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Physicians are challenged by the recognition and treatment of older patients with rheumatoid arthritis (RA). The aim of this case-control study was to evaluate the retention and safety of conventional disease-modifying anti-rheumatic drugs in older patients with RA.In this observational case-control study, we assessed older patients with RA (≥65 years) who were diagnosed in 3 different rheumatology centers from Turkey. Patients were divided as to those aged ≥65 years (elderly rheumatoid arthritis [ERA]) and those aged, NA

Rheumatoid arthritis (RA) prevalence increases with age and old people are special patient population. The recognition of functional disability related to RA could be challenging in elderly patients because aging itself and potential co-morbid disease may also cause functional disability. In this study, we aimed to look at the correlation between disease activity and functional disability in elderly RA patients. Elderly RA patients, ≥65 years old at their routine visits were included in the study. The composite 'disease activity score' in 28 joints (DAS-28) was used to determine disease activity groups. Health assessment questionnaire (HAQ) scores were calculated to describe the functional disability and compared across the disease activity groups. Two hundred and fifty-eight RA patients with the mean age of 71 ± 5 (65-90) and a total disease duration of 8.4 ± 8.5 (.5-50) years were recruited. The proportion of patients with high and moderate disease activity was 70%. HAQ scores were significantly correlated with disease activity (p .05). Functional disability estimated by HAQ was correlated with disease activity in elderly patients with RA.

Objective To determine the relationship between vascular biomarkers reflecting the vascular injury and neoangiogenesis with capillaroscopic changes in systemic sclerosis (SSc). Methods Nailfold video-capillaroscopy (NVC) was performed qualitatively (early, active and late scleroderma patterns) in 72 SSc patients (66 female) fulfilling ACR/EULAR (2013) criteria. Serum samples of patients were collected and analysed by flow cytometer with multiplex kits of sCD40L, tPA, MCP-1, sE-selectin, IL-8, IL-6, VEGF, sP-selectin, TGF-β1 and VCAM at the same time with NVC. Results Compared to healthy subjects; tPA ( p = 0.02), MCP-1 ( p = 0.001), sE-selectin ( p = 0.008) and TGF-β1 ( p = 0.001) levels were significantly higher, however sP-selectin ( p = 0.011) and IL-8 ( p = 0.001) levels were lower in SSc patients. SSc patients were defined according to NVC patterns as ‘early’ ( n = 10), ‘active’ ( n = 37) and ‘late’ ( n = 25). According to NVC patterns of SSc patients, only sCD40L levels were significantly lower in the ‘late’ group ( p = 0.039). The other markers were similar among NVC groups. Conclusions NVC is a useful method for investigating the vascular pathogenesis and severity of SSc. Although the levels were similar to healthy controls in patients with early/active NVC patterns, there were lower sCD40L serum levels in patients with late NVC pattern. CD40L may have a role in the early/active phase of vascular involvement.

Background Assessment of disease activity in systemic sclerosis (SSc) is challenging and usually hard to distinguish from damage or chronicity. Objectives We aimed to evaluate disease activity by different indexes and compare them in a SSc cohort. Methods Disease activity was evaluated by revised EUSTAR (European Scleroderma Trials and Research group) and EScSG (European Scleroderma Study Group) activity indexes in 131 SSc patients fullfiling ACR/EULAR classification criteria (2013). The patients with the scores of EUSTAR activity index ≥2.5 or EScSG activity index ≥3 were accepted as having active disease. Results Demographics, disease characteristics and nailfold video-capillaroscopic (NVC) pattern details were summarised in table-1. The scores of EUSTAR and EScSG activity indexes were correlated well (r=0.576, p=0.000) and the agreement between two scores for activity was moderate (cohen kappa:0.407). The percentages of SSc patients described as having active disease or not according to two activity indexes were summarised in table-2. Of the patients, 9.9% had active and 70.9% had inactive disease according to both indexes in this SSc cohort. Twenty -one (for EUSTAR) and 4 patients (for EScSG) were described as active according to one index and not to the other. Revised EUSTAR activity index was found to have 76.5% sensitivity and 81.6% specificity when the activity was defined by EScSG activity index. Conclusion This SSc cohort predominantly had limited cutanous disease, digital vasculopathy and late scleroderma pattern. Defining active disease was differed in 19% of the patients according to EUSTAR and EScSG activity indexes, former described higher frequency for activity. This difference might be related to validation procedures of these indexes in patients with different predominant stages of SSc disease, content of the index and the features of the cohort. Disclosure of Interests None declared

Aim To assess subclinical atherosclerosis and the role of inflammatory mediators, vascular endothelial cell activation markers and adipocytokines in systemic lupus erythematosus (SLE) in the presence or absence of metabolic syndrome (MetS). Methods We studied 66 premenopausal female SLE patients (20 with MetS) and 28 female healthy controls (HCs) without history of cardiovascular disease (CVD). Subclinical atherosclerosis was screened by measuring carotid intima media thickness (CIMT). Serum levels of high sensitivity C-reactive protein (hs-CRP), tumour necrosis factor α (TNFα), interleukin 6 (IL-6), soluble intercellular adhesion molecule 1 (sICAM-1), soluble E-selectin, leptin and visfatin were measured. Results The mean age of MetS+SLE, MetS- and HC were 38.3 ± 6.7, 32.7 ± 9.3 and 29.9 ± 5.6 years, respectively. The mean disease duration, SLICC (Systemic Lupus International Collaborating Clinics damage index) and Systemic Lupus Erythematosus Disease Activity Index scores were 74.8 ± 54.9 months, 0.16 ± 0.48 and 1.18 ± 1.5, respectively, and were similar between MetS+and MetS- SLE patients. CIMT values were higher in both MetS+ and MetS- SLE patients than HCs ( p + and MetS- SLE patients than HCs ( p + group had higher CIMT values than SLE MetS- (right: p = 0.003; left: p = 0.025). Leptin levels and homeostatic model assessment (HOMA) scores were significantly higher in SLE MetS+ than SLE MetS- ( p = 0.018; p = 0.04). Leptin and CRP levels and body mass index, SLICC and HOMA scores were correlated with CIMT values (right: p = 0.03, p Conclusions In premenopausal women with SLE without a history of CVD, CIMT values were increased and related to MetS. Leptin was increased in patients with MetS and correlated with CIMT values.

Background The number and morphology of telangiectases (T) have been studied in terms of severity and organ involvement in sytemic sclerosis (SSc). T are located more frequently on face and trunk than extremities. Objectives We aimed to evaluate the impact of the localisation of T on different skin areas in addition to number on disease severity of SSc. Methods SSc patients fulfilling ACR/EULAR classification criteria (2013) who had the manifestation T were included. The number of T were calculated by using telangiectasia score (TS) (Shah A., et al) and localisation was classified according to presence of T on extremities or not. Simultaneously; ealy, active and late scleroderma patterns (Cutolo et al.) were determined qualitatively and capillary number (CN) was calculated per linear mm at distal row quantitatively by using nail fold video-capillaroscopy (NVC) in all patients. Results In 113 (106 female) SSc patients with T; the mean age was 52±12, the duration of follow-up 57±62 months, Raynaud and non-Raynaud symptom 10±8 and 7±7 years. Limited cutaneous form was found to be in 77 (%68), ANA positivity in 102 (%90) ve anti-Scl70 positivity in 33 (%29) patients. In SSc patients with TS score ≥6 or extremity T; the duration of non-Raynaud symptom was found to be longer (p=0010 or 0,009), MRSS and activity scores were higher (p=0004 or 0012 and p=0010 or 0,009) and severity scores of general, peripheral vascular involvement and skin were higher (p=0022 or 0,014, p=0030 or 0025 and p=0006 or 0,02), digital ulcers and flexion contractures were more frequent (p=0008 or 0035 and p=0027 or 0,032), late NVC pattern was more frequent and CN was lower (p=0001 or 0003 and p=0001 or 0,007). When patients were classified in 3 groups according to TS and presence of extremity T, differences in terms of organ involvement, disease activity and severity scores and NVC findings were summarised in table 1. Conclusions Disease duration was shown to be long, disease activity and severity were high and NVC findings were severe in patients with high scores of TS and extremity T. In patients with lower TS the presence of T on extremities was found to be related to severe disease. The number and localisation of T was emphasised as they are easy to evaluate in clinical practice and may be useful in determining severe patients with SSc. Disclosure of Interest None declared

Background/Purpose Patients with systemic lupus erythematosus (SLE) have increased rates of cardiovascular disease (CVD) that are one of the major causes of mortality. The aim of this study was to determine the frequencies of metabolic syndrome (MetS) and CVD in SLE patients and investigate the link between these and clinical features of SLE. Methods A total of 311 SLE patients were consecutively assessed for cumulative organ damage (SDI/SLICC scores), history of CVD and MetS as defined by the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III). Clinical data of SLE patients were collected from the records. Results The mean age of the patients was 40.2 ± 13.4 years and 89% were female. The frequencies of CVD and MetS were 15.2% and 19%, respectively. In this SLE cohort increased age, cumulative damage, disease duration and CVD were associated with MetS. CVD was associated with disease duration, cumulative damage, pericarditis, hematologic involvement, lymphopenia, thrombocytopenia, neurological involvement and antiphospholipid antibody (aPL) positivity. Hydroxychloroquine (HCQ) use was found as a protective factor for CVD. Conclusion In SLE patients, MetS was associated with CVD and both increased with disease duration. Patients who developed MetS and/or CVD had increased cumulative organ damage. Certain clinical features of SLE and the presence of aPL were also associated with CVD. There was a significant protective effect of HCQ from CVD. The prevention of MetS and long-term use of HCQ may be beneficial in improving the prognosis of SLE.

Background Rheumatoid arthritis (RA)9s prevalence increases with age and the recognition of functional disability related to RA could be challenging in elderly patients (1). Objectives In this study, we aimed to look at the correlation between disease activity and the functional disability by using HAQ score in elderly RA patients. Methods Elderly RA patients, ≥65 years old at their routine visits were included to the study. The composite “disease activity score” in 28 joints (DAS-28) and “Physician Global Assessment” (PhGA) were used to determine disease activity. Health assessment questionnaire (HAQ) scores were calculated to describe the functional disability and compared across the disease activity groups according to DAS-28. Results Two hundred and fifty eight RA patients with the mean age of 71±5 (65–90) were included. Seropositivity rate was 71% and 47% of the patients had erosive disease. Joint deformity was seen in 72 (28%) of patients and 28 (11%) patients had undergone total arthroplasty. Lung involvement (8.5%) and Sjogren9s syndrome (7.4%) were found as the most frequent extra-articular manifestations. Hypertension (66%) and osteoporosis (36%) were the common co-morbidities. The proportion of patients with high and moderate disease activity was found as 70%. HAQ and PhGA scores were significantly correlated with the disease activity (Figure). Conclusions We provided a novel data concerning the usefulness of HAQ for prediction of disease activity in RA patients who are elderly as well. In the future, our report will be supported by the studies which suggest that HAQ score improve with effective treatment in elderly RA patients. References Uhlig T, Loge JH, Kristiansen IS, Kvien TK. Quantification of reduced health-related quality of life in patients with rheumatoid arthritis compared to the general population. J Rheumatol 2007;34: 1241–1247. Disclosure of Interest None declared

Objective.Associations between autoantibodies and clinical features have been described in systemic lupus erythematosus (SLE). Herein, we aimed to define autoantibody clusters and their clinical correlations in a large cohort of patients with SLE.Methods.We analyzed 852 patients with SLE who attended our clinic. Seven autoantibodies were selected for cluster analysis: anti-DNA, anti-Sm, anti-RNP, anticardiolipin (aCL) immunoglobulin (Ig)G or IgM, lupus anticoagulant (LAC), anti-Ro, and anti-La. Two-step clustering and Kaplan-Meier survival analyses were used.Results.Five clusters were identified. A cluster consisted of patients with only anti-dsDNA antibodies, a cluster of anti-Sm and anti-RNP, a cluster of aCL IgG/M and LAC, and a cluster of anti-Ro and anti-La antibodies. Analysis revealed 1 more cluster that consisted of patients who did not belong to any of the clusters formed by antibodies chosen for cluster analysis. Sm/RNP cluster had significantly higher incidence of pulmonary hypertension and Raynaud phenomenon. DsDNA cluster had the highest incidence of renal involvement. In the aCL/LAC cluster, there were significantly more patients with neuropsychiatric involvement, antiphospholipid syndrome, autoimmune hemolytic anemia, and thrombocytopenia. According to the Systemic Lupus International Collaborating Clinics damage index, the highest frequency of damage was in the aCL/LAC cluster. Comparison of 10 and 20 years survival showed reduced survival in the aCL/LAC cluster.Conclusion.This study supports the existence of autoantibody clusters with distinct clinical features in SLE and shows that forming clinical subsets according to autoantibody clusters may be useful in predicting the outcome of the disease. Autoantibody clusters in SLE may exhibit differences according to the clinical setting or population.

Pulmonary arterial hypertension (PAH) is an important complication of connective tissue diseases (CTD) and especially seen in systemic sclerosis, systemic lupus erythematosis (SLE), and mixed connective tissue disease (MCTD). In systemic sclerosis, PAH is isolated or accompanied by interstitial lung disease and currently, a major cause of mortality. It has been shown to be developed in approximately 10% of cases and annual screening with echocardiography has been recommended. Right heart catheterization is required for definite diagnosis. Limited skin involvement, late onset, Raynaud's phenomenon, digital ulcers, telangiectasias, diminished nail fold capillaries, anti-U3RNP and anticentromere antibodies are known as risk factors for PAH development in systemic sclerosis. Following diffusion lung capacity for carbon monoxide (DLCO) and pro-brain natriuretic peptide (pro-BNP) levels can be helpful for evaluating PAH development. PAH in SLE linked to antiphospholipid antibodies and Raynaud's phenomenon in some studies. MCTD is an overlap syndrome with features of systemic sclerosis, SLE, polymyositis and positive anti-U1RNP antibodies. PAH develops in 9-27% of the patients and the leading cause of mortality in patients with MCTD. Endothelin receptor antagonists, prostacyclin analogs and phosphodiesterase 5 inhibitors are being used in patients with systemic sclerosis. In SLE/MCTD patients with early diagnosis immunosuppressive treatments may be effective.

Background Antiphospholipid syndrome (APS) is an autoimmune disease characterized mainly by thrombosis and/or pregnancy morbidity in the presence of antiphospholipid (aPL) antibodies. Significant mortality and morbidity has been reported in patients with APS. Objectives To characterize a single center cohort of patients with APS (including non-criteria manifestations) and to assess their survival rates, causes of mortality and associations with disease characteristics. Methods Records of 240 patients with APS were studied. Demographic characteristics, cumulative clinical and laboratory features, autoantibody profiles were retrieved from the existing database. Unattending patients were contacted by telephone and were searched on the national death information system (NDIS). Patients who were non-responsive to telephone calls, not seen in the outpatient clinic within the last 6 months and could not be traced on the NDIS were considered lost-to follow-up. Results There is a total of 240 patients in this cohort 118 of whom had primary APS and 122 had APS associated with SLE. 83% of the patients were female. The mean age at diagnosis was 41±12, duration of disease and follow-up were 110±85 and 92±82 months respectively. Of 240 patients, 65% had vascular thrombosis (VT), 24% had pregnancy morbidity (PM), 10% had both VT and PM and 3 had catastrophic antiphospholipid syndrome. Overall 29% patients had thrombotic risk factors among which smoking followed by homozygous factor V Leiden mutation were the most prevalent. Of patients with VT 49% had arterial (a), 38% had venous (v) and 13% had both a and v thrombosis. 95 patients experienced a single thrombotic episode whilst 62 had more than once, most commonly v followed by a thrombosis. In the PM group, there were 31 patients with fetal deaths beyond 10 weeks, 39 with 3 or more abortions before 10 weeks, 18 with premature labour and 14 with pre-eclampsia. Overall, 46% of patients had aCL IgG, 36% had IgM and LA was present in 54%. Anti-β2GPI was tested in 117 patients and 38% were positive for IgG and 25% for IgM. Of the non-criteria manifestations of APS, the most common presentation was heart valve lesions followed by thrombocytopenia. In total there were 25 deaths and 19 patients were lost to follow-up. Survival rates were 94, 86, 78 and 71% at 5, 10, 15 and 20 years respectively. Comparison of survival between patients with VT and PM displayed a marked reduction in the VT group (p=0.04) whilst primary and lupus associated APS patients had similar rates. Causes of death could be identified in 19 patients. Myocardial infarction, alveolar hemorrhage and pulmonary hypertension were the leading causes of death. Mortality was significantly associated with LA positivity (p=0.02). Conclusions In this cohort, the most prevalent manifestation of APS was arterial thrombosis. Long-term follow up revealed that patients with APS had significant mortality and APS-related manifestations dominated the causes. Thrombotic patients had a reduced survival relative to PM patients. No single aPL test was sufficiently sensitive in the evaluation of APS. LA positivity was a risk factor for reduced survival. Disclosure of Interest None declared

symptom but this was similarly reported in both patient groups (15/24 vs 29/42), as were buttock (7/24 vs 9/42), neck (9/24 vs 11/42), knee (5/ 24 vs 8/42), shoulder (5/24 vs 11/42), and foot (6/24 vs 7/42) pain. Crucially, eye inflammation (later diagnosed as uveitis) was reported as a first symptom for 39% (9/24) of uveitis patients. Importantly, hip pain (10/24 vs 10/42; P

Background Takayasu’s arteritis (TA) is a large vessel vasculitis of the young women in their reproductive age. It’s been previously reported as having conflicting results on the pregnancy outcome in TA. Objectives Herein, we reported the pregnancy outcome and the effect of the pregnancy on the disease course in a well established TA cohort. Methods TA patients diagnosed by ACR criteria and had the history of pregnancy were included into the study. Clinical and laboratory findings including serum ESR and CRP levels were evaluated both retrospectively and prospectively. Pregnancy and newborn outcome consists of the history of abortus, delivery mode, prematurity, intrauterin growth retardation, preeclampsia and eclampsia that were obtained from medical records. Data were noted into a predefined protocol. Disease activity and damage evaluated by Kerr criteria and VDI and concomittant immunosuppressives were recorded within the 3rd trimester and 6 months of pre and postpartum period in a subgroup prospectively followed-up. Pre-diagnosis (pre-d) and post-diagnosis (post-d) pregnancies were compared according to the maternal and fetal outcome. Results Eighty-two pregnancies in 34 patients were assessed in TA cohort of 103 patients. Only 10% of all pregnancies were planned. Mean (median) age of 34 patients at pregnancy period were 24,5±6,6 (22). Subclavian (85%), carotis (44%) and pulmonary arteries (26%) were the most frequently involved vessels. Hypertension (47%), pulselessness (%34), mild pulmonary hypertension (18%) related to valvular disease (26%) were the prominent clinical features. Comparison of fetomaternal prognosis between the pre-d (63 in 24 TA) and post-d (19 in 15 TA) pregnancies demonstrated that hypertension (3% vs 16%), preeclampsia (0% vs 10%), prematurity (2% vs 10%) and Cesarean section (CS) (9% vs 37%) were significantly high in post-d pregnancies. Eight patients (of 4 newly diagnosed) prospectively followed-up during their pregnancies. Glucocorticoid (GC) (4 pts) and azathioprin (2 pts) were maintained after taking the patients’ consents. Four patients had flare during the 3rd trimester. Two of 4 patients had taken 10 mg/d GC and other 2 patients denied to be treated. The patient had renal artery involvement complicated with preeclampsia and the other experienced accelerated hypertension. Five TA patients underwent Ceaserean section mainly because of the probable risk of cerebral hypoperfusion during the delivery. One TA patient who was exposed to infliximab during the conception, has since been followed-up succesfully at the 3rd trimester under the low dose of GC. There were no obvious fetomaternal abnormality in TA cohort. No flare was observed during the 6th month of postpartum period. VDI scores did not increase in all patients. Conclusions Majority of the pregnancies were found as successfull in a well established TA cohort. Higher rates of preeclampsia, prematurity and CS in post-d pregnancies were attributed to the exposure of GC treatment and physicians’ bias for delivery route. CS and prematurity were found as similar with our healthy population rates. Flares did not cause damage accrual in a short postpartum follow-up period. Flare has to be differentiated from the aberrant physiological changes and acute phase increase during the pregnancy. Close monitorization of arterial tension could be helpful for maintaining succesful pregnancy Disclosure of Interest None Declared

Objectives To determine the association of nailfold videocapillaroscopy(NVC)findings and telangiectasia score with DU history and severity of peripheral vascular involvement(PVI) in Systemic Sclerosis(SSc). Methods Fifty-nine SSc patients fulfilling Leroy and Medsger criteria were evaluated including Telangiectasia Score(TS)(Shah AA et al. J Rheumatol 2010), Modifiye Rodnan Skin Score(MRSS), Valentine Activity Scale(VAS) and Medsger Severity Scale(SS). Qualitative(early, active and late patterns) and semiquantitative assessments [capillary number(CN), irregularly enlarged capillaries(IEC), giant capillaries(GC), capillary ramifications(CR), microhaemorrhages(H), capillary array disorganisation(CAD) and microangiopathy evolution score(MES)]. was performed by NVC(Sulli et al. Ann Rheum Dis 2008) Results The mean age of patients was 45.6 and 91,5% were females. The mean duration of Raynaud’s(RS), non-Raynaud symptoms(NRS), skin involvement(SI)(year) were 6.1±6.5, 3.1±2.0, 3.0±2.0 respectively. Of the patients 20(34%) were diffuse cutaneous,35(59%) were limited and 4(7%) were sine-scleroderma;13(22%) were anti-centromere(+) and 29(49%) were anti-Scl70(+). DU history (DU+) was present in 27(46%) and telangiectases were present in 34(58%). When we compare DU- and DU + groups, the mean score of CN was 1.4±0.7 vs 2.0±0.5*(p Conclusions DU history and severe PVI in SSc was associated with capillary loss and microangiopathy. ‘Early’ NVC pattern was very rare in patients with DU history and was not found in severe PVI. Severe PVI in males was more frequent than females. Telangiectasia scores were not found to be related to PVI. NVC may be a helpful method in the assessment of SSc patients for PVI prognosis, warranting prospective studies. Disclosure of Interest None Declared