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As an autosomal recessive autoinflammatory disease, treatment of Familial Mediterranean fever (FMF) has still gaps. Clinical studies are proving the safety and efficacy of colchicine in patients with FMF. However, there are very limited data on colchicine-resistant patients treated with canakinumab. This study presents the real-life experience of two rheumatology clinics choosing canakinumab in adult patients with FMF resistant to standard therapy. Treatment-resistant FMF patients with validated diagnoses enrolled from two rheumatology clinics. A special database was generated for the study and patients' demographic characteristics, FMF attack characteristics, adverse events seen during treatment, family history, MediterraneanFeVer (MEFV) mutations, and laboratory results recorded. Patients with missing dates were excluded from the analysis. PRAS score is used to assess the disease activity. A total of thirty colchicine and/or anakinra-resistant patients were enrolled to study. Twenty-one patients were female (70%) and the average disease duration was 21 years. The time from colchicine to anakinra was 4.27 years and the time to canakinumab was 1.52 years. Abdominal pain (100%), fever (93.3%), chest pain (56.7%) were the most prevailed findings. Morning stiffness, myalgia, low back pain, chest pain was the predominant musculoskeletal findings. Median colchicine dose was 2 mg/day (min–max 0.5–3 mg/day). The most common side effect during anakinra treatment, apart from treatment unresponsiveness, was injection site reactions. Before canakinumab treatment, the mean number of attacks was 8.3 in the 24 weeks, 4.33 in the third month of canakinumab treatment, and 1.56 at the last visit (p

Objective: Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA. Methods: The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed. Results: The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA). Conclusion: Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes. © 2021 Société française de rhumatologie

Background Juvenile idiopathic arthritis (JIA) can cause reduced exercise capacity, deterioration in functional activities, and poor health-related quality of life. This study aims to objectively reveal lower extremity involvement in the peripheral predominant forms of juvenile idiopathic arthritis through qualitative evaluations and to determine the effects of these involvements on exercise, function, and quality of life. Methods Thirty-two patients with a history of peripheral arthritis and aged between 7 and 16 years participated in the study. Demographics, JIA subtype, disease duration, arthritis and deformities of the lower extremity, disease activity score, 6-min walk test (6MWT), cycling exercise test (CYC-E), childhood health assessment questionnaire (CHAQ), and pediatric quality of life inventory (PedsQoL) scores were recorded. In case of clinical suspicion of arthritis, an ultrasonographic examination was performed for a definitive diagnosis. Regression analyses were performed to explore the most associated lower extremity involvement and patient characteristics for each of the dependent variables including 6MWT, CYC-E, CHAQ, and PedsQoL. Results Of the total number of patients, with a mean age of 12.91 (SD 2.37) years, 28.1% had knee arthritis, 15.6% foot arthritis, 12.5% hip arthritis, and 37.5% lower extremity deformity. The parameters that were most associated with CHAQ and PedsQoL were hip and knee arthritis, whereas CYC-E was found to be most associated with knee arthritis and height, and 6MWT was found to be most associated with hip arthritis, knee arthritis, and demographic characteristics. Conclusion This study emphasizes the importance of hip and knee arthritis, which are among the determinants of walking endurance, function, and quality of life; and knee arthritis, which is among the determinants of cycling performance in JIA with lower extremity involvement.

Keskin, Yasar/0000-0003-4457-5917; KILIC, Erkan/0000-0003-4355-4356; Yurdakul, Ozan Volkan/0000-0003-4567-8133; cuzdan, nihan/0000-0001-7238-657X; gezer, halise hande/0000-0001-8790-304X; alkan, hakan/0000-0001-8461-9131 WOS:000541406200002 PubMed: 32564159 Fatigue is a substantial problem in patients with psoriatic arthritis (PsA) that needs to be considered in the core set of domains. This study aimed to evaluate fatigue and its relationship with disease parameters, functional disability, anxiety, depression, quality of life, and correlation with disease activity as determined by various scales. A total of 1028 patients (677 females, 351 males) with PsA who met the CASPAR criteria were included [Turkish League Against Rheumatism (TLAR) Network multicenter study]. The demographic features and clinical conditions of the patients were recorded. Correlations between fatigue score and clinical parameters were evaluated using the Disease Activity Score 28 (DAS28), Disease Activity in Psoriatic Arthritis (DAPSA), Clinical DAPSA (cDAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Fibromyalgia Rapid Screening Tool (FiRST), minimal disease activity (MDA), and very low disease activity (VLDA). Fatigue was assessed with the Functional Assessment of Chronic Illness Therapy (FACIT-F) and a 10-point VAS (VAS-F). The mean age of the patients was 47 (SD: 12.2) years, and the mean disease duration was 6.4 (SD: 7.3) years. The mean VAS-F score was 5.1 (SD: 2.7), with fatigue being absent or mild, moderate, and severe in 12.8%, 24.6%, and 62.5% of the patients, respectively. Fatigue scores were significantly better in patients with DAS28 remission, DAPSA remission, cDAPSA remission, MDA, and VLDA (p < 0.001). Fatigue scores significantly increased with increasing disease activity levels on the DAS28, DAPSA, and cDAPSA (p < 0.001). VAS-F scores showed correlations with the scores of the BASDAI, BASFI, PsAQoL, HAD-A, FiRST, pain VAS, and PtGA. FiRST scores showed fibromyalgia in 255 (24.8%) patients. FACIT-F and VAS-F scores were significantly higher in patients with fibromyalgia (p < 0.001). In regression analysis, VLDA, BASDAI score, FiRST score, high education level, HAD-Anxiety, and BMI showed independent associations with fatigue. Our findings showed that fatigue was a common symptom in PsA and disease activity was the most substantial predictor, with fatigue being less in patients in remission, MDA, and VLDA. Other correlates of fatigue were female gender, educational level, anxiety, quality of life, function, pain, and fibromyalgia.

Objectives Subunits of the nail can be evaluated by nail ultrasonography (NUSG). The purposes of this study are to document NUSG properties (both nail-based and participant-based evaluations) in patients with psoriatic arthritis (PsA) and healthy controls and to explore the final scorings. Methods After the literature review and a pilot study, a consensus was reached to evaluate 12 nails and 5 parameters by NUSG: nail plate impairment (NPI), nail plate thickness (NPT), nail bed thickness (NBT), nail thickness (NT), and Doppler activity (DA); further, scorings for each parameter (NPIs, NPTs, NBTs, NTs, and DAs) were calculated. Group comparisons and diagnostic performances (with ROC curve analysis) were applied to both parameters and scorings. Final scorings to predict PsA diagnosis among the NUSG scorings were reached by regression analysis. Feasibility, reliability, and clinical associations of the scores were also performed. Results Sixty-four patients with PsA and 26 controls (3240 baseline images) were assessed. The most affected nails, PsA/control comparisons, and the ROC analysis varied among the nails, within the higher values of PsA; therefore, 12 nails remained in the scorings. Participant-based scorings showed better content and diagnostic performances than the nail-based. Diagnostic performances, feasibility, reliability, and regression analysis of the scorings documented that NPIs, NTs, and DAs were the best. Some demographics, employee status, hemoglobin, and disease activity of the participants were associated with them. Conclusions The NUSG Index (NUSGI) including NPIs, NTs, and DAs is a feasible, reliable, and discriminative method to predict PsA diagnosis, with its rich content. Clinicaltrials.gov-ID: NCT04718428

Background: In Familial Mediterranean Fever (FMF), although cognitive functions have been shown to be impaired in children and adolescents, it has been shown that colchicine can be preservative on the cognitive functions in patients who are on long term colchicine treatment. Objectives: This study aimed to evaluate cognitive functions in adult patients with FMF and cognitive effects of colchicine use. Methods: The study included patients who were diagnosed with FMF according to Tel-Hashomer criteria. The control group included patients with no other inflamatory or systemic disease. Clinical features such as disease duration, comorbid diseases, colchicine treatment duration and dosage, amyloidosis and chronic renal failure (CRF), FMF gene mutation and PRAS scoring for evaluation of disease activity were recorded. Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Scale, FMF Quality of Life Scale and Beck Depression Scale were used to assess patents clinical situations. Cognitive measurements were evaluated under executive-propellent functions. KAS test was used for information processing and fluency skills; fruit-name test was used for the evaluation of focusing, concentration, and attention skills; animal counting test and The Montreal Cognitive Rating Scale (MOCA) which can evaluate different subunits (visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall, and orientation) were used for the fluency and maintenance of attention. Different attention parameters were evaluated for patients and healthy individuals. These attention parameters were; focusing, eloborate, sustainability, ability to pay attention to two information at the same time. Descriptive analysis was performed for all parameters. Mann-Whitney U-test and Spearman correlation coefficient were used to compare parameters. P Results: The study included 24 (21 women, 3 men) patients with FMF and 10 (7 female, 3 male) age, sex and BMI matched healthy controls. The mean age of the patients and controls were 36.83 (SD:10.9) and 39.3(SD:8.6), respectively. No significant difference was found between FMF and healthy control groups regarding animal counting, KAS test, MOCA test, and subgroups. Only fruit-name counting test was decreased in the FMF group compared to the healthy controls (p Conclusion: FMF patients attention parameters are impaired compared to the healthy controls. Information processing and fluency performance is increased in FMF patients with the duration of colchicine treatment that demonstrate the ability to categorize and fluent use of the information. Number of attacks are correlated with poor sleep quality and depression. References: [1] Keskindemirci, G., et al., Does familial Mediterranean fever affect cognitive function in children? Electrophysiological preliminary study. Int J Neurosci, 2018. 128(1): p.10-14. [2] Leibovitz, A., et al., Colchicine therapy and the cognitive status of elderly patients with familial Mediterranean fever. Isr Med Assoc J, 2006. 8(7): p.469-72. Disclosure of Interests: Halise Hande Gezer: None declared, Ozge Devezer Uslu: None declared, Didem Erdem: None declared, Sevtap Acer Kasman: None declared, Mehmet Tuncay Duruoz Grant/research support from: Abvie, Speakers bureau: Novartis, AMGEN, Abdi Ibrahim, Ilko

Background: Work disability is an important functional outcome measure in psoriatic arthritis (PsA) and includes unemployment and loss of work productivity. Objectives: The aim of this study is to investigate the working status and the factors associated with work productivity in patients with PsA. Methods: Patients with PsA according to Classification Criteria for Psoriatic arthritis (CASPAR) were included in the study consecutively, without sample selection. Data about age, sex, disease duration (month) were noted. Disease activity was assessed with DAPSA (Disease activity in Psoriatic arthritis) and BASDAI (Bath ankylosing Spondylitis Disease activity index). The Health assessment Questionnaire (HAQ) was used to evaluate physical disability. The Psoriatic arthritis Quality of Life (PsAQoL) scale was used to assess the quality of life. Fatigue and stiffness were assessed on the Visual analogue Scale (VAS). Anxiety and depression were evaluated with HAD (Hospital anxiety and Depression) scale. Assessing work disability, we asked some questions to the patients including employment status, and early retirement, changing or reducing work due to PsA. We used WPAI: PsA (Work Productivity and activity Impairment Questionnaire) to evaluate the impact of PsA on work productivity. WPAI: PSA consists of six questions and gives four scores: the percentage of absenteeism (work time missed due to PsA), the percentage of presenteeism (reduced productivity at work due to PsA), an overall work impairment (combines absenteeism and presenteeism) and percentage of impairment in daily activities. The association between WPAI: PsA scores and HAQ, PsAQoL, HAD, fatigue and stiffness was determined by Spearman’s correlation coefficient. The Mann Whitney-U test was used to compare the means of groups. The descriptive analysis was done for demographic data. P Results: The mean age of 60 patients (38 female, 22 male) with PsA was 48.13 (SD: 11.53) years. The median (min-max) duration of disease was 36 (3-384) months. 63.33% of the patients were not working and 57.89% of these patients were housewives, and 23.68% were retired. 11.66% of the patients with PsA were unemployed. There were no patients who were retired early due to the disease. Percentage of the stopping work, changing work or reducing working hours due to PsA was 3.3%, 6.7% and 10%, respectively. There was no significant difference between the working and not-working groups of patients according to the disease duration, DAPSA, BASDAI and HAQ scores (p>0.05). The mean age was higher in the non-working group (p There was no absenteeism in 63.3% of patients. The mean percentage of the presenteeism was 36 (SD: 30.79) and the mean percentage of the overall work impairment was 41 (SD: 34.06). There were no significant correlations between WPAI: PsA scores and age, disease duration, DAPSA score (p>0.05). Presenteeism and overall work impairment had significant moderate correlations with fatigue (rho: 0.639, p: 0.001; rho: 0.607, p: 0.003), morning stiffness (rho: 0.424, p: 0.049; rho: 0.484, p: 0.023), HAQ (rho: 0.532, p: 0.011; rho: 0.551, p: 0.008), PsAQoL (rho: 0.481, p: 0.023; rho: 0.510, p: 0.015), HAD depression (rho: 0.650, p: 0.001; rho: 0.634, p: 0.002), and HAD anxiety scores (rho: 0.486, p: 0.022; rho: 0.527, p: 0.012), respectively. Conclusion: Psoriatic arthritis can cause loss of work productivity. The severity of work impairment is associated with fatigue, stiffness, physical disability, depression, anxiety and health-related quality of life. In our study population, the percentage of housewives and retired was high and the rate of unemployment was 11.66%. This is a preliminary study and will continue in larger patient populations. Disclosure of interests: Didem Erdem: None declared, Halise Hande Gezer: None declared, Sevtap acer Kasman: None declared, Mehmet Tuncay Duruoz Grant/research support from: abvie, Speakers bureau: Novartis, aMGEN, abdi Ibrahim, Ilko

Background Familial Mediterranean fever (FMF) is the most common hereditary inflammatory disease characterized by recurrent attacks of fever and serositis. The most devastating complication of FMF is amyloidosis, leading to chronic renal failure (CRF). The amyloid protein may accumulate in many tissues including the cartilage, particularly in the kidneys. Sonographic femoral cartilage thicknesses (FCT) was evaluated in many chronic rheumatic diseases and was shown to be thinner than healthy individuals. Objectives The aim of this study was to determine FCT in FMF patients and healthy individuals and to assess the relationship of FCT with the development of amyloidosis and clinical features. Methods Patients diagnosed with FMF according to the Tel-Hashomer criteria were included in the study. Patients with trauma and other inflammatory disease and patients with a history of knee operation were excluded. Femoral cartilage thickness of both knees was measured with a 7-12 MHz linear probe in maximum knee flexion. Three mid-point measurement were obtained from each knees: lateral femoral condyle (LFC), intercondylar area (ICA) and medial femoral condyle (MFC). Clinic characteristics of the patients including disease duration, medications, comorbid conditions, amyloidosis, CRF, FMF gene mutation, arthritis, sacroiliitis, PRAS score and physical activity scores were recorded. Descriptive analysis was performed for all parameters. The Mann-Whitney U-test and Spearman’s correlation coefficient were used in statistical analysis. P Results A total of 45 patients with FMF (35 women, 10 men) and 20 age-sex-BMI matched controls (14 women, 6 men) were enrolled in this study. The mean age of the patients and controls were 38.2 (SD:12.2) and 37.5 (SD:8.5) years, respectivelly. Amyloidosis occurred in 7 patients (15.6%), CRF in 3 (6.7%), sacroilitis in 10 (22.2%) and arthritis in 16 (35.6%). Disease activity was mild in 48.9%, moderate in 20% and severe 22.2% of the patients. The mean FCT in centimeters values in the FMF and control groups were as follows: on the right side LFC 0.19 (SD:0.03) and 0.22 (SD:0.05), ICA 0.23 (SD:0.05) and 0.24 (SD:0.06), MFC 0.20 (SD:0.04) and 0.24 (SD:0.06); on the left side LFC 0.19 (SD:0.03) and 0.21 (SD:0.03), ICA 0.22 (SD:0.05) and 0.24 (SD:0.06), MFC 0.19 (SD:0.03) and 0.22 (SD:0.04). Patients with FMF had decreased cartilage thickness at the lateral condyle of both knees (p Conclusion These findings suggest that patients with FMF have decreased FCT compared with controls. There is no significant relationship between the FCT and amyloidosis, it has significant relation with proteinuria level. References [1] Ozcakar, L., et al., Femoral cartilage thickness measurements in healthy individuals: learning, practicing and publishing with TURK-MUSCULUS. J Back Musculoskelet Rehabil, 2014. 27: p. 117-24. [2] Mitrovic, D.R., et al., Amyloid deposits in human knee and hip joints. J Rheumatology International. 1985. 5(2): p. 83-89. Disclosure of Interests Halise Hande Gezer: None declared, Didem Erdem: None declared, Sevtap Acer Kasman: None declared, Hatice Sule Baklacioglu: None declared, Mehmet Tuncay Duruoz Grant/research support from: Abvie, Speakers bureau: Novartis, AMGEN, Abdi Ibrahim, Ilko

Background The incidence of cardiovascular disease (CVD), diabetes mellitus, metabolic syndrome and subclinical atherosclerosis is markedly increased in patients with psoriatic arthritis (PsA). The autonomic nervous system is the visceral nervous system of the body consisting of two parts; sympathetic and parasympathetic. Patients with PsA have predominantly parasympathetic involvement autonomic nervous system. Objectives The aim of this study was to evaluate the symptoms of autonomic dysfunction and their relationship with cardiovascular involvement and other clinic parameters in patients with PsA. Methods The study included patients diagnosed with PsA according to the CASPAR criteria. For evaluation of cardiovascular involvement, body mass index (BMI), abdominal obesity, hypertension (HT), diabetes mellitus (DM), hyperlipidemia (HL), metabolic syndrome, fasting glucose levels, lipid levels, systolic and diastolic blood pressures (SBP-DBP) were assessed. DAPSA (Disease Activity in Psoriatic Arthritis), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), Leeds enthesitis index, Psoriasis Area Severity Index (PASI), Psoriatic Arthritis Quality of Life (PsAQoL) and Health Assessment Questionnaire (HAQ) were used to assess patients clinical situations. The Composite Autonomic Symptom Score (COMPASS-31) (range:0-100) consisting of 6 subdivisions including orthostatic, vasomotor, secretomotor, gastrointestinal (GIS), bladder and pupillomotor was used for the symptoms of autonomic dysfunction. The Mann-Whitney U-test, student’s t-test and Spearman’s correlation coefficient were used for statistical analysis. P Results A total of 64 subjects (43 female, 21 male) with a mean of age 49 years (SD:12.3) and disease duration of 59 months (SD:71.3) were recruited into the study. The patients had HT (23.4%), DM (17.2%), abdominal obesity (62.5%), metabolic syndrome (45.3%) and dyslipidemia (42.2%). The mean total COMPASS-31 score was 19.7 (SD:8.3). There was no significant difference in COMPASS-31 scores in patients with or without HT, DM, dyslipidemia. Bladder scores were significantly higher in patients with abdominal obesity and metabolic syndrome (p Conclusion The total score of COMPASS-31 and its subdivisions were high in PsA patients as compared with literature data on healthy subjects. The symptoms of autonomic dysfunction were increased in PsA patients. Disease activity, functional impairment, fatigue, LDL and quality of life are associated with autonomic dysfunction. Autonomic symptoms improve with disease control. References [1] Sletten, D.M., et al., COMPASS 31: a refined and abbreviated Composite Autonomic Symptom Score. Mayo Clinic Proceedings, 2012. 87(12): p.1196-1201. [2] Syngle, A., et al., Autonomic dysfunction in psoriatic arthritis. Clin Rheumatol, 2013. 32(7): p.1059-64. Disclosure of Interests Halise Hande Gezer: None declared, Didem Erdem: None declared, Mehmet Tuncay Duruoz Grant/research support from: Abvie, Speakers bureau: Novartis, AMGEN, Abdi Ibrahim, Ilko

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:Familial Mediterranean Fever (FMF), which is more common in groups in the Mediterranean basin, is a monogenic autoinflammatory disease characterized by recurrent attacks of febrile peritonitis, pleuritis and arthritis.Objectives:In this study, we aimed to investigate the clinical, demographic and genotypic features that may be associated with subclinical inflammation in FMF and to determine the related parameters with subclinical inflammation.Methods:FMF patients according to the Tel-Hashomer criteria were included into the study. The demographic characteristics of the patients, duration of the disease, concomitant diseases, MEFV genotype mutation, colchicine use and resistance were collected. Acute-phase reactants such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels during the attacks and attack-free periods were noted. Subclinical inflammation was defined as the continuation of the acute phase response (CRP) between episodes. We divided study population into two groups as; patients with or without subclinical inflammation (Group 1 and Group 2, respectively) and these group were compared with the parameters described above. Patients with infectious disease (viral or bacterial) in the past two months were excluded from the studyResults:Eigthy patients (72.5% female) with mean age 37.1 SD 11.2 years were recruited into the study. Twenty-three (28.7%) patients were determined with subclinical inflammation. Group 1 had significantly higher rate of concomitant rheumatic disease(i.e spondyloarthropathy), erythrocyte sedimentation rate and MEFV homozygous mutation compared with Group 2 (p 0.05).Conclusion:FMF patients whose elevated erythrocyte sedimentation rate and MEFV homozygous mutation should be closely monitored for subclinical inflammation even during attack-free periods. Concomitant disease should be detected in FMF patients with subclinical inflammation.References:[1]Shinawi M, Brik R, Kepten I, Berant M, Gersoni B. Familial Mediterranean fever: high gene frequency and heterogenous disease among Israeli-Moslem Arab population. J Rheumatol 2000;27:1492–5[2]Bayram MT, Çankaya T, Bora E, Kavukçu S, Ülgenalp A, Soylu A, Türkmen M. Risk factors for subclinical inflammation in children with Familial Mediterranean fever. Rheumatol Int. 2015 Aug;35(8):1393-8.Table 1:Demographic and clinical features of the patients with familial Mediterranean feverWithout Subclinical inflamationn= (57)With Subclinical inflamationn= (23)P valueAge (years; mean SD)37,78 SD 13,2236,82 SD 10,490.987Female, gender, n (%)45(%78)13(%56)0.055Disease duration(month; mean SD)255,3 SD 195,1180,2 SD 121,10.191PRASS score(mean SD)6,08 SD 2,155,36 SD 1,590.147BMİ, kg/m226,12 SD 4,832,13 SD 28,480.629Current smoking status (%)17(%29)3(%13)0.067Age at onset of symptoms (month; mean SD)15,69 SD 9,4117,28 SD 10,340.54Family history of FMF(%)37(%64)18(%78)0.295Response to colchicine(%)6(%10)4(%17)0.462Attack time(day; mean SD)1,9 SD 1,12,26 SD 1,40,523Attack in the last 6 months (mean SD)2,79 SD 3,14,56 SD 5,50,184FMF quality of life(mean SD)31,5 SD 13,625.7 SD 16,40,130Delay in diagnosis(month; mean SD)12,29 SD 10,914,3 SD 14,90,840Disclosure of Interests:None declared

Background:The 20-item Mini-OAKHQOL was derived from the 40-item OAKHQOL questionnaire which was developed to assess the quality of life in subjects with osteoarthritis of the lower limbs. It has 5 subscales containing physical activities, mental health, pain, social support, social functioning; and two independent items addressing sex life and professional life (1). The Mini-OAKHQOL’s good psychometric properties have recently been shown and validation studies have been done in several populations (1,2).Objectives:We aimed to investigate the validity and reliability of the Turkish version of the Mini-OAKHQOL in patients with knee and hip osteoarthritis.Methods:Patients diagnosed with knee or hip osteoarthritis clinically and radiologically were included in the study. Demographic data were noted. The French version of Mini-OAKHQOL was used for translation and adaptation. Translation-back translation methodology was applied and cross-cultural adaptation of the Mini-OAKHQOL into Turkish was done. Face and content validities were evaluated by cognitive information interviews with patients and expert committee. Internal consistency of the scale was made with Cronbach alpha coefficient. Convergent validity was evaluated by the correlations of Mini-OAKHQOL with Nothingam Health Profile (NHP), subscales of Short form 36 (SF-36), and VAS of the quality of life. The relations of the Mini-OAKHQOL with age, BMI, disease duration, VAS of the pain, WOMAC, and Lequesne Index were assessed for divergent validity. P Results:Seventy-three patients (63 female, 10 male) with the mean age of 57.22 (SD: 9.91) years were recruited. The main site of the symptomatic lower limb osteoarthritis was knee in 44, hip in 25, and both in 4 patients. The mean BMI was 31.69 (SD: 11.06) and the median disease duration was 36 months (IQR: 12–72). Turkish version of Mini- OAKHQOL had a good face and content validity. Cronbach’s alpha coefficients of the subscales for internal consistency were 0.927, 0.841, 0.867, 0.771, and 0.677. Physical activities, mental health, pain dimensions of Mini-OAKHQOL had moderate to high correlations with Nottingham Health Profile and the physical functioning, physical role limitations, energy/fatigue, social functioning, pain, and general health subscales of SF-36 (rho between 0.484-0.748). The social function subscale of Mini-OAKHQOL had mild significant correlations with emotional well-being (rho: 0.239) and general health (rho: 0.315) subscales of SF36. The subscales of Mini-OAKHQOL had no correlation with disease duration, BMI, and age; and had generally moderate correlations with VAS-pain, Lequesne Index, and the WOMAC subscales. These data show good convergent and divergent validities of Mini-OAKHQOL.Conclusion:The Turkish version of the Mini-OAKHQOL is a valid and reliable instrument to assess the quality of life in patients with knee/hip osteoarthritis. In addition, it is a simple, accurate, disease-specific, and not time-consuming self-report instrument.References:[1]Guillemin F, Rat AC, Goetz C, Spitz E, Pouchot J, Coste J. The Mini-OAKHQOL for knee and hip osteoarthritis quality of life was obtained following recent shortening guidelines. J Clin Epidemiol. 2016;[2]Gonzalez Sáenz de Tejada M, Bilbao A, Herrera C, García L, Sarasqueta C, Escobar A. Validation of the Mini-OAKHQOL for use in patients with osteoarthritis in Spain. Clin Rheumatol. 2017;Disclosure of Interests:None declared

Background:Familial Mediterranean Fever (FMF), which is more common in groups in the Mediterranean basin, is a monogenic auto inflammatory disease characterized by recurrent attacks of febrile peritonitis, pleuritis and arthritis.Objectives:The aim of this study is to investigate the clinical features of patients diagnosed with juvenile and adult-onset Familial Mediterranean Fever (FMF).Methods:Patients with FMF were included in the study consecutively without sample selection. Data about age, sex, disease duration (month), symptom duration, age at diagnosis, diagnosis delay time, comorbid diseases, and medications were noted. Patients with onset of symptoms ≤ 20 years old were classified as juvenile-onset, those > 20 years old were classified as adult-onset FMF. The frequency and characteristics of attacks and the presence of amyloidosis will be recorded.Disease activity was assessed with the PRAS disease activity score. The Health Assessment Questionnaire (HAQ) and SF-36 were used to evaluate physical disability and quality of life, respectively.The descriptive analysis was done for all parameters. Differences between categorical variables were assessed by Chi-square test and Fisher’s exact test. The Mann Whitney-U test was used to compare two sample means. PResults:The mean age of 86 patients (63 female, 23 male) with FMF was 38.38 (SD: 12.13) years. The patients with the juvenile-onset FMF were 26.7% of the patients.There were no differences between juvenile and adult-onset FMF groups in terms of gender, frequency of attacks, duration of attacks, acute phase values between attacks, colchicine dose, presence of colchicine resistance, and presence of amyloidosis (p>0.05). The latency to diagnosis was significantly higher in patients with adult-onset FMF (pThe PRAS disease activity scores were significantly higher in the juvenile-onset FMF group (p=0.001). There were no significant differences between the two groups in terms of SF-36 and HAQ scores (p> 0.05).Conclusion:While there were no differences between juvenile and adult-onset FMF patients in terms of quality of life and functional disability, the PRAS disease activity scores were higher in patients with juvenile-onset FMF.References:[1]Shinawi M, Brik R, Kepten I, Berant M, Gersoni B. Familial Mediterranean fever: high gene frequency and heterogenous disease among Israeli-Moslem Arab population. J Rheumatol 2000;27:1492–5.Disclosure of Interests:None declared

Background:Although osteoporosis is an inherent comorbidity in inflammatory rheumatic disease and the risk of bone loss is high in patients with several rheumatic diseases, evidence is limited in psoriatic arthritis (PsA). One of the most prominent features in PsA is increased serum urate (SU) levels. Due to its antioxidant effects and protective role against osteoporosis, high SU levels are associated with increased bone mineral density (BMD) and reduced bone loss in the healthy population, and in patients with rheumatoid arthritis. However, whether this association is also present in patients with PsA has not been investigated.Objectives:The aim of this study was to evaluate PsA patients with respect to the presence of osteoporosis and its association with SU levels.Methods:This ongoing study included 86 patients (68 female, 18 male) who were diagnosed with PsA according to the CASPAR criteria and had indications for BMD testing according to the National Osteoporosis Foundation. Clinical characteristics including body mass index (BMI), pain VAS, patient global VAS, enthesitis, and tender and swollen joint counts were recorded. Evaluations included the PASI, PsAQoL, and HAQ. Disease activity was assessed using the DAPSA, BASDAI, and MDA. Osteoporosis was defined as a BMD T-score of -2.5 or less and osteopenia as a BMD T-score between -1 and -2.5 (WHO osteoporosis).Results:The mean age of the study group was 55.4 (SD:9.2) years and the mean disease duration was 84.5 (SD:91.6) months. Indicators of secondary osteoporosis were type-1 diabetes mellitus (1%), hyperthyroidism (2.3%), early menopause (1-L4T- and Z-scores were lower in female patients (p0.05). The frequency of osteoporosis did not differ significantly between patients with DAPSA remission and non-remission (p>0.05). The mean L1-L4T- and Z-scores, and BMD g/cm2were significantly higher in patients with MDA than those without MDA (p0.05). BMI showed a weak correlation with femur total T-score (r=0.244). PASI showed weak inverse correlations with femur neck T-score (r=-0.286) and total femur T-score (r=-0.245). BMD variables showed no correlations with disease duration, acute phase reactants, BASDAI, PsAQoL, and cumulative steroid dose.Conclusion:Patients with PsA did not have an increased prevalence of low BMD despite fractures. Osteoporosis was associated with MDA and the severity of psoriasis, but not with DAPSA, SU level, functional impairment, and quality of life.References:[1]Gulati AM, Michelsen B, Diamantopoulos A, et al. Osteoporosis in psoriatic arthritis: a cross-sectional study of an outpatient clinic population. RMD Open 2018;4: e000631. DOI: 10.1136/rmdopen-2017-000631[2]Han W, Bai X, Wang N, Han L, Sun X, Chen X. Association between lumbar bone mineral density and serum uric acid in postmenopausal women: a cross-sectional study of healthy Chinese population. Arch Osteoporosis 2017; 12:50. DOI: 10.1007/s11657-017-0345-0.Disclosure of Interests:None declared

Background:Due to the complex nature of psoriatic arthritis (PsA), diverse disease activity measures have been developed, the most common of which include Disease Activity Score for Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA) and Very Low Disease Activity (VLDA). Recently, new composite measures have been developed such as Psoriatic Arthritis Disease Activity Score (PASDAS) and GRACE index. Due to different domains and assessments, even though these measures may indicate remission or low disease activity, residual disease activity (RDA) may persist.Objectives:The aim of this study was to evaluate RDA in patients with PsA.Methods:A total of 148 patients (105 female, 43 male; mean age 47.5 (SD:12.6) years) who met the CASPAR criteria for PsA were recruited. Demographic and clinical characteristics of patients were recorded, including pain visual analog scale (VAS), joint VAS, patient global VAS, and tender and swollen joint counts. Evaluations included the Leeds Enthesitis Index (LEI), Psoriasis Area and Severity Index (PASI), Psoriatic Arthritis Quality of Life (PsAQoL), Short-Form 36 Health Survey (SF-36) and Health Assesment Questionnaire (HAQ). Disease activity and remission were assessed using the DAPSA, MDA, VLDA, PASDAS and GRACE Index. MDA was calculated with 5 and 6 positivity criteria separately. Low disease activity (LDA) was defined as follows: DAPSA≤14, PASDAS≤3.2 and GRACE Index≤2.3. RDA was defined as the presence of at least one of the following criteria despite remission or LDA: tender and/or swollen joints >1, dactilitis >1, LEI>1, HAQ>0.5, PASI>1, PtGA>20, physician VAS>20, or pain VAS>15.Results:The mean duration of disease was 68.2 (SD:80.2) months. DAPSA-LDA, PASDAS-LDA, GRACE-LDA, MDA and VLDA were observed in 48.6%, 14.6%, 14.9%, 23.6% and 2% of PsA patients, respectively. RDA as determined by at least one domain was identified in 91%, 95%, 86% and 86% of patients who were classified as having MDA, DAPSA-LDA, PASDAS-LDA and GRACE-LDA, respectively. Undetected RDA was most common with DAPSA, whereas VLDA completely ruled out RDA. PASDAS and GRACE resulted in similar rates of RDA (Table-1). With DAPSA-LDA, the incidence of RDA in the pain domain was significantly lower with older age. Female patients had higher rates of RDA with the LEI and HAQ (pConclusion:VLDA was the most and DAPSA was the least sensitive method to detect remission/LDA. RDA should be kept in mind in patients with PsA when using current measures to assess remission or LDA.References:[1]Ennio Lubrano, Silvia Scriffignano, Fabio Massimo Perrotta, Residual disease activity and associated factors in Psoriatic Arthritis. The Journal of Rheumatology Nov 2019, jrheum. 190679; DOI: 10. 3899/jrheum.190679[2]Kilic, G., Kilic, E., Nas, K.et al.Residual symptoms and disease burden among patients with psoriatic arthritis: is a new disease activity index required?.Rheumatol Int39, 73–81 (2019).https://doi.org/10.1007/s00296-018-4201-3Table 1.RDA in patients with LDA according to diverse activity scoresRDA, n (%)Remission and LDA according to disease activity scores, n (%)MDA-5n:35MDA-6n:13VLDAn:3DAPSA LDAn:72PASDAS LDAn:22GRACE LDAn:22RDA_TJC4 (11.4)1 (7.7)025 (34.7)3 (13.6)1 (4.5)RDA_SJC1 (2.9)003 (4.2)00RDA_dactilitis2 (5.7)002 (2.8)1 (4.5)1 (4.5)RDA_PASI4 (11.4)1 (7.7)023 (31.9)5 (22.7)5 (22.7)RDA_VAS pain23 (65.7)3 (23.1)056 (77.8)13 (59.1)13 (59.1)RDA_VAS Global21 (60)4 (30.8)056 (77.8)10 (45.5)11 (50)RDA_physician VAS26 (83.9)8 (61.5)1 (33.3)64 (88.9)15 (71.4)16 (72.7)RDA_HAQ1 (2.9)1 (7.7)016 (22.2)1 (4.5)0RDA_LEI1 (2.9)1 (7.7)024 (33.3)3 (13.6)2 (9.1)RDA: residual disease activity, MDA: Minimal disease activity, VLDA:Very Low disease activity, LDA: Low disease activity, TJC:Tender joint count, SJC: Swollen joint countDisclosure of Interests:None declared

Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children that often results in persistent and disabling foot impairments (1). Foot and ankle problems are common but relatively neglected manifestations of JIA (2). Ultrasound examination is beneficial for detecting subclinical disease, especially in foot and ankle, which are otherwise difficult to examine in children (3). Therefore, in this study, we evaluated the involvement of foot and ankle in JIA patients using both ultrasonography and physical examination. Objectives The aim of the study was to investigate the foot and ankle involvement in JIA patients and determine the relationship between this involvement and disease activity, functional status, and quality of life. Methods We evaluated those children who attended the Pediatric Rheumatology Department between December 2014 and April 2015. Thirty two JIA patients, aged between 6–16 years, participated in this study. Along with the demographic characteristics, the Disease Activity Score-28 (DAS-28), Childhood Health Assessment Questionnaire (CHAQ), and Pediatric Quality of Life (PEDsQoL) scores were recorded for the measurement of disease activity, physical functional status, and quality of life, respectively. The involvement of foot and ankle was investigated by both physical examination (tenderness, swelling and deformities) and detailed gray-scale ultrasonographic evaluation. Results Of the total included JIA patients, 17 patients (53%) showed foot and ankle involvement. Foot or ankle tenderness was detected in eight patients, swelling in four patients, pes planus in four patients, calcaneal valgus in four patients, limited ankle joint range in two patients, and hallux valgus was detected in three patients. The ultrasonographic investigation revealed tenosynovitis in five patients, ankle joint effusion in four patients, synovial hypertrophy in one patient, bursitis in one patient, and plantar fasciitis in one patient. There was no difference between the group with foot and ankle involvement and the group with no such involvement in terms of demographical data or disease activity (p>0.05). A lower physical functional state was detected in the patients of the foot and ankle involvement group compared to the patients who had no such sign (p 0.05). Conclusions This study showed that foot and ankle disorders are not rare in children with JIA. Appropriate evaluation and management of the foot and ankle are important for better functional status of JIA patients. References Spraul G. Koenning G. A descriptive study of foot problems in children with juvenile rheumatoid arthritis (JRA). Arthritis Care Res 1994;144–50. Hendry GJ. Turner DE. McColl J. Lorgelly PK. Sturrock RD. Watt GF et al. Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA): a randomised controlled trial of an integrated foot care programme for foot problems in JIA. J Foot Ankle Res 2009;2:21. Hendry GJ. Gardner-Medwin J. Steultjens MP. Woodburn J. Sturrock RD. Turner DE. Frequent discordance between clinical and musculoskeletal ultrasound examinations of foot disease in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2012;64:4417. Disclosure of Interest None declared