Search

Background Spondylartritis (SpA) are usually observed in young patients and a clinical onset after 45 years is rare. The average life expectancy is getting longer and the proportion of late onset of SpA in rheumatology practice may became more common. SpA patients with late onset may have a distinctive clinical pattern in terms of functional impairment, extra-articular disease, co-morbidities and treatment status. Objectives The aim of this study was to compare the drug survival and effectiveness of tumour necrosis factor (TNF) inhibitors in patients with late onset SpA (LoSpA) compared with early onset SpA (EoSpA). Methods TReasure is a prospective, multicenter biological treatments registry from Turkey since 2016. It includes 15 different rheumatology centres. Patients with SpA fulfilling the ASAS criteria from TReasure database were divided into two groups as LoSpA (symptom onset >45 years of age) and EoSpA (symptom onset ≤45 years of age). Drug retention rates of first TNF inhibitors were calculated using the time until drug discontinuation independent of the reason that drug interruption. Specific reasons for discontinuing drugs were also assessed. Results Of 1382 SpA patients treated with TNF inhibitors, 9.4% (n=130) were included in the LoSpA and 90.6% (n=1252) were included in the EoSpA group. LoSpA had more female, enthesitis and psoriasis The median treatment duration was 53 months in LoSpA and 61 months in EoSpA. The baseline disease activity measures were similar except from ASDAS-ESH which is higher in LoSpA (table 1). The rate of major treatment response (BASDAI50) was lower in LoSpA than EoSPA at the last visit (26.1% vs 46.2%; p=0.009). Regarding the survival rates of TNF inhibitors, there was no significant difference between the patient groups (figure 1). The major cause of discontinuation in both of groups was drug ineffectiveness (68.6% in LoSpa and 60% in EoSpA, p>0.05). Conclusions LoSpA patients were almost 10% of all biological registry. LoSpA patients were predominantly female, and they had relatively higher baseline disease activity and lower biological treatment response. On the other hand the drug survival rate and discontinuation reasons of TNF inhibitors in the LoSpA group was comparable to that in the younger group. Reference [1] - Chen HA, Chen CH, Liao HT, Lin YJ, Chen PC, Chen WS, et al. Clinical, functional, and radiographic differences among juvenile-onset, adult-onset, and late-onset ankylosing spondylitis. J Rheumatol. 2012; 39:1013–8 Disclosure of Interest None declared

Background Conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) are drugs of choice in the treatment of rheumatoid arthritis and their concomitant use with TNFi is also of unequivocal importance. On the other hand there is limited evidence regarding the efficacy of csDMARD in axial spondyloarthritis (SpA) and concomitant use with TNFi are not recommended. However recently there is conflicting results about the comedication with csDMARD on the TNFi drug survival in patients with AS. Objectives To evaluate the effect of concomitant csDMARD use on first TNFi drug survival in patients with spondyloarthritis. Methods The data of patients that have been included in two Turkish registries (TURKBIO (n=356) and TReasure (n=1382)) with the diagnosis of ankylosing spondylitis (AS) or SpA obtained. Drug survival was calculated from the date of first TNFi prescription to the last visit or until the stop date of first biologic agent. For drug survival analysis Kaplan-Meier method with log-rank test. Cox proportional hazard method was used to evaluate the relative effects of each covariate on the drug survival. Results In total 1738 patients (1040 [59.1%] male, median [range] age 3916–81 years) with SpA initiating first TNFi were included in the analysis. Median disease duration was 116 months. 690 (39.7%) patients received adalimumab, 387 (22.3%) etanercept, 324 (18.6%) infliximab, 202 (11.6%) golimumab and 135 (7.8%) certolizumab. At the time of first biologic prescription 794 (45.7%) were using sulfasalazine or methotrexate. Baseline median BASDAI score was 60 (0–100), BASFI score was 46 (0–100), patient global assessment of disease activity was 70 (0–100), ESR was 231–140 mm/h and median CRP value was 13 (0–659) mg/L. In our study group median drug survival time was 12 (0–205) months. In total 585 (33.7%) of our patients stop their first TNFi. 323 (55.2) patients discontinued the medication due to inefficacy, 133 (22.7) due to adverse effect. Drug survival was significantly better in patients using concomitant csDMARDs at baseline (with a median survival 104 vs 30 months; p Conclusions The results of present study showed that considerable amount of SpA patients were using csDMARDs at time of first TNFi initiating and drug survival was significantly better in those patients. Disclosure of Interest None declared

Background The environmental and genetic factors play a crucial role in the pathogenesis of psoriatic arthritis (PsA) which may cause a difference in disease characteristics for patients from different geographical regions. Objectives The aim of the study was to explore the disease characteristics, treatment choices and comorbidities in patients with PsA in different countries to see the impact of geographic factors. Methods PsArt-ID (Psoriatic Arthritis- International Database) is a prospective, multicentre registry in PsA, which was initially developed in Turkey in 2014, with participation of Canada since 2015 and Italy since 2017. Patients with PsA are consecutively registered to this registry with the aim of investigating the real-life data. Patient characteristics across Turkey (n=1283) and Canada (n=119) are compared for this analysis. Results Canadian patients were older at the time of recruitment (Table). They also were more frequently smokers, had higher duration of education and higher BMI than patients in Turkey. Patients in Canada had more frequent polyarthritis (66.7% vs 39.6%, p Conclusions Geographical differences have impacts on the disease features in PsA, which may be due to genetic, environmental and cultural differences. The treatments are comparable suggesting a similar approach by the physicians. Disclosure of Interest None declared

Background In concept, the state of remission constitutes a clinical condition in which no active disease is present. Target of rheumatoid arthritis (RA) is achieve to remission. Tocilizumab (TOC) is a humanised monoclonal antibody that binds to the interleukin-6 receptor Objectives The aim of this study was to assess the remission rate of TOC for the treatment of RA patients in randomised controlled trials (RCTs) and longitudinal observational studies (LOS). Methods In January 2017, a systematic Review (SR) was performed in PUBMED MEDLINE. Publications were identified using the MeSH terms: (‘‘rheumatoid arthritis and Tocilizumab’’) with a limitation to ‘‘humans’’, ‘‘all adults: 19+years’’, ‘‘English’’ and ‘‘clinical trials’’. All available studies describing the retention rate of TOC were recruited to SR. Retention rate of TOC were calculated according to route (SC or IV), dosage (4 mg/kg vs 8 mg/kg), monotherapy or combination with methotrexate. Of the 662 publications identified by the literature search, 42 were recruited in the analysis. Retention rates of TOC at 12–16 weeks, 24–32 weeks, 48–52 weeks, 2. Years, 3. Years and 5. years were analysed. Open label extension period of RCTs included to LOS. The causes of withdraw of TOC were recorded as inefficacy, adverse event, and others. Results Of the 34 studies, 13 (38%) were RCTs and 21 (62%) were LOSs. Totally 12 043 patients (9834 (81%) female) were pooled to analysis that 6190 patients (51%) were from RCTs. The mean age was 53 years and mean disease duration was 9 years. Seropositivty was 73.6% for rheumatoid factor and 72.2% for ACPA. Overall, 5493 (54.6%) of patients were biologic-naive. TOC was used as monotherapy (2469/6077, 35.4%), or concomitant with methotrexate (8037/11429, 70.3%). Available baseline DAS-28 score, CDAI, SDAI, and HAQ-DI score were 6.2, 32.1, 33.3, and 1.49 respectively. Remission rate of TOC according to study type were shown in table 1. Conclusions These systematic literature results show that treatment with of TOC has a high likelihood of inducing a clinically important benefit in terms of different remission criteria. Remission achieved both RCTs and real life results Moreover, remission rate of TOC in LOSs was comparable with other biologic DMARDs, as well. Disclosure of Interest None declared

Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterised by numerous organ involvement. In SLE, autoantibody development against nucleic acids and their binding proteins plays an important role in disease pathogenesis. Objectives Purpose of this study is the determination of the diagnostic value of anti-carbamyl antibody in patients with Systemic Lupus Erythematosus and rheumatoid arthritis and the relationship with disease prognosis. Methods Fifty-seven SLE patients (F/M 50/7; median age 40.9±13.7; median disease duration 2 years) were included in the study according to the 2012 SLICC SLE diagnostic criteria. 46 RA patients (F/M 38/8, median age 54.2±12.4 years, the median duration of disease 2 years) selected according to 2010 ACR/EULAR diagnostic criteria were included. 30 healthy control groups were selected. Anti carP antibody Anti-carbamylated Protein Human anti-carbamylated Protein Antibody (ACP-Ab) ELISA Kit (SunRedBio, China) was used for measurement of antibodies against carbamylated proteins. Results The study population consisted of 133 subjects, 30 controls, 57 SLEs and 46 RAs. The mean age of SLE patients was lower than that of RA patients. (40,9±13,7 versus 54,2±12,4; p Conclusions Antibody positivity was found to be 54.4% in SLE patient group. It is significantly higher in SLE compared to healthy control and RA patient group. In the SLE group, it is still a more significant diagnostic prognostic than the healthy control and RA group. Both SLE and RA patients have significant sensitivity and specificity compared to the healthy control group. Disclosure of Interest None declared

Background Interleukin (IL)−35 is a member of the IL-12 family. Studies show that IL-35 is an important anti-inflammatory cytokine and suppresses effector T cell activity. Systemic sclerosis (SSc) is a chronic disease characterised by vascular damage, autoimmunity and fibrosis. Objectives In this study, we aimed to evaluate serum IL-35 level in SSc patients and its potential relation with disease findings. Methods Fifty-five SSc patients and 25 healthy controls were included in the study. All patients were diagnosed according to 2013 ACR/EULAR systemic sclerosis classification criteria. Serum IL-35 was measured using a commercial ELISA kit (Cloud-Clone Corp, Wuhan, China). Results SSc patients and healthy controls had similar ages and genders. The mean of serum IL-35 level was significantly higher in SSc patients (8,2±1,3 pg/ml) than in healthy controls (6,9±0,7 pg/ml) (p Conclusions It has been reported that serum IL-35 level is higher SSc patients than healthy volunteers and is associated with interstitial lung disease. In our study, the level of IL-35 was higher SSc patients than healthy controls. There is no relationship between clinical parameters and IL-35 levels, this may be due to small sample size. Our results suggest that IL-35 may have a role on the pathogenesis of SSc. Further investigations are needed in large sample size of SSc patients. Disclosure of Interest None declared

It was aimed to evaluate KL-6 glycoprotein levels to determine if it may be a diagnostic marker for the connective tissue diseases (CTDs) predicting CTD-related interstitial lung diseases (ILDs) (CTD-ILD) development and to examine if there was a difference between patients and healthy controls. The study included 113 patients with CTD (45 CTD without lung involvement, 68 CTD-ILD) and 45 healthy control subjects. KL-6 glycoprotein levels were analyzed with ELISA in patients and the control group. The relationship between KL-6 glycoprotein levels and CTD-ILD was assessed. In the comparison of all the groups in the study, significantly higher levels of KL-6 were determined in the CTD-ILD group than in either the CTD without pulmonary involvement group or the healthy control group (p

Background: Disease activity in primary Sjogren syndrome (PSS) is measured by the EULAR Sjogren’s syndrome disease activity index (ESSDAI) and patient reported index (ESSPRI). Studies investigating the association between ESSDAI and ESSPRI and previously reported indicators of systemic inflammation are few in the literature. The aim of this study was to determine the clinical utility of the mean platelet volume (MPV) in predicting disease activity in PSS patients. Methods: A total of 190 subjects including ninety-five PSS patients and ninety-five healthy controls were enrolled. Associations between MPV and other known indicators of systemic inflammation (red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and patient clinical characteristic, ESSDAI and ESSPRI were investigated by using spearman correlation and linear regression analysis. Results: MPV levels were found to be significantly higher in the PSS group than the control group (10.5±1.2 versus 9.0±1; P

The immune system restrains benign melanocytic lesions, however the relationship between immunosuppression and changes in nevi is not known.We sought to investigate the development of new nevi in patients using immunosuppressive agents, to evaluate any size or dermoscopic changes in existent nevi, and to evaluate any risk of developing melanoma.There were 266 melanocytic lesions in 103 patients undergoing immunosuppressive therapy and 180 melanocytic lesions matched for age, sex, race, and Fitzpatrick skin type in 60 healthy control subjects.Nevus counts increased from baseline in the treatment group (P .001) as did nevus size (P = .046) but the increase compared with the control group only remained statistically significant for nevus numbers (P = .001). There was a statistically significant appearance of dermoscopic changes in the nevi of immunosuppressed patients compared with healthy control subjects (P .001). Ten lesions were excised including 6 because of significant dermoscopic change during treatment and all were benign.Follow-up duration was short and the number of patients was small.Immunosuppressive therapy was associated with increased nevus counts and changed dermoscopic appearance but as none of the changed and subsequently excised nevi were malignant, continued monitoring for invasive features is a reasonable alternative to excision.

Introduction Spondyloarthritis (SpA) are a group of inflammatory rheumatic diseases that share some common clinical and genetic features such as inflammatory back pain, peripheral arthritis, enthesitis, anterior uveitis, sacroiliitis, and HLA-B27 positivity. The aim of the present study was to describe the clinical, radiologic, and genetic features of patients with undifferentiated spondyloarthritis (uSpA) and ankylosing spondylitis (AS). Patients and methods This study included 225 SpA patients (134 uSpA and 91 AS) attending our Rheumatology Outpatient Clinic consecutively. Patients underwent peripheral and axial joint and enthesitis assessment, erythrocyte sedimentation rate or C-reactive protein determination, HLA-B27 tissue typing, radiographic evaluation, and sacroiliac MRI. Results In total, 26 of 91 AS patients and 115 of 134 uSpA patients were women (28.6 vs. 85.8%) and 65 of AS and 19 of uSpA were men (71.4 vs. 14.2%). The time for diagnosis was 15.82 ± 20.7 months for AS patients and 5.91 ± 3.63 months for uSpA patients. Diagnostic delay was 102.46 ± 88.99 (median 83, range 8-377) months for AS and 74.23 ± 60.7 (median 55.5, range 0-238) months for uSpA patients. HLA-B27 positivity was present in 51.6% of AS and 14.9% of uSpA patients. The mean BASDAI level of patients with AS was 6.4 ± 1.1 and that of uSpA patients was 4.8 ± 2.1. Conclusion SpA are frequent diseases and physicians other than rheumatologists should also be aware of them. uSpA is more frequent in women than men. Early diagnosis of SpA is important because early treatment with new biological therapies may lead to much better Results than applying them in the advanced stages.

Çalışmada 25 yazar bulunmaktadır. Bu yazarlardan sadece Bursa Uludağ Üniversitesi mensuplarının girişleri yapılmıştır. Psoriatic arthritis (PsA) may affect different joints, including the spine. The prevalence of spinal involvement is variable depending on the definition and a subset of patients have been identified in cohorts that do not have clinical features of axial disease and yet have imaging findings. Still, there is not a consensus on how and when to screen axial disease. In this study, we aimed to investigate factors associated with being underdiagnosed for axial psoriatic arthritis (axPsA) and its impacts on outcomes. Disease features and outcomes of axPsA according to the physician (n=415) were compared with patients with imaging findings only (sacroiliitis fulfilling the modified New York criteria, n=112), using data from a real-life PsA registry. Patients with imaging findings only were more frequently women (83/220 (37.7%) vs 29/122 (23.8%); p=0.008). This group also had higher peripheral disease activity (imaging only vs clinical AxPsA: mean (SD) tender joint count 5.3 (6.1) vs 3.3 (4.7), swollen joint count 1.9 (2.9) vs 1.2 (2.4); p

This study aimed to compare the effectiveness of a 6-week combined exercise program with and without connective tissue massage (CTM) on pain, fatigue, sleep problem, health status, and quality of life in patients with fibromyalgia syndrome (FMS). Patients were randomly allocated into Exercise (n = 20) and Exercise + CTM (n = 20) groups. The exercise program with and without CTM was carried out 2 days a week for 6 weeks. Pain, fatigue, sleep problem with Visual Analog Scales, health status with Fibromyalgia Impact Questionnaire (FIQ), and quality of life with Short Form-36 were evaluated. After the program, pain, fatigue and sleep problem reduced, health status (except of the scores of FIQ-1 and FIQ-10), physical functioning, role limitations due to physical health, bodily pain, role limitations due to emotional health, vitality, and general health perceptions parameters related to quality of life improved in the Exercise group, (P

Background Acute rheumatic fever (ARF) is a delayed, inflammatory sequela of pharyngitis secondary to Group A Streptococcus infection. ARF remains one of the most important causes of cardiovascular morbidity and mortality in developing countries. Although it is mainly known as a childhood disease, it is also encountered in adult clinics in developing countries. Objectives To investigate the clinical and laboratory characteristics of patients who were diagnosed with ARF in two rheumatology outpatient clinics from June 2015 to January 2017. Methods The data of 20 patients (12 female; median age 29.5 (21–40) years) were evaluated. The diagnosis of ARF was based on the 2015 Jones criteria. The data collected included patient age, gender, arthralgia, arthritis, erythema marginatum (EM), subcutaneous nodules (SN), ECG/ Doppler transthoracic echocardiography findings, and other rare findings. The erythrocyte sedimentation rate (ESR), antistreptolysin O (ASO) and CRP levels of the patients and the drugs initiated were also recorded. Anti-streptolysin O (ASO) test or throat culture were used for the evidence of preceding Streptococcus infection. Patients with post-streptococcal reactive arthritis were differentiated and excluded by clinically. Patients with positive rheumatoid factor or ACPA were also excluded. Joint fluid examination was done to exclude septic arthritis in patients with monoarthritis. Results All patients were referred to rheumatology for arthralgia or arthritis. Patients were taking some sort of nonsteroidal antiinflammatory (NSAI) drugs before the referral. The median follow-up time was 9 months (0–18). Sixteen out of 20 patients had mono-, oligo- or poliarthritis (25%, 25% and 30%, respectively). Knees and ankles were the most common involved joints. The median duration of arthritis was 1 week (1–50 weeks). Six out 20 patients had subclinical carditis (30%). Nine out of 20 patients had a history of ARF attack previously. Three patients had chronic rheumatic mitral valve thickening without any severe insufficiency. EM and SN were observed in 15% and 60% of patients, respectively. Chorea was diagnosed in one patient. NSAI drugs were given to all patients with maximum dosages. High dose salicylate therapy were not given to patients due to intolerance or side effects. Nine patients were given prednisolone therapy (5–20 mg/d). The median duration of prednisolone therapy was 2 weeks (0–6 weeks). Sulfasalazine was given to two patients for the prolonged arthritis. All patients received secondary prophylaxis with penicillin. Conclusions ARF should be considered in the differential diagnosis of arthritis in young adults in developing countries. Arthritis of ARF in adults seems to be resistant to classical NSAI drugs. Our data show that steroid therapy can be given safely instead of salicylates in carditis or arthritis. References GewitzMH,BaltimoreRS,TaniLY,etal. AmericanHeart Association Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease of the Council on Cardiovascu- lar Disease in the Young. Revision of the Jones criteria for the diagnosis of the rheumatic fever in the era of Doppler echocardiography: a scientific statement of the American Heart Association. Circulation 2015; 131: 1806–18. He VY, Condon JR, Ralph AP, et al. Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease: A Data-Linkage and Survival Analysis Approach. Circulation. 2016 Jul 19;134(3):222–32. Disclosure of Interest None declared

Familial Mediterranean fever (FMF) is a chronic autoinflammatory condition characterized by fever attacks and recurrent polyserositis. Subclinical inflammation that persists during attack-free periods can result in oxidative stress (OS) damage. Thiol groups bind to reactive oxygen radicals and protect cells and tissues from OS damage. The aim of this study was to investigate the relationship between thiol-disulfide balance and colchicine resistance in FMF patients during an attack or attack-free period. A newly developed spectrophotometric method was used to measure native thiol (NT) and disulfide (DS) levels in FMF patients and an age-sex matched group of healthy controls. NT and DS levels were compared in FMF patients 1) with vs. without colchicine resistance; and 2) during an attack (FMF-AP) vs. attack-free period (FMF-AFP). A total of 118 FMF patients and 60 healthy controls were studied. NT (P < 0.001) and total thiol (TT) (P < 0.001) levels in FMF patients were significantly lower compared to healthy controls. NT (P = 0.030) and TT (P = 0.010) levels of FMF-AP patients were significantly lower than that of FMF-AFP patients. FMF-AP patients had significantly higher DS levels than FMF-AFP patients (P = 0.039). Compared to FMF patients without colchicine resistance, elevated levels of DS (P = 0.019) but not NT (P = 0.620) and TT (P = 0.718) were found in those with colchicine resistance. Thiol-disulfide homeostasis is altered in FMF patients during an attack period and this imbalance may be associated with colchicine resistance., Graphical Abstract

Retro-orbital granuloma is a rare and devastating component of granulomatosis with polyangiitis (GPA). Current medical treatment protocols are falling short, and outcomes are poor. The aim of the study was to investigate the frequency, clinical features, and treatment outcomes of retro-orbital granuloma in patients with GPA. This is a retrospective, multi-centre study, which involves GPA cohorts from five different clinics. Data were extracted from patient charts including history, physical examination, radiological-laboratory-histological findings, and treatment protocols. Major clinical outcome measures were changes in the volume of the granuloma on comparative MRI, and visual acuity on repeated ophthalmologic examinations. Among 141 GPA patients, nine (five females and four males) were diagnosed with a retro-orbital granuloma. Median duration of disease was 8 years. Proptosis and diplopia were the dominant presenting symptoms (77 %), followed by orbital pain (55 %). Three out of nine patients had isolated retro-orbital granulomas, without other organ involvement of GPA. Five patients received conventional pulse steroid and pulse cyclophosphamide (CYC) as the first-line remission induction therapy. Four of these patients had progressive disease, and a regression in granuloma size was observed in one patient using this regimen. Two patients were already receiving immunosuppressants when they were diagnosed with retro-orbital granuloma. Six patients had been treated with RTX as the second-line remission induction therapy. None of these patients had progression following RTX therapy. Three patients underwent orbital decompression surgery. The indication for the decision for surgery was either progressive loss of vision or intractable pain. Standard first-line chemotherapy (CYC and steroids) was ineffective against retro-orbital granuloma associated with GPA. RTX could be an alternative in these cases. Surgical intervention may help to decrease the morbidity. Further prospective studies with greater patient numbers are needed to test the clinical efficiency of RTX as a first-line remission induction chemotherapy.

Aim In systemic sclerosis (SSc), this single-centre study aimed to define the frequency and association of pulmonary arterial hypertension (PAH), occurring either alone in SSc-PAH or together with interstitial lung disease (ILD-PH). Material-Methods SSc cases between the years 1990-2011 were reviewed, retrospectively. Patients' clinical, laboratory findings, Modified Rodnan Skin Score and Medsger score, 6-minute walk distance (6MWD), carbon monoxide diffusion test (DL CO ), echocardiography, thorax HRCT, and right heart catheterisation findings were recorded. Results One hundred and forty-one cases (F/M:124/17, diffuse cutaneous SSc (DcSSc)/limited cutaneous SSc (LcSSc): 84/57) were included in the study with the mean age of 52.70±15.17 years and disease duration of 107.07±99.44 months. PaO 2 , FEV1 and FVC were lower in DcSSc (p CO and 6MWD did not differ significantly, between the two forms. Ground glass opacity (64.7%) and interlobular septal thickening (58.8%) were the most frequent findings on HRCT of such subjects. PAH was detected in 34 subjects (24.1%). Seven of them had SSc associated PAH (SSc-PAH) and 27 ILD-PH. Both frequencies were similar between DcSSc and LcSSc. Mean sPAP was higher in SSc-PAH. Conclusion PAH was observed in approximately one fourth of patients; therefore advanced cardio-pulmonary investigation should be routinely performed in the SSc patients' management.

©2013 Turkish League Against Rheumatism. All rights reserved. Bu yazida astim ve plevral efuzyon oykusu ve gogus agrisi ile acil servisimize basvuran 35 yasinda bir kadin olgu sunuldu. Laboratuvar bulgularinda, elektrokardiyografide ST segment ve T dalgasinda (ST-T) anlamli bir degisiklik olmaksizin, kardiyak biyobelirtec [(troponin I (TnI) ve kreatin kinaz-MB izoenzim (CK-MB)] duzeylerinde artis goruldu. Transtorasik ekokardiyografide %48 ejeksiyon fraksiyonu ile on duvarda hipokinezi ve minimal perikardiyal efuzyon izlendi. Koroner anjiyografide ise, sol on inen koroner arter distalinde tikaniklik saptandi. Akut koroner sendromla birlikte seyreden ChurgStrauss syndrome tanisi konuldu. Hastaya sistemik kortikosteroid tedavisi baslandi. Tedaviyi takiben herhangi bir olay gorulmeden iyilesme gozlendi.

Objectives This study aims to investigate the role of serum levels of vitamin B12 (VitB12), homocysteine (Hcy), and methylmalonic acid (MMA) in the development of parenchymal neuro-Behcet's syndrome (NBS) and to compare them with healthy controls and Behcet's syndrome (BS) patients without NBS. Patients and methods Serum VitB12, Hcy, and MMA were measured using enzyme-linked immunosorbent assay in 64 patients (36 males, 28 females; mean age 36±8.3 years; range 20 to 56 years) who met the criteria of the International Study Group for Behcet's Disease and 30 matched healthy controls (17 males, 13 females; mean age 35.76±9.6 years; range 20 to 50 years). The study participants were grouped as BS patients with NBS, BS patients without NBS, and healthy controls. Results There was no significant difference between the groups regarding serum VitB12, Hcy, and MMA levels (p>0.05). Serum VitB12 levels were below the lower limit and serum Hcy levels were above the upper limit in all participants. MMA levels were normal in all participants. There was no correlation between the serum levels of VitB12, Hcy, and MMA and disease activity (p>0.05). Conclusion The results of this study suggest that there is no significant association between VitB12 deficiency and parenchymal NBS. Further studies are needed to investigate the underlying mechanisms of the variable effects of VitB12 deficiency on different clinical manifestations of BS.

Introduction The aim of the study was to investigate whether there is a relationship between the European League Against Rheumatism (EULAR) outcome measures and quality of life (QoL), fatigue, anxiety and depression in patients with pSS and to define determinants which could affect quality of life. Material and methods The study included 105 pSS patients and 72 age/sex-matched healthy controls (HCs). Cross-sectional clinical data were collected, including the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Assessment of Fatigue (MAF) scale, the Short Form (SF-36), EULAR Sjögren’s syndrome disease activity index (ESSDAI) and EULAR Sjögren’s syndrome patient reported index (ESSPRI). Results The SF-36 scores were significantly lower and anxiety, depression and fatigue scores were significantly higher in the pSS group than in the control group (all p-value < 0.05). ESSDAI was negatively correlated with SF-36 scores and positively with MAF. ESSPRI was negatively correlated with SF-36 scores except for the mental health subdimension, and a positive correlation was determined with MAF, HADS-A and HADS-D. Multiple linear regression analysis revealed that HADS-A, HADS-D, MAF, ESSPRI and ESSDAI were associated with most SF-36 subscales. Conclusions The results of this study provide further evidence supporting the use of ESSDAI and ESSPRI in daily practice. Quality of life was diminished in patients with pSS and was associated with different symptoms. This should be taken into account when managing patients with pSS.

Amaç: Fibromiyalji sendromu (FMS) olan kadınlarda denge, gövde kas enduransı ve esneklik skorlarını araştırmak ve sağlıklı kadınlarla karşılaştırmaktı. Yöntem: FMS olan 23 kadın (FMS grubu) ve olmayan benzer özellikteki 21 kadın (Kontrol grubu) çalışmaya dahil edildi. (FMS), Amerikan Romatizma Birliği (ARB) 1990 kriterlerine göre tanımlandı. Denge gözler açık ve kapalı olarak Tek Bacak Denge Testi ile, gövde kas enduransı McGill’in Gövde Kas Endurans Testleri ile, esneklik Otur Uzan Testi ile değerlendirildi. Sonuçlar: FMS grubunda kontrol grubuna göre gözler açık ve kapalı iken hem sağ hem de sol bacak denge skorlarında ve gövde kas endurans skorlarında azalma görüldü (p0,05). Tartışma: FMS olan kadınların denge ve gövde kas endurans skorları sağlıklı bireylere göre daha düşüktür. Dengedeki bozulma ve gövde kaslarının enduransındaki azalmaya karşı FMS olan kadınlara koruyucu egzersiz programları önerilebilir.

To investigate the effect of anti-interleukin-1 (anti-IL-1) treatment on the frequency and severity of attacks and other disease-related clinical parameters and to evaluate the adverse effects associated with anti-IL-1 treatment in 26 patients with refractory familial mediterranean fever (FMF).The study included 26 FMF patients followed up in our centre using colchicine for 4 months to 30 years. The treatment was switched to anti-IL-1 treatment for various reasons; 20 cases were resistant to colchicine, 8 were intolerant to colchicine, and 3 had prolonged arthritis under colchicine. Clinical response was monitored through the number of attacks, and laboratory inflammation was monitored through erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A concentrations. Colchicine resistance was defined as at least two attacks/month together with C-reactive protein and serum amyloid A levels above the normal range between attacks. The colchicine dose was increased to 2 mg/day before they were considered colchicine-resistant.24 patients used anakinra (100 mg/day), and 2 used canakinumab (150 mg/month), for -36 months. Sixteen patients with colchicine resistance had no attacks under anti-IL-1 treatment, and 4 had decreased frequency and duration of attacks. Seven of 8 patients intolerant to colchicine used anakinra, and 6 were attack-free under treatment, while 1 using canakinumab had attacks under treatment. One patient with prolonged arthritis used canakinumab but arthritis showed progression and the treatment was changed to IL-6 inhibitor. Three patients had injection site erythema and one had fatigue with anti-IL-1 treatment. Topical steroids with systemic antihistaminics were sufficient for symptom control in two cases, but canakinumab treatment was given due to severe injection site erythema in one case.Anti-IL-1 agents are rational treatment modalities in patients resistant or intolerant to colchicine. Anti-IL-1 agents can control FMF attacks quite effectively and they have a promising role in the treatment of FMF.

Objectives: This study aims to investigate the effects of bosentan on the prevention and treatment of digital ulcers in systemic sclerosis (SSc) patients.Patients and methods: The study included 30 patients (4 males, 26 females; mean age 49.6±15.4 years; range 23 to 71 years) diagnosed with SSc and treated with bosentan for digital ulcers. Bosentan was administered to all patients for a mean of 14±10.3 months. All SSc cases were refractory to calcium channel antagonists or angiotensin II inhibitors. The diagnosis of SSc was based on the American College of Rheumatology criteria and patients were classified as limited or diffuse cutaneous SSc according to the LeRoy classification.Results: Mean disease duration was 8.8±8.0 years and mean duration of digital ulcers was 29.4±6.6 months. Under the bosentan treatment, eight patients (26.7%) developed new digital ulcers; all of these patients had diffuse cutaneous SSc. Health Assessment Questionnaire scores improved after 12 months and 24 months of treatment (p

Familial Mediterranean fever (FMF), affecting people of Mediterranean origin, is an endemic and sometimes problematic disease because of colchicine resistance/intolerance, with relative lack of treatment alternatives, and disease- or treatment-related issues, such as subfertility. Anakinra, being a rational and effective treatment alternative, has no conclusive human pregnancy data. Here we report a case of FMF with infertility who became pregnant with in vitro fertilization (IVF) under treatment with anakinra, along with the pregnancy outcome.

The relationship between brucellosis and p-antinuclear cytoplasmic antibody (p-ANCA)-associated vasculitis (pAAV) is a rare condition. Herein, we report a 52-year-old man who was diagnosed as rapidly progressive glomerulonephritis (RPGN) and endocarditis due to brucellosis. He was treated with antimicrobial agents, steroids, plasmapheresis, renal replacement therapy and aortic valve replacement. According to our best of knowledge, no similar case has been reportedpreviously in the literature in regard to p-ANCA anti-lactoferrin antibodies associated-glomerulonephritis with brucellosis and endocarditis. J Microbiol Infect Dis 2011;1(1):31-34.

Çalışmada 24 yazar bulunmaktadır. Bu yazarlardan sadece Bursa Uludağ Üniversitesi mensuplarının girişleri yapılmıştır. In this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy-based on creatinine level, proteinuria and disease activity-was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2 % of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17 months), two RA patients died and two developed tuberculosis. In AS group, 45.7 % of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38 months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern.

WOS: 000376969600001, PubMed ID: 29900952, Objectives: This study aims to investigate whether the protein tyrosine phosphatase non-receptor type 22 (PTPN22) C1858T gene polymorphism plays a role in the pathogenesis of familial Mediterranean fever (FMF) through T-lymphocyte activation. Patients and methods: We conducted a case-control study with 180 FMF patients (68 males, 112 females; mean age 38.2 +/- 1.6 years; range 16 to 81 years) and 184 healthy controls (86 males, 98 females; mean age 32.9 +/- 9.2 years; range 18 to 58 years). The PTPN22 C1858T polymorphism (rs2476601) was genotyped by polymerase chain reaction restriction fragment length polymorphism. In patients with FMF, clinical features, disease severity score, the frequencies of amyloidosis, positive family history, and Mediterranean fever gene mutations were determined. Results: The frequencies of heterozygous genotype (CT) were 4.5% in FMF patients and 2.8% in healthy controls, respectively. The frequencies of polymorphic homozygous genotypes (TT) were 0.5% in both FMF patients and healthy controls. There were no statistically significant differences in the frequencies of CT and TT genotypes between FMF patients and healthy controls (odds ratio: 1.65, 95% confidence interval: 0.53-5.14, p>0.05 for CT genotype). The frequencies of clinical features, sex, amyloidosis, positive family history, Mediterranean fever gene mutations, and disease severity score were not significantly different between the patients. Conclusion: The distribution of PTPN22 C1858T polymorphism did not reveal any association with FMF in a Turkish population., Ankara University Research Fund, The study is supported by the Ankara University Research Fund.

To establish the prevalence of the single nucleotide polymorphisms (SNPs) of endoplasmic reticulum aminopeptidase 1 (ERAP1), IL-23 receptor (IL-23R), signal transducer and activator of transcription 3 (STAT-3) and Janus kinase 2 (JAK-2) in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) in a Turkish population.Materials and Methods: A total of 562 subjects who presented at the Ankara University internal medicine departments of rheumatology and gastroenterology outpatient clinics were recruited in this study, including 365 patients with AS, 197 patients with IBD and 230 healthy controls. ERAP1, IL-23R, STAT-3 and JAK-2) were genotyped in competitive allele-specific polymerase chain reactions. Results: The ERAP1 (rs26653) polymorphism was found to increase the disease risk in patients with AS and IBD compared with the control group (p=0.02 and p=0.01, respectively). In addition, this polymorphism revealed a significant relationship with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI) in patients with AS (r=0.829, p

The relationship between brucellosis and p-antinuclear cytoplasmic antibody (p-ANCA)-associated vasculitis (pAAV) is a rare condition. Herein, we report a 52-year-old man who was diagnosed as rapidly progressive glomerulonephritis (RPGN) and endocarditis due to brucellosis. He was treated with antimicrobial agents, steroids, plasmapheresis, renal replacement therapy and aortic valve replacement. According to our best of knowledge, no similar case has been reported previously in the literature in regard to p-ANCA anti-lactoferrin antibodies associated-glomerulonephritis with brucellosis and endocarditis.

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease with unknown etiology. Here, a 30-year-old man who developed miliary tuberculosis during the course of AOSD was presented due to very rare coincidence of these two diseases. The diagnosis of military tuberculosis was documented by bone marrow biopsy and culture. The patient\'s clinical findings improved with anti-tuberculosis treatment and steroids.

WOS: 000365587100005, PubMed ID: 27708953, Objective: The reactivation of hepatitis B virus (HBV) infection is a well-known event in hepatitis B surface antigen (HbsAg)-positive patients receiving immunosuppressive therapy. The objective of this study was to assess the antiviral practice and course of HBV infection in inflammatory arthritis. Material and Methods: Nineteen rheumatology centers participated in this retrospective study. HbsAg-positive patients who were taking disease-modifying antirheumatic drugs and who were being tested for HBV viral load at a minimum of two different time points were included. The case report form (CRF) consisted of demographic data, rheumatic diseases, treatment profiles, transaminase levels, viral hepatitis serological markers, and HBV viral load. The reactivation of HBV was defined as the abrupt rise in HBV replication by an increase in serum HBV DNA levels in a patient with a previously inactive HBV infection. Results: In total, the data of 101 (female 50.5%) patients were included (76 patients with inactive HBV carriers and 25 patients with chronic HBV infection). The mean age of patients was 44 +/- 12 years, and the mean follow-up duration was 31 +/- 22 months. Of the 101 patients, 70 (69.3%) received antiviral treatment. HBV reactivation was detected in 13 of 76 (17.1%) patients with inactive HBV carriers. HBV reactivation was observed less frequently, not although significantly, in those patients receiving antiviral prophylaxis compared with those not receiving prophylaxis [5/41 (12.2%) vs. 8/33 (24.2%), p=0.17]. Forty-two patients (31 patients had inactive HBV carriers) were using anti-tumor necrosis factor agents. HBV reactivation was detected in 6 of the 31 (19.3%) patients. Twenty-five patients had chronic hepatitis, and five (20%) of them had not received antiviral prophylaxis. HBV viral loads were persistently elevated in 7 (28%) of 25 patients (three patients under and four patients not under antiviral treatment). Conclusion: HBV reactivation was observed in approximately 17% of patients under immunosuppressive treatments. HBV reactivation was more frequently observed in those who did not receive antiviral prophylaxis.

Introduction: The aim of this study was to evaluate the relationship between oxidative stress and pulmonary involvement and its severity in patients with systemic sclerosis (SSc). Materials and Methods: 34 patients (30 female, 4 male) and 27 healthy volunteers (21 female, 6 male) were included into the study. All patients fullfilled the American College of Rheumatology criteria for the diagnosis of SSc. Oxidant-antioxidant enzymes malondialdehyde (MDA), Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX), xanthine oxidase (XO), and adenosine deaminase (ADA) enzyme activities were measured by spectrophotometric methods. Results: Plasma ADA levels was significantly higher in patients than the control group. On contrary, XO levels of erythroctes were lower. Of 34 patients, 11 had no pulmonary involvement, 14 had mild to moderate and 9 had severe-end stage pulmonary involvement. In patients with pulmonary involvement, plasma XO level was statistically significantly lower but intraerythrocyte XO levels were higher (not statistically significant) than the patients without pulmonary involvement. Severe-end stage group had significantly higher intraerythrocyte XO activity. In limited early disease, intraerythrocyte SOD level was significantly lower than the other groups. Plasma MDA level was significantly higher in limited early and diffuse early disease. Plasma MDA, GSH-PX and intraerythrocyte ADA levels were negatively correlated with disease duration. Intraerythrocyte MDA level was positively correlated with pulmonary arterial pressure. Conclusions: This study may show that besides the role in the pathogenesis of systemic sclerosis, oxidative stress may also play a role in the severity of the pulmonary involvement of the disease.

Aim: Systemic Sclerosis (SSc) is a chronic autoimmune-multisystemic disease with unknown aetiology. Fibrosis, vasculopathy and immune system activation are responsible for SSc pathogenesis. Cytokines such as interleukin (IL)-17 and IL-23 may play a role in disease development, disease severity, involvement and characteristics rather than one. For this reason, we aimed to compare the serum levels of serum IL-17 and IL-23 in SSc patients and healthy controls. Material and Method: Fourty patients with SSc and fourty healthy control were included in the study. Autoantibody profiles, organ involvement of the patients were determined. Modified Rodnan skin scores (MRSS) of the patients were calculated. Serum IL-17 and IL-23 levels were measured by ELISA. Results: The patients had a mean MRSS of 13.15. Any statistically significant difference between MRSS and IL-17/IL-23 levels were not detected. (p=0.142 and p=0.668, respectively). Twenty-one (52.5%) patients had lung involvement and 16 (40%) patients had gastrointestinal involvement. Thirty-six (90%) patients were ANA positive, 21 (52.5%) patients were anti-Scl-70 positive, 6 (15%) of the patients were anti-centromere positive. The mean IL-17 levels of the patients and control group were 0.67±0.55 pg/ml and 0.52±0.10 pg/ml (Mann-Whitney U, p=0.007), respectively. The mean of IL-23 levels of healthy control group and patients were found to be 30.27±12.68 pg/ml and 29.32±10.52 pg/ml, respectively (p=0.60). There were no statistically significant relation between serum levels of IL-17/IL-23 and age, pulmonary and gastrointestinal involvement, disease severity, autoantibody profiles. The levels of IL-17 differed significantly in SSc patients and control group but not so in IL-23. Discussion: In our study we concluded that SSc is associated with IL-17, but not with IL-23. IL-17 might contribute to SSc pathogenesis, but no correlation was found between the serum levels of IL-17/IL-23 and clinical symptoms, laboratory findings or disease activity. Anti-IL-17 can be a potential therapeutic agent in SSc patients.

Aim: Cardiovascular (CV) disease is the reason for most mortality cases in RA and cannot be explained only by the presence of traditional CV risk factors. In this study, we aimed to investigate the relationship between local carotid stiffness (CS) parameters measured by a novel ultrasound method and inflammatory disease activity in rheumatoid arthritis (RA) patients. Material and methods: The study was conducted with 70 RA patients and 35 control subjects. According to their disease activity score (DAS-28), the RA patients were classified into active RA (n = 36; DAS-28 > 3.2) and inactive RA (n = 34; DAS-28 ≤ 3.2) groups. A novel non-invasive echo-tracking system was used to measure carotid intima-media thickness (C-IMT), diameter, pulsatile strain, distensibility, and carotid pulse wave velocity (PWV) on 128 sites of the common carotid artery. Erythrocytesedimentation rate (ESR) and C-reactive protein (CRP) levels were also determined.Results: Carotid PWV and IMT were significantly higher in the active RA patients (8.20±1.47 m/s and 6.88±1.50 mm, respectively) compared to the inactive group (6.06±1.21 mm and 7.32±1.19 m/s, respectively) and the control subjects (0.68±0.12 mm and 6.41±0.98, respectively). In all RA patients, a statistically significant correlation was found between carotid PWV and age (r=0.435, p

Hoffa’s disease is an obscure cause of knee pain resulting from impingement and inflammation, with haemorrhagic and fibrous changes of the Hoffa fat pad probably due to acute or chronic repetitive microtrauma. The acute phase of the disease is charecterised by inflammation and at the chronic stag, ossification of the patellar pat occurs. The final status of the disease is an osteochondroma. Hoffa’s disease should be considered in the differential diagnosis of anterior knee pain., ÖzetHoffa hastalığı (HH), Hoffa yağ yastığının tekrarlayan akut ya da kronik mikrotravmalara bağlı inflamasyonu veya sıkışması sonuçu meydana gelen, hemorajik ve fibröz değişikliklerin eşlik ettiği dizde ağrı ile karakterize bir hastalıktır. Hastalığın akut döneminde inflamasyon belirgin olup, kronik seyrinde patellar yağ yastıkcığı kemikleşme gösterip, osteokondroma ile sonuçlanmaktadır. Hoffa hastalığı kronik anterior diz ağrısının ayırıcı tanısında dikkate alınmalıdır.

We report the case of a male patient with limited cutaneous systemic sclerosis (SSc) that was complicated with severe digital ischemia, resistant to medical treatment. Due to the lack of treatment response, further laboratory and imaging studies were conducted. Findings were compatible with antiphospholipid syndrome and oral warfarin was added to the treatment regimen. After successful anticoagulation no further recurrences of digital ischemia were seen. An underlying etiology in SSc patients with treatment resistant digital ischemic necrosis should be suspected for accompanying antiphospholipid syndrome (APS).

To investigate microchimerism (Mc) in peripheral blood mononuclear cells (PBMC) taken from female patients with systemic sclerosis (SSc) and healthy females. We also intended to research the association between Mc and the clinical subsets.This study included 50 females with lcSSc, 30 females with dcSSc and 40 healthy females. The Y-chromosome sequences were studied by RT-PCR in DNA obtained from PBMC.Mc was found in 28 (35 %) patients and 8 (20 %) healthy controls as well as in 6 dcSSc patients with son(s) (27.3 %), 10 lcSSc patients with son(s) (32.3 %) and 7 control females with son(s) (18.9 %) (p0.05). Mc was detected in 6 nulliparous lcSSc patients (31.6 %) and in 1 nulliparous dcSSc patient (11.1 %) (p0.05). The mean time elapsed between the first pregnancy and the diagnosis of SSc was 3.5 (0-49) years in the Mc-positive patients and 14 (0-55) years in the negative patients (p = 0.020). The mean modified Rodnan skin scores (ModRSS) of the patients with and without Mc was 10 (4-24) and 13 (4-26), respectively (p = 0.038). The relationship between Mc and the system involvement, disease severity, autoantibody profile, number of children and age of children was not found.Various etiological factors rather than just one play a role in the development of scleroderma. Mc is thought to be one factor that shortens the elapsed time of disease development in SSc. Mc is inversely related to the ModRSS, and no association was detected between Mc and autoantibodies or the clinical subsets.

OBJECTIVE: The aim of the present study was to evaluate the plasma vitamin D (vit D) levels and their association with the disease activity in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) compared with healthy populations. METHODS: This study included 161 spondyloarthritis patients (113 uSpA patients and 48 AS patients) attending our rheumatology out-patient clinic, along with 92 controls. RESULTS: The plasma vit D levels were 18 μg/L (8-38) in the AS group, 20 μg/L (4-92.3) in the uSpA group and 24.3 μg/L (7.2-76.8) in the control group. The plasma vit D levels of the AS patients were significantly lower than those of the patients in the control group (p=0.004). The men in the AS group had significanly lower vit D levels than those in the control group (p=0.005). On the other hand, the women in the uSpA group had significanly lower vit D levels than those in the control group (p=0.011). The vit D levels were inversely related to both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the AS patients (p=0.002, R=-0.428; p

Background Relapsing polychondritis (RP) is a rare systemic and inflammatory disease. Objectives to assess clinical features, management and prognosis in RP. Methods Retrospective medical records were collected from 16 centers for 37 patients with RP diagnosed by Michet criteria. Data included patients9 demographics, clinical features, laboratory findings and outcome. Results A total of 37 patients, (Male/female=19/18) with a mean disease onset of 45.7±11.8 years and median follow up period is 20 (1–360) months were enrolled. The most common initial complaints and organs involved were showed in table 1. Mean lead time to diagnose was 28.6±54.3 (0–228) months. Four patients had a known history of cartilage injury before the RP diagnosis (Three goiter operation and 1 resuscitation due to a drowning). Twelve of the patients (32.4%) had also various autoimmune or hematologic diseases. After the diagnosis, moderate or high dose prednisone (n=37, 100%), plus methotrexate (n=15, 40.5%) or azathioprine (AZA) (n=11, 29.7%) or hydroxychloroquine (HQ) (n=3, 8.1%) or cyclophosphamide (CYP) (n=2, 5.4%), or (AZA+ HQ n=3, 8.1%) treatments were initiated. In the case of resistant disease, CYP (n=6, %16.2), tocilizumab (n=2, 5.4%), etanercept (n=1, 2.7%), infliximab (n=1, 2.7%) and bevacizumab (n=1, 2.7%) treatments were given. Due to tracheal stenosis surgery applied to 2 patients, one patient died due to respiratory collapse, 21 patients on remission without any complications, 13 (35.1%) patients had developed tracheal stenosis (n=5, 13.5%), major airway cartilage loss (n=5, 13.5%), auricular collapse (n=2, 5.4%), nasal collapse (n=3, 8.1%), subglottic stenosis (n=2, 5.4%), hearing loss (n=5, 13.5%), vision loss (n=1, 2.7%) and deforming arthritis (n=1, 2.7%). In the univariate analysis, only major airway involvement had a relationship with complication development. (OR 12, 95% CI 1.97–72.8, p=0.007) Conclusions RP is a rare disease which diagnosis is commonly delayed and lead to cartilage loss. RP developed after trauma in 4 patients, possibly trauma can be blamed as an etiologic factor. Awareness and early diagnosis results with better prognosis Disclosure of Interest None declared

Background Comorbidities are frequent in Psoriatic arthritis (PsA) and can have an impact on morbidity and mortality. Objectives We aimed to investigate the frequency of different comorbidities in PsA, how comorbidities have an impact on PsA features and which factors were associated with the occurrence of comorbidities in a large number of patients, using PsART (Psoriatic Arthritis Registry of Turkey)registry. Methods PsART is a national, web-based registry where consecutive patients with PsA are recruited and demographic, clinical and therapeutic information are collected as well as comorbidities. The following comorbidities are questioned: Hypertension (HT), hyperlipidemia, depression, diabetes mellitus (DM), hyperuricemia, coronary arterial disease, liver disease, cerebrovascular accident, cancer, and depression. BMI more than 30 is recorded as obesity. Patients with or without comorbidities were compared for their demographic features and outcome tools. Results One thousand and sixty-nine patients whom comorbidity data were available were analyzed. Within these 693 (64.8%) were women. Mean (SD) age was 46.9 (12.8), with a median (range) PsA duration 45 (0–545) months. The number of patients with 1, 2 and 3 comorbidities were 642 (60.1%), 345 (32.3%), and was 191 (17.9%), respectively. Frequency of comorbidities was obesity in 327 (30.6%), HT in 256 (23.9%), hyperlipidemia in 199 (18.6%), depression in 188 (17.6%), DM in 161 (15.1%), hyperuricemia in 74 (6.9%), coronary artery disease in 39 (3.6%), liver disease 38 (3.6%), cerebrovascular event in 19 (1.8%), and cancer history 16 (1.5%). Patients with at least one comorbidity were older (51.1 (11.8) vs 40.9 (11.7), p Conclusions Our registry supported that comorbidities are frequent in PsA increasing the complexity of the disease and have an impact on the disease severity. Patients with comorbidities are less educated showing that education and awareness are important to improve patient outcomes in PsA in long term. Disclosure of Interest None declared

Background PsART (PsA registry of Turkey) is a multicenter web-based registry. Objectives The objective of this registry is to assess characteristics of PsA and compare the differences among genders in our population. Methods PsART was established in 2014 including 32 rheumatology centers. Detailed data regarding demographics for the skin and joint disease, disease activity assessments and treatment choices were collected. Results One thousand and eighty-one patients (64.7% women) with a median (range) PsA duration for 3.7 (0–45) years were enrolled. Median psoriasis duration was 13 (0–59) years. The most frequent type of PsA was polyarticular 437 (40.5%) followed by oligoarticular 407 (37.7%) and axial disease 372 (34.4%). Patients with a combination of axial and peripheral disease had a longer disease duration than patients with one type of joint disease (52 (0–545) vs 42 (0–486) months, p=0.008). Mean (SD) swollen and tender joint counts were 1.7 (3) and 3.6 (4.8). 38.6% of patients were on csDMARD monotherapy, 7.1% were anti-TNF monotherapy and 22.5% were using anti-TNF plus csDMARD combinations. Within items included in the minimal disease activity, only 17.6%>67% of patients had inactive disease state. The major differences among genders were women being older (48.3 (12.8) VS 44.4 (12.5), P Conclusions PsART had similarities with the previously published registries, supporting its external validity. Women having more fatigue and worse functioning and as well as the high percentage of active disease state point out to the unmet need in treatment of PsA. Disclosure of Interest None declared

Background There is not valid outcome measures for assessment Adult onset Still9s disease (AOSD) activity. The patients or physicians global view is relevant way to assess this kind of complex diseases. However, it is well known that there is discordance between patient and physician perspective for disease activity in different inflammatory diseases. Objectives Objective of this study was to evaluate agreement of patient and physician perspective in AOSD patients. Methods We conducted a cross-sectional, multicenter study for assessment of disease activity in AOSD patients. All AOSD patients were fulfilled Yamaguchi criteria. For every center, at least 20% of AOSD patients had to be an active state according to physician assessment. Age, sex, disease duration, current disease symptoms was recorded. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leucocyte, and ferritin level also recorded. Visual analog scale (VAS) (0–10 cm) used for physician and patient global assessment of disease activity. Disease activity status were also assessed by likert scale (as remission, low, moderate, severe, and more severe disease activity) for both patients and physician perspective. Patient global assessment VAS and physician global assessment were correlated by correlation coefficient (r). Agreement of disease activity level for patient and physician perspective were calculated with kappa. Kappa >0.6 was accepted as significant. Results One hundred thirty (83, 63.4% female) AOSD patients were enrolled. Mean age was 38 (14) years old and median disease duration was 3 years (0–29). Currently AOSD symptoms followed; fever 34 (26.2%), rash 28 (21.5%), arthritis 31 (23.8%), arthralgia 60 (46.2%), sore throat 28 (21.5), myalgia 42 (32.3), lympadenopathy 12 (9.2%), splenomegaly 17 (13.1%), hepatomegaly 7 (5.4%), pleuritic 3 (2.3%), hemophagocytic syndrome 2 (1.5%). ESR 47.7%, CRP 43.8%, ferritin 27.0%, and leucocyte 43.1% were higher than upper limit. Mean patient global assessment VAS was 3.53 (3.25), and mean physician global assessment VAS was 2.71 (2.95). Correlation coefficient (r) of patient and physican global VAS was 0.89. There was excellent agreement according to severe/more severe disease activity at patient and physician level (kappa 0.88 (CI 95% 0.79–0.98). There was also good to excellent agreement according to low disease activity/remission at patient and physician level (kappa 0.74 (CI 95% 0.62–0.86). Conclusions Although, features of AOSD seems more complex with constitutional symptoms, joint or reticuloendothelial system involvement, patients and physicians assess level of disease activity similarly. We thought, this results will be helpful for procedure of new composite index in AOSD. Disclosure of Interest None declared

Background Psoriatic arthritis is a complex disease with a wide range of manifestations. In this inception cohort of PsA patients we aimed to identify the initial manifestations as well as disease activity characteristics and compare with an unselected group of patients with longstanding disease. Methods PsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre study in Turkey on patients with PsA. Patients are consecutively recruited to this registry. Patients who have been newly diagnosed with PsA have been identified, and their characteristics were compared with longstanding disease. Results Within 746 patients recruited, 111 (14.9%) had a new diagnosis for PsA. Patients in the inception cohort were significantly younger than the rest of the cohort (p=0.03) (table). Females were 53.2% of the inception and 66.8% of the non-inception cohort (p=0.007). For types of joint patterns, 14.4% of the inception cohort had only axial involvement whereas this was seen in 8.2% for the other group (p=0.05). The other joint patterns were comparable among groups. Both groups had similar tender and swollen joint counts, BASDAI and BASFI. Patient (p=0.002) and physician global assessments (p Conclusions More patients present with sole axial involvement at the beginning, which may explain the higher disease activity agreed by the patient and the physician despite similar tender and swollen joint counts. Females may have a different perception of the disease with worse patient global assessments and fatigue in longstanding disease. Disclosure of Interest None declared