Frequency and the effects of spondyloarthritis-spectrum disorders on the clinical course and management of Takayasu arteritis: an observational retrospective study

OBJECTIVES

Extravascular findings of Takayasu arteritis (TAK) often share features with the spondyloarthritis (SpA) spectrum of disorders. However, the characteristics of this overlap and its effect on the vascular manifestations of TAK are not fully known. Therefore, we aimed to investigate the frequency of SpA-related features in TAK patients.

MATERIAL AND METHODS

In this observational retrospective study, 350 patients with TAK classified according to ACR 1990 criteria, from 12 tertiary rheumatology clinics, were included and evaluated for the presence of axSpA, IBD, or psoriasis. Demographic, clinical features, angiographic involvement patterns, disease activity, and treatments of TAK patients with or without SpA were analyzed.

RESULTS

Mean age was 45.5 ± 13.6 years and mean follow-up period was 76.1 ± 65.9 months. Among 350 patients, 31 (8.8%) had at least one additional disease from the SpA spectrum, 8 had IBD, 8 had psoriasis, and 20 had features of axSpA. In the TAK-SpA group, TAK had significantly earlier disease onset, compared to TAK-without-SpA (p = 0.041). SpA-related symptoms generally preceded TAK symptoms. Biological treatments, mostly for active vasculitis, were higher in the TAK-SpA group (70.9%) compared to TAK-without-SpA (27.9%) (p < 0.001). Vascular involvements were similar in both.

CONCLUSION

Our study confirmed that diseases in the SpA spectrum are not rare in TAK. Vascular symptoms appeared earlier in such patients, and more aggressive therapy with biological agents was required in the TAK-SpA group, suggesting an association between TAK and SpA spectrum. Key Points • The pathogenesis of Takayasu arteritis is mediated by an MHC class I alelle (HLA-B*52), similar to spondyloarthritis-disorders. • Extravascular findings of Takayasu arteritis are in the spectrum of spondyloarthritis disease. • This frequent coexistence between Takayasu arteritis and spondyloarthritic disorders suggests a relationship rather than a coincidence.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Neurologic manifestations of Behçet disease: rheumatology experience

OBJECTIVE

Neurologic involvement in Behçet disease (BD) is a rare manifestation. Herein, we aimed to evaluate the clinical features and treatment choices of neuro-Behçet (NB) patients.

METHODS

There were records of 800 BD patients between 1998 and 2021. Fifty-five of the BD patients had NB and the files of these patients were retrospectively evaluated. Patients were grouped into three subgroups: 22 (40%) had non-parenchymal, 25 (45%) had parenchymal, and 8 (15%) had both parenchymal and non-parenchymal (mixed) involvement.

RESULTS

Of the 55 patients, 32 were male. Twenty-six of the NB patients were diagnosed with BD simultaneously. The most common complaint was headache (n = 24, 44%). The most affected site was periventricular white matter (n = 21, 38%). All patients had received corticosteroids. Azathioprine (AZA; n = 39, 71%) was the most common immunosuppressive agent after corticosteroids, followed by cyclophosphamide (n = 16, 29%).

CONCLUSION

Neurologic involvement is a rare complication of BD but is related to increased mortality and morbidity. Neurologic manifestations may be the initial symptom of BD, thus leading to diagnosis. Both neurology and rheumatology specialists should be aware of this rare condition.

Does decision tree analysis predict oral ulcer activity-related factors in patients with Behçet's syndrome?

OBJECTIVES

The study aimed to identify the interactions among treatment protocols and oral ulcer activity related factors in patients with Behçet's syndrome (BS) using the Classification and Regression Tree (CART) algorithm.

METHODS

In this cross-sectional study, 979 patients with BS were included from16 centres in Turkey, Jordan, Brazil and the United Kingdom. In the CART algorithm, activities of oral ulcer (active vs. inactive), genital ulcer (active vs. inactive), cutaneous involvement (active vs. inactive), musculoskeletal involvement (active vs. inactive), gender (male vs. female), disease severity (mucocutaneous and musculoskeletal involvement vs. major organ involvement), smoking habits (current smoker vs. non-smoker), tooth brushing habits (irregular vs. regular), were input variables. The treatment protocols regarding immunosuppressive (IS) or non-IS medications were the target variable used to split from parent nodes to purer child nodes in the study.

RESULTS

In mucocutaneous and musculoskeletal involvement (n=538), the ratio of IS use was higher in patients with irregular toothbrushing (ITB) habits (27.1%) than in patients with regular toothbrushing (RTB) habits (14.2%) in oral ulcer activity. In major organ involvement (n=441), male patients with ITB habits were more likely treated with IS medications compared to those with RTB habits (91.6% vs. 77.6%, respectively).

CONCLUSIONS

Male BS patients on IS who have major organ involvement and oral ulcer activity with mucocutaneous and musculoskeletal involvement have irregular toothbrushing habits. Improved oral hygiene practices should be considered to be an integral part for implementing patient empowerment strategies for BS.

Epidemiological characteristics of hepatitis B and C in patients with inflammatory arthritis: Implications from treasure database

Objectives

This study aimed to evaluate the hepatitis B (HBV) and C (HCV) frequency and clinical characteristics among patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) who receive biological treatments.

Patients and methods

The observational study was conducted with patients from the TReasure database, a web-based prospective observational registry collecting data from 17 centers across Türkiye, between December 2017 and June 2021. From this database, 3,147 RA patients (2,502 males, 645 females; median age 56 years; range, 44 to 64 years) and 6,071 SpA patients (2,709 males, 3,362 females; median age 43 years; range, 36 to 52 years) were analyzed in terms of viral hepatitis, patient characteristics, and treatments used.

Results

The screening rate for HBV was 97% in RA and 94.2% in SpA patients. Hepatitis B surface antigen (HBsAg) positivity rates were 2.6% and 2%, hepatitis B surface antibody positivity rates were 32.3% and 34%, hepatitis B core antibody positivity rates were 20.3% and 12.5%, HBV DNA (deoxyribonucleic acid) positivity rates were 3.5% and 12.5%, and antibody against HCV positivity rates were 0.8% and 0.3% in RA and SpA patients, respectively. The HBsAg-positive patients were older and had more comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, rheumatoid factor (RF) positivity was more common in HBsAg-positive cases. The most frequently prescribed biologic disease-modifying antirheumatic drugs were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group and adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. Hepatitis B reactivation was observed in one RA patient during treatment, who received rituximab and prophylaxis with tenofovir.

Conclusion

The epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the comprehensive registries in rheumatology practice.

The First Effect of COVID-19 Pandemic on Starting Biological Disease Modifying Anti-Rheumatic Drugs: Outcomes from the TReasure Real-Life Database

OBJECTIVE

The coronavirus disease 2019 pandemic has been resulting in increased hospital occupancy rates. Rheumatic patients cannot still reach to hospitals, or they hesitate about going to a hospital even they are able to reach. We aimed to show the effect of the first wave of coronavirus disease 2019 pandemic on the treatment of biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis or spondyloarthritis.

METHODS

Patients were divided into three groups as follows: pre-pandemic (Pre-p: starting on biological disease-modifying anti-rheumatic drug therapy for the first time within 6 months before March 11, 2020); post-pandemic A (Post-p A: starting on biological disease-modifying anti-rheumatic drug therapy for the first time within the first 6 months after March 11, 2020); post-pandemic B (Post-p B: starting on biological disease-modifying anti-rheumatic drug therapy for the first time within the second 6 months).

RESULTS

The number of rheumatoid arthritis patients in the Post-p A and B groups decreased by 51% and 48%, respectively, as compared to the Pre-p group similar rates of reduction were also determined in the number of spondyloarthritis patients. The rates of tofacitinib and abatacept use increased in rheumatoid arthritis patients in Post-p period.

CONCLUSION

The number of rheumatoid arthritis and spondyloarthritis patients starting on biological disease-modifying anti-rheumatic drugs for the first time decreased during the first year of the coronavirus disease 2019 pandemic.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Minimal Change Disease and Primary Sjogren Syndrome Concurrence: Case-Based review

Primary Sjogren's syndrome is a chronic autoimmune disease with glandular and extraglandular features. Renal involvement is less frequent when compared with other systemic manifestations. Glomerulonephritis is a relatively rare manifestation of primary Sjogren's syndrome. Among all types of glomerular manifestations, minimal change disease is rarely identified, and there are only a few cases in the literature. Herein, we present a 53-year-old male patient who was diagnosed with primary Sjogren's syndrome and minimal change disease while searching for the etiopathogenesis of nephrotic syndrome. The patient had edema, dyspnea, hypertension, and 12 g/day proteinuria at admission. Serum albumin level was 1.82 g/dL, and renal function tests were within normal ranges. Renal biopsy findings were consistent with minimal change disease. At the same time, he was diagnosed with primary Sjogren's syndrome based on dry eyes demonstrated with Schirmer's test, positive antinuclear antibody, anti-SS-A, and anti-SS-B antibodies. Hydroxychloroquine with methylprednisolone 1 mg/kg (64 mg/day) was started, and methylprednisolone was slowly tapered. His proteinuria regressed to 79.2 mg/day, creatinine level was 0.83 mg/dL, and serum albumin level increased to 3.88 g/dL on the second week of the glucocorticoid treatment. In this case-based review, we present our case with 5 other reports of minimal change disease associated with primary Sjogren's syndrome. Our aim was to increase the awareness of this rare concurrence both among rheumatologists and nephrologists in light of the literature review.

Minimal Change Disease and Primary Sjogren Syndrome Concurrence: Case-Based review

Primary Sjogren's syndrome is a chronic autoimmune disease with glandular and extraglandular features. Renal involvement is less frequent when compared with other systemic manifestations. Glomerulonephritis is a relatively rare manifestation of primary Sjogren's syndrome. Among all types of glomerular manifestations, minimal change disease is rarely identified, and there are only a few cases in the literature. Herein, we present a 53-year-old male patient who was diagnosed with primary Sjogren's syndrome and minimal change disease while searching for the etiopathogenesis of nephrotic syndrome. The patient had edema, dyspnea, hypertension, and 12 g/day proteinuria at admission. Serum albumin level was 1.82 g/dL, and renal function tests were within normal ranges. Renal biopsy findings were consistent with minimal change disease. At the same time, he was diagnosed with primary Sjogren's syndrome based on dry eyes demonstrated with Schirmer's test, positive antinuclear antibody, anti-SS-A, and anti-SS-B antibodies. Hydroxychloroquine with methylprednisolone 1 mg/kg (64 mg/day) was started, and methylprednisolone was slowly tapered. His proteinuria regressed to 79.2 mg/day, creatinine level was 0.83 mg/dL, and serum albumin level increased to 3.88 g/dL on the second week of the glucocorticoid treatment. In this case-based review, we present our case with 5 other reports of minimal change disease associated with primary Sjogren's syndrome. Our aim was to increase the awareness of this rare concurrence both among rheumatologists and nephrologists in light of the literature review.

AB1292 CHARACTERISTICS OF UVEITIS IN BEHCET’S SYNDROME; A RETROSPECTIVE ANALYSIS OF 109 PATIENTS

Background

Uveitis is still an important cause of morbidity leading to vision loss in Behcet’s syndrome (BS).

Objectives

Our aim in this study was to retrospectively evaluate characteristics of uveitis, long term complications, and its association with the other components of BS.

Methods

800 patients with BS diagnosis according to International Study Group for Behcet’s Disease (ISG) criterias in our center were screened and among those, data of 109 patients with BS-related uveitis were included in this study.

Results

The overall prevalence of uveitis was found 13% among all BS population. Majority of BS-related uveitis were male (65,1%/34,9%). Mean age for BS diagnosis and onset of uveitis were found 28 ± 8,48 and 27 ± 8,42 years. In this group, uveitis developed before BS diagnosis in 33% of patients, whereas 44% were diagnosed at onset of uveitis.The frequency of this population was estimated 6% among all BS patients,. Characteristics of uveitis were as following; unilateral (45/99), bilateral (54/99), anterior (12), posterior (30), panuveitis (30), retinal vasculitis (9) and not defined (9). 25 patients experienced only one attack, whereas more than one attack was seen in 45 patients during follow up. 74 patients whose complications data was available, cataract, maculopathy, glaucoma, and optic atrophy developed in 10, 7, 6 and 3 patients, respectively. Vision loss was seen in 8 patients as partial, in 28 as total (Table 1).

Table 1.

Characteristics of uveitis, complications and other components of BS patients

Male/female, (n), (%)71/28 (%65,1/%34,9)Age at diagnosis, years (Mean± SD)28 ±8,48Age at uveitis, years (Mean± SD)27 ±8,42Uveitis-Behcet’s diagnosis relationship, (n)109-Before, (n), (%)36 (%33)-At the time of, (n), (%)48 (%44)-After, (n), (%)25 (%23)Characteristics of uveitis, (n)99/109-Unilateral/Bilateral45/54-Anterior12-Posterior30-Panuveitis30-Retinal vasculitis9Complications, (n)26/74-Maculopathy7-Glaucoma6-Cataract10-Optic atrophy5-Vision loss (partial/total)8/28

BS; Behcet’s syndrome

Conclusion

Male gender and onset at young age are important risk factors for uveitis development. Uveitis is seen as a critical component for diagnosis. Complications, despite declining in the era of biologics use, are still a major concern. Retrospective design and missing data are limitations of this study.

References

[1]Saadouli D, Lahmar A, Ben Mansour K, El Afrit N, Yahyaoui S, El Afrit MA. Les manifestations oculaires au cours de la maladie de Behçet [Ocular manifestations of Behçet’s disease]. J Fr Ophtalmol. 2021;44(2):196-202.

Disclosure of Interests

None declared

POS1184 EPIDEMIOLOGICAL CHARACTERISTICS OF VIRAL HEPATITIS IN PATIENTS WITH RHEUMATIC DISEASES – IMPLICATIONS FROM TREASURE DATABASE

Background

Recent epidemiological data on HBV and HCV in Turkey revealed that the seroprevalence rates of hepatitis B surface antigen and antibody against HCV were 4% and 1%, respectively, and seropositivity rates for hepatitis B surface antibody and hepatitis B core antibody were 31.9% and 30.6%, respectively. A previous multicenter nationwide study conducted in Turkey reported that the HBsAg positivity was determined in 2.3% of patients with rheumatoid arthritis (RA) and 3% of patients with ankylosing spondylitis (AS), and the anti-HCV positivity was detected in 1.1% of patients in each group. Given these rates, viral hepatitis is still considered a potential threat to patients with rheumatic diseases, specifically for the treatment-related viral reactivation.

Objectives

This study aimed to evaluate the serologic HBV and HCV frequency and clinical characteristics among our patients with RA or SpA and receive biological treatments based on this background.

Methods

The prospective TReasure database, which observationally collects data of patients with rheumatic diseases from fifteen centers across Turkey, was analyzed for viral hepatitis, patient characteristics, and treatments used. TReasure registry study protocol, and the data collection was started on December 2017. At the time of the analysis for this study was performed, the registry database included 3147 patients with RA and 6071 patients with SpA. For hepatitis B; Hepatitis B surface antigen (HBsAg), anti-HBV core antibody (anti-HBc) and anti-HBV surface antibody (Anti-HBs) tests were evaluated. HBV-DNA was studied in HBsAg positive patients. Anti-HCV antibody has been studied for HCV. The clinical and serological HBV reactivation in the follow-up of the patients was evaluated by looking at the HBV-DNA viral loads.

Results

A total of 9218 patients (3147 RA and 6071 patients with SpA) were included in the analyses. The screening rate for HBV was 97% in RA and 94.2% in SpA groups. HBsAg positivity rates were 2.6% and 2%, anti-HBs positivity rates were 32.3% and 34%, anti-HBc positivity rates were 20.3% and 12.5%, HBV DNA positivity rates were 3.5% and 12.5%, and anti-HCV positivity rates were 0.8% and 0.3% in these groups, respectively (Table 1).

Table 1.

Serological analyses in the study group

RASpApNn (%)Nn (%)Hepatitis testing28962809 (97.0)54445130 (94.2)<0.001HBsAg positivity275071 (2.6)501799 (2)0.080Anti-HBs positivity2708876 (32.3)48931663 (34)0.147Anti-HBc positivity2362480 (20.3)4194524 (12.5)<0.001HBV-DNA positivity45416 (3.5)63735 (5.5)0.129Anti-HCV positivity260222 (0.8)462716 (0.3)0.005

The HBsAg (+) patients were older and had higher comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, RF positivity was more in HBsAg(+) cases. The most frequently prescribed bDMARDS were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group, whereas adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. HBV reactivation was observed in one patient with during RA treatment, who received rituximab and prophylaxis with tenofovir.

Figure 1.

Prescription proportions of medications in the rheumatoid arthritis (RA) and spondyloarthritis (SpA) groups

Conclusion

The epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the most comprehensive registries in rheumatology practice. According to the results of our study; It can be thought that there is no risk in the choice of treatment by the rheumatologist in patients who receive appropriate prophylaxis.

Disclosure of Interests

None declared

AB0355 THE DIFFERENCES BETWEEN THE FIRST PREFERRED BIOLOGICAL DMARD AND THE DRUG SURVIVAL IN GERIATRIC AND YOUNGER ADULT POPULATION WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS: TREASURE REAL-LIFE DATA

Background

Inflammatory musculoskeletal diseases are frequent in the elderly population, and this number is expected to increase significantly near future. The exclusion of older adults from the studies due to their age and comorbidities causes insufficient data about this population. Insufficient data cause clinicians to have difficulties using and selecting biological therapy in the elderly patient group. In real life, physicians’ approaches to the selection and use of biological disease modifying anti-rheumatic drugs (DMARDs) in the geriatric population with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have not been well studied.

Objectives

To compare the clinicians’ first choice of biological DMARDs in elderly and younger RA and PsA patients and investigate the drug survival of first biological DMARDs in both populations.

Methods

The traditional chronological age for the human to be classified in the geriatric population is ≥ 65 years (1). The TReasure web-based registry, created in 2017, is a multicenter observational cohort established to collect data on RA and spondyloarthritis (SpA) patients from the participating 17 rheumatology centers in different regions of Turkey. Physicians’ first choice biological and targeted synthetic DMARDs in younger and elderly patients with RA and PsA was evaluated using the descriptive statistical method. The survival of the first b/tsDMARDs was assessed using the Kaplan-Meier method.

Results

3136 RA and 738 PsA patients were evaluated. 12% of 3136 patients with RA were in the geriatric population. In patients with RA, the first choice of biologic DMARDs was adalimumab (20.6%), followed by etanercept (19.9%), and tofacitinib (13.6%) in patients < 65 years of age, while rituximab (24%) was the first choice in patients ≥ 65 years, tofacitinib (20.9%) in the second place and etanercept (13%) in the third. Of 738 PsA patients, 3% were over 65 years. Adalimumab (41.1%) was the first choice of <65 years of age, etanercept (17.6%) was the second choice, and infliximab (15.5%) was the third choice, while adalimumab (28.6%) was the first choice in patients ≥ 65 years followed by etanercept (17.9%) and certolizumab (17.9%). In RA group, drug survival was significantly higher in patients ≥ 65 years (estimated median drug survival; <65 age: 37.5 (34.1-41.1) months vs ≥65 age: 53.5 (24.9-82.2) months; log-rank p=0,016) (Figure 1). In PsA group, drug survival was significantly higher in patients < 65 years (estimated median drug survival; <65 age: 31.2 (26.4-36.1) months vs ≥65 age: 9.1 (0.4-17.7) months; log-rank p<0,001) (Figure 1).

Figure 1.

Comparison of first bDMARD retention rates between <65 years and ≥ 65 years. A: In rheumatoid arthritis patients, B: In psoriatic arthritis patients

Conclusion

With these findings, it is thought that in Turkey, the limited socioeconomic support in the geriatric patients has led physicians to prescribe treatments such as rituximab, which are administered in the hospital under the supervision of a physician, are relatively preferred in malignancies, and are considered to be relatively less risky in terms of tuberculosis. Adalimumab and etanercept were chosen in the first two lines in both geriatric and young populations in the patient group with PsA. While the drug survival was significantly higher in patients with RA geriatric age group than the younger group, in PsA in which tumor necrosis factor-alpha (TNF-α) inhibitors were chosen as initial therapy in both age groups was lower in the geriatric population.

References

[1]Kotsani et al. JCM 2021. https://doi.org/10.3390/jcm10143018

Disclosure of Interests

None declared

AB0774 Paradoxical reactions, especially psoriasis in rheumatology patients receiving biologic therapy from the Treasure database: a 5-year follow-up study

Background

Biologic agents have altered our ability to treat chronic inflammatory diseases effectively. Although paradoxical reactions (PRs) were initially described with TNF-α inhibitors, they have been reported with newly developed biologic agents or classes too (1). Due to the potential consequences of PRs, it is critical to identify and treat these drug class side effects as soon as possible.

Objectives

The aim of this study was to characterize PRs, especially psoriasis, in a large cohort of patients treated with biologic agents and to investigate their clinical implications.

Methods

TReasure database, which was launched in 2017, is a web-based prospective observational cohort comprised of patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) from 17 centers located throughout Turkey. Characteristics of patients with PRs and clinicians’ treatment approaches and outcomes were evaluated using descriptive statistics.

Results

3147 RA and 6071 SpA patients were evaluated. 139 (1.5%) patients (40 (28.8%) with RA and 99 (71.29%) with SpA) developed a PRs (Table 1). The rate of paradoxical psoriasis was 90.6% and 9.7% of the patients had a family history of psoriasis. Females constituted 64% of the patients. The mean age was 46±12 years and the disease duration were 146±92 months. Mean time interval between the PRs and diagnosis was 99,6±86 months, whereas median 12 (1-132) months between the PRs and the biological agent. Adalimumab (30.9 %), etanercept (20.1 %), and infliximab (18.7 %) were the three most frequently used agents during the PRs. However, 8.6% of the patients developed PRs with non-TNF agents. Only seven patients (5.1%) who had PRs discontinued the drug, while 28 patients (20.6%) continued to receive the agent that caused the PRs. Majority of patients were switched to other TNF-α inhibitors (48.5%) and non-TNF agents (25.7%). When we limited our analysis to paradoxical psoriasis patients, we observed complete remission in 43.5% of patients and progression in only six (4.7 %) of patients. (Figure 1).

Table 1.

Characteristics of RA and SpA patients who developed paradoxical reactions

NPatients (N, %)Paradoxical reactions (PRs)139  Psoriasis126 (90.6%)  Uveitis6 (4.3%)  Sarcoidosis2 (1.4%)  IBD1 (0.7%) Other*4 (4.3%)Primary disease139  RA40 (28.8%)  SpA99 (71.29%)Time interval between PRs-diagnosis of RA/SpA (months)12499,6±86† 72 (3-420) ††Time interval between PRs-biological onset (months)12622±25† 12 (1-132) ††BMI, kg/m212328±5† 27,8 (17,3-49,7) ††Smokers (Current/ex)13161 (46.6%) / 10 (8.5%)Biological agents used during PRs139  TNF-α inhibitor used**127 (91.3%)  Secukinumab2 (1.4%)  Abatacept6 (4.3%)  Rituximab4 (2.9%)Biological agents used after PRs101  Etanercept31 (22.8%)  Adalimumab15 (11%)  Secukinumab12 (8.8%)  Other***43 (57.5%)

PRs: Paradoxical reactions IBD: Inflammatory bowel disease. *Drug-induced lupus:3 Vasculitis:1. ** Adalimumab: 43 (30.9%), Etanercept: 28 (20.1%), Infliximab: 26 (18.7%), Certolizumab: 20 (14.4%), Golimumab: 10 (7.2%). *** Certolizumab: 9 (6.6%), Tofacitinib: 9 (6.6%), Infliximab: 7 (5.1%), Tocilizumab: 5 (3.7%), Golimumab: 4 (2.9%), Ustekinumab: 4 (2.9%), Rituximab:3 (2.2%), Abatacept: 1 (0.7%), Anakinra: 1 (0.7%). † mean ± standard deviation. †† median (min-max)

Conclusion

Clinicians should be aware that PRs may develop with biologic agents other than TNF-α inhibitors. Additionally, it is important to keep in mind that the development time of PRs could be variable. The mechanism(s) behind PRs remain unknown, and there is no currently available diagnostic or therapeutic protocol (2). The decision whether to continue or discontinue biologic agents should be individualized. We found that the majority of patients can be managed without discontinuing biologic agents. Finally, we believe that the experience of our large cohort can help physicians in clinical practice where sufficient protocol is lacking.

References

[1]Lluís Puig. Curr Probl Dermatol. 2018; 53:49-63.

[2]Michael J Murphy. J Am Acad Dermatol. S0190-9622(20)33154-6.

Disclosure of Interests

None declared

POS1008 FACTORS ASSOCIATED WITH HIP INVOLVEMENT AND ITS IMPACT ON TREATMENT DECISION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS; TREASURE EXPERIENCE

Background

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting sacroiliac joints, spine and peripheral joints. In addition to spinal and peripheral manifestations, root joints (hip or sholder) involvement may also develop. Hip involvement is reported 24-36% in patients with Ankylosing Spondylitis (AS) by clinical evaluation of the rheumatologists. However, there is limited data regarding the factors related with the presence of hip involvement and treatment preference in patients with axSpA.

Objectives

The aim of this study was to evaluate the factors/covariates associated with the hip involvement and its impact on the treatment preferences in patients with axSpA patients who initiated their first biologic therapy.

Methods

In total, 1600 axSpA patients who initiated his/her first biologic were included in the study. The data for the current study was obtained from the TReasure web-based registry. Baseline demographics and disease related characteristics were collected. Characteristics and treatment preference of patients with and without hip involvement were compared. The factors/covariates associated with the presence of hip involvement were evaluated by regression analysis.

Results

Hip involvement was reported in 375 patients (23.4%). Patients with hip involvement were more common male patients in addition they had lower education level, lower BMI and more frequent HLA-B27 positivity as well as longer disease duration. Hip involvement was more frequent in patients with r-axSpA than patients with nr-axSpA. We found lower percentages of peripheral arthritis, enthesitis and dactylitis, higher BASFI or ASDAS-CRP scores, higher serum CRP levels and ESR values in patients with hip involvement. Moreover, patients with hip involvement had less frequently SpA-related family history (Table 1). When we analyzed patients according to age at diagnosis (≥ 16 years, <16 years) we found that patients with hip involvement were more common in juvenile onset axSpA group. In multivariate analysis, we found that lower education level (OR:2.029, 95%CI:[1.461-2.817]; p<0.001), diagnosis (r-axSpA) (OR:0.532, 95%CI:[0.337-0.839]; p=0.007) longer disease duration (OR:1.002, 95%CI:[1.001-1.004]; p=0.002), lower percentages of enthesitis (OR:0.405, 95%CI:[0.283-0.579]; p<0.001), higher BASFI scores (OR:1.086, 95%CI:[1.025-1.151]; p=0.005) and serum CRP levels (OR:1.005, 95%CI:[1.001-1.010]; p=0.019) absence of SpA family history (OR:0.713, 95%CI:[0.528]; p=0.027) were associated with hip involvement.

Table 1.

Characteristics of patients with axSpA

All patients (n=1600)Hip involvement (+) (n=375)Hip involvement (-) (n=1225)P*Juvenile (<16 years) onset, n(%)30 (1.9)12 (3.2)18 (1.5)0.031Male sex, n(%)940 (58.8)255 (68)685 (55.9)<0.001HLA-B27 positivity, n(%)605 (55)178 (62.7)427 (52.3)0.002BMI, kg/m2mean (SD)27.2 (5.2)26.7 (5.0)27.4 (5.2)0.023Education duration (≤12 years), n (%)1014 (65.9)263 (71.3)751 (64.2)0.013mNY positivity, n(%)1276 (79.8)338 (90.1)938 (76.6)<0.001Disease duration (month) median (IQR 25-75)82 (36-151)111 (52-200)74.5 (32-139)<0.001SPA-related family history, n (%)544 (34)110 (29.3)434 (35.4)0.029BASFI, mean (SD)3.9 (2.5)4.3 (2.1)3.8 (2.7)0.007ASDAS-CRP, mean (SD)3.1 (1.5)3.7 (1.4)2.9 (1.5)<0.001CRP (mg/dl), median (IQR 25-75)8.6 (3-21)12.0 (4.0-27.9)7.6 (2.5-19)<0.001

When we compared the treatment patterns of axSpA patients with and without hip involvement, we found that the percentages of NSAID as well as csDMARD use were similar in groups. However, the percentages of patients who were prescribed etanercept were higher in axSpA patients with hip involvement (p<0.001).

Conclusion

In addition to inflammation and function, hip involvement seems to be related with diagnosis (r-axSpA), education level and absence of SpA family history. Moreover, enthesitis may not accompany hip involvement.

Disclosure of Interests

None declared

AB0766 Biologic Drug Preferences of Turkish Rheumatologists in Spondiloartropathy Patients with Advanced Chronic Renal Disease

Background

Biological therapies are the main treatment options for patients with active spondyloarthropathy (SpA) who do not respond to nonsteroidal anti-inflammatory drugs or conventional synthetic disease-modifying drugs. Kidney diseases are not a contraindication to biologic therapies. However, there are some safety concerns for these drugs for patients with advanced chronic kidney disease. De novo infection or recurrence of infections are the main challenges in patients with multiple comorbidities during biologic treatments. Neverthless, physicans should initiate these treatments in active and resistant diseases.

Objectives

Here, we evaluated which biologic therapies clinicians’ first option to initiate in SpA patients with advanced chronic kidney disease (CRD).

Methods

Total 140 patients of TREASURE database who fullfield axial and/or peripheral ASAS SpA criteria with glomerular filtration rate < 60 ml/dk (stage 3,4 or 5 CRD according to The National Kidney Foundation classification) were included to the study. Renal stages of the patients were evaluated when biologic therapy was initiated. Five anti-TNF (adalimumab, certolizumab, etanercept, golimumab, infliximab) and an interleukin-17A blocker (secukinumab) were on the market during the study. We evaluated physicans’ first choice for biologic therapy for patients with stage 3,4 and 5 CRD respectively.

Results

More than two thirds of the patients had stage 3 CRD. Anti-TNF drugs were the first choice of biologic treatment in the patients with advanced CRD. Etanercept was started at most to the patients in general, in stage 3 and in stage 5 CRD groups. However, adalimumab was the first choise in stage 4 CRD. Both etanercept and adalimumab were the first drug of choise in three fourth of the stage 4 and stage 5 patients. All two patients on Il-17A blocker had stage 3 CRD (Table 1).

Table 1.

Drug of choise in the SpA patients with advanced chronic renal diseases

NTotal n (%)NStage 3 n (%)NStage 4 n (%)NStage 5 n (%)Adalimumab14044 (31.4)10830 (27.8)209 (45.0)125 (41.6)Etanersept52 (37.1)41 (38.0)5 (25.0)6 (50.0)Golimumab9 (6.0)7 (6.5)2 (10.0)0 (0)Infliksimab28 (20.0)23 (21.3)4 (20.0)1 (8.4)Secukinumab3 (2.1)3 (2.8)0 (0)0 (0)Sertolizumab4 (2.8)4 (3.7)0 (0)0 (0)

Conclusion

We show that rheumatologists in the TREASURE group prefer to initiate anti-TNF drugs first in all advanced CRD stages. Etanercept was the first choice in these patients.

References

[1]Sieper J, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009 Jun;68 Suppl 2:ii1-44. doi: 10.1136/ard.2008.104018. PMID: 19433414.

[2]Antoni C, Braun J. Side effects of anti-TNF therapy: current knowledge. Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S152-7. PMID: 12463468.

[3]Kalyoncu U, et al. Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci. 2018 Aug 16;48(4):856-861. doi: 10.3906/sag-1807-200. PMID: 30119164.

Disclosure of Interests

None declared

AB1290 SOMETIMES IT IS ALL IN THE HEART; CARDIAC INVOLVEMENT IN BEHCET’S SYNDROME

Background

Cardiac involvement is an uncommonly seen but might be a fatal clinical manifestation of Behcet’s syndrome (BS), if not recognized early and treated aggressively.

Objectives

Our aim was to retrospectively evaluate the characteristics of cardiac involvement in Behcet’s syndrome and investigate possible risk factors.

Methods

800 patients with BS diagnosis according to International Study Group for Behcet’s Disease (ISG) criterias in our center were screened. 14 patients with cardiac involvement were included in this study.

Results

All the patients were male with positive smoking history. The age at the onset cardiac involvement was 32.5 ± 7.8 years. In 3 patients, diagnosis of BS was made simultaneously with cardiac involvement. Types of cardiac involvement were as following; intracardiac thrombosis (ICT) in 8, right coronary artery aneurysm in 2, and myocardial infarction in 4 patients. The majority of ICT was seen in right ventricle followed by right atrium (75% vs 25%). Deep vein thrombosis (DVT) was the most common accompanying other vascular involvement (57%).Thrombophilic factors were studied in 8 patients, whom only 2 cases were found positive for heterozygous factor V Leiden mutation. Cyclophosphamide was the most common used immunosuppressive agent and anticoagulation was used in 9 patients (Table 1).

Table 1.

Characteristics of cardiac involvement in BS patients

Male/female, (n), (%)14 (100%)Diagnosis age, years (Mean ± SD)30 ± 7Age of cardiac involvement, years, (Mean ± SD)32.5 ±7.8Smoking history, (n), (%)14 (100%)Other vascular involvement, (n), (%)12 (85%)-Deep vein thrombosis, (n)8-Pulmonary involvement, (n)4-Peripheral artery aneurysm, (n)1Cardiac involvement patterns-ICT, (n), (%)•RV6•RA2-CAA, (n), (%)2(14.3%)-AMI, (n), (%)4(28.6%)Immunosuppression, (n)-Steroid14-CYC9-AZA3-IFN1Anticoagulation, (n)9

ICT; intracardiac thrombosis, RV; right ventricle, RA; right atrium, CAA; coronary artery aneurysm, AMI; acute myocardial infarction, CYC; cyclophopshamide, AZA; azathioprine, IFN; interferon

Conclusion

Most common type of cardiac involvement is pericarditis, whereas intracardiac thrombosis has its unique characteristics (1). Male gender and smoking seems to be major significant risk factors.

References

[1]Wang H, Guo X, Tian Z, Liu Y, Wang Q, Li M, Zeng X, Fang Q (2016) Intracardiac thrombus in patients with Behcet’s disease: clinical correlates, imaging features, and outcome: a retrospective, single-center experience. Clinical Rheumatology 35(10):2501–2507

Disclosure of Interests

None declared

POS1345 BEYOND PULMONARY ARTERY ANEURYSM; PULMONARY INVOLVEMENT IN BEHCET’S SYNDROME

Background

Pulmonary involvement (PI) other than pulmonary artery aneurysm (PAA) in Behcet’s syndrome (BS) is still an area of investigation.

Objectives

Herein, we aimed to retrospectively evaluate all types of pulmonary involvement associated with Behcet’s syndrome (BS).

Methods

Among 800 BS patients according to International Study Group for Behcet’s Disease (ISG) criterias, 28 patients were selected based on their radiologic examination consistent with BS-related PI. Demographic features, other clinical manifestations of BS, treatment modalities and types of PI were analyzed.

Results

The overall prevalence of PI was estimated 3,5% among all BS patients. PI was more common in males (82.1% vs 17.9%). Mean age for BS diagnosis and onset of PI were as following; 32 ± 10,9 and 37 ± 11,4 years. Deep vein thrombosis (DVT) was the most common accompanying vascular involvement (53,6%). PAA, pulmonary vasculitis (PV), and pulmonary thromboembolism (PTE) were seen in 7 (25%), 13 (46,3%), and 18 (64,4%) of patients, respectively. In 5 patients, intracardiac thrombosis was present simultaneously in the right ventricle. Cyclophosphamide (CYC) was the most common preferred agent (78%) followed by azathioprine (AZA) as first line. Warfarin used in 18 patients (Table 1) Mortality was seen in 3 patients during follow up (1 due to PAA bleeding, others with unknown causes).

Table 1.

Characteristics of pulmonary involvement in BS patients

Male/Female, (n), (%)23/5 (82,1%/17,9%)Age of diagnosis, years (Mean± SD)32 ± 10,9Age of pulmonary involvement, years (Mean ± SD)37 ± 11,4Oral ulcer, (n), (%)28 (100%)Genital ulcer, (n), (%)20 (71,4%)Osteofollicular lesion,(n), (%)20 (71,4%)Erythema nodosum, (n), (%)13 (46,4%)Uveitis, (n), (%)8 (28,6%)DVT, (n), (%)15 (53,6%)Cardiac involvement, (n), (%)5 (17,8%)Pulmonary involvement, (n)-PAA, (n), (%)287 (25%)-PV, (n), (%)13 (46,4%)-PTE, (n), (%)18 (64,3%)Immunosuppression (first line agents)26/28-Steroid, (n), (%)26/28-CYC, (n), (%)22/26 (84,6%)-AZA, (n), (%)4/26 (15%)Anticoagulation (warfarin), (n), (%)18

PAA; pulmonary artery aneurysm, PTE; pulmonary thromboembolism, PV; pulmonary vasculitis, CYC; cyclophosphamide, AZA; azathioprine, DVT; deep vein thrombosis

Conclusion

Despite the importance of PAA in BS patients, capillaritis and thromboembolism other than PAA may occur commonly in BS as well. Onset at young age, male gender and previous DVT seem to be significant risk factors for the development of PI.

References

[1]Yazgan Ç, Ertürk H, Taşkin A. Imaging Features of Thoracic Manifestations of Behçet’s Disease: Beyond Pulmonary Artery Involvement. Curr Med Imaging. 2021;17(8):996-1002.

Disclosure of Interests

None declared

P102 The hidden face of Behcet’s syndrome; central nervous system involvement, a single-center experience

Background/Aims

Neurologic involvement in Behcet’s syndrome (BS) remains an unelucidated area that needs further attention. In this study, we aimed to analyze the patterns of neurologic involvement and evaluate their association with other clinical features.

Methods

800 patients with BS diagnosis according to The International Criteria for Behcet’s Disease (ICBD) followed in our center were retrospectively screened and 55 patients with central nervous system involvement and 20 patients with non-vascular BS were enrolled in this study. These patients were classified as sinus vein thrombosis (SVT), parenchymal involvement, and mixed (SVT and parenchymal). These groups were compared in terms of demographic and clinical features.

Results

Thirty-two (58,2%) of the patients were male. Distribution of neurologic involvement were as follows; 22 (40%) with isolated sinus vein thrombosis (SVT), 25 (%45) with isolated parenchymal, and 8 (%15) with mixed pattern. Central nervous involvement was the diagnostic feature of BS in 25 patients. Headache was the most common symptom followed by neurologic deficits and dizziness (44%, 25%, 16%). The most common sites of involvement were subcortical and periventricular areas followed by brainstem (63% vs 37%). In SVT group, positive family history of BS (p &lt; 0.001) and previous deep vein thrombosis (DVT) (p:0.004) were found higher. Smoking history, erythema nodosum, cardiac and pulmonary involvement were significantly higher in parenchymal group (p &lt; 0.001) (Table 1).

Conclusion

Although brainstem involvement is considered as more characteristic in BS, white matter and periventricular involvement were also found as common in our study. Notably, these subgroup analyses may suggest the speculation that BS shows clusters even within the neuro-vascular involvement.

Disclosure

R. Yıldırım: Other; Reşit Yıldırım is a member of Rheumatology journal as an associate editor. M. Dinler: None. A.E. Arslan: None. N.S.Y. Bilge: None. T. Kaşifoğlu: None.

Clinical and laboratory factors associated with the bamboo spine in patients with axial spondyloarthritis: are there clues for the bamboo spine?

OBJECTIVES

To analyse the clinical and laboratory factors associated with bamboo spine.

METHODS

Data of patients fulfilling the 2009 ASAS classification criteria for axial spondyloarthritis, registered in the national, multicentre, longitudinal, and observational database of TReasure was analysed. Radiographs were assessed using the Bath Ankylosing Spondylitis Radiologic Index (BASRI). Data of patients with a bamboo spine (Group 1) was compared to data derived from patients with a longstanding disease of at least 15 years but no syndesmophytes (Group 2).

RESULTS

Out of the 5060 patients, 1246 had eligible radiographs. There were 111 patients (8.9%) with a bamboo spine. Male sex was more common among patients with bamboo spine. The median BMI of 27.7 (25.8-31.1) in Group1 was higher than the BMI of 25.9 (22.9-29.2) in Group 2 (p<0.001). Hip arthritis, present or documented by a physician, was more common in Group 1 [(58/108 (53.7%) vs. 35/103 (34%), p=0.004]. There was a tendency towards a more prevalent enthesitis in these patients [29.1% (25/86) vs. 15.9%(11/69), p=0.054]. HLA-B27 status did not differ between groups. Smoking was more prevalent in Group 1. Multivariate logistic regression analysis revealed that male sex, body mass index, hip arthritis, and enthesitis are associated with bamboo spine in axSpA.

CONCLUSIONS

Bamboo spine was more common in the male sex and associated with a delay in diagnosis, high BMI, hip involvement, and enthesitis. The constellation of increased body weight, hip arthritis, and enthesitis may imply that mechanical stress contributes to radiographic damage in the presence of chronic inflammation.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Phenotypic characterization of Familial Mediterranean Fever patients harboring variants of uncertain significance

Background/aim

Familial Mediterranean Fever (FMF) is the prototype of hereditary autoinflammatory disorders and caused by mutations on the MEFV gene located on the short arm of chromosome 16. Although some MEFV variants are clearly associated with disease phenotype, there are numerous variants with unknown clinical association which are termed as variants of uncertain significance (VUS). Here, we present clinical correlations of VUS in a large cohort of adult FMF patients from three tertiary centers located in Central Anatolia.

Materials and methods

All patients were recruited from FMF in Central Anatolia (FiCA) cohort. Demographic (sex, age at disease onset) and clinical features (disease characteristics, attack frequency, mean colchicine dose, colchicine nonresponsiveness, amyloidosis, and persistent inflammation) of patients with VUS were compared with those harboring pathogenic variants. Disease severity and damage were also evaluated using international severity score for FMF (ISSF) and autoinflammatory disease damage index (ADDI), respectively.

Results

Among 971 participants included, MEFV gene analysis results were available for 814 patients. Twenty-six (3.2%) patients had single heterozygous VUS and 54 (6.6%) had pathogenic/VUS complex heterozygous variants. Patients with single heterozygous VUS had similar demographic/clinical features, ISSF and ADDI scores compared to those with single heterozygous pathogenic variant (p > 0.05 for all). No difference was observed in the demographic and clinical features of patients with single heterozygous pathogenic mutation and pathogenic/VUS complex heterozygous variant (p > 0.05 for all). ISSF and ADDI scores were lower in pathogenic/VUS complex heterozygous patients than those harboring single pathogenic mutation (p = 0.006 and 0.004, respectively).

Conclusion

Our findings suggest that patients with single heterozygous VUS has mild FMF phenotype similar to those with single pathogenic mutation. Pathogenic/VUS complex heterozygosity does not lead to a more severe clinical phenotype than having a single pathogenic variant.

Appendectomy history is associated with severe disease and colchicine resistance in adult familial Mediterranean fever patients

Background/aim

Peritonitis attacks of Familial Mediterranean Fever (FMF) usually requires emergency medical admissions and it’s hard to distinguish a typical abdominal attack from surgical causes of acute abdomen. Therefore, history of abdominal surgery, particularly appendectomy, is very common in patients with FMF. However, history of appendectomy might also give some clues about the course of FMF in the adulthood. This study was to determine whether the history of appendectomy help to anticipate disease course of FMF in the adulthood.

Materials and methods

All patients recruited from FMF in Central Anatolia (FiCA) cohort, comprising 971 adult subjects. All patients fulfilled the Tel Hashomer criteria. Demographic data, FMF disease characteristics, co-morbid conditions, past medical history, surgical history and disease complications were meticulously questioned and laboratory features and genotype data (if available) were recruited from patient files.

Results

Appendectomy history was evident in 240 (24.7%) subjects. Disease onset was earlier and peritonitis is strikingly more prevalent (97.1% vs. 89.6%, p < 0.001) in appendectomized patients. These patients had reported almost two fold more frequent attacks in the last year compared to appendix intact patients (median 3.5 vs. 2 attacks, p = 0.001) without a difference in frequency of musculoskeletal and skin attacks. Severe disease was more common (10% vs. 5.9%, p = 0.038) due to involvement of more attack sites throughout the life and more frequent attacks. Appendectomy patients had used higher daily doses of colchicine to control disease (1.43 ± 0.6 mg vs. 1.27 ± 0.52 mg, p = 0.002) but colchicine resistance was also more common in these patients, 15% vs. 6.7% respectively, p < 0.001.

Conclusion

Appendectomy history is common in FMF patients and associated with frequent serositis attacks in adulthood. These patients require higher colchicine doses with a lower rate of response and more need for Interleukin-1 antagonist therapies.

Preferences of inflammatory arthritis patients for biological disease-modifying antirheumatic drugs in the first 100 days of the COVID-19 pandemic

Background/aim

To evaluate treatment adherence and predictors of drug discontinuation among patients with inflammatory arthritis receiving bDMARDs within the first 100 days after the announcement of the COVID-19 pandemic.

Materials and methods

A total of 1871 patients recorded in TReasure registry for whom advanced therapy was prescribed for rheumatoid arthritis (RA) or spondyloarthritis (SpA) within the 3 months (6–9 months for rituximab) before the declaration of COVID-19 pandemic were evaluated, and 1394 (74.5%) responded to the phone survey. Patients’ data regarding demographic, clinical characteristics and disease activity before the pandemic were recorded. The patients were inquired about the diagnosis of COVID-19, the rate of continuation on bDMARDs, the reasons for treatment discontinuation, if any, and the current general disease activity (visual analog scale, [VAS]).

Results

A total of 1394 patients (493 RA [47.3% on anti-TNF] patients and 901 SpA [90.0% on anti-TNF] patients) were included in the study. Overall, 2.8% of the patients had symptoms suggesting COVID-19, and 2 (0.15%) patients had PCR-confirmed COVID-19. Overall, 18.1% of all patients (13.8% of the RA and 20.5% of the SpA; p = 0.003) discontinued their bDMARDs. In the SpA group, the patients who discontinued bDMARDs were younger (40 [21–73] vs. 44 years [20–79]; p = 0.005) and had higher general disease activity; however, no difference was relevant for RA patients.

Conclusion

Although the COVID-19 was quite uncommon in the first 100 days of the pandemic, nearly one-fifth of the patients discontinued bDMARDs within this period. The long-term effects of the pandemic should be monitored.

Budd-Chiari syndrome in Behçet's disease: a retrospective multicenter study

OBJECTIVE

To compare the clinical features, laboratory findings, and prognosis of Behçet's disease (BD) patients with and without Budd-Chiari syndrome (BCS).

METHODS

This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017.

RESULTS

Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p < 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14-47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%).

CONCLUSION

To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

POS0935 DO PERIPHERAL AND EXTRA MUSCULOSKELETAL MANIFESTATIONS HAVE AN IMPACT ON BIOLOGIC DMARD PRESCRIBING PATTERNS IN AXIAL SPONDYLOARTHRITIS: THE RESULTS OF TREASURE EXPERIENCE

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease mainly affecting sacroiliac joints and spine. Peripheral arthritis, dactylitis and enthesitis may also occur. Extra musculoskeletal manifestations (EMMs; uveitis [AAU], inflammatory bowel disease [IBD] and psoriasis [Pso] are among the most common ones) are important features and might have an impact on the disease burden in patients with axSpA. The presence of EMM, in particular IBD and AAU could influence the choice of TNFi however little is known regarding the role of peripheral manifestations together with the EMM on the prescribing patterns in axSpA patients.

Objectives:

To examine the frequency of peripheral and EMMs in a real-world axSpA cohort and their effect on the choice of first advanced treatment.

Methods:

In total 1687 axSpA patients (58% male and the mean age (±SD) was 38.5 ± 10.9) who initiated his/her first biologic were included in the present analysis. The data for the current study was obtained from the TReasure web-based registry; in which RA and SpA patients treated with bDMARDs from different regions of Turkey. Baseline demographic, disease related characteristics, peripheral and EMMs were extracted. Characteristics of patients with and without peripheral/extra-musculoskelatal involvement were compared as well as factors/covariates associated with the choice of first TNFi and secukinumab was analysed.

Results:

Enthesis (28.2%) was found the most common peripheral manifestations and peripheral arthritis (26.4%) and hip arthritis (24.4%) followed it. Symptom duration to the first advanced treatment initiation was significantly shorter in axSpA patients with peripheral arthritis, enthesitis, dactylitis and psoriasis and longer in hip arthritis and AAU. HLA-B27 positivity was significantly lower in patients with arthritis, psoriasis and IBD and higher with hip arthritis and AAU. In multivariate analysis the presence of IBD is significantly associated with the preference of monoclonal TNFi (mab) over etanercept (ETA) (OR 5,770; 95%CI 1.788-18.616). However ETA was preferred in patients with hip arthritis (p=0.003), longer symptom duration (p=0.049), and using sulfasalazine (p=0.043). In comparison with mabs, secukinumab (SEC) prescription was found to be significantly associated with higher age (p=0.001), sulfasalazin (p=0.001) and methotrexate usage (p=0.053) among axSpA patients need their first advanced treatment.

Conclusion:

The results of the current study confirm the pathophsyologic associations of peripheral involvement and EMM in axSpA patients. Apart from hip arthritis the presence of IBD has an impact on the prescription of advanced treatment in real-life.

Table 1.

Clinical characteristics of patients in cohort

All patients(n=1678)Peripheral arthritis(n=445)Dactilitis(n=81)Enthesis(n=476)Uveitis(n=193)Psoriazis(n=152)IBD(n=78)Hip involvemet(n=412)Age, mean±SD38,5±10,938,3±11,637,4±11,137,9±10,741,3±11,439,9±11,341,6±12,239,2±11,2Male sex,n (%)974 (57,7)184 (41,3)34 (42)238 (50)96 (49,7)54 (35,5)43 (55,1)272 (66)Symptom duration, mean month±SD108,5±98,996,9±92,979,1±76,5100,4±92,7144,7±110,287,7±9494,5±98133,3±108,2HLA B27 positivity, n (%)621 (53,7)142 (46,3)27 (51,9)174 (49,4)104 (77)34 (36,2)16 (27,1)186 (59,8)Concomitant cDMARD usage (yes), n (%)420 (24,9)170 (38,2)39 (48,1)133 (27,9)53 (27,5)58 (38,2)24 (30,8)99 (24)BASDAİ,mean±SD5,1±2,55,1±35,3±3,15,3±2,94,7±2,55,6±2,44,8±2,35,3±2,1ASDAS-CRP, mean±SD3,1±1,52,6±1,92,5±1,82,8±1,72,9±1,73,4±1,33,1±1,53,7±1,4

Disclosure of Interests:

None declared

AB0893-HPR TREATMENT SATISFACTION, EXPECTATIONS, PATIENT PREFERENCES, AND CHARACTERISTICS IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA): TURKISH COHORT RESULTS OF THE SENSE STUDY

Background:

Suboptimal control of RA may lead to severe and progressive articular damage, loss of function, and deterioration of the quality of life (QoL).

Objectives:

To assess treatment satisfaction, sociodemographic, clinical, health care resource utilization, and QoL characteristics of patients with sub-optimally controlled RA and treated with conventional synthetic and/or biologic DMARDs.

Methods:

This study was an international, multicenter, cross-sectional, non-interventional study. Adult RA patients with moderate to severe disease activity (DAS28>3.2) were enrolled. Patient satisfaction was evaluated with Treatment Satisfaction Questionnaire for Medication (TSQM, version 1.4) with a scale ranging from 0 (indicating poor satisfaction) to 100 (indicating perfect satisfaction). Patients were questioned regarding treatment adherence, patient preferences, and expectations. Workability was evaluated using Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis (WPAI-RA, version 2.0). Short Form 36 (V2) survey were performed to all patients.

Results:

One hundred sixty-four patients were included in the study and most (78.0%) were female. The median age was 57.0 years, ranging between 22.0 and 84.0 years. Half of the patients (50.6%) were primary school graduates and 6.1% were unemployed due to RA and seeking work. Median time since RA diagnosis was 8.0 years and mean (±SD) DAS28-CRP score was 4.8 (±1.0). Mean total activity impairment was 54.9% (±27.4). In the past 3 months from enrollment, the mean number of healthcare professional and emergency room visits were 1.8 (±1.1) and 1.8 (±1.3), respectively. Mean number and length of hospitalizations in the previous 3 months were 1.1 (±0.3) times and 8.3 (±7.2) days, respectively. Mean TSQM scores were 53.5 (±21.4) for effectiveness, 86.0 (±26.7) for side effects, 67.8 (±16.5) for convenience, and 57.7 (±22.0) for global satisfaction. The leading expectation was ‘lasting relief of RA symptoms’ (mean score: 5.8). Preferred time until the effect of onset was ‘up to 1 week’ for 76.2% of the patients. Most of the patients (57.9%) preferred oral administrations and the most preferred frequency of administration was ‘once per day’ (46.3%). Mean physical and mental component summary scores for Short Form 36 (V2) survey were 37.9 (±8.3) and 40.1 (±10.7).

Conclusion:

Two-thirds of the patients with RA who have suboptimal responses are not satisfied with their treatments. Moreover, oral and once-daily treatment approaches stand out in patient preferences. Finally, suboptimal control leads to deterioration in clinical characteristics, workability, and QoL of patients with RA.

Acknowledgements:

The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication. All authors have received research funding for this study. The authors wish to thank B. Murat Ozdemir of Monitor CRO for medical editing and reviewing services of this manuscript. AbbVie provided funding to Monitor CRO for this work.

Disclosure of Interests:

Umut Kalyoncu Speakers bureau: AbbVie, Pfizer, UCB, Novartis, and Janssen, Consultant of: AbbVie, Pfizer, UCB, Novartis, and Lilly, Grant/research support from: AbbVie, Pfizer, and Janssen, Adem Kucuk Speakers bureau: AbbVie, Gokhan Sargin: None declared, Fatih Ozdener Speakers bureau: UCB, Nutricia Advanced Medical Nutrition, Grant/research support from: Nutricia Advanced Medical Nutrition, Servet Yolbaş Speakers bureau: AbbVie, UCB, Pfizer, and MSD, Berna Yurttas: None declared, Sezin Turan: None declared, Gezmiş Kimyon Speakers bureau: AbbVie, Amgen, Pfizer, Novartis, UCB, MSD, Johnson and Johnson, and Celltrion, Consultant of: Amgen, and Pfizer, ALI SAHIN Speakers bureau: Roche, Pfizer, and AbbVie, Consultant of: Roche and Pfizer, Sedat Yilmaz Speakers bureau: UCB, Pfizer, AbbVie, MSD, Novartis, and Celltrion, Consultant of: Pfizer and Novartis, Ridvan Mercan Speakers bureau: AbbVie, Novartis, MSD, Pfizer, UCB, Roche, Amgen, and Celltrion, Consultant of: Novartis, MSD, Pfizer, and Celltrion, Hakan Emmungil Speakers bureau: AbbVie, Pfizer, Novartis, and MSD, Muhammet Çinar Speakers bureau: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, Grant/research support from: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, İlhan Sezer Speakers bureau: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Consultant of: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Timuçin Kaşifoğlu Speakers bureau: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Fulya Cosan Speakers bureau: AbbVie, Pfizer, Novartis, UCB, and MSD, Taskin Senturk: None declared, Nevsun Inanc Speakers bureau: AbbVie, UCB, Novartis, Pfizer, Roche, Lilly and MSD, Consultant of: Roche and Pfizer, Grant/research support from: Roche and Pfizer

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

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

Moderation analysis exploring associations between age and mucocutaneous activity in Behçet's syndrome: A multicenter study from Turkey

The aim of the present study was to examine the effects of age on mucocutaneous activity by using moderation analysis in Behçet's syndrome (BS). In this cross-sectional study, 887 BS patients (female : male, 481:406; mean age, 38.4 ± 10.9 years) followed in 13 tertiary centers in Turkey were included. Mucocutaneous activity was evaluated by using the Mucocutaneous Index (MI) according to sex and disease course. Moderation analysis was performed to test the effect of age on mucocutaneous activity. A moderator variable is a third variable and affects the relationship between independent and outcome variables. Age was chosen as a potential moderator variable (interaction effect), MI score as the outcome variable and sex as an independent variable in the analysis. The moderation analysis tested the effects of age in three steps: whole BS patient group, patients without systemic involvement and those with systemic involvement. The moderation model was only significant in BS patients with systemic involvement (P = 0.0351), and a significant relationship was observed between female sex and MI score (P = 0.0156). In addition, the interaction plot showed that female patients had increased MI scores compared with male patients, especially in the 28-year-old age group (P = 0.0067). Moreover, major organ involvement was newly diagnosed in the majority of these young female BS patients. Our results suggest that the relationship between sex and mucocutaneous activity was moderated by age in the systemic involvement group. Also, increased mucocutaneous activity may be associated with new major organ involvement in young female BS patients with systemic involvement.

Colchicine intolerance in FMF patients and primary obstacles for optimal dosing

Background/aim

Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in a substantial number of patients due to its side effects. In this study, we aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and cause permanent discontinuation.

Materials and methods

All patients were recruited from “FMF in Central Anatolia” (FiCA) cohort, 915 adults with a minimum follow-up time of 6 months during which they had obeyed all treatment instructions. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications, and treatment features were recorded on a web-based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed.

Results

Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows: diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in five (0.5%), and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male sex and obesity were found to be associated with liver toxicity, and having a normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine-intolerant patients, and they had reported more frequent attacks compared to those tolerating optimal doses.

Conclusion

Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing is associated with complications.

AB0492 INTESTINAL MICROBIOTA COMPOSITION OF PATIENT’S WITH BEHCET’S DISEASE: DIFFERENCES BETWEEN EYE, MUCOCUTANEOUS AND VASCULAR INVOLVEMENT (RHEUMA-BIOTA STUDY)

Background:

Recently, it has been shown that changes in microbiota composition play a role in the etiology and pathogenesis of chronic diseases. Changes in oral and intestinal microbiota diversity and composition are suggested in Behcet disease (BD), however there are no study available about the potential gut microbiota changes among different clinical forms of BD.

Objectives:

The aim of this study was to evaluate the intestinal microbiota composition of patient with BD and healthy controls, and also compare BD patients regarding to their eye, mucocutaneous and vascular involvement.

Methods:

In this prospective cohort study,27 patients diagnosed with BD and 10 aged and sex matched healthy controls were included. Patients with a body mass index> 35, who have used antibiotics or probiotics in the last 4 weeks, patients with chronic gastrointestinal or other systemic diseases, and those with acute / severe gastrointestinal symptoms requiring medical treatment were excluded from the study. For the intestinal microbiota analysis, gene amplification, library formation, sequence analysis and bioinformatic evaluation of the results were performed with 16SrRNA next generation sequencing methods with Illumina MiSeq.

Results:

There was no difference between the BD group and the control group in terms of alpha (Chao-1 and Shannon) and beta (Bray-Curtis) microbiota diversity indices (p> 0.05).Actinomyces, Libanicoccus, Collinsella, Eggerthella, Enetrohabdus, Catenibacterium and Enterobacterwere significantly higher in BD group compared to the control group. In addition,Bacteriodes, Cricetibacter, Alistipes, Lachnospira, Dielma, Akkermansia, Sutterella, Anaerofilum, Ruminococcease-UCG007, Acetanaerobacterium; and Copropaacterwere lower than the control group. There was no difference between the uveitis, mucocutaneous and vascular involvement groups in terms of alpha (Chao-1 and Shannon) and beta (Bray-Curtis) microbiota diversity and wealth indices (p> 0.05) while we obtained a significant p value of the beta diversity between three groups in weighted UniFrac PCoA (p<0.05). When we compared 3 three different system involvement (Eye, Mucocutaneous and Vascular), The LEfSe provides us with cladograms of six-level (from kingdom to genus). We found difference for the generaLachnospiraceae NK4A136in uveitis group,Dialister, İntestinomonas and Marvinbryantiain mucocutaneous group andGemellain vascular involvement group.

Conclusion:

There was a significant difference in the composition of intestinal microbiota in Behçet’s disease compared to healthy adults. We found also found the different clinical forms of Behcet’s disease have some different gut microbiota composition. Especially in Behçet’s disease, it will be useful to evaluateCatenibacterium, Collinsella and Eggerthellaincrease,Bacteroides and Akkermansiadecrease in larger series. In addition, due to the increase in theEggerthella lentastrain observed both in the FMF and Behcet patient group, it is useful to make more detailed metagenomic analyzes regarding the role of this agent in the etiopathogenesis and course of rheumatic diseases.

Disclosure of Interests:

None declared

AB0650 BIOSIMILAR INFLIXIMAB EXPERIENCE IN SPONDYLOARTRITIS PATIENTS: TREASURE REAL LIFE RESULTS

Background:

Biosimilar infliximab (bio-INF) was approved for all indications of the reference product in several countries. It has been marketed since 2014 in Turkey and used in the same indications with its bio-originator.

Objectives:

Herein, we aimed to analyse clinical features and the drug survival rates of spondyloarthritis patients who have recieved bio-INF.

Methods:

This multicenter, prospective observational cohort study used the TReasure database in which web-based registration of rheumatoid arthritis and SpA patients are being performed in 13 centers across different regions of Turkey. Age, gender, and acute phase responses (erythrocyte sedimentation rate and C-reactive protein), HAQ scores, VAS patient global, VAS fatigue, VAS pain, VAS physician global, BASDAI, BASFI, ASDAS ESH and ASDAS CRP values, clinical findings of SpA patients, number of patients who has received bio-INF as first line therapy or after switch, treatments which are used before bio-INF, the reasons for switching bio-INF to another biologic DMARD and drug survival rates were retrospectively evaluated.

Results:

A total number of 231 SpA (94 (40.7 %) female, 137 (59.3%) male, mean age 43±11 yrs) patients have received biosimilar infliximab in the database. Of the 231 patients 127 (55%) had received bio-INF as first line therapy, whereas 104 (46 (19.9%) 2ndchoice, 58 (25.1%) 3rdchoice) patients used switching after another biologic DMARD. Previously used biologic and synthetic DMARDs were adalimumab (28.6%), etanercept (22.5%), golimumab (9.1%), original infliximab (8.2%), secukinumab (13.4%), methotrexate (23.8%), leflunamid (10.4%), sulphasalazine (60.6%). The baseline and first visit (3. Months) diseases activity scores were shown in Table 1. Drug survival rates were 79.1 in 12. months, 65.5 in 24. months and 54.6 in 60. months. (Figure 1). The most common reasons for switching from biosimilar infliximab to another biologic DMARD is secondary (25(10.8%)), and primary ineffectiveness (22(9.5%)). Other reasons to discontinuation of treatment are psoriasis (5 (2.1%)), infusion reaction (3(1.2%)), allergic reaction (22(8.8 %)), chest pain (3(1.2%)), dyspnea (1 (0.4%)), vasculitis (1 (0.4%)) and patient or doctor wish (7 (3.4%)).

Conclusion:

The results of this real life data provides evidence that biosimilar infliximab is an effective and safe treatment option with long term use in SpA patients. Drug survival rates of bio-INF is similar to its bio-originator.

Table 1.

Disease activity scores

Baseline visit3.monthpmedian (Q1-Q3)median (Q1-Q3)HAQ score0,63 (0,4-1)0,25 (0-1)<0,001BASDAI6,2 (4,8-7)2,8 (1-5)<0,001BASFI5,05 (3,3-6)2,1 (0,45-4)<0,001VAS Patient Global70 (50-80)30 (10-50)<0,001VAS Doctor Global60 (40-70)30 (20-40)<0,001VAS Pain50 (3-80)30 (10-50)0,572VAS fatigue70 (50-80)40 (10-65)<0,001ESR24 (11-45)11 (6-23)<0,001CRP12,1 (4,4-30)3,91 (2,19-9)<0,001ASDAS ESR3,12 (2,51-4)2,05 (1,39-3)<0,001ASDAS CRP3,53 (2,86-4)2,21 (1,5-3)<0,001

*Wilcoxon Signed Rank Test

Figure 1.

Drug survival rates

Disclosure of Interests:

Nazife Sule Yasar Bilge: None declared, Timuçin Kaşifoğlu: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Ediz Dalkiliç: None declared, Cemal Bes: None declared, Hakan Emmungil: None declared, Belkis Nihan Seniz: None declared, Burcu Yağiz: None declared, Muhammet Çinar: None declared, Servet Akar: None declared, Önay Gerçik: None declared, Duygu Ersözlü: None declared, Gezmiş Kimyon: None declared, Ridvan Mercan: None declared, Omer Karadag: None declared, Yavuz Pehlivan: None declared, Levent Kiliç: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

FRI0507 COLCHICINE INTOLERANCE IN FMF PATIENTS AND PRIMARY OBSTACLES FOR OPTIMAL DOSING

Background:

Colchicine is the mainstay of treatment in FMF. However, in daily practice it is not easy to maintain effective colchicine doses in substantial number of patients, due to its side effects.

Objectives:

It was aimed to investigate prevalence and risk factors for colchicine side effects that limit optimal drug dosing and permanent discontinuation.

Methods:

All patients were recruited from “FMF in Central Anatolia” (FiCA) cohort, 915 adult subjects with minimum follow up time of 6 months and had compliance of treatment were included. Demographic and anthropometric data, FMF disease characteristics, disease severity, complications and treatment features were recorded on a web based registry. Prevalence of colchicine intolerance and characteristics of intolerant patients were analyzed.

Results:

Effective colchicine doses cannot be maintained in 172 (18.7%) subjects. Main side effects that limit optimal dosing were as follows; diarrhea in 99 (10.8%), elevation in transaminases in 54 (5.9%), leukopenia in 10 (%1.1), renal impairment in 14 (1.3%), myopathy in 5 (0.5%) and allergic skin reaction in two. Colchicine had to be permanently ceased in 18 (2%) patients because of serious toxicity. Male gender and obesity were found to be associated with liver toxicity and having normal body weight was associated with diarrhea. Chronic inflammation and proteinuria were more common in colchicine intolerant patients and they had reported more frequent attacks compared to those tolerating optimal doses.

Conclusion:

Colchicine intolerance is an important problem in daily clinical practice, mainly due to diarrhea and liver toxicity. Suboptimal colchicine dosing associated with complications.

References:

[1] Sönmez, H.E., E.D. Batu, and S. Özen,Familial Mediterranean fever: current perspectives.Journal of inflammation research, 2016.9: p. 13.

[2] Sari, İ., M. Birlik, and T. Kasifoğlu,Familial Mediterranean fever: an updated review.European journal of rheumatology, 2014.1(1): p. 21.

[3] Ozen, S., et al.,EULAR recommendations for the management of familial Mediterranean fever.Annals of the rheumatic diseases, 2016.75(4): p. 644-651.

Table 1.

Prevalence of all side effects of colchicine and reasons for drug discontinuation

Side effectAll side effectsN=172*Permanent cessationN=18*Diarrhea9911Liver toxicity544Leukopenia101Muscle toxicity52Skin reaction2-Nausea4-Infertility2-

* some patients had more than one clinically significant side effect

Table 2.

Disease course in colchicine tolerant and intolerant patients

Colchicine TolerantN=743Colchicine IntolerantN=172p valueChronic inflammation115 (15.4%)45 (26.1%)<0.001Number of attacks in the last year4.05±6.087.60±9.6<0.001Proteinuria44 (5.9 %)20 (11.6%)0.025Amyloidosis33 (% 4.4)23 (13.3%)<0.001ADDI (median)1 (1)1 (1)<0.001

ADDI: auto-inflammatory disease damage index, FMF: familial Mediterranean fever

Disclosure of Interests:

Hasan Satiş: None declared, Berkan Armagan: None declared, Erdal Bodakci: None declared, Nuh Atas: None declared, Alper Sari: None declared, Dilek Yapar: None declared, Nazife Sule Yasar Bilge: None declared, reyhan bilici salman: None declared, Gözde Kübra Yardimci: None declared, Hakan Babaoglu: None declared, Levent Kiliç: None declared, mehmet akif ozturk: None declared, Berna Goker: None declared, seminur haznedaroglu: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Timuçin Kaşifoğlu: None declared, abdurrahman tufan: None declared

AB1035 INTESTINAL MICROBIOTA COMPOSITION OF ADULT PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER AND HEALTHY CONTROLS (THE RHEUMA-BIOTA STUDY)

Background:

Although Familial Mediterranean Fever (FMF) is a monogenic disease, microbiota composition may play role in the pathogenesis or phenotypic expression.

Objectives:

We aim to evaluate the intestinal microbiota composition in patients with FMF and to compare with healthy controls.

Methods:

In this prospective cohort study, a group of 10 adult patients with FMF and 10 age-appropriate healthy controls, for which there was strict inclusion/exclusion, were enrolled. Fecal samples were stored at -80°C until DNA extraction. A region of the 16S rRNA gene (V3-V4) was selected and sequencing was performed on the Illumina MiSeq platform at the Sequencing and Bioinformatics Service of FISABIO foundation.

Results:

Alpha and beta diversity tests were similar between FMF and control groups except that Chao1 index. Chao1 index was modestly decreased in FMF group comparing the healthy controls (p<0.05). Our results showed differences in the intestinal microbiota composition of patients with FMF, with a higher abundance ofEggerthella, at genus level. At species level,Eggerthella sinensisandEggerthella lentawere more abundant in patients with FMF.

Conclusion:

Eggerthella lentawas previously shown to be higher in type II diabetes, multiple sclerosis, rheumatoid arthritis and some disseminated infections. In this study we firstly showed abundance ofEggerthellain patients with FMF, especially inE. sinensisandE. lenta;in addition to. Whether any of observed associations are causal, or the direction of causality is unclear yet and further studies with patients with FMF at the first diagnosis might clarify this issue.

Disclosure of Interests:

None declared

Comparison of clinical features in FMF patients according to severity scores: An analysis with the ISSF scoring system

OBJECTIVE

Familial Mediterranean fever (FMF), is an auto-inflammatory disease characterized by attacks of fever and serositis. Some scoring systems have been developed to evaluate the severity of the disease, however, predicting the severity of FMF is not possible with current knowledge. Our aim in this study was to evaluate the factors affecting disease severity in FMF.

METHODS

This study included 150 FMF patients. The medical data of the patients were collected retrospectively and the International severity scoring system for Familial Mediterranean fever (ISSF) was used to evaluate disease severity.

RESULTS

Patients were sorted into 3 groups based on the ISSF scores; ≤2=mild (Group 1; n: 61), 3-5=moderate (Group 2; n: 70), and ≥6=severe (Group 3; n: 19). Age at the onset of disease and age at diagnosis was younger in patients with severe disease (p: 0.009 and p: 0.031, respectively). Fever, peritonitis, and vasculitis were similar in all 3 groups. Pleuritis, erysipelas-like erythema (ELE), arthritis, myalgia, amyloidosis, and chronic kidney disease (CKD) were more common in Group 3.

CONCLUSION

FMF patients with early onset and early diagnosis, having more frequent pleuritis, ELE, arthritis, and myalgia tended to manifest a more severe form of the disease. Close monitoring of such patients may prevent the development of amyloidosis and CKD and improve the long-term prognosis of the disease.

Predictive factors for work-day loss in Behçet's syndrome: A multi-center study

OBJECTIVE

The aim of this multi-center study was to assess predictive factors for work-day loss as an indirect cost element in Behçet's syndrome (BS).

METHODS

In this cross-sectional, multi-center study, 834 BS patients (F/M: 441/393, age mean: 38.4 ± 10.9 years) were included. Data were collected by a questionnaire regarding treatment protocols, disease duration, smoking pattern, frequency of medical visits during the previous year and self-reported work-day loss during the previous year.

RESULTS

Work-day loss was observed in 16.2% of patients (M/F: 103/32). The percentages of being a smoker (81.8%), using immunosuppressive (IS) medications (82%), and having disease duration <5 years (74%) were higher in male patients with work-day loss (P < .05). The majority of males (90.9%) had more than four clinic visits during the previous year. Moreover, the mean work-day loss (30.8 ± 57.7 days) was higher in patients with vascular involvement (56.1 ± 85.9) than those without (26.4 ± 50.6 days) (P = .046). In addition, increased frequency of ocular involvement (25.9%) was also observed in patients with work-day loss compared to others (8.6%) (P = .059).

CONCLUSION

Work-day loss was associated with both vascular and ocular involvement. Close associations were observed among male gender, early period of the disease, frequent medical visits, being a smoker and treatment with IS medications in patients with work-day loss.

Oral ulcer activity assessment with the composite index according to different treatment modalities in Behçet's syndrome: a multicentre study

OBJECTIVES

The aim of this multicentre study was to understand patients' needs and to evaluate the oral ulcer activity with the Composite Index (CI), according to different treatment modalities in Behçet's syndrome (BS).

METHODS

BS patients (n=834) from 12 centres participated in this cross-sectional study. Oral ulcer activity (active vs. inactive) and the CI (0: inactive vs. 1-10 points: active) were evaluated during the previous month. The effects of treatment protocols [non-immunosuppressive: non-IS vs. immunosuppressive: (ISs)], severity (mild vs. severe), disease duration (<5 years vs. ≥5 years) and smoking pattern (non-smoker vs. current smoker) were analysed for oral ulcer activity.

RESULTS

Oral ulcer activity was observed in 65.1% of the group (n=543). In both genders, the activity was higher in mild disease course with non-IS treatment group compared to severe course with ISs (p<0.05). As a resistant group, patients with mild disease course whose mucocutaneous symptoms were unresponsive to non-IS medications were treated with ISs in a limited period and achieved the highest CI scores in females. Oral ulcer activity and poor CI score were associated with disease duration less than 5 years compared to others in male patients (p<0.05).

CONCLUSIONS

Oral ulcer activity pattern is affected by both the combination of disease course, treatment protocols and disease duration. CI scores reflected the oral clinical activity and CI might be a candidate scale to evaluate the efficacy of treatments during the follow-up of oral ulcer activity in BS.

Exon 2: Is it the good police in familial mediterranean fever?

Objective

Familial Mediterranean fever (FMF) is the most common autoinflammatory disease. Most of the identified disease-causing mutations are located on exon 10. As the number of studies about the effect of the exonal location of the mutation and its phenotypic expression is limited, we aimed to investigate whether the exonic location of the Mediterranean fever (MEFV) mutation has an effect on the clinical manifestation in patients with FMF.

Methods

Study population was derived from the main FMF registry that included 2246 patients from 15 different rheumatology clinics. We categorized the mutations according to their exon locations and retrieved the clinical and demographic information from the database.

Results

Patients having the MEFV mutations on exon 2 or 10 (n:1526) were divided into three subgroups according to the location of the MEFV mutations: Group 1 (exon 2 mutations), Group 2 (exon 10 mutations), and Group 3 (both exon 2 and exon 10 mutations). Group 2 patients were of a significantly younger age at onset, and erysipel-like erythema, arthritis, amyloidosis, and a family history of FMF were more common in this group.

Conclusion

Patients with FMF and exon 10 mutations show more severe clinical symptoms and outcome. Exon 2 mutations tend to have a better outcome.

Methodology of a new inflammatory arthritis registry: TReasure

Background/aim

The TReasure registry, created in 2017, is an observational multicenter cohort that includes inflammatory arthritis patients. This article reviews the methodology and objectives of the TReasure registry established to collect data from rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients.

Methodology

Fifteen rheumatology centers in Turkey will contribute data to the TReasure database. The actual proprietor of the database is the Hacettepe Rheumatology Association (HRD) and Hacettepe Financial Enterprises. Pharmaceutical companies that operate in Turkey (in alphabetical or er), Abbvie, Amgen, BMS, Celltrion Healthcare, Novartis, Pfizer, Roche, and UCB, support the TReasure registry. TReasure is a web-based database to which users connect through a URL (https://www.trials-network.org/treasure) with their unique identifier and passwords provided for data entry and access. TReasure records demographic and clinical features, comorbidities, radiology and laboratory results, measures of disease activity, and treatment data.

Discussion

TReasure will provide us with various types of data, such as a cross-sectional view of the current nationwide status of the patients currently receiving these treatments, and retrospective data as much as allowed by the participating centers’ records. Finally, a high-quality prospective dataset will be built over the ensuing years from patients with a new diagnosis of RA or SpA.

Do clinical findings of Behçet's disease vary by gender?: A single-center experience from 329 patients

OBJECTIVE

Behçet's disease (BD) is a systemic vasculitis with a significantly varying clinical course following relapses and remissions, which may involve a number of organs such as the skin, joints, lungs, and blood vessels as well as systems such as the central nervous system and gastrointestinal system. Its prognosis is known to be worse in males. There are several studies in the literature on the clinical features and gender distribution of BD. The aim of the present study was to determine the clinical characteristics of BD and the presence of a relation with gender and to investigate the correlation of our results with the current literature.

MATERIAL AND METHODS

We retrospectively reviewed 329 patient files. The demographic features of the patients, their symptoms and findings of BD, the results of pathergy tests, the presence of any individuals in the family with BD, and HLA-B51 antigen positivity were recorded.

RESULTS

The most frequent findings were oral aphtous ulcers (100%), genital ulcers (84%), papulopustular lesions (69.9%), and joint involvement (57.4%). Vascular involvement and ocular involvement were significantly higher in males, whereas joint involvement and headache were more common in females (p<0.001, p=0.014, p<0.001, and p<0.001, respectively). Contrary to the literature, we found that the disease had an earlier onset in individuals with a positive familial history of an oral aphthous ulcer or BD (p=0.03 and p=0.02, respectively) and that joint involvement was more common in patients with erythema nodosum (p=0.02).

CONCLUSION

The clinical features of BD may vary between the genders. Variations exist in the results depending on the population size, the department where the study was conducted, the patient inclusion criteria, and the region where the patients live.

The role of MEFV mutations in the concurrent disorders observed in patients with familial Mediterranean fever

OBJECTIVE

This study aimed to investigate the frequency in which familial Mediterranean fever (FMF) coexists with other diseases and determine whether Mediterranean fever (MEFV) gene mutations are involved in such coexistence.

MATERIAL AND METHODS

In total, 142 consecutive patients with FMF investigated for MEFV mutation were enrolled in this study [Female: 87; Male: 55, mean age 32±12 years (11-62)]. All the patients were questioned for the presence of concurrent disorders, and the medical records of these patients were revised retrospectively. A previous diagnosis of inflammatory disorder other than FMF was considered true if it met the relevant criteria. MEFV mutations were divided into 2 groups, namely M694V and its subgroup (homozygous or heterozygous) (Group I) and others (Group II). Compound heterozygosity for M694V mutation was included in Group II to form a homogeneous group for Group I. Group I and Group II were compared according to phenotypical features. The presence of MEFV mutation was investigated in exons 2, 3, 5, and 10 by the multiplex-PCR reverse hybridization method.

RESULTS

Concomitant disorders were found in 17 of 73 patients with FMF (23%) in Group I and 5 of 56 patients (8.9%) in Group II (p=0.04). Concomitant disorders in Group I were as follows: 7 cases of amyloidosis, 2 cases of Behcet's disease (BD), 4 cases of ankylosing spondylitis (AS), 1 case of antiphospholipid syndrome, 1 case of Henoch-Schonlein purpura (HSP), 1 case of combination of psoriatic arthritis, HSP, and membranoproliferative glomerulonephritis, and 1 case of AS and amyloidosis. In Group II, the following disorders were found: 1 case of amyloidosis, 1 case of BD, 1 case of AS, 1 case of ulcerative colitis, and 1 case of vitiligo.

CONCLUSION

The presence of M694V mutation may predispose patients with FMF to developing other inflammatory disorders.

Myocardial infarction in young patients (≤35 years of age) with systemic lupus erythematosus: a case report and clinical analysis of the literature

The present study aims to report a-20-year old girl with systemic lupus erythematosus (SLE) who developed myocardial infarction (MI) and also aims to review acute myocardial infarction (AMI) in young SLE cases (≤35 years) reported in the literature. We conducted a comprehensive review of the English literature from 1975 to 2006 to analyse data on MI in SLE patients who had developed AMI either at 35 or earlier. In 32 English articles, we identified 49 SLE patients, plus our case, with AMI. They consist of 41 female and nine male patients, their mean age being 24 ± 6.4 years (range of 5—35). Disease duration varied between 0 and 13 years. The lag time between the onset of the SLE manifestations and development of AMI was 7.7 ± 5.4 year (range of 1 month to 20.5 years). We divided the patients into three subgroups according to their coronary involvement type (Group I: normal coronary artery or coronary thrombosis ( n = 16); Group II: coronary aneurysm/arteritis ( n = 12); Group III: coronary atherosclerosis ( n = 22)). The lag time between the onset of the SLE manifestations and development of MI in the subgroups showed variations: Group I < Group II < Group III. Both prevalence of renal involvement and steroid therapy were higher in patients with coronary atherosclerosis than were in Group I. There were one or more risk factors for atherosclerosis in 39 SLE patients. AMI in young SLE patients may be seen, albeit rare. We suggest that clinicians should have a low threshold for cardiac evaluation in patients with SLE. Also, traditional risk factors could be managed through preventive measures. Lupus (2007) 16, 289—297.