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Background:Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease accompanied by recurrent attacks of fever and serositis. It is prevalent among Mediterranean populations, mainly Turks, Armenians; Jews and Arabs. As genetic factors are variable in the population, environmental factors can also affect phenotypic characteristics.Objectives:This study aimed to determine the geographic differences in disease characteristics and burden in patients with FMF in Turkey.Methods:Patients diagnosed with FMF according to the Tel-Hashomer criteria were included in this multi-center study. Patients were included from the different regions of Turkey. Demographic features and clinic characteristics of the patients including disease duration, medications, comorbid conditions, attack characteristics, amyloidosis, acute phase reactants, FMF gene mutations, arthritis, sacroiliitis, and febrile myalgia were recorded. PRASS disease activity score, FMF-QoL, HAD, and HAQ were assessed. Patients from different parts of Turkey were divided into 3 groups the Central Anatolia, Western, and Eastern. Disease activity, characteristics and burden were also investigated among 3 distinct geographic regions.Results:A total of 281 patients with FMF (195 women, 86 men) were enrolled in this study. The mean age of the patients was 34.9 (SD:12.3) years. While the patients in the eastern areas of Turkey were diagnosed earlier age (p), the patients in the western area had a longer diagnostic delay time (p). Patients enrolled from western regions tended to have higher ESR and PRASS scores than those from eastern and central Anatolian regions, but attack numbers per 6 months were similar among the regions. The highest proportion of patients who were M694V/M694V homozygous patients were in western, and then eastern and central Anatolia (19.5%, 18%, and 5.4%). While fever and arthritis were more common in the eastern, pleuritis and sacroiliitis were more common in the central anatolia. Peritonitis and erysipelas like erythema rates were similar among the regions. The majority of patients were receiving colchicine treatment in all three regions. FMF-QoL scores were highest in the eastern and lowest in the western (p=0.006). Patients enrolled in the central Anatolia region experienced more functional disability than those from the western and eastern regions (p=0.009). Anxiety and depression scores were similar between groups (p=0.385 vs p=0.549).Conclusion:These findings suggest that patients with FMF have diversity concerning the age at diagnosis, diagnostic delay time, disease activity, quality of life, and functional disability among the 3 regions. In the genotypic analysis, the M694V mutation is the most common pathogenic mutation in all regions. Regional genetic and environmental varieties may explain the areal differences. These relationships can occur more clearly in larger patient populations.References:[1]Ureten K,et al. Demographic, clinical and mutational characteristics of Turkish familial Mediterranean fever patients: results of a single center in Central Anatolia. Rheumatol Int. 2010;30(7):911-915.Table 1.Clinical and demographic characteristics of patients by geographic regionWestern, n=107Central, n=74Eastern,n=100pAge37.7 (12.5)36 (12.6)31.2 (10.9)<0.001Sex, female79 (73.8%)58 (78.4%)58 (%58)0.007Age at the symptom onset, year16.8 (11.3)20.4 (13.2)18.5 (11)0.229Age at the diagnosis, year29.6 (13.4)27.7 (13.3)22.1 (12.1)<0.001Diagnostic delay time, year12.3 (12.9)7.3 (10.5)3.6 (5.3)<0.001ESR, mm/hr26.8 (18.9)15.5 (12)13.1 (13.1)0.003PRASS41 (55.4%)0.577 Low50 (46.7%)28 (37.8%)51 (51%) Moderate48 (44.9%)45 (45%) High9 (8.4%)5 (6.8%)4 (4%)Fever83 (77.6%)60 (81.1%)96 (96%)0.001Peritonitis98 (91.6%)64 (86.55)92 (92%)0.412Pleuritis35 (32.7%)27 (36.5%)18 (18%)0.013Arthritis18 (16.8)16 (21.6)36 (36%)0.005Sacroiliitis8 (7.5%)14 (18.9%)1 (1%)0.000Erysipelas like erythema2 (1.9%)7 (9.5%)7 (7%)0.075Data are presented as mean (SD), median (min-max), and n (%)Disclosure of Interests:None declared

Background:Familial Mediterranean fever (FMF) is the most common hereditary auto-inflammatory disease, which is more common in groups in the Mediterranean basin, characterized by recurrent attacks of febrile peritonitis, pleuritis and arthritis.Objectives:The aim of this study is to investigate the gender differences in clinical and demographic features in patients with familial Mediterranean fever (FMF).Methods:Patients with FMF diagnosed according to Tel-Hashomer criteria were included in this multi-center study. Data about age, sex, disease duration, symptom duration, age at diagnosis, comorbid diseases and medications were noted. All patients were screen with Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaires (HAQ), Short Form 36 (SF-36). The severity of FMF was assessed by the PRASS scoring system.Results:Of the 286 patients, 199 (69,6%) were female with the mean age 36,2(SD:12.32) years and 87 (30,4%) were male with the mean age 32,9(SD:12,6) years (p=0,017). Age of diagnosis in male patients was lower than in females (p=0,008). The most common genetic mutation in both genders was M694V gene mutation. Homozygous M694V positivity was higher in males (31,79% vs 17,4%). More than 90% of patients were receiving colchicine,10 (3,5%) patients were receiving anakinra and 5(1,75%) patients were receiving canakinumab. Among the patients regularly taking colchicine, 86.2% were females and 86% were males (p=0,981). There were no differences between male and females in terms of clinical findings, frequency and duration of attacks, presence of colchicine resistance, and the presence of amyloidosis (p>0.05). ESR was detected higher in female group (p=0,011). Headache (p=0,001), migraine (p=0,031), and concomitant diseases (p=0,017) were also more common in females than males. Anxiety and depression scores were higher in females (p0,05). All parameters of SF-36 were higher in male patients, while HAQ score was higher in females (pConclusion:Although clinical findings, disease severity and treatment compliance are similar in both genders, males are diagnosed with FMF earlier than females, but findings such as anxiety, depression, migraine, and headache are more common in female patients.References:[1]Doğan HO, Koca Y, Erden G, Karaaslan Y, Bozat H. Evaluating MEFV mutation frequency in Turkish familial Mediterranean fever suspected patients and gender correlation: a retrospective study. Mol Biol Rep. 2012 May;39(5):6193-6.Table 1.Demographic and clinical features between female and male FMF patients.Female (n:199)Male (n:87)PDemographic features, mean (SD) Age36,2 (12.32)32,9 (12,6)0,017 BMI26,87(5,73)25,79(5,28)0,177 Educational level, years8,77(4,36)12,08(3,23)0,000 Age at diagnosis28 (13,31)23,7 (13,42)0,008 Age at onset of disease19,2 (12,6)17 (10,6)0,265Clinical features, n (%) Fever166 (83,4)77 (88,5)0,268 Abdominal pain180 (90,5)78 (89,7)0,835 Chest pain62 (31,2)20 (23)0,160 Erysipelas like erythema12 (6)4 (4)0,628 Arthritis46 (23,1)24 (24)0,419 Arthralgia102 (51,3)42 (48,3)0,643 Myalgia101 (50,8)47 (54)0,611MEVF mutations, n (%) M694V/M694V24 (12.3)19 (22)0.047 M694V heterozygous38 (19,5)14 (16,3)0.523 M694V/any25 (12,8) 15 (17,4)0.307PRASS disease severity, n (%)0,813 Mild99(49,7)46(52,9) Moderate88(44,2)35(40,2) Severe12(6)6(6,9)ESR, mm/hour, mean (SD)23,77(16,27)18,25(18,41)0,011HAQ, mean (SD)0,49 (0,63)0,16 (0,43)0,000HAD, mean (SD) Anxiety8,4 (4,4)6,7 (3,44)0,003 Depression7,1 (4,27)5,7 (3,81)0,006SF-36, mean (SD) Physical functioning63,56 (23,81)79,93 (19,32)0,000 Physical role limitation45,78 (40,95)61,41 (39,14)0,003 Emotional role limitation47,36 (42,04)66,20 (40,69)0,020 Energy/fatigue42,50 (20,64)53,64 (19,82)0,000 Emotional well-being51,61 (18,47)58,74 (18,30)0,003 Social functioning57,06 (23,09)70,52 (23,82)0,000 Pain51,66 (24,05)65,72 (24,51)0,000 General health39,53 (20,01)52,46 (23,83)0,000Disclosure of Interests:None declared

Background Due to its effect on the immune system and antioxidant features melatonin (MLT) has attracted a great deal of attention in recent years. Its role in pathogenesis of chronic inflammatory diseases have been studied. However only few studies have investigated its role in Ankylosing Spondylitis (AS). Objectives The aim of this study is to investigate the circadian rhythm of MLT and its relationship with disease activity, quality of life and enthesitis score in AS patients. Methods Sixteen AS patients diagnosed according to the Modified New York 1984 criteria and 16 age and sex matched healthy controls were enrolled in the study. Serum MLT levels were measured at 20:00, 03:00 and 08:00 via melatonin direct radioimmunoassay kit (LDN BA R-3300) in both groups. Bath AS Disease Activity Score (BASDAI), Bath AS Functional Index (BASFI), Maastricht AS Enthesitis Score (MASES) and AS Quality of Life (ASQoL) were calculated in AS group. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured, duration of morning stiffness was questioned Results The mean morning (08:00) and evening (20:00) MLT levels were significantly higher in the patient group (34.00±13.51 pg/ml versus 24.88±7.10 pg/ml and 34.25±7.92 pg/ml versus 27.75±8.25 pg/ml respectively) (p Conclusions Ankylosing Spondylitis patients have higher melatonin levels and the melatonin levels of AS patients are associated with the duration of morning stiffness, disease activity, quality of life and enthesitis scores. We suggest that our results should be supported by studies performed in wider study populations also involving patients with non-radiographic axial spondyloarthritis as a subgroup and with more frequent melatonin measurements performed especially at night in order to assess the exact circadian rhythm of melatonin in spondyloarthritis. References Cutolo M, Maestroni GJ,Otsa K, Aakre O, Villaggio B, Capellino S et al. Circadian melatonin and cortisol levels in rheumatoid arthritis patients in winter time: a north and south Europe comparison. Ann Rheum Dis 2005;64:212-216 Senel K,Baykal T, Melikoglu MA, Erdal A, Karatay S, Karakoc A, Ugur M. Serum melatonin levels in ankylosing spondylitis: correlation with disease activity. Rheumatol Int 2011;31:61-63 Senna MK, Olama SM, El-Arman M. Serum melatonin level in ankylosing spondylitis: is it increased in active disease. Rheumatol Int 2012;32:3429-3433. Disclosure of Interest None declared

Background Rheumatoid Arthritis (RA) has different clinical phenotypes. RA with co-existing fibromyalgic features has been termed as fibromyalgic- RA (FRA). Fatigue is a common symptom in rheumatological diseases. Objectives The aim of this study is to evaluate the effects of biological and conventional Disease-Modifying Anti-Rheumatic Drugs (DMARD) on fatigue in FRA patients. Methods Thirty (30) RA patients who met the 2010 ACR/EULAR classification criteria were enrolled in the study. Patients who had other possible causes of fatigue were excluded. The ones who met the ACR 1990 criteria for fibromyalgia were grouped in FRA group. The FRA and non- fibromyalgic RA (non-FRA) groups were divided into subgroups according to the medications used as biological-DMARD and conventional-DMARD subgroups. Fatigue was evaluated via Multidimensional Assessment of Fatigue scale (MAF) and disease activity was assessed by using Disease Activity Score-28 (DAS 28). Results The mean MAF total score of RA patients was 21.35±15.82. Eight (26.7%) of the RA patients had co-existing FMS (FRA group). The mean MAF total score in FRA group was statistically higher than the the non-FRA group (36.56±7.10, 15.81±14.45 respectively) (p Conclusions Fatigue is common in RA. Fatigue becomes more prominent if there is co-existing fibromyalgia. In non-FRA patients fatigue is correlated with the disease activity however such a correlation is absent for FRA patients. In non-FRA patients biological DMARD usage improved fatigue when compared with the conventional- DMARD therapy. However biological DMARD did not have additional benefit on fatigue in FRA patients when compared with the conventional DMARD group. When dealing with fatigue in RA patients possibility of co-existing fibromyalgia must be taken into account for treatment success. Disclosure of Interest None Declared