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To evaluate associations between salivary gland ultrasonography (SGUS) and clinical characteristics, disease activity and outcome in patients with primary Sjögren's syndrome (pSS).The parotid and submandibular salivary glands were examined by ultrasonography using two different scoring systems proposed by Hocevar et al. and Milic et al. on 85 pSS patients. Patients with inhomogeneity/hypoechoic areas with scores ≥2 in parotid and submandibular glands were classified as severe parotid or severe submandibular involvements, respectively. Disease activity and patient-reported severity were evaluated using the European League Against Rheumatism Sjögren's Disease Activity Index (ESSDAI) and the European League Against Rheumatism Sjögren's Patient Reported Index (ESSPRI). Salivary gland functional capacity was investigated by unstimulated whole saliva flow rate (U-WSFR).Of the activity scores, ESSPRI dryness component was higher in pSS patients who had scores above the cut-off values for Hocevar (6.1±2.3 vs. 4.9±2.6, p=0.026). The patients with any type of systemic involvement more frequently showed higher SGUS scores, according to both Hocevar (72.4 vs. 44.6%, p=0.013) and Milic (75.9 vs. 51.8%, p=0.026). These patients also showed a higher percentage of severe parotid/submandibular changes on US imaging (65.5 vs. 33.9%, p=0.005 and 75.9 vs. 51.8%, p=0.026 respectively). Higher SGUS scores according to cut-off values of both scoring systems and severe parotid/submandibular involvements were associated with both anti-Ro or double anti-Ro/La autoantibodies and inversely associated with U-WSFR.SGUS may be a useful imaging modality for the selection of patients with more severe disease status or who may require a tight follow-up schedule.

Objective.To identify and synthesize the best available evidence on the application of musculoskeletal (MSK) ultrasound (US) in patients with systemic lupus erythematosus (SLE) and to present the measurement properties of US in different elementary lesions and pathologies.Methods.A systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Original articles were included that were published in English between August 1, 2014, and December 31, 2018, reporting US, Doppler, synovitis, joint effusion, bone erosion, tenosynovitis, and enthesitis in patients with SLE. Data extraction focused on the definition and quantification of US-detected synovitis, joint effusion, bone erosion, tenosynovitis, enthesitis, and the measurement properties of US according to the OMERACT Filter 2.1 instruments selection.Results.Of the 143 identified articles, 15 were included. Most articles were cross-sectional studies (14/15, 93%). The majority of the studies used the OMERACT definitions for ultrasonographic pathology. Regarding the measurement properties of US in different elementary lesions and pathologies, all studies dealt with face validity, content validity, and feasibility. Most studies achieved construct validity. Concerning the reliability of image reading, 1 study (1/15, 7%) assessed both intraobserver and interobserver reliability. For image acquisition, 4 studies (4/15, 27%) evaluated interobserver reliability and none had evaluated intraobserver reliability. Criterion validity was assessed in 1 study (1/15, 7%). Responsiveness was not considered in any of the studies.Conclusion.This literature review demonstrates the need for further research and validation work to define the involvement of US as an outcome measurement instrument for the MSK manifestations in patients with SLE.

To determine predictors and optimal duration of sustained remission (SR) in patients with rheumatoid arthritis (RA). A total of 428 consecutive patients with RA visiting our clinic routinely between 2012 and 2013 were evaluated. Seventy seven of these patients in DAS28 remission were enrolled and followed up for 62.2 ± 9.9 months. Patients in remission ≥ 6 months (SR) and shorter (non: N-SR) were compared in terms of demographic-clinical data and the psychosocial factors. At enrollment, 1st and 5th years, patients in DAS28, SDAI, and Boolean remission were determined. Sixty three patients were in SR and 14 in N-SR. Lower baseline DAS28 and HAQ scores, anti-CCP were positive predictors of SR. Although the presence of anxiety, depression, fibromyalgia, and fatigue were lower in the SR group, there was no significance. Patients in DAS28 remission (100%) at baseline reduced to 64% at 1st and 42.6% at 5th years. Patients satisfying SDAI and Boolean remission at these three visits were 49%, 44%, and 32.4% vs 41%, 28%, and 20.6%, respectively. If the duration of remission is defined as 6 months, the remission rates of SDAI at inclusion and fifth years’ visits were similar but Boolean remission rates differed significantly and if it is accepted as ≥ 12 months, both the SDAI and Boolean remission rates were not different. Low DAS28 and HAQ scores at baseline, anti-CCP were positive predictors of SR. Instead of 6 months, remission duration for ≥ 12 months would probably help us to predict SR independently from the chosen criteria; Boolean or SDAI.

Objective: The aim of this study was to assess the contributing factors for oral ulcer activity in Behcet's disease (BD). Methods: Ninety-two patients with BD (F/M: 42/50, mean age: 38.7 +/- 10.02 years) participated in this cross-sectional study. Data regarding disease-related factors, smoking patterns, and self-reported dietary/non-dietary triggering factors for oral ulcer activity were collected by a questionnaire. Treatment protocol was categorized as mild and intensive groups associated with organ involvements. Results: A mild treatment protocol was more common in females (52.4% vs 20%) than in males (p=0.002). During the last three months, the number of oral ulcers in female patients was higher in the mild treatment group (6.4 +/- 6.5) than in the intensive treatment group (3.3 +/- 4.9) (p=0.045). In patients with active oral ulcers (n=63), rate of being a non-smoker was also higher in females (86.7% vs 63.6%) than in males. Daily frequency of tooth brushing was 1.2 +/- 0.8 in patients with BD, and was higher in females (1.5 +/- 0.9 vs 0.9 +/- 0.6) (p=0.001). Stress and fatigue (78.3%) were reported as the most frequent triggering factors for oral ulcer presence in patients with BD. A total of 148 different dietary factors associated with oral ulcer presence were reported in the study. Conclusion: A mild treatment protocol and being a non-smoker were found to be the contributing factors associated with oral ulcer activity in patients with BD. Being motivated for oral hygiene and being non-smokers were positive health behaviors observed in females. Irrespective of gender, stress and fatigue were defined as the most common self-reported triggering factors for oral ulcer presence in BD. In addition, the roles of some dietary factors were also reported.

Objective To determine the frequency of subclinical atherosclerosis in patients with systemic sclerosis (SSc; scleroderma) compared to healthy subjects (HS) and rheumatoid arthritis (RA) patients and to determine the ability of cardiovascular (CV) risk indices in detecting SSc patients with subclinical atherosclerosis. Methods A total of 110 SSc patients (102 females and 8 males, mean ± SD age 50.5 ± 11.9 years), 110 age- and sex-matched RA patients, and 51 HS without CV disease were examined with ultrasonography (US). Carotid intima-media thickness (cIMT) >0.90 mm and/or carotid plaques were used as the gold standard for subclinical atherosclerosis (US+). Systematic Coronary Risk Evaluation (SCORE), QRisk II, and 2013 American College of Cardiology (ACC)/American Heart Association (AHA) CV risk indices were calculated. Results Twenty-one (19.1%) SSc patients, 24 (21.8%) RA patients, and 3 (5.9%) HS had subclinical atherosclerosis (SSc versus RA: P = 0.62, SSc versus HS: P = 0.029). cIMT in SSc was higher compared to HS (0.68 ± 0.15 mm versus 0.61 ± 0.10 mm; P = 0.008) but similar to RA patients (0.66 ± 0.14 mm; P = 0.82). Subclinical atherosclerosis in SSc was associated with age (odds ratio [OR] 1.07, P = 0.013), elevated erythrocyte sedimentation rate (OR 3.4, P = 0.045), and pulmonary arterial hypertension (OR 4.27, P = 0.012). Concerning CV risk indices, of the 21 US+ SSc patients only 0, 3 (14.2%), and 6 (28.6%) were classified as high CV risk according to SCORE, QRisk II, and ACC/AHA risk indices, respectively. Conclusion Subclinical atherosclerosis in SSc patients is more frequent than in HS, but is as frequent as in RA patients in which accelerated atherosclerosis is clearly defined. CV risk indices for the general population are considerably insufficient to detect SSc patients with atherosclerosis.

The aim of this study is to investigate the prevalence of subclinical ankle involvement by ultrasound in patients with rheumatoid arthritis (RA). The study was conducted on 216 patients with RA and 200 healthy sex- and age-matched controls. Patients with no history or clinical evidence of ankle involvement underwent US examination. For each ankle, tibio-talar (TT) joint, tibialis anterior (TA) tendon, extensor halux (EH) and extensor common (EC) tendons, tibialis posterior (TP) tendon, flexor common (FC) tendon and flexor hallux (FH) tendon, peroneous brevis (PB) and longus (PL) tendons, Achilles tendon (AT) and plantar fascia (PF) were assessed. The following abnormalities were recorded: synovitis, tenosynovitis, bursitis, enthesopathy and rupture. BMI, DAS28, RF ESR and CRP were also obtained. A total of 432 ankles of patients with RA and 400 ankles of healthy controls were assessed. In 188 (87%) patients with RA, US showed ankle abnormalities whereas, in control group, US found abnormalities in 57 (28.5 %) subjects (p = 0.01). The most frequent US abnormality in RA patients was TP tenosynovits (69/216) (31.9 %), followed by PL tenosynovitis (58/216) (26.9 %), TT synovitis (54/216) (25 %), PB tenosynovitis (51/216) (23.6 %), AT enthesopathy (41/216) (19 %) and AT bursitis (22/216) (10.2 %). In 118 RA patients out of 216 (54.6%), a positive PD was found. No statistically significant correlation was found between the US findings and age, disease duration, BMI, DAS28, RF, ESR and CRP. The present study provides evidence of the higher prevalence of subclinical ankle involvement in RA patients than in age- and gender-matched healthy controls identified by US.

In this study, the best ultrasound (US) aspect for detection of fifth metatarsophalangeal (MTP) joint erosions, the most frequently eroded joint, in rheumatoid arthritis (RA) patients is investigated. Forty-eight RA patients (F/M = 35/13, mean age and disease durations 50.3 ± 11.8 and 7.9 ± 6.9 y, respectively) were evaluated by B-mode US for erosion. Images were obtained from the dorsal, lateral and plantar aspect of the fifth MTP joint, in longitudinal and transverse scans. The fifth MTP erosions were detected in 36 of 48 patients (75%) and 67 of 96 feet (69.8%). Of the erosions, 15 (22.4%), 53 (79.1%) and 59 (88.0%) were observed at dorsal, lateral and plantar aspects, respectively. Despite not being statistically different, the detection rate of fifth MTP erosions was numerically higher in the plantar aspect than both the lateral and dorsal aspects. In conclusion, the fifth MTP erosions in RA patients are more commonly detected in the plantar aspect US than in dorsal and lateral assessments.

Background:The presence of rheumatoid factor (RF) in patients (pts) with rheumatoid arthritis (RA) is associated with higher disease activity,1and is regarded as a risk factor for more aggressive RA.1Most studies on anti-tumour necrosis factor (TNF) monoclonal antibodies such as infliximab, etanercept and adalimumab have shown better response in pts with negative versus positive and low versus high baseline RF titres.2-3Certolizumab pegol (CZP), a PEGylated, Fc-free anti-TNF, has shown rapid and sustained reduction in signs and symptoms of moderate to severe RA, inhibition of radiographic progression and improvements in physical function in pts with an inadequate response to methotrexate (MTX).4–7The efficacy of CZP in pts with different baseline RF levels has not been studied.Objectives:To assess the efficacy of CZP, as measured by Disease Activity Score 28-erythrocyte sedimentation rate (DAS28[ESR]), in pts with active RA across baseline RF levels.Methods:In this post-hoc analysis, data were pooled from four clinical trials of CZP in RA: two global trials (RAPID 1,NCT00152386and RAPID 2,NCT00175877), a Japanese trial (J-RAPID,NCT00791999) and a Chinese trial (RAPID-C,NCT02151851). Pts ≥18 years with adult onset RA for ≥6 months (defined by ACR 1987 criteria), who received MTX for ≥6 months (≥3 months for RAPID-C) prior to baseline, were randomised 1:1 to receive placebo (PBO) every two weeks (Q2W)/CZP 400 mg Q2W/CZP 200 mg Q2W (CZP 400 mg at Weeks [Wks] 0/2/4) plus MTX for at least 24 Wks. Complete study design and pt characteristics were reported previously.4–7Here we include only pts who received CZP 200 mg Q2W (CZP 400 mg at Wks 0/2/4). RF titres were measured by validated assays in local hospital laboratories. Pts were stratified into quartiles based on pooled baseline RF levels: Results:Data were pooled from 1,017 and 504 pts in the CZP 200 mg Q2W and PBO Q2W groups, respectively. At baseline, mean [SD] DAS28(ESR) was similar with PBO vs CZP across RF quartiles (6.5 [0.9] – 7.0 [0.9] vs 6.6 [0.9] – 7.0 [0.9]). Compared with the PBO group, numerically higher DAS28(ESR) REM and LDA rates were observed for CZP 200 mg Q2W group at Wk 24 across RF quartiles (Figure 1). DAS28(ESR) REM and LDA responder rates increased to Wk 24 in pts treated with CZP. In general, LDA and REM rates were similar across RF quartiles at all timepoints (Figure 2).Conclusion:Over 24 Wks of treatment, trends showed steady efficacy of CZP across baseline RF quartiles in pts with active RA. In this pooled post-hoc analysis, efficacy of CZP appeared to be consistent and independent of RF levels; observed efficacy may be related to the unique molecular structure of CZP. CZP treatment in association with MTX may be a feasible option in pts with RA regardless of baseline RF status.References:[1]Aletaha D. Arthritis Research & Therapy 2015;17:229;[2]Bobbio-Pallavicini F. Ann Rheum Dis 2007;66:302–7;[3]Potter C. Ann Rheum Dis 2009;68:69–74;[4]Keystone E. Arthritis Rheum 2008;58:3319–29;[5]Smolen J. Ann Rheum Dis 2009;68:797–804;[6]Yamamoto K. Mod Rheumatol 2014;24:715–24;7.Bi L. Clin Exp Rheumatol 2019;37:227–234.Acknowledgments:This study was funded by UCB Pharma. Editorial services were provided by Costello Medical, Singapore.Disclosure of Interests:Yoshiya Tanaka Grant/research support from: Asahi-kasei, Astellas, Mitsubishi-Tanabe, Chugai, Takeda, Sanofi, Bristol-Myers, UCB, Daiichi-Sankyo, Eisai, Pfizer, and Ono, Consultant of: Abbvie, Astellas, Bristol-Myers Squibb, Eli Lilly, Pfizer, Speakers bureau: Daiichi-Sankyo, Astellas, Chugai, Eli Lilly, Pfizer, AbbVie, YL Biologics, Bristol-Myers, Takeda, Mitsubishi-Tanabe, Novartis, Eisai, Janssen, Sanofi, UCB, and Teijin, Zhanguo Li: None declared, Nevsun Inanc: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche, Nicola Tilt Employee of: UCB Pharma, Carlos Cara Employee of: UCB Pharma, Carine Saadoun Employee of: UCB Pharma, Tsutomu Takeuchi Grant/research support from: Eisai Co., Ltd, Astellas Pharma Inc., AbbVie GK, Asahi Kasei Pharma Corporation, Nippon Kayaku Co., Ltd, Takeda Pharmaceutical Company Ltd, UCB Pharma, Shionogi & Co., Ltd., Mitsubishi-Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co. Ltd., Consultant of: Chugai Pharmaceutical Co Ltd, Astellas Pharma Inc., Eli Lilly Japan KK, Speakers bureau: AbbVie GK, Eisai Co., Ltd, Mitsubishi-Tanabe Pharma Corporation, Chugai Pharmaceutical Co Ltd, Bristol-Myers Squibb Company, AYUMI Pharmaceutical Corp., Eisai Co., Ltd, Daiichi Sankyo Co., Ltd., Gilead Sciences, Inc., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi K.K., Dainippon Sumitomo Co., Ltd.

Background:Rheumatoid arthritis(RA) is one of the most frequent rheumatic disease, and the age of onset is between 30-50 years old. Late-onset RA(LORA) is usually defined as RA with onset at age 60 or over.Objectives:To investigate the choice, effectiveness and the retention rate of biological drugs in LORA patients.Methods:TURKBIO registry is the Turkish version of Danish DANBIO rheumatological database which has been established in 2011. We studied RA patients in TURKBIO registry cohort between the dates of 2011 and 2020. All patients fulfilled the American College of Rheumatology criteria for RA and were classified into two groups based on their age at symptom onset: adult-onset RA(>18-Results:From 10 centers, 2111 RA patients recruited, and 8.8% of them was LORA patients. In LORA, the frequency of female was less than AORA. While, there was no difference between LORA and AORA in terms of erosion presence and RF positivity, antiCCP positivity was more frequent in LORA group. The use of antiTNF was lower, and the use of rituximab was more frequent in LORA. At 12 months after bDMARDs therapy, serum CRP and ESR levels and DAS28-CRP showed higher changes compared to baseline values in LORA. Although the mortality rate was higher in LORA, the adverse reactions were reported to be higher in AORA, and most common advers reaction was infections in both groups(Table). The longest survival was observed in infliximab and rituximab(median 22 and 20months) in LORA, in rituximab and golimumab(median 16 and 12months) in AORA.Conclusion:The frequency of LORA who uses bDMARDs was 8.8% in our database. In the elderly patient population, there are some reservations about the use of biological drugs in general due to several co-morbidities and concommitant drug used. Although data on this issue are limited, appropriate biological use can be effective and reliable in required patients.References:[1]Zulfigar AA, Niazi R, Pennaforte JL, Andres E. Late-onset rheumatoid arthritis: clinical, biyological, and therapeutic features about a retrospecttive study. Geriatr Psychol Neuropsychiatr Viell 2019;17:51-62Table.Comparison of demographic, laboratory findings and biological treatment(median;25-75)n(%)AORA ((n:1925)LORA (≥60)(n:186)pAge (year)54 (43-61)71 (68-74)Disease duration (year)11.4 (7-18)6 (4-9)Gender (Female)1562 (81)124 (67)Anti-CCP positivity747 (62)65 (72)0.044RF positivity721 (61)63 (70)0.085Erosion presence486 (56)41 (62)0.955Drug survival (months)18 (6-44)18 (4-31)0.046Concomitant csDMARDsMTX629 (34)39 (22)0.001SZP146 (8)13 (7)0.781LEF501 (27)35 (20)0.032bDMARDsAntiTNF1068 (56)73 (39)TCZ304 (16)20 (11)0,069TOFA294 (15)27 (15)0,784RTX439 (23)57 (31)0,016ABA298 (16)34 (18)0,317Response ΔESH-6 (-21-4)-18 (-36--3)0.016(12 months) ΔCRP-2 (-12-0.6)-9.3 (-28--0.1)0.014ΔDAS28-CRP-1.3 (-3--0.1)-2.2 (-3--1)0.023ΔHAQ-0.3 (-0.8-0)-0.4 (-0.8--0.1)0.114Adverse effects440 (23)32 (17)0.077Malignancy9 (0,5)3 (1.6)0.082Infection192 (10)10 (5)0.042Allergy63 (3)4 (2)0.404Dermatitis62 (3)1 (0,5)0.040Death18 (0.9)7 (4)0.004Other136 (7)11 (6)0.556Acknowledgments :NoneDisclosure of Interests: :None declared

Background:Sjögren’s syndrome (SjS) is a chronic systemic autoimmune disease targets primarily the salivary and lacrimal glands, the severe dryness of the mouth and eyes are common manifestations in patients. Therefore, daily life could be affected by these manifestations in patients with SjS.Objectives:The aim of the study was to assess associations among daily activity impairment and scores of EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and major salivary gland ultrasonography (SGUS) in primary SjS.Methods:In this cross-sectional study, 41 patients with primary SjS (F/M:39/2; mean age: 52,1±10,5) were included. The mean disease duration was 9.5±6,6 years in the group.Data were collected by clinical examinations and a questionnaire regarding two patients reported outcome measures (PROMs). Firstly, Work Productivity and Activity Impairment (WPAI) questionnaire assessed paid and unpaid work during the last seven days. Scores of WPAI subgroups as absenteeism, presenteeism, overall work impairment as well as daily activity impairment were calculated by using 6 items. Secondly, dryness, fatigue and pain in ESSPRI scale were evaluated by visual analogue scale (VAS; 0-10 points) in SjS. High scores in both PROMs indicates that disease manifestations affect patient ‘life poorly.In addition, structural damage of parotid and submandibular salivary glands were examined by using Milic and Hocevar USG scoring methods. Unstimulated whole salivary flow rate (U-WSFR; as ml/min) were also used to interpret the functional status of major salivary glands. High SGUS score and low U-WSFR reflects that disease activity affects major glands poorly.Results:Daily activity impairment was calculated as 63,9±31,1 in patients with primary SjS. High scores in ESSPRI-dryness, ESSPRI-fatigue and ESSPRI-pain were also observed in the group (7,5±2,4; 6,4±2,8 and 6,1±3,1, respectively). Daily activity impairment was correlated with scores of ESSPRI-dryness (r:0,55 p=0.000), ESSPRI-fatigue (r:0,38 p=0.014) and ESSPRI-pain (r:0,56 p=0.000) as well as parenchymal inhomogeneity USG scores of right and left parotid glands (r:0,49 p=0.032; r:0,51 p=0.025).U-WSFR (0.20±0.20 ml/min) was moderately correlated with parenchymal inhomogeneity USG scores of major salivary glands (pConclusion:Firstly, subgroup scores of ESSPRI and low U-WSFR associated to daily activity impairment in patients with primary SjS. Secondly, parenchymal inhomogeneity scores of both parotid glands could give an important clue to clinicians for the disease-related damage. Finally, WPAI with 6-item could be thought as an useful tool to understand the effect of the disease manifestations on patients’ daily life.Disclosure of Interests: :None declared

Introduction: Rheumatoid arthritis (RA), which is an autoimmune disease with chronic joint inflammation, is usually associated with pleural parenchymal involvement. Nodules can be seen in lung parenchyma but cavitary properties are rare. Methods: Six patients with necrotic cavitary pulmonary nodules are included. Clinical features, treatment and imaging details were presented. Results: All patients (n=6) with necrotic cavitary nodules were seropositive. All patients received leflunomide as conventional disease modifying anti-rheumatic drug (DMARD), while etanercept (n=1), infliximab (n=1), rituximab (n=1) and abatacept (n=3) as biological DMARD treatment. Except for one case (Case 2), all patients underwent bronchoscopy and nothing isolated from microbiological cultures. In the only biopsied case, the pathology was interpreted as a necrotizing rheumatoid nodule. In four patients, nodules were interpreted as in favor of the rheumatoid nodule. Mild-to-moderate FDG uptake was observed in five patients with PET-CT. In one patient (Case 6) without pulmonary nodules with methotrexate, new pulmonary nodules were developed, showed cavitation and progression after the transition to leflunomide. In another patient (Case 4), nodules developed under leflunomide were observed to cavitate after abatacept. In a patient (Case 1) receiving certolizumab, treatment was discontinued after nodules gain cavitary properties but even after those nodules tended to progress in size. Conclusion: It should be kept in mind that cavitary pulmonary nodules in patients with RA can be associated with the disease itself or with the conventional (especially leflunomide) or biological DMARD therapies.

Background Salivary flow rates (SFR) and oral health were known to be frequently impaired in Sjogren’s syndrome (SjS) due to chronic inflammation and destruction of the salivary glands. Ultrasonography (USG) of major salivary glands (SG-USG) is a non-invasive widely used tool to evaluate salivary glands in SjS. Objectives The aim of the study was to assess the relationships between SFRs, oral health and USG changes of major salivary glands in patients with primary SjS. Methods Fifty-nine SjS patients (F/M:57/2) with the mean age of 52.2±11.5 years. The duration of follow-up period of 9.±7.1 years fulfilling ACR-EULAR classification criteria (2002) were included. Major salivary glands (bilateral parotis and submandibular glands) were scored according to two different scoring systems which are Hocevar A.(0–48) and Milic VD. (0–12). Oral health was assessed by indices. Measurements of whole unstimulated and stimulated SFRs were carried out in patients between 9 a.m. and 10 a.m in the morning. Oral health related quality of life (OHRQoL) as a patient reported outcome measure was evaluated by using Oral health impact profile (OHIP-14). High scores indicated poor OHRQoL status. Pathologic findings in oral health (GM) and USG images (NI) were evaluated by two authors as double-blind. Results Unstimulated SFR (0,2±0,2 ml/min) was correlated with stimulated SFR (1,1±0,7 ml/min) in the whole group (r=0,8 p=0.000). Moderate correlations were seen between unstimulated and stimulated whole SFRs and scores of hypoechogenic areas in bilateral parotid and submandibular glands (p Conclusions Unstimulated and stimulated SFRs were found correlated with the structural changes of major salivary glands. Tooth loss and poor OHRQoL were shown in patients due to reduced salivary outputs. USG images of salivary glands could give insight to physicians about oral health and OHRQoL as outcome measure in patients with SjS. Disclosure of Interest None declared

Objectives In this study, we aimed to investigate the concordance of ultrasonographic remission with other remission criteria and to show the influence of non-inflammatory patient-induced factors such as depression, anxiety, fibromyalgia and fatigue on both clinical and ultrasonographic remission. Methods Fifty consecutive patients with clinical remission (DAS-28-ESR Patients were also assessed whether they met the Boolean and SDAI remission criteria. 28 joint grey scale (GS) and power Doppler (PD) ultrasonography were performed. Patients‘ depression and anxiety were assessed by The Hospital Anxiety and Depression Scale (HADS), and their fatigue was assessed by multidimensional Assessment of Fatigue (MAF) scores and patients’ fibromyalgia was assessed by widespread pain index (WPI) and symptom severity score (SS). Results Patients were divided into 4 groups according to different remission definitions by ultrasonography. (Group1: PD=0 and GS=0, Group2: PD=0 and GS ≥0, Group3: PD=1 or 0 and GS=1 or 0, Group4: PD=1 or 0 and GS ≥0). Although it is not statistically significant, the highest agreement with all the clinical remission criteria was found in the USG remission group 4 (table 1). Patients with ultrasonographic remissions at their first visit in 2011 were reevaluated with clinical remission criteria at the end of 5 years. The highest remission rates were found in patients with USG remission group 3 (DAS28 58%, Boolean 29%, SDAI 47%). There was no significant difference between fatigue, fibromyalgia, depression and anxiety measures between remission and non-remission in all USG remission groups. In contrast, depression (p Conclusions Clinical and ultrasonographic remission was found to be compatible in half of the patients. The compliance of the USG remission in Group 4 with the clinical remission definitions was good, and clinical remission continuity was higher in the group meeting the definition of group 3. In contrast the ultrasound remission, the high levels of depression and anxiety in patients without SDAI and Boolean remission suggest that non-inflammatory patient-derived measures have less influence on the ultrasound remission. Disclosure of Interest None declared

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: Although there is good evidence that smoking has a dose-dependent impact on structural damage progression in ankylosing spondylitis (AS) the evidence is poor for its impact on disease activity, physical mobility, life quality and treatment response. Objectives: We aimed to investigate the impact of smoking on disease acitivity, treatment adherence and treatment response in Turkish patients with AS treated with their first tumour necrosis factor-alpha inhibitor (TNFi) therapy in a real-life cohort. Methods: 561 patients fulfilling the modified New York criteria for AS and treated with their first TNFi therapy since 2011 from 8 centers in Turkey were included in the analysis. Treatment response was evaluated as achievement of “BASDAI50” or “ASDAS Clinically important improvement (CII)” at the 3-months’ and 6 months’ visits. Clinical and demographic parameters were compared between current/never and current/previous smoker groups. Demographic and descriptive data are presented by medians/interquartile ranges (IQRs). Groups were compared by non- parametric tests (x 2 , Kruskal Wallis and Mann Whitney tests). Kaplan Meier plots, Cox and logistic regression analyses were calculated for treatment adherence and treatment response. Results: Among 561 AS patients included in the study, 506 (90%) had known smoking status (37% current, 35% never, 17% previous smokers). The median follow-up time was 1.9 years (IQR 0.85–3.5) and disease duration was 3.1 years (0,6–7,7). At baseline, current smokers were younger (34, IQR 29–41) compared with never (38, IQR 30–46 p=0.007) and previous smokers (42, IQR 34–49 p 0,05). Conclusions: In this study of TNFi-treated AS patients in clinical practice, smoking was not found to be associated with disease activity, treatment response and treatment adherence. Disclosure of Interest: None declared

Background The management of RA have been changed during past decades and sustained remission (SR) is the ultimate goal to halt joint damage and prevent the accrual of disability. Factors predicting SR are essential to individualise treatment and recognise patients that have an opportunity to taper medications in daily practice. Objectives To determine baseline predictors of sustained remission and comparison of its predictability by different remission criteria. Methods A total of 428 consecutive patients with RA visiting our outpatient clinic routinely between September 2012–2013 were evaluated. Seventy seven of these patients satisfying the DAS28 remission ( Results Of these 77 patients, 63 were in SR and 14 were in N-SR. Lower baseline DAS28 and HAQ scores (p=0.045; p=0.026, respectively) and anti-CCP positivity (p=0.035) were positive predictors of SR. Although the presence of anxiety, depression, fibromyalgia and fatigue were lower in SR group, there was no statistical significance. DAS28 remission visit counts of patients in Boolean (n=32) and DAS28 (n=77) remission at enrollment (5.7±3.2 vs 5.4±3.1; p=0.995) were not different. Similarly, no difference was found between patients in SDAI (n=38) and DAS28 remission (5.6±3.3 vs 5.4±3.1; p=0.769). Patients meeting the DAS28 criteria (n=77, 100%) reduced 64% (n=50) at first and 42.6% (n=29) at fifth years. Patients satisfying SDAI and Boolean criteria were 49%, 44% vs 32.4% (n=22) and 41%, 28% vs 20.6% (n=14), respectively. If the duration of SR is considered as 6 months, the remission rates of SDAI were not different between patients at inclusion and fifth years but Boolean remission rates differed significantly and if it is accepted as ≥12 months, the SDAI and Boolean remission rates were not different than at fifth year visit. Conclusions Low DAS28 and HAQ score at baseline and anti-CCP positivity were positive predictors of SR. Although the presence of anxiety, depression, fibromyalgia and fatigue were lower in SR group, there was no statistical significance. Compared to the DAS28, remission determined by the Boolean and especially SDAI criteria continued consistently in long term. References [1] Castrejon I, Dougados M, Combe B, et al. Prediction of remission in a French Early Arthritis Cohort by RAPID3 and other core data set measures, but not by the absence of rheumatoid factor, anticitrullinated protein antibodies, or radiographic erosions. J Rheumatol. 2016Jul;43(7):1285–91. [2] Radner H, Alasti F, Smolen JS, et al. Physical function continues to improve when clinical remission is sustained in rheumatoid arthritis patients. Arthritis Res Ther. 2015Aug 11;17:203. Acknowledgements None. Disclosure of Interest None declared

Background Ultrasonography (USG) of major salivary glands (SG-USG)is a non-invasive tool that has been used to evaluate salivary glands in primary and secondary Sjogren’s syndrome (SjS). Objectives We aimed to investigate relation between the ultrasonographic scoring of major salivary glands and systemic disease activity or salivary secretion in patients with primary SjS. Methods Seventy-five SjS patients (F/M:73/2) with the mean age of 52±12 and duration of follow-up period of 58±54 months fulfilling ACR-EULAR classification criteria (2002) were included. Disease activity indexes (Sjogren’s Syndrome Patients Reported Index (ESSPRI), Visual Analogue Scale (VAS), EULAR Sjogren’s Syndrome Disease Activity Index (ESSDAI)] were recorded. Simultaneously, sialometric evaluation of the salivary glands was performed. Major salivary glands (bilateral parotis and submandibular glands) were scored according to two different scoring systems [Hocevar A.(0–48) and Milic VD. (0–12)] and elastography was recorded as well. Results Demographics, clinical characteristics, disease activity indexes and SG-USG scores were summarised in table 1 and table 2. Forty-one (55%) and 45 (60%) patients had the cut-off values of ≥17 (Hocevar) and ≥6 (Milic USG). The patients with the scores of ≥17 (Hocevar) were found to have higher scores of ESSPRI-total (16±6 vs 13±7, p=0,045) and lower sialometry (4,6±4,7 vs 8,4±4,6 ml, p=0,002). Scores of Hocevar and Milic-USG were negatively correlated with sialometry (r=-,430, p=0001 and r=-,430, p=0,001). Hocevar, Milic and elastography-USG scores were shown to be higher in patients with sialometry of ≤1,5 ml (n=7)(28±3 vs 17±10, p=0,010, 8±1 vs 5±3, p=0006 and 9±1 vs 5±2, p=0,028) and anti-Ro positivity(n=24) (24±10 vs 13±8 7±3 vs 4±2, p Conclusions Hocevar scoring system of major salivary glands was found to be related to patient reported activity in SjS. USG scores were associated with reduced saliva secretion and anti-Ro positivity. Severe parotid involvement was shown to be related to anti-RO and La positivity. Evaluation of SG-USG including different scoring systems and elastography might reflect function of the salivary glands. Disclosure of Interest None declared

Background The aim of this study was to investigate the drug survival, its efficacy and safety in patients withRA based on the database from the Turkish TURKBIO registry Methods A total of 180 patients were treated with TOFA forRA. Drug survival was assessed. In 118 patients with available data, treatment response was evaluated using thenumber of sensitive and swollen joints, VAS values, DAS28, HAQ and CRPat weeks 12,24,48 and 60 Results At baseline, RA patients had a median(Q1-Q3)disease duration of 14 years.75 patients had used ≥1 biologics previously. The other demographic and clinical features of the patients were shown in table 1. Median(Q1-Q3)followup period was137 weeks. After48 and137 weeks,75% and 48%of the patients respectively, maintained TOFA (figure 1). The most common reason for drug discontinuation was ineffectiveness of treatment(63%), followed by adverse events (23%). After 12 weeks, all disease activity parameters were reduced significantly compared to the baseline and most of them continued to be reduced until week60. No difference was observed in disease activity parameters between the groups with and without previous ≥1biologics at weeks 0,12 and 24 (table 2) Remission rate was(43%)at week 60(observed data) (table 2) A total of 9 adverse events(3infection,3allergic rx,2 rash)were observed during the followup period Conclusions Treatment with TOFA may provide good response rates in RA patients refractory previous biologicals Disclosure of Interest None declared

Background Lung involment is one of the extra-articular manifestations that is shown to be related to morbidity and mortality in Rheumatoid arthritis (RA). Objectives We evaluated the progression of lung involvement in RA patients receiving biological treatment. Methods Eighty RA patients fulfilling ACR/EULAR classification criteria (2010) receiving biologics who had high-resolution computerised tomography (HRCT) of chest within 6 months of respiratory symptoms (cough/dyspnea) and/or any pathology in chest radiography were included. Warrick score, evaluating alveolitis and fibrosis, was calculated in RA patients by using HRCT of chest. Results The demographics and clinical findings were summarised in table 1. In 29 RA patients with interstitial findings in HRCT of chest; 7 (24%) were regressed and 1 (4%) was progressed with biologic drugs. Findings of alveolitis and fibrosis were completely regressed in 2, only alveolitis component was completely regressed in 3 and partially in 2 patients. The patient who progressed had new findings of alveolitis (table 2). Twenty-one patients in whom Warrick scores did not change, 5 received rituximab (RTX) and 10 received TNF inhibitors (TNF-inh). The mean Warrick scores was improved after biologics (11,3±9 (3–30) vs 10,3±9 (0–30), p=0,035). The improvement in alveolitis scores was significant (2,1±1,6 vs 1,5±1,6, p=0,031) while fibrosis scores were not (9,2±7,7 vs 8,8±8). Initial and control Warrick scores were higher in RTX receivers (16±9 vs 9,2±8, p=0034 and 14,8±10,1 vs 8,4±8,1), but the improvement after biologics was not different. Conclusions This study revealed an improvement in alveolitis after biologic drugs in RA patients. Fibrosis was not found to be effected by therapy. Lung lesions were improved in both RTX and TNF-inh groups. Disclosure of Interest None declared

Background In patients with seronegative rheumatoid arthritis (RA) there is a difficulty to make the differential diagnosis with the spondyloarthropathies. Objectives To assess the presence of enthesitis in patients with seronegative RA in comparison with the healthy controls (HC), patients with seropositive RA and ankylosing spondylitis(AS). Methods In this cross-sectional study, seronegative and seropositive RA patients, who fulfilled the 2010 ACR/EULAR criteria, patients with AS and HC have been assessed by grey scale and power doppler ultrasonography for the presence of enthesopathy at the achilles tendon, plantar fascia, proximal patella, distal patella, quadriceps, tibialis anterior, triceps, common flexor and extensor tendons. Clinical assessment of the patient groups included demographic findings, health assessment questionnaire and DAS28. Results In our study, we recruited age and sex matched 27 seronegative RA, 19 healthy controls, 24 seropositive RA and 23 ankylosing spondylitis patients. We evaluated and analysed both right and left sides of the enthesis regions separately which have been indicated in the methods section. The mean DAS28, mean ESR and mean CRP of the patients with seronegative RA were 3.6±1.28, 32.2±21.2 and 12.37±27.77 respectively (table 1). Median of Madrid sonographic enthesitis index (MASEI) was 5 in patients with seronegative RA. 4 patients have severe scores (MASEI score ≥20). There were significant differences between seronegative RA and healthy controls (MASEI score:3), (p=0.014) but no differences has been observed between seronegative RA with seropositive RA (MASEI score:6) and anklosing spondylitis (MASEI score:7) in MASEI scores. In comparison, hypoechogenicity of quadriceps tendon (16 (29.6%) vs 6 (12.5%), p=0.037), bone erosion at the quadriceps tendon attachment (9 (16.6%) vs 0, p=0.003), calsification at achilles tendon (17 (31.4%) vs 6 (12.5%), p=0.023) have been observed more frequently in patients with seronegative RA than seropositive RA. Significantly higher number of patients with bone erosion at the common extansor tendon (26 (48.1%) vs 3 (6.5%), p= Conclusions We observed that enthesis involvement was not seldom in patients with seronegative RA. Furthermore there were also similar frequency of entesis involvement in seropositive patients with RA. The value of enthesis sites evaluation for the differential diagnosis of patients with seronegative RA should be further investigated and the assessment of enthesis sites in seronegative and seropositive RA patients can be important to detect active and chronic changes at the enthesis region. Disclosure of Interest None declared

Background TURKBIO registry is the Turkish version of Danish DANBIO rheumatologic database which has been established in 2011. Demographics and previous or current treatment with conventional (csDMARD) and targeted synthetic (tsDMARD), and biological DMARDs (bDMARDs) were collected. Objectives We aimed to investigate the efficacy and safety status of methotrexate (MTX) vs. leflunomide (LEF) use as a concomitant treatment with bDMARDs and tsDMARD in this registry. Methods Frequencies of achievement of remission or remission +low disease activity (LDA) at the 6th month of bDMARD or tsDMARD treatment were compared between patients who were on these medications with MTX vs. LEF as a concomitant treatment. Drug survival and switch rates of bDMARDs and tsDMARD treatments either with MTX or LEF were compared. The adverse effects with MTX and LEF concomitant use were evaluated as well. Results The study included 725 bDMARD or tsDMARD receiving RA patients from 8 participating centres of the TURKBIO registry. Of these patients, 462 (63.7%) were receiving concomitant MTX and 263 (36.3%) LEF. Demographic findings are given in the table 1. Achievement of remission and remission +LDA at the 6th month of bDMARD or tsDMARD initiation was similar in concomitant MTX vs LEF groups (51.4% vs. 53%, p=0.683). When each bDMARD and tsDMARD was evaluated separately, achievement of remission were again similar in MTX and LEF concomitant users (TNFi: 53% vs. 54%; ABA: 50% vs. 59%; RTX: 53% vs. 61%; TCZ: 42% vs. 35%; p>0.05 for all). For TOFA, although remission +LDA rate was numerically higher in MTX concomitant group than LEF group (42% vs. 21%), the difference was not statistically significant due to the smaller sample size of TOFA (n=33). The results were similar for all DMARD groups when remission was evaluated alone. Drug survival (17±12 vs. 16±11 months, p>0.05) and drug discontinuation (42,2 vs 38, p>0.05) rates of bDMARDs or tsDMARD were also not different in MTX vs. LEF concomitant users. Adverse effects rate (19.5% vs 20.5%, p>0.05) were similar between MTX vs. LEF concomitant users as well. Conclusions Achievement of remission or remission +LDA was not different with the concomitant use of MTX vs. LEF with any bDMARD or tsDMARD treatment in RA patients with a similar safety profile. LEF might be an alternative as a concomitant DMARD in MTX-intolerant RA patients initiating bDMARDs or tsDMARD. Disclosure of Interest None declared

Background Biosimilar infliximab (CT-P13) has been used to treat patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in Turkey since 2013. Objectives The aim of this study was to examine its efficacy, drug survival and compare it to the original reference infliximab (inf) in patients with inflammatory rheumatic diseases based on the database from the TURKBIO registry. Methods All patients with RA, SpA, PsA, and other diseases receiving CT-P13 and inf registered in the TURKBIO database between the dates of June 2013 and January 2017 were included in the study. Demographic information, laboratory parameters and disease indices were collected (at baseline, and months 6 and 12). We used Kaplan Meier survival curves to examine drug survival patterns. Results Data collected from a total number of 614 patients were analysed (table 1). The analysis of each treatment group was made according to gender, age, and diagnosis. In both groups most of the patients were diagnosed as having axial SpA, followed by RA, PsA and other diseases. CT-P13 group had female predominance. In patients with RA and PsA, baseline DAS28 scores were found to be higher in CT-P13 group. Baseline values of ASDAS-CRP in SpA patients and CRP in all patients were similar for both groups (table 2). Mean CRP levels at month 6 and ASDAS scores at month 12 were found to be higher in inf group. The ratio of males was higher in axial SpA patients receiving inf, but did not statistically affect the 12th month ASDAS results. The results of the database analysis showed that the drug survival rate of CT-P13(78,4%) is higher than inf(63,6%) at year 4 (figure 1). At 4 year follow-up, drug withdrawal was observed in both groups due to ineffectiveness (CT P13;n=13 54,16%, inf;n=89 41,58%) and side effects (CT-P13;n=8 33,33%, inf;n=43 20,09%). In CT-P13 group, six patients had switched from inf to biosimilar and other 20 had used ≥1 previous biologicals. Of the 503 patients who used inf, 164 had used ≥1 biologicals previously. Conclusions The results of this study demonstrated long term higher drug survival rate of biosimilar CT-P13. The study also suggested that efficacy of CT-P13 on disease activity was similar to original infliximab in patients with inflammatory rheumatic diseases. Disclosure of Interest None declared

Background Limited data are available on anti-TNF survival in non-radiographic axial spondyloarthritis (nr-axSpA) patients and their long-term survival in ankylosing spondylitis (AS). Objectives The aim of the study was to evaluate long term survival of the first anti-TNF drug treatment among patients with AS and nr-axSpA enrolled in the TURKBIO database and to compare the discontinuation rates for infliximab (INF), etanercept (ETN), and adalimumab (ADA) in each of the two groups. Methods All AS and nr-axSpA patients receiving biological therapies registered in the TURKBIO database between the dates of october 2011 and april 2017 were included in the study. AS diagnosis was made according to modified New York classification criteria and nr-axSpA according to ASAS AxSpA classification criteria. Demographic and clinical data, the date of starting to use biological drug, using frequency and dose of biological drugs, BASFI, BASDAI, BASMI, ASDAS scores, date and reason for discontinuing to use drug were collected. Baseline characteristics and drug survival rates were compared between AS and nr-axSpA patients. Drug survival was calculated by the Kaplan-Meier method and risk for discontinuation among treatment groups cpmpared by Long Rank test. Results A total of 924 patients were included in the study (AS, n=871 and nr-axSpA, n=53). More than half of the patients with AS were male (60.7% in AS vs 34.0% in nr-axSpA group, p Conclusions In contrast to the literature that revealed similar short term survival rates for anti-TNF drugs in patients with AS and nr-axSPA, we found higher survival rates in patients with AS compared to patients with nr-axSpa in this long-term observational study.A limitation of the study may be the low number of nr-axSpa patients using anti-TNF, related to the requirements of social insurance system. Disclosure of Interest None declared

Background Pulmonary involvement in rheumatoid arthritis (RA) is one of the extra-articular manifestations affecting morbidity and mortality during the course of the disease. Pulmonary function tests (PFTs) and thoracic high-resolution computerised tomography (HRCT) are the standard of care in the assessment of pulmonary involvement in RA. In this study, we aimed to compare the findings between self-reported questionnaires and HRCT to detect pulmonary abnormalities in RA patients. Methods Forty-two RA patients fulfilling ACR/EULAR classification criteria (2010) who had thoracic HRCT within 6 months of any symptom and/or any pathology on radiography of chest were included in the study. The patients were also assessed by modified Borg Scale, SF-36 Quality of Life Scale and Leicester Cough Questionnaire for the evaluation of respiratory symptoms. Results Demographics and clinical characteristics were summarised in table 1. Warrick score, assessing the severity and extent of alveloitis and fibrosis on thoracic HRCT, was evaluated in 15 patients with ILD (score range:4–28). DLCO values were lower in patients with Warrick score ≥1 (73±22% vs. 88±12%, p=0.019) while FVC were not found to be different. The findings of HRCT and self-reported questionnaires were summarised in table 2. Any relationship between self-reported questionnaires and Warrick scores was not detected. Presence of any parenchymal lesions was found to be associated with SF-36 total score (p=0,048). DLCO levels were found to be negatively correlated with SF-36 total scores (r=-0,470, p=0,006). Conclusions In this study, we could not show any relationship between self-reported questionnaires and thoracic HRCT findings, except a weak association of the presence of parenchymal lesions with SF-36 scores. Alveolitis and/or fibrosis on thoracic HRCT were found to be associated with lower DLCO. DLCO was shown to be negatively correlated with SF-36 scores. SF-36 might be included in the detection of pulmonary evaluation in RA patients. The relationship between thoracic HRCT findings and self-reported questionnaires in RA necessitates further studies. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease leading to deformities and disabilities. in the treatment of RA glucocorticoids are selected sometimes to relief symptoms and to increase compliance for treatment. Objectives The purpose of our study is to investigate whether concomitant glucocorticoid treatment at the baseline affects drug survival for abatacept treatment in RA. Methods Data on patient characteristics, diagnosis, previous treatment and outcomes have been collected since 2011 in Turkish Biologic (TURKBIO) Registry. By the end of December 2017, 338 RA patients, received abatacept from the TURKBIO registry, were included in the analysis. Patients were divided into groups according to the use of glucocorticoid when abatacept therapy was started. Demographic and clinical data including age, sex, disease type, disease duration, and previous or current treatment with DMARDs and biological drug durations are recorded in the database. Kaplan-Meier survival analysis was performed to estimate the drug survival. Subgroups were compared by log-rank. Results There were no significant differences in age, gender, seropositivity, tender and swollen joint counts at baseline in the study groups. The disease duration was higher in the glucocorticoid users (p=0.001). Abatacept was the first choice bDMARDs in the 44.5% of glucocorticoid users while it was 68.6% in the glucocorticoid non-users (p Conclusions When abatacept treatment started, concomitant use of glucocorticoid at the baseline could not significantly alter drug survival for abatacept in the RA. Disclosure of Interest None declared

Objective Observed low prevalence of SLE among familial Mediterranean fever (FMF) patients in several large cohorts suggests a possible protective effect of the MEFV mutations from SLE. In contrast, SLE patient carriers for the common MEFV mutations had rather complex disease expression with an increased frequency of febrile episodes and pleurisy and a decreased renal complication rate. Our aim was to investigate the prevalence of MEFV gene mutations in patients with SLE and their effect on organ involvement in a well-defined group of biopsy-proven SLE nephritis patients. Material and method The prevalence of four MEFV gene mutations (M694V, M680I, V726A and E148Q) was investigated in 114 SLE patients and effect on disease severity was analyzed in patients with biopsy-proven SLE nephritis. Results None of the SLE patients fulfilled the revised Tel-Hashomer criteria. Fourteen of 114 SLE patients (12.2%) were found to carry at least one MEFV mutation. A single patient in the SLE-Nephritis group was compound heterozygous for M694V/M680I mutations and only one patient in the SLE-Mild group was homozygous for E148Q mutation. Carrier frequency was similar to controls in SLE patients (12.2 vs 18.8%, p = 0.34). After the exclusion of the less penetrant E148Q mutation, re-analysis revealed an association between exon 10 mutations and SLE nephritis ( p = 0.050, odds ratio (OR) = 4.16, 95% confidence interval (CI) = 1.04–16.6). Carrier rate for the E148Q mutation decreased in the SLE group (controls vs. SLE = 20/186 vs. 3/114, p = 0.08) and E148Q mutation was absent in SLE nephritis (controls vs. SLE nephritis = 20/186 vs. 0/47, p = 0.016, OR = 11.69, 95% CI = 0.69–197.13). Conclusions Carrier rate for the studied MEFV mutations was slightly lower in the SLE group, which is in agreement with previous observations that FMF may confer some protection from SLE. Exon 10 mutations were associated with SLE nephritis after the exclusion of the E148Q mutation. The significance of the E148Q as a disease-causing mutation is controversial, and whether E148Q substitution is a polymorphism generally affecting inflammatory pathways is not addressed in the current literature. In this regard, absence of the E148Q mutation in SLE nephritis may serve as a clue for further investigation into its role as a general modulatory polymorphism for inflammation. This clarification is necessary to conclude whether other more penetrant MEFV gene mutations confer susceptibility to nephritis in SLE.

Background Sjogren9s syndrome (SjS) is characterised by chronic autoimmune inflammation primarily affects the salivary and lacrimal glands. Recently, ultrasonography (USG) of major salivary glands (SG-USG) has been used to evaluate salivary glands in primary and secondary SjS. Objectives We aimed to investigate the association between the ultrasonographic scoring of major salivary glands and disease activity indexes in patientswith primary SjS. Methods Forty-two primary SjS patients fulfilling ACR-EULAR classification criteria (2002) were included. Disease activity indexes (Sjogren9s Syndrome Patients Reported Index (ESSPRI), Visual Analogue Scale (VAS), EULAR Sjogren9s Syndrome Disease Activity Index (ESSDAI)] were recorded. Major salivary glands (bilateral parotis and submandibular glands) were scored according to two different scoring system [Hocevar A. (0–48) ve Milic VD. (0–12)]. Results Demographics, clinical characteristics, disease activity indexes and SG-USG scores were summarised in table 1 and table 2. Twenty-four (57%) and25 (60%) patients had the cut-offvalues of ≥17 (Hocevar) and ≥6 (Milic USG).The patients with the scores of ≥17 (Hocevar)were found to have higher scores of ESSPRI-total (18±5 vs 14±5, p=0,01). Hocevar and Milic USG scores were shown to be higher in anti-Ro(+) SjS patients (25±10vs14±7and7±3vs4±2, p=0,01).USG scores were not found to be associated with the scores of ESSDAI, VAS and ESSPRI items. Conclusions Hocevar scoring system of major salivary glands was found to be related to patient reported activity in SjS. USG scores were associated with anti-Ro positivity. Evaluation of SG-USG might promote the diagnosis and follow-up of the SjS patients. Disclosure of Interest None declared

Background Patient-reported outcomes (PROs) are important in monitoring and making treatment decisions.Recently,we reported that the translation of“tender points” in the fourth question of the Turkish version of BASDAI was not correctly understood,and replacing this question with an entheses examination (BASDAI-Q4) decreased the score (ΔBASDAI:0.99,p Objectives We report here the results of an investigator initiated clinical trial using a self-developed mobile phone application (MPA)2 to overcome the problem of untranslability. Methods Out of 135 invited 95 axSpA patients participated.Initially,BASDAI self-report forms (BSRF) were administered.Thereafter,patients were randomized into two groups (2:1).GroupA completed a second set of BSRF after using the MPA with embedded videos defining terms and grading for each domain.GroupB completed a second set of BSRF under guidance of an inexperienced family physician (FP).A third set of BSRFs were completed by GroupB with the same FP after he went through the MPA.Afterwards,an entheses examination (EE) was performed by a blinded rheumatolgist and patients graded enthesis pain between 0–10.StandartQ4 was replaced with the EE scoring (BASDAI-Q4).Patients older than 45 years of age were excluded. Results Fifththree male (%55.7) and 42 female (%44.3)patients,with a mean disease duration of 13 years (SD=8.7)were studied.Sixtyfour and 31 patients were randomized to Groups A and B, respectively.Nine patients reported the Q4 as“not understood”.32 patients had no enthesitis on EE,but of those only 21 scored“0” for Q4 during the unassisted-PRO.Eleven reporting no enthesitis had so on EE.In GroupA,out of six“not understood” responders forQ4,five reported enthesitis after MPA assistance and four had enthesitis at the final EE.Nineteen patients had no enthesitis on physical examination,but of those only 12 scored“0” for Q4 during the unassisted PRO,and an additional nine scored“0” forQ4 after MPA assistance.Six out of seven patients reporting no enthesitis,but with enthesitis on EE reported,enthesitis after MPA assistance.In GroupB,scoring forQ4 was similar after both the unassisted- and FP9s first assistance PRO.Out of four “not understood” responders for Q4,two reported enthesitis after the second assistance of FP and both had enthesitis at the final EE.Six patients had no enthesitis on EE,but of those only4 scored“0” for Q4 during the unassisted-PRO,and an additional two scored“0” for Q4 after second FP-assistance.Two out of four patients reporting no enthesitis,but with enthesitis on EE,reported enthesitis after second FP-assistance.Mean BASDAI was significantly higher in both groups then BASDAI-Q4 (Group A=3.97±1.95 vs. 2.84±1.98, p Conclusions Mobile applications may improve the quality of collected data in cases of untranslability even in previously validated PROs. References AtagunduzP,et-al.Arthritis Rheumatol.2015;67(suppl10). https://secure.yonetimislemleri.com/asasistan/. Disclosure of Interest None declared

Background Gastrointestinal system (GI) is commonly involved in systemic sclerosis (SSc) beginning after early stages of disease. Objectives We aimed to investigate capillaroscopic findings among the SSc patients with GI involvement and malnutrition. Methods GI involvement was evaluated by UCLA SCTC GIT 2.0 questionnaire (Khanna D.) (7 multi-item; reflux, distension, soilage, diarrhea, social functioning, emotional wellbeing and constipation) in SSc patients ACR/EULAR classification criteria (2013). To report the nutrition status of the patients “malnutrition universal screening tool (MUST)” (sum of the scores of body mass index, weight loss in last 3–6 months and acute disease effect) scores were calculated. Simultaneously, nail fold video-capillaroscopy (NVC) was performed in all paatients to deterimine ealy, active late scleroderma patterns (Cutalo et al.). Results In 58 SSc patients (51 female); the mean age, duration of Raynaud9s, non-Raynaud symptom (year) and follow-up (month) were 46±13, 54±50, 10±9 and 7±7, respectively. Limited cutaneous form, positive ANA and anti-Scl70, telangiectases, dysphagia, digital ulcers, lung disease were found in 40 (71%), 48 (83%) and 21 (36%), 45 (78%), 39 (67%), 33 (57%), 23 (40%) in patients, respectively. Of the NVC patterns, early was found in 16 (28%), active was in 11 (19%), late was in 28 (48%) and normal in 3 (5%). The scores of disease activity, severity and GI were shown to be higher in patients with late NVC pattern (table-1). Of the patients with MUST score of >0 (n=10), 9 had late and 1 had early NVC pattern. Conclusions This SSc cohort predominantly had limited cutanous disease and vascular manifestations. In patients with late scleroderma pattern, severity of GI was higher similar to disease activity and severity. Undernutrition was frequently seen in patients with late pattern. NVC might be useful to predict the severity of GI and malnutrition and allow to direct the patients to required procedures earlier. Disclosure of Interest None declared

Background Severity of peripheral vascular involvement (PVI)is known as an important determinig cause of morbidity in sytemic sclerosis (SSc). Different vasodilating agents have been found to reduce severity and contribute to healing of digital ulcers (DU)in SSc. Objectives We aimed to evaluate the characteristics and capillaroscopic patterns of the patients with severe PVI under different vasodilator therapeutic regimens. Methods The patients were grouped as “severe PVI” if score of PVI is ≥2 (PVT=2,digital pitting scars; PVT=3, digital tip ulcerations and PVT=4, digital gangrene; Medsger) and “non-severe PVI” if score of PVI is ≤1 (PVI=0,no Raynaud9s; PVI=1, Raynaud9s requiring vasodilators). We included patients with severe PVI who received cyclic iloprost and bosentan and/or sildenafil and compared to non-severe PVI. Nail fold video-capillaroscopy (NVC)was assessed qualitatively (Cutalo et al., early, active and late patterns). Results Severe PVI group more frequently had diffuse cutaneous form, contractures, lung disease, anti-Scl70 positivity and high acute phase response and exposed to immunosuppressives (table-1). Scores of telangiectasia, skin, activity and severity were lower in non-severe group. NVC late pattern was frequent and early pattern was rare in severe PVI groups. Forty-one% (9/22) of patients received second oral agent for PVI. Monotherapy and combination groups had similar scores (table-2). Conclusions NVC late pattern was frequent in severe PVI group with long disease duration, exposed to intensive immunosuppresives and received specific vasodilators for PVI. Disease activity and severity were higher in severe PVI group. One third of the severe group required oral combination therapy for PVI. Monotherapy and combination groups were similar in terms of severity. NVC is a useful method to monitor digital ischemia and severe organ involvement in SSc. Disclosure of Interest None declared

Background MR Enterography (MRE), a part of the diagnosis in patients with inflammatory bowel disease (IBD), is increasingly used to exclude Crohn9s Disease (CD) in SpA patients with diarrhea. Two important retrospective studies1,2, on IBD suggest that acute and structural findings of sacroiliitis can be evaluated on MRE. But, it needs to be verified whether it really correlates with sacroiliac MRI. Objectives We aimed to determine whether assessment of sacroiliitis on MRE correlates with magnetic resonance imaging (MRI) of sacroiliac (SI) joint. Methods MREs used for screening of IBD in Axial SpA patients with chronic diarrhea and routine semi-coronal SI joint MR images were screened for the presence of acute inflammatory lesions and structural changes of the SI joint by the same radiologist in a blinded fashion to time and diagnosis. Firstly, MRE images and then MR images were evaluated on two separate occasions. Only patients with two imaging modalities with a maximum time distance of a month were evaluated. Results Forty-four patients with MRE imaging were included. Two MRE studies were excluded because of low resolution. Of those 11 patients (26%) had active inflammatory lesions involving mostly both SI joints and 3 had accompanying chronic structural changes. Ten patients (%24) in the MRE group had chronic structural changes, only. In the remaining 20 (47%) MRE evaluated patients SI joint were not affected. Twenty-five axSpA patients had both MRE and SI joint MRIs performed within a month. In 19 cases, out of 25 with both modalities the finding “no sacroiliitis” overlapped. An additional four patients had acute inflammatory lesions on both investigations. In only two patients either MRE or SI joint MRI had acute inflammatory lesions. In general, chronic structural changes overlapped in both modalities as well; Fourteen out of 25 patients with no changes and eight with chronic changes overlapped in both examinations. Both modalities differ in only three patients; Chronic changes was present in two patients in SI joint MRI and one patient in MRE only. Conclusions In SpA patients with chronic diarrhea a present MRE may substitute a conventional semi-coronal MRI of the SI joints and may hence decrease diagnostic expenses. Evaluation of MRE for the acute inflammatory and chronic structural changes of the SI joints may also have a place in the diagnostic flow in IBD patients referred by the gastroenterology clinics, as well. References Leclerc-Jacob, S., et al. The prevalence of inflammatory sacroiliitis assessed on magnetic resonance imaging of inflammatory bowel disease: a retrospective study performed on 186 patients. Alimentary pharmacology & therapeutics, 2014, 39.9: 957–962. Gotler, Jakob, et al. Utilizing MR Enterography for detection of sacroiliitis in patients with inflammatory bowel disease. Journal of Magnetic Resonance Imaging, 2015, 42.1: 121–127. Disclosure of Interest None declared

Background In patients with seronegative rheumatoid arthritis (RA) there is a difficulty to make the differential diagnosis with the spondyloarthropathies. Objectives To assess the presence of enthesitis in patients with seronegative rheumatoid arthritis in comparison with the healthy controls, patients with seropositive rheumatoid arthritis and ankylosing spondylitis. Methods In this cross-sectional study, seronegative and seropositive rheumatoid arthritis patients, who fulfilled the 2010 ACR/EULAR criteria, patients with ankylosing spondylitis and healthy controls have been assessed by grey scale and power doppler ultrasonography for the presence of enthesopathy at the achilles, plantar fascia, proximal patella, distal patella, quadriceps, tibialis anterior, triceps, common flexor and extensor tendons. Clinical assessment of the patient groups included demographic findings, health assessment questionnaire and disease activity score. Results In our study, we recruited age and sex matched 27 seronegative RA, 17 healthy controls, 20 seropositive RA and 12 ankylosing spondylitis patients. We evaluated and analysed both right and left sides of the enthesis regions separately which have been indicated in the methods section. The mean DAS28, mean ESR and mean CRP of the patients with seronegative RA were 3.6±1.28, 32.2±21.2 and 12.37±27.77 respectively (Table 1). Median of Madrid sonographic enthesitis index (MASEI) was 5 in patients with seronegative RA. 4 patients have severe scores. There were significant differences between seronegative RA and healthy controls (3, p=0.014) but no differences has been observed between seronegative RA with seropositive RA (6) and anklosing spondylitis (7) in MASEI scores. In comparison, hypoechogenicity of quadriceps tendon (16 (29.6%) vs 1 (2.5%), p=0.001), bone erosion at the quadriceps tendon attachment (9 (16.6%) vs 0, p=0.007), hypoechogenicity of triseps (13 (24%) vs 7 (17.5%), p=0.049) have been observed more frequently in patients with seronegative RA than seropositive RA. Significantly higher number of patients with bone erosion at the distal patella (10 (41.6%) v 3 (5.5%), p= Conclusions We observed that enthesis involvement was not seldom in patients with seronegative RA. Furthermore there were also similar frequency of entesis involvement in seropositive patients with RA. The value of enthesis sites evaluationfor the differential diagnosis of patients with seronegative RA should be further investigated and the assessment of enthesis sites in seronegative and seropositive RA patients can be important to detect active and chronic changes at the enthesis region. Disclosure of Interest None declared

Background and aims Pulmonary hypertension is one of the most debilitating and fatal complications of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). These patients are prone to chronic thromboembolic pulmonary hypertension (CTEPH), for which the treatment of choice is pulmonary endarterectomy (PEA). It is a complex surgical procedure with removal of obstructive thromboembolic material from the pulmonary arteries in order to reduce pulmonary vascular resistance, relieve pulmonary hypertension (PH) and alleviate right ventricular dysfunction. Hereby, we share our clinical experience of PEA for CTEPH in SLE and APS patients. Methods Data were collected prospectively for consecutive patients with APS and SLE who underwent PEA over a 5 year period [2011–2016]. Case selection was made by consensus of a team consist of a cardiologist, pulmonologist, rheumatologist and thoracic surgeon. All the operations were performed by the same surgical team. Results We identified 22 patients (5 male, 17 female) with APS and SLE. Mean age was 35 (range=7 to 57). Median NYHA score was III (II to IV). Mean pulmonary artery pressure (mPAP) of the patients fell immediately from 77.4±30.8 mmHg to 28.8±8.9 mmHg right after surgery, and 31.2±7.5 mmHg on discharge. One (5.9%) patient developed acute respiratory distress syndrome and died on postoperative day 10. Mean follow-up duration was 31 months, with no additional mortality. Conclusions Patients with SLE and/or APS should be screened for CTEPH, since they are more susceptible to intravascular thrombosis. PEA is the treatment of choice for CTEPH patients, with its low morbidity and high success rates.

Objective.To investigate the effect of depression, anxiety, fatigue, and fibromyalgia (FM) on the remission status in patients with rheumatoid arthritis (RA), defined according to the 28-joint count Disease Activity Score (DAS28)-erythrocyte sedimentation rate (ESR) and the Boolean-based new American College of Rheumatology/European League Against Rheumatism remission criteria.Methods.The subjects were patients with RA who participated in a hospital-based observational cohort. Patients who met the DAS28-ESR remission criteria at their latest visit were invited to participate in our study. The patient groups fulfilling or not fulfilling the Boolean remission criteria were identified and compared with each other with regard to the presence of depression, anxiety, fatigue (0–50), and FM. The relationship between psychosocial factors and Simplified Disease Activity Index (SDAI) remission, which is the index-based definition of remission in RA, was also investigated.Results.A total of 87 out of 428 patients (20%) with RA met the DAS28-ESR remission criteria and 32 (37%) of these also met the Boolean remission criteria, while 55 (63%) did not. Forty patients were also in SDAI remission. In the Boolean remission group, 2 patients had depression and 2 had anxiety (p = 0.004). In the Boolean nonremission group, 19 patients had depression and 13 had anxiety (p = 0.04). Continuous scales of anxiety (3.34 ± 3.76 vs 5.83 ± 4.70, p = 0.012) and depression (2.18 ± 2.75 vs 4.63 ± 4.10, p = 0.001) were also lower in the Boolean remission group in comparison with the nonremission group. Though FM syndrome was detected in only 1 patient of the Boolean remission group and in 7 patients of the Boolean nonremission group (p = 0.249), patients’ polysymptomatic distress scores of FM in the Boolean remission group were significantly lower than those of the nonremission group (3.12 ± 3.25 vs 6.27 ± 5.19, p = 0.001). The mean fatigue scores were 9.5 ± 10.6 in the Boolean remission group and 16.8 ± 12.8 in the Boolean nonremission group (p = 0.006). In multivariate analysis, patient’s global assessment (PtGA) and depression were found as the independent discriminators of Boolean-based definition. Similar relationships were also observed between psychosocial factors and SDAI remission.Conclusion.In patients with RA who do not fulfill the Boolean remission criteria, to avoid overtreatment, assessment of anxiety, fatigue, FM, and especially depression must be considered if PtGA scores and disease activity variables are significantly different.

The clinical course of Behcet’s disease (BD) as a multisystemic disorder with a remitting-relapsing nature is insufficiently explored. As complete remission should be aimed in all inflammatory diseases, we investigated the frequency of complete remission in patients with BD followed in long-term, routine practice. In this retrospective study, 258 patients with BD who were regularly followed in outpatient clinics were assessed. The demographic and clinical data for active organ manifestations and treatment protocols were evaluated, and “complete remission” for this study was defined as no sign of any disease manifestation in the current visit and the preceding month. Two hundred fifty-eight patients with BD (F/M 130/128, mean age 41.1 ± 11.5 years) were included to the study. Mucocutaneous disease was present in 48.4 % (n = 125). Mean visit number was 6.8 ± 2.7, and mean follow-up duration was 45.8 ± 36.5 months. Patients were clinically active in 67.2 % (n = 1,182) of the total visits (n = 1,757), which increased to 75.6 % (68.1–90.3) when the month preceding the visit was also included. The most common active manifestation was oral ulcers (39.4–63.2 %) followed by other mucocutaneous manifestations and musculoskeletal involvement. When multivariate analysis was performed, oral ulcers, which are the main cause of the clinical activity, negatively correlated with immunosuppressive treatments (β = −0.356, p < 0.000) and age (β = −0.183, p = 0.04). It is fairly difficult to achieve complete remission in BD with current therapeutic regimens. The reluctance of the clinician to be aggressive for some BD manifestations with low morbidity, such as mucocutaneous lesions and arthritis, might be influencing the continuous, low-disease activity state, especially due to oral ulcers, in BD patients.

Aim: The laboratory findings are non-specific in Rheumatoid arthritis (RA). We have based our study on this idea and chose cytokines and chemokine to evaluate ; we then tried to establish a relationship between the progress of the disease and the levels of these molecules before and 3-6 months after the TNF-α blocker treatment.Material and Methods: A total of 34 RA patients (28 females, 6 males) who were diagnosed with RA and received TNF-α blocker therapy were included in the study.Blood samples were drawn from the patients before the TNF-α treatment began and then in the following 3rd and 6th months of the treatment.Results: The mean age of the study group is 49.15±11.03. the mean disease period is 9.77±6.29 years and the mean treatment period is 6.88±4.33 years. 84.6% (n=22) of the study group is female and 15.4% (n=4) is male.Patients with good treatment response to TNF-α blocker treatment were younger than the patients with medium treatment response. The increase of mean hemoglobin (Hgb) levels between 0 and 6 months were statistically meaningful (both p0.05).Conclusion: In RA patients receiving TNF-α blocker therapy. cytokine levels decreased with treatment.The relationship between IL-6 and DAS28 change in the pre-treatment and 6-month period may help the clinician to show the disease activity and to guide the course of the disease.

Summary Objective The aim of this study was to investigate the effects of azithromycin on mucocutaneous manifestations and ex vivo intracellular cytokine responses in patients with Behcet's disease (BD). Methods Ten BD patients with active manifestations and nine healthy controls (HCs) were included in the study. Patients were treated with azithromycin (1500 mg/week) for four weeks. Clinical and immunological responses were evaluated in the pre- and post-azithromycin treatment periods. Peripheral blood mononuclear cells (PBMCs) of patients and controls were stimulated by Streptococcus sanguinis, lipopolysaccharide (LPS), lipoteichoic acid (LTA), and heat shock protein-60 (HSP-60) for three hours. Ex vivo intracellular interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) levels were measured. Results Follicular lesions and genital ulcers completely healed, and the number of oral ulcers decreased after treatment (P = 0.000). The stimulated intracellular IFN-γ response to S. sanguinis was higher in BD patients (5.75%) than in HCs (3.9%) before treatment (P = 0.05). Likewise, the pretreatment IFN-γ response was significantly higher than the post-treatment response (1.95%). In BD patients, pretreatment stimulated intracellular IFN-γ responses to LTA (5.8%) were also higher than post-treatment responses (3.15%), but the difference did not reach statistical significance (P = 0.07). Conclusions Azithromycin treatment decreased the mucocutaneous manifestations in BD patients and suppressed the intracellular IFN-γ responses of PBMCs to S. sanguinis ex vivo, which suggests this treatment has an immunomodulatory effect.

Objective To assess intercentre variability in the ACR core set measures, DAS28 based on three variables (DAS28v3) and Routine Assessment of Patient Index Data 3 in a multinational study. Methods Seven thousand and twenty-three patients were recruited (84 centres; 30 countries) using a standard protocol in the Quantitative Standard Monitoring of Patients with RA study. Analysis of variance (ANOVA) and mixed-effect analysis of covariance models were used to model the relationship between study centre and different patient-reported and physician-reported RA activity measures. These models were built to adjust for the remaining ACR core set measure (for each ACR core set measure or each composite index), socio-demographics and medical characteristics. ANOVA and analysis of covariance models yielded similar results, and ANOVA tables were used to present variance attributable to recruiting centre. Results The proportion of variances attributable to recruiting centre was lower for patient reported outcomes (PROs: pain, HAQ, patient global) compared with objective measures (joint counts, ESR, physician global) in all models. In the full model, variance in PROs attributable to recruiting centre ranged from 1.53% for patient global to 3.71% for HAQ compared with objective measures that ranged from 5.92% for physician global to 9.25% for ESR; and was lower for Routine Assessment of Patient Index Data 3 (2.6%) compared with DAS28v3 (11.75%). Conclusion Intercentre variability in PROs is lower than objective measures of RA activity demonstrating that PROs may be more comparable across centres, and the need for standardization of objective measures.

Background: Pulmonary hypertension is one of the most debilitating and fatal complications of systemic lupus erythematosus (SLE). Antiphospholipid syndrome (APS) is a risk factor for chronic thromboembolic pulmonary hypertension (CTEPH), for which the treatment of choice is pulmonary endarterectomy (PEA). Hereby, we share our clinical experience of PEA for CTEPH in SLE and APS patients. Patients and Methods: Data were collected prospectively for consecutive patients with APS and SLE who underwent PEA over a 5-year period [2011-2015]. Results: We identified 17 patients (5 male, 12 female) with APS and SLE [5% of all pulmonary endarterectomies]. Mean age was 35 (range= 7 to 57). The preoperative diagnosis was APS in 8, SLE in 6, and concomitant SLE and APS in 3. Median NYHA score was III (II to IV). Mean pulmonary artery pressure (mPAP) of the patients fell immediately from 45.5±18.7 mmHg to 30.7±21.2 mmHg right after surgery, and 35.9±19.4 mmHg on discharge. One (5.9%) patient developed acute respiratory distress syndrome and died on postoperative day 10. Mean follow-up duration was 31 months, with no additional mortality. Conclusion: Patients with SLE and/or APS should be screened for CTEPH, since they are more susceptible to intravascular thrombosis. PEA should be the treatment of choice for these patients, with its low morbidity and high success rates.

WOS: 000380854200011, PubMed ID: 26834222, Objective. To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/ American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study. Methods. Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated. Results. Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%-93%) compared with the new clinical criteria in discriminating PMR from all other controls. Conclusion. The new 2012 EULAR/ ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.

Due to the possible risk of infusion reactions of rituximab (RTX), a slow infusion rate (total infusion time, 255 min) is suggested for rheumatological use. However, especially in oncology field, accelerated infusion of RTX is reported to be well tolerated and safe. The aim of our study was to evaluate whether accelerated infusion rates of RTX would similarly be safe and tolerable in rheumatoid arthritis (RA) patients and other off-label rheumatological indications. All patients treated with RTX for RA and other autoimmune diseases between May 2011 and January 2012 were recruited to the study. Each treatment course consisted of two RTX 1,000 mg infusions, 2 weeks apart. Total time of the infusion for the first cycle was 255 min. Second and subsequent infusions were administered over 120 min as follows: 0-30 min, 100 mg; 30-60 min, 200 mg; 60-90 min, 300 mg; and 90-120 min, 400 mg. The Clinical Trials Classification of Adverse Events (CTCAE) version 4.3 was used to categorise side effects. The study population comprised 68 patients [F/M, 59:9; mean age, 52.4 (10.6) years]: 60 with RA, 4 with systemic lupus erythematosus (SLE), 1 with non-Hodgkin's lymphoma with SLE and 3 with vasculitis. A total of 77 fast infusions were administered. Eleven patients (16.2 %) had taken a fast infusion at the first course. A total of nine patients experienced at least one AE. Seven patients had a reaction on the first infusion (infusion-related reaction (IRR)), two patients on the second infusion and one patient on both infusions. When graded from 1 to 5 according to CTCAE v. 4.3, grade 1 IRRs were observed in a total of seven patients and grade 2 IRR in three patients. In this study of fast infusions, adverse events after RTX were mostly mild and seem to be well tolerated. Faster rituximab infusion times seem to be safe and might be incorporated into routine practice.

Background Oral ulcer is the cardinal clinical sign and increased neutrophilic activity is a part of the pathogenesis in Behcet's disease (BD). Saliva, as a part of the innate immune response, contains antimicrobial peptides (AMPs) that are derived from both oral epithelial cells and neutrophils. The aim of this study was to investigate the associations between salivary levels of AMPs HNP 1-3, LL-37 and S100 and disease course in patients with Behcet's disease (BD). Methods Fifty-three patients with BD and 44 healthy controls (HC) were included in the study. Disease severity score reflecting organ involvement was calculated. Salivary HNP 1-3, LL-37 and S100 levels were measured in unstimulated saliva samples by ELISA. Results Salivary HNP 1-3 and S100 levels in BD patients (2715.2 ± 1333.4 μg/ml and 430.6 ± 203.9 ng/ml) were significantly higher compared to HC (1780.6 ± 933.2 μg/ml and 365.3 ± 84.7 ng/ml) (p = 0.000 and p = 0.004, respectively). Although LL-37 levels were also higher in BD than HC (190.9 ± 189.1 vs 143.1 ± 128.9 ng/ml), no significant difference was observed (p = 0.53). Salivary HNP 1-3 and LL-37 levels were associated with the severity of BD (mild disease: 1975.1 ± 1174.2 μg/ml and 115.9 ± 109.4 ng/ml vs severe disease: 2955.7 ± 1305.6 μg/ml and 215.3 ± 203.8 ng/ml, p = 0.020 and p = 0.031, respectively). Salivary LL-37 levels also correlated with the number of monthly oral ulcers (r = 0.5 p = 0.000). Conclusion An increase in salivary HNP 1-3 and S100 levels might be associated with enhanced local and systemic innate responses in BD.

The tuberculin skin test (TST) has low sensitivity for the diagnosis of tuberculosis (TB). QuantiFERON-TB Gold (QFT-G) is an IFN-gamma-release assay that measures the release of interferon-gamma after stimulation in vitro by Mycobacterium tuberculosis antigens using ELISA. The main advantage of this assay compared with TST is the lack of cross-reaction with Bacillus Calmette-Guérin (BCG) as well as most of non-tuberculous mycobacteria. The aim of our study is to compare QFT-G with TST for the detection of latent tuberculosis infection (LTBI) among patients with systemic lupus erythematosus (SLE). Methods: Seventy-eight patients with SLE and 49 healthy subjects (HCs) participated in the study. All patients and controls were interviewed for a history of TB then BCG vaccinations were recorded and chest X-rays were examined for a sign of TB infection. QTF-G and TST were performed on both patients and controls. QTF-G results were recorded as positive, negative or indeterminate. A positive TST for SLE was defined as ≥5 mm. Results: Seventy-six SLE patients (97.4%) had been BCG vaccinated. Similar to the HC (28.5%), 19 of 78 (24.3%) SLE patients had positive QTF-G. Two patients had an indeterminate result. The agreement between QTF-G and TST was 49/76 (64.4%) (κ = 0.33). There were fewer positive QFT-G test results than positive TST results (24.3% vs. 50%; p Discussion: In a TB-endemic and BCG vaccinated population, the QuantiFERON-TB Gold assay seemed to be a more accurate test for the detection of LTBI in SLE patients. Although 5 mm is usually accepted to be the standard cut-off for TST in immunocompromised patients such as SLE, the level of agreement between QTF-G and TST was better with a 10 mm cut-off in our population.

Background Although number, frequency and healing time of oral ulcers and pain are generally used for clinical practice and studies in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS), no standardized activity index is currently present to monitor clinical manifestations associated with oral ulcers. The aim of this study was to develop a standardized composite index (CI) to assess oral ulcer activity in BD and RAS. Methods In this cross-sectional study, 121 patients with BD and 45 patients with RAS were included. Sixty-five percentage of BD and 68.9% of RAS patients were in active stage during the previous 3 months. The developed CI included the presence of oral ulcers, ulcer-related pain and functional status and was evaluated in patients with both active and inactive disease for content validity. Results Composite index score was observed to be higher in active patients with RAS (6.94 + or - 2.19) compared with active BD patients (6.01 + or - 2.04) (P = 0.04). The number of oral ulcers and healing time of oral ulcers were significantly higher in RAS compared with BD (P = 0.018, P = 0.001 respectively). CI score correlated with the number of oral ulcers in both BD and RAS (P = 0.000, P = 0.002 respectively). CI score was '0' for inactive patients without oral ulcer in BD and RAS. Conclusions The presented CI as an oral ulcer activity index seems to be a reliable and suitable tool for evaluating the clinical impact and disease-specific problems in BD and RAS.

Objective To investigate the frequency and clinicopathological features of skin involvement in rheumatoid arthritis (RA), to find out whether early and aggressive disease-modifying treatment is changing the spectrum towards a milder disease pattern. Methods Two hundred and fifteen consecutive RA patients were enrolled. Main outcome measures were the frequency of cutaneous features and their relation to disease severity and treatment modality, ultrasound (USG) examination of nodules, histopathological examination of nodules and papules. Results Mean age and disease duration were 55.3 years and 138.1 months, respectively. Sixty-six percent of the patients had erosive disease, 70% were rheumatoid factor (RF) positive and 44% had Classes III and IV functional index. Among 43 patients having nodules, 20 were diagnosed as rheumatoid nodules (RNs) and the others as synovitis, bursitis, and so on, on clinical basis and by ultrasound. In 7 of 20 RNs, diagnosis was confirmed by histopathological examination. When clinical, histopathological, and USG data were analyzed collectively, sensitivity, and specifity of USG were found as 100 and 75%, respectively. Sixteen patients had relevant papular lesions. Fourteen of these were diagnosed as palisading neutrophilic granulomatous dermatitis (PNGD) and two as rheumatoid neutrophilic dermatitis (RND) on histopathological examination. Accelerated nodulosis was seen in one, and vasculitis in two of the patients. Conclusions We observed a milder disease pattern compared to Anglo-Saxon countries with lower RN and vasculitis frequency. This cannot be explained by early and aggressive treatment as disease onset to treatment interval was long in our patient group. PNGD resembles RN in terms of frequency and association with severe disease.

Background: The aim of the study was to test multidimensional properties of oral health impact profile-14 (OHIP-14) in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS) patients with active oral ulcers. Methods: Ninety-six BD patients, 28 patients with RAS and 117 healthy controls (HC) were included in this study. In patients with active oral ulcers, the frequency and healing time of ulcers were recorded. Multidimensional properties of OHIP-14 were examined by factor analysis. Results: Factor analysis revealed three subscales and explained 66.49% of overall variance in these patients with active oral ulcers. The score of Subscale 1 was positively correlated with the recurrence of oral ulcers per month (P = 0.037). Subscale 3 scores of the patients treated with colchicine were worse than those treated with immunosuppressives (P = 0.035). Conclusions: The factor structure of OHIP-14 was found to be reliable and sensitive to clinical parameters and treatment modalities in active patients.