVIEW OF AA AMYLOIDOSIS AMONG PATIENTS WITH BEHÇET’S SYNDROME

Background

Data on patients with Behçet’s syndrome (BS) complicated with AA amyloidosis is limited to case reports or case series with a small number of patients.

Objectives

In this study, we aimed to perform a systematic review (SR) of published reports on BS patients with AA amyloidosis.

Methods

PubMed and EMBASE were searched with the keywords “Behcet* AND amyloidosis”, without date and language restriction, until May 2020. Two independent reviewers (SNE, GK) performed title/abstract and full text screening and data extraction. A third reviewer (GH) made the final decision in case of disagreement between the two reviewers. Studies that reported patients who were reported by authors as having BS and AA amyloidosis were included. The risk of bias assessment was done using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

Results

The systematic literature search yielded 760 articles of which 703 were excluded after title and abstract review. After full-text review, we further excluded 15 duplicate articles and 1 article was added after handsearching the reference lists of the full texts. Finally, we included 43 articles reporting 96 cases. Among these articles, 38 were case reports and 5 were case series reporting between 6 and 14 patients. All patients but 8 were reported from Mediterranean countries. The quality of all articles according to GRADE was very low due to the lack of a control group.

The main features of the patients were male predominance (81/96, 84%), a high frequency of major organ involvement (62/80, 77.5%) especially vascular involvement (60%), a low frequency of comorbidities predisposing to AA amyloidosis (11/96, 11.5%), and a very low frequency of gastrointestinal involvement (3/72, 4%). All but 8 patients were diagnosed with BS and AA amyloidosis simultaneously. The most common presentation was nephrotic syndrome (60/81, 74%). Presenting symptoms other than proteinuria were diarrhea (n=2), acute renal failure (n=2), upper gastrointestinal bleeding (n=1), end stage renal disease (ESRD) (n=1), cardiac symptoms due to cor pulmonale (n=1), and hypertension (n=1). Renal biopsy (72%) and rectal biopsy (17%) were the most commonly used procedures to diagnose AA amyloidosis.

After diagnosing AA amyloidosis, colchicine was initiated in 58 patients, cyclophosphamide in 16, and biologics in 3 (1 anakinra and 2 tocilizumab). In the 67 patients with available data on follow-up, 43% of the patients were followed-up for ≤1 year and median follow-up duration was 20 months (IQR: 4-48). Among the 64 patients with available data, 30 (47%) had developed ESRD. Among the 72 patients with available data on survival status, 30 patients (42%) had died. Ten patients (33%) had died within 6 months, 15 had died after a median follow-up of 48 months (IQR: 24-150), and follow-up duration was not available in the remaining 5 patients including 3 patients whose diagnoses were made by autopsy. Reasons for death were infection (n=7), ESRD (n=6), intractable diarrhea (n=3), pulmonary embolism (n=1), cor pulmonale (n=1), hemorrhage due to pulmonary artery aneurysm (n=1), liver cirrhosis (n=1), gastric cancer (n=1), subarachnoid hemorrhage (n=1), and not reported (n=8).

Conclusion

Male gender and major organ involvement, especially vascular involvement, appear to be risk factors for the development of AA amyloidosis in BS patients. While BS patients complicated with AA amyloidosis have been reported rarely, it is a fatal complication of BS. One third of the patients had died within 6 months after AA amyloidosis diagnosis.

Disclosure of Interests

Güzin Karatemiz: None declared, Sinem Nihal Esatoglu Speakers bureau: Sinem Nihal Esatoglu has received honorariums for presentations from UCB Pharma, Roche, Pfizer, and Merck Sharp Dohme., Mert Gurcan: None declared, Yesim Ozguler Speakers bureau: Yesim Ozguler has received honorariums for presentations from UCB Pharma, Novartis, and Pfizer., Sebahattin Yurdakul: None declared, Vedat Hamuryudan Speakers bureau: Vedat Hamuryudan has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma., Grant/research support from: Vedat Hamuryudan has received grant/research support from Celgene., Izzet Fresko: None declared, Melike Melikoglu: None declared, Emire Seyahi Speakers bureau: Emire Seyahi has received honorariums for presentations from Novartis, Pfizer, AbbVie, and Gliead., Serdal Ugurlu: None declared, Huri Ozdogan: None declared, Hasan Yazici: None declared, Gulen Hatemi Speakers bureau: Gulen Hatemi has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma, Grant/research support from: Gulen Hatemi has received grant/research support from Celgene.

POS1378 ARTHRITIS IN PATIENTS WITH FAMILY MEDITERRANEAN FEVER

Background

Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent episodes of fever and serositis. Arthritis is one of the most common attack manifestations. Arthritis in FMF is usually in the form of acute mono- or oligoarthritis of the large joints of the lower extremities. While acute attacks of arthritis usually heal without causing permanent deformity, the severe, long-lasting form of chronic arthritis can last for months or even years and result in permanent deformity.

Objectives

In this study, we described the characteristics of joint involvement in FMF in a single cohort.

Methods

The medical records of patients with joint involvement from our cohort of 2350 patients who were diagnosed with familial Mediterranean fever were retrospectively scanned through the files and hospital database. The prevalence, demographic information, genetic test results, clinical features, features of joint involvement, treatments and responses, acute phase values in the attack and remission periods, and family history of patients with joint involvement were recorded.

Results

953 patients (n=953) from a total of 2350 patients had arthralgia or arthritis (40%). In our study, the male/female ratio was found to be 0.49 (male n=316, female n=637). The number of patients who underwent genetic testing was 787 (82%), and 702 (89%) of these patients had mutations in the MEFV gene. The most common pathogenic mutation is the M694V mutation with a rate of 43%. Concomitant diseases and their frequencies are shown in Table 1, the most common accompanying disease was spondylarthritis at a rate of 27%. Arthritis was present in the first attack in 55% (n=531), while arthritis was found in the ongoing attacks in 45%. The duration of the attack was between 24-96 hours in 77% (n=837) of the patients, and the duration was longer than 96 hours in 23% (n=116). The most common finding accompanying the attacks was exercise-related leg pain. Family history was present in 61% (n=580). 73% of the patients (n=696) were involved in the ankle and 51% were involved in the knee (n=492). The incidence of sacroiliitis was 14% (n=142). As for the number of joints, 91% of the patients had mono- and oligoarthritis. Asymmetric involvement was detected in 77% of the patients. Red arthritis was present in %73 of our study group. HLA-B27 was examined in 185 patients, 24 of them were positive (12%). It was found that 43% of the patients had treatment changes due to arthritis. Colchicine dose increases and changes were performed in 32% of these patients. NSAIDs were started in 21%, corticosteroids in 15%, DMARDs in 12%, anti-TNF in 10%, and anti-IL-1 in 8%. The mean dose of colchicine was as 1.56 ± 0.5 mg. Unresponsiveness to colchicine was found in 21% (n=122).

Table 1.

Concomitant diseases of our FMF cohort

Conclusion

FMF diagnosis should definitely be considered in people with red mono-oligoarthritis in the large joints of the lower extremities. One of the most important features of joint involvement in FMF patients is the short duration of arthritis. The accompanying effort-related leg pain is an important symptom that should suggest FMF. In patients with a diagnosis of FMF and arthritis, the required colchicine dose in the treatment and the rate of colchicine unresponsiveness are higher than in other attack types. The incidence of sacroiliitis and spondyloarthropathy increases in patients with FMF, and joint involvement features are similar. FMF should be considered in the differential diagnosis of patients with inflammatory low back pain.

Disclosure of Interests

None declared

AB1323 THE MYSTERY OF FAMILIAL MEDITERRANEAN FEVER: IS THERE ANY FACTOR TRIGGERING THE ATTACKS?

Background

Familial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by recurrent episodes of fever and serositis. Although it is known that the attack frequency differs among patients carrying different mutant genotypes [1], whether physical and environmental factors play a role in triggering attacks or whether they have an influence on timing of attacks remains to be elucidated.

Objectives

We aimed to identify different conditions causing flare-ups in FMF course and to investigate if there is a significant difference between patients carrying distinct mutations, regarding the distribution of the factors mentioned.

Methods

Two hundred patients were randomly selected among individuals who were routinely followed-up with FMF diagnosis in our centre. Individuals carrying only a variant of unknown significance or polymorphism such as R202Q, according to Infevers database, were excluded in order to gather a cohort consisting of patients with definite FMF. An inquiry was made based upon triggering factors determined by the patients themselves. The patients were classified into subgroups by their sex and mutation genotype. Since M694V variant is responsible for pronounced FMF course [2], we sorted the patients according to their status for M694V mutant allele. Group A included patients carrying M694V homozygously. Group B included patients carrying at least one M694V mutant allele whereas Group C consisted of patients who were non-M694V carriers. Chi-square test was performed to assess distribution of the trigger factors in terms of establishing its significance.

Results

Detailed distribution of trigger factors is shown in Table 1. 144 out of 200 patients described a culprit condition. Patients usually stated more than one factor, however some patients reported only one. The most-reported trigger factors by the cohort are summarized as following: 76 emotional stress (38%), 60 menstruation (30%), 40 cold exposure (20%), 34 fatigue (17%), 13 seasonal changes (6.5%). The distribution of trigger factors between Group A, B, and C were non-significant (p=0.88).

Table 1.

The distribution of triggering factors in subgroups.

GroupTotal(%)Reported trigger factor (%)Mens- truation(%)Emotionalstress(%)Cold exposure(%)Fatigue(%)Seasonalchanges(%)Others(%)Female12397 (78.8)60 (48.8)47 (38.2)24 (19.5)19 (15.4)7 (5.7)6 (4.9)Male7747 (61)-29 (37.7)16 (20.8)15 (19.5)6 (7.8)7 (9.1)Group A6144 (72.1)14 (23)24 (39.3)13 (21.3)12 (19.7)4 (6.6)6 (9.8)Group B165120 (72.7)49 (29.7)66 (40)34 (20.6)29 (17.6)13 (7.9)11 (6.6)Group C3524 (68.6)11 (31.4)10 (28.6)6 (17.1)5 (14.3)01 (2.8)

Group A: M694V homozygous patients, Group B: patients with at least one M694V allele, Group C: non-M694V carriers

Conclusion

We concluded that trigger factors did not vary between distinct mutant genotypes. Although emotional stress is the most reported trigger factor by the participants, one should bear in mind that emotional stress influences most chronic diseases negatively. We also observed that menstruation overtly triggers an FMF attack. Additionally, cold exposure should be considered as a notable trigger factor. It is still unclear what triggers an FMF attack in 28% of the patients, remains a mystery.

References

[1]Grossman C, Kassel Y, Livneh A, Ben-Zvi I. Familial Mediterranean fever (FMF) phenotype in patients homozygous to the MEFV M694V mutation. Eur J Med Genet. 2019 Jun;62(6):103532. doi: 10.1016/j.ejmg.2018.08.013.

[2]Egeli BH, Ugurlu S. Familial Mediterranean Fever: Clinical State Of The Art. QJM. 2020 Oct 20:hcaa291. doi: 10.1093/qjmed/hcaa291.

Disclosure of Interests

None declared

AB1325 DIAGNOSTIC DELAY IN FAMILIAL MEDITERRANEAN FEVER: IS IT STILL A PROBLEM?

Background

Familial Mediterranean fever (FMF) is a rare hereditary autoinflammatory disease with disease onset in childhood in most cases. Although autoinflammatory disease awareness is increasing among physicians, delayed diagnosis is still prevalent as a cause of greater morbidity[1].

Objectives

We aimed to study the characteristics of FMF patients diagnosed between 2000-2010 and 2011-2021 and to see if there was a difference in diagnostic delay.

Methods

We retrospectively evaluated the medical records of the FMF patients followed up in our rheumatology clinic that were diagnosed between 2000-2021 and split them into two groups according to the year they received their diagnosis. There were 1151 patients diagnosed between 2000-2010 (Group 1) and 821 patients diagnosed between 2011-2021 (Group 2). The data studied included gender, age of onset, diagnostic delay, attack characteristics, MEFV mutation, and family history.

Results

The median current age of patients in Group 1 is 37 years (IQR:30-46) and the median current age of the patients in Group 2 is 36 years (IQR:29-44). The female to male ratio was 1.57 in Group 1 and 1.75 in Group 2, with no significant difference between the groups. Group 2 had later disease onset (p<0.001) and later diagnosis (p<0.001) than Group 1 as shown in the Table 1. The proportion of patients with at least one M694V mutation was higher in Group 2 (p<0.001). The attack durations did not vary between the groups. There was no significant difference in the prevalence of abdominal pain, fever, arthritis, and arthralgia between Group 1 and Group 2. Chest pain (p=0.005), myalgia (p<0.001), and erysipelas-like erythema (p=0.041) were more common in Group 2 than Group 1. Patients with positive family history were more frequent in Group 2 than Group 1 (p=0.046).

Table 1.Group 1 (2000-2010, n=1151)Group 2 (2011-2021, n=821)pFemale/Male, n704/447522/2990.275Age at onset, median (IQR) years13 (7-21)18 (12-26)<0.001Delay in diagnosis, median (IQR) years4 (1-11)5,5(2-15)<0.001Attack duration, median (IQR) years3(2-4)3(2-4)0.325Presence of at least one M694V mutation (%)526(46%)390(60%)<0.001Presence of abdominal pain in the initial attack (%)936(81%)669(81%)0.926Presence of fever in the initial attack (%)855(74%)592(72%)0.281Presence of chest pain in the initial attack (%)218(19%)199(24%)0.005Presence of arthritis in the initial attack (%)330(29%)215(26%)0.224Presence of arthralgia in the initial attack (%)213(19%)170(21%)0.223Presence of myalgia in the initial attack (%)45(4%)65(8%)<0.001Presence of erysipelas like erythema in the initial attack (%)31(3%)36(4%)0.041Presence of positive family history (%)652(57%)502(61%)0.046

Conclusion

There was some increase in the diagnostic delay in 2011-2021 compared to 2000-2010. This may be partly due to the later onset of symptoms in patients diagnosed in 2011-2021, which could have led the physicians to consider other differential diagnoses. Nevertheless, diagnostic delay in FMF still seems a prevalent problem that should be addressed to prevent excess morbidity and mortality.

References

[1]Erdogan M, Ugurlu S, Ozdogan H, Seyahi E. Familial Mediterranean fever: misdiagnosis and diagnostic delay in Turkey. Clin Exp Rheumatol. 2019;37 Suppl 121(6):119-124.

Disclosure of Interests

None declared

POS1255 SAFETY OF THE PFIZER/BIONTECH AND SINOVAC/CORONAVAC VACCINES AMONG PATIENTS WITH BEHCET’S SYNDROME AND FAMILIAL MEDITERRANEAN FEVER

Background

Since first emerged in December 2019, the COVID-19 pandemic has resulted in a death toll surpassing 5.5 million worldwide and had severe consequences on the global economy, environment, public health and social life [1, 2]. Multiple potential vaccines against COVID-19 have been developed swiftly and as shown in several phase 3 clinical trials, they demonstrated considerable efficacy without an unusual safety signal in healthy individuals.

Objectives

In this study, we aimed to evaluate vaccine reactivity and disease flare following vaccination with either Sinovac/CoronaVac or Pfizer/BioNTech among BS and FMF patients compared with patients with various diagnosis of RD and healthy controls.

Methods

Only those patients and healthy controls who rece,ved at least one single shot of either CoronoVac or BioNTech against COVID-19 were included in the study. We tried to contact all of these patients and controls consecutively by telephone and attempted to make interviews with the eligible ones.

Results

We studied the efficacy, side effects and disease flares after COVID-19 vaccination in 256 patients with Behcet’s syndrome (BS), 247 with familial Mediterranean fever (FMF), 601 with rheumatic diseases (RD) and 612 healthy controls (HC). Study participants were vaccinated either with CoronaVac (BS:109, FMF: 90, RD: 343, and HC: 334) or BioNTech (BS: 147, FMF:157, RD: 258 and HC: 278). BioNTech ensured a significantly better efficacy than CoronaVac against COVID-19 in all patient groups (BS: 1.4% vs 10.1%; FMF: 3.2% vs 12.2%, RD:2.7% vs 6.4%). Those with at least one adverse event (AE) were significantly more frequent among those vaccinated with BioNTech than those with CoronaVac (BS: 86.4% vs 45%; FMF: 83.4% vs 53.3%; RD: 83.3% vs 45.5% and HC: 86.3% vs 52.1%). The majority of AEs were mild to moderate and transient and this was true for either vaccine. There were also AEs that required medical attention in all study groups following CoronaVac (BS:5.5%, FMF:3.3%, RD:2.9% and HC:3.3%) or BioNTech (BS:5.4%, FMF:1.9%, RD:4.7% and HC:4.7%). The main causes for medical assistance were disease flare, and cardiovascular events. Disease flares after vaccination were significantly more frequent among BS (41/256; 16.0%) and FMF (43/247; 17.4%) patients compared to patients with RD (36/601; 6.0%). This was true for both CoronaVac (BS: 11.0%, FMF: 24.4% and RD: 5.2%, p<0.001) and BioNTech (BS: 19.7%, FMF: 13.4% and RD: 7.0%, p=0.001)(Table 1).

Table 1.

Flares among patients with Behçet’s syndrome, familial Mediterranean fever, rheumatic diseases after vaccination with CoronaVac and BioNTech

CoronaVacBehçet’s syndrome,n=109Familial Mediterranean Fever,n=90Rheumatic diseases, n=343Flares, n (%)Flares, n (%)Flares, n (%)12 (11.0)22 (24.4)18 (5.2)BioNTechBehçet’s syndrome, n=147Familial Mediterranean Fever, n=157Rheumatic diseases, n=258Flares, n (%)Flares, n (%)Flares, n (%)29 (19.7)21 (13.4)18 (7.0)

RA, Rheumatoid Arthritis; BS, Behçet’s syndrome; FMF, Familial Mediterranean Fever

Conclusion

Our study demonstrates that BS and FMF patients vaccinated with either CoronaVac or BioNTech demonstrated almost similar AE profile and frequency compared to RD patients and HC. AEs that required physician consultation or hospitalization occurred in all study groups after either CoronaVac or BioNTech. Caution should be required when monitoring these patients after vaccination. Increased frequency of flares in BS and FMF compared to that seen in RD might reflect defects in innate immunity and deserves further investigation.

References

[1]https://covid19.who.int Accessed date 22.01.2022

[2]Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, Agha M, Agha R. The so-cio- economic implications of the coronavirus pandemic (COVID-19): A review. Int J Surg. 2020 Jun; 78:185-193. doi: 10.1016/j.ijsu.2020.04.018. PMID: 32305533; PMCID: PMC7162753.

Disclosure of Interests

Ayse Ozdede: None declared, Sabriye Güner: None declared, Guzin Ozcifci: None declared, Berna Yurttas: None declared, Zeynep Toker Dincer: None declared, Zeynep Atli: None declared, Ugur Uygunoglu: None declared, Eser Durmaz: None declared, Didar Ucar: None declared, Serdal Ugurlu Speakers bureau: Novartis,Pfizer,Celltrion and Lilly, Sebahattin Saip: None declared, Ömer Fehmi Tabak Speakers bureau: Abbvie, Gilead, MSD and GSK, Consultant of: Abbvie, Gilead, MSD and GSK, Vedat Hamuryudan: None declared, Emire Seyahi Speakers bureau: Pfizer, Abbvie, Novartis and Gilead,

AB1502 AWARENESS OF BIOLOGICAL AGENTS RELATED SIDE EFFECTS AMONG INTERNAL MEDICINE RESIDENTS IN A UNIVERSITY HOSPITAL

Background

Biological agents have become a core component of therapeutic strategies in the last two decades. The number of patients treated with biological agents has been increasing with the expansion of these agents’ indications among rheumatic disorders.

Objectives

Unfortunately, biological agents have varied side effect profiles, and rheumatic patients with possible side effects are commonly consulted with internal medicine physicians in emergency departments. We surveyed to assess the awareness of biological agents related side effects among internal medicine residents in our university hospital.

Methods

We conducted a web-based multiple-choice test with 10 questions in total. Monoclonal antibodies (anti-TNF, anti-CD20), anti-cytokines, and JAK inhibitors related side effects and management of these adverse events were assessed. Figure 1 depicted the topics and the correct answer rate of the related questions.

Figure 1.

The topics and the correct answer rate of the related questions

Results

A total of 57 responses were collected and analyzed. The mean number of the correct answers was 6,4± 1,5. Fourteen (24,6%) out of the 57 participants scored below 5, whereas 58% of the participants scored ≥6 points. The majority of the participants have correctly answered the anti-TNF, rituximab and tocilizumab-related questions, however, less than half of the participants have accurately answered the anakinra and JAK inhibitors-related questions (Figure 1). Awareness of the JAK inhibitors related zoster reactivation and increased risk of serious cardiovascular events were 35% and 42%, respectively. The approach to the delayed and mild infusion reactions was adequate, however, 33% of the participants accurately approached the severe infusion reaction.

Conclusion

Our survey suggests that the awareness of biologic agents related side effects among the internal medicine residents is satisfactory. Poorer results were observed especially in JAK inhibitors related side effects and severe infusion reaction management which indicate the educational needs of the residents for these topics.

Disclosure of Interests

None declared

POS0814 OUTCOME OF VASCULAR INVOLVEMENT OF BEHÇET’S SYNDROME TREATED WITH INFLIXIMAB: A RETROSPECTIVE COHORT STUDY

Background

Vascular involvement is the most common cause of mortality and an important cause of disability in patients with Behçet’s syndrome (BS). Cyclophosphamide has been the treatment choice for severe vascular involvement, but high frequency of adverse events such as infertility and infections cause concern. TNF inhibitors can be an alternative for BS patients with vascular involvement.

Objectives

To survey the efficacy and safety of infliximab (IFX) in BS patients with arterial and venous vascular involvement.

Methods

We reviewed the charts of BS patients who used IFX for vascular involvement. We extracted data on demographic and clinical features, type of vascular involvement, laboratory tests, imaging modalities, concomitant immunosuppressives, duration of IFX use, and outcome. The primary endpoint was remission, defined as the presence of all of the following 3 parameters: 1) lack of new clinical symptoms/findings associated with the vascular lesion 2) normalization of CRP level defined as <10 mg/dl) 3) lack of worsening of the primary vascular lesion or a new lesion vascular at another site on imaging. Remission was assessed at month 6 and month 12. Secondary endpoints were relapse, overall disease activity assessed with BDCAF at baseline and at the final visit, development of new organ involvement other than vascular involvement during IFX treatment, severe adverse events leading to discontinuation of IFX therapy, hospitalization or death, and death.

Results

Among the 371 patients who used IFX between 2004 and June 2021, 127 patients (102 men, 25 women, mean age 40 ± 8.7 years) had used it for vascular involvement. The types of vascular involvement that required IFX were venous thrombosis in 61 patients (48%), pulmonary artery involvement in 37 (29%), non-pulmonary artery involvement in 16 (13%), and venous ulcer in 13 (10%). Remission rate was 72% (92/127) at month 6 and 61% (71/117) at month 12. 17/99 (17%) patients experienced 22 relapses during a mean follow-up of 28.4±21 months of IFX therapy. Among the 22 relapses, 12 were the progression of the pre-existing vascular lesion and 10 were new vascular lesions. Overall disease activity improved with a decrease in mean BDCAF score from 1.76 ± 1.27 to 0.6 ± 0.8 at the final visit (p<0.001). Remission and relapse rates according to type of vascular involvement and causes of IFX discontinuation are presented in the Table 1. Adverse events leading to IFX discontinuation were infusion reactions in 5, tuberculosis, disseminated zona, lung adenocarcinoma, fibromyxoid sarcoma, heart failure, SLE, palmoplantar pustulosis, auricular chondritis, and aortic stent graft infection in 1 patient each.

Table 1.

The frequency of concomitant immunosuppressive use, duration of infliximab use and outcomes of BS patients with vascular involvement treated with IFX

Venous thrombosis (n=61)Pulmonary artery involvement (n=37)Non-pulmonary arterial involvement (n=16)Venous ulcers (n=13)Overall (n=127)Number of patients who used concomitant immunosuppressives48 (79)24 (65)14 (87)7 (54)93 (73)Duration of IFX use (mean ± SD months)24 ± 19.725 ± 19.335 ± 29.626 ± 2425 ± 21Remission rate at month 650 (82)31 (84)10 (63)1 (8)92 (72)Remission rate at month 12a40 (70)21 (64)8 (53)2 (17)71 (60)Relapse rate4 (7)4 (11)9 (60)017 (13)Number of patients who discontinued IFX31 (51)23 (62)5 (31)9 (69)68 (54)Due to remission1560122Due to inefficacy313411Due to relapse10102Due to adverse event741113Due to noncompliance340310Due to new organ development10001Due to other reasonsb18009Death22004

a Since 10 patients did not reach the 12th month yet, the percentages were calculated on 117 patients.

b Other reasons were preparation for surgical operation (n=2), not wanting to come to the infusion frequently during the pandemic (n=2), pregnancy (n=1), willing to get pregnant (n=1), lack of health insurance (n=1), due to prison sentence (n=1), and death (n=1).

Conclusion

Infliximab may be beneficial in BS patients with vascular involvement, even in those who are refractory to immunosuppressives and corticosteroids.

Disclosure of Interests

Gulen Hatemi Speakers bureau: Gulen Hatemi has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma, Grant/research support from: Gulen Hatemi has received grant/research support from Celgene, Beyza Tukek: None declared, Sinem Nihal Esatoglu Speakers bureau: Sinem Nihal Esatoglu has received honorariums for presentations from UCB Pharma, Roche, Pfizer, and Merck Sharp Dohme., Yesim Ozguler Speakers bureau: Yesim Ozguler has received honorariums for presentations from UCB Pharma, Novartis, and Pfizer., Sitki Safa Taflan: None declared, Melike Melikoglu: None declared, Serdal Ugurlu: None declared, Izzet Fresko: None declared, Zekayi Kutlubay: None declared, Sebahattin Yurdakul: None declared, Hasan Yazici: None declared, Vedat Hamuryudan Speakers bureau: Vedat Hamuryudan has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma, Grant/research support from: Vedat Hamuryudan has received grant/research support from Celgene.

AB1322 APPENDICITIS STILL A MISDIAGNOSIS FOR FMF PATIENTS

Background

Familial Mediterranean Fever(FMF) is an autoinflammatory disease characterized by recurrent polyserositis attacks. Attacks typically consist of fever and/or abdominal pain and/or chest pain and/or arthritis. The disease is caused by mutations in the MEFV gene. Abdominal pain during the attacks is frequently misdiagnosed as acute abdomen and these patients go undersurgical intervention is not uncommon [1].

Objectives

Severe abdominal pain during FMF attacks is frequently misdiagnosed as acute abdomen and patients receive surgical intervention. In this study, we aim to compare the clinical and genetic characteristics of FMF patients with appendectomies to those without appendectomies.

Methods

We reviewed 176 patients with FMF who went under appendectomy. We randomly matched these patients with 176 FMF patients without appendectomy for comparison. We compared clinical manifestations, MEFV mutations, and treatment modalities.

Results

In this study, 176 patients with FMF went under appendectomy. Only 2 of these appendectomies were performed after FMF diagnosis. In the appendectomy group fever(84% vs 68%), abdominal pain(91% vs 79%), pathogenic exon 10 mutations(65% vs 59%), lower leg pain(0.5% vs 0%) and orchitis(0.5% vs 0%) were more common but only the abdominal pain and fever was statistically significant. In the control group chest pain(18% vs 19%), arthralgia(46% vs 53%), arthritis(29% vs 37%), anti IL-1 usage(3% vs 5%), amyloidosis (0% vs 3%) and erysipelas(1% vs 3%) were more common but none of them were statistically significant. Myalgia(3%) was the same in both groups[Table 1]. Median diagnostic delay was 8(IQR 2-15) years in the appendectomy group and 3.5(IQR1-10) years in the control group.

Table 1.

Characteristics of the patients

No Of Patients(%)AppendicitisNo Of Patients(%)P valueControl GroupPatients176(100)176(100)Fever148(84)120(68)0.0007Abdominal Pain160(91)139(79)0.0029Chest Pain32(18)33(19)1Arthralgia81(46)94(53)0.20Arthritis51(29)65(37)0.12Myalgia5(3)5(3)1Erysipelas2(1)5(3)0.45Lower Leg Pain1(0.5)0(0)-Orchitis1(0.5)0(0)-Anti IL-1 usage6(3)9(5)0.6Amyloidosis0(0)6(3)-Diagnostic Delay8.5(IQR2-15) years3.5(IQR1-10) years0.0002Pathogenic Exon 10 Mutations114(65)103(59)0.27Appendectomy Before FMF diagnosis174(99)0(0)

Conclusion

Even after the discovery of colchicine and identification of the MEFV gene diagnosis of FMF remains a challenge. Previous studies reported a median diagnostic delay of 8.2-11 years. In these studies, 28%-32% of the patients went under abdominal surgical intervention before the diagnosis of the FMF[2,3]. The most common symptoms of FMF(fever and abdominal pain) are also the most common symptoms of acute abdomen. Thus distinguishing between FMF and acute abdomen in undiagnosed FMF patients represents an understated problem. These patients have a longer diagnostic delay[8(IQR 2-15) vs 3.5(IQR1-10) years], worse control of attacks, poorer quality of life. In our study, most of the appendectomies were unnecessary in the FMF patients. Thus we recommend investigating the patient for FMF if the evidence of the acute abdomen does not expand beyond the symptoms.

References

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

[2]Erdogan M, Ugurlu S, Ozdogan H, Seyahi E. Familial Mediterranean fever: misdiagnosis and diagnostic delay in Turkey. Clin Exp Rheumatol. 2019 Nov-Dec;37 Suppl 121(6):119-124.

[3]Hageman IMG, Visser H, Veenstra J, Baas F, Siegert CEH. Familial Mediterranean Fever (FMF): a single centre retrospective study in Amsterdam.

Disclosure of Interests

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

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

Table 1.

The correlations of IPAQ, PSQI and HADS scores.

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

-Pearson Correlation

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

References:

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

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

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

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

Table 1.

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

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

-Pearson Correlation

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Comparison of important laboratory findings and the mean steroid dose

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

Presenting signs and the symptoms of the patients

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

Conclusion:

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

Disclosure of Interests:

None declared

POS0820 INFLIXIMAB FOR VASCULAR INVOLVEMENT IN BEHÇET SYNDROME

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Figure 1.

The presenting signs and symptoms of the patients

Conclusion:

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

Table 1.

The laboratory findings at initial encounter

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Figure 1.

Performance Among Patients with Each Domain

Conclusion:

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

Table 1.

Diagnostic estimates of screening tools in different studies

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

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

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

Disclosure of Interests:

None declared.

POS1351 CAUSES OF HOSPITALIZATION IN BEHÇET SYNDROME

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Table 1.

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

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

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

Disclosure of Interests:

None declared

FRI0296 AN ALTERNATIVE APPROACH TO SPONDYLOARTHRITIS TREATMENT: PAMIDRONATE CASE SERIES

Background:

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

Objectives:

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

Methods:

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

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

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

Results:

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

Conclusion:

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

References:

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

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Current Treatment Information of the Patients

Current Treatment InformationDMARD26Colchicine23Adalimumab21Etanercept10NSAID4Tocilizumab3Cyclophosphamide3Rituximab2Prednisolone7Mycophenolate Mofetil1Canakinumab1

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

Figure:

Figure.

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Table 1.

Clinical Features of Patients and TREM-1 levels

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

Conclusion:

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

Disclosure of Interests:

None declared

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

Background:

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

Objectives:

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

Methods:

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

Results:

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

Figure 1.

The Presenting Signs and Symptoms of the Patients

Table 1.

The Treatment Information of the Patients

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

Conclusion:

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

Disclosure of Interests:

None declared

SAT0534 RITUXIMAB FOR REFRACTORY IDIOPATHIC RETROPERITONEAL FIBROSIS: A SINGLE TERTIARY CENTER EXPERIENCE

Background:

Idiopathic retroperitoneal fibrosis (RPF) is a progressive disorder of the retroperitoneum which is often idiopathic. Although prednisolone is the mainstay approach to treating RPF, the remission rates range between 75% to 95% (1-2).

Objectives:

Here, we report the outcomes and steroid-sparing effect of Rituximab (Rtx) therapy in 14 patients with RPF.

Methods:

This retrospective study was conducted at a tertiary rheumatology center. Patients were diagnosed with RPF and had at least a course of 0.5-1 mg/kg prednisolone treatment previously. These patients were switched to Rtx due to inadequate response or side effects while on prednisone, tamoxifen, azathioprine or cyclophosphamide therapy. Patients were treated with Rtx in order to be included in this study. Involvement and activation of RPF was shown via PET-CT either before or at least 6 months after the therapy. Daily prednisolone dose was noted before rituximab initiation and 6 months after the therapy. All of the patients reported, except two, were followed for at least 6 months after the Rtx treatment. The final disease status of the three patients were not included in the study.

Results:

Fourteen patients (7F) received at least 2 cycles (1 gr for each) of Rtx. The age of diagnosis was 54.3 ± 11.0 years, follow-up duration was 46.0 ± 37.2 months. The previous treatments, number of the cycles of Rtx and final disease status were shown in the Table. The Control PET-CT revealed metabolic and radiologic remission in 3 patients. In 6 patients, the disease remained stable. In 2 patients there was disease progression hence they were treated with the second course of Rtx. One of the two patients had the progression two years after the first cycle but then, was lost to follow-up. The mean prednisolone dose decreased from 15.5 ± 12.4 mg to 2.2 ± 2.2 mg/day after 6 months of Rtx initiation. Final prednisolone dose was 2.6 ± 5.5 mg/day (Figure). Rtx treatment was ceased in 6 patients with sustained remission.

Conclusion:

The present study shows that Rtx could be a therapeutic option after gluocorticoid or DMARD failure. The steroid sparing effect of Rtx is essential and further prospective studies are needed to assess the Rtx efficacy more objectively in RPF treatment.

Table.

Characteristics and final disease status of the patients

NumberAge of Rituximab InitiationSexPrevious TreatmentsNumber of Rituximab Cycle(s)Final Pet-CT149MPred, Mtx1Stable disease254MPred,Mtx1Stable disease346FPred,Aza,Tmx,Mmf2Progression440MPred,Aza,Mtx4Remission563FPred,Tmx10Stable disease647FPred,Mtx2Stable disease730FPred1Stable disease852MPred,Aza2Progression954MPred1N/A1059MPred,Aza,Mtx1N/A1130FPred, Mtx6Remission1240FPred,Aza,Tmx;Cyc3Stable disease1350MPred2N/A1445FPred,Aza3Remission

Pred:Prednisolone, Aza:Azathioprine, Tmx:Tamoxifen,Mtx:Methotrexate,Cyc:cyclophosphamide

References:

[1]Vaglio A, Palmisano A, Alberici F, Maggiore U, Ferretti S, Cobelli R, Ferrozzi F, Corradi D, Salvarani C, Buzio C: Prednisone versus ta- moxifen in patients with idiopathic retroperitoneal fibrosis: an open-label randomised controlled trial. Lancet 378: 338–346, 2011

[2]van Bommel EF, Siemes C, Hak LE, van der Veer SJ, Hendriksz TR: Long-term renal and patient outcome in idiopathic retroperito- neal fibrosis treated with prednisone. Am J Kidney Dis 49: 615–625, 2007

Disclosure of Interests:

None declared

AB0573 IDIOPATHIC INFLAMMATORY MYOPATHIES: A SINGLE-CENTER EXPERIENCE

Background:

Idiopathic inflammatory myopathies (IIM), mainly dermatomyositis (DM) and polymyositis (PM) are the diseases of the musculoskeletal system most commonly affecting the proximal muscles of the limbs. In addition to muscle inflammation, these conditions are multisystemic, presenting with a variety of complaints.

Objectives:

As IIMs are infrequent, a single-center experience presenting quantitative data describing in-depth information on the nature of disease and treatment seems useful.

Methods:

This retrospective study was conducted at a tertiary rheumatology center. Patients were diagnosed with an idiopathic inflammatory myopathy (DM, PM) in order to be included in this study. Clinical signs and symptoms of the presentation were noted during the first patient encounter as well as the follow-up. Parameters of disease activity including acute phase reactants, muscle enzyme levels, and disease-specific autoantibodies were analyzed. Treatment and prognosis information was also noted with additional information from phone call interviews.

Results:

The study includes 108 patients (78 DM, 30 PM). The mean age of diagnosis was 43.17 ±18.73 years, follow-up duration was 44.37 ±60.58 months. The presenting signs and symptoms of the patients are shown in Figure 1. The parameters of disease activity before and after treatment are summarized in Table 1. The clinical tests ordered during the disease management are summarized in Table 2. The mean corticosteroid dose decreased from 45.65 ±114.53 mg to 15.22 ±16.77 (p=0.007). Other treatment methods were methotrexate (n=72), rituximab (n=28), Intravenous Immunoglobulin (IVIG) (n=9), and cyclophosphamide (n=5). Ten patients died during the follow-up. Thirty-six patients were lost to follow-up.

Table 1.

The Parameters of Disease Activity Before and After Treatment

Before TreatmentAfter TreatmentP ValueCPK, mean ± std (U/L)2429.55 ± 5503.85210.23 ± 352.97<0.0001LDH, mean ± std (U/L)659.48 ± 458.74262.83 ± 139.81<0.0001AST, mean ± std (U/L)82.22 ± 92.6325.94 ± 18.76<0.0001ALT, mean ± std (U/L)75.28 ± 83.326.48 ± 21.68<0.0001ESR, mean ± std (mm/hour)28.7 ± 25.3625.62 ± 22.530.35CRP, mean ± std (mg/L)14.76 ± 26.869.12 ± 18.230.07RF, mean ± std (U/mL)15.72 ± 19.96N/AN/AANA, n (%)26 (24.07)N/AN/AAnti- JO 1, n(%)5 (4.63)N/AN/ATable 2.

The Clinical Tests Ordered during the Disease Management

TestedPositive Muscle Biopsy, n(%)28 (25.93)23 (82.14) Skin Biopsy, n(%)9 (8.33)9 (100) Thorax CT, n(%)24 (22.2218 (75) Abdominal CT, n(%)11 (10.19)8 (72.73) EMG, n(%)43 (39.81)36 (83.72)Figure 1.

The Presenting Signs and Symptoms of the Patients

Conclusion:

IIMs are very rare and can present with very different signs and symptoms. Referral to rheumatology can be challenging along with treatment. With inadequate clinical insight diagnosis and management of these patients can be delayed and quite expensive. Long term follow-up in our center enabled adequate control of disease activity as proven by the highly significant decrease in parameters of disease activity, especially muscle enzyme levels. Furthermore, we reported the variety of clinical symptoms, investigation methods and treatment essays in our center trying to reflect the potential challenges that can hinder a health clinical practice as well as highlight the requirement of a standardized approach.

Disclosure of Interests:

None declared

AB0571 IS RITUXIMAB AN ADEQUATE GLUCOCORTICOID SPARING AGENT IN IDIOPATHIC INFLAMMATORY MYOPATHIES?

Background:

Idiopathic inflammatory myopathies (IIM) are essentially treated aiming improvement of muscle function and extra muscular disease manifestations. The backbone of the treatment is corticosteroids enhancing the survival and patient quality of life. The lack of consensus on target-specific immunosuppressive treatment highlights the need for further studies evaluating alternative treatment methods. Rituximab is potentially a glucocorticoid-sparing agent which was reviewed in multiple studies with small sample sizes due to the rarity of the disease.

Objectives:

Higher statistical power can enhance the trustworthiness of alternative treatment methods yielding the main objective of this study.

Methods:

This retrospective study was conducted at a tertiary rheumatology center. Patients were diagnosed with an idiopathic inflammatory myopathy (dermatomyositis [DM], polymyositis [PM]) and were treated with rituximab in order to be included in this study. Clinical signs and symptoms of the presentation were noted during the first patient encounter as well as the follow-up. Parameters of disease activity including acute phase reactants, muscle enzyme levels, and disease-specific autoantibodies were analyzed.

Results:

The study includes 28 patients (20 DM, 8 PM). The age of diagnosis was 43.44 ± 15.77 years, follow-up duration was 60.7 ± 70.7 months. The presenting signs and symptoms of the patients are shown in Figure 1. The parameters of disease activity before and after treatment are summarized in Table 1. The mean corticosteroid dose decreased from 31.429 ±23.934 mg to 10.278 ±12.001 (p=0.001). Other treatment methods were methotrexate (n=18), Intravenous Immunoglobulin (IVIG) (n=7), and cyclophosphamide (n=2). There were not any deaths during the follow-up. Two patients were lost to follow-up.

Table 1.

The Parameters of Disease Activity Before and After Treatment

Before TreatmentAfter TreatmentP ValueCPK, mean ± std (U/L)1426 ± 2049.92263.44 ± 265.630.004LDH, mean ± std (U/L)557.5 ± 365379.78 ± 192.10.03AST, mean ± std (U/L)62.52 ± 5930.16 ± 27.590.01ALT, mean ± std (U/L)56.48 ± 49.2127.64 ± 24.520.008ESR, mean ± std (mm/hour)26.38 ± 28.9820.39 ± 18.760.36CRP, mean ± std (mg/L)19.23 ± 46.1512.53 ± 26.670.5RF, mean ± std (U/mL)0 (0)N/AN/AANA, n (%)3 (10.71)N/AN/AFigure 1.

The Presenting Signs and Symptoms of the Patients

Conclusion:

Rituximab is shown to be effective in treating myositis along with corticosteroids as well as a corticosteroid-sparing agent in retrospective studies and open-label clinical trials; however, lack of statistical power should be underlined. Long term decrease in steroid use and decrease in disease activity markers hints the effective use of rituximab as a glucocorticoid sparing agent as well as its safety with minimal side effects.

Disclosure of Interests:

None declared

SAT0243 SUBPHENOTYPES IN POLYARTERITIS NODOSA (PAN): TARGET ORGAN ASSOCIATIONS OF A WORLDWIDE COLLABORATION STUDY

Background:

There is a paucity of information on the current phenotypes, ethnic and geographic differences of PAN. A global PAN study group has been working for clinical subphenotype and GWAS studies.

Objectives:

This study is aimed to look for target organ associations in PAN.

Methods:

PAN patients fulfilling the EMA vasculitis classification algorithm were recruited. In addition to baseline characteristics, treatment and outcome data, occurrence of any of the clinical manifestations related to PAN during disease course was recorded.

Factor analysis was used to analyse target organ associations of 306 patients. Five factors were identified by factor analysis of variables sex, paediatric-onset, HBV, monogenic disease relationship, cutaneous features, musculoskeletal symptoms, constitutional symptoms and involved areas (abdominal, renal, neurologic, ENT, cardiac, pulmonary).

Results:

PAN cohort from 7 countries were used (Italy: n=59, Japan: n=39, Mexico: n=29, Slovenia: n=14, Sweden:11, TUR: n=106, UK: n=48). 306 (M/F: 171/135 and Caucasian 77.1%, Asian 13.4%, and Hispanic 9.5%) patients were included. 8 were HBV-related, and 22 of TUR patients had a monogenic form of disease (FMF n=15, DADA2 n=7). 21.8% of patients were cutaneous-only PAN patients. 48.4% of patients had radiologic, 64% had biopsy-proven PAN. Median age at disease onset was 40 (IQR 27.0-57.5) years. During a median 57 (16-120) months follow-up, 39 (13%) patients died.

Factor analysis revealed 5 factors that explained 54.1% of the original information on the matrix as follows:Factor 1,represented the association between gastrointestinal and renal involvement, male gender and negatively associated with cutaneous features;Factor 2,the association between monogenic relationship with paediatric onset disease;Factor 3,any of musculoskeletal findings with positive constitutional symptoms;Factor 4any neurologic involvement was associated with ENT and pulmonary findings;Factor 5cardiac involvement in non-HBV patients (Table).

The eigenvalues of the 5 factors were 2.034, 1.470, 1.427, 1.079 and 1.030, in decreasing order, i.e., the highest contribution to the overall variance in the matrix came from the togetherness of the 4 clinical and demographic characteristics that made up Factor 1.

Conclusion:

Target organ associations could support distinctive subphenotypes in PAN. Factor 1 seems the most severe form. Patients with FMF or DADA2 have distinct target organ associations. The jury is out to decide whether these patients should be classified as ‘vasculitis associated with probable etiology’ just as HBV-related-PAN. Factor 4 might define a different subphenotype (ANCA- medium vessel vasculitis?).

Disclosure of Interests:

Omer Karadag: None declared, Ertugrul Cagri Bolek: None declared, Shunsuke Furuta: None declared, Giacomo Emmi: None declared, ALOJZIJA HOCEVAR: None declared, Andrea Hinojosa-Azaola: None declared, Aladdin J Mohammad Speakers bureau: lecture fees from Roche and Elli Lilly Sweden, PI (GiACTA study), Serdal Ugurlu: None declared, Fatma Alibaz-Oner: None declared, Ayten Yazici: None declared, Luca Quartuccio: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Giuseppe Alvise Ramirez: None declared, Luca Cantarini: None declared, Gina Gregorini: None declared, Jeannin Guido: None declared, Sara Monti: None declared, Eduardo Martin-Nares: None declared, Franco Schiavon: None declared, Roberto Padoan: None declared, Hajime Kono: None declared, Augusto Vaglio: None declared, Saadettin Kiliçkap: None declared, Ali İhsan Ertenli: None declared, Haner Direskeneli: None declared, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis, David Jayne Grant/research support from: ChemoCentryx, GSK, Roche/Genentech, Sanofi-Genzyme, Consultant of: Astra-Zeneca, ChemoCentryx, GSK, InflaRx, Takeda, Insmed, Chugai, Boehringer-Ingelheim